Download Anatomy Block 2 Exam Review Questions

THE SKULL
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Anatomy Exam Review Questions:
What does the Anterior Fontanelle become?
o Bregma
What does the Posterior Fontanelle become?
o Lambda
What bones make up the Pterion?
o Frontal, Parietal, Temporal, and Sphenoid
Name the Fossa that the following Cranial Nerves go through when exiting
the skull:
o CN I – Olfactory – Cribiform Plate
o CN II – Optic – Optic Canal
o CN III – Oculomotor – Superior Orbital Fissure
o CN IV – Trochlear – Superior Orbital Fissure
o CN V – Trigeminal
 V1 – Opthalmic – Superior Orbital Fissure
 V2 – Maxillary – Foramen Rotundum
 V3 – Mandibular – Foramen Ovale
o CN VI – Abducens – Superior Orbital Fissure
o CN VII – Facial – Internal Auditory Meatus
o CN VIII – Vestibulocochlear – Internal Auditory Meatus
o CN IX – Glossopharyngeal – Jugular Foramen
o CN X – Vagus – Jugular Foramen
o CN XI – Accessory – Jugular Foramen
o CN XII – Hypoglossal – Hypoglossal Canal
What goes through the Foramen Spinosum?
o The Middle Meningeal Artery  Maxillary Artery  External Carotid
Artery
What is a common cause of an Epidural Hematoma?
o Fracture of the Pterion
What type of blood is pooling in the brain during an Epidural Hematoma?
o Arterial Blood from the Middle Meningeal Artery  Maxillary Artery
 External Carotid
What type of shape will you see in an X-Ray of the Brain when the patient has
an Epidural Hematoma? Why will you see this?
o A Lenticulate Shape because an Epidural Hematoma is between the
Skull and the Dura, which means it does not have a lot of room to
disperse.
What nerve can be compressed during an Epidural Hematoma? How does
the patient present?
o CN III can be compressed, leading to Oculomotor Palsy.
o Presentation: Eyes are down and out due to CN IV and CN VI still
being in tact. Pupils are dilated. Ptosis due to paralysis of the Levator
Palpebrae muscle.
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What are two causes of a Subdural Hematoma?
o Shaken Baby Syndrome
o Roller Coasters
What type of blood pools in a Subdural Hematoma?
o Venous Blood
What type of shape will you see in an X-Ray of the Brain when a patient has a
Subdural Hematoma?
o Crescent Shape. More spread out because it is between the layers of
the Dura where there is space.
When you have multiple concussions, there is a build up of what? What are
diseases that this can cause?
o Neurofibrillary Tangles
o Parkinson’s Disease and Alzheimer’s Disease
VENTRICLES OF THE BRAIN
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What are the names of the ventricles in the brain?
o 2 Lateral Ventricles
o 3rd Ventricle
o 4th Ventricle
 What connects the 2 Lateral Ventricles to the 3rd Ventricle?
o Foramen of Monroe
 How is the 3rd Ventricle Connected to the 4th Ventricle?
o The Aqueduct of Sylvius
 How does the CSF exit the ventricles?
o Two Foramen of Luschka (on the sides)
o 1 Foramen of Magendie (in the middle)
 What produces the CSF?
o Choroid Plexus
 How can Hydrocephalus happen?
o Usually a blockage in the Aqueduct of Sylvius which leads to CSF being
trapped in the Lateral and Third Ventricles
 What is Pneumocephalus?
o Commonly caused by a fracture of the Frontal Sinus by a blow to the
nose. CSF leaks out of the nose
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VENOUS SINUS DRAINAGE
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What is the order of Drainage for the Superior Saggital Sinus?
o Superior Saggital Sinus  Transverse Sinus  Sigmoid Sinus 
Internal Jugular Vein
What is the order of Drainage for the Inferior Saggital Sinus?
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o Inferior Saggital Sinus  Straight Sinus  Transverse Sinus 
Sigmoid Sinus  Internal Jugular Vein
What is the route of infection for the “danger space” around the nose?
o Facial Vein  Angular Vein  Opthalmic Vein  Cavernous Sinus 
Petrosal Sinus  Sigmoid Sinus  Internal Jugular Vein
What is the Confluence of Sinus?
o The point where the Superior Saggital Sinus, Inferior Saggital Sinus,
and the Transverse Sinus meet before all going down the Sigmoid
Sinus to the Internal Jugular Vein
CIRCLE OF WILLIS
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Between what two arteries does CN III sit?
o Posterior Cerebral
o Superior Cerebellar
Which artery comes off of the Vertebral Artery?
o PICA: Posterior Inferior Cerebellar Artery
Which artery comes off of the Basilar Artery?
o AICA: Anterior Inferior Cerebellar Artery
Which carotid artery gives off the Middle Cerebral Artery?
o Internal Carotid Artery
Which artery is the most common for aneurysms?
o The Anterior Communicating Artery because it is the smallest.
What artery gives off Striate Arteries?
o The Middle Cerebral Artery
What is the difference between a hemorrhagic and ischemic stroke? Where
are these located?
o Hemorrhagic – rupture of the blood vessels
o Ischemic – a blood clot breaks off from somewhere else and lodges in
the artery, causing a block.
o Both are found in the Striate Arteries
THE EYE:
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What eye muscles do CN III (oculomotor) innvervate?
o Levator Palpebrae
o Inferior Oblique
o Superior Rectus
o Medial Rectus
o Inferior Rectus
What eye muscle does CN IV (trochlear) innervate?
o Superior Oblique
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What eye muscle does CN VI (abducens) innervate?
o Lateral Rectus
What nerves are within the orbit?
o Oculomotor
o Trochlear
o Abducens
o Optic
o Opthalmic Division of Trigeminal Nerve (V1)
What is the blood supply to the eye?
o Opthalmic Artery
What happens to the eye if it is under Parasympathetic Control?
o The pupil constricts, allowing for close vision.
What two eye muscles are innervated parasympathetically?
o Ciliary Muscles
o Constrictor Pupillae
What is the parasympathetic route of innervation for the eye?
o Edinger-Westphal Nucleus  Ciliary Ganglion  Short Ciliary Nerves
 Ciliary Muscles and Constrictor Pupillae
What happens to the eye if it is under Sympathetic Control?
o The pupil dilates, allowing for far vision
What eye muscle is innervated sympathetically?
o Dilator Pupillae Muscle
What is the sympathetic route of innervation for the eye?
o Superior Cervical Ganglion  Carotid Plexus  Ciliary Ganglion 
Long Ciliary Nerves
LESIONS OF THE EYE
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In the following lesions, state what is being paralyzed and how the patient
would present as a result:
o CN IV Trochlear Palsy
 SO4: Superior Oblique would be paralyzed.
 Presentation: Medial Strabismus with Diplopia when
attempting to look down. Compensatory head tilt.
o CN VI Abducens Palsy
 LR6: Lateral Rectus would be paralyzed
 Presentation: Medial Stabismus and Diplopia
o CN III Oculomotor Palsy
 Inferior Oblique, Superior Rectus, Medial Rectus, and Inferior
Rectus would be paralyzed. Also Levator Palpebrae
 Presentation: Eye would be looking down and out. Patient
would be ptosis as a result of Levator Palpebrae paralysis.
Mydriasis (pupil dilation) and no accommodation.
o Sympathetic Chain
 Tarsal and Dilator Pupillae would be paralyzed.
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Presentation: Horner’s Syndrome. Pseudo-Ptosis from the
Tarsal Paralysis. Miosis from dilator pupillae paralysis.
Anhydrosis of the area.
REFLEX OF THE EYE
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What are the two nerves involved in the Consenual Blink Reflex?
o Sensory – CN Vi (Trigeminal – Opthalmic Nerve)
o Motor – CN VII (Facial Nerve)
What is the normal reflex when one eye is touched?
o Both eyes should blink.
If you touch the right eye, and only the right eye blinks, what is the problem?
o There is a lesion in the facial nerve going to the left eye.
If you touch the right eye and neither eye blinks, what is the problem?
o There is a lesion in the V1 branch of CN V going to the right eye.
CAVERNOUS SINUS
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What nerves run through the Cavernous Sinus?
o CN III
o CN IV
o CN VI
o CN V1/V2
What arteries run through the Cavernous Sinus?
o Internal Carotid Artery
What nerve gets damaged first if there are tumors, vascular incidents, etc.?
o Abducens (CN VI)
AIR SINUSES
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What drains into the Superior Meatus?
o Posterior Ethmoidal Sinus
What drains into the Middle Meatus?
o Semilunar Hiatus:
 F: Frontal Sinus
 A: Anterior Ethmoidal Sinus
 M: Maxillary Sinus
o Bulla:
 Middle Ethmoidal Sinus
What drains into the Inferior Meatus?
o Nasolacrimal Duct
NASAL CAVITY
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What is the area of the nasal cavity where a bunch of arteries anastomose,
resulting in nosebleeds?
o Kiessalbach Area
 What are the names of the arteries that anastomose?
o Sphenopalatine Artery
o Greater Palatine Artery
o Anterior Ethmoidal Artery
o Posterior Ethmoidal Artery
 What is the main arterty responsible for nose bleeds and what is it a branch
off of?
o The Sphenopalatine Artery is the major cause of nosebleeds.
o It is a branch of the Maxillary Artery, which is a branch of the External
Carotid Artery
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ORAL CAVITY
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What is the innervation of the Maxillary Teeth?
o The Superior Alveolar Nerve which is a branch of the Maxillary
Division of CN V (V2)
What is the innervation of the Mandibular Teeth?
o The Inferior Alveolar Nerve which is a branch of the Mandibular
Division of CN V (V3)
Where does the Parotid Duct drain? What is the duct called?
o Near the 2nd Maxillary Molar.
o Stensen’s Duct
What nerve parasympathetically innervates the Sublingual and
Submandibular glands? What path does it take?
o CN VII (Facial)
o Superior Salivary Nucleus  Submandibular Ganglion  Sublingual
and Submandibular Gland
What is the name of the branch of CN VII that goes to the Submandibular and
Sublingual glands?
o Lingual Branch of the Facial Nerve
What nerve piggybacks on the Lingual Nerve, and what does it innervate?
o The Chorda Tympani piggybacks on the Lingual Nerve.
o It innervates Special Sensory Taste to the Anterior 2/3 of the Tongue
What nerve parasympathetically innervates the Parotid Gland? What path
does it take?
o CN IX (Glossopharyngeal)
o Inferior Salivary Nucleus  Otic Ganglion  Parotid Gland
What is the name of the CN V (V3) branch that goes to the Parotid Gland?
o Auriculotemporal Nerve
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GAG REFLEX
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What is the nerve that SENSES the touch for the Gag Reflex?
o CN IX – Glossopharyngeal Nerve
What is the nerve that activates the pharyngeal constrictors to cause the gag?
o CN X – Vagus
In what nucleus do the CN IX and CN X communicate to cause the Gag Reflex?
Where is the nucleus located?
o Nucleus Ambiguus, located in the Medulla
THE PALATE
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When you open your mouth, what are the two “curtain” muscles that you see
at the back of your throat?
o 1. Palatoglossus
o 2. Palatopharyngeus
 What are all of the muscles in the palate innervated by?
o CN X – Vagus
 Which palate muscle is an exception and is NOT innervated by CN X (vagus)?
o Tensor Veli Palatini – Innervated by CN V (V3)
 What nerve does the sensory innervated to the palate (and the pharynx)?
o CN IX – Glossopharyngeal
 The Mylohyoid and the Geniohyoid make up the floor of the mouth. What are
these muscles innervated by?
o Mylohyoid – CN V (V3)
o Geniohyoid – C1 (piggybacks on the Hypoglossal Nerve)
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THE TONGUE
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What innervates all of the muscles of the tongue (motor)?
o Hypoglossal Nerve (CN VII)
What muscle is the exception and is NOT innervated by the Hypoglossal
Nerve (CN XII)? What is it innervated by?
o The Palatoglossus is NOT innervated by the Hypoglossal Nerve (CN
VII)
o It is innervated by the Pharyngeal Branch of CN X (Vagus)
What three nerves are involved in taste?
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o CN VII
o CN IX
o CN X
What is the nucleus that the three nerves for taste communicate at called?
o Solitary Nucleus
What nerve innervates the Posterior 1/3 of the tongue (Sensory and Taste)?
o CN IX – Glossopharyngeal
What nerve innervates the Anterior 2/3 of the tongue (Sensory)?
o The Lingual Branch of V3 (CN V – Trigeminal)
What nerve does taste to the Anterior 2/3 of the tongue?
o The Chorda Tympani Branch of the CN VII (Facial)
What nerve does taste to the epiglottis?
o CN X – Vagus
MUSCLES OF MASTICATION
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What are the 4 muscles of mastication?
o Medial Pterygoid
o Lateral Pterygoid
o Masseter
o Temporalis
All of these muscles close the jaw except one. Which one opens the jaw?
o Lateral Pterygoid
What innervates the muscles of mastication?
o CN V (Trigeminal) V3 Branch
Where does the Lateral Pterygoid Originate and Insert?
o Origin: Lateral side of the Lateral Pterygoid Plate
o Insertion: Condyloid Process of Mandible
Where does the Medial Pterygoid Originate and Insert?
o Origin: Medial side of the Lateral Pterygoid Plate
o Insertion: Angle of the Mandible
Where does the Temporalis Originate and Insert?
o Origin: Temporal line of the skull
o Insertion: Coronoid Process of the Mandible
Where does the Masseter Originate and Insert?
o Origin: Maxilla
o Insertion: Coronoid Process of the Mandible
THE PHARYNX
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What innervates the entire Pharynx?
o CN X – Vagus
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What muscle is an exception and NOT innervated by CN X (Vagus)? What is it
innervated by?
o Stylopharyngeus Muscle
o Innervated by Glossopharyngeal (CN IX)
THE LARYNX
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What is the space between the True and False Vocal Cords called?
o Laryngeal Vestibule
What is another name for the False Vocal Cords?
o Vestibular Folds
If one side of the Recurrent Laryngeal Nerve, how does the patient present?
o Hoarseness
If both Recurrent Laryngeal Nerves are damaged, how does the patient
present?
o They don’t – because they’re dead.
o They cannot abduct their vocal cords
What is the muscle that abducts the vocal cords?
o Posterior Cricoarytenoid (PCA)
What is the muscle that produces higher pitch?
o The Cricothyroid
What muscle is important for Valsalva’s?
o The Lateral Cricoarytenoid Muscle
o When you are exerting yourself, this muscle holds you breath to make
your muscles stronger
What muscle is used in Whispering?
o Interarytenoid Muscle
What nerve gives MOTOR innervation to the entire Larynx? What is the path
from the Vagus? What is the muscle exception?
o Vagus  Recurrent Laryngeal Nerve
o Exception: Cricothyroid (Vagus  Superior Laryngeal Nerve 
External Laryngeal Nerve)
What nerve gives SENSORY innervation above the Vocal Cords? What is the
path from the Vagus?
o Vagus  Superior Laryngeal Nerve  Internal Laryngeal Nerve
What nerve gives SENSORY innervation below the Vocal Cords? What is the
path from the Vagus?
o Vagus  Recurrent Laryngeal Nerve  Inferior Laryngeal Nerve
What nerve gives MOTOR to the exception muscle in the Larynx
(Cricothyroid)? What is the path from the Vagus?
o Vagus  Superior Laryngeal Nerve  External Laryngeal Nerve
Which artery runs with the External Laryngeal Nerve?
o External Laryngeal Nerve
o Superior
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o Thyroid
o SUPERIOR THYROID ARTERY
Which artery runs with the Internal Laryngeal Nerve?
o Internal Laryngeal Nerve
o Superior
o Laryngeal
o SUPERIOR Laryngeal Artery
HYPOGLOSSAL AND VAGUS NERVE LESION ANALYSIS
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If a patient has a Hypoglossal Nerve Lesion, what do you ask them to do?
How does this present?
o You ask them to stick out their tongue. The direction the tongue
points is the side of the nerve lesion. For example, if the patient’s
tongue points to the left, the lesion is on the Left Hypoglossal Nerve.
If a patient has a Vagus Nerve Lesion, what do you ask them to do? How does
this present?
o You ask them to open their mouth so that you can look at their uvula.
The direction that the uvula is pointing is opposite of the side of the
nerve lesion. For example, if the patient’s uvula points to the left, the
lesion is on the right Vagus Nerve.
THE EAR
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Where is the Cone of Light located?
o Anterior/Inferior part of the Tympanic Membrane
What is the clinical significance of the Cone of Light?
o If you must make an incision in the ear, this is where you would cut. It
is furthest away from important structures that you do not want to
cut.
What is the Cone of Light caused by?
o The Handle of Malleus Bone
There are three important areas of the ear that are all innervated by different
nerves. What are the innervations for:
o Tympanic Membrane: Glossopharyngeal CN IX
o Tensor Tympani: Mandibular Division of Trigeminal (V3)
o Stapedius: Facial Nerve
What is the division/ganglion called for Hearing?
o Cochlear Division/Corti Ganglion
What is the division/ganglion called for Balance?
o Vestibular Division/ Vestibular Ganglion
FACIAL NERVE LESIONS
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ADDITIONAL QUESTIONS
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What are all of the muscles of the Pharynx Innervated by?
o CN X
What is the exception in the Pharynx?
o Stylopharyngeus – CN IX
What are all of the muscles of the Palate Innervated by?
o CN X
What is the excetion in the Palate?
o Tensor Veli Palatini – CN V – V3
What are the Mylohyoid and the Anterior Belly of Digastric Innervated by?
o CN V – V3
What are the Stylohyoid and the Posterior Belly of the Digastric Innervated
by?
o CN VII
What is the Geniohyoid Innervated by?
o CN XII
What are the Infrahyoid Muscles innervated by?
o Ansa Cervicalis (C3, C4, C5)
What is the exception in the Infrahyoid?
o The Thyrohyoid – CN XII
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