Anatomy, 3Rd Block

Front 1

Avascular necrosis of the femoral head is caused by cutting what nerve?

Back 1

medial circumflex femoral

Front 2

what are the two front and back sutures we should know? what's the one that connects 4 bones?

Back 2

the lambdoid (back) and bergma (front)

the pterion

Front 3

what are the layers of the scalp?

Back 3

5 layers!
S.C.A.L.P
Skin

Connective tissue (where the VAN lives)

Aponerosis (encloses frontalis)

Loose aerolar tissue (danger area - infection through emissary veins to the dural sinuses)

Pericranium (wraps around each individual bone)

Front 4

what kind of fascia does the face have?

Back 4

no deep fascia - that's why bruises spread so easily

Front 5

What are the 3 branches of the trigeminal nerve, what hole do they exit, and what do they have to do with embryology?

Back 5

Sensory to face: (standing room only)
V1 = opthalmic nerve, through superior orbital fissure, from fronto-nasal process

V2 = maxillary nerve, through foramen rotundum, from 1st maxilary process of pharyngeal arch

V3 = mandibular nerve - through foramen ovale, also motor root for mastication muscles. from mandibular part of 1st pharyngeal arch

Front 6

Trigeminal nerve divisions - where is pain referred?

Back 6

V1 - frontal sinus pain referred to orbit.

V2 - maxillary sinus pain referred to upper molars

Front 7

What arteries feed the face, and where do they come from?

Back 7

Most from external carotid:
facial, superfiical temporal, posterior aricular, occipital, transverse facial.

EXCEPTION: supraorbital and supratroclear, via opthalmic artery (internal) = anastamoses

Front 8

what's the danger zone of the face, and why?

Back 8

around the nose - bacteria can drain through the facial vein to the cavernous sinus

Front 9

muscles of facial expression - what nerve innervates, and what embryologic structure are they derived from?

Back 9

all from CN7 = Facial Nerve. Think buccinator, occipito frontalis, orbicularis occuli/oris. All from 2nd pharyngeal arch.

Front 10

Parotoid gland and cancer - what nerve should i think of?

Back 10

3rd branch of the facial nerve goes over it and is often affected.

Front 11

What are the branches of the external corotid?

Back 11

Some Angry Lady Figured Out PMS:

Superior thyroid
ascending pharyngeal
lingual
facial
occipital
posterior auricular
maxillary
(transverse facial?)
superficial temporal

Front 12

what are the branches of the facial nerve?

Back 12

to zanzibar by motor car, or ten zebras bit my cock.

temporal, zygomatic, bucchal, marginal mandibular, cervical

Front 13

what cranial nerves are motor, mixed, or both?

Back 13

some say marry money, but my brother says big boobs matter more

Front 14

what are the muscles of mastication?

Back 14

MTPP (empty pee pee)

masseter, temporal, pterygoids (lat/med)

Front 15

what nerve innervate the occular muscles?

Back 15

LR6 SO4 R3

Lateral rectus = 6 (abducens)
Superior oblique = 4 (troclear)
Rest = 3 (occular motor)

Front 16

Cranial nerves - tell me about GSE:

Back 16

General Sensory Efferent - SOMITE DERIVED muscle groups, cell bodies in brain stem. 3, 4, 6, 11, 12 (ALL MOTOR ONLY)

Front 17

Tell me about SVE cranial nerves:

Back 17

Functionally the same as GSE, but derived from brachial arches (not somites!) = 5, 7, 9, 10, 11 (all MIXED!)

Front 18

Tell me about GVE cranial nerves

Back 18

Sympathetics - we already know they're 3, 7, 9 and 10. Like to hitch rides on vessels.

Front 19

Tell me about GSA cranial nerves

Back 19

Pain, pressure. 5, 7, 9, 10 (all only mixed!). Normal sensory stuff.

Front 20

Tell me about GVA cranial nerves

Back 20

burning, thirst, hunger, stretch. 9/10

Front 21

Tell me about SSA nerves:

Back 21

vision/hearing and balance - 2 and 8 (vision and hearing, respectively)

Front 22

Tell me about SVA nerves

Back 22

Taste/smell - 1, 7, 9, 10

Front 23

CN1 - what kind of nerve bodies are present on the cribiform plate? What kind of cell bodies transmit the information? What's unique about CN1?

What kind of injury can happen here?

Back 23

Unique because it leaves the CNS.

Bipolar neuron and mitral cells.

The subarachnoid space extends through here - so severe nose injuries can cause the leakage of CSF.

Front 24

CN2 - what's a requirement for binocular vision? What is the nerve called before this are? What is it called after?

Back 24

Decussation at the optic chiasm.

Optic nerve between eyball and middle, then it becomes the optic tract as it goes to the genticulate bodies

Front 25

Lesions of the optic pathway - what happens if 1 optic nerve is damaged?

Back 25

Total blindness in one eye on the same side,

Front 26

What CN2 lesion is typical in strokes?

Back 26

at the chiasm - this results in LOSS OF PERIPHERAL VISION

Front 27

What happens in a CN2 lesion on the optic tract?

Back 27

Loose half-vision in each eye, opposite to injury - meaning if right optic tract damaged, loose left lateral and right medial.

Front 28

What is seen in people with ocularmotor (CN3) nerve palsy?

Back 28

droopy eyelid (ptosis due to levator palpebrae),

DOWN AND OUT gaze (unopposed action of LR/SO)

Dilated pupil (parasympathetics traveling with CN3)

double vision, prominence of the globe, sensitivity to light.

Front 29

CN4 - troclear nerve - what muscle does it control? What are symptoms of injury?

Back 29

Happens after severe head injuries -

problems going down stairs, tilted head.Enters superior orbital fissure.

Front 30

CN6 injury - what's up?

Back 30

One eye is crosseyed - problem with aneurysm in the circle of willis, pressure on cavernous sinus, fracture of cranial base.

Front 31

What are the 3 divisions of CN5 (trigeminal nerve?) What kind of information do they convey?

Back 31

Opthalmic (Sensory)

Maxillary (sensory)

Mandibular (mixed) - only one to innervate skeletal muscles. Muscles of mastication.

Front 32

What are the 3 divisions of V3?

Back 32

Anterior - goes to pterygoid, masseter, and temporalis

Lingual (GSA to anterior 2/3 of tongue for pain, temperature, touch)

Inferior Alveolar (to the teeth!)

Front 33

Trigeminal nerve - Where do all the GSA cell bodies live?

Back 33

The semilunar or trigeminal ganglion

Front 34

What muscles are innvervated by the trigeminal nerve?

Back 34

MD my TV:

Mastication muscles (masseter, temporal, pterigoids)

Digastric (ant. belly)

Myohyoid

Tympani tensor

Veli palatini

Front 35

What is trigeminal neuralgia?


What other disease should we think of?

Back 35

Caused by compression at the root, can be messed with by elongated superior cerebellar artery or elongated anterior inferior cerebellar artery.

Get electroc shock like stabs, usually in v2

HERPES ZOSTER

Front 36

CN 7 - Facial Nerve: How many roots?

Back 36

2 - a large root with all the SVE fibers for muscles of facial expression

small root (nervus intermedius) with TASTE SVA fibers going to the ANT 2/3 of the tongue)

Front 37

What are the sensory branches of the facial nerve?

Back 37

To Zanzibar by Motor Car.

Temporal
Zygomatic
Bucchal
Marginal Mandibular
Cervical

Front 38

Facial and Taste - what should i be thinking of?

Back 38

Chorda Tympani 3rd branch of facial nerve. Anterior 2/3 of the tongue for taste, SVA

Front 39

What is the stapedius?

Back 39

A muscle controlled by the 2nd division of the facial nerve, the nerve to the stapidius. contracts to keep sound from being too loud - if not working, every sound is too loud.

Front 40

3 kinds of facial nerve lesions.

1. before geniculat ganglion
2. just after
3. around stylomastoid foramen

Back 40

1. Complete same side facial paralysis with loss of lacrimation/salivation/taste from 2/3 ant tongue.

2. just like above, but with taste

3. bell's palsy - taste/lacrimation work, but all same side facial expression muscles affected

Front 41

CN-8 - Vestibulochocolear - What kind of nerve fiber is it? What branches make it up?

Back 41

SSA.

Front 42

What cranial nerves control the tongue, what information do they carry, and to which part?

Back 42

Anterior 2/3:
pain/temp/touch = CN5 (trigeminal)
taste = CN7 (facial)

Posterior 1/3:
pain/temp/touch/taste = CN9

Front 43

What cranial nerves pass through the jugular foramen?

Back 43

9, 10, 11.

Front 44

What's one way to test the functionality of the glossopharyngeal nerve (9?)

Back 44

Gag reflex.

Front 45

Tell me about the tongue - what nerves do pain/temperature/touch/taste on which part?

Back 45

Anterior 2/3:
Pain/Temp/Touch by CN5 (trigeminal)
Taste by CN7 (facial)

Posterior 1/3:
Pain/Temperature/Touch/Taste by CN9 (glossopharyngeal)

Front 46

Tell me about the vagus nerve (cn10). Where does it exit? What are its branches?

Back 46

Exits the jugular foramen.

Branch to the pharyngeal plexus

Superior laryngeal nerve (which has two branches - the internal and external...internal is sensory to upper half of larynx, external is motor)

Recurrent laryngeal - sensory.motor to lower half of larynx.

Front 47

What are some problems of lesions to CNX?

Back 47

Hoarsness due to recurrent laryngeal nerve issues

Aphonia if both nerves messed up by cancer

Dysphagia

if the palate doesn't elevate when says "aha", problems. Loss of gag reflex.

Front 48

What are the roots of the spinal accessory nerve (CN11)? Where do they come from and where do they go?

Back 48

Spinal root comes from c1-c6, ascends through foramen magnum. joins cranial root from medulla, both exit jugular foramen.

Cranial root continues with the Vagus nerve.

Front 49

Spinal accessory nerve (11) - What do lesions present as, and how might they happen?

Back 49

Spinal part is sucbutaneous to the posterior cervical triangle - can be injured by nodal biopsies. Have trouble lifting head/drooped shoulder

Front 50

Hypoglossal Nerve (CN12): What does it innervate? What muscle does it pass deep to? What problems can arise, and how are they tested?

Back 50

Deep to mylohyoid.

Supplies extrinsic muscles of tongue (genioglossus, hyoglossus, styloglossus) and intrinsic muscles

EXCEPT - palatoglossus (vagus)

Problems show up as difficulty in articulation of words. Testing - stick out tongue, it deviates to the side of damage.

Front 51

What muscles insert on the hyoid bone?

Back 51

UP pulling
Mylohyoid (floor of mouth)
Geniohyoid (run front to back on top of mylohyoid)

Up/back pulling:
Stylohyoid (long, slender)
Digastric (from behind styloid, passes through styloid, to front of chin). Post/ant belly.

Down:
Omohyoid (most lateral, to scapula
Sternohyoid (straight down, to sternum)
Thyrohyoid (short, backside, to thyroid cartilege)

Front 52

Legs:

What's that tendon on the leg that's an insertion for 3 muscles? what muscles?

Back 52

Pes Anserinus:

Common insertion of:
gracilis, sartorious, semitentinosus.

Front 53

Tell me about the superior and inferior gluteal nerves. Where do they come out of? What spinal segments do they represent?

Back 53

Both from Sacral Plexus.

Superior Gluteal: comes out above piraformis, in the greater siatic foramen. Made of L4, 5, S1

Inferior Gluteal: comes out below piraformis, in the greater siatic foramen. Made of L5, S1, S2

Front 54

What nerve innervates the hamstrings?

Back 54

Hamstrings are controlled by the siatic nerve, via the tibial nerve.

Exception: short head of biceps femoris is controlled by the common perioneal branch of the siatic.

Front 55

damage to the deep perioneal nerve causes what typical symptom?

Back 55

foot drop! no dorsiflexion.

Front 56

damage to the tibial nerve results in what typical symptom?

Back 56

shuffling - loss of plantar flexion, difficulty getting the heel off the ground.

Front 57

Leg dermatomes: what's important?

Back 57

t12 - ends at inguinal ligament.
below inguinal ligament: L1

L4: knee, medial foot, ankle.
L5: medial foot.
S2: posterior/medial thigh

Front 58

Where does the lymph of the urethra, external genitalia (not testes) and lower half of anal canal drain?

Back 58

superficial inguinal lymph nodes!

Front 59

What are the structures below the medial mallelous?

Back 59

Going medial to lateral:
Tom Dick Van Harry:

Tibialis posterior tendon
Flexor Digitorum Longus
Vein/Artery: Posterior Tibial
Flexor Hallicus Longus

Front 60

Foot! On the dorsal side, what artery feeds it? what does it break into? What nerve?

Back 60

Dorsal Side: Anterior Tibial Artery becomes the DORSALIS PEDIS, get lateral and medial tarsal branmches

The Deep Peroneal Nerve becomes the "medial branch of the deep peroneal"

Front 61

Foot! Plantar side - what main artery and nerve feed it?

Back 61

Artery: The posterior tibial artery becomes the MEDIAL/LATERAL Plantar Artery!

Nerve: The tibial nerve becomes the MEDIAL/LATERAL plantar nerve

Front 62

What's a positive trendelenburg sign?

Back 62

Due to lesion of the superior gluteal nerve:
if pt. lifts left leg, pelvis slopes to left (right side higher). this is a right superior gluteal nerve injury.

also, they waddle. little abduction of the affected leg.

Front 63

Describe the lymph drainage of the superfiical and deep gluteal region:

Back 63

superficial - exits to superficial inguinal to external iliac

deep - exits to superior/inferior gluteal nodes to the int/ext/common iliac to lateral aortic lumbar

Front 64

Inversion/Eversion of the foot - what's the motion?

Back 64

Think of the sole of the foot - inversion points the sole inwards (big toe up), eversion points the sole laterally (big toe down).

Front 65

What muscles/nerves control eversion of the foot?

Back 65

the deep peroneal and tibial nerves - tibialis anterior, tibialis anterior, extensor hallcuis longus.

Front 66

Where should butt injections be given?

Back 66

Upper lateral quadrant to avoid hurting the siatic nerve.

Front 67

What can the gluteus medius/minimus do differently from the piriformis, opturator internus, quadratus femoris?

Back 67

they all abduct - but the gluteus minimus/medius medially rotate. the rest laterally rotate.

Front 68

What nerve(s) innervate the adductor magnus? What about the short/long heads of biceps femoris?

Back 68

Adductor magnus: top portion by the obturator, distal portion by the tibial branch of the siatic.

Short head: by the common peroneal branch of the siatic
Long head: by the tibial portion of the siatic.

Front 69

how do rectus femoris and sartorious differ in their action?

Back 69

rectus femoris can flex the thigh and extend the leg.

sartorious can flex the thigh and flex the leg

Front 70

what structures are in the adductor canal?

Back 70

femoral artery and vein, and the saphenous nerve

Front 71

Foot nerves - what's up? what muscles do they innervate?

Back 71

Tibial Nerve splits into the medial and lateral plantar nerves.

Medial plantar nerve: cutaneous of 3/5 toes and muscles: abductor halucis, flexor halucis brevis, flexor digitorum brevis, and 1 lumbrical.

lateral plantar n: 1.5 toes and muscles: all 14 remaining muscles

Front 72

plantar arteries: what are they? what important branch do they give off?

Back 72

plantar arteries = posterior tibial A branches into the medial/lateral plantar arteries.

the lateral makes the deep plantar arch

Front 73

Feet: At what ligaments do inversion and eversion take place?

Back 73

Subtalar and transverse tarsal ligaments, respectively?