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BCM Elective Flashcards

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1
Q

What is the function of the middle ear?

A

To transmit and amplify sound waves from the tympanic membrane to the stapes footplate, thus converting energy from air to fluid of the membranous labyrinth.

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2
Q

Tympanic membrane:

  1. The 3 layers?
  2. The area superior of the annulus?
  3. Inferior?
A
  1. Outside/lateral: squamous epithelium

Middle: fibrous layer

Inside/medial: cuboidal epithelium

  1. Pars flaccida
  2. Pars tensa

(the incomplete ring is formed by the thickened fibrous layer around the tympanic membrane)

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3
Q

What is the structure medial to the oval window?

Its two components?

What is anterior and posterior to it?

A

Vestibule, with utricle and saccule

Cochlear is anterior, and semicircular canals are posterior

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4
Q

What is the names of the fluids outside and inside of the membranous labyrinth?

A

Perilymph and endolymph

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5
Q

What are the 3 semicircular canals?

A

Superior, posterior and lateral or horizontal

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6
Q

Name and compoments of CN VIII?

A

Vestibulocochlear nerve

It has the afferent and efferent fibers from both the cochlear and vestibular nerves

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7
Q

Describes the cartilages and bones of the external nose

A

Cartilages: Lower lateral, upper lateral, septal, lesser alar, lateral nasal (upper nasal)

Bones: nasal, maxillary, frontal

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8
Q

Blood supplies for the external nose?

A

External carotid branches: external maxillary –> lateral nasal, angular, alar, septal, external nasal

Internal carotid branches: ophthalmic –> anterior ethmoid, posterior ethmoid, and dorsal nasal vessels

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9
Q

Nerve supply to the external nose?

A

Sensory trigeminal: ophthalmic and maxillary

     (Ophthalmic brainches: external nasal, nasociliary and infratrochlear, 

      Maxillary branch: infraorbital)

Motor facial: bucca, zygomatic

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10
Q

What are the structures that make up the internal nose? (Floor, roof and lateral walls)

A

Floor: hard palate anteriorly, and soft palate at the back

Roof: cribriform plate, with tiny perforations for sensory fibers to go to the oldfactory bulbs

Lateral walls: turbinates

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11
Q

What drains into these nasal meatuses:

Inferior, Middle, Superior, and Spheno-ethmoid recess

A

**Inferior: **nasolacrimal

**Middle: **maxillary, frontal and anterior ethmoidal sinuses

**Superior: **posterior ethmoid cells

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12
Q

What kind of structures does the nasopharynx house?

A

Adenoid tissue and orifices of Eustachian tubes

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13
Q

What are the small hair-like columns at the base of the tongue called?

A

Circumvallate papillae

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14
Q

What is the vallecula (of the oropharynx)?

A

Vallecula = furrow or depression

The epiglottic vallecula at the base of the tongue

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15
Q

What are palatine tonsils?

A

Tonsils. They are lymphoid aggreates betwen the mucosal folds created by palatoglossus and palatopharyngeus muscles.

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16
Q

Functions of the larynx?

A

The voice box, regulator of respiration, cough, valsalva

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17
Q

What are the bony/cartilaginous structures of the larynx?

A

Hyoid bone, epiglotis, thyroid cartilage, cricoid cartilage, arytenoids

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18
Q

Describe the structure and function of glottis

A

Glottis are the true vocal folds attached to the thyroid cartilage at the anterior commissure. The vocal folds attach to the arytenoids and are mobile. The arytenoids abduct for inspiration and adduct for phonation, cough and valsalva.

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19
Q

Location of the submandibular gland in relation to floor of mouth muscles?

Which nerve supplies it?

Which nerves run deeps to this gland?

A

Below the mylohyoid muscle but above the digastric muscle.

Parasympathetic secretory afferents arise from superior salivatory nucleus, leave brainstem with facial nerve, to chorda tympani to lingual nerve.

Lingual and hypoglossal nerves

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20
Q

What are the innervation of the larynx?

A

Branches of the vagus nerves:

  1. Superior laryngeal nerve: sensation of glottis and supraglottis, and motor fibers to cricothyroid muscles to tense vocal cords
  2. Recurrent laryngeal nerve: senstation of subglottis, and motor fibers to intrinsic muscles of the larynx. Note: on the R it travels inferior to the subclavian artery and on the L the aorta
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21
Q

What are the cranial nerves in the neck, and what do they intervate?

A

CN VII: the marginal mandibular branch dips into the neck to innervate the platysma, stylohyoid, and posterior belly of the digastric

CN X: exits the jugular foramen and travels inferiorly to the carotid sheath, carry the laryngeal and pharyngeal sensory and motor branches

CN XI - spinal accessory nerve : innervates trapezius and sternocleidomastoid muscles

CN XII - hypoglossal nerve : muscle of the tongue

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22
Q

What are the cervical nerves other than the cranial nerves?

A

Cervical plexus - C1-4 : ansa cervicalis innervates strap muscles. Also branches of phrenic nerve and sensory components

Phrenic nerve - C3-5

Branchial plexus - C5-T1

Posterior rami - to posterior muscles and skin

Cervical sympathetic chain - travels in carotid sheath

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23
Q

What are the arteries in the neck?

A

Internal carotid

External carotid - branches:

Superior thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Post-auricular, Superficial temporal, Internal maxillary

Thyrocervical trunk

Vertebral artery

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24
Q

Which embryonic structure gives rise to parathyroid gland?

A

Branchial pouches, III makes inferior gland and IV the superior

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25
Name the lymph node group around the pyramidal thyroid lobe
Delphian lymph node group
26
Name the most posterior extension of the lateral thyroid lobes
Tubercle of Zuckerkandl
27
Which cell secretes calcitonin?
Parafollicular cells of thyroid
28
What is Plummer's disease?
Toxic multinodular goiter
29
What kind of cancers Multiple Endocrine Neoplasm presents with?
MEN 1: pituitary adenoma, parathyroid hyperplasia, pancreatic tumor MEN 2a: parathyroid hyperplasia, medullary thyroid cancer, pheochromocytoma MEN 2b: mucosal neuroma, medullary thyroid cancer, phenochromocytoma (and Marfanoid body habitus)
30
What are the 5 thyroid carcinomas in descending order of frequency?
1. Papillary carcinoma - 70% 2. Follicular carcinoma - 10% 3. Medullary carcinoma - 5% 4. Hurthle cell carcinoma - 2% 5. Undifferentiated carcinoma - 1%
31
What are some associated conditions of pt with papillary thyroid adenocarcinoma?
Past Hx of neck radiation Has Gardner syndrome
32
What is an associated histologic finding of papillary thyroid adenocarcinoma? Spreading route and speed? 10-yr survival rate?
Psammoma bodies Lymphatics, slowly 95%
33
What is an option for post-op treatment of papillary thyroid adenocarcinoma?
131I at ablative doses. Uptake can also be used for looking up and treat mets
34
What are the 5 F's of follicular thyroid adenocarcinoma?
1. **F**emale dominant (3:1 ratio) 2. **F**ar-away metastasis, hematogenous to bones 3. **F**NA is NOT useful because tissue structure is needed for Dx 4. **F**avorable prognosis (10-year survival rate of 85%) 5. **P**ost-op 131I scan and/or treatment
35
How is Hurthle cell cancer different from regular follicular thyroid adenocarcinoma?
Even though they come from follicular cells, they don't take up 131I, and they spread through lymphatic route more than hematogenous
36
What are the 6 M's for medullary cancer?
MEN II aMyloid Median lymph node dissection Modified neck dissection if lateral nodes are positive Medium 10-year survival rate of 50% Minimal 131I uptake
37
What is the most common cause of hyperthyroidism?
Graves' disease, in which antibodies stimuating TSH receptor circulates and cause secretion of thyroid hormones
38
What is the ratio of F:M in Graves' disease?
6:1
39
Which specific physical finding is found with Graves' disease?
Exophthalmos
40
What are the treatments for Grave's disease?
1. Medical blockade: iodine, propanolol, propylthiouracil (PTU), methimazole, Lugol's solution of KI 2. Radioactive ablation 3. Surgial resection: bilateral subtotal thyroidectomy
41
What is the major complication for radioiodide or surgery for Graves' disease?
Hypothyroidism
42
Mechanism of action for PropylThioUracil?
1. Blocking peroxidase oxidation of iodide to iodine, thus inhibits incorportation of iodine into T4/T3 2. Inhibits peripheral conversion of T4 into T3
43
Mechnism of action for methimazole?
Blocks peroxidase oxidation of iodine into iodine, thus inhibits incorporation of iodine to T4/T3
44
What is Pemberton's sign?
A large goiter causes plethora of head when arms are raised
45
What are the signs and causes of acute thyroiditis?
Painful, swollen thyroid, F, erythema of overlying skin, dysphagia Bacteria - Staph or Strep, usually associated with a fistula or anatomic variant
46
What is the signs and cause of subacute thyroiditis?
Swelling, tenderness following URI Viral infection --\> thus only supportive care (NSAID, steroids)
47
What is De Quervain's thyroiditis?
Subacute thyroiditis post URI
48
What are the 2 types of chronic thyroiditis?
1. Hashimoto: firm, rubbery gland, 95% Female, with **lymphocyte invasion, **positive antithyroglobulin and microsomal antibodies 2. Riedel: benign inflammatory thyroid enlargement with **fibrosis. **Large, painless thyroid.
49
What percentage of patients have 5 or 3 parathyroid gland?
5% and 10%
50
What is the usual position of inferior parathyroid gland?
Posterior and lateral of the thyroid gland, and below the inferior thyroid artery
51
Where is the most common site for the extra parathyroid gland? Other sites?
Thymus. Thyroid gland, mediastinum, carotid sheath, tracheoesophageal groove, behind esophagus
52
What is the blood supply to parathyroid gland?
Inferior thyroid artery in 80% of pts
53
How does DiGeorge's syndrome affect parathyroid gland?
There is none in these pts
54
What is the most common cause of hypercalcemia in outpatients vs inpatients?
Outpt: Hyperparathyroidism vs inpt: cancer
55
Which cells secret PTH?
Chief cells
56
What does PTH do?
Increase serum calcium through bone breakdown, GI absorption, kidney resorption Decrease serum phosphate: decrease kidney resorption, Gi absoprtion
57
How does vitamin D work?
Increase both calcium and phosphate absorption from GI
58
Where in the gut is calcium absorbed?
Duodenum and proximal jejunum
59
Primary vs secondary vs tertiary hyperparathyroidism?
Primary: increased PTH **secretion** --\> high serum Ca low phosphate Secondary: renal failure/failure of GI to absorb --\> **Ca wasting**/can't absorb --\> low serum Ca Tertiary: Ca supplement for secondary hyperparathyroidism --\> normal Ca level --\> but PTH is still high due to unresponsiveness to neg feedback
60
How do we image parathyroid?
1. Open them up during surgery 2. Ultrasound 3. **Sestamibi scan** 4. 201Technetium-thallium subtraction 5. CT/MRI 6. venous sampling of PTH
61
What are the most common causes for primary hyper-parathyroidism? Risk factors?
Adenoma - 85%, Hyperplasia - 10%, Carcinoma - 1% Irradiation, family history, MEN-I and MEN-IIa
62
What are some symptoms of primary HPTH?
Stones, bones, groans, and psychiatric overtones ## Footnote **Stone: **Kidney stones **Bones: **fracture, bone pain, subperiosteal resorption **Groans:** muscle pain and weakness, pancreatitis, gout, constipation **Psychiatric overtones: **depression, anorexia, anxiety Other Sx: polydipsia, wt loss, HTN, polyuria, lethargy
63
What is the 33:1 rule in primary HPTH?
serum Cl to phosphate ratio
64
What is an x-ray finding for HPTH?
Subperiosteal bone resorption in hand digits
65
What is another common cause for hypercalcemia without involving the parathyroid?
Familial hypocalciuric hypercalcemia
66
Differentials of hypercalcemia?
CHIMPANZEES ## Footnote **C**alcium overdose, **H**yperparathyroidism/**H**ypocalciuric Hypercalcemia, **I**mmobility/**I**atrogenic (thiazide diuretics), **M**ets, **P**aget's disease, **A**ddision disease, **N**eoplasm, **Z**ollinger-Ellison syndrome, **E**xcessive vit D or A, **S**arcoidosis
67
What is the initial **medical treatment** of primary HPTH?
Fluids, furosemide
68
How much parathyroid gland should be saved post-op?
30-40mg
69
How does parathyroid carcinoma present?
Hypercalcemia, elevated PTH, and **palpable neck mass**
70
What is a marker for parathyroid carcinoma?
Human chorionic gonadotrophin
71
What is hungry bone syndrome?
After resection of parathyroid adenoma, bones who have been derived of Ca aggressively absorb Ca leading to hypocalcemia
72
Signs and Sx of hypocalcemia?
Perioral tingling, paresthesia, positive Chvostek's sign, positve Trousseau's sign Q-T prolongation
73
What are the 4 pairs of strap muscles? Innervation?
Sternohyoid, sternothyroid, thyrohyoid, and omohyoid All but thyrohyoid: C1-3 - ansa cervicalis Thyrohyoid: C1 through hypoglossal nerve
74
What are the fascial layers of the neck?
1. Superficial: contains dermis and platysma muscle 2. Deep cervical: investing layer (sternocleidomastoid muscle and trapezius), pretracheal layer (visceral and muscular parts), prevertebral layer 3. Carotid sheaths

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