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Y2 ENT > Week 1 > Flashcards

Week 1 Flashcards

1
Q

How are the senses of taste and smell stimulated

A

Buy chemoreceptors (sensory receptor cells) binding to particular chemicals

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2
Q

Function of taste and smell

A

Protects us from poisons / spoiled food
Influences the flow of digestive juice
Smell can influence taste

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3
Q

Where are the sensory receptor cells for taste mainly packaged in

A

Taste buds

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4
Q

What does a taste bud consist of

A

Taste receptor cells
Support cells between taste receptor cells
Basal cells
Afferent nerve fibres

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5
Q

How long is the life span of taste receptor cells and what happens when it dies

A

10 days
Basal cells will differentiate into new taste receptor cells and replace the old one

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6
Q

Where are taste buds located at

A

Tongue
Pharynx
Epiglottis
Palate

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7
Q

Where are taste buds mostly located at

A

In papillae in the tongue

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8
Q

What are papillae seen as on tongue

A

Raised bumps or little red dots

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9
Q

4 types of papillae

A

Filliform
Fungiform
Vallate
Foliate

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10
Q

Which papillae contain taste buds

A

Fungiform
Vallate
Foliate

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11
Q

Which papillae is the most abundant

A

Filliform but it does not contain taste buds

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12
Q

How does action potentials travel from taste receptor cells to the brainstem

A
  1. Chemicals trigger the Taste receptor cells to produce action potentials
  2. Action potentials travel through the afferent nerve fibres
  3. to cranial nerves (V / IX / X)
  4. Action potential is then conveyed by the cranial nerves to cortical gustatory areas
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13
Q

What is cortical gustatory areas

A

Region of cerebral cortex responsible for the perception of taste

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14
Q

What are the cranial nerves involved in transmitting signals from afferent taste nerve fibres

A

Chorda tympani branch of facial nerve CN VII
Glossopharyngeal nerve CN IX
Vagus nerve CN X

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15
Q

Taste signals from where are conveyed to the brainstem via chorda tympani branch of facial nerve

A

Anterior 2/3 of the tongue (innervated by chorda tympani)

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16
Q

Taste signals from which part are conveyed to the brainstem via glossopharyngeal nerve

A

posterior 1/3 of the tongue

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17
Q

Taste signals from which part are conveyed to the brainstem via vagus nerve

A

Epiglottis
Pharynx

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18
Q

Why may patients who had undergone middle ear surgery experience an alteration to sense of taste

A

Because the facial nerve is closely related to the middle ear hence if it can damaged during the surgery and taste will be altered

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19
Q

What is bitter taste stimulated by

A

Alkaloids
Poisonous substances
toxic plant derivatives

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20
Q

What is the sour taste stimulated by

A

High amounts of free H+

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21
Q

What is the salty taste stimulated by

A

NaCl

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22
Q

What is the sweet taste stimulated by

A

Glucose

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23
Q

What is umami taste stimulated by

A

Amino acids especially glutamine

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24
Q

What is ageusia

A

Loss of taste

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25
Q

What can cause ageusia

A

Nerve damage
Glossitis
Radiation
Tobacco
Endocrine disorders

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26
Q

What is hypogeusia

A

Reduced taste function

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27
Q

What can cause hypogeusia

A

Chemotherapy
Medications

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28
Q

What is dysgeusia

A

Distortion of taste

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29
Q

Causes of dysgeusia

A

Glossitis
Gum infections
URTI
Medications
Chemotherapy
Neoplasms
Zinc deficiency

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30
Q

What are the 2 main cranial nerves involved in the sense of smell

A

Olfactory Nerve CN I
Trigeminal Nerve CN V

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31
Q

What is the difference between the types of smells that each cranial nerve is involved in

A

CN I is involved in common odours such as rose, chocolate, mint whereas CN V is involved in chemical stimulus such as smells that irritates you (ammonia) , burning, cooling

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32
Q

If you smelled something harmful, which nerve is involved to stop inhalation and why does it do it

A

CN V (trigeminal)
to protect the lungs

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33
Q

Where is the olfactory neuroepithelium located at

A

At the top of each nasal cavity

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34
Q

Does all the air breathed in reaches the olfactory neuroepithelium

A

No, only 10-15% reach the neuroepithelium. Most of the air goes down the nasopharynx into the airways

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35
Q

How is the smell of the food enhanced by swallowing

A

Due to retrograde airflow from the nasopharynx back to the nasal cavity

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36
Q

How does air reach the olfactory mucosa during quiet breathing

A

Because the olfactory mucosa is above the normal path of airflow, the air reaches above by diffusion

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37
Q

How does sniffing enhance smelling

A

Draws air currents upwards to the olfactory mucosa

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38
Q

What features does a substance must have in order to be smelled

A

Volatile
Water soluble

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39
Q

Why does the substance need to be water soluble in order to be smelled

A

So it can dissolve in the mucous which coats the olfactory mucosa

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40
Q

Function of the mucous coating the olfactory mucosa

A

Ensures moist environment and protection
Disperses odour substances to the olfactory receptors

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41
Q

How are odour substances transported to the receptors after it enters the mucous

A

Diffuse or by specialised proteins

42
Q

What happens if you have too little mucous around your olfactory mucosa

A

Dry
Reduced sense of smell

43
Q

What type of epithelium does the olfactory mucosa have

A

Pseudostratified columnar epithelium

44
Q

What does the olfactory mucosa contain

A

Bi-polar neurones- receptor cells extend its axons on both sides
Supporting cells
Basal cells
Duct cell of Bowmans glands

45
Q

Function of supporting cell in the olfactory mucosa

A

To protect the receptor cells

46
Q

Function of duct cell of Bowmans glands

A

Secrete mucous that coats the olfactory mucosa

47
Q

The axons of the olfactory receptor cells collectively form the

A

Afferent fibres of olfactory nerve

48
Q

Describe how we smell

A
  1. Air containing odourants enters the nasal cavity and diffuse / drawn up to (by sniffing) the olfactory mucosa
  2. Odourants dissolves into the mucous that is coating the olfactory mucosa, becoming aqueous
  3. Aqueous odourants are picked up by the receptor cells
  4. Action potential fired from the receptor cells to the olfactory bulb via afferent fibres of olfactory nerve
  5. The chemical stimuli is converted into neural stimuli in the olfactory bulb then sent to the brain
49
Q

Which part of the brain does olfactory bulb neuron’s pass the stimuli to

A

Temporal lobe
Olfactory areas

50
Q

What is anosmia

A

Inability to smell

51
Q

What is hyposmia

A

Reduced ability to smell

52
Q

What is dysosmia

A

Altered sense of smell

53
Q

What is phantosmia

A

Smell perceived in the absence of stimulus (olfactory hallucination)

54
Q

Aetiology of abnormalities in smell can be

A

Conductive or sensorineural

55
Q

What does it mean when an abnormality in smell is due to conductive reasons

A

Due to something blocking the molecules from getting to the olfactory mucosa

56
Q

Examples of conductive reasons in abnormalities of smell

A

Polyps
Discharge
Mucous

57
Q

What does it mean when an abnormality in smell is due to sensorineural reasons

A

Due to problems with the olfactory nerves / olfactory bulb itself

58
Q

Examples of sensorineural reasons in abnormalities of smell

A

Head injuries
Neurological conditions (parkinson, alzheimers)
Brain tumours
Medications

59
Q

What is UPSIT

A

Objective testing for sense of smell; clinicians asks patients to smell certain things then ask the patient to fill in the answer

60
Q

What is epistaxis

A

Nose bleed

61
Q

Causes of epistaxis

A

Idiopathic
Injury
Foreign bodies
Tumour
Inflammation
Hereditary hemorrhagic telangiectasia
Coagulopathy
Drug use

62
Q

What is hereditary hemorrhagic telangiectasia

A

Autosomal dominant disorder that leads to abnormal formation of the vessels

63
Q

Examples of coagulopathy

A

thrombocytopenia

64
Q

Arteries that supplies the nasal cavity branched off from

A

Internal and External carotid arteries

65
Q

Which artery that supplies the nasal cavity branched off from the internal carotid artery

A

Ophthalmic artery which branches off into anterior and posterior ethmoidal arteries

66
Q

Which arteries that supply the nasal cavity branched off from the external carotid artery

A

Maxillary artery which branches -> sphenopalatine and greater palatine arteries

Facial artery which branches -> superior labial artery and lateral nasal artery

67
Q

Where does epistaxis usually originate from

A

Kiesselbach’s plexus at nasal septum

68
Q

Kiesselbach’s plexus is formed by which arteries

A

Anterior ethmoidal atery
Posterior ethmoidal artery
Sphenopalatine artery
Greater palatine artery
Septal branch of superior labial artery

69
Q

Sometimes, the bleeding may originate from the posterior nasal cavity. Which artery is responsible

A

Sphenopalatine

70
Q

Anterior or posterior epistaxis bleeds more profusely

A

Posterior

71
Q

Management sequence for epistaxis

A
  1. Conservative (pressure, ice, drugs
  2. Nasal cautery
  3. Nasal packing
72
Q

What is the conservative management for epistaxis

A

Apply external pressure to soft part of the nose

Ice pack on forehead or neck

Topical vasoconstrictors +/- lignocaine

Reversal of anti-coagulants

73
Q

What should the position of the patient be when managing epistaxis conservatively

A

leaning forward

74
Q

What should the patient do if there is blood in their mouth due to epistaxis?

A

Spit it out

75
Q

What may happen if the patient swallows too much blood

A

Nausea and vomiting because blood is an emetic

76
Q

Examples of anti coagulant

A

Warfarin
Rivaroxaban
Dabigatran

77
Q

What is nasal cautery

A

Cauter the damaged vessel using silver nitrate stick

78
Q

What can make nasal cautery difficult to perform

A

Heavy bleeding
Cannot identify the bleeding point

79
Q

When is nasal packing used

A

Heavy bleeding unresolved by nasal cautery
Bleeding points that cannot be identified so cannot undergo nasal cautery

80
Q

Examples of nasal packings

A

Nasal tampons
Rapid rhino

81
Q

Why should nasal packing be avoided if possible

A

Because it requires hospital admission for observation

82
Q

How is profuse epistaxis caused by posterior bleeding mostly treated

A

By ligation;
Sphenopalatine artery ligation

83
Q

Which group of patients who presented with epistaxis should you suspect to have underlying conditions

A

Young children under 2
Elderly (cancer risk is higher) with recurrent epistaxis
Family history of hereditary haemorrhagic telangiectasia
Signs of cancer

84
Q

What should you suspect in young children under 2 who present with epistaxis

A

NAI or underlying conditions because epistaxis usually does not occur in young children under 2

85
Q

What are the nerves that can cause referred otalgia

A

Trigeminal (CN V3)
Vagus
Facial
Glossopharyngeal
Spinal nerve C2 C3

86
Q

Why is CN V3 the only branch involved in referred otalgia

A

Because it is the only branch that provides general sensory innervation to the external ear

87
Q

CN V3 provides general sensory innervation to

A

External ear
Lower lip
Chin
General sensation to anterior 2/3 of tongue
Lower molar, incisor and canine teeth
Lower gingiva
3 salivary glands

88
Q

Name the branch of CN V3 that gives general sensory innervation to anterior 2/3 of tongue

A

Lingual nerve

89
Q

Which branch of CN V3 innervates the external ear

A

Auriculotemporal nerve

90
Q

What pathologies can cause referred otalgia due to CN V3

A

Lower teeth cavities, abscesses
Salivary gland infections / neoplasm
Anterior 2/3 of tongue infections / injury (piercings)

91
Q

Which branch of the facial nerve gives general sensory innervation to the external ear

A

Posterior auricular branch

92
Q

Other branches of facial nerve gives general sensory innervation to

A

Ethmoid sinus
Maxillary sinus
Nasal mucosa

93
Q

Name the branches that gives general sensory innervation to ethmoid and maxillary sinuses and nasal mucosa

A

Vivian nerve
Greater petrosal nerve

94
Q

pathologies that can cause referred otalgia due to facial nerve

A

Ethmoid / maxillary sinusitis
Nasal pathologies - foreign bodies

95
Q

Vagus nerve gives general sensory innervation to

A

Inferior aspect of laryngopharynx
Inferior parts of external ear canal and tympanic membrane

96
Q
A
97
Q

Where is piriform fossa located at

A

Posterolaterally to each side of the laryngeal inlet

98
Q

Pathologies that can cause referred otalgia due to vagus nerve

A

Foreign body in piriform fossa (e.g. fishbones)
Carcinoma of the larynx or piriform fossa
Piriform abscess

99
Q

Glossopharyngeal nerve provides general sensory innervation to

A

Middle cavity
Superior part of tympanic membrane
Oropharynx
Posterior 1/3 of tongue
Tonsils

100
Q

Pathologies that can cause referred otalgia due to glossopharyngeal nerve

A

Tonsilitis
post-tonsillectomy
Carcinoma at posterior 1/3 of the tonguee

101
Q

Which branches of C2 and C3 are involved in giving general sensory in innervating the external ear

A

Lesser occiptal
Greater auricular

102
Q

Pathologies that can lead to referred otalgia due to spinal nerves C2 and C3

A

Cervical neuritis
Herpes zoster

Y2 ENT (7 decks)

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