Q1

Larynx TextLarynx

On the model, identify the structures of the larynx and upper airway.

  • Cartilages
    • Thyroid
    • Cricoid
    • Epiglottis
    • Arytenoids
    • Corniculate
    • Cuneiform
  • Ligaments
    • Cricothyroid membrane
    • Thyrohyoid
    • Vocal cords
  • Muscles
    • Cricothyroid muscle
    • Thyrohyoid
    • Cricoarytenoid
  • Spaces & Folds
    • Vallecula
    • Aryepiglottic folds

Pass Criteria:

  • Must name 4 of 5 bold and 2 others

Describe the nerve supply to the intrinsic laryngeal muscles (muscles of vocalisation)

  • All muscles supplied by branches of Cranial Nerve X (Vagus)
  • All except cricothyroid supplied by Recurrent Laryngeal Nerve
  • Cricothyroid supplied by External Laryngeal Nerve

Pass Criteria:

  • Must name Recurrent Laryngeal Nerve and Cranial Nerve X as its source

What is the results of an injury to the recurrent laryngeal nerve?

  • Hoarse voice
  • If bilateral injury – stridor due to inability to abduct cords as posterior cricoarytenoids are the only abductors.

Pass Criteria:

  • Supplemental question only

Q2

Skull Text Skull

What are the major bony compartments within the Base of Skull and what are the major bones forming them?

Osteology - Base of SkullOsteology - Base of Skull 2Acknowledgements – 

1. – Clinically Oriented Anatomy
Moore, Dalley, Agur (Lippincott Williams & Wilkins)

2. – McMinn’s Clinical Atlas of Human Anatomy
Mosby

 

  • Anterior cranial fossa – frontal bone (anterior), ethmoid (middle) and lesser wing of Sphenoid (posterior).
  • Middle cranial fossa – Sphenoid plus Squamous Temporal laterally, contains Sella Turcica
  • Posterior cranial fossa – Occipital Bone plus dorsum sella of Sphenoid anteriorly

Pass Criteria:

  • Must identify all 3 fossae plus identify major bone in each.

Identify the various foramina in the Base of Skull.

Osteology - Base of SkullOsteology - Base of Skull 2Acknowledgements – 

1. – Clinically Oriented Anatomy
Moore, Dalley, Agur (Lippincott Williams & Wilkins)

2. – McMinn’s Clinical Atlas of Human Anatomy
Mosby

 

  • Anterior cranial fossa
    • Cribriform Plate – Olfactory Nerve
  • Middle cranial fossa
    • Optic Canal – Optic Nerve, Ophthal Artery
    • Superior Orbital Fissure – Cranial Nerve III, IV, VI
    • Foramen Lacerum – Internal Carotid Artery plus associated sympathetic
    • Internal acoustic meatus – CN VII, VIII plus labyrinthine artery
    • Foramen Rotundum – V2
    • Foramen Ovale – V3, accessory meningeal artery
    • Foramen Spinosum – middle meningeal artery
    • Groove for Petrosal Nerve and Petrosal Branch Middle Meningeal Artery
  • Posterior cranial fossa
    • Foramen Magnum – Medulla/Brainstem, plus vertebral artery, XI
    • Jugular Foramen – CN IX, X, XI, superior bulb of IJV
    • Hypoglossal Canal – CN XII
    • Condylar Canal – emissary veins (sigmoid sinus)
    • Mastoid Foramen – Mastoid emissary vein

Pass Criteria:

  • Must identify 5 foramina

What structures pass through the foramen magnum?

  • Medulla/Brainstem
  • Vertebral artery
  • Cranial Nerve XI

Pass Criteria:

  • Bold to pass

 


Q3

C3 Head:Neck

Identify the intracranial structures visible on this CT.

PROMPT – Identify level of the CT slice if necessary.

(level of anterior and posterior horns lat ventricles)

  • Lobes
    • Frontal
    • Temporal
    • Parietal
    • Occipital
  • Lateral ventricle: Anterior and posterior horns
  • 3rd ventricle
  • Caudate nucleus
  • Choroid plexus
  • Lentiform nucleus (putamen & globus pallidus)
  • Thalamus
  • Septum pellucidum
  • Falx
  • Anterior & posterior limbs of internal capsule
  • Sylvian fissure

Head CT with Labels - Lobes   Head CT with Labels - Thalamus etc   Head CT with Labels - Grey Matter  

CT Head with Labels - Fissures   CT Head with Labels - Ventricles

Pass Criteria:

  • Bold to pass

Case courtesy of Dr David Cuete, Radiopaedia.org, rID: 23768 & Radiology Masterclass

What arteries supply the main areas of the cerebral cortex?

  • Anterior Cerebral Artery:
    • Anterior to anterior horns lateral ventricle
    • (Frontal and parietal lobes medially and superiorly)
  • Middle Cerebral Artery:
    • Between anterior & posterior horns lateral ventricle
    • (Most of lateral surface anterior, parietal and temporal lobes)
  • Posterior Cerebral Artery:
    • Posterior to posterior horn lateral ventricle
    • (Inferior and medial aspects of occipital and temporal lobes)

Pass Criteria:

  • Anterior, middle and posterior cerebral arteries
  • Reasonable distribution

Describe the venous drainage of the cerebral hemispheres.

  • Superior cerebral veins (superolateral surface of the brain) > superior sagittal sinus
  • Inferior and superficial middle cerebral veins (inferior, posterior and deep aspects of cerebral hemisperes) > straight, transverse and superior petrosal sinuses
  • Great cerebral vein (midline vein formed from the paired internal cerebral veins) > merges with inferior sagittal sinus to form the straight sinus. Eventually terminate in Internal jugular veins.

Pass Criteria:

  • 2/3 bold to pass

Q4

Model – Eye (model no. F13)

Identify the muscles responsible for eye movement.

  • Recti
    • Superior (elevation, adduction, medial rotation)
    • Inferior (depression, abduction, lateral rotation)
    • Medial (adduction)
    • Lateral (abduction)
  • Obliques
    • Superior (depression, abduction)
    • Inferior (elevation, abduction)

Pass Criteria:

  • All bold to pass

Describe their actions.

  • Recti
    • Superior (elevation, adduction, medial rotation)
    • Inferior (depression, abduction, lateral rotation)
    • Medial (adduction)
    • Lateral (abduction)
  • Obliques
    • Superior (depression, abduction)
    • Inferior (elevation, abduction)

Pass Criteria:

  • Bold to pass

What nerves supply these muscles?

  • Oculomotor (CN III) Nerve to all, except:
    • Abducens (CN VI) Nerve to Lateral Rectus
    • Trochlea (CN IV) Nerve to Superior Oblique

Pass Criteria:

  • Bold plus one to pass

How are the actions of these muscles tested clinically?

PROMPT – Why is the “H” pattern used?External Ocular Movements

  • In Abduction (Lateral Rectus):
    • Elevation (Superior Rectus) and
    • Depression (Inferior Rectus)
  • In Adduction (Medial Rectus):
    • Elevation (Inferior Oblique) and
    • Depression (Superior Oblique)

Pass Criteria:

  • Abduction and adduction isolates recti and obliques to pass

Q5

Q5 Head_Neck

What are the boundaries of the anterior triangle of the neck?

  • Sternocleidomastoid
  • Mideline
  • Mandible

Pass Criteria:

  • All 3 to pass

SCM has been removed in this photo. Where is the internal jugular vein? Describe its course.

  • Internal Jugular Vein
  • Contained in carotid sheath. Lies lateral and ventral to artery. Goes deep to SCM and 2 heads of SCM (sternal and clavicular heads). Joins subclavian vein posterior to sternal end of clavicle. Forms brachiocephalic vein.

Pass Criteria:

  • Need to identify internal jugular vein
  • Concept. 4/5 bold to pass

What major structures are at risk during insertion of an IJ line?

  • External carotid artery
  • Common carotid artery
  • Vagus
  • Other nerves
  • Lung
  • Trachea
  • SCM
  • Thyroid
  • Thoracic duct

Q12 Head_Neck

Pass Criteria:

  • 2 to pass

Q6

Facial Bone CT

What air filled structures are visible on this CT?

  • Maxillary
  • Mastoid
  • Ethmoidal

Pass Criteria:

  • Bold and 1 other to pass

What other structures are visible?

  • Bones
    • Frontal
    • Zygoma
    • Ethmoid
    • Nasal septum
    • Maxilla
    • Nasal concha (middle and inferior)
    • Crista galli
  • Other
    • Orbit
    • Ocular muscles
    • Frontal lobe (coronal slice)
    • Temporal lobe
    • Parieto-occipital lobe

Pass Criteria:

  • 2 bones and 3 others

What structure passes through the infra-orbital foramen?

  • Infra-orbital nerve

Pass Criteria:

  • Bold to pass

What is its sensory distribution?

  • Superior lip
  • Lateral nose
  • Cheek
  • Inferior eyelid
  • Upper teeth
  • Gingiva

Pass Criteria:

  • 2 to pass

Q7

Larynx TextLarynx

(a) Identify the structures in the upper airway that could lead to airway obstruction. (b) What other structures are visible?

(a)  Structures in the upper airway that could lead to airway obstruction

  • Tongue
  • Tonsils
  • Pharynx
  • Epiglottis
  • Glottis

(b)  Other visible structures are

  • Hyoid bone, floor of mouth – mylohyoid (Prompt)
  • Mandible
  • Buccal muscles, cheek
  • Medial pterygoid muscles
  • Ary-epiglottic folds & vallecula
  • Piriform fossa

Pass Criteria:

  • Bold 5/6 total
  • 2 underlined

What are the bony and cartilaginous components of the larynx?

  • Cartilage:
    • Cricoid
    • Thyroid
    • Arytenoids
    • Epiglottis
  • Bone:
    • Hyoid

Pass Criteria:

  • All bold

What is the innervation of the larynx?

  • Motor:
    • Recurrent laryngeal nerve (inferior laryngeal – terminal branch of recurrent laryngeal)
    • Except for cricothyroid which is External laryngeal nerve (tenses cords)
    • Both from Crania Nerve X
  • Sensory:
    • Above cords – Internal laryngeal nerve (branch of superior laryngeal nerve)
    • Below cords – Recurrent laryngeal nerve (inferior laryngeal branch) (branch of Cranial Nerve X)

Pass Criteria:

  • Bold to pass

Q8

Mandible TextMandible

Which nerves run on or within the bony mandible?

  • Inferior alveolar/mental nerve (V3 – mandibular)
  • Lingual nerve
  • + 1 other of
    • Auriculotemporal nerve (V3)
    • Nerve to mylohyoid (V3 – branch of inferior alveolar)
    • Mandibular branch of the facial nerve (VII)

Pass Criteria:

  • Bold to pass

Show the course of the inferior alveolar nerve on this mandible and why it is prone to injury.

(a)  The course of the inferior alveolar nerve:

  • Early large branch of mandibular trigeminal after it exits the foramen ovale
  • Runs on surface of inside mandible ramus to Mandibular foramen (gives off nerve to mylohyoid)
  • Passes inferiorly and anteriorly through bone in alveolar canal which is v close to roots of 3rd molar supplying all lower teeth and exits as (mental nerve) from mental foramen anteriorly/superiorly (in edentulous)

(b)  It prone to injury because of it’s close relationship to the bony mandible

Pass Criteria:

  • Bold to pass

If the lingual nerve is damaged, what deficits would you expect?

  • Anterior 2/3 tongue – taste + sensory loss (via the chorda tympani)
  • Loss of secretory function – submandibular salivary glands
  • Sensory loss to floor of mouth and/or to gums

Pass Criteria:

  • Bold to pass

Q9

X-ray – cervical spine

Interpret this cervical spine X-ray.

PROMPT – What are the radiological lines to examine?

  • X-ray C1-C7
  • C7/T1 not visualised
  • Step at C5/C6 consistent with bi-facet dislocation
  • Disruption of all 4 lines: soft tissue, anterior, posterior, spinolaminar lines.

Pass Criteria:

  • Bold to pass

Q10

Model/picture – C1 and C2

Please describe these cervical vertebrae.

PROMPT – Demonstrate their anatomical orientation and function.

  • C1 “Atlas”
    • Anterior and posterior arch
    • Lateral mass with Transverse processes
    • Articular facet for Dens
    • Superior articular facet – articulates with occipital condyles
    • Inferior articular facet – articulates with axis
    • Anterior and posterior tubercles
    • Foramina: vertebral and transverse
  • C2 “Axis”
    • Dens with anterior and posterior articular facet
    • Body
    • Pedicle
    • Lateral mass
    • Transverse and spinous process
    • Superior and inferior articular facet

Pass Criteria:

  • Must display correct anatomical position and articulation
  • Name the bold

What are the characteristics of a typical cervical vertebra?

PROMPT – Demonstrate their anatomical orientation and function.

  • Small, oval body with large vertebral canal, concave on superior surface and convex on infeiror surface.
  • Superior surfaces of bodies have raised processes (uncinate), each of which articulates with a depressed area on inferior lateral aspect of the superior vertebral body.
  • Spinous processes are short, bifid, and downward sloping (C7 usually non bifid)
  • Facet joints are more horizontal allowing a greater range of movement.
  • Anterior and posterior transverse process with a foramen transversarium allowing passage of vertebral artery, vein and sympathetic plexus

Pass Criteria:

  • 3 to pass

Head & Neck 11 to 20