Head Neck Clinical Correlates

Front 1

1. Torticollis

Back 1

(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

Front 2

2. Eagle's syndrome

Back 2

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.

Front 3

3. Lesion of the accessory nerve in the neck

Back 3

Denervates the trapezius, leading to atrophy of the muscle.

It causes a downward displacement or drooping of the shoulder.

Front 4

4. Neurovascular compression syndrome

Back 4

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.

Front 5

5. Subclavian steal syndrome

Back 5

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.

Front 6

6. Carotid sinus syncope

Back 6

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.

Front 7

7. Carotid endarterectomy

Back 7

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.

Front 8

8. Temporal (giant cell) arteritis

Back 8

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

Front 9

9. Central venous line

Back 9

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.

Front 10

10. Tracheotomy

Back 10

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.

Front 11

11. Goiter

Back 11

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

Front 12

12. Grave's disease

Back 12

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).

Front 13

13. Papillary carcinoma of the thyroid

Back 13

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.

Front 14

14. Thyroidectomy

Back 14

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.

Front 15

15. Parathyroidectomy

Back 15

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.

Front 16

16. Cricothyrotomy

Back 16

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.

Front 17

17. Horner's syndrome

Back 17

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.

Front 18

18. Stellate ganglion block

Back 18

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.

Front 19

19. Danger space

Back 19

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.

Front 20

20. Retropharyngeal abscess or infection

Back 20

May spread from the neck into the posterior mediastinum through the retropharyngeal space.

Front 21

21. Thyroglossal duct cyst

Back 21

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.

Front 22

22. Corneal (blink) reflex

Back 22

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.

Front 23

23. Bell's palsy

Back 23

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)

Front 24

24. Trigeminal neuraglia (tic douloureux)

Back 24

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.

Front 25

25. Danger area of the face

Back 25

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.

Front 26

26. Scalp hemorrhage

Back 26

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.

Front 27

27. Frey's syndrome

Back 27

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.

Front 28

28. Rupture of the middle meningeal artery

Back 28

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.

Front 29

29. Mumps (epidemic parotitis)

Back 29

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.

Front 30

30. Dislocation of the temporomandibular joint

Back 30

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.

Front 31

31. Skull fracture (pterion)

Back 31

Fracture at the pterion may rupture the middle meningeal artery, and a depressed fracture may compress the underlying brain.

Front 32

32. Skull fracture (petrous portion of temporal bone)

Back 32

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.

Front 33

33. Skull fracture (anterior cranial fossa)

Back 33

Fracture of the anterior cranial fossa causes anosmia, periorbital bruising, and CSF leakage from the nose.

Front 34

34. Skull fracture (blow to the top of the head)

Back 34

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.

Front 35

35. Tripod fracture

Back 35

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.

Front 36

36. Pial hemorrhage

Cerebral hemorrhage

Back 36

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)

Front 37

37. Subarachnoid hemorrhage

Back 37

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)

Front 38

38. Subdural hematoma

Back 38

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.

Front 39

39. Epidural hematoma

Back 39

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.

Front 40

40. Cavernous sinus thrombosis

Back 40

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.

Front 41

41. Lesion of the olfactory nerve

Back 41

May occur as a result of ethmoidal bone fracture and cause anosmia, or loss of olfactory sensation.

Front 42

42. Lesion of the optic nerve (optic neuritis)

Back 42

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.

Front 43

43. Lesion of the occulomotor nerve

Back 43

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.

Front 44

44. Lesion of the trochlear nerve

Back 44

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.

Front 45

45. Lesion of the trigeminal nerve

Back 45

Causes sensory loss on the face and motor loss of mastication w/deviation of the mandible toward the side of the lesion.

Front 46

46. Lesion of the lingual nerve of V3 near oral cavity

Back 46

Causes loss of general and taste sensation to the anterior two thirds of the tongue and salivary secretion from submandibular and subligual glands.

Front 47

47. Lesion of opthalmic division (V1)

Back 47

Cannot mediate the afferent limb of the corneal reflex by way of the nasociliary branch

*Facial nerve mediates the efferent limb

Front 48

48. Lesion of maxillary division (V2)

Back 48

Cannot mediate the afferent limb of the sneeze reflex

*Vagus nerve mediates the efferent limb

Front 49

49. Lesion of the mandibular division (V3)

Back 49

Cannot mediate the afferent and efferent limbs of the jaw jerk reflex

Front 50

50. Lesion of the abducens nerve

Back 50

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.

Front 51

51. Lesion of the facial nerve

Back 51

-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.

Front 52

52. Lesion of the vestibulocochlear nerve

Back 52

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.

Front 53

53. Lesion of the glossopharyngeal nerve

Back 53

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.

Front 54

54. Lesion of the vagus nerve

Back 54

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.

Front 55

55. Lesion of the superior laryngeal nerve

Back 55

Numbness of the upper part of the larynx and paralysis of the cricothyroid muscle resulting from lesion of the sup. laryngeal nerve

Front 56

56. Lesion of the recurrent laryngeal nerve

Back 56

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.

Front 57

57. Lesion of the accessory nerve

Back 57

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

Front 58

58. Lesion of the hypoglossal nerve

Back 58

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"

Front 59

59. Fracture of the orbital floor

Back 59

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.

Front 60

60. Hemianopia (hemianopsia)

Back 60

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.

Front 61

61. Bitemporal hemianopia

Back 61

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

Front 62

62. Homonymous hemianopia

Back 62

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.

Front 63

63. Papilledema (choked disk)

Back 63

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.

Front 64

64. Diplopia (double vision)

Back 64

Is caused by paralysis of one or more extraocular muscles resulting from injury of the nerves supplying them

Front 65

65. Strabismus (squint eye or crossed-eye)

Back 65

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.

Front 66

66. Crocodile tears syndrome (Bogorad's syndrome)

Back 66

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.

Front 67

67. Accommodation

Back 67

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.

Front 68

68. Argyll-Robertson pupil

Back 68

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.

Front 69

69. Pupillary light reflex

Back 69

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.

Front 70

70. Horner's syndrome

Back 70

Caused by injury to the cervical sympathetic nerves and is characterized by:
-miosis
-ptosis
-enophthalmos (retraction of the eyeball
-anhidrosis
-vasodilation

Front 71

71. Anisocoria

Miosis

Mydriasis

Back 71

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.

Front 72

72. Retinal detachment

Back 72

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.

Front 73

73. Retinitis pigmentosa

Back 73

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.

Front 74

74. Macular degeneration

Back 74

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.

Front 75

75. Glaucoma

Back 75

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.

Front 76

76. Cataract

Back 76

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

Front 77

77. Presbyopia

Back 77

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.

Front 78

78. Lesion of the vagus nerve

How does it affect the uvula?

Back 78

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.

Front 79

79. Tongue-tie

Back 79

Is an abnormal shortness of the frenulum linguae, resulting in limitation of its movement and thus a severe speech impediment.

Front 80

80. Abscess or infection of the maxillary teeth

Back 80

Irritates the maxillary nerve, causing upper toothache.

It may result in symptoms of sinusitis, w/pain referred to the distribution of the maxillary nerve.

Front 81

81. Abscess or infection of the mandibular teeth

Back 81

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.

Front 82

82. Ludwig's angina

Back 82

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.

Front 83

83. Cleft palate

Cleft lip

Back 83

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.

Front 84

84. Pharyngeal tumors

Back 84

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.

Front 85

85. Adenoid

Back 85

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.

Front 86

86. Palatine tonsillectomy

Back 86

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.

Front 87

87. Epistaxis

Back 87

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.

Front 88

88. Sneeze

Back 88

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.

Front 89

89. Ethmoidal sinusitis

Back 89

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.

Front 90

90. Frontal sinusitis

Back 90

Is an inflammation in the frontal sinus that may erode the thin bone of the anterior cranial fossa, producing meningitis or brain abscesses.

Front 91

91. Maxillary sinusitis

Back 91

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.

Front 92

92. Sphenoidal sinusitis

Back 92

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.

Front 93

93. Lesion of the nerve of the pterygoid canal

Back 93

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.

Front 94

94. Laryngotomy

Back 94

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.

Front 95

95. Lesion of the recurrent laryngeal nerve

Back 95

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.

Front 96

96. Lesion of the internal laryngeal nerve

Back 96

Results in loss of sensation above the vocal cord and loss of taste on the epiglottis

Front 97

97. Lesion of the external laryngeal nerve

Back 97

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.

Front 98

98. Ottis media

Back 98

A middle ear infection that may be spread from the nasopharynx thru the auditory tub, causing temporary or permanent deafness.

Front 99

99. Hyperacusis

Back 99

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.

Front 100

100. Otosclerosis

Back 100

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

Front 101

101. Conductive deafness

Back 101

Hearing impairment caused by a defect of a sound-conducting apparatus such as the auditory meatus, eardrum, or ossicles.

Front 102

102. Neural or sensorineural deafness

Back 102

Hearing impairment b/c of a lesion of the auditory nerve or the central afferent neural pathway.

Front 103

103. What is the significane of the arachnoid granulations?

Back 103

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.

Front 104

104. Which vessel supplies the major arterial supply to the dura?

Back 104

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

Front 105

105. Identify the major sensory nerves that supply the dura.

Tentorium?

Back 105

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.

Front 106

106. In which layer of the scalp do the vessels travel?

Muscles?

Danger layer?

Back 106

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.

Front 107

107. Identify by landmarks the distribution of CN V to the face

Back 107

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.

Front 108

108. Identify the 4 major arteries that contribute to the circulation of the face.

Back 108

1. Facial artery
2. Maxillary artery
3. Opthalmic artery
4. Transverse facial artery

Front 109

109. Where does the parotid duct open?

Back 109

The vestibule of the mouth upon a small papilla opposite the upper second molar tooth.

Front 110

110. Identify the important structures that course thru the parotid gland

Back 110

1. Facial nerve
2. Auriculotemporal nerve
3. External carotid artery
4. Retromandibular vein
5. Transverse facial artery
6. Superficial temporal artery

Front 111

111. Identify the muscles that close the eye.

Mouth?

Keep food btwn the teeth?

Back 111

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

Front 112

112. Identify muscles that elevate the larynx and pharynx during swallowing

Back 112

Larynx:
1. Stylopharyngeus
2. Salpingopharyngeus
3. Palatopharyngeus
4. Digastric
5. Stylohyoid

Pharynx:
1. Superior constrictor
2. Middle constrictor
3. Inferior constrictor

Front 113

113. Identify the muscle, which, when it contracts, opens the auditory-pharyngeal tube.

Back 113

Tensor veli palatine (and levator veli palatini)

Front 114

114. Paralysis of the right levator palatini muscle results in deviation of the uvula to which side?

Back 114

The uvula will deviate toward the unaffected side, so the left.

Due to damage of the vagus nerve.

Front 115

115. Identify two antagonistic muscles working at the cricothyroid joint

Back 115

1. Cricothyroid
2. Thyroarytenoid

Front 116

116. Which muscle acts to abduct the true vocal folds?

Adducts?

Tensing?

Relaxing?

Approximation?

Back 116

Abduction: posterior cricoarytenoid

Adduction: lateral cricoarytenoid

Tensing: cricothyroid

Relaxing: thyroarytenoid

Approximation: transverse arytenoids

Front 117

117. Innervation of the intrinsic muscles of the larynx is accomplished by which cranial nerve?

Cricothyroid?

Mucosa of the true vocal fold?

Back 117

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.

Front 118

118. Which muscles of mastication close the mandible?

Back 118

1. Temporalis
2. Masseter

Front 119

119. Identify the innervation of the muscles of mastication

Comes for which embryological arch?

Back 119

Trigeminal (mandibular branch V3) from pharyngeal arch 1

Front 120

120. Which muscles are responsible for side-to-side movements of the mandible?

Back 120

Medial and lateral pterygoids

Front 121

121. Identify two specific branches of GVE-P cranial nerves whose postganglionic fibers travel with V3

Back 121

1. Chorda tympani nerve via lingual (to submandibular ganglion)

2. Auriculotemporal nerve (otic ganglion to parotid gland)

Front 122

122. The lingual and inferior alveolar nerves pass between which two muscles?

Back 122

Medial and lateral pterygoids once again

Front 123

123. Identify the nerve that innervates both the inside and the outside of the cheek.

Back 123

Buccal branch of mandibular nerve (V3)

Front 124

124. The superior and middle nasal conchae are part of which bone?

Back 124

Ethmoid bone

Front 125

125. What are the three components of the nasal septum?

Back 125

1. Septal cartilage
2. Vertical plate of the ethmoid
3. Vomer bone

Front 126

126. Identify the paranasal sinuses that open into the middle meatus.

Back 126

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.

Front 127

127. What arteries form Kiesselbach's plexus?

Back 127

1. Anterior ethmoid artery
2. Great palatine artery
3. Sphenopalatine artery
4. Superior labial artery
5. Septal branches from facial artery

Front 128

128. Identify three major areas to which venous blood of the nasal cavity drains.

Back 128

1. Cavernous sinus/plexus
2. Facial vein
3. Pterygoid plexus

Front 129

129. What are the major nerves that supply branches to the nasal mucosa?

Back 129

1. Olfactory nerves
2. Opthalmic branch of trigeminal (V1) via nasociliary
3. Maxillary branch of trigeminal (V2)
4. Nasopaline nerve
5. Infraorbital nerve (possible)

Front 130

130. Which cranial nerve has a specific GVE-P branch which provides preganglionic parasympathetic innervation to nasal mucosal glands?

Back 130

Greater petrosal nerve of CN VII

It hitchhikes on CN V2 into PPG and then maxillary branches split off.

Front 131

131. The pterygopalatine ganglion provides postganglionic parasympathetic innervation to which general areas/structures of the head?

Back 131

1. Lacrimal gland
2. Nasopharynx
3. Mucosa membrane of oral/nasal cavity.

Front 132

132. What are four major osseous and cartilaginous attachments of the tongue musculature?

Back 132

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)

Front 133

133. A patient protrudes his tongue and it deviates to the right.

Identify the nerve and the side of the lesion

Back 133

Hypoglossal nerve CN XII and the ipsilateral side: right side

Front 134

134. Which nerves supply SVA fibers to the tongue?

GSA fibers?

GSE fibers?

GVA fibers?

Back 134

SVA: CN VII (Facial)

GSA: CN V (Trigeminal)

GSE: CN XII (Hypoglossal)

GVA: CN IX/X (Glossopharyngeal and Vagus)

Front 135

135. Explain the sensation of the anterior 2/3 of the tongue

Back 135

Anterior 2/3 of the tongue sensation is the lingual branch of V3 and taste is chorda tympani branch of facial nerve.

Front 136

136. Explain the sensation of the posterior 1/3 of the tongue

Root of tongue?

Back 136

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)

Front 137

137. How do sublingual medications reach the heart?

Back 137

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.

Front 138

138. Where do you locate the deep portion of the submandibular gland?

Back 138

Beneath the mucous membrane of the mouth on the lower side of the tongue.

Front 139

139. What structure crosses the submandibular duct twice?

Back 139

Lingual nerve

Front 140

140. Describe the route of sympathetic and parasympathetic innervation to the submandibular and sublingual salivary glands

Back 140

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

Front 141

141. Which cranial nerve is used to adduct the eye?

Back 141

Looking medially (adduction) is medial rectus muscle.

CN III

Front 142

142. Which cranial nerve is used to abduct the eye?

Back 142

Looking laterally (abduction) is lateral rectus mucle.

CN VI

Front 143

143. Accommodation involves what three actions?

By what cranial nerve are they mediated?

Back 143

1. Accommodation of lens (parasympathetics)

2. Convergence of lens (CN II for medial rectus)

3. Constriction of pupil (parasympathetics)

Front 144

145. Identify the mucosal innervation of the middle ear cavity

Back 144

Tympanic plexus of glossopharyngeal nerve (CN IX) and sympathetic fibers

Front 145

146. What mechanism is provided to keep the middle ear ossicles from over-vibrating?

Back 145

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.

Front 146

147. List and describe the origin and course of the chorda tympani

Back 146

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

Front 147

148. List and describe the origin, course, and importance of the tympanic branch of IX

Back 147

Supplies the mucosa, tube, and mastoid air cells. Continues as the lesser petrosal nerve.

Front 148

149. Light reflex

Back 148

In by 2 out by 3

Front 149

150. Corneal reflex

Back 149

In by 5 out by 7

Front 150

151. Gag reflex

Back 150

In by 9 SVA out by 10 SVE

Front 151

152. Cough reflex

Back 151

In by 10 GVA, out by 10

Front 152

153. Vertebral level of hyoid bone

Back 152

C3

Front 153

154. Vertebral level of thyroid cartilage

Back 153

C4, C5

Front 154

155. Vertebral level of cricoid cartilage

Back 154

C6

Front 155

156. Structures that course between anterior and middle scalenes

Back 155

1. Brachial Plexus
2. Ansa cericalis

Front 156

157. Innervation of omohyoid, sternohyoid and sternothyroid

Back 156

Ansa cervicalis

Front 157

158. Innervation of digastric muscle

Anterior and Posterior bellies?

Back 157

Anterior belly: CN V

Posterior belly: CN VII

Front 158

159. Innervation of carotid sinus and carotid body

Back 158

CN IX, CN X

Front 159

160. Major structures to pass through the pharyngeal wall superior to superior constrictor

Back 159

1. Auditory tube
2. Levator veli palatini

Front 160

161. Nerves of pharyngeal plexus

Back 160

CN IX, CNX, Sympathetics

Front 161

162. Only muscle innervated by CN IX

Back 161

Stylopharyngeus

Front 162

163. Structures that pierce the thyrohyoid membrane

Back 162

1. Internal laryngeal nerve
2. Superior laryngeal artery

Front 163

164. Only muscle to abduct vocal cords

Back 163

Posterior cricoarytenoid

Front 164

165. Innervation of laryngeal muscles exclusive of cricothyroid

Back 164

Recurrent laryngeal

Front 165

166. Site of aspirated lodged fishbone

Back 165

Piriform recess

Front 166

167. Chief structures that traverse the internal acoustic meatus

Back 166

CN VII and CN VIII

Front 167

168. Foramen where VII exits skull

Back 167

Stylomastoid foramen

Front 168

169. Major artery to internal structures of head

Back 168

Maxillary

Front 169

170. Spinal levels of sympathetic fibers to head

Back 169

T1 - T2

Front 170

171. Autonomic ganglia for CN III

Back 170

Ciliary

Front 171

172. Sensory ganglia for CN VII

Back 171

Geniculate

Front 172

173. Autonomic ganglia for CN VII

Back 172

PPG and submandibular

Front 173

174. Autonomic ganglia for CN IX

Back 173

Otic

Front 174

175. Muscle attached to disc of TMJ

Back 174

Lateral pterygoid

Front 175

176. Muscle that retracts mandible

Back 175

Temporalis

Front 176

178. Major never to TMJ pain

Back 176

Auriculotemporal nerve

Front 177

179. Specific nerves that elicit secretion from the parotid gland

Back 177

1. Tympanic branch of CN IX

2. Lesser petrosal nerve

Front 178

180. Branch of CN V that carries parasympathetics to the parotid

Back 178

Auriculotemporal

Front 179

181. Structures that opens into the superior meatus of the nasal cavity

Back 179

Posterior ethmoid sinus

Front 180

182. Structures that open into the middle meatus of the nasal cavity

Back 180

Frontal, maxillary, anterior and middle ethmoid sinuses

Front 181

183. Structures that opens into the inferior meatus of nasal cavity

Back 181

Nasolacrimal duct

Front 182

184. Major artery to nasal cavity

Back 182

Sphenopalatine artery

Front 183

185. Innervation of levator veli palatini

Back 183

CN X

Front 184

186. Muscle that opens the auditory tube

Back 184

Tensor veli palatini

Front 185

187. Innervation of tensor veli palatini

Back 185

CN V3

Front 186

188. Nerve that provides taste to anterior 2/3's of tongue

Back 186

Chorda tympani (from CN VII)

Front 187

189. Site of cell bodies for nerve that carries taste to anterior 2/3 of tongue

Back 187

Geniculate ganglion

Front 188

190. Specific nerve that elicits secretions for submandibular gland

Back 188

Chorda tympani

Front 189

191. Branch of CN V that carries parasympathetics to submandibular

Back 189

Lingual

Front 190

192. Nerve injured when tonsillar pillars sag and ulula deviates

Back 190

CN X

Front 191

193. Nerve potentially injured with tonsillectomy

Back 191

CN IX

Front 192

194. Muscle that protrudes the tongue

Back 192

Genioglossus

Front 193

195. Nerve injured when deviation of protruded tongue

Back 193

Ipsalateral CN XII

Front 194

196. Specific nerve that stimulates tear production

Back 194

Greater petrosal nerve (CN VII)

Front 195

197. Sensory nerve to cornea

Back 195

CN V1 (Nasociliary)

Front 196

198. Muscle that elevates and abducts eye

Back 196

Inferior oblique

Front 197

199. Muscles that depresses and abducts eye

Back 197

Superior oblique

Front 198

200. Site of preganglionic nerve cells that elicits dilation of pupil

Back 198

Lateral horn, T1-T2

Front 199

201. Site of postganglionic nerve cells that elicits dilation of pupil

Back 199

Superior cervical ganglion

Front 200

202. Site of preganglionic nerve cells that elicits constrition of pupil

Back 200

Edinger-Westphal nucleus

Front 201

203. Site of postganglion nerve cells that elicits constriction of pupil

Back 201

Ciliary ganglion

Front 202

204. Innervation of external surface of tympanic membrane

Back 202

Auriculotemporal nerve and CN X

Front 203

205. Innervation of internal surface of tympanic membrane

Back 203

CN IX

Front 204

206. Part one of subclavian artery

Back 204

1. Vertebral artery (enters at C6 transverse foramen)
2. Thyrocervical trunk
3. Internal thoracic artery

Front 205

207. Part two of subclavian artery

Back 205

Costocervical trunk

Front 206

208. Part three of subclavian artery

Back 206

50% of people have a descending scapular artery (dorsal scapular artery)

Front 207

209. Branches of the thyrocervical trunk

Back 207

1. Inferior thyroid artery
2. Transverse cervical artery
3. Suprascapular artery

Front 208

210. Branches of the costocervical trunk

Back 208

1. Deep cervical artery
2. Superior intercostal artery

Front 209

211. Branches of the internal carotid artery

Back 209

1. Opthalmic artery
2. Anterior cerebral artery
3. Middle cerebral artery

Participates in the formation of the circulus arteriosus

Front 210

212. Branches of the external carotid artery

Back 210

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

Front 211

213. Superficial lymph nodes of the head

Back 211

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

Front 212

214. Lymph drainage from middle ear

Back 212

The middle ear drains into the retropharyngeal and upper deep cervical nodes

Front 213

215. Lymph drainage from nasal cavity and paranasal sinuses

Back 213

Drain into:

1. Submandibular
2. Retropharyngeal
3. Upper deep cervical

Front 214

216. Lymph drainage from tongue

Back 214

Drains into:

1. Submental
2. Submandibular
3. Upper cervical
4. Lower cervical

Front 215

217. Lymph drainage from larynx

Back 215

Drains into:

1. Upper deep cervical
2. Lower deep cervical

Front 216

218. Lymph drainage from pharynx

Back 216

Drains into:

1. Retropharyngeal
2. Upper deep cervical
3. Lower deep cervical

Front 217

219. Lymph drainage from the thyroid gland

Back 217

Drains into:

1. Lower deep cervical
2. Prelaryngeal
3. Pretracheal
4. Paratracheal

Front 218

218. test card

Back 218

test 1

Front 219

219 test card 2

Back 219

test 2