ENT miscellaneous 2

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Kianoosh
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139237
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ENT miscellaneous 2
Updated:
2012-07-13 01:53:31
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ENT ORL otorhinolaryngology Kian Kianoosh Nahid
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ENT miscellaneous part 2 Disclaimer: These flashcards are designed to help ENT residents/master's student in their preparations for final exams. The sources are different textbooks, lecture notes, and pictures uploaded in internet. Please send suggestions/feedbacks to dr.kian@ymail.com.
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  1. genes types?
    • 1) autosomal
    • 2) mitochondrial
  2. genes' action types?
    • 1) dominant
    • 2) recessive
    • 3) Co-dominant ( semi- dominant)
    • 4) X -linked ( can be dominant or recessive)
  3. Where is the action point of radiotherapy on cell cycle?
    • 1) M ( mitosis)
    • 2) G2 ( prepare to divide)
  4. Where is the action point of chemotherapy on cell cycle?
    S ( DNA synthesis)
  5. What gene is responsible for tumor suppression?
    P53
  6. Classification of chemotherapy agents?
    • 1) Alkalating agents (nytrogen mustard)
    • 2) heavy metals (cisplatin)
    • 3) antimetabolites (Metotrexate)
    • 4) cytotoxic antibiotics (Doxorubicine)
    • 5) spindle poisons (Vinca)
    • 6) Topoisomerase inhibitors (Etopocide)
  7. What is the main limitng factor for dosing chemotherapy?
    Bone marrow suppression
  8. What are the chemotherapy strategies?
    • 1) Combination
    • 2) Adjuvant
    • 3) Neoadjuvant
    • 4) Concurrent
    • 5) Chemoprevention (retinoids)
  9. What is interpupillary diameter?
    60mm
  10. What is normal intercanthal diameter?
    30mm
  11. Branches of ophtalmic nerve?
    • Nasocilliary
    • Frontal
    • Lacrimal
  12. Marx's Grades of microtia?
    • I: slightly small but normal looking ear
    • II: partial or hemi-ear
    • III: peanut ear
    • IV: anotia
  13. Dela Cruz classification of Microtia?
    • -Minor malformation (normal mastoid, OW, inner ear, CN VII, footplate)
    • -Major malformation
  14. Colman's clasification of canal atresia?
    • -Minor aplasia ( incomplete canalization)
    • -Moderate: failed canalization of tympanic bone
    • - Severe: complete abscence of EAC
  15. Schuknecht's TYPES of canal atresia?
    • A: cartilaginous
    • B: total canal
    • C: Middle ear invlovement
    • D: Inner ear, mastoid involvement
  16. Jahrsdoerfer classification for surgery outcome of canal atresia?
    • Better outcome if anatomical structures exist:
    • stapes: 2
    • OW open 1
    • middle ear space 1
    • FN 1
    • Malleus-incus complex 1
    • Mastoid pneumatization 1
    • Incus- stapes connection 1
    • RW 1
    • External ear 1

  17. what divides level VA from VB?
    the line which passes through the inferior border of cricoid cartilage
  18. what is the safe margin for lip cancer resection?
    1cm
  19. what is the lasting time for vicryl and PDS sutures?
    4 weeks and 60 days respectively
  20. when a drain is removed?
    when it drains less than 25ml/day of serous fluid
  21. what is the voltage and advantage of megavoltage RT?
    • 4-20million volts
    • skin is relatively spared during RT
  22. types of delivery of RT?
    • conventional ( 30x2 Gy over 42 days)
    • hypofraction
    • hyperfraction
    • acceleration
    • split course
  23. classification of surgical complications?
    EARLY : bleeding, airway obstruction, increased intrecranial pressure, carotid sinus syndrome, nerve injury

    INTERMEDIATE: pneumothorax, basal pulmonary collapse, bronchopneumonia, DVT, chylous fistula, seroma, skull base syndrome, infection, failure of skin healing, carotid artery rupture, flap failure, fistula

    LATE: recurrence, mets, thyroid/parathyroid failure, parotid gland hypertrophy, lymphedema, hypertrophic scars, HIV,

    • local
    • systemic
  24. Cogan's syndrome?
    • Autoimmune disease acute nonsyphilitic interstitial keratitis
    • sensorineural hearing loss
    • Medium- and large-vessel arteritis
    • severe vertigonausea/ vomiting

  25. Waardenburg's syndrome?
    • Transmitted in an autosomal-dominant fashion
    • and consists of a constellation of findings, including
    • (1) dystopia canthorum
    • (lateral displacement of the medial canthi),
    • (2) broad nasal root,
    • (3) confluence of the medial portions of the eyebrows, (4) partial or total heterochromia iridis,
    • (5) a white forelock
    • (6) SNHL
  26. Apert syndrome?
    • AD?
    • Craniofacial synostosis
    • syndactily
    • crowding
  27. Commonest spot of otosclerosis?
    Fissula ante fenestram
  28. Other name of papillary cystadenoma lymphomatosum?
    • Warthin's tumor
  29. Hennebert's sign?
    false positive fistula test in congenital syphilis and 25% of Meniere's disease.
  30. wallenberg's syndrome?
    • Thrmobosis of PICA (from basilar artery)
    • vertigo, diplopia, dysphagia, hoarseness, horner's syn, sensory loss of ipsilat face and contralateral side of body, ataxia.

  31. Diagnosis? characteristics?
    + auricular crease
  32. Klippel Feil syndrome?
    • synostosis (fusion of cervical vertebrae), brevicollis (short/absent neck) and low posterior hairline with many other associated malformations
  33. tumarkin crisis?
    acute utriculosaccular dysfunction causing sudden fall with no loss of conciousness. in 2-6 % on Meniere's disease.
  34. Variants of SCC ?
    • Verrucous (oral cavity)
    • Hybrid verrucous
    • Pseudosarcoma
    • Basaloid SCC
  35. abductor of vocal cords?
  36. posterior cricoarytenoid : videns VCs
  37. Trotter's triad?
    • Locally invasive NPC:
    • - Ipsilateral headache
    • - unilateral soft palate palsy
    • - CHL
  38. Griesinger's sign?
    pain over mastoid due to phlebitis of emissary vein after lateral sinus thrombophlebitis
  39. What is the diagnosis method of choice for paraganglioma?
    Gadolinium enhanced MRI

  40. Churg- strauss Syn?
    • allergic granulomatous angiitis
    • (in Nose: crusting, polyps)
    • P-ANCA + in 70%
    • phase I: Allergic rhinitis + Asthma
    • phase II: Eosinophillic infiltrative + e. pneumonia
    • phase III: systemic vasculitisi and granulation
  41. CHARGE syn?
    • Coloboma
    • Heart
    • Atresia of choanna
    • Retarded growth
    • Genitalia problem
    • Ear deformity
  42. What do you know of Mucoepidermoid Ca of salivary gland?
    • Comonest ca of major salivary glands and minor ones in oral cavity (34%)
    • mainly in parotid
    • mage 45
    • grading is important
  43. What do you know of adenoid cystic Ca of salivary gland?
    • commonest malignant Ca of minor glands
    • m=f
    • 60th
    • facial pain/paresis
    • nerve spread
    • infiltrative growth and slowly progressive behavior with recurrences and spread over a protracted course of many years

    • subtypes:
    • -cribriform
    • -tubular
    • -solid
  44. Specifications of Acinic cell carcinoma?
    • Low grade
    • Almost always in parotid
    • F>M 30th
    • FNAC not very conclusive (similar to normal gland)
    • 30% recurrence post op
    • Recurrence up to many years later
  45. what is RDI?
    AHI + respiratory effort related arousal (RERA)
  46. UARS?
    upper airway resistance syndrome : exessive daylight somnolence without OSA
  47. Fujita classification of pattern of OSA
    • Type I: collapse in retropalatal
    • Type II: collapse in Retropalatal and retrolingual
    • Type III: collapse in retrolingual
  48. BMI?
    • 19-25 normal
    • 26-30 overweight
    • 30-40 obese
    • >40 very obese
  49. Chemotherapy for Hodgkin's disease?
    • MOPP ( mustagen, oncovin, procarbazine, prednisolone)
    • ABVD (adriamycin, bleomycin, vinblastin, dacarbazine)
  50. Chemotherapy for NHD?
    CHOP: (cyclophosphamide, adriamycin [hydroxy doxorubicin], vincristine [Oncovin], Prednisolone)
  51. Causes of nasal polyposis?
    • allergy
    • infection by H-influ
    • vasomotor changes
    • Due to Bernoli's law ( negative pressure increases in narrow areas when air flows through them)
    • Plysaccaride changes in ground substance
  52. definition of Apnea?
    cessation of airflow for >10sec
  53. Definition of Hypopnea?
    • Reduced airflow >30%, >10sec + >4% reduced SPO2
    • or
    • Reduced airflow >50%, >10sec + >3% reduced SPO2
    • or
    • ECG arousal
  54. Types of OSA?
    • Obstructive: throacoabd effort with reduced airflow
    • Central: No throacoabd effort with reduced airflow
    • Mixed: Ineffective and weak throacoabd effort
  55. Paragangliomas of H&N?
    • carotid
    • jugulotympanic
    • vagal
  56. Related diseases with paragnaglioma?
    • MEN IIA
    • MEN IIB
    • Neurofibromatosis type I
    • Chromosome 2
    • Living in high altitude ( carotid body tumor)
  57. Risk of malignancy in paraganglioma?
    6%
  58. University of Pittsburgh TNM for Neoplasms of the External Auditory Canal?
    • T1
    • Tumor limited to the external auditory canal without bony erosion or evidence of soft tissue extension

    • T2
    • Tumor with limited external auditory canal bony erosion (not full-thickness) or radiographic finding consistent with limited (less than 0.5 cm) soft tissue involvement

    • T3
    • Tumor eroding the osseous external auditory canal (full-thickness) with limited (less than 0.5 cm) soft tissue involvement, or tumor involving middle ear or mastoid, or patients presenting with facial paralysis

    • T4
    • Tumor eroding the cochlea, petrous apex, medial wall of middle ear, carotid
    • canal, jugular
    • foramen or dura, or with extensive (greater than 0.5 cm) soft tissue involvement
  59. Fisch classification for glomus jugulare?
    Type A tumor - Tumor limited to the middle ear cleft (glomus tympanicum)

    Type B tumor - Tumor limited to the tympanomastoid area with no infralabyrinthine compartment involvement

    Type C tumor - Tumor involving the infralabyrinthine compartment of the temporal bone and extending into the petrous apex

    Type C1 tumor - Tumor with limited involvement of the vertical portion of the carotid canalType

    C2 tumor - Tumor invading the vertical portion of the carotid canal

    Type C3 tumor - Tumor invasion of the horizontal portion of the carotid canal

    Type D1 tumor - Tumor with an intracranial extension less than 2 cm in diameter

    Type D2 tumor - Tumor with an intracranial extension greater than 2 cm in diameter
  60. Glasscock-Jackson classification for Glomus jugular?
    Grade I refers to a small tumor involving the jugular bulb, middle ear, and mastoid;

    Grade II is a tumor extending under the internal auditory canal;

    Grade III is one extending into the petrous apex;

    Grade IV is one extending beyond the petrous apex and into the clivus or infratemporal fossa.

    Grades II, III, or IV may exhibit intracranial extension.
  61. Glasscock-Jackson classification for glomus tympancum?
    • A: small tumor on promontory
    • B: Filling middle ear
    • C:
    • C1: from midle ear to mastoid
    • C2: from middle ear to EAC
    • C3: from middle ear to IAC
  62. types of leukoplakia?
    • homogenous
    • nodular
    • ulcerative
  63. The most common sites of oral cancer?
    • edge of tobgue
    • alveola
  64. types of mandibulectomy?
    • marginal
    • -horizontal
    • -vertical
    • pertial
    • subtota
    • total
  65. types of cordectomy?
    • I: subepithelial
    • II: subligamental
    • III: Transmuscular
    • IV: Total
    • V: Extended
    • -a: Contralat VC or ant commisure
    • -b: arythenoid
    • -c: subglottic
    • -d: ventricle
  66. symptoms of LPR?
    Differential dignosis if symptoms persist >6 months?
    • Cough
    • dysphonia
    • globus
    • clearing throat

    Hypopharynx Ca
  67. Treatment of LPR?
    • general (avoid cofeine, mint, late supper, oily food, keep head up while sleeping)
    • medical (metoclopramide, H2 blockers, PPIs)
    • surgical ( pull down LES into abd and fix)
  68. paradoxical vocal cord movement
    definition?
    cause?
    symptoms?
    • VCs don't open or close properly while breathing
    • Wheezing, SOB ( not responding to bronchodilators)

    LPR, cerebral/pontine problems
  69. what are the symptoms and types of labyrinthitis?
    • profound SNHL
    • Acute vertigo

    • Serous: Toxic, viral
    • Suppurative: bacterial
    • Peri L: labyrinth fistula after mastoid surgery
    • Para L: Vertigo/nystagmus in the prescence of CSOM
  70. Griesinger's sign?
    pain over the mastoid due to phlebitis of emissary veins after lateral sinus thrombophlebitis
  71. Blood supply of facial nerve?
    • AICA
    • Labyrinthine
    • Superficial petrosal
    • Stylomastoid
  72. segments of facial nerve?
    • Intracranial: 25mm
    • Meatal: 8-10mm
    • Labyrithine: 4mm
    • Tympanic: 11mm
    • Mastoid: 13mm
    • Extracranial
  73. Melkersson–Rosenthal syn?
    idiopathic triad of:

    • Facial nerve palsy
    • Swelling of lips
    • Fissured tongue
  74. symptoms/ signs of hypopharynx Ca?
    • Symptoms:
    • dysphagia
    • sore throat
    • FB sensation in throat
    • Referred otalgia
    • for more than 2-4 months, in a heavy smoker/drinker
    • Signs:
    • Neck mass
    • LOW
    • hemoptysis
    • hoarseness
  75. Risk of hypothyroidism after
    RT for Ca larynx?
    Leryngectomy?
    Laryngectomy +RT?
    • 20%
    • 50%
    • 65%
  76. Hystopathology of Neck mets with occult primary?
    • 50% SCC
    • 25% Adeno Ca
    • 25% Undiff
  77. Possible origin of primary Ca based on neck node levels?
    • Overall: 90% from H&N
    • 1,2,3: oral cavity, oropharynx
    • 2,3,4: larynx
    • 5: NPC
    • supraclavicular: esophagus, lung, abdominal, pelvic
  78. Shamblin classification for Carotid body tumor? (paraganglioma)
    • I: small, localized, minimally attached to carotid
    • II: partially surrounding vessel
    • III: Complete encasing carotid
  79. Signs of Glumos jugulare?
    • Rising sun (TM)
    • Brown's: siegelization: blanching
    • Aquino's: Gentle pressure on ICA: blanching
    • Audible bruit over mastoid
  80. 10% of Paragangliomas secret what?
    • Thyrosine (norepinephrine)
    • Serotonin
    • Vasomotor intestinal peptide
  81. Layers of esophagus?
    • Mucosa
    • Meissner (sense)
    • Submucosa
    • Circumferential m.
    • Auerbach (peristaltism)
    • Longitudinal m.
    • Adventitia
  82. Pahryngeal pouch:
    Other name?
    Location?
    Related to?
    • Killian dehiscence
    • Posteromedial, between Thyropharyngeus and cricopharyngeus m. ( two parts of Inferior Constrictor m.)
    • Diverticulum of Zenker due to contacture of Cricopharyngeus and neuologic disturbance of pharynx in old men.
  83. Psoterolateral dehiscence of pharynx?
    • Leimer's, dehiscence, between upper pole of vertical esophageal muscles
  84. Natural narrowings of esophagus?
    • UES:15cm from incisiors
    • LMB: 24cm ( left main bronchus)
    • LES: 40cm
  85. What is battle's sign and what does is suggest?
    Postauricular ecchymosis due to traumatic temporal bone fracture
  86. What nodes are contained in level VI?
    • .From hyoid bone to suprasternal notch
    • . pretracheal, paratracheal, precricoid, perithyroid
  87. Where is the association and location of Virchow node?
    • Visceral mets
    • Level IV
  88. Fordyce spots?
    Yellow spots on buccal mucosa which are cebaceous glands.
  89. Bent & Kuhn criteria for Allergic fungal rhinosinusitis?

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