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191 Cards in this Set
- Front
- Back
A blowout fracture of the orbit involves
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multiple fractures of the inferior and medialis wall
|
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The queous humor is formed by
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Ciliary body--it perculates through the posterior chamber of the eye, gives nutrients to the lens and then goes to the anterior chamber and pupil
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Presbyopia is a disease of the
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Lens
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Parasympathetic stimulation of the eye results in
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Pupillary constriction and tears
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WHere does the aqueous humor finally drain into
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scleral venous system--Canal of Schlemm
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What are the functions of the eye socket
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contains and protects the eyeball
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What do the tarsal glands do
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Secrete lipid and lubricate the eyelids so that they don't stick together
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A sty is an infection of what gland
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ciliary gland
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In what direction do the eyelids close
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from lateral to medial
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What is another name for sty
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Hordeolum
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What is a chalazia
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cyst of ciliary gland
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WHere are the lacrimal glands located
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superior lateral fossa....Not in lacrimal fossa
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Fluid from the lacrimal gland drain in the
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nasolacrimal duct
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What is the nerve supply of the lacrimal gland and on what nerve do they piggy-back on
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Parasympathetic from facial (CN VII)
Sympathetic from superior cervical ganglion They both piggy back on the ophtalmic branch of the trigeminal |
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Injury to what nerve causes these symptoms:
paralysis of the orbicularis oculi muscle eyelids cannot close porotective eyeblink is lost lower lid falls away from eyeball (loss of tone) Irritation, drying despite excessive tears (from irritation) |
Injury to the Facial Nerve (CN VII)
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What is in each layer of the eyeball
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Outer-sclera and cornea
Middle-choroid, ciliary body, and iris. This is the vascular/pigmented layer Inner layer- retina |
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What is responsible for 80-90% of refraction
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Cornea
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What folds on internal surface and secretes aqueous humor (which fills the chambers of the eye)
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Ciliary body
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What is the space between the cornea and iris/pupil
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anterior chamber of the eye
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WHat is the space between the iris/pupil anteriorly and lens and ciliary body posteriorly
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posterior chamber of the eye
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What do the sphincter pupillae and dilator pupillae do? what type of innervation do they have? Where are they found?
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-Sphincter pupillae-constricts and is innervated by the parasympathetic of CN III
-Dilator pupillae- dilate and is innervated by the sympathetic these are muscles of the iris |
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What are the 3 parts of the retina
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optic
ciliary iridial |
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the neural layer of the optic part of the retina does what?
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light reception
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The pigmented layer of the optic part of the retina does what?
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reduces scattered light
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True or flase
The ciliary and iridial parts of the retina recieve light |
False--the optic part does
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What usually follows trauma, fluid between neural and pigmented layers of the retina
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retinal detachment
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What is the path of light through the eye
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Cornea
aqueous humor lens vitreous humor retina |
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how does the cornea get it's nourshment
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by the aqueous humor, lacrimal fluid, capillaries at the periphery and oxygen is absorbed from the air
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What shape does the lens have for far vision and for near vision
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far vision-flat
Near vision-round |
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What is loss of transparency of the lens, and what can be done to correct this?
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Cataracts
can replace the lens with a plastic lens |
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What holds the retina in place
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vitreous humor
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True or False
If the pressure in the vitreous humor is to great you could end up with blindness, if the pressure is to low it could predispose you to retinal detachment |
true
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What condition is related to aging and the lens becoming harder and flatter. The person has good far vision but loss of near vision
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presbyopia
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How can you repair a clouded cornea
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cornea transplant
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Glaucoma is
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-build up pressure in eye
-reduced drainage of aqueous humor -painless silent damage of neural layer of retina -irreversible blindess |
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What muscle
-elevates the upper eyelid -is the antagonist of the orbicularis oculi -part of this muscle is smooth--sup tarsal muscle |
Levator palpebrae Superioris
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WHich muscle of the eye
-is innervated by sympathetic NS -helps levator elevate upper eyelid -gives the wide eyed look with fight/flight/fright reaction |
Sup Tarsal Muscle
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What is the term for double vision which occurs if eye movements are not coordinated, and both pupils aimed at same target
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Diplopia
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True or False
Most people born with a eye muscle problem will not experience double vision |
True
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WHich muscle directs teh pupil laterally and superiorly
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Inferior oblique
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Which muscle directs the pupil inferiorly and laterally
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Superior oblique
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What is the function of the check ligaments in the eye
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limits abduction and adduction
(prevents the eye from going to far medial and lateral) |
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What envelops eyeball form optic nerve to corneoscleral juction
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Bulbar sheath or Tenon's Capsule
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What retracts inferior eyelid inferiorly when gaze is in downward direction. And comes from the sheath of the inferior rectus muscle
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Inferior Check Ligament
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What is the innervation of the eye muscles
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Oculomotor (CN III)- supplies the inferior, superior, and medial rectus. And the inferior oblique muscle
Trochlear (CN IV)-supplies the superior oblique Abducent (CN VI)- supplies the lateral rectus |
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What is it called when a patient says they felft like a curtain went over their eyes and then went away
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Amaurosis fugax
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The only arteries which can be seen in a living person on routine fundoscopic exam.
hint--a window into the body |
Central retinal artery
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What happens when there is blockage of the central retinal artery
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since it is an end artery you get immediate loss of vision in area of distribution of that vessel
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Veins of the orbit
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Superior and inferior ophthalmic veins.
pass through the superior orbital fissure and enter the cavernous sinus |
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True or false
the retinal artery branches are end arteries |
true
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A 60 year old man with clotting disorder: thrombo cythemia--platelet count is over 1 million. He comes to the hospital with severe swelling of the right orbit, decreased vision in the right eye, a bruised look around the right orbit. There is no sign of infection. What is likely going on?
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Cavernous sinus thrombosis
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A 25 yo male in a high speed motorcycle accident. He initially looked good although his helmet was smashed. Over 1 hour, he looses consciousness, and his right pupil dilates and is no longer responsive to light. Left pupil is normal. what do you think happened?
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Patient has a blown pupil. loss of parasympathetic and the CN III and suggest brain herniation
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THe superior oblique muscle tends to pull the gaze
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infero laterally
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The levator palpebrae superioris is made of
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It is a straited muscle. and has a smooth muscle component. This is what gets knocked out in Horner's
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Needs to have neck surgery involving the sympathetic nerves. She fears any type of cosmetic deformity of her face, and wants a guarantee. The surgeon refuses, and tells her she may have a ptosis post op. Why?
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The levator has smooth muscle that is innervated by the sympathetic and can cause the ptosis
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following left parotid surgery, a patient notices a dry left eye, yet has excessive tears. What nerve may have been injured? Why the excessive tears? Can this patient squint in a bright light?
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-The facial nerve (CN VII) may have been injured.
-there are excessive tears b/c the patient is not able to blink. and the parasymp. produces more tears. |
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What connects the middle ear to the nasopharynx
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auditory tube (eustabchian tube)
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What does the external acoustic meatus do?
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conducts sound to the ear drum
(sensory nerves form CN V |
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What is the nerve supply tot he tympanic membrane
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External is mandibular branch of CN V-auriculotemporal
Internal is glossopharyngeal (CN IX) |
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Where can an ear infection have referred pain to?
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The back of the throat. b/c of the glossopharyngeal nerve
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where are the malleus, incus, and stapes found? and what are they?
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They are the auditory ossicles (3 small bones)
-they are found in the tympanic cavity (middle ear cavity) |
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A student working for the Peace Corps in a third world country, developed otitis media. It took 6 weeks to get to a doctor and receive antibiotics. Despite this, reddness, swelling and pain remained in the bony prominence post to the ear (mastoid process). what is going on?
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mastoiditis
-infection got into the mastoid air cells which are lined with mucosa. Need antibiotics for a long time. Might end up with chronic mastoiditis which requires surgery. |
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A 17 year old has a severe sore throat. His face and nostrils feel quite swollen. He then develops an ear ache. What is the mechanism?
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could be referred pain or could be infection spreading from the nasalpharynx to the ear. Swelling of the eustachian tube would cause stagnant fluid leading to infection
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Why is the maxillary sinus more prone to sinusitis than other sinuses?
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It has to drain against gravity
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Which wall separates the tympanic cavity from inner ear
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Labyrinthine wall (medial)
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Which wall separates tympanic cavity form internal carotid artery. (people often hear their heart beating)
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Carotid Wall (anterior)
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What transfers vibrations of the tympanic membrane to the oval window of the vestibule
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auditory ossicles (malleu, incus, stapes)
-they actually magnify sound |
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What two muscles prevent damage to the ear due to transmission of very loud sounds by dampening or resisting vibrations
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Stapedius and the tensor tympani
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What results in hyperacusis, excessively acute hearing
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Paralysis of the stapedius and tensor tympani (facial nerve Injury)
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What is responsible in the maintaince of balance
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vestiblar labyrinth
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True or False
the vestibular labryinth deals with reception of sound |
False,
the cochlear labyrinths deals with reception of sound |
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What is the organ of hearing
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The spiral canal of conclear duct is the organ of hearing
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What is the function of the vestibule in the ear
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it is the mechanism of balance.
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what nerve innervates the cochlea and vestibule
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Facial nerve (CN VII)
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What are the 3 parts of the inner ear
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Semicircular canals, vestibule, and cochlea
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What maintains balance with movement of the head
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Semicircular canals
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What are the two things that the vestibule contains which are the parts of the balancing apparatus
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Utricle and Saccule. Have to do with linear acceleration.
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What is the chamber between in the semicircular canal and cochlea
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vestibule
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What lies at right angles to each other. Occupy 3 planes in space. And communicate with the vestibule
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Semicircular Canals
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What contains semicircular duct of the membranous labyrinth
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Semicircular canals
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What is a membrane lining the bony canals-a tube within a tube-the membranous tule lies within the bony tube
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Membranous Labyrinth
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What contains endolymph and is suspended from bony labyrinth
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Membranous Labyrinth
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what is suspended from the bony labyrinth
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membranous labyrinth
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What does the membranous labyrinth form
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a closed system of sacs and ducts that communicate with each other: Semicircular canals open into utricle. Utricle empties into saccule. Saccule communicates with cochlear
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What is the macula
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specialized sensory epithelium found in the utricle and saccule
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What is the innervation of the hair cells in the maculae
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Vestibulocochlear (CN VIII)
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True or False
Hair cells in each semicircular canal also record movement of endolymph |
true
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What detects angular acceleration and helps keep you eyes fixed on a point even as you move your head
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Semicircular Canals
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What is the vestibulo-ocular reflex
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A compensatory system, whereby the changes in angular acceleration of the head (rotating in any direction) result in matched responses from the ocular muscles (recti and obliques) o compensate for the movement and keep the gaze of the pupils upon the object of interest
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Whats is the name for when the vestibulo-ocular reflex is out, it is a sign of severe brain stem malfuction, one of the criteria for brain death
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Doll's Eye Sign
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What equalizes pressure in the middle ear, with atmospheric pressure, thereby allowing free movement of the tympanic membrane. Occurs automatically with swallowing yawning, via tensor veli palatini muscle of the soft palate.
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Eustachian tube
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As the airplane is landing, the baby awakens from sleep, and begins to cry. The parent, gives the baby a bottle. The babay sucks furiously for 20 min and then drifts back to sleep. Was the baby simply hungry or ?
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No, he was trying to equilibrate the pressure in the ear, because babies have a harder time with that.
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Is transmission of sound through the internal acoustic meatus important for hearing
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No, the internal acoustic meatus has nothing to do with sound just with passage of nerves. Sound goes through the oval window and into the cochlea
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Trace the course of a sound wave from the radio, to your brain.
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sound waves approach your ear and then they go to the external auditory meatus, then the sound vibrates the tympanic membrane, then the maellus, incus, and stapes. Then it causes the vibration on the oval window, a hydraulic wave travels in the perilymph and then the cochlea then travels down the cochlea and the sound exists through the round window and then the sound gets dissipate the air of the middle ear.
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a viral infection of the hair cells in the semicircular canals would likely cause
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vertigo and maybe loss of hearing
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do the semicircular canals communicate with the vestibule? the cochlea
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yes to both
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You hear a loud noise and turn your head sharply to teh left. Whcih sensory organs is/are involved? Specifically, how does your brain know where you are in 3 dimension space, when you have a completed the head turn
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the semicircular canal
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You have been accepted to the astronaut program. As your rocket ship is lifting off, you sense the acceleration. Which sensory organ is detecting the linear acceleration
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utricle and saccule
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True or False
The anterior septum is boney and the posterior septum is cartilaginous |
False
The anterior septum-cartilaginous and posterior septum is boney |
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Is the nose vulnerable to lateral blows
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yes sir.
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What could happen if the cribriform plate of the ethmoid bone is fractured?
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may lead to CSF rhinorrhea, people will be a clear watery discharge and the sign is called halo sign.
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what is the inferior 2/3 nasal mucosa resoponsilbe for
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respiration
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what is the superior 1/3 of the nasal mucosa responsible for
|
olfactory
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What is the function of the choanae
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to mix the air and humidify it. Also exposes it to the immune system so that it could detect potential evaders
|
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what does the sphenoidal sinus open into
|
sphethmoidal recess
|
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What does the superior meatus receives
|
fluid from the ethmoidal sinuses
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what does the middle meatus recieve
|
the maxillary sinuses
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what does the inferior meatus receive
|
the nasolacrimal duct
|
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Which sinus gets infected more often
|
the maxillary sinus
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the area in the anterior part of the nasal septum with anastomosis of 5 arterial branches and rich in capillaries is known as
|
Kiessselbach Area
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What is the common site for severe nose bleeds
|
Kiesselbach area
|
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How would you treat a nose bleed
|
apply pressure with your thumb and index finger on the tip of the nose. Sit her up to get artial pressure to drop, decreasing the venous component
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The only area in the face that gets supply from the internal carotid is the?
|
eye, from the central retinal artery
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What is the venous drainage from the nose
|
plexus drains to facial veins and opthalmic veins
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Does the venous drainage pre-dispose the spread of infection via ophtalmic veins, into cavernous sinus? The brain?
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yes to both, they can spread to the veins because they have a direct route into the cavernous sinus
|
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The respiratory area in the nose (inferior 2/3) gets its nerve supply from what?
|
CN V the ophthalmic and maxillary branch
|
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the olfactory area (superior 1/3 ) of the nose is supplied by what nerve?
|
CN I (olfactory)
|
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What is the danger of csf leaking through your nose
|
fluid and bacteria may move in both directions, leading to meningitis
|
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What is the tx for a csf leak that doesn't stop spontaneously
|
go through the anterior cranial fossa and put on the dural patch
|
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How can rhinitis lead to sinusitis
|
it will block the drainage of the sinus
|
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Can infection from the nose spread through cribriform plate into anterior cranial fossa
|
yes. can get abscess in teh anterior cranial fossa from a nasal infection. you tx this with antibiotics
|
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True or false
the spread of infection from the nose goes to the nasopharynx and retropharynx |
true
|
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Since the eustachain tube empties into the nasal pharynx. An infection can cause back up of flow causing what?
|
otitis media
|
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Where do the frontal, ethmoid, sphenoid, and maxilla sinuses drain into?
|
nasal cavity
|
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What can infection in the ethmoidal cells lead to
|
Infection my spread to orbit because there is a very thin wall b/w the ehtmoidal cell and the orbit. and can lead to blindness
|
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What extends from the base of the cranium to inferior border of cricoid anteriorly and inferior border of C6 posteriorly
|
pharynx
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The pharynx is the widest opposite what bone
|
hyoid bone
|
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the pharynx is the narrowest opposite what
|
cricoid cartilage
|
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True or False
The cricoid cartilae is the only complete ring around the airway so on space for the pharynx to expand anteriorally at that point |
true
|
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What is posterior to the nose and superior to soft palate
|
nasopharynx
|
|
what muscle opens the tube during swallowing
|
spingopharyngeus muscle
|
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Where is the oropharynx
|
from the soft palate to the epiglottis
|
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What is deglutition
|
swallowing -transfer of food from mouth, through pharynx, into esophagus and into stomach
|
|
first stage of swallowing
|
voluntary, chewing and the tongue pushes food into pharynx
|
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second stage of swallowing is
|
automatic, rapid
-soft palate is elevated to block the nasopharynx -suprahyoid muscles contract, elevating the larynx. -depends on reflexes |
|
3rd stage of swallowing
|
automatic
-sequential constriction of 3 pharyngeal constrictor muscles forces food into esophagus |
|
What extends from the epiglottis to esophagus at level of inferior margin of cricoid (C4-C6)
|
laryngopharynx
|
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What are found in the posterior and lateral walls of the pharynx, roughly circular in orientation. These are the outer walls of the pharynx
|
constrictor muscles of the pharynx
|
|
What innervates the constrictor muscles of the pharynx
|
sensory and motor--pharyngeal plexus (from CN IX and X, and from cervical symp. fibers)
|
|
Which muscles constrict in sequence forcing food bolus into esophagus
|
constrictor muscles of the phraynx
|
|
the palatine tonsils which are found in the lateral wall of the pharynx seen through the mouth receives blood supply from what
|
external carotid
|
|
Which tonsils occasionally need removal due to chronic ear infections
|
pharyngeal tonsils, b/c they block the eustachian tube when they are infected.
|
|
What goes from the pharynx to the stomach
|
esophagus
|
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Define the borders of the pharynx and its 3 divisions
|
-nasalpharynx- nose to soft palate
-oral pharynx- soft palate to the epiglottis -laryngopharynx- epiglottis to the esophagus |
|
A 2 year old comes to the ER with stridor. The mother says he was playing with a penny and put it in his mouth. If he swallowed the coin, where is it most likely to hang up?
|
cricoid cartilage
-if the child aspirated the coin it would be the sphincter of the vocal cords. |
|
A teenager sees you in the office with his tenth case of documented strept throat in 1 year. On oral exam, his tonsils are filled with pus. You could send him to an ENT surgeon for consideration of what
|
tonsilectomy
|
|
What is the anterior part of the neck. approximately b/w C3 and C6 vertebrae,
|
larynx
|
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What is responsible for voice production and guarding of air passages
|
larynx
|
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The recurrent laryngeal nerve will innervate all of the intrinsic muscles of the larynx except for what
|
the circoidthyroid muscle, which is innervated by the superior laryngeal nerve
|
|
How many cartilages does the larynx have
|
9
|
|
what are the 3 single cartilages of the larynx
|
thyroid, cricoid, and epiglottic
|
|
What are the 3 paired cartilages of the larynx
|
arytenoid, corniculate, and cuneiform
|
|
What does the thyroid cartilage articulate with inferiorly
|
cricoid cartilage
|
|
what joints rotate and glide---resulting in changes in length of vocal folds
|
cricothyroid joints
|
|
What forms the only complete cartilaginous ring around the airway
|
cricoid cartilage
|
|
what are the attachments of the circoid cartilage
|
cricothyroid membrane and cricotracheal ligament
|
|
what articulate with supero-lateral parts of cricoid cartilage
|
arytenoid cartilages
|
|
what is the attachment of the ary-epiglottic fold
|
apex
|
|
the lateral and posterior cricoarytenoid muscles attach where
|
arnytenoid cartilage
|
|
What responds to changes in the movement of the arytenoid cartilages
|
vocal cords
|
|
does more or less sound come result form the vocal cords being closer together
|
more sound
|
|
What permits the arytenoid cartilages to slide toward or away from one another, to tilt anterior, and posterior, and to rotate
|
cricoarytenoid joints
|
|
what muscle acting on the arytnoid cartilage produces sound
|
intrinsic muscle
|
|
Which groups of muscles help the thyroid cartilage move superiorly
|
suprahyoid muscles
|
|
what extends form laryngeal inlet to the inferior border of cricoid cartilage
|
laryngeal cavity
|
|
What is superior to teh vestibular folds
|
vestibule
|
|
What is b/w the vestibule and vocal folds
|
ventricle
|
|
what is the space below the vocal folds
|
infra-glottic space
|
|
what is the main sphincter of the respiratory tract (valsalva maneuver)
|
vocal folds
|
|
what is the term that refers to the entire vocal apparatus, and includes vocal folds and processes and the space b/w the vocal folds (rima glottis)
|
glottis
|
|
what is supraglottic
|
the vestibule and the vestibular folds
|
|
what is the infraglottic
|
below the vocal cords, begins with the infraglottic portion of the larynx and extends into the trachea
|
|
what do the intrinsic muscles of the layrnx do
|
move laryngeal parts latering vocal cord length and tension
|
|
what muscle depresses the larynx and the hyoid
|
infrahyoid muscle
|
|
what muscle elevates the larynx and hyoid
|
suprahyoid
|
|
your tongue pushes a bolus of food back into the pharynx and since you dont want that food going down the airway what muscles help with this
|
the suprahyoid contract and elevates the larynx and once food passes the infrahyoid depresses the larynx
|
|
what is the arterial supply of the larynx
|
superior and inferior laryngeal arteries
|
|
venous drain of the larynx
|
drain into IJV
|
|
lymph in the larynx drain where
|
into deep cervical lymph nodes
|
|
The superior laryngeal nerve supplies what in the larynx
|
sensory to the tracheal mucous membrane superior to vocal folds and motor to cricothyroid muscle
|
|
what does the recurrent laryngeal nerve supply in the larynx
|
sensory to mucosa inferior to vocal folds. Motor to all intrinsic muscles of the larynx except the cricoithyroid muscle
|
|
what is aspiration
|
when food or fluid g0et into airway.
solids can get trapped above vocal folds as vocal folds close (due to muscle spasm) results in immediate stridow (labored respiration |
|
when you do a tracheostomy what level should you go through
|
go through 1st or 2nd tracheal ring. so that you don't harm the vocal cords
|
|
Name 3 functions of the larynx
|
airway, phonation, and main sphincter of the airway
|
|
name 3 functions of the trachea
|
conveying air, clearing particles and mucus with ciliary epithelium and defending against infection
|
|
what is the function of the suprahyoid muscle
|
to elevate the hyoid and the larnyx
|
|
describe the course of the right recurrent laryngeal nerve?
What does it innervate: sensory and motor |
hooks around the subclavian artery and then ascends in the tracheal esophageal groove.
It innervates all the intrinsic muscles of the larynx and sensory of the mucosa and inferior to vocal folds |
|
What are the extrinsic muscles of the larynx?
What actions do they perform |
infrahyoid and suprahyoid and they move the larynx and hyoid
|
|
When you perform cricothyroidotomy what membrane do you cut?
|
the cricothyroid membrane
|
|
what cartilages must you avoid when doing a cricothyroidotomy
|
cricoid and thyroid
|
|
what is the danger of taking incision too far laterally when doing a cricothyroidotomy
|
hit the muscle and injuring the vocal mechanism
|