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ENT > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Branches of the maxillary artery

A

DAM I AM Piss Drunk But Stupid Drunk I Prefer, Must Phone Alcoholics Anonymous

Deep auricular
Anterior tympanic
Middle meningeal
Inferior alveolar
Accessory meningeal
Masseteric
Pterygoid
Deep temporal
Buccinator
Sphenopalatine
Descending palatine
Infraorbital
Posterior superior alveolar
Middle superior alveolar
Pharyngeal
Anterior superior alveolar
Artery of the pterygoid canal
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2
Q

Branches of the external carotid

A

Some Asians Like Fucking, Others Prefer SM

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Superficial temporal
Maxillary
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3
Q

Layers of the scalp

A 
Skin
Connective tissue
Aponeurosis (Galea Aponeurotica) 
Loose areolar connective tissue
Pericranium
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4
Q

What arteries contribute to Kiesselbach’s plexus?

A

FOMM

Facial (superior labial branch)
Ophthalmic (ant ethmoidal branch)
Maxillary (greater palatine branch)
Maxillary (sphenopalatine branch)

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5
Q

What drains to each nasal turbinate meatus?

A

PS-FAMM-N

Superior meatus:

  • Posterior ethmoidal air sacks
  • Sphenoidal sinus

Middle meatus:

  • Frontal sinus
  • Anterior ethmoidal air sacks
  • Middle ethmoidal air sacks
  • Maxillary sinus

Inferior meatus:
-Nasolacrimal duct

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6
Q

Three muscles off of styloid process & their innervations

A

Stylopharyngeus (glossopharyngeal n.)
Stylohyoid (facial n.)
Styloglossus (hypoglossal n.)

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7
Q

Which CN’s contain parasympathetics?

A

3, 7, 9, 10

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8
Q

Which laryngeal muscles are aBductors & aDductors?

A

Abductor: PCA (oPen)
Adductor: LCA (cLose)

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9
Q

Which laryngeal muscles affect pitch?

A

Cricothyroid - raises pitch

Thyroarytenoid - lowers pitch

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10
Q

How is the auricle attached to the skull?

A

Anterior, posterior, superior ligaments
Anterior, posterior, superior auricular muscles
Skin
EAC cartilage

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11
Q

What proportion of the EAC is bony vs. cartilaginous?

A

2/3 bony
1/3 cartilagenous

Opposite of eustachian tube

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12
Q

Cutaneous innervation of the auricle

A

Anterosuperior: Auriculotemporal n. (V3)
Posterosuperior: Lesser occipital n. (cervical plexus)
Inferior: Great auricular n. (cervical plexus)

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13
Q

What borders the pars flaccida?

A

Anterior & posterior malleolar folds (tympanic striae)

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14
Q

Where is there no fibrous annulus to the TM?

A

Notch of Rivinus (where pars flaccida connects directly to temporal bone)

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15
Q

What bony plate separates squamous & petrous air cells?

A

Koerner’s (Petrosquamous) septum

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16
Q

Borders of the facial recess

A

Superior: Short process of incus
Medial: Facial nerve
Lateral: Chorda tympani

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17
Q

What surface marking on the temporal bone shows where the tegmen is?

A

Temporal line

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18
Q

What are the major parts of the temporal bone

A

Petrous
Mastoid
Squamous
Tympanic

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19
Q

What suture lines are found in the EAC?

A

Tympanomastoid fissure
(posterior)

Tympanosquamous fissure
(anterosuperior)

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20
Q

What is the landmark used to gain access to the mastoid antrum?
What defines the borders?

A

Macewen’s triangle (mastoid fossa)

Anterior: Spine of Henle
Superior: Temporal line
Posterior: A line connecting the two

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21
Q

Landmark on superior temporal bone for superior semicircular canal

A

Arcuate eminence

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22
Q

Superior temporal bone: contains internal carotid

A

Foramen lacerum

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23
Q

What does the facial hiatus contain?

A

Greater superficial petrosal n.

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24
Q

How is the IAC divided?

A

Divided by falciform crest (horizontal) & Bill’s bar (vertical, top half only)

UL: Facial n. & NI
UR: Superior vestibular
LR: Inferior vestibular
LL: Cochlear

“7up, coke down”

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25
Q

What are the embryologic precursors to the ossicles?

A

First branchial arch: Malleus head/neck, incus body & short process
Second branchial arch: Malleus manubrium, incus long & lenticular processes, stapes cruses

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26
Q

Innervation of tensor tympani & stapedius

A

Tensor tympani = V3

Stapedius = VII

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27
Q

Where does the tensor tympani come out from?

A

Cochleariform process

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28
Q

Where does the stapedius come out from?

A

Pyramidal eminence

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29
Q

What attaches the stapes footplate to the bony margins of the oval window?

A

Annular ligament

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30
Q

Embryologic precursor to the stapes footplate & annular ligament

A

Otic capsule

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31
Q

Embryologic precursor to the eustachian tube

A

Ventral 1st branchial arch

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32
Q

What parts of eustachian tube are bony vs. cartilaginous?

A

Posterior 1/3 is bony

Anterior 2/3 is cartilaginous

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33
Q

What muscle opens the eustachian tube?

A

Tensor veli palatini (CNV3)

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34
Q

Middle ear space divisions

A

Epitympanum
Mesotympanum
Hypotympanum

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35
Q

What is the lateral bony wall of epitympanic recess?

A

Scutum

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36
Q

What is the promontory?

A

Basal turn of the cochlea - forms the medial wall of the middle ear

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37
Q

What CN is Jacobson’s n. from?

What does it supply?

A

CNIX

Functions:

1) Sensory to the EAC
2) Jacobson’s –> Lesser petrosal –> otic ganglion –> auriculotemporal –> parotid parasympathetics

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38
Q

What CN is Arnold’s n. from?

What does it supply?

A

CNX

Sensory fibers to EAC. Responsible for otoscope-cough reflex and referred otalgia in laryngeal pathology

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39
Q

Ridge of bone between round window niche and pyramidal eminence

A

Subiculum

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40
Q

Date of developmental arrest & associated inner ear deformities

A

Weeks 3-7: “Missionary coitus actually helps monogamy”

3) Michel aplasia
4) Common cavity
5) Aplasia (of cochlea)
6) Hypoplasia (of cochlea)
7) Mondini aplasia

8th week - normal development

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41
Q

What two spaces does the periotic duct (cochlear aqueduct) connect?

A

Subarachnoid space and scala tympani

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42
Q

What two spaces does the endolymphatic duct (vestibular aqueduct) connect?

A

Vestibule to endolymphatic sac (abuts posterior fossa dura)

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43
Q

Electrolyte compositions of perilymph & endolymph

A

Perilymph:
Na+ > K+
Similar to ECF & CSF

Endolymph:
K+ > Na+
Similar to ICF

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44
Q

How are perilymph & endolymph formed?

A

CSF filtered to perilymph

Perilymph filtered to endolymph

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45
Q

What is the ampulla?

A

Pear-shaped expansion at one end of each of the SCC

Contains the Cupula

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46
Q

What is the cupula?

A

Gelatinous layer within each ampulla of the SCC’s. Seals the SCC to detect pressure (cupula contains hair cells).

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47
Q

What is the crista ampullaris?

A

Sensory element of the SCCs - contains hair cells extending into the cupula

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48
Q

Which otolithic organ senses which type of acceleration?

A

Utricle - horizontal linear

Saccule - vertical linear

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49
Q

Which vestibular nerves carry information from which organs?

A

Inferior vestibular n.

  • Posterior SCC
  • Saccule

Superior vestibular n.

  • Superior SCC
  • Horizontal SCC
  • Utricle
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50
Q

What fluid is contained in the Scala Vestibuli?

A

Perilymph

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51
Q

What fluid is contained in the Scala Media?

A

Endolymph

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52
Q

What fluid is contained in the Scala Tympani?

A

Perilymph

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53
Q

What membrane separates the scala media and scala vestibuli?

A

Reissner’s membrane

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54
Q

What membrane separates the scala media and scala tympani?

A

Basilar membrane

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55
Q

What is the area advantage of the middle ear?

A

17:1

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56
Q

What is the lever advantage of the middle ear?

A

1.3:1

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57
Q

What is the total mechanical advantage of the middle ear?

A

22:1

~30 dB gain

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58
Q

What are the neurovascular structures contained within the cavernous sinus?

A

CN: III, IV, VI, V2, V3

ICA

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59
Q

Nerves supplying sensation to the V2 distribution

A

Infraorbital n.

Zygomaticotemporal n.

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60
Q

Nerves supplying sensation to the V3 distribution

A

Mental n.
Buccal n.
Auriculotemporal n.

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61
Q

What is contained in the posterior triangle?

A

Accessory nerve
cutaneous branches of the cervical plexus
external jugular vein
transverse cervical and suprascapular vessels
subclavian vein (occasionally) and artery
posterior (inferior) belly of the omohyoid
roots and trunks of the brachial plexus.

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62
Q

What triangles are formed by the posterior belly of the omohyoid?

A

Occipital and subclavian triangles

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63
Q

What triangles comprise the anterior triangle?

A

Submental triangle
Digastric triangle
Carotid triangle
Muscular triangle

Divided by the anterior and posterior digastric and the anterior omohyoid

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64
Q

What muscles insert onto the body of the hyoid?

A

geniohyoid
mylohyoid
omohyoid
sternohyoid muscles.

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65
Q

What inserts onto the greater cornua of the hyoid?

A 
middle constrictor
hyoglossus
digastric (anterior and posterior) bellies
stylohyoid
thyrohyoid muscles.
66
Q

What attaches to the lesser cornua of the hyoid?

A

Stylohyoid ligament

67
Q

What comes off of the styloid process?

A

Stylohyoid
Styloglossus
Stylopharyngeus

Stylohyoid ligament
Stylomandibular ligament

68
Q

What comes off of the brainstem from under the pons?

A

CNVI
CNVII
CNVIII
AICA

69
Q

Which cranial nerves come out of the brainstem anteriorly?

A

CNII
CNIII
CNVI
CNXII

70
Q

What are the 5 spaces within the infrahyoid neck?

A 
Visceral space
Carotid sheath
Retropharyngeal space
Posterior cervical space
Periverterbal space
71
Q

What is the retropharyngeal space continuous with vertically?

A

The suprahyoid space superiorly

The middle mediastinum inferiorly

72
Q

Contents of the visceral neck space

A 
Larynx/Trachea
Hypopharynx/Esophagus
Thyroid/Parathyroid
Pre/Paratracheal LN's
Superior & Recurrent Laryngeal nerves
Embryologic remnants
73
Q

What is the pathophysiology of Eagle’s Syndrome?

A

Elongated styloid process puts pressure on glossopharyngeal n. causing pain and dysphagia. Can also compress great vessels. Tx: styloidectomy.

74
Q

What runs through the inferior tympanic canaliculus?

A

Jacobson’s n. (Tympanic branch of IX)
Inferior tympanic artery

It is located between inferior carotid canal opening and jugular foramen

75
Q

What runs through the mastoid canaliculus?

A

Arnold’s n. (auricular branch of X)

It is found in the lateral aspect of the jugular fossa

76
Q

What two recesses straddle the mastoid portion of the facial n?

A 
Facial recess (lateral)
Sinus tympani (medial)
77
Q

What are the ligaments of the malleus?

A

Anterior
Lateral
Superior

78
Q

What is the ligament of the incus?

A

Posterior incudal

79
Q

What branches of the facial nerve are given off in the temporal bone?

A

Greater superficial petrosal n. (Becomes vidian)

N. to stapedius

Chorda tympani

80
Q

What does the cochlear aqueduct connect?

A

Perilymphatic space and subarachnoid space

81
Q

Where is a pars tense cholesteatoma found?

A

AKA Sinus cholesteatoma

Found in the sinus tympani and FN recess

82
Q

Where do sinus cholesteatomas erode the ossicles?

A

Medial incus

Manubrium of malleus

83
Q

What runs through foramen ovale?

A

CNV3
Lesser petrosal n.
Accessory meningeal artery

84
Q

What runs through foramen spinosum?

A

Middle meningeal artery

Meningeal branch of CNV3

85
Q

What opening connects the middle cranial fossa & the pterygopalatine fossa?

A

Foramen rotundum

86
Q

What opening connects the middle cranial fossa & the infratemporal fossa?

A

Foramen ovale

87
Q

What are the CT findings for persistent stapedial artery?

A

Absent ipsilateral foramen spinosum

Soft tissue prominence with enlargement of tympanic segment of facial nerve

88
Q

What does the vidian canal transmit?

A 
Vidian nerve (GSPN+DPN)
Vidian artery
89
Q

Where do foramen rotundum & vidian canal lie on coronal CT?

A 
Rotundum = superolateral
Vidian = inferomedial
90
Q

What is the foramen of Vesalius?

A

Variant anatomic foramen located between rotundum and ovale. Transmits emissary vein.

91
Q

What is the palatovaginal canal?

A

Found just medial to vidian canal. Variant foramen what connects pterygopalatine fossa to pharyngeal roof. Contains the pterygovaginal artery & pharyngeal nerve.

92
Q

What does the jugular spur divide?

A

Separates the Pars nervosa from the Pars vascularis in the jugular foramen.

93
Q

What is contained in the Pars nervosa of the jugular foramen?

A

Pars nervosa contains CNIX and inferior petrosal sinus.

94
Q

What is contained in the Pars vascularis of the jugular foramen?

A

Internal jugular vein
CNX
CNXI
Posterior meningeal artery

95
Q

Which jugular foramen is larger?

A

R > L in 2/3 of cases

96
Q

What defines a high riding jugular bulb?

A

Dome reaches higher than IAC.

If sigmoid plate is dehisced, considered dehiscent jugular bulb.

97
Q

When do salivary glands present as pseudomasses?

A

1) Accessory parotid tissue (overlies masseter)

2) Mylohyoid defect (sublingual tissue/fat/vessels can protrude)

98
Q

What can cause reetropharyngeal edema?

A

Jugular thrombosis
SVC syndrome
Retropharyngeal adenitis

Don’t mistake for retropharyngeal abscess

99
Q

What lies within the carotid sheath?

A

Carotid
IJ
CNIX, X, XI, XII
Deep cervical LN’s

100
Q

Masses of the parapharyngeal space

A

Prestyloid: Salivary gland tumors (pleomorphic adenoma most common)

Poststyloid: Neural tumors (schwannoma, paraganglioma, neurofibroma)

101
Q

What arises from the 5th/6th ethmoturbinal?

A

Supreme turbinate

102
Q

What arises from the 1st ethmoturbinal?

A

Agger Nasi (ascending) & Uncinate process (descending)

103
Q

What arises from the 2nd ethmoturbinal?

A

Ethmoid bulla

104
Q

What arises from the 3rd ethmoturbinal?

A

Middle turbinate

105
Q

What arises from the 4th ethmoturbinal?

A

Superior turbinate

106
Q

What separates the parotid gland from the submandibular gland?

A

Stylomandibular ligament

107
Q

What are the histology cell types of the salivary glands?

A

Parotid: serous
Submandibular: mixed
Minor salivary glands: mucinous

108
Q

What are the components to a salivary duct?

A 
AISE:
Acini cells
Intercalated duct
Striated duct
Excretory duct
109
Q

Innervation of the parotid

A 
CNIX
Jacobson's
LSPN
Otic ganglion
Auriculotemporal (V3)
Parotid
110
Q

Innervation of the sublingual/submamdibular glands

A 
Nervus intermedius
Chorda tympani
Lingual nerve
Submandibular ganglion
Glands
111
Q

Saliva production rate

A

1-1.5 pints per day

112
Q

CSF production rate

A

20cc/hr

113
Q

What are the subsites of the supraglottis?

A

Epiglottis
AE folds
Arytenoids
False cords

114
Q

What innervates the strap muscles?

A

C1-C3

115
Q

What controls the pitch of voice?

A

Cricothyroid

116
Q

What are the vocal fold ADductors?

A

LCA
Thyroarytenoid/Vocalis
Cricothyroid
Interarytenoid

117
Q

What is the sensory innervation of the larynx?

A

Superior to vocal fold: Internal superior laryngeal n.

Inferior to vocal fold: RLN

118
Q

What cartilage can be mistaken for a foreign body?

A

Triticeous cartilage

Normal variant that can calcify and be mistaken for a foreign body.

119
Q

What are the types of cartilage found in the larynx?

A

Hyaline: Thyroid, cricoid, arytenoid
Fibroelastic: Epiglottis, corniculate, cuneiform

120
Q

Layers of the vocal fold

A

Squamous epithelium
Lamina propria (superficial, intermediate, deep)
Thyroarytenoid/Vocalis muscles

121
Q

Where is Reinke’s space?

A

It is within the superficial lamina propria of the vocal fold

122
Q

What does the vocal fold cover consist of?

A

Squamous epithelium & superficial lamina propria

123
Q

What does the vocal ligament consist of?

A

Intermediate and deep lamina propria

124
Q

What nerve carries negative pressure sensors?

A

Superior laryngeal n.

Responsible for reflex ABduction with inspiration

125
Q

Where can pressure be applied to break laryngospasm?

A

Larson’s notch (behind angle of mandible)

126
Q

Direction of normal vocal fold vibration

A

Inferior to superior (can’t see)

Medial to lateral (can see)

127
Q

What are the fundamental frequencies of speech?

A

Males 128 Hz

Females 256 Hz

128
Q

When is laryngoscopy indicated in the hoarse patient?

A

> 3mo of hoarseness

Significant risk factors or warning signs

129
Q

Most common cause of aphonia (no contact of vocal folds)?

A

Psychogenic

Bilateral ABductor spasmodic dysphonia is rare

130
Q

What is normal vocal jitter?

A

Variation in vocal pitch

0.4%

131
Q

What is normal vocal shimmer?

A

Variation in vocal amplitude

0.5 dB

132
Q

What are the perceptual testing scales for voice?

A

GRBAS

CAPE-V

133
Q

Most common cause of a non-recurrent RLN

A

Right-sided

Caused by a retroesophageal right subclavian artery

134
Q

Which pharyngeal cleft has an adult correlate?

A

1st branchial cleft forms the EAC, all others involute

135
Q

What muscles are derived from the 1st branchial arch?

A 
Muscles of mastication
Mylohyoid
Anterior belly of Digastric
Tensor tympani
Tensor veli palatini
136
Q

What artery is derived from the 1st branchial arch?

A

Maxillary

137
Q

What nerve is derived from the 1st branchial arch?

A

CNV3

138
Q

What muscles are derived from the 2nd branchial arch?

A

Muslces of facial expression
Stapedius
Stylohyoid
Posterior belly of digastric

139
Q

What branchial arches are the Hillocks of His derived from?

A

2nd branchial arch = HoH 1-3

3rd branchial arch = HoH 4-6

140
Q

What nerve is derived from the 2nd branchial arch?

A

CNVII

141
Q

What artery is derived from the 2nd branchial arch?

A

Stapedial

142
Q

What is derived from the 2nd branchial pouch?

A

Tonsillar fossae

143
Q

What muscles are derived from the 3rd branchial arch?

A

Stylopharyngeus

Superior and middle constrictors

144
Q

What bone is derived from the 3rd branchial arch?

A

Hyoid

145
Q

What nerve is derived from the 3rd branchial arch?

A

CNIX

146
Q

What artery is derived from the 3rd branchial arch?

A

Carotid

147
Q

What is derived from the 3rd branchial pouch?

A

Inferior parathyroid gland and Thymus

148
Q

What is derived from the 4th branchial arch?

A

Muscles of soft palate (except tensor veli palatini), Muscles of the pharynx (except stylopharyngeus)
Cricothyroid
Inferior pharyngeal constrictor

Thyroid & cuneiform cartilage

149
Q

What nerve is derived from the 4th branchial arch?

A

SLN

150
Q

What artery is derived from the 4th branchial arch?

A

Aorta (left)

Subclavian (right)

151
Q

What is derived from the 4th branchial pouch?

A

Superior parathyroids

C-cells of thyroid

152
Q

What muscles are derived from the 6th branchial arch?

A 
Laryngeal cartilages (Cricoid, arytenoid, corniculate)
Intrinsic muscles of larynx (except cricothyroid)
Upper muscles of esophagus
153
Q

What nerve is derived from the 6th branchial arch?

A

RLN

154
Q

What is the external continuation of the anterior ethmoid nerve called?

A

External nasal nerve

Exits nasal cavity between the nasal bones and lateral nasal cartilage.

155
Q

What does the anterior ethmoidal nerve divide into?

A

Septal branch

External nasal nerve

156
Q

What nerves supply posterior nose sensation?

A

Posterior superior lateral nasal nerves
Posterior superior medial nasal nerves
Nasopalatine nerve

All come from sphenopalatine foramen
Nasopalatine runs on septum to incisive foramen

157
Q

What supplies sympathetic and parasympathetic innervation to the nose?

A

Greater superficial petrosal nerve (pterygopalatine ganglion)

158
Q

Where do lymphatics of the nasal cavity drain to?

A

Anterior to SM nodes

Posterior to RP then upper deep cervical nodes

159
Q

All muscles of the soft palate are innervated by X except for which muscle?

A

Tensor veli palatini (V3)

160
Q

Where does the mental nerve exit?

A

Second bicuspid

ENT (10 decks)

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