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Year 4 > ENT2 > Flashcards

ENT2 Flashcards

1
Q

What is found in the anterior triangle of the neck?

A

Larynx
Pharynx
Carotid vessels

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2
Q

Mass in the supraclavicular fossa is likely to be__

A

Chest disease rather than neck disease

eg breast tumour or lung tumour

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3
Q

Why is the fascia of the neck clinically relevant?

A

Superficial fascia: If broken in a stab wound then surgical investigation is necessary
?can you see muscle fibres

In quinsy, pus outside of tonsils can track downwards

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4
Q

If a mass in the neck moves when you swallow, what is it?

A

Means it is attached to trachea

Probably thyroid goitre

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5
Q

If a tongue deviates to left due to nerve injury, what nerve is injured? On which side?

A

Left hypoglossal nerve

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6
Q

What would cause nodes in the deep cervical chain to be inflamed?

A

Inflammation/infection of parotid, base of tongue, tonsil, skin of face and neck

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7
Q

What would cause submandibular nodes to be inflamed?

A

Dental infection, salivary disease, issues with skin of lip

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8
Q

Describe the pharyngeal phase of swallowing

A 
Triggered at anterior facial arch
•	Elevation and retraction of the velum
•	Initiation of pharyngeal peristalsis
•	Elevation and closure of the larynx
•	Relaxation of the cricopharyngeal sphincter
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9
Q

What does the oral phase of swallowing rely on?

A

Intact labial seal, anterior to posterior tongue movement

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10
Q

Describe Zenker’s diverticulum

A

Pharyngeal out-pouching under the inferior pharyngeal constrictor muscle, between thyroid cartilages posteriorly, just above oesophagus

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11
Q

Describe the larynx

A

Protects the airway
Source of voice
Suspended, mobile structure
Made up of supraglottis, glottis and subglottis

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12
Q

Describe the subglottis

A

Narrowest part of the airway
At level of cricoid ring
Worried about subglottic stenosis after prolonged intubation

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13
Q

Describe the route of the recurrent laryngeal nerve

A

Left loops around liagmentum arteriosum: intrathoracic.

Right goes under subclavian artery.

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14
Q

How does aerodigestive tract cancer usually evolve?

A

95% SCC

Irritation-> dysplasia-> carcinoma in situ-> frank invasive carcinoma

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15
Q

Risk factors for aerodigestive tract carcinoma?

A
  • Disease of men in urban areas

* Cigarette smoking, alcohol, HPV, beetle nut chewing

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16
Q

Describe 9 ways an aerodigestive tract cancer presents

A
  • Chronic mouth ulcer or lump on tongue
  • Tonsillar mass
  • Persistent unilateral sore throat
  • Difficulty swallowing (dysphagia)
  • Odynophagia (pain on swallowing)
  • Change in voice
  • Stridor, breathing noise if impinges on airway
  • Mass in the parotid
  • Lump in the neck
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17
Q

What time frame would you get worried about a neck lump/mouth ulcer?

A

After 4-6 weeks, should be referred for a 2 week wait appt

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18
Q

What is done in a 2 week wait clinic for aerodigestive tract lumps/suspected cancers?

A
  • Look at associated symptoms and risk factors
  • ENT surgeon is the only person that can examine whole oropharynx
  • Fine needle aspiration under USS used to diagnose lump, remove if lymphoma
  • Rigid endoscopy (pandendoscopy) under GA and biopsy of primary site
  • Stage (TMN), grade (histopathology aggression and differentiation)
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19
Q

Pros and cons of radiotherapy as treatment for aerodigestive cancer

A

Good due to: normal anatomy is preserved

Bad due to fibrosis, mouth dryness, soreness.
Normal tissue damage makes subsequent surgery more difficult.
Can’t re-irradiate the same tissues.

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20
Q

Treatment of aerodigestive tract cancer

A
  • Early: Surgery or radiotherapy
  • Late: Surgery and radiotherapy, chemoradiotherapy.
  • Chemotherapy: cisplatin. Given at same time as radiotherapy for best outcome.
  • Surgery: minimally invasive laser microsurgery or open. Damages normal anatomy. Only works of you can get around the cancer with a clear margin.
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21
Q

Describe the ladder of reconstruction (7 steps)

A
  • Secondary healing (secondary intention, esp scalp and floor of mouth)
  • Direct closure (crescent shape and suture)
  • Skin graft (using planer, from thigh)
  • Obturation and implants (eg for hard palate, must occlude hole)
  • Local flaps
  • Pedicled flaps (artery, vein and tissue supplied by them)
  • Free flaps (esp bone from fibula)
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22
Q

Risk factors for oral cancer

A
  • Smoking (x3 risk) , + alcohol (x6 risk), Beatle quid chewing, HPV 16 and 18
  • Sun exposure (lower lip, cigarette rest), immunosuppression
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23
Q

Which is worse, a white patch or a red patch in the mouth?

A

Red is more invasive

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24
Q

How might oral cancer present? (6)

A

Ulcer, white patch, red patch (higher risk), lymphadenopathy, lump/mass, pathological fracture

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25
Q

What are the red flags for an oral ulcer? (3)

A

Raw edges, feels hard, present for over 3 weeks

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26
Q

Name 3 frenulums in the mouth

A

Superior labial
Inferior labial
Lingual

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27
Q

Name 4 structures of the soft palate

A

Glossopalatine arch
Pharyngopalatine arch
Palatine tonsil
Uvula

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28
Q

What is the opening at the back of the mouth-> oropharynx called?

A

Fauces

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29
Q

Where is the dorsal side of the tongue?

A

Dorsal is top of tongue, ventral is underneath

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30
Q

What makes up the gums?

A

Alveolar mucosa

Gingiva

31
Q

Name the types of taste buds on the anterior tongue

A

Fungiform
Filliform
Foliate

32
Q

Name the type of taste bud on the posterior tongue

A

Valate

33
Q

Describe the sensory nerves of the tongue

A

Anterior 2/3 Trigeminal (lingual from mandibular) is for sensation of tongue. Facial nerve is taste sensation.
Posterior 1/3: glossopharyngeal

34
Q

Describe the salivary glands and where they empty

A

Parotid to 2nd molar level inner cheek
Submandibular gland, under floor, to papillae under tongue either side of lingual frenulum (stones are common, swells at dinner time)
Sublingual gland: empties under tongue in lots of little papillae

35
Q

What should be screened for in someone with mouth ulcers

A

Iron and B12 deficiency

36
Q

Describe oral lichen planus

A 
White, lace-like pattern on the inner
surfaces of the cheeks and tongue
Can cause ulcers
Autoimmune
1-5% are malignant, referred (non urgent)
37
Q

Describe an mucucele

A

mucous retention cyst or mucous extravasation cyst. Usually lower lip, usually caused by trauma from biting lower lip.

38
Q

What can happen with bisphosphonates and dental treatment?

A

When you remove a tooth you can cause necrosis of the jaw. = medication related osteonecrosis of the jaw (MRONJ).

39
Q

What drugs can cause gingival hyperplasia? (3)

A

cyclosporine, nifedipine, phenytoin

40
Q

When is pseudomembranous candidiasis seen?

A

If immunosuppressed, denture wearing, recent antibiotic use.

41
Q

Describe the appearance of an oral SCC

A

raised rolled edge, granular surface, fixed to deep structures. Hardened (indurated), non-healing, bleeding. Classically on lower lips, especially on people that work outside.

42
Q

What is the NICE RULE for referring an oral lesion?

A 
RULE
Red or white patch (erythroplacia/leucoplacia)
Ulceration
Lump, loose tooth or lymphadenopathy
Extending for more than 3 weeks
->>Then refer under 2 week wait.
43
Q

Explain how teeth are named

A

Teeth: 8 is wisdom tooth. Permanent teeth are numbers, baby teeth are letters.
Incisors (1&2), canine (3), premolar (4&5), molar (6, 7, 8)

44
Q

Layers of a tooth

A

Enamel-> dentin-> pulp

45
Q

Describe 4 ways of preventing tooth decay

A
  • Reduce amount and frequency of sugary snacks and sugary drinks
  • Brush teeth for 2 mins BD using fluoride toothpaste (don’t rinse out!)
  • Floss and interdental brushes daily (in adults)
  • Have regular dental checks
46
Q

Describe peridontal disease

A

Ankylosis occurs: teeth become fixed to the bone, esp after trauma.
Peridontal ligament can be broken down by bacteria if plaque and poor oral hygiene. Gingivitis occurs, bleeding occurs on brushing-> clean more!
Gum disease, bone shrinks, teeth fall out!

47
Q

How to avoid peridontal disease

A

Stop smoking
Healthy diet
Leave dentures out at night and clean them
Clean teeth BD and use interdentals.

48
Q

When are antibiotics used in dentistry?

A 
Antibiotics are used in: 
•	Facial swelling
•	Spreading infection
•	Systemic infection
•	Bites to the face
•	Open fractures
49
Q

Define laceration

A

burst of the skin over a bony structure after blunt force.

50
Q

Define vermillion border

A

Between cheek and lip mucosa

51
Q

What drug is used in uncooperative pts and children to suture their face?

A

Ketamine

52
Q

Name the layer of the scalp

A 
SCALP
Skin
C: subcutaneous tissue
Apponeurosis
L: gap
Pericranium
53
Q

Name 7 common causes of swelling in the anterior triangle of the neck

A 
– Reactive lymphadenitis
– Lymphoma
– Metastasis
– Branchial cyst
– Thyroglossal cyst
– Dermoid cyst
– Goitre
54
Q

3 common causes of swelling in the posterior triangle of the neck

A

Lymphadentitis
Lymphoma
Lipoma

55
Q

Blood supply of thyroid gland

A

Superior thyroid a. (from internal carotid)

Inferior thyroid a. (from thyrocervical trunk from subclavian)

56
Q

Where is the parathyroid?

A

Posterior aspect of thyroid gland

57
Q

Which arteries are at risk when removing palatine tonsil?

A

Facial artery (+ tonsillar brach)
Ascending pharyngeal
Ascending palatine
Carotids aren’t far away

58
Q

How is aspiration prevented?

A

Aspiration is prevented by good sensation
allowing the epiglottis to tilt, the larynx to
rise, and the false cords and cords to close

59
Q

What is weakness at the back above

cricopharyngeus called?

A

Dehiscence of Killian
Proximal to upper oesophageal sphincter
Zenker’s diverticulum

60
Q

Name the parts of the larynx, superior to inferior

A 
Epiglottis
Hyoid bone
Thyroid cartilage
Arytenoids & vocal ligaments
Cricoid cartilage
Trachea
61
Q

Describe ventricle of larynx

A

Vestibular fold superiorly
Vocal fold inferiorly
Thyroarytenoid muscle as base

62
Q

Describe voice production

A

The lungs power voice
Sound produced in the larynx by vocal fold
vibration
Modified in the mouth and nose (resonation chambers)
Pitch altered by vocal fold/cord tension

63
Q

2 functions of eustachian tube

A
  1. ventilation of middle ear
    Swallowing action pushes small volume of air into middle ear
  2. mucociciliary function
    Cilia clear mucus and debris
64
Q

Where is the pars flaccida?

A

Superior part of ear drum

65
Q

Describe the mechanism of hearing

A

Stapes compresses the fluid in the vestibule

The pressure wave travels up the scala vestibule and back down the scala tympani to the round window

66
Q

What does a negative Rinne’s test mean?

A

Bone conduction is louder than air conduction

Conductive hearing loss

67
Q

When can you get a false negative Rinne’s test?

A

In severe unilateral deafness when testing on side of deafness
Bone conduction heard on other side

68
Q

If Weber is heard in the left ear more loudly, what is wrong?

A

Either conductive hearing loss in left ear or sensorineural hearing loss in right ear

69
Q

What forms the external nose?

A

Upper and lower lateral cartilages
Fibrofatty tissue
Bony pyramid

70
Q

Where does the posterior ethmoid and sphenoid sinuses drain?

A

Sphenoethmoid recess, superior meatus

71
Q

Where does the middle and anterior ethmoid and frontal sinuses drain?

A

Middle meatues

72
Q

Where does the nasolacrimal duct drain?

A

Inferior meatus

73
Q

Function of turbinates

A

Increase resistance to airflow & regulate temperature and humidity of air before it reaches the lower respiratory tract

74
Q

Venous drainage of nasal cavity

A

Facial and ophthalmic veins

Year 4 (9 decks)

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