Block 3 Jeopardy

I've got a BONE to pick with you

100

Name 2 muscles that attach here

Mastoid process: 

1. SCM

2. posterior belly of digastric 

3. splenius capitus (block 1 throwback)

200

What bones/articulation points take part in the TMJ? 

the condylar process of the mandible and the mandibular process of the temporal bone

300

The middle nasal concha is part of what bone?

ethmoid

400

What attaches to the crista galli?

The falx cerebri - separates the cerebral hemispheres

500

In what bone does the pituitary gland live? What the area called? 

Sella turcica = nook of sphenoid bone where pituitary sits

Getting on my last NERVE

100

Which nerve provides motor innervation to the buccinator muscle?

Bonus: what's the action of the buccinator?

buccal branches of CNVII (facial nerve) 

Bonus: buccinator acts to compress the cheeks (ex = playing trumpet)

200

What nerve innervates stapedius? 

Bonus: what symptom would you see with a lesion/palsy here?

CN VII = facial nerve - nerve to stapedius

Bonus: stapedius activation/contraction decreases sound transmission in the middle ear (think protective) - so if it's not working, patient will be hypersensitive to sound/sounds are overly loud for them 

remember also that tensor tympani has a similar action - but it's innervated by CNV3

300

What innervates the infrahyoid muscles? 

Bonus: What other nerve runs alongside it?

Ansa cervicalis = nerve loop of anterior rami from C1-C3

Bonus: CNXII (hypoglossal) runs alongside the superior aspect

400

What nerve provides taste to the anterior 2/3 of the tongue?

Bonus: what else does this nerve do?

chordae tympani from CN VII = taste 

general sensation of tongue = lingual nerve from CN V3 - chordae tympani runs with it

Bonus: chorda tympani also innervates secretory function of sublingual and submandibular glands 

500

Uvula is deviated to the left - what cranial nerve is affected, and on which side?

right CN X (vagus) palsy - uvula deviates away from the side of the lesion (right side is weak, so uvula is pulled left)

EYE have issues and you've got em too

100

A patient can't wink/forcefully close their eye - which nerve is affected? 

Bonus: If it were ptosis/drooping eyelid, which nerve would be affected? 

CNVII (facial nerve) = orbicularis occuli

Bonus: CNIII (oculomotor) = levator palpebrae superioris 

200

What does mydriasis mean? What branch of the autonomic nervous system causes mydriasis?

Mydriasis = dilated pupils - this is mediated by the sympathetic nervous system (don't care about reading fine print when you're running from a bear) 

Miosis = constricted pupils - this is mediated by the parasympathetic 

300

A patient presents with inability to elevate and abduct the eye after a head injury - pupil is dilated - mild ptosis is observed. What cranial nerve is affected?

CNIII (oculomotor) - this is a "down and out" sign - often caused by uncalled herniation which puts pressure on/compresses CNIII

With superior oblique (CNIV/trochlear) and lateral rectus (CNVI/abducens) left unopposed, eye pulls down and out

400

What passes through that opening?

supraorbital nerve (branch of CN V1) and supraorbital artery

500

How would you test the integrity of the CNIV/trochlear nerve (what direction do you want the patient to look)? 

Ask the patient to look in (toward the nose) and down - testing superior oblique 

Holes in the head (+ what goes through them)

100

What travels through the optic canal?

CNII (optic nerve) + ophthalmic artery (from internal carotid)

200

Where does CNVIII (vestibulocochlear) exit the skull?

Bonus: what else travels with it?

Internal acoustic meatus 

Bonus: CNVII (facial nerve) travels with it 

300

Where does CNIX (glossopharyngeal) exit the skull?

Bonus: what travels with it? 

Jugular foramen 

Bonus: CNIX, CNX, CNXI, and jugular vein all exit together

400

What runs through this foramen? (in green)

foramen rotundum - CN V2 = maxillary division 

500

What foramen does the middle meningeal artery run through?

Foramen spinosum

A blow to the head (+ miscellaneous issues)

100

A baseball player is hit on the side of the head (near their temple) with a fastball. They lose consciousness, wake up briefly, then become comatose on the way to the ER. CT scan shows a lemon/lens shaped accumulation of blood on the right side compressing the cerebrum. What blood vessel is the bleed coming from? 

Bonus: what area on the skull did the ball likely hit/fracture?

Middle meningeal artery - this is a classic epidural hemorrhage 

Bonus: the skull likely fractured at the pterion - weak point where the parietal, frontal, temporal, and sphenoid bones meet - middle meningeal artery runs right under it 

200

What kind of bleed is this? 

Bonus: What vessels cause it?

This is an acute subdural hematoma - banana shaped/crosses suture lines - white on CT (will darken with time) 

Bonus: Caused by ruptured bridging veins  

300

Infection in the sinuses or nasal cavity can spread up to the meninges via the olfactory nerve fibers + bulb

Where does it enter the cranial cavity?

Cribiform plate

remember this is the ethmoid bone

400

A newborn presents with their head tilted to one side, what is the name for this condition and what nerve is impacted?

 

Torticollis ("wry neck") - CNXI (spinal accessory nerve) is compressed, causing the SCM to be shortened/hyper-contracted on the affected side

500

Shortly after a thyroidectomy (which required ligation of the inferior thyroid artery), a patient presents with hoarse voice and isn't breathing well. What nerve was injured? 

recurrent laryngeal nerve (branch of CNX/vagus) - handles all intrinsic muscles of the larynx except for cricothyroid 

cricothyroid is innervated by superior laryngeal nerve