Head & Neck – Pharynx and Larynx
1
Describe the position of the pharynx
Max.
Mark
The Pharynx is the superior, expanded part of the Alimentary
System, posterior to the nasal and oral cavities and extending
inferiorly past the larynx (x1)
Actual
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1
2
Max.
Mark
Describe the boundaries of the pharynx and where it is widest
and narrowest
The Pharynx extends from the Cranial Base to the Inferior Border
of the Cricoid Cartilage Anteriorly (x1) and the Inferior Border of C6
Vertebra Posteriorly (x1)
It is widest (Approximately 5cm) opposite the hyoid (x1) and
narrowest (approximately 1.5cm) (x1) at its inferior end, where it is
continuous with the oesophagus.
Actual
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4
3
Max.
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5
Name the most superior part of the pharynx. Describe its
location, function and epithelium. Describe its clinical
relevance.
Nasopharynx (x1)
Posterior to the nose and superior to the soft palate (x1)
Respiratory Function as it is the posterior extension of the nasal
cavities (x1)
Pseudostratified Ciliated Epithelium with Goblet Cells (x1)
Lymphoid tissue forms a Tonsillar ring around the superior part of
the pharynx, which aggregates to form the Adenoids. The adenoids
may become swollen during infection in children, blocking the
Eustachian tube and leading to otitis media. (x1)
Actual
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4
Max.
Mark
Name the middle part of the pharynx. Describe its location,
boundaries, function and epithelium
Oropharynx (x1)
Posterior to the mouth (x1)
Extends from the soft plate to the superior border of the epiglottis
(x1)
Digestive Function (x1)
Stratified Squamous Epithelium non-Keratinised (x1)
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5
5
Max.
Mark
Name the inferior part of the pharynx. Describe its location,
boundaries and epithelium
Laryngopharynx (x1)
Posterior to the Larynx (x1)
Ends from the superior border of the epiglottis to the inferior border
of the cricoid cartilage, where it becomes continuous with the
oesophagus (x1)
Stratified Squamous Epithelium non-keratinised (x1)
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4
6
Max.
Mark
Describe the wall of the pharynx
The wall of the Pharynx consists of an incomplete outer circular
muscle layer and an inner longitudinal muscle layer (x1)
The muscle layer is covered internally by the Pharyngobasilar
Fascia (x1), which is in turn covered by the Mucous Membrane (x1)
Actual
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3
7
Max.
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4
Name the muscles involved in the outer circular muscle layer
of the pharynx
Superior Constrictor (x1)
Middle Constrictor (x1)
Inferior Constrictor (x1)
Lower horizontal fibres known as Cricopharyngeus (x1)
Actual
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8
Max.
Mark
Describe where the outer muscle layer attaches posteriorly
and what happens to them anteriorly. Describe their function
during swallowing
The outer muscle layer attaches posteriorly at the midline raphe
(x1)
The muscles overlap each other and are incomplete anteriorly (x1)
During swallowing the muscle constrict to propel the bolus of food
downwards (involuntarily during the swallowing reflex) (x1)
Actual
Mark
3
9
Max.
Mark
Name the muscles involved in the inner longitudinal muscle
layer of the pharynx. Describe their function during
swallowing.
Stylopharyngeus (x1)
Palatopharyngeus (x1)
Salpingopharyngeus (x1)
During swallowing these muscles act to shorten and widen the
pharynx (x1)
Actual
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4
10
Max.
Mark
Describe the innervation of the pharynx
Innervation of the Pharynx is by the Pharyngeal Plexus of nerves
(x1)
This is formed by branches of the Vagus (CN X) (x1) and
Glossopharyngeal (CN IX) (x1) nerves along with sympathetic
fibres from the Superior Cervical Ganglion (x1)
Actual
Mark
4
11
Describe the sensory innervation of the pharynx
Max.
Mark
Glossopharyngeal Nerve (x1)
Nasopharynx is via the Opthalmic and Maxillary divisions of the
Trigeminal Nerve (CN V1+2) (x1)
2
Actual
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12
Describe the motor innervation of the pharynx
Max.
Mark
Vagus Nerve (CN X) (x1)
Exception to this is the Stylopharyngeus Muscle which is
innervated by the glossopharyngeal nerve (CN IX) (x1)
Actual
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2
13
Name and describe the first phase of swallowing
Max.
Mark
Voluntary phase (x1)
Tongue moves bolus to the back of the pharynx (x1)
Actual
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2
14
Max.
Mark
Name and describe the second phase of swallowing
Pharyngeal Phase (x1)
Afferent information from pressure receptors in the palate and
anterior pharynx reaches the swallowing centre in the brain stem
(x1)
A set of movements is triggered
Inhibition of breathing
Raising of the larynx – Suprahyoid and Longitudinal Muscles
Closure of the glottis
Opening of the upper oesophageal ‘sphincter’
(x1) for every 2 of the sets of movement
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4
15
Max.
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4
Name and describe the third phase of swallowing
Oesophageal Phase (x1)
A wave of peristalsis sweeps down the oesophagus, propelling the
bolus to the stomach in ~9 seconds (x1)
Coordinated by extrinsic nerves from the swallowing centre of the
brain (x1)
Lower oesophageal ‘sphincter’ opens (x1)
Actual
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16
Max.
Mark
Describe the different muscle in different areas of the
oesophagus and what control they are under
The muscle in the upper third of the oesophagus is voluntary
striated muscle (x1) under somatic control (x1)
The muscle of the lower two thirds is smooth muscle (x1) under
control of the parasympathetic nervous system (x1)
Actual
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4
17
Max.
Mark
Describe the blood supply of the pharynx. What artery do
these vessels all branch off of?
The blood supply of the Pharynx is via branches of the External
Carotid Artery (x1)
Ascending Pharyngeal Artery
Lingual Artery
Facial Artery
Maxillary Artery
Actual
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(x1) for every 2 correct branches
3
18
Describe the venous drainage of the pharynx
Max.
Mark
Venous drainage of the Pharynx is via the Pharyngeal Venous
Plexus (x1) → Internal Jugular Vein (x1)
Actual
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2
19
Max.
Mark
Describe the nerves in the afferent pathway and efferent
pathway of the gag reflex
Afferent - Glossopharyngeal Nerve (CN IX) (x1)
Efferent - Vagus Nerve (CN X) (x1)
Actual
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2
20
Max.
Mark
1
What does the gag reflex test?
Pharyngeal innervation and musculature (x1)
Actual
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21
Max.
Mark
What are the adenoids? Describe their location. What happens
to them during infection? What happens to them in recurrent
infections?
Sub-epithelial collection of lymphoid tissue (x1)
Junction of roof and posterior wall of Nasopharynx (x1)
Enlarge with viral / bacterial infections (x1)
Recurrent infections may lead to chronically enlarge adenoids (x1)
Actual
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4
22
Max.
Mark
Describe the clinical features of enlarged adenoids
Nasal obstruction
Mouth breathing, nasal speech
Feeding difficulty (especially infants)
Snoring / Obstructive Sleep Apnoea
Block the opening of the Eustachian Tube
Actual
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(x1) for every 2, 3 marks for all 5
3
23
Max.
Mark
The Palatine Tonsils lie in the Tonsillar fossa between two
arches Name these two arches and describe their position
Anterior – Palatoglossal Arch (x1)
Boundary between mouth and oropharynx (x1)
Posterior – Palatopharyngeal Arch (x1)
Contains the Palatopharyngeus Muscle that blends with walls of
the pharynx (x1)
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4
24
Max.
Mark
2
Describe the lymphatic drainage of the palatine fossa and its
location
Jugulo-Digastric (Tonsillar) node (x1)
Angle of the mandible (x1)
Actual
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25
Max.
Mark
During a Tonsillectomy, there is a potential for bleeding as the
palatine tonsils are very vascular. Describe what artery the
bleeding is usually from. Describe any other nearby
neurovascular structures
Bleeding often from the large External Palatine Vein (x1)
Internal Carotid Artery (x1) and Glossopharyngeal Nerve (x1) lie
just lateral to Tonsillar fossa
Actual
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3
26
Max.
Mark
What is Quinsy? How does it progress? What is a sign? How
do you treat it?
Peritonsillar Abscess (x1)
Infection spread to peritonsillar tissue and abscess formation (x1)
Uvula pushed to the other side (x1)
Requires abscess drainage (x1)
Actual
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4
27
Max.
Mark
Describe common sites for food becoming stuck in the second
part of the pharynx
Vallecula (x1) - Mucosal Pouch between the base of the tongue
and epiglottis
Base of tongue (x1)
Region of palatine tonsil (x1)
Actual
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3
28
Max.
Mark
2
Describe common sites for food becoming stuck in the third
part of the pharynx
Piriform Fossa (x1) - Mucosal Recess between the central part of
the larynx and lateral lamina of the thyroid cartilage
Cricopharyngeus (x1)
Actual
Mark
29
Describe where the Larynx extends to and from
Max.
Mark
The Larynx extends from the Laryngeal Inlet (x1) through which it
communicates with the Laryngopharynx to the level of the inferior
border of the cricoid cartilage (x1)
Actual
Mark
2
30
What is the larynx’s most vital function?
Max.
Mark
Guard the air passages (x1), especially during swallowing when it
serves as the sphincter/valve of the lower respiratory tract
Actual
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1
31
Max.
Mark
The Laryngeal Skeleton is made up of the hyoid bone and 9
cartilages. How many unpaired cartilages are there? Name
them
3 (x1)
Actual
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Epiglottis (x1)
Thyroid Cartilage (x1)
Cricoid Cartilage (x1)
4
32
Max.
Mark
The Laryngeal Skeleton is made up of the hyoid bone and 9
cartilages. How many paired cartilages are there? Name them
3 (x1)
Arytenoid Cartilage(s) (x1)
Corniculate Cartilage(s) (x1)
Cuneiform Cartilage(s) (x1)
Actual
Mark
4
33
What is the epiglottis? How and where is it attached?
Max.
Mark
Leaf-shaped fibro-cartilage (x1)
Attached by ligaments to the back of the hyoid bone and thyroid
cartilage (x1)
2
Actual
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34
Max.
Mark
What is the thyroid cartilage colloquially known as? What
portion of it can be used to find a spinal level, what spinal
level is this and what happens at this level?
‘Adam’s Apple’/’Joey’s Apple’ (x1)
Upper Surface (x1) Used to mark C4 (x1)
Bifurcation of Common Carotid Artery and level of Carotid Body
(x1)
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4
35
Max.
Mark
The thyroid cartilage has 2 lamina and 2 horns. Describe how
and what the horns articulate to or with
Superior Thyroid Horns → Ligament → Hyoid Bone (x1)
Inferior Thyroid Horn → Synovial Joint with Cricoid (x1)
Actual
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2
36
Max.
Mark
What shape is the Cricoid Cartilage? It has 2 articular facets
on either side, what do they articulate with? What can its
surface marking indicate?
Signet ring shaped (x1)
Inferior horn of thyroid cartilage (x1)
Arytenoid Cartilage (x1)
Surface marking for C6 Level (x1)
Actual
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4
37
Max.
Mark
4
What shape is the Arytenoid Cartilage? What is it crucially
involved in? Describe its anterior and lateral sides
Pyramid shaped (x1)
Crucial in vocal cord movement (x1)
Anterior – Vocal process (x1)
Lateral – Muscular process (x1)
Actual
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38
Max.
Mark
What is the crico vocal ligament/membrane also known as?
What does it mainly consist of? Describe its upper and lower
borders
A.k.a. Conus Elasticus / Lateral Cricothyroid ligament (x1)
Consists mainly of elastic fibres (x1)
Lower border attached to cricoid cartilage (x1)
Upper, Free Border = Vocal Ligament - Attached to the deep
surface of the angle of the thyroid cartilage, vocal process of
arytenoid cartilage (x1)
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4
39
Max.
Mark
The internal larynx is split into 3 divisions. Name the first one
and its borders.
Supraglottic space (x1)
Laryngeal Inlet (x1) → Vestibular folds (false vocal cords) (1)
Actual
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3
40
Max.
Mark
The internal larynx is split into 3 divisions. Name the second
one and its borders.
Glottis (x1)
Vocal Cords (x1) and Rima Glottis (x1) (space between vocal
cords)
Actual
Mark
3
41
Max.
Mark
The internal larynx is split into 3 divisions. Name the third one
and its borders.
Subglottic Space (x1)
Below vocal cords (x1) → Lower border of Cricoid Cartilage (x1)
Actual
Mark
3
42
Max.
Mark
4
Name the extrinsic laryngeal muscles and their function
Infrahyoid muscles (x1)
Depress larynx (x1)
Suprahyoid muscles (x1)
Elevate larynx (x1)
Actual
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43
Max.
Mark
Name what the intrinsic laryngeal muscles act on and their
function
Vocal folds (x1) - Open and close glottis (x1)
Aryepiglottic folds (x1) - Help to close the laryngeal inlet (x1)
Actual
Mark
4
44
Describe the innervation of the intrinsic laryngeal nerves
Max.
Mark
The Recurrent Laryngeal Nerve supplies the intrinsic muscles (x1)
except is the Cricothyroid Muscle (x1) which is supplied by the
External Laryngeal Nerve (x1)
Actual
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3
45
Name the layers of the vocal cords
Max.
Mark
Stratified Squamous Epithelium (x1)
Vocal Ligament (x1)
Vocalis Muscle (x1)
Actual
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3
46
Max.
Mark
Describe the mucosa of the vocal cords and explain the
implication of this
Firmly adherent to the vocal ligament, with no submucosa (x1)
Vocal cords look pearly white on laryngoscopy (x1)
No oedema during infections (x1)
Delayed spread of carcinoma of vocal cords (x1)
Actual
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4
47
Max.
Mark
3
Describe the actions of the lateral cricoarytenoid, posterior
cricoarytenoid and the cricothyroid muscles
Posterior Cricoarytenoid - ONLY muscle which opens the true
vocal cords – Abduction (x1)
Lateral Cricoarytenoid – Adduction (x1)
Cricothyroid - Only intrinsic muscle on the outside - Increases vocal
cord tension (x1)
Actual
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48
What cranial nerve innervates the larynx
Max.
Mark
The Larynx is innervated by Branches of the Vagus Nerve (CN X)
(x1)
Actual
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1
49
Max.
Mark
Describe the innervation of the larynx
Superior Laryngeal Nerve (x1)
Internal Laryngeal Nerve – Sensory to Larynx above true vocal
cord (x1)
External Laryngeal Nerve – Motor to Cricothyroid Muscle (x1)
Actual
Mark
Recurrent Laryngeal Nerve (x1)
Sensory below the true vocal cord (x1)
Motor to all intrinsic laryngeal muscles (except Cricothyroid) (x1)
6
50
Max.
Mark
Describe what levels the right and left recurrent laryngeal
nerves descend to and what they curve around
Right Recurrent Laryngeal Nerve - Descends to T2 (x1) - Curves
around the Subclavian Artery (x1)
Left Recurrent Laryngeal Nerve - Descends to T4 (x1) - Curves
around the Arch of the Aorta (x1)
Actual
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4
51
Max.
Mark
1
Why is hoarseness of voice a red flag symptom?
Malignancy (x1)
Actual
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52
Max.
Mark
Name some causes of hoarseness of voice
Infection
Laryngitis – Viral, Streptococcal
Overuse of the voice
GORD – Gastro Oesophageal Reflux
Benign nodules on vocal cords (Singers)
Apical Lung Tumour - Recurrent Laryngeal Nerve Palsy (Both
sides)
Bronchial Carcinoma - Left Recurrent Laryngeal Nerve Palsy (right
doesn’t go low enough)
Actual
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(x1) for 4 different things on the list
4
53
Max.
Mark
Describe blood supply to the larynx and what the vessels are a
branches of
External Carotid Artery → Superior Thyroid Artery → Superior
Laryngeal Artery (x1) for name (x1) for branches
Actual
Mark
Subclavian Artery → Inferior Thyroid Artery → Inferior Laryngeal
Artery (x1) for name (x1) for branches
2
54
Max.
Mark
Describe the venous drainage of the larynx and what these
veins drain into
The Superior Laryngeal Vein (x1) joins the Superior Thyroid Vein
before draining into the Internal Jugular Vein. (x1) for branches
Actual
Mark
The Inferior Laryngeal Vein (x1) joins the Inferior Thyroid Vein,
which empties into the Left Brachiocephalic Vein. (x1) for branches
4
55
Max.
Mark
4
What are some causes of laryngeal obstruction?
Laryngeal Oedema (x1)
Infection – Acute epiglottitis, croup, anaphylaxis (x1)
Inhalation of foreign body (x1)
Tumours (x1)
Actual
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56
Max.
Mark
2
Describe the procedures that can be done in an emergency
situation in a laryngeal obstruction.
In an emergency situation an airway is opening through the
Cricothyroid Membrane (Cricothyroidotomy) (x1)
If less urgent, a Tracheostomy is performed (opening into the
trachea) (x1)
Actual
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