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ESA4 Old syllabus > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

What are the borders of the anterior and posterior triangles of the neck?

A

Anterior -
medially imaginary sagittal line, superiorly lower border of mandible, lateroposteriorly medial edge of sternocleidomastoid
Posterior -
superomedially lateral edge of SCM, inferiorly middle 1/3 of clavicle, posteriorly trapezius

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2
Q

Where would you insert a central line?

A

Subclavian vein or internal jugular vein in posterior triangle of the neck or femoral vein

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3
Q

List the fascial layers of the neck.

A 
Deep investing fascia of the neck
Subcutaneous fascia
Pre-tracheal
Pre-vertebral
Carotid sheath
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4
Q

What 4 triangles can the anterior triangle of the neck be divided into?

A

Carotid, submental, mandibular and muscular

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5
Q

What 2 triangles can the posterior triangle of the neck be divided into?

A

Occipital and subclavian

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6
Q

What is the function of having multiple fascial planes in the neck?

A

To allow easy independent movement of structures during swallowing and movements of the neck. It also usually contains infections within the compartments formed.

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7
Q

What is the retro-pharyngeal space and what is its relevance?

A

The potential space between the pretracheal and prevertebral fascias. It extends down to the diaphragm and thus can become a conduit for infection in the neck to spread to the chest, and potentially cause life-threatening mediastinitis. However this is extremely rare.

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8
Q

What are the borders of the carotid triangle and what are its contents?

A 
Borders:
superiorly - posterioir belly of digastric
posteriorly - medial border of SCM
inferioirly - superioir belly of omohyoid
Contains:
bifurcation of the carotid artery
internal jugular vein
Hypoglossal and Vagus nerves
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9
Q

Where would you palpate a carotid pulse?

A

Between SCM and trachea, roughly at level of cricoid cartilage with the patient’s head gently tilted to one side. Do not go above the thyroid cartilage to avoid inadvertently massaging the carotid sinus.

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10
Q

How do you measure JVP? Which jugular vein is inspected and why?

A

Position patient reclined at 45’ with head turned away.
Look for pulsation between sternal and clavicular heads of SCM (can check if arterial by palpation)
Measuring the vertical height from sternal angle to the top of the pulse. Add 5cm to obtain the right heart filling pressure in cm of water. A pressure above 9 = elevated.
Can exaggerate pulsations be eliciting hepato-jugular reflux.
Internal jugular vein - more accurate

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11
Q

What are the pharyngeal arches?

A

A system of mesenchymal proliferations in the neck region of the embryo

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12
Q

Where can branchial cysts be located and how do they develop?

A

Anywhere along the anterior border of the SCM. They develop if the cervical sinus (2nd branchial cleft) is not obliterated during development.

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13
Q

Briefly describe diGeorge syndrome.

A

Failure of development in the 3rd & 4th Ph pouches: CATCH 22
Cardiac defects
Abnormal facial appearence
Thymic hypoplasia
Cleft palate
Hypocalcaemia (due to absence of parathryoid glands)
Due to Deletion on chromosome 22

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14
Q

What is Treacher Collins syndrome?

A

Causes hypoplasia of mandible and facial bones
It is an example of a first arch syndrome (failure of colonisation of the 1st Ph arch with neural crest cells)
Inhertited autosomal dominant

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15
Q

What are the branches of the arch of the aorta?

A

Brachiocephalic trunk
Left common carotid
Left subclavian

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16
Q

What is the clinical relevance of the bifurcation of the aorta (3 things)?

A

Location of carotid body
Location of carotid sinus
Common site of atheroma formation

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17
Q

As they travel in the neck, where are the vertebral arteries located?

A

Within the transverse foramina in C6-1

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18
Q

Which 2 sets of arteries supply the brain?

A

Internal carotid arteries and the vertebral arteries

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19
Q

In which layer of the scalp is its blood supply located, and so why do scalp injuries tend to bleed profusely?

A

Dense connective tissue layer, because this limits contriction plus wounds are often help open by the epicranial aponeurosis

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20
Q

What are the dural venous sinuses and where are they located?

A

Endothelium lined spaces between the periosteal and meningeal layers of dura
Located posteriorly in the cranial cavity:
superficial sagittal sinus superfically
inferior sagittal sinus deep

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21
Q

What are the layers of the scalp and so what is an extra-dural haemorrhage?

A 
Skin
Connective tissue (dense)
Aponeurosis 
Loose connective tissue
Periosteum 
An extra-dural haemorrhage is where a collection of blood forms between the skull and the periosteum
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22
Q

What is the risk of a strong blow to the temple and why?

A

Location of the pterion which is a relatively weak area of the skull where 4 bones join over which the middle meningeal artery passes. If this artery ruptures it can cause an extradural haemorrhage which can cause increased intracranial pressure.

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23
Q

How might a scalp infection become dangerous?

A

The veins that drain the scalp connect to the diploic veins of the skull through various valveless emissionary veins which them drain into the dural venous sinuses. Thus infections can spread from the scalp to the cranial cavity and affect the meninges.

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24
Q

What is the “danger triangle” of the face and why is it called so?

A

Bounded by bridge of nose and corners of mouth
Infections here may result in thrombophlebitis of the facial vein after which the infected clot can travel into the intracranial venous system and potentially cause cavernous sinus thrombosis. Infections can also spread to the dural venous sinuses and affect the meninges.

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25
Q

What is the cavernous sinus and where is it located?

A

A plexus of extremely thin walled veins located on the upper surface of the sphenoid

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26
Q

Which cranial nerves may be affected by cavernous sinus thrombosis?

A

Typically abducens
But also Occulomotor CNIII ,Trochlear CN IV, and ophthalmic and maxillary branches of the Trigeminal CNV2 and 3
Mnemonic for contents of cavernous sinus = OTOM CAT
Where C is for internal carotid artery

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27
Q

What is the function of the lymphatic system?

A

Allows small proteins, damaged cells and other components of tissue fluid that can’t be reabsorbed to be drained, thus preventing oedema.

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28
Q

Give 6 causes of chronic lymphoedma.

A 
Removal of lymph nodes
Chronic enlargement of lymph nodes
Certain infections
Damage to lymphatics due to radiotherapy etc 
Lack of limb movement 
Congenital - Milroy syndrome
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29
Q

How would you examine the lymph nodes of the head and neck?

A

Palpate under chin for sub mental, under angle of jaw for submandibular, in front of ear for preauricular, behind ear for post auricular, at back of head for occipital, down neck for anterior and posterior cervical chains and in supraclavicular fossa for those nodes (L for Virchows node)

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30
Q

What is Waldeyer’s ring?

A

A ring of nodules of MALT surrounding superior pharynx

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31
Q

What features of typical cervical vertebrae differentiate them from thoracic and lumbar vertebrae?

A

Bifid spinous process
Transverse foramina
Triangular vertebral foramen

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32
Q

Which cervical vertebra is most easily palpable?

A

C7

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33
Q

How do atlas and axis fit together and what movements do they allow?

A

Odontoid peg of axis inserts between anterior arch and transverse ligament of atlas
Allows rotation of head in vertical plane (nodding yes - atlas) and in transverse plane (shaking no - axis)

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34
Q

What cervical spine fracture is likely to occur due to a fall head first from a height?
(Name and Describe)

A

Burst or Jefferson fracture

2 breaks in anterior arch of atlas and 2 in posterior arch

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35
Q

What is a Hangman’s fracture and how might it occur? (A likely cause)

A

Paired fracture in axis vertebra, located on both sides just posteriorly of the transverse processes
Occurs due to hyperextension of the head of the neck eg falling onto chin or in a RTA

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36
Q

Describe the structure and function of the cranial sutures in the neonate.

A

Coronal suture across skull anteriorly, lamboid suture posteriorly, joined by sagittal suture. Unlike adults also have metoptic suture within frontal bone and these sutures are wide containing thick connective tissue matrix.
Allows the bones to push together and temporarily interlock during birth to protect brain during childbirth.

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37
Q

What are bregma and lamda?

A

Membranous island gaps between the cranial sutures

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38
Q

What features of the skull facilitate its protective function? (Remember layers)

A

Consists of flat bones which are dense and thus strong

Has 2 layers of compact bone (outer and inner - middle is spongy)

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39
Q

The foramina of the skull allow passage of neurovasculature and lymphatics in and out of the the skull. What is a disadvantage of the skull having foramina?

A

Makes the cranium floor weak thus it is likely to fracture in high energy impacts to the head

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40
Q

Where is the ethmoid bone located and what is a likely consequence of a fracture?

A

Midline of anterior cranial fossa

Anosmia (loss of sense of smell)

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41
Q

Where is the mastoid part of the temporal bone and what does it contain?

A

Behind pina

Mastoid air cells

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42
Q

How can otitis media lead to meningitis?

A

Otitis media can lead to infection in the mastoid air cells of the temporal bone (mastoiditis) which can then spread to the middle cranial fossa where it can spread to the meninges.

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43
Q

What are the possible consequences of a fractured temporal bone?

A

Vertigo and other balance problems
Sensorineural, conductive or mixed hearing loss
Facial paralysis
CSF fistula

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44
Q

Describe the parts of the embryo at week 4 of gestation that will later become the face.

A

Frontonasal prominence

Paired maxillary prominences and paired mandibular prominences both from 1st Ph arch

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45
Q

From which embryological tissue does the facial skeleton originate?

A

Neural crest (of the 1st pharyngeal arch)

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46
Q

Describe how cleft lip and cleft palate may develop.

A

Embryological failure of fusion of medial nasal prominence and maxillary prominence combined with failure of palatine shelves to fuse in the midline.

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47
Q

What might low set ears indicate? Explain how they might develop.

A

A chromosomal abnormality
The auricles of the ears develop from proliferation within the 1st and 2nd pharyngeal arches, initially developing as auricular hillocks in the neck which then ascend as the mandible grows. Any cause of failure of the ascent would cause low set ears.

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48
Q

What are the features of foetal alcohol syndrome and how common is it?

A

Smooth philtrum, low nasal bridge, epicanthal folds, small eye openings, underdeveloped jaw, flat mid face
Can cause neurodevelopmental delay
Fairly common - 1/100 births

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49
Q

Name the cranial nerves.

A

Oh oh oh to touch a female’s vagina gives Verne a hallucination:
Olfactory, Optic, Occulomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Vagus, Accessory, Hypoglossal

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50
Q

Which cranial nerves aren’t technically nerves and why?

A

Olfactory and Optic

They are brain tracts

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51
Q

Where are the jugular foramen and which nerves pass through it?

A

Paired - one on each side, lateral to occipital condyles on base of the skull
Glossopharyngeal IX, Vagus X and Accesorry XI

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52
Q

Which foramina do the 3 branches of the trigeminal nerve pass through?

A

Ophthalmic branch - sup orbital foramen
Maxillary branch - foramen rotundum
Mandibular branch - foramen ovale
(Some Random (h)’Ole)

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53
Q

How would you test the cranial nerves?

A

Olfactory - orange or coffee smell
Optic - Visual fields and acuity. Pupillary response - direct light reflex, consensual, accommodation. Fundoscopy
Occulomotor, Trochlear and Abducens - inspect resting gaze, “follow my finger” ask about double vision, look for nystagmus
Trigeminal - light touch in ophthalmic, maxillary and mandibular regions. Palpate temporalis and masseter, move jaw side to side
Facial nerve - raise eyebrows, screw up eyes, smile and show teeth, blow out cheeks
Vestibulocochlear- simple test of hearing, Rinne’s, Weber’s
Glossopharyngeal & Vagus - cough, soft palate movement (“ah”), gag reflex if necessary
Accessory - shrug shoulders, turn head side to side
Hypoglossal - wasting or fasiculations? tongue movement, protrude tongue

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54
Q

List some causes of anosmia

A

Trauma to cribriform plate
Meningitis
Upper respiratory tract infection

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55
Q

Describe the pupillary light reflex

A

The afferent limb (within the Optic nerve) relays stimulus from the retina to Edinger Westphal nucleus from which the efferent limb (within the Occulomotor nerve) relays the stimulus to cause direct (Ie in stimulated eye) and consensual (ie in ipsilateral eye) pupillary constriction.

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56
Q

A lesion in which cranial nerve would cause ptosis with a “down and out” pupil? Why is this often associated with a pupil dilation on the affected side?
What are the main causes of this?

A

Occulomotor
Parasympathetic fibres controlling sphincter papillae and cilary muscles hitchhike on the nerve
Increased intracranial pressure, aneurysm of posterior cerebral artery, cavernous sinus infection, trauma

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57
Q

In which cranial nerve does a “false localising sign” imply a lesion in and why?

A

Abducens

It is the first nerve affected by raised intracranial pressure

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58
Q

Which nerve is responsible for the corneal reflex?

A

Trigeminal nerve

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59
Q

In which structure does the facial nerve divide into its branches?

A

Parotid gland

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60
Q

What are the branches of the facial nerve?

A

Two Zulus Buggered Mmy Cat:

Temporal, Zygomatic, Buccal, Marginal mandibular, Cervical

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61
Q

What are the functions of the facial nerve?

A

Supplies muscles of facial expression, stapedius, posterior belly of diagastric muscle and stylohyoid muscle
Special sensory to anterior 2/3 of tongue (taste)
Supplies lacrimal and salivary glands (plus many other glands of head and neck)

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62
Q

What is a vestibular schwannoma and what symptoms can it cause?

A

Benign tumour of the Schwann cells covering the Vestibulocochlear nerve
Causes hearing and balance problems and if large can cause headaches with blurred vision, one sided facial numbness/pain due to compression of facial nerve and one sided limb and coordination problems

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63
Q

Which nerves are responsible for the gag reflex?

A

Glossopharyngeal- sensory

Vagus - motor

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64
Q

What is the sensory innervation to the carotid sinus?

A

Glossopharyngeal nerve!

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65
Q

What does the spinal accessory nerve do?

A

Motor supply to sternocleidomastoid and trapezius muscles

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66
Q

If there is damage to the innervation of the tongue, to which side will it deviate?

A

Towards the side of the lesion

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67
Q

Describe the sensory innervation of the face

A

Supplied by Trigeminal nerve:
Ophthalmic branch - central forehead and centre of nose
Maxillary branch - temples, cheeks and sides of nose, upper lip
Mandibular branch - jaw line from ear to ear, chin, bottom lip

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68
Q

What triad of symptoms does Horner’s syndrome encompass?

A

Partial Ptsois - partial drooping eyelid
Miosis - excessively contracted pupil
Anhydrosis - no sweating on that side

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69
Q

Describe the aetiology and pathology of Horner’s syndrome

A

Unilateral stretching or damage of sympathetic fibres especially sup. cervical due to trauma to sympathetic trunk or ganglia in the neck, spinal nerve lesions, pancoast tumour (apical lung tumour)
Ptsois is partial as only superior tarsal muscle is paralysed

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70
Q

What are the 4 parasympathetic ganglia in the head and neck and what do these supply?

A

Cilary - sphincter papillae and cilary muscles
Pterygopalatine - lacrimal gland, glands of nose, palate and nasopharynx
Submandibular - submandibular, sublingual and other glands of oral cavity
Otic - parotid gland and glands of oropharynx and posterior 1/3 of tongue

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71
Q

Which bones contribute to the orbit?

A

Frontal, Zygomatic, Maxilla, Ethmoid, Sphenoid and Lacrimal

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72
Q

In which bone is the superior orbital fissure located?

A

Sphenoid

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73
Q

Which nerves pass through the superior orbital fissure?

A

Occulomotor nerve (frontal, superior and inferior branches)
Trochlear nerve
Nasocilary branch of Ophthalmic nerve
Abducens nerve

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74
Q

Where is the optic canal located and what travels within it?

A

Within the sphenoid bone

The optic nerve and ophthalmic artery

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75
Q

Which nerve supplies most of the muscles supplying the eye?

A

(Remember LR6 SO4 R3)

CN III - Occulomotor

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76
Q

What is the innervation of the lateral rectus muscle?

A

(Remember LR6 SO4 R3)

CN VI - Abducens

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77
Q

Which muscle of the eye does the Trochlear nerve supply?

A

(Remember LR6 SO4 R3 and Trochlear nerve is CNIV)

Superior oblique

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78
Q

Which muscle is supplied by fibres from the superior cervical ganglion?

A

Superior tarsal muscle in the eyelid

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79
Q

Which muscles allow you to open and close your eyes?

A

Levatator palpaebrae superioris - retracts and elevates eyelid
Orbicularis oculi - shuts eyes

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80
Q

From which branch of the Internal Carotid Artery does the central retinal artery originate from?

A

The ophthalmic artery

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81
Q

What would be the result of central retinal artery occlusion and why?

A

Instant and total blindness as it is an end artery

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82
Q

What clinical sign can be seen on fundoscopy in central retinal artery occlusion?

A

Central cherry red spot

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83
Q

Why is there a risk of infection in the eye tracking back into the cranial cavity?

A

Central retinal vein that drains the eye drains into superior ophthalmic vein which then drains into the cavernous sinus which is found within the cranial cavity.

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84
Q

Why does your nose run when you cry?

A

Tears run down nasolacrimal duct into the nasal cavity

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85
Q

Where is the lacrimal gland located?

A

Under the lateral side of the eyebrow, above the eyelid

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86
Q

What are the differences between a stye and a Meibomian cyst?

A

A stye forms due to an infection some of the cilary glands, is usually painful and requires antibiotics. While a meibomian cyst is due to blocked tarsal glands (located further up the eyelid), is usually painless and can be treated with a hot compress.

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87
Q

Which areas of the eye would you expect to be inflamed in conjunctivitis?

A

The surface if the eyeball and the inner surface of the eyelid (bulbar and palpebral conjunctiva respectively)

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88
Q

What is the function of the eyelid?

A

Protect eye from injury, excessive light and dryness

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89
Q

Which layer of the eyeball is responsible for the “red eye reflex”?

A

The choriod - vascular layer between sclera and retina that supplies retina

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90
Q

What is the difference between the posterior chamber and the posterior segment of the eye?

A

Posterior chamber is the posterior part of the anterior segment at the front of the eye behind the ciliary muscle
While the posterior segment is that behind the posterior chamber and contains vitreous humour

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91
Q

What is the other name for the posterior segment?

A

The vitreous chamber

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92
Q

Where is the anterior chamber located?

A

At the front of the eyeball between cornea and ciliary muscles

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93
Q

How can photophobia be a sign of meningitis?

A

Optic nerve is a brain tract thus has meningeal covering and so can be affected by meningitis

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94
Q

What are the 3 main layers of the eyeball?

A

Outer fibrous layer
Middle vascular layer
Inner layer

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95
Q

What are the symptoms of retinal detachment?

A

Flashes of light, “floaters”, blurred or distorted vision -> blindness

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96
Q

Where is the aqueous humour? What produces it?

A

Within the anterior segment of the eye

Produced by ciliary body

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97
Q

What pathological changes in the eye result in the symptoms of cataracts?

A

Increasing hardening, flattening and opacity of the lens of the eye leads to vision becoming increasingly blurred and dazzled

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98
Q

What are the risk factors for cataracts?

A

Age
Smoking
Diabetes
Sunlight

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99
Q

What is papilloedema?

A

An optic disc swelling that occurs due to raised intracranial pressure

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100
Q

What are the signs of papilloedma?

A

Elevated margins and congested vessels

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101
Q

What causes papilloedema?

A

Causes of raised intracranial pressure such as a brain tumour, some medications, rarely extreme dehydration

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102
Q

What is the clinical term for double vision?

A

Diplopia

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103
Q

What is surgical / subcutaneous emphysema?

A

Collection of air in subcutaneous tissue

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104
Q

What is proptosis?

A

Abnormal protrusion of eyeball - “starey eyes”

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105
Q

What signs are associated with an Occulomotor nerve (CNIII) palsy?

A

Ptosis, “down and out” eye (pupil positioned inferiorly and laterally) and dilated pupil

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106
Q

Why can palsy of CNVI cause binocular horizontal diplopia?

A

CNVI is the Abducens nerve which innervates the lateral rectus muscle allowing abduction of the eyeball such as occurs when looking sideways. This will mean that when looking sideways, eyes are misaligned and images detected will not be superimposable and so 2 separate images will be perceived by the visual cortex causing double vision.

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107
Q

Palsy of which cranial nerve can present with a head tilt, and why?

A

Trochlear nerve (CNIV) - innervates superior oblique muscle of the eye which allows intortion of the eye - tilting of the head is an attempt to overcome these problems with eye rotation caused by palsy of the nerve

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108
Q

What are the 3 key questions in a case of orbital fracture?

A

(Think what is sight threatening)
Is optic nerve compromised?
Is there a risk of retrobulbar haemorrhage?
Is there an injury to the globe?

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109
Q

Besides the 3 key questions, what other questions should you also consider in the case of orbital fracture?

A

Are other facial bones involved?

Is there a risk of foreign bodies in the eye?

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110
Q

What are the signs and symptoms of an orbital fracture?

A

Lid swelling, double vision (diplopia), reduced vision

Restriction of eye movements, reduced visual field and vision, enophthalmos (sunken eye)

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111
Q

What sign may you see on scans in the case of orbital fracture?

A

Eye protruding out of orbital cavity through broken bone

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112
Q

What is the most commonly fractured bone in orbital fractures?

A

Maxillary

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113
Q

What are the clinical signs of ethmoidal (medial orbital) fractures?

A

Horizontal diplopia, surgical emphysema

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114
Q

What are the symptoms of thyroid eye disease?

A

Ocular irritation, redness, double vision (diplopia)

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115
Q

How do you evaluate the severity of thyroid eye disease?

A 
Use NOSPECS method:
0 No symtoms or signs
1 Only symptoms, no signs
2 Soft tissue involvement (eg lid oedema)
3 Proptosis
4 Extra-ocular muscle involvement
5 Corneal ulceration
6 Sight loss
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116
Q

What are the signs and symptoms of orbital cellulitis?

A

Inflamed eyelids, pain, sticky discharge

Fever, painful/restricted eye movements, decreased vision and colour vision, RAPD, proptosis if severe

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117
Q

Which signs of orbital cellulitis are not associated with other inflammatory diseases?

A

RAPD, decreased vision and colour vision, proptosis, painful/restricted eye movements (i.e. all but fever)

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118
Q

What is an important potential clinical consequence of a capillary haemangioma in a child?

A

Can affect sight development

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119
Q

What is dacryoadenitis?

A

Lacrimal gland irritation - potential cause of an orbital mass lesion

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120
Q

Why is it important to consider Wegener’s in the case of an orbital mass lesion?

A

Wegener’s (necrotising granulomatous vasculitis) has systemic implications

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121
Q

List 7 causes of orbital mass lesions

A

Wegener’s (necrotising granulomatous vasculitis)
Dacryoadenitis
Pseudo-tumour (idiopathic orbital inflammatory disease)
Dermoid cyst
Mucocele
Capillary haemangioma
Cavernous haemangioma

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122
Q

Describe the innervation of the external ear

A

Auriculotemporal nerve - superomedial incl crus of helix
Auricular branch of the Vagus nerve - concha
Great auricular nerve - lateral lobe, helix except most medial part and lateral part of antihelix

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123
Q

What is the ear-cough reflex and why does it occur?

A

Triggering of gag/cough reflex by irritation to concha of external ear in the area innervated by the branches of the vagus nerve, irritation is referred along other branches of vagus including efferent branch of cough/gag reflex

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124
Q

What glands does the epithelium of the external acoustic canal have?

A

Ceruminous and sebaceous glands (produce cerumen - earwax)

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125
Q

How do the sensory fibres of the Vestibulocochlear nerve reach the inner ear?

A

Through the internal acoustic meatus within the petrous temporal bone

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126
Q

What fluid is contained within the membranous labyrinth of the inner ear?

A

Endolymph

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127
Q

Where is the perilymph located, and what function of the ear does it support?

A

Located within the bony labyrinth

Supports hearing

128
Q

What is the difference between the pars flaccida and pars tensa of the tympanic membrane?

A

Pars tensa has radial and circular fibres, pars flaccida has neither

129
Q

What is the innervation of the tympanic membrane?

A

External surface: mainly Auriculotemporal nerve (branch of CNV3) and some Auricolotemporal branch of Vagus
Internal surface: Glossopharyngeal nerve

130
Q

What separates the tympanic and cranial cavities?

A

A thin layer of bone called the tegmen tympani

131
Q

What forms a communication between the middle ear and the nasopharynx?

A

The Eustachian (pharyngotympanic) tubes

132
Q

Name the auditory ossicles and describe how they are arranged

A

Malleus - articulates with -> Incus articulates with -> Stapes

133
Q

Name the 2 muscles of the inner ear

A

Tensor tympani and Stapedius

134
Q

What is the function of the round window of the cochlea?

A

Allows movement of fluid within the cochlea, which in turn allows hair cells of basilar membrane to move and audition to occur

135
Q

Where is the round window in the inner ear located?

A

At the basal turn of the cochlea

136
Q

Where does the stapes attach to?

A

The membrane covering the oval window in the lateral vestibule

137
Q

What number of semi-circular canals are there in the inner ear? Describe their arrangement

A

3, set at right angles to each other

138
Q

What lies between the semi-circular canals and the cochlea?

A

The vestibule of the inner ear

139
Q

How would you examine the tympanic membrane?

A

With an otoscope, gently pulling ear upwards and back to straighten external auditory canal

140
Q

What is associated with congenital deformities of the pina?

A

Chromosomal syndromes and thus other malformations

141
Q

What is a perichondrial pina haematoma?

A

A build up of blood between the perichrondium and cartilage of the pina due to trauma causing ripping of the perichrondial vessels

142
Q

What can a perichrondrial pina hematoma lead to and why?

A

Cauliflower ear as the resulting separation of cartilage from its bloood supply will cause pressure necrosis resulting in scarring if not treated

143
Q

What are the causes of tympanic perforation?

A

Trauma or secondary to infection (causing pressure necrosis)

144
Q

Explain an important potential clinical consequence of otitis externa in an immunocompromised individual

A

Can lead to necrotising otitis externa where infection (often pseudomonas aeuginosa) spreads to bone

145
Q

Describe how “glue ear” can develop after an acute ear infection

A

Thick effusions behind the tympanic membrane

Can develop after acute otitis media if it causes prolonged tympanic retraction

146
Q

Which species of bacteria are implicated in the aetiology of acute otitis media?

A

Pneumooccus
Haemophilus
Streptococci

147
Q

What rare complication of otitis media causes swelling behind the ear?

A

Mastoiditis

148
Q

How can otitis media lead to facial drooping?

A

If the causative infection causes damage to CNVII (Facial nerve) which runs through the middle ear to then supply the muscles of facial expression

149
Q

What are the classical 4 symptoms of Meniere’s disease?

A

Vertigo
Tinnitus
Hearing loss
Aural fullness

150
Q

Give 3 examples of locations from where pain may be referred to the ear

A

Nasopharynx
Teeth
Jaw and Temporomandibular joint

151
Q

What is otalgia?

A

Ear ache

152
Q

What is the cause of benign positional paraoxysmal vertigo

A

Otolith displacement

153
Q

Describe the aetiology of cholesteatoma

A

Negative ear pressure -> retraction pockets -> dead skin cells accumulate and become necrotic, forming a mass known as a cholesteatoma

154
Q

Why is a cholesteatoma called so?

A

It behaves somewhat like a malignancy in that it causes the erosion of middle ear and bone due to lytic enzymes

155
Q

List 3 clinical consequences of a cholesteatoma

A

Painless otorrhea - the hallmark symptom
Conductive hearing loss
Meningitis (and other CNS complications)

156
Q

What are the functions of the nose?

A

Humidification and filtering
Olfaction and respiration
Drain and eliminate paranasal sinus and nasolacrymal duct secretions

157
Q

What is the limen nasi?

A

The border between the vestibule, which is lined by skin, and the nasal cavity proper

158
Q

What are the alae? (singular: ala)

A

The ridges forming the lateral boundaries of the nostils

159
Q

What bones contribute to the nose?

A

Frontal, Nasal, Ethmoid, Sphenoid, Vomer, palatine process of Maxilla, horizontal process of Palatine bone

160
Q

*What may happen if the cribriform plate is fractured?

A

Anosmia (loss of sense of smell)

161
Q

*How can a nasal fracture lead to a saddle nose deformity?

A

Septal deviation and haematoma -> avascular necrosis

162
Q

What are the choanae?

A

The two posterior openings/apertures of the nasal cavity into the nasopharynx

163
Q

What type of epithelia lines the nasal cavity?

A

Respiratory - pseudostratified columnar ciliated epithelium with goblet cells

164
Q

What are conchae and what is their function?

A

Protrusions on the lateral wall of the nasal cavity that create turbulent airflow, allowing the mixing of air, facilitating the humidifcation and warming of inspired air

165
Q

Which structures drain into the nasal cavity?

A

The paranasal sinuses
Lacrimal apparatus
Middle ear

166
Q

What is the spheno-ethmoidal recess?

A

The space between the superior turbinate and the roof (cribriform plate) of the nasal cavity (sphenoid sinuses drain here)

167
Q

What are the superior, middle and inferior meatuses of the nose?

A

The spaces between the turbinates / conchae

168
Q

*Branches from which 3 arteries of the face anastomose to form the blood supply to the nasal cavity?

A

The facial artery, the maxillary artery and the ophthalmic artery

169
Q

*Name the arteries supplying the nasal septum

A

Posterior and Anterior ethmoid arteries
(branches of) Superior labial artery
Greater palatine artery
Sphenopalatine artery

170
Q

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

A

An area of rich anastomoses on the anterior nasal septum that is the commonest site of ruptured vessels in epistaxis (nose bleeds)

171
Q

*What is epistaxis?

A

Nosebleed

172
Q

*Branches originating from which cranial nerves innervate the nose?

A

CNI - Olfactory

CNV1and2 - Opthalmic and Maxillary divisions of Trigeminal

173
Q

What nerves supply the external nose?

A 
Infraorbital nerve (CNV2)
External nasal nerve (CNV1)
174
Q

Name the nerves that supply to nasal mucosa

A

Nasopalatine nerve
branches of Greater palatine nerve
branches of Nasocilary nerve

175
Q

What is the innervation to the paranasal sinuses?

A

Branches of Opthalmic (CNV1) and Maxillary (CNV2)

176
Q

Why does chronic sinusitis tend to present after puberty?

A

Sinuses small, or not present in case of frontal, at birth and enlarge around puberty

177
Q

Name the paranasal sinuses and describe their locations

A

Frontal - forehead
Ethmoidal - between orbit and nasal cavity
Sphenoid - related to pituitary and middle cranial fossae
Maxillary - cheeks

178
Q

How can tooth ache be linked to sinusitis?

A

Sensory innervation of maxillary sinus, which is the most commonly inflamed, includes branches of alveolar nerves thus pain can be referred to the teeth (and the skin of cheek and upper jaw)

179
Q

How can you ascertain if tooth ache is linked to sinusitis?

A

The pain will be worse on leaning forward

180
Q

Describe the drainage of the maxillary sinus

A

Upwards into posterior middle meatus

181
Q

How could inflammation in the sphenoid sinus potentially affect endocrine function?

A

It is anatomically related to the pituitary gland

182
Q

How can an infection in the ethmoidal sinus be dangerous to the eye?

A

Posterior ethmoidal air cells are located near orbit, near to optic canal, and so, if drainage is blocked, infections can break through into orbit and potentially damage the optic nerve causing blindess

183
Q

What are the symptoms of rhinitis?

A

Increased secretions - runny nose
Swelling - stuffy nose
Headaches
Sneezing

184
Q

Describe the common aetiology of sinusitis

A

Often viral with secondary bacterial infection - S. pneumoniae, H. influenzae

185
Q

How do rhinitis and sinusitis cause the symptom of headaches?

A

Sensory innervation is via the Trigeminal nerve which also supplies meninges etc. and so pain can be referred to cause a headache

186
Q

*Resp. What are the main causative organisms of upper respiratory tract infections?

A

Rhinovirus, Coronavirus, Influenza, Parainfluenza, Respiratory Syncitial Virus

187
Q

Describe the two main types of nose bleeds

A

Anterior - bleeding from Kiesselbach’s plexus

Posterior - bleeding from sphenopalatine artery

188
Q

What are the main causes of nose bleeds?

A

Local - infections, trauma, mucosal drying

Systemic - hypertension, coagulation defects, NSAIDs

189
Q

What is the epidemiology of nose bleeds?

A

Bimodal distribution - common in young children and older people

190
Q

How would you first manage a nose bleed?

A

Pinch soft part of nose just below nasal bones and lean forward for 20 mins, apply ice if possible

191
Q

What treatments are indicated if initial (first aid level) management of a nose bleed is unsuccessful?

A

Cautery -> anterior packing with rapid rhino or merocel -> posterior packing with a female / Foley catheter and then anterior pack as well -> ligation of SPA, maxillary, external carotid arteries

192
Q

Describe and explain the main signs of a “pupil sparing” Occulomotor nerve lesson

A

Lesion of just the Occulomotor nerve itself,
causing ptosis due to denervation of levator palpaebrae superoris,
and “down and out” position of eye due to unopposed actions of lacteral rectus and superior oblique muscles (only muscles of the eye not supplied by Occulomotor n)

193
Q

Why can a lesion of the Occulomotor nerve cause pupil dilation?

A

Autonomic parasympathetic fibres from Edinger-Westphal nucleus “hitchhike” on Occulomotor nerve so are often also affected by lesions affecting the Occulomotor nerve due to their proximity. These fibres supply the sphincter pupillae muscle of the eye, denervation of which causes pupil dilation due to unopposed action of dilator pupillae muscle.

194
Q

What is mydriasis?

A

A “blown” or abnormally dilated pupil

195
Q

What are the branches of the Occulomotor nerve and what do they supply?

A

Superior branch supplies sup. rectus and levator palpabrae superioiris
Inferior branch supplies inf. rectus, inf. oblique and medial rectus

196
Q

Name the 3 nerve roots of the Trigeminal nerve

A

Opthalmic, Maxillary and Mandibular

197
Q

Which nerve is responsible for the corneal reflex?

A

Nasociliary branch of Opthalmic branch of Trigeminal nerve

198
Q

What types of nerve fibres does the Trigeminal nerve carry?

A

Sensory, motor and sympathetic

199
Q

What types of nerve fibres does the Facial nerve (CNVII) carry?

A

Sensory, special sensory, motor and autonomic

200
Q

What part of the tongue does CNVII innervate?

A

Anterior 2/3

201
Q

When can unilateral facial paralysis be forehead sparing and why?

A

In upper motor neurone lesions in facial nerve CNVII, as frontalis muscle receives bilateral innervation

202
Q

What is Bell’s Palsy?

A

Idiopathic CNVII palsy, common, symtoms usually temporary

203
Q

How can the facial nerve be damaged?

A

Parotitis, tumours of parotid gland, parotidectomy
Forceps delivery
Inflammation, usually due to infection
Typhanectomy
Surgical procedures of infratemporal fossa

204
Q

What are the borders of the oral cavity?

A

Hard palate and soft palate
Teeth
Imaginary line between left and right palatoglossal folds
Mylohyoid muscle (inferiorly)

205
Q

Where exactly are the palatine tonsils located?

A

Between the anterior and posterior tonsillar pillars of the oropharynx (i.e. the palatoglossal and palatopharyngeal arches)

206
Q

What is the intermaxillary suture and what is its embryological origin?

A

Central sagittal join in bones of hard palate, leaving a ridge down the majority of the roof of the mouth, formed by fusion of palatal shelves of maxillary process

207
Q

Name the muscles of the soft palate and describe their overall function

A 
M. uvulae
M. levator veli palatini
M. tensor veli palatini
M. palato pharyngeus
M. palato glossus
Pull on uvula and coordinate swallowing etc.
208
Q

Describe the normal appearance of the gingival mucosa

A

Paler than adjacent alveolar mucosa

209
Q

Describe the nature and potential consequences of being “tongue tied”

A

Abnormally large lingual frendulum can cause problems with feeding and speech

210
Q

Where do the sublingual and submandibular salivary glands open into the oral cavity?

A

At the sublingual and submandibular papillae either side of the lingual frendulum under the tongue

211
Q

Where does the parotid gland open into the oral cavity?

A

Into buccal mucosa above 2nd molar

212
Q

What might a painful mass located under the tongue be?

A

Salivary calculi (stone)

213
Q

Describe the naming of the teeth

A

Upper / lower?
Left / right?
Central incisor, lateral incisor, canine, 1st 2nd pre-molar or 1st 2nd or 3rd molar ?

214
Q

Which nerves innervate the muscles of the tongue?

A

Hypoglossal nerve - all muscles except..

Palatoglossus muscle - supplied by Vagus nerve

215
Q

Describe the sensory innervation to the tongue

A

Small central area posteriorly - Internal laryngeal nerve (CNX)
Rest of posterior 1/3 - Glossopharyngeal nerve for sensory and special sensory
Anterior 2/3 - Lingual nerve (CNV) for sensory, Chorda tympani (CNVII) for special sensory
Overlapping region 2/3 posteriorly has mixed supply of Glossopharyngeal, Lingual and Chorda tympani

216
Q

Name and describe the locations of the extrinsic muscles of the tongue

A

Genioglossus - arises from the mental symphysis and inserts into the dorsum of the tongue
Styloglossus - arises from the hyoid bone and inserts into the side of the tongue
Hypoglossus - arises from the hyoid bone and inserts into the side of the tongue
Palatoglossus - arises from the palatine aponeurosis and inserts broadly across the tongue

217
Q

Name and describe the actions of the intrinsic muscles of the tongue

A

Superior and Inferior longitudinal - make tongue short and thick and retract tongue
Vertical and transverse - make tongue long and narrow, protrude tongue

218
Q

Describe the common appearance of the tonsils in tonsillitis

A

Swollen, with white spots of exudate within crypts

219
Q

What is quinsy and how should it be managed?

A

Peritonsillar abscess - needs surgical draining

220
Q

What type of cartilage does the temporomandibular joint contain? and Tob Describe the features of this cartilage

A

Fibrocartilage!

Contains fibroblasts, few chrondrocytes, type 1 & 2 collagen with coarse fibres parallel to direction of stress

221
Q

Describe the structural features and function of the articular disc of the TMJ

A

Concavo-convex upper surface
Concave lower surface
Thinner centrally and thicker at the edges
-> Facilitates articulation of the poorly aligned temporal and mandibular bone

222
Q

How is the stability of the TMJ increased?

A

By support from various ligaments - particularly the temporomandibular ligament, sphenomandibular ligament and stylomandibular ligament

223
Q

How is posterior, anterior or inferior displacement of the TMJ limited?

A

Posterior - posterior glenoid tubercle
Anterior - articular tubercle
Inferior - the accessory ligaments - sphenomandiular and stylomandibular

224
Q

Describe the muscles and movements involved in opening the mouth

A

Lateral Pterygoids pull condyles forward

Digastric muscles pull chin down and back

225
Q

Describe the muscles and movements involved in closing the mouth

A

Posterior fibres of Temporalis retract the mandible

Rest of Temporalis, Masseter and the Medial Pterygoids elevate the mandible

226
Q

What is bruxism?

A

Clenching the jaw and grinding of teeth especially during sleep

227
Q

How common is TMJ pain?

A

Very common - 25% of population (though only a small number of these seek medical help)

228
Q

What symptoms suggest arthritis of the TMJ?

A

Pain, stiffness, feelings of “joint grinding”

229
Q

What are the boundaries of the infratemporal fossa?

A 
Lateral - Ramus of mandible
Medial - Lateral pterygoid plate of sphenoid
Anterior - Posterior surface of maxilla
Posterior - Carotid sheath
Roof - Greater wing on sphenoid
Floor - Medial pterygoid muscle
230
Q

Describe the arterial contents of the infratemporal fossa and their clinical relevance

A

Maxillary artery branching into Middle Meningeal Artery
Superficial temporal artery passes NEXT TO fossa
Injuries to these can lead to considerable bleeding

231
Q

Describe the venous contents of the infratemporal fossa

A

Pterygoid venous plexus
Maxillary vein
Middle meningeal vein

232
Q

Which nerves pass through the infratemporal fossa?

A

Mandibular nerve - branches within fossa
Chorda tympani
Otic ganglion

233
Q

What areas does an inferior alveolar nerve block anaesthetise?

A

Mandibular teeth and lower lip

234
Q

Why may tumours in the infratemporal fossa be advanced at presentation?

A

Fossa provides potential space into which tumours can grow quite large before becoming symptomatic

235
Q

Where is the pituitary gland located?

A

Within pituitary fossa of sphenoid bone, near to hypothalamus

236
Q

Describe the embryological origin of the pituitary gland

A

Anterior - ectoderm from Rathke’s pouch

Posterior - neuroectoderm from infundibulum (outgrowth of forebrain)

237
Q

Which pharyngeal arches does the tongue develop from?

A

1, 2, 3 and 4

238
Q

How is the nature of the sensory innervation of the tongue explained by its embryological origin?

A

Anterior 2/3 derived from Ph arches 1 and 3 - supplied by CNV and CNIX - the cranial nerves of the 1st and 3rd arches respectively
Posterior 1/3 derived from Ph arches 3 and 4 - supplied by cranial nerves corresponding to those pharyngeal arches CNIX and CNX
(NB Papillae - special sensory from Facial nerve - nerve of second arch)

239
Q

Where does the primordium of the thyroid gland develop?

A

In the floor of the pharynx

240
Q

Why do some people have a pyramidal lobe of their thyroid gland?

A

Remnant of embryological thyroglossal duct which normally regresses

241
Q

What is the embryological origin of the parafollicular cells of the thyroid gland? and What is their function?

A

Ultimobranchial body of the 4th Ph pouch (migrate into thryoid gland)
They produce calcitonin

242
Q

Where may ectopic thyroid tissue be located?

A

Anywhere along path of descent of thyroid gland from floor of pharynx to thryoid cartilage

243
Q

What may a midline neck swelling close to the hyoid bone be?

A

A thyroglossal cyst (50% are close to hyoid bone)

244
Q

What is the vertebral level of the thyroid gland?

A

C5

245
Q

Why might a thyroidectomy result in a disturbance in calcium and/or phosphorus metabolism?

A

If the parathyroid glands which are located on the posterioir surface of the thyroid gland and control calcium and phoshorus metabolism are also removed

246
Q

Met What are the symptoms of hypocalcaemia?

A

Parathesia, tetany, paralysis and convulsions (due to hyperexcitablity of neuromuscular junction)

247
Q

What muscles are related to the thyroid cartilage?

A

Omohyoid, sternohyoid and thyrohyoid muscles

248
Q

Why might an enlarged thyroid gland (goitre) cause the voice to become hoarse?

A

If it compresses the recurrent laryngeal nerve

249
Q

Describe the blood supply to the thyroid gland

A

Superior thyroid artery, the first branch of the external carotid, supplies anterosuperior aspect
Inferior thyroid artery, from the thryocervical trunk which is a branch of the subclavian, supplies posterior aspect

250
Q

Describe the venous drainage of the thyroid gland

A

Superior, middle and inferior thyroid veins form thyroid plexus located on anterior surface if the gland

251
Q

Which lymph nodes receive drainage from the thyroid gland?

A

Prelaryngeal, pre-tracheal and paratracheal which drain to the deep cervical lymph nodes

252
Q

How is secretion by the thyroid gland controlled? (Met)

A

TSH secretion which is controlled by Hypothalamus-Pituitary-Thryoid axis

253
Q

Name the parts of the pharynx and their borders

A

-base of skull-
Nasopharynx - chonane anteriroly, pharyngeal tonsil & C1 posteriorly
- soft palate-
Oropharynx - oral cavity anteriorly, C2&3 posteriorly
-epiglottis-
Laryngopharynx - larynx anteriorly, C3-6 posteriorly

254
Q

What are the contents of the nasopharynx?

A 
Nasopharyngeal tonsil (adenoids)
Eustachian tube orifice
255
Q

What are the contents of the oropharynx?

A

Pharyngeal tonsils

Anterior and posterior tonsillar pillars (palatoglossal and palatopharyngeal arches)

256
Q

Describe the nature of the epithelium of the pharynx

A

Nasopharynx - respiratory - pseudostratified cilated columnar epithelium with goblet cells
Rest - stratified squamous non-keratinised

257
Q

*What is the lymphatic drainage of the palatine tonsil?

A

Jugulo-digastric node (at angle of mandible)

258
Q

*Describe Waldeyers ring

A

Ring of 4 aggregated sets of MALT that act as a barrier to infection: pharyngeal tonsil, tubal tonsils, palatine tonsils, lingual tonsils

259
Q

Describe the musculature of the pharynx

A

3 circular layers that overlap each other - the superior, middle and inferior constrictors. Inferior has 2 components - thyropharyngeus and cricopharyngeus
3 longitudinal muscles - stylopharyngeus, paltopharyngeus and salpingopharyngeus

260
Q

Describe the process of swallowing

A

Voluntary oral phase -> rapid non-voluntary pharyngeal phase in which tongue and suprahyoid muscles pull hyoid and larynx up, soft palate elevates to close off nasopahrynx and sup. constrictors contract -> food bolus pushed into hypopharynx by middle and inferior constrictors

261
Q

How is the larynx protected during swallowing?

A

By overhanging tongue, epiglottis and vocal cords

262
Q

What is the action of the longitudinal muscles of the pharynx?

A

Shorten and widen pharynx

Elevate larynx

263
Q

Describe the motor innervation of the pharynx

A

Vagus

Glossopharyngeal nerve - stylopharyngeus

264
Q

Which nerves provide sensory innervation to the pharynx?

A

CNV2 - nasopharynx
CNIX (glossopharyngeal) - oropharynx
CNXII (hypoglossal) - hypopharynx

265
Q

Describe the blood supply of the pharynx

A

Sup. thyroid artery
Ascending pharyngeal artery
Ascending and descending palatine arteries
branches of Lingual, Facial and Maxillary arteries

266
Q

Describe the venous drainage of the pharynx

A

Pharyngeal venous plexus from internal jugular vein

267
Q

Why might the adenoid (pharyngeal) tonsils be enlarged?

A

Infection - viral or bacterial

268
Q

What are the potential consequences of enlargement of the adenoid (pharyngeal) tonsils?

A

Eustachian tube obstruction -> recurrent or chronic otitis media
Nasal obstruction -> mouth breathing, feeding difficulty, snoring or obstructive sleep apnoea

269
Q

What are the potential complications of an adenoidectomy?

A

Bleeding
Dislocation of atlanto-occipital joint from infection
Eustachian tube stenosis

270
Q

Describe the epidemiology of nasopharyngeal carcinoma and name the most common type

A

Extremely rare in UK, more common in Chinese population

Squamous cell carcinoma most common type

271
Q

What are the indications for tonsillectomy?

A

Recurrent tonsilitis
Previous peritonsillar abscess
Suspected cancer
Obstructive sleep apnoea

272
Q

Describe how a pharyngeal pouch can form

A

Posterior herniation of pharyngeal mucosa in Killian’s area - between inferior constrictor and cricopharyngeal muscles due to weakness in this area, incoordination of pharyngeal phase of swallowing or cricopharyngeal spasm

273
Q

Describe how a patient with a pharyngeal pouch may present (include epidemiology)

A

Dysphagia, hallitosis, regurgitation, aspiration, chronic cough, wieght loss
Typically over 70 and male

274
Q

Describe the presentation of acute epiglottitis

A

Septic / Pyrexial >38’c
Leaning forward in classical tripod position with hands on knees
Drooling
Usually children

275
Q

Describe the aetiology of acute epiglottitis

A

Bacterial infection - usually H. Influenzae type B, Staphylococci,
B. Haemolytic strep,
Pneumococci

276
Q

How would you manage acute epiglottitis?

A 
Don't attempt to examine!
Secure the airway
Broad spectrum antibiotics - ceftriaxone
Steroids
Throat swab and bloods
277
Q

Describe the aetiology of laryngotracheobronchitis (croup)

A

Viral infection - Parainfluenza or influenza

278
Q

Describe the presentation of laryngotracheobronchitis (croup)

A

Stridor

Harsh, subglottic “barking” cough

279
Q

How should you manage a patient with laryngotracheobronchitis (croup)?

A

If mild - at home with oral antibiotics and steam inhalation

If mod/severe - inpatient -> IV antibiotics, humidifed O2, dexamethasone, nebulised adrenaline, if worsening intubate

280
Q

What are the symptoms of foreign body airway obstruction?

A

Choking, coughing, disappearance of toy / after playing with foreign body

281
Q

How serious is a foreign body airway obstruction?

A

Leading cause of death in 1-3 year olds!

282
Q

What signs may you seen on radiology in a patient with a foreign body airway obstruction?

A

Opaque foreign body
Segmental or lobar collapse
Localised emphysema (from ball valve effect)
Air trapping

283
Q

Name the parts of the larynx

A 
Supraglottis
Glottis
Subglottis
Piriform fossa
Epiglottis
Thyroid cartilage
Cricoid cartilage
Arytenoid cartilages
Vocal cords
284
Q

If food is stuck in the larynx where is it likely to be?

A

The piriform fossa - pear shaped depressed either side of laryngeal inlet

285
Q

What is the epiglottis?

A

Leaf shaped plate of elastic fibrocartilage that is depressed during swallowing to cover larynx

286
Q

Describe the various cartilages of the larynx

A

Thyroid cartilage with superior horns that articulate with hyoid bone and inferior horns that articulate with cricoid cartilage. This is a signet ring shape with 2 articular facets on each side.
Arytenoid cartilages are pyramid shaped and are located on top of the cricoid cartilage. They are involved in vocal cord movement.
Also - epiglottis

287
Q

Describe the contents of the glottis

A

Vocal cords- have 4 layers: stratified squamous epithelium, Reinkes space, vocal ligament and vocalis muscle

288
Q

Name the principle muscles of the vocal cords and state which is responsible for abduction and which is responsible for adduction

A

Posterior cricoarytenoid - ABduction

Lateral cricoarytenoid - ADduction

289
Q

Which nerves provide motor innervation to the larynx?

A

Recurrent Laryngeal nerve - all muscles except..

Cricothyroid supplied by External Superior Laryngeal nerve

290
Q

Describe the laryngeal blood supply and venous drainage

A

Superior and inferior laryngeal arteries - branches of sup. and inf. thyroid arteries
Superior and inferior laryngeal veins

291
Q

List 6 causes of recurrent laryngeal nerve palsy, excl. idiopathic, thyroid disease and trauma

A 
Laryngeal cancer
Cervical lymphadeopathy
Oesophageal cancer
Apical lung cancer
Aortic aneurysm
Neuropathic - diabetes
292
Q

Describe the epidemiology of laryngeal carcinoma

A

Rare but commonest head and neck cancer in the west

More common in males

293
Q

List 3 causes of laryngeal carcinoma

A

Smoking, alcohol and HPV

294
Q

Is hypopharyngeal cancer common?

A

No

295
Q

What cell type is typically affected in carcinomas of the larynx?

A

95% of cases are squamous cell carcinoma

296
Q

What is laryngeal crepitus and what is the clinical relevance of it?

A

Grating feeling when larynx is moved side to side by examiner
Its absence is a sign of laryngeal carcinoma or laryngeal trauma

297
Q

What features in a history may lead you to suspect laryngeal cancer?

A 
Foreign body sensation in throat
Dysphagia
Odynohagia (painful swallowing)
Otalgia (ear ache)
Hoarse voice
Coughing
Weight Loss
Smoking history
298
Q

What examinations and investigations may you perform in suspected laryngeal cancer?

A 
Examine larynx for laryngeal crepitus
Examine cervical lymph nodes
Fibroptic endoscopy
Barium swallow
CT or MRI
Direct pharyngo-laryno-oesophagoscopy and biopsy
299
Q

2017 Why does a subdural haematoma tend to progress slower than an extradural one?

A

Subdural tends to be venous bleed while extradural tends to be arterial

300
Q

2017 Explain the appearance of a sub arachnoid haemorrhage on CT scan.

A

Opacities extending down into sulci as blood collects between arachnoid and pia mater, the latter if which is closely related to the surface of the brain, (including down into its sulci.)

301
Q

2017 Briefly describe how you can differentiate an extradural-from subdural- haemorrhage on CT

A

Extra dural - lens shaped / biconcave / lemon shaped

Epidural - crescent / banana shaped

302
Q

2017 What risk do the falx cerebri and tentorium cerebelli pose in raised intracranial pressure?

A

Brain can be displaced and compressed against them

303
Q

2017 Through which foramina do each of the cranial nerves exit the skull?

A 
CN I - holes of cribriform plate
CNII - optic canal
CNIII, IV and Va - superior orbital fissure
CNVb - foramen rotundum
CNVc - foramen ovale
CNVII and VIII - internal acoustic 
CNX and XI - jugular foramen
Cranial roots of CNXI - foramen magnum
CNXII - hypoglossal canal
304
Q

2017 Where does the middle meningeal artery enter the cranial cavity?

A

Through the foramen spinosum in the base of the skull

305
Q

2017 Name the most prolific type of immune cells in the brain

A

Microglia

306
Q

2017 Describe the parts of the brainstem and (briefly) their functions

A

Midbrain - eye movements and reflex responses to sound and vision
Pons - sleeping, feeding
medulla - CVS and respiratory control

307
Q

2017 Wheres the central sulcus of the brain?

A

Between the frontal and parietal lobes, on dorsal surface of brain

308
Q

2017 What are the main functions of the cerbellum?

A

Co-ordination and motor learning

309
Q

2017 Which lobe of the brain deals with vision?

A

Occipital

310
Q

2017 What does the corpus callosum of the brain do?

A

Connects the 2 cerbreal hemispheres

311
Q

2017 What is the uncus and what is its clinical relevance?

A

Central parts of the temporal lobes which can herniate and compress the midbrain if there is an increased intracranial pressure

312
Q

2017 What is the hypothesised reason behind the strength of the connection between scents and/or sounds and memories?

A

All processed within the temporal lobe of the brain

313
Q

2017 Why might frontal lobe damage cause impaired impulse control?

A

Frontal lobe is responsible for higher cognition

314
Q

2017 What is the role of the thalamus?

A

Sensory relay station projecting to sensory cortex

315
Q

2017 Which nerves pass through the cavernous sinus?

A

Occulomotor II, Trochelar IV,
Abducens VI,
Opthalmic and Maxillary branches of trigeminal VaVb

316
Q

2017 Explain, with reference to the specific anatomy, how atherosclerosis in the carotid artery could lead to monocular blindness.

A

Thrombus could embolise and travel up internal carotid and ophthalmic arteries to occlude the central retinal artery.

317
Q

2017 List 6 signs of cerebellar dysfunction

A 
D - dysdiadochokinesia and dysmetria
A - Ataxia
N - Nystagmus
I - Intention tremor
S - Slurred speech / scanning dysarthria
H - Hypotonia / heel-shin test positivity

ESA4 Old syllabus (3 decks)

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