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GIR Test 4 > B5.049 Neck, Swallowing, Pharynx, and Larynx > Flashcards

B5.049 Neck, Swallowing, Pharynx, and Larynx Flashcards

1
Q

what is investing fascia

A

outermost layer of deep cervical fascia
synonymous with deep fascia anywhere else in the body
surrounds sternocleidomastoid in the front and trapezius in back

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2
Q

pretracheal fascia

A

begins in front of trachea but wraps around to cover trachea, thyroid gland, and esophagus on lateral sides

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3
Q

what is inside the carotid sheath

A

common carotid
internal jugular
vagus nerve

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4
Q

orientation of carotid sheath

A 
artery = deep/medial
vein = superficial/lateral
nerve = posterior
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5
Q

retropharyngeal space

A

potential space of loose connective tissue between prevertebral fascia and pretracheal fascia
continues down into mediastinum and may spread infections

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6
Q

prevertebral fascia

A

surround vertebral column and deeper musculature of neck

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7
Q

triangles of neck

A

formed by muscle

SCM separates posterior (lateral) from anterior

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8
Q

what is congenital muscular torticollis

A 
twisted neck/ wryneck
condition in which an infant holds his or her head tilted to one side and has difficulty turning head
0.3%-2% incidence
75% of the time, right side
more frequent in males
presents at 2-4 wweks
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9
Q

how does torticollis occur

A

tearing of SCM during passage through birth canal

shortens in response to being torn

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10
Q

what is spasmotic torticollis

A

rare, sudden contraction of SCM

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11
Q

anterior triangles of the neck

A 
submandibular triangle
carotid triangle
submental triangle
muscular triangle
all separated by muscles that act on the hyoid bone
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12
Q

carotid triangle

A

SCM
superior omohyoid
posterior digastric

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13
Q

submandibular triangle

A

mandible
anterior digastric
posterior digastric

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14
Q

muscular triangle

A

superior omohyoid
sternohyoid
SCM

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15
Q

posterior triangle of neck

A

trapexius
posterior edge of SCM
clavicle

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16
Q

2 zones of posterior triangle

A

carefree- superior, mostly muscle

careful- inferior, important nerves and vessels present

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17
Q

components of careful/danger zone

A

accessory nerve (11)
brachial plexus
phrenic nerve anterior to anterior scalene
subclavian artery and vein behind omohyoid

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18
Q

omohyoid muscle

A

inserts onto scapula and goes up to hyoid bone

passes through both anterior and posterior trangles

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19
Q

platysma

A

muscle of facial expression
innervated by CN7
tightening occurs when one shaves the neck

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20
Q

boundary between careful and carefree zones

A

spinal accessory nerve

innervates SCM and trapezius

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21
Q

external jugular vein

A

partially behind platysma

crosses SCM and eventually pierces investing fascia, but not deep fascia, about 1/3-1/2 way up SCM

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22
Q

clinical significance of external jugular

A

may fill in individuals suffering from CHF

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23
Q

Erb’s point

A

nerve point of neck within posterior triangle

1/2 way up SCM near lower edge of mandible 3 cm from clavicle

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24
Q

Erb’s point injection

A 
used to block 4 cervical cutaneous nerves:
lesser occipital
greater auricular
transverse cervical
supraclavicular
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25
Q

lesser occipital nerve

A

serves region on top of occipital bone

behind ear following SCM (C2,3)

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26
Q

greater auricular nerve

A

serves area around ear (C2,3)

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27
Q

transverse cervical nerve

A

anterior region under mandible and up the mandible
most of the anterior triangles
(C2,3)

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28
Q

supraclavicular nerves

A

branch out over clavicle (C3.4)

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29
Q

scalene muscles

A

originate in C1-C4 and attach onto rib 1 or 2
anterior/middle scalenes onto rib 1
posterior scalene onto rib 2

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30
Q

structures between the middle and anterior scalene

A

brachial plexus

subclavian artery

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31
Q

structures anterior to anterior scalene

A

subclavian vein

phrenic nerve

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32
Q

6 branches of external carotid

A 
3 anterior: 
-superior thyroid
-lingual
-facial
2 posterior:
-occipital
-posterior auricular
1 medial:
-ascending pharyngeal
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33
Q

superior thyroid artery

A

supplies thyroid gland

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34
Q

lingual artery

A

tongue

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35
Q

facial artery

A

crosses mandible and can be palpated

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36
Q

occipital artery

A

pierces through investing fascia from SCM to the trapezius and eventually ends up behind ear

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37
Q

posterior auricular artery

A

passes behind and around ear

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38
Q

ascending pharyngeal artery

A

serves pharyna and part of nose

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39
Q

end of external carotid

A

splits into maxillary and superficial temporal arteries

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40
Q

suprahyoid muscles

A 
4 total
pull the hyoid bone and larynx up
mylohyoid (CN V3)
geniohyoid (C1)
stylohyoid (CN7)
digastric (CNV3)
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41
Q

infrahyoid muscles

A

4 total

pull hyoid bone and larynx down

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42
Q

ansa cervicalis

A

loop of the neck
innervates 4 infrahyoid muscles
arises from ventral rami off the cervical spinal levels of C1,2,3
surrounds carotid sheath

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43
Q

importance of carotid sinus massage

A

treats some forms of tachycardia
manually massaging carotid sinus to increase pressure within carotid artery
increases afferent feedback by CN 9 to increase parasympathetic outflow through CN X
slows heart

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44
Q

internal jugular vein

A

main vessel responsible for collecting blood from brain, superficial face, and neck
valve at the bottom in the thoracic region to stop blood from rushing out of thorax

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45
Q

why might a patient need a central line

A

caustic meds need to be given in large veins to avoid deterioration of endothelial lining

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46
Q

where are most central lines started

A

internal jugular
subclavian
femoral

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47
Q

process of central line placement

A

introduces a catheter which opens into the right atrium

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48
Q

middle approach to place a central line

A

internal jugular is lateral to common carotid
palpate SCM and locate apex of clavicular and sternal heads
push carotid medially and inject laterally at a 45 degree angle through the skin aiming towards ipsilateral nipple

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49
Q

how is US used in central line placement

A

probe can compress IJV while CA stays round

helps tell the two apart and direct needle

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50
Q

placement of central line in subclavian vein

A

right side preferred
-supine position, head neutral, arm abducted
-shoulders neutral with mild retraction
junction of medial and middle third of the clavicle
site of needle insertion: 1 cm inferior to the clavicle, parallel to skin, aimed at supraclavicular notch

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51
Q

submental triangle

A

only triangle that crosses the midline
has submental lymph nodes which receive drainage from lower lip
common site of melanoma due to excess sun exposure

52
Q

lower lip and tongue tumors

A

first metastasize to palpable submental lymph nodes

53
Q

describe the general structure of the thyroid gland

A

2 major lobes (R and L) with a central isthmus across the trachea
small pyramidal lobe in 40% of people, remnant of embryonic thyroglossal duct

54
Q

generally: where is aberrant thyroid gland tissue located

A

may occur anywhere along the course of the thyroglossal duct

abnormal enlargements = goiter

55
Q

specific locations of ectopic thyroid tissue

A

65% below thyroid bone and isthmus of thyroid gland at trachea ring 3-4
15% at/around hyoid
20% superior to hyoid, but not within tongue
1% within tongue
<1% caudal to isthmus of thyroid

56
Q

thyroglossal duct

A

generally run posterior to hyoid bone, but can be anterior

57
Q

thyroglossal duct cysts

A 
midline masses below hyoid bone
may interfere w swallowing
65% between hyoid and thyroid
15% at hyoid
20% above hyoid
mass will rise when patient sticks out tongue
58
Q

embryonic origin of thyroglossal cysts

A

originate from the junction of anterior 2.3 tongue with posterior 1/3 tongue at sulcus terminalis, specifically at foramen cecum

59
Q

who gets thyroglossal cysts?

A

common in kids 2-10

surgical treatment recommended unless infected (if infected antibiotics first)

60
Q

how common is ectopic thyroid tissue?

A

27% of population have some ectopic thyroid gland tissue OR a pyramidal lobe

61
Q

blood supply to thyroid gland

A

2 pairs of arteries
1. superior thyroid arteries (20% blood) off external carotid
2. inferior thyroid arteries (80% blood) off thyrocervical trunk
occasionally a 3rd, thyroid ima artery

62
Q

prevalence of thyroid ima artery

A

10%

63
Q

clinical significance of thyroid ima

A

possible presence is one of the reasons emergency tracheotomies are not done more frequently below the isthmus of the thyroid gland at the suprasternal notch

64
Q

relationships of the pharynx

A

extends 14 cm from base of skull to the esophagus, at cricoid cartilage, vertebral level C6
widest at hyoid bone, narrowest at junction of esophagus

65
Q

most likely spot for food to get stuck

A

junction of pharynx with esophagus
narrowest and least distensible portion (1.5 cm)
can cause reflex closure of glottis

66
Q

Heimlich maneuver

A

forceful increase in the intra abdominal and intrathoracic pressure
may help expel stuck food

67
Q

divisions of pharynx

A

nasopharynx
oropharynx
laryngopharynx

68
Q

nasopharynx

A

posterior opening of nasal cavities (choanae)
pharyngeal openings of auditory (Eustachian) tubes on lateral walls
torus of auditory tube superior to opening

69
Q

oropharynx

A

posterior to mouth

separated from nasopharynx during swallow w soft palate

70
Q

laryngopharynx

A

posterior inlet of larynx

71
Q

3 “valves” to separate air and food pathways

A

soft palate- closes nasopharynx from oropharynx
epiglottis- covers inlet of larynx as food and water pass
glottis- vocal cords and apertures may be closed to prevent food from entering respiratory tract and to allow increased thoracic and abdominal pressure

72
Q

pharyngeal constrictors

A 
3 total
superior constrictor
middle constrictor
inferior constrictor
all innervated by CNX
73
Q

pharyngeal elevators

A

3 total
palatopharyngeus (CN X)
salpingopharyngeus (CN X)
stylopharyngeus (CN IX)

74
Q

prevalence of sleep apnea and snoring

A

24% of men, 13.8% of women

increases susceptibility with advanced age

75
Q

causes of snoring

A
  1. drooping of tongue (overweight, common)
  2. enlarged tonsils (palatine, younger)
  3. drooping of soft palate into the oral pharynx, blocking normal airflow through now (older, overweight)
76
Q

treatments for snoring

A

weight loss

palatouvuloplasty: surgical shortening of soft palate, typically to prevent or reduce snoring

77
Q

auditory tube opening

A

salphinopharyngeus and tensor palatine muscles pull on opposite sides of the cartilage of auditory tube to transiently open it during swallowing just as soft palate is raises, sealing oropharynx from nasopharynx
allows air from nasopharynx to move into middle ear

78
Q

infant feeding recommendations

A

never allow infants to drink flat on their backs
fluid in oropharynx can reflux into nasopharynx as soft palate moves to neutral position between swallowing
fluid in nasopharynx can be pulled into auditory tube and lead to otitis media

79
Q

lymphatics in CNS

A

channel found adjacent to superior sagittal dural sinus within dura matter in 2016

80
Q

what is waldeyers tonsillar ring

A

lymphatic ring

4 tonsils in both nasal and oral pharynx to “protect” the entrances to the respiratory and digestive tracts

81
Q

nasopharynx tonsils

A
  1. pharyngeal (adenoids): single, midline at roof of nasopharynx
  2. tubular: near opening of auditory tube, paired
82
Q

oropharynx tonsils

A
  1. lingual: base of tongue
  2. palatine: layman tonsils, in palatopharyngeal arch formed by palatoglossus and palatopharyngeal muscles
    superior constrictor of pharynx lies deep to the palatine tonsils
83
Q

2 groups of head and neck lymph nodes

A

superficial

deep cervical nodes

84
Q

Virchow’s node

A

signal node
firm, supraclavicular lymph node sufficiently enlarged so it is palpable
especially on left side
may be first recognized presumptive evidence for metastatic neoplasm of patient’s viscera

85
Q

structure of larynx

A 
9 cartilages
3 unpaired:
-thyroid
-cricoid
-epiglottic
3 paired:
-arytenoid
-corniculated
-cuniform
all hyaline cartilage except epiglottis, which is elastic cartilage
86
Q

thyroid cartilage

A

2 lateral plates (Laminae) which contain and oblique line and superior and inferior horns
attached to hyoid bone by thyrohyoid membrane
pierced by CNX and superior laryngeal artery

87
Q

oblique line of thyroid cartilage

A

site of attachment for 3 muscles:

  1. sternothyroid
  2. thyrohyoid
  3. inferior constrictor of pharynx
88
Q

function of androgen receptors on thyroid cartilage

A

when exposed to rising levels of androgens during puberty, grows in size and lengthens vocal cords, deepening voice

89
Q

male vocal cords

A

17.5-25 mm

90
Q

female vocal cords

A

12.5-17.5 mm

91
Q

spaces in larynx

A 
vestibule (above cords)
vestibular fold = false cord
ventricle (between false and true cords)
vocal fold = true cord (space between = glottis)
infraglottic cavity
92
Q

saccule

A

rare continuation of ventricle space between false and true cords

93
Q

posterior cricoarytenoid muscles

A

paired
largest and most important muscles of larynx
only major abductor of the vocal cords, responsible for opening the airway during inspiration
all other intrinsic muscles help close the rima glottis (opening between vocal cords)

94
Q

vocal cord paralysis

A

bilateral paralysis of posterior cricoarytenoid muscles

may require surgical cricothyrotomy, cricotomy tracheostomy, or intubation to allow air into lungs

95
Q

transverse arytenoid muscle

A

adducts vocal cords

pulling arytenoid cartilages together

96
Q

oblique arytenoid muscle

A

extends superiorly into aryepiglottic folds and forms aryepiglottic muscle
helps close vestibule of larynx during swallowing
pull epiglottic cartilage down

97
Q

action of crycothyroid muscle

A

increases tension on the true vocal cords
helps hit high notes
innervated by external laryngeal nerve, branch of superior laryngeal nerve, CN X

98
Q

what are hiccups

A

diaphragmatic spasm which causes a sudden inhalation of air which is interrupted by a reflex closure of the glottis

99
Q

what causes hiccups

A

large mean

alcoholic or carbonated beverages

100
Q

treatment for persistent hiccups

A

crushing one of the phrenic nerves to result in temporary paralysis of one hemidiaphragm

101
Q

why must fetuses hiccup

A

get amniotic fluid into lungs

102
Q

extrinsic muscles of larynx

A

have one attachment to the larynx and another to external structures
2 groups
1. suprahyoid
2. infrahyoid

103
Q

contraction of thyrohyoid muscle

A

causes laxity of hypoepiglottic membrane, allowing epiglottis to close over laryngeal inlet during swallow

104
Q

mucosa of interior of the larynx

A

primarily respiratory epithelium: pseudostratified columnar epithelium

105
Q

when does the mucosa convert to stratified squamous epithelium in the larynx?

A

over true vocal cords, epiglottis, and edge of laryngeal inlet
due to air turbulence in these areas`

106
Q

laryngeal cancer

A

13,000 americans annually
25% of head and neck cancers
increased risk at vocal cords, where one epithelial type transitions to another
95% of laryngeal cancers arise from squamous epithelial cells

107
Q

cure of laryngeal cancer

A

radiation and laryngeal preservation surgery can cure a high proportion of patients with early stages
5 year survival > 90% for stage 1

108
Q

epiglottitis

A

rare
inflammation of epiglottis
may interfere with breathing and present as a medical emergency
presentation: abnormal breathing sounds, difficulty swallowing

109
Q

treatment of epiglottitis

A

hospitalization
IV antibiotics
intubation

110
Q

laryngitis

A

inflammation of vocal cords
due to viral infection of resp epithelium within the larynx
common

111
Q

other causes of laryngitis

A

shouting/straining voice
breathing harsh chemicals
acid reflus

112
Q

appearance of vocal cords in laryngitis

A

white to red and thickened due to edema

loosens ones voice due to impaired vibration

113
Q

innervation of the larynx

A

supraglottic: internal laryngeal nerve (CN X)
infraglottic: recurrent laryngeal nerve (CN X)

114
Q

function of recurrent laryngeal nerve

A

mixed, both sensory and motor

motor to all intrinsic muscles of the larynx except cricothyroid

115
Q

innervation of cricothyroid

A

external laryngeal nerve, branch of superior laryngeal ( CN X)

116
Q

superior laryngeal nerve damage

A

unilateral damage to superior laryngeal nerve causes unilateral paralysis of cricothyroid and unilateral loss of sensation to supraglottic mucosa
weak, rough, easy fatiguing voice
loss of ability to sing high pitched

117
Q

recurrent laryngeal nerve damage

A

most common traumatic neurolaryngological lesion
unilateral damage = immediate flaccidity of ipsilateral vocal cords, loss of abduction and adduction, severe dysphonia to complete aphonia, and frequent aspiration

118
Q

treatment of permanent loss of recurrent laryngeal nerve

A

injections to place vocal cords in a fixed, paramedian position
may allow return of some voice and breathing

119
Q

loss of all innervation to laryngeal muscles

A

passive closure of the glottis necessitating intubation to keep glottis open

120
Q

vocal cord nodules

A

callous like
thicken the stratified squamous epithelium
typically due to overuse of voice

121
Q

tracheostomy

A

emergency airway below cricoid cartilage
cranial to isthmus of thyroid gland, through trachea
bypasses larynx

122
Q

tracheotomy

A

incising the trachea

below isthmus of thyroid gland

123
Q

cricothyroidotomy

A

incision through skin and cricothryroid membrane caudal to thyroid cartilage & cranial to cricoid cartilage
easiest to locate and perform

124
Q

Kah sound

A

soft palate elevation
CN X
forces air out of mouth

125
Q

La sound

A

test of tongue function

CN XII

126
Q

Ma sound

A

test of opening of mouth
CN VII
building oral pressure that is released when mouth is opened
CN X raises soft palate

GIR Test 4 (20 decks)

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