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2nd Year Medicine > ENT Anatomy > Flashcards

ENT Anatomy Flashcards

1
Q

Function of nasal cavity? (5)

A

Acts as a patent conduit for air to be transported to the nasopharynx

Filters air of particulate material (vibrissae = small hairs)

Humidifies air (glands)

Warms inspired air in the nasal passage (blood)

Sense of smell as air passes over the olfactory epithelium

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2
Q
A

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3
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4
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5
Q

Ethmoid bone relation to nasal cavity?

A

Ethmoid bone forms parts of the roof, lateral walls and septum of the nasal cavity

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6
Q
A

Arrow pointing to sella turcica (hypophyseal fossa contains pituitary gland)

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7
Q

What splits the left and right nasal cavities?

A

Vomer

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8
Q

Which fractures can disrupt the cribiform plate of the ethmoid?

S/s? (2)

A

Le fort II and III fractures

* Anosomia (loss of smell) - however, olfactory nerve can regerate so can get sense of smell back

* Facilitate spread of infection

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9
Q

Nasal mucosa? (3)

A

Nasal vestibule

* stratified squamous epithelium (keratinsied to non-keratinised)

Nasal cavity

* respiratory epithelium

* olfactory epithelium

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10
Q

How are olfactory nerves described?

Which nerve?

A

hairs of toothbrush coming down through cribiform plate

* CN I - olfactory nerve

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11
Q

Olfactory pathway? (5)

A
  1. Receptor cells in the olfactory epithelium
  2. Pass up through cribriform plate
  3. Synapse with olfactory bulb (ganglion)
  4. Then neurons pass along olfactory tract
  5. To Temporal lobe and olfactory areas
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12
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A

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13
Q
A

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14
Q

Somatic sensory to nasal cavity?

A

CN V1 - opthalmic division of trigeminal nerve (upper half)

CN V2 - maxillary division of trigeminal nerve (lower half)

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15
Q
A

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16
Q

Explain course of anterior ethmoidal nerve (CN V1) and nasopalatine nerve (CN V2)?

Function?

A

Anterior ethmoidal nerve is a branch of CN V1. It passes through the anterior ethmoidal foramen.

Nasopalatine nerve is a branch of CN V2, passing through the sphenopalatine foramen.

Function = somatic sensory

* temperature, pain, touch

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17
Q

Blood supply to face? (3)

Origins?

A

Opthalmic artery - internal carotid artery

Facial artery - external carotid

Maxillary artery - external carotid

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18
Q

blood supply to nasal cavity?

A

* Anterior + posterior ethmoidal artery - from opthalmic artery

* sphenopalatine + greater palatine artery - from maxillary artery

* lateral nasal and septal branches - facial artery

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19
Q

What is Kiesselbach’s (Little’s) area? (2)

What occurs there?

A

Site where anastomosis occurs between nasal arteries

Located anteroinferiorly on nasal septum

* EPITAXIS - nose bleed

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20
Q

What conchae project from lateral nasal wall?

A

* Superior nasal concha

* Middle nasal concha

* inferior nasal concha

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21
Q
A

a) sphenoethmoidal recess
b) superior meatus
c) middle meatus
d) inferior meatus

1,2,3 = nasal concahe

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22
Q
A

Inserted below inferior concha

* need anaesthetic or can cause gag reflex

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23
Q

What is the sensory nerve supply of inferior nasal concha?

A

CN V2

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24
Q

What are conchae often referred to as? Why?

What can airflow through nose be impacted by?

Explain

A

Turbinates - they cause turbulent airflow thru nasal cavity

* airflow thru nose impacted by engorgement of nasal mucosa

* one side will be engorged then change to other side every 1-5 hours

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25
Q

is this worrying?

A

No - just engorgement of nasal mucosa on one side

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26
Q

What are paranasal sinuses?

Explain arrangement within nasal cavity? (4)

What are they lined with?

A

Open spaces within bone

4 bilateral pairs assoctaed with nasal cavity

* frontal sinuses

* ethmoidal air cells

* maxillary sinuses

* sphenoid sinuses

Each sinus lined with respiratory epithelium

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27
Q
A

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28
Q
A

Paranasal sinuses = dark because they have air

(maxillary sinus on floor of orbit)

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29
Q
A

paranasal sinuses

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30
Q

Drainage of paranasal sinuses? (5)

A

* Sphenoid sinus = sphenoethmoidal recess

* Postrior ethmoidal air cells = superior meatus

* frontal sinus, maxillary sinus + anterior ethmoidal air cells = middle meatus (semilunar hiatus)

* Middle ethmoidal cair cells = middle meatus (ethmoidal bulla)

* Nasolacrimal duct = inferior meatus

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31
Q

Where do paranasal sinuses drain eventually?

A

GI system

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32
Q

Lacrimal fluid drainage?

A

Lacrimal fluid drains inferomedially to the nasolacrimal duct which drains to inferior meatus

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33
Q

Sinusitits?

A

Inflammation of mucosa in 1 or more of the paranasal sinuses

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34
Q

Complications of sinusitis?

A

Ifected mucous can cause increased pressure in ethmoid and break the medial wall of the orbit and impact the eye/spread infection to optic nerve

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35
Q

What is painful sensation in sinusitis caused by?

A

CN V1 and V2 - may be referred to teeth

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36
Q

Which sinus is predisposed to infection?

Why?

A

Maxillary sinus

* ostium of maxillary sinus is superior in relation to cavity - cilia must work against gravity

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37
Q
A
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38
Q

What is the ora-antral fistula? (remeber antrum is another name for maxillary sinus)

Complications of this? (2)

A

Communication between maxillary sinus and tooth socket

* tooth infection can lead to sinus infections

* sinusitis can be referred to teeth

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39
Q

Divisions of the ear? (2)

Where are these divisions located?

A

Anatomical divisions

* external ear

* middle ear

* inner ear

Functional divisions

* hearing (auditory system)

* balance (vestibular system)

ALL LOCATED IN TEMPORAL BONE

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40
Q

What is tympanic membrane?

A

Eardrum

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41
Q
A

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42
Q

What does temporal bone contain? (2)

A

* organs of hearing and balance (special sensory)

* contains facial and vestibulocochlear nerves (CN VIII)

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43
Q

What is the pterion?

Complications of pterion?

A

H-shaped structure

* made up of frontal, parietal, temporal and sphenoid

* THINNEST part of skull

Because it is so thin, it can break and rupture middle meningeal artery

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44
Q

Processes of temporal bone?

A

* zygomatic process - gives rise to zygomatic arch (CN 7 + 8 pass thru)

* styloid process

* mastoid process

(also eternal acoustic meatus!)

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45
Q
A

Petrous = rock-like

Ethmoid bone in pink

Facial nerve exits through stylomastoid foramen

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46
Q

What does facial nerve exit thru?

A

Stylomastoid foramen

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47
Q
A

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48
Q

Which cranial nerves pass thru internal acoustic meatus?

A

CN VII

* motor to face + stapedius

* taste to ant. 2/3rds tongue

* secretomotor to lacrimal + salivary glands

* sensation to external ear

CN VIII (vestibulocochlear nerve)

* balance

* hearing

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49
Q

What vasculature passes thru internal acoustic meatus?

A

Labyrinthe artery + vein

* branch of anterior inferior cerebellar artery

* from circle of willis

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50
Q

External ear function?

A

* auricle to tympanic membrane

* external acoustic meatus

* collects and conveys sound waves to tympanic membrane

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51
Q

Middle ear function?

A

* tympanic membrane to oval window

* also Eustachian tube

* amplifies and conducts sound waves to internal ear

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52
Q

Function of internal ear?

A

* oval window to internal acoustic meatus

* converts special sensory information: into fluid waves, then APs to brain

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53
Q
A

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54
Q
A

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55
Q
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56
Q

Where does ear canal begin?

Made up of?

What does it produce?

A

Begins at external acoustic meatus

* composed of outer 1/3 elastic cartilage, inner 2/3 bony

* produces earwax via ceruminous glands

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57
Q

What is the auricle (pinna)?

Label parts of ear

A

Visible part of the ear

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58
Q

Innervation of auricle

A

tympanic membrane - 2/3rds is CNV3, 1/3rd CN X

* CNV3 = superior parts of EAM + tympanic membrane

* CN X = infrior parts of EAM + tympanic membrane

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59
Q

Lymphatic drainage of auricle?

A

* lateral surface of superior half to parotid lymph nodes

* cranial surface of superior half to mastoid lymph nodes (and deep cervical)

* rest of auricle to supeifical cervical lymph nodes

ALL EVENTUALLY DRAIN INTO DEEP CERVICAL NODES

then thoracic duct or right lymphatic duct at venous angles

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60
Q

Otoscopic examination?

Explain process

A

Examination of EAM and tympanic membrane

* in child = EAM is short and straight. Careful not to damage tympanic membrane when gently pull auricle posteroinferiorly

* •In an adult – EAM is curved. Gently pull auricle posterosuperiorly

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61
Q

What is the pars flaccida?

Pars tensa?

A

Flaccida = thin part of the tympanic membrane (superiorly)

Para tensa = thick part of the tympanic membrane (posteroinferiorly)

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62
Q

What is umbo?

A

the most inwardly depressed part of the tympanic membrane

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63
Q

Internal surface of tympanic membrane supplied by?

A

CN IX

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64
Q

Glossoparyngeal nerve (CN IX) provides sensory innervation to? (5)

A
  • Middle ear cavity
  • Eustachian tube
  • Nasopharynx
  • Oropharynx
  • Tonsils
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65
Q

Middle ear contains? (3)

A

3 bones

* malleus

* incus

* stapes

2 muscles

* stapedius

* tensor tympani

Nerve branches from

* facial nerve

* glossopharyngeal nerve

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66
Q
A

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67
Q
A

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68
Q
A

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69
Q

Eustachian tube?

Function?

Complications?

A

Auditory tube, pharyngotympanic tube

* connects anterior wall of middle ear cavity to nasopharynx

* comps: bacteria and viruses can spread between the 2 i.e from pharynx/tonsils, reuslting in pain and hearing loss

(CN IX is common sensory nerve supply - pain from tonsilitis can mimic earache)

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70
Q
A

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71
Q

Nasopharynx/oropharynx sensory innervation?

Laryngopharynx?

A

* naso/oro = CN IX

* laryngo = CN X

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72
Q

Facial nerve composed of? (4)

Explain course

A

Special sensory, sesnory, motor and parasympathetic

* comes from pontomedullary junction

* passes through internal acoustic meatus

* splits and passes through stylomastoid foramen

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73
Q

What connects the internal acoustic meatus to the stylomastoid foramen?

A

facial canal of the temporal bone - so CN VII passes through here to get to stylomastoid foramen

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74
Q

What is the stapedius?

Function?

A

Smallest skeletal muscle in the body

* reduces stapes movement to protect the internal ear from excessive noise

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75
Q

What is chorda tympani?

Function? (2)

A

Branch of CN VII

* taste buds of the anterior 2/3rds of tongue

* parasympathetic supply to submandibuar and sublingual salivary glands (connects to lingual nerve branch of CN V3)

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76
Q
A

Frontalis - raises eyebrows

Puff out and tap cheeks - obicularis oculi

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77
Q

Function of inner ear?

Innervation?

A

Converts special sensory information

CN VIII in 2 parts (vestiulocochlear nerve)

* cochlear nerve (hearing)

* vestibular nerve (balance)

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78
Q

where is otic capsule found?

What is it?

What does it contain?

A

Inner ear

* densest bone in body

* contains bony labyrinth (contains perilymph fluid) and communicating sacs and ducts (contain endolymph fluid)

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79
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A

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80
Q
A

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81
Q

Vestibular apparatus? (3)

Explain

A

* ampullae

* urticle

* saccule

* hair cells stimulated by movement of endolymph

* clusters of hair cells in regions maculae

* semicircular ducts detect angular movement change

* utricle and saccule detect linear movement change

* utricle (horizontal)

* saccule (verticle)

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82
Q

Explain sound transmission in internal ear

A
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83
Q

Cochlear apparatus?

A
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84
Q

Explain cochlear apparatus function

A

receptor cells in organ corti detect auditory stimuli (located on basilar membrane of cochlear duct)

* cochlae duct is suspected by spiral ligaent and divded cochlaer canal into 2 parts

* scala vestibuli

* scala tympani

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85
Q

Explain route of vestibulocochlear nerve?

A

* CN VIII comes from ponmedullary junction

* exits at internal acoustic meatus

* splits into cochlear and vestibular nerve axons

* vestibular nerve axons from the semicircular ducts (+ the saccular + utricle)

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86
Q
A

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87
Q
A

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88
Q
A

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89
Q

What is middle ear lined with?

What openings does it contain? (2)

A

columnar lined mucosa

* contains openings to eustachian tube and mastoid cavity

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90
Q
A

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91
Q

What is respiratory epithelium?

A

pseudostratified ciliated columnar

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92
Q

what is throat lined with?

A

respiratory and squamous epithelium depending on site

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93
Q

Components of salivary glands? (3)

A

* Serous cells - darkly staining (contain digestive enzymes including amylase)

* Mucinous component - clear grey staining

* Peripheral myoepithelial cells - have contractile properties

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94
Q
A

Serous cells (right) -darker, most likely parotid gland

Mucinous cells (left) - sublingual mostly mucinous

Submandibular - both

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95
Q

Pathology of the ear?

A

* otitis media

* cholesteatoma

* tumours - bestibular schwannoma

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96
Q

What organisms can cause CHRONIC otitis media (middle ear inflammation)? (3)

A

Pseudomonas auerginosa, staph aureus, fungal

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97
Q

Cholesteatoma?

Where is it found?

Ax?

A

Not a tumour and doesn’t contain cholesterol

* superior posterior middle ear and/or petrous apex

* Ax = chronic otitis media and perforted typanic membrane (acquired)

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98
Q

Pathogenesis cholesteatoma?

A

Normal lining of middle ear is cuboidal/columnar epithelium

* turns into squamous epithelium and produces lots of keratin

* associated inflammation

99
Q
A

Keratin production

Cholesteatoma in suprior aspect, below that is tympanic membrane

100
Q

What is vestibular schwannoma associated with?

A

Associated with vestibular portion of vestibulocochlear nerve (VIII)

* MOST COMMON tumour of temporal bone

101
Q
A

vestibular schwannoma

* white tumour, temporal bone, well-defined margin

102
Q

Ax vestibular schwannoma?

A

Most are unilateral and sporadic

* if bilateral and young - consider neurofibromatosis type 2

103
Q

Appearance vestibular schwannoma?

A

tan, white, yellow mass

104
Q
A

vestibular shwannoma - looks like a tiger

105
Q

Ax nasal polyps?

A

Allergy, infection, asthma, nickel exposure

* if young, consider cystic fibrosis

106
Q
A

nasal polyps

107
Q

Granulomatosis with polyangitis (GPA)?

A
  • Wegner’s granulomatosis
  • Autoimmune disorder of unknown aetiology characterised by a small vessel vasculitis and necrosis, usually limited to respiratory tract and kidneys
108
Q

Dx GPA?

A
  • Characterised by high frequency of anti-neutrophil antibody levels – ANCA +ve
  • cANCA – GPA
  • pANCA – microscopic polyangiitis
109
Q
A

GPA

multineucleate giant cells

Inflammatory cells

110
Q

Nasal tumours?

A

* benign - squamous papillomas, “Schneiderian” papillomas. Angiofibromas

* malignant - squamous cell carcinoma, also less commonly: adenocarcinoma, nasopharyngeal carcinoma, neuroblastoma, lymphoma

111
Q

Types of schneiderian papilloma?

Ax? (3)

A

•Inverted, exophytic or oncocytic

* HPV, smoking, organic solvents

112
Q

s/s Schneiderian papilloma?

A

Blocked nose

113
Q

Where are schneiderian papillomas?

A

•Inverted and oncocytic on lateral walls and paranasal sinuses,

* exophytic on nasal septum

114
Q
A

Inverted subtype of schneiderian papilloma

(can become malignant SCC)

115
Q

Nasopharyngeal carcinoma associated with?

A

EBV and volatile nitroasamines in food

116
Q

What malignancies in EBV associated with?

Why?

A

B cell lymphomas + Hodgkin’s

* mimics helper T cells, leading to proliferatin and survival of B cells

117
Q

Ax laryngeal polyps?

A

Change in laryngeal mucosa secondary to vocal abuse (singers), infection and smoking

118
Q
A

Laryngeal polyps

*dilated blood vessels

* stroma - fibrinous

119
Q

Contact ulcer throat?

Ax? (4)

A

Posterior vocal cord

* chronic throat clearing, voice abuse, GORD, intubation

120
Q
A

laryngeal contact ulcer

121
Q

Squamous papilloma associated with?

groups affected?

A

HPV

* in children it is far more aggressive!!

122
Q
A

Squamous papilloma

123
Q

Paraganglioma?

How to differentiate?

A

Tumours arising in clusters of neuroendocrine cells throughout body

* Chromaffin positive = adrenal medulla (phaeochromocytoma, chromaffin associated with catecholamines)

* Non-chromaffin = nose + throat

124
Q

What are paragangliomas associated with?

A

Multiple endocrine neoplasia 2

125
Q

Risk factors SCC?

A

Smoking, alcohol + HPV (esp. in oropharynx)

126
Q

Pathology of salivary glands? (3)

A

* Sialolithiasis - stones

* infection

* tumours (parotid is the most common site)

General rule = if young and painful mass, think malignant

127
Q

Most common tumour of salivary glands?

Risk?

A

Pleomorphic adenoma

* can turn malignant

128
Q
A

pleomorphic adenoma

* stroma - myxoid

* made up of epithelial cells

129
Q

What is second most common benign tumour of salivary glands?

Characteristics?

A

Warthin’s tumour

* bilateral and multicentric

130
Q
A

Warthin’s tumour

131
Q

Malignant tumours of salivary glands? (2)

A

* most common worldwide = mucoepidermoid carcinoma

* in UK = adenoid cystic carcinoma

132
Q

from salivary gland

A

mucoepidermoid carcinoma = mucinous cells, squamous cells + intermediate cells

133
Q

where is cholesteatoma found?

A

middle ear

134
Q

Larynx lined with?

A

respiratory epithelium

pseudostratified columnar epihelium

135
Q

from salivary gland

A

adenoid cystic

* punched-out, cribiform pattern

* perineural invasion

136
Q
A

…

137
Q

what divides oropharynx and nasopharynx?

A

soft palate

138
Q

where is hyoid bone found?

A

bone—level C3. in line with inferior aspect of mandible

139
Q
A

…

140
Q

What are the muscles of the floor of the mouth?

A

Geniohyoid - C1 (spinal nerve), piggybacks on hypoglossal

Mylohyoid - CN V3

141
Q

Types salivary glands?

A

Major glands

* parotid

* submandibular

* sublingual

Minor glands

* 1000s

* function = keep mouth moist

142
Q
A

…

143
Q
A

Submandibular and sublingual

144
Q

Nerve supply to parotid gland?

Submandibular?

Sublingual?

A

* parotid = Glossopharyngeal

* submandibular = CN VII by piggybacking on CN V3

* sublingual = CN VII by piggybacking on CN V3

145
Q

Where does chorda tympani run?

A

Between malleus and incus in middle ear then joins with CN V3 (lingual nerve)

146
Q
A

…

147
Q

Innervation to tongue?

A

Posterior 1/3rd

* taste + general sensory = CN IX

Anterior 2/3rds

* General sensory = CN V3

* Taste = CN VII

148
Q
A

…

149
Q

Where does thyroid originate (during development)?

Examples of thyroid swellings?

Clinical sign?

A

Thyroid originates in the pharynx and descends through the foramen caecum of tongue

* Thyroglossal duct cysts or ectopic thyroid tissue

* thyroid swellings move superiorly then inferiorly on swallowing due to attachment to larynx

(thyroglossal duct cyst - when stick tongue out?)

150
Q

Extrinsic muscles of the tongue? (4)

Function?

A

Palatoglossus, styloglossus, hyoglossus, genioglossus

* function: change position of tongue during mastication, swallowing or speech

151
Q

Intrinsic muscles of the tongue?

Function?

A

4 pairs - located posteriorly

* function = modify shape of tongue

152
Q

Course of hypoglossal nerves (CN XII)?

What do they lack?

A

Medulla oblangata -> thru hypoglossal canal (anterior wall of foramen magnum) -> descends in neck -> at level of hyoid (C3), passes anteriroly towards laterla aspect of tongue -> supplie smost of the muscles of the tongue

Lack sensory component

153
Q

Innervation of tongue?

A

Most supplied by CN XII

154
Q

Tongue injury?

A

if both CN XII’s are functional, tongue tip remains in middle when patient sticks tongue out

* if unilaterla CN XII damage, tongue tip will point TOWARDS side of injured nerve

155
Q

Blood supply to tongue?

A

Lingual artery from external carotid

(hypoglossal nerve runs laterally alongside artery)

156
Q

Where do tongue arteries pass in relation to hyoglossus?

Tongue nerves?

A

Arteries = pass medial to hyoglossus

Nerves = pass lateral to hyoglossus

157
Q
A

colour change between hard palate and soft palate

158
Q

What is hard palate made up of?

A

Bones

* palatine bones

Misc

* palatal rugae

* duct openings of palatine glands

* minor salivary glands

159
Q

What passes through grater and lesser palatine foramina of hard palate?

A

Branches of CN V2

Branches of maxillary artery

160
Q
A

Hard palate

161
Q

Muscles of the soft palate? (5)

A

* Tensor veli palatini (CN V3) - tenses palatine aponeurosis

* musculus uvuvlae (CN X) - shortens uvula

* levator veli palatini (X) - elevates palatine aponeurosis

* palatoglossus (X) - extrinsic muscle of tongue

* palatopharyngeus (X) - lifts pharynx and thyroid cartilage

all innvertaed by vagus nerve except tensor veli palatini - CN V3

162
Q

Soft palate function?

A

Functions as a “trapdoor”:

  1. Stops food entering the nose during swallowing
  2. Directs air into the nose or the mouth during speech, sneezing, coughing & vomiting
  3. Helps to close off the entrance into the oropharynx during the gag reflex
163
Q

Clinical testing on CN X?

A

Ask patient to say “Aahh”

* if nerves functioning normally, uvula should lift straight up in the midline

* if unilateral nerve pathology, uvula will be pulled away from non-functioning side by normal side

(different from tongue cause goes tongue goes towards non-functioning side)

164
Q
A
165
Q

Muscles of the pharynx?

A

Outer circular layer

* 3 constirctor muscles

* skeletal (voluntary) - pushes food bolus into oesophagus

Inner longitudinal layer

* 3 paired vertical muscles

* skeletal - pulls larynx superiorly during swallowing

166
Q

What are muscles of the pharynx innervated by?

A

All innervated by CN X

except stylopharyngeus

* innervated by glossopharyngeal

167
Q

Where are circular consrictors of pharynx found?

A

Superior

* from pterygoid hamulus to mylohyoid line

Middle

* greater horn of hyoid)

Inferior

* from thyroid cartilage to cricoid cartilage

168
Q

Feature of superior constrictor of pharynx?

A

Pterygomandibular raphe

169
Q

What is the gap between constrictor muscles of the pharynx called?

Function?

A

Gateway to mouth

Allows:

* CN IX

* Lingual artery]* stylopharyngeus muscle

to pass thru

170
Q

What are circular muscles of pharynx supplied by?

A

Vagus CN X

171
Q

Where do all circular muscles of the pharynx insert into?

A

Midline raphe

172
Q
A

…

173
Q

Example of longitudinal muscle?

What is it attached to?

Supplied by?

What is significant about it?

A

Stylopharyngeus

* attached to styloid process

* passes through “gateway to mouth” with Cn IX (glossopharyngeal)

only pharynx muscle supplied by CN IX

174
Q

Longitudinal muscles? (3)

Where do they insert?

Innervation?

A

Stylopharyngeus, palatopharyngeus, salpingopharyngeus

* all insert into posterior border of thryoid cartilage

All innervated by CN X except stylopharyngeus (CN IX)

175
Q
A

longitudinal muscles of pharynx

176
Q

Waldeyer’s tosilar ring?

Where is it found?

Function?

A

Pharyngela tonsil, tubal tonsil, palatine tonsil, lingual tonsil

* found in mucosa of nasopharynx and oropharynx

* Function = defence against invading pathogens

177
Q
A

Waldeyer’s ring

* tubal tonsil surrounds eustachian tube

178
Q

Lymphatic drainage of face and neck?

A
179
Q

Lymph nodes in illness?

A

Infection

* swollen

* painful

* smooth

* soft

* not fixed

* improves with antibiotics

Cancer

* swollen

* not painful

* hard

* irregular

* fixed

* do not improve

180
Q
A

lymph node examination

181
Q
A

…

182
Q

Where is larynx located?

A

Between pharynx and trachea

183
Q

where is larynx enclosed within?

Along with?

A

pretracheal fascia

* ‘strap’ muscles

* Thyroid gland

* Trachea & larynx

* Oesophagus & pharynx

* Recurrent laryngeal nerves

184
Q
A

…

185
Q
A

…

186
Q
A

…

187
Q
A

…

188
Q

Which wall of septum are nasal conchae found in?

A

lateral

189
Q

explain structure of larynx

function (3)

A

composed of cartilages suspended from hyoid bone

* Maintaining patency of URT

* Cartilages help prevent entry of foreign bodies into LRT

* Vocal cords and cough reflex produce sound

190
Q
A

…

191
Q
A

…

epiglottis is leaf shaped

192
Q

what is important for preventing both regurgitation and aspiration during ventilation?

A

Press on the cricoid cartilage

Lamina of the cricoid cartilage compresses the oesophagus

Presses it against the C6 vertebral body

Oesophagus is closed but the larynx/airway is open

193
Q
A

…

194
Q
A

…

195
Q

pairs of vocal cords?

A

2 pairs

* true vocal cords = vocal processes of arytenoid cartilage + thyroid cartilage

MOVEMENT IMPACTS SOUND

* false vocal cords = arytenoid cartilage to epilgottis

196
Q

where is laryngoscope placed?

A

into the vallecula (space between epiglottis and tongue)

197
Q
A

…

198
Q

intrinsic muscles of the larynx?

Function?

Innervation?

A

skeletal muscle - cause movement of vocal cords

* tension (increase pitch)

* relaxation (decreaes pitch)

* adduction (quieter)

* abduction (louder)

all innervated by CN X (vagus nerve)

199
Q

tensors of the larynx?

function?

attachments?

A

cricothyroid muscles

* increases pitch

* attachments - anterolateral cricoid cartilage to inferior horn of thyroid cartilage

200
Q

relaxors of larynx?

function?

attachments?

A

Thyroarytenoid muscles

* decreases pitch

* posterior thyroid to anteriorarytenoid cartilage

201
Q

adductors of the larynx?

function?

attachments?

A

Arytenoid muscles

* Makes voice quieter by closing rima glottidis

* one arytenoid cartilage to another cricoid cartilage (cross)

202
Q

abductors of the larynx?

function?

attachments?

A

Posterior Crico-arytenoid muscles

* make voice louder by opening rima glottidis

* posterior cricoid cartilage to muscular process of arytenoid cartilage (horseshoe)

203
Q
A

…

204
Q

where do supra-glottis tumours drain to?

A

Drain to superior deep cervical nodes

205
Q

glottic tumours found?

S/s?

A

On the cords

* voice changes/airway obstruction

206
Q

sub-glottic tumour features? (2)

A
  • Spread to paratracheal nodes
  • Present with voice/airway obstruction
207
Q

is larynx sufficient to produce a loud sound?

A

No, Laryngeal ‘buzz’ is amplified by the pharynx, oral and nasal cavities

208
Q

explain how oral sounds are produced?

A
  • Soft palate tenses (CN V3) and elevates (CN X) to close off entrance into nasopharynx
  • Directs stream of air through oral cavity
  • Sound interrupted by the tongue (CN XII) and the teeth/lips (CN VII) to produce most vowels and consonants in English language
209
Q

explain how nasal sounds are created?

A
  • Soft palate tenses (CN V3) and descends (CN X) to close off entrance into oropharynx
  • Directs stream of air through nasal cavities
  • Produces one of three sounds: “m”, “n” or “ing” depending on position of tongue (CN XII), teeth and lips (CN VII).
210
Q
A

…

211
Q

innervation of the larynx?

A

* all intrinsic muscles apart from cricothyroid innervated by inferior laryngeal nerve (cricothyroid is superior LN)

* mucosa above the folds is supplied by internal laryngeal nerve

* mucosa below the folds is supplied by inferior laryngeal nerve

212
Q
A

…

213
Q
A

…

214
Q
A

….

215
Q

vagus nerves supply?

Clinical test?

A

Vagus nerves are sensory and motor supply to palate, pharynx and larynx

PHARYNX

Ask patient to swallow small sip of water

  • Watch larynx move up and down
  • Do they ‘splutter’?

LARYNX

Listen to patient speak

  • Is voice hoarse?
  • Are the intrinsic muscles of larynx functioning normally to move the vocal cords

Ask patient to cough

  • Is cough normal and powerful?
  • Also requires functioning diaphragm, phrenic nerves, abdominal wall etc.
216
Q
A

normal ear drum

it’s the left ear (hammer of malleous slopes backwards)

217
Q
A

otitis externa

(inflammation of the ear canal)

218
Q
A

acute otitis media

219
Q
A

otitis media with effusion

yellow is the colour of fluid

220
Q
A

myringotomy

(relieve pressure from otitis media)

221
Q
A

retraction of pars tensa due to cholesteatoma

222
Q
A

cholesteatoma

(note loss of ossicles e.g. incus - can see stapes head)

223
Q
A

mastoiditis (left ear abnormally projected)

complication of cholesteatoma

224
Q
A

cholesteatoma

(middle ear space should be filled with air so should be black)

225
Q
A

brain abscess (outside ring enhanced on scan)

complication of cholesteatoma

226
Q
A

presbycusis

227
Q
A

nose-induced hearing loss

(classical dip at 4 kHZ)

228
Q
A

vestibular schwannoma

229
Q
A

Meniere’s disease

(low frequency sensorinerual hearing loss)

230
Q
A

Battle’s sign - suggests base of skull fracture

231
Q
A

skull base fracture

bilateral air depositis - bilateral hearing loss

232
Q
A

Left = acute otitis media

Right = cholesteatoma

233
Q
A

menieres disease

Low frequency hearing loss in one ear

sensoryneural not conductive

234
Q
A

rhinitis - should see air in sinuses (however, no air visible)

235
Q
A

Orbital cellulitis

(complication of acute sinusitis)

236
Q
A

Pinna haematoma

237
Q
A

Battle sign - temporal lobe fracture

238
Q
A

deep neck space infection

239
Q
A

orbital blowout fracture - tear drop sign

CT sinuses

(remember a blowout fracture is medial wall + floor!)

240
Q
A

know where tonsils are

241
Q
A

peritonsilar abscess

* medial displacement of tonsil and uvula
* concavity of palate lost

242
Q
A

glandular fever

* Tonsillar enlargement with membranous exudate
* petechial haemorrhages on palate

243
Q
A

Eustachian tube dyfunction

* severely retratced TM

* altered TM colour

* fluid/bubbles

244
Q
A

AOM

* red, inflammed

* no cone of light

2nd Year Medicine (24 decks)

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