Page 1 of 2 12 LastLast
Results 1 to 10 of 15

Thread: new mcqs who can answer

  1. #1
    Join Date
    Feb 2009
    Posts
    1
    Rep Power
    0

    Thumbs up new mcqs who can answer

    hi guys i got some mcqs which i will post here, i didnt get the chance to answer them yet so hope we can answer them together.
    1- The hypopharynx consist of all the following regions Except

    A. Pyrifom sinuses
    B. Posterior pharyngeal wall
    C. Anterior pharyngeal wall
    D. Postcricoid area
    E. None of the above

    2- In the cervical area, the carotid triangle is bordered by the following muscles
    Except:

    A. The digastric muscle
    B. The sternocleidomastoid muscle
    C. The omohyoid muscle
    C. The sternohvoid muscle
    E.

    3- Which of the following statements regarding the lateral triangle of the neck is False

    A. It is bordered inferiorly by the anterior margin of the trapezium muscle
    B. It is bordered inferiorly by the posterior margin of the sternocleidomastoid muscle
    C. It is bordered inferiorly by the lateral half of the clavicle
    D. It contains the cutaneous component of the cervical nerve pleux.
    E. It contains the accessory nerve

    4. The prevertrbral facia envelops all of the following Except the:

    A. Vagal nerve
    B. Brachial plexus
    C. Sympathetic trunk
    D. Cervical nerve plexus
    E. Phrenic nerve

    5. Which of the following statements regarding the spinal accessory nerve is False'

    A. It has rootlets of origin only from the cervical cord
    B. It enters the cranium at the foramen magnum'
    C. It exists the cranium by way of the jugular foramen
    D. It can be identified entering the deep surface of the sternocleidomastoid muscle about 4 cm below the mastoid process
    E. It can be identified at the anterior margin of the trapezius muscle

    6. The quinolone ciprofloxacin provides excellent coverage for all of the following bacteria Except:

    A. S aureus
    B. H. influenzae
    C. M. catarrhalis
    D. S. pneumoniae
    E. P. aerations




    7. Which of the following antibiotics is bacteriostatic?

    A. Cerfuroxime
    B. Erythromycin
    C. Ampicilline
    D. Ciprofloxacin
    E. Imepenem

    8. Toxicity uniquely associated with cisplatin includes

    A. Mucositis
    B. Cystitis
    C. Alopecia
    D. Nephrotoxicity
    E. Neurotoxicity

    9. Malnutrition is assessed reliably by increased

    A. Transferrin levels
    B. Total lymphocyte count
    C. Erythrocyte volume
    D. Albumin level
    E. None of the above

    10. The first priority after injury is:

    A. Wound debridement
    B. Haemostatic plug formation
    C. Neovascularization
    D. Mounting an inflammatory response
    E. Controlling infection

    11. The carotid sheath is formed by contributions from

    A. All three layers of the deep cervical fascia
    B. All three layers of the deep cervical fascia and a small Contribution from the superficial cervical fascia
    C. The visceral cervical fascia and the prevertebral fascia only
    The visceral layer of the cervical fascia only
    E. The prevertebral fascia

    12. The tensor veli palatinin muscle is innervated by the

    A. Mandibular division of the trigeminal nerve
    B. Maxillary division of the trigeminal nerve
    C. Glossopharyngeal nerve
    D. Vagus nerve
    E. Hypopharyngeal nerve




    13. Wounds in a radiated bed exhibit

    A. Inhibited collagen production
    B. Histologically normal blood vessels that are decreased in number
    C. Neutrophil injury
    D. All of the above
    E. None of the above

    14. What is the primarily purpose of premedication in any patient?

    A. Amnesia induction
    B. Pain relief
    C. Vagal block induction
    D. Anxiety relief
    E. Hypotention

    15. Which of the following immunoglobulins is most important in memory immune responses

    A. IgG
    B. IOM
    C. ICFA
    D. I.E
    E. IgD

    16. Eosinophils produce all of the following Except:

    A. Peroxidases
    B. Neurotoxins
    C. Proteins
    D. Cytokines
    E. Histamine

    17. All of the following progenitor cell develop in the bone marrow into their final cellular components Except --------------- progenitors:

    A. Mast cell
    B. T-lymphocyte
    C. B- lymphocyte
    D. Eosinophils
    E. Monocyte/macrophage

    18. Which of the following cells is important in antigen presentation (antigen ¬presenting cells)?

    A. Monocytes
    B. Macrophages
    C. Dendritic cells
    D. B cells
    E. Langerhans' celles



    19. Changes in nasal physiology associated with acting include

    A. Reduction in nasal cilia
    B. Increase in mucociliary clearance
    C. Decrease in olfactory epithelium
    D. Decrease in nasal airflow resistance
    E. General decrease in autonomic function

    20. The temporal branch of the facial nerve innervates the frontalis muscle --------- cm above the lateral mar-in of the eyebrow

    A. 0.5
    B. 1.0
    C. 1.5
    D. 2.5
    E. 3.0

    21. What is the maximum non-toxic dose (in mg/kg) of lidocaine mixed with 1:100,000 epinephrine?

    A. 2 to 4
    B. 5 to 7
    C. 9 to 11
    D. 12 to 15
    E. 16 to 19

    22. The Most important ion in the secretion of amylase is

    A. Calcium
    B. Lithium
    C. Phosphorus
    D. Zinc
    E. Iron

    23. What structure is visible in the lateral wall of the sphenoid sinus

    A. Vidian nerve
    B. Optic nerve
    C. Internal carotid artery
    D. Maxillary nerve
    E. Ophthalmic artery

    24. Innervation of the ethmoid air cells includes all but the ----- nerve

    A. Ophthalmic
    B. Nasociliary
    C. Maxillary
    D. Sphenopalatine
    E. Nasopalatine


    25. The frontal sinus is fully developed by--------year(s) of age

    A. 1
    B. 4
    C. 8
    D. 12
    E. 18

    26. In addition to cranial nerve 1 (olfactory nerve), which of the following cranial nerves provides the next most important odorant chemoreceptivity

    A. II
    B. V
    C. VIII
    D. X
    E. XII

    27. Which of the following nasal arteries do not arise from the external carotid artery?

    A. Infraorbital
    B. Sphenopalatine
    C. Pharyngeal
    D. Ophthalmic
    E. Artery of the pteryaoid canal


    28. The external nasal nerve is a branch of the_______ nerve

    A. Supratrochlear
    B. Posterior ethmoid
    C. Sphenopalatine
    D. Anterior ethmoid
    E. Infra-orbital

    29. The Sphenopalatine ganglion is

    A. A special sensory afferent
    B. Sympathetic
    C. Parasympathetic
    D. A somatic sensory afferent
    E. None of the above

    10. The nasopalatine nerve supplies sensation to the mucosa of the

    A. Anterior premaxillary palate
    B. Soft palate
    C. Lateral nasal passage
    D. Anterior cheek
    E. Uvula


    31. Which component of the nasal septum may be bilaminar?

    A. Quadrangular cartilage
    B. Vomer
    C. Perpendicular plate of the ethmoid
    D. None of the above
    E. All of the above

    32. The nasal septum and which of the following make up the nasal valve an-le?

    A. Lower lateral cartilages
    B. Head of the inferior turbinate
    C. Upper lateral cartilages
    D. Pyrifom aperture
    E. Nasal bones

    33. Blood supply to the cartilaginous nasal septum is directly via the

    A. Anterior ethmoid artery
    B. Posterior ethmoid artery
    C. Labial artery
    D. Sphenopalatine artery
    E. Overlying mucoperichonddrium

    34. The uncinate process is a portion of which bone?

    A. Maxillary
    B. Ethmoid
    C. Palatine
    D. Frontal
    E. Sphenoid

    35. The buccopharyngeal fascia fuses inferiorly with the

    A. Middle layer of deep cervical fascia
    B. Anterior insertion of the middle constrictor muscle
    C. Thyrohyoid membrane
    D. Pretracheal and visceral fascia
    E. Posterior midline pharyngeal raphe

    36. Originating, from a different branchial arch than the other muscles of the soft palate, the tensor veli palatini is innervated by the

    A. Pharyngeal plexus
    B. Facial never
    C. Superior laryngeal branch of the Vagus nerve
    D. Mandibular branch of the trigeminal nerve
    E. Glossopharyngeal nerve


    37. The Mandibular nerve divides into its four main branches in the

    A. Interval between the skull base and superior constrictor muscle
    B. Interval between the superior and middle constrictor muscles
    C. Interval between the middle and inferior constrictor muscles
    D. Interval between the inferior constrictor and esophagus
    E. Parapharyngeal space

    38. The central pattern generator for swallowing is located in the

    A. Thalamus
    B. Mesencephalic trigeminal nucleus
    C. Caudal nucleus of the solitary tract
    D. Lateral leminiscus
    E. Cerebellum

    39. After sectioning the chorda tympani, one would expect the involved side to
    demonstrate

    A. Decreased sensitivity to bitter stimuli
    B. Increased sensitivity to sweet stimuli
    C. Decreased sensitivity to aversive stimuli
    D. Decreased sensitivity to salty stimuli
    E. All of the above

    40. Oral sensations triggered by menthol and hot peppers

    A. Represent a common chemical sense discrete from taste sensation
    B. Are relayed via the chorda tympani nerve
    C. Are mediated by specialized nerve innervates
    D. Are not thought to protect the oral cavity
    E. None of the above

    41. Which of the following lasers produces energy in the infrared (invisible) region of the electromagnetic spectrum?
    A. Carbone dioxyde
    B. Argon
    C. KTP
    D. Nd: YAG
    E. A&D

    42. The platysmal muscle gives off slips of muscle that attach to the
    A. Mandibule
    B. Maxilla
    C. Clavicle
    D. Second rib
    E. None of the above


    41. Which of the following, anatomic structures has relations with the deep surface of the parotid gland?

    A. Styloid process and its associated muscles
    B. Internal carotid artery and internal jugular vein
    C. Cranial nerves IX, X, XI and XII
    D. A&B
    E. A, B, and C

    44. The oral phase of swallowing

    A. Is most dependent on the tongue
    B. Moves the food bolus upward and backward
    C. Lasts 1.0 to 1.5 seconds in average
    D. All of the above
    E. None of the above

    45. Normal pharyngeal swallowing

    A. Is triggered by cranial nerves IX, X, and XII
    B. Requires five sequenced neuromuscular events
    C. Triggers as the bolus passes the soft palate-hard palate junction
    D. May be bypassed in oral feeding
    E. Does not require pharyngeal contraction

    46. The laryngeal cartilages

    A. Ossify in the third (men) and fourth (women) decades
    B. Include hyaline and elastic types
    C. Are more susceptible to tumor invasive when ossified
    D. Have areas deficient of perichondrium
    E. All of the above

    47. Laryngeal epithelium is stratified squamous

    A. On the vocal folds
    B. On the vocal and false folds,
    C. On the vocal folds, false folds, and arytenoid
    D. On the vocal folds, false folds, arytenoid, and epiglottis
    E. In the ventricle

    48. The vocal fold comprises

    A. Stratified, and epithelium
    B. Three layers of lamina propria
    C. Vocalis muscle and fibrous connection to the conus elasticus
    D. All of the above
    E. None of the above


    49. Vertical component of the mucosal wave

    A. Is unaffected by elasticity of the lamina propria
    B. Is propagated by subglottic air forces
    C. Moves at a rate of 10m/sec
    D. Has maximal amplitude in the subglottis
    E. Is unaffected by Reinke's edema

    50. The larynx develops during embryonic growth from the

    A. Ectoderm
    B. Foregut
    C. Neural crest
    D. Hindgut
    E. Stomadeum

    51. Thyroartenoid muscle contraction renders the vocal fold

    A. Thinner
    B. Longer
    C. Thicker and shorter
    D. Abducted
    E. Positioned for inspiration

    52. Posterior cricoarytenoid muscle contraction

    A. Stunts and opposes diaphragmatic contraction
    B. Widens the glottis
    C. Ceases during sleep
    D. Ceases during, anesthesia
    E. All of the above

    53. Phonation requires

    A. Breath support
    B. Vocal folds approximation
    C. Favorable vibration
    D. Control of length and tension
    E. All of the above

    54. The most important neuromuscular function in the oral preparatory phase of swallowing is

    A. Jaw motion
    B. Soft palate forward positioning
    C. Cerebellar input
    D. Lip closure
    E. Lateral rolling motion of the tongue


    55. The only muscle that activity opens the Eustachian tube is the

    A. Levator veli palatini
    B. Tensor veli palatini
    C. Salpingopharyngeus
    D. Lateral pterygoid
    E. Medial pterygoid

    56. What is the most reliable way to differentiate the internal from the external carotid artery in the neck?

    A. The internal carotid artery has no branches in the neck
    B. The internal carotid artery lies anterior to the external carotid artery
    C. The external carotid artery has no branches in the neck
    D. The external carotid artery lies anterior to the internal carotid artery
    E. None of the above

    57. What are the branches of the thyrocervical trunk?

    A. Superior thyroid, inferior thyroid, and suprascapular arteries
    B. Superior and inferior thyroid arteries and cervical artery
    C. Inferior thyroid, ascending cervical, transverse cervical, and suprascapular arteries
    D. Ascending, transverse, and descending, cervical arteries
    E. Thyroid IMA artery

    58. Which portions of the ossicular chain derive from the first branchial arch

    A. Stapes suprastructure
    B. Malleus and incus
    C. Lone, processes of the Malleus and incus
    D. Short process of the malleus and Iong process of the incus
    E. Stapes foot plate

    59. Which portions of the ossicular chain derives from the second branchial arch

    A. Stapes suprastructure
    B. Stapes suprastructure and long processes of the malleus and incus
    C. Stapes suprastructure and short processes of the malleus and incus
    D. Malleus and incus
    E.

    60. What are the embryologic origins of the laryngeal cartilages?

    A. First branchial arch
    B. Second bronchial arch
    C. Third bronchial arch
    D. Fourth, fifth, and sixth bronchial arches.
    E. A&B


    61. The squamous part of the temporal bone articulates with all of the following except the

    A. Parietal bone
    B. Greater wing the sphenoid
    C. Occipital bone
    D. Frontal bone
    E. Zygoma

    62. Korner's septum in the mastoid is a remnant of which of the following

    A. Tympanosquamous suture
    B. Petrotympanic septum
    C. Tympanomastoid fissure
    D. Petrosquamous suture
    E. Hyrtl's fissure

    63. Which of the following nerves does not provide sensory nerve supply to the auricle and meatus

    A. V
    B. VII
    C. IX
    D. X
    E. C2

    64. Shrapnel’s membrane is attached directly to the squama of the temporal bone at the

    A. Suprameatal spine
    B. Petrosquamous suture
    C. Tympanic sulcus
    D. Notch of Rivinus
    E. Cribriform area

    65. In the vestibular labyrinth, fluid with a low sodium content (15 to 25 mM/L) and a high potassium content is likely to be

    A. An ultrafiltrate of blood
    B. An ultrafiltrate of cerebrospinal fluid
    C. Produced by the stria vascularis
    D. Produced by "dark cells" of the cristae and maculae
    E. Present immediately below the stapes footplate

    66. In afferent neurons innervating vestibular hair cells, an increased firing rate compared with resting discharge frequency occurs with

    A. Utriculopetal endolymph flow in any of three semicircular canal ducts
    B. Utriculofugal endolymph flow in any of three semicircular canal ducts
    C. Linear acceleration
    D. Displacement of stereocilia toward the kinocilium
    E. Displacement of stereocilia away from the kinocilium


    67. Melanocytes, capillaries, marginal cells, intermediate cells, and basal cells are found in what inner-car structure?

    A. Spiral ligament
    B. Spiral prominence
    C. Modiolus
    D. Stria vascularis
    E. Habenula perforata

    68. The neurons that give rise to efferent fibres projecting to the hair cells of the organ of Corti are located in the

    A. Cochlear nuclei
    B. Superior olivary complex
    C. Inferior colliculus
    D. Medial geniculate body
    E. Auditory cortex

    69. In testing the hearing all are false Except:

    A. The 1024 Hz tuning fork is best for general use.
    B. Masking the good ear in severe unilateral sensorineural deafness is essential
    C. The Weber test always lateralizes to the bad ear in sensorineural deafness.
    D. The Stenger test is a test to detect a feigned unilateral hearing loss, where two tones of different frequencies but the same intensity are presented to each ear simultaneously.
    E. In normal ears, the Rinne test is usually equal.

    70. Development of the temporal bone:

    A. The tympanic ring and squama are ossified in cartilage
    B. The foramen of Huschke is a defect in the tympanic ring.
    C. Ossification of the endosteal layer of the petromastoid may be defective, particularly in the vicinity of the fistula ante-fenestram
    D. The facial nerve is well protected at birth by the mastoid process.
    E. In the infant, the mastoid antrum lies below the tympanic cavity and about 5 mm deep to the bony surface.

    71. The blood supply of the labyrinth, all are correct Except:

    A. The internal auditory artery divides into anterior vestibular and common cochlear branches.
    B. The cochlear artery ultimately forms the stria vascularis.
    C. The spiral modiolar artery has rich anastomoses with terminal branches of the vestibulocochlear artery.
    D. The vestibulocochlear artery is a branch of the common cochlear artery.
    E. The labyrinthine artery is the principal arterial supply of the inner ear.

    72. Sensory nerve supply of the ear, all are true Except:

    A. The lesser occipital nerve (Cl) supplies the upper medial surface of the pinna.
    B. The 'Arnold's nerve' may be stimulated by instilling spiril or instruments into the external meatus.
    C. The Glossopharyngeal nerve supplies sensory fibers to the middle ear cleft.
    D. The mandibular nerve supplies sensation to the lateral surface of the pinna and the anterior halves of the external meatus and tympanic membrane.
    E. The VII th cranial nerve gives a sensory supply to the ear.

    73. Sound transmission in the middle car all are correct Except:

    A. The intact tympanic membrane protects the round window and directs sound energy to the ossicular chain and oval window.
    B. The ossicular leverage action ratio of the malleus and incus is about 1.3: 1.
    C. The mode of vibration of the stapes changes with high sound intensifies.
    D. The physiological ratio of tympanic membrane to oval window surface area is about 21:1.
    E. The transformer ratio of the ossicular chain plus the tympanic membrane is about 18: 1.

    74. In Cerumin (ear wax) the following are true Except for:

    A. Secreted by ceruminous glands in the inner part of the external auditory canal
    B. Is a colourless secretion when first secreted?
    C. Is insect repellent
    D. Vagal fibres are secretomotor
    E. Is hygroscopic

    75. Cochlear physiology, which one of the following is true?

    A. The perilymph and cerebrospinal fluid are connected by the vestibular aqueduct
    B. The scala media has a resting electrical potential of +8OmV with reference to the scala tympani
    C. Short travelling waves in the basilar membrane are produced by low-pitched sound stimuli.
    D. The cochlear microphonic potential is generated by the inner hair cells
    E. A summating potential (SP) is predominantly produced by outer hair cell activity

    76. Nasal anatomy, all are true Except:

    A. The cell bodies of olfactory neurones lie in the nasal mucosa
    B. The greater palatine nerve supplies most of the inferior turbinate with common sensation
    C. The posterior lateral nasal nerves are branches of the posterior ethmoidal nerve
    D. Lymph from the anterior part of the nose drains to the submandibular nodes
    E. The posterior part of the nasal cavity drains to the retropharyngeal and upper deep cervical lymph nodes

    77. The infantile larynx in comparison with the adult, all are true Except:

    A. The infantile larynx is the same relative size as the adult larynx
    B. It has its narrowest point at the subglottis
    C. It lies at a higher level than the adult larynx
    D. It collapses easily because the laryngeal cartilages are softer than in the adult
    E. It has an inlet lying less oblique

    78. Cartilaginous framework of the larynx, all of the following are true except:

    A. The thyroid alae meet to make an angle of 90' in the female
    B. Calcification of the posterior part of the cricoid lamina can be confused radiographically with a foreign body
    C. The epiglottis is formed of elastic fibrocartilage
    D. The cartilages of Wrisberg do not articulate with any other
    E. The crico-arytenoid joint can both rotate abnd glide


    79. Development of the foetal car, which one of the following is true

    A. The Eustachian tube is formed from the ectoderm of the first visceral cleft
    B. The auricle develops from the first visceral cleft as a series of six tubercles
    C. The stapes footplate is derived from ectoderm
    D. The inner ear is developed from endoderm, and has reached full adult size by the fourth foetal month
    E. The stapes superstructure, Styloid process and hyoid are derived from the first arch

    80. Middle ear muscles, which one of the following is true?

    A. Reflex contraction of the stapedius to sound stimulus is ipsilateral
    B. Contractions may not be audible
    C. The tensor tympani pulls the tympanic membrane medially and stiffens the ossicular chain
    D. Contraction attenuates the middle and high frequencies
    E. Contraction allows protection against acoustic trauma due to explosions

    81. During deglutition, which one of the following is not correct?

    A. Elevation of the hyoid bone reduces the size of the oval cavity
    B. Passavant's bar assists closure of the nasopharyngeal hiatus
    C. A fixed thyroid cartilage is necessary in the pharyngeal phase
    D. The epiglottis directs the food stream into two lateral channels
    E. A peristaltic wave starts in the top of pharynx as the bolus enters the oesophagus

    82. The adult oesophagus. Which one of the following is true?

    A. The pharynx joins the oesophagus at the glosso-epiglottic folds
    B. There are only two constrictions along its length
    C. The upper third is non-striated muscle
    D. Portal-systemic anastomoses are located in the middle third
    E. The cricopharyngeal sphincter is about 3 cm in length

    83. The carbon dioxide laser, the following are true Except

    A. Light is absorbed by water
    B. This can seal blood vessels up to 0.5 mm in diameter
    C. Nerve endings are sealed
    D. Skin incisions heal greater rapidity than conventional scalpel wounds
    E. The light beam can't be transmitted by flexible fibres

    84. Local anaesthetic and vasoconstrictor agents used in ENT, all the followings are true Except

    A. In the early stages of cocaine toxicity, there is a rise in blood pressure and respiratory rate

    B. The maximum dose of adrenaline by injection is 0.5 mg in a fit adult
    C. A low pH in tissue will render local anesthesia less effective
    D. Felypressin has a greater effect on the myocardium than adrenaline
    E. If adrenaline is contraindicated, prilocalne may be employed


    85. In the cavity of the larynx, which one of the following is correct?

    A. The rima glottidis is interval between the false cords
    B. Reinke's space is found between the surface epithelium and the deeper elastic layer
    C. Keratinizing stratified squamous epithelium lines the true cords -
    D. The posterior part of the ventricular sinus contains the mucus-secreting saccule
    E. The length of the glottis is about 2.5 cm in the adult female

    86. Neurovascular supply and lymphatic drainage of the larynx, all of the following are correct except:

    A. The main blood supply is from branches of the superior and inferior thyroid arteries
    B. Lymph from the supraglottic larynx drains to the pre-epiglottic and upper deep cervical nodes
    C. The internal branch of the superior laryngeal nerve is entirely motor
    D. The external branch of the superior laryngeal nerve supplies the cricothyroid muscle
    E. The recurrent laryngeal nerve is sensory below the true cords

    87. Relations of the trachea in the neck, all are false Except:

    A. The recurrent laryngeal nerves lie in the groove between the trachea and the vertebral bodies
    B. The thymus lies behind the trachea
    C. The thyroid isthmus is at a higher level in children than adults
    D. Lymphatic drainage is to the deep cervical nodes
    E. The recurrent laryngeal nerves pass in front of the inferior thyroid artery

    88. Immunology of the pharyngeal lymphoid tissue, all are correct Except:

    A. B-lymphocytes proliferate in active follicles
    B. T-lymphocytes secrete cytokines, which act locally to control the inflammatory response
    C. B-lymphocytes synthesize IgA-secretory antibodies
    D. Macrophages are involved in presenting antigen to T-lymphocytes
    E. T4-lymphocytes required for cell-mediated immunity are found in excessive numbers in AIDS patients

    89. The parotid gland, all the following are true Except:

    A. Is covered on its outer aspects by a thickened layer of deep cervical fascia
    B. The stylomandibular ligament forms a thick fascial barrier
    C. Secretomotor fibers to the gland travelling, in the auriculotemporal nerve are involved in Frey's syndrome
    D. The facial nerve trunk lies superficial to the retromandibular vein
    E. Development abnormalities of the ear are associated with a double trunk of the facial nerve in the parotid


    90. The second pharyngeal pouch, all of the following are correct Except:

    A. This is lined with endoderm
    B. It has dorsal and ventral diverticula
    C. It forms the whole of the Eustachian tube
    D. It contributes to the formation of the middle ear
    E. It forms the supratonsillar fossa

    91. Dental anatomy, all of the following are correct Except:

    A. The deciduous teeth consist of two incisors, one canine and tow molars in each half jaw
    B. There are 32 permanent teeth
    C. Teeth develop from ectoderm only
    D. The teeth of the upper jaw are supplied via the anterior, middle and posterior superior alveolar nerves
    E. The apex of the root of the lower third molar lies below the mylohyoid line

    92. Anatomy of the oropharynx, all are correct Except:

    A. The upper border of the oropharynx is at the level of the soft palate
    B. The posterior third of the tongue is part of the oropharynx
    C. The posterior boundary of the valleculla is the epiglottis
    D. The oropharynx is lined with squamous epithelium -
    E. The motor and Vagus nerves, with cell bodies in the nucleus ambiguous

    9'). The parapharyngeal space, all are true Except:

    A. This has no anatomical floor, allowing communication from skull base to superior mediastinum
    B. There is free communication with the retropharyngeal space
    C. The deep lobe of the parotid projects into its lateral wall
    D. The contents include the carotid sheath, the lower four cranial nerves, and deep cervical lymph nodes
    E. At the level of C5 vertebra, the lateral wall is formed by the sternomastoid muscle

    94. Lymphatic drainage of the pharynx, all of the following are true Except:

    A. All areas of the pharynx drain ultimately to the lower deep cervical group of nodes
    B. The nasopharynx drains via retropharyngeal and upper deep cervical nodes
    C. The tonsil drains to the jugulodigastric node
    D. The base of the tongue has very little lymphatic drainage
    E. The pyriform fossa may drain to paratracheal nodes

    95. The submandibular gland, all of the following are false Except:

    A. The lingual nerve is attached to the superficial lobe by a fibrous band
    B. The hyoglossus muscle divides deep from the superficial lobe
    C. The duct runs between mylohyoid and hyoglossus to open laterally in the floor of the mouth opposite the second molar tooth
    D. The mandibular division of the facial nerve lies superficial to the capsule of the gland
    E. The facial artery can usually be retracted and kept intact during, excision of the gland


    96. Development of the mouth, all of the following are correct Except:

    A. The stomatodeum, or primitive mouth, lies between frontonasal process cranially and first bronchial arch caudally
    B. The stomatodeum is lined by ectoderm
    C. Cleft lip results from failure of fusion of the medial nasal, lateral nasal and maxillary processes
    D. Failure of fusion of the palate shelves of the maxillary processes results in cleft palate posterior to the incisive foramen
    E. Rathke's pouch is an endodermal derivative, which forms the posterior part of the pituitary gland

    97. Development of the tongue, all of the following are true Except:

    A. The anterior two-thirds develops from the second bronchial arch
    B. The posterior one-third develops from
    C. Internal musculature id derived from suboccipital myotomes
    D. The foramen caecum is the lingual opening of the thyroglossal duct
    E. The glossopharyngeal nerve supplies third arch structures

    98. In the upper air passages, all of the following are correct Except:

    A. The length of cervical trachea can alter in any one individual
    B. The trachea is nearest to the skin at the fourth tracheal ring
    C. The larynx descends during postnatal growth
    D. The pleural dome is at risk during tracheostomy
    E. The cricoid cartilage may be more easily palpated than the thyroid cartilage

    99. Anatomy of the palatine tonsil, all the following are true Except:

    A. The crypts are lined by squamous epithelium
    B. There are no afferent lymphatics
    C. The tonsillar artery is a branch of the facial artery
    D. Pain sensation from the tonsil is carried in the glossopharyngeal nerve
    E. The size of the tonsil can be assessed accurately by looking in the mouth while using a tongue depressor

    100. Which one of the followings regarding the mucociliary "conveyor belt" of the upper respiratory tract is True?

    A. The cilia beat 100 times a second
    B. The movement directs the mucus to the anterior nares
    C. Lysozymes are produced by bacteria and act to paralyse cilia
    D. A deviated nasal septum can produce localized drying, with ciliary stasis, crusting and secondary infection
    E. Ephedrine 0.5 per cent nose drops cause ciliary damage

    101. In voice production, all the followings are true Except:

    A. The frequency of tone can be altered by adjusting the shape of the free mar in of the vocal cords
    B. Articulation is performed by the vibrating cords
    C. An increase in infraglottic air pressure leads to a rise in intensity and a slight increase in pitch.

    D. The vocal folds are lengthened by the action of the cricothyroid muscle
    E. The volume of sound produced is governed by the infraglottic pressure

    102. All the followings regarding anatomy of the nasopharynx are true Except:

    A. The lower boundary of the nasopharynx is the anterior faucial pillar
    B. The Eustachian tube opens at the level of the inferior turbinate
    C. Pseudostratified ciliated columnar epithelium lines the normal nasopharynx
    D. Passavant's muscle is made up of fibers of the inferior palatopharyngeus
    E. The internal carotid artery is in close relation to the lateral nasopharyngeal recess (fossa of Rosenmuller)

    103. Pseudomonas aeroginosa

    A. Is commonly cultured from the infected mastoid cavities
    B. It is the most common aracobic organism isolated
    C. Most commonly found in chronic middle car effusion
    D. Natural inhabitants of external ear
    E. Best antibiotic is the metheprim

    104. The mastoid is:

    A. The aditus and antrum contain the posterior semicircular canal at its medial wall
    B. The medial wall of the antrum related to the lateral semicircular canal
    C. The endolymphatic sac and dura of posterior cranial fossa forms part of medial wall of the mastoid
    D. The lateral wall of the antrum in adults corresponds to the suprameatal (MacEwen's) triangle on the outer surface of the skull
    E. The floor of the mastoid antrum is related to the digastric muscle medially and sigmoid sinus laterally

    105. The facial nerve relation

    A. It pass between the cochlea posteriorly and the superior semicircular canal anteriorly
    B. The narrowest part of facial canal is at its entry
    C. The tympanic portion of facial nerve passes above the promontory and round window and above the lateral semicircular canal
    D. The posterior landmark of facial nerve is marked by the processes cochleariformis
    E. The stylomastoid foramen leaves lateral to the digastric groove

    106. In the nose

    A. Nasal mucosa supplied by fibers from ophthalmic and maxillary division of trigeminal nerve
    B. Infraorbital nerve supply only the external part of the nose
    C. The Vidian nerve (secretomotor) to nasal glands formed by union of lesser petrosal nerve and deep petrosal nerve
    D. Sympathetic supply of the nose through both superior and middle sympathetic ganglia
    E. All the sympathetic and parasympathetic fibers relay in the sphenopalatine ganglia

    107. The human middle car is

    A. Low - frequency sensitive organ
    B. Mid- frequency sensitive organ
    C. High frequency sensitive organ
    D. All of the above
    E. None of the above

    108. The torus tubarius can usually be made functional by

    A. Yawning or chewing
    B. Chewing
    C. Valsalva manoeuvre
    D. All of the above
    E. None of the above

    109. The equilibrium comprise the sensory input of the proprioceptors in the muscles of

    A. Limbs
    B. Trunk
    C. Neck
    D. A&C
    E. All of the above

    110. The following inter in the humidification of the air in the nose Except one:

    A. Anterior serous glands
    B. Mixed serous and mucous glands
    C. Minor salivary glands
    D. Capillary permeability
    E. Expired air

    -: Nasal secretions formed accordingly Except one:

    A. By glycoproteins
    B. Water and ions
    C. An upper layer more watery and lower layer more viscous
    D. There are two secretory cell types cell types in the mixed nasal glands (mucous and serous cell)

    E. The serous cells secretes lysozymes, lactoferrene and immunoglobulin A

    - Identify which ganglion lies in the meckel cave

    A. Scarpa ganglion
    B. Trigeminal ganglion
    C. Nodose ganglion
    D. Otic ganglion
    E. Olfactory ganglion

    - One of the major side effects of lona-term isoniazid treatment is

    A. Aplastic anemia
    B. Peripheral neuropathy
    C. Leukopenia
    D. Seizures
    E. Erthema multiforme

    -. The following medication can be otoxic in high doses

    A. Rifampin
    B. Amphotericin B
    C. Ketoconazole
    D. Ciprofloxacin
    E. Vancomyein

    -. The lateral pharyngeal space is divided into two compartments by the

    A. XI th cranial nerve
    B. Carotid artery
    C. Deep layer of the deep cervical fascia
    D. Styloid process
    E. Jugular artery

    -The parasympathetic nerve supply of the parotid gland synapses in the

    A. Otic ganglion
    B. Geniculate ganglion
    C. Superior salivatory nucleus
    D. Spinal cord
    E. Superior cervical ganglion
    - The major landmark in intranasal ethmoidectomy to identify the cribiform plate is the

    A. Attachment of the superior turbinate
    B. Attachment of the inferior turbinate
    C. Middle meatus
    D. Inferior meatus
    E. Superior attachment of the middle turbinate

    - The following medication has been implicated in the cause of gingival hyperplasia in about 25% of chronically treatment patients

    A. Furosemide
    B. Nitrogen mustard
    C. Diphenylhydantion (Dilantin)
    D. Quinine
    E. Scopolamine(hyoscine)

    - The V2 cranial nerve exits the skull via the
    A. Foramen lacerum
    B. Foramen ovale
    C. Foramen rotundum
    D. Foramen spinosum
    E. Hypoglossal canal







    - The following organism(s) are characteristically transmitted by healthy Carriers

    A. Shigella boydii
    B. E. Coli
    C. Staph. Aureus
    D. N. gonorrhoea
    E. H. influenza

  2. #2
    Join Date
    Feb 2009
    Age
    50
    Posts
    4
    Rep Power
    0

    Thumbs up please answers your mcqs

    hi dictora ent please answer these questions it will kindness of yours sorry most of answers i dont know bye

  3. #3
    Join Date
    Apr 2009
    Age
    40
    Posts
    5
    Rep Power
    0

    Default

    anyone tried these questions.. if so please post the answers. i kindda strugling.

  4. #4
    Join Date
    Aug 2008
    Posts
    6,603
    Rep Power
    46

    Arrow

    .


    MCQ:


    The hypopharynx consist of all the following regions Except:

    A. Pyrifom sinuses
    B. Posterior pharyngeal wall
    C. Anterior pharyngeal wall
    D. Postcricoid area
    E. None of the above


    Hypopharynx



    The hypopharynx is the region between the oropharynx above (at the level of the hyoid bone) and the esophageal inlet below (at the lower end of the cricoid cartilage). Embryologically, the larynx interjects into the hypopharynx anteriorly and is therefore considered a separate structure.


    Hypopharyngeal cancers are often named for their location, including pyriform sinus, lateral pharyngeal wall, posterior pharyngeal wall, or postcricoid pharynx (see Images 1-2). Most arise in the pyriform sinus.

    In the United States and Canada, 65-85% of hypopharyngeal carcinomas involve the pyriform sinuses, 10-20% involve the posterior pharyngeal wall, and 5-15% involve the postcricoid area.

    As in other head and neck cancer sites, more than 95% of hypopharyngeal malignancies arise from the epithelium of the mucosa and, therefore, are squamous cell cancers. Premalignant mucosal lesions evolve into hyperproliferative lesions that develop the capacity to enlarge, to invade local structures, to invade lymphatics to spread to regional lymph nodes, and to invade vascular channels to metastasize to other organs.


    Hypopharyngeal cancer is a term used for tumors of a subsite of the upper aerodigestive tract, and like most other subsite designations, the distinction is anatomic rather than pathophysiologic within the group of head and neck malignancies.





    Hypopharyngeal anatomy

    .



    The hypopharynx is the longest of the 3 segments of the pharynx. It is wide superiorly and progressively narrows toward the level of the cricopharyngeal muscle. It is bounded anteriorly by the posterior face of the cricoid cartilage. The parts of the hypopharynx that lie partly to each side of the larynx form the pyriform sinuses or fossae.

    In-Depth Details:

    [HIDE]
    Age

    The incidence of hypopharyngeal cancer rises in people older than 40 years; it is rare in people younger than 30 years. The mean age at presentation is 65 years. Patients diagnosed with hypopharyngeal cancer are typically men aged 55-70 years with a history of tobacco use and/or alcohol ingestion.

    Prognosis

    The biological behavior of carcinoma of the hypopharynx differs greatly from that of carcinoma of the larynx. Carcinomas of the hypopharynx are usually poorly differentiated and patients are usually asymptomatic; early presentations are unfortunately uncommon. In fact, T1 N0 cases (see Staging in Workup) account for only 1-2% of all patients seen.

    Most patients have no symptoms to bring them to medical attention until their disease is advanced, at which point the prognosis is poor. The rate of metastases is high, with nodal involvement present in 50-70% of cases at presentation. Of patients with hypopharyngeal cancers, 70% have stage III disease at presentation. Cervical lymph node metastases occur as the presenting symptom in approximately 50% of cases. The frequency of distant metastases is also among the highest of all head and neck cancers.2

    Prognosis varies with the stage. The 5-year survival rate with small (T1-T2) lesions is about 60%, but with T3-T4 lesions or multiple node involvement, survival falls to 17-32%. Five-year survival for all stages is approximately 30%.

    Morbidity is predominantly due to the primary tumor itself causing pain, bleeding, poor swallowing (with subsequent malnutrition), or aspiration. Very advanced tumors may cause airway obstruction as they grow into the larynx. Laryngectomy is often needed, leading to permanent loss of voice and permanent tracheostomy. Functional problems from surgical or radiation treatment can include swallowing dysfunction, recurrent aspiration pneumonias, neck fibrosis, facial edema, and pain.



    Pathology

    More than 95% of hypopharyngeal tumors are squamous cell carcinoma, less than 60% are keratinizing, 33% are nonkeratinizing, and all are usually poorly differentiated. Variants include basaloid squamous cell carcinoma, superficial spreading cancer, sebaceous cancer, adenosquamous cancer, and signet-ring and verrucous types. Uncommon histologic types include adenocarcinoma, lymphoma, and sarcoma.

    Studies have reported that tumor margins are usually infiltrating (80%) but can be pushing (20%). Unsuspected submucosal spread can extend beyond 1 cm of visible tumor margins. Skip lesions or multifocal areas of disease are not unusual.



    Anatomy


    The hypopharynx, or laryngopharynx, is the longest and most inferior portion of the 3 segments of the pharynx and links the oropharynx to the esophagus (see Images 1-2). It is located posterior to the cartilaginous structures of the larynx. It is wide superiorly and progressively narrows toward the level of the cricopharyngeal muscle. The hypopharynx is a continuous area; the oropharynx is above it and the cervical esophagus through the cricopharyngeal sphincter is below it. This region is known as the pharyngoesophageal junction or postcricoid area. It is bounded anteriorly by the posterior face of the cricoid cartilage. The hypopharynx extends from the hyoid bone to the cricoid cartilage and is further subdivided into the regions of the pyriform sinus, pharyngeal wall, and posterior cricoid.



    •Pyriform sinuses: The parts of the hypopharynx that lie partly to each side of the larynx form the pyriform sinuses or fossae, so named for their pear shape. The pyriform sinuses are bound laterally by the thyroid cartilage and medially by the lateral surface of the aryepiglottic fold, arytenoids, and cricoid cartilages. It is posteriorly open. The apex, or most inferior extent, lies below the vocal cords and, occasionally, below the cricoid cartilage. The superior extent is bordered by the pharyngoepiglottic mucosal fold that extends from the lateral pharyngeal wall to the epiglottis. The pyriform sinuses extend from the glossoepiglottic folds to the upper esophagus.

    •Posterior pharyngeal wall: The posterior pharyngeal wall extends from the level of the hyoid bone to the inferior aspect of the cricopharyngeus muscle. It is formed by the constrictor muscles and is in direct contact with the prevertebral fascia.

    •Pharyngoesophageal junction (postcricoid area): The posterior cricoid area is the posterior surface of the larynx and extends from the arytenoids to the inferior edge of the cricoid cartilage and beginning of the esophagus. The superior laryngeal nerve lies deep to the mucosa of the lateral wall of the pyriform fossa. The constrictor muscles, covered with mucous membrane, form the posterior wall of the hypopharynx. It extends from the level of the floor of the vallecula to the level of the cricoarytenoid joint. The anterior wall of the hypopharynx is bounded by the larynx.

    The pharyngeal plexus of nerves, which receives contributions from the glossopharyngeal and vagus nerves, supplies the innervation of the hypopharynx. The vagus nerve supplies motor innervation to the constrictors. Sensory information from the hypopharynx travels along the glossopharyngeal nerve and the internal laryngeal branch of the superior laryngeal nerve, which arises from the vagus nerve.

    The primary lymphatic drainage of the hypopharynx includes the jugulodigastric lymph nodes and middle jugular chains. The spinal accessory and retropharyngeal and paratracheal lymph nodes communicate freely.

    The pyriform sinuses are drained by a network of lymphatics, which drain primarily to the upper and middle jugular nodes, posterior cervical nodes, and retropharyngeal lymph nodes. Lymphatics of the posterior wall of the hypopharynx drain to the jugular nodes and retropharyngeal nodes. Postcricoid lymphatics drain to the middle and lower jugular nodes and to the paratracheal nodes.



    Symptoms of hypopharyngeal cancer include dysphagia, chronic sore throat, and foreign body sensation in the throat or referred otalgia. (Otalgia is pain referred to the ear via the Arnold nerve, a division of the 10th cranial nerve. It suggests an underlying malignancy.) For hypopharyngeal cancer, a metastatic node in the neck is often the presenting symptom. An asymptomatic mass in the neck, usually a jugulodigastric or jugulo-omohyoid lymph node, is present in 20% of patients. The average duration of symptoms before presentation is 2-4 months.

    Other symptoms, which usually develop later, include weight loss, hemoptysis, laryngeal stridor, and hoarseness when the vocal cord becomes affected by direct extension into the arytenoid cartilage or the recurrent laryngeal nerve. Of patients with hypopharyngeal cancers, 70% have stage III disease at presentation.

    •Neck mass: Cervical lymph node metastases occur as the presenting symptom in approximately 50% of cases. As many as 70% of patients with pyriform sinus lesions have palpable lymph nodes upon initial clinical examination.

    •Sore throat
    ◦Typically, pain is unilateral and well localized.
    ◦Often, pain radiates to the ears.
    ◦Patients commonly undergo one or more courses of empiric antibiotics without response.

    •Hoarseness: This indicates either involvement of the recurrent laryngeal nerve, which runs deep to the anterior wall of the pyriform sinus, or direct invasion of the larynx (see Image 4).

    •Dysphagia (Image 5. See related CME at Diagnostic Evaluation of Dysphagia.)
    ◦Tumor invasion often causes a combination of painful swallowing (odynophagia) and neuromuscular dysfunction (dysphagia). Patients frequently report food sticking in the upper esophagus or upper throat; this is because the hypopharynx is involved in the coordination of the swallowing function around the larynx.
    ◦Aspiration is occasionally seen.
    ◦Weight loss and malnutrition are common at presentation.

    •Otalgia: Referred pain to the ear is mediated by branches of the tenth cranial nerve (see Image 6). Invasion of the laryngeal nerve causes spread of neuropathic impulses to the auricular nerve (sensory to posterior external auditory canal and back of pinna).

    •Hemoptysis

    •Halitosis: Fetid breath is due to saprophytic bacterial overgrowth in fungating necrotic tumors.

    Physical examination

    Assessment begins in the office with a thorough head and neck examination, including inspection, palpation, and indirect or fiberoptic examination. Flexible fiberoptic endoscopic examination is important to attempt to localize and stage the primary tumor. Because of the patient's gag reflex, a flexible fiberoptic examination is the preferred examination technique and often allows the mucosa of the hypopharynx to be well examined. Hypopharyngeal cancer is typically advanced at presentation, and an obvious abnormality is usually present in either the pharynx or the neck. Occasionally, only subtle signs such as submucosal fullness or unilateral pooling of saliva are present. Typical findings of hypopharyngeal cancer include mucosal ulceration; pooling of the saliva in the pyriform fossa; edema of the arytenoids; or fixation of the cricoarytenoid joint, true vocal cords, or both.

    During the flexible laryngoscopy, the assessment of vocal cord mobility or fixation is important for staging purposes. The patient who puffs out his or her cheeks or performs a Valsalva maneuver may distend the pyriform fossae for inspection.

    The neck should be examined in a systematic fashion. Any lymph nodes should be assessed with regard to size, location, and mobility. On neck examination, loss of the grating sensation (laryngeal crepitus) of the laryngeal cartilages over the prevertebral tissues may indicate deep pharyngeal wall involvement.

    •Oral examination
    ◦The hypopharynx is not visible directly, but other regional pathologies, including the synchronous oral cavity or oropharyngeal tumors, might be seen.
    ◦Asymmetry of tonsillar pillars can be a clue to a tumor invading the palatopharyngeus muscle at insertion to the inferior constrictor muscle.

    •Larynx and pharynx examinations
    ◦The mirror examination is the quickest and simplest screening tool, but it cannot reveal lower pyriform sinus or postcricoid lesions. Fiberoptic laryngoscopy is the examination of choice.
    ◦Findings include mass lesions, hyperkeratotic or erythematous mucosal lesions, ulcerations, and vocal cord paralysis.

    •Neck examination
    ◦Examine and document the size, location, and number of palpable lymph nodes in all cervical and supraclavicular node-bearing areas.
    ◦Palpate and wiggle the larynx from side to side. Tenderness suggests invasion, while loss of normal tracheal crepitus suggests invasion of prevertebral tissue or a large postcricoid tumor.

    •Head examination
    ◦Assess cranial nerve function.
    ◦Assess jaw mobility. Trismus suggests invasion of pterygoid muscles.
    ◦Areas of mass lesions or tenderness are suggestive of regional metastases.

    •General examination for distant metastases and comorbidities
    ◦Examination of the lungs may reveal chronic obstructive pulmonary disease (COPD). Chest x-ray films may demonstrate metastases, synchronous lesions, or effusions suggesting metastases to pleura or lymphatic obstruction.
    ◦Examination of the heart may demonstrate congestive heart failure (CHF) or right-sided failure and pulmonary hypertension.
    ◦Examination of the extremities may reveal peripheral vascular disease or clubbing suggestive of advanced lung disease or synchronous lung cancer.
    ◦Hepatomegaly with a hard irregular contour suggests metastatic disease.
    ◦General neurologic examination may show toxic or metabolic encephalopathy or neuropathy. Focal neurologic findings suggest brain metastases or prior cerebrovascular accident (CVA).
    ◦Perform a peripheral lymph node examination to assess for possible distant lymph node metastases.




    ---------------------------------------------------------------------------------------



    ANATOMY OF THE HYPOPHARYNX

    The hypopharynx extends from its juncture with the oropharynx at the tip of the epiglottis (or level of the hyoid bone) superiorly to the inferior border of the cricoid cartilage. It can be divided into three sites: the pyriform sinus, the postcricoid area, and the posterior pharyngeal wall.

    The pyriform sinus is a funnel shaped structure that begins superiorly at the glossoepiglottic fold and extends inferiorly with its apex at the level of the cricopharyngeus. It is bounded laterally by the thyroid lamina and posteriorly by the lateral wall of the hypopharynx. Its medial boundary is the lateral surface of the arytenoid.

    The second region is the posterior pharyngeal wall, which extends from a plane drawn at the level of the tip of the epiglottis (some describe at the level of the vallecula or hyoid) to a plane at the inferior border of the cricoid. The superior and inferior margins of the hypopharynx blend with the posterior wall of the oropharynx and esophagus, respectively.

    The third area is the postcricoid area. This includes the posterior surface of the aryepiglottic fold and posterior surface of the arytenoid to the inferior border of the cricoid cartilage. This area is the most difficult to examine by both mirror exam and direct laryngoscopy.

    The lining of the hypopharynx is stratified squamous epithelium and has a rich submucosal network of lymphatics that exit superiorly through the thyrohyoid membrane into the superior and middle jugular nodes. Inferiorly, the lymphatics drain to the paratracheal and low jugular nodes.

    The hypopharynx functions as a dynamic conduit for food that helps prevent aspiration. As the food bolus is propelled past the epiglottis, contraction of the constrictor muscles propel the food towards the cricopharyngeus. The cricopharyngeus relaxes as the food enters the esophagus, where peristaltic action propels the food to the stomach. Motor innervation of the superior and middle constrictors is by the superior pharyngeal nerve and the pharyngeal branches of the vagus and glossopharyngeal nerves. Innervation of the inferior constrictor is from the external and recurrent branches of the vagus nerve. Sensory innervation of the pyriform sinus is from the internal branch of the superior laryngeal nerve. This complex muscular coordination is disrupted by major surgical reconstruction in this area and may result in severe aspiration even when the laryngeal sphincter is intact.

    INCIDENCE AND RISK FACTORS

    Cancer of the hypopharynx is not common but generally has a very poor prognosis. Laryngeal cancer is three times as common as hypopharyngeal cancers and often presents earlier due to hoarseness. Almost all cancers of the hypopharynx are squamous cell carcinomas and the vast majority of patients present with at least stage III disease. This is likely due to a combination of the lack of symptoms with smaller lesions, the propensity for early submucosal spread and skip lesions, and the lack of definitive anatomic boundaries to prevent early spread of the cancer.

    Most patients who develop cancer of the hypopharynx have a history of heavy smoking and drinking. Males are about eight times more susceptible to cancer of the hypopharynx but a certain group of females have an increased incidence of cancer of the postcricoid area. These females are of Irish and Scandinavian descent and have the Plummer-Vinson syndrome. This syndrome is characterized by esophageal webs, iron deficiency anemia, glossitis and an increased incidence of esophageal cancer. The malignancy usually develops just proximal to the web and is felt to be due to chronic irritation. Progressive dysphagia is characteristic of the disorder and can be reversed if treated early with iron replacement, esophageal dilation and vitamin therapy.

    DIAGNOSIS

    Many patients with hypopharyngeal cancer have been treated at a primary care facility for many months before referral. Chronic inflammatory changes of the pharynx due to smoking often leads to a diagnosis of chronic pharyngitis and multiple courses of antibiotic are common. Referred otalgia by Arnolds nerve (a branch of CN X) may also be a presenting symptom. Twenty percent of patients with hypopharyngeal cancer will present with an asymptomatic neck mass, usually in level II or III. With advanced disease, severe weight loss and nutritional deficiencies are common . The physical exam should include a thorough head and neck exam and attention to the oral cavity and general appearance for signs of severe nutritional deficiencies. A hot potato voice or hoarseness due to vocal cord paralysis may be present. The mirror and fiberoptic exam should look for pooling of secretions in the pyriform sinus or vocal cord paralysis and should include a search for a second primary. The neck exam should include a search for metastasis and fine needle aspiration is indicated.

    RADIOLOGY

    When a diagnosis of a hypopharyngeal malignancy is suspected, a CT scan is essential, due to the possibility of submucosal spread. It is not uncommon for the CT scan to demonstrate more extensive disease than appreciated by indirect or direct laryngoscopy. The finding of edema on CT scan may be more suggestive of submucosal infiltration than biopsy. CT also aids in the ability to stage the lesion and look for cartilage or preepiglottic space invasion and determine if direct extension into the neck, usually between the middle and inferior constrictors has occurred.

    CT evaluation of the neck, especially of the contralateral neck in cases of palpable ipsilateral adenopathy, may also affect treatment planning. Carotid involvement may also be an issue but MRI and ultrasound may be better at predicting carotid artery involvement.

    Other essential radiologic tests include a chest x-ray to rule out metastasis or a second lung primary, a barium swallow or modified barium swallow to determine the dynamic effects of the tumor on swallowing and the status of the upper esophagus. Bone scans are not routinely indicated in hypopharyngeal cancer.

    STAGING ENDOSCOPY

    The single most important goal of the staging endoscopy is to determine the inferior extent of the tumor, and its relation to the pyriform apex, esophageal inlet, and the cervical esophagus. The evaluation should be performed under general anesthesia with complete paralysis after the barium swallow and CT have been performed. Identification of the inferior extent of tumor spread can be facilitated by passing a small laryngoscope, such as an anterior commissure scope, into the postcricoid area on the opposite side of the tumor and gently withdrawing the scope to look for the inferior margin of the tumor. Whether the apex of the pyriform is involved also has important treatment implication as will be discussed later. Esophagoscopy and biopsies should be performed after mapping the tumor and complete evaluation of the esophagus down to the gastroesophageal junction is mandatory. If gastric interposition is planned, then complete gastroscopy is indicated.

    PATHOLOLGY

    Over 95% of malignancies of the hypopharynx are squamous cell carcinomas. Most of the remaining 5% are adenocarcinomas. Most hypopharyngeal carcinomas arise in the pyriform fossa, followed by the posterior hypopharyngeal wall and lastly, the postcricoid area. Of the tumors that involve the pyriform sinus, approximately 90% involve the apex of the sinus.

    A prominent feature of hypopharyngeal tumor is submucosal spread, and this has been often related to treatment failure. This characteristic appears to be more common as the tumor approaches the cervical esophagus, likely due to the increased submucosal lymphatics in this area. Satellite tumors are also common in this area and whether they represent micrometastases or separate primary tumors is controversial.

    Lateral wall pyriform sinus tumors have been shown to invade the thyroid cartilage and extend directly into the thyroid or metastasize to the thyroid. Ipsilateral thyroidectomy is usually indicated in these cases even if the thyroid is not clinically involved. Most authors consider pyriform apex or thyroid cartilage involvement a contraindication for partial laryngectomy. Tumors of the medial wall of the pyriform tend to extend towards the supraglottis and preepiglottic space resection should be done if partial laryngectomy is performed. The status of surgical margins appears to have a profound affect on survival, which is in contrast to supraglottic tumors, where close or positive margins have not been shown to affect survival. One study correlated positive inferior margins in hypopharyngeal cancer with a 5% 5 year survival.

    Tumor size was also correlated with positive neck disease, with 50% positive neck metastasis in tumors less than 4cm in size and 85% metastasis in tumors larger than 4 cm. As stated earlier, most (about 75%) cases present with positive neck disease.

    Vocal cord paralysis can occur through several mechanisms. Pyriform sinus tumors can infiltrate into the posterior cricoarytenoid muscle. Involvement of the cricoarytenoid joint or direct invasion of the recurrent laryngeal nerve may also occur.

    PROGNOSIS

    The overall survival of patients with hypopharyngeal cancer is about 40%. The site, size and status of the neck have significant affects on outcome. In patients with cervical metastasis, there is a 20 to 25% incidence of distant metastasis within 2 years of treatment. Stage I and II posterior hypopharyngeal wall cancers have an excellent prognosis. In contrast, even small pyriform sinus cancers are notorious for metastasizing early and carry a poor prognosis. Postcricoid lesions usually present as advanced lesions with extensive paratracheal and mediastinal metastasis and has a poor prognosis.

    MANAGEMENT

    Radiation therapy

    Primary radiation therapy is can be curative for small (T1) lesions of the hypopharynx, particularly exophytic tumors that involve the medial wall of the pyriform sinus and do not extend to the apex. Radiation therapy for T2 lesions, leaving surgery for salvage is controversial. Signs of recurrent disease include persistent arytenoid edema, pain, and vocal cord fixation. Radiation therapy may also be preferable for small tumors of the posterior hypopharyngeal wall or for palliation with larger stage III and IV tumors. Planned preoperative or postoperative radiation therapy is the most common technique for using radiation therapy in the treatment of hypopharyngeal cancer.

    Suprahyoid pharyngotomy

    This approach can be used for lesions localized to the posterior hypopharyngeal wall. It involves a direct approach above the hyoid bone into the vallecula. The hyoid bone can be removed for exposure once the pharyngotomy is made. The incision of the posterior pharyngeal wall is usually carried down to the pervertebral fascia in most cases, but prevertebral muscles may be excised if necessary. Reconstruction can usually be performed with a bolstered skin graft which can be removed transorally in 10 to 14 days.

    Partial laryngopharyngectomy or Extended supraglottic laryngectomy
    Conservation surgery for small tumors of the posterior hypopharyngeal wall has been described by Ogura in 1960 and was expanded to include pyriform sinus tumors if certain criteria are met. The three most important criteria include: normal vocal cord mobility, no extension of the tumor to the apex of the pyriform sinus, and no thyroid cartilage involvement. The operation is an extension of the supraglottic laryngectomy concept and involves the combination of suprahyoid and lateral pharyngotomy approaches. Interarytenoid and aryepiglottic cuts allow excision of the ipsilateral arytenoid and pyriform sinus with cuts similar to a supraglottic laryngectomy on the contralateral side. In general, these operations are oncologically unsafe for anterior pyriform sinus and aryepiglottic fold cancers. Laccourreye noted a 41% failure rate at the lateral margin with the lateral supraglottic laryngopharyngectomy and has abandoned the procedure.

    Supracricoid Hemilaryngopharyngectomy (SCHLP)

    In contrast to the partial laryngopharyngectomy, the supracricoid hemilaryngopharyngectomy resects the entire ipsilateral thyroid ala and arytenoid which allows more adequate resection of the pyriform sinus. T2 lesions of the pyriform fossa without pyriform apex or postcricoid involvement are candidates for SCHLP. The main advantage of SCHLP is that the cricoid cartilage is preserved and thus decannulation is possible. Sphinteric functional recovery with airway protection and swallowing is possible due to the remaining mobile arytenoid and vocal cord.

    Determining the feasibility of SCHLP depends on both tumor and patient factors. Due to the possibility of significant aspiration, the patient must have a thorough pulmonary evaluation preoperatively and be informed of the possibility of either intraoperative conversion to a total laryngectomy or delayed laryngectomy for chronic aspiration. As stated earlier, vocal cord fixation with bulky pyriform sinus involvement usually indicates paraglottic space involvement and either cricoarytenoid joint or posterior cricoarytenoid muscle involvement. Such patients are not candidates for SCHPL. On the other hand, impaired cord mobility due to tumor bulk without invasion of the cricoarytenoid muscles may still be amenable to SCHPL. In these cases CT and MRI may help evaluate the paraglottic space and cricoarytenoid joint. Other contraindications include involvement of the postcricoid area, interarytenoid area, posterior pharyngeal wall, tonsillar pillar (due to possible infiltration of the stylopharyngeus muscle) and involvement of the preepiglottic space, although the latter is controversial because both the ipsilateral and contralateral preepiglottic fat pad can be resected.

    As described by Laccourreye, the operation is performed under general anesthesia with direct laryngoscopy to confirm suitability of the tumor for SCHLP. A tracheotomy is performed and a standard apron incision is made with adequate exposure for a neck dissection. A radical or modified radical neck dissection is performed with resection of the ipsilateral hemithyroid and the larynx is exposed from the hyoid to trachea. The posterior border of the ipsilateral infrahyoid muscles is identified and retracted medially, exposing the posterior border of the thyroid cartilage. The perichondrium is incised and elevated medially towards the midline as a musculoperichondrial flap. The hyoid may be resected or preserved depending on the location of the tumor. The superior laryngeal pedicle is ligated and a midline thyrotomy is performed with extension through the cricothryroid membrane.

    The incision is carried through the preepiglottic space and epiglottis, including the contralateral preepiglottic fat pad. Resection is continued laterally above the hyoid, exposing the tumor and pyriform sinus. Under direct vision, the posterior margin is taken caudally through the interarytenoid area. This cut is taken close to the contralateral arytenoid to avoid mucosal excess and edema. The cricoarytenoid joint is disarticulated, releasing the lower pyriform sinus from the cricoid. The inferior margin is taken where the cricothryroid membrane attaches to the cricoid. The mucosa is closed over the arytenoid and the superior border of the cricoid is left exposed. Two options exist for closure and creating a buttress for the remaining arytenoid. The remaining lateral pharyngeal wall can be sutured to the medial laryngeal remnant or the musculoperichondrial flap can be directly sutured to the lateral pharyngeal wall.

    Postoperatively, decannulation is usually performed within a week and oral feeding is started at about 2 weeks. Prolonged feeding difficulties are common and may take up to a year for resolution. Aspiration is a chronic risk following SCHLP and is likely partially due to resection of the ipsilateral superior laryngeal nerve. Laccourreye noted a 20% aspiration pneumonia rate and 11 of 233 patients required conversion to a total laryngopharyngectomy. 20 patients required gastrostomy for impaired swallowing and aspiration. Overall 87% of patients recovered satisfactory swallowing without aspiration. Ten local recurrences (5.2%) were noted and occurred most frequently in the pharynx. No pharyngocutaneous fistulas occurred.

    Near-Total Laryngopharyngectomy (NTLP)

    Near-total laryngopharyngectomy (NTLP) can be performed for selected hypopharyngeal cancers for which total laryngopharyngectomy is considered. It differs from the SCHLP in that tumors with cord fixation and pyriform apex involvement can be included, but the ipsilateral cricoid is resected so a permanent tracheostoma is required.

    The nomenclature concerning near-total laryngectomy is confusing. Hemicricolaryngectomy, as described by Krespi is a more specific description of a similar operation. The near-total laryngectomy was initially described by Pearson at the Mayo Clinic in 1980 as an extended hemilaryngectomy but this led to confusion as the term hemilaryngectomy usually refers to conservative operations that preserve the cricoid. Also, near-total laryngectomy is not to be considered a typical conservation operation such as a supraglottic or vertical partial laryngectomy because it requires a permanent stoma, but a lung powered voice is still possible.

    NTLP can be considered in patients with T2 and T3 lesions of the pyriform sinus in which total laryngectomy is contemplated. According to Pearson, it is not meant to replace total laryngectomy, but it just reduces the indications. The key to a NTLP is an bloc resection of the paralaryngeal space, including the ipsilateral cricoid. Conservation procedures preserve the cricoid ring, but in the case of pyriform apex involvement, resection would require stripping the mucosa off the cricoid, preventing an en bloc resection. Similarly, pyriform sinus cancers cause vocal cord fixation early due to paralaryngeal space invasion. Therefore, vocal cord fixation is not a contraindication to a NTLP as opposed to the supracricoid laryngectomy. In fact, can be thought of as indications for NTLP. NTLP is not recommended for radiation failures, postcricoid or interarytenoid tumors, bilateral cord fixation, tumors approaching the midline posteriorly and in cases with bilateral palpable nodes. Some consider NTLP safe in cases of pyriform apex involvement but Krespi sites a lack of a cartilagenous barrier to prevent submucosal spread across the midline and recommends total laryngectomy in these cases.

    The resected specimen from a NTLP includes the entire hermilarynx from the base of tongue to the trachea, pyriform sinus and part of the posterior pharyngeal wall if indicated. If the resulting defect requires reconstruction with a flap, near-total laryngectomy can still be performed. The remaining contralateral posterior glottic tissues are reconstructed to form a semirigid glottic shunt to allow phonation and effective swallowing. Reconstruction of the pharyngeal defect with a skin graft or pectoralis myocutaneous flap is usually necessary to prevent pharyngeal stenosis.

    Advocates for NTLP claim good speech with NTLP and site problems with tracheoesophageal speech such as leakage and the need for frequent care and changing the prosthesis. Despite reported functional successes and oncologic safety, in general, the NTLP has not been accepted as a viable alternative to total laryngectomy outside the Mayo Clinic. This may be in part due to technical problems with the speaking shunt, including mucosal breakdown, aspiration, stenosis and fistulae and a general acceptance of total laryngectomy with tracheoesophageal speech.

    Other Procedures for Hypopharyngeal Cancer

    Total laryngectomy should still be considered the baseline procedure for hypopharyngeal cancer for which all lesser procedures should be measured. Indications for total laryngectomy are the same as contraindications for NTLP previously described. Other techniques for reconstructing circumferential defects of the hypopharynx (myocutaneous flaps, gastric pull-up and jejunal free flap) have been discussed in a previous grand rounds.

    ----------



    .[/HIDE]
    Last edited by trimurtulu; 04-15-2009 at 08:32 PM.

  5. #5
    Join Date
    Aug 2008
    Posts
    6,603
    Rep Power
    46

    Arrow

    .

    MCQ:


    In the cervical area, the carotid triangle is bordered by the following muscles
    Except:



    A. The digastric muscle
    B. The sternocleidomastoid muscle
    C. The omohyoid muscle
    D. The sternohvoid muscle



    The Carotid Triangle



    Boundaries of Carotid Triangle


    The boundaries of the carotid triangle are:
    • posterior belly of digastric muscle (pbd)
    • superior belly of the omohyoid muscle (so)
    • anterior border of sternomastoid(st)


    [HIDE]
    The sternocleidomastoid (also known as the "sternomastoid") is a long muscle in the neck that rotates the neck and flex the head. [/HIDE]

    Nerves.—The Sternocleidomastoideus is supplied by the accessory nerve and branches from the anterior divisions of the second and third cervical nerves.

    Actions.—When only one Sternocleidomastoideus acts, it draws the head toward the shoulder of the same side, assisted by the Splenius and the Obliquus capitis inferior of the opposite side. At the same time it rotates the head so as to carry the face toward the opposite side. Acting together from their sternoclavicular attachments the muscles will flex the cervical part of the vertebral column. If the head be fixed, the two muscles assist in elevating the thorax in forced inspiration.

    Branches of the External Carotid Artery can also be described using the following diagram:




    The Common Carotid Artery arises in the base of the neck from the brachiocephalic artery on the right side and directly from the arch of the aorta on the left side in the superior mediastinum of the thorax. It passes into the base of the neck through the thoracic inlet bounded by T1 vertebral body, the sternum and first rib and ascends into the carotid triangle

    • Medial to the artery is the esophagus and trachea
    • Internal jugular vein lies lateral to it
    • It can be compressed on the transverse process of C6 (the carotid tubercle).
    • CN IX and the pharyngeal btranches of IX and X run between the internal and external carotid arteries
    • Both CN Xl and XII run laterally to the internal and external carotid arteries
    • Bifurcation into the internal and external carotid arteries occurs at the level of the upper border of the thyroid cartilage(C4)



    Internal:
    • Gives no branches in neck and simply ascends to enter the base of the skull into the carotid canal
    • Has the carotid sinus (baroreceptors associated with CN IX) at its beginning
    • The carotid body is present at the bifurcation and has chemoreceptors.


    The carotid sinus and body are for mechanisms controlling blood pressure.

    • Lies posterolateral to the external carotid artery.
    • Cranial nerve IX or glossopharyngeal nerve runs anterior to the internal carotid artery and penetrates the lateral pharyngeal wall with the stylopharyngeus muscle. It is motor to this muscle and sensory to the mucosa of posterior 1/3 of tongue, mucosa of pharynx, palatine tonsil and soft palate.


    External:
    • Main arterial supply to structures of the neck and superficial face
    • Gives off several branches, some of which originate in or pass through the carotid triangle.
    • Lies inferior to (I), deep to (D) or superior to (S) the posterior belly of the digastric
    .


    Branches of the External Carotid Artery can be described through SALFOP | S-MAX

    Superior thyroid artery (I) arises close to the carotid bifurcation. It descends anteriorly across the triangle to enter the superior pole of the thyroid gland anastomosing with its opposite counterpart and the inferior thyroid artery. Its branches are:

    • The superior laryngeal artery supplying the inner aspect of the larynx
    • The cricothyroid branch running with the external laryngeal nerve.
    • The muscular branch to the sternocleidomastoid muscle.


    Location Tip: Seen running with the internal laryngeal nerve piercing thyrohyoid membrane

    Ascending pharyngeal artery (I) arising near the carotid bifurcation from the posterior surface of the external carotid and passing posteriorly to the back of the pharynx. It supplies the pharyngeal constrictor muscles (lateral wall of the pharynx and the nasopharynx) and gives off small branches that supply the prevertebral muscles, middle ear and meninges, tonsil (palatine)

    Lingual artery (DI) passes superiorly deep to the suprahyoid muscles to enter and supply the tongue. It also gives branches to the suprahyoid muscles and the sublingual gland (tonsil)

    Facial artery (D) arises Immediately above the level of the hyoid bone and dips into the digastric triangle and around the submandibular gland. It ascends and crosses over mandible to supply the anteromedial aspect of the face (incl. lips, nose). It also sends branches to the palatine tonsil (tonsillar br.), the submandibular gland and on the face, to both the lips and the nose. It ends as the angular artery which anastamoses with the infraorbital

    Occipital artery (D) arises on posterior side of ext. carotid, opposite facial artery, above the ascending pharyngeal, sends branches to the SCM, the dura mater, and then courses to the back of the head to supply the scalp

    Location Tip: found by identifying the hypoglossal nerve (CN XII) which loops around it from posterior to anterior.

    Posterior Auricular (S) courses behind the external ear and helps to supply the scalp, the middle ear, and the auricle. Neuritis of CNVII might be due to compression of this artery due to proximity to the nerve. In general, palsy of CNVII is termed Bell's palsy.

    Superficial Temporal (S) Large terminal branch arising opposite external auditory meatus supplying the scalp on the lateral side of the head and giving off the transverse facial artery which courses across the face. Splits into parietal and temporal branches(Temporalis m.)

    Maxillary artery (S) second large terminal branch, is the principal artery of the deep face. It has 3 divisions and many branches in each division. It supplies the tympanic membrane, gives rise to the middle meningeal artery, supplies the muscles of mastication, all lower and some upper teeth, the infraorbital region, the hard and soft palate, and the walls of the nasal cavity. More information regarding the maxillary artery can be found in its dedicated section.

    .------------------------------------

    Further Knowledge:





    Submental Triangle: between the anterior belly of the digastric, superior to the hyoid bone, and the midline of the neck

    • Floor is formed by the mylohyoid muscle
    • Most noted for the presence of several submental lymph nodes which drain the floor of the oral cavity, tip of the tongue and middle lower lip and central incisors
    • Anterior jugular veins: Lying in the midline, running from the submental triangle, they pierce the deep fascia above manubrium. They pass between the posterior border of the sternocleidomastoid muscle and the upper border of the clavicle to drain into the external jugular veins in the posterior triangle of the neck.


    Submandibular (Digastric) Triangle: between the posterior and anterior bellies of the digastric muscle and inferior border of the mandible. Its floor is formed by the mylohyoid, hyoglossus and middle constrictor muscles.

    • Continuous with the fossa for the parotid gland
    • Mylohyoid muscle lies superior to the anterior belly of the digastric
      1. Forms a sling passing from side to side from its attachment to the internal surface of the mandible (mylohyoid line)
      2. Forms the floor of mouth: It is attached from the mylohyoid line to the superior aspect of body of hyoid bone and the midline raphé.
      3. Around the free edge of this muscle lies the duct of submandibular salivary gland which occupies a significant part of the triangle
      4. Associated with the anterior belly of digastric, as both are derived from the 1st Branchial Arch and therefore share the same innervation: Mylohyoid Br. of the Inferior Alveolar N. of V3
    • Hypoglossal nerve (CN XII) also passes into the triangle as it goes to the tongue between Hyoglossus and mylohyoid close to the hyoid bone
    • Facial artery, arising from the external carotid, passes superiorly deep to the posterior belly of digastric, follows the floor of the triangle and winds posteriorly over the submandibular gland and "grooves" the inferior edge of the mandible at anterior-inferior angle of the masseter muscle to reach the face
    • Posterior belly of the digastric:
      1. Originates from the digastric fossa medial to the mastoid process,
      2. Attaches to the anterior belly of digastric by the intermediate tendon which is tied down by a fascial sling to the body of the hyoid.
      3. Associated with the stylohyoid, which arises from the lateral surface of the styloid process and it splits around the Common tendon of the digastric to insert into the hyoid bone.
      4. Both muscles are derived from the 2nd Branchial Arch and therefore share the same innervation: Facial N. (CN VII)



    Muscular Triangle: between the superior belly of the omohyoid, lower anterior margin of the sternocleidomastoid and the median line of the neck.

    Medially contains infrahyoid muscles.

    • As stated, these strap muscles lie between the investing deep fascia and the visceral fascia covering the thyroid gland, trachea and esophagus.
    • Are depressors of the larynx and the hyoid bone.
    • Except for Thyrohyoid, they are all innervated by the ansa cervicalis (a motor plexus from the ventral rami of C1, 2, 3 and 4) discussed in the Carotid Triangle Section in detail.
    • Deep in the Muscular Triangle it contains visceral structures of the neck including the thyroid gland, larynx, trachea and esophagus.
    • Also includes the recurrent laryngeal nerve, inferior laryngeal artery, and external laryngeal nerve parallel to superior laryngeal nerve


    Sternohyoid m.: lying close to the midline
    1. The superior belly of the omohyoid lies lateral to it
    2. Muscles pass from the posterior surface of the manubrium of the sternum to insert on the hyoid bone.
    Sternothyroid m.: deep to sternohyoids
    1. Also pass from the posterior sternum but insert onto the oblique line of thyroid cartilage
    2. The superior belly of the omohyoid lies lateral to it
    Omohyoid m.:
    1. Splits both the anterior and posterior triangles
    2. Two bellies united by an intermediate tendon which is connected to the clavicle by a fascial sling

    Thyrohyoid m.: above the thyroid cartilage
    1. Completes the gap from thryoid cartilage to hyoid bone
    2. Innervated by fibers from C1 which have piggybacked onto the hypoglossal nerve (CN XII) and subsequently jump off that nerve twice: Once to supply this muscle, and a second time in the floor of the mouth to supply the geniohyoid.
    3. Covers visceral structures of the neck including the thyroid gland, larynx, trachea and esophagus.



    .
    Last edited by trimurtulu; 04-15-2009 at 11:27 PM.

  6. #6
    Join Date
    Aug 2008
    Posts
    6,603
    Rep Power
    46

    Default

    ,


    The prevertrbral facia envelops all of the following Except the:

    A. Vagal nerve
    B. Brachial plexus
    C. Sympathetic trunk
    D. Cervical nerve plexus
    E. Phrenic nerve




    Prevertebral fascia labeled in red, both according to older literature (e.g. Gray's) and newer literature




    Location
    The prevertebral fascia extends medially behind the carotid vessels, where it assists in forming their sheath, and passes in front of the prevertebral muscles.

    The prevertebral fascia is fixed above to the base of the skull, and below it extends behind the esophagus into the posterior mediastinal cavity of the thorax. It descends in front of the longus colli muscles.

    The prevertebral fascia is prolonged downward and laterally behind the carotid vessels and in front of the scaleni, and forms a sheath for the brachial nerves and subclavian vessels in the posterior triangle of the neck; it is continued under the clavicle as the axillary sheath and is attached to the deep surface of the coracoclavicular fascia.


    Surrounding structures
    It forms the posterior limit of a fibrous compartment, which contains the larynx and trachea, the thyroid gland, and the pharynx and esophagus.

    Parallel to the carotid sheath and along its medial aspect the prevertebral fascia gives off a thin lamina, the buccopharyngeal fascia, which closely invests the constrictor muscles of the pharynx, and is continued forward from the constrictor pharyngis superior on to the buccinator. This is attached to the prevertebral layer by loose connective tissue only, and thus an easily distended space, the retropharyngeal space, is found between them.

    Immediately above and behind the clavicle an areolar space exists between the investing layer and the sheath of the subclavian vessels, and in this space are found the lower part of the external jugular vein, the descending clavicular nerves, the transverse scapular and transverse cervical vessels, and the inferior belly of the Omohyoideus muscle.

    ,

    The Prevertebral Fascia

    • This layer of deep cervical fascia forms part of a tubular sheath for the prevertebral muscles that surrounds the vertebral column.
    • It is also continuous with the deep fascia covering the muscular floor of the posterior triangle of the neck.
    • The prevertebral fascia extends from the base of the skull to the third thoracic vertebra, where it fuses with the anterior longitudinal ligament.
    • The prevertebral fascia extends inferiorly and laterally as the auxiliary sheath, which surrounds the axillary vessels and brachial plexus.


    .

  7. #7
    Join Date
    Aug 2008
    Posts
    6,603
    Rep Power
    46

    Default

    .

    Which of the following statements regarding the spinal accessory nerve is False'


    A. It has rootlets of origin only from the cervical cord
    B. It enters the cranium at the foramen magnum'
    C. It exists the cranium by way of the jugular foramen
    D. It can be identified entering the deep surface of the sternocleidomastoid muscle about 4 cm below the mastoid process
    E. It can be identified at the anterior margin of the trapezius muscle










    fm--foramen magnum

    jf--jugular foramen




    CN XI. Spinal Accessory Nerve

    The spinal accessory nerve originates from neuronal cell bodies located in the cervical spinal cord and caudal medulla. Most are located in the spinal cord and ascend through the foramen magnum and exit the cranium through the jugular foramen. They are branchiomotor in function and innervate the sternocleidomastoid and trapezius muscles in the neck and back.

    The cranial root of the accessory nerve originates from cells located in the caudal medulla. They are found in the nucleus ambiguus and leave the brainstem with the fibers of the vagus nerve. They join the spinal root to exit the jugular foramen. They rejoin the vagus nerve and distribute to the same targets as the vagus. Most consider the cranial part of the eleventh cranial nerve to be functionally part of the vagus nerve.

    CN XI: Accessory nerve Spinal Root: segments from C6 to C1 join and ascend up through the foramen magnum

    Cranial Root: 4 or 5 rootlets from the lateral part of the medulla

    --------------

    The accessory nerve consists of two parts: a cranial and a spinal.

    1.The Cranial Part (ramus internus; accessory portion) is the smaller of the two. Its fibers arise from the cells of the nucleus ambiguus and emerge as four or five delicate rootlets from the side of the medulla oblongata, below the roots of the vagus. It runs lateralward to the jugular foramen, where it interchanges fibers with the spinal portion or becomes united to it for a short distance; here it is also connected by one or two filaments with the jugular ganglion of the vagus. It then passes through the jugular foramen, separates from the spinal portion and is continued over the surface of the ganglion nodosum of the vagus, to the surface of which it is adherent, and is distributed principally to the pharyngeal and superior laryngeal branches of the vagus. Through the pharyngeal branch it probably supplies the Musculus uvulæ and Levator veli palatini. Some few filaments from it are continued into the trunk of the vagus below the ganglion, to be distributed with the recurrent nerve and probably also with the cardiac nerves.

    2. The Spinal Part (ramus externus; spinal portion) is firm in texture, and its fibers arise from the motor cells in the lateral part of the anterior column of the gray substance of the medulla spinalis as low as the fifth cervical nerve. Passing through the lateral funiculus of the medulla spinalis, they emerge on its surface and unite to form a single trunk, which ascends between the ligamentum denticulatum and the posterior roots of the spinal nerves; enters the skull through the foramen magnum, and is then directed to the jugular foramen, through which it passes, lying in the same sheath of dura mater as the vagus, but separated from it by a fold of the arachnoid. In the jugular foramen, it receives one or two filaments from the cranial part of the nerve, or else joins it for a short distance and then separates from it again. As its exit from the jugular foramen, it runs backward in front of the internal jugular vein in 66.6 per cent. of cases, and behind in it 33.3 per cent. (Tandler). The nerve then descends obliquely behind the Digastricus and Stylohyoideus to the upper part of the Sternocleidomastoideus; it pierces this muscle, and courses obliquely across the posterior triangle of the neck, to end in the deep surface of the Trapezius. As it traverses the Sternocleidomastoideus it gives several filaments to the muscle, and joins with branches from the second cervical nerve. In the posterior triangle it unites with the second and third cervical nerves, while beneath the Trapezius it forms a plexus with the third and fourth cervical nerves, and from this plexus fibers are distributed to the muscle.





    Course and distribution of the glossopharyngeal, vagus, and accessory nerves.

    .
    Last edited by trimurtulu; 04-16-2009 at 12:11 AM.

  8. #8
    Join Date
    Aug 2008
    Posts
    6,603
    Rep Power
    46

    Default

    .



    The quinolone ciprofloxacin provides excellent coverage for all of the following bacteria Except:

    A. S aureus
    B. H. influenzae
    C. M. catarrhalis
    D. S. pneumoniae
    E. P. aerations


    Answer : A. S aureus

  9. #9
    Join Date
    Aug 2008
    Posts
    6,603
    Rep Power
    46

    Default

    .



    Which of the following antibiotics is bacteriostatic?


    A. Cerfuroxime
    B. Erythromycin
    C. Ampicilline
    D. Ciprofloxacin
    E. Imepenem



    All are Bacteriostatics except: Cerfuroxime

    .
    .
    Last edited by trimurtulu; 04-16-2009 at 07:49 AM.

  10. #10
    Join Date
    Jun 2009
    Age
    66
    Posts
    1
    Rep Power
    0

    Default

    thank you


    MCQ:


    The hypopharynx consist of all the following regions Except:

    A. Pyrifom sinuses
    B. Posterior pharyngeal wall
    C. Anterior pharyngeal wall
    D. Postcricoid area
    E. None of the above


    Hypopharynx



    The hypopharynx is the region between the oropharynx above (at the level of the hyoid bone) and the esophageal inlet below (at the lower end of the cricoid cartilage). Embryologically, the larynx interjects into the hypopharynx anteriorly and is therefore considered a separate structure.


    Hypopharyngeal cancers are often named for their location, including pyriform sinus, lateral pharyngeal wall, posterior pharyngeal wall, or postcricoid pharynx (see Images 1-2). Most arise in the pyriform sinus.

    In the United States and Canada, 65-85% of hypopharyngeal carcinomas involve the pyriform sinuses, 10-20% involve the posterior pharyngeal wall, and 5-15% involve the postcricoid area.

    As in other head and neck cancer sites, more than 95% of hypopharyngeal malignancies arise from the epithelium of the mucosa and, therefore, are squamous cell cancers. Premalignant mucosal lesions evolve into hyperproliferative lesions that develop the capacity to enlarge, to invade local structures, to invade lymphatics to spread to regional lymph nodes, and to invade vascular channels to metastasize to other organs.


    Hypopharyngeal cancer is a term used for tumors of a subsite of the upper aerodigestive tract, and like most other subsite designations, the distinction is anatomic rather than pathophysiologic within the group of head and neck malignancies.







    .





    In-Depth Details:

    hidden content may not be quoted[/QUOTE]

Page 1 of 2 12 LastLast

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Anatomy 100 mcqs with answer
    By cooldude in forum MCQs
    Replies: 0
    Last Post: 10-21-2010, 02:29 PM
  2. How to answer the MCQs
    By dhaval in forum Students' HangOut
    Replies: 1
    Last Post: 10-06-2010, 01:32 AM
  3. PLZ I want an answer for this ?????
    By oOo A K R A M oOo in forum Pediatrics
    Replies: 5
    Last Post: 07-26-2009, 09:36 PM
  4. Try these n answer...
    By PreDator in forum MCQs
    Replies: 0
    Last Post: 05-27-2008, 07:23 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •