NAPPI Practices Ch.2 CNS, HEAD AND NECK PORTION

the largest portion of the brain and controls thinking, emotions, speech, and voluntary movement

cerebrum

part of the brain located inferiorly and posteriorly in the head and controls movement, balance, and posture

cerebellum

what is the most inferior part of the brain and connects the brain to the spinal cord?

brain stem

how many ounces of CSF does the CNS have

3-5 ounces

how many ventricles are there and what do they do?

4 - two lateral, third ventricle, and fourth ventricle, they produce CSF

what is gray matter made up of

supportive nerve cells

what is the white matter made up of

nerve fiber, axons, and dendrites

Explain the locations of white and grey matter in relation to the brain

the grey matter is peripheral and the white matter is central

explain the location of white and grey matter in relation to the spinal cord

the white matter is peripheral and the grey matter is central

what is the main source of blood of the brain called, and what is it made up of ?

the circle of willis, made up of internal carotid and vertebral arteries

the spinal cord extends from what and ends to the what

from the medulla oblongata to the filum terminale (L1-L2)

What kind of substances can cross the blood brain barrier

lipid soluble substances

water molecules such as glucose, amino acids, and sodium may only cross the BBB if…

they have a carrier molecule

what is the most primary brain tumor in children

astrocytoma

what is the second most common primary brain tumor in kids

medulloblastoma

what is the most common primary brain tumor in adults

malignant gliomas, more specifically; glioblastoma mutiforme

OVERALL, what are the most common brain tumors

metastatic tumors

what is the most common route of spread for CNS tumors

local invasion and seeding through the CSF

Where does most CSF seeding take place

in the lumbosacral region

What are some common symptoms of CNS tumors

increased intracranial pressure → nausea/vomiting, headache, and papilledema

Seizures are common with what kind of CNS tumor

low grade neoplasms

In the WHO grading system what does G1 stand for

low-grade, well differentiated, slow growing, least likely to spread, and may be removed following surgery

What does G3 stand for

poorly differentiated, more likely to spread to nearby tissues

What does G4 stand for

High grade, cells do not resemble normal cells at all, spread quickly, and cannot be completely reomved during surgery

The anterior 2 thirds of the tongue are located…

in the oral cavity

where does the oral cavity extend from and to

extends from the lips to the posterior aspect of the hard palate

Where is the posterior part of the tongue?

in the oropharynx

oral cavity cancers are associated with ______ syndrome (iron deficiency in females

plummer vinson syndrome

cancers of the tongue, floor of the mouth, and tonsils are associated with what kind of virus

HPV

Where is the most common site for cancer in the oral cavity

lips

oral cavity pathology

Oral cavity; Squamous cell Carcinoma

Lymphatic spread for oral cavity

buccinator, jugulodigastric, submandibular, and submental

Where does the upper lip drain to

submandibular and preauricular nodes

where does the lower lip and anterior mouth drain to

submental nodes

Where does the oral tongue drain to

to the anterior cervical chain npodes

where does the buccal mucosa drain to

submandibular and subdigastric nodes

In the oral cavity, where is the most common site of spread

cervical lymph nodes

from superior to inferior, name the subdivisions of the pharynx

nasopharynx, oropharynx, and laryngopharyx/hypopharynx

pharynx cancer symptoms…

consistent sore throat, pain while swallowing, pain in ear, and cervical node enlargement

Where is the nasopharynx located

posterior to the nose and extends inferiorly to the uvula @ the level of C1

Where are the adenoids located

nasopharynx

Why are tumors in the nasopharynx typically not treated with surgery

hard to reach place, and located close to the base of the brain

Caricomas of the nasopharynx typically occur in the _____ walls of it

lateral

There is a strong connection between nasopharyngeal cancers and this virus

epstein barr virus

the epstein barr virus is most closely related to…

Mononucleosis

Where is the oropharynx located

posterior to the oral cavity and extrends from the soft palate to the hyoid bone (C2 to C3)

Where are the palatine tonsils located

oropharynx

Where do most cancers in the oropharynx occur?

tonsils

Oropharynx cancers are associated with what habits

alcohol, smoking, and HPV

Where is the laryngopharynx located

extends from the hyoid bone to the esophagus (epiglottis is supeior border at C3)

The plaryngopharynx is _____ to the larynx

posterior

Where is the most common location for cancer within the laryngo/hypopharynx

pyriform sinus

Most pharynx cancers are…

squamous cell carcinoma - pharynx

Where does the oropharynx drain to

subdigastric, upper cervical, submaxillary, and parapharyngeal

Where does the nasopharynx drain to?

cervical, retropharyngeal (node of rouviere), and JD nodes

Where does the hypopharynx drain to

midcervical nodes, superior deep, middle and low jugular nodes, and node of rouviere

WHere does the nasopharynx spread to?

cranial nerve involvement and mets to the bone, lung, or liver

where does the oropharynx spread to?

lymph nodes (contra or ipsilateral), and invade structures located close to the tumor

where does the hypopharynx spread to

lymph nodes and invades nerves and muscles nearby

where does the larynx extend to and from

extends from the epiglottis to the cricoid cartilage (level of C3 to C6)

name the divisions of the larynx

supraglottis, glottis, and subglottis

what does the supraglottis contain

epiglottis, false vocal cords, ventricles, aryepiglottic folds, arytenoids

what does the glottis contain

true vocal cords, and anterior/ posterior commissures

The subglottis is ___ cm below the true vocal cords

1 cm

What is the most common symptom from larynx cancer

sore throat and hoarseness

Most larynx cancers are

squamous cell carcinoma - larynx

Glottic cancers rarely spread to…

the lymph nodes

supraglottic cancers spread first to the…

JD and midjugular nodes

Subglottic cancers spread to…

the pretracheal, paratracheal, and inferior jugular nodes

What is the main spread pattern for larynx cancers

spread to the local nodes or supraclavicular nodes

What are the 3 main parts of the salivary glands

• parotid

• submandibular

• sublingual

largest salivary gland

parotid

the parotid gland is…

the most common salivary gland where cancer occurs

How is the parotid gland treated

with a wedge-pair technique

Most salivary gland cancers present with…

a rapidly growing mass

What is the most common malignant type of salivary gland cancer?

mucoepidermoid carcinoma

Parotid cancers can be of what pathology?

adenocarcinoma - parotid

Most tumors in the major salivary glands are…

benign

Salivary gland tumors spread to…

nodes of the same side (ipsilateral) of the tumor

SPECIFICALLY, what nodes can salivary gland tumors spread to?

facial, submandibular, and extraglandular parotid group

Salivary gland spread patterns

cranial, facial nerves, and arteries within the neck

the thryoid consists of…

a right and left lobe connected by an isthmus

thyroid cancers may present as a…

palpable mass

What is the most common type of thyroid cancer?

papillary

what are thyroid cancers most commonly treated with?

I-131

What is the half life of I-131

8.02 days

Where does the thyroid drain to?

Internal jugular chain, anterior cervical/delphian, pretracheal nodes, and paratracheal nodes

How do papillary and mixed papillary-follicular nodes spread?

thru lymph nodes

follicular cancers spread through…

blood stream to bone, lungs, liver, and brain

Medullary cancers spread…

regionally and to cervical lymph nodes (distant mets to lungs, liver, and bone)

Anaplastic cancers spead…

locally to skin and trachea and to lymph nodes

The jugulodigastric node is also known as the…

subdigastric node

The jugulodigastric nodes receives…

almpst all lymph from the head and neck area and is commonly involved in treatment fields

The Node of Rouviere is also known as…

the retropharyngeal node

The node of rouviere is difficult or impossible to reach during _____ which leads to….

surgery which leads to higher risk of distant mets

The spinal accessory chain is also known as…

posterior cervical lymph node chain

the mastoid node is also known as…

the retroauricular node