APDN OF ORO&HYPO (AB) Flashcards
(142 cards)
1
Q
What structure connects the oral cavity to the oropharynx?
A
Faucial isthmus.
2
Q
What are the anatomical contents of the oropharynx?
A
Posterior third of the tongue. Anterior and posterior tonsillar pillars. Soft palate. Lateral and posterior pharyngeal wall. Vallecula.
3
Q
What structure marks the anterior boundary of the oropharynx?
A
Tongue base and lingual tonsil.
4
Q
What vertebral levels form the posterior boundary of the oropharynx?
A
Second and third cervical vertebrae.
5
Q
What flanks the palatine tonsils laterally in the oropharynx?
A
Faucial pillars.
6
Q
What imaginary line separates the nasopharynx from the oropharynx?
A
A line from the soft palate perpendicular to the posterior pharyngeal wall.
7
Q
What epithelium lines most of the oropharynx and hypopharynx?
A
Stratified non-keratinized squamous epithelium.
8
Q
What are the three subsites of the hypopharynx?
A
Piriform sinuses. Posterior hypopharyngeal wall. Postcricoid area.
9
Q
What vertebral levels correspond to the posterior wall of the hypopharynx?
A
Third through sixth cervical vertebrae.
10
Q
What forms the anterior wall of the hypopharynx?
A
Back of the larynx protruding into the hypopharynx forming the piriform sinuses.
11
Q
Why are tumors in the hypopharynx often diagnosed late?
A
Because they are relatively silent and asymptomatic in early stages.
12
Q
What forms the vallecula?
A
Space between the base of the tongue and the epiglottis.
13
Q
What are the muscular boundaries of the pharynx?
A
Constrictor pharyngis muscles: superior. medius. and inferior.
14
Q
Which pharyngeal muscle overlaps and joins the esophageal musculature?
A
Inferior constrictor muscle.
15
Q
Where is the Killian triangle located?
A
Between the inferior constrictor and the uppermost fibers of the cricopharyngeus muscle.
16
Q
What is a common site of Zenker diverticulum formation?
A
Killian triangle.
17
Q
Which artery supplies most of the oropharynx and hypopharynx?
A
External carotid artery via facial. maxillary. ascending pharyngeal. lingual. and superior thyroid arteries.
18
Q
Into which vein do the pharyngeal veins drain?
A
Internal jugular vein.
19
Q
What lymph nodes drain the upper pharynx?
A
Retropharyngeal lymph nodes.
20
Q
What lymph nodes drain the lower pharynx?
A
Parapharyngeal or deep cervical nodes.
21
Q
What nerves contribute to the pharyngeal plexus?
A
Glossopharyngeal and vagus nerves.
22
Q
Where is the pharyngeal plexus located?
A
On the outer aspect of the constrictor pharyngis medius muscle.
23
Q
What is the shape of the pharyngeal space?
A
Inverted pyramid.
24
Q
What are the two parts of the pharyngeal space?
A
Retropharyngeal space and lateral pharyngeal space.
25
What important structures traverse the retrostyloid space?
Internal carotid artery. internal jugular vein. cranial nerves IX–XII.
26
What are the components of Waldeyer's ring?
Pharyngeal. palatine. and lingual tonsils. plus smaller lymphoid tissue in the pharyngeal recess.
27
What type of epithelium covers the palatine and lingual tonsils?
Stratified non-keratinized squamous epithelium.
28
What is the function of tonsillar crypts?
To increase surface area for antigen contact.
29
What cells are found in secondary follicles of the tonsils?
B lymphocytes at various stages and scattered T lymphocytes.
30
At what age does palatine tonsil activity peak?
Around 8–10 years old.
31
What condition is caused by extreme tonsillar hyperplasia in children?
Obstructive Sleep Apnea (OSA) Syndrome.
32
What is the term for touching tonsils due to hyperplasia?
Kissing tonsils.
33
What imaging is preferred for evaluating soft tissue in the pharynx?
MRI.
34
What imaging is preferred for evaluating bony involvement in the pharynx?
CT scan.
35
What is chronic rhinosinusitis?
Inflammation of the nose and paranasal sinuses lasting more than 12 weeks.
36
What are the two main types of chronic rhinosinusitis?
With nasal polyps and without nasal polyps.
37
What are common symptoms of chronic rhinosinusitis?
Nasal obstruction
38
What is the first-line treatment for chronic rhinosinusitis?
Nasal saline irrigation and intranasal corticosteroids.
39
When is surgery indicated for chronic rhinosinusitis?
If maximal medical therapy fails or complications arise.
40
What imaging is best for evaluating chronic rhinosinusitis?
CT scan of the paranasal sinuses.
41
Which bacteria are commonly involved in chronic rhinosinusitis?
Staphylococcus aureus
42
What is the main difference between acute and chronic rhinosinusitis?
Chronic lasts >12 weeks
43
What are nasal polyps?
Benign growths in the nasal or sinus mucosa
44
What conditions are nasal polyps commonly associated with?
Asthma
45
What are the most common benign nasal tumors?
Inverted papilloma and juvenile nasopharyngeal angiofibroma.
46
What are key features of inverted papilloma?
Unilateral nasal obstruction
47
What imaging is used for nasal tumors?
CT or MRI to assess extent and bony destruction.
48
What is the treatment for inverted papilloma?
Surgical excision due to risk of malignancy.
49
Who typically gets juvenile nasopharyngeal angiofibroma?
Adolescent males.
50
What are symptoms of juvenile nasopharyngeal angiofibroma?
Recurrent epistaxis
51
Why is biopsy avoided in juvenile nasopharyngeal angiofibroma?
Risk of severe bleeding due to high vascularity.
52
What are common malignant tumors of the nasal cavity?
Squamous cell carcinoma
53
What are symptoms of malignant nasal tumors?
Nasal obstruction
54
How is olfactory neuroblastoma diagnosed?
Biopsy and immunohistochemistry (positive for neuron-specific enolase).
55
What is the main treatment for malignant nasal tumors?
Surgical excision often followed by radiotherapy or chemotherapy.
56
What are common noxious agents that cause chronic pharyngitis?
Nicotine. alcohol. chemicals. and gaseous irritants.
57
What nasal condition is often associated with chronic pharyngitis?
Chronic sinusitis.
58
What are hallmark symptoms of chronic pharyngitis?
Dry throat. frequent throat clearing. dry cough. and globus pharyngeus.
59
What are two mirror exam findings in chronic pharyngitis?
Red grainy mucosa from lymphatic hyperplasia or shiny smooth mucosa in atrophic form.
60
Why should the middle meatus be examined in chronic pharyngitis?
It connects the nasal cavity to the maxillary. ethmoid. and frontal sinuses.
61
What is the treatment approach for chronic pharyngitis?
Avoid irritants. use herbal airway moisturizers. and address nasal obstruction surgically if needed.
62
What is the main pathogenesis of chronic tonsillitis?
Recurrent tonsillar inflammation causing scarring and bacterial colonization in crypts.
63
Which systemic diseases can chronic tonsillitis sustain?
Rheumatic fever. glomerulonephritis. iritis. psoriasis. and erythema nodosum.
64
What are common symptoms of chronic tonsillitis?
Recurrent throat pain. lethargy. poor appetite. fetid breath odor.
65
What are key mirror exam findings in chronic tonsillitis?
Small. firm. immobile tonsils with peritonsillar redness and expression of purulence from crypts.
66
What lab findings support chronic tonsillitis diagnosis?
Elevated ESR. CRP. left shift. and ASO titer ≥ 400 IU/mL.
67
What is the definitive treatment for chronic tonsillitis?
Tonsillectomy under general endotracheal anesthesia.
68
What is the most common symptom of OSAS?
Loud. irregular snoring.
69
What symptom of OSAS is usually witnessed by a bed partner?
Apnea during sleep.
70
What causes the collapse of airway in OSAS?
Loss of muscle tone in velum. oropharynx. or hypopharynx during sleep.
71
What systemic consequence results from frequent apnea episodes?
Reduced blood oxygen causing cardiopulmonary strain.
72
Name three common causes of pharyngeal obstruction in OSAS.
Obesity. adenoids. and tonsillar hyperplasia.
73
Name three nasal causes of obstruction in OSAS.
Turbinate hyperplasia. septal deviation. nasal polyps.
74
What habits and conditions reduce muscle tone leading to OSAS?
Alcohol. nicotine. sedatives. sleep deprivation. and hypothyroidism.
75
What diagnostic test is the gold standard for OSAS?
Polysomnography.
76
What does PSG measure during sleep?
Respiratory excursions. Po2. EEG. blood pressure. and brain activity.
77
What are general treatment recommendations for OSAS?
Weight loss. no alcohol or sedatives. regular sleep cycle.
78
What device is used for mild-moderate OSAS to move jaw forward?
Esmarch splint.
79
What is the function of CPAP in OSAS?
Applies pneumatic splint to keep pharynx open during sleep.
80
What surgery removes redundant mucosa in OSAS?
Uvulopalatopharyngoplasty with tonsillectomy.
81
What are surgical options for refractory OSAS?
Septoplasty. mandibular advancement. tongue base reduction.
82
What type of tumor is most common in the oropharynx?
Squamous cell carcinoma.
83
Which oropharyngeal sites are most commonly affected by cancer?
Palatine tonsils and tongue base.
84
What lifestyle factors contribute to oropharyngeal cancer?
Chronic nicotine and alcohol use.
85
What symptom may indicate advanced oropharyngeal cancer?
Trismus from invasion of pterygoid muscles.
86
What finding may be the first sign of tonsillar carcinoma?
Cervical lymph node metastasis.
87
What imaging modalities help assess tumor spread?
CT and MRI.
88
What is the primary treatment for most oropharyngeal cancers?
Surgical removal of the tumor.
89
What post-op treatment is often added after oropharyngeal tumor surgery?
Radiotherapy to tumor site and lymphatic drainage pathways.
90
What alternative treatment is used for advanced tumors?
Primary radiotherapy or combined chemoradiation after surgery.
91
What are the three major diseases that affect the hypopharynx?
Foreign body.Hypopharyngeal diverticula.Malignant tumors.
92
What type of necrosis do acids cause in caustic ingestion?
Coagulation necrosis with denaturation of proteins.
93
What type of necrosis do alkalis cause in caustic ingestion?
Colliquative necrosis with liquefaction of necrotic tissue.
94
What long-term complication is common after caustic ingestion?
Esophageal strictures with risk of malignancy.
95
What are acute symptoms of caustic ingestion?
Severe mouth and pharyngeal pain.Drooling.Retrosternal or epigastric pain.Possible subcutaneous emphysema.
96
What are signs of esophageal perforation after caustic ingestion?
Subcutaneous emphysema.Pneumomediastinum.Mediastinitis.
97
What generalized symptoms can appear 1–2 days after caustic ingestion?
Renal and liver failure.Electrolyte imbalance.Hemolysis.
98
What is the initial diagnostic step in caustic ingestion?
Mirror examination of oral cavity.oropharynx.hypopharynx and larynx.
99
What imaging is used to rule out perforation in caustic ingestion?
Chest and abdominal radiographs.
100
When is esophagoscopy indicated in caustic ingestion?
If imaging studies cannot confirm diagnosis.
101
What is the acute treatment priority in caustic ingestion?
Treat shock.Stabilize airway.Replace fluids.Correct electrolytes.Relieve pain.Provide sedation.
102
What medications may be given acutely for caustic ingestion?
High-dose corticosteroids and antibiotics.
103
Where do foreign bodies typically lodge in the esophagus?
Upper esophageal constriction or hypopharynx.
104
What is the most common cause of foreign body ingestion in children?
Swallowed coins.nuts.or toy parts.
105
What predisposing factor in older adults leads to foreign body ingestion?
Decreased sensation due to maxillary denture.
106
What are common symptoms of foreign body in hypopharynx?
Pressure.Pricking sensation.Retrosternal pain.Dysphagia.
107
How is a radiopaque foreign body diagnosed?
Lateral soft tissue neck radiograph.
108
What test should be done for radiolucent foreign bodies?
Oral contrast examination with water-soluble medium.
109
Why is barium swallow avoided in suspected foreign body perforation?
Risk of FB reaction or aspiration pneumonia.
110
What are treatment options for foreign bodies in the hypopharynx?
Immediate removal via esophagoscopy.transcervical removal.or thoracotomy.
111
What is Boerhaave syndrome?
Spontaneous esophageal rupture due to forceful vomiting.
112
Where does Boerhaave syndrome usually occur?
Left posterolateral portion of terminal esophagus above hiatus.
113
Who are at higher risk for Boerhaave syndrome?
Patients with habitual vomiting and alcoholics.
114
What are symptoms of Boerhaave syndrome?
Severe retrosternal or epigastric pain.Hematemesis.Dyspnea.Progressive shock.
115
What is the preferred imaging for suspected esophageal rupture?
Chest radiograph.CT scan.Oral contrast radiography with water-soluble contrast.
116
What is the treatment for Boerhaave syndrome?
Immediate thoracotomy with primary closure and pleural drainage under antibiotic coverage.
117
What is a pulsion diverticulum?
Herniation of mucosa due to increased intraluminal pressure through muscular weakness.
118
What is a traction diverticulum?
Diverticulum formed by scar traction from hilar lymphadenitis involving all layers.
119
What is the most common diverticulum of the esophageal inlet?
Hypopharyngeal diverticulum or Zenker's diverticulum.
120
Which gender is more commonly affected by Zenker’s diverticulum?
Males.3:1 ratio over females.
121
Where does Zenker’s diverticulum occur anatomically?
Posteroinferior hypopharyngeal wall above cricopharyngeal muscle.
122
What are common symptoms of Zenker’s diverticulum?
Dysphagia.Regurgitation of undigested food.Halitosis.Foreign body sensation.
123
How is Zenker’s diverticulum diagnosed?
Mirror exam or indirect laryngoscopy.Oral contrast study of esophagus.
124
What test should be added if reflux esophagitis is suspected in diverticulum?
24-hour pH-metry and esophageal manometry.
125
What are the two surgical approaches for Zenker’s diverticulum?
Endoscopic approach.External approach.
126
What is done during the endoscopic approach to Zenker’s?
Transection of cricopharyngeal septum with reintegration of pouch.
127
Who is a good candidate for endoscopic treatment of Zenker’s?
Older patients with high surgical risk.
128
What is done in the external approach to Zenker’s?
Cricopharyngeus is exposed and divided.Pouch is excised.
129
What should always be done postoperatively after external Zenker’s surgery?
Radiograph to assess esophageal integrity.
130
How common are benign hypopharyngeal tumors?
Rare.
131
What are symptoms of benign hypopharyngeal tumors?
Dysphagia.Regurgitation.Retrosternal pain.
132
How are benign tumors of the hypopharynx diagnosed?
Incisional biopsy via endoscopy under general anesthesia.
133
What is the treatment for benign hypopharyngeal tumors?
Surgical removal depending on size.
134
What type of cancer is most common in the hypopharynx?
Squamous cell carcinoma.
135
What are major risk factors for hypopharyngeal cancer?
Chronic alcohol and nicotine use.
136
Why are hypopharyngeal cancers often diagnosed late?
Early lesions are asymptomatic.
137
What are early symptoms of hypopharyngeal cancer?
Dysphagia.Fetid breath odor.
138
What are later symptoms of hypopharyngeal cancer?
Otalgia.Hoarseness.Dyspnea.Cervical lymphadenopathy.
139
What is the initial diagnostic step for hypopharyngeal tumors?
Mirror or indirect examination.
140
What imaging is used to assess tumor extent in hypopharyngeal cancer?
CT or MRI.
141
What is the definitive diagnosis for hypopharyngeal cancer?
Endoscopic biopsy under general anesthesia.
142
What are treatment options for hypopharyngeal cancer?
Tumor resection.Neck dissection.Laryngectomy.Radiotherapy.Advanced radiotherapy.
