RCA head and neck questions


RCA Head and Neck Questions
Ashutosh Kumar
Flashcards by Ashutosh Kumar, updated more than 1 year ago
Ashutosh Kumar
Created by Ashutosh Kumar over 7 years ago

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Question Answer
Why do facial lacerations tend to gape (part widely)? Because the face has no distinctive deep fascia and the connective tissue between the facial muscles is loose.
What is the nerve supply of platysma? Cervical branch of the facial nerve.
What structures pass through the inferior orbital fissure? Maxillary nerve and artery, Zygomatic nerve (branch of maxillary nerve) and infraorbital vessels.
The inferior orbital fissure communicates with two fossae. Name these. Infratemporal fossa and pterygopalatine fossa.
The infraorbital nerve is a branch of which nerve? Where does the infraorbital nerve emerge onto the face? Maxillary nerve (V2). Infraorbital foramen.
Which nerve gives rise to the supraorbital nerve? Frontal nerve, a branch of the ophthalmic (V1).
What might be the signs in the face if the 7th cranial nerve is damaged in its course through the parotid gland? b) What is the most urgent action that needs to be taken and why? Hemiplegia of the face. Protect the eye from drying out on the affected side. This is because the temporal branch of the facial nerve innervates the orbicularis oculi muscle, which is required for closure of the eyelid. Damage to the facial nerve means this muscle is paralyzed on the affected side and therefore the eyelid is unable to be close fully, leaving the eye prone to drying out. As a result, infection can occur, followed by ulceration and fibrosis leading to blindness.
Which nerve does the corneal reflex test? Ophthalmic division of the trigeminal (V1), specifically the long ciliary nerve from the nasociliary from ophthalmic.
The branches of which cranial nerve emerge from the anterior border of the parotid gland? Facial nerve (cranial nerve 7).
Auriculotemporal nerve is a branch of? Mandibular division of trigeminal (V3).
Describe two sites in the face where arterial pulsation can be readily felt? The facial artery at the inferior border of the mandible as it winds its way onto the face just anterior to the masseter. The superficial temporal artery compressing it against the root of the zygomatic process of the temporal bone.
Why are pustules of the upper lip dangerous? Infection could spread via the facial vein, which anastomoses with both the superior ophthalmic vein and deep facial vein to pterygoid plexus drained by emissary veins, both into the cavernous sinus.
Where does the facial artery terminate? Medial canthus of the eye.
Superficial temporal artery is a branch of? External carotid artery
What is the principle action of the masseter muscle? b)What is its nerve supply? Elevate the mandible (deep fibres can also retract the mandible). Masseteric nerve, originating from the mandibular division of the trigeminal (V3).
In the event of dislocation of the temporomandibular joint, in which direction would you expect the head of the mandible to move? b) In this instance will the mouth be open or closed? Anteriorly, lying anterior to the articular tubercle. Wide open.
From the following list, what are the muscles that close the jaw? Temporalis, Buccinators, Medial pterygoid, lateral pterygoid and mylohyoid. Of these, the temporalis and medial pterygoid close the jaw.
Chorda tympani is a branch of which cranial nerve? b) From which part of the tongue does it carry taste sensation? c) What is the nerve which supplies general sensation to this part of the tongue, and which division of the trigeminal is it a branch of? Facial nerve (cranial nerve 7). Anterior two thirds. Lingual nerve, branch of the mandibular division of the trigeminal (V3).
Which division of the trigeminal nerve has a motor component? Mandibular division of the trigeminal (V3).
Explain why injury to the mandibular nerve (V3) does not cause paralysis of the entire digastric muscle? The digastric muscle consists of two muscle bellies; anterior and posterior. The anterior belly is supplied by the mylohyoid nerve, from the inferior alveolar nerve arising from the mandibular division of the trigeminal (V3). On the other hand, the posterior belly is innervated by the marginal mandibular branches of the facial nerve (cranial nerve 7). Hence, damage to the mandibular division of the trigeminal only causes paralysis of the anterior belly of digastric and not the entire muscle.
What are the principal actions of sternomastoid, trapezius, and the strap muscles? Sternomastoid: Unilaterally flex the neck, rotate the head so that it faces superiorly to the opposite side. Bilaterally bring the head forwards. Trapezius; Upper part elevates the scapula, middle part retracts the scapula, inferior part depresses the scapula. Can also rotate the scapula. Strap muscles: Fix and anchor the hyoid bone so that the suprahyoid muscles can act. Otherwise, depress the hyoid bone and larynx during swallowing and speaking. (sternohyoid, sternothyroid, omohyoid depress the hyoid bone, thyrohyoid depresses the hyoid bone and elevates the larynx).
How do sternomastoid and scalene anterior contribute to respiration? The sternomastoid inserts as two heads; sternal head and clavicular head. The sternal head inserts into the upper surface of the manubrium of the sternum whilst the clavicular head inserts into the upper surface of the medial third of the clavicle. The scalenus anterior inserts into the scalene tubercle on the anterior surface of the first rib. During forced inspiration, sternomastoid and scalene anterior can raise the rib cage to increase the intrathoracic volume, reducing the intra-alveolar pressure much below atmospheric, causing air to enter the lungs.
Where does cancer of the central part of the lower lip spread to? Lymph from the medial lower lip and chin drains into the submental lymph nodes, which then drain into the deep cervical lymph nodes forming a chain along the internal jugular vein deep to the sternocleidomastoid muscle in the neck.
Name the group of lymph nodes to which lymph from: Upper lip and lateral part of the lower lip passes into? Medial part of the lower lip initially passes into? Submandibular lymph nodes. Submental lymph nodes.
The contents of the carotid sheath include all the following structures except: Common carotid artery Internal carotid artery Internal jugular vein Cervical sympathetic chain Vagus chain The cervical sympathetic chain is located posterior to the carotid sheath, embedded in the prevertebral fascia.
Name the muscle that separates the anterior and posterior triangles of the neck. Sternocleidomastoid.
What are the spinal nerves that form the cervical plexus? Cervical spinal nerves C1-C5.
Physical examination of a patient with a stab injury to the neck reveals that the patient has lost sensation from the skin over the angle of the mandible. Which nerve is most likely damaged? Greater auricular nerve (C2 and C3).
A woman had a malignant melanoma surgically removed by an extensive surgical dissection. It was located in the skin along the posterior border of right sternomastoid muscle. Later, she noticed that she had trouble coming her hair. She had difficulty in lifting the hairbrush to the top of her head. What muscle(s) would be involved in the movements with which this patient was having difficulty? Considering the history of surgery, what structure might have been damaged to produce this condition? Trapezius. Spinal accessory nerve.
What is the anatomical basis for a swelling in the mid anterior region of the neck, which moves up and down during swallowing? If this swelling required surgical removal, what other endocrine glands might be inadvertently removed? Enlarged thyroid gland. Parathyroid glands.
Do all the veins draining the thyroid gland drain into the internal jugular vein? No, the superior and middle thyroid veins drain into the internal jugular vein whereas the inferior thyroid veins drains into the brachiocephalic veins.
Is the arterial supply to the thyroid gland derived entirely from the external carotid artery? No. The superior pole of the thyroid gland is supplied by the superior thyroid artery, which is either the 1st or second branch of the external carotid artery (definitely the inferior most anterior branch) and travels deep to the infrahyoid muscles. The inferior pole of the thyroid gland is supplied by the inferior thyroid artery, which arises as the third and largest branch of the thyrocervical trunk. The thyrocervical trunk has 3 branches, the suprascapular artery, transverse cervical artery and inferior thyroid artery, and arises as the 2nd branch of the subclavian artery, after the internal thoracic artery and before the vertebral artery are given off.
Name the two terminal branches of the external carotid artery. Superficial temporal and maxillary artery
Which carotid artery does not have any branches in the neck? Internal carotid artery.
Main contribution to the origin of the phrenic nerve is from which spinal nerve? What would be the effects of damage to one phrenic nerve? Major contribution from C4, minor from C3 and C5. Hemiplegia of diaphragm.
Internal jugular vein commences as a continuation of which sinus? Where? Sigmoid sinus. Jugular bulb.
Name the structure that separates the subclavian artery from the subclavian vein at the root of the neck. Phrenic nerve, which runs between the two (artery posterior, vein anterior).
Name the cervical vertebra that does not have a body. Atlas (C1).
Movement occurs between which parts of the first and second cervical vertebrae, when rotating the head? Interior surface of the anterior arch of C1 and the dens of C2, held against the arch by the transverse ligament between the lateral masses of C1.
Describe the consequences that could result from the rupture of the transverse ligament of the atlas as a result of trauma or if weakened by disease? Dens is set free, and may be driven into the cervical spinal cord causing quadriplegia or into the medulla causing instant death.
In the condition called “adenoiditis”: Which anatomical structure is inflamed? What effect will it have on air flow? The breathing will be: How might it affected the middle ear? Pharyngeal tonsils. Obstruction. Noisy. Infection can spread to the middle ear resulting otitis media. If infection spreads to the tubal tonsil located on tubal elevation above the opening of the auditory tube into the nasopharynx, the opening can become blocked. As a result, air is trapped in the middle ear. Overtime, this air is absorbed by the surrounding tissues resulting in negative air pressure in the middle air. Eventually, this negative pressure will suck fluid from the surrounding tissues into it (middle ear effusion) which will subsequently become infected. This leads to inflammation and more fluid resulting in otitis media with effusion, colloquially called ‘glue ear’. The negative pressure and fluid in the middle ear can impair the vibration of the tympanic membrane, thereby impairing transfer of sound waves to the ossicles.
Which anatomical structure is inflamed in the condition commonly known as “tonsillitis”? Name the two muscles located on either side (anterior and posterior) of this structure. Palatine tonsil. Oropharyngeal arch created by the palatoglossal muscle anteriorly, palatopharyngeal arch created by the palatopharyngeal muscle posteriorly.
What is a common site for foreign bodies such as chicken bones and safety pins to become lodged in the throat? Piriform recess.
When a foreign body enters the larynx What happens to the rima glottidis? Contraction of which muscles brings about this action? Laryngeal obstruction occurs when a foreign body gets lodged in which part of the larynx? The rima glottidis is opened by which pair of muscles? The rima glottidis closes due to spasm of laryngeal muscles. Lateral cricoarytenoids and transverse arytenoids Rima glottidis. Posterior cricothyroid.
What is the immediate danger to a patient with a crushing injury of the laryngeal skeleton? Submucous hemorrhage and oedema resulting in respiratory obstruction.
A patient complains of a painful swelling occurring during meals, below the right lower border of the mandible. Explain. Obstruction of the submandibular duct, most likely as a result of the a stone. This means saliva cannot escape from the gland during meal times.
What is the function of the hyoglossus muscle? What is its nerve supply? Retract the tongue and make the dorsum convex (depress). Hypoglossal nerve.
What is the function of the chorda tympani nerve? Provides special sensation of taste to the anterior two thirds of the tongue as well as carries the preganglionic parasympathetic fibres from the superior salivatory nucleus to the submandibular ganglion where the post ganglionic fibres will then go on to innervate the submandibular and sublingual glands.
What is the function of the genioglossus muscle? Protrude and depress the tongue.
What is the clinical importance of paralysis of this muscle in the unconscious patient? Tongue falling posteriorly obstructing the airway.
What disability is caused when the lingual frenulum is too large and extends to the tip of the tongue? “Tongue-tied”, unable to protrude the tongue.
When one hypoglossal nerve is damaged: Which direction does the tongue deviate during protrusion? What will eventually occur on that side of the tongue? Towards the affected side. Atrophy.
When pills are placed under the tongue, after dissolving, into which blood vessels does the drug rapidly enter? Deep lingual veins.
Into which lymph nodes do malignant tumours of the posterior third of the tongue metastasis? Where are these nodes situated? Superior deep cervical lymph nodes. Situated on the superior aspect along the internal jugular vein.
On anatomical grounds, what might be a common cause of obstruction of the auditory tube in a young child? Infection of the nose or nasopharynx spreading to the auditory tube or tubal tonsils.
On the basis of your anatomical knowledge can you construct a “worst case scenario” string of consequences for a young child who develops obstruction to an auditory tube? Infection - swelling of mucous membrane - blockage of auditory tube leading to infection of the middle ear - through the unossified region in the roof of the middle ear direct spread to the meninges (meningitis) and brain (cerebritis).
State five regions in which infections of nasal cavities may spread. 1. The anterior cranial fossa through the cribriform plate of the ethmoid bone 2. The nasopharynx and retropharyngeal soft tissues 3. The middle ear through the auditory tube 4. The paranasal sinuses 5. The lacrimal apparatus and conjunctiva through the nasolacrimal duct.
Explain why the maxillary sinus is commonly involved in infection. Due to poor natural drainage because its opening is located superior to the floor of the sinus.
A young boy presented with severe earache. An otoscopic examination revealed a bulging, inflamed tympanic membrane. His mother told that the boy was recovering from a severed cold and throat infection. Where do you think the infection was located? If not adequately treated, where could the ear infection spread? How could an infection from the throat spread to this location? In the middle ear. To the mastoid air cells and produce mastoiditis. Spread to the middle ear via the auditory tube.
A patient who has had a fall presents with “anosmia” during the physical examination. Which bone is most likely to have fractured? The cribriform plate of the ethmoid bone. The axons of olfactory nerves run directly through the cribriform plate to synapse in the olfactory bulb, and a fracture of the bone can damage these axons.
Name the nerve that provides sensory to the posterior part of the hard palate? Greater palatine nerve (from the maxillary (V2)).
What structures pass through: Optic canal: Superior orbital fissure: Inferior orbital fissure: Optic nerve and ophthalmic artery. Cranial nerves 3, 4 and 6 as well as the ophthalmic division of trigeminal and the superior ophthalmic vein. Maxillary nerve and artery, zygomatic nerve (branch of maxillary) and infraorbital vessels.
An eye examination of a patient involved in a motorcycle accident revealed a medial deviation (strabismus) of the right eye. Injury to which cranial nerve could cause this? Which muscle was paralyzed? Abducens nerve (cranial nerve 6). Lateral rectus muscle.
What type of orbital fracture may have occurred in a patient with a history of being hit in the eye with a squash ball? A nonpenetrating blow to the eye may produce herniation of the orbital contents inferiorly (blow-out fracture) through the thin floor of the orbit into the maxillary sinus.
A patient presents with left eyeball fixed in an abducted and depressed position with the pupil dilated, and drooping left eyelid. Which cranial nerve is most likely affected? Left oculomotor nerve, this is due to the unopposed actions of the lateral rectus (abducens nerve) and the superior oblique muscle (trochlear nerve). The pupil is dilated due to the interruption of parasympathetic fibers that innervate the constrictor pupillae muscle.
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