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322 Cards in this Set
- Front
- Back
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what is the significance of the deltopectoral triangle?
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important landmark for brachial plexus block
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what is the anterior body border of the axillary fossa?
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clavical
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whats the medial bony border of the axillary fossa?
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1st rib
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what are the contents of the axilla?
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axillary artery
axillary vein cords of brachial plexus |
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the lymphoid tissue in axilla recieves and filters lymph from where?
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Upper extremity
thorax and abdomen |
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what are the 3 lymph nodes in the axilla?
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subscapular
clavicular brachial |
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when axillary artery is bleeding profusely you can?
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compress it against the humerus or the 1st rib
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what joints does the clavicle form?
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sternoclavicular
acromioclavicular |
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what ligament attaches the corocoid process and the acromion proces?
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coracoacromial ligament
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what do the acromion and corocoid form?
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coracoacromial ligament forms the coracoacromial arch
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what two groups of muscles move the pectoral girdle?
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anterior axioappendicular
posterior axioappendicular |
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what four muscle make up the axioappendicular group?
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pec major
pec minor subclavius serratus anterior |
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what are the actions and innervation of serratus anterior?
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protract scapula, adduct scapula, rotate inferiomedially, hold it against the thoracic wall
Long thoracic C5,6,7 |
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how do you test head of pec?
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clavicular head: abduct the arm to 90 degrees and bring arm anteriorly against resistance and clavicular head is observable and palapable
sternocostal head: raise to 60 degrees and adduct arm against resistance |
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injury to the long thoracic nerve that paralyzes serratus anterior muscle causes?
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winged scapula
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what are the muscles of the superficial group of the posterior axioappendicular group?
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Trapezius
Latissimus dorsi |
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what are teh muscles of the intermediate group of posterior axioappendicular group?
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Levator scapulae
rhomboids |
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what are the muscles of the rotator cuff and what innervates them?
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supraspinatous and infraspinatous innervated by suprascapular nerve
Teres minor innervated by axillary nerve subscapularis innervated by upper and lower subscapular |
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if dorsal scapular nerve is injured on the left what muscles will be effected and how will it affect the scapula?
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rhomboids and levator scapulae on the left
scapula will be lower |
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what innervate deltoid?
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axillary nerve
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what rotator cuff muscle is commonly injured and what action is most affected?
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Supraspinatous
Abduction |
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what is painful arch syndrome?
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when you have pain between 50 to 130 degrees because of subacromial bursitis because it is pinched between the supraspinatus and coracoacromial ligament
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what type of joint is the glenohumeral joint?
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ball and socket
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what type of joint is the SC joint?
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saddle joint
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what type of joint is the AC joint?
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planar
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what are the two apertures of the glenohumeral joint?
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opening for biceps tendon between tubercles below the coracoid process
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what is the function of the 3 bands of the glenohumeral ligament?
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strengthens the anterior aspect of capsule
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what is strange about the 3 bands of the glenohumeral ligament?
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no tensile strength along the long axis
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what do the coracohumeral ligaments do?
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prevent superior dislocation
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what joint dislocates more than any joint in the body?
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glenohumeral joint
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what muscles are involved in elevation of the scapula?
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levator scapulae
rhomboids trapezius |
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what muscles are involved in depression of the scapula?
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latissimus dorsi
trapezius serratus anterior pec major and minor |
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what muscles are involved in protraction fo the scapula?
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serratus anterior
pec major and minor |
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what muscles are involved in retraction of the scapula?
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rhomboids
trapezius latissimus dorsi |
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what muscles are involved in upward rotation of the scapula?
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trapezius
serratus anterior |
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what muscles are involved in downward rotation of the scapula?
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latissimus dorsi
rhomboids pec major and minor levator scapula |
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which is true about the pectoral fascia?
1. Becomes costacoracoid membrane 2. forms floor of the axilla 3. forms suspensory ligament 4. is the deep fascia investing the pec muscles |
is the deep fascia investing the pec muscles
forms the floor of the axilla |
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describe the clavipectoral fascia.
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forms costacoracoid membrane which is pierced by the pec nerve and suspensory ligament
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what type of fascia encloses the arm like a shirtsleeve
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Brachial
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what type of fascia runs deep to both extensor and flexor retinaculum?
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deep fascia
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what fascia separates into two compartments, flexor and extensor?
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brachial and antebrachial fascia
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what type of fascia becomes fibrous tendon sheath of each digit?
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deep fascia
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what fascia becomes extensor and flexor retinaculum?
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antebrachial fascia
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what occurs in the middle part of the posterior portion of the humerus?
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radial groove
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what separates greater and lesser tubercles from the head?
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anatomical neck
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what includes both tubercles of the humerus?
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head
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what is the anterior surface is covered by?
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biceps, brachialis, and coracobrachialis
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what is the posterior surface covered by?
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triceps and aconeus
shaft |
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what is formed by the groove circumscribing the head?
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anatomical neck
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The medial epicondyle:
a. is the site of radial collateral ligament b. is the site of the ulnar collateral ligament c. origin of common extensor tendons d. origin of common flexor tendons |
is the site of ulnar collateral ligament
origin of the common flexor tendons |
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the Capitulum is on the:
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lateral side
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Coronoid fossa is on the:
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medial side
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trochlea is on the?
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medial side
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olecranon fossa is on the:
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medial side
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most common fracture of humerus:
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surgical neck fracture
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surgical neck fractures:
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are extracapsular
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a direct blow to the arm may cause
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a transverse fracture
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a patient presents to your office with avulsion of the greater tubercle. Do you expect the radiographs to show an anterior or posterior dislocation?
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Anterior
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what action can cause an avulsion?
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Fall on point of shoulder
Acromion Fall on outstretched arm |
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what nerve and artery should be considered in humeral shaft fractures?
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Radial nerve
Profunda brachii artery |
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A patient presents having just fallen on the point of his flexed elbow. Radiographs show the olecranon driven like a wedge into the condyle. At what location do you expect a fracture?
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Distal humerus, intercondylar fracture
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describe a biceps tendonitis
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involves long head of biceps
inflammation, irritation, crepitus Caused by microtrauma from overuse |
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describe long head of biceps tendon dislocation
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involves long head of biceps
sensation of catching or popping when arm is rotated Forceful flexion of arm against excessive resistance |
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Name the anterior compartment arteries of the arm
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Brachial
Profunda brachii Ulnar collateral superior & inferior |
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Name veins of anterior compartment
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Cephalic
Basilic Vena comites |
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Describe most common variation of brachial artery?
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splits high
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describe the other variation of brachial artery.
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splits high and then comes back together and splits again
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what is the best place to compress the brachial artery
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distal to profunda brachii artery because its branches anastomose with the brachial artery in the elbow
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why do you not compress the brachial artery proximal to the profunda brachii artery?
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because it will produce ischemia of the arm
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what is the joint between the 2 rows of carpal bones?
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midcarpal joints
extension occurs here |
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what are the classes of bones in the wrist and hand?
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carpal and metacarpal
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what tendon does the pisiform develop in?
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Flexor carpi radialis
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what other tendons develop sesamoid bones in the hand?
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develop at the head of the 1st metacarpal
Flexor pollicus brevis (radial side) Adductor pollicus (ulnar side) |
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at what joint does pronation and supination occur?
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radioulnar
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what is the main joint of extension of the wrist?
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midcarpal joint
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what joint allows for cupping of the hand?
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intermetacarpal joint
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functionally the hand is an extension of what bone of the forearm?
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radius
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with malunion after Colle's fracture, what tendon is at risk?
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extensor pollicus longus
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what tendons of the 6 tunnels of extensor retinaculum house?
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extensor tendons of:
extensor digitorum extensor digiti minimi extensor indices |
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what kind of symptoms can arise with ganglion cysts in flexor sheath?
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can be painful
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Carpal tunnel syndrome arises from entrapment of what nerve?
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Median nerve
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what structure limits abduction of the wrist?
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styloid process of the radius
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what produces abduction of the wrist?
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flexor carpi radialis
extensor carpi radialis |
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what flexor muscle breaks the rule that muscles that cross more joints are superficial?
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flexor digitorum profundi
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what muscles would ou expect to be innervated by ulnar nerve and are innervated by median nerve?
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Thenar emminance
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what are the contents of the anatomical snuffbox?
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radial artery
superficial branches of radial nerve |
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what two tendons compose the anatomical snuffbox?
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extensor pollicus longus
abductor pollicus longus |
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At what joints do flexion and extension of the thumb occur?
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Carpometacarpal
Metacarpophalangeal Single interphalangeal joint |
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What movements do that of the dorsal and plantar interossei allow for?
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dorsal: ABDuction
plantar: ADduction |
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Where do interossei originate and insert?
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originate on the side of metacarpals and double insertions into the base of the proximal phalanges and extensor hood
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what nerve innervates interossei?
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deep branch of ulnar nerve
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what muscles produce movements key to pinching with or oppressing pads of fingers with the thumb pad?
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lumbricals
flex the MP joint Extend PIP and DIP |
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what muscles are in the thenar e
compartment? |
opponens pollicis
aductor pollicis brevis Flexor pollicis brevis Adductor pollicis |
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what nere innervates the thenar compartment of the hand?
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median nerve
except for adductor pollicis is innervated by ulnar nerve |
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why is dorsal ulnar cutaneous sensation not affected in dorsal canal syndrome?
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because the ulnar nerve branches before it gets to the retinaculum and the wrist compartment
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what nerve innervates the skin on the dorsum of the hand?
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superficial branches of radial nerve
dorsal cutaneous branches of ulnar nerve |
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You see an x-ray of a male hand in which the pisiform is ossified, but the sesmoid bones in the flexor pollicis brevis and adductor pollicis are not visible. Assuming a healthy individual, about how old is he?
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12 to 15 years of age
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what are the contents of the central compartment of the hand?
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palmar aponeurosis
superficial palmar branch of median nerve flexor tendon sheath lumbricals superficial branch of ulnar midpalmar space |
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which muscles of the hand attach to the extensor hood?
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extensor palmaris longus
extensor indices extensor digiti minimi |
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what are the spinal nerves involved in Erb-duchenne palsy?
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C5-C6
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what usually causes nerve injuries?
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traction or pressure
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what type of motion may cause Erb-Duchenne's palsy?
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displacement of the head toward the contralateral side and depression of the shoulder to the ipsilateral side
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what type of injury may cause Erb-Duchenne's palsy?
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may result from a newborn's neck being excessively stretched during delivery or
a fall from a horse or motorcycle |
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what is upper radicular syndrome and what does it affect?
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Roots of C5-C8 may be injured by prolapsed intervertebral disck
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what myotomes/actions/muscles does Erb-Duchenne's palsy effect?
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C5: at the shoulder, abduction of arm & lateral rotation
C5-C6: at the elbow flexion causes paralysis to the muscles of the shoulder, arm, and forearm supplied by C5-C6 deltoid, biceps brachii, brachialis, brachioradialis |
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what are features of Erb's point lesion?
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junction of C5-C6
Arm is abducted and medially rotated at shoulder Arm hangs at the side in a medial position and is extended at the elbow Forearm is rotated medially and palm of hand faces superiorly |
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What is the waiter's tip?
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abnormal attitude of the upper brachial plexus lesion
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Klumpke's palsy involves what spinal nerves?
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C8-T1 spinal nerves
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Claw-hand is a symptom of which syndrome?
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Klumpke's palsy
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What movement/motion may cause Klumpke's palsy?
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may occur due to difficult breech birth or occur as a result of grasping something to break a fall which causes the arm to abduct excessively
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what may cause injury to the inferior trunk?
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the upper limb is suddenly pulled superiorly
affecting the short muscles of the hand causing claw deformity of the hand |
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Thoracic outlet syndrome involves what region?
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superior thoracic aperture
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what syndrome attributes to the compromise of blood vessels or nerves at any location between the base of the neck and the axilla?
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thoracic outlet syndrome
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what syndrome is associated with a difficult breech birth?
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Klumpke's palsy
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what syndrome is associated with a difficult birth?
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Klumpke's palsy
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what are the two types of thoracic outlet syndrome?
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obstruction that occurs in the root of the neck with the manifestation of the syndrome involves the upper limb
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what is costaclavicular syndrome?
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coldness of the skin of the upper limb and diminished radial pulse
results from the compression of the subclavian artery between the clavicle and 1st rib |
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what myotomes/actions/muscles are affected by Klumpke's palsy?
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myotomes and actions of the upper limb
C8: Flexion of the wrist T1: intrinsic muscles of the hand |
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what is Horner's syndrome?
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ptosis, miosis, anhydrosis
proximal injuries that cause damage to the cervicothoracic ganglion producing sympathetic denervation of the head |
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what is the physical manifestation of Klumpke's palsy?
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injury to C8-T1 produced combined claw hand (ulnar n.) and simian hand (median n.) cannot oppose thumb
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what does damage to ulnar nerve cause?
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prevents thumb from being adducted because of nerve loss to the adductor pollicis muscle
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what does damage to median nerve cause?
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holds the thumb in the same plane as the palm because the motor loss of the thenar muscles
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why is loss of hyperextension of MCP joints occurring in Klumpke's palsy but little clawing of the IP joints?
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because of the weak flexor muscles of the forearm
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With a lesion of median nerve can the thumb be opposed?
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NO
loss of opposition of the thumb |
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If C8 is involved in the lesion of Klumpke's palsy what occurs?
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flexion is weak for the wrist and finger
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what myotomes does the middle brachial plexus segment syndrome effect?
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C7: extension of the elbow
extension of wrist and digits so with the syndrome: loss of triceps reflex and loss of extension at elbow and wrist drop |
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Damage to the ulnar nerve causes what?
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compression of the ulnar nerve occurs where it passe between the pisiform and hook of hamate
damage causes hypoesthesia in the medial 1 and 1/2 digits, and weakness of the intrinsic muscles of the hand |
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what is simian hand?
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when the thumb is in the same plane as the palm of the hand because of damage to median nerve causing loss of abudctor pollicis
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what are the symptoms of injury to musculocutaneous nerve?
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flexion of the elbow joint and supination of forearm greatly weakened
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what syndrome is Radial nerve palsy similar to?
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Damage to C7 middle brachial plexus syndrome
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what is the symptom of the associated syndrom with radial nerve palsy but not the similar syndrome?
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brachioradialis reflex escapes but the loss of triceps reflex
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hand of benediction may be caused by injury to what nerve?
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lesion of the median nerve at or above the elbow
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what is the path of the median nerve
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passe between the two head of pronator teres-- its deep branch arises from the cubital fossa -- occurs between superficial and deep flexors of the forearm -- occurs superficial to the flexor tendons at the level of the wrist --- passes through the carpal tunnel to enter the palm -- short stubby muscular branch given off from radial side
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what dose the median nerve innervate?
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muscles of the anterior compartment of forearm (flexor)
muscles of the thenar eminence radial most two lumbricals (2,3) sensation to the area skin used in precisions gripping over the pulps of the thumb and index fingers |
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what are the symptoms of median nerve injury?
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forearm is supinated and the index finger is extended and middle finger extended and there is serial flexion of digits IV-V
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where can the ulnar nerve lesions or compressions occur?
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posterior to medial epicondyle
cubital tunnel wrist hand |
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what is Guyon's canal?
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compression of the ulnar nerve occurs where it passes between the hook of hamate and pisiform. Depression converted by pisohamate ligament into an osseofibrous tunnel
resulting in hypoesthesia in meidal 1 & 1/2 digits weakness of intrinsic muscles of hand |
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what does the ulnar nerve supply?
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flexor capri ulnaris
intrinsic muscles of hand sensory supply to the ulnar side of hand |
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what is the path of the ulnar nerve?
|
passe posterior to the medial epicondyle--passes between the two heads of flexor carpi ulnaris -- lies between the flexor carpi ulnaries and flexor digitorum profundus -- occurs superficially at the level of the wrist -- lies lateral to the pisiform bone and passe in the passageway referred to as the ulnar canal
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what are symptoms of ulnar nerve lesions at or above the elbow?
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flattening of ulnar forearm musculature
wasting of hypothenar muscles and interossei between metacarpals inability to hold a piece of paper between the pulp of straight thumb and curved index finger weakness of key grip due to loss of 1st dorsal interossei and adductor pollicis muscle flexion of wrist produces radial deviation |
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what is the ulnar nerve paradox?
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the higher the ulnar nerve lesion the less obvious the clawing is
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what does the radial nerve supply
|
muscles of posterior compartments of the arm and forearm
only exception is brachioradialis which occurs in the anterior compartment and is a flexor or the arm |
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what is the path of radial nerve?
|
posterior aspect of humerus within radial groove --lies anterior to lateral epicondyle between brachialis & brachioradialism --divides into superficial and deep branches --superficial branch is sensory and lies deep to brachioradialis
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what is the path of the deep branch of radial nerve?
|
deep branch penetrates supinator muscle and emerges between it and abductor pollicis longus supplying EDC, ECU, EDM muscles
posterior interossei in continuation of deep branch that supplies the ABPL, EPB, EPL, EI |
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what is saturday night palsy?
|
compression of radial nerve
because of poor fitting crutches or arm of chair while being asleep -pressure on the radial nerve in the axilla area or in the radial groove |
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radial nerve can be damaged in fracture of what?
|
radial nerve can be damaged by a fracture of the surgical neck or the shaft of the humerus
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what are the symptoms of radial nerve injury at the axilla or the elbow?
|
loss of the ability to flex and extend the forearm at the elbow
loss of extension of the wrist -- resulting in wrist drop loss of supination of the extended forearm loss of extension of IP and MCP joints of the thumb & MCP joints of digits II-IV |
|
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injury to deep branch of radial nerve results from what
|
inability to extend the thumb and MP joints of other digits
digits remained flexed at MCP joints |
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what is the cranial nerve and artery that originates from pharyngeal arch 1?
|
Cranial nerve V3
part of maxillary artery muscles of mastication |
|
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what is the cranial nerve and artery that originates from pharyngeal arch 2?
|
cranial nerve VII
stapedial and hyoid artery muscles of facial expression |
|
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what is the cranial nerve and artery originates from pharyngeal arch 3?
|
cranial nerve IX
common carotid artery styloharyngeaus |
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what is the cranial nerve and artery originating from pharyngeal arch 4?
|
Cranial nerve X
superior laryngeal aortic arch and subclavian artery |
|
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what is the cranial nerve and artery originating from pharyngeal arch 6?
|
cranial nerve X
inferior laryngeal pulmonary artery and ductus arteriosus |
|
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what rhombomere does growth of V come from?
|
Rhombomere 2
pharyngeal arch 1 |
|
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what rhombomere does growth of VII come from?
|
rhombomere 4
pharyngeal arch 2 |
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what rhombomere does growht of IX come from?
|
Rhombomere 6
pharyngeal arch 3 |
|
|
what type of diaphragmatic hernia is thought to be due to congenital shortness of the esophagus?
|
Esophageal hernia
upper portions of stomach are retained in thorax and the stomach is constricted at the level of the diaphragm |
|
|
what is the frequency of a diaphragmatic hernia?
|
1/2000
|
|
|
at what age do most diaphragmatic hernias occur and which sex is most commonly affected?
|
4 weeks
male |
|
|
what is polyhydramnios?
|
too much amniotic fluid
|
|
|
what is oligohydraminos?
|
too little amniotic fluid
|
|
|
what treatments are used to stimulate surfactant production in Type II pneumocytes?
|
Glucocorticoids stimulate surfactant production
|
|
|
what type of diaphragmatic hernia is thought to be due to congenital shortness of the esophagus?
|
Esophageal hernia
upper portions of stomach are retained in thorax and the stomach is constricted at the level of the diaphragm |
|
|
how many alveoli are there at birth?
|
1/6th that of an adult
|
|
|
what type of defects would be expected with a baby born with TEF?
|
vertebral abnomalies
anal atresia cardiac defects tracheoesophageal fistula esophageal atresia renal anomalies limb defects |
|
|
what is the frequency of a diaphragmatic hernia?
|
1/2000
|
|
|
can diaphragmatic defects in CDH be repaired by surgery before birth? what is the mortality rate of CDH? why do most new borns with CDH die?
|
Yes
Mortality rate is 75% pulmonary hypoplasia and pulmonary hypertension |
|
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at what age do most diaphragmatic hernias occur and which sex is most commonly affected?
|
4 weeks
male |
|
|
what stimulates an infant to start breathing at birth?
|
fluid in the lungs is cleared through the mouth and nose and taken up into the capillaries and lymphatics and allows for rapid replacement of intraalveolar fluid by air
|
|
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what is polyhydramnios?
|
too much amniotic fluid
|
|
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what is oligohydraminos?
|
too little amniotic fluid
|
|
|
what treatments are used to stimulate surfactant production in Type II pneumocytes?
|
Glucocorticoids stimulate surfactant production
|
|
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how many alveoli are there at birth?
|
1/6th that of an adult
|
|
|
what type of defects would be expected with a baby born with TEF?
|
vertebral abnomalies
anal atresia cardiac defects tracheoesophageal fistula esophageal atresia renal anomalies limb defects |
|
|
can diaphragmatic defects in CDH be repaired by surgery before birth? what is the mortality rate of CDH? why do most new borns with CDH die?
|
Yes
Mortality rate is 75% pulmonary hypoplasia and pulmonary hypertension |
|
|
what stimulates an infant to start breathing at birth?
|
fluid in the lungs is cleared through the mouth and nose and taken up into the capillaries and lymphatics and allows for rapid replacement of intraalveolar fluid by air
|
|
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can an infant born at 22 weeks after fertilization survive? how many deaths are there among newborns as a result of RDS?
|
not likely because no production of surfactant
20% of newborns with RDS die |
|
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what are the functions of amniotic fluid?
|
absorbs jolts
prevents adherence of embryo to amnion allows for fetal movement |
|
|
describe dextrocardia?
|
the heart lies on the right side of the thorax instead of the left side
is caused by right heart loops to the left instead of the right may coincide with situs inversus |
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list reasons for importance of right to left blood flow during heart development
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Mainly to sculpt and develop the atria
important when sculpting the atria when forming the atrial septum also involved in build up of pressure of left atrium will help to close foramen ovale in atria |
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list structures arising from bulbus cordis
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Bulbus cordis is the early embryonic ventricle
the bulbus coris is narrow except for its proximal third forms: 1. proximal third becomes the trabeculated part of the right ventricle 2. Midportion forms the outflow tracts of both ventricles 3. distal part the truncus arteriosous which becomes the proximal portion of the aorta and pulmonary artery |
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what are the boundaries of the midgut?
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liver and vitelline duct
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what is the artery of the midgut?
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superior mesenteric artery
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what is the artery of the foregut?
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celiac trunk
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what is the artery of the hindgut?
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inferior mesenteric artery
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what is the fate of the umbilical veins?
|
umibilical vein becomes the round ligament of the uterus
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what is the fate of the ductus arteriosus?
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ligamentum venosum
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describe the pathway of blood before birth.
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1. Blood returns from placenta via the umbilical vein
2. Some goes through the liver sinusoids and some through the ductus venosus 3. Blood enters the IVC and mixes with deoxygenated blood from lower limbs 4. Goes toward formane ovale and enter left atrium 5. some blood goes through the pulmonary circulation but most goes to left ventricle and then aorta 6. Blood is shunted through ductus arteriosus |
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what is the ductus arteriosus?
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small vessel connecting the pulmonary trunk and the aorta
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what is the fate of ductus arteriosis?
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ligamentum arteriosus
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what does damage to the AV node result in?
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heart block
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how is right or left dominance of coronary arteries determined?
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by which coronary artery gives rise to posterior interventricular artery
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|
nerve roots of thoracoabdominal nerves?
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T7-11
continuation of lower intercostal nerves which course between the 2nd and 3rd layers of the abdominal muscles |
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nerve roots of subcostal nerve
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from ventral ramus of 12th thoracic nerve and runs inferior to border of the 12th rib
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what does the lumbar plexus arise from?
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anterior rami of L1-L3 and part of L4 and is embedded in the psoas major muscle and has major branches and segmental derivatives
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nerve roots of iliohypogastric nerve?
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arise from ventral rami of L1
pierces the transverse abdominal muscle and branches |
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ilioinguinal nerve roots
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arise from ventral rami of L1 and pass between the 2nd and 3rd layers of the abdominal muscles and through the inguinal canal
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nerve roots of genitofemoral nerve
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L1-L2 spinal nerves
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A patient presents with a stab wound in the superior 2/3 of the abdominal wall. Describe the order of the layers that the knife passed through.
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superior 2/3 of the anterior abdominal wall sheath is formed by the external oblique and internal oblique alone. Here the IO splits into two layers at the border of rectus abdominus muscle. One lamina courses anterior to the rectus abdominus.
The posterior wall of the sheath is formed by a second lamina of the IO and transverse abdominal muscle to the arcuate line. |
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describe the cremasteric reflex
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where the clinician strokes the inside of the thigh to elicit a response with the cremaster muscle.
If a young male has a cryptic testi, the clinician can try to encourage the drop of that testi into the scrotum by lightly stroking the medial surface of the thigh which will stimulate the cremaster muscle and maybe lower the testicle. The area of skin is innervated by illioinguinal nerve. The rapid elevation of the testis on the same side is the cremasteric reflex |
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what type of inguinal hernia is the most common?
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indirect hernia
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describe an indirect hernia of the inguinal canal.
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most common
occur lateral to the inferior epigastric artery. Such hernias enter the deep inguinal ring or the canal of Nuck in females. |
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describe an indirect inguinal hernia
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a type of hernia which leaves the abdominal cavity medial to the inferior epigastric artery. It protrudes through an area of weakness in the posterior wall of the inguinal canal. The hernial sac is formed by transversalis fascia. It occurs outside the process vaginalis and is usually obliterated, parallel to the spermatic cord. Thus it is outside one or two of the fascial coverings of the cord. It will not traverse the entire canal and protrudes through the inguinal canal wall. It emerges from or about the conjoint tendon to reach the superficial inguinal ring. Thus it gains an outer covering of external spermatic fascia inside or parallel to that of the cord. In males it usually does not enter the scrotum.
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what separates the parotid gland and submandibular gland?
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stylomandibular ligament
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what makes up the parotid bed
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mastoid
styloid spine of sphenoid ramus of mandible |
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what does the facial nerve innervate?
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muscles of facial expression:
stylohyoid muscle posterior belly of digastric auricular muscles occipitalis muscle |
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where are the sensory fibers associated with the facial nerve located?
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geniculate ganglion
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what are the 5 named branches of the facial nerve
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temporal
zygomatic buccal mandibular cervical |
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what are the terminal branches for the external carotid artery
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superficial temporal a.
maxillary artery |
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what two veins anastomose to make the retromandibular vein?
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superficial temporal vein
maxillary vein |
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what does the retromandibular vein divide into after it has passed inferior to the parotid gland?
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external jugular vein
common facial vein |
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where does the common facial vein empty into?
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internal jugular vein
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what nerve travels with the superficial temporal artery?
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auriculotemporal nerve a division of V3
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what nerve provides preganglionic parasympathetic innervation for the secretomotor control of the parotid gland?
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lesser petrosal nerve a branch of IX
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what ganglion do the preganglionic parasympathetic nerves of the lesser petrosal nerve synapse in?
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Otic ganglion
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after the lesser petrosal nerve has synapsed in the Otic ganglion what nerve do the post ganglionic nerve fibers join to deliver secretomotor information to the parotid gland?
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join auriculotemporal nerve
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describe the path of parasympathetic innervation of the parotid duct
|
it is for secretomotor control
lesser petrosal nerve (IX) -- Otic ganglion --- Auriculotemproal nerve |
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what carries pain sensation of the parotid gland that might be felt with mumps?
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intraglandular branches of auriculotemporal nerve (V3)
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what is fluid content of the parotid gland controlled by?
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Sympathetic innervation
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what ganglion does sympathetic preganglionic fibers synapse in for fluid content control of the parotid gland?
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Superior cervical ganglion from the external carotid plexus
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what are the muscles of mastication innervated by?
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branches of V
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action of masseter muscle
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elevation of mandible
protrusion of mandible |
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actions of temporalis
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elevates mandible
retraction of mandible |
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action of medial pteygoid
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synergistically acts with masseter
elevates mandible protrusion of mandible lateral motions |
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actions of lateral pterygoid
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superior head: protrusion of mandible
inferior head: opening of mouth |
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what motions are used to test for lesions of V3?
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protrusive motions of the jaw
paralysis of either lateral pterygoid will cause the mandible to deviate to the other side of damaged muscle or injured nerve |
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what type of joint is the tempromandibular joint?
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inferior compartment: hinge rotation
superior compartment: sliding joint |
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what ligaments stabilize the TMJ?
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lateral ligament
stylomandibular ligament sphenomandibular ligament |
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How are the muscles of mastication tested? what nerve are you testing ?
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1. palpation of temporalis and masseter while patient clenches teeth
2. patient protrudes jaw testing Trigeminal nerve branches (V3) |
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what passes through foramen rotundum?
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V2
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what passes through foramen ovale
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V3
accessory meningeal artery lesser petrosal nerve (IX) |
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what passe through foramen spinosum?
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middle meningeal artery and vein
meningeal branches of V3 located at the base of the sphenoid spine |
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what passes through foramen lacerum?
|
greater petrosal nerve
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what muscle wraps around the pterygoid hamulus?
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tensor veli palatini
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what are the contents of the infratemporal fossa?
|
temporalis muscle
lateral pterygoid m medial pterygoid m maxillary atery pterygoid venous plexus V3 chorda tympani nerve (VII) Otic ganglion (PS ganglion) |
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what are the divisions of the mandibular portion of the maxillary artery
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deep auricular a.
anterior tympanic a. middle meningeal a. accessory meningeal a. inferior alveolar a. |
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what does the deep auricular artery supply
|
external auditory meatus and TMJ
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what does the anterior tympanic artery supply
|
tympanic cavity
vascular network around tympanic membrane |
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what does the middle meningeal artery supply?
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principle artery of the cranial dura and bone
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what foramen does middle meningeal artery pass through?
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foramen spinosum
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what does accessory meningeal a. supply?
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semilunar ganglion and adjacent dura if artery is present
passes though the foramen ovale |
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what does the inferior alveolar artery supply?
|
substance of the mandible through the mandibular foramen, lower teeth
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what are the branches of inferior alveolar artery?
|
artery to myelohyoid and mental artery
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what nerve is distributed with the pterygoid branches of the maxillary artery?
|
V3 branches
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what are the branches of the 2nd part of the maxillary artery?
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masseteric artery
deep temporal branches pterygoid branches Buccal artery |
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what nerve distributes with the pterygopalatine portion of the maxillary artery?
|
branches of V2
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what does the posterior superior artery branch of maxillary supply?
|
teeth, maxillary sinus, gingiva, buccinator
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what does the infraorbital artery supply?
|
enters the orbit through the inferior orbital fissure
proceeds forward with infraorbital nerve and emerges on the face supplies teeth and maxillary sinus through alveolar branch |
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what does the descending palatine artery supply? where does it course?
|
courses through the oral surface of the hard palate
supplies the soft palate, palatine tonsil, and continues forward as the Greater palatine artery |
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what does the greater palatine artery supply ?
|
gingiva, palatine glands, mucus membrane of mouth
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|
what does the greater palatine artery anastomose with?
|
sphenopalatine artery in the incisive canal
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what does the artery of pterygoid canal supply?
|
pharynx
auditory tube tympanic cavity |
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what does the pharyngeal artery supply ?
|
pharynx
sphenoid sinus auditory tube |
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what does the sphenopalatine artery supply?
|
passe straight medially into the nasal cavity
supplies lateral nasal wall and nasal septum |
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what are the posterior divisions of V3?
|
meningeal branch
medial pterygoid nerve |
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what does the middle meningeal branch of V3 supply?
|
re-enters the skull with middle meningeal artery through foramen spinosum
sensory to dura and mastoid air cells |
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what does the medial pterygoid nerve supply?
|
associated with Otic ganglion
branches to nerve to tensor veli palatini and tensor tympani |
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|
what are the pure motor divisons of V3?
|
masseteric nerve
anterior, middle, and posterior deep temporal nerve nerve to lateral pterygoid |
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|
this nerve branches from the anterior division of V3 but is purely sensory. It is the terminal division of the anterior division of V3.
|
Buccal nerve
Exclusively sensory |
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|
what does the Auricotemporal nerve supply?
|
2 roots that encircle middle meningeal artery
Postganglionic PS fibers from Otic ganglion that are secretomotor to the parotid gland branches to Parotid, TMJ, external pinna of ear, and temporal area Sensory for pain and general sensation over the upper portions of V3 dermatome of the face |
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|
what does the inferior alveolar nerve supply?
|
enters mandibular foramen
Entirely sensory lies posterior to LIngual nerve motor branch to myelohyoid and anterior belly of digastric muscles mental nerve branches and exits the mental foramen supplies gingiva, mucosa, and skin of lower lip |
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|
what nerve does nerve to myelohyoid and anterior belly of digastric branch from?
|
inferior alveolar nerve
division of V3 |
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|
what nerve receives chorda tympani nerve?
|
LIngual nerve
|
|
|
describe the function of the chorda tympani nerve?
|
preganglionic secretomotor fibers from VII from tympanic plexus
Special Sensory Afferent for TASTE running from anterior 2/3 of tongue to the geniculate ganglion of VII |
|
|
describe the course of the LIngual nerve?
|
passe lateral to styloglossus and hypoglossus and enters the floor of the mouth
|
|
|
what is the function of the Lingual nerve?
|
general sensation from anterior 2/3 of tongue, mucus membrane, and floor of the mouth
|
|
|
what does the optic canal transmit?
|
CN II
ophthalmic artery |
|
|
what is the trochlear spine an attachment site for?
|
superior oblique muscle tendon
|
|
|
what does the inferior orbital fissure transmit?
|
maxillary nerve (V2)
|
|
|
superior orbital fissure transmits what?
|
II
III IV V3 VI superior ophthalmic vein |
|
|
how do infections of the sphenoid sinus pass through to the carotid sinus?
|
infections of the sphenoid sinus can penetrate the bony wall and enter the venous sinus
|
|
|
what is the mechanism of the lens bulging?
|
contractions of the ciliary muscle relaxes the suspensory muscles which allows the lens to bulge
|
|
|
what contains the sphincter papillae and dilator papillae muscles
|
Iris
both are smooth muscle |
|
|
What are the two layers of the retina?
|
outer layer: pigmented
inner layer: neural |
|
|
what is the ora serrata?
|
light sensitive area/layer ends at the posterior edge of the ciliary body
|
|
|
Optic disc
|
optic nerve enters the eyeball
no photoreceptors -- blind spot |
|
|
Macula lutca
|
lateral to the optic disc
area of most acute vision |
|
|
what supplies the retina?
|
central retina artery
|
|
|
Cornea is vascular/avascular?
|
avascular
|
|
|
Lens is vascular/avascular?
|
avascular
|
|
|
what holds the lens in place?
|
suspensory ligament of lens
|
|
|
describe the vitreous humor.
|
forms about 4/5 of the eyeball
holds retina in place provides support for the lens |
|
|
what are the check ligaments of the eye?
|
attach to walls of orbit
limit excessive actions of medial rectus muscle and lateral rectus muscle posterior pull of rectus muscles |
|
|
what is the levator palpebrae superioris muscle innervated by?
|
III
cervical sympathetic trunk |
|
|
describe what happens in III palsy
|
the upper eyelid cannot be raised voluntarily because of the unopposed o.o. supplied by VII
|
|
|
what is the origin of rectus muscles of the eye?
|
common tendinous ring
|
|
|
what is the origin of the inferior oblique muscle?
|
maxilla
|
|
|
actions of medial rectus
|
moves cornea medially
adducts eyeball |
|
|
actions of lateral rectus
|
moves cornea laterally
abducts eyeball |
|
|
actions of superior rectus
|
elevates moves cornea medially
rotates cornea medially |
|
|
actions of inferior rectus
|
depresses moves cornea medially
rotates cornea laterally |
|
|
actions of superior oblique
|
depress moves cornea laterally
rotates cornea medially (downward and outward) |
|
|
actions of inferior oblique
|
elevates moves cornea laterally
rotates laterally (upward and outward) |
|
|
what supplies the orbital contents
|
infraorbital artery, branch of maxillary
ophthalmic artery, branch of internal carotid |
|
|
what is the most important branch of the ophthalmic artery
|
central artery of the retina
|
|
|
describe CN II
|
special sensory nerve
accompanied by pia, arachnoid, and dura mater any rise in pressure in CSF will be transmitted to the back of the eyeball |
|
|
describe the Lacrimal nerve
|
division of V1
joins zygomaticotemporal nerve to supply PS secretomotor to lacrimal gland sympathetic fibers join enroute |
|
|
describe the frontal nerve
|
division of V1
divides into supratrochlear nerve and supraorbital nerve |
|
|
descrive Nasociliary nerve
|
division of V1
gives branches to: ciliary ganglion long ciliary nerve anterior/posterior ethmoidal nerve continues as infratrochlear nerve |
|
|
what does the Nasociliary nerve supply?
|
sympathetics to dilator papilae muscle of iris
sensory to ethmoid sinuses sensory to medial eyelid and adjacent part of nose |
|
|
describe the ciliary ganglion
|
preganglionic PS fibers from III
postganglionic PS fibers leave it in short ciliary nerve supply sphincter papillae in iris & ciliary muscle of ciliary body |
|
|
describe III innervation
|
supplies majority of extrinsic muscles of the eye
intrinsic muscles of the eye: sphincter papillae and ciliary muscles |
|
|
what does CN VI supply
|
supplies lateral rectus muscles
|
|
|
what does CN IV supply
|
superior oblique muscle
|
|
|
function of hyoglossus muscle
|
flatten tongue
|
|
|
action of genioglossus muscle
|
protrusion and prevents posterior shift of tongue
|
|
|
action of styloglossus muscle
|
elevates and retracts tongue
|
|
|
what palatal muscle is the only muscle of the palate not innervated by CN X?
|
Tensor veli palatini and it is innervated by V3
|
|
|
action of palatoglossus
|
depresses soft palate
|
|
|
action of palatopharyngeous m.
|
elevates larynx in swallowing
|
|
|
what are the components of Waldeyer's ring?
|
pharyngeal tonsil
tubal tonsil palatine tonsil lingual tonsil |
|
|
inflammation of what can interfere with normal drainage of the paranasal sinuses?
|
inflammation of middle meatus mucosa
|
|
|
what concha are processes of the ethmoid bone?
|
superior and middle meatus
|
|
|
what drains into the superior meatus?
|
posterior ethmoid air cells
|
|
|
what drains into the sphenoethmoidal recess?
|
sphenoid sinus
|
|
|
what does the maxillary nerve transmit through?
|
foramen rotundum
|
|
|
describe what the pterygopalatine ganglion receives and transmits
|
preganglionic PS fibers from Greater Petrosal Nerve (VII)
Postganglionic PS neurons are secretomotor glands above the floor of the mouth through the Greater Palatine nerve |
|
|
what is the nasal septum innervated by mainly?
|
Nasopalatine nerve
|
|
|
where does the terminal branch of the Nasopalatine nerve travel?
|
through the incisive foramen to the anterior 1/3 of the hard palate
|
|
|
what is the principle blood supply to the nose
|
sphenopalatine artery
|
|
|
what passe through the incisive foramen
|
sphenopalatine artery and greater palatine artery anastomose here
Nasopalatine nerve transmits through it to innervate the anterior 1/3 of the hard palate |
|
|
what is the nerve supply to the mucosa of the maxillary sinus?
|
posterior and middle alveolar nerves of V2
|
