USMLE Step 1 Web Prep Head and Neck: Part 2

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SECTION III Gross Anatomy and Organogenesis Head and Neck ( art !"
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CN Name I II Olfactory O tic

Ta#$e III%&%'( Crania$ Ner)es* +,nctiona$ +eat,res Lesions E.its/Enters -egion Ty e +,nction -es,$t In Crani,m Inner)ated Sensory Smells Sensory Sees !o tic nerve is really a tract of CNS "it# menin$es% Anosmia Cribriform Plate Nasal Cavity Orbit

&is'al fiel( O tic Canal (eficits !ano sia% )oss of li$#t refle* "it# III Only nerve to be affecte( by +S !s"in$in$ flas#li$#t test% Sensorine'ral Internal #earin$ loss a'(itory )oss of meat's balancenysta$m's /i loria e*ternal strabism's )oss of arallel $a0e /ilate( ' illoss of li$#t refle* "it# II )oss of near res onse Ptosis

&II &estib'lococ#lear Sensory ,ears

Inner ear

III

Oc'lomotor

+otor

)inear acceleration !$ravity% An$'lar acceleration !#ea( t'rnin$% +oves eyeball in all (irections A(('ction !me(ial rect's% most im ortant action Constricts ' il !s #incter ' illae% Accommo(ates !ciliary m'scle% .aises eyeli( !levator al ebrae s' erioris%

S' erior Orbit orbital fiss're

CN Name &

Ty e +,nction

Lesions -es,$t In

E.its/Enters -egion Crani,m Inner)ated

1roc#lear2t(> +otor S' erior obli3'e4 (e resses an( ab('cts eyeball !ma5es eyeball loo5 (o"n an( o't% Intorts

6ea5ness S' erior Orbit loo5in$ (o"n orbital fiss're "it# a(('cte( eyes 1ro'ble $oin$ (o"n stairs ,ea( tilts a"ay from lesione( si(e

&I Ab('cens

+otor )ateral rect's ab('cts /i lo ia 4 S' erior Orbit eyeball internal orbital fiss're strabism's )ess of aralle( $a0ese'(o tosis +otor 1'rns #ea( to o osite si(e !sternoclei(omastoi(% 8levates an( rotates sca 'la !tra e0i's% +otor +oves ton$'e !styo$loss's#yo$loss's$enio$loss's- an( intrinsics: alato$loss's is by 7% 6ea5ness 9'$'lar t'rnin$ #ea( to foramen o osite si(e S#o'l(er (roo Nec5

7I Accessory

7II ,y o$lossal

1on$'e ,y o$lossal 1on$'e ointe( to"ar( canal same !affecte(% si(e on rotr'sion &; 4 loss of $eneral sensation in s5in of fore#ea(2scal )oss of blin5 refle* "it# &II &; 4 s' erior Orbit an( orbital fiss're scal !o t#almic (ivision%

&

1ri$eminal +i*e( <eneral sensation o t#almic !&;% !to'c#- aintem erat're% of fore#ea(2scal 2cornea

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CN Name

Ta#$e III%&%'( Crania$ Ner)es* +,nctiona$ +eat,res (continued) 1y e >'nction )esions 8*its28nters .e$ion .es'lt In Crani'm Innervate( <eneral sensation of alate- nasal cavity- ma*illary face- ma*illary teet# <eneral &2?loss of $eneral sensation in s5in over ma*illama*illary teet# &3@loss of &2? foramen rot'n('m !ma*illary (ivision% Ptery$o alatine fossa !leave by o enin$s to face- oral an( nasal cavity%

+a*illary !&2%

+an(ib'lar !&3%

&3?

Infratem oral

sensation of anterior t"o t#ir(s of ton$'eman(ib'lar faceman(ib'lar teet# +otor to m'scles of mastication !tem oralismasseterme(ial an( lateral tery$oi(s% an( anterior belly of (i$astricmylo#yoi(tensor tym anitensor alati &II >acial +i*e( 1o m'scles of facial e* ressionosterior belly of (i$astricstylo#yoi(sta e(i's 1astes anterior t"o t#ir(s of ton$'e2 alate

$eneral sensation in s5in over man(ibleman(ib'lar teet#ton$'e"ea5ness in c#e"in$ 9a" (eviation to"ar( "ea5 si(e 1ri$eminal ne'ral$ia? intractable ain in &2 or &3 territory

foramen >ossa ovale !man(ib'lar (ivision%

Corner of mo't# (roo s- canAt close eyecanAt "rin5le fore#ea(loss of blin5 refle*#y erac'sis

Internal a'(itory meat's

>ace- nasal- an( oral cavity !branc#es leave s5'll in stylomastoi( foramenetrotym anicfiss're- or #iat's of facial canal%

Salivates Alteration or !s'bman(ib'lar- loss of taste s'blin$'al !a$e'sia% $lan(s% 8ye (ry an( 1ears !lacrimal re( $lan(% Bell alsy? +a5es m'c's lesion of !nasal an( nerve in alatine $lan(s% facial canal I7 <losso #aryn$eal +i*e( Senses #aryn*- )oss of $a$ 9'$'lar caroti( refle* "it# 7 foramen sin's2bo(y Salivates ! aroti( $lan(% 1astes an( senses osterior one t#ir( of ton$'e Nec5 P#aryn*2ton$'e

+otor to one m'scles@ stylo #aryn$e's

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CN Name 7 &a$'s

Ta#$e III%&%'( Crania$ Ner)es* +,nctiona$ +eat,res (continued) 1y e >'nction )esions .es'lt In 8*its28nters .e$ion Crani'm Innervate( +i*e( 1o m'scles of alate an( #aryn* for s"allo"in$ e*ce t tensor alati !&% an( stylo #aryn$e's !I7% 1o all m'scles of laryn* ! #onates% Senses laryn* an( laryn$o #aryn* Nasal s eec#- nasal 9'$'lar re$'r$itation foramen /ys #a$ia- late (roo Cv'la ointin$ a"ay from affecte( si(e ,oarseness2fi*e( vocal cor( )oss of $a$ refle* "it# I7 )oss of co'$# refle* Nec5 P#aryn* 2 ton$'e 1#ora*ab(omen

Sym at#etics +otor .aises eyeli( to #ea( !s' erior tarsal m'scle% /ilates ' il Innervates s"eat $lan(s of face an( scal Constricts bloo( vessels in #ea(

,orner sym(rome eyeli( (roo ! tosis%- constricte( ' il !miosis%- loss of s"eatin$ !an#y(rosis%fl's#e( face

Caroti( Orbit- facecanal on scal internal caroti( artery

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C$inica$ Corre$ate Ca)erno,s Sin,s T3rom#osis Infection can s rea( from veins of t#e face into t#e caverno's sin'ses- ro('cin$ infection an( t#rombosisE S'c# infection may involve t#e cranial nerves- "#ic# co'rse t#ro'$# t#e caverno's sin'sE Cranial nerves ;;;- ;&- an( &; an( t#e o #t#almic an( ma*illary (ivisions of CN &- as "ell as t#e internal caroti( artery an( its eriarterial le*'s of ost$an$lionic sym at#etic fibers traverse t#e caverno's sin'sE All of t#ese cranial nerves co'rse in t#e lateral "all of t#e sin's e*ce t for CN &;- "#ic# co'rses t#ro'$# t#e mi((le of t#e sin'sE As a res'lt- CN &; is ty ically affecte( first in a caverno's sin's t#rombosis or by an ane'rysm of t#e internal caroti( artery- "it# t#e ot#er nerves bein$ affecte( laterE
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C$inica$ Corre$ate S,#arac3noid Hematoma A s'barac#noi( #emorr#a$e res'lts from a r' t're of a berry ane'rysm in t#e circle of 6illisE 1#e most common site is in t#e anterior art of t#e circle of 6illisE A common site for an ane'rysm is at t#e branc# oint of t#e anterior cerebral an( anterior comm'nication arteriesE Ot#er common sites are in t#e ro*imal art of t#e mi((le cerebral artery- or at t#e G'nction of t#e internal caroti( an( osterior comm'nicatin$ arteriesE A ty ical resentation associate( "it# a s'barac#noi( #emorr#a$e is t#e onset of a severe #ea(ac#eE