Lesson 2

Topic: Clinical anatomy, physiology, examination methods of the nose, paranasal

sinuses, pharynx, larynx, trachea, bronchi and esophagus.
1. The actuality of a topic: Patients with pathology of the upper respiratory tract
(URT) see practically all types of doctors. Quite often the reason of chronic
tracheobronchitis may be a latent sinusitis or, conversely, sinusitis can be caused
by a chronic nasal or bronchial pathology. Lymphadenoid pharyngeal ring is a
powerful immunologic organ that plays a significant role in the formation of local
and systemic immunity, but under the influence of negative factors it can become
a source of infection and cause pathological changes in many organs and body
systems. Lesion of the larynx, trachea or esophagus (e.g. foreign body) can
become a reason of airway stenosis, which requires urgent medical assistance
(tracheotomy, esophagoscopy). A number of allergic diseases of the URT are
increasing all over the world. It is impossible to understand the mechanisms of
the URT disorders, pathogenesis, lesion - related complications or distant organs
and systems without a profound knowledge of anatomy, physiology and methods
of analysis of the URT.
2. Lesson duration – 2 academic hours.
3. Purpose of a lesson: to learn clinical anatomy, physiology and methods of
examination of the nose, paranasal sinuses, throat, larynx, trachea, bronchi and
esophagus
4. The student is expected to learn:
- clinical anatomy of the nose, paranasal sinuses, throat, larynx, trachea, bronchi
and esophagus;
- age peculiarities of these organs;
- physiology and pathophysiology of the upper respiratory tract (URT), bilateral
influence on other organs and systems;
- methods of examination of the upper respiratory tract (URT)
5. The student should be able to
- conduct an endoscopic examination of the upper respiratory tract;
- be able to evaluate the obtained endoscopic data and perform differential
diagnosis;
- be able to read X-ray of the paranasal sinuses, nose and ear;
- conduct data analysis of the CT, MRI of paranasal sinuses, nose and ear;
- perform diagnostic and therapeutic manipulations (taking smears from the
nasal cavity, and pharynx, lubricating of the nasal cavity mucosa);
- conduct a research of nasal breathing (test with a cotton wool) and olfactory.
6. Reference:
1. Otorhinolaryngology / Edited by Y.Mitin, Y.Deyeva. – Kyiv: «MEDICINE» –
2009. – P. 73-77, 117-120, 162-170, 224-225, 228-229.
2. Diseases of the ear, nose and throat / Edited by Martin Burton, Susanna
Leighton, Andrew Robson, John Russel. – Edinburgh London Nesw York
Philadelphia St Louis Sydney Toronto: Churchill Livingstone. – 2000. – P. 81-
93, 133, 151-156, 167-176.
3. Essentials of Otolaryngology / Edited by Frank E. Lucente, Steven M. Sobol. -
Philadelphia New York: Lippincott-Raven. – 1997. – P. 11-35.
 4. A color atlas of ENT Diagnosis / Edited by T.R. Bull. – London: Wolfe
Medical Publications Ltd. – 1987. – P. 36-49
5. Otolaryngology. The Essentials / Edited by Allen M.Seiden, Thomas A.Tami,
Myles L.Pensak, Robin T.Cotton, Jack L.Gluckman. – New York Stuttgart:
Thieme. – 2001.- P.77-94, 177-182, 207-212, 235-246, 275-294, 331-342.
7. Control questions:
 Clinical anatomy of the nose and paranasal sinuses (peculiarities of
blood supply, and innervation).
 Physiology of the nose and paranasal sinuses.
 Examination methods of the nose and paranasal sinuses.
 Clinical anatomy of the pharynx (blood supply, and innervation).
 Structure of palatine tonsils and functions of Waldeyer's-Pirogov
tonsillar ring.
 Clinical anatomy and physiology of the larynx.
 Examination methods of the larynx and pharynx.
 Clinical anatomy, physiology and methods of examination of trachea,
bronchi and esophagus.
8. Tests examples:
I. The thickest wall of a frontal sinus is:
1 - from below
2 - back
3 - front
4 – middle

II. Ciliary movement of the nasal ciliated epithelium is directed to:

1 - to nostrils
2 - to choanas
3 - chaotically

III. The Kiesselbach plexus, or the Little area is located:

1 - in anteroinferior part of nasal septum
2 - in posteroinferior part of nasal septum
3 - in anterosuperior part of nasal septum

IV. Which nasal sinus drains to the middle meatus?

1 - maxillary sinus та nasolacrimal duct
2 - frontal sinus, frontal and middle cells of ethmoidal sinus
3 - frontal sinus, maxillary sinus, frontal and middle cells of ethmoidal
sinus

V. To the second degree of hypertrophy of palatal tonsils correspond:

1 - palatal tonsils come into contact with each other
2 - palatal tonsils come forward for front palatal handles on 1/3
distances between the edge of front palatal handle and tongue
3 - palatal tonsils are hidden after front palatal handles
4 - palatal tonsils come forward for front palatal handles on 2/3
 distances between the edge of front palatal handle and tongue

VI. Space between the capsule of palatal tonsil and pharyngeal muscles is filled
with:
1 - fat
2 - lymphoid tissue
3 - connective tissue

VII. Postpharyngeal space is connected with:

1 - with frontal mediastinum
2 - with back mediastinum
3 - with parapharyngeal space

VIII. Situational task.

A 34 year old patient visited an otorhinolaryngologist with complaints on
headache, aggravated when bending a head forward and exercisising, general
weakness, fever, disturbance of nasal breathing, purulent nasal discharge from the
right nostril. During the endoscopic examination from the right side were revealed
hyperemia and swelling of nasal mucous membrane, purulent discharge in middle
pathway. What lesions of paranasal sinus can be suspected?
1. left frontal, maxillary
2. sphenoid, right frontal, front cell of ethmoidal labyrinth
3. right frontal, maxillary, front cell of ethmoidal labyrinth
4. right frontal, maxillary, rear cell of ethmoidal labyrinth
5. right frontal, front cell of ethmoidal labyrinth, sphenoid