Q11

Model-Face Dissection

Demonstrate on the model the arterial supply to the face.

  • Facial artery (61)
    • Arises External Carotid a.
    • Contacts submandibular gland
    • Hooks up over mandible anterior to masseter m.
    • Tortuous course to the medial angle of the eye
  • Transverse facial artery (62)
    • Anastomoses with above

Pass Criteria:

  • Demonstrate on model
  • Bold  to pass

Using the model can you demonstrate the branches of the facial nerve?
Prompt: Start from the parotid gland

  • Facial n. (66)
    • Motor supply of the face
  • 5 branches
    • Temporal n. (67)
    • Zygomatic n. (68)
    • Buccal n. (69)
    • Marginal Mandibular n. (70)
    • Cervical n. (Exits BOS at stylomastoid foramen)

Pass Criteria:

  • Bold + 3/5 branches

What is the function of the facial nerve?

  • Motor supply to the face
  • Muscles of facial expression
  • Taste anterior 2/3 of tongue

Pass Criteria:

  • Bold

What is the sensory nerve supply of the face?
Prompt: What are the branches?

  • Trigeminal n. (5th Cranial n.)
    • 3 branches:
      • Opthalmic
      • Maxillary
      • Mandibular
      • NB – not on model but candidate can map sensory division supply
  • Bold + 2/3 branches

Q12

Q12 Head_Neck copy

Identify the venous structures in this photo.

  • SVC
  • Right brachiocephalic vein
  • Left brachiocephalic vein
  • Subclavian vein
  • Internal jugular vein
  • Inferior thyroid vein

Pass Criteria:

  • 4 to pass

Identify the nerves in this photo.

  • Phrenic nerve
  • Right vagus nerve
  • Right recurrent laryngeal nerve
  • Left vagus nerve
  • Sympathetic trunk

Pass Criteria:

  • 3 to pass

Q12 Head_Neck

What is the difference between the course of the right and left recurrent laryngeal nerve?

  • Right: hooks around subclavian artery
  • Left: hooks around aorta
  • After looping, they ascend in trachea-oesophageal groove to supply intrinsic muscles of larynx (except cricothyroid)

Pass Criteria:

  • Both to pass

Q13

Model – C2 Bone

Identify this bone.

  • C2 (axis)

Pass Criteria:

  • Must say C2

Describe its features.

  • Body (1)
  • Dens (2)
  • Impression for alar ligament (3)
  • Superior and inferior articular surface (4)
  • Pedicle (5)
  • Lamina (6)
  • Bifid spinous process (7)
  • Transverse process with foramen (8)
  • Vertebral foramen (9)

Pass Criteria:

  • Bold + 4 other features

Name the ligaments that stabilize the atlanto-axial joint.
Prompt: How is the dens kept in place?

  • Cruciate ligament
    • Transverse ligament
    • Superior & inferior longitudinal band
  • Alar ligaments
  • Tectorial membrane
    • Continuation of posterior longitudinal ligament
  • Anterior atlanto-axial membrane
    • Continuation of anterior longitudinal ligament
  • Posterior atlanto-axial membrane
    • Continuation of ligamentum flavum
  • Apical ligament

Pass Criteria:

  • Bold + 2 others

What movement occurs at the atlanto-axial joint?

  • Rotation around vertical axis

Pass Criteria:

  • Bold

Q14

CT Brain

Could you identify some normal structures on this head CT?

  • Lobes:
    • Frontal
    • Temporal
    • Parietal
    • Occipital
  • Lateral ventricle
    • Anterior/posterior horns
    • 3rd ventricle
  • Caudate nucleus
  • Lentiform nucleus (putamen & globus pallidus)
  • Thalamus
  • Anterior & posterior limbs of internal capsule
  • Septum pellucidium
  • Falcx

Pass Criteria:

  • 5 Structures

What is the arterial supply of the brain?

  • ACA area anterior to anterior horns of lateral ventricle
    • Frontal and parietal lobes medially and superiorly
  • MCA area between the anterior & posterior horns of lateral ventricle
    • Most of the lateral surface, anterior, parietal, and temporal lobes
  • PCA area posterior to posterior horn of lateral ventricle
    • Inferior & medial aspects of occipital and temporal lobes

Pass Criteria:

  • 3 Major vessesls + detail

Q15

 MODEL: Muscles of vocalization/Nerve supply

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

•    Thyroid cartilage
•    Cricoid cartilage
•    Cricothyroid membrane
•    Cricothyroid muscle
•    Epiglottis
•    Vocal cords, vocal folds
•    Aryepiglottic folds, vallecula

Pass Criteria:

•    6 to pass

Name the muscles of vocalization.

  • Cricothyroid
    • Anterolateral cricoid to inferior margin and inferior horn of thyroid
    • External laryngeal nerve
  • Thyroarytenoid
    • Lower ½ post angle of thyroid laminae and cricothyroid ligament to anterolateral arytenoid
    • Inferior laryngeal nerve
  • Lateral cricoarytenoid
    • Arch of cricoid to vocal process of arytenoid
    • Inferior laryngeal nerve
  • Transverse and oblique arytenoids
    • One arytenoid cartilage to contralateral arytenoid
    • Inferior laryngeal nerve
  • Vocalis
    • Lateral surface process of arytenoid cartilage to contralateral arytenoid

Pass Criteria:

•    Bold to pass

If needed: Please describe the nerve supply to the intrinsic laryngeal muscle.

  • All except cricothyroid supplied by recurrent laryngeal nerve
  • Recurrent laryngeal nerve is a branch of CNX
  • Cricothyroid supplied by external laryngeal nerve
  • External laryngeal nerve is one of the 2 terminal branches of the superior laryngeal nerve

Pass Criteria:

  • Bold  to pass

Q16

MODEL: Tongue/Muscles and nerve supply

On this model, identify structures that make up the floor of the mouth.

  • Mandible
  • Tongue
  • Lip
  • Teeth
  • Geniohyoid muscle
  • Hyoid bone
  • Stylohyoid muscle
  • Genioglossu muscle

Pass Criteria:

  • 4 to pass

Describe the innervation of the tongue.

  • Motor:
    • All muscles except palatoglossus innervated by CN12 (hypoglossal nerve)
    • Palatoglossus is actually a palatine muscle, therefore supplied by pharyngeal plexus
  • General sensation (touch & temperature)
    • Mucosa of anterior 2/3 supplied by lingual nerve (branch of CN V 3 Mandibular)
    • Taste for anterior 2/3 (EXCEPT for vallate papillae) is via chorda tympani nerve (branch of CN VIII, the chorda tympani joins the lingual nerve and runs anteriorly in it’s sheath
    • Posterior 1/3 of tongue and vallate papillae, BOTH general sensory to mucous membrane and taste are supplied by the lingual branch of glossopharyngeal nerve (CN IX)
  • Twigs of internal laryngeal nerve (branch of vagus) supply mostly general but some special sensation to a small area of tongue just anterior to epiglottis, these mostly sensory fibres also carry parasympathetic secretomotor fibres to serous glands of tongue
  • Paraympathetic fibres from chora tympani travel with lingual nerve to submandibular and sublingual salivary glands, these nerve fibres synapse in the submandibular ganglion which hangs from the lingual nerve

Pass Criteria:

  • Hypoglossal main motor
  • Lingual anterior 2/3 sensation
  • Chorda tympani anterior 2/3 taste

Q17

Demonstrate the features of the mandible.

  • Condylar process (head & neck)
  • Ramus, notch
  • Coronoid process
  • Angle
  • Mental & mandibular foramen
  • Mental tubercle and symphisis
  • Alveolar process

Pass Criteria:

  • 5 to pass, 10=10

Describe the features of the temperomandibular joint.
Prompt: Bones, synovial cavities, ligaments?

  • Bones
    • Condyle of mandible
    • Articular tubercle & mandibular fossa
  • Disc
    • Separates superior synovial cavity (gliding in/out) and inferior synovial cavity (hinge up/down)
  • Postglenoid tubercle and temperomandibular (lateral) ligament
    • Prevents posterior dislocation
  • Stylomandibular and sphenomandibular ligaments
    • Weak

Pass Criteria:

  • 2 bones to pass + superior & inferior cavities

If time: Describe the mandibular attachments of the muscles of mastication.

  • Temporalis
  • Temporal fossa to medial coronoid & anterior ramus
  • Masseter
  • Maxillary process & zygomatic arch to angle & lateral ramus
  • Lateral pterygoid
  • Greater wing sphenoid and lateral surface
  • Lateral pterygoid plate to joint capsule
  • Disc & pterygoid fossa on neck of mandible
  • Medial pterygoid
  • Medial surface lateral pterygoid plate & tuberosity of maxilla to medial ramus below foramen

Pass Criteria:

  • 2 to pass

Q18

Model: Larynx

Using the model, demonstrate the main features of the larynx. Remove left side of mandible and tongue.

  • From epiglottis to inferior border of cricoid
  • Cartilage (9)
    • Thyroid:
      • Superior/inferior horns
      • Oblique line
      • Laryngeal prominence
      • Laminae
      • Thyroid notch
    • Cricoid
      • Cricothyroid joint – allows change in length of vocal cords
    • Epiglottis
    • Cuneieform & Corniculate (paired)
    • Arytenoid (paired)
  • Membranes
    • Thyroid
    • Median cricothyroid
  • Ligaments
    • Cricothtracheal
    • Medial/lateral cricothyroid
    • Aryepiglottic/thyroepiglottic
    • Medial/lateral thyrohyoid

Pass Criteria:

  • Need all to pass: thyroid cartilage, cricoid cartilage, epiglottis, cricothyroid membrane, location of the arytenoids

What is the motor innervation of the muscles of the larynx?

  • Extrinsic:
    • Infrahyoid
    • Suprahyoid
    • Stylopharyngeus
    • CNX –-> recurrent laryngeal –> superior and inferior laryngeal
  • Intrinsic:
    • CNX –> recurrent laryngeal supplies all except cricothyroid supplied by external branch of superior laryngeal
  • Principal adductors:
    • Lateral cricoarytenoids (plus trans/oblique arytenoids)
  • Principal abductors:
    • Posterior cricoarytenoid
  • Tensor
    • Cricothyroid
  • Relaxer
    • Thyroarytenoid
  • Sphincters
    • Action of most other than posterior cricothyroid

Pass Criteria:

  • To pass: recurrent laryngeal nerve

Q19

Media: Neck model (sagittal section)

Identify the boundaries of the anterior triangle of the neck on this model.

Anterior border of the SCM, midline of the neck and the inferior border of the mandible.

Pass Criteria:

  • All bold to pass.

Describe the surface markings of the carotid sheath in the neck.

Runs along a line joining the SCJ and a point midway between the mastoid process and the angle of the mandible.

Pass Criteria:

  • All bold to pass.

What are the contents of the carotid sheath?

  • Common carotid artery
  • Internal jugular vein
  • Vagus nerve

Pass Criteria:

  • All bold to pass.

Describe the position and features of the thyroid gland.

  • Anterior in the neck at level C5 – T1
  • Deep to the sternohyoid muscle
  • Right and left lobes sit anterolateral to the larynx and trachea
  • The isthmus joins these at the level approximately 2 – 3 tracheal rings

Pass Criteria:

  • At least 2/3 bold to pass.

Q20

Media: Cerebral circulation (CT)

What is the arterial supply of the cerebral cortex? Name the corresponding parts they supply.
Prompt: demonstrate on the CT.

  • ACA – area anterior to the anterior horns of the lateral ventricles (frontal and parietal lobes medially and superiorly)
  • MCA – area between the anterior and posterior horns of the lateral ventricles (most of lateral surface, parietal, and temporal lobes)
  • PCA – area posterior to the posterior horns of the lateral ventricles (inferior and medial aspects of the occipital and temporal lobes)

Pass Criteria:

  • Anterior, middle and cerebral artery with 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 the cerebral hemispheres) – 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 the internal jugular veins

Pass Criteria:

  • General concept to pass.

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