Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
878 Cards in this Set
- Front
- Back
|
What are the three parts of the External Ear?
|
Auricle, External Auditory Meatus, Tympanic membrane
|
|
|
This is the rimmed part of the auricle?
|
Helix
|
|
|
This part of the auricle is a curved part internal and parallel to the helix?
|
Antihelix
|
|
|
This is the opening of the auricle leading to the external auditory meatus?
|
Concha
|
|
|
This is a prominence of the anterior border of the concha?
|
Tragus
|
|
|
The soft tissue forming the inferior part of the auricle is the?
|
Lobule
|
|
|
Extrinsic muscles of the auricle which provide movement, are innervated by which nerve?
|
Facial (CN VII)
|
|
|
Sensory to the auricle (GSA) is provided by which 4 cranial nerves?
|
5, 7, 9, 10 (as well as the cervical plexus)
|
|
|
This part of the external ear functions by conducting sound waves from the auricle to the tympanic membrane?
|
External Auditory Meatus
|
|
|
This part of the external auditory meatus (outer 1/3, inner 2/3) contains sebaceous ceruminous (wax) glands?
|
Outer 1/3 of the Canal
|
|
|
This part of the external ear serves as a boundary and innermost structure of the external auditory meatus?
|
Tympanic Membrane
|
|
|
What are the three layers of the tympanic membrane?
|
Outer-Epithelium ; Middle-Fibrous Tissue ; Inner-Mucosa
|
|
|
This part of the tympanic membrane is not secured in the tympanic sulcus and has NO fibrous layer?
|
Pars Flaccida
|
|
|
This Tympanic Membrane component is secured in the tympanic sulcus and is comprised of all three layers?
|
Pars Tensa
|
|
|
Pars Flaccida and Pars Tensa BOTH have which layers (epithelium, fibrous, mucosa, all, A and C, A and B )
|
A and C, They both have epithelium and mucosa
|
|
|
This part of the tympanic membrane is attached to the fibrous layer and produces a depression called the Umbo?
|
Handle of the Malleus
|
|
|
This structure , which lies under the pars flaccida must be avoided when draining the middle ear?
|
Chorda Tympani
|
|
|
The small space medial to the tympanic membrane is referred to as what?
|
Tympanic Cavity Proper
|
|
|
Within the tympanic cavity, the small space above the membrane is called the ?
|
Epitympanic recess
|
|
|
What inserts near the root of the handle of malleus?
|
Tensor tympani
|
|
|
The Chorda Tympani pass (medial/lateral) to the handle of the malleus and (Medial/Lateral) to the process of the incus?
|
Medial/Lateral
|
|
|
This is the term for the space above the tympanic membrane which houses the body of the incus and the head of the malleus?
|
Epitympanic recess
|
|
|
The epitympanic recess communicates with what two things anteriorly and psoteriorly?
|
Nasopharynx and Mastoid Antrum respectively
|
|
|
Mastodiditis with facial nerve palsy sould be a result of what?
|
An infection from the nasopharynx passing into the middle ear (ottis media) and then to the mastoid air cells, which is where the CN VII descends in the posterior wall of the middle ear
|
|
|
Tegmen tympani is found in which cranial bone?
|
Petrous temporal bone
|
|
|
What two things are at risk for pathology above the tegmen tympani?
|
Meninges (Meningitis) and temporal lobe (temporal lobe abscess)
|
|
|
What bone makes up the floor of the tympanic cavity?
|
Mastoid bone
|
|
|
What nerve perforates the junction of the floor and medial wall of the tympanic membrane?
|
Tympanic branch of CN 9
|
|
|
Infection spreading through the floor of the tympanic cavity could cause what?
|
Thrombosis of the internal jugular vein
|
|
|
The opening of the tensor tympani and the auditory tube are found in which wall of the tympanic cavity?
|
Anterior
|
|
|
What is located in between the openigns of the auditory tube/tensor tympani?
|
A bony shelf whose extension is the procesus cochleariformis?
|
|
|
What is the name for the structure that serves as a pulley for the tendon of tensor tympani's insertion on the malleus?
|
Processus cochleariformis
|
|
|
These fibers pierce the anterior wall below the opening of the auditory tube?
|
Postganglionic sympathetic fibers which leave the ICA on their way to the promontory on the medial wall
|
|
|
Thrombosis of the ICA results from otitis media spreading through this wall?
|
Lower part of the Anterior Wall
|
|
|
The medial wall of the tympanic cavity is also the ______ wall of the internal ear?
|
Lateral
|
|
|
What are the three elevations on the medial wall of the tympanic membrane?
|
Promontory, Prominence of facial canal, lateral semicircular canal
|
|
|
This is an anterior elevation of the medial wall caused by a basal turn of the cochlea?
|
Promontory
|
|
|
The tympanic plexus covers the promontory on the medial wall of the tympanic cavity, what fibers is it composed of?
|
CN IX, Sympathetic Fibers, and CNVII Twigs
|
|
|
Preganglionic parasympathetics of CN IX and postganglionic sympathetic fibers from the plexus on ICA leave the promontory to form THIS nerve?
|
Lesser Petrosal Nerve
|
|
|
The Lesser petrosal nerve gains contributory fibers from these two things on the medial wall?
|
PreGang. Parasympathetics of CN 9, PostGan Sympathetics from plexus of ICA
|
|
|
The prominence of the facial canal can be found on which wall, and is WHAT in relationship to the oval window (superior/inferior)?
|
Medial Wall, Superior to the Oval Window
|
|
|
An elevation on the middle ear superior to the facial canal (prominence) is what?
|
Lateral Semicircular canal
|
|
|
What are the two aperatures of the medial wall of the tympanic membrane?
|
Fenestera Vestibuli (oval window), Fenestera cochleae (round window)
|
|
|
This aperature is located posterior and inferior to the promontory?
|
Round Window (fenestra cochleae)
|
|
|
This aperature is located on the medial wall superior and posterior to the promontory?
|
Oval Window (fenestra vestibuli)
|
|
|
The footplate of the stapes covers this aperature, separating perilymph in the scala vestibuli of the inner ear with the middle ear?
|
Oval window (fenestra vestibuli)
|
|
|
The "secondary tympanic membrane" covers this aperature of the medial wall, and separates perilymph in the scala tympani of the internal ear from the middle ear cavity?
|
Round Window (fenestra cochleae)
|
|
|
Infection of the medial wall of the tympanic membrane can lead to what, as a result of it's close association of the wall with CN VII and CN VIII and the internal ear?
|
Facial Nerve Palsy, Labyrinthitis with vertigo, and deafness in one ear
|
|
|
The openin gto the mastoid antrum is located on which wall of the tympanic cavity?
|
Posterior
|
|
|
The stapedius muscle originates here, a hollow projection below the mastoid antrum opening on the posterior wall?
|
Pyramid
|
|
|
The facial nerve descends in the posterior wall and gives off two branches, what are they?
|
Nerve to the stapedius and the chorda tympani
|
|
|
Infection of the posterior wall can lead to what?
|
Mastoiditis with facial nerve palsy and/or sinus thrombosis (due to relationship between the posterior wall and the sigmoid sinus and cerebellum)
|
|
|
Bleeding from the ear and possible leakage of CSF can be indicative of what kind of injury?
|
Basilar skull fracture
|
|
|
What are the three auditory ossicles?
|
Malleus, incus, and stapes
|
|
|
The ossicles extend in a chain from the _____ wall to the _____ wall
|
Lateral to Medial
|
|
|
This part fo the malleus is in the epitympanic recess and articulates with the body of the incus?
|
Head of the malleus
|
|
|
This part of the incus articulates with the stapes?
|
Long process
|
|
|
This part of the stapes is where the stapedius muscle inserts?
|
Neck
|
|
|
What are the two labyrinth divisions of the internal ear?
|
Bony and membranous
|
|
|
What bone is the bony labyrinth found in?
|
Petrous temporal
|
|
|
The perilymph is found outside or inside the membranous labyrinth?
|
Outside (in between the bony and membranous)
|
|
|
What type of fluid is found inside the membranous labyrinth?
|
Endolymph
|
|
|
These two kinds of glands lie in the external auditory meatus?
|
Sebaceous glands and ceruminous glands
|
|
|
Sebaceous glands and ceruminous glands along with desquamated epithelial cells make up this. Along with hair it serves a protective function.
|
Cerumen (earwax)
|
|
|
This structure serves the function of converting SOUND waves to VIBRATIONS?
|
Tympanic Membrane
|
|
|
This layer of the tympanic membrane is the outer most covering?
|
Skin
|
|
|
Connective tissue layer of the tympanic membrane is lined with these fibers?
|
Collagen (Pars flaccida is absent in collagen fibers)
|
|
|
This layer of the tympanic membrane is continous with the lining of the middle ear cavity?
|
Mucosa Layer
|
|
|
How many semicircular canals of the bony labyrinth are there?
|
3 (superior, posterior, horizontal)
|
|
|
Are all the components of the membranous labyrinth continous with each other?
|
Yes
|
|
|
The widest turn of this structure of the bony labyrinth produces the promontory on the medial wall of the tympanic membrane?
|
Cochlea
|
|
|
This sense changes in the speed of angular movement in the head, and is located within each ampulla of the semicircular ducts?
|
Crista Ampullaris
|
|
|
This patch of epithelium, located within the Utricle and the Saccule, senses gravity and linear movement?
|
The Macula
|
|
|
This feature is connected to the cochlear duct (Utricle, Saccule)?
|
Saccule
|
|
|
The cochlear duct contains this, which functions as the sound receptor?
|
Organ of Corti
|
|
|
Where is endolymph reabsorbed?
|
Endolymphatic sac
|
|
|
What connects the utricle and sacculae to the endolymphatic sac?
|
Endolymphatic duct
|
|
|
What kind of cells line the semicircular ducts?
|
Simple squamous epithelium
|
|
|
The crista ampullaris is covered by an epithelium consisting of what kinds of cells?
|
Hair cells and supporting cells
|
|
|
What kinds of hair cells are there in the crista ampullaris?
|
Type 1 and type 2
|
|
|
How many cilium do the hair cells possess?
|
A single cilium, Kinocilium
|
|
|
This hair cell type are columnar and are innervated by many small synaptic endings?
|
Type 2 hair cells
|
|
|
This hair cell type are flask shaped and are enclosed in a chalice-like nerve terminal
|
Type 1
|
|
|
This gelatinous structure rides on top of the hair cells all the way up to the roof of the ampulla?
|
Cupula
|
|
|
Bending hairs TOWARDS the cilium does what to the membrane (Depolarize/Hyperpolarize)?
|
Depolarize
|
|
|
Rotation of the head will cause hairs to be bent in the same or opposite direction as the head?
|
Opposite
|
|
|
What secretes the matrix of the cupula?
|
Suporting cells
|
|
|
Instead of cupula, what do the maculae have that the crista ampullaris doesn't?
|
Otolithic membranes
|
|
|
What are otolithic membranes?
|
gelatinous layers with crystals of calcium carbonate known as otoconia
|
|
|
Are otoconia more or less dense than endolymph?
|
More dense
|
|
|
Which maculae sense vertical accelaration (utricle, sacculae, both, neither)?
|
Saccule
|
|
|
Which maculae senses horizontal acceleration (Utricle, saccule, both, neither)
|
Utricle
|
|
|
What nerve recieves sensory information from the utricle, saccule, and semicircular canals?
|
Vestibular nerve
|
|
|
The bony core of the cochlea is called what?
|
Modiolus
|
|
|
How many turns do the cochlear duct make?
|
2 and 3/4
|
|
|
What does the modiolus house?
|
The spiral ganglion of the cochlear nerve
|
|
|
This is the spiraling ridge that projects outward from the Modiolus like the thread of a screw
|
Spiral Lamina
|
|
|
What partially divides the cochlear cavity into an upper and lower part?
|
Spiral Lamina
|
|
|
These two spaces within the bony cochlea contain perilymph?
|
Scala vestibuli and scala tympani
|
|
|
This membrane separates the endolymph of the cochlear duct with the perilymph of the scala vestibuli?
|
Vestibular membrane
|
|
|
The endolymph has a high concentration of these ions (Na+, Ca2+, K+, CL-)?
|
Potassium K+
|
|
|
What separates the cochlear duct from the scala tympani?
|
Basilar membrane
|
|
|
The opening at the apex of the cochlea allows the scala tympani to be continous with the scala vestibuli, what is it called?
|
Helicotrema
|
|
|
This spans the distance from the osseous spiral lamina to the outer wall of the cochlea (basilar lamina, vestibular lamina, both, neither)
|
Both
|
|
|
The stapes fits into the oval window which is the beginning of the (scala tympani, scala vestibuli, both, neither)?
|
Scala vestibuli
|
|
|
[Word association] Round Window
|
Scala tympani
|
|
|
This feature of the middle ear cavity allows vibrations to be dissipated by bulging into the cavity?
|
Round window
|
|
|
This membrane underlies the organ of corti and is sensitive to vibrations of specific pitch?
|
Basilar membrane
|
|
|
The basilar membrane at the apex of the cochlea is sensitive to (low/high) tones?
|
Low
|
|
|
This is the lining of the outer cochlear duct?
|
Stria Vascularis
|
|
|
What feature of the stria vascularis, aside from it being stratified cuboidal epithelium, allows it to secrete endolymph?
|
Intimate contact with capillaries
|
|
|
What are the two types of hair cells located within the organ of corti?
|
Inner and Outer
|
|
|
These hair cells receive 90-95% of the afferent fibers from the cochlear nerve?
|
Inner Hair cells
|
|
|
TRUE/FALSE The hairs of the inner hair cells are thought to be imbedded in the overlying gelatinous membrane, the tectorial membrane
|
FALSE()
|
|
|
These hair cells of the organ of corti receive innervation ONLY at their bases (inner, outer, both, neither)
|
Outer
|
|
|
These hair cells have hairs embedded in the tectorial membrane (inner, outer, both, neither)
|
Outer
|
|
|
Phalangeal cells support these hair cell types nearly completely (inner, outer, both, neither)
|
Inner
|
|
|
What do the phalangeal sells send to the apex of the outer hair cells?
|
A phalangeal process to form an apical supportive plate (cuticular plate)
|
|
|
This provides a barrier between the endolymph and the intercellular spaces of the organ of corti?
|
Apical plates (formed by phalangeal cells)
|
|
|
These cells are modified phalangeal cells and border the tunnel of corti?
|
Pillar cells
|
|
|
Nuclei of pillar cells are located at their (apex, base)?
|
Base
|
|
|
This membrane contacts the hairs of the organ of corti causing them to bend upon sound vibrations?
|
Tectorial membrane
|
|
|
Potassium channels of the hair cells open when the hair cells are bent in what direction?
|
Toward the tallest stereocilia
|
|
|
Cells in this structure secrete the tectorial membrane. It is located in the inner angle of the cochlear duct closest to the Modiolus?
|
Spiral Limbus
|
|
|
The entire epithelial lining is derived from this structure? Is it endo or ectoderm?
|
Otic Placode, Ectoderm
|
|
|
What are the 4 bones of the face?
|
Nasal, Zygomatic, Maxilla, and Mandible
|
|
|
Which bones of the face are paired?
|
Nasal, zygomatic, and maxilla
|
|
|
What three things (not including itself) does the nasal bones articulate with?
|
Frontal process of the maxilla, Frontal bone, perpendicular plate of the ethmoid
|
|
|
This facial bone forms the prominence of the cheek?
|
Zygomatic
|
|
|
What three bones does the zygomatic articulate with?
|
frontal, maxillary, and temporal
|
|
|
What can be found lodged in the alveolar process of the maxilla?
|
the upper teeth
|
|
|
The infrarbital groove can be found in this bone?
|
Maxillary
|
|
|
The mental foramen can be found in what bone?
|
Mandible (bdy)
|
|
|
What are the two process of the ramus of the mandible?
|
Condylar and Coronoid
|
|
|
Which process of the madnibular ramus articulates with the temporal bone?
|
Condylar process
|
|
|
This can be found at the joining of the body and ramus of the mandible?
|
Angle of the mandible
|
|
|
True/False Muscles of facial expression lie only in the face
|
False (lie in the neck and scalp)
|
|
|
Where do all muscles of facial expression originate from during embryological development?
|
2nd pharyngeal arch
|
|
|
What nerve innervates ALL muscles of facial expression?
|
Facial nerve 7
|
|
|
What are the five MOST clinically oriented facial muscles?
|
Orbicularis Oculi, Zygomaticus Major, Orbicularis Oris, Buccinator, Platysma (Oskar the Zombie Often Bites People ??? You come up with a better one…yeah im talkin to you!)
|
|
|
This muscle surrounds the orbit and occupies the eyelids?
|
Orbicularis Oculi
|
|
|
What are the 3 parts of the orbicularis oculi?
|
orbital, palpebral, lacrimal
|
|
|
This part of the orbicularis oculi aids in the flow of tears?
|
lacrimal
|
|
|
This part of the orbicularis oculi is responsible fro involuntary closure during blinking?
|
Palpebral
|
|
|
This part of the orbicularis oculi is involved in TIGHT closure of the eye?
|
Orbital
|
|
|
Where does the zygomaticus major originate and insert into?
|
zygomatic bone to the corner of the mouth
|
|
|
What does the zygomaticus major do?
|
Pulls the corner of the mouth upward and outward, smiling and laughing
|
|
|
You are most likely using this facial muscle to express your affection
|
Orbicularis Oris (purses the lips)
|
|
|
The buccinator arises from these three things?
|
Maxilla, Mandible, and the pterygomandibular raphe
|
|
|
The duct of this gland pierces the buccinator?
|
Parotid gland
|
|
|
This muscle functions in the expression of horror and in deep sudden inspiration?
|
Platysma Muscle
|
|
|
Sensory innervation of the facial muscles comes from what?
|
Trigeminal nerve and smaller contributions from the cervical plexus via the great auricular nerve
|
|
|
Where does the facial nerve emerge from the base of the skull?
|
At the stylomastoid foramen
|
|
|
What are the two branches of the facial nerve that emerge close to the stylomastoid foramen?
|
Posterior auricular, and nerve to the posterior belly of the digastric and stylohyoid muscles
|
|
|
The facial nerve enters the parotid gland superficial to what two structures?
|
ECA and retromandibular vein
|
|
|
Within the parotid gland, what does the facial nerve divide into?
|
Upper temporofacial division and Lower cervicofacial division
|
|
|
What are the three branches of the temporofacial division?
|
Temporal, zygomatic, and buccal
|
|
|
This branch of the temporofacial division of the facial nerve supplies the muscles of the upper lip?
|
Buccal
|
|
|
The buccinator, orbicularis oris, and levator anguli oris receive innervation from this branch of the cervicofacial division?
|
Buccal
|
|
|
What are the three branches of the cervicofacial division of the facial nerve?
|
Buccal, mandibular, and cervical
|
|
|
Damage to the facial nerve at the stylomastoid process will result in what?
|
Paralysis of the ipsilateral muscles, inability to shut the eye, loss of motor limb of the corneal reflex
|
|
|
Does damage to the facial nerve result in loss of corneal sensation?
|
No it is maintained by the trigeminal nerve
|
|
|
All the division of the trigeminal contain fibers of only GSA except for which one?
|
Mandibular (has GSA and SVE fibers)
|
|
|
What are the three nerves that emerge on the face from the divisions of the trigeminal?
|
Supraorbital nerve, infraorbital nerve, mental nerve
|
|
|
Supraorbital nerve supplies what part of the face?
|
Skin of the forehead above the orbit and upper part of the conjunctiva and cornea
|
|
|
This nerve supplies sensation to the teeth of the upper jaw, lower eyelid and nose, as well as skin and mucosa of the cheek and upper lip?
|
Infraorbital nerve
|
|
|
The mental nerve is terminal branch of what?
|
The inferior alveolar nerve
|
|
|
What does the mental nerve supply sensation to?
|
Skin of the chin and lower lip
|
|
|
What arteries supply blood to the face?
|
Facial, superficial temporal, and branches of the maxillary and opthalmic
|
|
|
What is the relationship of the facial artery as it first appears in the face?
|
Anterior border of the masseter and anterior to the facial vein
|
|
|
The facial artery terminates into what, and where does it terminate?
|
Into the angular artery at the medial border of the eye
|
|
|
What is the benefit of the sinous nature of the facial artery?
|
allows for jaw movement
|
|
|
What are the four major branches of the facial artery?
|
Superior and inferior labial, lateral nasal, and angular
|
|
|
The superficial temporal artery is one of the terminal branches of what?
|
ECA
|
|
|
What ascends along with the superficial temporal artery to the temple?
|
Auriculotemporal nerve
|
|
|
This artery, given off by the superficial temporal artery in the parotid gland supplies the aprotid gland, duct and adjacent skin?
|
Transverse facial artery
|
|
|
The transverse facial artery runs superior or inferior to the parotid duct?
|
Superior
|
|
|
What joins the facial vein below the mandible to form the common facial vein?
|
Anterior branch of the retromandibular vein
|
|
|
The common facial vein drains into what?
|
IJV
|
|
|
What two veins come together to form the retromandibular vein?
|
Superficial temporal and the maxillary (within the parotid gland)
|
|
|
What does the posterior retromandibular vein join to eventually become the external jugular vein?
|
Posterior auricular vein
|
|
|
Can infection of the skin and face spread to the cavernous and other intracranial sinuses?
|
Yes (due to the communication between the facial veins and the intracranial venous sinuses)
|
|
|
What region lies between the ramus of the mandible and the external ear?
|
Parotid Region
|
|
|
What border of the parotid gland does the parotid duct emerge from?
|
Anterior border
|
|
|
Parotid duct courses over/under the masseter muscle?
|
Over
|
|
|
Does the parotid duct pass superficial or deep to the buccal fat pad?
|
deep
|
|
|
What border the superficial parotid gland superiorly?
|
Lower edge of the zygomatic arch
|
|
|
What borders the superficial parotid gland inferiorly?
|
Angle of the mandible
|
|
|
What borders the superficial parotid gland posteriorly?
|
External acoustic meatus
|
|
|
What relationship is the carotid sheath to the deep parotid?
|
Medial
|
|
|
Which fascia is the fibrous capsule of the parotid gland derived from?
|
Investing layer of the deep cervical fascia
|
|
|
The deep layer of the fibrous capsule that surrounds the parotid forms this thickening?
|
Stylomandibular ligament
|
|
|
The stylomandibular ligament separates the parotid gland from what?
|
The submandibular gland
|
|
|
describe the development of the parotid gland?
|
Starts where the parotid duct opens in the oral cavity > migrates posteriorly > encloses the facial nerve > grows medially to create a deep part
|
|
|
What is the most superficial structure of the parotid gland?
|
Facial nerve
|
|
|
What are the three structures found within the parotid gland?
|
Facial nerve, retromandibular vein, and ECA
|
|
|
What structure is the deepest one within the parotid gland?
|
ECA
|
|
|
Parasympathetic secretomotor innervation to the parotid gland is provided by which nerve? Which nerve do these fibers hitchhike?
|
Glossopharyngeal; hitchhike on the auriculotemporal
|
|
|
Sensory innervation of the parotid gland is provided by which nerve?
|
Auriculotemporal (V2)
|
|
|
Parotid fascia is innervated by what?
|
Great auricular nerve from the cervical plexus
|
|
|
Which nerve must be located in a parotidectomy?
|
The facial nerve
|
|
|
Due to the parotid gland's close location with WHAT bony structure is pain worsened during chewing while infected with mumps?
|
Ramus of the mandible
|
|
|
Parotid gland disease is associated with pain from the auricle, external acoustic meatus, temple, and TMJ due to these structures sharing sensory innervation from what nerve?
|
Auriculotemporal
|
|
|
The infratemporal fossa is located superficial or deep to the ramus of the mandible?
|
deep
|
|
|
These three structures lie superficial to the infratemporal fossa?
|
Masseter Muscle, Zygomatic Arch, and Temporalis Muscle
|
|
|
Where does the masseter muscle arise from?
|
Anterior 2/3 of the zygomatic arch and infratemporal surface of the maxilla
|
|
|
Where does the masseter insert?
|
Ramus of the mandible
|
|
|
What lies deep to the masseter muscle?
|
Temporalis muscle and the ramus of the mandible
|
|
|
The zygomatic arch is formed by what two bones?
|
temporal (zygomatic process) and zygomatic (temporal process)
|
|
|
Where does the temporalis muscle arise from?
|
Temporal fossa and the deep surface of the temporal fascia
|
|
|
Where does the temporalis insert?
|
Coronoid process of the mandible and the anterior border of the mandible
|
|
|
What is the lateral boundary of the infratemporal fossa?
|
Medial surface of the ramus of the mandible
|
|
|
What is the medial boundary of the infratemporal fossa?
|
Lateral pterygoid plate
|
|
|
What is the anterior boundary of the infratemporal fossa?
|
posterior aspect of the maxilla
|
|
|
What is the posterior boundary of the infratemporal fossa?
|
Tympanic plate and styloid process of the temporal bone
|
|
|
The infratemporal surface of the greater wing of the sphenoid and the squamous temporal form the (roof/floor) of the infratemporal fossa?
|
Roof
|
|
|
The floor of the infratemporal fossa is formed by what?
|
The attachment of the medial pterygoid muscle to the mandible
|
|
|
This feature located in the medial surface of the ramus of the mandible is the opening through which the inferior alveolar nerve passes?
|
Mandibular foramen (into the mandibular canal)
|
|
|
This is the triangular piece of bone that overlies the mandibular foramen antero-medially?
|
Lingula
|
|
|
What attaches to the lingula?
|
Sphenomandibular ligament
|
|
|
The mylohyoid groove transmits this nerve to the floor of the mouth?
|
Mylohyoid nerve (V3)
|
|
|
This bony structure is a thin, wing shaped protrusion posterior to the pterygomaxillary fissure?
|
Lateral pterygoid plate
|
|
|
What is the hook-like process of the medial pterygoid plate?
|
The hamulus
|
|
|
This is the vertical opening formed by the divergence of the maxilla from the lateral pterygoid plate?
|
Pterygomaxillary fissure
|
|
|
The pterygomaxillary fissure connects the infratemporal fossa with this fossa?
|
pterygopalatine fossa
|
|
|
This is a feature located on the posterior aspect of the maxilla and opens into the floor of the orbit?
|
Inferior orbital fissure
|
|
|
This is the concave part of the temporal bone lying anterior to the styloid process and forming the posterior wall of the infratemporal fossa?
|
Tympanic plate
|
|
|
This opening is located in the roof of the infratemporal fossa and transmits the mandibular division of the trigeminal and lesser petrosal nerves?
|
Foramen Ovale
|
|
|
This is a small opening in the roof of the infratemporal fossa which is posterior to the foramen ovale?
|
Foramen spinosum
|
|
|
What does the foramen spinosum transmit?
|
middle meningeal artery and meningeal branch of V3
|
|
|
This bony protrusion can be found posterior to the foramen spinosum and in the roof of the infratemporal fossa?
|
Spine of the sphenoid
|
|
|
What originates at the spine of the sphenoid?
|
Sphenomandibular ligament
|
|
|
This network of veins is located superficial in the infratemporal fossa in close association with the pterygoid muscles?
|
Pterygoid venous plexus
|
|
|
What does the pterygoid venous plexus connect?
|
Facial vein with the cavernous sinus
|
|
|
The pterygoid venous plexus drains into what vein?
|
Maxillary vein
|
|
|
Why is the pterygoid venous plexus clinically relevant?
|
provides conduit for the spread of infection to multiple sites
|
|
|
This is the larger terminal branch of the ECA and is found in the infratemporal fossa?
|
Maxillary artery
|
|
|
where does the maxillary artery arise?
|
Behind the neck of the mandible
|
|
|
How does the maxillary artery enter the infrtemporal fossa?
|
between the neck of the mandible and the sphenomandibular ligament
|
|
|
What is the relationship between the maxillary artery and the lateral pterygoid muscle?
|
Usually lateral (superficial) but sometimes deep
|
|
|
How does the maxillary artery exit the infratemporal fossa?
|
anteriorly through the pterygomaxillary fissure
|
|
|
From posterior to anterior, how can the maxillary artery be divided?
|
Mandibular, pterygoid, and palatine
|
|
|
What two branches come off the mandibular part of the maxillary?
|
Middle meningeal and Inferior alveolar artery
|
|
|
This artery arises from the medial aspect of the mandibular part of the maxillary artery?
|
Middle meningeal artery
|
|
|
This artery arises from the lateral part of the mandibular part of the maxillary artery
|
Inferior alveolar artery
|
|
|
This artery passes between the two roots of the auriculotemporal nerve?
|
middle meningeal artery
|
|
|
What does the middle meningeal artery supply blood to?
|
Meninges
|
|
|
This artery supplies blood to the teeth and gums of the lower jaw and the skin of the chin?
|
Inferior alveolar artery
|
|
|
The inferior alveolar artery passes through what foramen and canal, and where does it exit this canal?
|
mandibular foramen and canal, exits at the mental foramen
|
|
|
What branches come off the pterygoid part of the maxillary artery?
|
Masseteric, deep temporal, buccal, and pterygoid
|
|
|
The masseteric artery courses with the masseteric nerve deep to the tendon of the temporalis and enters the (superficial or deep) surface of the Masseter?
|
Deep
|
|
|
These arteries pass between the temporalis muscles and the pericranium?
|
deep temporal arteries
|
|
|
This artery runs obliquely forward to the lateral surface of the buccinator?
|
Buccal artery
|
|
|
What are the four terminal branches of the maxillary artery?
|
Posterior superior alveolar artery, Infraorbital artery, Sphenopalatine artery, Descending palatine artery
|
|
|
This artery supplies blood to the molar and premolar teeth?
|
Posterior Superior Alveolar artery
|
|
|
Through what does the infraorbital artery exit the infratemporal fossa?
|
Inferior orbital fissure
|
|
|
What does the infraorbital artery supply?
|
upper incisor and canine teeth and mucous membrane of the maxillary sinus; Facial tissue over the maxilla
|
|
|
Which artery passes thorugh the pterygopalatine fossa and exits through an opening on its medial wall, the sphenopalatine foramen?
|
Sphenopalatine artery
|
|
|
What does the sphenopalatine artery supply?
|
The sinuses of the nasal cavity
|
|
|
This canal connects the pterygopalatine fossa to the palate?
|
pterygopalatine canal
|
|
|
Within the pterygopalatine canal, what does the descnding palatine artery bifurcate into?
|
Greater and lesser palatine arteries
|
|
|
Lesser palatine and greater palatine supply what respectively?
|
Soft palate and hard palate
|
|
|
The upper head of the lateral pterygoid muscle arises from what?
|
infratemporal surface of the greater wing of the sphenoid bone
|
|
|
The lower head of the lateral pterygoid muscle arises from what?
|
Lateral surface of the lateral pterygoid plate
|
|
|
Where do fibers of the lateral pterygoid muscle converge and insert?
|
pterygoid fossa, a depression on the neck of the mandible
|
|
|
The deep head of the medial pterygoid muscle arises from the medial surface of this bony feature?
|
Lateral pterygoid plate
|
|
|
Where does the smaller superficial head of the medial pterygoid muscle arise from?
|
maxillary tuberosity and pyramidal process of the palatine bone
|
|
|
Where does the medial pterygoid muscle insert?
|
medial surface of the angle of the mandible
|
|
|
What two muscles acting together form a muscular sling around the angle of the mandible?
|
Medial pterygoid muscle and the masseter
|
|
|
This is the only muscle in the infratemporal fossa that is innervated by nerve fibers that arise from the main trunk of V3
|
Medial pterygoid muscle
|
|
|
Where does the large sensory trunk and small motor trunk unite to form the main trunk of V3?
|
just after traversing the foramen ovale in the roof of the infratemporal fossa
|
|
|
After the main trunk of V3 gives off smaller divisions it branches into two parts; anterior and posterior. Which is Chiefly Sensory?
|
Posterior
|
|
|
What are the two branches off the MAIN trunk of V3?
|
Meningeal nerve and Medial pterygoid nerve
|
|
|
Meningeal nerve carries what kind of nerve fibers?
|
GSA
|
|
|
The medial pterygoid nerve carries nerve fibers of what type?
|
SVE
|
|
|
What muscles does the medial pterygoid nerve innervate ?
|
medial pterygoid, tensor veli palatini, and tensor tympani
|
|
|
What is the only sensory branch of the anterior division of V3?
|
Buccal Nerve (GSA)
|
|
|
The Buccal nerve passes between the heads of which muscle?
|
Lateral pterygoid muscle
|
|
|
The Buccal nerve supplies what?
|
Skin and mucosa of the cheek
|
|
|
What are the 4 branches off the anterior division of the V3?
|
Buccal nerve, Deep temporal nerves, masseteric nerve, nerve to the lateral pterygoid
|
|
|
This nerve ascends vertically to enter the DEEP surface of the temporalis muscle?
|
Deep temporal nerve (SVE)
|
|
|
This nerve traverses the mandibular notch and enters the deep surface of the masseter muscle?
|
Masseteric nerve (SVE)
|
|
|
Where do all the motor nerves of the anterior division of V3 enter the infratemporal fossa?
|
between the skull and the upper head of the lateral pterygoid muscle
|
|
|
What are the three branches of the posterior division of V3?
|
Auriculotemporal (GSA), Lingual (GSA), and Inferior Alveolar Nerve (GSA)
|
|
|
This nerve passes between the sphenomandibular ligament and the neck of the mandible?
|
Auriculotemporal nerve
|
|
|
The auriculotemporal nerve ascends (posterior/anterior) to the ear along with the superficial temporal artery?
|
Anterior
|
|
|
Which nerve has two roots and encircles the middle meningeal artery?
|
Auriculotemporal nerve
|
|
|
This nerve conveys sensory information from the auricle, temporal region, temporomandibular joint, and parotid gland?
|
Auriculotemporal nerve
|
|
|
This nerve runs medial to the lateral pterygoid muscle on the surface of the tensor veli palatini?
|
Auriculotemporal nerve
|
|
|
This nerve enters the infratemporal fossa in between the bottom of the lateral pterygoid and the top of th emedial pterygoid muscle?
|
Lingual nerve; inferior alveolar nerve
|
|
|
During its desccent medial to the lateral pterygoid muscle, the lingual is in what relationship to the inferior alveolar nerve?
|
Anterior and medial
|
|
|
The lingual is joined by this nerve in the deep part of the infratemporal fossa?
|
Chorda tympani
|
|
|
This nerve conveys general sensation from the anterior 2/3 of the tongue?
|
Lingual
|
|
|
This nerve supplies sensation to the teeth and gums of the lower jaw while within the mandibular canal.
|
Inferior alveolar nerve
|
|
|
The inferior alveolar nerve exits the madibular canal at the mental foramen and becomes this nerve?
|
Mental nerve
|
|
|
What does the mental nerve supply sensation to?
|
chin and lower lip
|
|
|
The inferior alveolar nerve gives off this branch just before entering the mandibular canal?
|
Nerve to the mylohyoid (SVE)
|
|
|
What is the ONLY motor branch of the posterior division of V3?
|
Nerve to the mylohyoid (SVE)
|
|
|
This autonomic ganglia lies just below the foramen ovale on the main trunk of V3?
|
Ottic Ganglion
|
|
|
What synapse on the otic ganglion?
|
Lesser petrosal (preganglionic GVE of CN9)
|
|
|
Postganglionic parasympathetic fibers of the otic ganglion course with this nerve to innervate the parotid gland?
|
Auriculotemporal Nerve of V3
|
|
|
What is the function of the ottic ganglion?
|
Parotid gland salivation (secretomotor)
|
|
|
This nerve arises from the facial nerve just before it exits the skull through the stylomastoid foramen?
|
Chorda Tympani
|
|
|
Where does the chorda tympani nerve exit the skull?
|
petrotympanic fissure
|
|
|
Where does the preganglionic parasympathetic fibers of the chorda tympani synapse?
|
Submandibular ganglion
|
|
|
What do the postganglionic parasympathetic fibers from the submandibular ganglion innervate?
|
Submandibular and sublingual glands
|
|
|
SVA fibers of the chorda tympani, whose peripheral processes end in taste buds, have their cell bodies in what ganglion?
|
Geniculate
|
|
|
What is TMJ syndrome caused by?
|
Stress related use of TMJ such as teeth grinding (can cause facial pain)
|
|
|
These two structures form the superior surface of the TMJ?
|
Mandibular fossa and articular tubercle
|
|
|
This superior surface structure of the TMJ is a concave depression in the squamous portion of the temporal bone?
|
Mandibular fossa
|
|
|
This convex structure of the superior surface of the TMJ is located anterior to the mandibular fossa?
|
Articular tubercle
|
|
|
This forms the inferior surface of the TMJ?
|
Head of the mandible
|
|
|
The articular surfaces of the TMJ are lined with what?
|
Fibrocartilage
|
|
|
Loose fibers can be found in the (upper or lower part of the TMJ)?
|
Upper
|
|
|
Tight fibers are found in the (upper or lower part of the TMJ)
|
Lower
|
|
|
The loose and tight fibers in the TMJ function as what?
|
Limit the forward and backward movement of the articular disc with mandibular movement
|
|
|
How many lateral and medial ligaments maintain the head of the mandible in the mandibular fossa?
|
One lateral and 2 medial
|
|
|
This cranial nerve is the major sensory nerve of the face and innervates muscles derived from the 1st pharyngeal arch?
|
Trigeminal
|
|
|
What fiber types are carried by the trigeminal nerve?
|
SVE and GSA
|
|
|
What does the motor component of the trigeminal innervate?
|
Muscles of mastication, tensor tympani, tensor veli palatini, mylohyoid, and anterior belly of the digastric
|
|
|
Where does the trigeminal nerve emerge?
|
from the anterolateral portion of the pons
|
|
|
What division of the trigeminal exits the skull at the superior orbital fissure?
|
Opthalmic
|
|
|
Where does the maxillary division exit the skull?
|
Foramen rotundum
|
|
|
Where does the mandibular division exit the skull?
|
At the foramen ovale
|
|
|
What is the most superior and medial division of the trigeminal?
|
Opthalmic
|
|
|
The opthalmic division contains fibers of (GSA, SVE, both, neither)?
|
GSA
|
|
|
What are the three main branches of the opthalmic division?
|
Nasociliary, frontal, lacrimal
|
|
|
This nerve courses along the upper border of the lateral rectus muscle?
|
Lacrimal
|
|
|
What does the lacrimal nerve receive from the maxillary nerve?
|
postganglionic parasympathetics from the pterygopslstine ganglion via a communicating branch of the maxillary, the zygomatico-temporal
|
|
|
What does the lacrimal nerve innervate?
|
lacrimal gland and lateral part of the upper eyelid
|
|
|
This nerve passes on the levator palpebrae superioris muscle?
|
Frontal nerve
|
|
|
What does the frontal nerve divide into?
|
The supraorbital and supratrochlear nerves
|
|
|
This nerve innervates sensation of the skin and conjuctiva of the upper eyelid as well as th lateral forehead and the scalp as far superiorly as the vertex?
|
Supraorbital Nerve
|
|
|
This nerve innervates sensation of the skin of the medial side of the upper eyelid and the root of the nose and the adjacent forehead?
|
Supratrochlear nerve
|
|
|
What is the path of the nasociliary nerve in relationship to the optic nerve?
|
Initially lateral > crosess over > runs obliquely to the medial wall
|
|
|
What does the nasociliary give off as it crosses over the optic nerve?
|
Long ciliary nerves
|
|
|
What are the two terminal branches of the nasociliary nerve?
|
Anterior ethmoidal and infratrochlear nerves
|
|
|
After leaving the anterior ethmoidal foramen, the anterior ethmoidal nerve takes a course in the anterior cranial fossa over the cribiform plate and then through it into the nasal cavity to finally end on the face as what nerve?
|
External Nasal Branch
|
|
|
What nerves provide sensory information from the cornea?
|
Long ciliary nerves
|
|
|
Long ciliary nerves act as a taci bringing what to the dilator pupillae muscle of the iris?
|
Motor sympathetic innervation
|
|
|
What nerve gives sensation on the skin of the lower half of the nose
|
Anterior ethmoidal nerve
|
|
|
This nerve provides sensory innervation of the lacrimal sac, skin of the eylids medially and skin on the side of the nose?
|
Infratrochlear nerve
|
|
|
Most of the branches of V2 aris ein what fossa?
|
Pterygopalatine fossa
|
|
|
Where does the terminal branch of V2 leave the pterygopalatine fossa?
|
inferior orbital fissure (infraorbital nerve)
|
|
|
What is the only branch of the main trunk of the maxillary nerve that doesn’t originate from the pterygopalatine fossa?
|
Meningeal
|
|
|
What artery does the meningeal nerve course with?
|
Middle meningeal nerve
|
|
|
These connecting branches go through the pterygopalatine ganglion without synapsing through them?
|
Ganglionic branches
|
|
|
The zygomatic nerve leaves the pterygopalatine fossa through what opening?
|
Inferior orbital fissure
|
|
|
What dos the zygomatic nerve divide into while on the lateral wall of the orbit?
|
zygomaticotemporal and zygomaticofacial nerves
|
|
|
The zygomatiotemporal and zygomaticofacial give sensory innervation to what part of the face?
|
Lateral cheek and temple
|
|
|
The posterior superior alveolar nerve leaves the pterygopalatine fossa thorugh what ?
|
Pterygomaxillary fissure
|
|
|
posterior superior alveolar nerve gives sensory innervation to the?
|
uper molars and maxillary sinus
|
|
|
What is the terminal branch of V2?
|
Infraorbital nerve
|
|
|
Within the infraorbital canal, what arises from the infraorbital nerve?
|
middle and anterior superior alveolar nerves
|
|
|
What nerves, when affeceted, give people the misconception of a toothache when they actually have sinusitis?
|
Superior alveolar branches of the maxillary and infraorbital
|
|
|
This is the only division of the trigeminal that contains both motor and sensory fibers?
|
Mandibular division
|
|
|
What do the SVE fibers of the mandibular division of the trigeminal supply?
|
Muscles of mastication, tensor tympani, tensor veli palatini, mylohyoid, and anterior belly of the digastric
|
|
|
What is the only branch of the anterior division of the mandibular that is sensory?
|
Buccal nerve
|
|
|
The infratemporal surface of the maxilla (tuberosity) is what wall of the pterygopalatine fossa?
|
Anterior
|
|
|
The pterygoid process of the sphenoid is which wall of the pterygopalatine fossa?
|
Posterior
|
|
|
The perpendicular plate of the palatine is which wall of the pterygopalatine fossa?
|
Medial
|
|
|
The pterygomaxillary fissure is which wll of the pterygopalatine fossa?
|
Lateral
|
|
|
The sphenopalatine foramen is located on which wall of the pterygopalatine fossa
|
medial
|
|
|
Both the pterygoid canal and the pharyngeal canal are located on this wall of the pterygopalatine fossa
|
Posterior
|
|
|
This opening is located on the anterior wall of the pterygopalatine fossa?
|
Inferior orbital fissure
|
|
|
What are the contents of the pterygopalatine fossa?
|
maxillary artery/vein; pterygopalatine ganglion; maxillary nerve
|
|
|
The pterygopalatine ganglion contains neurons of what type?
|
Parasympathetic
|
|
|
Parasympathetic fibers heading into the pterygopalatine ganglion come from what nerves?
|
Greater petrosal nerve and the nerve of the pterygoid canal
|
|
|
Sympathetics from the plexus on the ICA and sensory fibers from the maxillary nerve (do/do not) synapse in the ganglion?
|
Do Not
|
|
|
This nerve arises from the pterygopalatine ganglion and courses through the sphenopalatine foramen to supply the nasal cavity?
|
Nasopaltine nerve
|
|
|
The nasopalatine nerve provides sensory innervation to what?
|
Nasal septum and oral mucosa
|
|
|
This nerve innervates the mucosa of the hard palate and originates from the pterygopalatine fossa?
|
Greater palatine nerve
|
|
|
This nerve innervates the soft palate and originates from the pterygopalatine fossa?
|
Lesser palatine nerve
|
|
|
This nerve innervates the mucosa of the nasopharynx and originates in the pterygopalatine fossa?
|
Pharyngeal branch
|
|
|
A patient comes in with left sided anasthesia of the face, along with loss of the corneal reflex. When asked to speak his mandible moves to the left side. What is most likely his problem?
|
Left sided trigeminal nerve lesion
|
|
|
What is trigeminal neuralgia or Tic Douloureux?
|
a condition of the sensory part of V, affects areas of distribution of the maxillary and/or mandibular branches, Very painful
|
|
|
What is a common viral infection affecting the trigeminal nerve?
|
Herpes Zoster
|
|
|
Where do the SVE fibers of the facial nerve originate from (where are there cell bodies)?
|
Facial motor nucleus of the pons
|
|
|
What nucleus do axons fo the facial nucleus loop around on their way out of the pons?
|
Abducens nucleus
|
|
|
Where do axons of the facial motor nucleus exit the pons?
|
cerebellopontine angle (as motor root of CN VII)
|
|
|
Which pharangyeal arch do the fibers of the facial motor nucleus innervate?
|
2nd
|
|
|
GVE fibers of the facial nerve originate in this nucleus?
|
Superior salivary nucleus
|
|
|
GVE fibers of the facial nerve exit the brainstem at the cerebellopontine angle as part of which nerve?
|
Intermediate nerve
|
|
|
What is the spatial relationchip for the three nerves that exit the cerebellpontine angle?
|
From lateral to medial (VIII, Intermediate, motor of VII)
|
|
|
What do the GVE fibers of VII do?
|
Provide parasympathetic innervation for the submandibular, sublingual and lacrimal glands
|
|
|
This fiber component of VII carries taste information from the anterior 2/3 of the tongue?
|
SVA
|
|
|
Where are the cell bodies of the SVA fbers of VII located?
|
geniculate ganglion
|
|
|
Processes carrying SVA fibers from the geniculate body enter the brain with which nerve, and where do they terminate?
|
intermediate nerve, and terminate in solitary nucleus
|
|
|
This fiber type of VII provides cutaneous sensation from a small region near the external auditory meatus?
|
GSA fibers
|
|
|
Processes carrying GSA fibers from the geniculate body enter the brain with which nerve, and where do they terminate?
|
intermediate nerve and terminate at the spinal V nucleus
|
|
|
After exiting the cerebellopontine angle, what course does motor/intermediate of VII take?
|
laterally in posterior cranial fossa into the internal auditory meatus with CNVIII
|
|
|
Where do the motor root and intermediate root of VII merge to form the facial nerve?
|
At the distal end of the internal auditory meatus
|
|
|
This canal is located abov the bony vestibule of the inner ear and houses one of the nerves that traverses the internal auditory meatus?
|
Facial canal
|
|
|
Where is the geniculate ganglion located in relationshiop to the tympanic cavity?
|
Medial wall (within the facial canal)
|
|
|
What is the name of the sensory ganglion associated with facial nerve VII?
|
geniculate ganglion
|
|
|
Geniculate ganglion contains cell bodies of this fiber type (GSA, SVA, both, neither)?
|
Both
|
|
|
Does the geniculate ganglion have any synapses within it?
|
No
|
|
|
What two changes occur to the facial nerve at the site of the geniculate ganglion?
|
greater petrosal branches from it; it bends posteriorly abruptly
|
|
|
Which wall does the facial nerve descend after the geniculate ganglion (in tympanic cavity)?
|
Posterior
|
|
|
What two nerves does the facial nerve give ff during it's descent down the posterior wall of the tympanic cavity?
|
nerve to stapedius and chorda tympani
|
|
|
Where does the facial nerve exit the skull?
|
stylomastoid foramen
|
|
|
what is the relationship between the retromandibular vein and the eca to the facial nerve within the parotid gland?
|
Facial is superficial to the both
|
|
|
Sve fibers that leave the facial nerve in the tympanic cavity innervate what?
|
The stapedius muscle
|
|
|
SVE fibers leaving the facial just below the stylomastoid foramen form what?
|
posterior auricular branch (occipitalis muscle) and nerves to the posterior digastric and stylohyoid muscles
|
|
|
What does the greater petrosal nerve do?
|
parasympathetic input to the lacrimal gland
|
|
|
After leaving the geniculate ganglion and traveling in the groove for the greater petrosal, what nerve joins the greater petrosal at the foramen lacerum?
|
Deep petrosal nerve
|
|
|
what nerve is created by the joining of the greater petrosal and the deep petrosal?
|
nerve of the pterygoid canal
|
|
|
What kinds of fiber does the deep petrosal nerve have?
|
postganglionic sympathetic fibers from the superior cervical ganglion
|
|
|
The nerve of the pterygoid canal has fibers of what (parasympathetic, sympathetic, both, neither)
|
Both (preganglionic parasympathetic of VII and postganglionic sympathetic from ICA)
|
|
|
Which fibers of the nerve of the pterygoid canal synapse on the pterygopalatine ganglion (sympathetic, parasympathetic, both, neither)?
|
parasympathetic (preganglionic; the sympathetics are postganglionic)
|
|
|
Where do the GVE fibers for the submandibular/sublingual enter after coursing along the facial past the geniculate?
|
The Chorda Tympani
|
|
|
What is the relationship of the chorda tympani and the handle of the malleus?
|
It courses medial to it
|
|
|
How does the chorda tympani get to the infratemporal fossa
|
Passes through the petrotympanic fissure
|
|
|
What nerve does the chorda tympani join within the infratemporal fossa?
|
Lingual nerve
|
|
|
GVE fibers from the chorda tympani continue with the lingual and synapse where (in the oral cavity)?
|
Submandibular ganglion
|
|
|
Taste receptors on the anterior 2/3 of the tongue receive innervation from what fiber types and from what nerve?
|
SVA fibers of CN VII
|
|
|
What is the path for the fibers from the taste receptors on the anterior 2/3 of tongue?
|
lingual > chorda tympani > Facial nerve > Intermediate nerve > solitary tract > solitary nucleus
|
|
|
What is the pathway for fibers that innervate cutaneous regions near the external auditory meatus?
|
Facial nerve > intermediate nerve > spinal V tract > spinal V nucleus
|
|
|
What is the key clinical features of lesions of the facial nerve?
|
paralysis or weakness of facial musculature
|
|
|
What are the possible locations for lower motor neuron damage commonly referred to peripheral facial nerve palsy?
|
motor root of CN VII, motor nucleus of VII (lower pons), ventral lower pons (where SVE fbers exit the brainstem)
|
|
|
Peripheral facial nerve palsy is characterized by paresis of what?
|
Entire ipsilateral face
|
|
|
A patient comes in and you notice his right eyebrow and corner of mouth is drooped, and right corneal reflex is absent, what is a likely problem?
|
Lower motor neuron lesion of R facial nerve (peripheral facial nerve palsy)
|
|
|
If a patient has ipsilateral hyperacusis, where is the lesion?
|
facial nerve PROXIMAL to the nerve to the stapedius (sounds percieved louder)
|
|
|
If a lesion occurs in the facial nerve proximal to the origin of the chorda tympani, aside from other clinical features, what two things would the patient have?
|
ipsilateral reduced salivary secretion and ipsilateral impaired taste sensation (anterior 2/3)
|
|
|
Ipsilateral dry eye occurs with facial nerve lesions proximal to the origin of what nerve?
|
Greater petrosal nerve
|
|
|
What exacerbates ipsilateral dry eye (impaired lacrimal secretion) with peripheral facial nerve palsy?
|
Inability to close the eye
|
|
|
A common disorder of the facial nerve that leads to a gradual unilateral impairment of all divisions is called what?
|
Bell's Palsy
|
|
|
A lesion of the corticobulbar system will cause what kind of dysfunction?
|
Upper motor neuron facial palsy or voluntary central facial palsy
|
|
|
These are the principal upper motor neurons for the lower motor neurons (SVE and GSE) of several cranial nerves?
|
Corticobulbar fibers
|
|
|
Where are corticobulbar neurons located?
|
in the face area of the primary motor cortex
|
|
|
Corticobulbar fibers DO NOT innervate GSE neurons in which 3 cranial nerve nuclei?
|
3,4,6
|
|
|
What four nuclei do corticobulbar fibers terminate on directly?
|
LMNs of motor nucleus V, motor nucleus VII, nucleus ambiguus, hypoglossal nucleus
|
|
|
Do unilateral lesions of the corticobulbar system impair the function of muscles innervated by motor nucleus V, nucleus ambiguus, or hypoglossal nucleus?
|
No (corticobulbar input to these three nuclei is bilateral)
|
|
|
A unilateral lesion of the corticobulbar system produces paralysis of the muscles of what?
|
contralateral LOWER face
|
|
|
SVE neurons that innervate muscles of the upper part of the face receive (unilateral, bilateral) input from the corticobulbar system?
|
Bilateral (Upper face)
|
|
|
SVE neurons that innervate muscles of the lower part of the face receive (crossed, uncrossed, both, neither) corticobulbar fibers ?
|
Crossed only
|
|
|
What two things remain intact in voluntary central facial palsy than in peripheral facial palsy?
|
corneal reflex and voluntary movements of the upper face
|
|
|
What is the indication that input to the facial motor nucleus for emotional facial movements DOES NOT involve corticobulbar system?
|
Retained emotionally motivated facial movements in voluntary central facial palsy
|
|
|
Emotional facial palsy is characterized as what?
|
paresis of lower facial muscles in response to emotional stimuli with NO impairment of voluntary facial expression
|
|
|
Where are the associated lesions for emotional facial palsy?
|
R frontal lobe; Anterior thalamus; Anterior limb of internal capsule
|
|
|
What are the four fiber types of facial nerve?
|
SVE, GVE, SVA, GSA
|
|
|
Cell body location of the SVE fibers of the facial nerve?
|
Facial motor nucleus
|
|
|
What fiber type is found in the superior salivatory nucleus (VII)?
|
GVE
|
|
|
Superior salivatory nucleus provides innervation to what
|
Lacrimal gland (via greater petrosal); Submadibular and sublingual (via chorda tympani)
|
|
|
These two bones form the roof of the orbit?
|
Orbital plate of the frontal; Lesser wing of the sphenoid
|
|
|
These two bones form the lateral wall of the orbit?
|
zygomatic and greater wing of the sphenoid
|
|
|
These three bones form the floor of the orbit?
|
maxilla, zygomatic, and palatine
|
|
|
These four bones make up the medial wall of the orbit?
|
maxilla, lacrimal, ethmoid, sphenoid
|
|
|
This orbital opening lies in the junction of the roof and medial wall b/w the two roots of the lesser wing of the sphenoid
|
Optic canal
|
|
|
This orbital opening is bounded by the greater and lesser wings of the sphenoid?
|
Superior orbital fissure
|
|
|
What are the three principle orbital openings?
|
optic canal, superior orbital fissure, inferior orbital fissure
|
|
|
What are the three fascia of the orbit?
|
Periorbita, bulbar sheath, muscular fasciae
|
|
|
The periorbita is what?
|
Periosteum fo the bones surrounding the walls of the orbit
|
|
|
Which fascia surrounds the lacrimal gland?
|
Periorbita
|
|
|
The bulbar sheath covers all of the eyeball except for what?
|
The cornea
|
|
|
Which fascia of the orbit give off fibrous expansions that act as check ligaments?
|
Muscular fascia
|
|
|
The medial check ligament extends from what muscle and to what bone?
|
medial rectus to the lacrimal bone
|
|
|
The lateral check ligament extends from what muscle to what bone?
|
Lateral rectus to the zygomatic
|
|
|
What originates from the common tendinous ring in the orbit?
|
The four rectus muscles
|
|
|
What four nerves does the common tendinous ring encircle?
|
optic, oculomotor, abducens, nasociliary
|
|
|
What two structures pass through the optic canal?
|
Optic nerve and opthalmic artery
|
|
|
What structures pass through the superior orbital fissure THROUGH the common tendinous ring?
|
oculomotor, abducens, nasociliary
|
|
|
What structures pass through the superior orbital fissure ABOVE the common tendinous ring?
|
Frontal nerve, Lacrimal nerve, Trochlear nerve, Superior opthalmic vein
|
|
|
What structures pass through the inferior orbital fissure?
|
Inferior opthalmic vein, infraorbital nerve, zygomatic branches of V2
|
|
|
What are the three motor nerves that supply muscles of the orbit?
|
Oculomotor, trochlear, Abducens
|
|
|
Preganglionic parasympathetics found in the oculomotor synapse in what ganglion?
|
Ciliary ganglion
|
|
|
Describe the course of CNIII?
|
interpeduncular fossa > lateral wall of cavernous sinus > divides into superior and inferior > superior orbital fissure
|
|
|
Which division of CNIII supplies the levator palpebrae and superior rectus?
|
Superior Division
|
|
|
Which muscles does the inferior division of the oculomotor nerve supply?
|
medial rectus, inferior rectus, inferior oblique
|
|
|
What is the only cranial nerve that emerges from the brain on the dorsal surface?
|
Trochlear
|
|
|
What nerve innervates the superior oblique muscle?
|
Trochlear
|
|
|
The abducens innervates which muscle?
|
lateral rectus muscle
|
|
|
What do parasympathetic fibers from the oculomotor nerve supply?
|
sphincter pupillae and ciliary muscles
|
|
|
What do parasympathetic fibers from the facial nerve supply?
|
Lacrimal gland
|
|
|
What do the sympathetic fibers in the orbit supply?
|
Dilator pupillae muscles
|
|
|
Downward and abducted eye position due to the unopposed action of the superior oblique and lateral rectus can be a result of damage to which nerve?
|
Oculomotor
|
|
|
What is strabismus?
|
inability to direct both eyes toward the same object…will produce diplopia
|
|
|
Damage to the oculomotor and paralysis of this muscle will lead to ptosis (lid droop)?
|
Levator palpebrae
|
|
|
Dilation of the pupil, in oculomotor damage, is a result of what?
|
Loss of parasympathetic innervation of the pupillary constrictors
|
|
|
Extorsion of the affected eye due to the unopposed action of the inferior oblique can be caused by damage to what nerve?
|
Trochlear (paralysis of superior oblique)
|
|
|
A patient comes in tilting his head to the left. He says that he does this in order to prevent a vertical double vision that occurs. Where is the possible damage?
|
R trochlear nerve
|
|
|
paralysis of the lateral rectus muscle resulting in the inability to abduct the affected eye beyond the midline of gaze is a result of damage to what nerve?
|
Abducens
|
|
|
A patient comes in with his right eye deviated medially, he complains of medial strabismus and horizontal diplopia. Where is his damage?
|
R abducens
|
|
|
What are the sensory nerves found in the orbit?
|
Optic, opthalmic and maxillary
|
|
|
This sensory nerve in the orbit is formed by axons of the ganglion cells of the retina?
|
Optic nerve
|
|
|
What artery enters the optic nerve halfway along its length?
|
Central artery of the retina
|
|
|
How many ocular muscles are there?
|
7
|
|
|
Which is the only ocular muscle that doesn't move the eyeball, but rather elevates the upper eyelid?
|
Levator palpebrae superioris
|
|
|
What innervates the superior rectus?
|
Superior division of the oculomotor
|
|
|
What innervates the inferior rectus?
|
inferior division of the oculomotor
|
|
|
What innervates the medial rectus?
|
inferior division of the oculomotor
|
|
|
What innervates the lateral rectus?
|
Abducens nerve
|
|
|
What innervates the superior oblique?
|
trochlear nerve
|
|
|
what innervates the inferior oblique?
|
inferior division of the oculomotor
|
|
|
What innervates the levator palpebrae superioris?
|
superior division of oculomotor and sympathetics
|
|
|
Levator palpebrae superioris has (striated, smooth muscle, both, neither)?
|
Both
|
|
|
Which muscles adduct the globe?
|
superior rectus, inferior rectus, and medial rectus
|
|
|
Which muscles abduct the globe?
|
lateral rectus, superior oblique, inferior oblique
|
|
|
Which muscles elevate the globe?
|
superior rectus, inferior oblique
|
|
|
Which muscles depress the globe?
|
superior oblique and inferior rectus
|
|
|
What are the three distinct actions of the accomodation reflex?
|
convergence of the eyes, accomodation, constriction of the pupil
|
|
|
The eye at rest, are the suspensory ligaments tensed or relaxed?
|
Tensed, and the lens is flattened
|
|
|
How does near vision change the shape of the lens to more rounded?
|
Ciliary nerves innervating ciliary muscles causes these muslce to contract and pull the ciliary processes toward the central axis thereby decreasing the tension of the suspensory ligaments and causing the lens to revert back to its rounded shape
|
|
|
What does the short ciliary nerves innervate?
|
ciliary muscle and sphincter pupillae muscle of the iris
|
|
|
Miosis is caused by contraction of which muscle?
|
sphincter pupillae muscle
|
|
|
What is the main artery supplying the orbital structures?
|
opthalmic artery
|
|
|
The opthalmic artery arises from what artery?
|
ICA
|
|
|
Within the orbit, the opthalmic artery crosses the optic nerve from what side to what side?
|
lateral to medial (over the nerve)
|
|
|
The opthalmic terminates in the medial corner of the eye into these two arteries?
|
dorsal nasal and supratrochlear
|
|
|
This artery branches off the opthalmic and is the sole supply to the retina?
|
central artery of the retina
|
|
|
What are the principla veins of the orbit and the eyeball?
|
superior and inferior opthalmic (drain into the cavernous sinus and infraorbital vein)
|
|
|
What are the clinical application of the opthalmic veins?
|
they connect the facial vein with cavernous sinus and provide a path for spread of infection to intracranial spaces
|
|
|
This property of a soundwave is the number of oscillations occuring at a particular point in space per unit time?
|
Frequency
|
|
|
This is the distance between two consecutive pressure peaks on the waveform?
|
Wavelength
|
|
|
This is the difference between the mean pressure and the peak pressure?
|
Amplitude
|
|
|
The ear is most sensitive in what range of frequencies?
|
3 - 5 kHz
|
|
|
Sound travles faster or slower in water than in air?
|
Faster (4 times)
|
|
|
Loss of the auricle can result in what defecits?
|
Compromised sound localization and some hearing loss at the frequency between 2-5 kHz
|
|
|
Is there a loss of neergy during the transfer between the external and middle ears?
|
No loss of energy
|
|
|
Vibration of the tympanic membrane is transmitted to the (oval window or round window)
|
Directly to the oval window through the three bony ossicles
|
|
|
What two factors contribute to the pressure amplification seen in the middle ear?
|
Reduction of surface area from the tympanic membrane to the oval window; Lever and piston action of ossicles (malleus and incus = lever, stapes = piston)
|
|
|
What is the final pressure amplification in the middle ear?
|
18:01
|
|
|
What is the purpose of the stapedius and tensor tympani in sound recognition?
|
Attenuate ossicle movement to decrease the loudness of sound
|
|
|
Why gunshots still incredible loud, even though the stapedius and tensor tympani are attenuating the ossicles?
|
Due to the reflex latency being long
|
|
|
Otosclerosis is a result of what?
|
Bony accumulations around the stapes which limits ossicle movement
|
|
|
A normal response in a Webers Test would be percieved as what?
|
No lateralization, sound coming from the center of the head
|
|
|
In unilateral conductive hearing loss, sound is perceived as lateralized to which ear (deaf, non-deaf)
|
Deaf Ear
|
|
|
In Uniateral sensorineural loss (hair cells or auditory nerve damage) tone will be hear in the (deaf ear, non deaf ear)
|
Non-deaf ear
|
|
|
Frequency and loudness discrimination is a process that begins in what part of the ear?
|
Inner ear
|
|
|
What is the order of pressure wave transmission in the internal ear?
|
Oval window > scala vestibuli> scala tympani > round window
|
|
|
The movement of this membrane results in the stimulation of the hair cells of the organ of Corti?
|
Basilar membrane
|
|
|
Where (base/apex) is the basilar membrane more narrow and stiff?
|
Base
|
|
|
In the cochlear duct, the location of the basilar membrane that is displaced the greatest due to the traveling wave is a result of what PROPERTY of the sound?
|
its frequency
|
|
|
Increased firing of action potentials for a high frequency sound is found at the (base/apex) of the cochlear duct?
|
Base
|
|
|
What are the two mechanisms of HIGH freqeuncy discrimination?
|
The place theory and the tuning process
|
|
|
The tuning process is mediated by the (inner hair cells, outer hair cells, both, neither)?
|
Outer hair cells
|
|
|
In the temporal theory of frequency discrimination, how does the CNS determine frequency?
|
Using the time between bursts of action potentials in inner hair cells
|
|
|
What two ways is amplitude encoded (loudness)
|
increasing the firing rate of the stimulated hair cells, and increaseing recruitment of surroinding hair cells
|
|
|
People with shooter notch have what kind of defecit?
|
Defecit at specific frequency due to hair cell damage, clinically difficult to recognize speech of certain sounds
|
|
|
What are psychoacoustics?
|
subjective experiences described by a listener related to measurable physical properties of sound (Loudness, Pitch, Timbre)
|
|
|
The minimum sound pressure level necessary for perception is termed what?
|
Detection level
|
|
|
The human ear has the (lowest/highest) detection threshold between sounds of 3-5kHZ?
|
Lowest (easier to detect, more sensitive)
|
|
|
What frequency of sounds has the lowest detection level?
|
4kHz
|
|
|
This is the subjective experience of the amount of energy in a sound?
|
Loudness
|
|
|
Percieved loudness varies depending on what aspect of sound?
|
Frequency
|
|
|
What is the subjective experience of the frequency of the sound?
|
Pitch
|
|
|
This is the quality of sound that distinguishes one sound from another of the SAME pitch and volume?
|
Timbre
|
|
|
Striking the A key of the piano is a sound composed of a SINGLE frequency (T/F)?
|
False(it is made up of many frequencies)
|
|
|
What system informs the CNS about the position of the head in space?
|
The vestibular system
|
|
|
What are the two types of head movements that are detected by the vestibular system?
|
Linear acceleration and angular acceleration
|
|
|
Hair cells of this monitor the position of the head with respect to gravity AND linear acceleration?
|
Maculae (utricle and saccule)
|
|
|
Hair cells of this monitor angular or rotational acceleration of the head?
|
Crista Ampullaris (semicircular ducts and canals)
|
|
|
This nerve transmits impulses from the vestibular system to the CNS?
|
vestibular nerve
|
|
|
What is the difference in the hair cell sensitivity between auditory hair cells and vestibular hair cells?
|
Auditory respond to high frequency changes in air pressure; Vestibular respond to slow displacement of otoconia/fluid of the semicircular ducts
|
|
|
What is the benefit of having a basal firing rate of 100 action potentials/sec in the vestibular nerve fibers?
|
Higher sensitivity/lower thresholds
|
|
|
Depolarization of the vestibular hair cells occurs with deflection of cilia ______ (toward /away) kinocilium?
|
Toward
|
|
|
A deflection of cilia toward intermediate positions will result in what kind of change in the action potentials?
|
Intermediate change (hyper/depolarization)
|
|
|
What kind of change in the action potential firing rate will occur from deflection perpendicular to a line from the shortest cilia to the kinocilium?
|
No change
|
|
|
This is a patch of sensory epithelium containing hair cells on the utricle and saccule?
|
Macula
|
|
|
The macula which is oriented parrallel to the floor can be found in this otolith organ?
|
Utricle
|
|
|
The macula which is oriented perpendicular to the ground in a sagittal orientation can be found in this otolith organ?
|
Saccule
|
|
|
This is a gelatinous sheet that covers the macula and has cilia of the hair cells embedded in it?
|
Otolithic membrane
|
|
|
These are calcium carbonate crystals embedded in the otolithic membrane?
|
Otoconia
|
|
|
Otoconia make the otolithic membrane (more/less) dense than the endolymph and hair cells?
|
More
|
|
|
Which moves with the head, and doesn't lag behind (otolithic membrane, hair cells)?
|
Hair cells
|
|
|
This curved ridge found in the utricle and saccule determine the orientation of the hair cells?
|
Striola
|
|
|
In the utricle, hair cell kinocilia are aligned (toward/ away from ) the striola?
|
Toward
|
|
|
In the saccule, the hair cell kinocilia are aligned (toward/away from ) the striola?
|
Away from
|
|
|
When deprived of other sensory input, what is the threshold for head tilt?
|
30 degrees
|
|
|
What is the positional relationship between the three semicircular canals with one another?
|
They are all perpendicular to one another
|
|
|
This is the thickened crest on the inner surface of the Ampulla of the semicircular ducts that contain sensory epithelium?
|
Crista Ampullaris
|
|
|
What covers each crist ampullaris?
|
Cupula
|
|
|
True/False The cupula completely blocks the passage of endolymph within the ampulla?
|
TRUE()
|
|
|
During what kind of acceleration (linear/angular) does the inertia of the endolymph create a force on the cupula resulting in the bending of hair cells?
|
Angular
|
|
|
What does alcohol do to the density of the cupula?
|
It reduces it
|
|
|
What is affected faster by alcohol, endolymph or cupula?
|
Cupula
|
|
|
What produces endolymph?
|
stria vascularis
|
|
|
Alcohol results in unequal forces displacing the cupula which allows what kind of acceleration to bend hair cells, and be interpreted differently?
|
linear acceleration will be interpreted as angular acceleration
|
|
|
True/False During angular acceleration, hair cells from each of the complimentary ducts are depolarized at the same time?
|
False(depolarization occurs in heair cells of one duct, and hyperpolarization occurs in the complimentary duct)
|
|
|
During rotation of the head to the left, the cupula moves in what direction?
|
Right (due to the lagging endolymph)
|
|
|
During rotation of the head to the left, depolarization occurs in hair cells of which side?
|
Left
|
|
|
During rotation of the head to the left, hyperpolarization occurs in hair cells of which side?
|
Right
|
|
|
During rotation of the head to the left, which sided vestibular nerve has an increase in the firing rate of action potentials?
|
Left
|
|
|
What is the threshold of detecting angular motion?
|
.1 degrees/sec^2
|
|
|
Under normal physiological condtions (short duration accelerations) what is the firing rate of the vestibular nerve proportional to?
|
Angular velocity
|
|
|
During prolonged angular acceleration, what is the firing rate of the vestibular nerve proportional to?
|
Angular acceleration (percieved incorrectly as CONSTANT angular velocity)
|
|
|
What is the purpose of the vestibulo-ocular revflex?
|
to allow gaze to remain fixed on one point in space during vertical and horizontal movements
|
|
|
The slow phase of eye movement in the direction opposite that of the head is reffered to as what?
|
Slow eye movement
|
|
|
Snapping back of the eye rapidly when it reaches the edge of the orbit is termed what?
|
A saccade
|
|
|
The repetetive slow and quick movements of the eye during prolonged rotation is termed what?
|
Nystagmus
|
|
|
In which direction is nystagmus normally named?
|
In the direction of rotation (fast eye movement)
|
|
|
In the afferent limb of the VOR, the cells in the vestibular nuclei project to the extraocular cranial motor nuclei via what tract?
|
MLF
|
|
|
Where are the nuclei for the efferent limb of the VOR?
|
Extraocular cranial nerve motor nuclei (CN 3, 4, 6)
|
|
|
During inititation of rotation to the RIGHT, the VR produced will result in ______ of the right eye and ________ fo the left eye (abduction/adduction)?
|
adduction of the right, abduction of the left
|
|
|
During steady state rotation, what happens to the endolymph with respect to the motion of the head?
|
it reaches the same velocity (no longer deflects the cupula)
|
|
|
Throughout barany chair stimulation, in which direction is the nystagmus (opposite or same as perceived rotation)
|
Same as the direction of percieved rotation
|
|
|
During cessation of the barany chair (to the right), what is the perceived rotation?
|
To the left
|
|
|
Why does the patient perceive rotation in the correct direction when the Barany Chair stimualtion occurs in the LIGHT?
|
Because of optokinetic nystagmus, regulated by visual pathways
|
|
|
Lack of VOR is highly indicative of brain stem injury during what clinical exam?
|
Doll's eye maneuver (VOR test)
|
|
|
What will result from a unilateral labyrinthectomy?
|
tilting of the head and body to the side of the damage
|
|
|
decrease blood supply to somatic muscle (parasympathetic or sympathetic)
|
parasympathetic
|
|
|
slow heart reat (parasympathetic or sympathetic)
|
parasympathetic
|
|
|
constric pupil (parasympathetic or sympathetic)
|
parasympathetic
|
|
|
Parasympathetic is often called craniosacral outflow because?
|
transmitted by cranial and sacral (S2-S4) nerves
|
|
|
What are the effector tissues for parasympathetic innervation?
|
smoth muscle, cardiac muscle, and glands
|
|
|
In the thorax, abdomen and pelvis, where are the postganglionic cell bodies located?
|
un-named autonomic ganglia WITHIN the wall of effector tissue (vs the head and neck)
|
|
|
Are the postganglionic cell bodies of parasympathetics of the head and neck located within the effectro tissue?
|
NO
|
|
|
Which postganglionic axons are longer? (head and neck ; thorax, abdomne and pelvis)?
|
Head and Neck
|
|
|
What three nerves carry parasympathetics in the head and neck?
|
3,7,9
|
|
|
What are the 4 parasympathetic gamglion for the head and neck?
|
ciliary, otic, pterygopalatine, submandibular (COPS)
|
|
|
Which nerves innervate the specific parasympathetic ganglion of the head and neck?
|
3 innervates ciliary, 9 innervates otic, 7 innervates pterygopalatine and submandibular)
|
|
|
In most cases, which nerve do the parasympathetics hitch-hike on due to it'as broad distribution in the head and neck region?
|
CN V
|
|
|
Are there any parasympathetic functions of CN V?
|
NO
|
|
|
What two smooth muscles of the eye are effector tissues for parasympathetics?
|
sphincter pupillae and ciliary muscle
|
|
|
Which muscle constricts the pupil?
|
sphincter pupillae
|
|
|
Which muscle relaxes the suspensory ligaments of the eye to accommodate for near-vision?
|
ciliary muscle
|
|
|
Secretomotor innervation of the parotid gland is carried out by parasympathetics from this nerve?
|
CN 9
|
|
|
Where are the preganglionic parasympathetic cell bodies for cranial nerve 9 located?
|
Inferior salivatory nucleus (upper medulla)
|
|
|
What path do the preganglionic fibers leaving the inferior salivatory nucleu take to get to the Otic ganglion?
|
CN 9 > tympanic nerve> tympanic plexus > lesser petrosal
|
|
|
Postganglionic parasympathetic fibers from the Otic ganglion hitch-hike on what nerve in order to reach the parotid?
|
Auriculotemporal nerve (posterior divison of V3)
|
|
|
The lesser petrosal nerve carries (parasympathetic, sympathetic, both, neither)
|
Both (remember the sympathetics it gets from the tympanic plexus on the promontory)
|
|
|
Where are the preganglionic parasympathetic cell bodies for cranial nerve 7?
|
superior salivatory nucleus
|
|
|
The parasympathetics of CN 7 leave the brainstem in what nerve?
|
intermediate nerve
|
|
|
What is the path for the preganglionic parasympathetics to the lacrimal gland?
|
superior salivatory nucleus > intermediate nerve > facial nerve > greater petrosal > nerve to the pterygopalatine canal > pterygopalatine ganglion > hitch-hike CN V2 then CN V1 then lacrimal nerve > lacrimal gland
|
|
|
What is the path for the preganglionic parasympathetics to the sublingual and submandibular glands?
|
superior salivatory nucleus > intermediate nerve > facial nerve > chorda tympani > Lingual taxi > submandibular ganglion > Lingual taxi >glands
|
|
|
Chorda tympani contains (GVE, SVA, both, neither)?
|
Both (SVA from anterior 2/3 of tongue)
|
|
|
ipsilateral impairment of lacrimation AND salivation can be due to a lesion (proximal or distal ) to the geniculate ganglion of VII?
|
Proximal
|
|
|
What impairment will result for a lesion of VII distal to the geniculate ganglion?
|
Impairment of salivation but persistance of lacrimation
|
|
|
The deep petrosal nerve donates what kinds of fibers to the greater petrosal to form the nerve of the pterygoid canal?
|
Postganglionic sympathetics
|
|
|
Where are the preganglionic parasympathetic cell bodies located for CN III?
|
Edinger-Westphal (GVE nucleus in the midbrain)
|
|
|
What is the pathway for parasympathetic innervation of the ciliary muscles?
|
Edinger-Westphal > CN 3 > inferior ramus of CN 3 > ciliary ganglion > short ciliary nerve > muscle
|
|
|
Loss of pupillary light reflex and accomodation, or a fully dilated pupil can be a sign of damage to which nerve?
|
ipsilateral CN 3
|
|
|
Where are the preganglionic sympathetic cell bodies for innervation of the head located?
|
intermediolateral cell column of T1 - T4
|
|
|
Where are the postganglionic cell bodies found for sympathetic innervation of the head?
|
superior cervical ganglion
|
|
|
What are the postganglionic sympathetic nerves of the head?
|
internal and external carotid nerves (sympathetic plexus around these two arteries)
|
|
|
What are the effector tissues for sympathetics of the head?
|
glands and smooth muscle of blood vessels
|
|
|
Postganglionic cell bodies for segmental sympathetic innervation of sweat glands and smooth muscles of the head are located where?
|
superior, middle, and inferior cervical ganglion
|
|
|
What are the dermatome levels assosicated with the superior, middle, and inferior cervical ganglion?
|
C1-C4 (superior), C5-C6 (middle), C7-C8 (inferior)
|
|
|
Sympathetics leaving the internal carotid plexus and then going to the superior ramus of CN III are going to what muscle?
|
Levator palpebrae smooth muscle
|
|
|
What is the path that postganglionic sympathetics take from the internal carotid plexus to the Dilator pupillae muscles?
|
internal carotid plexus > opthalmic artery plexus > nasociliary nerve > long ciliary nerve
|
|
|
What is the smooth muscle portion of the levator palpebrae called?
|
Superior tarsal muscle
|
|
|
What are the effector tissues for sympathetic innervation of the eye/orbit?
|
dilator pupillae of the iris, superior tarsal muscle
|
|
|
What are the clinical signs and symptomps of Horners?
|
pseudoptosis, redness, enophthalmos, miosis, dryness
|
|
|
Which symptom of horners is sinking of the eyball into the orbit?
|
Enophthalmos
|
|
|
What can you lesion to produce ipsilateral horners syndrome?
|
descending autonomics, intermediolateral cell columns of T1-T4, T1-T4 ventral roots, T1-T4 spinal nerves, cervical sympathetic trunk, superior cervical ganglion
|
|
|
Movement of the stapes causes displacement at the (oval/round window)?
|
Oval window (scala vestibuli)
|
|
|
What property of the sound wave determines the amount of displacement of the basilar membrane?
|
Amplitude
|
|
|
What part of the basilar membrane is most sensitive to high frequency sound (Base/apex)?
|
Base
|
|
|
Axons of bipolar neurons of what form the cochlear nerve?
|
Spiral ganglion
|
|
|
Spiral ganglion consists of what kind of nerve fibers (SVE, SSA, GSE, SVA)?
|
SSA
|
|
|
Cochlear nerve enters the brainstem where?
|
At the cerebellopontine angle lateral to the ICP
|
|
|
The cochlear nerve terminates in what two things?
|
Dorsal and Ventral cochlear nuclei
|
|
|
Where are the two cochlear nuclei located?
|
Lateral surface of the ICP in the Upper Medulla
|
|
|
Are both dorsal and ventral cochlear nuclei innervated by each cochlear nerve on the same side?
|
Yes
|
|
|
A tonotopic map can be found in the cochlear nuclei that corresponds to the basilar membrane, where would you find representation of nerve fibers (in the nuclei) from the apex of the basilar membrane (Ventral or Dorsal nuclei)?
|
Ventral (Apex of basilar membrane is sensitive to LOW frequency)
|
|
|
How many pathways are formed by the axons of the cochlear nuclei through the pontine tegmentum?
|
2 main pathways (dorsal acoustic stria, Ventral acoustic stria)
|
|
|
Fibers in the lateral leminiscus are from which cochlear nuclei (dorsal, ventral, both, neither)
|
Both (via dorsal and ventral acoustic stria)
|
|
|
Crossing auditory fibers form this structure found in the ventral part of the pontine tegmentum?
|
Trapezoid Body
|
|
|
Axons of the ventral acoustic stria send fibers to the contralateral lateral leminiscus and also send collaterals here, on both sides?
|
Superior olivary complex
|
|
|
Clusters of small nuclei located adjacent to the trapezoid body in the pontine tegmentum is called what (it recieves auditory info…)?
|
Superior olivary complex
|
|
|
Individual neurons in the superior olivary complex receive information from which ear (ipsilateral, contralateral, both, neither ear)?
|
Both (via ventral acoustic stria)
|
|
|
Neurons in the Superior olivary complex use binaural information (from both ears) to detect these TWO differences in the incoming sound, which gives us info on the Spatial localization of sounds?
|
Intesity and time of arrival of the sound
|
|
|
Axons of neurons in the Superior Olivary complex ascend in (ipsilateral, contralateral, both) lateral leminiscus?
|
Both
|
|
|
This is an ascending auditory pathway found in the pons and the lower midbrain?
|
Lateral Leminiscus
|
|
|
Information ascending each lateral leminiscus comes from (ipsilateral ear, contralateral ear, binaural, neither ear)?
|
Binaural (both ears)
|
|
|
What is the most prominent location of the nucleus of the lateral leminiscus in the brainstem?
|
At the level of the isthmus along the course of the lateral leminiscus
|
|
|
What is the site of termination of the lateral leminiscus?
|
Inferior Colliculus
|
|
|
The purpose of this small cluster of nuclei is the spatial localization of sounds?
|
Superior olivary nucleus
|
|
|
Inferior colliculus recieves input from where?
|
ipsilateral lateral leminiscus AND crossing fibers from the opposite IC
|
|
|
Axons of neurons in the inferior colliculus form what?
|
Brachium of the inferior colliculus
|
|
|
Axons of the brachium of the inferior colliculus terminate ipsilaterally where?
|
Medial geniculate body of the thalamus
|
|
|
Axons of what course in the internal capsule?
|
Medial Geniculate Body
|
|
|
Auditory radiations, formed by the axons of the MGB in the internal capsule project where?
|
Ipsilateral primary auditory cortex
|
|
|
Where is the primary auditory cortex located?
|
Transvers Gyri of Heschl in the temporal lobe
|
|
|
This is involved in higher order auditory functions such as recognition and interpretation of auditory information, including speech?
|
Auditory Association Cortex
|
|
|
The auditory association cortex recieves input from what?
|
Primary auditory cortex
|
|
|
The superior olivary complex gives rise to efferent fibers of the vestibulocochlear nerve that are called what?
|
Olivocochlear bundle
|
|
|
Selective attention of certain sound frequencies and inhibition of others is a function of what?
|
Efferent Auditory pathway
|
|
|
What is tinnitus?
|
Noise (ringing, humming) in the ears
|
|
|
defects in conductive mechanisms in the external or middle ear is what kind of deafness?
|
Conductive deafness
|
|
|
Defects in the production or transmission of the auditory neural signal is what type of deafness?
|
Sensorineural deafness
|
|
|
What is the deafness called, if defects are found in the auditory pathway ABOVE the cochlear nuclei?
|
Central deafness
|
|
|
Why is central deafness rare?
|
Ascending pathway above the cochlear nuclei is binaural
|
|
|
Middle ear infection might result in what kind of deafness?
|
Conductive
|
|
|
Abnormal production of endolymph in the membranous labyrinth is found in this disease?
|
Meniere's
|
|
|
A tumor of the schwann cells of the vestibular nerve at the cerebellopontine angle is called what?
|
Acoustic Neuroma
|
|
|
Utricle and saccule have sensory receptor regions called what?
|
Macula
|
|
|
Hair cells of the macula (utricle/saccuel) project cilia into what membrane?
|
otolithic membrane
|
|
|
What kinds of meovement of the head will alter the firing rate of the hair cells in macula?
|
tilting and linear acceleration
|
|
|
The anterior semicircular duct forms a "complimentary pair" with which duct?
|
Posterior on the other side
|
|
|
Rotation of the head to the right increases the firing of afferents in the (right horizontal, left horizontal)?
|
Right horizontal (decreases action potential firing in the left)
|
|
|
This part of the vestibular system detects rotation of the head and is important in reflex eye movemetns (saccule, utricle, semicircular ducts)?
|
Semicircular ducts
|
|
|
This nerve is formed by axons of the bipolar nerves that innervate the hair cells of the macula and the cristae ampullaris?
|
Vestibular nerve
|
|
|
Where does the vestibular nerve enter the brainstem?
|
cerebellopontine angle
|
|
|
True/False ALL fibers of the vestibular nerve terminate on the vestibular nuclei?
|
FALSE (some go to the ipsilateral cerebellum)
|
|
|
How many vestibular nuclei are there?
|
4 (superior, inferiror, lateral, and medial)
|
|
|
What are the 3 MOST importanrt connections of the vestibular nuclei?
|
spinal cord, cranial nerves that control eye movements, cerebellum
|
|
|
Projections to what structure, from the vestibular nuclei are important in maintenance of posture and equilibrium?
|
Spinal Cord
|
|
|
This descending tract projects ipsilaterally to all levels of the spinal cord and courses in the anterior funiculus AND participates in the "righting reflex"?
|
LVST
|
|
|
This descending tract controls neck movements and stabilizes the head and projects bilaterally to the cervical spinal cord within the MLF?
|
MVST
|
|
|
Connections of the vestibular nuclei with this is important in reflexive eye movements in order to stabilize the visual field?
|
Extraocular nuclei
|
|
|
Vestibulo-ocular fibers from the vestibular nuclei ascend in this composite fiber bundle to terminate in the nuclei of CN 3,4,6?
|
MLF
|
|
|
The vestibular nuclei contributes these kinds of fibers to the MLF (ascending, descending, both, neither)
|
Both
|
|
|
Rotation to the right will cause contraction of which eye muscles?
|
Right medial rectus (adductor), Left lateral rectus (abductor)
|
|
|
This nerve innervates the medial rectus (eye)?
|
Occulomotor
|
|
|
This nerve innervates the lateral rectus (eye)?
|
Abducens
|
|
|
When tracking a moving object by rotating your head, it becomes nessecary for you to cancel the reflexive movements of the eye, connection between these two structures funtion in this inhibition?
|
Vestibular nuclei and cerebellum (also provide for cerebellar control of posture and balance)
|
|
|
Efferent vestibular fibers which excite hair cells of cristae and macula are important for what?
|
Increasing the dynamic range of detection
|
|
|
A unilateral lesion of the vestibular system will cause the eyes, limbs and body to veer toward the (unlesioned side, lesioned side)?
|
Lesioned side
|
|
|
Vertigo, nystagmus, and past-pointing are just some of the clinical signs of dysfuntion of this system?
|
Vestibular system
|
|
|
This vestibular dysfunction may be caused by displacement of otoconia from the utricle into the semicircular ducts?
|
Benign paroxysmal positional vertigo
|
|
|
If normal, injecting cold/warm water into the external ear will or will not cause nystagmus?
|
Will
|
|
|
A patient in the prone position will have nystagmus of the opposite side if what temperature water is injectd (warm, cold)
|
Cold (COWS)
|
|
|
Absence of the VOR is indicative of a lesion here?
|
Brainstem
|
|
|
The space in between the stria medullaris acoustica and the decussation of the trochlear nerve, on the Dorsal aspect of the midbrain defines the boundary of this?
|
The Pons
|
|
|
What are the boundaries of the Pons on the ventral aspect?
|
Inferior pontine sulcus and superior pontine sulcus
|
|
|
This is an elevation of the dorsal aspect of the pons on each side of the midline just rostral to the stria medullaris acoustica?
|
The facial colliculus
|
|
|
This is the membrane that forms the rostral part of the roof of the 4th ventricle?
|
Superior Medullary Velum
|
|
|
This peduncle is the most larteral, and originates on the ventral pons?
|
Middle cerebelar peduncle
|
|
|
This cranial nerve exits the lower pons at the inferior pontine sulcus close to the pyramid in line with CNXII?
|
Abducens (VI)
|
|
|
This cranial nerve emerges in the lower pons at the cerebellopontine angle and divides into a motor root and an intermediate nerve?
|
CNVII
|
|
|
This cranial nerve emerges from the mid-pons at the junction of the middle cerebellar peduncle and the transverse fibers of the basilar pons?
|
CNV
|
|
|
What is the dorsal portion of the pons called?
|
Pontine tegmentum
|
|
|
What is the ventral portion of the pons called?
|
Basilar pons
|
|
|
Wat two things constitute the roof of the pons?
|
Cerebellum and the superior medullary velum
|
|
|
What SPACE lies between the roof of the pons and the pontine tegmentum?
|
4th ventricle
|
|
|
Longitudinal fiber bundles in the basilar pons are derived from what structure in the brain?
|
Cerebral Cortex
|
|
|
These fibers within the basilar pons project to the spinal cord via pyramids?
|
Corticospinal Fibers
|
|
|
These fibers within the basilar portion of the pons are derived from the motor cortex and constitute the upper motor neuron pathway for cranial nerve motor nuclei?
|
Corticobulbar Fibers
|
|
|
These fibers are derived from the 4 lobes and descend ipsilaterally and synapse on pontine nuclei within the basilar pons?
|
Corticopontine Fibers
|
|
|
The axons of these neurons within the basilar pons form the transverse fibers of pons (pontocerebellar fibers)
|
Pontine Nuclei
|
|
|
These fibers cross and form the contralateral middle cerebellar peduncle, and are part of the system by which the cortex influences the contralateral cerebellum
|
Pontocerebellar fibers
|
|
|
This GSE cell group is located medial to the sulcus limitans closest to the midline in the lower pons?
|
Abducens nucleus
|
|
|
CN 6 innervates what muscle?
|
Lateral rectus muscle
|
|
|
This SVE cell group located in the lower pons is medial to the sulcus limitans and its position is comparable to the nucleus ambiguus of the medulla?
|
Facial motor nucleus
|
|
|
What is the area called where axons from the facial motor nucleus bend dorsally around CN VI?
|
Internal Genu of VI
|
|
|
The axons of this nucleus located in the lower pons innervate the stapedius, posterior digastric, and stylohyoid?
|
Facial motor nucleus
|
|
|
The vestibular nuclei and spinal V nucleus and tract are (lateral/medial) to the sulcus limitans in the lower pons?
|
Lateral
|
|
|
This nucleus in the lower pons has nuerons of SSA fiber component?
|
Vestibular nuclei
|
|
|
This structure is located ventral to the motor nucleus of CNII in the lower pons, and is associated with the auditory system?
|
Superior Olivary Complex
|
|
|
This band of auditory relay fibers can be located in the ventral tegmentum?
|
Trapezoid body
|
|
|
This tract rotates upon entry into the pons from the medulla,to extend horizontally….dont slip!!
|
Medial Leminiscus
|
|
|
These tracts are located at the lateral edge of the medial leminiscus?
|
Spinothalamic tracts
|
|
|
This structure in the lower pons is located on each side of the midline (retaining its original position) and is ventral to the internal genu of 7?
|
MLF
|
|
|
This fiber tract is located between CN VI and CNVII fibers in the middle tegmentum and contains both ascending and descending fibers
|
Central Tegmental Tract
|
|
|
This GSA nucleus in the middle pons is lateral to the CN V nerve?
|
Principle sensory nucleus of V
|
|
|
What sensory modalities does principle sensory nucleus of V convey?
|
Tactile and pressure sensations from the face
|
|
|
This SVE nucleus is located medial to CN V in the pontine tegmentum?
|
Motor nucleus of V
|
|
|
This tract/nucleus duo is located In the middle pons at the border of tegmentum with the lateral wall of the fourth ventricle?
|
Mesencephalic tract and nucleus of V
|
|
|
What kind of neurons are found in the mesencephalic nucleus?
|
pseudounipolar neurons
|
|
|
What is the function of the mesencephalic nucleus and tract of V?
|
unconscious proprioception for the face (jaw jerk reflex)
|
|
|
This is the auditory relay tract that begins in the middle pons, and is lateral to the STT?
|
Lateral Leminiscus
|
|
|
What forms the roof of the pons in the middle pons level?
|
Superior medullary velum
|
|
|
What forms the roof of the pons at the lower pons level?
|
Cerebellum
|
|
|
These crossing fibers are found in the superior medullary velum at the level of the isthmus?
|
CN IV
|
|
|
What muscle does CN 4 innervate?
|
Superior Oblique Muscles
|
|
|
These pigmented cells located at the upper pons control cortical activation (focus our attention)?
|
Locus Ceruleus
|
|
|
What nuerotransmitter do locus ceruleus use?
|
NE norepinephrine
|
|
|
This peduncle's fibers decussate at the level of the upper pons in the ventral tegmentum?
|
Superior Cerebellar Peduncle
|
|
|
This tract in the upper pons is EXTERNAL to the superior cerebelar peduncle and is an auditory relay fiber tract?
|
Lateral Leminiscus
|
|
|
The intermediate nerve contains fiber types of (GVE, SVA, Both, neither)
|
Both
|
|
|
Which part of cranial nerve VII (intermediate nerve or motor nerve) gives GVE innervation of the lacrimal, subingual and submandibular glands?
|
Intermediate
|
|
|
Where do axons of the principle nucleus of V project to?
|
Thalamus
|
|
|
What type of sensation does the mesencephalic nucleus of V give?
|
Tactile - afferent limb of "jaw jerk" reflex
|
|
|
Neuron cell bodies of the "jaw jerk" reflex are found where?
|
Mesencephalic tract and nucleus of V (NOT trigeminal ganglion)
|
|
|
Where does the central process of the mesencephalic nucleus of V give off collaterals to?
|
Motor nucleus of V (contract muscles of jaw)
|
|
|
What is the pathway of the sensory limb of the corneal reflex?
|
long ciliary > nasociliary > CN V > trigeminal ganglion > trigeminal nerve > spinal V tract > spinal V nucleus > Bilateral motor nuclei of CN VII
|
|
|
What is the pathway of the motor limb of the corneal reflex?
|
Bilateral Facial motor nuclei > CN VII > upper divisions of CNVII > zygomatic nerves of CN VII > palpebral part of the orbicularis oculi
|
|
|
You touch a patients right eye and both eyes blink, you touch his left and you get no response in either eye, where is the lesion?
|
Left CN V
|
|
|
You touch a patients right eye his right eye blinks but nothing happens inhis left eye, when you touch his left eye, his right eye blinks but no blinking in the left, where is the lesion?
|
Left CNVII
|
|
|
Superior, middle, and inferior alternating hemiplegia involve damage to which three cranial nerves, respectively?
|
3,6,12
|
|
|
What structures are affected in Millard-Gubler syndrome?
|
corticospinal tract, corticobulbar tract, abducens nerve, and facial nerve
|
|
|
The reticular formation occupies the central core of the brainstem known as what?
|
the tegmentum in the pons and midbrain
|
|
|
Lesions of the reticular formation, especially of upper brain stem levels can cause what?
|
devastating neurological defecits such as loss of consciousness, and gaze paralysis
|
|
|
What are some of the sensory inputs to ARAS?
|
spinothalamic, trigeminal and acoustic systems
|
|
|
Does the dorsal column system contribute inputs appreciably to the ARAS?
|
NO
|
|
|
What feature of the neurons of the ARAS makes them well designed to receive multiple inputs from different sources?
|
long radiating dendrites
|
|
|
Where do the outgoing fibers from ARAS ascend in ?
|
central tegmental tract
|
|
|
Where do the ascending fibers go to from ARAS?
|
Intralaminar thalamic nuclei
|
|
|
Intralaminar nuclei have localized or diffuse projections to cortical areas?
|
Diffuse projections to widespread cortical areas
|
|
|
Is strong stimulation from intact sensory pathways alone enough to reverse the unconscious state?
|
No, you need ARAS activity to maintain consciousness
|
|
|
This system maintains consciousness, arouses someone from sleep, mediates cortical activity during REM, and makes cortical neurons more excitable to ascending systems?
|
Ascending Reticular Activating System
|
|
|
What is the location of the descending medial pathway for pain modulation?
|
next to the midline fo the medulla
|
|
|
What kinds of cells are in the descending medial pathway for pain modulation?
|
Large serotonergic neurons
|
|
|
What are some of the inputs to the descending medial pathway for pain modulation?
|
pain suppresion systems such as the midbrain periaquaductal gray
|
|
|
Where do outputs from the descending medial pathwway for pain modulation go to ?
|
bilaterally to lamina 1 and 2 to suppress pain
|
|
|
This system is responsible in producing analgesia in response to fight or flight?
|
Descending Medial Pathway for Pain modulation
|
|
|
The pontine reticulospinal tract arises from the giant nuclie of cells located where?
|
medial reticular zone of pons and rostral medulla
|
|
|
Th medullar reticulospinal tract originates from giant nuclei found where?
|
medial reticular zone of the mid-medulla
|
|
|
Which reticulospinal motor pathway descends uncrossed in the MLF to all spinal levels?
|
pontine reticulospinal tract
|
|
|
Which reticulospinal motor pathway descends bilaterally via the ventrolateral funiculus to all spinal levels?
|
medullary reticulospinal tract
|
|
|
Which reticulospinal motor pathway facilitates muscle tone and mediates phasic motor activity particularly for axial and proximal limb muscles?
|
PRST
|
|
|
Which reticulospinal motor pathway is inhibitory and plays a rol in the atonia seen during REM sleep?
|
MRST
|
|
|
Various catecholaminergic cell groups throughout the intermediate region of the medullary and pontine reticular formation perform what function?
|
control blood pressure and heart rate (autonomic control)
|
|
|
Where do projections from the catecholaminergic cell groups project to?
|
thoracic IML (sympathetic preganglionic cell column) and rostrally to the hypothalamus
|
|
|
The ventrolateral catecholaminergic cell group plays a particularly important role in what?
|
blood pressure
|
|
|
What is the location of cells that are involved in serotonergic pathways?
|
raphe nuclei (midline of the brain stem)
|
|
|
What do the ascending serotonergic neurons function in?
|
"gating" or suppressing sleep mechanisms
|
|
|
Serotonergic neurons that innervate blood vessels cause dilation or constriction?
|
vasoconstriction
|
|
|
agents that block serotonin neurotransmission are used in the treatment of what?
|
migraines
|
|
|
What monoaminergic transmitter is made within cells located in the tegmentum of the upper pons just lateral to the periaqueductal gray within the locus ceruleus?
|
noradrenaline
|
|
|
Norepinephrine (noradrenaline) is released throughout the CNS in situations that require what?
|
vigilance and focused attention
|
|
|
Neurons that synthesize dopamine can be found where?
|
substantia nigra, pars compacta, and ventral tegmental region (ventral to red nucleus)
|
|
|
Degeneration of dopamine-containing neurons in the pars compacta can lead to what
|
Parkinsons
|
|
|
An overriding dominance of dopaminergic activity due to loss of other functions in the forebrain, can be seen in patients with?
|
schizophrenia
|
|
|
This small cell group lateral to the mammilary bodies houses histamine synthesizing neurons?
|
tuberomammillary nucleus
|
|
|
What does the histaminergic pathway in the CNS function as?
|
stimulating arousal during wakefulness, and functions in sleep-wake cycle
|
|
|
Inability to remember moments just before the injury is called what?
|
retrograde amnesia
|
|
|
Inability to remember events after the injury is called?
|
Anterograde amnesia
|
|
|
What is the immediate biomechanical effect that can cause concussion?
|
rotation of the neuraxis at flexure of brainstem with diencephalon
|
|
|
What does the release of glutamate do that causes some of the symptoms of concussion?
|
increases metabolic demand and reduces O2 levels
|
|
|
Decreased cerebral metabolsim of what can persist for days to months after the injury?
|
glucose
|
|
|
What are the two main CNS structures involved with coma and other altered states of consciousness?
|
diffuse cortical damage; damage to brainstem at upper pontine or midbrain levels
|
|
|
Consciousness involves the coordinated action of what three things?
|
cerebral cortex, thalamus, and ARAS
|
|
|
Does cortical or thalamic damage need to be extensive in order to alter the state of consciousness?
|
Yes, should be a mass lesion or herniation
|
|
|
Damage to a small region is worse in the cortex or upper brainstem in terms of altering the state of consciosness?
|
upper brainstem
|
|
|
The largest subgroup of patients presentign with altered states of consciousness have what kind of impairment?
|
metabolic interuption of neuronal activity (subcellular processes are disrupted)
|
|
|
What are the "big three" causes of altered states of consciousness?
|
intoxication, stroke, cranial trauma
|
|
|
What are the three main states of altered consciousness?
|
Coma, vegetative, minimally conscious
|
|
|
A patient who is unresponsive and does not open eyes to stimulation exhibits what state of consciousnes?
|
coma
|
|
|
a patien who is unresponsive but opens eyes and expresses random reflexes and emotions is in what state of consciousness?
|
vegetative
|
|
|
A patient who is awake, alert, and communicative but can only open eyes and move eyelids is suffereing from what?
|
Locked in syndrome
|
|
|
Variable or inconsistent state of awareness, communication, and movement on commands is found in what state of consciosness?
|
Minimally-conscious state
|
|
|
The red nucleus is largely encapsulated by crossing fibers of what?
|
superior cerebelar peduncle
|
|
|
What is the function of the red nucleus?
|
excite upper limb FLEXOR via rubrospinal tract
|
|
|
This area of the substantia nigra is dorsally located and secretes dopamine?
|
pars compacta
|
|
|
This area of the substantia nigra is ventrally located and secretes GABA?
|
pars reticulata
|
|
|
This nucleus located in the pretectal midbrain, mediates the pupillary light reflex?
|
pretectal olivary nucleus
|
|
|
Where does the pretectal olivary nucleus send fibers to ?
|
GVE (edinger-Westphal)
|
|
|
This structure is dorsal to the cerebral aqueduct and PAG and demarcates the rostral end of the midbrain?
|
Posterior commissure
|
|
|
What does the posterior commissure contain at the pretectal level?
|
crossing fibers of the pupillary light reflex of the contralateral eye
|
|
|
What are the two nuclei found in the tegmentum in the pretectal region?
|
accessory oculomotor and red nucleus
|
|
|
When light is shone into one eye, both pupils constrict, what reflex is this?
|
pupillary light reflex
|
|
|
During the pupillary light reflex, the response in the opposite eye is (direct or indirect)?
|
indirect pupillary light reflex
|
|
|
What path does information take from the retina to the pretectal olivary nucleus during the pupillary light reflex?
|
right retina > optic nerve > optic tract > brachium of the superior colliculus > pretectal olivary nucleus
|
|
|
How do fibers from the pretectal olivary nucleus get to the contralateral edinger-westphal nucleus?
|
via posterior commissure
|
|
|
Which muscles are innervated during the pupillary light reflex?
|
bilateral sphincter pupillae muscles
|
|
|
Which nerves carries information from the edinger-westphal nucleus to the ciliary ganglion?
|
oculomotor
|
|
|
Which nerves carries information from the ciliary ganglion to the sphincter pupillae muscles?
|
short ciliary nerves
|
|
|
A lesion of the optic nerve will have what effect on the pupillary light reflex?
|
The affected side will show no pupillary reflex for both eyes upon stimulation, unaffected stimulation will result in both pupillary reflexes
|
|
|
A lesion in the oculomotor nerve will result in what effect on the pupillary reflex?
|
The affected side will show no pupillary reflex when either eye is stimulated by light, unaffected side will show reflex upon stimulation of either eye
|
|
|
A patient with complete ptosis of his r eyelid most likely has a lesion to what nerve?
|
R oculomotor nerve (LMN ipsilateral effects)
|
|
|
What are the only two extraocular muscles not innervated by the oculomotor nerve?
|
lateral rectus and superior oblique
|
|
|
In a lesion of the oculomotor, the affected eye is deviated in which direction due to unoppose action by the only two extraocular muscles not innervated by the oculomotor?
|
laterally and downward
|
|
|
Vascular disturbance in the posterior part of the circle of willis will result in what syndrome?
|
Weber's syndrome (superior alternating hemiplegia)
|
|
|
What are the symptoms of Weber's?
|
ipsilateral oculomotor nerve palsy, contralateral hemiplegia, contralateral paralysis of lower facial muscles
|
|
|
Lateral tegmental vascular infarct will result in what named syndrome?
|
Benedikt's syndrome
|
|
|
What 5 structures are involved in Benedikt's syndrome?
|
red nucleus, SCP, medial leminiscus, spinothalamic tract, oculomotor nerve
|
|
|
A patient complains of eyelid droop on his right side and tremors in his left limbs, as well as loss of pain and thermal sensation in his left arms and legs. What is the likely diagnosis?
|
Benedikts syndrome (tegmental)
|
|
|
Vascular disturbance in the tectum or pineal gland tumor can result in this?
|
Collicular (parinaud's) syndrome
|
|
|
What are some of the symptms of Parinaud's?
|
paralysis of upward or downward gaze depending on the level of the midbrain lesion
|
|
|
where do the axons of the edinger-westphal nucleus synapse?
|
ciliary ganglion
|
|
|
Postganglionic parasympathetics from the ciliary ganglion form what nerves and innervate which muscles?
|
short ciliary nerves and ciliary muslces and sphincter palpebrae
|
|
|
In a unilateral lesion of CN III, what position is the ipsilateral eye in?
|
extreme abduction and downward position (virtually immobile)
|
|
|
A patient with a lesion in the right oculomotor nerve is looking at you, what do you see?
|
R eyelid completely shut (ptosis)
|
|
|
How do the pupils look in a patient with a unilateral lesion of the oculomotor nerve?
|
ipsilateral pupil is completely dilated (mydriasis); Anisocoria (pupils of unequal size)
|
|
|
Are the pupillary light reflex present in the affected eye of a patient with a unilateral lesion in the oculomotor?
|
NO (both consensual and direct)
|
|
|
Is the accomodation reflex present in a patient with unilateral lesion of CN III?
|
It is absent in the affected eye
|
|
|
This nucles mediates the VOR, which keeps the eyes fixed on a stationary point in space while the head moves?
|
vestibular nuclei
|
|
|
Rotation of the head to the right causes which hair cells to depolarize (Right or Left)?
|
Right
|
|
|
Rotation of the head to the left causes which hair cells to hyperpolarize (right or left)?
|
right
|
|
|
Where do axons of the vestibular nuclei project to?
|
contralateral abducens nuclei
|
|
|
Where do the axons of the LMNs of the abducens project to?
|
ipsilateral lateral rectus
|
|
|
Where do the internuclear neurons of the abducens project to?
|
contralateral oculomotor complex (via the contralateral MLF)
|
|
|
During VOR, the eyes move in the (Same direction, opposite direction) to the rotation of the head?
|
Opposite
|
|
|
What part of the cerebellum participates in eye movement control via bidirectional connections with the vestibular nuclei?
|
vestibulocerebellum
|
|
|
What are some of the functions of the vestibulocerebellum?
|
suppresses VORs to allow tracking of an object by moving the head; smooth pursuit movements (directs eyes to follow objects moving in the visual field)
|
|
|
This is located in the pontine reticular formation near each abducens nucleus?
|
horizontal gaze center
|
|
|
What three things give input to the horizontal gaze center?
|
vestibular nuclei (head position); superior colliculus (objects in contralateral visual hemifield); cerebral cortex (for initiating voluntary and reflexive saccades)
|
|
|
Axons from the horizontal gaze center project to where?
|
ipsilateral abducens nucleus
|
|
|
What is the function of the horizontal gaze center?
|
mediates conjugate horizontal eye movements to the ipsilateral side
|
|
|
lesions of the horizontal gaze center will produce hypometric or completely absent horizontal saccades to which side?
|
to the side of the lesion
|
|
|
This gaze center is located in the reticular formation of the rostral mesencephalon/pretectum, close to each OMC?
|
Vertical gaze center
|
|
|
What is the funciton of the vertical gaze center?
|
mediates conjugate vertical eye movements (saccades)
|
|
|
Does the superior colliculus have direct connections to the nuclei of the extraocular muscles?
|
No
|
|
|
How does the superior colliculus mediate eye movement?
|
through projections to the contralateral horizontal/vertical gaze centers
|
|
|
This structure functions in orienting eyes and head toward visual or other sensory stimuli in the contralateral visual hemifield?
|
superior colliculus
|
|
|
A lesion in the superior colliculus will result in what?
|
disrupted ability to orient to visual stimuli in the contralateral half of the visual field; saccades are hypometric and have a high latency
|
