Anatomy- Exam 4 Clinical Flashcards (Week 8 & 9) Harder Set

Front 1

A patient with a history of atherosclerosis is having difficulty moving the eye. The eye is observed and it is facing down and out. Where is the aneurysm?

Back 1

Either the Superior cerebellar or Posterior inferior cerebral arteries compressing occulomotor nerve

Front 2

A patient presents with a partial ptosis. Stenosis should be suspected of what opening into the skull?

Back 2

Carotid Canal. sympathetics to the eye travel with the internal carotid artery

Front 3

A patient with a pterion fracture presents with blurry vision . What structure is being compressed?

Back 3

Edinger Westfall nucleus is compresses by epidural hematoma due to uncal herniation through transtentorial notch

Front 4

A patient has a calcium deficiency and has no few otoliths. She often has loss of balance. How will her hearing be affected?

Back 4

It will still be fine, there are no otoliths or Kinocilia in the cochlear part of the inner ear.

Front 5

Aa child complains of an ear ache. It is determined to be otitis media. You place a tube to drain the inner ear and after the procedure, the patient can no longer taste. What went wrong during the procedure?

Back 5

The chorda tympani was injured as it passes through the inner ear.

Front 6

The greater palatine nerve is a branch off of V2 passing the greater palatine foramen into the palate. What parasympathetic ganglion does it likely pass through?

Back 6

pterygopalatine is associated with V2 (DOES NOT synapse though, just passes through)

Front 7

A patient's vermillion zone of the lips has a very dull appearance. What arteries could be blocked to cause just the lower lip to become ischemic?

Back 7

facial, but it would cause both upper and lower to block. mental artery is the difference between upper and lower. mental goes to lower lip.

Front 8

A patient has lost sensory innervation of their upper lip. What parasympathetic ganglion, though not involved with this sensation, could potentially be damaged?

Back 8

V2 is damaged; pterygopalatine ganglion is closely associated with the V2 nerve

Front 9

A patient is having severe pain while chewing. With each chew, there is severe shock to the tooth. Which tooth layer may be worn down?

Back 9

periodontal ligament absorbs shock during chewing

Front 10

A patient has been diagnosed with scurvy. Why might they still have perfect enamel around their tooth?

Back 10

enamel contains no collagen

Front 11

A patient has damage to some of their tongue papillae, but have no loss of taste. Which papillae are damaged?

Back 11

filliform have no taste buds

Front 12

A patient is having trouble with taste near his sulcus terminalis. What papillae are likely involved?

Back 12

circumvallate

Front 13

A patient is poked by a sharp stem while eating fruit. What nerve will sense this pain form the anterior 2/3 of the tongue?

Back 13

trigeminal V3

Front 14

A patient's tongue is examined and their right posterior tongue is slightly higher than their left. What nerve is likely damaged?

Back 14

left vagus is not innervating the left palatoglossus to lift the tongue

Front 15

The palatoglossus muscle originates from the soft palate. Why would we expect the uvula to be innervated by the vagus nerve based on this data?

Back 15

Uvula is derived from the soft palate

Front 16

A patient has lost the ability to produce saliva in the parotid gland. An aneurysm of what vessel can compress a major post-ganglionic nerve in this pathway?

Back 16

Middle meningeal artery; auricotemporal branch of V3 carries post-ganglionic fibers to parotid gland and forks around the middle meningeal artery

Front 17

A patient has lost the ability to secrete from the submandibular duct due to a blockage. What sensory deficits will we see in a patient?

Back 17

Swelling of the duct leads to compression of the lingual nerve that wraps around it. Lingual nerve gives mental nerve for v3 dermatome.

Front 18

If all aspects of the hard palate were burned from a burn victim patient, could we still examine the uvula for vagus nerve damage?

Back 18

no, uvula is hanging on hard palate (derived from soft though)

Front 19

A patient cannot swallow. Their uvula is not deviated. What nerve is likely damaged?

Back 19

V3 (tensor veli palatini and mylohyoid must initiate swallowing)

Front 20

A patient has a tumor of their parotid gland. What group of muscle will be likely be dennervated?

Back 20

terminal facial motor muscles; facial nerve passes through parotid gland

Front 21

In an H/E slide you are examining a salivary gland notice many clear cells in stain. Which gland can this not be?

Back 21

parotid only has serous (blue). mucous cells are clear

Front 22

A patient has the mumps. Why might we expect facial paralysis?

Back 22

mumps = parotid gland swelling. facial nerve is dennervated as it passes through the swollen parotid gland

Front 23

While examining a H/E slide of parotid gland, what accounts for the visible cells' distinct borders?

Back 23

serous cells have many lateral membrane infoldings for electrolyte and water transport (to create serous secretions)

Front 24

A patient has damage to the facial nerve. What % of saliva production do we expect to see in this patient?

Back 24

Only about 25% of saliva will be produce by the parotid gland. The others are dennervated by the facial nerve damage = no submandibular gland innervation.

Front 25

While examining an H/E slide of tonsil, you notice that there are no crypts. What tonsils are you examining?

Back 25

pharyngeal tonsils have no crypts, but do have pleats

Front 26

A patient has a swelling of the cavernous sinus on an X-ray. Bloodwork shows no infection. What is another explanation for the swelling?

Back 26

aneurysm of internal carotid artery passing through the sinus

Front 27

A patient has a tumor compressing their interpeduncular fossa. We will see deficits in what nerves?

Back 27

occulomotor and corticospinal tract both pass through interpeduncular fossa

Front 28

A patient is suffering a very fatal herniation of the brain. The respiratory centers of the pons are being directly compressed. What is the diagnosis?

Back 28

Tonsilar herniation

Front 29

A patient is stabbed in the masseter muscle. What salivatory duct is most likely to be damaged?

Back 29

parotid duct passes laterally to the masseter muscle

Front 30

After a TMJ repositioning, a patient is unable to secrete saliva from the parotid gland. What nerve was damaged?

Back 30

auriculotemporal

Front 31

A patient has a tumor growing in their infratemporal fossa. What branches of V3 would be dennervated?

Back 31

All branches of V3 originate in infratemporal fossa

Front 32

A patient has a tumor growing in their infratemporal fossa. What arteries are most likely to be damaged?

Back 32

Maxillary, middle meningeal with auriculotemporal wrapped around it

Front 33

During oral surgery of the posterior molars, what nerve is most likely to be damaged?

Back 33

lingual nerve

Front 34

After oral surgery on the posterior molars, a parasympathetic ganglionis damaged. What symptoms are we likely going to see in this patient?

Back 34

no submandibular gland innervation. submandibular gland is near the posterior molars

Front 35

A patient has the mumps. What artery is like to become compressed?

Back 35

Mumps = parotid swelling. maxillary arises within the parotid

Front 36

A patient suffers a lesion in the parasympathetic pathway to the lacrimal gland. The lesion occurs right after the greater petrossal (with deeper petrossal) exits the foramen lacerum. What fossa did this lesion occur in?

Back 36

Pterygpalatine fossa

Front 37

The pterygopalatine fossa contains the pterygopalatine ganglion. What cranial nerve is also likely found in the fossa?

Back 37

V2 is associated with the pterygopalatine ganglion

Front 38

A tumor is growing inside a patients pterygopalatine fossa. Autonomic innervation to what structure will be most hindered?

Back 38

lacrimal glands receive innervation from pterygopalatine ganglion in the fossa (nerve to vidian canal also in there)

Front 39

A patient has a tumor in their infratemporal fossa. Autonomic innervation will be lost to what structure?

Back 39

Parotid gland. infratemporal fossa contains otic ganglion and lesser petrosal

Front 40

A tumor is growing inside a patients pterygopalatine fossa. Autonomic innervation to what structure will be most hindered?

Back 40

lacrimal glands receive innervation from pterygopalatine ganglion in the fossa (nerve to vidian canal also in there)

Front 41

A patient has a tumor in their infratemporal fossa. Autonomic innervation will be lost to what structure?

Back 41

Parotid gland. infratemporal fossa contains otic ganglion and lesser petrosal

Front 42

A patient has stenosis of the foramen rotundum. What bone has been altered by this stenosis?

Back 42

Sphenoid bone

Front 43

A patient has fluid perilymph coming out of their mouth. What parasympathetic pathway in the patient is damaged?

Back 43

oval window damage allows perilymph to leak out of inner ear. tympanic plexus to otic ganglion sits on the oval window and is also likely disrupted. parotid gland will receive no parasympathetics

Front 44

A patient has otitis media. You place a tube and sever the chorda tympani. What salivary glands are no longer receiving parasympathetics?

Back 44

submandibular and sublingual glands

Front 45

A patient has no innervation to their lacrimal gland. A lesion is localized to the greater petrossal nerve. Which 2 fossa should we examine to find the lesion?

Back 45

middle cranial fossa and pterygopalatine fossa. greater petrossal goes through foramen lacerum which connects the 2 fossa

Front 46

A patient has loss of 25% of saliva production. When examining an H/E slide of the affected tissue, do we expect to see any clear cells?

Back 46

No, parotid gland only contains serous cells (basophilic). no mucous cells (clear)

Front 47

A patient has lost their corneal reflex. They still have sensation on all aspects of their face. What parasympathetic post-synaptic ganglia could also be affected by the potential damage?

Back 47

the facial nerve is damaged (blink reflex efferents) since the trigeminal is fine (blink reflex afferents). pterygopalatine ans submandibular receive preganglionics via the facial nerve branches.

Front 48

A patient has lost their corneal reflex. They still have sensation on all aspects of their face. The facial nerve is damaged. What is the diagnosis?

Back 48

Facial nerve palsy (not Bell''s palsy if we know the facial nerve is lacerated)

Front 49

A patient suffers from a displaced incus bone in the middle ear. What nerve will be most affected by this? What parasympathetic ganglion will be most affected by this?

Back 49

chorda tympani; carries preganglionics to the submandibular ganglion

Front 50

A patient with hyperacusis suffers a tear of their oval window. What salivary gland will likely be no longer receiving parasympathetic innervation?

Back 50

parotid. tympanic nerve (from hypoglossal inferior salivatory nucleus) goes to tympanic plexus on oval window. lesser petrosal form plexus goes to otic ganglion (through ovale). auriculotemporal (V3) carries parasympathetic postganglionic neurons to the parotid

Front 51

A patient has a damaged facial nerve right before the internal acoustic meatus. Even though facial nerve fibers do not innervate the parotid gland, why could parotid gland innervation be impaired?

Back 51

Facial nerve gives off the nerve to stapedius which stabilizes the stapes. If the stapes is not stabilized, it can damage the oval window which has the tympanic plexus on it. Tympanic plexus damage = otic dennervation = parotid dennervation

Front 52

A patient has damage to their t1 white communicating rami. Are any structures passing the foramen lacerum affected?

Back 52

T1 white rami = sympathetics. Deep petrossal has sympathetics . deep petrossal joins greater petrossal to form nerve of pterygoid canal passing through foramen lacerum

Front 53

A patient suffers damage to the right upper motor neurons supplying facial motor nerves. What parts of their face will be paralyzed?

Back 53

Just contralateral (left) lower face. forehead will receive secondary innervation, and

Front 54

A patient suffers damage to the left lower motor neurons supplying facial motor nerves. What parts of their face will be paralyzed?

Back 54

Just ipsilateral (left) lower face. damage to lower motor (after the nerves cross) is ipsilateral.

Front 55

Damage to the origin of the vagus nerve is suspected to be damaged during development. What part of the developing brain is damaged?

Back 55

Myelencephalon = medulla = origin of the vagus nerve

Front 56

A patient is having difficulty hearing due to a decreased amount of endolymph. What unique cells may be damaged?

Back 56

Stria vascularis epithelium (in scala media) makes endolymph

Front 57

A patient is unable to process sensory innervation from the parotid gland. What ganglion will is likely damaged if we are not receiving this sensation?

Back 57

Trigeminal ganglion; auriculotemporal nerve carries afferent fibers to CN V ganglion

Front 58

A patient suffers from hydrocephalus. A blockage is likely occuring in a structure derived from what part of the developing brain?

Back 58

Aqueduct of Sylvius is derived from mesencephalon

Front 59

A patient is stabbed in the side of the cheek. The masseter muscle is damaged and the patient suffers from dry mouth. What structure is damaged? saliva is not

Back 59

parotid duct passes masseter

Front 60

A patient is having trouble dilating and constricting his pupil. Damage is localized to the ciliary ganglion. Even though this is a parasympathetic ganglion, why are the dilator pupilae myoepithelium dennervated?

Back 60

sympathetics are passing through the ciliary ganglion. they are not synapsing though

Front 61

A patient has been seen to have poor ethmoid bone structure. Which cranial nerve will be most likely hindered by this deformation?

Back 61

olfactory passes through the cribiform plate (part of the ethmoid bone)

Front 62

A patient is diagnosed with a partial ptosis. What muscle is damaged or dennervated?

Back 62

Mueller's muscle, the small autonomic portion of the levator palpebrae (smooth muscle).