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ENT Flashcards

1
Q

Name the four major components of the upper respiratory tract

A
  1. Nose (and nasal passages)
  2. Paranasal sinuses
  3. Pharynx
  4. Larynx
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2
Q

Name the three regions of the inner nasal cavity (3):

A

Name the three regions of the inner nasal cavity (3):
1. Vestibule closest to the tip of the nose
2. Respiratory
3. Olfactory regions closest to cribiform plate

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3
Q

The vestibule portion of the nose is lined with _

A

The vestibule portion of the nose is lined with skin

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4
Q

The respiratory portion of the nose is lined with _

A

The respiratory portion of the nose is lined with mucosa and it is highly vascular

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5
Q

The olfactory region of the nose is the location of [specialized cells]

A

The olfactory region of the nose is the location of olfactory receptor neurons

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6
Q

The _ bone provides the roof of the inner nasal cavity and the medial and lateral walls

A

The ethmoid bone provides the roof of the inner nasal cavity and the medial and lateral walls

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7
Q

The anterior portion of the roof of the nasal cavity is formed by [bone]

A

The anterior portion of the roof of the nasal cavity is formed by frontal bone

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8
Q

The [cartilagenous + bony region] divides the nose

A

The nasal septum divides the nose
* Cartilage + ethmoid and vomer bone

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9
Q

The _ bone forms the external bridge between the orbits

A

The frontal bone forms the external bridge between the orbits

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10
Q

The posterior portion of the nasal cavity roof is formed by the _ bone

A

The posterior portion of the nasal cavity roof is formed by the sphenoid bone

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11
Q

In addition to the ethmoid bone, part of the medial wall is formed by the _ bone

A

In addition to the ethmoid bone, part of the medial wall is formed by the vomer bone

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12
Q

The floor of the nasal cavity is formed by [bone] and [bone]

A

The floor of the nasal cavity is formed by maxilla and palatine

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13
Q

The lateral wall of the nasal cavity is formed by the _ bone

A

The lateral wall of the nasal cavity is formed by the maxilla

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14
Q

We have three turbinates in the nose, the _ , _ , and _

A

We have three turbinates in the nose, the inferior , middle , and superior

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15
Q

The turbinates’ bony component is called _ , but the term turbinate includes the mucosa lining

A

The turbinates’ bony component is called conchae but the term turbinate includes the mucosa lining

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16
Q

The purpose of the turbinates is to _

A

The purpose of the turbinates is to humidify and warm the air
* Turbinates provide a large surface area –> cause tubulent mixing which helps to warm and humidify

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17
Q

ID the three turbinates

A
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18
Q

The [structures] are the spaces between the turbinates that direct airflow and allow drainage from the sinuses/ nasolacrimal duct

A

The meatuses are the spaces between the turbinates that direct airflow and allow drainage from the sinuses/ nasolacrimal duct
* Inferior, middle, superior meatuses

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19
Q

The superior meatus drains the _ sinus

A

The superior meatus drains the posterior ethmoid sinus
* Located between the superior and middle turbinate

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20
Q

The middle meatus drains the [sinuses]

A

The middle meatus drains the frontal, anterior and middle ethmoid, maxillary sinuses
* Located between the middle and inferior turbinates

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21
Q

The inferior meatus drains the _

A

The inferior meatus drains the nasolacrimal duct (drains tears from the eye)
* This is why the nose runs when a person cries

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22
Q

The sphenoid sinus is drained by the _

A

The sphenoid sinus is drained by the sphenoethmoidal recess
* Also helps drain the posterior ethmoid sinus

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23
Q

The nose’s blood supply branches off of two major arteries, _ and _

A

The nose’s blood supply branches off of two major arteries, internal carotid and external carotid

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24
Q

_ is a collection of small vessels that supplies the anterior nasal septum

A

Kiesselbach plexus is a collection of small vessels that supplies the anterior nasal septum
* Branches off of internal and external carotid arteries

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25
Q

_ is a collection of vessels responsible for posterior epistaxis

A

Woodruff’s plexus is a collection of vessels responsible for posterior epistaxis
* These nose bleeds are generally more severe

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26
Q

Anterior nose bleeds arise from bleeding at the [vessels]

A

Anterior nose bleeds arise from bleeding at the Kiesselbach plexus
* These are more common and less severe

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27
Q

Special sensory innervation to the nose comes from [nerve], while sensory innervation comes from [nerve]

A

Special sensory innervation to the nose comes from CN I, while sensory innervation comes from CN V

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28
Q

The nasal septum and the lateral walls of the nose are innervated by branches of [nerve]

A

The nasal septum and the lateral walls of the nose are innervated by branches of V1

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29
Q

The postero-inferior half to two-thirds of the nasal mucosa is innervated by [nerve]

A

The postero-inferior half to two-thirds of the nasal mucosa is innervated by V2

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30
Q

In addition to conchae, [nasal cavity feature] also helps to increase temperature of air

A

In addition to conchae, rich vascular network (capillaries) also helps to increase temperature of air

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31
Q

Olfactory receptor cells of CN I are found in the _ of the _ bone

A

Olfactory receptor cells of CN I are found in the cribiform plate of the ethmoid bone
* Responsible for smell

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32
Q

Mucus and vibrissae (stiff hairs in nose) help to [function]

A

Mucus and vibrissae (stiff hairs in nose) help to filter debris in the air

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33
Q

Allergies cause a runny nose via histamines triggering _

A

Allergies cause a runny nose via histamines triggering capillary leakage

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34
Q

Name the (4) paranasal sinuses

A

Name the (4) paranasal sinuses
1. Frontal
2. Sphenoid
3. Maxillary
4. Ethmoid

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35
Q

ID the sinus

A

Ethmoid sinus

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35
Q

ID the sinus

A

Frontal sinus

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36
Q

ID the four paired paranasal sinuses

A
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37
Q

The small canals that connect the sinuses to the lateral nasal wall are called _

A

The small canals that connect the sinuses to the lateral nasal wall are called ostia
* Form the osteomeatal complex

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38
Q

The frontal, ethmoid, sphenoid sinuses/bone are innervated by [nerve]

A

The frontal, ethmoid, sphenoid sinuses/bone are innervated by opthalmic nerve (V1)

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39
Q

The maxillary sinus is innervated by [nerve]

A

The maxillary sinus is innervated by maxillary nerve (V2)

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40
Q

Blood supply to the frontal and ethmoid sinuses comes from branches of [artery]

A

Blood supply to the frontal and ethmoid sinuses comes from branches of opthalmic artery (from internal carotid)

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41
Q

Blood supply to the sphenoid and maxillary sinuses comes from branches of [artery]

A

Blood supply to the sphenoid and maxillary sinuses comes from branches of maxillary artery (external carotid)

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42
Q

ID the bone

A

Ethmoid bone

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43
Q

ID the bone

A

Sphenoid bone

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44
Q

ID the bone

A

Frontal bone

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45
Q

Name (4) functions of the paranasal sinuses:

A

Name (4) functions of the paranasal sinuses:
1. Lighten the weight of the head
2. Activate immune system against pathogens
3. Humidies inspired air
4. Increase vocal resonance

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46
Q

The pharynx is a shared space for air and food until [region] where the respiratory and GI tracts will diverge

A

The pharynx is a shared space for air and food until laryngopharynx where the respiratory and GI tracts will diverge

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47
Q

ID the (3) regions of the pharynx

A
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48
Q

Name the borders of the nasopharynx:
Superior:
Inferior:
Anterior:
Posterior:

A

Name the borders of the nasopharynx:
Superior: skull base
Inferior: soft palate
Anterior: back of nose
Posterior: vertebral bodies

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49
Q

Another name for the eustachian tube is _

A

Another name for the eustachian tube is pharyngotympanic tube
* Tells you that it connects the nasopharynx to the middle ear
* Functions to equalize pressures of the middle ear

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50
Q

ID the structure found in the nasopharynx

A

Adenoid (pharyngeal tonsils)

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51
Q

If an adult presents with unilateral fluid in the ear you need to rule out _

A

If an adult presents with unilateral fluid in the ear you need to rule out nasopharyngeal carcinoma
* A mass can cause chronic otitis media

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52
Q

The primary blood supply to the nasopharynx is _

A

The primary blood supply to the nasopharynx is ascending pharyngeal artery (external carotid branch)

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53
Q

Venous drainage of the nasopharynx occurs via the _ and _

A

Venous drainage of the nasopharynx occurs via the pterygoid plexus and pharyngeal venous plexus
* These go into the internal jugular vein

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54
Q

The nasopharynx is innervated by the pharyngeal plexus which gets contributions from [CN] and [CN]

A

The nasopharynx is innervated by the pharyngeal plexus which gets contributions from glassopharyngeal nerve and vagus nerve
* The sympathetic fibers from the superior cervical ganglion also contribute to motor innervation

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55
Q

The anterior roof of the nasopharynx gets sensory innervation from [CN]

A

The anterior roof of the nasopharynx gets sensory innervation from V2

56
Q

The oropharynx extends from [soft tissue structure] to the [bone]

A

The oropharynx extends from uvula to the hyoid bone

57
Q

The _ tonsils are the ones best visualized inside a patient’s mouth

A

The palatine tonsils are the ones best visualized inside a patient’s mouth

58
Q

The [structure] closes the nasopharynx off when swallowing

A

The uvula closes the nasopharynx off when swallowing

59
Q

_ provides blood supply to the oropharynx

A

Facial artery provides blood supply to the oropharynx

60
Q

The oropharynx is innervated by [CN]

A

The oropharynx is innervated by glossopharyngeal nerve

61
Q

Inflammation of the nasal mucosa is simply called _

A

Inflammation of the nasal mucosa is simply called rhinitis
* Can have allergic rhinitis or nonallergic rhinitis

62
Q

Allergic rhinitis, aka hay fever, is caused by [type] hypersensitivity reaction

A

Allergic rhinitis, aka hay fever, is caused by Type 1 hypersensitivity reaction
* IgE mediated
* Degranulation of mast cells –> histamine release

63
Q

Inflammation of the mucosa of paranasal sinuses is called _ while inflammation of the sinuses and nasal cavity mucosa is called _

A

Inflammation of the mucosa of paranasal sinuses is called sinusitis while inflammation of the sinuses and nasal cavity mucosa is called rhinosinusitis

64
Q

Subacute sinusitis is defined as symptoms for [time]

A

Subacute sinusitis is defined as symptoms for 4-12 weeks
* < 4 weeks: acute
* > 12 weeks: chronic
* Recurrent > 4 episodes/year

65
Q

The most common viral cause of rhinosinusitis is _

A

The most common viral cause of rhinosinusitis is rhinovirus
* Other causes include RSV, influenza, adenovirus, parainfluenza virus

66
Q

Acute rhinosinusitis is only bacterial 1-2% of the time; most common bugs are _ , _ , _

A

Acute rhinosinusitis is only bacterial 1-2% of the time; most common bugs are Strep pneumo , H flu , Moraxella
* Suspect bacterial infection if symptoms last more than 10 days without improving

67
Q

Fungal rhinosinusitis occurs in _ individuals; most common pathogens are _

A

Fungal rhinosinusitis occurs in immunocompromised individuals; most common pathogens are Aspergillus, Fusarium, Mucorales
* Can extend to the orbit and brain

68
Q

_ are areas of swollen nasal mucosa filled with neutrophilic inflammation

A

Nasal polyps are areas of swollen nasal mucosa filled with neutrophilic inflammation
* Sometimes these occur from aspirin sensitivity
* Most common benign nasal tumor

69
Q

ID the pathology

A

Maxillary sinusitis

70
Q

First line for allergic rhinitis is _

A

First line for allergic rhinitis is intranasal corticosteroids

71
Q

ID the pathology

A

Nasal polyps: hyperplastic connective tissue intermixed with glands and inflammatory cells

72
Q

Aspirin-exacerbated respiratory disease is also known as _ triad; it includes (3) features:

A

Aspirin-exacerbated respiratory disease is also known as Samter’s triad; it includes:
1. Nasal polyps
2. Aspirin sensitivity
3. Asthma

73
Q

_ is a rare highly vascular tumor within the posterior nasal cavity found almost exclusively in adolescent boys

A

Juvenile nasopharyngeal angiofibroma is a rare highly vascular tumor within the posterior nasal cavity found almost exclusively in adolescent boys

74
Q

A papilloma in the nasal cavity can be caused by [virus- two types] or EBV

A

A papilloma in the nasal cavity can be caused by HPV type 6, 11 or EBV

75
Q

Sinonasal papillomas are associated with [gene mutations]

A

Sinonasal papillomas are associated with epidermal growth factor (EGFR) gene mutations

76
Q

ID the pathology

A

Sinonasal papilloma:
combination of squamous, transitional, columnar epithelial cells and mucocytes
* Inverted are the most common type

77
Q

_ is a malignant neuroendocrine tumor of the nose that arises from olfactory epithelium

A

Olfactory neuroblastoma is a malignant neuroendocrine tumor of the nose that arises from olfactory epithelium

78
Q

The laryngopharynx extends from the superior [structure] to the inferior [structure]

A

The laryngopharynx extends from the superior epiglottis to the inferior cricoid cartilage (where it continues into the esophagus)

79
Q

The (larynx/ laryngopharynx) is the most anterior

A

The larynx is the most anterior (sits in front of the laryngopharynx)

80
Q

The laryngopharynx and larynx are connected by the _ and sit adjacent to the _ sinuses

A

The laryngopharynx and larynx are connected by the laryngeal inlet and sit adjacent to the pyriform sinuses
* Food/objects can get trapped in the pyriform sinuses causing obstruction

81
Q

_ diverticulum occurs when laryngopharyngeal muscles herniate and trap food

A

Zenker’s diverticulum occurs when laryngopharyngeal muscles herniate and trap food

82
Q

The laryngopharynx gets blood supply via branches of [main artery]

A

The laryngopharynx gets blood supply via branches of external carotid

83
Q

The two major nerves which supply motor and sensory innervation to the pharynx are [CN] and [CN]

A

The two major nerves which supply motor and sensory innervation to the pharynx are glossopharyngeal and vagus
* most motor = vagus
* most sensory = glossopharyngeal

83
Q

[CN] supplies all of the motor innervation to pharynx and soft palate except for the stylopharyngeus and tensor veli palatini

A

CN X supplies all of the motor innervation to pharynx and soft palate except for the stylopharyngeus and tensor veli palatini

84
Q

Stylopharyngeus is innervated by [CN]

A

Stylopharyngeus is innervated by CN IX

85
Q

Tensor veli palatini is innervated by [CN]

A

Tensor veli palatini is innervated by CN V3

86
Q

The _ is sometimes called the “voice box”

A

The larynx is sometimes called the “voice box”
* It has roles in sound production, breathing, protecting the trachea from foreign objects

87
Q

The superior border of the larynx is the _ and the inferior border is the _

A

The superior border of the larynx is the epiglottis and the inferior border is the trachea

88
Q

Name the (3) portions of the larynx

A
  1. Supraglottis from epiglottis to vocal cords
  2. Glottis vocal cords
  3. Subglottis from vocal cords to trachea
89
Q

The largynx is formed by three unpaired cartilages (3):

A

The largynx is formed by three unpaired cartilages (3):
1. Epiglottis
2. Cricoid around the subglottis
3. Thyroid cartilage the visible adam’s apple

90
Q

When a person swallows, the _ bone elevates, moving the epiglottis more horizontally, covering the _

A

When a person swallows, the hyoid bone elevates, moving the epiglottis more horizontally, covering the trachea
* This prevents food from entering the trachea
* Otherwise the epiglottis points upward to allow air to enter trachea

91
Q

_ are paired folds of mucous membranes that lie adjacent to the vocal cords

A

Vestibular folds are paired folds of mucous membranes that lie adjacent to the vocal cords
* Called false vocal cords
* Help with some special phonation sounds
* Also help to maintain airway and prevent aspiration

92
Q

The main intrinsic muscle of the larynx which helps to support respiration is the _

A

The main intrinsic muscle of the larynx which helps to support respiration is the posterior cricoarytenoid

93
Q

The muscles that help to control the vocal cords include: _

A

The muscles that help to control the vocal cords include:
* Cricothyroid
* Cricoarytenoids (posterior and lateral)
* Arytenoid (transverse and oblique)
* Thyroarytenoid

94
Q

(3) extrinsic muscles that help to depress the larynx

A
  1. Sternothyroid
  2. Omohyoid
  3. Sternohyoid
95
Q

Extrinsic muscles that help to elevate the larynx

A
  1. Digastric
  2. Genioglossus
  3. Stylohyoid
  4. Mylohyoid
  5. Hypoglossus
  6. Geniohyoid
  7. Thyrohyoid
96
Q

The larynx gets its blood supply from two vessels, the _ and _

A

The larynx gets its blood supply from two vessels, the superior laryngeal artery and inferior laryngeal artery
* Come off of the external carotid and thyrocervical trunk respectively

97
Q

Innervation to the epiglottis comes from [nerve]

A

Innervation to the epiglottis comes from superior laryngeal nerve (branch CN X)

98
Q

Phonation is controlled by two branches of the vagus nerve, _ and _

A

Phonation is controlled by two branches of the vagus nerve, superior laryngeal nerve and recurrent laryngeal nerve

99
Q

_ is the actual sound production of speech

A

Phonation is the actual sound production of speech
* Recall that the vocal cords are controlled by the vagus nerve
* Injury to these nerves can cause hoarseness and inability to maintain airway

100
Q

_ is the fullness and reverberation of speech

A

Resonation is the fullness and reverberation of speech

101
Q

_ is the distinction of consonants and vowel sounds to form clear words

A

Articulation is the distinction of consonants and vowel sounds to form clear words

102
Q

The _ removes particles and pathogens by the mechanical actions of cilia and cough; extends from trachea to bronchioles

A

The mucociliary escalator removes particles and pathogens by the mechanical actions of cilia and cough; extends from trachea to bronchioles
* Involve goblet cells, submucosa glands, cilia

103
Q

Testosterone during puberty leads to vocal cord _ and _ which leads to lower pitched voice

A

Testosterone during puberty leads to vocal cord elongation and thickening which leads to lower pitched voice
* Loosening of cords creates lower pitch

104
Q

The mucociliary escalator involves the actions of [cells], [cells], and [glands]

A

The mucociliary escalator involves the actions of goblet cells, cilia, and submucosal glands

105
Q

Inflammation of the pharynx, whether due to infectious or allergic cause is called _

A

Inflammation of the pharynx, whether due to infectious or allergic cause is called pharyngitis

106
Q

_ is difficulty swallowing, _ is pain with swallowing

A

Dysphagia is difficulty swallowing, odynophagia is pain with swallowing

107
Q

An adolescent with pharyngitis, fatigue, swollen lymph nodes, and lymphocytosis may have [virus]

A

An adolescent with pharyngitis, fatigue, swollen lymph nodes, and lymphocytosis may have Epstein-Barr virus
* Diagnosed via heterophile test which detects anti-EBV antibodies

108
Q

(Bacterial/viral) pharyngitis is more common

A

Viral pharyngitis is more common

109
Q

“Strep throat” is caused by [pathogen]

A

“Strep throat” is caused by Group A streptococcus

110
Q

Treatment for strep throat is _

A

Treatment for strep throat is amoxicillin or penicillin

111
Q

Bacterial pharyngitis that is accompanied by fever is more likely to be _

A

Bacterial pharyngitis that is accompanied by fever is more likely to be GAS
* Gonorrhea does not have fever

112
Q

Neisseria gonorrhea pharyngitis is treated with _

A

Neisseria gonorrhea pharyngitis is treated with ceftriaxone
* Plus azithromycin or doxycycline for chlamydial infection

113
Q

The most common fungal cause of pharyngitis is _

A

The most common fungal cause of pharyngitis is candida albicans
* Causes oropharyngitis (thrush), tonsillitis, and esophagitis

114
Q

Cobble-stoning of the posterior pharynx is suggestive of _

A

Cobble-stoning of the posterior pharynx is suggestive of allergic pharyngitis

115
Q

PSGN is a [type] hypersensitivity reaction caused by _ deposition in the glomerulus that occurs 2-4 weeks after GAS pharyngitis

A

PSGN is a type 3 hypersensitivity reaction caused by immune complex deposition in the glomerulus that occurs 2-4 weeks after GAS pharyngitis

116
Q

Acute rheumatic fever is a [type] hypersensitivity reaction mediated by _ generated against the bacterium that cross react with _

A

Acute rheumatic fever is a Type 2 hypersensitivity reaction mediated by antibodies generated against the bacterium that cross react with M protein

117
Q

Unilateral swelling in the back of the throat, uvular deviation, voice changes, and unilateral eat/throat pain is concerning for _

A

Unilateral swelling in the back of the throat, uvular deviation, voice changes, and unilateral eat/throat pain is concerning for peritonsillar abscess
* Secondary to tonsillitis typically of the palatine tonsils
* Treatment is to drain the abscess

118
Q

Recurrent tonsillitis/ refractory tonsillitis may be indication for [surgery]

A

Recurrent tonsillitis/ refractory tonsillitis may be indication for tonsillectomy
* Often done in children with the removal of adenoids as well

119
Q

Diagnosis?

A

Epiglottitis: thumbprint sign

120
Q

(4) clinical features of epiglottitis presentation

A

(4) clinical features of epiglottitis presentation
1. Inspiratory strider turbulent airflow in larynx
2. Hot-potato voice
3. Tripod breathing position
4. Drooling

121
Q

Epiglottitis is most commonly caused by [pathogen]

A

Epiglottitis is most commonly caused by non-typeable H flu
* “Cherry red” epiglottitis on laryngoscopy
* Treat with antibiotics, steroids, possible intubation

122
Q

Laryngitis will present as _

A

Laryngitis will present as hoarseness with intermittent aphonia

123
Q

The most common cause of laryngitis is _

A

The most common cause of laryngitis is viral (rhinovirus, coronavirus, influenza, parainfluenza)
* Can also be allergies, smoking, GERD, etc

124
Q

_ is often called “croup”

A

Tracheolaryngitis is often called “croup”
* Inflammation of both the larynx and the trachea; often extends into bronchi

125
Q

Croup is characterized by [presentation]

A

Croup is characterized by vocal hoarseness, inspiratory stridor, distinct bark-like cough

126
Q

The most common cause of tracheolaryngitis is [pathogen]

A

The most common cause of tracheolaryngitis is parainfluenza virus
* Can also be RSV, adenovirus, influenza

127
Q

Croup will appear as [sign] on chest x-ray

A

Croup will appear as stepple sign on chest x-ray

128
Q

Unvaccinated children who present with croup-like symptoms should be evaluated for possible _

A

Unvaccinated children who present with croup-like symptoms should be evaluated for possible diptheria

129
Q

Diptheria will present with croup-like symptoms, fever, tachycardia, and _ in the throat

A

Diptheria will present with croup-like symptoms, fever, tachycardia, and grayish diptheritic membrane in the throat
* Due to toxin produced by bacteria
* Complications include myocarditis, respiratory failure, nervous system toxicity

130
Q

Nasopharyngeal carcinoma often presents as _ and _ in adults

A

Nasopharyngeal carcinoma often presents as chronic otitis media and painless neck mass in adults

131
Q

Nasopharyngeal carcinoma risk is increased by [infection], [modifiable risk factor], and [ethnicity]

A

Nasopharyngeal carcinoma risk is increased by EBV infection, smoking, and Asian ethnicity

132
Q

Laryngeal cancer risk is increased by [virus]

A

Laryngeal cancer risk is increased by HPV infection

133
Q

Laryngeal cancer is typically [form]

A

Laryngeal cancer is typically squamous cell carcinoma

134
Q

HPV can disrupt tumor suppressor proteins p53 and Rb, resulting in lack of control over transition from [cell cycle phase]

A

HPV can disrupt tumor suppressor proteins p53 and Rb, resulting in lack of control over transition from G1 –> S

135
Q

HPV encodes protein E6 which disrupts tumor suppressor protein _

A

HPV encodes protein E6 which disrupts tumor suppressor protein p53

136
Q

HPV encodes protein E7 which disrupts tumor suppressor protein _

A

HPV encodes protein E7 which disrupts tumor suppressor protein Rb

Neuro (18 decks)

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