Neuro I: (Neuro)Anatomy Post-Midterm

Front 1

Under unusual conditions, this layer of the eyelid may accumulate fluid (black eye).

Back 1

What is the subcutaneous tissue layer

Front 2

These structures may become infected and form a sty.

Back 2

What are the ciliary glands?

Front 3

What pathology could cause complete ptosis?

Back 3

destruction of the oculomotor nerve or one of its branches to the levator palpebrae superioris m. --> paralysis of this muscle

Front 4

What muscle (part )is responsible for gentle closing of the eyelid?

Back 4

palpebral portion of the orbiculari oculi m

Front 5

What muscle (part) is responsible for increasing lid contact to the surface of the eyeball and dilation of the lacrimal sac?

Back 5

lacrimal portion of orbicularis oculi m

Front 6

Paralysis of this muscle is responsible for the slight ptosis seen in horner's syndrome.
Why?

Back 6

1. tarsal muscle
2. This muscle is innervated by post-gang symp fibers

Front 7

What is the significance of differentiating b/w partial and complete ptosis?

Back 7

partial = horner's syndrome (tarsal muscle)
complete = destroyed CN III which innervates the LPS m.

Front 8

What is the location of the lacrimal gland?
Where do its ducts drain?

Back 8

1. lacrimal fossa of the orbit
2. drain into apex of superior fornix

Front 9

What is the PSNS and SNS innervation to the lacrimal gland?

Back 9

1. PSNS: SSN --> CN VII --> greater superficial petrosal n --> vidian n --> SPG (synapse) -->maxillary n--> zygomatic n--> lacrimal n --> gland
2. SNS: SCG --> int carotid plexus --> deep petrosal n --> vidian --> etc.

Front 10

What is the course of tears from the lacrimal gland to the nose?

Back 10

gland --> medially across cornea --> lacrimal canaliculi --> punctum --> papilla --> lacrimal sac --> nasolacrimal duct --> inferior meatus (inf. concha).

Front 11

What portion of the optic nerve is especially vulnerable to ischemia due to orbital fracture?

Back 11

The intracanalicular portion
This can happen when forces are transmitted from temporal, maxillary, and frontal regions

Front 12

What is the most likely cause of a traumatic optic neuropathy?

Back 12

head struck by blunt object

Front 13

What passes into/out of the orbit via the superior orbital fissure?

Back 13

CN III, IV, V, & VI
ophthalmic vein

Front 14

What passes into/out of the orbit via the inferior orbital fissure?

Back 14

infraorbital a/v
zygomatic n

Front 15

What may happen to the structures w/in the orbit as a result of a blow-out fracture?

Back 15

herniation of structures (periorbita, inf oblique m, inf rectus m, orbital fat pad) into maxillary sinus.

Front 16

What is the classification of a maxillary fracture that occurs transversely just above the alveolar processes?

Back 16

Le Fort Type 1

Front 17

What is the classification of a maxillary fracture that involves the medial margin of one of the orbits?

Back 17

Le Forte type II

Front 18

What is the classification of a maxillary fracture that occurs transversely across the many facial bones, including both orbits?

Back 18

Le Fore type III (craniofacial dysfunction)

"panda bear face"
face separates from base of the skull

Front 19

In a Le Forte type III fracture, what would you want to be aware of possibly dripping out the nose?

Back 19

CSF ---> going to get meningitis!

Front 20

This dural layer is continuous w/ periosteal fascia, palpebral fascia, and the periosteum of the orbital rim.

Back 20

What is the endosteal dura?

Front 21

This dural layer is continuous with the sheath of the optic nerve and bulbar fascia.

Back 21

What is the meningeal dura?

Front 22

What fascia covers the optic nerve and entire eyeball except the cornea?

Back 22

Bulbar fascia

Front 23

!!!!! All of the extraocular muscles are innervated by the ____ except the _____ & _____. What are they exceptions innervated by?

Back 23

All are CN III
except:
Sup oblique: IV
Lateral Rectus: VI

SO4 LR6 R3!

Front 24

Paralysis of what muscle results in complete ptosis?

Back 24

LPS

Front 25

Paralysis of what muscle results in inability to abduct and ELEVATE the affected eye?

Back 25

SR

Front 26

Paralysis of what muscle results in inability to adduct the affected eye?

Back 26

MR

Front 27

Paralysis of what muscle results in aBduct and DEPRESS the affected eye?

Back 27

IR

Front 28

Paralysis of what muscle results in adduct and elevate the affected eye?

Back 28

IO

Front 29

Paralysis of what muscle results in inability to adduct and depress the affected eye?

Back 29

SO

Front 30

Paralysis of what muscle results in inability to abduct the affected eye?

Back 30

LR

Front 31

Increased ICP may compress what nerve and result in paralysis of what muscle?

Back 31

nerve: abducens (VI)
muscle: LR

Front 32

What is the main sensory nerve to the eyball?

Back 32

nasociliary nerve (GSA)

Front 33

What nerves accompany the cavernous portion of the ICA?

Back 33

CN III, IV, V1, V2, & VI

Front 34

What are the afferent and efferent components to the corneal reflex?

Back 34

A: nasociliary nerve (VI)
E: zygomatic branch of VII

Front 35

What are the components of the direct and consensual corneal reflex?

Back 35

Stim: lightly touch cornea
Rec: naked nerve endings on cornea
Afferent: nasociliary nerve (long ciliary nn)
Sensory nucleus: Descending nucleus of V
Motor nucleus: facial nucleus
Eff: facial n
Effector: orbicularis oculi m
Response: blinking

Front 36

The ciliary canglion is located b/w what 2 structures?

Back 36

optic n
LR muscle

Front 37

What is the general pathway of the PSNS innervation of the intrinsic muscles of the eye?

Back 37

Edinger-westphal nucleus --> ciliary ganglion --> sphincter pupillae & ciliary m

Front 38

Accommodation is a ______-mediated response.

Back 38

cortically (NOT a reflex)

Front 39

Thickening of the lens is controlled by what division of the nervous system?

Back 39

PSNS

Front 40

paralysis of what nerve results in external strabismus, complete ptosis, & dilated/unreactive pupils?

Back 40

oculomotor (III)

Front 41

Paralysis of what nerve results in inablity to adduct and depress the affected eye? The pt tends to tilt his head away from the affected eye.

Back 41

trochlear

Front 42

Paralysis of what nerve results in inability to abduct the affected eye? Diplopia occurs due to the internal strabismus.

Back 42

Abducens

Front 43

The opthalmic a courses with what nerve within the orbit?

Back 43

nasocilliary n
(later the infratrochlear n)

Front 44

What is the chief artery of the orbit and is usually the first branch of the ICA?

Back 44

ophthalmic artery

Front 45

The opthalmic artery gives rise to the ______ & _____, both of which supply the optic nerve.

Back 45

posterior ciliary a
central retinal a

Front 46

What is the main arterial supply to the retina?

Back 46

central retinal artery

Front 47

What 2 arteries form the arterial circle of Zinn-Haller?

Back 47

posterior ciliary a
central retinal a

Front 48

The opthalmic a courses with what nerve within the orbit?

Back 48

nasocilliary n
(later the infratrochlear n)

Front 49

What is the chief artery of the orbit and is usually the first branch of the ICA?

Back 49

ophthalmic artery

Front 50

The opthalmic artery gives rise to the ______ & _____, both of which supply the optic nerve.

Back 50

posterior ciliary a
central retinal a

Front 51

What is the main arterial supply to the retina?

Back 51

central retinal artery

Front 52

What 2 arteries form the arterial circle of Zinn-Haller?

Back 52

posterior ciliary a
central retinal a

Front 53

The central artery supplies the four quadrants of the retina through what "end" arteries?

Back 53

upper and lower temporal branches
upper and lower nasal branches

Front 54

This is the term for the presence of blood in the anterior chamber of the eyeball (usually) due to trauma.
What artery must rupture?

Back 54

1. hyphema
2. arterial circle of iris

Front 55

Subconjunctival hemorrhage is due to rupture of what?
Where is the bleeding restricted to?

Back 55

1. deep pericorneal plexus
2. restricted to subconjunctival tissue or bulbar fascia

Front 56

What blood vessels are involved in conjunctivitis?

Back 56

superficial pericorneal plexus

Front 57

What nerve courses through the anterior and posterior mallear folds?

Back 57

Chorda tympani n.

Front 58

What nerve innervates the tensor tympani m?

Back 58

mandibular nerve (V)

Front 59

What two muscles protect the inner ear from excessive sound vibrations?

Back 59

1. tensor tympani m --> tightens tympanic membrane (attenuates vibrations)
2. stapedius m --> pulls out of fenestra vestibuli

Front 60

The inner ear is supplied by what artery?
Arteriosclerosis of this artery may result in what?

Back 60

1. labyrinthine a. (from AICA)
2. vertigo, nausea, & other inner ear abnormalities

Front 61

The bony core of the cochlea is referred to as the _____, through which the _____ passes.

Back 61

1. modiolus
2. cochlear nerve

Front 62

The cochlear duct is attached to what structure?

Back 62

the spiral lamina

Front 63

All veins of the orbit drain into what?

Back 63

the cavernous sinus

Front 64

What CN's are tested with the corneal reflex?
What fibers/specific nerves constitute the afferent part of the reflex?

Back 64

1. V1/V2 tested
2. GSA pain/tactile fibers --> long ciliary nerves

Front 65

What is the specific site for resorption of aqueous humor?

Back 65

sinus venosus sclera (on inner surface of irido-corneal angle)

Front 66

What is sympathetic ophthalmia?

Back 66

Condition where the damaged choroid layer of a traumatized eye may release factors that trigger an autoimmune rejection of the normal eye

Front 67

What is the site of production of aqueous humor?

Back 67

ciliary processes

Front 68

What is the afferent and efferent of the direct light reflex?

Back 68

A: optic nerve
E: oculomotor (PSNS)

Front 69

What is the important structure in the brain responsible for the consenual light reflex?

Back 69

The posterior commisure

Front 70

What is the pathway for the direct/consensual light reflex?

Back 70

Light in retina
optic n
optic tract
brachium of superior colliculus
superior colliculus
pretectum
(posterior commisure for consenual)
E-W nucleus
oculomoter n
ciliary ganglion
pupillary constrictor muscles (constriction)

Front 71

What is the pathway for the pupillary dilation response?

Back 71

decreased light
retina
optic n
superior colliculus (sophisticated response involving cortical areas)
pretetum
reticular formation
lateral reticulospinal tract
pregang symp neurons (ILCC at T1)
superior cervical ganglion
pupillary dilator muscles (dilation)

Front 72

What makes up the components of the triad of accommodation?

Back 72

convergence of vision (gaze)
pupillary constricion
thickening of lens

Front 73

What is the pathway for accommodation?

Back 73

(This is cortically mediated)
frontal eye field (8)
corticorectal fibers
superior colliculus
E-W nucleus --- oculomotor nucleus
ciliary ganglion \/
convergance of gaze ---- pupillary constriction/lens thickening

Front 74

What is the critical link of the direct light reflex?

Back 74

pretectum

Front 75

What is the critical link of pupillary dilation?

Back 75

ILCC at T1

Front 76

What is the critical link of accommodation?

Back 76

cortically-mediated response

Front 77

What is the critical link of the consensual light reflex?

Back 77

posterior commisure

Front 78

You discover a pt.'s pupil will constrict upon accomodation but is unreactive to light.
What is the pathology?
What structure is damaged?
What is the name of this phenomenon?

Back 78

1. neurosyphilis
2. probably pretectum
3. argyll-robertson pupil

Front 79

What is holmes-adie pupil?

Back 79

benign condition
lesion of ciliary ganglion
tonic pupil --> slow to constrict on convergence

Front 80

What are 3 mechanisms of protection from trauma in the inner ear?

Back 80

1. sudden loud sounds: footplate of stapes rocks side-to-side
2. continous loud sounds: contraction of stapedius & tensor tympani m
3. cochlear path is CNS can filter, focus, and attenuate sound.

Front 81

Match type of sound conduction with structures responsible:
1. air transmission
2. bone conduction
3. fluid conduction

Back 81

1. EAM
2. ossicles of middle ear
3. inner ear

Front 82

What is located in the inferio-posterior portion of the tympanic membrane?

Back 82

fenestra cochleae