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X. MRCS: Pathophysiology > Head/Neck > Flashcards

Head/Neck Flashcards

1
Q

Salivary glands

A

Parotid gland
Sublingual
Submandibular

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2
Q

Parotid gland: anatomic position

A 
Lies in deep hallow: parotid region
Superior: zygomatic arch
Inferior: inferior border of mandible
Anterior: masseter
Posterior: external ear/sternocleidomastoid
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3
Q

Parotid gland: structure

A

Bilobed: deep and superficial lobes
Secretions are transported to oral cavity via Stensen duct (transversing master muscle)
Opens into cavity near second upper molar

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4
Q

Parotid gland: anatomical relationships

A

Facial nerve gives 5 terminal branches within parotid.
External carotid: ascends through parotid
Retromandibular vein: formed within gland by convergence of superficial temporal and maxillary veins

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5
Q

Parotid gland: blood supply

A

Post auricular artery

Superficial temporal artery

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6
Q

Parotid gland: venous drainage

A

Retromandibular vein

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7
Q

Parotid gland: innervation

A

Sensory: auriculotemporal nerve (gland), great auricular nerve (fascia)

Parasympathetic: glossopharyngeal nerve (CNIX)

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8
Q

Sublingual gland: structure & anatomical position

A

Small gland. Almond shaped. Joins other gland to form U-shape around lingual frenulum.
Situated beneath tongue in sublingual fossa
Lateral: mandible
Medial: genioglossus
Submandibular duct and lingual nerve travel medial to sublingual

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9
Q

Sublingual gland: drainage

A

Drains into oral cavity by minor sublingual ducts (of Rivinus): 8-20 ducts per gland.
Anatomical variance: sublingual papillae (large single duct)

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10
Q

Sublingual gland: blood supply

A

sublingual and submental arteries (branches from lingual and facial, from ECA)

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11
Q

Sublingual gland: venous drainage

A

Sublingual and submittal veins

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12
Q

Sublingual gland: innervation

A

Parasympathetic: CNVII –> chorda tympani
Sympathetic: superior cervical ganglion

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13
Q

Submandibular gland: anatomic position

A

In submandibular triangle
Superior: inferior body of mandible
Anterior: anterior belly of digastric
Posterior: posterior belly of digastric

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14
Q

Submandibular gland: Structure

A

Superficial arm and deep arm

Travel to oral cavity via submandibular duct (Wharton’s duct)

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15
Q

Submandibular gland: anatomical relationships

A

Lingual nerve: start lateral, loops beneath duct, terminating as several medial branches
Hypoglossal nerve: lies deep to gland and runs superficial to hypoglossus
Facial nerve: MM branch curves inferior to gland

All can be damaged during excision of SM gland

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16
Q

Submandibular gland: blood supply

A

Submental artery

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17
Q

Submandibular gland: venous drainage

A

Facial vein

Sublingual vein

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18
Q

Submandibular gland: innervation

A

Parasympathetic: CNVII –> chorda tympani
Symp: superior cervical ganglion

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19
Q

Salivary gland tumours

A

Benign: pleomorphic adenoma, Warthin’s tumour
Malignant: Mucopeidoermoid carcinoma, Adenoid Cystic Carcinoma, acinic cell carcinoma, SCC, adenocarcinoma

Parotid: 80/20 benign/malignant
Submand: 50/50
Sublingual: 20/80

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20
Q

Sialolithiasis

A

Calculi in salivary glands/ducts
Calcium phosphate or hydroxyapatite stones
RF: drugs (diuretics/anti-cholinergics), dehydration, gout smoking, hyperPTH
Sx: intermittent pain/swelling

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21
Q

Sialadenitis

A

Inflammation of salivary gland

Causes: infective (viral: mumps), stones, malignancy, automimmune (sarcoid, Sjogren’s)

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22
Q

Tonsils

A

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

Mucosa associated lymphoid tissue: MALT

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23
Q

Lingual tonsil

A

Location: submucosa of posterior 1/3 tongue
Blood supply: lingual artery
Nerve: glossophyaryngeal (CNIX)
Lymph: jugulodiagastric/deep cervical

24
Q

Pharyngeal tonsil

A

Roof of nasopharynx
Covered by ciliated pseudostratified epithelium
Blood supply: ascending palatine. ascending pharyngeal, Pterygoid canal. tonsillar branch of facial
Venous: pharyngeal plexus
Lymph: retropharyngeal nodes

25
Q

Tubal tonsils

A

Around opening of Eustachian tube in lateral wall of nasopharynx
Blood: ascending pharyngeal
Venous: pharyngeal plexus
Nerve: maxillary, glossopharyngeal nerves
Lymph: retropharyngeal/deep cervical

26
Q

Palatine tonsils

A

Location: Tonsil bed of lateral oropharynx between palatoglossal arch (anterior) and palatopharyngeal arch (posterior)
Covered by stratified non-keratinised squamous epithelium
Blood: tonsils branch of facial
Venous: external palatine vein
Nerve: maxillary, glossopharyngeal
Lymph: jugulodigastric/deep cervical

27
Q

Post tonsillectomy bleeding

A

5%
Primary: <24hrs. Loosened sutures
Secondary: >24hrs. Infection, collection

28
Q

Parts of the ear

A

External ear
Middle ear
Inner ear

29
Q

Parts of external ear

A

Auricle
External acoustic meatus
Tympanic membrane

30
Q

Parts of the auricle

A 
Helix: outer curvature
Antihelix
Superior crus
Inferior crus
Concha: middle hollow depression
Tragus: elevation immediate anterior to EAM
Antitragus
Lobule
31
Q

External acoustic meatus

A

Sigmoid shaped tube: S shaped curve
Extends from deep part of concha to tympanic membrane
External 1/3: cartilage walls
Inner 2/3: temporal bone forms walls

32
Q

Tympanic membrane

A 
Connect tissue with skin on outside.
Membranous inside. 
Parts:
Lateral process
Handle of malleus
Umbo
Pars tensa
33
Q

Blood supply to external ear

A 
Branches of external carotid:
Post. auricular
Superficial temporal
Occipital
Maxillary
34
Q

Innervation to external ear

A

Sensory:
Greater & lesser auricular nerves (from C-plexus): skin of auricle
Auriculotemporal n. (CNV3) skin of auricle and external auditory meatus
Branches of vagus and facial also innervate deeper aspects of auricle and external auditory meatus

35
Q

Parts of the middle ear

A

Tympanic cavity

Epitymanic recess

36
Q

Borders of middle ear

A 
Roof: petrous part of temporal
Floor: jugular wall
Lateral: tympanic membrane
Medial: lateral wall of inner ear
Anterior: thin bony plate w. 2 openings (auditory tube and tensor tympani)
Posterior: Mastoid wall
37
Q

Bones of the middle ear

A

“Auditory ossicles”
Malleus
Incus
Stapes

38
Q

Mastoid air cells

A

Located posterior to epitympanic recess
Collection of air filled spaces in mastoid process of temporal bone
Acts as “buffer” releasing air into tympanic cavity when pressure it too low

39
Q

Muscles of middle ear

A 
Tensor tympani (tesnor tympani nerve, CNV3)
Stapedius (nerve to stapedius, CNVII)

Function: protection of middle ear
Contract in response to loud noise, inhibiting vibrations of malleus, incus and stapes. reducing sound transmission to inner ear.

40
Q

Auditory tube

A

“Eustachian tube”
Cartilaginous and bony tube that connects middle ear to nasopharynx
Equalise pressure

41
Q

Parts of inner ear

A

Bony labyrinth

Membranous labyrinth

42
Q

Bony labyrinth

A

Series of bony cavities within petrous part of temporal bone
Cochlea
Vestibule
3 semi-circular canals

43
Q

Membranous labyrinth

A

Continuous duct system filled with endolymph
Cochlear duct
Saccule & Utricle
Semi-circular ducts

44
Q

Blood supply to inner ear

A

Bony:
Anterior tympanic branch (maxillary artery)
Petrosal branch (middle meningeal, from Maxillary)
Stylomastoid branch (from posterior auricular)
Membranous:
Labyrinthine artery

45
Q

Innervation to inner ear

A

Vestibulocochlear nerve

46
Q

Rinne’s test

A
  1. Place tuning fork (512Hz) on mastoid. Tests bone conduction.
  2. Pt confirms they can hear it and says when its stops.
  3. When cannot hear it move to external auditory meatus. Tests air conduction.
  4. Ask if they can still hear (If yes: normal)

Air conduction > bone (Rinne’s positive): normal/sensorineural
Bone > air (Rinne’s negative): conductive deafness

47
Q

Weber’s test

A
  1. 512Hz tuning fork placed in midline of forehead
  2. Ask where patients hears sound

Normal: equal in both ears
Sensorineural: louder on intact
Conductive: louder on affected

48
Q

Conductive hearing loss

A 
Impacted earwax
Foreign body
Tympanic membrane perforation
Infection: otitis externa/media
Cholesteatoma
Middle ear effusion
Otosclerosis
Neoplasm (SCC of external ear)
Exostoses
49
Q

Sensorineural hearing loss

A 
Age-related hearing loss
NIHL
Meniere's
Ototoxic substances (amino glycoside substances), loop diuretics, anti-malarial, cytotoxic (cisplatin, bleomycin)
Labyrinthitis 
Vestibular schwannoma (acoustic neuroma)
Neuro: MS/stroke
Malignancy
Autoimmune: RA, SLE, sarcoid
Hereditary: Alport's
50
Q

Acute otitis externa

A

Infection of external ear
RF: water exposure (swimming), trauma to canal, blockage
Sx: red, swollen, tender canal
Cause: Pseudomonas (40%), Staph epidermis/aureus. Can be fungal.
Brighton Grading System I-IV
Rx: topic Abx

51
Q

Acute Otitis media

A

Bacterial infection of middle ear resulting from nasopharyngeal organisms migrating via Eustachian tube
Cause: Strep pneumoniae (most common), H influenza, M catarrhalis
RF: age (6-15mths), M>F, parental smoking, bottle feeding
Sx: pain, malaise, fever, coryzal
TM redness and bulging
Complications: CNVII involvement, intracranial complications, mastoiditis
Rx: conservative if uncomplicated. Abx for unwell, RFs. Mastoiditis: IV abx +/- mastoidectomy

52
Q

Otitis media with effusion

A

“Glue ear”
Build up of viscous inflammatory fluid in middle ear
Sx: conductive hearing impairement
TM appears dull +/- bubble seen
Rx: 50% resolve in 3 months
Surgical: myringotomy + grommet insertion
Non-surg: hearing aid insertion

53
Q

Cholesteatoma

A

Abnormal sac of keratinising squamous epithelium and accumulation of keratin in middle ear.
Sx: persistent, recurrent ear discharge
Complications: local destruction of ossicles (conductive HL), semicircular canals (vertigo), cochlea (sensorineural HL), facial canal (CNVII palsy)

54
Q

Acoustic neuroma (vestibular schwannomas)

A

Benign tumours from Schwann cells surrounding vestibulocochlear n. (CNVIII). Slow growing.
Vestibular portion most commonly affected (80%). 80% at cerebellopontine angle.
RFs: NF2 (bilateral)
Sx: triad of: unilateral SNHL, tinnitus, vertigo. Sx of raised ICP: headache, seizures.
Rx: MRI monitoring. Stereotactic radio surgery. Surgical resection.

55
Q

Vertigo

A 
Central: 
MS
Posterior stroke
Migraine
SOL
Otological:
BPPV
Meniere's
Vestibular neuronitis

X. MRCS: Pathophysiology (13 decks)

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