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MRCS - ENT Nov > Anatomy > Flashcards

Anatomy Flashcards

1
Q

divisions of posterior triangle of neck?

A

occipital triangle
subclavian/supraclavicular triangle

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2
Q

which nerves are at risk in submandibular gland nerve surgery

A

nerve to mylohyoid
marginal mandibular
lingual
hypoglossal

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3
Q

where to make incision for submandibular gland surgery

A

2cm/finger breadths below ramus mandible

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3
Q

what does the investing layer of the deep cervical fascia encase

A

SCM
trapezius
forms parotid sheath

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3
Q

3 layers of deep cervical fascia

A

investing layer
pretracheal
prevertebral

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3
Q

nerves at risk during surgery in carotid triangle

A

hypoglossal
superior laryngeal
great auricular
superior fibres of ansa cervacalis
lingual nerve
hypoglossal

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4
Q

what does the pretracheal layer of deep cervical fascia encase

A

strap muscles
trachea
oesophagus
thyroid
parathyroid

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5
Q

what does the prevertebral fascia encase

A

spinal cord
vertebrae
paravertebral muscles

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6
Q

what is the anterior border of the prevertebral fascia known as and what does it form?

A

alar fascia
forms the posterior border of retropharyngeal space

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7
Q

borders of the retropharyngeal space

A

anteriorly buccipharyngeal fascia
laterally carotid sheaths
posteriorly prevertebral fascia
superiorly base of skull
inferiorly superior mediastinum

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8
Q

what is the buccopharyngeal fascia also known as

A

posterior border of pretracheal fascia

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9
Q

what is carotid sheath formed from

A

all 3 layers of deep cervical fascia

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10
Q

axillary sheath is formed from?

A

prevertebral fascia

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11
Q

label

A
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12
Q

describe the path of tear production and drainage

A
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13
Q

emrbyologically where do muscles of facial expression arise from

A

mesoderm of 2nd pharyngeal/branchial arch

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14
Q

consequences of buccinator muscle paralysis

A

food accumulation in the vestibule of mouth
patient cannot blow or whistle

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15
Q

describe the sensory innervation of the face

A

3 divisions of trigeminal nerve
small part of angle of mandible is supplied by greater auricular nerve from ventral rami of C2,3

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16
Q

how does the facial nerve leave the cranial cavity

A

via stylomastoid foramen, winds down lateral aspect of styloid process and enters parotid gland to give off 5 terminal branches

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17
Q

list branches cervical part of facial artery

A

ascending palatine
tonsillar
glandular (to submandibular gland)
submental

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18
Q

list the branches of facial part of facial artery

A

lateral nasal
angular
superior labial
inferior labial

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19
Q

where can pulsations of the facial artery be felt

A

base of mandible at anteroinferior angle of masseter

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20
Q

how is external jugular vein formed

A

union of posterior division of retromandibular vein and posterior auricular vein

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21
Q

list the branches of the ECA

A

superior thyroid
lingual
facial
ascending pharyngeal
occipital
posterior auricular
maxillary
superficial temporal

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22
Q

what does ansa cervicalis supply

A

all infrahyoid muscles except thyrohyoid (which is supplied by c1)

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23
Q

how many branches come from subclavian artery and what are they

A

4
vertebral
internal thoracic
thyrocervical trunk
costocervical trunk (on left side only from 1st part of subclavian, on right side comes from 2nd part of subclavian)

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24
Q

what does the term masking mean in audiology

A

It means presenting a constant noise to the non-test ear. It is done to prevent non-test ear from detecting the sound presented to the test ear by crossover.

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25
Q
A
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26
Q
A
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27
Q

spinal level of hyoid bone

A

C3

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28
Q

Spinal level of cricoid

A

C6

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29
Q

USS grading of thyroid

A
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30
Q

FNA grading thyroid

A

thy1 - non diagnostic
thy 2- benign
thy3a - possible atypia/non diagnostic –> repeat US FNA
thy3f - possible follicular –> hemithyroidectomy
thy 4 - suspicious –> diagnostic hemithyroidectomy
thy 5 - malignant –> total thyroidectomy

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31
Q

autoantibodies associated with hashimotos

A

anti-TPO

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32
Q

autoantibodies associated with graves

A

anti TSH

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33
Q
A
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34
Q

causes of primary hyperparathyroidism

A

parathyroid adenoma

35
Q

secondary hyperparathyroidism cause

A

chronic renal failure
vit d deficiency

36
Q

tertiary hyperparathyroidism

A

end stage renal failure

37
Q

men 1 components

A

pituitary adenoma
parathyroid hyperplasia
pancreatic tumours

38
Q

men2a components

A

parathyroid hyperplasia
medullary thyroid ca
phaeochromocytoma

39
Q

men2b components

A

mucosal neuroma
marfanoid body habitus
medullary thyroid ca
phaeochromocytoma

40
Q

investigations of hypopharyngeal ca

A

uss +/- fna
CT/MRI
panendo and biopsy
CTPET

41
Q

treatment of lichen planus

A

steroid mouthwash

42
Q

management of leukoplakia

A

biopsy

43
Q

most likely composition of submandibular stones

A

ca
hydroxyapetite

44
Q
A
45
Q

laryngeal injury classification name and description

A
46
Q
A
47
Q
A
48
Q
A
49
Q
A
50
Q
A
51
Q
A
52
Q

4 muscular attachments of mastoid process

A

stenocleidomastoid
splenius capitis
posterior belly digastric to digastric groove/fossa
longissimus capitis muscle

53
Q

where do the styloid process and its attachments develop from

A

second branchial arch

54
Q

what are the 3 muscular and 2 ligamentous attachments to the styloid apparatus called

A
55
Q

tracheostomy safety

A

A spare tube of identical size, plus the size below and a tracheostomy dilator must always be available at the bedside in case a quick change is necessary. A cuffed tube should be available in the event of an emergency when a cuffed tube may be needed for ventilation.

56
Q

4 indications for a tracheostomy

A

airway osbtruction
protection of airway e.g. neurological disease
reduce dead space to facilitate weaning from mechanical ventilation
as part of another procedure e.g. laryngectomy

57
Q

what is trousseaus tracheal dilator used for

A

open tracheostoma to reinsert tube

58
Q

what is a cricoid hook used for

A

allows anterior displacement of trachea

59
Q

middle ear cavity boundaries

A

laterally - TM
supriorly - skull base
medially - inner ear
inferiorly - jugular bulb
posteriorly - mastoid cavity
anteriorly - ICA, eustachian tube

60
Q

what is the anterior boundary of the external ear

A

TMJ

61
Q
A

u - umbo of malleus
m - manibrium of malleus
sp - lateral process of malleus
n - neck of malleus
fn - facial nerve
isj - incudostapedial joint - where lenticular process of incus articulates with stapedial tendon
pe - pyramid
hy - hypotympanum
fi -finiculus
sst - sinus tympani
se - styloid eminence
pr - promontory
jn - jacobsens nerve (runs on pulmontary)
ttm - tensor tympani
ttf - tensor tympani fossa

62
Q

middle ear sensation?

A

glossopharyngeal nerve

63
Q

sensation to medial part of TM?

A

glossopharyngeal nerve

64
Q

sensation to lateral surface of TM

A

nervus intermedius - branch of facial nerve
also the vagus nerve

65
Q

sensation to EAC

A

nervus intermedius - branch of facial nerve
auriculotemporal nerve - branch of trigeminal nerve

66
Q

sensation to pinna

A

lesser occipital nerve C2/C3 (upper pinna)
greater auricular nerve C2,C3 (lower pinna)

67
Q
A

1 - superior SCC
2 - ampulla to SCC
3 - ampulla to lateral SCC
4 - utricle
5 - cochlea
6 - helicotrema - where scala vetibulae meets scala tympani
7 - lateral SCC
8 - posterior SCC
9 - ampulla to posteior SCC
10 - oval window
11 - round window
12 - scala vestibuli (attaches to oval window)
13 - Scala tympani (attaches to round window)
14 - utricle

68
Q

where is the inner ear located

A

within petrous temporal bone

69
Q

blood supply to inner ear

A

labyrinthine artery from anterior cerebellar/superior cerebellar/basillar artery

70
Q

describe the vestibule

A

houses the utricle and saccule

71
Q

how does the saccule connect to the scala media

A

connects to scala media/cochlear duct via ductus reuniens

72
Q

how is endolymph drained

A

by endolymphatic sac which connects to utricle and saccule via vestibular aqueduct

73
Q

what are the turns of the cochlea called

A

basal
middle
apical

74
Q

what is the modiolus

A

the conical central axis around which the cochlea spirals

75
Q

Describe the mechanism of hearing

A

sound waves focussed through pinna and EAC
vibrations of TM are transmitted via ossicles
stapes creates vibrations of perilymph via oval window which acts as a seal between scala vestibuli and middle ear
scala vestibuli (vestibular duct) meets scala tympani (tympanic duct) at the helicotrema within the apical turn of the cochlea. The round window is closed to seal off scala tympani from middle ear i.e. prevent sound from escaping.
vibrations in the perilymph are transmitted across the basilar membrane
the organ of corti is the specialised sensory epithelium overlying the basilar membrane, inner hair cells transduce auditory vibrations into action potentials via mechanical action on their sterocilia
Action potentials are transmitted across nerve endings of cochlear part of vestibulocochlear nerve, passing via spiral ganglion and auditory pathway to reach auditory cortex

76
Q

describe the ascending and descending auditory pathways

A

ascending - as in photo
descending - efferent fibres travelling from brain to cochlea/cochlear nuclei

77
Q
A
78
Q

nerve supply to nose (sensory)

A

infraorbital nerve
external nasal branch of anterior ethmoidal nerve
infratrochlear nerve

79
Q

which sinuses drain into the osteomeatal complex and what is this also known as

A

frontal
maxillary
anterior ethmoidal

MIDDLE MEATUS

80
Q

where does the tear duct drain into

A

inferior meatus

81
Q

3 sensory inputs for balance

A

proprioception (muscles)
vision (eye)
vestibule (ear)

82
Q

borders of parotid gland

A

superiorly - inferior 2/3 of zygomatic arch
anteriorly - anterior border of masseter
inferiorly - inferior border of mandible
posteriorly - SCM and external ear

83
Q

surface marking of parotid duct

A

middle 1/3 of a line between the tragus of the ear and midway between ala of nose and angle of mouth

84
Q

what is the parotid fascia made up from

A

investing layer of deep cervical fascia

85
Q

what is the parotid fascia sensory innervation supplied by

A

auriclotemporal nerve (mandibular division of trigeminal nerve)

86
Q

what is the nerve for secretomotor function of parotid gland

A

lesser petrosal nerve from glossopharyngeal nerve

87
Q

layers overlying parotid gland

A
88
Q

list 5 benign parotid tumours

A

pleomorphic adenoma
warthins tumour
lymphangioma
haemangioma
neurofibroma

89
Q

list malignant tumours of parotid

A

adenoid cystic carcinoma
adenocarcinoma
undifferentiated carcinoma
lymphoma

MRCS - ENT Nov (7 decks)

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