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ENT > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Give five functions of the nasal cavity

A
  1. Acts as a patent conduit for air to be transported to the nasopharynx
  2. Filters air of particulate material (vibrissae = small hairs)
  3. Humidifies air (glands)
  4. Warms inspired air in the nasal passage (blood)
  5. Sense of smell as air passes over the olfactory epithelium
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2
Q

Name some different parts of the external nose and point to where they are

A 
Root (between eyebrows)
Dorsum (long bit which sticks out)
Tip
Ala (thickened but above each nostril)
Nostril/nares
Septum 
Philtrum (Cupid's bow)
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3
Q

Which of the three nasal conchae is a bone in itself?

A

Inferior nasal conchae

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4
Q

Which parts of the nasal cavity does the ethmoid bone form?

A

Roof, lateral walls and septum

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5
Q

Where is the crista galli located?

A

On the superior surface of the ethmoid bone - looks like a dorsal fin
You can see it peaking up in the anterior fossa in the base of the skull

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6
Q

Which bit of the ethmoid bone has lots of little holes in it?

A

Cribriform plate

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7
Q

If you break up the ethmoid bone into three, what is the middle bit called?
What lies in the other two bits?

A

Perpendicular plate

Ethmoidal air cells

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8
Q

What are the three components of the nasal septum?

A

Septa cartilage
Perpendicular plate of ethmoid bone
Vomer

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9
Q

What shape are the palatine bones?

A

Each is a “L” shape - they come together to form a “U” shape

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10
Q

What can a Le Fort II fracture cause?

A

Severing of the olfactory nerves - loss of smell

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11
Q

Describe the different types of mucosa found in the nasal cavity

A

Nasal vestibule - this is the same as the skin - stratified squamous epithelium - gradually transitions form ketatinised to non-keratinised
The nasal cavity is mainly respiratory epithelium - ciliated pseudostratified columnar epithelium
The most superior part of the nasal cavity is olfactory epithelium

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12
Q

Describe the five parts of the olfactory pathway

A
  1. Receptor cells in the olfactory epithelium
  2. Pass up through cribriform plate
  3. Synapse with olfactory bulb (ganglion)
  4. Then neurons pass along olfactory tract
  5. To Temporal lobe and olfactory areas
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13
Q

What is the somatic sensory nervous innervation of the nasal cavity
Which nerves lie in which parts

A

Draw a diagonal line from superoposterior to inferoanterior:
- Top part is CN V1
- Bottom part is CN V2
Nerves
- Top part - anterior ethmoidal nerve (CN V1)
- Bottom part - nasopalatine nerve (CN V2)

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14
Q

Which three arteries are found in the nasal cavity?
What do they anastomose to form?
What is the purpose of this?

A 
Anterior ethmoidal artery
Posterior ethmoidal artery
Sphenopalatine artery
Kiesselbach's area - located anteroinferiorly on nasal septum
To warm the air we breath in
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15
Q

Where does the sphenopalatine artery pass through?

A

Sphenopalatine foramen

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16
Q

What are the names of the four spaces associated with the nasal conchae and where do they lie?

A

From superior to inferior
a) Sphenoethmoidal recess

  1. Superior nasal conchae
    b) Superior meatus
  2. Middle nasal conchae
    c) Middle meatus
  3. Inferior nasal conchae
    d) Inferior meatus
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17
Q

What do the nasal conchae do to air in the nasal cavity?

A

They cause turbulent airflow through the nasal cavity

Increasing opportunity for humidifying, warming and filtering

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18
Q

Name the four pairs of bilateral sinuses

What lines each sinus?

A 
Frontal sinuses
Ethmoidal air cells 
Maxillary sinuses
Sphenoid sinuses
Respiratory epithelium - ciliated pseudostratified columnar epithelium
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19
Q

How is the lacrimal sac drained?

A

Lacrimal fluid drains inferomedially to the nasolacrimal duct which drains to the inferior meatus
-> makes your nose run

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20
Q

Which sinus is predisposed to infection?

Why?

A

Maxillary sinus is predisposed to infection
Ostium of maxillary sinus is location superior in relation to its cavity
Cilia must work against gravity

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21
Q

In which bone is the ear located?

A

All in the temporal bone

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22
Q

What is the weakest point in the skull called?

What is it?

A

Pterion

“H” shaped suture - connection of frontal, parietal, temporal and sphenoid

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23
Q

Which two nerves does the temporal bone contain?

A

CN VII - facial

CN VIII - vestibulocochlear

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24
Q

What are the two parts of the temporal bone?

A

Petrous

Squamous

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25
Q

What passes through the internal acoustic meatus?

A

CN VII - facial
CN VIII - vestibulocochlear
Labyrinthine artery (+ vein)

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26
Q

Where do CN VII and VIII leave the skull?

A

Internal acoustic meatus

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27
Q

Give 5 functions of CN VII

A
  1. Motor to face
  2. Motor to stapedius
  3. Taste to Ant. 2/3rds of tongue
  4. Secretomotor to salivary glands and lacrimal gland
  5. General sensory to external ear
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28
Q

Give 2 functions of CN VIII

A

Balance

Hearing

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29
Q

External ear

  • Boundaries?
  • Function?
A

Auricle to tympanic membrane
Via external acoustic meatus
Collects and conveys sound waves to tympanic membrane

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30
Q

Middle ear

  • Boundaries?
  • Function?
A

Tympanic membrane to oval window
Also Eustachian tube
Amplifies & conducts sound waves to the internal ear

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31
Q

Internal ear

  • Boundaries?
  • Function?
A

Oval window to internal acoustic meatus
Converts special sensory information
into fluid waves -> APs
-> conducts APs to brain

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32
Q

What is the blood supply to the external ear?

A

Avascular - nutrients from skin

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33
Q

Ear canal

  • Composed of?
  • Lined with?
  • What makes wax?
A

Composed of 1/3 cartilage, 2/3 bony
Lined with skin
Produces earwax via ceruminous glands

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34
Q

Describe the parts of the external ear

A

Helix
Antihelix - has two crura
Tragus
Anti-tragus

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35
Q

What is the nervous supply off the external surface of the tympanic membrane?

A 
2/3 = CN V3 (mandibular portion of trigeminal nerve)
1/3 = CN X (vagus)
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36
Q

What is the pars tensa?

What changes it’s location?

A

The thick part of the tympanic membrane

Changes in pressure in the middle ear can change it’s location

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37
Q

What is the pars flaccida?

A

The thin part of the tympanic membrane

38
Q

What is the nervous innervation of the tympanic membranes internal surface?

A

CN IX - glossopharyngeal

39
Q

What does the glossopharyngeal nerve provide sensory innervation to?

A 
Middle ear cavity
Eustachian tube
Nasopharynx
Oropharynx
Tonsils
40
Q

What does the Eustachian tube connect?

A

Tympanic cavity to the lateral wall of the nasopharynx

41
Q

Contents of the inner ear?

A

3 Bones:
Malleus
Incus
Stapes

2 Muscles:
Stapedius
Tensor tympani

Nerve branches from:
Facial nerve
Glossopharyngeal nerve

42
Q

What does the base of the stapes fit onto?

A

The oval window - connection with inner ear

43
Q

Tensor tympani

  • What does it attach to?
  • Innervated by?
  • Function
A

Malleus
CN V3
Reduces the noise you make when you eat

44
Q

What does the stapedius muscle attach to?

What is it innervated by?

A

Stapes

CN VIII

45
Q

Sensory nerve supply to middle ear vs nasopharynx?

A

Both is CN IX - common example of referred pain, tonsilitis or pharyngitis can mimic ‘ear ache’

46
Q

Chorda tympani

  • What is it a branch of?
  • Two functions?
A

Branch of CN VII

  • Taste buds of the anterior 2/3rds of the tongue
  • Parasympathetic supply to the submandibular & sublingual salivary glands (salivation)
47
Q

What is the smallest skeletal muscle in the body?

-Function

A

Stapedius

Reduces stapes movement to protect the internal ear from excessive noise

48
Q

How can you test the motor function of CN VII?

A 
By asking patient to:
Frown (frontalis)
Close eyes tightly (orbicularis oculi)
Smile (elevators of lips)
Maintain puffed out cheeks (orbicularis oris)
49
Q

What does the otic capsule contain?

A

A bony labyrinth containing perilymph

Suspended in the perilymph is a membranous labyrinth which contains endolymph fluid

50
Q

Cochlear duct

- What is it and what does it contain?

A

A long balloon-like structure within the cochlea filled with endolymph:
APs conducted to the brainstem in the cochlear nerve

51
Q

Semicircular duct

- What is it and what does it contain?

A

Inter-linked balloon-like structures within the semicircular canals filled with endolymph
APs conducted to the brainstem in the vestibular nerve

52
Q

What are clusters of hair cells called?

A

Maculae

53
Q

What do the semicircular ducts detect?

What do the urticle and saccule detect?

A

Semicircular ducts detect angular movement change

Utricle and saccule detect linear movement change

  • Utricle (horizontal)
  • Saccule (vertical)
54
Q

Describe the process of sound transmission

A
  1. Sound waves make tympanic membrane vibrate
  2. Vibrations transmitted through ossicles
  3. Base of stapes vibrates in oval window
  4. Vibration of stapes creates pressure waves in perilymph
  5. Hair cells in the cochlea are moved, APs stimulated and conveyed to brain by cochlear nerve
  6. Pressure waves descend and become vibrations again
  7. Pressure waves are dampened at the round window
55
Q

Floor of mouth

  • What is the vein running along here that you can see?
  • What is the name of the structure which attaches the ventral aspect of the tongue to the floor of the mouth?
  • What is the caruncle?
A

Deep lingual vein
Frenulum
Opening for submandibular glands

56
Q

What are the two main muscles in the floor of the mouth and what are they innervated by?

A

Geniohyoid - hypoglossal

Mylohyoid - CN V3

57
Q

What are the three pairs of major salivary glands?

A

Parotid
Submandibular
Sublingual

58
Q

Where does the parotid salivary gland secrete into the mouth?

A

Upper 2nd molars

59
Q

Which muscles does the parotid duct come into contact with?

A

Crosses the masseter and pierces medially through the buccinator

60
Q

Which nerves innervate the following salivary glands?

  • Submandibular
  • Sublingual
  • Parotid
A

The sublingual and submandibular glands are stimulated by parasympathetics in the corda tympani branch of CN VII (facial)
Parotid - -parasympathetic innervation (secretomotor) from CN IX
(‘Hitches a ride’ on branches of CN V3)

61
Q

Describe the innervation of the tongue

A

Anterior 2/3 = horizontal portion
- Taste from chorda tympani (CN VII – facial)
- General sensation by V3 via the lingual nerve
Posterior 1/3 lies more in the oropharynx
- General sensory by CN IX (glossopharyngeal)
- Taste from by CN IX (glossopharyngeal)

62
Q

What is the term used to decribe the boundary between the anterior 2/3 and posterior 1/3 of the tongue?

A

Sulcus terminalis

63
Q

What are the four types of papillae on the tongue?

A 
Foliate
Vallate
Fungiform
(These three have taste buds)
Filiform - touch, temperature
64
Q

How do thyroid lumps move on swallowing?

A

Thyroid swellings move superiorly then inferiorly on swallowing due to attachment to the larynx

65
Q

How can you divide the muscles of the tongue?

What are the functions of each?

A

Extrinsic muscles of the tongue
- Function to change the position of the tongue during mastication, swallowing and speech

4 pairs of skeletal intrinsic muscles of the tongue

  • Located mainly dorsally/posteriorly
  • Modify the shape of the tongue during function
66
Q

What is the big curved muscle of the tongue?

A

Genioglossus

67
Q

Which nerve supplies the muscles of the tongue?

What type of nerve is this?

A

Everything is hypoglossal (CN XII) nerve except from palatoglossus
Purely motor

68
Q

How can you cliniclaly test CN VII in relation to the tongue?

A

Ask patient to stick their tongue straight out
If both CN XII’s are functional the tongue tip remains in the MIDLINE upon protrusion
In unilateral CN XII damage the tongue tip will POINT TOWARDS
the side of the injured nerve

69
Q

What is the location of nerves and arteries in the tongue?

A

Arteries pass medial to hyoglossus

Nerves pass lateral to hyoglossus

70
Q

What is the difference in histology between hard and soft palate?

A

non-keratinised stratified squamous epithelium of the soft palate
keratinised stratified squamous epithelium of the hard palate

71
Q

What are the five muscles of the soft palate and which nerve supplies them?

A 
Tensor veli palatini
Levator veli palatini
Palatopharyngeus
Palatoglossus
Musculus uvulae
Skeletal muscles of the soft palate are all supplied by CN X (Vagus nerve) except tensor veli palatini (CN V3)
72
Q

Give three functions of the soft palate

A

Functions as a “trapdoor”:

  1. Stops food entering the nose during swallowing
  2. Directs air into the nose or the mouth during speech, sneezing, coughing & vomiting
  3. Helps to close off the entrance into the oropharynx during the gag reflex
73
Q

How can you clinically test CN X using the mouth?

A

Ask patient to say “Aahh”
If the nerves are functioning normally the uvula should lift straight up in the MIDLINE
If there is unilateral nerve pathology the uvula will be pulled AWAY FROM the non-functioning side by the normal side

74
Q

How can the muscles of the pharynx be divided up?

Which nerve innervates them?

A

Outer Circular Layer

  • 3 constrictor muscles
  • Skeletal (Voluntary)
  • During sequential contraction, pushes food bolus inferiorly towards oesophagus

Inner Longitudinal Layer

  • 3 paired vertical muscles
  • Skeletal (Voluntary)
  • During contraction, pulls larynx superiorly shortening pharynx during swallowing

All CN X except stylopharyngeus (CN IX)

75
Q

What do the gaps between the circular muscles of the pharynx allow?

A

A “gateway” to mouth

  • CN IX
  • Lingual artery
  • Stylopharyngeus muscle
76
Q

Where do the longitudinal muscles of the pharynx insert?

A

Posterior border of thyroid cartilage

77
Q

What is the anterior border of the nasopharynx?

A

Chonoa

78
Q

What is the collective name for the ring formed by the tonsils of the pharynx?
Which tonsils are involved?

A

Waldeyer’s Tonsillar Ring

Adenoid, tubal, palatine, lingual

79
Q

What are some key differences in swollen lymph nodes in cancer compared to infection?

A

Infection = painful, soft, smooth, not fixed to adjacent structures

Cancer = not painful, hard, irregular, fixed

80
Q

Which fasical layer of the neck does the larynx sit in?

A

Pretracheal fascia

visceral layer

81
Q

What is the vertebral level of the larynx?

A

C4-C6

82
Q

What is the joint between the thyroid and cricoid cartilage called?
Where is it?
Why is it significant?

A

Cricothyroid joint
At the inferior horn of the thyroid cartilage
Marks the changing of name of left recurrent laryngeal nerve to the inferior thyroid nerve

83
Q

What is the name of the three prominent cartilages superior to the cricoid cartilage?

A

Arytenoid cartilages

84
Q

What is the laryngeal ventricle?

A

Laryngeal ventricle is an outpouching which attaches to the saccule – inside this there are lots of serimucous glands – need to keep the vocal cords moist as they dry out quickly

85
Q

What are the four vocal cord movements and what sound do they each produce?
What moves them?
Innervated by?

A 
Tension (Increase pitch)
Relaxation (Decrease pitch)
Adduction (Quieter)
Abduction (Louder)
Intrinsic muscles of the larynx 
CN X
86
Q

Function of cricothyroid muscles?

A

TENSOR
Tenses vocal ligament
Increasing pitch (high voice)
‘Nods’ thyroid cartilage

87
Q

Function of the thyroarytenoid muscles?

A

RELAXOR
Relaxes vocal ligament
Decreasing pitch (lowering voice)

88
Q

Function of the lateral crico-arytenoid muscles?

A

ADDUCTORS
Adducts/ brings vocal ligaments together
Making voice quieter

89
Q

Function of the arytenoid muscles?

A

ADDUCTORS
Adducts/ brings vocal ligaments together
Making voice quieter by closing rima glottidis

90
Q

Function of the posterior crico-arytenoid muscles?

A

ABDUCTORS
Abducts vocal cords
Making voice louder by opening rima glottidis

ENT (10 decks)

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