Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCS (ENT) > Anatomy + Other > Flashcards

Anatomy + Other Flashcards

1
Q

What meets at the helicotrema and what is it?

A

The Scala Vestibuli and Scala Tympani
It is the most apical part of the cochlea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the modiolus?

A

Modiolus = the conical shaped central axis of the cochlea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the major cations of perilymph and endolymph

A

Perilymph - Sodium
Endolymph - Potassium

PS EP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is found in (fluid):
Scala vestibuli
Scala media
Scala tympani

A

Scala vestibuli - Perilymph
Scala media - Endolymph
Scala tympani - Perilymph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What separates the scala vestibuli from the scala media?

A

Reissner’s membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What area of the cochlea is involved in Ménière’s disease?

A

Scala media …. Endolymphatic hydrops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the organ of corti sit on?

A

The basilar membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What compartments do the oval and round windows open into

A

Oval = Scala vestibuli
Round = Scala tympani

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What membrane sits within the scala media?

A

Tectorial membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Skull Foramina - Look at table

A

Cribiform foramina of Cribriform plate
CN1 - Olfactory nerve
Anterior Ethmoidal nerves

Optic canal
CN2 - Optic nerve
Opthalmic Artery
Central retinal vein

Superior orbital fissue
CN3 - Occulomotor nerve (superior and inferior divisions)
CN4 - Abducens nerve
CNV1 - Opthalmioc division of trigeminal nerve (Lacrimal / Frontal / Nasociliary branches)
CN6 - Trochlear Nerve

Superior ophthalmic vein
Branch of inferior ophthalmic vein

Recurrent meningeal artery (passes backward through fissure, is branch of lacrimal artery, anastomisis with MMA)

Sympathetic nerves

8 things:
4 proper nerves
2 veins
1 artery
Sympathetic nerves

Inferior orbital fissue
CNV2 - Zygomatic branch

Branch of inferior ophthalmic vein
Infraorbital artery
Ascending branches of pterygopalatine ganglion

4 things (half of SOF)

Nerve, Ganglion, Vein, Artery

Foramen rotundum
CNV2 (Maxillary division of the trigeminal nerve)
Artery of foramen rotundum
Emissary veins

Foramen Ovale
CNV3 (Mandibular division of the trigeminal nerve)
Lesser petrosal nerve

Accesory meningeal artery
Emissary veins
Ortice ganglion just below foramen

Foramen spinosum
CNV3 - Meningeal branch

Middle meningeal artery
Middle meningeal vein
MMA fighter bust someones SPINE

Foramen Lacerum
Is closed by cartilage in life so nothing
Associated:
Greater petrosal nerve (on top of fora- men)
Internal carotid artery (on top of foramen)
Internal auditory meatus
CN7 - Facial Nerve
CN8 - Vestibulocochlear nerve
Labrythine artery
Vestibular ganglion

Jugular foramen
CN9 - Glossopharyngeal
CN10 - Vagus
CN11 - Accessory

Meningeal branches of occipital and ascending pharyngeal arteries
Superior bulb of internal jugular vein
inferior petrosal sinus
Sigmoid sinus

Hypoglossal canal
CN12 - Hypoglossal nerve

Foramen magnum
CN11 - Spinal part of accessory nerv

Spinal cord (medulla)
Meninges
Vertebral arteries
Anterior and posterior spinal arteries
Dural veins

MS VADA eating a MAGNUM

Stylomastoid foramen
CN7 - Facial nerve
Stylomastoid artery

**Condylar canal **
Emmissary vein from sigmoid sinus to vertebral veins in neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pharyngeal clefts / arches / pouches… see table

A

Pouches

1 - Eustachian tube + middle ear
2 - Lining of palatine tonsils
3 - INFERIOR parathyroid glands + Thymus (descend together)
4 - SUPERIOR parathyroid glands + C cells (parafollicular of thyroid)

Clefts
Pharyngeal clefts (ectodermal) are small sinuses between arches - all obliterated except:
1st Pharyngeal cleft = EAM! External Acoustic Meatus
IF 2nd 3rs 4th NOT obliterated (failure of fusion of 2nd pharyngeal arch and epicardial ridge) = BRANCHIAL CYST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What attaches to the styloid process? (5 things)

A

Styloglossus muscle
Stylopharyngeus muscle
Stylohyoid muscle
Stylomandibular ligament
Stylohyoid ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Openings into the nasal cavity and location

A

Frontal
Maxillary
Anterior ethmoidal sinuses
> open into the middle meatus via the semilunar hiatus
(bounded inferiorly and anteriorly by the sharp concave margin of the uncinate process of the ethmoid bone) (The opening of this all is the osteomeatal complex)

Middle ethmoidal sinuses empty out onto
> The ethmoidal bulla in the middle meatus

The posterior ethmoidal sinuses open out at the level of the
> superior meatus

Sphenoid sinus opens into the > posterior nasal roof

Nasolacrimal duct – opens into the
> inferior meatus.

Auditory (Eustachian) tube – opens into the nasopharynx at the level of
> inferior meatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Advantages / Disadvantages of CT

A

Advantages

Painless
Non-invasive
Good evaluation of boney structures
More information than plain XR
Good for use in surgical plannning and image guidance techniques (e.g. CT guided biopsy)
Quicker (and cheaper than MRI)
Can be performed with implanted medical devices

Disadvantages

Uses ionising radiation
Poor evaluation of soft tissue (vs MRI)
Slower and more expensive than plan XR
Patientsa must lie flat and still

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Unilateral nasal obstruction, facial pain, foul odour, and left upper dental pain

CT shows complete opacification of unilateral (left) maxillary sinus + ? tooth infection

Possible Dx (2)

A

Fungal ball / Fungal sinusitis
Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Fungal ball

Symptoms
& Investigations

A

Nasal obstruction, facial pain, foul odour, and left upper dental pain

Maxillary sinus most commonly affected

FNE
Orthopantomogam (OPG)
CT Paranasal sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of fungal ball (mycetoma)

A

Online it looks like for fungal ball - Surgery is generally used to clear out the sinus - FESS

Then antifungals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Excluding the superior orbital and inferior orbital fissure there are 3 other foramen in the orbit

What are they?
What runs through them?
How far apart are they?

A

Foramen anterior and posterior ethmoidal arteries

Optic canal
- CN2 - Optic nerve
- Opthalmic Artery
- Central retinal vein

The rule of halves:

Anterior ethmoidal artery is 24 mm from anterior edge of the lacrimal
crest

Posterior ethmoidal artery is 12 mm behind the anterior ethmoidal artery

Optic nerve is 6 mm behind the posterior ethmoidal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Mechanism for referred otalgia in laryngeal malignancy

A

Stimulation of the auricular branch of the vagus nerve (Arnold’s nerve) when the sensory branches of the vagus nerve supplying the larynx (internal branch of superior la- ryngeal nerve) are stimulated by laryngeal malignancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which artery can cause bleeding into the orbit after a FESS

A

Anterior ethmoidal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Intrinsic muscles of larynx (5)

And nerve supply

A

Intrinsic laryngeal muscles are:

Thyroarytenoid (vocalis) (paired)
Transverse arytenoid (unpaired).
Lateral cricoarytenoid (paired)
Posterior cricoarytenoid (paired)

= recurrent laryngeal nerve.

Cricothyroid muscle.

= external branch of the superior laryngeal nerve supplies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Sensaory supply to the larynx?

A

The internal branch of the superior laryngeal nerve of the vagus is responsible for sensation to the the vocal cords / glottis and above

Recurrent laryngeal nerve
supplies sensation to the SUBglottis and below

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

The 4 laryngeal cartilages are:

A

Thyroid cartilage
Cricoid cartilage
Arytenoid cartilage
Epiglottis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Damage to external branch of superior laryngeal nerve - symptoms and why?

A

Cricothyroid muscle = This muscle tenses the vocal cords to increase the pitch of voice.

Damage = unable to hit high pitch / high notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Type of joint: arytenoid > cricoid cartilage
The arytenoid moves on the cricoid cartilage by means of a synovial joint. It is susceptible to all the disorders that affect the larger synovial joints elsewhere in the body.
26
Explain why some patients cough when their ear is microsuctioned (specific nerve)? *What else is explained by this?
Arnold nerve reflex (Auricular branch of the Vagus nerve) Innervates - - Inferior boney canal - Posteriorsuperior cartilaginous canal - Adjacent tympanic membrane - Conchal bowl When touched stimulates vagus nerve cough reflex Also explain referred pain from laryngeal cancer to the ear/ear canal
27
Innervation of the pinna?
Facial nerve vagus nerve Trigeminal nerve Greater auricular nerve (via C2 C3)
28
Innervation of conchal bowl?
Auricular branch of vagus Facial nerve (intermediate branch)
29
Greater auricular nerve supplies what part of Pinna?
The pinna is innervated - laterally - inferiorly - posteriorly by the greater auricular nerve (derived from the cervi- cal plexus).
30
What supplies the anterior portion of the Pinna?
Auriculotemporal branch of the mandibular division of the trigeminal nerve supplies the anterior portion of the pinna
31
Greater auricular nerve innervates what areas?
Greater auricular nerve runs from Erbs point at the midpoint of the posterior border of sternocleidomastoid muscle to the parotid gland. It divides into anterior branch and posterior branches. Anterior branch supplies skin over the angle of the mandible Posterior branch supplies the ear lobe and mastoidf process?
32
What innervates the earlobe? And what else does it innervate?
Posterior branch of the grater auricular nerve Mastoid process
33
Innervation of lateral surface of TM and EAM
Auriculotemporal branch of Mandibular branch of **Trigeminal (CNV3)** Intermediate branch of **Facial nerve** Auricular branch of **Vagus nerve**
34
Innervation of medial surface of TM & middle ear?
Tympanic branch of the Glossopharyngeal nerve
35
Innervation of EAM?
Auriculotemporal branch of Mandibular branch of **Trigeminal (CNV3)** Intermediate branch of **Facial nerve** Auricular branch of **Vagus nerve**
36
Skin behind the ear innervated by?
Innervates the skin and the scalp posterosuperior to the auricle (C2) Greater auricular nerve (C1-C2)
37
Axial Coronal Sagittal
Axial > Horizontal slices (e.g. head to toe) Coronal > Vertical slices (front to back) Sagittal > Side (left to right)
38
How do you describe colours on MRI scan and what are the two types and differences?
Low signal is black, High signal is white What = high signal changes depending on T1 vs T2 MRI - T2 Water White (WW) i.e high signal - T1 Water Black, i.e. Low signal Fat is high on both T1 + T2 Contrast (gadolinium) **is only given in T1**
39
How to describe and MRI
PCAP - - Plane - Contrast given - Anatomical location - Pathology demonstrated
40
How to describe and CT
PwCAP - - Plane - WIndow (soft tissue or bone) - Contrast given - Anatomical location - Pathology demonstrated
41
What becomes of the pharyngeal pouches?
Pharyngeal Pouches = Outpocketings on LATERAL wall (endodermal) Separate the arches = (5 pairs, 4 survive) “P”ouch for “P”arathyroids and “P”alatine tonsils 1 - Eustachian tube + middle ear 2 - Lining of palatine tonsils 3 - INFERIOR parathyroid glands + Thymus (descend together) 4 - SUPERIOR parathyroid glands + C cells (parafollicular of thyroid
42
What becomes of the pharyngeal clefts? What pathology is associated with them, explain how it occurs?
Pharyngeal clefts (ectodermal) are small sinuses between arches - all obliterated except: 1st Pharyngeal cleft = EAM! External Acoustic Meatus IF 2nd 3rs 4th NOT obliterated (failure of fusion of 2nd pharyngeal arch and epicardial ridge) = BRANCHIAL CYST
43
1st Pharyngeal Arch - Nerve - Bone - Artery - Muscles - Sensation
Nerve * V: Trigeminal Bone * Maxillary prominence – maxilla, zygomatic bone, part of temporal bone - associated with: * Maxillary cartilage = Incus * Mandibular prominence - mandible, associated with: * Meckel’s cartilage = malleus, mandible Artery * Maxillary Muscles (ATTM) Trigeminal “all the Tensors!” * Temporalis, Masseter, Pterygoids * Mylohyoid, Anterior belly digastric * Tensory tympani, Tensor veli palatini Sensation * Face * General sensation anterior 2/3 tongue * Oral cavity lining and nose
44
2nd Pharyngeal Arch - Nerve - Bone - Artery - Muscles - Sensation
Nerve * VII: Facial Bone Reichart’s cartilage = * Stapes * Styloid * Stylohyoid ligament * Upper body + lesser horn of Hyoid Artery * Stapedial: Regresses before birth. * Hyoid artery – gives rise to the *corticotympanic artery* in the adult Muscles * Muscles facial expression, * Stapedius * Stylohyoid * Platysma * Posterior belly of digastric Sensation * Taste sensation anterior 2/3 tongue * Part of EAM & lateral TM
45
3rd Pharyngeal Arch - Nerve - Bone - Artery - Muscles - Sensation
Nerve * IX: Glossopharyngeal Bone * Lower hyoid Artery * Common carotid artery Muscles * Stylopharyngeus StylopharanGeous Sensation * Taste + general sensation posterior 1/3 tongue
46
4th Pharyngeal Arch - Nerve - Bone - Artery - Muscles - Sensation
Nerve * X: Superior laryngeal Bone * Laryngeal cartilages: Thyroid, Corniculate and Cuneiforme Artery * Left - Aortic arch * Right - proximal portion of the subclavian artery Muscles Cricothyroid and the PLP * Pharyngal constricters * ? Palatopharyngeous * Levator palatini * Palatoglosus * Cricothyroid Sensation * Root of tongue / lower pharynx / upper larynx
47
5th Pharyngeal Arch - Nerve - Bone - Artery - Muscles - Sensation
Nothing in life - regresses before birth
48
6th Pharyngeal Arch - Nerve - Bone - Artery - Muscles - Sensation
Nerve * X: Recurrent laryngeal Bone - None Artery * Left – ductus arteriosus * Right – proximal portion of the pulmonary arteries Muscles Intrinsic muscles of the larynx (with the exception of cricothyroid) * Thyroarytenoid * Transverse arytenoid * Lateral cricoarytenoid * Posterior cricoarytenoid Sensation * General sensation below the vocal cords
49
Uses for BIPP and what is it?
Bismuth Iodoform Paraffin Paste and ribbon gauze. BIPP is an astringent and antiseptic dressing which slowly releases iodine over time Ear surgery: - myringoplasty - mastoid surgery - Pack the nasal cavity, especially in cases of posterior epistaxis
50
Bismuth Iodoform Paraffin Paste - main ingredient?
Iodine
51
Bismuth Iodoform Paraffin Paste - what can happen with some patients when it is used?
Type IV hypersensitivity reaction Generally 48-72 hours post Remove and can use plain ribbon gauze instead
52
Why must BIPP be removed prior to embolisation?
The strip down the middle of it is radiopaque, indestiguishable from a vessel
53
Name the extrinsic tongue muscles (4)
Genioglossus Hyoglossus Styloglossus Palatoglossus
54
Where is the superior laryngeal nerve found and what are it's landmarks?
‘Jolly Joll because he’s superior in every way’ Jolly because he likes “Ss & M” Joll's triangle: Midline Superior thyroid pedicle Strap muscle - sterenothyroid
55
Where is the recurrent laryngeal nerve found and what are it's landmarks?
Beahr's triangle: Common carotid artery Trachea Inferior thyroid artery “Beahr has a TIC”
56
Where is the Fossa of Rosenmuller? What else is nearby and what's it's clinical significance?
Behind the ostium of the eustachian tube is a deep recess, the pharyngeal recess (fossa of Rosenmüller) At the base of this recess is the retropharyngeal lymph node (the Node of Rouvier). Fossa of Rosenmuller is where nasopharyngeal carcioma (SCC) commonly arises
57
What / where is the sinus of Morgagni? Clinical significance
= defect in the anterior aspect of the pharyngobasilar fascia. Enclosed space between the superior pharyngeal constrictor muscle, the base of the skull and the pharyngeal aponeurosis / pharyngobasilar fascia Transmits the Eustachian tube and levator veli palatini muscle = allows communication between the nasopharynx and middle ear Trotter's syndrome of cancer arises / invades here
58
Imaging modality of choice for imaging the primary cancer in most head and neck CAs?
MRI with contrast - T1 with gadolinium enhancement CT of head / neck / throax for staging (nodes & mets)
59
Facial layers of the neck
**Superficial cervical fascia **- skin, subcutaneous tissue and the platysma **Deep cervical fascia** Superficial layer of deep fascia = the Investing layer, encloses * SCM / traps /Straps / Parotids Middle = Pretracheal layer, encloses * Organs of the neck: thyroid, parathyroid glands, larynx, trachea, pharynx,oesophagus. Deep = Pre vertebral layer * Vertebral column and the paravertebral muscles Space between the middle and deep layers anteriorly = retropharyngeal space, which is subdivided by a thin membrane called the alar fascia. Danger space = posterior to the alar fascia, which extends from the oropharyngeal region inferiorly into the posterior mediastinum (to the level of the diaphragm)
60
What is the danger space in the neck
Space between the middle and deep layers anteriorly = retropharyngeal space, which is subdivided by a thin membrane called the alar fascia. Danger space = posterior to the alar fascia, which extends from the oropharyngeal region inferiorly into the posterior mediastinum (to the level of the diaphragm)
61
Where is the retropharyngeal space? Clinical relevance?
Space between the middle (pretracheal) and deep layers of the neck (prevertebral) anteriorly = retropharyngeal space, which is subdivided by a thin membrane called the alar fascia. Extends from skull base to lower border of pharynx, but there is an extension posterior to the alar fascia .... Danger space = posterior to the alar fascia, which extends from the oropharyngeal region inferiorly into the posterior mediastinum (to the level of the diaphragm)
62
Where is the parapharyngeal space? Clinical relevance?
Parapharyngeal space is a potential space, shaped like an inverted pyramid - extends from the skull base to the hyoid bone. Carotid sheath is Lateral and inferior to it Communicates with the retropharyngeal space so a parapharyngeal abscess can also lead to mediastinial spread.
63
LASER stands for:
Light amplification by stimulated emission of radiation
64
What precautions should be taken in ORs when LASERs are in use? (min 5)
* Skin of sedated or anaesthetised patients must be shielded * Patients eyes must be protected * Theatre staff should wear eye protection * Doors should be locked * Windows covered * Warning signs / lamps at entrance to theatres
65
What does KTP laser stand for?
Potassium Titanyl Phosphate
66
Differences between KTP (what stand for) and C02 lasers?
Potassium Titanyl Phosphate Wavelength Target Chromophore
67
Explainwhat determines wavelength and taregt chromophore in LASER
The laser medium (gas / liquid / solid ) determines wavelength Different substances have different targets (chromophores) which selectively uptake that laser C02 - water (Cutting / ablating) KTP Potassium Titanyl Phosphate - Haemoglobin (photoangiolytic)
68
Indications for LASER I.e what can you use it on?
Leukoplakia Laryngeal stenosis Laryngomalacia Pharyngeal pouch surgery Laryngeal pappilomatosiis HHT Oropharyngeal cancer resection Vocal cord nodules
69
How to ventiolate pt during laser
Laser Safe ET tube Jet ventilation
70
Advantages and disadvantages of LASER
Advs: * Precision * Better haemostasis * Cost effective * Minimal tissue manipulation * Increased sterility Disadvs * Increased staff no.s * Increased training * Safety aspects * Cost of equiptment
71
Compression of superiornorbital fissure structures - symptoms:
Superior orbital fissure syndrome: Diplopia Opthalmoplegia Exophthalmos (Proptosis) Ptosis Eyelid & forehead anaesthesia Detail: Ophthalmoplegia: compression / damage to oculomotor, trochlear and abducens nerves Ptosis: due to loss of oculomotor motor supply to the levator palpebrae superioris and loss of sympathetic input Proptosis: decreased tension in extraocular muscles due to loss of innervation Fixed dilated pupil: due to loss of parasympathetic supply to the pupil by the oculomotor nerve Lacrimal hyposecretion and eyelid or forehead anaesthesia: due to damage to branches of the ophthalmic division of the trigeminal nerve Loss of corneal reflex
72
Superior orbital fissure syndrome - causes:
Trauma e.g. orbital blow out fracture Infection Inflammatory condition Neoplasia (benign or malignant).
73
What is orbital apex syndrome (signs / symptoms)?
Blindness / Visual loss + Cranial neuropathies e.g. Opthalmoplegia Hypoasthesia of eyelid / upper face Diplopia Ptosis etc. = SOF Syndrome + decreased visual acuity
74
Orbital apex syndrome - causes
Commonly a middle cranial fossa tumour involving the orbital apex Also - Trauma - Inflammatory e.g. Sarcoid, GPA - Infection - Vascular e.g. cavernous sinus thrombosis
75
Types of melanoma
Superfical Spreading Nodular Acral lentiginous Lentigo maligna Regressed
76
What are the warning features for a mole / melanoma
ABCD * Asymmetry * Border irregular * Colour * Diameter greater than 6mm Other: * Itching, burning * Swelling, * Pain in a pre-existing mole, Development of a raised area in a previously flat mole * Change in the consistency of the mole * Change in the surface characteristics * such as bleeding, scaling, ulceration or crusting * Development of satellite lesions. * New moles on an elderly person
77
Most common site of malignant melanoma
Trunk
78
Histological staging systems for malignant melanoma (2)
Breslow Clark
79
What makes up a salivary unit in a slivary gland? (5)
Cells which make up salivary unit MAISE: * Myoepithelial * Accinic * Intercalated duct * Secretory * Excretory. Tumours of one of these cell types = Monomorphic Tumours of >1 = Pleomorphic
80
Differential diagnosis for red marks/lesions on face:
**Vascular tumours** Benign: - Haemagiomas - Pyogenic granuloma Malignant: Angiosarcoma **Vascular malformations:** High flow: Arteriovenous e.g. Arterial malformation, Arteriovenous fistula, Arteriovenous malformation Low flow: --- Venous malformation (most common ~40%) --- Lymphatic malformations e.g. Cystic hygroma / lymphangioma ----Capillary malformations / Portwine stain **Malignant neoplasm** Note: Vascular anomilies is the blanket term for vascular tumours + vascular malformations
81
Vascular malformations, types and presentations
**LOW FLOW** **Venous malformations (most common) ** * Bluish lesion * Compressible on palpation * Enlarge with physical activity or if in a dependent position. * Painful in the morning due to stasis Rx: Camouflauge makeaup, laser therapy, sclerotherapy, resection **Capillary malformation / Port wine stain** * Flat, reddish lesions * Mostly around the head and neck Rx: ... same as above **Lymphatic malformation/Lymphangioma** Fluid-filled cysts that form in children, often on the head and neck e.g. cystic hygroma Rx: Surgical excision **HIGH FLOW** **Arteriovenous malformations** Most commonly in the CNS and asymptomatic or general symptoms e,.g. hadaches, seizures, focal neurology etc.
82
Vascular tumours types
**Benign: ** **Infantile haemagioma / Strawberry naevus** - Develop after birth - Grow rapidly involute over several years by apoptosis - Complications: stridor due to obstruction, ulceration, bleeding, infection Rx - Conservative mostly - Beta blockers + corticosteroids can be used **Pyogenic granuloma ** Common on: Gums, skin, nasal septum Proliferation capillaries due to trauma, hormones, drugs Rapidly grow over weks Rx: Topical: Imiquimod cream 5% / topical (or oral) beta-blockers Surgical excision / curretage **Malignant: Angiosarcoma**
83
Difference between haemagioma and vascular malformation?
haemagiomas are vascular tumours and unlike vascualr malformations they are: - absent at birth - grow fast - Involute spontaneously around 2 years of age
84
Oesophageal levels from incisors (cm / vertebra)
* C6: Cricopharyngeal sphincter / cricoid / cricophjaryngeous 15cm * T4: Aortic arch crosses / Trachea bifurcates / Bronchoaortic constriction 22-24cm * T5: Left main bronchus 27cm * T10: Entrance to abdomen 38cm * T10: Incisors > OG junction 40cm
85
Structures and distances from the anterior edge of the lacrimal crest
Rule of halves: * 24mm behind: Anterior ethmoidal artery * 12mm behind that: posterior ethmoidal artery * 6mm behind that: Optic nerve
86
What is vidians nerve, location/route/function
= Nerve of the pterygoid canal (Vidian nerve) formed by junction of: - Greater petrosal nerve: parasymp to lacrimal / mucous of nose - Deep petrosal nerve: symp to blood vessels Passes from the foramen lacerum to the pterygopalatine fossa through the pterygoid canal
87
Where is the Pharyngeal tubercle, what attaches to it?
Pharyngeal tubercle = just anterior to foramen magnum (part of basialrt part of occipital bone) Attachement = fibrous raphe of the pharynx, also known as the pharyngeal raphe = connects with the superior pharyngeal constrictor muscle.
88
Explain the embryological origin of the external ear
External ear develops from the first two pharyngeal arches They form six hillocks of His in the five weeks of development. 1st Arch forms first three hillocks = fuse together to = - tragus - helix - Crus of helix (Innervated by the Trigeminal nerve… 1st Arch) 2nd arch forms the last 3, fuse to = - antihelix - antitragus - lobule (Areas innervated by the cervical plexus and the facial nerve ..2nd Arch) … also explains why in Ramsey Hunt vesicles occur on the pinna
89
What part of the external ear is formed by the first three hillocks of his?
1st Arch forms first three hillocks = fuse together to = - tragus - helix - crus of helix (Innervated by the Trigeminal nerve… 1st Arch) 2nd arch forms the last 3, fuse to = - antihelix - antitragus - lobule (Areas innervated by the cervical plexus and the facial nerve ..2nd Arch) … also explains why in Ramsey Hunt vesicles occur on the pinna
90
What can happen if the hillocks of His fail to fuse?
Pre auricular sinus
91
Benefits of mono and braided sutures
Braided: * Greater tensile strength * Better pliability and flexibility * Handles and ties well * Less likely than monofilament to be crushed/crimped which weakens suture Mono: * More resistant to harboring microorganisms * Exhibits less resistance to passage through tissue than multifilament suture does
92
True Vocal Cord (Vocal Folds) Layers (Medial to lateral / superficial to deep) (7)
* (Non keratenised stratified) Squamous epithelium * Basement membrane * Superficial lamina propria * --.. this layer = Reinke's space (watery, amorphous layer is rich in glycosaminoglycans. Due to its fluidity, the epithelium is able to vibrate freely above it to create sound) * Intermediate lamina propria * Deep lamina propria * ….. = these two layers = the Vocal ligament - Lies at the free upper edge of the cricothryoid ligament * Muscle > Thyroarytenoid muscle (Vocalis muscle)
93
False vocal cords (Vestibular folds ) - Consist of (2) Function (1)
Consist of the * vestibular ligament (free lower edge of the quadrangular membrane) * Covered by a mucous membrane Fixed folds, which act to provide protection to the larynx
94
What are Agger Nasi cells and where are they?
Agger nasi air cells are the most anterior ethmoidal air cells - Anterolateral and inferior to the frontal recess ‘A’gger for ‘A’nterior
95
What is concha bullosa? Associated with? (1)
Concha bullosa (middle turbinate pneumatisation) is a common finding and although associated with deviation of the nasal septum,
96
What is an Onodi air cell? Significance?
Onodi air cell (above)- Sphenoethmoidal air cell - anatomical variant I mportant due to its close proximity to the optic nerve and internal carotid artery
97
What are Haller cells and where are they found? WHat problems can occur due to them ?
Haller cells( infraorbital ethmoidal air cells) = ethmoid air cells located lateral to the maxillo-ethmoidal suture along the inferomedial orbital floor * Generally asymptomatic * Can get infected > track to orbit * Surgeons may enter orbit via them if not recognised during FESS * If large can block osteomeatl complex
98
Attachements to mastoid process
Posterior belly of digastric muscle Sternocleidomastoid Splenius capitus Longissimus capitus
99
What is the difference between monospot abd Paul-Bunnel test (and what is similiar - other than they both test for EBV)
Both heterophile antibody tests: Paul-Bunnell test uses sheep erythrocytes Monospot test, horse red cells
100
Contents of neck levels
Contents of Neck Levels: 1 * Submandibular gland * Hypoglossal nerve * Facial, submental and mylohyoid vessels * Anterior jugular veins * Mylohyoid nerve * ? Lingual nerve ? Marginal mandibular 2 * Accessory nerve * Hypoglossal nerve * Greater auricular nerve * Internal and external laryngeal nerves * IJV * External carotid artery and number of branches e.g. superior thyroid ? * Internal carotid artery * Superior root of the ansa cervicalis 3 * IJV * Common carotid artery * Internal and external laryngeal nerves * Superior thyroid vein 4 * Common carotid artery * IJV * Phrenic nerve * Thoracic duct or Right lymphatic trunk * ? Lung apices 5 * Accessory nerve * Brachial plexus trunks * Cervical plexus branches * External jugular, Transverse cervical, suprascapular veins * Subclavian, Transverse cervical, Suprascapular, Occipital arteries * Inferior belly of omohyoid * ? Lung apices 6 * Trachea * Larynx * Thyroid gland * Parathyroid glands * Vagus nerve * Glossopharyngeal nerve * Superior, middle and inferior thyroid vessels
101
Level 6 neck contents
6 * Trachea * Larynx * Thyroid gland * Parathyroid glands * Vagus nerve (Recurrent laryngeal nerve) * Glossopharyngeal nerve * Superior, middle and inferior thyroid vessels
102
Level 5 neck contents
5 * Accessory nerve * Brachial plexus trunks * Cervical plexus branches * External jugular, Transverse cervical, suprascapular veins * Subclavian, Transverse cervical, Suprascapular, Occipital arteries * Inferior belly of omohyoid * ? Lung apices
103
Level 4 neck contents
4 * Common carotid artery * IJV * Phrenic nerve * Thoracic duct or Right lymphatic trunk * Lung apices * Transverse cervical artery
104
Level 3 neck contents
3 * IJV * Common carotid artery * Vagus nerve * Superior thyroid vein
105
Level 2 neck contents
2 * Accessory nerve * Hypoglossal nerve * Greater auricular nerve * Internal and external laryngeal nerves * IJV * External carotid artery and number of branches e.g. superior thyroid ? * Internal carotid artery * Superior root of the ansa cervicalis
106
Level 1 neck contents
1 * Submandibular gland * Hypoglossal nerve * Facial, submental and mylohyoid vessels * Anterior jugular veins * Mylohyoid nerve * ? Lingual nerve
107
Submucous cleft & bifid uvula embryology
Submucous cleft palate = failure of fusion of the maxillary processes / palatine shelves Bifid uvular is related to this and = failure of fusion of the uvula - so also failure of fusion of the maxillary processes / palatine shelves
108
Cleft palate embryology
Palatal shelves fail to fuse in the midline
109
Cleft lip embryology
Failure of fusion from the incisive foramen to the alveolus and the lip – occurs when the **medial nasal prominence** and **maxillary prominence fail to fuse**. (failed merging of the maxillary and medial nasal elevations on one or both sides due to the inadequate migration of neural crest cells.)
110
Three structures preserved in modified radical neck dissection
Accessory IJV SCM

MRCS (ENT) (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions