Clinical Relevance

Question 1

what is the significance of the carotid sinus

Answer 1

baroreceptors in wall, supplied by glossopharyngeal nerve detect blood gas levels

Question 2

what does the vagus nerve supply

Answer 2

motor - pharynx, larynx, palate, GIT and chest organs
sensory - tongue, external auditory meatus and EAM

Question 3

what is the sentinel node and if infected what does this mean

Answer 3

first node of that area to be biopsied and if it is infected then infection is not localised

Question 4

3 types of haemorrhage and cause

Answer 4

1. extra dural - middle meningeal artery
2. sub dural - cerebral veins
3. sub arachnoid - cerebral artery (berry aneurysm)

Question 5

what is a cavernous sinus thrombosis and how does it come about

Answer 5

bacterial infection in the face spreads to cavernous sinus via sphenoid emissary vein through pterygoid venous plexus. triggers blood clotting mechanism which can put pressure on CN VI. symptoms are swelling of eye as blood cannot drain from eye via ophthalmic veins and temperature

Question 6

sudden sharp facial pain caused by

Answer 6

trigeminal neuralgia which has no known cause other than it may be caused by compression of nerve around foramen ovale. treatment is carbamazepine, necrosis of nerve with alcohol or peripheral neurectomy

Question 7

in a blow to the parietal lobe what area might be damaged and what could this result in?

Answer 7

Broca’s area damaged so can’t form words in speech
Wernicke’s area damaged so can’t understand spoken language

Question 8

explain damage to CN XII in stroke

Answer 8

pyramidal decussation in lower medulla, the nerve from one side of the brain crosses over to the other. motor fibres are damaged so no innervation to the opposite side of the body and tongue is paralysed

Question 9

explain relevance of pineal gland

Answer 9

controls melatonin secretion for modulating sleep patterns and also circadian rhythms i.e. body clock

Question 10

what is vertebral basilar ischaemia

Answer 10

osteophytes press on vertebral artery temporarily blocking blood supply resulting in dizziness (osteoarthritis)

Question 11

if pupils do not constrict, what nerve has been damaged

Answer 11

CN III constrictor papillae

Question 12

patient has exaggerated reflexes, what might this suggest? What relevance has a Babinski effect?

Answer 12

stroke - positive response to Babinski reflex (plantar reflex)

Question 13

damage to sympathetic cervical trunk, what are they symptoms and what is this called?

Answer 13

Horner’s syndrome - ptosis, loss of sweating and constricted pupils as dilator pupillae damaged; loss of sympathetic innervation

Question 14

function of muscles of mastication

Answer 14

temporalis - elevate and retrude
masseter - elevate and retrude
medial pterygoid - elevate and protrude
lateral pterygoid - protrude and depress

Question 15

what is glue ear

Answer 15

inflammation of middle auditory tube from infection of nasopharynx, hypertrophy of tubular tonsils due to repeated throat infections. lymphoid tissue and increased mucous into auditory tube. treated by grommet to allow ‘new air’

Question 16

main problem associated with doing a biopsy of pharyngeal recess

Answer 16

very deep and close to internal carotid artery

Question 17

clinical name for nosebleed, what artery causes this and how do you treat your patient?

Answer 17

epistaxis - sphenopalatine artery - treat patient by sitting upwards to reduce venous pressure

Question 18

blockage of auditory tube

Answer 18

otitis media - use grommet to let new air in

Question 19

what are the 3 common causes of deafness

Answer 19

1. calcification of annular ligament or stapes
2. wax from cerumenous glands
3. glue ear

Question 20

explain referred pain in a heart attack

Answer 20

sensory fibres use sympathetic fibres to get up the neck and then into the spinal cord thus causing referred pain

Question 21

what nerve is likely to be affected if ptx experiences numbness in pinna / auricle of ear

Answer 21

greater auricular nerve (derived from cervical plexus receiving innervation from C2 & C3)

Question 22

what areas are supplied by greater auricular nerve

Answer 22

lower ear, ear lobe, skin over parotid gland and mastoid process

Question 23

following surgery on the side of the neck area, ptx experiences drooping eyelid and no sweating on that side. what is likely to have been damaged?

Answer 23

sympathetic trunk

Question 24

name another sign other than drooping eyelid and no sweating that is indicative of sympathetic trunk damage

Answer 24

constriction pupil on same side

Question 25

where does submandibular duct enter the mouth

Answer 25

sublingual near frenulum

Question 26

if surgery to sublingual area, what nerve is at risk?

Answer 26

lingual nerve

Question 27

upon laceration of the lip, there may be profuse bleeding; why?

Answer 27

rupture of facial artery (inferior labial branch), where the left and right branches anastomose

Question 28

what muscle of mastication is responsible for most protraction movements

Answer 28

lateral pterygoid

Question 29

tendon of which muscle inserts into the coronoid process of mandible

Answer 29

temporalis

Question 30

if a patient was to have a stroke / cerebrovascular accident affecting the RHS, name 2 main muscle groups affected

Answer 30

LHS of lower face and LHS of the tongue

Question 31

what nerve innervates motor supply of the tongue

Answer 31

hypoglossal

Question 32

which muscle is responsible for protrusion of the tongue

Answer 32

genioglossus

Question 33

what is the name for a long standing ear ache

Answer 33

chronic otitis media

Question 34

what nerve is at risk of damage during an operation to the middle ear

Answer 34

facial nerve

Question 35

what nerve causes the shoulders to roll

Answer 35

accessory nerve

Question 36

what muscle causes the shoulders to roll

Answer 36

trapezius

Question 37

what nerve innervates the carotid sinus

Answer 37

glossopharyngeal nerve

Question 38

in which area of the pharynx is it likely that a patient may get a fish bone stuck

Answer 38

pyriform fossa or vallecula

Question 39

ptx is admitted to A&E with bruising on the side of the head, which type of haemorrhage may have occurred

Answer 39

extra dural haemorrhage

Question 40

which blood vessel has been damaged in an extra dural haemorrhage

Answer 40

middle meningeal artery

Question 41

which cranial nerve supplies the larynx

Answer 41

vagus CN X

Question 42

which type of epithelium is found covering the larynx

Answer 42

stratified squamous epithelium

Question 43

when making full dentures, where should they be extended in relation to the mylohyoid line

Answer 43

should finish above the line

Question 44

where do the lymph nodes from the maxillary sinus drain

Answer 44

submandibular nodes

Question 45

extraction of a maxillary molar (possibly close to a sinus) may cause which problem

Answer 45

oroantral communication

Question 46

lymph node drainage of maxillary sinus

Answer 46

submandibular gland nodes

Question 47

lymph node drainage of oropharynx

Answer 47

cervical nodes

Question 48

muscle near submandibular gland

Answer 48

genioglossus

Question 49

muscle deep to zygomatic arch

Answer 49

temporalis

Question 50

damage to temporal branch of CN VII results in

Answer 50

inability to close eyelid thus cornea dries out

Question 51

if there is a loss of sensory supply to mucosa of larynx what nerve has been damaged

Answer 51

recurrent laryngeal nerve

Question 52

describe the epithelium of the larynx

Answer 52

pseudostratified columnar epithelium covers the majority of the larynx except from true vocal folds which is covered in stratified squamous epithelium

Question 53

describe oroantral communication

Answer 53

this can occur when roots positioned too close tot he maxillary sinus are extracted causing an opening between the maxillary sinus floor and oral cavity. when this occurs, fluid and food can come out of the nose when swallowing

Question 54

motor supply from vagus nerve

Answer 54

larynx, pharynx, palate, thorax, GIT

Question 55

sensory supply from vagus nerve

Answer 55

tongue and external auditory meatus

Question 56

where is the pineal gland located

Answer 56

behind the 3rd ventricle under the corpus callosum bathed in CSF

Question 57

osteosclerosis

Answer 57

calcification of annular ligament

Question 58

chronic otitis media

Answer 58

can cause tympanic membrane perforation due to infection in the medial ear that can lead to pus flowing into the external auditory meatus

Question 59

explain referred pain in heart attack

Answer 59

pain is felt in the neck due to sympathetic fibres of cervical sympathetic trunk travelling up from the heart. it can also be due to the homunculus model

Question 60

what can happen EJV in heart disease / hypertension caused by smoking

Answer 60

can become distended so EJV fills up, bulges and pulsates

Question 61

what is diplopia

Answer 61

double vision

Question 62

what causes diplopia

Answer 62

blow out fracture, sinusitis, MS, temporal arteritis which damages CN III / IV / VI

Question 63

Hodgkin lymphoma

Answer 63

malignancy of lymphatic system with multiple lymph nodes affected. reed-sternberg cells found

Question 64

non-Hodgkin lymphoma

Answer 64

lymphocytes become abnormal

Question 65

what is trismus and what causes it

Answer 65

it is reduced opening of the jaw and this can be caused by LA into the medial pterygoid muscle

Question 66

occult tumour

Answer 66

tumour located in the pharyngeal recess

Question 67

to tell difference between facial palsy and stroke

Answer 67

ptx will be unable to move eyebrows in facial palsy

Question 68

what can cause facial palsy

Answer 68

injection of LA into parotid gland which will anaesthetise muscles of facial expression