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Medicine year 3- EOCP > ENT > Flashcards

ENT Flashcards

1
Q

Vocal cords

A

Folds of connective tissue that stretch across the opening of the larynx and produce a person’s voice

Air is expelled between adducted vocal cords
This results in them vibrating
The intrinsic muscles of the larynx affects the shape, tension and position of the cords to produce sounds of different pitch and character

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2
Q

Nasal turbinates

A

These are what cleanse and humidify air that passes through the nostrils into the lungs

There are 3 on the lateral wall of the nasal cavity - the superior, middle and inferior

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3
Q

Boundaries of the nasal cavity

A

Roof: frontal, ethmoidal and sphenoidal sinuses and the skull base

Floor: palatine process of the maxilla, horizontal plate of the palatine bone

Medial wall: nasal septum

Lateral wall: 3 nasal turbinates

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4
Q

Sinuses

A

Air-filled, bony cavities in the skull which drain in to the nasal cavity

There are 4 paired ones - maxillary, ethmoid, frontal, sphenoid

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5
Q

Waldeyers tonsillar ring

A

A ring of lymphoid tissue in the pharynx (back of throat) consisting of (from top to bottom):
- adenoids
- tubal tonsils
- palatine tonsils- most commonly affected in tonsilitis
- the lingual tonsil

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6
Q

Middle ear

A

• Tympanic membrane- separates external and middle ear
• Ossicles- Malleus, Incus, Stapes
• Eustachian tube- connects the middle ear and the nasopharynx

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7
Q

Role of inner ear

A

Controls equilibrium, hearing sensors

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8
Q

Nasal sinuses

A

• Paranasal sinuses- mucus lined, air filled cavities that surround the nasal cavity, function to clean, warm and moisten air
• Olfactory cells connect to the olfactory nerve (cranial nerve I) and are responsible for the sense of smell
• Helps provide resonance for the voice

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9
Q

Examination findings of tonsilitis

A

The tonsils are symmetrical, enlarged and have a white exudate coating

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10
Q

Quinsy (peritonsillar cellulitis)

A

The tonsils are not enlarged, they are symmetrical in size, the are surrounding the tonsils is known as the peritonsillar area and is swollen and bulging, it pushes the anterior arch medially. Requires treatment with drainage.

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11
Q

Neck anatomy

A

• Anterior triangle- carotid, jugular, vagus and ansa-cervicalis, hypoglossal nerve, submandibular gland, strap muscles, thyroid
• Posterior triangle- Accessory nerve, Cervical plexus, Lymph nodes, muscles

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12
Q

Virchows node

A

Lymph node located in the left supraclavicular area, has clinical significance as can be due to metastatic malignancy, infection. Neck examination can identify other prominent nodes

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13
Q

Thyroglossal cyst

A

Common in children remnant of the thyroglossal tract, largely asymptomatic but can become inflamed during acute infection. Usually located higher up in the neck and in the midline

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14
Q

Goiter

A

Palpable neck lump that moves during swallowing, can be smooth or irregular. Can compress the trachea. Get a detailed history of the thyroid

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15
Q

Amblyopia

A

Decrease in visual acuity caused by visual deprivation during childhood, for which there is no identifiable pathology in the eye or visual pathway

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16
Q

Anterior chamber

A

Aqueous humour-filled space between the posterior surface of the cornea (endothelium) and the iris.

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17
Q

Choroid

A

Pigmented, vascular layer of the eye that lies between the sclera and the retina. Supplies blood to the outer layers of the retina.

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18
Q

Ciliary body and Ciliary zonules

A

Ciliary body- A posterior extension of the iris, consists of ciliary processes that produce aqueous humour, ciliary zonules that hold the crystalline lens in place, and the ciliary muscle which facilitates lens accommodation.

Ciliary zonules- thin fibrous strands that connect the ciliary body to the crystaline lens

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19
Q

Conjunctive and cornea

A

Conjunctiva- Vascularised, transparent tissue that lines the sclera and the posterior aspect of eyelids.

Cornea- Transparent five-layered tissue that forms the major refractive component of the eye.

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20
Q

Corneal endothelium, corneal epithelium

A

Corneal endothelium- Posterior layer of the cornea, made of hexagonal cells. Maintains optical transparency by actively pumping water out of the cornea.

Corneal epithelium- Anterior layer of the cornea which acts as a barrier against foreign material. Heals without forming scar tissue.

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21
Q

Corneal stroma and extraocular muscles

A

Corneal stroma- Middle layer of the cornea, making up 90% of corneal thickness. Contains collagen fibrils of uniform diameter and spacing that create an optically transparent layer.

Extraocular muscles- Extrinsic muscles of the eye responsible moving the eye to fixate on an object.

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22
Q

Fovea and Iris

A

Fovea- central part of the macula of the retina containing the highest density of cone cells to provide sharp and colour vision

Iris- pigmented layer of the eye responsible for controlling pupilary diameter and thus the amount of light entering the eye

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23
Q

Glaucoma

A

Optic nerve damage frequently, but not always, associated with raised intraocular pressure (IOP). Open-angle glaucoma: Refers to the angle made by the iris and cornea which is “open”. This is the most common form of glaucoma worldwide.
Closed-angle glaucoma: Refers to the iris creating a narrow angle with the cornea, blocking the trabecular meshwork which lies in between. This form of glaucoma may develop slowly over time, or may develop acutely “acute closed-angle glaucoma”.

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24
Q

Ishihara test, keratitis

A

Ishihara test- a test to screen for red green colour blindness

Keratitis- inflammation of the cornea

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25
Q

Lens, Leukocoria

A

Len- The crystalline lens of the eye is responsible for refracting light on to the retina, and enabling near vision via accommodation.

Leukocoria- A white pupillary reflex on distant direct ophthalmoscopy, signifies presence of significant ocular pathology.

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26
Q

Limbus, Macula

A

Limbus- Another name for the junction between the cornea and sclera.

Macula- Pigmented central region of the retina, responsible for high-resolution colour vision.

27
Q

Meibomian glands, Optic disc/Optic nerve head

A

Meibomian glands- Located within the tarsal plate of the eyelids. Produce the superficial, lipid layer of the tear film.

Optic disc/ Optic nerve head- The point of exit for retinal ganglion cell axons leaving the eye as they form the optic nerve. Visible as an orange-yellow oval structure at the posterior-nasal aspect of the retina.

28
Q

Optic neuritis, Papilledema

A

Optic neuritis- Inflammation of the optic nerve due to various aetiology (demyelination, infection etc.)

Papilloedema- Optic nerve swelling secondary to raised intracranial pressure.

29
Q

Posterior chamber, Pupil

A

Posterior chamber- Aqueous humour filled space between the iris and the anterior surface of the lens.

Pupil- A black hole at the centre of the iris to allow light to enter the eye.

30
Q

Retina, Sclera

A

Retina- Light sensitive layer at the back of the eye responsible for conversion of light energy into nerve impulses via phototransduction.

Sclera- White, tough, fibrous coat of the eye that helps maintain its shape.

31
Q

Squint/strabismus
Tarsal plate
Vitreous humous

A

Squint / strabismus- Misalignment of the eyes.

Tarsal plate- Dense connective tissue that provides structural support to eyelids.

Vitreous Humour- A clear gel that fills the space between the posterior surface of the lens and the retina.

32
Q

Visual pathway

A

Retina -> Optic nerve -> Optic chiasm -> Optic tract -> LGN (Lateral Geniculate Nucleus) -> Optic radiation -> Striate cortex

33
Q

How the image on the retina appears in real life

A

The image on the retina appears inverted to real life. Quadrant 1 which is in the Superior Temporal lobe moves to the Inferior Nasal quadrant. Quadrant 2 which is in the superior nasal location moves to the inferior nasal lobe
The optic nerve goes through the optic chiasm and along the optic tract.

34
Q

How light is transported through the optic chiasm

A

• Information from the nasal retina (1,2,7,8) crosses over at the chiasm i.e. going from the left eye to the right optic tract.
• Information from the temporal retina (3,4,5,6) remains on the same side
• All information from the right half of both visual fields is transferred to the left optic tract (3,4,7,8) i.e. the left half of the left and right eye
• All information from the left half of both visual fields is transferred to the right optic tract (1,2,5,6)

35
Q

How light is transported through the optic radiation

A

• From LGN -> Lateral fibres (Mayers loop) -> Carry information about the inferior retinal field, because the image was inverted it corresponds to the superior visual field -> Primary visual cortex
• From LGN -> Medial fibres -> Pass through the parietal lobe -> Carry information about the superior retinal field because the image was inverted it corresponds to the inferior visual field -> Primary visual cortex

36
Q

PITS

A

Parietal lobe -> inferior visual fields. Temporal lobe -> superior visual field.

37
Q

Where the different quadrants end up

A

• Left optic tract, Lateral loop temporal- 3,7
• Left optic tract, Medial loop parietal- 4,8
• Right optic tract, Medial loop parietal- 2,6
• Right optic tract, Lateral loop temporal- 1,5

38
Q

Light reflex

A

• Light is shone to the left eye and is picked up by the retina
• Information is picked up by the optic nerve and goes through the optic chiasm to the optic tract.
• Before the LGN there are some branching fibres which go to the midbrain
• It goes to the Pretectal area and then via interneurons to the Edinger-Westphal nucleus. One pretectal area connects to both Edinger-Westphal nuclei. There is bilateral innervation of the nucleus
• The Edinger-Westphal nuclei is the parasympathetic nuclei of Cranial nerve III. The Oculomotor cranial nerve continues to the Ciliary ganglion. Post ganglionic fibres continue via the short ciliary nerve to the iris and causes constriction of the pupil
• The bilateral innervation of the Edinger-Westphal nucleus means there is constriction of both pupils so you have a direct and consensual response

39
Q

Sphincter and Dilator pupillae muscles of the iris

A

Sphincter pupillae muscle of the iris= Circular muscles, Parasympathetic, Constriction/miosis

Dilator pupillae muscle of the iris= Radial muscle, Sympathetic, Dilation/mydriasis

40
Q

Afferent limb of the pupillary reflex

A

Light -> Cornea -> Pupil -> Lens -> Vitreous -> Retina -> Optic nerve -> Optic chiasm -> Optic tract -> Pre-tectal area

41
Q

Relative afferent pupil defect (RAPD)

A

• Swinging light test/Marcus Gunn test
• Problems with optic nerve or retina
• Shine the eye from eye to the other and look at the pupil response
• Each pupil should construct quickly and equally to both direct (light to the eye) and consensual (light to the other eye) application of light

42
Q

Normal response to the swinging light test

A

Dimly lit room, distant focus i.e. get them to look at something far away. A light is shone in one eye and you get bilateral constriction from both eyes, when shone to the other eye the same happens.

43
Q

Left afferent pupil defect (RAPD)

A

• Dimly lit room, distant focus
• When the light is shone in the right eye you get bilateral constriction
• When the light is shone in the left eye you get abnormal constriction as it appears to dilate

44
Q

What is required for the accomodation reflex:

A

The process of focusing on objects as they move closer.
• Pupillary constriction
• Increased refractive power of the lens
• Convergence of the eyeballs

45
Q

Accomodation reflex- pupil constriction and Lens

A

• Pupil constriction- Corticobulbar fibres activate the parasympathetic pathway as in the light reflex through to the pretectal area from the primary visual cortex. Bilateral innervation of the Edinger-Westphal nuclei and fibres sent down the Occulomotor nerve causing pupil constriction
• Lens- the short ciliary nerve also supplies the ciliary muscle. Contraction of this muscle relaxes the zonular fibres. The lens becomes fatter, increased refraction for near vision

46
Q

Accommodation reflex- Ciliary muscles, Convergence

A

• Ciliary muscles= the ciliary muscle is circumferential. Contraction causes anterior movement of the ciliary process as it removes tension on the suspensory ligament. This reduces the tension on the fibres. The lens becomes fatter (globular)
• Convergence- Oculomotor (CNIII) nucleus activation. CN III stimulates the contraction of the medial rectus bilaterally. The eyes converge and move medially.

47
Q

Outer ear

A

Outer ear structures include the pinna and the external ear canal. The opening of the ear canal is termed the external auditory meatus. The function of the outer ear is to funnel sound waves towards the tympanic membrane which forms the boundary between the outer and middle ear.

48
Q

Middle ear

A

The middle ear lies medial to the tympanic membrane and is lined by modified respiratory mucosa. The middle ear is filled with air. The opening of the eustachian tube is located on the medial wall of the middle ear space and communicates with the nasopharynx, maintaining normal air pressure within the middle ear and allowing drainage of secretions produced by the middle ear mucosa.. The ossicular chain connects the tympanic membrane to the cochlea. Its made of 3 bones, the malleus, the incus and the stapes which attaches to the oval window

49
Q

Inner ear

A

Consists of the cochlea and the vestibular system. The cochlea is the organ of hearing whereas the vestibular system (made up of a central chamber called the vestibule and three semi-circular canals) controls balance. The function of the cochlea is to convert the vibrations into a neurological signal that is then transmitted along the auditory nerve, the eighth cranial nerve to the brain.

50
Q

Rhinne test

A

• Tuning fork is placed on the mastoid process then in front of the ear
• Rhinnes positive = normal finding / sn loss = AC > BC = louder in front of the ear than the mastoid
• Rhinnes negative = conductive hearing loss = BC > AC = louder at the mastoid process

51
Q

Webers test

A

• Tuning fork is placed in the middle of the forehead to test for lateralisation of sound
• No lateralisation = normal
• Conductive hearing loss = sound hear best in the abnormal ear
• Sensorineural hearing loss = sound heard best in the normal ear

52
Q

Typanometry

A

• Tests the mobility and function of the tympanic membrane
• It can help to diagnose any fluid in the middle ear/ otitis media/ perforation/ eustachian tube dysfunction

53
Q

Typanometry results

A

• Include’s peak or lack of peak (flat line) which indicates; perforated membrane, otitis media, or obstruction of canal.
• Normal = normal movement and pressure, no fluid
• Flat line = stiff tympanic membrane / perforation / fluid / occlusion of the canal

54
Q

Audiometry

A

• A measurement of hearing by playing a variety of bones and volumes
• It uses headphones to test air conduction
• And an oscillator to test bone conduction (sends sounds directly through the bones of the skull)

55
Q

Audiogram

A

• Charts which document the volume at which patients can hear different tones
• Frequency in Hz is plotted on the x-axis (low to high pitched)
• Volume in dB is plotted on the y-axis
• Hearing is tested in both ears separately
• Air and bone conduction are tested independently
• Hearing is tested to establish the quietest volume at which a patient can hear each frequency
• The louder the volume has to be for the patient to hear, the worse their hearing is and the lower down on the chart they will plot
• 0 to 25db are normal

56
Q

Otoacoustic emissions

A

• Used in the newborn hearing screening programme
• Otoacoustic emissions are generated by the hair cell as part of the way sound energy is amplified by the cochlea
• Otoacoustic emissions are only generated by a healthy cochlea, they aren’t audible but can be recorded with a specialised microphone

57
Q

Congenital hearing loss

A

Any hearing loss present at birth. It is usually sensorineural in nature and may be genetic or caused by in-utero events such as maternal infections, illnesses or birth trauma. The neonatal hearing screening programme uses otoacoustic emmisions to identify individuals with congenital hearing loss so that early intervention can be initiated to enable normal acquisition of speech and language.

58
Q

When to treat acute otitis media

A

Acute otitis media that does not improve after 48 hours, or is associated with fever or >390c or suspicion of a complication of otitis media such as mastoiditis should be treated with oral antibiotics.

59
Q

Causes of conductive hearing loss

A

• Wax impaction
• Otitis externa
• Otitis media with effusion / acute otitis media
• Perforated ear drum
• Ossicular discontinuity - traumatic disruption of the ossicular chain
• Otosclerosis

60
Q

Otosclerosis

A

• The bones surrounding the cochlear become fixed in place, the cochlear cannot vibrate due to abnormal bone growth in the area
• Otosclerosis is treated either by hearing aids or by an operation called a stapedectomy where the abnormal bone that fixes the stapes is surgically removed and a new, prosthetic stapes bone is inserted.

61
Q

Presbyscusis

A

• Age related hearing loss
• Affects higher frequencies first because degeneration of the cochlear hair cells first occurs at the base which are responsible for higher frequencies
• Usually affects both ears to a similar degree

62
Q

Causes of sensorineural hearing loss

A

• Trauma (including ear surgery)
• Idiopathic
• Infection (complication of acute otitis media, labyrinthitis)
• Ototoxic medication
• Noise exposure
• Presbyacusis
• Vestibular schwannoma
• Menieres disease

63
Q

Vestibular schwannoma

A

• Symptoms- unilateral tinnitus and hearing loss
• A slow growing, benign nerve sheath tumour arising from the 8th cranial nerve
• Large vestibula schwannoma can cause facial numbness due to intracranial compression of the trigeminal nerve
• Facial nerve weakness and dizziness are rarer symptoms, large ones can cause raised intracranial pressure
• Treatment- Small tumours are simply observed with serial MRI scans, larger tumours may be treated with stereotactic radiosurgery (highly focused, high-dose radiotherapy) or surgery.

Medicine year 3- EOCP (27 decks)

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