Overview 2 Flashcards
What are the four paranasal air sinuses?
Ethmoid
Frontal
Sphenoid
Maxillary
Three functions of paranasal air sinuses are?
Humidify the air
Lighten the weight of the skull
Enhance resonance
Which paranasal air sinus is the most superiorly located?
Frontal sinus
Which paranasal air sinus is the most inferiorly located?
Maxillary sinus
Which paranasal air sinus is the most posteriorly located?
Sphenoid sinus
Which paranasal air sinus is just medial to the eyes?
Ethmoid sinus
Which paranasal air sinus is just lateral to the nose?
Maxillary sinus
Which paranasal air sinus is superior to the eyes?
Frontal
Which sinus cannot be seen in the coronal view and why?
Sphenoid sinus - most superiorly located
What is the ethmoid sinus known as?
Ethmoid air cells
What are the two main arteries that supply the nose (origins)?
External carotid artery
Internal carotid artery
What is the blood supply to the nose from the internal carotid artery?
Opthalmic artery
What are the five arteries that supply the nose?
Anterior ethmoidal artery Posterior ethmoidal artery Sphenopalatine artery Greater palatine artery Septal branch of the superior labial artery
What are the three main arteries that provide the blood supply to the nose?
Opthalmic artery x2
Maxillary artery x2
Facial artery x1
What is epistaxis?
Nose bleed
Majority of epistaxis is anterior or posterior? and what percentage?
Anterior - 90%
Posterior nose bleeds are more common in whom? x2
Elderly
Those with clotting disturbance
Most common cause of epistaxis?
Kisselbach’s plexus
What is sinusitis? Which sinus is affected?
Inflammation in the maxillary sinus
Consequence of sinusitis?
Inflammation can cause swelling and this can then block drainage of the sinuses
Which sinus is very closely associated with the pituitary gland?
Sphenoidal air sinus
First line treatment for sinusitis is?
Vasoconstrictors to reduce blood flow - reduces swelling
Second line treatment for sinusitis and inidications for this?
Antibiotics
If sinusitis is bad with a high fever
What is at the midline of the oral cavity?
Uvula
What is lateral to the uvula on both sides?
Tonsils
What are the two arches of the oral cavity?
Palatoglossal arch
Palatopharyngeal arch
Where are the arches of teh oral cavity in relation to each other?
Palatoglossal - more anteriorly located
Palatopharyngeal - more posteriorly located
Where does the frontal sinus exit into the nasopharynx?
Into the middle conchae
Where does the ehtmoid sinus exit into the nasopharynx?
Directly into the posteiror wall of the nasopharynx
Where does the maxillary sinus exit into the nasopharynx?
Into the middle conchae
What is the Kisselbach area?
This is where five facial arteries anastomose in the nose
What is the significance of Kisselbach area?
Trauma here can result in epistaxis
What is Waldeyer’s ring?
Four tonsils in the mouth organised into a ring
What are the four tonsils of Waldeye’s ring?
Superior to inferior: Adenoid tonsil Tubal tonsil Palatine tonsil Lingual tonsil
When is treatment required for tonsillitis?
When very severe - antibiotics
Indication for tonsil removal?
When very very very severe
Adverse effect of removal of tonsils?
Post tonsillectomy bleeding - very vascular region
Fatal complication of tonislitis is? (rare)
Quinsy - abscess formation in the peritonsilar space
Three components of the pharynx are?
Nasopharynx
Oropharynx
Laryngopharynx
Innervation to the pharynx is?
Sensory - glossopharyngeal IX
Motor - vagus X
Most superior bone of the larynx is?
Hyoid bone
Which cartilage ring is the only one that goes all the way around the trachea?
Cricoid cartilage
Which level is the cricoid cartilage at?
C6
Which level is the hyoid bone at?
C3
Laryngeal prominence formed by which cartilage?
Thyroid cartilage
Potential space located in the neck is called?
Retro-pharyngeal pouch
When can the potential space of the neck become a real space?
Name?
Infection of the larynx
Retro-pharyngeal pouch
Relation of vocal fold and vestibular fold
Vocal fold - more medial
Vestibular fold - more laterally located
Function of primary cricothyroid tensor muscles?
Increases the length and tension of the vocal folds
Increases the pitch of the voice
Central to the vocal folds is?
Rima glottidis
Function of the internal laryngeal nerve?
Sensation - cough reflex
Function of the external laryngeal nerve?
Motor to the cricothyroid muscles - increase the pitch of voice
Function of the recurrent laryngeal nerve?
Motor to all intrinsic muscles apart from cricothyroid muscle
Sensory below vocal folds
Innervation to the cricothyroid muscle is?
External laryngeal nerve (from superior laryngeal nerve)
Innervation to all motor muscles of larynx is? Apart from?
Recurrent laryngeal nerve
Apart from the cricothyroid muscle
What is the nerve of phonation?
Recurrent laryngeal nerve
What is the nerve of pitch?
External laryngeal nerve - cricothyroid muslce
Nerve sensory to the larynx is?
Internal laryngeal nerve
Damage to the recurrent laryngeal nerve presents as?
Hoarseness of voice
Damage to the superior laryngeal nerve presents as?
Loss of choking
Monotonous
Left recurrent laryngeal nerve loops under what?
Aorta
Right recurrent laryngeal loops under what?
Right subclavian artery
What can you look for in relation to the sphenoidal sinus to determine which sinus is the sphenoidal sinus?
The sella turcica - this has a very close relation to the sphenoidal air sinus
What is just posterior to the thyroid cartilage?
The vocal folds and the rima glottidis
Aschoff bodies are found in which layer of the heart?
Epicardium
Atheroma develops in which layer of the heart?
Tunica intima
How can you recognise an infarct region on a heart?
This region will appear bright red
Tissue at the centre of heart valves is?
Dense irregular connective tissue
Cells at the edge of heart valves are?
Endothelial cells
In venous valves, what is the direct of normal blood flow?
Right to left
Pericarditis occurs where on the heart?
Over the pericardium - outer layer casing the heart
Endocarditis will be seen where on the heart?
Within the heart on the edge of the valve cusps
Myocarditis will form where on the heart and how can this be recognised?
Forms at the myocardium layer
Aschoff bodies will be present
What is pancarditis?
This is when pericarditis, endocarditis and myocarditis are all present at the heart
Aschoff bodies are composed of what two cells?
Epitheloid macrophages
Lymphocytes
Myocardial infarct histology - the older the infarct, what colour will it appear?
The older the infarct, it will appear pinker
Myocardial infarct - what cells infiltrate the infarcted region?
Neutrophils
Myocardial infarct - the muscle is replaced by what tissue type?
Granulation tissue
Myocardial infarct region is at it’s weakest/most likely to rupture when?
Between 5-10 days post infarct
What tissue replaces the granulation tissue of myocardial infarct?
Collagen tissue - forms consolidated scar
Epithelium in the trachea and most respiratory airways is?
Pseudostratified columnar epithelium
Epithelium in the bronchioles is?
Simple columnar
What is metaplasia?
Change in tissue type from one mature type to another
What is anaplasia?
Lack of differentiation and loss of mature cells of tissue type
Psuedostratified columnar epithelium - what is secreted and by what cells?
Mucous secreted by goblet cells
Metaplasia of the respiratory epithelium can occur due to?
Presence of irritants e.g. cigarette smoke
Squamous cell carcinoma of the lung usually occurs after what has happened?
Metaplasia of the respiratory epithelium
Two types of lung carcinoma are?
Which is malignant
Small cell - malignant
Non-small cell
TB in lung will typically be contained in what?
Caseous granuloma
Caseous granuloma of TB is surrounded by what two layers of cells?
Epitheloid macrophages
These are then surrounded by lymphocytes
What are Langerhans giant cells?
Fused epitheloid macrophages surrounding caseous granuloma
Later stage of TB - what cells are activated and why?
Fibroblasts are activated to lay down collagen to case off the granuloma
Three cells involved with presence of TB in the lungs?
Macrophages
Lymphocytes
Fibroblasts
Why and when does the tubercle wall of TB thicken?
When the fibroblasts lay down the collagen and case off the TB
Primary TB - the lesions are located where on the lung and what is this called?
Gohn focus - middle lobe and at the hilum
Secondary TB - the lesions are located where on the lung and what is this called?
Assmann focus - superior lobe
Miliary TB - the lesions are located where on the lung?
Throughout the lobes of the lung
Primary/secondary TB - which lesion tends to be bilateral?
Assmann focus of secondary TB
Normal lung is what colour?
Dark brown
Pneumonia - area of consolidation of the lung will be what colour?
White ish
Defence cell normally found in alveolar spaces is?
Neutrophil
Most common organism causing lobar pneumonia is?
S. pneumoniae
What is meant by ‘-penia’?
Too little
What is meant by ‘-philia’?
Too much
What is meant by ‘-cytosis’?
Too much
What does neutrophil leycocytosis mean?
This is another term for neutrophilia
Increased numbers of neutrophils
Which blood cells have a blueish tint around them?
Reticulocytes
Three typical histological features of alcoholic liver disease?
Macrocytosis in the absence of anaemia
Thrombocytopenia
Target cells
Allergic rhinitis - increase in which lymphocyte?
Eoseinophil
Two lineages of WBCs?
Myeloid cells
Lymphoid cells
What different cells can myeloid cells differentiate into?
Basophils
Neutrophils
Eosinophils
What different cells can lymphoid cells differentiate into?
B/T lymphocytes
Plasma cells
NK cells
Function of neutrophil? x3
First cell at the site of infection
Role in immune surveillance
Kills microbes via phagocytosis
Neutrophilia - more common in bacterial or viral infections?
Bacterial
Cause of eosinophilia? x2
Allergy/atopy e.g. hayfever, eczema, asthma
Parasitic infections
Function of eosinophils? x2
Involved in defence against parasitic infections - helminths (worms) and protozoa
Increased against allergy/atopy
Function of basophils?
Release of histamine and heparin in inflammatory responses
B12/folate deficiency macrocytic anaemia can be recognised by?
Macrocytic cells
Hypersegmented neutrophils
Right marginal artery supplies blood to which region of the heart?
Right ventricle
Posterior inter ventricular artery supplies blood to which region of the heart?
Posterior 1/3 of interventricular septum
Left circumflex artery supplies blood to which region of the heart?
Left atrium and left ventricle
Left anterior descending artery supplies blood to which region of the heart?
Anterior 2/3 interventricular septum
Front and bottom of L ventricle
How can you recognise a drug as a beta blocker?
Ends in -lol
Atenolol
Proparonolol
Bisprolol
Pleural effusion is where in the lungs?
Base of the lungs
Pulmonary oedema is where in the lungs?
In the alveoli
Two muscles used in forced exhalation are?
Internal intercostal muscles
Abdominal muscles
Tremor seen in respiratory failure is?
Flapping tremor
Pa of O2 in hypoxemia is?
<8kPa
PaCo2 in hypercapnia is?
> 6.5kPa
Cells involved in immediate response to asthma?
Mast cells
Cells involved in delayed response to asthma?
Eosinophils
Cells involved in bronchitis?
Squamous cells
Olamtuzimab works against which Ig?
IgE
Streptococcus pneumoniae most commonly causes what type of pneumonia?
Community acquired
Mycoplasma pneumoniae most commonly causes what type of pneumonia?
Atypical
Main difference in the symptoms of pneumonia vs. TB is?
Pneumonia - headache
Right of left diaphragm is higher?
Right diaphragm higher - liver is underneath