ENT Flashcards by Molly Richard

What type of cartilage is the nasal cartilage?

Hyaline

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Which structures form the roof, lateral walls and septum of the nasal cavities?

Roof - cribriform plate and crista galli

Lateral wall -Conchae, ethmoidal air cells, orbital plate of the ethmoid

Septum - periperpendicular plate of the ethmoid and the vomer

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What are the three types of mucosa in the nasal cavity?

Keratinised stratified squamous epithelium

Respiratory epithelium

Olfactory mucosa

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Which nerve supplies the lateral wall and septum of the nasal cavity?

Ophthalmic CN V1 anterosuperiorly

Maxillary CN V2 posteroinferiorly

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Describe the blood supply to the nasal cavities

Facial artery

Nasal branch
Septal branch of the superior labiel artery

Maxillary artery

Sphenopalatine
Greater palatine

Ophthalmic artery
- Anterior and posterior ethmoidal arteries

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What is the name of the arterial anastomosis on the nasal septum?

Kiesselbach’s area

Common site of epistaxis

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Which arteries anastomose at Kisselbach’s area?

A&P ethmoidal arteries

Sphenopalatine artery

Greater palatine artery

Septal artery

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On inserting a nasogastric tube, where should the tip of the tube be seen on x-ray to confirm correct placement?

Below the diaphragm at 10cm beyond the gastro-oesophageal junction

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What are the functions of the nasal cavities?

Transport of air to the nasopharynx

Filter and humidify air

Warms air

Sense of smell (as air passes over the olfactory epithelium)

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What are sinuses?

Air-filled spaces within bones

These are extensions of the nasal cavities!

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Where does the sphenoidal sinus drain to?

Sphenoethmoidal reces

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Where does fluid in the ethmoidal cells drain to?

Superior and middle meatus

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Where does the frontal sinus drain to?

Middle meatus

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Where does the maxillary sinus drain to?

Middle meatus

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Where does lacrimal fluid drain to?

Inferior meatus

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Pain sensation from sinusitis is transmitted via which nerves?

CN V1 and CNV2

- May be referred to the teeth

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Which sinus is the most likely to be inflamed and which is this?

Maxillary sinus

Maxillary sinus mucus has to drain against gravity

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What are the two parts of the temporal bone

Squamous

Petrous

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Which part of the temporal bone articulates with other bones at the pterion (H-shaped suture)

Squamous

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What is the thinnest part of the skull?

Pterion

Between the frontal, parietal, temporal and sphenoid bones

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Which part of the temporal bone contains the inner ear/ otic capsule?

Petrous

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Which bones make up the anterior cranial fossa, what foramina are found here and what nerves pass through the skull here?

Frontal, ethmoid, sphenoid

Cribriform plate of the ethmoid bone

CN I

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Which bones make up the middle cranial fossa, what foramina are found here and what nerves pass through the skull here?

Sphenoid, temporal

Optic canal, superior orbital fissure, foramen rotundum, foramen ovale, intracranial opening of the carotid canal

CN II, CN III, CN IV, CN V, CN VI

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Which bones make up the posterior cranial fossa, what foramina are found here and what nerves pass through the skull here?

Occipital, temporal

Internal acoustic meatus, jugular foramen, hypoglossal canal

CN VII - CN XII

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Which nerves pass through the jugular foramen?

CN IX, CN X, CN XI

Which nerves pass through the internal acoustic meatus?

CN VII, CN VIII

What does the external ear consist of and what is its function?

Auricle to the tympanic membrane Collects and conveys sound waves to the tympanic membrane

What does the middle ear consist of and what is its function?

Tympanic membrane to the oval window + the eustachian tube Amplifies and conducts sound waves to the internal ear

What does the internal ear consist of and what is its function?

Oval window to the internal acoustic meatus Converts special sensory information and sends it to the brain

What is the sensory nerve supply to the helix and the ear lobes?

Anterior rami of C2, 3 spinal nerves

What is the sensory nerve supply to the superior parts of the external acoustic meatus and the tympanic membrane?

CN V3

What is the sensory nerve supply to the inferior parts of the external acoustic meatus and the tympanic membrane?

CN X

What type pf cartilage is the external ear?

Elastic

What are the glands called which produce earwax?

Ceruminous glands These are found in the skin lining the EAM

Where are the 3 bones of the internal ear and by which kind of joints do these articulate?

Malleus, incus, stapes Synovial

Which bone of the middle ear is in contact with the tympanic membrane?

Malleus | handle of malleus

Which bone of the middle ear fits into the oval window?

Stapes | base/ footplate of the stapes fits into the oval window

The eustachian tube connects the nasopharynx to which part of the ear?

Middle ear

The middle ear and nasopharynx have common sensory supply from which nerve?

CN IX

What are the borders of the middle ear? (aka tympanic cavity)

``` Roof - tegmental wall Floor - jugular wall Medial wall - labyrinthine wall Lateral wall - membranous wall Posterior wall - mastoid wall Anterior wall - carotid wall ```

How can CNVII function be tested clinically?

Ask the patient to frown, close eyes tightly, smile and puff out their cheeks (testing the muscles of facial expression)

What are the names of the 3 semicircular canals?

Anterior semicircular canal Posterior semicircular canal Lateral semicircular canal

Describe the course of the facial nerve

The facial nerve connects to the brainstem at the junction between the pons and the medulla It passes through the internal acoustic meatus to the inner ear where it travels within the facial canal of the petrous temporal bone Gives off chorda tympani Exits the skull via the stylomastoid foramen

The facial nerve gives off the chorda tympani. What are the functions of this nerve?

Special sensory to the anterior 2/3rds of the tongue Parasympathetic morot innervation of the sublingual and submandibular glands

Describe the course of the vestibulocochlear nerve

Connects to the brainstem at the junction between the pons and the medulla oblongata Passes through the internal acoustic meatus Cochlear nerve is for hearing Vestibular nerve is for balance

What symptoms might be associated with pathology of the internal acoustic meatus?

Dry mouth and loss of taste Dry eyes Loss of control over the muscles of facial expression Loss of hearing Loss of balance

Describe the course of the parotid duct

Crosses the master Pierces medially though the buccinator Opens onto the parotid papilla of the buccal mucosa opposite the 2nd upper molar tooth

What is the innervation of the parotid gland?

Parasympathetic secretomotor innervation from CN IX

Describe the course of the submandibular duct

Deep to the mucosa of the floor of the mouth Opens onto the sublingual papilla

What is the innervation of the submandibular gland?

Parasympathetic innervation (secretomotor) from CN VII

Describe the course of the sublingual duct

Deep to the mucosa of the floor of the mouth Sublingual ducts are on the sublingual fold in the floor of the mouth

What is the innervation of the sublingual gland?

Parasympathetic innervation (secretomotor) from CN VII

Describe the innervation to the anterior 2/3rds of the tongue

General sensory - CN V3 | Special sensory - CN VII

Describe the innervation to the posterior 1/3rd of the tongue

General and special sensory from CN IX

Describe the blood supply to the tongue

The external carotid artery supplies the tongue via the loop of the lingual artery

Describe the course of the hypoglossal nerve (CNXII)

Connects to the CNS at the medulla oblongata Exits the skull via the hypoglossal canal Descends in the neck lateral to the carotid sheath Passes anteriorly at the level of the hyoid bone towards the lateral aspect of the tongue

What are the 5 muscles of the soft palate?

``` Levator veli palatini Tensor veli palatini Palatoglossus Palatopharyngeus Muscularis uvulae ```

Which nerve supplies all the skeletal muscles of the soft palate? (except tensor veil palatini)

CN X

Which nerve supplies the tensor veil palatini, a muscle of the soft palate?

CN V3

Which nerve innervates the pharynx?

CN X NB Exception; stylopharyngess longitudinal muscle is innervated by CN IX

What are the regional nodes for the tip of the tongue?

Submental nodes

Which lymph nodes drain the palatine tonsil?

Jugular digastric nodes

What is the location of the larynx?

C4 - C6 Enclosed within the visceral layer of the pre tracheal fascia of the neck

What is the vertebral level of the hyoid bone?

What responses occur to prevent pulmonary aspiration?

Larynx is raised | Epiglottis moves posteriorly

Pressing on what structure compresses the oesophagus and prevents regurgitation/ aspiration but allows ventilation? (Done in emergency situations)

Cricoid cartilage

What are the true vocal cords and what are the false vocal cords?

True vocal cords - Vocal processes of the arytenoid cartilage to the thyroid cartilage False vocal cords - Arytenoid cartilage to the epiglottis

Where is the tip of the laryngoscope placed?

Vallecula

Which intrinsic muscles of the larynx are ADDUCTORS?

Arytenoid muscles Lateral circo-arytenoid muscles *Makes the voice quieter

Which intrinsic muscle of the larynx is an ABDUCTOR?

Posterior crico-arytenoid muscle *Makes the voice louder

Which intrinsic muscle of the larynx is a tensor?

Criothyroid muscle *Increases pitch

Which intrinsic muscle of the larynx is a relaxor?

Thyroarytenoid muscle *Decreases pitch

Where do supra-glottic tumours drain to?

Superior deep cervical nodes

Where do sub-glottic tumours drain to?

Paratracheal nodes

The soft palate tenses (CN V3) and elevates (CN X) to create which sounds?

Oral sounds

The soft palate tenses (CN V3) and descends (CN X) to create which sounds?

Nasal sounds

Which nerve innervates the intrinsic muscles of the larynx?

Inferior laryngeal nerve | except cricothyroid

Which nerve innervates the mucosa above the vocal folds?

Internal laryngeal nerve

Which nerve innervates the mucosa below the vocal folds?

Inferior laryngeal nerve

How is the CN XII nerve clinically tested?

Ask the patient to stick their tongue out Tests the genioglossus muscle Tongue moves towards the side of damage

What is the clinical test for R&L tensor veli palatini and levator veil palatini?

Patient is asked to say "aaah" CN X and CN V are being tested Uvula moves away from the damaged side

What cartilage is the epiglottis formed of?

Elastic

ENT Flashcards

(82 cards)