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PPE Revision > H&N > Flashcards

H&N Flashcards

1
Q

What is the retropharyngeal space? Why is it important?

A

Between alar fascia and buccopharyngeal fascia (part of pretracheal layer). Extends to posterior mediastinum, spread of infection. Has midline raphe so infections appear unilateral

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2
Q

What are the contents of the carotid sheath?

A

Vagus nerve Internal jugular vein Common carotid artery

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3
Q

What are the layers of the deep cervical fascia, superficial to deep?

A

Investing layer Prevertebral layer Alar fascia & carotid sheath Pretracheal layer (contains buccopharyngeal fascia)

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4
Q

How do the fibres from the superior cervical ganglion travel to their target?

A

Hitch-hikes along carotids Runs posterior carotid artery

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5
Q

How do the fibres from the middle cervical ganglion travel to their target?

A

Hitch-hikes along inferior thyroid artery Runs anterior to inferior thyroid artery

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6
Q

How do the fibres from the inferior cervical ganglion travel to their target?

A

Hitch-hikes along vertebral and subclavian arteries

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7
Q

What is the target of the fibres from the superior cervical ganglion?

A
  • Dilator pupillae
  • Superior tarsal muscle
  • Salivary, lacrimal, nasal glands
  • Carotid body
  • Artery smooth muscle
  • Cardiac plexus
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8
Q

What is the target of the fibres from the middle cervical ganglion?

A
  • Larynx
  • Trachea
  • Pharynx
  • Cardiac plexus
  • Artery smooth muscle
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9
Q

What is the target of the fibres from the inferior cervical ganglion?

A
  • Cardiac plexus
  • Artery smooth muscle
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10
Q

How does Horner’s syndrome occur? How does it present?

A

Injury to sympathetic trunk/ganglia Causes: Pupillary constriction (unopposed parasympathetic) Partial ptosis (paralysis of superior tarsal muscle) Flushing Absence of sweating

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11
Q

What is the danger space? Why is it important?

A

Between prevertebral and alar fascia. Extends to diaphragm, spread of infection.

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12
Q

Which nerve is associated with the following pharyngeal arches?

  • 1st
  • 2nd
  • 3rd
  • 4th
  • 6th
A
  • 1st - CN V
  • 2nd - CN VII
  • 3rd - CN IX
  • 4th - CN X (superior laryngeal nerve)
  • 6th - CN X (recurrent laryngeal nerve)
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13
Q

Which muscles arise from the following pharyngeal arches?

  • 1st
  • 2nd
  • 3rd
  • 4th
  • 6th
A
  • 1st - Muscles of masstication
  • 2nd - Muscles of facial expression
  • 3rd - Stylopharyngeus
  • 4th - Cricothyroid, levator palatini, constrictors of pharynx
  • 6th - Intrinsic muscles of larynx
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14
Q

What are the cartilage derivatives of the following pharyngeal arches?

  • 1st
  • 2nd
  • 3rd
  • 4th
  • 6th
A
  • 1st - Merkel’s = Mandibular, Malleus, Incus
  • 2nd - Reichert’s = Stapes, styloid process, lesser horn of hyoid bone
  • 3rd = Remainder of hyoid bone
  • 4th = Thyroid cartilage
  • 6th = Cricoid cartilage
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15
Q

Which arteries are associated with the following aortic arches?

  • 1st
  • 2nd
  • 3rd
  • 4th
  • 6th
A
  • 1st - disappear
  • 2nd - disappear
  • 3rd - internal carotid artery
  • 4th - L = arch of aorta, R = brachiocephalic artery
  • 6th - pulmonary arch
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16
Q

What are the derivatives of the following pharyngeal pouches?

  • 1st
  • 2nd
  • 3rd
  • 4th
A
  • 1st - Tympanic cavity and auditory tube
  • 2nd - Palatine tonsil
  • 3rd - Thymus and inferior parathyroid
  • 4th - Superior parathyroid
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17
Q

What are the fates of the pharyngeal clefts?

A
  • 1st cleft is all that remains - external auditory meatus
  • 2nd cleft grows down to cover the others
  • Can be remnants - brachial cysts and fistulae that occur along border of sternocleidomastoid
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18
Q

What is Di-George Syndrome? What are the defects expressed?

A
  • Deletion of part of chromosome 22 causing abnormal development of neural crest
  • Congenital thymic aplasia and absence of parathyroid glands
  • Results in ‘CATCH-22’ defects
    • C = Cardiac abnormalities (especially tetralogy of Fallot)
    • A = Abnormal face
    • T = Thymic aplasia
    • C = Cleft palate
    • H = hypocalcaemia
    • D = Deletion of chromosome 22
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19
Q

What are thyroglossal cysts and fistulae?

A
  • Persistance of thyroglossal duct - central
  • Thyroid primordium moves down from floor of pharynx to place in the neck
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20
Q

From which nucleus do the parasympathetic fibres of CN III arise, which ganglia do they synapse in and what is their target?

A
  • Edinger-Westphal nucleus
  • Ciliary ganglion
  • Sphincter pupillae, ciliary muscles
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21
Q

From which nucleus do the parasympathetic fibres of CN VII arise, which ganglia do they synapse in and what is their target?

A
  • Superior salivatory nucleus
  • Pterygopalatine ganglion which goes to lacrimal gland and mucous glands of nasopharynx, palate, nasal cavity
  • Submandibular ganglion which goes to sublingual and submandibular gland
22
Q

From which nucleus do the parasympathetic fibres of CN IX arise, which ganglia do they synapse in and what is their target?

A
  • Inferior salivatory nucleus
  • Otic ganglion
  • Parotid gland
23
Q

At what vertebral level do the superior, middle and inferior cervical ganglion lie?

A
  • Superior = C1-C4
  • Middle = C6
  • Inferior = C7
24
Q

What is the epithelium and innervation of the tympanic membrane?

A

Outside

  • Non-keratinised stratified squamous epithelium
  • Auriculotemporal branch of CN V3, and auricular branch of CN X

Inside

  • Simple cuboidal epithelium
  • Glossopharyngeal nerve (CN IX)
25
Q

What are the borders of the carotid triangle?

A
  • Superior - posterior belly of digastric
  • Lateral - sternocleiomastoid
  • Medial - superior belly of omohyoid
26
Q

What passes in the posterior triangle in the neck?

A

External jugular artery

27
Q

What are the borders of the anterior triangle in the neck?

A
  • Anterior - midline
  • Posterior - anterior border of SCM
  • Superior - inferior border of mandible
28
Q

What are the borders of the posterior triangle?

A
  • Anterior - posterior border of SCM
  • Posterior - anterior border of trapezius
  • Inferior - middle third of clavicle
29
Q

What are the suprahyoid muscles?

A
  • Stylohyoid
  • Digastric
  • Mylohyoid
  • Geniohyoid
30
Q

What are the inferior hyoid muscles?

A
  • Sternohyoid
  • Sternothyroid
  • Thyrohyoid
  • Omohyoid
31
Q

What runs through the cavernous sinus?

A
  • Internal carotid artery
  • CN III, IV, VI
  • 2 branches of CN V - V1 & V2
32
Q

What is the middle meningeal artery a branch of?

A

Maxillary artery

33
Q

What are the branches of the external carotid artery?

A
  • Superior thyroid
  • Ascending pharyngeal
  • Lingual
  • Facial
  • Occipital
  • Posterior auricular
  • Superficial temporal
  • Maxillary
34
Q

What are the two important lymphatic ducts, what do they drain and where do they drain to?

A

Right lymphatic duct

  • Right upper quadrant of the body
  • Drains into right venous angle (union between right internal jugular vein and right subclavian vein

Thoracic duct

  • Rest of the body
  • Drains into left venous angle (union between left internal jugular vein and left subclavian vein)
35
Q

What muscles are responsible for protrusion and retraction of mandible?

A

Protrusion = lateral pterygoid

Retraction = Temporalis, masseter, geniohyoid, digastric

36
Q

Which muscles are responsible for elevation and depression of the mandible?

A

Elevation = temporalis, massester, medial pterygoid

Depression = gravity, digastric, geniohyoid, mylohyoid

37
Q

What is the danger triangle and why is it important?

A
  • Area over the nose and top lip - venous drainage via facial vein
  • Communication between facial vein and cavernous sinus - via ophthalmic veins
  • Spread of infection
38
Q

Which walls of the orbit are most likely to break?

A

Medial and inferior - weaker

39
Q

What is otitis media with effusion?

A
  • Infection of the middle ear caused by eustachian tube dysfunction
  • Causes an imbalance in pressure
  • Residual air is absorbed into veins of mucosa causing decrease in pressure and retraction of tyampanic membrane
40
Q

What is otitis media?

A
  • Infection of middle ear caused by Eushachian tube dysfunction
  • Red, bulging tympanic membrane
41
Q

What is cholesteatoma?

A
  • Destructive and expanding growth of keratinising squamous epithelium in middle ear and/or mastoid process
  • Can cause bone erosion due to pressure and oesteolytic enzymes
42
Q

What is tympanosclerosis?

A
  • Calcification of tympanic membrane
  • Abnormal healing response
  • Associated with acute otitis media, and middle ear effusion
43
Q
A
44
Q

Where is Kisselbach’s area found and which arteries contribute?

A

Nasal septum

  • Greater palantine
  • Anterior ethmoid
  • Superior labial
  • Posterior ethmoid
  • Sphenopalatine
45
Q

What is Waldeyer’s ring?

A

Tonsils in the nasopharynx and oropharynx

  • Lingual tonsil
  • Palatine tonsil
  • Tubal tonsil
  • Adenoid (nasopharyngeal tonsil)
46
Q

What oropharynx and larynx structures sit at the following vertebral levels?

  • C1
  • C2
  • C3
  • C4
  • C5
  • C6
A
  • C1 - Hard Palate
  • C2 - Angle of mandible
  • C3 - Hyoid bone
  • C4 - Thyroid cartilage upper border
  • C5 - Thyroid cartilage lower border
  • C6 - Cricoid cartilage
47
Q

What bony structure is the carotid pulse palpated against?

A

Carotid tubercle of C6

48
Q

At what vertebral lelvel does the common carotid artery bifurcate?

A

C4

49
Q

What are the branches of the facial nerve?

A
  • Temporal
  • Zygomatic
  • Buccal
  • Mandibular
  • Cervical

‘To zanzibar by motor car’

50
Q
A

PPE Revision (16 decks)

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