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eMRCS questions > Head and neck surgery > Flashcards

Head and neck surgery Flashcards

1
Q

Epidemiology of sjorgrens

A

Female
Post menopausal

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2
Q

Features of acute otitis external

A

Acute pain on moving the pinna
Conductive hearing loss if lesion is large
When rupture occurs pus will flow from ear

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3
Q

Features of acute otitis media

A

Most common in children and rare in adults

May present with symptoms elsewhere (e.g. vomiting) in children

Severe pain and sometimes fever
May present with discharge if tympanic rupture occurs

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4
Q

Feature of pleomorphic adenoma

A

Pleomorphic adenomas are the commonest tumours of the parotid gland and are often slow growing, smooth and mobile

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5
Q

Features of warthog tumour

A

Second most common benign parotid tumor (5%)

Most common bilateral benign neoplasm of the parotid

Marked male as compared to female predominance

Occurs later in life (sixth and seventh decades)

Presents as a lymphocytic infiltrate and cystic epithelial proliferation

multiple cysts and solid components consisting of lymphoid tissue

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6
Q

Features of monomorphic adenoma

A

Account for less than 5% of tumours
Slow growing
Consist of only one morphological cell type (hence term mono)
Include; basal cell adenoma, canalicular adenoma, oncocytoma, myoepitheliomas

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7
Q

Post thyroidectomy- difficulty speaking and stridor what damage?

A

Bilateral recurrent laryngeal nerve injury

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8
Q

Nerves involved in speach

A

Superior laryngeal nerve (SLN)
Innervates the cricothyroid muscle

Recurrent laryngeal nerve (RLN)/Inferior laryngeal nerve
Innervates intrinsic larynx muscles

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9
Q

Use of cricothyroid and pathology

A

Since the cricothyroid muscle is involved in adjusting the tension of the vocal fold for high notes during singing, SLN paresis and paralysis result in:

a. Abnormalities in pitch
b. Inability to sing with smooth change to each higher note (glissando or pitch glide)

Tenses laynrx- enlongating vocal cords

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10
Q

Small epithelial defect anterior to the left ear and is has been noted to discharge foul smelling material

A

Pre auricular sinus

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11
Q

Phayrngeal pouch features

A

posteromedial herniation between thyropharyngeus and cricopharyngeus muscles

Midline lump gurgles on palpation

Halitosis, regurgitation of undigested food, coughing at night and throat infections.

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12
Q

Foul smelling ear discharge and facial nerve weakness

A

Cholesteatoma

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13
Q

Cholestetoma features

A

Destructive and expanding growth of keratinised squamous epithelium
Patients often complain of chronic ear discharge
Infection with Pseudomonas may occur resulting in foul smell to discharge

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14
Q

Adenoid cystic carcinoma features

A

Infiltrates the facial nerve and may cause neuropathy and facial pain.

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15
Q

Drugs causing parotid gland enlargement

A

Carbimazole
isoprenaline, phenylbutazone,
high oestrogen dose contraceptive pills

CIPO

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16
Q

Wharton vs stensens duct

A

Parotid -stensens

Submandibular-Wharton

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17
Q

Sx of Sialolithiasis

A

Patients typically develop colicky pain and post prandial swelling of the gland

halitosis recently and he frequently complains of a dry mouth

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18
Q

Ethmoidal sinusitis features

A

headache and a sensation of pressure between the eyes

Ethmoidal sinusitis may spread to the periorbital tissues resulting in periorbital cellulitis

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19
Q

Sarcoid features

A

Bilateral parotid swelling with facial nerve involvement

Reduces with steroids

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20
Q

Mass in submandibular gland, CT shows solid lesion, FNA undiagnostic what next

A

Submandibular gland excision

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21
Q

Tx of pleomorphic adenoma

A

Superficial parotidectomy

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22
Q

Pleomorphic adenoma histology

A

Biphasic appearance of the lesion and mucinous connective tissue

mixed stromal and epithelial elements

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23
Q

Brachial cyst features

A

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx

Develop due to failure of obliteration of the second branchial cleft in embryonic development

Usually present in early adulthood

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24
Q

Ameloblastoma sx

A

Ameloblastomas are rare tumours of the odontogenic epithelium.

They are slow growing and expand with a rim of periosteum that surrounds them.

It is the palpation and disruption of this layer that gives rise to the crepitus.

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25
Q

Features of unilateral inferior laryngeal nerve injustice

A

Diplophonia which causes a gargling sound. This is associated with dysphagia

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26
Q

Cystic hygroma features

A

Posterior triangel
Transillumates

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27
Q

Where does the majority of epistaxis occur

A

Littles area / Kiesselbachs plexus

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28
Q

Arterial supply of nose

A

Anterior and posterior ethmoidal from internal carotid
- supply superior portion

Sphenopalatine (sup), greater palatine and superior labial
- external carotid

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29
Q

DM with severe deep seated otalgia and a facial nerve palsy, causative organism

A

Malignant otitis externa

Caused by pseudomonas

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30
Q

Nerves at risk during branchial cyst excision

A

Mandibular branch of facial nerve, greater auricular nerve and accessory nerve.

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31
Q

Young male with pancreatitis and painful parotid enlargement

A

Mumps

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32
Q

Timeframe when secondary haemorrhage occurs after tosinllectomy

A

5-10 days after surgery

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33
Q

Adenocarcinoma of paranasal sinuses and nasopharynx Rf

A

Wood exposure
Most ethmoidal

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34
Q

Visual defect with craniopharyngoma vs pituitary tumour

A

Cranio- lower bitemporal
Piuitary- upper

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35
Q

CN with parasympathetic innervation

A

3,7,9,10

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36
Q

Lymphatic drainage of tongue

A

Tip- submental then to deep

Mid- submandibular then to ipsilateral deep

Posterior- cross over- bilateral-deep cervical

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37
Q

Drainage of sphenoethmoidal recess

A

Superior meatus- posterior ethmoidal sinus
Middle meatus- frontal, maxillary, anterior and middle ethmoidal sinus

Inferior- nasolacrimal duct

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38
Q

Which structures pass through superior orbital fissure

A

Lacrimal
Frontal
Sup ophthalmic vein
Trochlear
Oculomotor sup
Nasal
Inf oculomotor
Abducens
Inferior ophthalmic vein

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39
Q

Which structures pass through inferior orbital fissure

A

Inferior ophthalmic vein
Ganglionic branches from ptyeropalatine ganglion to maxillary nerve
Infraorbotal nerve, artery, vein
Zygomatic nerve

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40
Q

Which structures pass through muscular ring

A

Superior oculomotor nerve
Nasocilliary
Inferior oculomotor
Abducens

Optic nerve
Ophthalmic artery

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41
Q

What is the umbo

A

Most depressed part of wher handle of malleus attaches to tympanic membrane

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42
Q

Cell layers of tympanic membrane

A

Lateral aspect- stratified squamous
Medial - mucous

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43
Q

Chorda tympani in relation to tympanic membrane

A

Runs medially to pars flaccida

Pars flaccida -
The part of the tympanic membrane above the malleolar prominence is not taut as it bridges the tympanic sulcus

chorda tympani branches off the facial nerve and enters the lateral wall of the tympanic cavity within the middle ear, where it runs across the tympanic membrane (from posterior to anterior) and medial to the neck of the malleus.

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44
Q

Artery that lies between sub mandibular and mandible

A

Facial artery
Often ligated in surgery

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45
Q

Level of hyoid

A

C3

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46
Q

Level of thyroid cartilage

A

C4

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47
Q

Level of Cricoid cartilage ends

A

C6

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48
Q

Level where inferior thyroid artery goes to thyroid

A

C6

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49
Q

Most superficial strecuture overlying parotid

A

Facial
Retromandibular next
Then External carotid

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50
Q

Relation of carotid sheath at C6

A

Anterior- hypoglossal and ansa cervicalis
Posterior- cervical symp chain

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51
Q

Boundaries of deep inguinal ring

A

Superolaterally - transversalis fascia
Inferomedially - inferior epigastric artery

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52
Q

Which nerve supplies styloglossus

A

Hypoglossal

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53
Q

Which nerve supplies stylohyoid

A

Facial

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54
Q

Nerve supplying cricothyroid

A

External laryngeal

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55
Q

What seperates subclavian artery and vein

A

Anterior scalene muscle

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56
Q

Which arteries do the arteries in littles area drain into

A

Sphenopalatine- to maxillary

Ethmoid- to opthalmic

Greater palatine- maxillary

Superior labial - facial

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57
Q

Parasympathetic nerves from lacrimal gland originate from

A

Pterygoipalatine ganglion

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58
Q

4 parasympathetic ganglia of head and neck and nerves

A

Ciliary - 3- sphincter pupillae (contracts the pupil) and the ciliary muscles (accommodates for near vision).

Pterygopalatine - 7 greater petrosal- largest- lacrimal, nasal, palate

Submandibular - 7- sublingual and submandibular gland

Otic -9 lesser petrosal- (hitchhike across auriculotemporal) parotid

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59
Q

Nerves most at risk in carotid endarectomy

A

Hypoglossal
Greater auricular
Superior laynrgeal

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60
Q

Where do you find torus tubarius and choana

A

Choana- separates Nasal cavity and nasopharynx

Torub tubarius - is an elevation of the mucous membrane of the nasal part of the pharynx formed by the underlying base of the cartilaginous portion of the Eustachian tube

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61
Q

Medial branch of external carotid

A

Ascending pharyngeal

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62
Q

Damage to what can lead to parasthesia anterolateral aspect of tongue

A

Lingual nerve at 3rd molar

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63
Q

Content of posterior triangle

A

Nerves- 4 branches of cervical plexus Supraclavicular nerve, transverse cervical nerve, great auricular nerve, lesser occipital nerve
Three trunks of the brachial plexus-sup, middle, inf

2 other nerves
Accessory nerve
Phrenic nerve

Vessels - 1 vein- external jugular vein
1 artery- Subclavian artery

Muscles - 1/2 muscle- inferior belly of omo
Scalene

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64
Q

Cause of pneumoparotid

A

Hypotonia of the buccinator muscle, hypertrophy of the masseter muscle or temporary obstruction of the Stensens duct by mucous

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65
Q

Which muscles inserts into greater Cornu of hyoid

A

Middle pharyngeal constrictor
Hyoglossus

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66
Q

Sensory Nerves of cervical plexus, route and fucntion

A

Sensory
Greater auricular - angle of jaw, skin over parotid and inferior external ear

Transverse cervical - curves around post aspect of SCM to provide sensation to ant neck

Lesser occipital- curves around the accessory nerve, and passes superiorly, close to the posterior border of the sternocleidomastoid- innervates posterosuperior scalp

Supraclacicular nerves- posterior border of sternocleidomastoid, and provide sensation to the skin overlying the supraclavicular fossa and upper thoracic region and sternoclavicular joint.

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67
Q

Motor nerves of cervical plexus

A

Motor
Nervs to genio and thyrohyoid

Ansa cervicalis - 4 branches:
Superior belly of the omohyoid muscle
Inferior belly of omohyoid muscle
Sternohyoid
Sternothyroid

Phrenic

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68
Q

Only cranial nerve to cross over

A

Trochlear

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69
Q

Action of inferior oblique

A

Abduct and elevate

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70
Q

Action of superior and inferior rectus

A

Superior -adduct and elevate
Inferior- adduct and depress

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71
Q

Borders of orbit

A

Roof (superior wall) – Formed by the frontal bone and the lesser wing of the sphenoid.

Floor (inferior wall) – Formed by the maxilla, palatine and zygomatic bones.

Medial wall – Formed by the ethmoid, maxilla, lacrimal and sphenoid bones.

Lateral wall – Formed by the zygomatic bone and greater wing of the sphenoid.

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72
Q

Which nerves go through ciliary ganglion without synapsing

A

Sympathetic nerves from the internal carotid plexus – innervate the dilator pupillae muscle
Sensory fibres from the nasociliary nerve (a branch of the ophthalmic division of the trigeminal nerve) – innervate the cornea, ciliary body and iris.

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73
Q

Layers to cut through on tracheostomy

A

Skin
Superficial and platysma
2 Anterior jugular veins - avoid
Deep
Strap - sternohyoid and sternothyroid
Pre tracheal
Thyroid isthmus
Trachea

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74
Q

Tongue muscles action and innervation

A

Genio- depression and protrusion- hypoglossal
Hyoglossus- depression and retraction- hypoglossus
Styloglossus- elevation and retraction- hypo
Palatoglossus- elevation of post tongue- vagus

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75
Q

Innervation of the larynx

A

Vagus
Superior- external and internal
Interanl sensory above vocal cords and autonomic, External- cricothyroid

Recurrent- all laryngeal muscles, sensory below vocal cords

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76
Q

Which muscles does V3 supply

A

Muscles of mastication; medial pterygoid, lateral pterygoid, masseter, temporalis
Anterior belly of the digastric muscle and the mylohyoid muscle (these are suprahyoid muscles)
Tensor veli palatini
Tensor tympani

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77
Q

Which parasymp fibres does V3 carry

A

Submandibular and sublingual VII- lingual

Parotid from IX- by auriculotemporal

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78
Q

Which parasymp fibres does V1 and V2 carry

A

Lacrimal gland: Post ganglionic fibres from the pterygopalatine ganglion (derived from the facial nerve), travel with the zygomatic branch of V2 and then join the lacrimal branch of V1. The fibres supply parasympathetic innervation to the lacrimal gland.

Nasal glands: Parasympathetic fibres are also carried to the mucous glands of the nasal mucosa. Post-ganglionic fibres travel with the nasopalatine and greater palatine nerves (branches of V2)

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79
Q

Branches of mandibular nerve

A

Nerve to medial pterygoid muscle → Nerve to tensor veli palatini,
nerve to tensor tympani

Anterior division
Buccal nerve
Masseteric nerve
Deep temporal nerves
Nerve to lateral pterygoid muscle

Posterior division
Auriculotemporal nerve
Lingual nerve
Inferior alveolar nerve → nerve to mylohyoid muscle → muscular branch to anterior belly of digastric muscle

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80
Q

Function of auricletemporal nerve

A

Branch of V3
Superior
Sensory to
Anterior part of the auricle
Lateral part of the temple
Anterior external meatus
Anterior tympanic membrane

Inferior
carries secretory-motor parasympathetic fibres, originating from CN IX, to the parotid gland.

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81
Q

Where should strap muscles be divided

A

In their upper half
Since nerve supply from ansa cervicalis is from bottom

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82
Q

Vessel lateral to inferior parathyroid

A

Common carotid

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83
Q

Where does anterior and posterior inferior cerebellar artery arise

A

Anteirior- basillar
Posteiror- Vertebral

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84
Q

Which arteries does the oculomotor nerve pass between

A

Superior cerebellar and posterior cerebral

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85
Q

Where does labyrinthine artery arise from

A

AICA from Basillar

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86
Q

Sx if Mekels cave is damage

A

Whole trigeminal located there
- causing mastication weakness
-loss of sensation

aperture in the medial portion of the middle cranial fossa

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87
Q

Nerves at the cerebellopontine angle

A

Facial, vestibulocochlear, trigeminal, abducens

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88
Q

Lesion of acoustic neuroma

A

VIII
Then if massive facial too

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89
Q

Function of tense tympani and stapedius and innervation

A

Dampen loud sounds

TT- trigeminal
Stap- VII

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90
Q

Cause of otalgia post tonsillectomy

A

Referred pain from IX

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91
Q

Horners syndrome proximal vs distal, location and symptoms

A

Proximal lesions occur along the hypothalamospinal tract- can affect entire face

Distal lesions are usually post ganglionic e.g. at level of internal carotid artery or beyond- anhidrossi mild

92
Q

Roots of ansa cervicalis

A

C1,2,3

93
Q

Arterial supply of lacrimal apparatus

A

Ophthalmic artery

94
Q

Which vessel lies posterolateral to external carotid at origin

A

Internal carotid

95
Q

Innervation of external nose

A

Lateral- Lateral nasal branches of the anterior ethmoidal nerve. The ethmoidal nerve is a branch of the nasociliary nerve (V1)

Nostrils- Infraorbital

96
Q

Branches of maxillary nerve and innervation

A

Zygomatic- ant and post- innervates zygoma and aids communication of facial to lacrimal

Pterygopalatine nerves- go to PT ganglion and branch to
Nerve to nasal cavity
and Palatine nerves- greater/lesser palatine innervate hard palate

Posterior superior alveolar branches

Infraorbital nerve- branches to after foramen

-External nasal branches that innervate the skin that covers the side of the nose
-Internal nasal branches which provide sensory innervation to the nasal septum
-Superior labial branches that innervate the upper lip
-Inferior palpebral branches that provide innervation for the lower eyelid

Then anterior and middl superior alveolar- teeth of the upper jaw.

97
Q

The space between the vocal cords is referred to as ?

A

Rima glottis

98
Q

Origin of CN and exiting CNS

A

1,2 cerebrum
3,4- Midbrain
5 -Pons
6-8- Ponto-medullary junction
9-12- medulla (11 spinal)

99
Q

CNs with long course intracranial , most likely to be damaged in raised ICP

A

Trochlear

Abducens does too

100
Q

What separates subclavian artery and vein

A

Scalenus anterior

101
Q

Describe circle of willis

A

Vertebral- PICA branch
Forms basilar- AICA, pontine and superior cerebellar artery
Basillar form PCA
PCA connects to MCA via posterior communicating

Internal splits into MCA and ACA
ACA connected by communicating

102
Q

Lateral medullary vs lateral potine syndrome

A

Lateral medullary -PCIA- PIKA can’t Chew
Dysphagia
Ipsilateral ataxia, nystagmus,
Contralateral limb sensory loss

Lateral pontine -AICA (FACIAL)
Facial droop
Ipsilateral ataxia, nystagmus,
Contralateral limb sensory loss

Otherwise both get

103
Q

What does the buccal facial branch supply

A

Zygomaticus minor
Buccinator
Levator anguli fris
Orbicularis
Nasalis

104
Q

Structures passing through parotid

A

Facial nerve and branches
External carotid artery (and its branches; the maxillary and superficial temporal)
Retromandibular vein
Auriculotemporal nerve

105
Q

Where does anterior pituitary develop from

A

Rathkes pouch

106
Q

Middle meningeal artery ligated, which nerve might be damaged

A

Auriculotemproal

107
Q

During a radical neck dissection, division of which of the following fascial layers will expose the ansa cervicalis?

A

Pre tracheal

108
Q

What is encountered in submandibular removal after deep fascia

A

Facial vein

The facial vein is encountered first in this surgical approach because the incision is made 4cm below the mandible (to avoid injury to the marginal mandibular nerve).

109
Q

Lymph drainage of larynx

A

Supraglottic- upper deep
Glottic- low rate of lymphatic spread, attributed to an inadequate submucosal lymphatic supply.
Sub glottic part drains to the pre laryngeal, pre tracheal and inferior deep cervical nodes

aryepiglottic and vestibular folds have a rich lymphatic drainage and will metastasise early.

110
Q

Muscles of larynx and action

A

Posterior cricoarytenoid- abducts

Lateral cricoarytenoid- adducts

Thyroarytenoid- relaxes
These 3 attach to muscular process of arytenoid

Transverse and oblique arytenoids- closure of intercartilagenous part of the rima glottidis
Arytenoid cartilage to contralateral

Vocalis- relax post, tense ant

Cricothyroid- tense vocal fold
Cricoid to Inferior margin and horn of thyroid cartilage

111
Q

Age of Warthalin tumour vs pleomorphic adenoma

A

Warthalin- older age smokers

Pleomorphic- younger

112
Q

Indication for surgery in primary hyperparathyroid

A

Elevated serum Calcium > 1mg/dL above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations

113
Q

Level dural sac terminate

A

S1-2

114
Q

Transition between pharynx and oesophagus level

A

C6

115
Q

Vein damaged at vertex of head

A

Superior sagittal

116
Q

Which nerve lies medially to the lobes of the thyroid gland, in the groove between the oesophagus and trachea?

A

RLN

117
Q

Where does brachial plexus lie in relation to scalene

A

Roots and trunks in between SA and SM

118
Q

Content of anterior triangle

A

Digastric triangle Submandibular gland
Submandibular nodes
Facial vessels
Hypoglossal nerve

Muscular triangle Strap muscles
Jugular vein
superior thyroid artery, the anterior jugular and inferior thyroid veins

Carotid triangle -border, of diagstric, omo, scm
Carotid sheath (Common carotid, vagus and internal jugular vein)
Ansa cervicalis

119
Q

What drains into the sphenoethmoidal recess

A

Sphenoidal sinus

120
Q

Things that the vertebral artery has to transverse

A

Vertebral canal
Foreman magnum
Transverse processes foremen

121
Q

Ligamentum nuchae attachement

A

Triangle, from skull to spinous process until C7

122
Q

Tectorial membrane of Atlanta axial joint

A

With V Canal - upper part of posterior ligament
From C2 to skull base

123
Q

Mx of nasal fracture

A

After 5 days- reduction

124
Q

Child has hearing loss, difficulty speaking, recent URTI

A

Glue ear

125
Q

Biggest RF for NP carcinoma and para nasal

A

Nasal P- EBV

Para nasal- Woodwork ethmoidal

126
Q

Malignant submandibular tumour type

A

Adenoid cystic carcinoma

127
Q

Sialadenitis organism and features

A

taphylococcus aureus infection
Pus may be seen leaking from the duct, erythema may also be noted
Development of a sub mandibular abscess is a serious complication as it may spread through the other deep fascial spaces and occlude the airway

128
Q

Stones in sialothiasis

A

Stones are usually composed of calcium phosphate or calcium carbonate

129
Q

Ix and mx of colicky pain in mouth

A

sialography

Stones impacted in the distal aspect of Whartons duct may be removed orally, other stones and chronic inflammation will usually require gland excision

130
Q

Mass in submandibular gland mx

A

In view of the high prevalence of malignancy, all masses of the submandibular glands should generally be excised.

131
Q

Mx of parotid gland tumour

A

For nearly all lesions this consists of surgical resection, for benign disease this will usually consist of a superficial parotidectomy. For malignant disease a radical or extended radical parotidectomy is performed. The facial nerve is included in the resection if involved.

132
Q

Cyst in parotid with HIV

A

Lymphoepithelial cysts associated with HIV occur almost exclusively in the parotid
Typically presents as bilateral, multicystic, symmetrical swelling

133
Q

Most common parotid malignancy

A

Mucoepidermoid carcinoma

134
Q

Mucoepidermoid carcinoma features

A

mucus-secreting cells (muco-)
squamous cells (-epidermoid)
lymphoid infiltrate often also present

135
Q

Epistaxis management

A

Subject should sit upright and forward and pinch nose firmly, spit bloods out

Compress softer cartilage for 20mins

Simple anterior epistaxis may be managed using silver nitrate cautery.

If difficult to manage then custom manufactured packs may be inserted

Posterior packing or tamponade may be achieved by passing a balloon tamponade/foley Catheter device and inflating It.

Nasal packs should be left in-situ for 24 hour

Surgical after- ligation

136
Q

Progressive conductive deafness dx and mx

A

Otosclerosis
Secondary to fixation of the stapes in the oval window
Treatment is with stapedectomy and insertion of a prosthesis

137
Q

Signs of malignancy of sinuses

A

loose teeth, cranial nerve palsies and lymphadenopathy.

Most common in lateral nasal wall

138
Q

What do superior cerebral veins drain to

A

Superior sagittal

139
Q

What does the cavernous sinus drain

A

Sup and inf opthalmic(sup opthalmic anastomoses with facial vein)
Sphenopariteal
Superficial middle cerebral

140
Q

Superior petrosal sinus links

A

Cavernous to transverseI

141
Q

Inferior petrosal sinus function

A

Drains cavernous meetin gsignoid to form jugular

142
Q

Where is ethmoidal bulla located

A

Middle meatus

143
Q

Where does sphenopalatine branch and what does it supply

A

branches at superior meatus

Lateral and septum

144
Q

What passes through pterygomaxillary fissure

A

Posterior superior alveolar nerve and artery

145
Q

What passes through an opening in the diaphragm sellae

A

Infundibulum

146
Q

Attachments of scalene

A

Anterior - C3-6 1st rib
Middle- C2-7 1st
Posterior- C5-7 2nd rib

147
Q

Where does middle meningeal artery branch off maxillary

A

Infratemproal fossa

148
Q

Division of carotid relative to thyroid cartilage

A

Upper border- C4

149
Q

Where does transverse cervical drain

A

External jugular

150
Q

Which bone does carotid canal sit in

A

Temporal- petrous

151
Q

Level facial muscle sit in

A

Same as platysma
Subcutaneous

152
Q

Systemic effects of bilateral ligation of ITA

A

HypoPTH and lower Ca not enough to get symptoms

153
Q

What is the carotid sheath seperated by with the parotid

A

Styloid process and muscles

154
Q

Stensens duct relative to masseter

A

Anteriorly and superficial

155
Q

Denituclate ligament

A

Part of the Pia mater connecting spinal cord to arachnoid and dura

156
Q

What is in line with when the trachea starts

A

Cricoid at C6

157
Q

Where are the vocal cords formed

A

Superior free edge of conus elasticus

Which is the lateral part of cricothyroid

158
Q

Which fossa does facial nerve cross

A

Posterior

159
Q

What does lesser petrosal pass through
Originate from and innervate

A

Ovale

IX

Parotid

160
Q

Branches of anterior mandibular nerve

A

Lateral pterygoid, masseter, temporalis, buccal skin

161
Q

Branches of posterior mandibular nerve

A

Auriculotemporal
Lingual
Inferior alveolar - myohyoid and anterior digastric

162
Q

TMJ joint type, lining and anterior of

A

Synovial joint
Fibrous cartilage- atypical

Anterior to squamous tympanic fissure

163
Q

Waldeyers ring

A

They collectively form a ringed arrangement, known as Waldeyer’s ring:

Pharyngeal tonsil
Tubal tonsils (x2)
Palatine tonsils (x2)
Lingual tonsil

164
Q

What muscle bounds to the palatine tonsil

A

Superior constrictor

165
Q

Internal carotid, facial, IJV and external jugular relative to middle ear

A

IC- anterior and inferior
IJV- inferior
EJ- Medially and superior
Facial- medial

166
Q

What separates anterior and posterior chambers and segments of eye

A

Chambers- iris

Segments- lens
Posteiror- vitreous humour and optic nerve and retina

167
Q

Facial and lingual nerve relative to submandibular gland

A

Facial- inferior and superficial

Lingual- lateral- looping under gland to anteromedial

168
Q

Sx of marginal mandibular nerve lesion

A

Drooling and unable to close mouth

169
Q

Which part of skull does Eustachian tube penetrate

A

Petrous part of temporal

170
Q

What forms straight sinus

A

Inferior sagittal and great cerebral

171
Q

Where does posterior ethmoid drain

A

sphenoethmoidal recess in superior meatus

172
Q

What drains into infundibulum of middle meatus

A

Frontal and anterior ethmoidal- leads to semi lunar hiatus

173
Q

What drains into semilunar hiatus of middle meatus

A

Frontal, maxillary, anterior ethmoidal

174
Q

What areas of face could lead to cavernous sinus thrombosis

A

Upper lip, lower part of nose and surroundings- due to anterior facial vein

175
Q

Location of lingual tonsil

A

Posterior third midline

176
Q

What does RLN run between in neck

A

Trachea and oesophagus

177
Q

Where does trachea start

A

Cricoid C6

178
Q

Nerve most likely to get damaged in thyroidectomy

A

External laryngeal
As ligation of superior thyroid

179
Q

Muscle protruding and depressing jaw

A

Lateral ptyergoid

180
Q

Nerve suppling trachea

A

Recurrent laryngeal

181
Q

Berrys ligament attachment

A

Thyroid to cricoid ligament and upper trachea

182
Q

What muscle attaches to Eustachian tube

A

Tensor veli plantini

183
Q

Eustachian tube in swallowing

A

Opens due to tensor plalati and salpingopharyngeus

184
Q

Which artery is the RLN closely related to

A

Inferior thyroid

185
Q

What artery runs through submandibular

A

Facial

186
Q

Arteries from internal carotid that contribute to scalp

A

Supraorbital and supratrochelar

187
Q

Where must flaps be raised for tracheostomy

A

Deep to platysma

188
Q

Innervation, cells covering, arterial supply of tubal tonsils

A

Located as eustachian tube opening x2

V2 and IX

Ciliated

Ascending pharyngeal

189
Q

Innervation, cells covering, arterial supply of pharyngeal tonsil

A

x1- roof of nasopharynx, adenoid

X IX

Ciliated

Ascending pharyngeal and others

190
Q

Innervation, cells covering, arterial supply of palatine tonsils

A

Non ker squamous

V2 IX

Tonsillar- facial

191
Q

Innervation, cells covering, arterial supply of lingual tonsils

A

Post 1/3 of tongue

Non ker

IX

Lingual artery
External palatine venous

192
Q

Which gland is affected by stones the most

A

Submandibular

193
Q

Midline neck swelling ddx

A

Thyroglossal
Subhyoid bursa
Pharyngeal pouch
Laryngocele

194
Q

What is a chemodectoma

A

Carotid body tumour

195
Q

Most common location of laryngeal tumour and form of benign

A

On vocal cords

Papilloma

196
Q

Management of chyle leak

A

Adequate drainage and pressure dressing

Serial aspiration and nutritional modifications

197
Q

What should be conducted before cervical node biopsy

A

Nasoendoscopy
CXR

198
Q

What should you measure with a person with epistaxis

A

BP

199
Q

Most common oral malignancy

A

Tongue

200
Q

What is Pott’s puffy tumour

A

Subperiosteal abscess

Rare complication of acute sinusitis

CT head, drainage and IV abx

201
Q

Lateral neck swelling, vertigo and syncope

A

Chemodectoma

Tumour of gloms jugular

202
Q

One child has cleft lip chance of next

A

4%

203
Q

Tx of acute sinusitis

A

If systemically unwell or >10d of onset of sx
Co-amox

204
Q

Mx of leukoplakia

A

Biopsy and regular FU

205
Q

Mx of cholesteoma and risks if not managed

A

Surgical removal

Invasive- menigntiis, abscess, hearing loss, sinus thrombosis, facial palsy

206
Q

Depressed air conduction but normal bone conduction

A

Damage to ossicles or tympanic membrane

As cochlea embedded in bone- vibration can be directly transferred to cochlear fluid

207
Q

Head and neck cancer causing otalgia

A

Carcinoma of epiglottis

208
Q

Features of vestibular schwannoma

A

Vertigo, tinnitus

Late disease may affect trigeminal

No otalgia

209
Q

Patient develops osteomyelitis from sinusitis which sinus is most likely

A

Frontal

210
Q

Lump on posterior triangle, cannot be separated from skin

A

Sebaceous cyst

211
Q

Cause of leukoplakia in HIV

A

EBV

212
Q

Pre op workup for salivary masses

A

FNA- cytology

213
Q

Why is sudden loud sound worse then slow developing

A

Latent period before attenuation reflex

Damage is to cochlea

214
Q

Stabbed in neck, now getting loud buzzing and dizziness, dx and mx

A

Post traumatic AV fistula, surgical excision and repair of artery and vein

215
Q

HIV patient with headache and facial nerve palsy

A

Malignant otitis externa

Cysts are painless and don’t cause facial nerve palsy

216
Q

RF of oral cancer

A

HPV

217
Q

Ix of chemodectoma

A

CT angio

218
Q

Man from Sudan with parotid, submandibular swelling, biopsy giant cell and granuloma

A

TB

219
Q

Jaw cyst tx

A

Enucleation

220
Q

Severe headache, VI palsy, papilodema recent ear infection, dx

A

Optic hydrocephalus

221
Q

Primary and secondary haemorrhage in tonsillectomy

A

Primary <24 hrs
Secondary >24 hrs

Secondary self limiting

222
Q

TNM for head and neck cancers

A

T1 <2cm
2- 2-4cm
3- >4cm
4- local invading

N0-none
N1- <3cm
N2- 3-6cm
N3- >6m

223
Q

Feature suggesting malignant change of pleomorphic adenoma

A

Rapid increase in size

224
Q

Trachy location in adults and children

A

1-2 tracheal rings adults
2-3 children

Usually 2cm transverse incision 2cm above sternal notch with blunt incision

225
Q

Brachial cyst aspiration

A

Straw colour, sqamous cells
Cholesterol crystals

226
Q

Audible wheeze weeks after trachy removed

A

Subglottic stenosis

eMRCS questions (45 decks)

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