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Anatomy > HNS 3 > Flashcards

HNS 3 Flashcards

1
Q

label this diagram

A
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2
Q

What nerve are doctors testing when asking a patient to open their mouth (ah)?

A

Vagus nerve

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3
Q

Which cranial nerve provides motor functions to the uvula?

A

Vagus nerve

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4
Q

What would you expect to see of the uvula if vagus nerve functioning normally (when testing it clinically)?

A

Uvula should go straight up the midline

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5
Q

A lesion to the right vagal nerve of the uvula results in what deviation?

A

Deviation to the opposing side

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6
Q

What does a deviation of the uvula to one side suggest?

A

Problem with one of the vagus nerves

Uvula deviates away from the side where the lesion is

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7
Q

What pharynx is posterior to the oral cavity?

A

Oropharynx

Can see posterior wall of oropharynx behind the uvula in image shown

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8
Q

What is the palatoglossal fold?

A

Most anterior fold of tissue at back of mouth

From the palate at the top of the mouth down to the tongue

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9
Q

What is the palatopharyngeal fold?

A

Posterior to the palatoglossal fold

From the palette to the pharynx

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10
Q

What is the palatine tonsil?

A

In between the palatoglossal fold and the palatopharyngeal fold

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11
Q

What do the tonsils give you an idea of?

A

If there’s been infection or inflammation

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12
Q

Label the diagram and what view of the head is it?

A

Mid-saggital view

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13
Q

How does the hard palate assist eating?

A

Tongue is used to move food up against the hard palate to start breaking it down

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14
Q

What hangs from the soft palate?

A

The uvula

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15
Q

What 3 structures form the pharynx?

A

Nasopharynx

Oropharynx

Laryngopharynx

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16
Q

Function of the epiglottis?

A

Retroflexes over laryngeal inlet when you swallow food, preventing food going down into airways

Allows food to travel down back of pharynx down to oesophagus

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17
Q

Label this diagram

A
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18
Q

Where does the tongue sit?

A

Buccal cavity

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19
Q

What does the epiglottis cover?

A

Laryngeal inlet

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20
Q

What is the piriform fossa?

A

Area has quite a strong sensory innervation where you can get bits of bones stuck

Channel that directs solid & liquids from oral cavity around the raised laryngeal inlet and into the oesophagus

Sensitive are that can cause distress to someone that gets something caught there

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21
Q

What are the muscles of the pharynx?

A

Superior, middle and inferior constrictors

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22
Q

Which 2 nerves form the pharyngeal plexus and what does it provide?

A

Glossopharyngeal and vagus nerves (strong sensory innervation)

Strong sensory innervation to the muscles of the pharynx

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23
Q

Which nerve controls the motor functions of the constrictors?

A

Vagus nerve (CN10) + accessory nerve (XI)

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24
Q

What is the action of swallowing?

A

Coordinated sequential contraction of superior, middle and inferior constrictors

Allows coordinated contraction of food bolus from mouth down to oesophagus

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25
Q

What are the 3 main salivary glands within the oral cavity?

A

Submandibular

Sublingual

Parotid

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26
Q

What are salivary glands?

A

Glands that secrete amylase into the oral cavity.

Small glands reside within the submucosa or mucosa of the oral epithelial lining the tongue, palate, cheeks + lips

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27
Q

Explain the first part of digestive process

A

Breakdown of food in the mouth enzymatically. Produce saliva from 3 pairs of salivary glands: parotid, submandibular and sublingual.

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28
Q

What is the biggest salivary gland?

A

The parotid gland

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29
Q

Pathway of saliva through parotid gland?

A

Saliva fro the parotid gland passes through the parotid duct + passes into upper part of the mouth, passes through the boccinator muscle + opens up next to the second upper molar in the mouth

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30
Q

What is the consistency of the saliva produced by the parotid?

A

Thin + mainly serous

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31
Q

What is the parotid gland innervated by?

A

CN IX -> glossopharyngeal nerve

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32
Q

What are sublingual and submandibular glands innervated by?

A

Facial nerve

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33
Q

What saliva is produced by submandibular gland?

A

very thin serous saliva

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34
Q

What type of saliva is produced by sublingual glands?

A

Mucous saliva

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35
Q

Where does the tongue sit?

A

In the buccal cavity

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36
Q

Which nerve controls the function of the intrinsic muscles of the tongue?

A

Hypoglossal nerve

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37
Q

What does the hypoglossal nerve supply?

A

Intrinsic muscles and extrinsic muscles of tongue

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38
Q

Which extrinsic muscles of the tongue does this nerve supply?

A

Palatoglossus (from palate to tongue)

Styloglossus (from styloid process and base of skull all the way to tongue)

Genioglossus (from mandible to tongue)

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39
Q

How to test cranial nerve 12 (hypoglossal nerve)?

A

Ask patient to stick their tongue out + genioglossus contracts and tongue protracts out of the mouth

If there is a problem with one of the hypoglossal nerves, the tongue will deviate in the direction of the site of lesion (i.e. if tongue deviates to left there is a lesion in the left hypoglossal nerve)

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40
Q

Where are the submandibular glands?

A

Reside within the floor of the mouth, secrete saliva into the mouth through submandibular ducts

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41
Q

Where do the sublingual glands reside in relation to the tongue?

A

Inferior to the tongue

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42
Q

Where are the parotid glands?

A

Reside between the skin and masseter muscle, proximal to the ears

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43
Q

Where does the parotid duct enter into the oral cavity?

A

Penetrates the buccinator muscle, which is located near the second upper molar tooth

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44
Q

What are the 4 main extrinsic muscles of the tongue?

A

Genioglossus

Hypoglossus

Styloglossus

Palatoglossus

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45
Q

Which extrinsic tongue muscle protrudes the tongue out of the oral cavity, and depresses the centre?

A

Genioglossus

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46
Q

What is the function of the hyoglossus?

A

Depresses and retracts the tongue

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47
Q

What is the function of the genioglossus?

A

Muscle responsible for protruding the tongue

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48
Q

What is the function of the styloglossus?

A

Elevates + retracts the tongue

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49
Q

What is the function of the palatoglossus?

A

Elevates the posterior portion of the tongue

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50
Q

Which nerve is for touch sensation of the anterior two thirds of the tongue?

A

Trigeminal nerve

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51
Q

Which nerve is for touch sensation of the posterior 1/3rd of the tongue?

A

Glossopharyngeal provides sensory touch sensation

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52
Q

Which nerve is for taste of the anterior 2/3rds of the tongue?

A

Facial nerve

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53
Q

Which nerve is for taste of the posterior 1/3rd of the tongue?

A

glossopharyngeal

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54
Q

Where do both of these nerves send fibers back to?

A

Send fibers back to the nucleus solitarius in the brainstem (our taste perception centre)

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55
Q

Which cranial nerve innervates the epiglottis?

A

Vagus nerve (internal laryngeal nerve -> branch of the superior laryngeal nerve from the vagus nerve)

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56
Q

Which parts of the tongue detect different tastes (salty, bitter, sweet etc.)

A

Salty - front (anterior part of the tongue)

Bitter - back (posterior part of tongue)

sweet - front (anterior part of tongue)

sour - lateral part of the tongue

umami - hard to define taste; all over the tongue

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57
Q

A lesion in the hypoglossal nerve results in a tongue deviation towards?

A

Towards the lesion

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58
Q

What is food and liquid and chewed and formed into?

A

Bolus

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59
Q

What are the 4 main phases of swallowing?

A

Oral preparatory phase

Oral transit phase

Pharyngeal phase (1&2)

Oesophageal phase

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60
Q

What happens during the oral preparatory phase?

A

Food/liquid chewed → Bolus.

Bolus held on centre of tongue

To do this we have the lip, jaw, tongue and the palate [Dentition as well]. This stage is a voluntary task.

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61
Q

What nerves innervate the oral preparatory phase?

A

Cranial nerves number 5, 7, 9, 10 + 12

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62
Q

What happens during the oral transit phase?

A

Bolus propelled to back of mouth.

Palate seals entrance to nasal cavity (soft palate is raised → Stops food from going into the back of the nose).

Lip, jaw, tongue and palate sensory and motor function needed. Still a voluntary process (airway still opened)

Cranial nerves V, VII, IX, X and XII (same as first phase of swallowing)

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63
Q

What is triggered when the bolus reaches the faucial arches at the back of the mouth?

A

First part of pharyngeal phase

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64
Q

Is the airway open during the oral transit phase?

A

Yes

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65
Q

When does the airway close?

A

Pharyngeal phase 1

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66
Q

Which palate during the swallowing phase seals off the nasopharynx?

A

Soft palate

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67
Q

Outline the mechanism of pharyngeal phase 1

A

Palate stays elevated.

Tongue retracts to push the bolus of food into the pharynx. This requires the tongue, palate and laryngeal sensory and motor function needed.

The airway is closed at this point.

No voluntary control; Reflex control

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68
Q

What nerves innervate the pharyngeal phase 1?

A

Cranial nerves 9, 10 + 12

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69
Q

Outline the mechanism of pharyngeal 2 phase

A

Bolus propelled through pharynx

Tonge, palate and laryngeal sensory and motor function needed.

Reflex control

Involves cranial nerves IX, X and XII.

Airways are closed by epiglottis (retroflexes over laryngeal inlet), vocal cords and arytenoid action → Prevents food going into upper airway.

70
Q

What cranial nerves innervate the pharyngeal phase 2?

A

cranial nerves 9, 10 + 12

71
Q

Outline the mechanism of oesophageal phase

A

Oesophagus opens, airway still closed, breath held.

Bolus is propelled through oesophagus → Reflex control

Cranial nerves IX and X involved.

Respiration then resumes with an exhalation → Clears any food particles from airway entrance.

72
Q

What nerves innervate the oesophageal phase?

A

Cranial nerves 9 + 10

73
Q

What is a videofluoroscopy?

A

Patient given bolus of barium; visualise as it passes from mouth into pharynx + down to oesophagus

74
Q

What are the features of a normal swallow?

A

Transit through mouth: 1 sec

Pharyngeal transit: 1-2 sec

No residue in mouth/pharynx

No spillage from lips or into airway.

75
Q

What is an ataxic swallow?

A

Uncoordinated tongue retraction (due to cerebellar haematoma) to propel food. Quite difficult to propel food into pharynx

Delayed airway closure → Food enters airway.

Natural reaction is a cough, but the cough is delayed and ineffective to clear airway; hence food goes into the lung (aspirated into lung)

76
Q

What is a cerebellar haematoma + what does it make it difficult to do?

A

Bleed affecting the cerebellum

Coordinated muscle action has been impaired means it’s quite difficult to retract the tongue + propel food into pharynx

77
Q

What happens with the cerebellar haematoma and aspiration?

A

Some is aspirated into the lung

78
Q

Why does the bolus aspirate into the lungs during a cerebellar haemotoma?

A

Delayed and ineffective cough to clear airway

79
Q

What can be done to reduce aspiration of bolus for patients with a cerebellar haematoma?

A

Flexed neck during swallow

80
Q

What can an excised (removed) acoustic neuroma leave the patient with?

A

Lower motor neurone lesion

81
Q

What does a lower motor neurone lesion?

A

Ipsilateral paresis (partial paralysis) in pharynx, larynx and tongue.

Problems in bolus propulsion (weak bolus propulsion)

Failure of airway to close

82
Q

How can you treat lower motor neurone lesion?

A

Rotate head to direct the bolus down the strong side of the pharynx and this helps to the airway to closure as well.

83
Q

How does Parkinson’s disease cause swallow difficulty?

A

Difficult in initiating a swallow, repetitive tongue movements -> Linked with muscle rigidity , unable to lower the back of the tongue

84
Q

How can a speech therapist do to help patient with Parkinson’s Disease?

A

Train patient for an effective swallow → Active range of motion exercises of lips and tongue.

85
Q

What happens when you have a normal voice and swallow? What can be seen using a fibreoptic endoscope?

A

Vocal cords adduct to produce voice and close airway.

Saliva is cleared in a single swallow and doesn’t accumulate. Water swallowed <1 second.

No residue in pharynx or in trachea.

86
Q

What do you do when a patient’s airway is compromised?

A

Intubation - tube needs to be introduced into the upper airway

87
Q

Describe the structure of the larynx?

A

Hollow structure composed of cartilages, membranes and muscles.

88
Q

What is the main function of the larynx?

A

Is a sphincter to close the lower respiratory tract and an instrument to produce sound

89
Q

Which bone is the larynx suspended from?

A

Hyoid bone

90
Q

Label the diagram of the pharynx

A
91
Q

What does the trachea sit in the pharynx?

A

Inferiorly

92
Q

Functions of the larynx?

A

Acts as a valve - top of airway and allows air in + out of the airway

Sound producer - Air passing past the vocal folds

93
Q

Which nerve supplies most of the motor and sensory innervation to the larynx?

A

Vagus nerve

94
Q

Label the diagram

A
95
Q

Which laryngeal cartilage is the most inferior?

A

Cricoid cartilage

96
Q

What cartilage articulates with the cricoid?

A

Arytenoid cartilages

97
Q

What is the biggest cartilage involved in the larynx?

A

Thyroid cartilage

98
Q

What is the common name for the laryngeal prominence?

A

Adam’s apple

99
Q

What is the posterior broad region of the cricoid cartilage?

A

The lamina

100
Q

What is the anterior region of the cricoid cartilage?

A

Narrow arch of the cricoid cartilage

101
Q

Where are the 2 attachment facets on the cricoid cartilage which articulate with the arytenoid cartilage?

A

Posteriorly on the lamina

102
Q

Which cartilage articulates with the lateral articulation facets on the cricoid facets?

A

Medial surface of the thyroid horn of the thyroid cartilage

103
Q

Which two structures form a superior point of fusion of the thyroid cartilage?

A

Right and left lamina

104
Q

Which structure is formed upon the fusion of the right and left lamina anteriorly?

A

Laryngeal prominence

105
Q

Which bone are the superior horns of the thyroid cartilage attached to?

A

Hyoid bone

106
Q

Which structure do the inferior horns of the thyroid cartilage articulate with?

A

Cricoid cartilage

107
Q

Which ligament attaches the epiglottis to the thyroid cartilage?

A

Thyro-epiglottic ligament

108
Q

Which paired cartilage are pyramidal shaped and reside on the superoposteriar articular facets of the cricoid cartilage?

A

Arytenoid cartilages

109
Q

What is the area above the vocal folds called?

A

Vestibule

110
Q

What is beneath the vestibule?

A

Infrared glottic space

111
Q

What is laterally and superior to the vocal folds?

A

Vestibular fold

112
Q

What is the vestibular fold?

A

False vocal cords and superior to the vocal folds

113
Q

Label this diagram + what view is this

A
114
Q

What structure is at the back of the tongue?

A

Epiglottis (retroflex + close off airway during swallowing)

115
Q

Which group of larynx muscles are the most important in terms of the vocal cords?

A

Arytenoid muscle

116
Q

Contraction of which muscles will open up/adduct the vocal folds?

A

Posterior cricoarytenoid muscles

117
Q

Function of the cricothyroid muscle?

A

Lengthens and stretches the vocal fold (tensor)

118
Q

Contraction of which muscles will close (abduct) the vocal folds?

A

Lateral cricoarytenoid muscles

119
Q

What nerve innervates the circothyroid muscle?

A

Superior laryngeal branch of vagus nerve

120
Q

What does contraction of the cricothyroid muscle do?

A

Tense vocal folds, and will change the pitch of the noise produced by airflow between them

121
Q

What is the function of the oblique arytenoid muscle?

A

Narrows the laryngeal inlet

122
Q

What is the function of the transverse arytenoid muscle ?

A

In coordination with the oblique arytenoid muscle, the transverse muscle pulls the arytenoid cartilage closes together -> Closure of the posterior glottis

123
Q

Which muscle opens the glottis, and separates the vocal folds?

A

Posterior cricoarytenoid

124
Q

Protective mechanisms for the airway + explanation?

A

Swallowing (epiglottis retroflexes over opening of airway + stops food going into airway)

Gag reflex (stops you swallowing something you don’t want to); glossopharyngeal nerve is underlying this reflex.

Sneezing

Coughing

125
Q

Which nerve controls the gag reflex?

A

Glossopharyngeal nerve

126
Q

What are the 2 protective mechanisms involving expulsion of air at some speed?

A

Sneezing and coughing

127
Q

How does sneezing protect the airway?

A

Expel air through nose to try and clear the obstructions or irritations in the nose

128
Q

How does coughing protect the airways?

A

Reflex action to remove food away from trachea out through the oral cavity

129
Q

How is the larynx innervated?

A

By branches of the vagus nerve:

  • Superior laryngeal nerve (internal laryngeal nerve + external laryngeal nerve)
  • Recurrent laryngeal nerve
130
Q

What is the pathway of the recurrent laryngeal nerve?

A

Last branches of recurrent laryngeal nerve passes down into the thorax + comes back into the larynx

131
Q

Label this diagram

A
132
Q

If there is a lesion before any vagal branches arise, what does the patient present with?

A

Complete paralysis of the larynx

133
Q

If there is a lesion in the internal and external branches of the superior laryngeal nerve, what happens in each case?

A

Internal - Lesion causes loss of sensation above the vocal folds.

External - Lesion causes paralysis to the cricothyroid muscle.

134
Q

If there is a lesion in the recurrent laryngeal nerve what does the patient present with?

A

Paralysis of all the muscles of the larynx apart from the cricothyroid and loss of sensation below the vocal folds.

135
Q

Label this diagram of the thyroid gland

A
136
Q

What is the function of the external branch of the superior laryngeal nerve?

A

Supplies the cricothyroid muscle

137
Q

What gland is closely associated with the larynx?

A

Thyroid gland

138
Q

What sits in the middle of the 2 thyroid glands?

A

Isthmus

139
Q

Which nerve runs very close to the thyroid?

A

Recurrent laryngeal nerve

140
Q

Why can thyroid surgey be dangerous (thyroidectomy)?

A

Surgeons have to be careful not to damage the recurrent laryngeal nerve or they could risk paralysing the larynx.

141
Q

Which nerve provides motor function to the cricothyroid muscle?

A

External branch of the superior laryngeal nerve

142
Q

What is the thyroid isthmus?

A

Connects the lateral lobes

143
Q

What is the first branch of the external carotid artery?

A

Superior thyroid artery

144
Q

What is the first branch of the external carotid artery?

A

Superior thyroid artery

145
Q

Where does the facial vein drain into?

A

Into the internal jugular vein

146
Q

What is the most prominent superficial vein of the head and neck?

A

External jugular vein (lies on the surface of sternocleidomastoid)

147
Q

What do the opthalmic veins drain back into + why is it a potential route of infection?

A

Cavernous sinus

Potential route of infection back into the cranial cavity so the infection around the orbit

148
Q

Label this deep view of veins on diagram

A
149
Q

Where does the pterygoid plexus of deep veins drain ultimately into?

A

Internal jugular vein

150
Q

What is the function of the pterygoid plexus?

A

Collect the blood from the palate, nasal cavity, paranasal sinuses, nasopharynx and auditory tube

151
Q

Label this diagram of the neck

A
152
Q

Which 2 veins are potential routes for putting in a central line to monitor central venous pressure?

A

Interior jugular vein (most common site of introduction of a central line)

Subclavian vein (be wary of the subclavian artery, something you don’t want to hit with the needle)

153
Q

What are the 5 main superficial lymph nodes?

A

Submandibular
Submental
Occipital
Mastoid
Parotid

154
Q

What are the submandibular nodes?

A

Inferior to the body of the mandible, and associated with the facial artery

155
Q

What are the submental nodes?

A

Inferior and posterior to the chin

156
Q

Where are the occipital lymph nodes located?

A

Located posterior to the head at the lateral border of the trapezium muscle, collects lymph from the occipital region of the scalp

157
Q

Which lymph nodes are posterior to the ear, residing on the insertion of the sternocleidomastoid muscle into the mastoid process?

A

Mastoid nodes

158
Q

Where are the parotid nodes located?

A

Superficially to the parotid gland, collects lymph from the nasal cavity, the external acoustic meatus, the tympanic cavity and the lateral borders of the orbit

159
Q

What are the deep cervical lymph nodes?

A

Collection of lymph nodes that form a chain along the internal jugular vein. Divided into upper and lower groups where intermediate tendon of the omohyoid muscle crosses the common carotid artery & the internal jugular vein.

160
Q

Label the diagram of the nodes

A
161
Q

Label this diagram

A
162
Q

Label this diagram

A
163
Q

Where are the constrictors of the pharynx in this diagram?

A
164
Q

What muscle is highlighted here and what does it do?

A

Cricothyroid muscle

Tense vocal folds, and will change the pitch of the noise produced by airflow between them

Only tensor muscle of the larynx aiding with phonation. It is innervated by the superior laryngeal nerve.

165
Q

What muscle is highlighted here?

A

Cricothyroid muscle

Tense vocal folds, and will change the pitch of the noise produced by airflow between them

Only tensor muscle of the larynx aiding with phonation. It is innervated by the superior laryngeal nerve.

166
Q

What muscle is highlighted here and what does it do?

A

Oblique arytenoid muscle

Narrows the laryngeal inlet

167
Q

What muscle is highlighted here and what does it do?

A

Oblique arytenoid
Narrows the laryngeal inlet

168
Q

What does the highlighted muscle do?

A

In coordination with the oblique arytenoid muscle, the transverse muscle pulls the arytenoid cartilage closes together -> Closure of the posterior glottis

Transverse arytenoid

169
Q

What does the highlighted muscle do?

A

Posterior cricoarytenoid

opens the glottis, and separates the vocal folds

170
Q

What does the highlighted muscle do?

A

Posterior cricoarytenoid

opens the glottis, and separates the vocal folds

171
Q

What does the highlighted muscle do?

A

close (abduct) the vocal folds

Lateral cricoarytenoid

172
Q
A

Anatomy (8 decks)

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