Anatomy Past Paper 2015-2016 PDF

DEPARTMENT OF ANATOMY DEPARTMENT OF ANATOMY QUESTIONS AND ANSWERS 2015-2016 What’s INSIDE ANATOMY-2 SGS-244 0 DEPARTMENT OF ANATOMY 1. Draw a labeled...

DEPARTMENT OF ANATOMY DEPARTMENT OF ANATOMY QUESTIONS AND ANSWERS 2015-2016 What’s INSIDE ANATOMY-2 SGS-244 0 DEPARTMENT OF ANATOMY 1. Draw a labeled diagram of the sensory innervation of the face and scalp. Answer: U 2. Draw a labeled diagram of the sensory innervation and arterial supply of the scalp. Answer: U 1 DEPARTMENT OF ANATOMY 3. Give a short note on the nerve supply of the face Answer: U SENSORY MOTOR  Motor branches of the facial nerve: U 1. Temporal branch 2. Zygomatic branch 3. Buccal branch 4. Mandibular branch 5. Cervical branch  Sensory branches from the 3 divisions of the trigeminal nerve U A. Branches from the ophthalmic division V I : U URR RR 1. Supratrochlear nerve 2. Superaorbital nerve 3. Lacrimal nerve 4. Infratrochlear nerve 5. External nasal nerve B. Branches from the maxillary division V 2: U URR 1. Zygomaticotemporal nerve 2. Zygomaticofacial nerve 3. Infraorbital nerve C. Branches from the mandibular division V 3: U URR 1. auriculotemporal nerve 2. buccal nerve 3. mental nerve  Great auricular nerve to a triangular area opposite the angle of the mandible (C2) 2 DEPARTMENT OF ANATOMY 4. Describe the arterial supply of the face. Answer: U 1. The facial artery: branch from the external carotid artery. U U 2. The superficial temporal artery: branch of the external carotid artery. U U 3. The transverse facial artery: branch from the superficial temporal artery. U U 4. The infraorbital artery: is the direct continuation of the maxillary artery. U U 5. The zygomaticotemporal artery: branch from the zygomatic branch of the lacrimal artery. U U 6. The zygomaticofacial artery: branch from the zygomatic branch of the lacrimal artery. U U 7. The mental artery: branch from the inferior alveolar of the maxillary artery. U U  The arteries of the face are characterized by its free anastomosis with each other and with those of the opposite side, so wounds of the face bleed profusely and heal rapidly. 3 DEPARTMENT OF ANATOMY 5. Describe the venous drainage of the face. Answer: U 1. The facial vein begins at the medial angle of the eye by union of supratrochlear and U U supraorbital veins and receive the angular vein. It then descends in the face behind the facial artery and receives the nasal, superior and inferior labial tributaries. It then unites with the anterior division of the retromandibular vein to form the common facial vein, which drains U U U U U into the internal jugular vein. 2. The transverse facial vein drain into the retromandibular vein. U U 3. The posterior auricular vein unites with the posterior division of the retromandibular U U U vein to form the external jugular vein which drains into the subclavian vein at the root of U U U U U the neck.  The deep facial vein connects the facial vein with the pterytgoid venous plexus.  The dangerous area of the face is bounded by the nose, the eye, and the upper lip is a potentially dangerous zone to have an infection. 4 DEPARTMENT OF ANATOMY 6. Give a short note on the facial artery in the face. Answer: U It arises from the anterior aspect of the external carotid artery in the neck. It enters the face by piercing the deep fascia of the neck opposite the antero-inferior angle of the masseter muscle. It ascends in a tortuous course (to accommodate itself with movements of the facial expressions), to the angle of the mouth, and then runs along the lateral side of the nose till the medial angle of the eye where it ends as the angular artery. Branches in the face: 1. Inferior labial artery. 2. Superior labial artery. 3. Nasal branch. 4. Angular artery. 7. Write a brief account of the buccinator muscle. Answer: U It is one of the muscles of the facial expressions It takes origin from: U  Outer surface of the maxilla opposite the 3 molars  Pterygomandibular ligament (raphe)  Outer surface of the body of mandible opposite the 3 molars Insertion: U  The upper fibers into the upper lip  The lower fibers into the lower lip  The middle fibers decussate at the angle of the mouth to the upper and lower lips Nerve supply: U  Buccal branch of the facial nerve Action: U  Facial expressions: blowing, whistling and screwing up the lips …etc.  Prevent accumulation of the food in the vestibule of the mouth during mastication. 5 DEPARTMENT OF ANATOMY 8. Give the nerve supply of the parotid gland. Answer: U  Parasympathetic: U Inferior salivatory nucleus → glossopharyngeal nerve (preganglionic fibers) → tympanic branch → tympanic plexus → lesser petrosal nerve → relay in otic ganglion → post ganglionic fibers → mandibular nerve → posterior division → auriculotemporal nerve → parotid gland.  Sympathetic: From the sympathetic plexus around the external carotid artery to the blood U U vessels.  Sensory: From the auriculotemporal nerve to the fibrous capsule. U U 9. Describe the course of the parotid duct. Answer: U The parotid duct emerges from the anterior border of the gland and runs forwards across the outer surface of the masseter muscle till its anterior border. It then bends medially and pierces the following structures: 1. The buccal pad of fat. 2. The buccopharyngeal fascia. 3. The buccinators muscle. 4. The mucous membrane of the vestibule of the mouth. To open on a small papilla opposite the upper second molar tooth. 10. Name the structures that emerges from the upper and lower ends of the parotid gland. Answer: U From the upper end:  Superficial temporal vessels  Auriculotemporal nerve From the lower end:  Cervical branch of the facial nerve  The anterior and posterior divisions of the retromandibular vein 6 DEPARTMENT OF ANATOMY 11. Name the structures that lie within the substance of the parotid gland. Answer: U  Superficial parotid lymph nodes  Facial nerve and its branches in the face  Retromandibular vein and its tributaries (maxillary and superficial temporal veins) and its anterior and posterior divisions  External carotid artery and its two terminal branches (maxillary and superficial temporal arteries)  Auriculotemporal nerve 12. Give a brief account of the parotid salivary gland. Answer: U  The parotid gland is the largest of the salivary glands. Its average weight is 25 g. It is an irregular, lobulated, yellowish mass, lying largely below the external auditory meatus between the mandible and sternocleidomastoid. The gland also projects forwards onto the surface of masseter muscle.  It extends upwards to the zygomatic arch, backwards to overlap sternocleidomastoid, downwards to its apex posteroinferior to the mandibular angle, and forwards to lie on masseter below the parotid duct.  It presents a small superior surface, and superficial, anteromedial and posteromedial surfaces. It tapers inferiorly to a blunt apex. 7 DEPARTMENT OF ANATOMY  The concave superior surface is related to the cartilaginous part of the external acoustic meatus and posterior aspect of the temporomandibular joint. Here the auriculotemporal nerve curves round the neck of the mandible, embedded in the capsule of the gland.  The apex overlaps the posterior belly of digastric and the carotid triangle to a variable extent.  The superficial surface is covered by skin and superficial fascia, which contains the facial branches of the great auricular nerve, superficial parotid lymph nodes and the posterior border of platysma.  The anteromedial surface is grooved by the posterior border of the mandibular ramus. It covers the posteroinferior part of masseter, the lateral aspect of the temporomandibular joint and the adjoining part of the mandibular ramus. It passes forwards, medial to the ramus of the mandible, to reach medial pterygoid. Branches of the facial nerve emerge on the face from the anterior margin of this surface.  The posteromedial surface is moulded to the mastoid process, sternocleidomastoid, posterior belly of the digastric, and the styloid process and its associated muscles. The external carotid artery grooves this surface before entering the gland, and the internal carotid artery and internal jugular vein are separated from the gland by the styloid process and its associated muscles.  The anteromedial and posteromedial surfaces meet at a medial margin that may project so deeply that it contacts the lateral wall of the pharynx. 13. Give a short note on the facial nerve in the face. Answer: U  After its exit from the stylomastoid foramen the facial nerve gives off three branches (posterior auricular branch, nerve to posterior belly of digastric and nerve to stylohyoid muscles) then it enters the substance of the parotid gland.  In the parotid gland it divides into 2 divisions upper and lower and gives the following branches: 1. Temporal branches. 2. Zygomatic branches. 3. Buccal branches. 4. Mandibular branches. 5. Cervical branch. 8 DEPARTMENT OF ANATOMY 14. Give a short note on the falx cerebri. Answer: U  It is a sickle shaped fold of the inner layer of the cranial dura matter.  It separates the cerebral hemispheres from each other.  It has an anterior narrow end attached to the crista gale and a posterior wider end attached to the beak of the tentorium cerebelli from the internal occipital protuberance to the middle of its free border.  It has a superior convex border, attached to the lips of the sagittal sulcus, and an inferior concave free border.  It lodges the following venous dural sinuses: 1. The superior sagittal sinus in its attached superior border. 2. The inferior sagittal sinus in its free inferior border. 3. The straight sinus in its posterior wider end. 9 DEPARTMENT OF ANATOMY 15. Give a short note on the tentorium cerebelli. Answer: U  It is a tent like shaped fold of the inner layer of the cranial dura matter.  It separates the occipital lobes of the cerebral hemispheres from the superior surface of the cerebellum.  It has an outer convex attached border and inner concave free border.  The attached border is attached on each side to the posterior clinoid process, tip and superior border of the petrous part of the temporal bone, the lips of the transverse sulcus and the internal occipital protuberance.  The free border is attached to the anterior clinoid process in both sides.  It lodges the following venous dural sinuses: 1. The right and left superior petrosal. 2. The right and left transvers sinuses. 3. The straight sinus in its middle. 16. Give the relations of the cavernous sinus. Answer: U 1. It is a short wide venous channel lies alongside the body of the sphenoid bone, like a box. 2. It has anterior and posterior ends, roof, floor, medial and lateral walls. 3. Anteriorly it is related to the superior orbital fissure. 4. Posteriorly it is related to the apex of the petrous part of the temporal bone and the trigeminal ganglion in its pocket of dura matter (cavum trigeminal). 5. Medially it is related to the pituitary gland above, and body of sphenoid containing the sphenoidal air sinus below. 6. Laterally it is related to temporal lobe of the cerebral hemisphere. 7. Its floor is related to the body and root of greater wing of the sphenoid bone. 8. Its roof is related to the internal carotid artery infront and the uncus of the temporal lobe behind. 9. Its cavity is traversed by the internal carotid artery from the posterior to the anterior end and the abducent nerve runs infrolateral to it. 10. The following nerves run along the lateral wall from above downwards: oculomotor, trochlear, ophthalmic, and maxillary.  The artery and nerves are separated from the blood within the sinus by the endothelial lining only. 10 DEPARTMENT OF ANATOMY 17. Give the tributaries, drainage and connections of the cavernous sinus. Answer: U  Tributaries: U 1. The ophthalmic veins. 2. The spheno-parietal sinus. 3. Superficial middle cerebral vein. 4. Some inferior cerebral veins.  Drainage: U 1. To transverse sinus through the superior petrosal sinus. 2. To the internal jugular vein through the inferior petrosal sinus.  Connections: U 1. Communicated to the facial vein through the ophthalmic veins. 2. Communicated to that of the opposite side by the intercavernous sinuses and the basilar venous plexus. 3. Communicated to the pterygoid venous plexus by an emissary vein which passes through the foramen oval. 4. Communicated to the Pharyngeal venous plexus by an emissary vein which passes through the foramen lacerum. 5. Communicated to the end of transverse sinus by the superior petrosal sinus. 6. Communicated to the internal jugular vein by the inferior petrosal sinus. 11 DEPARTMENT OF ANATOMY 18. Write a brief account of the emissary veins. Answer: U  These veins connect the veins outside the cranial cavity with the venous sinuses within the cranial cavity. It is a valveless veins; the blood can pass through either direction.  So it can help in equalization of the blood pressure inside and outside the cranial cavity.  Its disadvantage is: transmission of infection from outside to inside the cranial cavity.  Three emissary veins in connection with the cavernous sinus: U 1. Ophthalmic vein which joins the anterior end of the sinus with the facial vein. 2. Emissary vein that connect the cavernous sinus with the pharyngeal venous plexus which passes through foramen lacerum. 3. Emissary vein that connect the cavernous sinus with the pterygoid venous plexus which passes through foramen ovale.  Two emissary veins in connection with the sigmoid sinus: U 1. Emissary vein passes through the mastoid emissary foramen that connects the upper end of the sinus with the occipital venous plexus. 2. Emissary vein passes through the posterior condylar canal that connects the lower end of the sinus with the suboccipital venous plexus.  Two emissary veins in connection with the superior sagittal sinus: U 1. One passes through the foramen cecum, which connects the sinus with the veins of the nasal cavity (only in 1% of adult skulls). U U 2. The parietal emissary foramina, connects the sinus with the veins of the scalp. 19.. Give the branches of the Mandibular nerve. Answer: U  Branches from the trunk: 1. Meningeal branch; enter the middle cranial fossa through foramen spinosum. 2. Nerve to medial pterygoid 3. Nerve to tensor palate 4. Nerve to tensor tympani  Branches from the anterior division: 1. Deep temporal nerves to temporalis muscle 2. Nerve to masseter muscle 3. Nerve to lateral pterygoid muscle 12 DEPARTMENT OF ANATOMY  Branches from the posterior division: 1. Lingual nerve (contains sensory fibers from the mandibular nerve and fibers U U from the chorda tympani nerve which join it deep to the lateral pterygoid muscle - preganglionic parasympathetic to the submandibular ganglion and taste fibers from the anterior 2/3 of the tongue). 2. Inferior alveolar nerve and its mylohyoid branch (which supply the mylohyoid U U and anterior belly of the digastric muscle). 3. Auriculotemporal nerve (contains sensory fibers from the mandibular nerve U U and postganglionic parasympathetic fibers from the lesser petrosal nerve to the parotid gland). 20. Give the branches of the first part of the Maxillary artery Answer: U 1. Deep auricular artery. 2. Anterior tympanic artery. 3. Middle meningeal artery. 4. Inferior alveolar artery. 5. Occasionally the accessory meningeal artery. 21. Give the branches of the third part of the Maxillary artery. Answer: U 1. Posterior superior alveolar artery (to upper teeth). 2. Sphenopalatine artery (to nose). 3. Greater and lesser palatine arteries. 4. Artery of the pterygoid canal. 5. Infraorbital artery. 13 DEPARTMENT OF ANATOMY 22. Give the branches of the Maxillary nerve. Answer: U Branches from the pterygopalatine Branches from the maxillary nerve ganglion 1. Meningeal branch 1. Orbital nerve 2. Ganglionic branches 2. Nasopalatine nerve 3. Zygomatic nerve: 3. Posterior superior nasal a) Zygomaticotemporal nerve branches b) Zygomaticofacial nerve 4. Greater palatine nerve 4. Posterior superior alveolar nerve 5. Lesser palatine nerve 5. Infra-orbital nerve: 6. Pharyngeal branches a) Middle superior alveolar n. b) Anterior superior alveolar n. c) And continues on the face (Infra-orbital nerve). 23. Give a short note on the otic ganglion. Answer: U  It is one of the cranial parasympathetic ganglia. It lies deep in the infratemporal fossa attached to the trunk of the mandibular nerve by sensory roots. Its parasympathetic root comes from the glossopharyngeal nerve through the lesser petrosal nerve.  The parasympathetic root: Inferior salivary nucleus → glossopharyngeal nerve (preganglionic fibers) → tympanic branch → tympanic plexus → lesser petrosal nerve → otic ganglion (relay) → (postganglionic fibers) → mandibular nerve → its posterior division → auriculotemporal branch → parotid salivary gland.  The sympathetic root: From the sympathetic plexus around the middle meningeal artery.  The sensory root: from the mandibular nerve trunk. 14 DEPARTMENT OF ANATOMY 24. Give a short note on the sphenopalatine ganglion. Answer: U  t is one of the cranial parasympathetic ganglia. It lies in the pterygopalatine fossa attached to the maxillary nerve by the sensory roots.  The parasympathetic root: Lacrimal nucleus → facial nerve (preganglionic fibers) → greater petrosal nerve → join the deep petrosal (sympathetic) → to form nerve of the pterygoid canal → to sphenopalatine ganglion. (relay) → (postganglionic fibers) → maxillary nerve → communicating branch to lacrimal nerve → to lacrimal gland.  The sympathetic root: The deep petrosal; from the sympathetic plexus around the internal carotid artery (postganglionic fibers) → to form nerve of the pterygoid canal → to sphenopalatine ganglion (pass without relay) → to be distributed along with the branches of the ganglion and the maxillary nerve.  The sensory root: From the maxillary nerve and distributed with the branches of the ganglion.  Branches of maxillary nerve and the ganglion → glands of nasal cavity and palate. 15 DEPARTMENT OF ANATOMY 25. Give the origin, insertion, nerve supply and action of the muscles of mastication. Answer: U Nerve Muscle Origin Insertion action supply Into coronoid  Elevate the mandible From temporal (closing the mouth) Anterior (1) process and fossa, temporal division of the anterior border  Posterior fibers Temporalis lines and the inner mandibular of the ramus of retract the mandible nerve aspect of the the mandible  antigravity M. temporal fascia Oblique head: U (Superficial)  Elevate the mandible from lower border of the zygomatic (closing the mouth) Anterior (2) Into the outer  Protrude the arch division of the surface of the Masseter Vertical head: mandible mandibular mandible U (Deep)  retract the mandible nerve From the inner  antigravity M. surface of the zygomatic arch  Protrude mandible Upper head: U Into the: Depress the mandible From the  Pterygoid infratemporal (opening the mouth) Anterior (3) fovea surface and ridge of  Side to side division of the Lateral  Capsule of the the sphenoid bone movement with the mandibular pterygoid TMJ nerve Lower head: lateral pterygoid  Intra-articular U From the lateral alternating on both surface of the lateral disc. sides pterygoid plate  Elevate the mandible Superficial head: (closing the mouth) U From maxillary Into the rough tuberosity triangular area  Protrude mandible From the trunk (4) Deep head: opposite the  Side to side of the Medial U From the medial inner surface of movement with the mandibular. pterygoid surface of the lateral the angle of the nerve lateral pterygoid pterygoid plate mandible alternating on both sides 16 DEPARTMENT OF ANATOMY 26. Give a short note on the Tempro-mandibular joint. Answer: U  It is the articulation between the head of the mandible and the mandibular fossa of the temporal bone.  It is a synovial joint of condylar variety.  The joint cavity is divided into upper and lower compartments by means of intra- articular disc of fibro cartilage.  The intra-articular disc is concavo-convex in shape and has an anterior and posterior ligament.  The fibrous capsule is attached to the margins of the articular surfaces.  The fibrous capsule is supplied by the auriculo-temporal nerve. Movements of the TMJ and muscles produce each U  Elevation: (close the mouth) Masseter, temporalis and medial pterygoid muscles.  Depression: (opening the mouth) Mylohyoid, geniohyoid and lateral pterygoid muscles.  Protrusion: Superficial fibers of masseter, medial pterygoid and lateral pterygoid muscles.  Retraction: Posterior fibers of temporalis and the deep fibers of masseter muscles.  Side to side movement: Medial and lateral pterygoid on one side alternating with that of the opposite side 17 DEPARTMENT OF ANATOMY The anterior and posterior ligaments of the intra-articular disc and the attachment of U the fibrous capsule: 27. Give a short note on the submandibular ganglion. Answer: U  It is one of the cranial parasympathetic ganglia. It lies on the lateral surface of the hyoglossus muscle between the lingual nerve and the deep part of the submandibular gland. It is attached to the lingual nerve by 2 roots.  The parasympathetic root: Superior salivary nucleus → facial nerve (preganglionic fibers) → chorda tympani → joins the lingual nerve deep to the lateral pterygoid muscle in the infratemporal fossa → relay in the submandibular ganglion → postganglionic fibers → lingual nerve → to submandibular and sublingual salivary glands.  The sympathetic root: Postganglionic fibers (superior cervical sympathetic ganglion) from the sympathetic plexus around the facial artery  The sensory root: From the lingual nerve by 2 small roots. 18 DEPARTMENT OF ANATOMY 28. Give the position and relations of the submandibular salivary gland. Answer: U 1. It lies in the digastric triangle overlapping its boundaries. 2. It consists of a large superficial part and a small deep part where they are continuous with each other around the posterior free border of the mylohyoid muscle. 3. The large superficial part is covered by the skin and fascia containing the platysma muscle. It is related laterally to the submandibular fossa of the body of the mandible and the facial artery between it and the mandible. It is related medially to the mylohyoid muscle and mylohyoid nerve and vessels in front and posteriorly to the hyoglossus muscles and structures related to it.  The deep part lies on the hyoglossus muscle between the lingual nerve above and the hypoglossal nerve below.  The submandibular duct emerges from the deep part of the gland and runs forwards to the floor of the mouth crossed laterally by the lingual nerve (triple relation). 29. Give the nerve supply and relations of the anterior belly of the digastric muscle. Answer: U  It is supplied by the mylohyoid branch of the inferior alveolar nerve.  It shares in the boundary of the digastric triangle (submandibular triangle).  Superficially it covered by the skin, the superficial fascia containing the platysma muscle and the anterior part of the submandibular salivary gland.  Deep to the muscle are the mylohoid nerve and vessels and the mylohoid muscle. 30. Name the structures attached to the styloid process. Answer: U 1. Styloglossus muscle – supplied by the hypoglossal nerve. 2. Stylopharyngeous muscle – supplied by the glossopharyngeal nerve. 3. Stylohyoid muscle – supplied by the facial nerve. 4. Stylomandibular ligament - condensation of the deep cervical fascia. 5. Stylohyoid ligament - one of the remnants of the second pharyngeal arch. 19 DEPARTMENT OF ANATOMY 31. Give the relations of the hyoglossus muscle. Answer: U  Relations of the superficial (lateral) surface: U  From above downwards U  The styloglossus muscle.  The lingual nerve.  The submandibular ganglion.  The deep part of the submandibular salivary gland.  The duct of the submandibular salivary gland.  The hypoglossal nerve.  The deep lingual vein.  Relations of the deep surface: U  Genioglossus muscle  Glossopharyngeal nerve  2nd part of lingual artery P P  Relations of the posterior border: U  Stylopharyngeus muscle  Glossopharyngeal nerve 20 DEPARTMENT OF ANATOMY  Stylohyoid ligament  Middle constrictor muscle of the pharynx  The styloglossus muscle.  Lingual artery  Hypoglossal nerve  Relations of the anterior border: U  Genioglossus muscle  Geniohyoid muscle  Sublingual salivary gland  Submandibular duct  Branches of lingual artery  Lingual nerve  Branches of hypoglossal nerve 32. Describe the nerve supply of the tongue. Answer: U  Motor: U  All the muscles of the tongue are supplied by the hypoglossal nerve except the palatoglossus muscle, which is supplied by the cranial accessory through the pharyngeal branch of the vagus nerve (pharyngeal plexus of nerves).  Sensory: (general) U 1. Anterior 2/3 of the tongue by the lingual nerve. 2. Posterior 1/3 of the tongue by the glossopharyngeal nerve.  Taste sensation: U 1. From the anterior 2/3 taste is carried by the chorda tympani (branch of the facial nerve). 2. From the posterior 1/3 and the vallate papillae carried by the glossopharyngeal nerve. 3. From the posterior part of the tongue (the epiglottic part) carried by the vagus nerve. 21 DEPARTMENT OF ANATOMY 33. Name the muscles of the tongue, and give the nerve supply and action of each. Answer: (in table form) U U Muscle Nerve supply Action Extrinsic muscles: U U Cranial accessory through Pull the tongue upwards and 1. Palatoglossus pharyngeal plexus of nerves backwards 2. Styloglossus Hypoglossal nerve Pull the tongue backwards Pull the tongue downwards and 3. Hyoglossus Hypoglossal nerve backwards Pull the tongue forwards to the same 4. Genioglossus Hypoglossal nerve side Intrinsic muscles U Longitudinal fibers Transverse fibers Hypoglossal nerve Alter the shape of the tongue Oblique fibers 34. Describe the movements of the tongue and the muscles produce each. Answer: U Movement Muscles produce it 1. Protrussion Genioglossus 2. Retraction Styloglossus + Hyoglossus 3. Depression Hyoglossus 4. Retraction and Elevation Styloglossus + Palatoglossus 22 DEPARTMENT OF ANATOMY 35. Write a brief account of the carotid sheath and its contents. Answer: U  It is a condensation of the deep cervical fascia and forms a sheath around the neurovascular bundle of the neck.  Its upper end attached to the base of the skull around the carotid canal, jugular foramen and the anterior condylar canal.  It descends vertically downwards in the neck lateral to the visceral bundle of the neck (larynx, pharynx, trachea, esophagus and thyroid gland).  It continues to the thorax as the fibrous sheaths of the vessels.  Anteriorly the posterior belly of digastric muscle and sternomastoid muscle overlaps it.  The ansa cervicals lies close to the anterior wall of the sheath.  Posteriorly it is related to the cervical sympathetic chain that lie on the prevertebral layer of the deep cervical fascia that covers the muscles.  The contents of the sheath are:  Common and internal carotid arteries.  Internal jugular vein.  Lower 4 cranial nerves (9th, 10th, 11th and 12th). P P P P  The glossopharyngeal, the accessory and the hypoglossal nerves leave the P P sheath in its upper part.  The vagus nerve descends in the whole length of the sheath posterior and in between the carotid arteries and the internal jugular vein.  The deep cervical lymph nodes lies in relation to the internal jugular vein. 36. Write a brief account of the glossopharyngeal nerve and its branches. Answer: U  Number: 9th or IX. P P  Foramen of exit: middle compartment of jugular foramen.  Type: Mixed contains motor, sensory, parasympathetic and taste fibers.  Descends for a short distance in the carotid sheath. It leaves the sheath and runs forwards in a curved course around the stylopharyngeus muscle to reach the tongue.  Branches: U 1. Communicating branch from the superior cervical sympathetic ganglion. 2. Motor to the stylopharyngeus muscle. 23 DEPARTMENT OF ANATOMY 3. Sensory branches to the pharyngeal plexuses. 4. Tympanic branch (contains parasympathetic fibers to the parotid gland). 5. Lingual branches to the posterior 1/3 of the tongue (general sensation and taste). 37. Write a brief account of the vagus nerve and its branches. Answer: U  Number: 10th or XP P  Foramen of exit: middle compartment of jugular foramen  Type: Mixed.  Descends vertically downward in the carotid sheath; posterior and in-between the internal carotid artery and internal jugular vein, to the thorax.  Branches: U 1. Communicating branch from the superior cervical sympathetic ganglion. 2. Auricular branch. 3. Superior laryngeal nerve which divides into internal and external laryngeal branches. 4. Pharyngeal branch to pharyngeal plexus. 5. Cardiac branches. 6. Recurrent laryngeal nerve. 38. Write a brief account of the hypoglossal nerve and its branches. Answer: U  Number: 12th or XII. P P  Foramen of exit: anterior condylar canal (hypoglossal canal).  Descends for a short distance in the carotid sheath. It leaves the sheath and runs forwards in a curved course on the lateral surface of the hyoglossus muscle to the tongue.  Type: purely motor.  Branches: U 1. Communicating branch from the superior cervical sympathetic ganglion. 2. Communicating branch from the first cervical nerve: a) Desendus hypoglossi (superior limb of ansa cervicalis). b) Nerve to geniohyoid muscle. c) Nerve to thyrohyoid muscle. 24 DEPARTMENT OF ANATOMY 3. Lingual branches to all muscles of the tongue except the palatoglossus m. (cranial accessory). 39. Write a brief account of the cervical plexus and its branches. Answer: U  It is formed of the anterior primary rami of the upper 4 cervical nerves.  It gives off the following branches: 1. Communicating branch from the first cervical to the hypoglossal nerve (distributed through its meningeal, descendus hypoglossi, nerve to geniohyoid and nerve to thyrohyoid muscles). 2. Communicating branch from the 2nd, 3rd and 4th cervical to the spinal accessory nerve P P P P P P (distributed through it to the sternomastoid and trapezius muscles) 3. Cutaneous branches: U U a) Great auricular. b) Lesser occipital. c) Transverse cutaneous nerve of the neck. d) The supraclavicular nerves. 4. Muscular branches: U a) Tto prevertebral muscles, the recti, scalene, levator scapulae. b) The phrenic nerve from C3, C4 and C5 nerves. 25 DEPARTMENT OF ANATOMY 40. Write a brief account of the cervical sympathetic chain. Answer: U  It is the upward direct continuation of the thoracic part of the sympathetic chain.  It consists of three ganglia (superior, middle and inferior) connected with each other by sympathetic fibers  Its preganglionic fibers originates from the thoracic part of the sympathetic system Superior cervical ganglion U  The largest, 2.5 cm, lies opposite the 2nd and 3rd C. vertebra P P P P  Branches: U 1. Communicating branches to 9, 10 and 12 cranial nerves 2. Grey rami communicants to 1, 2, 3 and 4 cervical nerves 3. Internal carotid nerve 4. Laryngopharyngeal branches 5. External carotid branches 6. Superior cervical cardiac branch 26 DEPARTMENT OF ANATOMY Middle cervical ganglion U  Small, lies on the inferior thyroid artery at the level of the cricoid cartilage  Branches: U 1. Grey rami communicants to 5, and 6 cervical nerves 2. Thyroid branches 3. Middle cervical cardiac branch 4. The ansa subclavia Inferior cervical ganglion U 1. Small and lies behined the common carotid and vertebral arteries anterior to the 8th P P cervical ventral ramus 2. Cervicothoracic or stellate ganglion , lies across the neck of the first rib 3. U Branches: 1. Grey rami communicants to 7, and 8 cervical nerves 2. Vertebral branches 3. Inferior cervical cardiac branch 4. The ansa subclavia 41. Name the branches of the external carotid artery. Answer: U A. From the anterior aspect: U 1. Superior thyroid artery. 2. Lingual artery. 3. Facial artery. B. From the back: U 4. Ascending pharyngeal artery. C. From the posterior aspect: U 5. Occipital artery. 6. Posterior auricular artery. D. Terminal branches: U 7. Superficial temporal artery. 8. Maxillary artery. 27 DEPARTMENT OF ANATOMY 42. Write a brief account of the beginning, termination and tributaries of the internal jugular vein. Answer: U  It begins as the direct continuation of the sigmoid sinus by a small dilatation (superior pulp) in the posterior compartment of the jugular foramen.  It descends vertically downwards in the carotid sheath lateral to the internal carotid artery.  It terminates by a small dilatation (inferior pulp) which joins the subclavian vein to form the brachiocephalic trunk.  Tributaries: 1. Inferior petrosal sinus. 2. Pharyngeal veins. 3. Lingual vein. 4. Common facial vein. 5. Superior thyroid vein. 6. Middle thyroid vein. 7. Jugular lymph trunk on the right side. 43. Give the branches of the subclavian artery. Answer: U  From the first part: 1. Vertebral artery. 2. Thyrocervical trunk:  Inferior thyroid artery.  Transverse cervical artery.  Suprascapular artery. 3. Internal thoracic artery.  From the second part: 1. Costocervical trunk:  Highest intercostal artery.  Deep cervical artery.  Third part has no branches. 28 DEPARTMENT OF ANATOMY 44. Give the origin, insertion, nerve supply and action of the scalenus anterior muscle. Answer: U  Origin: from the anterior tubercles of the transverse processes of the 3rd, 4th, 5th and 6th P P P P P P P P cervical vertebrae.  Insertion: to the scalene tubercle and the ridge on the upper surface of the first rib.  Nerve supply: branches from the anterior primary rami of the C4, C5, C6 and C7 nerves.  Action: accessory muscle of respiration as it fixes the first rib in forced inspiration. 45. Give the structure of the pharyngeal wall (layers) and its different parts. Answer: U  Pharyngeal wall: U 3. Mucous membrane. 4. Submucosa. 5. Pharyngeobasilar fascia. 6. Pharyngeal muscles (constrictor muscles). 7. Buccopharyngeal fascia.  Parts: U 1. Nasopharynx 2. Oropharynx 3. Laryngeopharynx 46. Name the muscles and gaps of the pharynx. Answer: U  Pharyngeal muscles: U  3 constrictors: U 1. Superior constrictor 2. middle constrictor 3. Inferior constrictor  3 longitudinal: U 1. stylopharyngeus 2. Salpingopharyngeus 3. Palatopharyngeus 29 DEPARTMENT OF ANATOMY  Gaps and structures passing through it: U 1. Between superior constrictor and base of the skull (tensor and levator palatei muscle and pharyngotympanic tube). 2. Between superior and middle constrictors (stylopharyngeus muscle and glossopharyngeal nerve). 3. Between middle and inferior constrictors (internal laryngeal nerve and superior laryngeal vessels). 47. Give the blood and nerve supply of the pharynx. Answer: U  Arterial supply: “Branches from” U 1. The ascending pharyngeal artery 2. The ascending palatine artery 3. The facial artery 4. The maxillary artery 5. The lingual artery  Venous drainage: the pharyngeal veins drains into the internal jugular vein. U U  Nerve supply (pharyngeal plexus): U  Motor: pharyngeal branches of the vagus “cranial accessory” and glossopharyngeal  Sensory:  Nasopharynx → mainly by the maxillary nerve  Oropharynx → mainly by the glossopharyngeal nerve  Laryngeopharynx → by the internal laryngeal branch of the vagus nerve 48. Write a brief account of the palatine tonsils Answer: U  Relations: o Anteriorly: palatoglossal fold. o Posteriorly: palatopharyngeal fold. o Superiorly: soft palate. o Inferiorly: posterior third of the tongue. o Medial: oropharynx. o Lateral: superior constrictor of the pharynx and the external palatine vein.  Arterial supply: tonsilar branch of the facial artery. 30 DEPARTMENT OF ANATOMY  Lymphatic drainage: → deep cervical (jugulodigastric node.) 49. Write a brief account of the paranasal air sinuses. Answer: U These are cavities in some bones of the skull (pneumatic bones). Its functions are: Decrease the weight of the skull. Provide the optimum temperature and humidity to the inspired air. Give resonance to the voice. Drainage: 1. Frontal air sinuses → infundibulum (middle meatus) 2. Maxilary air sinuses → hiatus semilunaris (middle meatus) 3. Ethmoidal air sinuses: a) anterior → hiatus semilunaris (middle meatus) b) middle → bulla ethmoidalis (middle meatus) c) posterior → superior meatus 4. Sphenoidal air sinuses → sphenoethmoidal recess 50. Give the nerves and vessels of the nasal cavity. Answer: U Nerves U 1. The olfactory nerves in the roof (the olfactory mucosa). 2. Branches from the maxillary nerve to the rest of nasal walls. 3. Nasopalatine nerve (from sphenopalatine ganglion). 4. Nasal branches of the greater palatine nerves. 5. Anterior ethmoidal nerve (branch from the nasociliary branch of the ophthalmic division of the trigeminal nerve). Arteries and veins: U 1. Sphenopalatine artery (branch from the maxillary a.) 2. Nasal branches from the anterior and posterior ethmoidal arteries (ophthalmic a.) 3. Septal branch the superior labial artery (facial a.) 31 DEPARTMENT OF ANATOMY 51. Describe the features of the nasopharynx. Answer: U  It is the upper part of the pharynx which communicates freely with the nasal cavities anteriorly through the posterior nasal apertures.  Laterally there are : 1. The pharyngotympanic tube. 2. The tubal elevation. 3. The salpigopharyngeal fold that contains the salpigopharyngeus muscle. 4. The pharyngeal recess above the tubal elevation.  The roof is occupied by the pharyngeal tonsil.  The floor is formed by the soft palate  Posteriorly there are the basisphenoid and basioccipital bones. 32 DEPARTMENT OF ANATOMY 52. Name the muscles of the soft palate and give their action and nerve supply. Answer: U Muscle Nerve supply Action 1. Tensor palati Mandibular nerve Tens the soft palate Cranial accessory 2. Levator palati through the pharyngeal Elevate the soft palate plexus of nerves Cranial accessory Elevate the pharynx during 3. Palatopharyngeus through the pharyngeal swallowing plexus of nerves Pull the tongue upwards and Cranial accessory 4. Palatoglossus backwards through the pharyngeal Or pull the soft palate downwards and plexus of nerves forwards Cranial accessory 5. Musculus uvulae through the pharyngeal Pull the uvula upwards plexus of nerves 33 DEPARTMENT OF ANATOMY ABOUT THIS DOCUMENT Prepared by the Staff members of the Department of Anatomy For the students of Anatomy-2 “SGS -244” It provides the students with: Short Essay Questions and their model answers 34