Unit 3 - Formative 1

Front 1

A patient complains of difficulty initiating swallowing. What kind of dysphagia is this?

Back 1

Oropharyngeal

Front 2

A patient complains of solid food sticking in his throat. What kind of dysphagia is this?

Back 2

Esophageal mechanical

Front 3

A patient complains of liquids 'sticking' in his throat. What kind of dysphagia is this?

Back 3

Esophageal motility

Front 4

A patient complains of solid foods sticking in his throat that occurs intermittently. Diagnosis?

Back 4

Esophageal spasm

Front 5

A patient complains of solid foods sticking in his throat that has been getting progressively worse. Differential?

Back 5

Scleroderma, achalasia, diabetes

Front 6

A patient presents with dysphagia to solids and occasionally liquids. There is occasional regurgitation which usually occurs shortly after a meal or while in the recumbent position. This patient also reports a history of chest pain following a meal. Diagnosis?

Back 6

Achalasia

Front 7

A patient presents with dysphagia to solids and occasionally liquids. There is occasional regurgitation which usually occurs shortly after a meal or while in the recumbent position. This patient also reports a history of chest pain following a meal. Barium esophagram reveals poor emptying of the barium from the esophagus which is dilated. You note a characteristic 'bird's beak' narrowing of the distal esophagus due to a non relaxing LES. What disease is this indicative of?

Back 7

Achalasia

Front 8

A patient presents with incomplete LES relaxation, increased LES tone, and aperistalsis of the esophagus. Diagnosis?

Back 8

Achalasia; results from a loss of distal esophageal inhibitory neurons (idiopathic)

Front 9

Using barium swallow you notice an outpouching directly above the upper esophageal sphincter. Diagnosis?

Back 9

Zenker diverticulum

can accumulate significant amounts of good, producing a mass and symptoms that include regurgitation

Front 10

An anemic patient presents with pain and dysphagia when her food hasn't been completely chewed. Barium swallow is notable for thin membranes of normal esophageal tissue consisting of mucosa or submucosa that protrudes out in the upper portion of the esophagus. Diagnosis?

Back 10

Esophageal web; can be congenital or acquired (anemia)

Front 11

After barium swallow you note that the patient has marked narrowing of the distal esophagus. A biopsy reveals mucosa, submucosa and hypertrophic muscularis propria in rings.

Back 11

Schatzki's Ring

Front 12

A patient eating steak presents with acute dysphagia and drooling. This patient is notable for a history of schatzki's rings.

Back 12

food bolus impaction; may require endoscopy to push the obstructing food into the stomach or remove it from the esophagus

Front 13

A child presents with intermittent dysphagia. You note in the history they have many allergies.

Back 13

Eosinophilic Esophagitis; allergic inflammatory condition of the esophagus; can tx with steroids; the esophagus is fragile so there is a greater risk of perfornation

Diagnosis is made with biopsy; normal esophageal tissue does not have any eosinophil

Front 14

A patient presents with dysphagia, heartburn and the occasional regurgitation of sour tasting fluid. The history is notable for alcoholism.

Back 14

Gastroesophageal Reflux Disease (GERD)

Alcohol decreases lower esophageal reflux tone

Front 15

A patient presents complaining of dysphagia and heartburn. Endoscopy reveals several patches of red, velvety mucoa extending upward from the gastroesophageal junction. A biopsy shows intestinal metaplasia within the esophageal squamous mucosa.

Back 15

Barrett Esophagus; due to chronic GERD; increases risk of esophageal adenocarcinoma

Management = frequent endoscopy and biopsy of the affected squamous mucosa to detect for dysplasia

Front 16

A patient presents with pain upon swallowing, progressive weight loss, chest pain and vomiting. The history is notable for a 30 year history of smoking and alcoholism.

Back 16

Barrett's Associated Adenocarcinoma or Squamous Cell Carcinoma

Front 17

A patient presents with dysphagia upon ingestion of solid foods only.

Back 17

Esophageal mechanical dysphagia

Front 18

A patient presents with dysphagia upon ingestion of both solids and liquids.

Back 18

Esophageal motor (neural) dysphagia

Front 19

What is the most common cause of fungal esophagitis?

Back 19

Candidiasis

Mucormycosis and aspergillosis may also occur

Front 20

A patient presents with dysphagia. History is notable for a history of connective tissue disease.

Back 20

Scleroderma

Front 21

A patient presents with a sense of solids and liquids sticking in the esophagus. You cannot detect any evidence of reflux or histopathology based esophageal motility disorder.

Back 21

Functional dysphagia

May tx with antidepressants

Front 22

A young man presents with solid dysphagia. What should you be on the lookout for?

Back 22

Eosinophilic Esophagitis

Front 23

What kind of dysphagia would you not use esophageal function testing (manometry)?

Back 23

Obstructive dysphagia

Front 24

If you knocked out cholinergic neurons in the myenteric plexus what disease would manifest?

Back 24

Achalasia; the LES is inhibited by the myenteric plexus using vasoactive intestinal polypeptide (VIP) and nitric oxide (NO) neurotransmitters; knocking out the MP would result in increased tone

Front 25

What action stimulates the cholinergic neurons in the myenetric plexus to inhibit the lower esophageal sphincter?

Back 25

Deglutition (swallowing)

Front 26

Barium swallow reveals a mid esophageal diverticulum. What is the likely etiology?

Back 26

It is the only true diverticulum of the esophagus (contains all the layers of the esophageal wall)

It's a traction diverticulum due to pulling of the esophageal wall by inflammatory or fibrotic tissue

Front 27

What might cause an epiphrenic diverticulum (located near the diaphragm/right above the LES)?

Back 27

Achalasia or another motility disorder

Front 28

What kind of diverticulum is Zenker's?

Back 28

False diverticulum; a herniation of just the MUCOSA and SUBMUCOSA through the muscular wall

Front 29

A patient presents with hypertrophy and fibrosis of muscle, coupled with incomplete relaxation, which causes a defect in the posterior cervical esophagus.

Back 29

Cricopharyngeal bar; the CP muscle constitutes the superior esophageal sphincter;

Front 30

Hypertrophied smooth muscle above the squamo-columnar junction is called what

Back 30

Esophageal A Ring (differs from Schatzki rings in that its muscular, not mucosa or submucosa)

Front 31

A bulemic patient presents with dysphagic. Barium swallow reveals narrowing of the esophagus.

Back 31

Caustic esophageal stricture; damage to esophageal tissue caused scar formation, which tightens the tissue/pulls traction causing difficulty upon swallowing

Front 32

A patient presents with abdominal pain and LES incompetence.

Back 32

Hiatal hernia; separation of the diaphragmatic cura and protrusion of the stomach into the thorax through the resulting gap

Front 33

Which arch and nerve is this describing:

Mesoderm: Muscles of mastication, mylohyoid, anterior belly of digastric, tensor veli palatini, tensor tympani

Neural crest: Maxilla, mandible,incus, malleus, zygomatic bone, squamous temporal bone, palatine bone, vomer, sphenomandibular ligament

Back 33

Arch 1: CN V

Front 34

Which arch and nerve is this describing?
Mesoderm: Muscles of facial expression, posterior belly of digastric, stylohyoid, stapedius

Neural Crest: Stapes, styloid process, stylohyoid ligament, lesser horn and upper body of hyoid bone

Back 34

Arch 2: CN VII

Front 35

Which arch and nerve is this describing?

Mesoderm: Stylopharyngeus, common carotid arteries, internal carotid arteries

Neural Crest: Greater horn and lower body of hyoid bone

Back 35

Arch 3: CN IX

Front 36

Which arch and nerve is this describing?

Mesoderm: Muscles of soft palate (except tensor veli palatini), muscles of the pharynx (except stylopharyngeus) cricothyroid, cricopharyngeus, laryngeal cartilages, right subclavian artery, arch of aorta

Neural Crest: None

Back 36

Arch 4: CN X (superior laryngeal nerve)

Front 37

Which arch and nerve is this describing?

Mesoderm: Intrinisic muscles of the larynx (except cricothyroid), upper muscles of the esophagus, laryngeal cartilages, pulmonary arteries, ductus arteriosus

Neural Crest: None

Back 37

Arch 6: CN X (recurrent laryngeal nerve)

Front 38

Which pouch gives rise to the epithelial lining of auditory tube and middle ear cavity?

Back 38

Pouch 1

Front 39

Which pouch gives rise to epithelial lining of palatine tonsil crypts?

Back 39

Pouch 2

Front 40

Which pouch gives rise to the inferior parathyroid gland and the thymus?

Back 40

Pouch 3

Front 41

Which pouch gives rise to the superior parathyroid gland and the ultimobranchial body?

Back 41

Pouch 4

Front 42

What are the three primordia swellings of the face?

Back 42

Frontonasal prominence, maxillary prominence (pharyngeal arch 1), mandibular prominence (pharyngeal arch 1)

Front 43

How are the nasal cavities and sinuses formed?

Back 43

Invaginations of ectoderm at the nasal pits

Front 44

A patient presents with an abnormally small jaw. You suspect this disease is characterized by a lack of migration of neural crest cells into pharyngeal arch 1 during development. Diagnosis?

Back 44

Treacher Collins Syndrome (mandibulofacial dysotosis)

Front 45

What happens when pharyngeal pouch 2 and pharyngeal groove 2 persist?

Back 45

Tracheoesophageal Fistula

Front 46

An abnormal migration of pouch's 3 or 4 would lead to what?

Back 46

Ectopic thymus, parathyroid, or thyroid tissue

Glandular tissue may be found anywhere along their migratory path

Front 47

Which anatomical landmark separates anterior from posterior cleft palate defects?

Back 47

Incisive foramen

Front 48

which type of cleft palate occurs when the palatine shelves fail to fuse with each other and with the nasal septum?

Back 48

Posterior Cleft Palate

Front 49

Which type of cleft palate occurs when the palantine shelves fail to fuse with the primary palate?

Back 49

Anterior cleft palate

Front 50

Which type of cleft palate occurs when there is a combination of both anterior and posterior defects?

Back 50

Anteroposterior cleft palate

Front 51

A patient presents with a small jaw, low set ears, wide spaced eyes and a cleft palate. Diagnosis?

Back 51

DiGeorge's Syndrome; occurs when pharyngeal pouches 3 and 4 fail to differentiate into the thymus and parathyroid glands

Front 52

Which two arches do the bulk of the tongue come from?

Back 52

1 (anterior 2/3) and 3 (posterior 1/3)

4 forms the very back of the tongue

Front 53

What is the nervous innervation of the general sensory of the tongue?

Back 53

V3 (anterior 2/3), IX (posterior 1/3), X (very back)

Front 54

What is the nervous innervation of the special sense of the tongue?

Back 54

VII (taste anterior 2/3 of tongue, does NOT precisely follow sulcus terminalis boundry), valate papallae which is just anterior to the sulcus terminalis is thus innervates by IX, and X still innervates very back

Front 55

Where do abnormal cysts generally occur?

Back 55

Anterior border of the sternocleidomastoid m.