SGW 10

Question 1

which muscles help keep food within the oral cavity proper while chewing and what are they innervated by?

Answer 1

orbicularis oris and buccinators
facial nerve (CN VII)
(muscles of mastication innervated by CN V)

Question 2

what happens during oral (preparatory and propulsive) phase of swallowing?

Answer 2

1. chewing of food into bolus to be swallowed
2. bolus pushed back to soft palate by teeth and tongue
   (all voluntary)

Question 3

what what happens in pharyngeal phase of swallowing>

Answer 3

automatic: food propel to pharynx
1. elevate soft palate (seal off nasopharynx)
2. upward and forward movement of hyoid bone + larynx (suprahyoid muscles)
3. tongue pushed back + down = push food into oropharynx
4. vocal cords close
5. epiglottis pulled posterior-inferiorly over laryngeal outlet = protect airways (trachea)
6. progressive contraction of pharyngeal constrictor muscles (superior to inferior) to move bolus down oesophagus

Question 4

oesophageal phase of swallowing?

Answer 4

movement of bolus by peristaltic action of oesophageal muscles

Question 5

how does upper oesophageal sphincter open?

Answer 5

contraction of thyropharyngeus and relax cricopharyngeus (inferior pharyngeal constrictor - prevent buildup of intrapharyngeal pressure)

Question 6

muscles of oesophagus?

Answer 6

upper 1/3rd: (straited) skeletal muscle
middle 1/3rd: mixed
inferior 1/3rd: smooth muscle

Question 7

role of suprahyoid muscles during swallowing?

Answer 7

larynx + hyoid lifted UP + FORWARD by suprahyoid muscles
prevent aspiration of food into airway (trachea)
(hyoid lifted up as attachment of suprahyoid muscles, so up when they contract)

Question 8

role of infrahyoid muscles during swallowing?

Answer 8

stabilise the larynx by opposing the actions of suprahyoids during swallowing

Question 9

how does acute tonsillitis present?

Answer 9

swollen, oedematous tonsils (palatine)
white exudate (pus) coating tonsils and filling the crypts (if become abscess = quinsy, medical emergency, drain, can obstruct nasopharynx)

Question 10

which lymph nodes are swollen during tonsillitis? location?

Answer 10

jugulo-digastric (deep cervical)

just below angle of mandible, form part of deep cervical chain of lymph nodes

Question 11

where do jugulo-digastric lymph nodes drain into?

Answer 11

tonsillar + posterior pharyngeal regions

Question 12

how do jugulo-digastric lymph nodes appear in tonsillitis?

Answer 12

enlarged + tender

Question 13

what are the deep cervical lymph nodes and where are they found?

Answer 13

deep to SCM
closely related to IJV + carotid sheath
(will be closely related to IJV as within carotid sheath)
jugulo-digastric (superior SCM)
jugulo-omohyoid (anteiror SCM)
supraclavicular lymph nodes (within supraclavicular fossa) - L. SLN = virchow’s (GI malignancy)

Question 14

contents of carotid sheath?

Answer 14

IJV, common carotid artery, internal CA, vagus (CNX)

Question 15

bifurcation of common carotid artery?

Answer 15

upper border of the thyroid cartilage (C4)

Question 16

what is quinsy? how does it occur?

Answer 16

peritonsillar abscess

rare complication of acute tonsillitis, but can occur without prior tonsillitis

Question 17

how does quinsy present?

Answer 17

unilateral swelling, causing deviation of soft palate + uvula to opposite side
symptoms of fever + painful swallow
trismus (difficulty opening mouth) may occur
voice may be altered (hot potato voice)

Question 18

why might trismus occur in quinsy?

Answer 18

(difficulty opening mouth)

due to muscle spasm

Question 19

why may voice be altered in quinsy?

Answer 19

by pharyngeal oedema + muscles spasm

Question 20

how do you treat quinsy?

Answer 20

refere to ENT:

IV antibiotics + aspiration of abscess (drain)

Question 21

what is glue ear and how does it appear?

Answer 21

otitis media with effusion
ear drum appears:
yellow, retracted (sucked in), with air bubble visible

Question 22

how does glue ear normally present?

Answer 22

history of recurrent ear infections
hearing is poor
complains of pain in ear, but otherwise well

Question 23

what causes glue ear?

Answer 23

eustachian (pharygotympanic) tube dysfunction
middle ear cannot equalise with atmosphere because the tube doesn’t open properly
mucous membrane continuously absorbs air in middle ear and the tube causing a negative pressure within
(absorb air but can’t leave = negative pressure)

Question 24

what can happen with glue ear?

Answer 24

fluid accumulates within the middle ear, may be thick + stick OR thin + watery
exudate = ideal growth medium for pathogens

Question 25

what does eustachian tube malfunction occur with?

Answer 25

adenoids hypertrophy
URTI
nasal allergy
tumours of nasopharynx

Question 26

what is the difference between glue ear and otitis media?

Answer 26

glue ear = doesn’t necessary have to be an infection

otitis media: CAUSED by an infection

Question 27

would glue ear hearing loss be conductive or sensorineural? why?

Answer 27

conductive hearing loss (middle ear)

accumulation of fluid within middle ear, prevents vibration of tympanic membrane + ossicles

Question 28

what does sensorineural hearing loss occur with?

Answer 28

pathology affecting inner ear structures / CN VII (vestibulocochlear nerve)

Question 29

how to treat glue ear?

Answer 29

surgical grommet insertion (lasts about 9 months)

Question 30

what is the function of a grommet?

Answer 30

helps drain away fluid in the middle ear and maintain air pressure