Based on Guiding Questions Flashcards
(163 cards)
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)
2
Q
Which structure is labeled by E?
A
Cricoid cartilage
3
Q
Which artery is labeled by B?
A
Maxillary artery
4
Q
Which nerve runs in the carotid sheath in the middle of the neck?
A
Vagus nerve
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)
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
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.
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)
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
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)
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
12
Q
What adult structure forms from the 1st pharyngeal groove?
(Groove = cleft)
A
External acoustic meatus
Outside of the tympanic membrane
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
14
Q
Describe the presentation of Behcet’s disease?
A
- Recurrent, painful apthous ulcers
- Genital ulcers
- Ocular inflammation
- Idiopathic vasculitis
15
Q
Describe lymph drainage from the tonsils
A
All tonsils drain directly into the deep ring
16
Q
The lining of the larynx/vocal cords is derived from…
- Ectoderm
- Mesoderm
- Mesenchyme
- Endoderm
A
Endoderm
(From foregut diverticulum)
17
Q
What is the afferent pathway for swallowing?
A
Nucleus tractus solitarius
(Signals from IX, and X going to the medulla oblongata)
18
Q
What msucles might stretch out from the chronic pressure of playing a wind instrument?
A
Buccinator
19
Q
Which nerve innervates the external auditory meatus?
A
Vagus (CN X)
General sensory
20
Q
Which nerve is general sensory to the external acoustic meatus?
A
Vagus (CN IX)
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
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
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”)
24
Q
Which structure is labeled by B?
A
Mylohyoid
25
Which division of the trigeminal nerve does not pass through the cavernous sinus?
V3, the mandibular division
26
What sinus does the internal carotid artery traverse on its way to the eye?
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
27
Inspiratory stridor is most likely caused by a **_[location]_** obstruction
Inspiratory stridor is most likely caused by a **_supraglottic or glottic_** obstruction
28
Which nerve supplies taste to the anterior 2/3 of the tongue?
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
29
Which nerve controls parotid gland secretion?
Glossopharyngeal (CN IX)
| (Via parasympathetic branches)
30
Which nerve is labeled by **E?**
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)
31
A patient presents with progressive low-frequency hearing loss. There is a history of hearing loss in thier family
What is your leading diagnosis?
Otosclerosis
Deposition of bone on the stapes footplate
-\> Progressive low-frequency hearing loss, loss of stapedial reflex
32
What cardiac pathology is associated with complete tracheal rings?
Cardiopulmonary sling
33
What is the causative agent of these lesions?
HPV: well-demarcated, painless lesions
Treat with excisional biopsy
34
The lining of the middle ear cavity deep to the eardrum is derived from...
1. Ectoderm
2. Mesoderm
3. Mesenchyme
4. Endoderm
Endoderm
| (From the first pharyngeal pouch)
35
Which portion of the brain is the "swallowing center"
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
36
Describe the blood supply of the nasal septum
* 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
37
What is the most common cause of sensorineural hearing loss?
Perinatal CMV
38
Between which two layers of the eye is the anterior chamber?
Between the cornea and the iris
39
What screening test for hearing is given to newborns?
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
40
Describe lymph drainage from the superficial cervical ring
* Superfical ring
* -\> Carotid sheath
* -\> Jugular trunk (deep jugular lymphatics)
* -\> Internal jugular vein/subclavian vein
41
Which nerve innervates the muscles of mastication?
Mandibular nerve
42
Which muscle abducts the vocal cords?
Posterior cricoarytenoid
\*\*Very important that this functions because abducting the vocal cords opens the airway!\*\*
43
The lining of the nasopharynx is derived from...
1. Ectoderm
2. Mesoderm
3. Mesenchyme
4. Endoderm
Endoderm
| (From the foregut)
44
Which structure is labeled by C?
| (Part and bone)
Perpendicular plate of the palatine bone
45
Which structure is labeled by D?
| (Part and bone)
Horizontal plate of the palatine bone
46
Expiratory stridor is most likely caused by a **_[location]_** obstruction
Expiratory stridor is most likely caused by a **_tracheobronchial_** obstruction
(aka tracheal narrowing)
47
Which muscles adduct the vocal cords?
Lateral cricoarytenoid
Transverse arytenoids (do not contract during whisper)
48
Describe lymph drainage from the tongue
* Anterior 2/3
* -\> Through the mylohyoid muscle
* -\> Submental/submandibular nodes in the superficial ring
* Posterior 1/3
* -\> Deep ring or deep jugular
49
Which structure is labeled by **E**?
Soft palate
50
Which muscles function to increse the pitch of the voice?
* Sternothyroid (a strap muscle)
* Lengthens the airway
* Cricothyroid
* Pulls the thyroid cartilage forward and down to stretch the vocal cords
51
Which artery runs through the parotid gland?
Superficial temporal artery
(A terminal branch of the external carotid artery)
52
Which patients are at highest risk of complications due to otitis externa?
Immunocompromised patients, especially elderly w/diabetes
Otitis externa can invade soft tissue and bone
53
Which nerve is labeled by **D?**
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.
54
Which cranial nerve senses changes in CO2/O2 levels?
Glossopharyngeal Nerve via chemoreceptors in the carotid body
| (Cranial nerve IX)
55
If there are communicating openings of a 2nd branchial arch cyst, where will they be?
* **Interior:**
* **Exterior:**
* **Interior:** Back of the throat/tonsil region
* **Exterior:** Upper lateral neck between the hyoid bone and thyroid cartilage
56
List the branches of the vagus nerve in the neck and their targets
* 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
57
Which structure is labeled by **A**?
| (Part and bone)
Sella turica of the sphenoid bone
58
Describe the presentation of Meniere's Disease
What is causing these symptoms?
* Adults 40+ y/o
* Episodic vertigo
* Fluctuating hearing loss
* Aural pressure
* Tinnitus
Due to endolympatic hydrops, but etiology is unknown
59
Which structure is labeled by **A?**
Geniohyoid
60
What does this patient have?
What is the appropriate next step in managment?
Leukoplakia
Refer to otolaryngologist (5-20% chance of malignancy)
61
Where will lymph from the skin of the face drain next?
Submandibular nodes of the superficial ring
* -\> plexus in/on the carotid sheath
* -\> Jugular trunk
62
What is Ludwig Angina?
What is usually infected first?
**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)
63
What is the function of the larynx?
Passageway for air between the pharynx and trachea
* Ensures that food/liquid is directed into the esophagus
* Critical for phonation
64
What is the efferent pathway for swallowing?
Nucleus ambiguous
(Sends signals from the medulla through IX, X, XII to initiate the patterned motor response for swallowing)
65
Why is the left vocal cord more often injured than the right?
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
66
Which structure is labeled by **D?**
| (Bone)
Axis C2
A. Basilar Part of Occipital Bone
B.
C.
D. Axis C2
67
A patient presenting with "lumpy jaw" most likely has infection with what bacteria?
What other signs support your diagnosis?
Actinomyces infection
Look for sinus tracts expelling yellow sulfur granules
* Less painful, less diffuse swelling than Ludwig Angina
68
What is the treatment of Meniere's disease?
* 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
What does this patient have?
What is your next step in management?
**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
Which space is labeled by **E?**
(Imagine the space at this level on either side of the larynx)
Piriform recess
| (Food can get stuck here)
71
What adult structure forms from the 2nd pharyngeal pouch?
Tonsillar sinus
72
Which nerve is responsible for our gag reflex?
Glossopharyngeal (IX)
73
Describe the appearance of the tympanic membrane during otitis media with effusion
* Retracted or normal
* May be amber in color
* May see bubbles in the inner ear
Can cause conductive hearing loss
74
What are the risk factos for infectious sialadenitis?
* Dehydration
* Post-Operative/Jaw Trauma
* Radiation and/or chemotherapy
* Sjogren's syndrome (autoimmune)
More common in people at the extremes of age
75
What is otosclerosis?
What is the effect on hearing?
What is the treatment?
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
Which space is labeled by **A?**
Nasopharynx
77
A cleft lip results form a failure of fusion of which two embryonic primordia?
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
What is the treatment for infectious mononucleosis?
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
Which artery is labeled by **D?**
Inferior alveolar artery
80
A defect in COL genes results in which syndrome associated with cleft palate?
Stickler syndrome
Also look for:
* Ocular abnormalities
* Myopia, glaucoma, cateracts, retinal detachment
* Hearing loss
* Flattened facial appearance
* Joint hyperflexibility or arthritis
81
Which nerve innervates the middle ear?
Tympanic nerve
(The pretrematic branch of glossopharyngeal CN IX)
Note: provides visceral sensation, but can produce sharp pain during an earache
82
Which cells are infected in EBV?
B cells
(But will have reactive T-cells; look for these to confirm)
83
Which space is labeled by **F?**
Infraglottic cavity (part of the larynx)
84
What is the most common cause of pediatric obstructive sleep apnea?
What about adult obstructive sleep apnea?
* **Pediatric:** hypertrophy of tonsils and adenoids
* **Adult:** obesity
85
Which space is labeled by **C?**
Vestibule of the larynx
(The most superior portion of the larynx)
86
Describe the consequences of a 22q11 deletion
May include:
* Cleft lip and/or palate
* Cardiac anomoly
* Learning deficiencies
* DiGeorge syndrome
87
Which movements would cause pain following a fracutre of the odontoid process?
Rotation at the atlanto-axial joint
Odontoid process = dens
88
Which structures are contained in the carotid sheath?
* 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
Swelling in the parotid gland would result in decreased salivation and what other major symptom?
Decreased facial expression
The facial nerve and the origin of its branches are within the gland and may be compressed if it swells
90
If there are communicating openings of a 1st branchial arch cyst, where will they be?
* **Interior:**
* **Exterior:**
* **Interior:** Ear canal
* **Exterior:** In front of the ear, at the angle of the jawline
91
Which structure is labeled by B?
(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
Would damage to the maxillary nerve (CN V2) in the foramen rotundum affect its parasympathetic targets?
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
Describe lymph drainage from the jaws:
* Mandible/lower teeth:
* Upper jaw:
* 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
If there are communicating openings of a 2nd branchial arch cyst, where will they be?
* **Interior:**
* **Exterior:**
* **Interior:** Pharynx
* **Exterior:** Lower lateral neck below the thyroid and cricoid cartilages, anterior to SCM
95
Describe the appearance of the tympanic membrane during acute otitis media
* 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
Glands in the head that require parasympathetic innervation are in the territory of what cranial nerve?
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
Inability to close the jaw may result from a lesion in which cranial nerve?
Mandibular branch of the Trigeminal neve (CN V3)
98
Which muscle is labeled by **C**?
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
What structures are found in the larynx?
* False and true vocal folds
* Arytenoid cartilages
* Epiglottis
100
Which pediatrick head and neck masses are likely to present as lateral structures?
Branchial cleft anomalies
Can be from 1st, 2nd or 3rd/4th arch
2nd branchial cleft anomoly is the most common
101
What adult structure forms form the 1st pharyngeal pouch?
Pharyngotympanic tube and middle ear cavity
102
What is the defect that causes Pierre-Robin sequence?
Mandibular hypoplasia (jaw underdeveloppment)
* -\> Tongue is pushed up
* -\> Palate cannot fuse
Typically presents with airway distress in infancy
103
Which syndrome does this child likely have?
Van der Woude
Cleft lip/palate + bilateral lower lip pits
104
What is being tested during acoustic reflex testing?
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
Loss of function of which nerve would impair swallowing?
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
Which hole is labeled by A?
Which structures pass through?
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
Which structure is labeled by **B?**
| (Part and bone)
Axis (C2) - Dens
108
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
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
Which nerve is responsible for our cough reflex?
Vagus (CN X)
110
What are the functions of the trapezius muscles?
Ipsilateral bending
Contralateral rotaiton
Neck extension at the atlanto-occipital joint
Innervated by CN 11 spinal accessory n.
111
Describe the results of a Weber hearing test
* Normal result:
* Sensorineural hearing loss:
* Conductive hearing loss:
* **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
The lining of the esophagus is derived from...
1. Ectoderm
2. Mesoderm
3. Mesenchyme
4. Endoderm
Endoderm
| (From the foregut)
113
Which structure is labeled by **F**?
| (Part and bone)
Crista galli - upper part of the perpendicular plate of the ethmoid bone
114
What are the mechanisms of sound amplification in the ear?
* 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
Which nerve is labeled by **A?**
Auriculotemporal nerve
| (Branch of CN V3)
116
Which curve represents eustachian tube dysfunction?
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
Which vessel supplies most of the blood to the larynx?
Superior thyroid artery
(The first branch of the external carotid artery)
118
Which structure in the neck does the middle constrictor attach to?
The hyoid bone
=\> damage to the hyoid -\> pain with swallowing when the middle constirctor contracts
119
Which nerve is labeled by **G?**
Buccal nerve
| (Branch of CN V3)
120
The sensory limb of the gag reflex is controlled by which nerve?
Glossopharyngeal - CN IX
121
What would the voice sound like without functioning transverse arytenoid muscles?
A whisper
Transvers arytenoids help close the vocal folds completely
122
Which nerve is labeled by **B?**
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
Which muscle is labeled by **F?**
Posterior cricoarytenoid
124
Which artery is labeled by **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
Which space is labeled by **B?**
Oropharynx
126
The lining of the primitive oral cavity is derived from...
1. Ectoderm
2. Mesoderm
3. Mesenchyme
4. Endoderm
Ectoderm
127
Which muscle functions to deepend the voice?
How?
Thyroarytenoid
Pulls the thyroid cartilage back and up, putting slack into the vocal cords
128
Which nerve runs through the parotid gland?
Which nerve controls parotid gland secretion?
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
When during the traditional three phases of swallowing does the reflexive swallow response start?
At the beginning of the pharyngeal phase
130
Where is the aqueous humor produced?
Between which two layers of the eye is this?
Aqueous humor is produced by the ciliary body in the **posterior chamber**
The posterior chamber is between the **lens and the iris**
131
Biphasic stridor is most likely caused by a **_[location]_** obstruction
Biphasic stridor is most likely caused by a **_subglottic_** obstruction
132
Where does blood from the cavernous sinus drain?
Cavernous sinus -\> sigmoid sinus -\> internal jugular vein
133
Which artery is labeled by **F?**
Facial artery
134
Which structure is labeled by **C?**
Thyroid cartilage
135
What aspects of a patients history would be consistent with acquired cholesteatoma?
* History of AOM or OME
* History of ear tubes
* Sniffing
* Chronic intermittent foul-smelling ear drainage
* Conductive hearing loss
136
Which part of the inner ear is stimulated and sending signals to your brain when you are going up an elevator?
Saccule
Hairs are oriented in a verticle plane, signal gravitational (vertical) forces
137
Which space is labeled by **D?**
Laryngopharynx
138
Which cranial nerve provides parasympathetic innervation to the eye?
What actions does it contorl?
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
Which structure is labeled by **C?**
| (Space)
Laryngopharynx
140
What bacteria causes Lemierre syndrome?
Describe the presentation
Fusobacterium necrophorum
* Spiking fever
* Due to septic jugular venous thrombophlebitis
* Neck pain
* Pharyngitis refractive to abx
* Abnormal chest CT
141
Describe the results of a Rhinne hearing test
* Normal result:
* Sensorineural hearing loss:
* Conductive hearing loss:
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
Endolymphatic hydrops can result in what disease?
Meniere's disease
Episodic vertigo, fluctuating hearing loss, aural pressure, tinnitus
143
Which structure is labeled by **D?**
| (Muscle under mucosa)
Thyroarytenoid
144
Which nerve runs through, but does not innervate, the parotid gland?
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
The intrinsic laryneal muscles are derived from which pharyngeal arch?
6
146
Thyroid cartilage and epiglottis are derived from pharyngeal arch \_\_\_
Cricoid and arytenoid cartilage are derived from pharyngeal arch \_\_\_
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
Where are the cell bodies of olfactory nerves?
Olfactory epithelium
148
Which structure is labeled by **B**?
| (Part and bone)
Basilar part of the occipital bone
149
Which laryngeal cartilage is a complete ring around the airway?
Cricoid cartilage
150
Which artery is most likely to compress the trachea?
Brachiocephalic artery
151
Which structure is labeled by **D**?
| (Part and bone)
Anterior arch of the atlas
152
Which intrinsic laryngeal muscle allows us to increase the pressure in the thorax and abdomen?
Lateral cricoarytenoids
Transverse arytenoids
Basically, the muscles that adduct the vocal folds to close the airway
153
Which cartilage is labeled by **G?**
Which muscle is directly posterior to this cartilage?
Arytenoid cartilage
Transverse arytenoid muscle
154
Which nerve is labeled by **I?**
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
Where is the opening of the submandibular salivary gland?
Frenulum of the tongue
156
What is the most common cause of stridor in neonates?
Laryngomalacia
* May be caused by an omega-shaped epiglottis
* Signs
* Supraglottic/inspiratory stridor
* Cyanosis
* Feeding difficulty/failure to thrive
* Reflux
* Apnea
157
Which part of the inner ear is stimulated and sending signals to your brain when you are driving forward in a car?
Utricle
Hairs are orietned horizontally, senses horizontal movement
158
Which structure is labeled by **A?**
| (Bone and part)
Occipital - Basilar part
## Footnote
A. Basilar part of occipital bone
B.
C.
D. Axis C2
159
Which artery is labeled by **C?**
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
What does this patient have?
What is the appropriate next step in managment?
Erythroplakia
Refer to otolaryngologist (25% chance of malignancy)
161
Which nerve is labeled by **H?**
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
Which artery is labeled by **G?**
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
Which artery is labeled by **E?**
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.)
