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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
What are the red flags for an oral ulcer? (3)
Raw edges, feels hard, present for over 3 weeks
26
Name 3 frenulums in the mouth
Superior labial Inferior labial Lingual
27
Name 4 structures of the soft palate
Glossopalatine arch Pharyngopalatine arch Palatine tonsil Uvula
28
What is the opening at the back of the mouth-> oropharynx called?
Fauces
29
Where is the dorsal side of the tongue?
Dorsal is top of tongue, ventral is underneath
30
What makes up the gums?
Alveolar mucosa | Gingiva
31
Name the types of taste buds on the anterior tongue
Fungiform Filliform Foliate
32
Name the type of taste bud on the posterior tongue
Valate
33
Describe the sensory nerves of the tongue
Anterior 2/3 Trigeminal (lingual from mandibular) is for sensation of tongue. Facial nerve is taste sensation. Posterior 1/3: glossopharyngeal
34
Describe the salivary glands and where they empty
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
What should be screened for in someone with mouth ulcers
Iron and B12 deficiency
36
Describe oral lichen planus
``` 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
Describe an mucucele
mucous retention cyst or mucous extravasation cyst. Usually lower lip, usually caused by trauma from biting lower lip.
38
What can happen with bisphosphonates and dental treatment?
When you remove a tooth you can cause necrosis of the jaw. = medication related osteonecrosis of the jaw (MRONJ).
39
What drugs can cause gingival hyperplasia? (3)
cyclosporine, nifedipine, phenytoin
40
When is pseudomembranous candidiasis seen?
If immunosuppressed, denture wearing, recent antibiotic use.
41
Describe the appearance of an oral SCC
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
What is the NICE RULE for referring an oral lesion?
``` 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
Explain how teeth are named
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
Layers of a tooth
Enamel-> dentin-> pulp
45
Describe 4 ways of preventing tooth decay
* 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
Describe peridontal disease
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
How to avoid peridontal disease
Stop smoking Healthy diet Leave dentures out at night and clean them Clean teeth BD and use interdentals.
48
When are antibiotics used in dentistry?
``` Antibiotics are used in: • Facial swelling • Spreading infection • Systemic infection • Bites to the face • Open fractures ```
49
Define laceration
burst of the skin over a bony structure after blunt force.
50
Define vermillion border
Between cheek and lip mucosa
51
What drug is used in uncooperative pts and children to suture their face?
Ketamine
52
Name the layer of the scalp
``` SCALP Skin C: subcutaneous tissue Apponeurosis L: gap Pericranium ```
53
Name 7 common causes of swelling in the anterior triangle of the neck
``` – Reactive lymphadenitis – Lymphoma – Metastasis – Branchial cyst – Thyroglossal cyst – Dermoid cyst – Goitre ```
54
3 common causes of swelling in the posterior triangle of the neck
Lymphadentitis Lymphoma Lipoma
55
Blood supply of thyroid gland
Superior thyroid a. (from internal carotid) | Inferior thyroid a. (from thyrocervical trunk from subclavian)
56
Where is the parathyroid?
Posterior aspect of thyroid gland
57
Which arteries are at risk when removing palatine tonsil?
Facial artery (+ tonsillar brach) Ascending pharyngeal Ascending palatine Carotids aren't far away
58
How is aspiration prevented?
Aspiration is prevented by good sensation allowing the epiglottis to tilt, the larynx to rise, and the false cords and cords to close
59
What is weakness at the back above | cricopharyngeus called?
Dehiscence of Killian Proximal to upper oesophageal sphincter Zenker's diverticulum
60
Name the parts of the larynx, superior to inferior
``` Epiglottis Hyoid bone Thyroid cartilage Arytenoids & vocal ligaments Cricoid cartilage Trachea ```
61
Describe ventricle of larynx
Vestibular fold superiorly Vocal fold inferiorly Thyroarytenoid muscle as base
62
Describe voice production
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
2 functions of eustachian tube
1. ventilation of middle ear Swallowing action pushes small volume of air into middle ear 2. mucociciliary function Cilia clear mucus and debris
64
Where is the pars flaccida?
Superior part of ear drum
65
Describe the mechanism of hearing
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
What does a negative Rinne's test mean?
Bone conduction is louder than air conduction | Conductive hearing loss
67
When can you get a false negative Rinne's test?
In severe unilateral deafness when testing on side of deafness Bone conduction heard on other side
68
If Weber is heard in the left ear more loudly, what is wrong?
Either conductive hearing loss in left ear or sensorineural hearing loss in right ear
69
What forms the external nose?
Upper and lower lateral cartilages Fibrofatty tissue Bony pyramid
70
Where does the posterior ethmoid and sphenoid sinuses drain?
Sphenoethmoid recess, superior meatus
71
Where does the middle and anterior ethmoid and frontal sinuses drain?
Middle meatues
72
Where does the nasolacrimal duct drain?
Inferior meatus
73
Function of turbinates
Increase resistance to airflow & regulate temperature and humidity of air before it reaches the lower respiratory tract
74
Venous drainage of nasal cavity
Facial and ophthalmic veins

Year 4 (9 decks)

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