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219 Cards in this Set
- Front
- Back
1. Torticollis
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(wryneck) a spasmodic contraction of the cervical muscles, producing twisting of the neck w/the chin pointing upward and to the opposite side.
It is due to injury to the SCM muscle or avulsion of the accessory nerve at the time of birth and unilateral fibrosis in the muscle, which cannot lengthen w/the growing neck (congenital torticollis |
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2. Eagle's syndrome
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An elongation of the styloid process or excessive calcification of the stylohyoid ligament or styloid process that causes neck, throat, or facial pain and dysphagia. The pain may occur due to compression of the glossopharyngeal nerve, which winds around the styloid process or stylohyoid ligament as it descends to supply the tongue, pharynx, and neck.
In addition, the pain is presumed to be caused by pressure on the internal and external carotid arteries by a medially or laterally deviated and elongated styloid process. Additional symptoms may include taste disturbance, earache, headache, dizziness, and transient syncope. Treatment is styloidectomy. |
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3. Lesion of the accessory nerve in the neck
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Denervates the trapezius, leading to atrophy of the muscle.
It causes a downward displacement or drooping of the shoulder. |
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4. Neurovascular compression syndrome
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Produces symptoms of nerve compression of the brachial plexus and the subclavian vessels. It is caused by abnormal insertion of the anterior and middle scalene muscles (scalene syndrome) and by the cervical rib, which is the cartilaginous accessory rib attached to C7.
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5. Subclavian steal syndrome
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Is a cerebral and brainstem ischemia caused by reversal of blood flow from the basilar artery thru the vertebral artery into the subclavian artery in the presence of occlusive disease of the subclavian artery proximal to the origin of the vertebral artery.
When there is very little blood flow thru the vertebral artery, it may steal blood flow from the carotid, circle of Willis, and basilar circulation and divert it thru the vertebral artery into the subclavian artery and into the arm, causing vertebrobasilar insufficiency and thus brainstem ischemia and stroke. |
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6. Carotid sinus syncope
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Is a temporary loss of consciousness or fainting caused by diminished cerebral blood flow. It results from hypersensitivity of the carotid sinus, and attacks may be produced by pressure on a sensitive carotid sinus such as taking the carotid pulse near the superior border of the thyroid cartilage.
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7. Carotid endarterectomy
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Is the excision of atherosclerotic thickening of intima of the internal carotid artery for the prevention of stroke in patients with symptoms of obstructive disease of the carotid artery.
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8. Temporal (giant cell) arteritis
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Is granulomatous inflammation w/multinucleated giant cells, affecting the medium sized arteries, especially the temporal artery.
Symptoms include severe headache, pain in the temporal area, temporal artery tenderness, visual impairment, transient diplopia, fever, fatigue, and weight loss. Responds to corticosteroids such as prednisone |
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9. Central venous line
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Is an IV needle and catheter placed into a large vein such as the internal jugular or subclavian vein to give fluids or medication.
A central line is inserted in the apex of the triangular interval btwn the clavicle and the clavicular and sternal heads of the SCM into the internal jugular vein. Complications include air embolism, laceration of the internal jugular vein, pneumothorax, and hemothorax. |
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10. Tracheotomy
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Is an opening into the trachea made by incising the third and fourth rings of the trachea, after making a vertical midline incision from the jugular notch of the manubrium sterni to the thyroid notch of the thyroid cartilage. A tracheotomy tube is then inserted into the tracheo and secured by neck straps.
Care must be taken not to damage the thyroid ima artery. |
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11. Goiter
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Is an enlargement of the thyroid gland that is not associated w/overproduction of thyroid hormones, inflammation, or cancer. It causes a soft swelling in the front part of the neck, which compresses other structures such as the trachea, larynx, and esophagus, causing symptoms of breathing difficulties, loss of speech, cough or wheezing, swallowing difficulties, neck vein distention, and vertigo.
Common cause if from iodine deficiency or overproduction of thyrotropin. Can be treated w/radioactive iodine to shrink the gland or surgical removal |
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12. Grave's disease
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Autoimmune disease in which the immune system overstimulates the thyroid gland, causing hyperthyroidism. Overproduction of thyroid hormones causes the eyeballs to protrude, and thyroid enlargement (goiter).
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13. Papillary carcinoma of the thyroid
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Is a malignancy of the thyroid and is the most common type of thyroid carcinoma, accounting for approx. 70% of all thyroid tumors. Thyroid cancer usually presents as a nodule in the thyroid gland and occurs in females more commonly than in males.
Symptoms include a lump on the side of the neck, hoarseness of the voice, and difficulty swallowing. |
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14. Thyroidectomy
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Is a surgical removal of the thyroid gland. During thyroid surgery or tracheotomy, the thyroid ima artery and inferior thyroid veins are vulnerable to injury.
Potential complications may include hemmorrhage resulting form injury of the anterior jugular veins, nerve paralysis, particularly of the recurrent laryngeal nerve; pneumothorax, and esophageal injury resulting from its immediate posterior location to the trachea. |
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15. Parathyroidectomy
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May occur during a total thyroidectomy and cause death if parathyroid hormone, calcium, or vitamin D is not provided.
It decreases the plasma calcium level, causing creased neuromuscular activity such as muscular spasms and nervous hyperexcitability, called tetany. |
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16. Cricothyrotomy
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Is an incision thru the skin and cricothyroid membrane and insertion of a tracheotomy tube into the tracheo for relief of acute respiratory obstruction.
When making a skin incision, care must be taken not to injure the anterior jugular veins, which lie near the midline of the neck. It is preferable for nonsurgeons to perform a tracheostomy for emergency respiratory obstructions. |
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17. Horner's syndrome
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Is caused by thyroid carcinoma, which may cause a lesion of the cervical sympathetic trunk; by Pancoast's tumor at the apex of the lungs, which injures the stellate ganglion; or a penetrating injury to the neck, injuring cervical sympathetic nerves.
This syndrome is characterized by presence of ptosis (drooping eyelids), miosis (constricted pupil), enophthalmos (recession of the eyeball within the orbit), anhidrosis, and vasodilation. |
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18. Stellate ganglion block
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Is performed under fluoroscopy by inserting the needle at the level of the C6 vertebra to avoid piercing the pleura, although the gangion lies at the level of the C7 vertebrae.
The needle of the anesthetic syringe is inserted btwn the trachea and the carotid sheath thru the skin over the anterior tubercle of the transverse process of the C6 vertebra and then direted medially and inferiorly. Local anesthetic is then injected into the prevertebral space. |
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19. Danger space
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Is the space between the anterior (alar part) and posterior layers of prevertebral fascia b/c of its extension from the base of the skull to the diaphragm, providing a route for the spread of infection.
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20. Retropharyngeal abscess or infection
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May spread from the neck into the posterior mediastinum through the retropharyngeal space.
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21. Thyroglossal duct cyst
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Is a cyst in the midline of the neck resulting from a lack of closure of a segment of the thyroglossal duct.
It occurs most commonly in the region below the hyoid bone. As the cyst enlarges, it is prone ot infection. Occasionally, a thyroglossal cyst ruptures spontaneously, producing a sinus as a result of an infection of the cyst. |
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22. Corneal (blink) reflex
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Is closure of the eyelids in response to blowing on the cornea or touching it w/a wisp of cotton.
It is caused by a bilateral contraction of the orbicularis oculi muscles. Its efferent limb is the facial nerve; its afferent limb is the nasociliary nerve of the opthalmic division of the trigeminal nerve. |
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23. Bell's palsy
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Is a paralysis of the facial muscles on the affected side b/c of a lesion of the facial nerve caused by herpes simplex infection, stroke, brain tumor, and other idiopathic causes.
Causes distortions of the face, such as a sagging corner of the mouth, inability to smile, whistle, blow drooping of the eyebrow, sagging of the lower eyelid, inability to close or blink the eye, and tingling around the lips. Also causes decreased lacrimation (as a result of a lesion of the greater petrosal nerve), loss of taste in the anterior two thirds of the tongue (lesion of the chorda tympani), painful sensitivity to sounds (damage of nerve to the stapedius), and deviation of the lower jaw and tongue (injury of nerve to the digastric muscles) |
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24. Trigeminal neuraglia (tic douloureux)
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Is marked by paroxysmal pain along the course of the trigeminal nerve, especially radiating to the maxillary or mandibular area. The common causes of this disorder are aberrant blood vessels, aneurysms, chronic meningeal inflammation, brain tumors compressing on the trigeminal nerve at the base of the brain, and other lesions such as MS.
If medical treatments are not effective, the neuralgia may be alleviated by sectioning the sensory root of the trigeminal nerve in the trigeminal (Meckel's) cave in the middle cranial fossa. |
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25. Danger area of the face
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Is the area of the face near the nose drained by the facial veins. Pustules (pimples) or boils or other skin infections, particularly of the nose and upper lip, may spread to the cavernous venous sinus via the facial vein, pterygoid venous plexus, and ophthalmic veins.
Septicemia leads to meningitis and cavernous sinus thrombosis, both of which may cause neurologic damage and are life threatening. |
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26. Scalp hemorrhage
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Results from laceration of arteries in the dense subcutaneous tissue that are unable to contract or retract and thus remain open, leading ot profuse bleeding.
Deep scalp wounds gape widely when the epicranial aponeurosis is lacerated in the coronal plane b/c of the pull of the frontal and occipital bellies of the epicranius muscle in the opposite directions. Scalp infection localized in the loose connective tissue layer spreads across the calvaria to the intracranial dural venous sinuses through emissary veins, causing meningitis or septicemia. |
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27. Frey's syndrome
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Produces flushing and sweating instead of salivation in response to taste of food after injury of the auriculotemporal nerve, which carries parasympathetic secretomotor fibers to the parotid gland and sympathetic fibers to the sweat glands.
When the nerve is severs, the fibers can regenerate along each other's pathways and innervate the wrong gland. It can occur after parotid surgery and may be treated by cutting the tympanic plexus in the ear. |
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28. Rupture of the middle meningeal artery
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May be caused by fracture of the squamous part of the temporal bone as it runs thru the foramen spinosum and just deep to the inner surface of the temporal bone.
It causes epidural hematoma w/increased intracranial pressure. |
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29. Mumps (epidemic parotitis)
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Is an acute infection and contagious disease caused by a viral infection. It irritates the auriculotemporal nerve, causing severe pain b/c of inflammation and swelling of the parotid gland and stretching of its capsule, and pain is exacerbated by compression from swallowing or chewing.
May be accompanied by orchitis, causing sterility if it occurs after puberty. |
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30. Dislocation of the temporomandibular joint
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Occurs anteriorly as the mandible head glides across the articular tubercle during yawning and laughing. A blow to the chin with the mouth closed may drive the head of the mandible posteriorly and superiorly, causing fracture of the bony auditory canal and the floor of the middle cranial fossa.
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31. Skull fracture (pterion)
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Fracture at the pterion may rupture the middle meningeal artery, and a depressed fracture may compress the underlying brain.
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32. Skull fracture (petrous portion of temporal bone)
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A fracture of the petrous portion of the temporal bone may cause blood or CSF fluid to escape from the ear, hearing loss, and facial nerve damage.
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33. Skull fracture (anterior cranial fossa)
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Fracture of the anterior cranial fossa causes anosmia, periorbital bruising, and CSF leakage from the nose.
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34. Skull fracture (blow to the top of the head)
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A blow to the top of the head may fracture the skull base w/related cranial nerve injury, CSF leakage from a dura-arachnoid tear, and dural sinus thrombosis.
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35. Tripod fracture
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Is a facial fracture involving the three support of the malar (cheek or zygomatic) bone including the zygomatic processes of the temporal, frontal, and maxillary bones.
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36. Pial hemorrhage
Cerebral hemorrhage |
Pial: Due to damage to the small vessels of the pia and brain tissue
Cerebral: Caused by rupture of the thin walled lenticulostriate artery, a branch of the middle cerebral artery, producing hemiplegia (paralysis of one side of the body) |
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37. Subarachnoid hemorrhage
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Is due to rupture of cerebral arteries and veins that cross the subarachnoid space. It may be caused by rupture of an aneurysm on the circle of Willis or, less commonly, by a hemangioma (proliferation of blood vessels leads to a mass that resembles a neoplasm)
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38. Subdural hematoma
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is a form of traumatic brain injury in which blood gathers between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges).
Unlike in epidural hematomas, which are usually caused by tears in arteries, subdural bleeding usually results from tears in veins that cross the subdural space as they pass into one of the venous sinuses. This bleeding often separates the dura and the arachnoid layers. Subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. |
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39. Epidural hematoma
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Is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the periosteal layer) and the skull. Is due to rupture of the middle meningeal arteries or veins caused by trauma near the pterion, fracture of the greater wing of the sphenoid, or a torn dural venous sinus.
An epidural hematoma may put pressure on the brain and form a biconvex pattern on CT scan or MRI. |
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40. Cavernous sinus thrombosis
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Is the formation of thrombus in the cavernous sinus leading to infection. Most commonly causes of septic type is Staphylococcus, and the most common cause of spread of infection to the cavernous sinus is squeezing a pimple on the face above the upper lip near the nose (danger area).
As a result, it can lead to meningitis. |
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41. Lesion of the olfactory nerve
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May occur as a result of ethmoidal bone fracture and cause anosmia, or loss of olfactory sensation.
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42. Lesion of the optic nerve (optic neuritis)
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may be caused by inflammatory, degenerative, demyelinating, or toxis disorders and result in blindness or diminished visual acuity and no direct pupillary light reflex.
A lesion of the optic chiasma produces bitemporal heteronymous hemianopsia or tunnel vision, and a lesion of the optic tract produces contralateral homonymous hemianopsia. |
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43. Lesion of the occulomotor nerve
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Causes paralysis of ocular muscles including the levator palpebrae superioris (ptosis) b/c of damage of GSE fibers, paralysis fo sphincter pupillae resulting in dilation of the pupil (mydriasis),
and paralysis of ciliary muscles resulting in loss of pupillary light reflex b/c of damage of parasympathetic fibers that mediate the efferent limb of the pupillary light reflex. |
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44. Lesion of the trochlear nerve
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Causes paralysis of the superior oblique muscles of the eye, causing diplopia (double vision) when looking down.
It may be caused by severe head injuries b/c of its long intracranial course. |
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45. Lesion of the trigeminal nerve
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Causes sensory loss on the face and motor loss of mastication w/deviation of the mandible toward the side of the lesion.
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46. Lesion of the lingual nerve of V3 near oral cavity
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Causes loss of general and taste sensation to the anterior two thirds of the tongue and salivary secretion from submandibular and subligual glands.
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47. Lesion of opthalmic division (V1)
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Cannot mediate the afferent limb of the corneal reflex by way of the nasociliary branch
*Facial nerve mediates the efferent limb |
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48. Lesion of maxillary division (V2)
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Cannot mediate the afferent limb of the sneeze reflex
*Vagus nerve mediates the efferent limb |
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49. Lesion of the mandibular division (V3)
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Cannot mediate the afferent and efferent limbs of the jaw jerk reflex
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50. Lesion of the abducens nerve
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Causes paralysis of the lateral rectus muscle of the eye, causing medial deviation of the affected eye.
It may result from a brain tumor or septic thrombosis in the cavernous sinus. |
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51. Lesion of the facial nerve
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-Causes loss of SVE fibers to innervate the muscles of facial expression (Bell's palsy);
-SVA (taste) fibers from the anterior two thirds of the tongue; -Parasympathetic GVE fibers for the lacrimal, submandibular, sublingual, nasal, and palatine glands -GVA fibers to the palate and nasal mucosa, carotid sinus, and carotid body; and GSA fibers from the external acoustic meatus and the auricle. Lesion causes loss of mediation of the efferent limb of the corneal reflex. |
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52. Lesion of the vestibulocochlear nerve
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Causes loss of SSA fibers to hair cells of the cochlea (organ of Corti), the ampullae of the semicircular ducts, and the utricle and saccule, resulting in loss of hearing, vertigo, and tinnitus.
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53. Lesion of the glossopharyngeal nerve
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Causes loss of:
-SVE fibers to the stylopharyngeus muscle; -SVA (taste) fibers to the posterior one third of the tongue and vallate papilae; -GVE fibers to the otic ganglion; -GVA fibers to the pharynx, posterior one third of the tongue, tympanic cavity, the mastoid antrum and air cells, and the auditory tube -GSA fibers to the external ear. Cannot mediate the afferent limb of the gag (pharyngeal) reflex. |
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54. Lesion of the vagus nerve
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Causes:
-Dysphagia, resulting from lesion of pharyngeal branches -Deviation of the uvula toward the opposite side of the lesion on phonation -Cannot mediate the afferent and efferent limbs of the cough reflex -Cannot mediate the efferent limbs of the gag (pharyngeal reflex) -Cannot mediate the efferent limbs of the sneeze reflex. |
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55. Lesion of the superior laryngeal nerve
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Numbness of the upper part of the larynx and paralysis of the cricothyroid muscle resulting from lesion of the sup. laryngeal nerve
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56. Lesion of the recurrent laryngeal nerve
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Hoarseness, difficulty speaking or loss of voice, and numbness of the lower part of the larynx resulting form a lesion to the recurrent pharyngeal nerve.
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57. Lesion of the accessory nerve
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Causes loss of SVE fibers to the SCM and trapezius muscles. The arm cannot be abducted beyond the horizontal position as a result of inability to rotate the scapula.
Lesion also causes torticollis b/c of paralysis of the SCM and shoulder drop from paralysis of the trapezius |
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58. Lesion of the hypoglossal nerve
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Causes loss of GSE fibers to all the intrinsic and extrinsic muscles of the tongue, except for the palatoglossus (X).
Lesion causes deviation of the tongue toward the injured side on protrusion. "You lick your wounds" |
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59. Fracture of the orbital floor
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Involving the maxillary sinus commonly occurs as a result of a blunt force to the face. This fracture causes displacement of the eyeball, causing symptoms of double vision and also causes an injury to the infraorbital nerve, producing loss of sensation of the skin of the cheek and gum.
This fracture may cause entrapment of the inferior rectus muscle, which may limit upward gaze. |
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60. Hemianopia (hemianopsia)
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Is a condition characterized by loss of vision in one half the visual field of each eye. Blindness may occur as a result of a lesion of the optic nerve.
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61. Bitemporal hemianopia
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Bitemporal (heteronymous) which is a loss of vision in the temporal visual field of both eyes resulting from a lesion of the optic chiasma caused by a pituitary tumor
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62. Homonymous hemianopia
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Can be left or right
Loss of sight in (right) half of the visual field of both eyes resulting from a lesion of the (right) optic tract or optic radiation. |
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63. Papilledema (choked disk)
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An edema of the optic disk or optic nerve, often resulting from increased intracranial pressure and increased CSF pressure or thrombosis of the central vein of the retina, slowing venous return from the retina.
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64. Diplopia (double vision)
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Is caused by paralysis of one or more extraocular muscles resulting from injury of the nerves supplying them
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65. Strabismus (squint eye or crossed-eye)
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Is a visual disorder in which the visual axes do not meet at the desired point as a result of incoordinate action of the extrinsic eye muscles. Strabismus results from weakness or paralysis of extrinsic eye muscles as a result of damage to the oculomotor nerve.
The affected eye may turn inward, outward, upward, or downward, and other symptoms include decreased vision and misaligned eyes. |
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66. Crocodile tears syndrome (Bogorad's syndrome)
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Spontaneous lacrimation during eating caused by a lesion of the facial nerve proximal to the geniculate ganglion. It follows facial paralysis and is due to misdirection of regenerating parasympathetic fibers, which formerly innervated the salivary (submandibular and sublingual) glands, to the lacrimal glands.
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67. Accommodation
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The adjustment of the eye to focus on a near object. It occurs as contraction of the ciliary muscle, causing a relaxation of the suspensory ligament (ciliary zonular fibers) and an increase in thickness, convexity, and refractive power of the lens. It is mediated by parasympathetic fibers running within the oculomotor nerve.
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68. Argyll-Robertson pupil
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Is a miotic (pupil constriction) irregular pupil that responds to accommodation (constricts on near focus) but fails to respond to light.
It is caused by a lesion in the midbrain and seen in neurosyphilis and in diabetes. |
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69. Pupillary light reflex
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Constriction of the pupil in response to light stimulation (direct reflex) and the contralateral pupil also constricts (consensual reflex).
It is mediated by parasympathetic nerve fibers in the oculomotor nerve (efferent limb). Its afferent limb is the optic nerve. |
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70. Horner's syndrome
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Caused by injury to the cervical sympathetic nerves and is characterized by:
-miosis -ptosis -enophthalmos (retraction of the eyeball -anhidrosis -vasodilation |
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71. Anisocoria
Miosis Mydriasis |
Anisocoria: An unequal size of the pupil;
Miosis is a constrictied pupil caused by paralysis of the dilator pupillae resulting from a lesion of the sympathetic nerve as seen in Horner's syndrome Mydriasis is a dilated pupil caused by paralysis of the sphincter pupillae resulting from a lesion of the parasympathetic nerve. |
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72. Retinal detachment
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A separation of the sensory layer from the pigment layer of the retina. It may occur in trauma such as a blow to the head and can be reattached surgically.
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73. Retinitis pigmentosa
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An inherited disorder that causes a degeneration of photoreceptor cells in the retina or a progressive retinal atrophy, characterized by night blindness, constricted visual fields, and pigment infiltration of the inner retinal layers.
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74. Macular degeneration
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A degenerative change in the macula in the center of the retina lateral to the optic disk. A patient w/a macular degeneration sees the edges of images but has no central vision.
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75. Glaucoma
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Characterized by increase intraocular pressure resulting from impaired drainage of the aqueous humor (which is produced by the ciliary processes) into the venous system through the scleral venous sinus, which is a circular vascular channel at the corneoscleral junction or limbus.
The increased pressure causes impaired retinal blood flow, producing retinal ischemia or atrophy of the retina; degeneration of the nerve fibers in the retina, particularly at the optic disk; defects in the visual field, and blindness. |
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76. Cataract
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Is an opacity (milky white) of the crystalline eye lens or of its capsule, which must be removed. It results in little light being transmitted to the retina, causing blurred images and poor vision
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77. Presbyopia
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A condition in which the power of accommodation is reduced. It is caused by the loss of elasticity of the crystalline lens and occurs in advanced age and is corrected w/bifocal lenses.
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78. Lesion of the vagus nerve
How does it affect the uvula? |
Causes deviation of the uvula toward the opposite side of the lesion on phonation b/c of paralysis of the musclus uvulae. This muscle is innervated by CN X and elevates the uvula.
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79. Tongue-tie
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Is an abnormal shortness of the frenulum linguae, resulting in limitation of its movement and thus a severe speech impediment.
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80. Abscess or infection of the maxillary teeth
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Irritates the maxillary nerve, causing upper toothache.
It may result in symptoms of sinusitis, w/pain referred to the distribution of the maxillary nerve. |
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81. Abscess or infection of the mandibular teeth
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Might spread thru the lower jaw to emerge on the face or in the floor of the mouth.
It irritates the mandibular nerve, causing pain that may be referred to the ear b/c this nerve also innervates part of the ear. |
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82. Ludwig's angina
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Is an acute infection of the submandibular space w/secondary involvement of the sublingual and submental spaces, usually resulting from a dental infection in the mandibular molar area or a penetrating injury of the floor of the mouth.
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83. Cleft palate
Cleft lip |
Cleft palate occurs when the palatine shelves fail to fuse w/each other or the primary palate
Cleft lip occurs when the maxillary prominence and the medial nasal prominence fail to fuse. |
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84. Pharyngeal tumors
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May irritate the glossopharyngeal and vagus nerves. Pain that occurs while swallowing is referred to the ear b/c these nerves contribute sensory innervation to the external ear.
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85. Adenoid
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Hypertrophy or enlargement of the pharyngeal tonsils that obstructs passage of air from the nasal cavities thru the choanae into the nasopharynx and thus causes difficult in nasal breathing and phonation.
It may block the pharyngeal orifices of the auditory tube, causing hearing impairment. The infection may spread form the nasopharynx thru the auditory tube the middle ear cavity, causing otitis media, which may result in deafness. |
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86. Palatine tonsillectomy
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Surgical removal of the palatine tonsil. During this procedure, the glossoharyngeal nerve may be injured, causing loss of general sensation and taste sensation to the posterior one third of the tongue. Severe hemorrhage may occur usually from the tonsillar branch of the facial artery and palatine branches of the ascending pharyngeal arteries or paratonsillar veins.
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87. Epistaxis
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A nosebleed resulting from rupture of the sphenopalatine artery. Nosebleed occurs from nose picking, which tears the veins in the vestibule of the nose. It also occurs from the anterior nasal septum (Kiesselbach's area), where branches of the sphenopalatine (from maxillary), greater palatine (from maxillary), anterior ethmoidal (from V1), and superior labial (from facial) arteries converge.
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88. Sneeze
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Is an involuntary, sudden, violent, and audible expulsion of air thru the mouth and nose.
The afferent limb of the reflex is carried by branches of the maxillary nerve, which convey general sensation from the nasal cavity and palate, and the efferent limb is mediated by the vagus nerve. |
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89. Ethmoidal sinusitis
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An inflammation in the ethmoidal sinuses that may erode the medial wall of the orbit, causing an orbital cellulitis that may spread to the cranial cavity.
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90. Frontal sinusitis
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Is an inflammation in the frontal sinus that may erode the thin bone of the anterior cranial fossa, producing meningitis or brain abscesses.
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91. Maxillary sinusitis
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Mimics the clinical signs of maxillary tooth abscess; in most cases, it is related to an infected tooth.
Infection may spread from the maxillary sinus to the upper teeth and irritate the nerves to these teeth, causing toothache. It may be confused w/toothache b/c only a thin layer of bone separates the roots of the maxillary teeth from the sinus cavity. |
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92. Sphenoidal sinusitis
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An infection in the sphenoidal sinus that may spread, may come from the nasal cavity or from the nasopharynx, and may erode the sinus walls to reach the cavernous sinuses, pituitary gland, optic nerve, or brainstem.
Close relationships of the sphenoidal sinus w/other surrounding structures are clinically important b/c of potential injury during pituitary surgery and the possible spread of infection to other structures. |
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93. Lesion of the nerve of the pterygoid canal
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Results in vasodilation; a lack of secretion of the lacrimal, nasal, and palatine glands; and a loss of general and taste sensation of the palate.
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94. Laryngotomy
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An operative opening into the larynx thru the cricothyroid membrane (cricothryotomy), thru the thyroid cartilate (thyrotomy), or thru the thyrohyoid membrane (superior laryngotomy).
It is performed when sever edema or an impacted foreign body calls for rapid admission of air into the larynx and trachea. |
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95. Lesion of the recurrent laryngeal nerve
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Could be produced during thyroidectomy or cricothyrotomy or by aortic aneurysm and may cause respiratory obstruction, hoarseness, inability to speak, and loss of sensation below the vocal cord.
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96. Lesion of the internal laryngeal nerve
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Results in loss of sensation above the vocal cord and loss of taste on the epiglottis
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97. Lesion of the external laryngeal nerve
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May occur during thyroidectomy b/c the nerve accompanies the superior thyroid artery.
It causes paralysis of the cricothyroid muscle, resulting in paralysis of the laryngeal muscles and thus inability to lengthen the vocal cord and loss of the tension of the vocal cord. |
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98. Ottis media
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A middle ear infection that may be spread from the nasopharynx thru the auditory tub, causing temporary or permanent deafness.
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99. Hyperacusis
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Excessive acuteness of hearing, because of paralysis of the stapedius muscle (causing uninhibited movement of the stapes), resulting from a lesion of the facial nerve.
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100. Otosclerosis
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Is a condition of abnormal bone formation around the stapes and the oval windows, limiting the movement of the stapes and thus resulting in progressive conduction deafness
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101. Conductive deafness
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Hearing impairment caused by a defect of a sound-conducting apparatus such as the auditory meatus, eardrum, or ossicles.
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102. Neural or sensorineural deafness
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Hearing impairment b/c of a lesion of the auditory nerve or the central afferent neural pathway.
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103. What is the significane of the arachnoid granulations?
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Aggregations of arachnoid villi are called arachnoid granulations and drain cerebral spinal fluid into the venous system.
They are most abundant in the superior saggital sinus. |
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104. Which vessel supplies the major arterial supply to the dura?
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The middle meningeal artery is the most clinically significant b/c it can be damaged via pterion fractures.
Other arteries that supply the dura: 1. Anterior meningeal 2. Posterior meningeal 3. Accessory meningeal 4. Internal carotid 5. Maxillary 6. Ascending pharyngeal 7. Occipital |
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105. Identify the major sensory nerves that supply the dura.
Tentorium? |
1. Trigeminal nerve
2. Vagus nerve 3. C1-C3 (via hypoglossal canal) and sympathetic branches Since the trigeminal nerve is involved, stretching of the dura could refer pain to the facial region. Tentorium of the dura is V1 (opthalmic). Ant. and Post. ethmoidal branches off of V1 part of nasociliary. |
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106. In which layer of the scalp do the vessels travel?
Muscles? Danger layer? |
The vessels are within the (dense) connective tissue layer, layer 2.
The muscles are found w/in the aponeurotic layer, layer 3. These muscles are innervated by CN VII. The danger layer is the loose areolar layer (loose connective tissue), layer 4. Infections int he danger layer can spread rapidly and even into the intracranial venous sinuses via the valveless emissary veins. |
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107. Identify by landmarks the distribution of CN V to the face
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V1 covers the top of the head and forehead including the tip of the nose.
V2 covers the maxillary region of the upper lip. V3 covers from the top of the ear to the jaw, not including the corner of the jaw, which is supplied by the great auricular nerve. Lower eyelid is V2, upper eyelid and eye is V1. |
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108. Identify the 4 major arteries that contribute to the circulation of the face.
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1. Facial artery
2. Maxillary artery 3. Opthalmic artery 4. Transverse facial artery |
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109. Where does the parotid duct open?
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The vestibule of the mouth upon a small papilla opposite the upper second molar tooth.
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110. Identify the important structures that course thru the parotid gland
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1. Facial nerve
2. Auriculotemporal nerve 3. External carotid artery 4. Retromandibular vein 5. Transverse facial artery 6. Superficial temporal artery |
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111. Identify the muscles that close the eye.
Mouth? Keep food btwn the teeth? |
Close eyes: orbicularis oculi; facial nerve, zygomatic branch; pharyngeal arch 2
Close mouth: orbicularis oris; trigeminal V3 branch; pharyngeal arch 1 Food between teeth: buccinator muscle; facial nerve (buccal branch); pharyngeal arch 2 |
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112. Identify muscles that elevate the larynx and pharynx during swallowing
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Larynx:
1. Stylopharyngeus 2. Salpingopharyngeus 3. Palatopharyngeus 4. Digastric 5. Stylohyoid Pharynx: 1. Superior constrictor 2. Middle constrictor 3. Inferior constrictor |
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113. Identify the muscle, which, when it contracts, opens the auditory-pharyngeal tube.
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Tensor veli palatine (and levator veli palatini)
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114. Paralysis of the right levator palatini muscle results in deviation of the uvula to which side?
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The uvula will deviate toward the unaffected side, so the left.
Due to damage of the vagus nerve. |
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115. Identify two antagonistic muscles working at the cricothyroid joint
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1. Cricothyroid
2. Thyroarytenoid |
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116. Which muscle acts to abduct the true vocal folds?
Adducts? Tensing? Relaxing? Approximation? |
Abduction: posterior cricoarytenoid
Adduction: lateral cricoarytenoid Tensing: cricothyroid Relaxing: thyroarytenoid Approximation: transverse arytenoids |
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117. Innervation of the intrinsic muscles of the larynx is accomplished by which cranial nerve?
Cricothyroid? Mucosa of the true vocal fold? |
Intrinsic muscles by the recurrent laryngeal nerve (vagus), except for the cricothyroid muscle which is innervated by the external branch of the superior laryngeal nerve.
Mucosa of true vocal folds is innervated by the internal branch of the superior laryngeal nerve. |
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118. Which muscles of mastication close the mandible?
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1. Temporalis
2. Masseter |
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119. Identify the innervation of the muscles of mastication
Comes for which embryological arch? |
Trigeminal (mandibular branch V3) from pharyngeal arch 1
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120. Which muscles are responsible for side-to-side movements of the mandible?
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Medial and lateral pterygoids
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121. Identify two specific branches of GVE-P cranial nerves whose postganglionic fibers travel with V3
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1. Chorda tympani nerve via lingual (to submandibular ganglion)
2. Auriculotemporal nerve (otic ganglion to parotid gland) |
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122. The lingual and inferior alveolar nerves pass between which two muscles?
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Medial and lateral pterygoids once again
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123. Identify the nerve that innervates both the inside and the outside of the cheek.
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Buccal branch of mandibular nerve (V3)
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124. The superior and middle nasal conchae are part of which bone?
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Ethmoid bone
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125. What are the three components of the nasal septum?
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1. Septal cartilage
2. Vertical plate of the ethmoid 3. Vomer bone |
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126. Identify the paranasal sinuses that open into the middle meatus.
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1. Maxillary sinuses (via hiatus semilunaris)
2. Frontal sinus (via infundibulum) 3. Anterior ethmoidal sinuses (via infundibulum) 4. Middle ethmoidal sinuses (on or above the bulla ethmoidalis) The posterior ethmoidal sinus goes to the superior meatus. |
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127. What arteries form Kiesselbach's plexus?
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1. Anterior ethmoid artery
2. Great palatine artery 3. Sphenopalatine artery 4. Superior labial artery 5. Septal branches from facial artery |
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128. Identify three major areas to which venous blood of the nasal cavity drains.
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1. Cavernous sinus/plexus
2. Facial vein 3. Pterygoid plexus |
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129. What are the major nerves that supply branches to the nasal mucosa?
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1. Olfactory nerves
2. Opthalmic branch of trigeminal (V1) via nasociliary 3. Maxillary branch of trigeminal (V2) 4. Nasopaline nerve 5. Infraorbital nerve (possible) |
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130. Which cranial nerve has a specific GVE-P branch which provides preganglionic parasympathetic innervation to nasal mucosal glands?
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Greater petrosal nerve of CN VII
It hitchhikes on CN V2 into PPG and then maxillary branches split off. |
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131. The pterygopalatine ganglion provides postganglionic parasympathetic innervation to which general areas/structures of the head?
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1. Lacrimal gland
2. Nasopharynx 3. Mucosa membrane of oral/nasal cavity. |
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132. What are four major osseous and cartilaginous attachments of the tongue musculature?
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1. Superior genial spine of mandible (genioglossus)
2. Body and greater horn of hyoid bone (hyoglossus) 3. Styloid process of temporal bone (styloglossus) 4. Palatine aponeurosis (palatoglossus) |
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133. A patient protrudes his tongue and it deviates to the right.
Identify the nerve and the side of the lesion |
Hypoglossal nerve CN XII and the ipsilateral side: right side
|
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134. Which nerves supply SVA fibers to the tongue?
GSA fibers? GSE fibers? GVA fibers? |
SVA: CN VII (Facial)
GSA: CN V (Trigeminal) GSE: CN XII (Hypoglossal) GVA: CN IX/X (Glossopharyngeal and Vagus) |
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135. Explain the sensation of the anterior 2/3 of the tongue
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Anterior 2/3 of the tongue sensation is the lingual branch of V3 and taste is chorda tympani branch of facial nerve.
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136. Explain the sensation of the posterior 1/3 of the tongue
Root of tongue? |
Posterior 1/3 of tongue sensation and taste is glossopharyngeal nerve (CN IX)
Root of tongue sensation, taste, and movement (palatoglossus muscle) is by the vagus nerve (CN X) |
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137. How do sublingual medications reach the heart?
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1. Sublingual meds enter the sublingual veins to the vena comitantes nervi hypoglossi to the facial vein and then to the jugular vein. The drugs quickly enter the caval venous circulation and bypass the liver, which reduces the initial breakdown and is useful for drugs with a high first pass metabolism.
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138. Where do you locate the deep portion of the submandibular gland?
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Beneath the mucous membrane of the mouth on the lower side of the tongue.
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139. What structure crosses the submandibular duct twice?
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Lingual nerve
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140. Describe the route of sympathetic and parasympathetic innervation to the submandibular and sublingual salivary glands
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Sympathetic: indirect via the sympathetic nervous system via the external carotid plexus
Parasympathetic: facial nerve via the chorda tympani. The postganglionic fibers come from the submandibular ganglion and go directly to the gland |
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141. Which cranial nerve is used to adduct the eye?
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Looking medially (adduction) is medial rectus muscle.
CN III |
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142. Which cranial nerve is used to abduct the eye?
|
Looking laterally (abduction) is lateral rectus mucle.
CN VI |
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143. Accommodation involves what three actions?
By what cranial nerve are they mediated? |
1. Accommodation of lens (parasympathetics)
2. Convergence of lens (CN II for medial rectus) 3. Constriction of pupil (parasympathetics) |
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145. Identify the mucosal innervation of the middle ear cavity
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Tympanic plexus of glossopharyngeal nerve (CN IX) and sympathetic fibers
|
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146. What mechanism is provided to keep the middle ear ossicles from over-vibrating?
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The tensor tympani and stapedius muscles dampen the vibrations of the tympanic membrane and stapes, respectively.
Paralysis of these muscles would result in sensitive, or amplified, hearing. |
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147. List and describe the origin and course of the chorda tympani
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In the middle ear, it traverses the posterior canaliculus, runs in the mucosa over the handle of the malleus and leaves via the anterior canaliculus
|
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148. List and describe the origin, course, and importance of the tympanic branch of IX
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Supplies the mucosa, tube, and mastoid air cells. Continues as the lesser petrosal nerve.
|
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149. Light reflex
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In by 2 out by 3
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150. Corneal reflex
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In by 5 out by 7
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151. Gag reflex
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In by 9 SVA out by 10 SVE
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152. Cough reflex
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In by 10 GVA, out by 10
|
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153. Vertebral level of hyoid bone
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C3
|
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154. Vertebral level of thyroid cartilage
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C4, C5
|
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155. Vertebral level of cricoid cartilage
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C6
|
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156. Structures that course between anterior and middle scalenes
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1. Brachial Plexus
2. Ansa cericalis |
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157. Innervation of omohyoid, sternohyoid and sternothyroid
|
Ansa cervicalis
|
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158. Innervation of digastric muscle
Anterior and Posterior bellies? |
Anterior belly: CN V
Posterior belly: CN VII |
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159. Innervation of carotid sinus and carotid body
|
CN IX, CN X
|
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160. Major structures to pass through the pharyngeal wall superior to superior constrictor
|
1. Auditory tube
2. Levator veli palatini |
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161. Nerves of pharyngeal plexus
|
CN IX, CNX, Sympathetics
|
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162. Only muscle innervated by CN IX
|
Stylopharyngeus
|
|
163. Structures that pierce the thyrohyoid membrane
|
1. Internal laryngeal nerve
2. Superior laryngeal artery |
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164. Only muscle to abduct vocal cords
|
Posterior cricoarytenoid
|
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165. Innervation of laryngeal muscles exclusive of cricothyroid
|
Recurrent laryngeal
|
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166. Site of aspirated lodged fishbone
|
Piriform recess
|
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167. Chief structures that traverse the internal acoustic meatus
|
CN VII and CN VIII
|
|
168. Foramen where VII exits skull
|
Stylomastoid foramen
|
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169. Major artery to internal structures of head
|
Maxillary
|
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170. Spinal levels of sympathetic fibers to head
|
T1 - T2
|
|
171. Autonomic ganglia for CN III
|
Ciliary
|
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172. Sensory ganglia for CN VII
|
Geniculate
|
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173. Autonomic ganglia for CN VII
|
PPG and submandibular
|
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174. Autonomic ganglia for CN IX
|
Otic
|
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175. Muscle attached to disc of TMJ
|
Lateral pterygoid
|
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176. Muscle that retracts mandible
|
Temporalis
|
|
178. Major never to TMJ pain
|
Auriculotemporal nerve
|
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179. Specific nerves that elicit secretion from the parotid gland
|
1. Tympanic branch of CN IX
2. Lesser petrosal nerve |
|
180. Branch of CN V that carries parasympathetics to the parotid
|
Auriculotemporal
|
|
181. Structures that opens into the superior meatus of the nasal cavity
|
Posterior ethmoid sinus
|
|
182. Structures that open into the middle meatus of the nasal cavity
|
Frontal, maxillary, anterior and middle ethmoid sinuses
|
|
183. Structures that opens into the inferior meatus of nasal cavity
|
Nasolacrimal duct
|
|
184. Major artery to nasal cavity
|
Sphenopalatine artery
|
|
185. Innervation of levator veli palatini
|
CN X
|
|
186. Muscle that opens the auditory tube
|
Tensor veli palatini
|
|
187. Innervation of tensor veli palatini
|
CN V3
|
|
188. Nerve that provides taste to anterior 2/3's of tongue
|
Chorda tympani (from CN VII)
|
|
189. Site of cell bodies for nerve that carries taste to anterior 2/3 of tongue
|
Geniculate ganglion
|
|
190. Specific nerve that elicits secretions for submandibular gland
|
Chorda tympani
|
|
191. Branch of CN V that carries parasympathetics to submandibular
|
Lingual
|
|
192. Nerve injured when tonsillar pillars sag and ulula deviates
|
CN X
|
|
193. Nerve potentially injured with tonsillectomy
|
CN IX
|
|
194. Muscle that protrudes the tongue
|
Genioglossus
|
|
195. Nerve injured when deviation of protruded tongue
|
Ipsalateral CN XII
|
|
196. Specific nerve that stimulates tear production
|
Greater petrosal nerve (CN VII)
|
|
197. Sensory nerve to cornea
|
CN V1 (Nasociliary)
|
|
198. Muscle that elevates and abducts eye
|
Inferior oblique
|
|
199. Muscles that depresses and abducts eye
|
Superior oblique
|
|
200. Site of preganglionic nerve cells that elicits dilation of pupil
|
Lateral horn, T1-T2
|
|
201. Site of postganglionic nerve cells that elicits dilation of pupil
|
Superior cervical ganglion
|
|
202. Site of preganglionic nerve cells that elicits constrition of pupil
|
Edinger-Westphal nucleus
|
|
203. Site of postganglion nerve cells that elicits constriction of pupil
|
Ciliary ganglion
|
|
204. Innervation of external surface of tympanic membrane
|
Auriculotemporal nerve and CN X
|
|
205. Innervation of internal surface of tympanic membrane
|
CN IX
|
|
206. Part one of subclavian artery
|
1. Vertebral artery (enters at C6 transverse foramen)
2. Thyrocervical trunk 3. Internal thoracic artery |
|
207. Part two of subclavian artery
|
Costocervical trunk
|
|
208. Part three of subclavian artery
|
50% of people have a descending scapular artery (dorsal scapular artery)
|
|
209. Branches of the thyrocervical trunk
|
1. Inferior thyroid artery
2. Transverse cervical artery 3. Suprascapular artery |
|
210. Branches of the costocervical trunk
|
1. Deep cervical artery
2. Superior intercostal artery |
|
211. Branches of the internal carotid artery
|
1. Opthalmic artery
2. Anterior cerebral artery 3. Middle cerebral artery Participates in the formation of the circulus arteriosus |
|
212. Branches of the external carotid artery
|
1. Superior thyroid artery
2. Ascending pharyngeal artery 3. Lingual artery 4. Facial artery 5. Occipital artery 6. Posterior auricular artery 7. Maxillary artery 8. Superficial temporal artery |
|
213. Superficial lymph nodes of the head
|
Lymph from face, scalp, and ear drain into the occipital, retroauricular, parotid, buccal, submandibular, submental and superficial cervical nodes.
These drain into the deep cervical nodes |
|
214. Lymph drainage from middle ear
|
The middle ear drains into the retropharyngeal and upper deep cervical nodes
|
|
215. Lymph drainage from nasal cavity and paranasal sinuses
|
Drain into:
1. Submandibular 2. Retropharyngeal 3. Upper deep cervical |
|
216. Lymph drainage from tongue
|
Drains into:
1. Submental 2. Submandibular 3. Upper cervical 4. Lower cervical |
|
217. Lymph drainage from larynx
|
Drains into:
1. Upper deep cervical 2. Lower deep cervical |
|
218. Lymph drainage from pharynx
|
Drains into:
1. Retropharyngeal 2. Upper deep cervical 3. Lower deep cervical |
|
219. Lymph drainage from the thyroid gland
|
Drains into:
1. Lower deep cervical 2. Prelaryngeal 3. Pretracheal 4. Paratracheal |
|
218. test card
|
test 1
|
|
219 test card 2
|
test 2
|