Doctors Acadamy - Head and Neck COPY Flashcards
what is the blood supply to the scalp?
- Supratrochlear Artery
- Supra orbital Artery
- Posterior audicular
- Occipital
what sinus is at risk during a mastoidectomy ?
sigmoid sinus
What are the 4 parasympathetic ganglion?
Cillary ganglion
Pterygopalentine ganglion
Submandibular ganglion
otic ganglion
what is the typical form of eye involvement in a patient with giant cell arteritis
AION
what is the typical biopsy finding in giant cell arteritis
inflammatory infiltration of the arterial wall at the transition between tunica adventitia and tunica media
What is secreted by the anterior pituitary gland?
- Prolactin
- FSH
- LH
- ACTH
- GH
- TSH
What is secreted by the posterior pituitary gland?
- Oxytocin
- Vasopressin (ADH)
what structures travel within the cavernous sinus
- Abducens Nerve
- Carotid Plexus
- internal carotid artery
Which structures travel within the lateral wall of the cavernous sinus
- Oculomotor Nerve
- Trochlear Nerve
- othamlmic (V1) and Maxillary (v2) branches of trigeminal
What is the nerve supply for the sensation of the external ear?
Upper 1/3 = Auriculotemporal (v3)
Middle 1/3 = Lesser Occipital (Cervical plexus)
Lower 1/3 = Greater Auricular Nerve (Cervical Plexus)
External Ear Canal = auricular branch of vagus
What is the nerve supply to the middle ear (sensation)
CN 9 - Glossopharyngeal
what is the nerve supply to the inner ear
CN 8 - vestibulocochlear
what is the nerve supply to the nose
External nasal branch of the anterior ethmoidal nerve
What 4 strucutres lie in close proximity to the parotid gland
- Facial Nerve
- Auriculotemporal nerve
- Superficial temporal artery
- retromandibular vein
which 2 veins contribute to the formation of the external jugular vein
- Posteiror auricular vein
- poterior division of the retromandibular vien
What are the contents of the anterior traingle
Nerves:
- Vagus nerve
- Hypoglossal Nerve
- Ansa Cervicularis
- Nerve to Mylohyoid
- Small branch of spinal accessory nerve
Artery:
- external carotid
- facial artery
- common carotid artery
Vein;
- facial veins
- internal jugular vein
- anterior jugular vein
Where are psomomma bodies found?
The Thymus
They are also commonly seen in papillary thyroid cancer
What condition would you suspect in a patient with bilateral parotid gland swelling?
- Sjograns if there are associated Autoimmune conditions e.g. Rheumatoid Arthritis + dry eyes and mouth etc
- Sarcoidosis can cause bilateral parotid swelling
- Mikulicz - presentation is similar but no dry eyes/ or arthritis
In what condition do you see Asteroid Bodies
Sarcoidosis
Where are Hassels Corpuscles found
In the medulla of the thymus
What are the features of Folicuar Thyroid cancer? what is the managment? what is the spread? and how do you monitor for it?
Demographic / Features: Females, iron defficient areas. Single Nodule
Managemet: total thyroidectomy +/- radioiodine
Spread: Haematogenous Spread (To the lung most commonly)
Monitor: Thyroglobulin
What are the features of Papillary Thyroid cancer? what is the managment? what is the spread? and how do you monitor for it?
Most common thyroid cancer (75%)
Features: Females, previous irradiation to neck. Multinodular. Papillary Projections. Psommoma bodies and orphan ani nuclei
Managment: Total thryoidecomy + central lymph node clearance if nodes involved
Monitor: Thyroglobulin
Spread: Lymphatic
What are the features of Anaplastic Thyroid cancer and what is the managment?
Common in Elderly Females
Local invasion is common
Managment: palliative debulking and palliactive chemotherapy.
What are the features of Medullary Thyroid cancer? what is the managment? what is the spread? and how do you monitor for it?
Features: They are tumours of the parafolicular C cells. Associated with MEN 2a and 2b. Multinodular.
Treatment: Total thyroidectomy + bilateral neck disection
Spread: Lymph and haem spread
Monitor: Calcitonin
What is the blood supply to the thyroid?
- Inferior thyroid artery (from thyrocervical trunk)
- Superior thyroid artery (From external carotid)
What antibodies are seen in Hashimotos thyroiditis
Anti TPO & anti thyroglobulin both raised
What abnormality of the parathyroid glands are most often found in MEN2 ?
Hyperplasia
What is the contents of the posteior traingle
Nerves:
- Accesory nerve
- Phrenic Nerve
- Trunks of brachial plexus
- branches of the cervical plexus
Artery:
- subclavian artery
Vein:
- External Jugular
What is the blood supply of the parathyroid glands
Inferior Thryoid Artery (Thyrocervial Trunk) - gives majority of blood supply
Superior thyroid artery (External Carotid)
in what facial layer would a haematoma form post thyroidectomy
pretracheal layer of the deep cervical fascia
which muscle splits the superficial from the deep lobe of the submandibular gland
mylohyoid
between which two muscles do pharyngeal pouches commonly arise
between the thyropharyngeas and the cricopharyngeas
what structures are commonly sacrificed in a radical neck disection
- sternocleidomastoid muscle (always)
- internla jugular vein
- accessory nerve
What are the branches of the external carotid
“Some Angry Ladies Figured Out PMS”
- Superior thryoid artery
- Asscending pharyngeal
- Lingual
- Facial
- Occipital
- Posterior auricular
- Maxillary
- Superficial Temporal
superficial temporal and maxillary arteries are your termainal branches
What are the branches of the Opthalmic Brach (V1) of the trigeminal Nerve?
- Frontal Nerve
- Lacriminal Nerve
- Nasocillary Nerve
- Supraorbital
- supra and infra trochlear
- external nasal
What are the branches of the Maxillary Branch (V2) of the trigeminal Nerve?
- Zygomatic Nerve
- Infra orbital Nerve
- Nasal nerves
- Greater and lesser palaentine
- Pterygopalentine Ganglion which gives off the Pharyngeal nerve
- Middle Meningeal nerve - accompanies middle meningeal artery and vein and supplies the dura
- Superior Alveolar Nerve - sensation to upper teeth
- Inferior Palprepal nerves - sensation eyelid and conjunctiva
- Superior labial - upper lip sensation
- zygomatofacial
- zygomatotemporal
What are the branches of the Mandibular Branch (V3) of the trigeminal nerve?
Sensory:
B - Buccal
A - Auriculotemporal
I - Inferior Alveolar
L - Lingual
Motor:
- Masseter
- Medial and lateral pterygoid
- temporalis
- TEnsor TEmpani
- Nerve to tensor veli pallitini
- Nerve to mylohyoid
- Nerve to ant belly of the diagastric
Name the suprahyoid muscles and their nervous innervation
Suprahyoid Muscsles:
- Mylohyoid
- Stylohyoid
- Geniohyoid
- Ant and Post belly of the
Nervous Innervation
- Mylohyoid - Nerve to Mylohyoid (Branch of V3)
- Stylohyoid - Facial Nerve
- Geniohyoid - Hypoglossal nerve
- Diagstric:
- Anterior belly - Nerve to Mylohyoid (branch of V3)
- Post Belly - facial nerve
What are the Infra hyoid (strap) muscles and what are their nervous innervation?
Infrahyoid Muscles:
- Sternohyoid
- Omohyoid
- Thyrohyoid
- Sternothyroid
Nerveous Innervation:
All supplied by Ansa Cervicularis appart from Thyrohyoid which is supplied by C1 fibres from Hypoglossal nerve
A hoarse voice is caused by damage to which nerve?
Recurrant Laryngeal Nerve
Airway obstruction can be caused by damage to what nerve
medial fibres of the recurrant laryngeal nerve
Loss of ability to make high pitched sound is caused by damage to which nerve?
Superior laryngeal nerve (supplies cricothyroid muscle which stretches vocal cords)
What antibodies are seen in Graves disease
- Anibodies to TSH receptors on thyroid
- TRAB antibodies
- TSI antibodies
What antibodies do you get in de quervans thyroiditis
none - it is a post viral inflamation, no autoantibodies are produced
if a patient presents with a hard woody swelling in the neck + hypothyroidism what is your top differential?
Riedles thyroditits
what are the contents of the carotid sheath?
- Common carotid artery
- Internal carotid artery
- Internal jugular vein
- Vagus nerve
Damage to which nerve is most likely to cause hyperacousia?
Facial Nerve
when is secondary haemorrhage most likely to occur following tonsillectomy
5-10 days
What is the treatment for benign parotid gland tumours?
Superficial Paritodectomy
If the question says there is a lesion at the cerebropontine angle what does this mean it likely is?
Acustic Neruoma
Name the structures found within the parotid gland and list them superior to deep
- Facial Nerve
- Retromandibular vein
- Superficial Temporal Artery
Which of the structures listed below lies posterior to the carotid sheath at the level of the 6th cervical vertebra
cervical sympathetic chain
From which vessels is the retromandibular vein formed?
The retromandibular vein is formed from the union of the maxillary and superficial temporal veins.
What is the sensation of the tongue?
Posterior 1/3: Glossopharyngeal
Anterior 1/3:
- General Sessation: lingual
- Taste specific sensation: Chordae tympanae (branch of fascial)
Where are oxyphil cells found/
Parathyroid gland
From what vessel does the middle menineal artery arise?
Maxillary artery
Damage to which vessel most common causes extra dual haemorrhages
Middle meningeal artery (branch of the maxillary artery)
What are the layers passed through when performing a lumbar puncture?
- skin
- subcutaneous tissue
- supraspinous ligament
- interspinous ligament
- ligamentum flavum
- epidural space
- dura
- arachnoid
- subarachnoid space.
The superior and redcurrant laryngeal nerves are branches of what nerve?
Vagus nerve
Which nerve is most commonly damaged in a superficial parotidectomy?
Greater auricular nerve
What nerve innervates the muscles of the tongue ?
Hypoglossal nerve
The sphenopalentine artery is a branch of what artery?
Maxillary artery
The middle meningeal artery is a branch of what artery?
The maxillary artery
If a patient develops a “breathy” sounding voice post tonsillectomy, what is the cause?
Unilateral inferior laryngeal nerve palsy
Which muscle(s) cause abduction and adduction of the vocal cords?
Abduction: posterior cricoarytenoid
Adduction: lateral cricoarytenoid, thyroarytenoid, interarytenoid, and cricothyroid
Which nerve carries the nerves for lacrimation?
Greater petrosal nerve
If the middle meningeal artery is lighted, what associated nerve may be damaged
The auriculotemporal nerve
Where does the chorda tympani nerve lie in relation to the pars flaccida
The chorda tympani passes on the medial side of the pars flaccida
What cell type is the tympanic membrane made up of?
Outer layer - stratified squamous epithelium
middle layer - fibours tissue
inner layer - mucus membrane which is consistent with the inner ear
Using the thy 1-5 classification for FNA findings of thyroid cancer, what is the treatment for each stage?
Thy 1 and 2 = likely benign
Thy 3a (atypical cells present) = do a core biopsy
Thy f (follicular cells present) = hemithryoidectomy
Thy 4 and 5 (likely malignant) = total thyroidectomy
In a tenitiam scan what does a hot and Cold nodule represent
Cold nodule - malignant
Hot nodule - benign
What is the treatment of Graves’ disease
- Carbomazapine (unless in first trimester of pregnancy then you use propylthiouracil)
- Radioiodine
- Partial or total thyroidectomy - patient must be euthyroid first which can be achieved by using lugals iodine
What is the most common type of brain tumour in children
Astrocytoma
What is a common complication of mastoiditis
Dural venous thrombosis
What level does the vertebral artery enter the transverse foramena
C6 (it then traverses the foramena of C6-C1)
Which muscles of mastication elevate and depress the jaw
All muscles of mastication elevate the jaw apart front he lateral pterygoid which depresses the jaw
In which bones are the 12 cranial fossa found
They are all found in the sphenoid bone apart from:
- internal autistic meats + jugular foramen - Temporal bone
- Hypoglossal foramen + foramen magnum - Occipital bone
Which cranial nerves carry parasympathetic fibres
10, 9, 7, 3
If a patient presents with thyroid swelling and CD20 what is the diagnosis
Lymphoma
Which organism is associated with nasal cancer
EBV
