learning outcomes Flashcards
(105 cards)
1
Q
describe the boundaries of the anterior triangle in the neck
A
anterior triangle is defined by the anterior midline of the neck, and the posterior border is the anterior border of the sternocleidomastoid
2
Q
what’s the contents of the anterior triangle
A
The anterior triangle contains; external carotid artery, facial artery, vagus and glossopharyngeal nerves, hypoglossal nerves, internal jugular, internal carotid and internal jugular, laryngeal nerve and submandibular and submental nodes.
3
Q
what’s the posterior triangle boundary of the neck
A
The posterior triangle consists of the anterior posterior border of the sternocleidomastoid and the anterior border of the trapezius forming the posterior border.
4
Q
posterior neck triangle contents
A
It only contains the accessory nerve, occipital artery and external jugular vein, cervical nerve plexus and some lymph nodes.
5
Q
what is the general boundary of the neck
A
the general boundary of the neck consists of the mandible superiorly, anteriorly the midline, inferiorly the clavicle and the trapezius posteriorly.
6
Q
what’s the anatomy and function of the thyroid
A
thyroid gland consists of 2 lobes left and right joined by an isthmus. It produces thyroid hormone and calcitonin. Calcitonin lowers calcium and raises phosphate.
7
Q
what’s the location and function of the parathyroid glands
A
there are 4 parathyroid glands that also help regulate calcium and phosphate located posterior to the poles of the thyroid.
8
Q
what is the arterial supply of the neck and the main artery
A
The main arteries of the neck are the common carotid which divides at C4. The external carotid supplies the neck through the superior thyroid, ascending pharyngeal, lingual, occipital, facial, posterior auricular, maxillary and superficial temporal.
9
Q
what is the venous drainage of the neck
A
Venous drainage arises from the facial vein draining into the internal vein jugular, and the posterior auricular and superficial temporal veins draining into the external jugular. They feed into the subclavian vein forming the brachiocephalic vein.
10
Q
what is the lymphatic drainage of the neck and grouping of the nodes
A
there are 600 lymph nodes in the head and neck that drain to the cisterna chyli and then to the thoracic duct on the left. Groups are the parotids, submental, submandibular, supraclavicular, cervical and occipital.
11
Q
parotid lymph nodes drain
A
scalp, face and gland
12
Q
occipital lymph nodes drain
A
scalp
13
Q
submandibular lymph nodes drain
A
tongue, nose, paranasal sinuses, gland, and oral cavity
14
Q
submental lymph nodes drain
A
lips and floor of the mouth
15
Q
supraclavicular cervical lymph nodes drains
A
breast and solid viscera
16
Q
deep cervical lymph nodes drain
A
final drainage to the thoracic duct
17
Q
common symptoms in head and neck cases
A
sore throat dysphonia – hoarseness dysphagia odynophagia ulcers neck lumps
18
Q
common methods for investigation in head and neck
A
laryngoscopy nasolaryngoscopy fine need aspiration and cytology CT/MRI/PET scan US scan X-ray contrast endoscopy.
19
Q
treatment modalities for head and neck
A
surgery, radiotherapy, chemotherapy or palliation. May involve neck dissection and flap reconstruction.
20
Q
common salivary gland conditions
A
tumours – pleomorphic adenoma
inflammation – parotitis
duct calculus (stones) particularly in submandibular glands
21
Q
diagnosis and management of tonsillitis
A
tonsillitis bacterial infection often presents with neck nodes, pus covered tonsils, fever with no cough. Often self limiting but if re-occurring regularly then offer tonsillectomy.
22
Q
how to assess a hoarse patient with a history
A
how long it’s been present, if there’s a pattern, pain, any coughing or choking when swallowing, voice use, asthma, smoker or medication use.
23
Q
how to assess a patient with dysphagia with a history
A
solids vs liquids difficulty, whether it’s got a pattern, if it’s painful and where.
24
Q
how to assess a patient with a neck lump
A
examine the site, size, shape, pain, skin and fixture of the lump. Ask how long it’s been present, site, pattern, radiation or related symptoms and travel history. Fine need aspirate the lump if possible and then send sample to cytology.
25
malignant nodes are like
round, firm, irregular, fixed and non-tender.
26
how to manage a patient with stridor
ABC – secure the airway via intubation, tracheostomy if necessary. Humified oxygen, steroids and adrenaline nebulizer.
27
oral cavity anatomy
the oral cavity consists of the cavity and vestibule (between lips and teeth). Its boundaries are the lips to the palatoglossal arch, palate to the floor of the mouth and the buccal mucosa.
28
general sensation of the anterior 2/3rd's of the tongue arises form
the lingual nerve a branch of the trigeminal nerve V3
29
anterior 2/3rds of the taste sensation of the tongue is innervated
is the result of the chorda tympani (CN 7 branch facial).
30
the posterior third of the tongue is supplied by what for both taste and sensation
the posterior 1/3 is supplied by the lingual branch of the glossopharyngeal (9th).
31
the muscles of the tongue are innervated by
The nerve supply CN 12 the hypoglossal nerve which supplies all except for the palatoglossus which is supplied by the pharyngeal plexus
32
the palatoglossus is innervated by what nerve
pharyngeal plexus
33
functions of the tongue are
masticate, swallow and speech.
34
taste summarized
chemoreceptors; sensory epithelium called gustatory cells projecting hairs via taste pores, are located in between the fungiform papillae. Ions from food are released and stimulate an action potential and travel along the facial, glossopharyngeal and vagus nerve.
35
mastication is muscles are
lateral pterygoid, medial pterygoid, temporalis and masseter.
36
mastication is supplied by what nerves
It’s supplied by the CN v3 of the trigeminal nerve and function is to act on the temporomandibular joint to produce a grinding action between the teeth.
37
swallowing summarized
tongue propels good and initiated reflex. The soft palate and larynx are pulled upwards. The epiglottis seals the larynx and inhibits respiration. The upper oesophageal sphincter relaxes and the bolus is propelled downwards via peristalsis mediated by myenteric plexus.
38
speech summarized
respiration, phonation from the vocal cords, resonation through the nasal, oral cavity and the nasopharynx. Articulation by lips, tongue and jaw and prosody, emphasis on syllables and tones.
39
name the various parts of the pharynx and sensory innervation
nasopharynx, oropharynx, and the hypopharynx. The oropharynx and hypopharynx is supplied by the pharyngeal plexus nerves 9 and 10.
40
the areas of the larynx
the larynx consists of the supraglottis which is from the epiglottis to the ventricular fold. The glottis which is from superior to the true vocal cord to below the vocal cord. And the subglottis which is from below the true vocal cord to the inferior border of the cricoid cartilage.
41
function of the larynx
the function of the larynx is that it’s a part of the respiratory tract, responsible for the voice and aiding in swallowing.
42
the motor innervation of the larynx is via
The motor innervation of the larynx is via the recurrent laryngeal nerve which supplies everything but the cricothyroid muscle which is supplied by the external laryngeal nerve.
43
the sensory innervation of the larynx is through
Sensory innervation for the supraglottis is the internal laryngeal nerve, the glottis and subglottis is the recurrent laryngeal nerve.
44
sensory innervation for the supraglottis is
internal laryngeal nerve
45
the glottis and subglottis sensory innervation
recurrent laryngeal nerve
46
function of the pharynx in reference to swallowing
the function of the pharynx is to receive the food from the oral phase of swallowing. Then during the pharyngeal phase, the soft palate if pulled upwards as the epiglottis covers the larynx as it is also moved upwards. The upper oesophageal sphincter is relaxing as respiration is inhibited.
47
state principles of voice production
there is air flow produced by respiration which goes past the cords at various positions, tension, vibration and lengths. The resonation depends on oral and nasal balance because cavities and nasopharynx. Articulation arises from the lips, tongue and jaw. Syllable stress and emphasis is essential for speech tone.
48
blood supply of the nose
from both internal carotid through the anterior and posterior ethmoidal, and the external through the sphenopalatine, greater palatine and superior labial.
49
external anatomy of the nose
one third of the nose is bone and 2/3rds if cartilaginous.
50
internal anatomy of the nose
the midline of the nose is the septum. The roof is the cribriform plate, the walls are the turbinate’s, and the floor is the hard palate.
51
innervation of the nose
almost all trigeminal through the ophthalmic and maxillary for sensation internally and externally.
52
function of the nose
the function of the nose is to warm, humidify air and Create laminar flow. The nasal mucous and nasal hairs also aid in being a immune barrier. The nose is also capable of smelling through the olfactory mucosa, transporting signals via the olfactory nerve through the cribriform plate.
53
paranasal sinuses anatomy
there are 2 frontal, 2 maxillaries, a sphenoid and ethmoid air cells anterior and posterior. They drain into the meatus of the turbinates except for the sphenoid sinus which drains via the sphenoethmoidal recess.
54
turbinates anatomy and function
functionally aid in making laminar flow, humidification and warming through increasing surface area. They are bony projections coated in erectile tissue. The nasolacrimal duct opens into the inferior meatus. The frontal sinus, anterior ethmoid air cell, and maxillary sinus drains into the middle meatus. The posterior ethmoids drain into the superior meatus.
55
what drains into the inferior meatus
nasolacrimal duct
56
what drains into the middle meatus
The frontal sinus, anterior ethmoid air cell, and maxillary sinus drains into the middle meatus.
57
what drains into the superior meatus
The posterior ethmoids drain into the superior meatus.
58
post nasal space consists of
contains the adenoids, Eustachian tube opening which attaches to the soft palate muscles to allow it to equalise middle ear pressure.
59
nasal mucosal consists of
first third is stratified squamous epithelium with nasal hairs. Posterior two thirds are pseudostratified columnar epithelium, it contains cilia, goblet cells. The mucus contains IgA, IgE, lysozymes and alkaline to aid in it being an immune barrier. It also contains olfactory mucosa which is an essential part of smelling.
60
sinuses function
functionally aid in making a reservoir of warm air. They also lighten the skull, and aid with vocal resonance.
61
the sinus ostium is
– the opening that connects a sinus to the nasal cavity.
62
the node of rouvier is
essential cause of unilateral middle ear fluid from pathological obstruction of the Eustachian tube.
63
describe the anatomy of the external ear
the external ear consists of a helix, antihelix, lobule, antitragus, concha, meatus, tragus and triangular area. The pinna of the ear is elastic cartilage, the external ear canal lateral third is skin and cartilage whereas the medial third consists of skin and bone.
64
describe the epithelial lining of the external ear canal and middle ear
the external ear consists of stratified keratinized epithelium with ceruminous and sebaceous wax producing glands with hairs, the medial third of epithelium however doesn’t produce wax, or have any hairs or cilia.
65
describe the structure of the tympanic membrane
the tympanic membrane has three layers, the outer is a continuation of the external ear’s stratified keratinizing epithelium. The middle layer is fibrous, and the inner layer is that of respiratory epithelium with ciliated columnar embedded with goblet cells.
66
the internal auditory meatus is
is a canal within the temporal bone of the skull between the posterior cranial fossa and the inner ear providing passage for the vestibulocochlear nerve and the facial nerve
67
anatomy of the ossicular chain
the ossicular chain consists of the tympanic membrane being connected to the handle of the malleus, the head of the malleus then connects to the uncus which leads to the stapes that ends with its foot plate in the oval window.
68
transmission of sound across the middles ear
The ossicles conduct sound waves to the inner ear.
| essentially the middle ear through the ossicular chain transforms acoustic energy from air to fluid.
69
eustachian tube in middle ear function
Tympanic function if optimal when middle ear pressure is equal to external atmospheric pressure this is possible through the eustachian tube during yawning or swallowing
70
describe the inner connection of the middle ear, mastoid air cell system and post nasal space
the middle ear is connected to the mastoid system via the nasopharynx and aditus via the eustachian tube.
71
describe the course of the facial nerve in the middle ear cavity and its importance to surgeons
the facial nerve leaves the pons as a cranial nerve, passing through the internal auditory porus as the meatal, then through the internal auditory fundus then as the labyrinthine, then horizontally as the tympanic nerve, then vertically as the mastoid before exiting through the stylomastoid foramen. It’s essential as it is the motor supply to the muscles of facial expression, and responsible for the anterior 2/3rd’s of the tongue for taste as the chorda tympani.
72
Describe the bony anatomy of the inner ear and the function of the constituent parts of the labyrinth and cochlea.
there is the bony and membranous labyrinth. The membranous labyrinth contains fluid the perilymph and endolymph. There is the cochlear, the organ of corti which is responsible for hearing. Then there is the peripheral vestibular apparatus with the utricle, saccule and semi-circular canals.
73
basic principles of pure tone audiometry
pure tone audiometry; determines faintest tones a person can hear at certain frequencies from low to high.
74
basic principles of tympanometry
tympanometry is the detection of pressure by using air to stimulate eardrum movement to reflect any possible perforation, damage or wax.
75
demonstrate understanding of the neural pathway of hearing
waves travel through the cochlea, stimulating movement of the basilar membrane that causes motion of the hair cells in the organ of corti. There is then a wave of depolarisation, closer hairs detect higher frequency and deeper hairs detect a lower frequency. The depolarising wave travels along the cochlear division of the vestibulocochlear nerve(8) combining with the signals from the other ear and travel to the brainstem to the pons and medulla.
76
Describe common presenting symptoms in otology cases
```
hearing loss
tinnitus
vertigo
otalgia
otorrhoea
facial weakness
```
77
describe Rhinnet's test and findings
```
Rhinne’s test
normal ear Air>bone
conductive hearing loss bone>air
sensorineural hearing loss
air>bone
```
78
Weber’s test description and findings
normal L=R
sensorineural in right ear L>R, left ear R>L
conductive hearing loss in right ear R>L, in left ear L>R
79
weber's test sensorineural hearing loss in Right ear findings
L>R
80
Rhinnet's sensorineural hearing loss
air>bone
81
weber's conductive hearing loss in right ear
R>L
82
Rhinnet's conductive hearing loss
bone>air
83
pure tone audiogram findings
Pure tone Audiogram
normal hearing at 20dB
conductive hearing loss when bone conduction is better than air
sensorineural hearing loss when bone conduction is the same as air
84
tympanogram findings
normal compliance and pressure
low middle ear compliance
low middle ear pressure
85
pure tone audiogram conductive hearing loss indication
bone > air
86
assessment of dizzy patient and management if the cause is benign positional vertigo
Dix-Hallpike test and management is Epley manoeuvre if the cause is benign positional vertigo.
87
pure tone audiogram sensorineural hearing loss
bone = air
88
tinnitus description and management
perception of sound that requires both unilateral and pulsatile investigation. It’s management involves treating the underlying cause, sound enrichment and stress management.
89
sensorineural hearing loss in left ear Weber's
R>L
90
otitis media with effusion presentation and management
with hearing loss and speech delay. It requires observation for three months, otovent treatment or a grommet in worse case scenarios.
91
acute suppurative otitis media presentation and management
presents with otalgia, otorrhoea and requires observation and amoxicillin.
92
chronic suppurative otitis media presentation and management
is a perforated membrane or cholesteatoma.
| perforation presents with recurrent infections and hearing loss. It may require a myringoplasty and water precautions.
93
cholesteatoma is caused by what, presents with and requires
by eustachian tube dysfunction or impaired skin migration presenting with chronic offensive otorrhoea and requires a mastoidectomy.
94
management of otitis externa
management involves antibiotic steroid ear drops, and possible suction under microscope. To prevent this, it is recommended not to use water or cotton buds.
malignant otitis externa (osteomyelitis of temporal bone) presents with severe pain in elderly diabetics, and possible cranial nerve palsy, the treatment for such is long term antibiotics.
95
bell's palsy pathophysiology
damage to the 7th cranial nerve the facial nerve resulting in facial weakness on one side of the face and drooping of facial features
96
symptoms of bell's palsy
May range from twitching, weakness, paralysis on one side of the face. Other symptoms may be pain around jaw and ear, ringing in the ear, headaches, loss of taste, hypersensitivity to sound, impaired speech, dizziness and difficult eating or drinking.
97
investigation, diagnosis and treatment of bell's palsy
Diagnosis is from clinical presentation or sometimes a electromyography can highlight nerve damage. MRI, CT and blood tests may be used to find the underlying cause. Sometimes it may not require treatment, however treating the underlying cause of the inflammation is key. Steroid prednisone may help as well as analgesics.
98
allergy definition
it can be skin based with urticara, upper respiratory as rhinitis, lower respiratory as asthma or systemic as anaphylaxis. Overall it is an acquired hypersensitivity disorder of the immune system in response to harmless antigens on allergens.
99
pathophysiology of allergy
allergens contain protein antigens that induce an type1 hypersensitivity immune response. It’s acquired through sensitization from IgE produced by plasma cells in response to an antigen, binding to mast cells. Then upon re-exposure there is mast cell degranulation release histamine, leukotrienes, prostaglandins and chemotactic factors.
100
what are the effects of the release of chemicals by mast cells during an allergic reaction
These chemicals stimulate vasodilation and permeability, smooth muscle cell contraction, nerve stimulation, mucous secretion and leukocyte infiltrate.
101
immediate effects of allergic reaction
immediate effects are sneezing, itching, nasal blockages and rinnorrhoea.
102
later effects of an allergic reaction
Later symptoms include chronic obstruction, hyposmia and hyperreactivity.
103
risk factors and stimulants or allergic reactions
risk factors of having an allergy include race, heredity, age. Environmental factors include exposure to infectious disease, pollution, allergen levels and dietary changes. Then there is occupational exposure of flour, latex and wood dust. Allergens include histamine, feather, pollen or hair. Food types such as lentils, pork, cocoa and mushroom may also stimulate a response.
104
diagnostic tests for allergy
diagnosis can be done through a skin test to known allergens. A RAST test may be performed to detect levels of allergen specific IgE. A level of greater than >100kU/L is highly sensitive, a level lower than <0.35kU/L is negative. Other tests include total serum IgE, nasal allergen challenge, nasal cytology.
105
treatment for allergies
a key treatment is simply allergen avoidance. Pharmacological methods involve topical steroids, systemic steroids, anti-histamines, sodium cromoglycate, allergen immunotherapy and Anti-IgE.
