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Anatomy Y2 S3 > A4 - ENT > Flashcards

A4 - ENT Flashcards

1
Q

Where does the pharynx start from/ end?

A

From base of skull to inferior border of C6

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2
Q

Where does the nasopharynx start/ end?

A

From base of skull to soft palate

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3
Q

What is the nasopharynx lined with?

A

Ciliated pseudostratified columnar epithelium with goblet cells

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4
Q

Which tonsils are within the nasopharynx?

A

Adenoid (pharyngeal) tonsils
Tubal tonsils - lateral wall (around Eustachian tube opening)

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5
Q

Where does the oropharynx start/ end?

A

Between the soft palate and superior border of the epiglottis

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6
Q

What does the oropharynx contain?

A

-Posterior 1/3 of tongue
-Lingual tonsils (base of tongue)
-Palatine tonsils (between palatoglossal and palatopharyngeal arches of oral cavity)
-Superior constrictor muscle

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7
Q

What is the Weldeyer’s ring?

A

Ring of lymphoid tissue in the nasopharynx and oropharynx, formed by the palatine tonsils, the adenoid (pharyngeal) tonsil, tubal tonsils and the lingual tonsil

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8
Q

What marks the boundary between the oral cavity and oropharynx?

A

Palatoglossal folds (arches)

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9
Q

What is the name of the arched opening that opens and closes when you eat food?

A

Oropharyngeal isthmus - closed when food is in your mouth by depression of soft palate and elevation of the tongue

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10
Q

Where does the laryngopharynx start/ end?

A

Superior border of epiglottis to inferior border of cricoid cartilage (C6)

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11
Q

Where does palatoglossal muscle extend from/to?

A

Palatine aponeurosis of the hard palate to the tongue

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12
Q

Where does palatopharyngeus muscle extend from/to?

A

Palatine aponeurosis of the hard palate to the thyroid cartilage (pharynx)

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13
Q

Which tonsils are typically inflammed with tonsilitis?

A

Palatine

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14
Q

What is the arterial supply to the pharynx?

A

Branches of the external carotid artery:
- Ascending pharyngeal artery
- Branches of facial artery
- Branches of lingual and maxillary artery

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15
Q

What is the venous drainage of the pharynx?

A

Pharyngeal venous plexus - drains into internal jugular vein

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16
Q

What supplies sensory and motor innervation to the pharynx?

A

Sensory= glossopharyngeal nerve
Motor = vagus, apart from the stylopharyngeus (motor innervation also by glossopharyngeal)

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17
Q

Describe the location of the pharyngeal (adenoid) tonsil

A

Midline on roof of nasopharynx

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18
Q

Describe the location of the tubal tonsils

A

Around opening of the pharyngotympanic (Eustachian) tube in the lateral wall of the nasopharynx

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19
Q

Describe the location of the palatine tonsils

A

Tonsillar bed of lateral oropharynx wall, between palatoglossal arch and palatopharyngeal arch

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20
Q

Describe the location of the lingual tonsil

A

Numerous lymphoid nodules on posterior 1/3 of tongue (responsible for the irregular appearance)

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21
Q

What type of tissue are tonsils and what do they contain?

A

Mucosa-associated lymphoid tissue (MALT) - contain B cells, T cells and macrophages

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22
Q

Describe the location of the larynx

A

Suspends from the hyoid bone and spans from C3 to C6
Sits almost posteriorly to the laryngopharynx, and anterior to the oesophagus

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23
Q

What is the larynx composed of?

A

3 unpaired cartilages: cricoid, thyroid, epiglottis
3 pairs of smaller cartilages: arytenoid, corniculate and cuneiform
Fibroelastic membrane
Intrinsic muscles

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24
Q

What are the 3 sections of the larynx and their boundaries?

A

Supraglottis: inferior surface of epiglottis to vestibular folds (false vocal cords)
Glottis: contains the vocal cords and 1cm below them
Subglottis: from inferior border of the glottis to inferior border of cricoid cartilage

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25
Q

What arteries supply the larynx?

A

Superior laryngeal artery - from superior thyroid (derived ECA)
Inferior laryngeal artery - from inferior thyroid (from thyrocervical trunk)

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26
Q

What is the motor innervation to the larynx?

A

ALL BRANCHES FROM VAGUS
Recurrent laryngeal nerve: inferior branch supplies all intrinsic muscles of the larynx, except the cricothyroid
Superior laryngeal nerve: external branch supplies the cricothyroid

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27
Q

What is the sensory innervation to the larynx?

A

ALL BRANCHES FROM VAGUS
Recurrent laryngeal nerve: sensory innervation to infraglottis
Superior laryngeal nerve: internal branch provides sensory innervation to supraglottis

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28
Q

Which muscle helps equalise pressure in the middle ear?

A

Salpingopharyngeus (originates from Eustachian tube)

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29
Q

What do the 2 facets on the cricoid cartilage articulate with?

A

Superior facet - with arytenoid cartilage
Lateral facet - with inferior horn of thyroid cartilage

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30
Q

What is the cricoid cartilage shaped as?

A

A signet ring - has a ridge down middle and depressions either side

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31
Q

Why do males have an ‘adams apple’ but females do not?

A

The laryngeal prominence on the thyroid cartilage is more acute in males (90 degrees) than in females (120 degrees)

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32
Q

Describe the structure of the thyroid cartilage

A

2 lamina joined anteriorly - the site of fusion is the laryngeal prominence. The posterior margin of each lamina have a superior and inferior horn

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33
Q

Where is the thyroid’s facet located that articulates with the cricoid cartilage?

A

Medial surface of the inferior horns

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34
Q

Describe the structure of the arytenoid cartilages

A

They are pyramid shaped, and the anterior angle of the base has an elongated vocal process (where vocal ligament attaches)

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35
Q

What does the facet on the arytenoid cartilage articulate with?

A

Corniculate cartilage

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36
Q

Where are the cuneiform cartilages found?

A

Suspended in fibroelastic membrane, located anterior to the corniculate cartilages

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37
Q

Name the 2 thickenings of thyrohyoid membrane and where they are located

A

Lateral thyrohyoid ligament (2x) - posterolaterally
Medial thyroid ligament - anteromedially

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38
Q

What does the hypo-epiglottic ligament attach?

A

The hyoid bone to the anterior aspect of the epiglottis

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39
Q

What joins the cricoid cartilage and the trachea?

A

Cricotracheal ligament

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40
Q

What ligament can be perforated to establish an airway in an emergency where the airway is blocked above the vocal cords?

A

Median cricothyroid ligament - anteromedial thickening of the cricothyroid ligament joining the cricoid and thyroid cartilages

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41
Q

What are the extrinsic membranes/ ligaments of the larynx?

A

Thyroyhoid membrane - inc. medial and lateral thyrohyoid ligaments
Hypo-epiglottic ligament
Cricotracheal ligament
Median cricothyroid ligament

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42
Q

What are the intrinsic membranes/ ligaments of the larynx?

A

Cricothyroid ligament - inc. vocal ligament
Fibroelastic membrane of larynx
Quadrangular membrane (‘aryepiglottic’) - inc. vestibular ligament

43
Q

Describe how the cricothyroid ligament is attached

A

Originates from cricoid cartilage and extends superiorly, terminates with an upper free margin.
On each side, the upper free margin is attached:
- Anteriorly to thyroid cartilage
- Posteriorly to the arytenoid cartilage

44
Q

The thickening of what ligament forms the vocal ligament?

A

Cricothyroid ligament

45
Q

What is the role of the fibroelastic membrane of the larynx?

A

Links together laryngeal cartilages and completes the framework of the laryngeal cavity

46
Q

Where does the quadrangular membrane span from?

A

Between anterolateral arytenoid cartilage and lateral aspect of the epiglottis

47
Q

What does the upper and lower borders of the quadrangular (aryepiglottic) membrane form?

A

Upper free border = aryepiglottic fold
Lower border= vestibular fold

48
Q

Describe the relationship of the aryepiglottic membrane and muscle to the vocal cords (true and false)

A

Aryepiglottic muscle attaches from the side of the epiglottis to the arytenoid cartilages either side. The aryepiglottic membrane lies over this muscle.
Beneath it is the vestibular folds (false vocal cords) which protect the true vocal cords beneath

49
Q

What forms the true vocal cords?

A

Free upper border of the cricothyroid membrane

50
Q

What is the rima glottidis?

A

Opening between the true vocal cords and the arytenoid cartilages

51
Q

What is the vestibule?

A

Space above the vocal cords (also called supraglottic cavity) - from laryngeal inlet to vestibular folds

52
Q

What is the ventricle of the larynx?

A

The space between the true and false vocal cords

53
Q

Where is the infraglottic cavity?

A

Below the vocal cords - between inferior aspect of vocal cords and first tracheal ring

54
Q

Where is the rima vestibuli?

A

Between the 2 vestibular folds at the entrance to the middle chamber

55
Q

What are the external muscles of the larynx?

A

suprahyoid group
infrahyoid group
Stylopharyngeus

56
Q

What is the role of the stylopharyngeus?

A

Elevates the larynx

57
Q

What is the laryngeal inlet?

A

Entrance into the larynx from the pharynx

58
Q

What are the borders of the laryngeal inlet?

A

Anterior - free edge of epiglottis
Laterally - aryepiglottic folds
Posteriorly - cuneiform and cuniculate tubercles, interarytenoid notch

59
Q

What is the function of the epiglottis?

A

Close off the laryngeal inlet during swallowing and prevent food entering the airway

60
Q

Where does the epiglottis attach?

A

Posterior surface of the laryngeal prominence of the thyroid cartilage, attached by thyroepiglottic ligament

61
Q

What is the role of the interarteynoid (oblique and transverse) muscles?

A

Adduct the vocal cords, i.e. bring them together/ closes them.
(THINK - inter = intertogether)

62
Q

What is the role of the posterior cricoarytenoid muscle?

A

ABduct - so opens the vocal cords
(think P looks like a B lol)

63
Q

What is the role of the lateral cricoarytenoid muscles?

A

Adduct - so closes the vocal cords

64
Q

What is the role of the thyroarytenoid muscles?

A

Control the pitch of the voice by tightening/ loosening the vocal cords when they contract.
» When they contract = loosens the vocal cords

65
Q

How does pitch change when vocal cords loosen?

A

Pitch gets lower

66
Q

What is the role of the cricothyroid muscles?

A

Stretches and tenses the vocal ligaments so creates forceful speech - can alter tone of voice with the thyroarytenoid muscles

67
Q

What innervates the cricothyroid muscles?

A

External laryngeal nerve - from superior laryngeal (derived from vagus nerve)

68
Q

The thyroarytenoids, posterior + lateral cricoarytenoids, and interarytenoids are all innervated by the same nerve. Name it

A

Inferior laryngeal nerve - branch of recurrent laryngeal nerve (derived from vagus nerve)

69
Q

Which muscles helps pull the epiglottis down when blocking the throat?

A

Aryepiglottic muscle
Transverse and oblique arytenoids

70
Q

List the functions of the larynx

A
  • Respiration
  • Phonation (speech) - vocal cords adducted so air is forced through the closed rima glottidis, this vibrates the vocal cords and produces sound
  • Effort closure - retains air in thoracic cavity during heavy lifting
  • Swallowing
  • Cough reflex
71
Q

What is the function of the vocalis muscle?

A

elongates muscles lateral and parallel to the vocal ligament, so adjusts the tension in the vocal cords

72
Q

What are the 2 main groups of pharyngeal muscles and what is their role?

A

Circular: contract sequentially from superior to inferior to propel food -> oesophagus
Longitudinal: act to shorten and widen the pharynx, and elevate the larynx during swallowing

73
Q

List the muscles in the circular pharyngeal group

A

Superior, middle and inferior pharyngeal constrictor muscles

74
Q

List the muscles in the longitudinal pharyngeal group

A

Stylopharyngeus
Palatopharyngeus
Salpingopharyngeus

75
Q

What is the pharyngeal raphe?

A

Long insertion down the posterior larynx where the pharyngeal muscles insert

76
Q

What is the wall of the external auditory meatus composed of?

A

External 1/3 = cartilage
Internal 2/3 = temporal bone

77
Q

What membranes seperate the scala tympani and scala vestibule from the cochlear duct?

A

Basilar membrane: separates scala tympani from cochlear duct
Reissner’s membrane: separates scala vestibule from cochlear duct

78
Q

What is the pars flaccida and pars tensa?

A

Pars flaccida - where the tympanic membrane is thin, the area above the handle of malleus
Pars tensa - where the tympanic membrane is thick and taught

79
Q

Where does the cone of light shine for an otoscope of a R and L ear?

A

RIGHT = 4-5 o’clock
LEFT = 7-8 o’clock

80
Q

Name the point of attachment of the handle of malleus to the tympanic membrane

A

Umbo

81
Q

List the 6 walls of the middle ear

A

Roof (tegmental wall): tegmen tympani - petrous part of the temporal bone
Floor (jugular wall): thin layer of bone seperates ear from IJV
Lateral wall: open, tympanic membrane
Medial wall: labyrinth wall - cochlear, oval and round windows (seperates from inner ear)
Anterior wall: carotid wall - carotid canal, pharyngotympanic tube
Posterior wall: partially complete - mastoid wall (has a hole - the aditus to mastoid antrum)

82
Q

What is the role of the mastoid air cells?

A

Act as a buffer system of air, i.e. release air into the tympanic cavity when the pressure is low

83
Q

List the features of the malleus

A

Head, neck, lateral process, anteiror process, handle, umbo

84
Q

List the features of the incus

A

Body, short limb, long limb

85
Q

List the features of the stapes

A

Head, anterior limb, posterior limb, footplate (base)

86
Q

How do the ossicles articulate together, joining between the tympanic membrane and the oval window?

A

Tympanic membrane - umbo of malleus
Head of malleus - body of incus
Long limb of incus - head of stapes
Footplate of stapes - oval window

87
Q

Which ducts do the utricle and saccule receive?

A

Utricle - receive the 3 semi circular ducts
Saccule - receives the cochlear ducts

88
Q

What do the bony and membraneous labyrinths include?

A

Bony = vestibule, semicircuar canals, cochlear
Membraneous = semicircular ducts, cochlear ducts and 2 sacs (utricle and saccule)

89
Q

What lines the bony labyrinth?

A

Periosteum

90
Q

What are the 3 layers of the cochlear?

A

Basilar membrane
Inner hair cells
Tectorial membrane with outer hair cells embedded (3x layers of OHCs)

91
Q

What does the cochlear twist itself around?

A

Modiolus

92
Q

What is the relation of the scala vestibule and scala tympani to the cochlear duct?

A

Scala vestibule - superior to cochlear duct, continuous with vestibule
Scala tympani - inferior to cochlear duct, terminates at round window

93
Q

What is the role of the outer hair cells?

A

Modify hearing and protect against loud sounds, send efferent fibres from the superior olivary complex
Contains prestin motor fibres which can contract and pull the tympanic membrane to the inner hair cells

94
Q

Where does endolymph drain from the utricle and saccule?

A

Into the endolymphatic duct

95
Q

Which nerves provide sensory innervation to the external ear?

A

Greater auricular
Auriculotemporal (branch of V3)

96
Q

What type cartilage forms the skeleton of the external ear?

A

Elastic cartilage

97
Q

What forms the promontory (rounded projection) on the medial wall of the middle ear?

A

First turn of the cochlear

98
Q

What level does the pharynx end and the oesophagus begin?

A

C6

99
Q

What nerves contribute to the pharyngeal plexus?

A

Motor fibres from vagus
Sensory fibres from glossopharyngeal
Cervical sympathetic fibres

100
Q

What are the true and false vocal cords formed by?

A

True = fold of upper free border of cricothyroid membrane
False= fold of lower free border of aryepiglottic membrane

101
Q

Which muscles depress the larynx?

A

Infrahyroid muscles:
- Sternohyoid
- Sternothyroid
- Omohyoid

102
Q

Which muscles elevate the larynx?

A

Thyrohyoid (an infrahyroid muscle) and stylopharyngeus
As well as suprahyroid muscles:
- Digastric
- Stylohyoid
- Geniohyoid
- Mylohyoid

103
Q

What nerves innervate stapedius and tensor tympani muscles?

A

Tensor tympani - trigeminal (maxillary branch)
Stapedius - branch of facial nerve

104
Q

List the steps in sound transduction from the tympanic membrane to cochlear structures

A

1- sound waves vibrate tympanic membrane
2- vibrations transmitted through ossicles, base of stapes vibrates the oval window
3- pressure waves generated in perilymph of scala vestibuli
4- basilar membrane is displaced
5- the hair cells of the spiral organ are displaced
6- NT released and action potentials generated in cochlear nerve
7- vibrations transferred across cochlear duct to perilymph of scala tympani
8- pressure waves dissipated by round window

Anatomy Y2 S3 (12 decks)

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