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Head and Neck Review by Minnie > Based on Guiding Questions > Flashcards

Based on Guiding Questions Flashcards

1
Q

Describe the consequences of a lesion in the tympanic nerve

A

Loss of sensation in the middle ear

Loss of parotid gland secretion

(Glossopharyngel nerve CN9 -> tympanic nerve -> lesser petrosal nerve -> parasympathetics follow auriculotemporal branch of V3 to the parotid gland)

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2
Q

Which structure is labeled by E?

A

Cricoid cartilage

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3
Q

Which artery is labeled by B?

A

Maxillary artery

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4
Q

Which nerve runs in the carotid sheath in the middle of the neck?

A

Vagus nerve

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5
Q

Pharyngitis with a “sandpaper rash,” tonsillar hypertrophy and exudates, and fever but no cough or rhinorrhea is most likely caused by…

A

Strep pyogenes

If the rash is not sandpapery and they were recently treated with amoxicillin with no benefit, consider infectious mononucleosis (EBV)

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6
Q

Swelling in the parotid gland would result in decreased salvation and what other major symptom?

A

Decreased salvation + burn for eternity

(But in addition to decreased salivation, you would have decreased facial expression)

The facial nerve and the origin of its branches are within the gland and may be compressed if it swells

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7
Q

Which nerve is labeled by C?

A

Inferior alveolar

(Branch of CN V3)

A.

B. Chorda Tympani (branch of CN 7)

C. Inferior Alveolar n. (branch of CN 5.3)

D. Facial n. (CN 7)

E. Lingual n. (branch of CN 5.3)

F. Posterior Superior Alveolar n. (branch of CN 5.2)

G.

H.

I. Mental n.

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8
Q

Where in the neck does the common carotid artery split into the internal and external carotid arteries?

A

At the level of the upper border of the thyroid cartilage

(Around C3/C4)

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9
Q

Which cranial nerves are in danger due to complications of otitis media?

What is the treatment?

A

Abducens (CN VI) and facial (CN VII) - patient may experience palsy

Drain any abscess or underlying infection, the nerve function should return

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10
Q

Which nerve is labeled by F?

A

Posterior superior alveolar nerve

(Branch of CN V2)

A.

B. Chorda Tympani (branch of CN 7)

C. Inferior Alveolar n. (branch of CN 5.3)

D. Facial n. (CN 7)

E. Lingual n. (branch of CN 5.3)

F. Posterior Superior Alveolar n. (branch of CN 5.2)

G.

H. Infraorbital n. (branch of CN 5.2)

I. Mental n. (branch of CN 5.3)

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11
Q

What is the carina?

What should it usually look like?

A

The carina is the tip of the trachea where the two bronchi split off

Shoudl be crisp and sharp; blunting indicates a pathology

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12
Q

What adult structure forms from the 1st pharyngeal groove?

(Groove = cleft)

A

External acoustic meatus

Outside of the tympanic membrane

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13
Q

What are the targets of the greater petrosal branch of the facial nerve?

A

Parasympathetic innervation, following branches of CN V2:

  • Nasopalatine nerve: Nasal mucosa
  • Greater and lesser palatine nerves: Palatal mucosa
  • Zygomatic nerve (V2) -> Lacrimal nerve (V1): Lacrimal gland
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14
Q

Describe the presentation of Behcet’s disease?

A
  • Recurrent, painful apthous ulcers
  • Genital ulcers
  • Ocular inflammation
  • Idiopathic vasculitis
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15
Q

Describe lymph drainage from the tonsils

A

All tonsils drain directly into the deep ring

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16
Q

The lining of the larynx/vocal cords is derived from…

  1. Ectoderm
  2. Mesoderm
  3. Mesenchyme
  4. Endoderm
A

Endoderm

(From foregut diverticulum)

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17
Q

What is the afferent pathway for swallowing?

A

Nucleus tractus solitarius

(Signals from IX, and X going to the medulla oblongata)

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18
Q

What msucles might stretch out from the chronic pressure of playing a wind instrument?

A

Buccinator

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19
Q

Which nerve innervates the external auditory meatus?

A

Vagus (CN X)

General sensory

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20
Q

Which nerve is general sensory to the external acoustic meatus?

A

Vagus (CN IX)

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21
Q

Which pediatric head and neck masses are likely to appear midline?

How do you tell them apart?

A
  • Thyroglossal duct cyst
    • Fluid filled - less echogenic (darker) on ultrasound
    • Persistent thyroglossal duct
    • Assoicated with the the hyoid
    • May have thyroid elements
    • Likely to present when infected
  • Cervical dermoid cyst
    • Composed of epithelial elements - More echogenic (lighter) on ultrasound
    • Not associated with the hyoid
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22
Q

What autoimmune syndromes can cause sialadenitis?

How will you determine the most likely culprit?

A
  • Heerfort’s syndrome - also look for:
    • Uveitis
    • Parotid enlargement
    • Facial nerve dysfunction
    • Sensorineural hearing loss
    • Fever
    • (This is basically extrapulmonary sarcoidosis)
  • Sjogren’s syndrome - also look for:
    • Dry eyes
    • Xerostomia (dry mouth)
    • History of lymphoma
    • White, middle-aged women are the most likely patients
    • Positive for SS-A/Ro or SS-B/La antibodies
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23
Q

What is tympanometry?

Describe the potential results and what they mean

A

A test that checks pressure in the ear, establishes eustachian tube function

Should be the same pressure on either side of the tympanic membrane

Helps establish eustachian tube function

  • Type A = normal
  • Type B = middle ear pathology (likely fluid)
  • Type C = negative pressure; Eustachian tube is not working to equalize pressure (Ears are “plugged”)
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24
Q

Which structure is labeled by B?

A

Mylohyoid

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25
Q

Which division of the trigeminal nerve does not pass through the cavernous sinus?

A

V3, the mandibular division

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26
Q

What sinus does the internal carotid artery traverse on its way to the eye?

A

Cavernous sinus

  • After crossing the cavernous sinus, it becomes the ophthalmic artery
  • The opthalmic artery and the optic nerve exit the skull (into the orbit) through the optic canal
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27
Q

Inspiratory stridor is most likely caused by a [location] obstruction

A

Inspiratory stridor is most likely caused by a supraglottic or glottic​ obstruction

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28
Q

Which nerve supplies taste to the anterior 2/3 of the tongue?

A

Facial nerve (CN VII)

The rest of taste is supplied by the glossopharyngeal nerve (CN IX)

Note: joins lingual nerve branch of 5.3 but ultimately facial nerve is responsible

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29
Q

Which nerve controls parotid gland secretion?

A

Glossopharyngeal (CN IX)

(Via parasympathetic branches)

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30
Q

Which nerve is labeled by E?

A

Lingual nerve

(Branch of CN V3)

A.

B. Chorda Tympani (branch of CN 7)

C. Inferior Alveolar n. (branch of CN 5.3)

D. Facial n. (CN 7)

E. Lingual n. (branch of CN 5.3)

F. Posterior Superior Alveolar n. (branch of CN 5.2)

G.

H.

I. Mental n. (branch of CN 5.3)

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31
Q

A patient presents with progressive low-frequency hearing loss. There is a history of hearing loss in thier family

What is your leading diagnosis?

A

Otosclerosis

Deposition of bone on the stapes footplate

-> Progressive low-frequency hearing loss, loss of stapedial reflex

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32
Q

What cardiac pathology is associated with complete tracheal rings?

A

Cardiopulmonary sling

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33
Q

What is the causative agent of these lesions?

A

HPV: well-demarcated, painless lesions

Treat with excisional biopsy

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34
Q

The lining of the middle ear cavity deep to the eardrum is derived from…

  1. Ectoderm
  2. Mesoderm
  3. Mesenchyme
  4. Endoderm
A

Endoderm

(From the first pharyngeal pouch)

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35
Q

Which portion of the brain is the “swallowing center”

A

Medulla oblongata

  • Receives signals from nucleus tractus solitarius via IX and X
  • Sends signals through the nucleus ambiguous via IX, X, XII
    • This initiates teh patterned motor response for swallowing
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36
Q

Describe the blood supply of the nasal septum

A
  • Anterior
    • Anterior and posterior ethmoidal arteries (branches of the ophthalmic artery, from the internal carotid artery)
    • These cannot be obliterated to treat epistaxis
  • Posterior
    • Sphenopalatine artery (branche of the maxillary portion of the external carotid artery)
    • Can be obliterated to treat epistaxis
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37
Q

What is the most common cause of sensorineural hearing loss?

A

Perinatal CMV

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38
Q

Between which two layers of the eye is the anterior chamber?

A

Between the cornea and the iris

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39
Q

What screening test for hearing is given to newborns?

A

Otoacoustic emmissions test

  • Test for the “click back” of the cochlea when a sound is applied
  • Absence of the otoacoustic emission => block in air conduction or within cochlea
  • Abnormal result: refer for Auditory Brainstem Response (ABR) testing
  • Note: The click back will be there if there are deficits of CN VIII, rather than in the structural components of the ear
  • Screening test as a rough estimate of hearing in newborns
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40
Q

Describe lymph drainage from the superficial cervical ring

A
  • Superfical ring
  • -> Carotid sheath
  • -> Jugular trunk (deep jugular lymphatics)
  • -> Internal jugular vein/subclavian vein
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41
Q

Which nerve innervates the muscles of mastication?

A

Mandibular nerve

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42
Q

Which muscle abducts the vocal cords?

A

Posterior cricoarytenoid

**Very important that this functions because abducting the vocal cords opens the airway!**

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43
Q

The lining of the nasopharynx is derived from…

  1. Ectoderm
  2. Mesoderm
  3. Mesenchyme
  4. Endoderm
A

Endoderm

(From the foregut)

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44
Q

Which structure is labeled by C?

(Part and bone)

A

Perpendicular plate of the palatine bone

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45
Q

Which structure is labeled by D?

(Part and bone)

A

Horizontal plate of the palatine bone

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46
Q

Expiratory stridor is most likely caused by a [location] obstruction

A

Expiratory stridor is most likely caused by a tracheobronchial​ obstruction

(aka tracheal narrowing)

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47
Q

Which muscles adduct the vocal cords?

A

Lateral cricoarytenoid

Transverse arytenoids (do not contract during whisper)

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48
Q

Describe lymph drainage from the tongue

A
  • Anterior 2/3
    • -> Through the mylohyoid muscle
    • -> Submental/submandibular nodes in the superficial ring
  • Posterior 1/3
    • -> Deep ring or deep jugular
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49
Q

Which structure is labeled by E?

A

Soft palate

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50
Q

Which muscles function to increse the pitch of the voice?

A
  • Sternothyroid (a strap muscle)
    • Lengthens the airway
  • Cricothyroid
    • Pulls the thyroid cartilage forward and down to stretch the vocal cords
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51
Q

Which artery runs through the parotid gland?

A

Superficial temporal artery

(A terminal branch of the external carotid artery)

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52
Q

Which patients are at highest risk of complications due to otitis externa?

A

Immunocompromised patients, especially elderly w/diabetes

Otitis externa can invade soft tissue and bone

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53
Q

Which nerve is labeled by D?

A

Facial nerve (CN VII)

A.

B. Chorda Tympani (branch of CN 7)

C. Inferior Alveolar n. (branch of CN 5.3)

D. Facial n. (CN 7)

E. Lingual n. (branch of CN 5.3)

F. Posterior Superior Alveolar n. (branch of CN 5.2)

G.

H.

I. Mental n.

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54
Q

Which cranial nerve senses changes in CO2/O2 levels?

A

Glossopharyngeal Nerve via chemoreceptors in the carotid body

(Cranial nerve IX)

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55
Q

If there are communicating openings of a 2nd branchial arch cyst, where will they be?

  • Interior:
  • Exterior:
A
  • Interior: Back of the throat/tonsil region
  • Exterior: Upper lateral neck between the hyoid bone and thyroid cartilage
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56
Q

List the branches of the vagus nerve in the neck and their targets

A
  • Pharyngeal nerve
    • Motor to the constrictors and palate muscles (except tensor palatini)
  • Superior laryngeal nerve
    • Internal
      • Visceral sensory to larynx above the vocal cords
      • Cough reflex
    • External
      • Motor to cricothyroid
  • Recurrent laryngeal nerve
    • Visceral sensory to larynx below the vocal cords
    • Motor to intrinsic laryngeal muscles
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57
Q

Which structure is labeled by A?

(Part and bone)

A

Sella turica of the sphenoid bone

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58
Q

Describe the presentation of Meniere’s Disease

What is causing these symptoms?

A
  • Adults 40+ y/o
  • Episodic vertigo
  • Fluctuating hearing loss
  • Aural pressure
  • Tinnitus

Due to endolympatic hydrops, but etiology is unknown

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59
Q

Which structure is labeled by A?

A

Geniohyoid

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60
Q

What does this patient have?

What is the appropriate next step in managment?

A

Leukoplakia

Refer to otolaryngologist (5-20% chance of malignancy)

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61
Q

Where will lymph from the skin of the face drain next?

A

Submandibular nodes of the superficial ring

  • -> plexus in/on the carotid sheath
  • -> Jugular trunk
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62
Q

What is Ludwig Angina?

What is usually infected first?

A

Life-threatening cellulitis of the floor of the mouth and neck, usually caused by multiple organisms

  • Begins in the lower molar
  • Spreads ->
    • Bull neck
    • Neck pain
    • Odynophagia, dysphagia
    • Stridor

(can obstruct airway)

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63
Q

What is the function of the larynx?

A

Passageway for air between the pharynx and trachea

  • Ensures that food/liquid is directed into the esophagus
  • Critical for phonation
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64
Q

What is the efferent pathway for swallowing?

A

Nucleus ambiguous

(Sends signals from the medulla through IX, X, XII to initiate the patterned motor response for swallowing)

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65
Q

Why is the left vocal cord more often injured than the right?

A

The left recurrent laryngeal nerve is at a higher risk for injury because it is close to the heart

  • Pediatric heart surgery = risk to left recurrent laryngeal nerve/vocal cord innervation
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66
Q

Which structure is labeled by D?

(Bone)

A

Axis C2

A. Basilar Part of Occipital Bone

B.

C.

D. Axis C2

67
Q

A patient presenting with “lumpy jaw” most likely has infection with what bacteria?

What other signs support your diagnosis?

A

Actinomyces infection

Look for sinus tracts expelling yellow sulfur granules

  • Less painful, less diffuse swelling than Ludwig Angina
68
Q

What is the treatment of Meniere’s disease?

A
  • Medical
    • Low-salt diet
    • Diuretics
  • Surgical
    • Gentamicin injection (ototoxic - will knock out the signaling from the vestibule that is causing vertigo)
    • Nerve section
    • Labyrinthectomy
    • Endolymphatic sac drillout

Note - lots of risks associated with surgical intervention

69
Q

What does this patient have?

What is your next step in management?

A

Peutz Jegher’s syndrome

  • Condition in which dark, pigemented spots appear ont eh lips and oral vestibular mucosa

Refer to gastroenterology!

  • Association with GI polyps and increased risk of epithelial malignancy
70
Q

Which space is labeled by E?

(Imagine the space at this level on either side of the larynx)

A

Piriform recess

(Food can get stuck here)

71
Q

What adult structure forms from the 2nd pharyngeal pouch?

A

Tonsillar sinus

72
Q

Which nerve is responsible for our gag reflex?

A

Glossopharyngeal (IX)

73
Q

Describe the appearance of the tympanic membrane during otitis media with effusion

A
  • Retracted or normal
  • May be amber in color
  • May see bubbles in the inner ear

Can cause conductive hearing loss

74
Q

What are the risk factos for infectious sialadenitis?

A
  • Dehydration
  • Post-Operative/Jaw Trauma
  • Radiation and/or chemotherapy
  • Sjogren’s syndrome (autoimmune)

More common in people at the extremes of age

75
Q

What is otosclerosis?

What is the effect on hearing?

What is the treatment?

A

Genetic disorder that results in deposition of new bone on the stapes footplate

  • Autosomal dominant w/ variable penetrance
  • Stapes cannot move -> Loss of stapedial reflex
  • Progressive low-frequency conductive hearing loss
  • Treat with hearing aid or surgery
76
Q

Which space is labeled by A?

A

Nasopharynx

77
Q

A cleft lip results form a failure of fusion of which two embryonic primordia?

A

Maxillary arch and frontonasal process

Can also produce cleft in the primary palate

(Whereas a cleft in the secondary palate results from a failure of the lateral palatine processes to merge together)

78
Q

What is the treatment for infectious mononucleosis?

A

Supportive

Give steroids if there is risk of airway obstruction

BUT very important to completely rule out bacterial etiology (esp. strep pyogenes) before giving steroids

79
Q

Which artery is labeled by D?

A

Inferior alveolar artery

80
Q

A defect in COL genes results in which syndrome associated with cleft palate?

A

Stickler syndrome

Also look for:

  • Ocular abnormalities
    • Myopia, glaucoma, cateracts, retinal detachment
  • Hearing loss
  • Flattened facial appearance
  • Joint hyperflexibility or arthritis
81
Q

Which nerve innervates the middle ear?

A

Tympanic nerve

(The pretrematic branch of glossopharyngeal CN IX)

Note: provides visceral sensation, but can produce sharp pain during an earache

82
Q

Which cells are infected in EBV?

A

B cells

(But will have reactive T-cells; look for these to confirm)

83
Q

Which space is labeled by F?

A

Infraglottic cavity (part of the larynx)

84
Q

What is the most common cause of pediatric obstructive sleep apnea?

What about adult obstructive sleep apnea?

A
  • Pediatric: hypertrophy of tonsils and adenoids
  • Adult: obesity
85
Q

Which space is labeled by C?

A

Vestibule of the larynx

(The most superior portion of the larynx)

86
Q

Describe the consequences of a 22q11 deletion

A

May include:

  • Cleft lip and/or palate
  • Cardiac anomoly
  • Learning deficiencies
  • DiGeorge syndrome
87
Q

Which movements would cause pain following a fracutre of the odontoid process?

A

Rotation at the atlanto-axial joint

Odontoid process = dens

88
Q

Which structures are contained in the carotid sheath?

A
  • Carotid artery
    • Common in the lower neck, internal in upper neck (at the upper border of thyroid cartilage, around C3/C4)
  • Internal jugular vein
  • Vagus nerve

Note: ansa cervicalis sits outside the sheath and innervates the strap muscles

89
Q

Swelling in the parotid gland would result in decreased salivation and what other major symptom?

A

Decreased facial expression

The facial nerve and the origin of its branches are within the gland and may be compressed if it swells

90
Q

If there are communicating openings of a 1st branchial arch cyst, where will they be?

  • Interior:
  • Exterior:
A
  • Interior: Ear canal
  • Exterior: In front of the ear, at the angle of the jawline
91
Q

Which structure is labeled by B?

A

(Right) medial pterygoid plate

Note on orientation:

  • Left on the screen is anterior face
  • Can see the perpendicular and horizontal plates of the palatine further into the screen than the turbinates/conchae. The perpendicular plate of the palatine is lateral to the conchae, so we know that these are the right conchae
  • This means that the plate closer to us is the medial plate, and the one further into the screen is lateral
92
Q

Would damage to the maxillary nerve (CN V2) in the foramen rotundum affect its parasympathetic targets?

A

No

Parasympathetics from the facial nerve (greater petrosal nerve) don’t join the maxiallary nerve until the pterygopalatine ganglion in the pterygopalatine fossa

Sensation to the V2 regions would be diminished, but parasympathetic innervation would persist

93
Q

Describe lymph drainage from the jaws:

  • Mandible/lower teeth:
  • Upper jaw:
A
  • Mandible/lower teeth
    • -> Posteriorly through mandibular canal
    • -> Deep cervical ring
  • Upper jaw:
    • -> Anteriorly through the infraorbital foramen
    • -> Submandibular node of the superficial cervical ring
94
Q

If there are communicating openings of a 2nd branchial arch cyst, where will they be?

  • Interior:
  • Exterior:
A
  • Interior: Pharynx
  • Exterior: Lower lateral neck below the thyroid and cricoid cartilages, anterior to SCM
95
Q

Describe the appearance of the tympanic membrane during acute otitis media

A
  • Bulging
  • Opaque
  • Does not move
  • May be purulent or erythematous
    • One color is not necessarily more indicative of AOM than the other

Systemic symptoms: Fevers, otalgia, irritability, hearing loss

96
Q

Glands in the head that require parasympathetic innervation are in the territory of what cranial nerve?

A

Trigeminal - leads parasympathetic branches of other nerves to their paraysmpathetic tarets

  • Lacrimal gland
    • CN VII sends greater petrosal nerve, joins CN V2 (zygomatic), jumps to CN V1 (lacrimal)
  • Submandibular and sublingual salivary glands
    • CN VII sends chorda tympani, joins CN V3 (lingual)
  • Parotid gland
    • CN IX sends deep petrosal nerve, joins CN V3 (auriculotemporal)

(Note CN3 sends parasympathetics to pupillary constrictors via short ciliary nerve)

97
Q

Inability to close the jaw may result from a lesion in which cranial nerve?

A

Mandibular branch of the Trigeminal neve (CN V3)

98
Q

Which muscle is labeled by C?

A

Levator palati

(Note - tensor palati is in this region but is much smaller, cannot be seen; any arrow to a muscle in this region is levator palati)

99
Q

What structures are found in the larynx?

A
  • False and true vocal folds
  • Arytenoid cartilages
  • Epiglottis
100
Q

Which pediatrick head and neck masses are likely to present as lateral structures?

A

Branchial cleft anomalies

Can be from 1st, 2nd or 3rd/4th arch

2nd branchial cleft anomoly is the most common

101
Q

What adult structure forms form the 1st pharyngeal pouch?

A

Pharyngotympanic tube and middle ear cavity

102
Q

What is the defect that causes Pierre-Robin sequence?

A

Mandibular hypoplasia (jaw underdeveloppment)

  • -> Tongue is pushed up
  • -> Palate cannot fuse

Typically presents with airway distress in infancy

103
Q

Which syndrome does this child likely have?

A

Van der Woude

Cleft lip/palate + bilateral lower lip pits

104
Q

What is being tested during acoustic reflex testing?

A

Reflex of stapedius muscle to loud sound

  • The stapedius should contract in response to loud sound to protect the ear
    • Remember - stapedius is innervated by CN VII
  • A loud sound in one ear should elicit a stapedial reflex in both ears
  • Reflex is absent in severe hearing loss/stapes fixation
105
Q

Loss of function of which nerve would impair swallowing?

A

Vagus nerve (CN X)

CN X is motor to the pharyngeal constrictors and the muscles of the soft palate - necessary for swallowing

Note: Pharynx sensation is supplied by the glossopharyngeal nerve (CN IX)

106
Q

Which hole is labeled by A?

Which structures pass through?

A

Sphenopalatine foramen

  • Sphenopalatine artery and vein
    • Blood suply to posterior nasal cavity
  • Nasopalatine nerve
    • Branch of V2
    • Enters the oral cavity through the incisive foramen
107
Q

Which structure is labeled by B?

(Part and bone)

A

Axis (C2) - Dens

108
Q

If a tumor disrupted the optic chiasma in a patient, which of the following would represent the visual fields of both eyes of the patient?

(Black = vision loss, white = intact vision)

A

A

The lateral fields of both eyes would be disrupted

  • The medial fibers of each retina can see the lateral vision in each eye
  • The medial fibers cross at the optic chiasma - if the chiasma is obliterated, you loose the information that these fibers transmit (aka the lateral field in each eye)
  • The lateral fibers do not cross the optic chiasma - the information they carry (aka the medial field that each eye sees) is transmitted to the brain
109
Q

Which nerve is responsible for our cough reflex?

A

Vagus (CN X)

110
Q

What are the functions of the trapezius muscles?

A

Ipsilateral bending

Contralateral rotaiton

Neck extension at the atlanto-occipital joint

Innervated by CN 11 spinal accessory n.

111
Q

Describe the results of a Weber hearing test

  • Normal result:
  • Sensorineural hearing loss:
  • Conductive hearing loss:
A
  • Normal result
    • ​Sound is equal in both ears
  • Sensorineural hearing loss:
    • Sound lateralizes to (is louder in) the good ear
  • Conductive hearing loss:
    • ​Sound lateralizes to the bad ear
    • Why? No distracting AC “noise” on that side?
112
Q

The lining of the esophagus is derived from…

  1. Ectoderm
  2. Mesoderm
  3. Mesenchyme
  4. Endoderm
A

Endoderm

(From the foregut)

113
Q

Which structure is labeled by F?

(Part and bone)

A

Crista galli - upper part of the perpendicular plate of the ethmoid bone

114
Q

What are the mechanisms of sound amplification in the ear?

A
  • Auricle captures and amplifies sound
  • Large surface area of tympanic membrane, concentrates sound in the small surface of the oval window is (20 : 1 ratio)
  • Lever action of the ossicles creates amplification
115
Q

Which nerve is labeled by A?

A

Auriculotemporal nerve

(Branch of CN V3)

116
Q

Which curve represents eustachian tube dysfunction?

A

Typically C

Negative deviation due to negative middle ear pressure

B is tympanic membrane perforation (eustachian tube dysfunction may be present)

(A is normal)

117
Q

Which vessel supplies most of the blood to the larynx?

A

Superior thyroid artery

(The first branch of the external carotid artery)

118
Q

Which structure in the neck does the middle constrictor attach to?

A

The hyoid bone

=> damage to the hyoid -> pain with swallowing when the middle constirctor contracts

119
Q

Which nerve is labeled by G?

A

Buccal nerve

(Branch of CN V3)

120
Q

The sensory limb of the gag reflex is controlled by which nerve?

A

Glossopharyngeal - CN IX

121
Q

What would the voice sound like without functioning transverse arytenoid muscles?

A

A whisper

Transvers arytenoids help close the vocal folds completely

122
Q

Which nerve is labeled by B?

A

Chorda Tympani

(Branch of CN VII)

A.

B. Chorda Tympani (branch of CN 7)

C. Inferior Alveolar (branch of CN 5.3)

D. Facial nerve (CN 7)

E. Lingual Nerve (branch of CN 5.3)

F. Posterior Superior Alveolar Nerve (branch of CN 5.2)

G.

H.

I.

123
Q

Which muscle is labeled by F?

A

Posterior cricoarytenoid

124
Q

Which artery is labeled by A?

A

Superficial temporal artery

A. Superficial temporal a.

B.

C. External carotid a.

D.

E. Occipital a.

F.

G. Middle Meningeal a. (Branch from the mandibular division of the maxilarry a., which is a branch of the external carotid a.)

125
Q

Which space is labeled by B?

A

Oropharynx

126
Q

The lining of the primitive oral cavity is derived from…

  1. Ectoderm
  2. Mesoderm
  3. Mesenchyme
  4. Endoderm
A

Ectoderm

127
Q

Which muscle functions to deepend the voice?

How?

A

Thyroarytenoid

Pulls the thyroid cartilage back and up, putting slack into the vocal cords

128
Q

Which nerve runs through the parotid gland?

Which nerve controls parotid gland secretion?

A

The facial neve (CN VII) runs through the parotid gland

The lesser petrosal brandh of the glossopharyngeal nerve (CN IX) controls parotid gland secretion

129
Q

When during the traditional three phases of swallowing does the reflexive swallow response start?

A

At the beginning of the pharyngeal phase

130
Q

Where is the aqueous humor produced?

Between which two layers of the eye is this?

A

Aqueous humor is produced by the ciliary body in the posterior chamber

The posterior chamber is between the lens and the iris

131
Q

Biphasic stridor is most likely caused by a [location] obstruction

A

Biphasic stridor is most likely caused by a subglottic ​ obstruction

132
Q

Where does blood from the cavernous sinus drain?

A

Cavernous sinus -> sigmoid sinus -> internal jugular vein

133
Q

Which artery is labeled by F?

A

Facial artery

134
Q

Which structure is labeled by C?

A

Thyroid cartilage

135
Q

What aspects of a patients history would be consistent with acquired cholesteatoma?

A
  • History of AOM or OME
  • History of ear tubes
  • Sniffing
  • Chronic intermittent foul-smelling ear drainage
  • Conductive hearing loss
136
Q

Which part of the inner ear is stimulated and sending signals to your brain when you are going up an elevator?

A

Saccule

Hairs are oriented in a verticle plane, signal gravitational (vertical) forces

137
Q

Which space is labeled by D?

A

Laryngopharynx

138
Q

Which cranial nerve provides parasympathetic innervation to the eye?

What actions does it contorl?

A

Oculomotor nerve (CN III)

The parasympathetic nervous system via CN III controlls:

  • Pupil contstriction (muscle = pupil constrictor)
  • Close-up vision (muscle = ciliary body; constricts for close vision)

(Parasympathetic = rest, digest, and read a book)

139
Q

Which structure is labeled by C?

(Space)

A

Laryngopharynx

140
Q

What bacteria causes Lemierre syndrome?

Describe the presentation

A

Fusobacterium necrophorum

  • Spiking fever
    • Due to septic jugular venous thrombophlebitis
  • Neck pain
  • Pharyngitis refractive to abx
  • Abnormal chest CT
141
Q

Describe the results of a Rhinne hearing test

  • Normal result:
  • Sensorineural hearing loss:
  • Conductive hearing loss:
A

For a given ear:

  • Normal result
    • A “positive” Rhinne test = AC > BC
  • Sensorineural hearing loss
    • ​AC > BC (Same as normal result, check Weber)
      • If sound lateralizes away from the ear that was tested, this confirms sensorineural hearing loss
  • Conductive hearing loss
    • A “negative” Rhinne test = BC > AC
142
Q

Endolymphatic hydrops can result in what disease?

A

Meniere’s disease

Episodic vertigo, fluctuating hearing loss, aural pressure, tinnitus

143
Q

Which structure is labeled by D?

(Muscle under mucosa)

A

Thyroarytenoid

144
Q

Which nerve runs through, but does not innervate, the parotid gland?

A

Facial nerve (CN VII)

Temporal, Zygomatic, Buccal, Marginal Mandibular, and Cervical branches effected

Ex: If the parotid gland is anesthetized, CN VII will be affected and function of facial muscles will be diminished

Note: Parotid gland secretion is from the glossopharyngeal nerve (CN IX)

145
Q

The intrinsic laryneal muscles are derived from which pharyngeal arch?

A

6

146
Q

Thyroid cartilage and epiglottis are derived from pharyngeal arch ___

Cricoid and arytenoid cartilage are derived from pharyngeal arch ___

A

Thyroid cartilage and epiglottis are derived from pharyngeal arch 4

Cricoid and arytenoid cartilage are derived from pharyngeal arch 6

Note - intrinsic laryngeal muscles are also from arch 6

147
Q

Where are the cell bodies of olfactory nerves?

A

Olfactory epithelium

148
Q

Which structure is labeled by B?

(Part and bone)

A

Basilar part of the occipital bone

149
Q

Which laryngeal cartilage is a complete ring around the airway?

A

Cricoid cartilage

150
Q

Which artery is most likely to compress the trachea?

A

Brachiocephalic artery

151
Q

Which structure is labeled by D?

(Part and bone)

A

Anterior arch of the atlas

152
Q

Which intrinsic laryngeal muscle allows us to increase the pressure in the thorax and abdomen?

A

Lateral cricoarytenoids

Transverse arytenoids

Basically, the muscles that adduct the vocal folds to close the airway

153
Q

Which cartilage is labeled by G?

Which muscle is directly posterior to this cartilage?

A

Arytenoid cartilage

Transverse arytenoid muscle

154
Q

Which nerve is labeled by I?

A

Mental nerve

(Branch of CN V3 - the mental nerve is the cutaneous continuation of the inferior alveolar nerve)

A.

B. Chorda Tympani (branch of CN 7)

C. Inferior Alveolar n. (branch of CN 5.3)

D. Facial n. (CN 7)

E. Lingual n. (branch of CN 5.3)

F. Posterior Superior Alveolar n. (branch of CN 5.2)

G.

H.

I. Mental n.

155
Q

Where is the opening of the submandibular salivary gland?

A

Frenulum of the tongue

156
Q

What is the most common cause of stridor in neonates?

A

Laryngomalacia

  • May be caused by an omega-shaped epiglottis
  • Signs
    • Supraglottic/inspiratory stridor
    • Cyanosis
    • Feeding difficulty/failure to thrive
    • Reflux
    • Apnea
157
Q

Which part of the inner ear is stimulated and sending signals to your brain when you are driving forward in a car?

A

Utricle

Hairs are orietned horizontally, senses horizontal movement

158
Q

Which structure is labeled by A?

(Bone and part)

A

Occipital - Basilar part

A. Basilar part of occipital bone

B.

C.

D. Axis C2

159
Q

Which artery is labeled by C?

A

External carotid artery

A. Superficial temporal a.

B.

C. External carotid a.

D.

E. Occipital a.

F.

G. Middle Meningeal a. (Branch from the mandibular division of the maxilarry a., which is a branch of the external carotid a.)

160
Q

What does this patient have?

What is the appropriate next step in managment?

A

Erythroplakia

Refer to otolaryngologist (25% chance of malignancy)

161
Q

Which nerve is labeled by H?

A

Infraorbital nerve

(Branch of CN V2)

A.

B. Chorda Tympani (branch of CN 7)

C. Inferior Alveolar n. (branch of CN 5.3)

D. Facial n. (CN 7)

E. Lingual n. (branch of CN 5.3)

F. Posterior Superior Alveolar n. (branch of CN 5.2)

G.

H. Infraorbital n. (branch of CN 5.2)

I. Mental n. (branch of CN 5.3)

162
Q

Which artery is labeled by G?

A

Middle meningeal artery

(Branch from the mandibular division of the maxilarry artery, which is a branch of the external carotid artery)

A. Superficial temporal a.

B.

C. External carotid a.

D.

E.

F.

G. Middle Meningeal a. (Branch from the mandibular division of the maxilarry a., which is a branch of the external carotid a.)

163
Q

Which artery is labeled by E?

A

Occipital artery

A. Superficial temporal a.

B.

C. External carotid a.

D.

E. Occipital a.

F.

G. Middle Meningeal a. (Branch from the mandibular division of the maxilarry a., which is a branch of the external carotid a.)

Head and Neck Review by Minnie (8 decks)

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