Podcast
Questions and Answers
If a patient presents with a lesion affecting the aponeurotic layer of the scalp, which of the following is the MOST likely consequence?
If a patient presents with a lesion affecting the aponeurotic layer of the scalp, which of the following is the MOST likely consequence?
- Increased risk of infection spreading to the brain due to direct communication with cranial venous sinuses.
- Impaired movement of the scalp, specifically the ability to raise the eyebrows. (correct)
- Severe bleeding due to the presence of large arteries within this layer.
- Loss of sensation in the forehead and anterior scalp due to nerve damage.
A patient presents with a traumatic head injury resulting in a blood accumulation between the dura mater and the skull. This is MOST accurately described as which type of hematoma, and what vascular structures are MOST likely involved?
A patient presents with a traumatic head injury resulting in a blood accumulation between the dura mater and the skull. This is MOST accurately described as which type of hematoma, and what vascular structures are MOST likely involved?
- Epidural hematoma, involving the middle meningeal artery. (correct)
- Subdural hematoma, involving the bridging veins that drain into the superior sagittal sinus.
- Subarachnoid hemorrhage, involving ruptured cerebral aneurysms.
- Intracerebral hematoma, involving small penetrating arteries within the brain parenchyma.
A patient presents with expressive aphasia and paralysis of the right arm. Imaging reveals a lesion affecting the motor cortex. Which of the following foramina, if affected by a space-occupying lesion, could MOST likely contribute to these symptoms due to compression of relevant neural structures?
A patient presents with expressive aphasia and paralysis of the right arm. Imaging reveals a lesion affecting the motor cortex. Which of the following foramina, if affected by a space-occupying lesion, could MOST likely contribute to these symptoms due to compression of relevant neural structures?
- Foramen spinosum.
- Foramen lacerum.
- Foramen ovale. (correct)
- Foramen rotundum.
Following a basilar skull fracture, a patient exhibits loss of taste sensation on the anterior two-thirds of the tongue, decreased salivation, and facial paralysis. Which foramen was MOST likely damaged, leading to these specific neurological deficits?
Following a basilar skull fracture, a patient exhibits loss of taste sensation on the anterior two-thirds of the tongue, decreased salivation, and facial paralysis. Which foramen was MOST likely damaged, leading to these specific neurological deficits?
A patient exhibits paralysis of the tongue and difficulty in speech. An MRI reveals compression of the cranial nerve responsible for tongue movement as it exits the skull. Which of the following foramina is MOST likely affected?
A patient exhibits paralysis of the tongue and difficulty in speech. An MRI reveals compression of the cranial nerve responsible for tongue movement as it exits the skull. Which of the following foramina is MOST likely affected?
A patient presents with vertigo, hearing loss, and tinnitus following a tumor resection near the petrous part of the temporal bone. Which cranial nerve was MOST likely affected during the procedure?
A patient presents with vertigo, hearing loss, and tinnitus following a tumor resection near the petrous part of the temporal bone. Which cranial nerve was MOST likely affected during the procedure?
During a surgical procedure, the greater petrosal nerve is inadvertently damaged. Which of the following is the MOST likely consequence of this injury?
During a surgical procedure, the greater petrosal nerve is inadvertently damaged. Which of the following is the MOST likely consequence of this injury?
A patient who had undergone a parotidectomy to remove a benign tumor now experiences flushing and sweating on the cheek when eating. These symptoms are MOST consistent with which of the following conditions?
A patient who had undergone a parotidectomy to remove a benign tumor now experiences flushing and sweating on the cheek when eating. These symptoms are MOST consistent with which of the following conditions?
Following a motor vehicle accident, a patient presents with diplopia (double vision) that worsens when looking downward and medially. Which cranial nerve is MOST likely affected?
Following a motor vehicle accident, a patient presents with diplopia (double vision) that worsens when looking downward and medially. Which cranial nerve is MOST likely affected?
A patient is unable to abduct the left eye. Which cranial nerve and muscle is MOST likely affected?
A patient is unable to abduct the left eye. Which cranial nerve and muscle is MOST likely affected?
Damage to the cavernous sinus can impact several cranial nerves. Which combination of deficits are MOST likely to arise from a lesion within the cavernous sinus?
Damage to the cavernous sinus can impact several cranial nerves. Which combination of deficits are MOST likely to arise from a lesion within the cavernous sinus?
During a neurosurgical procedure, the surgeon encounters a dural venous sinus. Which correctly identifies the MOST likely location, constituents, and drainage pathway of the straight sinus?
During a neurosurgical procedure, the surgeon encounters a dural venous sinus. Which correctly identifies the MOST likely location, constituents, and drainage pathway of the straight sinus?
A lesion in the infratemporal fossa affects the muscles of mastication. Which of the following nerves is MOST likely damaged?
A lesion in the infratemporal fossa affects the muscles of mastication. Which of the following nerves is MOST likely damaged?
A surgeon is planning to perform a mastoidectomy. Which describes the anatomical boundaries and MOST important consideration, concerning access into the mastoid antrum via the suprameatal triangle?
A surgeon is planning to perform a mastoidectomy. Which describes the anatomical boundaries and MOST important consideration, concerning access into the mastoid antrum via the suprameatal triangle?
A patient presents with a drooping eyelid (ptosis), constricted pupil (miosis), and absence of sweating on the forehead (anhidrosis). These signs are MOST consistent with damage to which pathway?
A patient presents with a drooping eyelid (ptosis), constricted pupil (miosis), and absence of sweating on the forehead (anhidrosis). These signs are MOST consistent with damage to which pathway?
A patient presents with conductive hearing loss. Otoscopic examination reveals a pearly white mass behind an intact tympanic membrane. Which ossicular chain structure is MOST likely affected?
A patient presents with conductive hearing loss. Otoscopic examination reveals a pearly white mass behind an intact tympanic membrane. Which ossicular chain structure is MOST likely affected?
A patient reports loss of taste sensation on the posterior one-third of the tongue, difficulty swallowing, and a diminished gag reflex. Which cranial nerve is MOST likely affected?
A patient reports loss of taste sensation on the posterior one-third of the tongue, difficulty swallowing, and a diminished gag reflex. Which cranial nerve is MOST likely affected?
A patient presents with the chief complaint of dry eye, what nerve is MOST likely affected?
A patient presents with the chief complaint of dry eye, what nerve is MOST likely affected?
During a dissection of the neck, a student identifies a structure that lies within the carotid sheath between the internal jugular vein and internal carotid artery. This structure is MOST likely:
During a dissection of the neck, a student identifies a structure that lies within the carotid sheath between the internal jugular vein and internal carotid artery. This structure is MOST likely:
A patient presents with new onset difficulty shrugging the right shoulder and weakness when turning their head to the left. Which nerve is most likely affected?
A patient presents with new onset difficulty shrugging the right shoulder and weakness when turning their head to the left. Which nerve is most likely affected?
A surgeon is performing a thyroidectomy and inadvertently damages a nerve that causes the patient to have difficulty speaking due to hoarseness. Which of the following nerves was MOST likely damaged?
A surgeon is performing a thyroidectomy and inadvertently damages a nerve that causes the patient to have difficulty speaking due to hoarseness. Which of the following nerves was MOST likely damaged?
During a surgical approach to the thyroid gland, the surgeon identifies a small arterial vessel that directly supplies the thyroid isthmus. This vessel is MOST likely:
During a surgical approach to the thyroid gland, the surgeon identifies a small arterial vessel that directly supplies the thyroid isthmus. This vessel is MOST likely:
A medical student describes the development of the tympanic membrane. Which correctly describes the embryological origins of each layer?
A medical student describes the development of the tympanic membrane. Which correctly describes the embryological origins of each layer?
A newborn presents with a midline neck mass that moves superiorly when the tongue is protruded. This mass is MOST likely derived from a remnant of what embryonic structure or process?
A newborn presents with a midline neck mass that moves superiorly when the tongue is protruded. This mass is MOST likely derived from a remnant of what embryonic structure or process?
Examination of a newborn reveals an opening along the anterior border of the sternocleidomastoid muscle that drains a serous fluid. What is the MOST likely embryological origin of this anomaly?
Examination of a newborn reveals an opening along the anterior border of the sternocleidomastoid muscle that drains a serous fluid. What is the MOST likely embryological origin of this anomaly?
A child is diagnosed with a malformation involving a failure of the maxillary prominence to merge with the medial nasal prominence. This developmental defect will MOST likely result in which of the following conditions?
A child is diagnosed with a malformation involving a failure of the maxillary prominence to merge with the medial nasal prominence. This developmental defect will MOST likely result in which of the following conditions?
A child is born with severe facial deformities, including mandibular hypoplasia and cleft palate. What syndrome is the MOST likely diagnosis, considering the structures derived from the first pharyngeal arch?
A child is born with severe facial deformities, including mandibular hypoplasia and cleft palate. What syndrome is the MOST likely diagnosis, considering the structures derived from the first pharyngeal arch?
An infant is diagnosed with DiGeorge syndrome. What embryonic malformation is the MOST likely cause the syndrome's characteristics?
An infant is diagnosed with DiGeorge syndrome. What embryonic malformation is the MOST likely cause the syndrome's characteristics?
A clinician discovers a foramen in a skull. This foramen transmits the ophthalmic nerve. What is the MOST likely name of the foramen?
A clinician discovers a foramen in a skull. This foramen transmits the ophthalmic nerve. What is the MOST likely name of the foramen?
A patient presents with new-onset diplopia (double vision), ptosis (drooping eyelid), and pupillary dilatation (mydriasis). An aneurysm in which location would BEST explain this symptom presentation?
A patient presents with new-onset diplopia (double vision), ptosis (drooping eyelid), and pupillary dilatation (mydriasis). An aneurysm in which location would BEST explain this symptom presentation?
If the trochlear nerve sustains damage, which of the following muscles is most likely affected?
If the trochlear nerve sustains damage, which of the following muscles is most likely affected?
A patient sustains trauma to their lower face after falling off a bike. Following observation, the patient is noted to have sensory deficits to their lower lip and anterior tongue. Function of which nerve is likely affected?
A patient sustains trauma to their lower face after falling off a bike. Following observation, the patient is noted to have sensory deficits to their lower lip and anterior tongue. Function of which nerve is likely affected?
The corneal reflex is an important test performed to assure proper functioning of the trigeminal nerve (CN V) and the facial nerve (CN VII). What nerves would be considered the afferent pathway of the corneal reflex that results in direct and consenual blinking bilaterally?
The corneal reflex is an important test performed to assure proper functioning of the trigeminal nerve (CN V) and the facial nerve (CN VII). What nerves would be considered the afferent pathway of the corneal reflex that results in direct and consenual blinking bilaterally?
How does intorsion and extortion affect extraocular eye movements?
How does intorsion and extortion affect extraocular eye movements?
When considering the muscles of mastication, which of the following muscles acts to protract the mandible?
When considering the muscles of mastication, which of the following muscles acts to protract the mandible?
A patient who had a parotidectomy presents with sweat and blushing near the surgical site after eating. Functionally, what occurred that led to this symptom?
A patient who had a parotidectomy presents with sweat and blushing near the surgical site after eating. Functionally, what occurred that led to this symptom?
If the emissary veins of the scalp were to facilitate the spread of infection, which intracranial structure would MOST likely be directly affected?
If the emissary veins of the scalp were to facilitate the spread of infection, which intracranial structure would MOST likely be directly affected?
Following a deep laceration of the scalp that extends through all layers, profuse bleeding occurs. Ligation of which specific layer would MOST effectively control the hemorrhage?
Following a deep laceration of the scalp that extends through all layers, profuse bleeding occurs. Ligation of which specific layer would MOST effectively control the hemorrhage?
A 2-year-old child is brought to the emergency room after a fall. A CT scan reveals a fracture near the intersection of the frontal, parietal, temporal, and sphenoid bones. Hemorrhage in this region would MOST directly endanger which artery?
A 2-year-old child is brought to the emergency room after a fall. A CT scan reveals a fracture near the intersection of the frontal, parietal, temporal, and sphenoid bones. Hemorrhage in this region would MOST directly endanger which artery?
A patient is diagnosed with an epidural hematoma resulting from a skull fracture. The fracture is located at the pterion. Injury to which of the following structures is MOST likely the cause of the hematoma?
A patient is diagnosed with an epidural hematoma resulting from a skull fracture. The fracture is located at the pterion. Injury to which of the following structures is MOST likely the cause of the hematoma?
A surgeon is planning a procedure near the anterior fontanelle in an infant. Understanding the anatomy of this area, through which of the following could the surgeon MOST directly access the cranial cavity after incising the skin and connective tissue?
A surgeon is planning a procedure near the anterior fontanelle in an infant. Understanding the anatomy of this area, through which of the following could the surgeon MOST directly access the cranial cavity after incising the skin and connective tissue?
Which of the following BEST describes the functional component of the oculomotor nerve (CN III)?
Which of the following BEST describes the functional component of the oculomotor nerve (CN III)?
A lesion affecting the glossopharyngeal nerve (CN IX) results in the loss of taste sensation in the posterior one-third of the tongue. Functionally, which component of CN IX is responsible for mediating this sensation?
A lesion affecting the glossopharyngeal nerve (CN IX) results in the loss of taste sensation in the posterior one-third of the tongue. Functionally, which component of CN IX is responsible for mediating this sensation?
Following a traumatic injury, a patient presents with the inability to smell. This sensory deficit is MOST directly attributed to damage of what?
Following a traumatic injury, a patient presents with the inability to smell. This sensory deficit is MOST directly attributed to damage of what?
After suffering a stroke, a patient exhibits pronounced ptosis, along with a 'down and out' gaze in the affected eye. Pupillary dilation (mydriasis) is also observed. Which additional deficit would MOST likely be present?
After suffering a stroke, a patient exhibits pronounced ptosis, along with a 'down and out' gaze in the affected eye. Pupillary dilation (mydriasis) is also observed. Which additional deficit would MOST likely be present?
A patient presents with vision changes and an MRI reveals a lesion compressing the superior orbital fissure. Which additional finding would MOST strongly suggest that the lesion is specifically affecting the trochlear nerve (CN IV)?
A patient presents with vision changes and an MRI reveals a lesion compressing the superior orbital fissure. Which additional finding would MOST strongly suggest that the lesion is specifically affecting the trochlear nerve (CN IV)?
A patient reports loss of sensation to the anterior 2/3 of the tongue, along with dry eyes and a reduction in nasal secretions. Dysfunction of which ganglion would MOST directly explain this combination of symptoms?
A patient reports loss of sensation to the anterior 2/3 of the tongue, along with dry eyes and a reduction in nasal secretions. Dysfunction of which ganglion would MOST directly explain this combination of symptoms?
Following a surgical procedure, a patient exhibits Frey's syndrome, characterized by sweating and flushing in the cheek area during meals. Which of the following is the MOST accurate underlying mechanism?
Following a surgical procedure, a patient exhibits Frey's syndrome, characterized by sweating and flushing in the cheek area during meals. Which of the following is the MOST accurate underlying mechanism?
A patient presents with an eye that is adducted and elevated, indicating that some extraocular muscles are not functioning properly. Assuming a single nerve lesion, what additional abnormality would BEST help to identify the specific nerve affected?
A patient presents with an eye that is adducted and elevated, indicating that some extraocular muscles are not functioning properly. Assuming a single nerve lesion, what additional abnormality would BEST help to identify the specific nerve affected?
A physician observes a patient's pupils during a neurological examination. Determine what condition is MOST LIKELY affecting the afferent arm of the pupillary light reflex, but NOT the efferent arm?
A physician observes a patient's pupils during a neurological examination. Determine what condition is MOST LIKELY affecting the afferent arm of the pupillary light reflex, but NOT the efferent arm?
During an otoscopy exam, a physician notes that the cone of light is displaced anteriorly. What structure has MOST likely been affected to cause this presentation?
During an otoscopy exam, a physician notes that the cone of light is displaced anteriorly. What structure has MOST likely been affected to cause this presentation?
A patient presents with conductive hearing loss, which is further diagnosed as otosclerosis. Which of the following ossicles is MOST likely affected FIRST by this disease process?
A patient presents with conductive hearing loss, which is further diagnosed as otosclerosis. Which of the following ossicles is MOST likely affected FIRST by this disease process?
Which of the following BEST describes the innervation of the tensor tympani and the stapedius muscles, respectively?
Which of the following BEST describes the innervation of the tensor tympani and the stapedius muscles, respectively?
During a particularly complex surgical procedure involving the middle ear, a surgeon notes the prominence of the facial canal. What area is this prominence found?
During a particularly complex surgical procedure involving the middle ear, a surgeon notes the prominence of the facial canal. What area is this prominence found?
A professional opera singer seeks treatment for voice weakening related to damage of the recurrent laryngeal nerve during a thyroidectomy. Injury to what vessel is MOST likely to be the source of this damage?
A professional opera singer seeks treatment for voice weakening related to damage of the recurrent laryngeal nerve during a thyroidectomy. Injury to what vessel is MOST likely to be the source of this damage?
Damage to the ansa cervicalis would MOST directly affect the function of which of the following muscles?
Damage to the ansa cervicalis would MOST directly affect the function of which of the following muscles?
A surgeon needs to clamp the facial artery. What artery would they want to clamp in conjunction to MOST effectively cut off blood supply.
A surgeon needs to clamp the facial artery. What artery would they want to clamp in conjunction to MOST effectively cut off blood supply.
A newborn presents with a branchial fistula along the lateral aspect of the neck. What BEST describes the embryological origin of this condition?
A newborn presents with a branchial fistula along the lateral aspect of the neck. What BEST describes the embryological origin of this condition?
A child is diagnosed with a thyroglossal duct cyst. From what embryological process does this occur?
A child is diagnosed with a thyroglossal duct cyst. From what embryological process does this occur?
A patient is diagnosed with Treacher Collins syndrome. Considering the content, which of the following is MOST likely to be impaired due to the syndrome's underlying developmental defects?
A patient is diagnosed with Treacher Collins syndrome. Considering the content, which of the following is MOST likely to be impaired due to the syndrome's underlying developmental defects?
An infant is born with significant craniofacial abnormalities, including abnormal ear development and cleft palate. Genetic testing reveals deletion in chromosome 22q11.2. Which of the following additional findings is MOST likely?
An infant is born with significant craniofacial abnormalities, including abnormal ear development and cleft palate. Genetic testing reveals deletion in chromosome 22q11.2. Which of the following additional findings is MOST likely?
Following a head injury, a patient develops a skull deformity characterized by premature fusion of the sagittal suture. What BEST describes the expected shape of the skull?
Following a head injury, a patient develops a skull deformity characterized by premature fusion of the sagittal suture. What BEST describes the expected shape of the skull?
Describe the composition of the middle layer of the tympanic membrane.
Describe the composition of the middle layer of the tympanic membrane.
During the development of the auricle (external ear), the auricular hillocks fail to fuse correctly, a condition that can lead to various ear malformations. Considering the embryological origin of these hillocks, from what embryonic cells do the cells arise?
During the development of the auricle (external ear), the auricular hillocks fail to fuse correctly, a condition that can lead to various ear malformations. Considering the embryological origin of these hillocks, from what embryonic cells do the cells arise?
A patient displays a coloboma of the iris, which leads the physician to check for other abnormalities. The physician should focus on the possibility of abnormalities in what region?
A patient displays a coloboma of the iris, which leads the physician to check for other abnormalities. The physician should focus on the possibility of abnormalities in what region?
What structure courses through the infratemporal fossa?
What structure courses through the infratemporal fossa?
An otolaryngologist is performing a mastoidectomy and uses the suprameatal triangle to access the mastoid antrum. What important structure should be at the forefront of caution during this procedure?
An otolaryngologist is performing a mastoidectomy and uses the suprameatal triangle to access the mastoid antrum. What important structure should be at the forefront of caution during this procedure?
A medical student is reviewing fascial layers of the neck. What structure does the investing layer surround?
A medical student is reviewing fascial layers of the neck. What structure does the investing layer surround?
A doctor is palpating the carotid pulse just superior of the thyroid cartilage. What best describes that location anatomically?
A doctor is palpating the carotid pulse just superior of the thyroid cartilage. What best describes that location anatomically?
What structure is the anterior boundary of the posterior triangle of the neck?
What structure is the anterior boundary of the posterior triangle of the neck?
A patient reports experiencing a diminished range of motion in the neck, particularly when turning the head to the opposite side. What triangle will the nerves run through?
A patient reports experiencing a diminished range of motion in the neck, particularly when turning the head to the opposite side. What triangle will the nerves run through?
Surgical errors towards the subclavian artery are often made towards what structure?
Surgical errors towards the subclavian artery are often made towards what structure?
A patient involved in a high-speed motor vehicle accident presents with a fracture at the pterion. If surgical intervention is required, what artery is at the GREATEST risk of being damaged?
A patient involved in a high-speed motor vehicle accident presents with a fracture at the pterion. If surgical intervention is required, what artery is at the GREATEST risk of being damaged?
During a neurosurgical procedure, an incision is made that extends through the loose connective tissue layer of the scalp. Why is it important for the surgeon to carefully ligate vessels in this layer?
During a neurosurgical procedure, an incision is made that extends through the loose connective tissue layer of the scalp. Why is it important for the surgeon to carefully ligate vessels in this layer?
A newborn presents with an unusual midline neck mass that noticeably elevates when the infant protrudes their tongue during examination. What embryological structure is MOST likely the origin of this mass?
A newborn presents with an unusual midline neck mass that noticeably elevates when the infant protrudes their tongue during examination. What embryological structure is MOST likely the origin of this mass?
A 3-month-old infant is brought in for a well-child visit. Palpation of the skull reveals a soft, membranous gap at the intersection of the sagittal and coronal sutures. What fontanelle is being described, and what is correct regarding the average expected timeline for closure?
A 3-month-old infant is brought in for a well-child visit. Palpation of the skull reveals a soft, membranous gap at the intersection of the sagittal and coronal sutures. What fontanelle is being described, and what is correct regarding the average expected timeline for closure?
A patient is diagnosed with a lesion affecting the sensory root of the trigeminal nerve as it passes through the superior orbital fissure. Which sensation would the patient MOST likely retain?
A patient is diagnosed with a lesion affecting the sensory root of the trigeminal nerve as it passes through the superior orbital fissure. Which sensation would the patient MOST likely retain?
A patient presents with a vestibular schwannoma impacting cranial nerve VIII in the internal acoustic meatus. Which signs would confirm this diagnosis?
A patient presents with a vestibular schwannoma impacting cranial nerve VIII in the internal acoustic meatus. Which signs would confirm this diagnosis?
During a surgical resection of a parotid tumor, the great auricular nerve is damaged. What area of the external ear would MOST likely experience sensory loss post-operatively?
During a surgical resection of a parotid tumor, the great auricular nerve is damaged. What area of the external ear would MOST likely experience sensory loss post-operatively?
A surgeon is preparing to access the mastoid antrum via the suprameatal triangle. What structure poses the GREATEST risk of injury if the approach is too deep?
A surgeon is preparing to access the mastoid antrum via the suprameatal triangle. What structure poses the GREATEST risk of injury if the approach is too deep?
A patient presents with dry eye and is diagnosed with damage to the lacrimal nerve. What nerve is MOST likely to be affected?
A patient presents with dry eye and is diagnosed with damage to the lacrimal nerve. What nerve is MOST likely to be affected?
During a particularly complex dissection, a motor branch of the trigeminal nerve (CN V) is severed. Which of the following muscles will exhibit paralysis?
During a particularly complex dissection, a motor branch of the trigeminal nerve (CN V) is severed. Which of the following muscles will exhibit paralysis?
A physician is assessing extraocular muscle function and notes that a patient is unable to depress and abduct their left eye. Which muscle is MOST likely affected?
A physician is assessing extraocular muscle function and notes that a patient is unable to depress and abduct their left eye. Which muscle is MOST likely affected?
A patient shows diminished sensation of the anterior 2/3 of the tongue and decreased salivation. Injury of which nerve explains these concurrent deficits?
A patient shows diminished sensation of the anterior 2/3 of the tongue and decreased salivation. Injury of which nerve explains these concurrent deficits?
What describes the relationship between the location of the Superior Oblique and Inferior Rectus muscles of the eye?
What describes the relationship between the location of the Superior Oblique and Inferior Rectus muscles of the eye?
A lesion of the ansa cervicalis would MOST directly affect which action?
A lesion of the ansa cervicalis would MOST directly affect which action?
A patient presents with a stab wound to the neck, specifically impacting the carotid sheath. If the vagus nerve is completely transected within the sheath, which is the MOST likely outcome?
A patient presents with a stab wound to the neck, specifically impacting the carotid sheath. If the vagus nerve is completely transected within the sheath, which is the MOST likely outcome?
Flashcards
What is the SCALP mnemonic?
What is the SCALP mnemonic?
Layers: Skin, Connective Tissue, Aponeurosis, Loose Areolar Tissue, Pericranium
What do you know about emissary veins?
What do you know about emissary veins?
Structure: Loose areolar tissue; contains emissary veins that connect to diploic veins and cavernous sinus.
Occipitofrontalis: Nerve Supply?
Occipitofrontalis: Nerve Supply?
NS from facial nerve
What are the Fontanelles?
What are the Fontanelles?
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Why is the Pterion significant?
Why is the Pterion significant?
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General Somatic Afferent Function?
General Somatic Afferent Function?
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General Visceral Afferent Function?
General Visceral Afferent Function?
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CN III lesion?
CN III lesion?
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CN IV Lesion?
CN IV Lesion?
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CN VI lesion?
CN VI lesion?
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Clinical Consequences of CN VII Issues?
Clinical Consequences of CN VII Issues?
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CN VIII lesion?
CN VIII lesion?
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CN IX lesion?
CN IX lesion?
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CN X lesion?
CN X lesion?
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CN XII lesion?
CN XII lesion?
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Function of the Stylomastoid foramen?
Function of the Stylomastoid foramen?
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Olfactory Nerve Function
Olfactory Nerve Function
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Optic Nerve Function
Optic Nerve Function
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What does the Pterygopalatine ganglion contain?
What does the Pterygopalatine ganglion contain?
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Function of the Geniculate ganglion
Function of the Geniculate ganglion
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What fibers does the Submandibular ganglion contain?
What fibers does the Submandibular ganglion contain?
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Horner's syndrome is characterized by?
Horner's syndrome is characterized by?
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Important relationships involved with cavernous sinus?
Important relationships involved with cavernous sinus?
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What facial function does CN 7 facilitate?
What facial function does CN 7 facilitate?
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Frey's syndrome
Frey's syndrome
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Where do the Recti originate from?
Where do the Recti originate from?
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Name NS of Submandibular gland
Name NS of Submandibular gland
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What does the 1st part of the subclavian artery contain?
What does the 1st part of the subclavian artery contain?
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What are the triangles of the neck?
What are the triangles of the neck?
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Which vessels branch from the external carotid artery?
Which vessels branch from the external carotid artery?
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Nerve supply to bony labrynth
Nerve supply to bony labrynth
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CN 3 location
CN 3 location
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CN innervation of face
CN innervation of face
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Study Notes
- Study notes for Block IV Review, covering the SCALP, fontanelles, cranial nerves, facial nerve, infratemporal fossa, meninges, eye and development.
SCALP Layers
- Skin contains hair follicles.
- Connective tissue contains blood vessels.
- Aponeurosis connects the occipitofrontalis muscle.
- Loose areolar tissue contains emissary veins, which are dangerous and can lead to cavernous sinus thrombosis via diploic veins.
- Pericranium is a dense connective tissue layer.
- Occipitofrontalis muscle has nerve supply from the facial nerve.
Fontanelles
- Anterior fontanelle closes at about 1.5-2 years of age.
- Posterior fontanelle closes at about 3-6 months of age.
- Anterolateral fontanelle closes at about 3-6 months of age.
- Posterolateral fontanelle closes at about 1.5-2 years of age.
- The pterion overlies the middle meningeal artery; rupture causes epidural hematoma.
Functional Components of Cranial Nerves
- General somatic efferent fibers innervate voluntary muscles derived from pharyngeal arches; cranial nerves III, IV, V, VI, VII, IX, XI, and XII are examples.
- General visceral efferent fibers innervate involuntary muscles or glands as part of the parasympathetic nervous system; cranial nerves III, VII, IX, and X are examples.
- General somatic afferent fibers transmit general sensations from the skin and mucous membranes; examples include cranial nerves V, IX, and X.
- General visceral afferent fibers convey sensation from the viscera; cranial nerves IX and X are examples.
- Special sensory fibers convey taste, smell, vision, hearing, and equilibrium via cranial nerves I, VII, IX, X, II, and VIII.
Cranial Nerve Lesions
- CN I lesion: Loss of sense of smell (olfaction).
- CN II lesion: Loss of sight (vision).
- CN III lesion: Droopy upper eyelid, eye "looks down and out," double vision, fixed and dilated pupil, and lack of accommodation; conditions are associated with diabetes.
- CN IV lesion: Extortion of the eye, vertical diplopia, and head tilting
- CN V lesion: Hemianesthesia of the face, loss of corneal reflex and oculocardiac reflex, paralysis of mastication muscles; deviation of jaw.
- CN VI lesion: Convergent strabismus and inability to abduct the eye.
- CN VII lesion: Paralysis of facial expression muscles (Bell's Palsy), loss of corneal reflex, hyperacusis, and Crocodile tears syndrome.
- CN VIII lesion: Disequilibrium, vertigo, and nystagmus (vestibular); acoustic neuroma results in hearing loss and tinnitus (cochlear).
- CN IX lesion: Loss of gag reflex and taste on posterior 1/3 of tongue.
- CN X lesion: Uvula deviates to opposite side of the lesion with paralysis of the pharynx and larynx.
- CN XI lesion: Inability to turn the head or shrug shoulders.
- CN XII lesion: Tongue deviates to the injured side.
Important Foramen and Structures
- Olfactory Nerve passes through the cribriform plate
- Optic canal transmits the Optic Nerve
- SOF contains: III, IV, V1, VI
- F. rotundum contains: V2
- F. ovale contains: V3
- IAM contains: VII, VIII
- Jugular F. contains: IX, X, XI,
- Hypoglossal canal contains: XII
Stylomastoid Foramen
- Serves as the exit point of the facial nerve before it enters the parotid gland and innervates muscles of facial expression.
- Deep petrosal nerve passes over it, joined by greater petrosal nerve
Cranial Nerves Origin, Classification, and Function
- Olfactory nerve (CN I): Sensory for smell.
- Optic nerve (CN II): Sensory for sight.
- Oculomotor nerve (CN III): Primarily motor.
- Trochlear nerve (CN IV): Motor.
- Trigeminal nerve (CN V): both sensory and motor
- Abducens nerve (CN VI): Motor; innervates the lateral rectus muscle
- Facial nerve (CN VII): Both sensory and motor.
- Vestibulocochlear nerve (CN VIII): Sensory.
- Glossopharyngeal nerve (CN IX): Both sensory and motor; innervates the posterior 1/3 of tongue.
- Vagus nerve (CN X): Both sensory and motor.
- Accessory nerve (CN XI): Motor.
- Hypoglossal nerve (CN XII): Motor; innervates the muscles of the tongue.
Ganglia Associated with the Facial Nerve
- Pterygopalatine ganglion contains parasympathetic secretomotor fibers for the lacrimal gland, mucous membrane of the nose, paranasal sinuses, palate, and pharynx.
- Geniculate ganglion is a sensory ganglion containing the cell bodies of taste fibers coming from the anterior 2/3 of tongue.
- Submandibular ganglion contains parasympathetic secretomotor fibers to the submandibular and sublingual glands.
- Greater petrosal nerve is associated with CN VII and the pterygopalatine ganglion, contributing to lacrimal gland function.
- Chorda tympani (CN VII) synapses in the submandibular ganglion.
- The geniculate ganglion contributes sensory fibers from the anterior 2/3 of the tongue.
Cranial Nerves & Circle of Willis
- IIIrd and IVth nerve are located b/w the Posterior cerebral and superior cerebellar arteries
- CN III is very close to the posterior communicating artery
- Abducent nerve (CN VI) is in proximity to the Anterior inferior cerebellar artery
- Nerve X and XI are intimately related to the Posterior inferior cerebellar artery
Reflexes and Cranial Nerves
- Pupillary Light Reflex: Afferent arm is Optic Nerve, Efferent Arm is Oculomotor nerve.
- Accommodation Reflex: Afferent arm is Optic nerve, Efferent Arm is Oculomotor nerve.
- Corneal Reflex: Afferent arm is V1/Long ciliary nerve and Efferent Arm is Facial nerve.
- Pharyngeal Reflex/Gag Reflex: Afferent arm is Glossopharyngeal and Efferent Arm is Vagus nerve.
Horner's Syndrome Symptoms
- Due to injury of cervical sympathetic fibers and results in:
- Miosis (constricted pupil)
- Ptosis (drooping eyelid)
- Enophthalmos (recession of eyeball)
- Anhidrosis (lack of sweating)
- Vasodilation
- Loss of ciliospinal reflex
Pterygopalatine Fossa
- Connects medially with the nasal cavity (sphenopalatine foramen), anteriorly with the orbit (inferior orbital fissure), laterally with the infratemporal fossa (pterygomaxillary fissure) and posterosuperiorly with the middle cranial fossa
- Relations to Infratemporal Fossa: Bony orbit via inferior orbital fissure; Pterygopalatine fossa via pterygomaxillary fissure; the temporal fossa and middle cranial
Meninges
- Falx cerebri divides the cerebrum, contains sagittal sinuses and attaches to the crista galli.
- Tentorium cerebelli separates the cerebellum from the occipital lobe and compresses CN III during herniation; contains the straight sinus.
- Falx cerebelli overlies the occipital sinus
- Subdural vein overlies dura
Dural Sinuses
- Cavernous sinus contains CN VI and the internal carotid artery.
- Dural Sinuses: CN III, IV & V1 and V2.
- Structures draining into: Ophthalmic veins, sphenoparietal, and intercavernous sinus
- the central retinal vein drains into the ophthalmic vein
Sensory supply of the face
- Ophthalmic nerve (V1) provides sensory innervation to the lacrimal, frontal, and nasal cavities.
- Maxillary nerve (V2) provides sensory innervation to the meningeal branch and zygomatic branches.
- Mandibular nerve (V3): Trunk comprises the meningeal branch; the auriculotemporal branch conveys sensation to the face
Face
- Sensory Innervation include the branches of trigeminal nerve
- Motor Innervation consists of facial nerve
- Orbicularis oculi and buccinator muscles.
- Infection can result from the dangerous/triangle area to cavernous sinus through the ophthalmic and deep facial veins
Frey's Syndrome
- Frey's Syndrome: Following injury to the ariculotemporal nerve, sweating occurs on the cheek after eating.
- Parasympathetic secretory motor fibers to the parotid gland and sympathetic fibres to the sweat glands innervate the wrong gland.
Oribital Muscles General
- Total of 7 orbital muscle; 6 for Eye Ball and 1 for Upper eye lid: Levator palpabrae superioris
- Conal: 4-Recti form a cone of muscles (not attached to a bone)
- Extraconal: 2 Obliques + 1Levator palpabrae superioris (are attached to bone at their origin
- Origination: Four (4) Recti originate from common tendinous ring which form a cone of muscles (and run forward)
Oribital Muscles Specific
- LPS elevates the upper eyelids.
- Superior rectus elevates, adducts, and intros eyeball.
- Inferior rectus depresses, adducts, and extorts eyeball.
- Medial rectus adducts the eyeball.
- Lateral rectus abducts the eyeball.
- Superior oblique intros, depresses, and abducts the eyeball.
- Inferior oblique extorts, elevates, and abducts the eyeball.
Muscles of eye action
- Vertically, the Superior rectus and Inferior oblique Elevate the eye.
- The Inferior recturs and superior oblique both Depress eye
-
- These function because in neutral position, the extra ocular muscles counter act each other (Antagonists action).
- In elevations, the superior rectus ads and intro's to cancled out inferior oblique
Cranial Nerves and Testing
- CNs & Muscles: -LR Lateral Rectus, MR-Medial Rectus, SR-Superior Rectus, IR-Inferior Rectus, SO-Superior Oblique, 10-Inferior Oblique
- Nerve: 6 for LR (LR 6), CN IV for SO (SO 4) with CN III for all the rest.
Orbit: Outside of Muscles
- Nerves Outside of Muscular Cone
- Lacrimal (VI): Is the branch Ophthalmic Nerve
- Frontal (V1): Branch of Ophthalmic Nerve
- Trochlear nerve (IV)
- Nerves inside the muscular cone
- division Inferior (CN III)
- Nasociliary (CN V1)
- Abducens (CN VI)
Lacrimal Apparatus
- Excess Flow (with tears): epiphora
- Components include:
- Lacrimal Gland
- Puncta of lacrimal papilla
- lacrimal canaliculus
- Lacrimal Sac
- Nasolacrimal duct
Eyelids
- Innervated via the long and ciliary nerve
- Superorbital of supratrochlear
- Has Lateral puntum of lacrimal papilla
Eye Anatomy
- The eye and its "Gross" Structures consist of 3 Layers which are fibrous, vascular and then nervous
- These layers all can be further broken
down
- Fibrous: Sclerea and Cornea.
- Vascular consists of Choriod and iris The chamber within consists of center of retning
Humors
- Aqueous humor: Produced in the body (at posterior body) with ciliary
- A clear Watery (fluid)
- Intracranial Pressure: Is balanced
Viewing Internally - Fundoscopy
- Internal Viewing of retinal - The optic disc should appear medial - Embolusin (of the retinal/vessels (optic - nerv) from Internal carotid
Sound/Ear General - Outer Ear
- Auricles
- catch/Direct
- Vidiuales
Sound/Earl - Nerve Supply
- Upper nerve: Half lateral branch (auriculotemporal) to the
Half cranial Lesser of
Mastoid Triange
• anterior: border External Acoustic Triange"
— superior: root Zygomatic triange
Tympanic Eardrum
- 1 cm diameter
- annular
- has 3 "parts"
- flaccida
- tenda
- process
Muscules
- damp sound
- consist internal - medial terggriid
Incus Stapedius —
Inner Ear - Development
- Bony (Cochlea): contains perilymph with sodium
- Membranous: contains endolymph
- -Has special functions depending on location
cristia amapulis : Kinetic
- static balance: macals - kinetic: angus
Muscles of Mastication
- Actions of muscles of Mastication
- These "muscles" take up space: as infra-temportal location --- Also TM). A point is they the face will (CNV5) with it :All "muscles (elevations , protracks), it Opens the month (Lateral)
Anatomy of Side Face
- Contents "Side Face" all be tempropal and lateral
- also "nerue" (arches) in gangling
Inferior Alv - Anesthetic
- Nerve in Nychiolgoid will be alfected
Dislocation
- Two (of nerves" to "TMJ and with great
--TM Lateral strong and resists
Deep Fasica
- There are "Layers and Form" that have pre-versical is from"
Clevrical
- Has what the Ligma
Sub -Clavicle
- cervical and vertebrastum
Pharyngeal - Devlopment Notes
- There are (3) "points to remermber" - * syndrome - cysts
DiGeorge Syndrome
- All "remnants and points
Face / Eye and more extra
- facial clefts
- Cleft (lip) points
- Colabnomma" points (that the be due , in lens
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