Circle, Square...TRIANGLE..
What are the contents of the carotid triangle?
Within carotid sheath: Common carotid artery (External and internal carotid arteries), Internal Jugular vein, Vagus Nerve
Other: Accessory nerve, Hypoglossal nerve (at the top)
3 year-old complains to you that she bit her cheek and it hurts. What nerve relays the pain and from what cranial nerve?
A 70 year-old male is admitted to the hospital due to loss of the ability to taste from the anterior two thirds of the tongue. What nerve is damaged?
Facial nerve: anterior 2/3 of taste
44 year-old female is having difficulty swallowing. Imaging reveals that she has a tumor compressing the jugular foramen. What structure is causing the patients symptoms?
Compression of the vagus nerve -> CN 10
35 year-old unconscious male was admitted to the ED after being hit in the head with a baseball. Imaging shows an epidural hematoma?
Where was this patient likely hit? What artery is most likely injured?
Pterion,
Middle meningeal artery
What is innervated by the ansa cervicalis? Name the muscles.
Infrahyoid muscles (sternohyoid, omohyoid, sternothyroid)
Patient develops sensitivity to loud sounds. What nerve is effected and what muscle?
Facial nerve --> nerve to stapedius --> stapedius muscle
55 year-old male w/ a history of a 90% occlusion his both is common carotid underwent carotid endarterectomy. On post-operative examination when the patient is asked to stick out her tongue, her tongue deviates to the right. Which nerve was injured during the procedure.
R hypoglossal nerve
A 62 year-old female is admitted to the hospital due to nausea, vomiting, and a severe headache. MRI shows that she has an acoustic neuroma. What nerves are likely compressed in what location?
CN 7 & 8 near the internal acoustic meatus.
10 year-old boy goes to his dentist to repair his dental cavity of one of his mandibular molar teeth. What nerve would the dentist need to anesthetize for the procedure?
Inferior alveolar nerve
50 year-old construction worker falls onto a nail protruding from a board. The nail penetrates the skin over the submental triangle lateral to the midline. What muscle of the neck would be last to be penetrated?
Geniohyoid
The nail would first pierce the platysma, then the anterior belly of the digastric, then the mylohyoid, then the genio- hyoid (and finally the genioglossus)
31 year-old female presents to the office due to vision changes. After further examination patient is diagnosed with a pituitary tumor. To access the tumor, which sinus should the surgeon enter?
Sphenoid sinus
A 42 year-old man is admitted to the ED due to visual problems. Imaging shows a tumor of the anterior pituitary gland. The patient states that he is unable to see the lateral halves of his visual field in both eyes.
What is the specific name of his symptom. What is the pituitary tumor compressing on?
Bitemporal hemianopia
Pituitary gland is compressing the optic chiasm
A 42 year-old man is suffering from trigeminal neuralgia (burning pain). Pain is seen between the lower eyelid and upper lip. To anesthetize the trigeminal nerve branch, the needle will need to be inserted through which opening?
Foramen rotundum
40 year-old female was seen postoperatively after undergoing excision of a parotid gland tumor. She states that she has weakness in the musculature of the patient's lower lip. What nerve was likely injured?
Marginal mandibular branch of the facial nerve
A 3 year old boy with a past medical history of a complicated birth presents to their pediatrician for evaluation of a tilted neck. They present with the right ear near the right shoulder and face turned upward and to the left.
What muscle was most likely damaged during birth? What is this condition known as?
SCM, Torticollis
A 30 year-old male goes to the dentist due to tenderness and pain in her cheek near the parotid gland, as well as bad breath and foul-tasting pouting at meal times. Testing shows a stone stuck int he parotid gland. What muscle does the parotid duct pass through that is blocking the passage of the stone?
Buccinator
23 year old-man was admitted to the hospital after a boxing match due to a suspected broken jaw. Further examination reveals that CN V3 is damaged. What muscles will be affected and what part of the face will have loss of sensation?
Muscles of mastication (masseter, temporalis, medial & lateral pterygoid)
+ MATT (mylohoid, anterior belly of digastric, tensor tympani, tensor velipalatini)
A 70 year-old man presents to the clinic due to difficulty eating. Imaging shows a tumor of the brainstem that effects the hypoglossal canal. What muscle of the tongue will not be affected by this tumor? Why?
Palatoglossus - innervated by CN 10
50 year-old woman presents to the ED due to swelling of the right side of the face. 3 months ago patient underwent removal of a parotid gland tumor. For the last month when she tastes or smells food, she complains her face sweats profusely. What nerve is injured?
Auriculotemporal nerve
27-year-old man was rushed to the ED after a stop wound to the superior neck. Imaging shows that no major structures are effected, however patient complains of loss of sensation from the skin over the angle of the jaw. What nerve is most likely injured.
Greater Auricular nerve
This is a nerve of the cervical plexus. (Lesser occipital, Greater auricular, Transverse cervical, Supraclavicular)
A 50 year-old man reports to the ED after falling. On physical examination the patient is noted to have a hematoma that formed in the danger zone of the scalp, spreading to the area of the eyelids. What layer of the scalp is known as the danger zone?
Loose areolar connective tissue layer is known as the danger zone because a hematoma can spread easily from the layer into the skull by the emissary veins that pass into and through the bones of the skull.
You are a professor at UMHS. A medical student asks you how to differentiate between CN 3, CN 4 and CN 6 lesions. How do you differentiate between the above lesions.
CN 3 - eye would be down and out
CN 4 - eye would be upward (difficult to look down)
CN 6 - eye would deviate medially (unable to look lateral)
A 99 year-old female is unable to abduct her right eye and has an absent corneal reflex on the same side. These symptoms may indicate a growth in what part of the skull?
Superior orbital fissure
A 53 year-old man is admitted to the ED with a fracture to the base of their skull. PE shows that the greater petrosal nerve has been injured. What physical exam finding will confirm the diagnosis of greater petrossal nerve injury?
Greater petrosal nerve has PSNS fibers involved in innervation of the lacrimal gland. Damage would have decreased lacrimal secretions of the right eye.