ENT Flashcards
Name the four major components of the upper respiratory tract
- Nose (and nasal passages)
- Paranasal sinuses
- Pharynx
- Larynx
Name the three regions of the inner nasal cavity (3):
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
The vestibule portion of the nose is lined with _
The vestibule portion of the nose is lined with skin
The respiratory portion of the nose is lined with _
The respiratory portion of the nose is lined with mucosa and it is highly vascular
The olfactory region of the nose is the location of [specialized cells]
The olfactory region of the nose is the location of olfactory receptor neurons
The _ bone provides the roof of the inner nasal cavity and the medial and lateral walls
The ethmoid bone provides the roof of the inner nasal cavity and the medial and lateral walls
The anterior portion of the roof of the nasal cavity is formed by [bone]
The anterior portion of the roof of the nasal cavity is formed by frontal bone
The [cartilagenous + bony region] divides the nose
The nasal septum divides the nose
* Cartilage + ethmoid and vomer bone
The _ bone forms the external bridge between the orbits
The frontal bone forms the external bridge between the orbits
The posterior portion of the nasal cavity roof is formed by the _ bone
The posterior portion of the nasal cavity roof is formed by the sphenoid bone
In addition to the ethmoid bone, part of the medial wall is formed by the _ bone
In addition to the ethmoid bone, part of the medial wall is formed by the vomer bone
The floor of the nasal cavity is formed by [bone] and [bone]
The floor of the nasal cavity is formed by maxilla and palatine
The lateral wall of the nasal cavity is formed by the _ bone
The lateral wall of the nasal cavity is formed by the maxilla
We have three turbinates in the nose, the _ , _ , and _
We have three turbinates in the nose, the inferior , middle , and superior
The turbinates’ bony component is called _ , but the term turbinate includes the mucosa lining
The turbinates’ bony component is called conchae but the term turbinate includes the mucosa lining
The purpose of the turbinates is to _
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
ID the three turbinates
The [structures] are the spaces between the turbinates that direct airflow and allow drainage from the sinuses/ nasolacrimal duct
The meatuses are the spaces between the turbinates that direct airflow and allow drainage from the sinuses/ nasolacrimal duct
* Inferior, middle, superior meatuses
The superior meatus drains the _ sinus
The superior meatus drains the posterior ethmoid sinus
* Located between the superior and middle turbinate
The middle meatus drains the [sinuses]
The middle meatus drains the frontal, anterior and middle ethmoid, maxillary sinuses
* Located between the middle and inferior turbinates
The inferior meatus drains the _
The inferior meatus drains the nasolacrimal duct (drains tears from the eye)
* This is why the nose runs when a person cries
The sphenoid sinus is drained by the _
The sphenoid sinus is drained by the sphenoethmoidal recess
* Also helps drain the posterior ethmoid sinus
The nose’s blood supply branches off of two major arteries, _ and _
The nose’s blood supply branches off of two major arteries, internal carotid and external carotid
_ is a collection of small vessels that supplies the anterior nasal septum
Kiesselbach plexus is a collection of small vessels that supplies the anterior nasal septum
* Branches off of internal and external carotid arteries
_ is a collection of vessels responsible for posterior epistaxis
Woodruff’s plexus is a collection of vessels responsible for posterior epistaxis
* These nose bleeds are generally more severe
Anterior nose bleeds arise from bleeding at the [vessels]
Anterior nose bleeds arise from bleeding at the Kiesselbach plexus
* These are more common and less severe
Special sensory innervation to the nose comes from [nerve], while sensory innervation comes from [nerve]
Special sensory innervation to the nose comes from CN I, while sensory innervation comes from CN V
The nasal septum and the lateral walls of the nose are innervated by branches of [nerve]
The nasal septum and the lateral walls of the nose are innervated by branches of V1
The postero-inferior half to two-thirds of the nasal mucosa is innervated by [nerve]
The postero-inferior half to two-thirds of the nasal mucosa is innervated by V2
In addition to conchae, [nasal cavity feature] also helps to increase temperature of air
In addition to conchae, rich vascular network (capillaries) also helps to increase temperature of air
Olfactory receptor cells of CN I are found in the _ of the _ bone
Olfactory receptor cells of CN I are found in the cribiform plate of the ethmoid bone
* Responsible for smell
Mucus and vibrissae (stiff hairs in nose) help to [function]
Mucus and vibrissae (stiff hairs in nose) help to filter debris in the air
Allergies cause a runny nose via histamines triggering _
Allergies cause a runny nose via histamines triggering capillary leakage
Name the (4) paranasal sinuses
Name the (4) paranasal sinuses
1. Frontal
2. Sphenoid
3. Maxillary
4. Ethmoid
ID the sinus
Ethmoid sinus
ID the sinus
Frontal sinus
ID the four paired paranasal sinuses
The small canals that connect the sinuses to the lateral nasal wall are called _
The small canals that connect the sinuses to the lateral nasal wall are called ostia
* Form the osteomeatal complex
The frontal, ethmoid, sphenoid sinuses/bone are innervated by [nerve]
The frontal, ethmoid, sphenoid sinuses/bone are innervated by opthalmic nerve (V1)
The maxillary sinus is innervated by [nerve]
The maxillary sinus is innervated by maxillary nerve (V2)
Blood supply to the frontal and ethmoid sinuses comes from branches of [artery]
Blood supply to the frontal and ethmoid sinuses comes from branches of opthalmic artery (from internal carotid)
Blood supply to the sphenoid and maxillary sinuses comes from branches of [artery]
Blood supply to the sphenoid and maxillary sinuses comes from branches of maxillary artery (external carotid)
ID the bone
Ethmoid bone
ID the bone
Sphenoid bone
ID the bone
Frontal bone
Name (4) functions of the paranasal sinuses:
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
The pharynx is a shared space for air and food until [region] where the respiratory and GI tracts will diverge
The pharynx is a shared space for air and food until laryngopharynx where the respiratory and GI tracts will diverge
ID the (3) regions of the pharynx
Name the borders of the nasopharynx:
Superior:
Inferior:
Anterior:
Posterior:
Name the borders of the nasopharynx:
Superior: skull base
Inferior: soft palate
Anterior: back of nose
Posterior: vertebral bodies
Another name for the eustachian tube is _
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
ID the structure found in the nasopharynx
Adenoid (pharyngeal tonsils)
If an adult presents with unilateral fluid in the ear you need to rule out _
If an adult presents with unilateral fluid in the ear you need to rule out nasopharyngeal carcinoma
* A mass can cause chronic otitis media
The primary blood supply to the nasopharynx is _
The primary blood supply to the nasopharynx is ascending pharyngeal artery (external carotid branch)
Venous drainage of the nasopharynx occurs via the _ and _
Venous drainage of the nasopharynx occurs via the pterygoid plexus and pharyngeal venous plexus
* These go into the internal jugular vein
The nasopharynx is innervated by the pharyngeal plexus which gets contributions from [CN] and [CN]
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
The anterior roof of the nasopharynx gets sensory innervation from [CN]
The anterior roof of the nasopharynx gets sensory innervation from V2
The oropharynx extends from [soft tissue structure] to the [bone]
The oropharynx extends from uvula to the hyoid bone
The _ tonsils are the ones best visualized inside a patient’s mouth
The palatine tonsils are the ones best visualized inside a patient’s mouth
The [structure] closes the nasopharynx off when swallowing
The uvula closes the nasopharynx off when swallowing
_ provides blood supply to the oropharynx
Facial artery provides blood supply to the oropharynx
The oropharynx is innervated by [CN]
The oropharynx is innervated by glossopharyngeal nerve
Inflammation of the nasal mucosa is simply called _
Inflammation of the nasal mucosa is simply called rhinitis
* Can have allergic rhinitis or nonallergic rhinitis
Allergic rhinitis, aka hay fever, is caused by [type] hypersensitivity reaction
Allergic rhinitis, aka hay fever, is caused by Type 1 hypersensitivity reaction
* IgE mediated
* Degranulation of mast cells –> histamine release
Inflammation of the mucosa of paranasal sinuses is called _ while inflammation of the sinuses and nasal cavity mucosa is called _
Inflammation of the mucosa of paranasal sinuses is called sinusitis while inflammation of the sinuses and nasal cavity mucosa is called rhinosinusitis
Subacute sinusitis is defined as symptoms for [time]
Subacute sinusitis is defined as symptoms for 4-12 weeks
* < 4 weeks: acute
* > 12 weeks: chronic
* Recurrent > 4 episodes/year
The most common viral cause of rhinosinusitis is _
The most common viral cause of rhinosinusitis is rhinovirus
* Other causes include RSV, influenza, adenovirus, parainfluenza virus
Acute rhinosinusitis is only bacterial 1-2% of the time; most common bugs are _ , _ , _
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
Fungal rhinosinusitis occurs in _ individuals; most common pathogens are _
Fungal rhinosinusitis occurs in immunocompromised individuals; most common pathogens are Aspergillus, Fusarium, Mucorales
* Can extend to the orbit and brain
_ are areas of swollen nasal mucosa filled with neutrophilic inflammation
Nasal polyps are areas of swollen nasal mucosa filled with neutrophilic inflammation
* Sometimes these occur from aspirin sensitivity
* Most common benign nasal tumor
ID the pathology
Maxillary sinusitis
First line for allergic rhinitis is _
First line for allergic rhinitis is intranasal corticosteroids
ID the pathology
Nasal polyps: hyperplastic connective tissue intermixed with glands and inflammatory cells
Aspirin-exacerbated respiratory disease is also known as _ triad; it includes (3) features:
Aspirin-exacerbated respiratory disease is also known as Samter’s triad; it includes:
1. Nasal polyps
2. Aspirin sensitivity
3. Asthma
_ is a rare highly vascular tumor within the posterior nasal cavity found almost exclusively in adolescent boys
Juvenile nasopharyngeal angiofibroma is a rare highly vascular tumor within the posterior nasal cavity found almost exclusively in adolescent boys
A papilloma in the nasal cavity can be caused by [virus- two types] or EBV
A papilloma in the nasal cavity can be caused by HPV type 6, 11 or EBV
Sinonasal papillomas are associated with [gene mutations]
Sinonasal papillomas are associated with epidermal growth factor (EGFR) gene mutations
ID the pathology
Sinonasal papilloma:
combination of squamous, transitional, columnar epithelial cells and mucocytes
* Inverted are the most common type
_ is a malignant neuroendocrine tumor of the nose that arises from olfactory epithelium
Olfactory neuroblastoma is a malignant neuroendocrine tumor of the nose that arises from olfactory epithelium
The laryngopharynx extends from the superior [structure] to the inferior [structure]
The laryngopharynx extends from the superior epiglottis to the inferior cricoid cartilage (where it continues into the esophagus)
The (larynx/ laryngopharynx) is the most anterior
The larynx is the most anterior (sits in front of the laryngopharynx)
The laryngopharynx and larynx are connected by the _ and sit adjacent to the _ sinuses
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
_ diverticulum occurs when laryngopharyngeal muscles herniate and trap food
Zenker’s diverticulum occurs when laryngopharyngeal muscles herniate and trap food
The laryngopharynx gets blood supply via branches of [main artery]
The laryngopharynx gets blood supply via branches of external carotid
The two major nerves which supply motor and sensory innervation to the pharynx are [CN] and [CN]
The two major nerves which supply motor and sensory innervation to the pharynx are glossopharyngeal and vagus
* most motor = vagus
* most sensory = glossopharyngeal
[CN] supplies all of the motor innervation to pharynx and soft palate except for the stylopharyngeus and tensor veli palatini
CN X supplies all of the motor innervation to pharynx and soft palate except for the stylopharyngeus and tensor veli palatini
Stylopharyngeus is innervated by [CN]
Stylopharyngeus is innervated by CN IX
Tensor veli palatini is innervated by [CN]
Tensor veli palatini is innervated by CN V3
The _ is sometimes called the “voice box”
The larynx is sometimes called the “voice box”
* It has roles in sound production, breathing, protecting the trachea from foreign objects
The superior border of the larynx is the _ and the inferior border is the _
The superior border of the larynx is the epiglottis and the inferior border is the trachea
Name the (3) portions of the larynx
- Supraglottis from epiglottis to vocal cords
- Glottis vocal cords
- Subglottis from vocal cords to trachea
The largynx is formed by three unpaired cartilages (3):
The largynx is formed by three unpaired cartilages (3):
1. Epiglottis
2. Cricoid around the subglottis
3. Thyroid cartilage the visible adam’s apple
When a person swallows, the _ bone elevates, moving the epiglottis more horizontally, covering the _
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
_ are paired folds of mucous membranes that lie adjacent to the vocal cords
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
The main intrinsic muscle of the larynx which helps to support respiration is the _
The main intrinsic muscle of the larynx which helps to support respiration is the posterior cricoarytenoid
The muscles that help to control the vocal cords include: _
The muscles that help to control the vocal cords include:
* Cricothyroid
* Cricoarytenoids (posterior and lateral)
* Arytenoid (transverse and oblique)
* Thyroarytenoid
(3) extrinsic muscles that help to depress the larynx
- Sternothyroid
- Omohyoid
- Sternohyoid
Extrinsic muscles that help to elevate the larynx
- Digastric
- Genioglossus
- Stylohyoid
- Mylohyoid
- Hypoglossus
- Geniohyoid
- Thyrohyoid
The larynx gets its blood supply from two vessels, the _ and _
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
Innervation to the epiglottis comes from [nerve]
Innervation to the epiglottis comes from superior laryngeal nerve (branch CN X)
Phonation is controlled by two branches of the vagus nerve, _ and _
Phonation is controlled by two branches of the vagus nerve, superior laryngeal nerve and recurrent laryngeal nerve
_ is the actual sound production of speech
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
_ is the fullness and reverberation of speech
Resonation is the fullness and reverberation of speech
_ is the distinction of consonants and vowel sounds to form clear words
Articulation is the distinction of consonants and vowel sounds to form clear words
The _ removes particles and pathogens by the mechanical actions of cilia and cough; extends from trachea to bronchioles
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
Testosterone during puberty leads to vocal cord _ and _ which leads to lower pitched voice
Testosterone during puberty leads to vocal cord elongation and thickening which leads to lower pitched voice
* Loosening of cords creates lower pitch
The mucociliary escalator involves the actions of [cells], [cells], and [glands]
The mucociliary escalator involves the actions of goblet cells, cilia, and submucosal glands
Inflammation of the pharynx, whether due to infectious or allergic cause is called _
Inflammation of the pharynx, whether due to infectious or allergic cause is called pharyngitis
_ is difficulty swallowing, _ is pain with swallowing
Dysphagia is difficulty swallowing, odynophagia is pain with swallowing
An adolescent with pharyngitis, fatigue, swollen lymph nodes, and lymphocytosis may have [virus]
An adolescent with pharyngitis, fatigue, swollen lymph nodes, and lymphocytosis may have Epstein-Barr virus
* Diagnosed via heterophile test which detects anti-EBV antibodies
(Bacterial/viral) pharyngitis is more common
Viral pharyngitis is more common
“Strep throat” is caused by [pathogen]
“Strep throat” is caused by Group A streptococcus
Treatment for strep throat is _
Treatment for strep throat is amoxicillin or penicillin
Bacterial pharyngitis that is accompanied by fever is more likely to be _
Bacterial pharyngitis that is accompanied by fever is more likely to be GAS
* Gonorrhea does not have fever
Neisseria gonorrhea pharyngitis is treated with _
Neisseria gonorrhea pharyngitis is treated with ceftriaxone
* Plus azithromycin or doxycycline for chlamydial infection
The most common fungal cause of pharyngitis is _
The most common fungal cause of pharyngitis is candida albicans
* Causes oropharyngitis (thrush), tonsillitis, and esophagitis
Cobble-stoning of the posterior pharynx is suggestive of _
Cobble-stoning of the posterior pharynx is suggestive of allergic pharyngitis
PSGN is a [type] hypersensitivity reaction caused by _ deposition in the glomerulus that occurs 2-4 weeks after GAS pharyngitis
PSGN is a type 3 hypersensitivity reaction caused by immune complex deposition in the glomerulus that occurs 2-4 weeks after GAS pharyngitis
Acute rheumatic fever is a [type] hypersensitivity reaction mediated by _ generated against the bacterium that cross react with _
Acute rheumatic fever is a Type 2 hypersensitivity reaction mediated by antibodies generated against the bacterium that cross react with M protein
Unilateral swelling in the back of the throat, uvular deviation, voice changes, and unilateral eat/throat pain is concerning for _
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
Recurrent tonsillitis/ refractory tonsillitis may be indication for [surgery]
Recurrent tonsillitis/ refractory tonsillitis may be indication for tonsillectomy
* Often done in children with the removal of adenoids as well
Diagnosis?
Epiglottitis: thumbprint sign
(4) clinical features of epiglottitis presentation
(4) clinical features of epiglottitis presentation
1. Inspiratory strider turbulent airflow in larynx
2. Hot-potato voice
3. Tripod breathing position
4. Drooling
Epiglottitis is most commonly caused by [pathogen]
Epiglottitis is most commonly caused by non-typeable H flu
* “Cherry red” epiglottitis on laryngoscopy
* Treat with antibiotics, steroids, possible intubation
Laryngitis will present as _
Laryngitis will present as hoarseness with intermittent aphonia
The most common cause of laryngitis is _
The most common cause of laryngitis is viral (rhinovirus, coronavirus, influenza, parainfluenza)
* Can also be allergies, smoking, GERD, etc
_ is often called “croup”
Tracheolaryngitis is often called “croup”
* Inflammation of both the larynx and the trachea; often extends into bronchi
Croup is characterized by [presentation]
Croup is characterized by vocal hoarseness, inspiratory stridor, distinct bark-like cough
The most common cause of tracheolaryngitis is [pathogen]
The most common cause of tracheolaryngitis is parainfluenza virus
* Can also be RSV, adenovirus, influenza
Croup will appear as [sign] on chest x-ray
Croup will appear as stepple sign on chest x-ray
Unvaccinated children who present with croup-like symptoms should be evaluated for possible _
Unvaccinated children who present with croup-like symptoms should be evaluated for possible diptheria
Diptheria will present with croup-like symptoms, fever, tachycardia, and _ in the throat
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
Nasopharyngeal carcinoma often presents as _ and _ in adults
Nasopharyngeal carcinoma often presents as chronic otitis media and painless neck mass in adults
Nasopharyngeal carcinoma risk is increased by [infection], [modifiable risk factor], and [ethnicity]
Nasopharyngeal carcinoma risk is increased by EBV infection, smoking, and Asian ethnicity
Laryngeal cancer risk is increased by [virus]
Laryngeal cancer risk is increased by HPV infection
Laryngeal cancer is typically [form]
Laryngeal cancer is typically squamous cell carcinoma
HPV can disrupt tumor suppressor proteins p53 and Rb, resulting in lack of control over transition from [cell cycle phase]
HPV can disrupt tumor suppressor proteins p53 and Rb, resulting in lack of control over transition from G1 –> S
HPV encodes protein E6 which disrupts tumor suppressor protein _
HPV encodes protein E6 which disrupts tumor suppressor protein p53
HPV encodes protein E7 which disrupts tumor suppressor protein _
HPV encodes protein E7 which disrupts tumor suppressor protein Rb
