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99 Cards in this Set
- Front
- Back
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Where are lymphatic vessels NOT found?
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CCEEBI
CNS Cartilage Eyeball Epidermis Bone Internal Ear |
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CC
Lymphangitis: Lymphadenitis: |
Inflamed lymphatic vessels due to bacterial infection
Lymphangitis causes surrounding lymph nodes to enlarge and be painful |
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Pericervical Ring Lymph Nodes Pneumonic (Posterior-->Anterior):
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OR PB Sandwich Snack
Occipital Nodes Retroauricular Nodes Parotid Nodes Buccal Nodes Submandibular Nodes Submental Nodes |
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What drains into the Jugulodigastric Node?
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Palatine tonsil and nasopharynx drainage
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What drains into the Juguloomohyoid Node?
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Tongue drainage
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What drains into the Supraclavicular Nodes (aka Sentinel Nodes)?
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Drainage from vast majority of body
Cancer from lungs, esophagus, stomach, etc can present here. |
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CC
Herpes Zoster Ophthalmicus (Shingles) |
Viral infection of face supplied by ophthalmic nerve
Cornea often involved Infection can spread to CN III, IV, and VI |
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CC
Trigeminal Neuralgia aka Tic Douloureux |
Toughing skin field of trigeminal nerve causes immense pain
Often in area of Maxillary Nerve |
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CC
Bell's Palsy |
Paresis (weakness) or paralysis of the facial muscles with no obvious injury
Causes by inflammation of facial nerve at stylomastoid foramen |
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Innervations of Facial Nerve (CN VII) Branches:
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Posterior Auricular Nerve- Posterior Auricular, Occipitalis
Temporal Branch - Frontalis, Orbicularis Oculi, Corrugator Supercilii, Anterior/Superior Auricular Muscles Zygomatic Branch - Zygomatic, Orbital, Infraorbital Muscles Buccal Branch - Buccinator, Upper lip and nostril Muscles Mandibular Branch - Lower lip and chin muscles Cervical Branch - Platysma |
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Danger Area of Face
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Centered on midline nose and eyes
Venous drainage communicates with the cavernous sinus of the brain |
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SCALP
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S - Skin
C - CT A - Aponeurosis Epicranialis L - Loose Areolar Tissue P - Pericranium Unit - SCA, remain together |
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Reinforcement of TMJ
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Medially - Spine of Sphenoid
Laterally - Lateral Ligament So strong, that TMJ does not ordinarily dislocated Medially OR Laterally! Dislocated anteriorly! |
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Masseter Muscle Action
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Both heads elevate mandible.
Superficial - May protrude mandible Deep - May retract mandible |
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Temporalis Muscle Action
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More vertical fibers = Elevate mandible
More horizontal fibers = Retract mandible |
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Lateral Pterygoid Muscle Action
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Bilateral = Protrusion of mandible (final 2/3 of opening jaw)
UNilateral = Deviation of mandible to opposite side |
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Medial Ptertygoid Muscle Action
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Elevate mandible, but can also move mandible contralaterally
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CC
Unique quality of veins in head: |
Valveless!
Reversal of blood flow into cavernous sinus may carry pathogens there resulting in meningeal infections. |
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What can be found between the 2 lateral ptergygoid muscles?
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Buccal Nerve of V3
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What can be found between the medial and lateral pterygoids?
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Lingual Nerve
Inferior Alveolar Nerve |
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3 Structures within Parotid Gland
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Facial Nerve
Retromandibular Vein External Carotid Artery |
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CC
Viral Infection of Parotid Gland |
Pain may be referred to Auricle, External Acoustic Meatus, Temporal Region, TMJ due to Auriculotemporal Nerve innervation!
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arcane
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- Secret or mysterious
ex. a few months ago few people outside the ARCANE world of contemporary music had heard of Gorecki |
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CC
Implications of dura being loosely attached to calvarium but firmly attached to base of skill: |
Blow to head - could detach dura from calvarium
Fracture to base of skull - usually leads to a tear of dura = leakage of CSF into nose, ear, or nasopharynx |
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CC
Extra-Dural Hemorrhage |
Blow to the head causes tearing of a middle meningeal artery.
Extradural hemotoma causes rise in intracranial pressure = force part of cerebellum through foramen magnum = compress medulla. |
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CC
Sub-Dural Hemorrhage |
Often due to tears of superior cerebral veins as they enter superior sagittal sinus
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CC
Subarachnoid Hemorrhage |
Follows rupture of aneurysm of an intracranial artery
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Contents of Cavernous Sinus (Coronal Section)
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Lateral, Superior --> Inferior
CN III CN IV CN V1 CN V2 Medial CN VI Internal Carotid Artery |
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CC
Pulsating Exophthalmos (eye pulsing with radial pulse) |
Fracture to base of skull tearing internal carotid artery --> blood rushes into venous system (cavernous sinus) = Anteriovenous Fistula
Arterial blood forced into ophthalmic veins--> eye bulges (exophthalmos) and conjunctiva become engorged (chemosis) ----> pulsating exophthalmos |
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Stroke Types:
A) Hemorrhagic B) Thrombotic |
A) Follows rupture of an artery or aneurysm
B) Results from embolis getting trapped in a small artery |
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CC
Blow to the Eye |
Causes increase in pressure within orbit, potentially causing a blowout fracture, leading to contents of orbit sinking into maxillary sinus, leading to double vision.
This is due to the medial wall and floor of the orbit being so thin. |
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CC
Tumors within Sphenoid and Posterior Ethmoid Sinuses |
Due to close proximity with optic nerve, erosion of the walls of these sinuses due to tumors can compress the Optic Nerve
Produces bulging of the eye - Exophthalmos |
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Arterial Supply to Eyelids:
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Superior and Inferior Palpebral Arterial Arches (branch of Opthalmic Artery)
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CC
Third Nerve Palsy |
Upper eyelid droops (ptosis) and cannot be raised
Due to damage of superior division of occulomotor which innervates levator palpebrae superioris |
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CC
Bell's Palsy |
Injury to Facial Nerve
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CC
Horner's Syndrome |
Interruption of cervical sympathetic trunk
Results in ptosis due to paralysis of superior tarsal muscle, constricted pupil, sinking of eye, redness, dryness, increase in T on affected side of face |
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CC
Swelling of optic disc can be indicative of what? |
Increased intracranial pressure
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CC
Retinal Detachment |
Tearing away of neural retina from underlying RPE (retinal pigmented epithelium) which is highly adherent to the choroid
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Action of Medial Rectus Muscle
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Adducts Eye
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Action of Lateral Rectus Muscle
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Abducts Eye
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Action of Superior Rectus Muscle
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Elevates and Adducts Eye
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Action of Inferior Rectus Muscle
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Depresses and Adducts Eye
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Action of Superior Oblique Muscle
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Depresses, Abducts, and Medially Rotates Eye
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Action of Inferior Oblique Muscle
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Elevates, Abducts, and Laterally Rotates Eye
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Testing Extraoccular Muscles:
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Look _______---> Tests _______
Lat ---> Lat Rectus Sup Lat ---> Sup Rectus Inf Lat ---> Inf Rectus Med ---> Med Rectus Sup Med ---> Inf Obl Inf Med ---> Sup Obl |
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Nerve Innervation of Orbit
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LR6, SO4, All others CN3
Lat Rectus - CN 6 (Abducent) Sup Oblique - CN 4 (Trochlear) Levator Palpebrae Sup, Sup Rectus, Med Rectus, Inf Rectus, Inf Oblique - CN 3 (Occulomotor) |
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Arterial Supply of Orbit
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Mostly from Opthalmic Artery (branch of ICA)
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CC
Presbyopia |
Gradual loss of focusing power due to hardening and flattening of lens
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CC
Pupillary Light Reflex |
Sensory info from retina relayed via CN2 (optic)
Parasympathetic outflow via CN3 (occulomotor) terminates in ciliary ganglion, causing pupillary sphincter to contract Lesions along this pathway can lead to loss of direct light reflex or consensual light reflex |
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CC
Blink Reflex |
Sensory info from cornea is transmitted via CN V1 (opthalmic)
Reflex look in brainstem initiates motor outflow via CN VII (facial) to constrict orbicularis oculi muscle Lid can then be reopened by CNIII (occulomotor) stimulation of levator palpebrae sup |
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CC
Vestibular-Ocular Reflex |
Rotation of head signaled via CN VIII (Vestibulocochlear)
Signals arising in midbrain and cerebellum relayed to CNIII (occulomotor) system to maintain vertical alignment of eye |
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Cartilages of Larynx (9)
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Unpaired (3)
-Epiglottic -Thyroid -Cricoid Paired (3): -Arytenoid -Corniculate -Cuneiform |
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Action of Cricothyroid Joint
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Change length (or tension) of the vocal ligament
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Action of Cricoarytenoid Joint
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Regulate size of space between the vocal folds (rima glottidis)
Aid in tensing/relaxing vocal ligaments |
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Conus Elasticus
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Vocal Ligament AND Cricothyroid Membrane TOGETHER
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CC
Cauliflower Ear |
Trauma --> Bleeding Within Auricle --> Produces Auricular Hematoma --> Hematoma interrupts blood supply to auricular cartilage
Result = Fibrosis |
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Composition of External Auditory Canal
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Outer 1/3 = Elastic Cartilage - Skin, Hair, Sebaceous and Ceruminous Glands
Inner 2/3 = Bone - Skin, but No Hair Nor Glands |
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Muscles of Auricle
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Instrinsic - Auricular Cartilage to Auricular Cartilage
Extrinsic - Auricle to Cranium - Vestigial, most peeps lack voluntary control of them |
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Nerve Innervation to Auricle
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Anterior Auricle + Anterior External Auditory Canal = Auriclotemporal Nerve (CN V3)
Posterior Auricle = Great Auricular Nerve Posterior Portion of External Auditory Canal = Great Auricular Nerve AND Auricular Branch of Vagus Nerve |
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CC
Tympanic Reflex |
Tension put on ossicles by 2 muscles to reduce excessively loud noises:
Tensor Tympani (CN V3) - Lives in canal just superior to auditory tube and attaches to Malleus Handle - safety against chronic loud noise (ie chewing) Stapedius (Facial Nerve) - Attaches to Stapes - Damage can cause Hyperacusia where loud noises are painful |
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Tympanic Membrane Parts
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Outer = Skin
Inner = Mucous Membrane |
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CC
Where are incisions made in tympanic membrane? |
Posterioinferiorly - Minimizes risk of injury to chorda tympani nerve and ossicles. Also, inferior portion is LESS vascular.
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CC
How is the sound of the pulse of the ICA commonly heard? |
Sound projecting though thin anterior wall of bone in tympanic cavity (wall separates tympanic cavity from ICA)
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Largest Air Cell
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Antrum!
Aditus opens into it! |
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CC
Main Cause of Earaches |
Otitis Media
Middle ear susceptible to infection via auditory tube, which opens into nasopharynx Children have short/straight auditory tube = Easier infection! |
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CC
Spread of Middle Ear Infection |
Posteriorly to Mastoid Antrum and Air Cells
Superiorly into Middle Cranial Fossa, infecting Meninges and Middle Temporal Lobe Medially - Facial nerve, causing palsy |
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CC
Inner Ear Infection |
Vertigo
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CC
A) Surgical Access to Mastoid Process B) Surgical Approach to Middle Ear |
A) Posterior Wall of External Acoustic Meatus
B) Mastoid Air Cells |
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Sensory Innervation for lining of Tympanic Cavity:
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Tympanic Plexus, formed by tympanic nerve, a branch of CN IX.
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Actions of Cochlea and Saccule/Utricle:
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Cochlea - Hearing
Saccule/Utricle - Gravity and Linear Acceleration |
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CC
Lesion of CNI (Olfactory Nerve) |
Result of Ethmoidal Bone Fracture, Tumors
Causes Anosmia (loss of smell) Many will complain of altered taste as a consequence. |
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CC
Lesion of CNII (Optic Nerve) |
Blindness or diminished visual acuity
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CC
Lesion of CNIII (Occulomotor Nerve) |
Paralysis of Ocular Muscles - Ptosis
Eyeball is abducted and directed slightly inferiorly Dilation of Pupil (loss of sphincter pupillae - parasym) Loss of Accomodation of Lens (loss of ciliary muscle - parasym) Loss of Pupillary Light Reflex |
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CC
Lesion of CN IV (Trochlear Nerve) |
May be caused by severe head injuries due to its long intracranial course.
Eye adducted and intorted Vertical Diplopia (double vision) when looking down and in (loss of Superior Oblique) |
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CC
Lesion of Lingual Nerve (CN V3) Near Oral Cavity |
Loss of general and taste sensation to the anterior 2/3 of tongue
Loss of salivary secretions from submandibular and sublingual glands |
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CC
Lesion of CN VI (Abducens Nerve) |
May result from brain tumor or septic thrombosis in cavernous sinus
Medial deviation of affected eye - medial strabismus (loss of lateral rectus muscle) --> Horizontal Diplopia |
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CC
Lesion of CN VII (Facial Nerve) |
Bells Palsy
Loss of taste on anterior 2/3 of tongue Loss of corneal blink response |
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CC
Lesion of CN VIII (Vestibulocochlear Nerve) |
Loss of hearing
Vertigo Tinnitus |
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CC
Lesion of CN IX (Glossopharyngeal Nerve) |
Loss of Gag Reflex
Loss of taste to posterior 1/3 of tongue Glosspharyngeal Neuralgia - Sever pain in throat, side of neck, anterior auricle, posterior mandible |
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CC
Lesion of CN X (Vagus Nerve) |
Lesion Inside Skull: Palpitation of heart, tachycardia, slowing of respiration, sensation of suffocation
Lesion Outside Skull (RARE): Paralysis of soft palate (say AHH) and larynx, hoarseness, anesthesia of larynx |
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CC
Lesion of CN V (trigeminal) |
Loss of Sensory to Face
Loss of Muscles of Mastication/ Tensors (V3) Loss of corneal reflex (afferent, facial nerve to orbicularis oculi is CN VII) |
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CC
Lesion of CN XII |
Unilateral lesion causes unilateral paralysis of tongue and its eventual atrophy
When protruded, tongue will deviate towards affected side: "lick your wounds) |
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Function of Movements around Cricothyroid Joints?
Around Cricoarytenoid Joints? |
Cricothyroid - Length (or tension) of Vocal Ligament
Cricoarytenoid - Size of Rima Glottidis (to some degree, also tensing/relaxing vocal lig) |
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Innervation of Recurrent Laryngeal Nerve (Inferior Laryngeal Nerve)
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Motor Innervation to all muscles of Larynx EXCEPT Cricothyroid
Sensory Innervation below Vocal Folds |
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Innervation of Internal Branch of Superior Laryngeal Nerve
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Sensory Innervation above Vocal folds
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Innervation of External Branch of Superior Laryngeal Nerve
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Motor Innervation of Cricothyroid Muscle
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Action of Thyroepiglottis Muscle:
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Widen Laryngeal Inlet
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Action of Aryepiglottis/Oblique Arytenoid Muscles:
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Close the Laryngeal Inlet
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Action of Thyroarytenoid Muscle:
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Relax Vocal Folds
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Action of Posterior Cricoarytenoid Muscle:
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Abduct Vocal Folds
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Action of Lateral Cricoarytenoid/Transverse Arytenoid Muscles:
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Adduct Vocal Folds
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Action of Cricothyroid Muscle
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Stretching and tensing of the vocal fold
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Action of Vocalis Muscle
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Regional tensing of vocal ligament
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CC
Hoarse voice (laryngitis) |
Mucous membrane of larynx becomes inflamed
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CC
2 Possible Complications during Surgery involving Larynx Area: |
1) Damage External Laryngeal Nerve - Cricothyroid cannot stretch vocal ligament on affected side = causes tiredness and hoarseness
2) Destruction of Recurrent Laryngeal Nerve: Unilateral - Voice quality is poor Bilateral - Sever respiratory distress requiring a tracheotomy |
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CC
Horner's Syndrome |
Interruption of Cervical Sympathetic Trunk
Resulting in: Ptosis due to paralysis of the superior tarsal muscle Constricted pupil Sinking of eye Redness Dryness Increase in Temp on affected side of face |
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CC
CSF leaking out of nose (CSF Rhinorrhea) |
Caused by fracture of Cribriform plate
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Contents of Meatuses In Nose:
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Sphenoethmoidal Recess (above Superior Concha) - Opening to Sphenoid Sinus
Superior Meatus (below the superior concha) - Opening to Posterior Ethmoidal Sinuses Middle Meatus (below middle concha) - Ethmoidal Infundibulum, Semilunar Hiatus, Ethmoidal Bulla Inferior Meatus (below Inferior Concha) - Opening of Nasolacrimal Duct |
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CC
Maxillary Sinus |
Ostium into middle meatus lies HIGH up on its medial wall - drains poorly by gravity!
Thus, infections do not drain well and take longer to treat. |
