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191 Cards in this Set

  • Front
  • Back
A blowout fracture of the orbit involves
multiple fractures of the inferior and medialis wall
The queous humor is formed by
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
Presbyopia is a disease of the
Lens
Parasympathetic stimulation of the eye results in
Pupillary constriction and tears
WHere does the aqueous humor finally drain into
scleral venous system--Canal of Schlemm
What are the functions of the eye socket
contains and protects the eyeball
What do the tarsal glands do
Secrete lipid and lubricate the eyelids so that they don't stick together
A sty is an infection of what gland
ciliary gland
In what direction do the eyelids close
from lateral to medial
What is another name for sty
Hordeolum
What is a chalazia
cyst of ciliary gland
WHere are the lacrimal glands located
superior lateral fossa....Not in lacrimal fossa
Fluid from the lacrimal gland drain in the
nasolacrimal duct
What is the nerve supply of the lacrimal gland and on what nerve do they piggy-back on
Parasympathetic from facial (CN VII)
Sympathetic from superior cervical ganglion
They both piggy back on the ophtalmic branch of the trigeminal
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)
What is in each layer of the eyeball
Outer-sclera and cornea
Middle-choroid, ciliary body, and iris. This is the vascular/pigmented layer
Inner layer- retina
What is responsible for 80-90% of refraction
Cornea
What folds on internal surface and secretes aqueous humor (which fills the chambers of the eye)
Ciliary body
What is the space between the cornea and iris/pupil
anterior chamber of the eye
WHat is the space between the iris/pupil anteriorly and lens and ciliary body posteriorly
posterior chamber of the eye
What do the sphincter pupillae and dilator pupillae do? what type of innervation do they have? Where are they found?
-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
What are the 3 parts of the retina
optic
ciliary
iridial
the neural layer of the optic part of the retina does what?
light reception
The pigmented layer of the optic part of the retina does what?
reduces scattered light
True or flase
The ciliary and iridial parts of the retina recieve light
False--the optic part does
What usually follows trauma, fluid between neural and pigmented layers of the retina
retinal detachment
What is the path of light through the eye
Cornea
aqueous humor
lens
vitreous humor
retina
how does the cornea get it's nourshment
by the aqueous humor, lacrimal fluid, capillaries at the periphery and oxygen is absorbed from the air
What shape does the lens have for far vision and for near vision
far vision-flat
Near vision-round
What is loss of transparency of the lens, and what can be done to correct this?
Cataracts
can replace the lens with a plastic lens
What holds the retina in place
vitreous humor
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
What condition is related to aging and the lens becoming harder and flatter. The person has good far vision but loss of near vision
presbyopia
How can you repair a clouded cornea
cornea transplant
Glaucoma is
-build up pressure in eye
-reduced drainage of aqueous humor
-painless silent damage of neural layer of retina
-irreversible blindess
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
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
What is the term for double vision which occurs if eye movements are not coordinated, and both pupils aimed at same target
Diplopia
True or False
Most people born with a eye muscle problem will not experience double vision
True
WHich muscle directs teh pupil laterally and superiorly
Inferior oblique
Which muscle directs the pupil inferiorly and laterally
Superior oblique
What is the function of the check ligaments in the eye
limits abduction and adduction
(prevents the eye from going to far medial and lateral)
What envelops eyeball form optic nerve to corneoscleral juction
Bulbar sheath or Tenon's Capsule
What retracts inferior eyelid inferiorly when gaze is in downward direction. And comes from the sheath of the inferior rectus muscle
Inferior Check Ligament
What is the innervation of the eye muscles
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
What is it called when a patient says they felft like a curtain went over their eyes and then went away
Amaurosis fugax
The only arteries which can be seen in a living person on routine fundoscopic exam.
hint--a window into the body
Central retinal artery
What happens when there is blockage of the central retinal artery
since it is an end artery you get immediate loss of vision in area of distribution of that vessel
Veins of the orbit
Superior and inferior ophthalmic veins.
pass through the superior orbital fissure and enter the cavernous sinus
True or false
the retinal artery branches are end arteries
true
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?
Cavernous sinus thrombosis
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?
Patient has a blown pupil. loss of parasympathetic and the CN III and suggest brain herniation
THe superior oblique muscle tends to pull the gaze
infero laterally
The levator palpebrae superioris is made of
It is a straited muscle. and has a smooth muscle component. This is what gets knocked out in Horner's
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?
The levator has smooth muscle that is innervated by the sympathetic and can cause the ptosis
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?
-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.
What connects the middle ear to the nasopharynx
auditory tube (eustabchian tube)
What does the external acoustic meatus do?
conducts sound to the ear drum
(sensory nerves form CN V
What is the nerve supply tot he tympanic membrane
External is mandibular branch of CN V-auriculotemporal
Internal is glossopharyngeal (CN IX)
Where can an ear infection have referred pain to?
The back of the throat. b/c of the glossopharyngeal nerve
where are the malleus, incus, and stapes found? and what are they?
They are the auditory ossicles (3 small bones)
-they are found in the tympanic cavity (middle ear cavity)
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?
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.
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?
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
Why is the maxillary sinus more prone to sinusitis than other sinuses?
It has to drain against gravity
Which wall separates the tympanic cavity from inner ear
Labyrinthine wall (medial)
Which wall separates tympanic cavity form internal carotid artery. (people often hear their heart beating)
Carotid Wall (anterior)
What transfers vibrations of the tympanic membrane to the oval window of the vestibule
auditory ossicles (malleu, incus, stapes)
-they actually magnify sound
What two muscles prevent damage to the ear due to transmission of very loud sounds by dampening or resisting vibrations
Stapedius and the tensor tympani
What results in hyperacusis, excessively acute hearing
Paralysis of the stapedius and tensor tympani (facial nerve Injury)
What is responsible in the maintaince of balance
vestiblar labyrinth
True or False
the vestibular labryinth deals with reception of sound
False,
the cochlear labyrinths deals with reception of sound
What is the organ of hearing
The spiral canal of conclear duct is the organ of hearing
What is the function of the vestibule in the ear
it is the mechanism of balance.
what nerve innervates the cochlea and vestibule
Facial nerve (CN VII)
What are the 3 parts of the inner ear
Semicircular canals, vestibule, and cochlea
What maintains balance with movement of the head
Semicircular canals
What are the two things that the vestibule contains which are the parts of the balancing apparatus
Utricle and Saccule. Have to do with linear acceleration.
What is the chamber between in the semicircular canal and cochlea
vestibule
What lies at right angles to each other. Occupy 3 planes in space. And communicate with the vestibule
Semicircular Canals
What contains semicircular duct of the membranous labyrinth
Semicircular canals
What is a membrane lining the bony canals-a tube within a tube-the membranous tule lies within the bony tube
Membranous Labyrinth
What contains endolymph and is suspended from bony labyrinth
Membranous Labyrinth
what is suspended from the bony labyrinth
membranous labyrinth
What does the membranous labyrinth form
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
What is the macula
specialized sensory epithelium found in the utricle and saccule
What is the innervation of the hair cells in the maculae
Vestibulocochlear (CN VIII)
True or False
Hair cells in each semicircular canal also record movement of endolymph
true
What detects angular acceleration and helps keep you eyes fixed on a point even as you move your head
Semicircular Canals
What is the vestibulo-ocular reflex
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
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
Doll's Eye Sign
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.
Eustachian tube
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 ?
No, he was trying to equilibrate the pressure in the ear, because babies have a harder time with that.
Is transmission of sound through the internal acoustic meatus important for hearing
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
Trace the course of a sound wave from the radio, to your brain.
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.
a viral infection of the hair cells in the semicircular canals would likely cause
vertigo and maybe loss of hearing
do the semicircular canals communicate with the vestibule? the cochlea
yes to both
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
the semicircular canal
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
utricle and saccule
True or False
The anterior septum is boney and the posterior septum is cartilaginous
False
The anterior septum-cartilaginous and posterior septum is boney
Is the nose vulnerable to lateral blows
yes sir.
What could happen if the cribriform plate of the ethmoid bone is fractured?
may lead to CSF rhinorrhea, people will be a clear watery discharge and the sign is called halo sign.
what is the inferior 2/3 nasal mucosa resoponsilbe for
respiration
what is the superior 1/3 of the nasal mucosa responsible for
olfactory
What is the function of the choanae
to mix the air and humidify it. Also exposes it to the immune system so that it could detect potential evaders
what does the sphenoidal sinus open into
sphethmoidal recess
What does the superior meatus receives
fluid from the ethmoidal sinuses
what does the middle meatus recieve
the maxillary sinuses
what does the inferior meatus receive
the nasolacrimal duct
Which sinus gets infected more often
the maxillary sinus
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
What is the common site for severe nose bleeds
Kiesselbach area
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
The only area in the face that gets supply from the internal carotid is the?
eye, from the central retinal artery
What is the venous drainage from the nose
plexus drains to facial veins and opthalmic veins
Does the venous drainage pre-dispose the spread of infection via ophtalmic veins, into cavernous sinus? The brain?
yes to both, they can spread to the veins because they have a direct route into the cavernous sinus
The respiratory area in the nose (inferior 2/3) gets its nerve supply from what?
CN V the ophthalmic and maxillary branch
the olfactory area (superior 1/3 ) of the nose is supplied by what nerve?
CN I (olfactory)
What is the danger of csf leaking through your nose
fluid and bacteria may move in both directions, leading to meningitis
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
How can rhinitis lead to sinusitis
it will block the drainage of the sinus
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
True or false
the spread of infection from the nose goes to the nasopharynx and retropharynx
true
Since the eustachain tube empties into the nasal pharynx. An infection can cause back up of flow causing what?
otitis media
Where do the frontal, ethmoid, sphenoid, and maxilla sinuses drain into?
nasal cavity
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
What extends from the base of the cranium to inferior border of cricoid anteriorly and inferior border of C6 posteriorly
pharynx
The pharynx is the widest opposite what bone
hyoid bone
the pharynx is the narrowest opposite what
cricoid cartilage
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
What is posterior to the nose and superior to soft palate
nasopharynx
what muscle opens the tube during swallowing
spingopharyngeus muscle
Where is the oropharynx
from the soft palate to the epiglottis
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
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
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
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
What is responsible for voice production and guarding of air passages
larynx
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