ANATOMY

030 - The scalp layer of loose connective tissue between the epicranial aponeurosis and the periosteum forms the subaponeurotic or "danger" space. Emissary veins connect with the dural sinuses with potential for __________ Hematogenous spread of infection through the calvaria.

031 - Cranial fractures preferentially pass through cranial foramina injuring the contained __________ Nerves.

032 - Principal Foramina of the Anteiror Cranial Fossa:

Foramen	Contents	Results of Injury
Olfactory	__________ Olfactory nerves	Anosmia
Foramen cecum	__________ An emissary vein

033 - Principal Foramina of the Middle Cranial Fossa:

Foramen	Contents	Results of Injury
Optic canal	__________ CN II	Unilateral blindness
	__________ Ophthalmic artery	Ischemic unilateral blindness
Superior orbital fissure	__________ CN III	Ophthalmoplegia
	__________ CN IV	Inability to look down and out
	__________ CN V	Unilateral loss of blink reflex
	__________ CN VI	Inability to abduct eye
	__________ Superior ophthalmic vein	Retinal engorgement
Foramen rotundum	__________ CN V2	Loss of sneeze reflex
Foramen ovale	__________ CN V3	Masticatory paralysis, loss of jawjerk reflex
Foramen spinosum	__________ Middle meningeal artery
Foramen lacerum	__________ Nothing (except occasionally the greater superficial petrosal nerve)
Hiatus of the facial canal	__________ Gr. Superficial petrosal n.	Dry eye, loss of submandibular and sublinguinal secretion

034 - Principal foramina of the posterior cranial fossa:

Foramen	Contents	Results of Injury
Internal auditory meatus	CN VII	__________ Facial paralysis
	CN VIII	__________ Auditory and vestibular deficits
Jugular foramen	CN IX	__________ Loss of gag and carotid reflexes
	CN X	__________ Loss of cough reflex. Paralysis of laryngeal muscles and some palatine muscles
	CN XI	__________ Inability to shrug shoulders
	Internal jugular vein
Anterior condylar canal	CN XII	__________ Paralysis of tongue muscles. Lingual deviation toward side of injury upon protusion

035 - CSF is produced by the choroids plexuses which project into the ventricles of the brain:

CSF Production	Through	Into
Lateral ventricles	Foramina of Monro	__________ Third ventricle
Third ventricle	Iter (cerebral aqueduct)	__________ Fourth ventricle
Fourth ventricle	Foramina of Magendie & Luschka	__________ Cisterna magna of subarachnoid space
From	Through	CSF Uptake
Subarachnoid space	__________ Arachnoid villi	Superior sagittal venous sinus

036 - The cerebral aqueduct is prone to occlusion, leading to __________ Hydrocephalus.

037 - Cranial and cerebral hematomas:

Hematoma	Prognosis	Location	Cause
Epicranial	__________ Resolves	Subaponeurotic Space	Superficial vessels
Epidural	__________ Life-threatening	Epidural space	Torn middle meningeal artery
Subdural	__________ Less serious	Subdural Space	Torn cerebral vein
Subarachnoid	__________ Lethal	Subaracnhnoid space	Torn cerebral artery, cerebral aneurysm
Subpial	__________ Usually resolves	Cerebrum	Cerebral contusion

038 - Regions of the orbit that are prone to fracture include the ethmoid lamina papyracea and the __________ Maxilla about the infraorbital groove.

039 - Contraction of the orbicularis oculi muscle, innervated by the facial nerve, produces the __________ Blink.

040 - Orbital muscle function and innervation:

Muscle	Primary function	Secondary functions (normally balance)	Innervation
Pupil	__________ Constriction Dilation		CN III parasympathetic sympathetic chain
Ciliary body	__________ Accommodation		CN III parasympathetic
Superior tarsal muscle	__________ Augment levator palpebrac superioris		Sympathetic chain
Levator palpebrae superioris	__________ Elevate eyelid		CN III (oculomotor)
Medial rectus	__________ Adduction		CN III (oculomotor)
Superior rectus	__________ Elevation	Adduction, intorsion	CN III (oculomotor)
Inferior oblique	__________ Elevation	Abduction, extorsion	CN III (oculomotor)
Inferior rectus	__________ Depression	Abduction, extorsion	CN III (oculomotor)
Superior oblique	__________ Depression	Abduction, intorsion	CN IV (Trochlear)
Lateral rectus	__________ Abduction		CN VI (Abducens)

041 - Parasympathetic innervation to the __________ Pupil is by the oculomotor nerve. Temporal lobe herniation (from tumor, hematoma, or edema) __________ Compresses the oculomotor nerve within the tentorial notch, causing a dilated pupil that is unresponsive to light.

042 - Special sensory tests and dysfunction:

Nerve	Foramen	Dysfunction	Test
CN I (Olfactory)	Cribriform plate	Anosmia	__________ Whiff of clove
CN II (Optic)	Optic canal	Blindness	__________ Optic field tests
CN VIII Cochlear Vestibular	Internal auditory meatus Internal auditory meatus	Deafness Balance	__________ Hearing threshold __________ Nystagmus

043 - Paralysis of the stapedius muscle, as a result of facial nerve palsy, produces __________ Hyperacusis.

044 - The infrahyoid muscles, innervated by the ansa cervicalis (C1-C3), stabilize the hyoid bone and larynx during __________ Deglutition and phonation.

045 - The pretracheal space, deep to the pretracheal fascia, surrounds the trachea and thyroid gland, but is anterior to the esophagus. Infection I this space may track into the __________ Superior mediastinum.

046 - The retropharyngeal (retrovisceral) space lies posterior to the oroparynx and esophagus and is defined by septa from the pretracheal fascia. Infection within this space may track into the __________ Posterior mediastinum.

047 - The mandibular neurovascular bundle enters the mandibular foramen adjacent to the lingual, the point of __________ Minimal movement. It may be anesthetized by directing a needle posteriorly through the buccal wall just __________ Lateral to the pterygomandibular raphe.

048 - The deep cervical nodes receive lymph from the __________ Anteroinferior portion of the face, the nasal cavities, and the oral cavity.

049 - The nasal vestibule (the most common site for nose bleeds) receives vascular branches from internal and external __________ Carotid arteries.

050 - The __________ Palatine tonsil receives vascular branches from the maxillary, facial, and lingual arteries.

051 - Abduction of the vocal cords is a function of the posterior cricoarytenoid muscle only, innervated by the recurrent __________ Laryngeal nerve.

052 - Branchiomeric nerve functions and tests:

Nerve	Course	Sensory	Motor	Test
CN V (tigeminal)
VI	Superior orbital fissure, supraorbital notch	Forehead	None	__________ Blink relfex
V2	Foramen rotundum, maxillary foramen	__________ Midface	None	Sneeze reflex
V3	Foramen ovale, mandibular foramen, mental foramen	Anterior pinna, jaw	Muscles of mastication, mylohyoid ant, belly of digastric, tensor palatine and tensor tympani	__________ Jaw jerk
__________ CN VII (facial)	Internal autitory meatus, facial canal, stylomastoid foramen	Concha of ear, taste anterior 2/3 of tongue via chorda tympani	Muscle of facial expression, stylohyoid, post belly of digastric, tensor tymani, parasympathetic to lacrimal nasal, palatine, lingual and submandibular glands via gr. Superficial petrosal nerve	Blink reflex
CN IX (glossopharyngeal)	Jugular foramen	External auditory, meatus, oropharynx, carotid body and sinus, taste posterior 1/3 of tongue	Stylopharyngeus muscle, parasympathetic to parotid gland via tympanic and lesser superficial petrosal nerves	__________ Gag reflex, carotid reflex
CN X (vagus)	Jugular foramen	External auditory matus, larynx, taste from epiglottis, aortic body	Palatine muscles, pharyngeal muscles, laryngeal muscles	__________ Phonation

053 - Nerve functions and tests:

Nerve	Course	Sensory	Motor	Test
CN XI (spinal accessory)	Foramen magnum, jugular foramen	None	Sternomastoid Upper trapezius	__________ Turn head to opposite side
CN XII (hypoglossal)	__________ Hypoglossal canal	None	Intrinsic and extrinsic tongue muscles	Protrudes straight