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Conditions + definitions > Head and neck 2 > Flashcards

Head and neck 2 Flashcards

1
Q

What constitutes the oral cavity?

A 
Oral vestible (area between lips/teeth)
Oral cavity proper
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2
Q

What are the boundaries of the oral cavity?

A

Lips to palatoglossaI arch (anterior pillar)
Palate to floor of mouth/tongue
buccal mucosa

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3
Q

What are the functions of the oral cavity?

A 
Taste
Mastication
>Teeth, tongue
Speech
>Tongue, cheek, lips
Digestion
>Salivary enzymes
Swallowing
>Tongue, hard and soft palate
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4
Q

What ducts enter the oral cavity?

A

Parotid

Submandibular duct

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5
Q

Describe the course of the parotid duct

A

duct pierces buccinator muscle,
then opening up into the oral cavity on the inner surface of the cheek
Opens opposite second molar

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6
Q

Describe the course of the submandibular duct

A

Lying superior to thedigastric muscle,
Both submandibular gland is divided into superficial and deep lobes,
separated by themylohyoid muscle.

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7
Q

How is the anterior 2/3rds of the tongue innervated?

A

From 1st branchial arch
Sensation - lingual nerve
>branch of mandibular divisionof theCN V

Taste
>Chorda tympani

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8
Q

How is the posterior 1/3rd of the tongue innervated?

A

Arises from 3rd brachial arch

Supplied by glossopharyngeal nerve (CN IX)

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9
Q

What are the functions of the tongue?

A

Taste
Mastication
Swallowing
Speech

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10
Q

What are the papillae of the tongue?

A

Fulliform
Gungiform
Folliate (very rudimentary)
Circumvallate

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11
Q

Describe the fulliform papillae

A

Most numerous

No taste buds

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12
Q

Describe the location of fungiform papillae

A

Scattered throughout dorsum of tongue

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13
Q

Describe the location of Circumvalate papillae

A

placed in a row just anterior to the sulcus terminalis

>(“V” shaped groove that demarcates the junction of the oral and pharyngeal portions of the tongue base)

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14
Q

What is teh innervation of the motor (muscle) aspect of tongue?

A

Everything innervated hy hypoglossal nerve (CN XII)
EXCEPT palatoglossus
>Innervated by pharyngeal plexus (CN IX/X)

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15
Q

What is the function of the intrinisic muscles of tongue?

A

Alter shape

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16
Q

What is the function of the extrinsic muscles of tongue?

A

Alter position

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17
Q

What are the main extrinsic muscles of the tongue?

A

Genioglossus,
styloglossus,
hyoglossus and palatoglossus

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18
Q

What muscles control mastication?

A

Lateral pterygoid
Medial pterygoid
Temporalis
Masseter

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19
Q

What is the innervation of the muscles of mastication?

A

CN V3

Mandibular division of trigemial nerve

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20
Q

Where do the muscles of mastication act?

A

Temporal-mandibular joint

>Grind food between teeth

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21
Q

What is the anterior/posterior boundaries of the orophaynx?

A

Palatoglossal arch to posterior pharyngeal wall

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22
Q

What is the inferior/superior boundaries of the orophaynx?

A

Lower border of soft palate to upper margin of epiglottis

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23
Q

What is the lateral boundary of the oropharynx?

A

faucial pillars & palatine tonsils

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24
Q

What is the nerve supply of the oropharynx?

A

Pharyngeal plexus- CN IX & X

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25
Q

What are the subsites of the hypopharynx?

A

Pyriform sinus
Post-cricoid area
Posterior pharyngeal wall

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26
Q

What is the innervation of the hypopharynx?

A

Pharyngeal plexus- CN IX & X

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27
Q

What is the blood supply of the hypopharynx?

A

Superior Thyroid Artery
Lingual Artery
Ascending Pharyngeal Artery.

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28
Q

What are superior/inferior boundaries of the hypopharynx?

A

Epiglottis To lower border of cricoid cartilage

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29
Q

What is the anterior boundary of the hypopharynx?

A

Back of larynx

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30
Q

What is the oral phase of swallowing?

A

Tongue propels food (bolus) into pharynx

Triggering swallowing reflex (afferent: CN V, IX, X – swallowing centre in medulla – efferent: CN VII, X, XII)

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31
Q

What is the pharyngeal phase of swallowing?

A

Soft palate pulled upwards
Epiglottis covers the larynx, vocal cord approximate, larynx moves upward
Upper oesophageal sphincter (UOS) relaxes
Respiration is reflex inhibited

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32
Q

What is the oesophageal phase of swallowing?

A

Once bolus passed UOS, the sphinter constricts
Bolus propelled downwards by peristaltic motion, reflex via myenteric plexus
Auerbach’s plexus(ormyenteric plexus) provides motor innervation to both layers of the tunica muscularis, having both parasympathetic and sympathetic input

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33
Q

What are the three phases of swallowing?

A

Oral
Pharyngeal
Oesophageal

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34
Q

What is the function of the larynx?

A

Part of resp tract
Voice
Swallowing

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35
Q

What forms the supraglottis?

A

extends from the superior tip of the epiglottis to the floor of the ventricular fold (junction of respiratory and squamous epithelium).

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36
Q

What forms the glottis?

A

superiorly: true vocal fold To inferior: a horizontal plane 5 mm inferior to the vocal cord.

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37
Q

What forms the subglottis?

A

begins 5 mm below the free edge of the true vocal cord and proceeds to the inferior border of the cricoid cartilage.

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38
Q

What are the three parts of the larynx?

A

Supraglottis
Glottis
Subglottis

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39
Q

What are the seven segments of cartilage?

A 
Cricoid cartilage
Thyroid cartilage
Epiglottis
Paired arytenoid cartilages (>corniculate 
>cuneiform 
> two of each)
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40
Q

What are the extrinsic muscles of the larynx?

A

Infrahyoid
Suprahyoid
Thyrohyoid

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41
Q

What is the function of the extrinsic muscles of the larynx?

A

Move the entire laryngeal complex

42
Q

What gives the motor innervation of the larynx?

A

CN X
All intrinsic muscles supplied by the recurrent laryngeal nerve

> Exception cricothyroid muscle (external laryngeal nerve)

43
Q

What nerve innervates the cricothyroid muscle?

A

External laryngeal nerve

44
Q

What is the function of the posterior circo-artenoid?

A

Abducts cords

Opens cords

45
Q

What is the function of the oblique artyenoids?

A

Close cords by drawing artyneoids together

46
Q

What is the function of the transverse arytenoid?

A

Closes cords by drawing arytenoids together

47
Q

What is the function of the lateral circoarytenoids?

A

Adduct/close cords by rotating arytenoids medially

48
Q

What is the function of the thyroarytenoids/vocalis?

A

Loosen cords by drawing thyroid cartilage and arytenoids together

49
Q

What is the resporatory phase of speech?

A

Air flow

Inhalation and exhalation

50
Q

What is the phonation phase of speech?

A 
Flow of air through different vocal cord features:
>Position
>Tension
>Vibration
>length
51
Q

What is the resonation phase of speech?

A 
Oral/nasal speech balance
Depends on 
>nasopharynx
>Nasal cavity
>Oral cavity
52
Q

What is the articulation phase of speech?

A

Production of speech determined by action of:
>Lips
>Tongue
>Jaw

53
Q

What is the prosody (nasal) phase of speech?

A

Production of syllable stress and emphasis

Provides effective speech tone

54
Q

What are common complaints in otology?

A 
Hearing loss
Otalgia (ear pain)
Otorrhoea (discharge)
Tinnitus
Vertigo
Facial weakness
55
Q

Who (paeds) is at risk for sensioneural hearing loss?

A 
Family history
Meningitis
Perinatal sepsis
>Toxoplasmosis
>Rubella
>CMV
>Herpes
56
Q

What tests can be used to test hearing in children?

A 
Distraction tests - distraction bell whilst looking at person. Testing to see if they turn head
Visually reinforced audiometry 
Play audiometry
Pure tone audiometry
Tympanometry
57
Q

What tests can be used to test hearing in neonates?

A

Objective tests - otoacoustic emissions

Auditory brainstem response

58
Q

What are the (child) risk factors for ottis media with infusion?

A 
M>F
Day care
Older sibilngs
Parental smoking
Cleft palate
Down's syndrome
59
Q

When are children likely to get ottis media with effision?

A

80% before 10 yrs

Peaks at 12/18 months and 4 years

60
Q

What are the symptoms of ottis media with effusion?

A

Hearing loss
Speech delay
Behavioral problems
Academic decline

61
Q

What are the signs of Ottis media with effusion?

A

Dull TM
Fluid levels
Bubbles

62
Q

What are the treatment options for ottis media with effusion?

A

General advice
>Stop parental smoking
>Seasonal variation
>Breast feeding reduces risk

Autoinflation
Hearing aids
Surgery (grommet +/- adenoidectomy)

63
Q

What are they symptoms of acute ottis media?

A 
Short history
Lots of pain
Fever
Systemic upset
Ear discharge
64
Q

What bacteria can cause acute ottis media?

A

Haemophiluus influenzae
Strep. pneumonia
Moraxella catarrhalis

65
Q

How do you manage acute ottis media?

A

Analgesia (capol/ibuprofen)

Anti-biotics

66
Q

What are the antibiotics taken for acute ottis media?

A

5-7 days of:
1st line: Amoxycilling/co-amoxiclav
2nd line: eythromycin/clarthromycin

67
Q

How do you treat recurrent acute ottis media?

A

With a long course (4-6 weeks) of antibiotics
Low dosage
Consider a grommit

68
Q

What are the extracranial complications of acute ottis media?

A 
Acute mastoiditis
Mastoid abcess
Facial nerve palsy
Ossicular/cochlear damage
Labrinthitis
Chronic perforation
69
Q

What are the intracranial complications of acute ottis media?

A

Febrile convulsion
Brain abscess
Meningitis
Subdural/extradural empyema

70
Q

What are the management options for hearing loss?

A

Bone anchored hearing aid
cochlear implant
Remove foreign body if present

71
Q

What investigations are indicated in a child with nasal symptoms?

A 
Allergy tests (RAST/Skin prick)
Plain x-ray (adenoids)
CT scan (choanal atresia)
72
Q

What can cause nasal obstruction in children?

A

Rhitinits
Adenoidal hypertrophy
Foreign body

73
Q

How do you treat nasal obstruction in children?

A 
Decongestants
Steroids (not under 4)
Nasa hygiene (douching)
Surgery
Diathermy (reduce turbinates)
Adenoidectomy
Correct choanal atresia
74
Q

What is periorbital cellulitis?

A

Complicated ethmoid sinusitis
Potentially sight threatening
Risk of intracranial sepsis

75
Q

What are the differentials of a neck lump in children?

A

Thyroglossal cyst
Branchial cyst
Lymph node enlargement

76
Q

What is the medical treatment of acute tonsillitis?

A

Penicillin V +/- anaerboic cover
AVOID amoxycillin/ampicillin
Antiseptic gargle
Analgesia

77
Q

What is the surgical treatment of acute tonsillitis?

A

Drain tonsillar abscess

Stop airway obstriction

78
Q

What tests can be used to gather more information in acute tonsilitis?

A

EBV serology
FBC
U&Es
CRP

79
Q

What are the anatomical differences in the H&N region between children and adults?

A 
Relative macroglossia
Tonsiller hypertrophy
Large epiglottis
Short neck
High larynx
Subglottis is norrowest point
80
Q

What is stertor?

A

Noisy breathing due to obstruction above larynx

81
Q

What is ronchi?

A

Noisy breathing due to narrowing of the lower respiratory airways

82
Q

What is a silogram?

A

Dye injection into salivary glands

Allows identification of stones/narrowing

83
Q

What is a sinogram?

A

Injection into a hole (dye) to see where it goes

84
Q

How do you treat a laryngeal pouch?

A

Laser endoscopy to help hypertonic muscle release tension

85
Q

What is a blom-singer valve?

A

Allows for speech after laryngectomy

86
Q

When is a barium swallow used?

A

When suspected leak in GI tract

If in doubt use iodine water based contrast

87
Q

What is siboeristeal?

A

Pus gathering behind eye

Must decompress eitherwise sight loss due to optic nerve impingement

88
Q

What is an allergy?

A

A hypersensitive disorder of the immune system
Occur to normally harmless environmental substances known as allergens; the reactions are acquired
Exaggerated or inappropriate immune reaction, causing damage to the host

89
Q

What is an allergen?

A

Antigen that causes allergic reactions
Usually proteins
Depending on the individual, allergen, and mode of introduction the symptoms can vary from systemic or localised
Asthma localised to resp system, eczema to dermis

90
Q

What are the common symptoms of an allaergy?

A 
Sneezing
	Nasal congestion
	Runny nose
	Swelling and tenderness of mouth
	Difficulty breathing
	Flushing or rash
	Burning/itching of skin
	Hives
	Nausea/vomitting
	Abdominal cramps
Diarrhoea
91
Q

What mechanism is behind an allergy?

A

IgE triggers mast cells

Results in a subsequent accumulation of inflammatory cells at sites of antigen deposition

92
Q

How do allergies develop?

A

First allergen exposure - response with T/B cells producing IgE
IgE circulates in blood and binds to IgE-specific receptors
Mast cells and basophils

93
Q

Describe an acute allergic response

A

Exposure of allergen
specific IgE
Leads to degranulation with release of contents

94
Q

What contents are released in degranulation in an allergy?

A 
histamine,
 cytokines, 
interleukins, 
leukotrienes, 
and prostaglandins
95
Q

What are the systemic effects caused by degranulation in an allergy?

A

vasodilation,
mucous secretion,
nerve stimulation
and smooth muscle contraction.

96
Q

What is the late phase response to an allergen?

A 
2-4 hours after inital exposure
Due to migration of other leukocytes to initial site
>Neutrophils, 
>lymphocytes, 
>eosinophils, 
>macrophages all migrate
97
Q

What is immunotherapy?

A

Controlled exposure to known allergens to reduce the severity of allergy
>Useful for allergic rhinitis, allergic asthma, allergic conjunctivitis etc
>Not for food allergy, urticaria, atopic dermatitis

98
Q

What is desensitisation therapy?

A

Desensitization - vaccinated with progressively larger doses of allergen
>Increasing IgG antibody production blocks excessive IgE production.
>The person builds up immunity to increasing amounts of the allergen in question.

99
Q

How do you treat allergies?

A

Allergen avoidance
Pharmaotherapy (reduce effets when exposed to allergen)
Immunotherpay

100
Q

What is allergic rhinitis?

A

Allergic inflammation of nasal airways
Occures when allergen inhaled by someone sensistised to allergen
Seasonal or perienial

101
Q

How do you diagnose allergies?

A

Skin tests

RAST test

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