ENT miscellaneous

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ENT miscellaneous
2012-07-13 01:57:26
ENT ORL otorhinolaryngology Kian Kianoosh Nahid

Miscellaneous notes regarding ENT 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. Opitz G syndrome?
    a genetic condition that affects several structures along the midline of the body. The most common features of this condition are hypertelorism; cleft lip, cleft palate, cleft larynx, and defects of trachea, and/or esophagus causing breathing problems and difficulty swallowing (dysphagia); and in males: hypospadias.
  2. What is facial hiatus?
    Hiatus for the passage of the greater superficial petrosal nerve and the petrosal branch of the middle meningeal artery
  3. In what disease we may see wash leather ulceration of epiglottis?
    Gumma of tertiary siphilis
  4. Indication of IMF ( immobilization of mandibular fracture)?
    IMF still has apart to play in two groups of patients. First, those with undisplaced fractures and no neural deficits who want to avoid more complex surgery and, second, those with unilateral condylar fractures.
  5. What is peripheral Giant cell granuloma (epulis)?
    What are differntial diagnoses?
    • Sessile or pedunculated red/blue soft lesion of gingivae less than 2 cm.
    • pyogenic granuloma and peripheral ossifying fibroma
  6. What is Dohlman's procedure?
    Endoscopic removal or closure of zenker diverticulum.

  7. What is the action of stylopharyngeus muscle?
    • elevates the larynx
    • elevates the pharynx
    • dilates the pharynx to permit the passage of a large food bolus, thereby facilitating swallowing
  8. What is Taub test?
    A test prior to insertion making trachooesophageal fistula in laryngectomy patients, they sould be able to produce speech following esophageal insufflation via a properly positioned esophageal catheter.
  9. Baffle effect?
    The prevention of the sound pressure to reach to round window as soon as to oval window, allowing the perilymph to move in scala vestibuli which is crucial for hearing. This is done by TM.
  10. Where is the first olfactory cells located at?
    olfactory epithelium of nasal cavity.

  11. ECOG performance status?
    • 0): Fully active, able to carry on all pre-disease performance without restriction
    • 1): Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
    • 2): Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours
    • 3): Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours
    • 4): Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair
    • 5): Dead
  12. Symptoms of otitic hydrocephalus?
    • headache, vomiting, and papilledema
    • CNVI palsy
  13. Describe the anatomy of retromandibular vein:
    The retromandibular vein (temporomaxillary vein, posterior facial vein), formed by the union of the superficial temporal and maxillary veins, descends in the substance of the parotid gland, superficial to the external carotid artery but beneath the facial nerve, between the ramus of the mandible and the sternocleidomastoideus muscle.
  14. Bezold abscess:
    • an abscess in the sternocleidomastoid muscle where pus from a mastoiditis escapes into the sternocleidomastoid. It is a rare complication of acute otitis media.
    • Severe pain in perimastoid region, difficulty of swallowing, sore throat, difficulty in breathing, nuchal rigidity, and fever.
  15. In noise induced hearling loss, what frequency shows the greatest loss?
    4 kHz
  16. complcations of UPPP?
    • death
    • change in voice, and Rhinolalia aperta
    • food regurgitation
    • Dysphagia
    • Taste disturbance
  17. Potter's syndrome?
    • it's due to oligohydramnios secondary to low renal output:
    • Widely separated eyes with epicanthal folds, broad nasal bridge, low set ears, and receding chin
    • Absence of urine output
    • Difficulty breathing
  18. can thyroiditis cause referral otalgia?
    occasionally yes
  19. Oral cancer risks mnemonics:
    • Plummer-vinson syndrome
    • Alcohol
    • Tobacco
    • Human papilloma virus
    • Leukoplakia
    • Asbestos
    • Bad oral hygiene
  20. Provisional diagnosis in esophagus?
    What would be the main presentation?
    Schatzki's ring (also known as B ring) occurs at the GEJ at the distal margin of the LES and is the most common cause of intermittent solid food dysphagia and food impaction.
  21. Main blood supply of facial nerve?
    • Superior petrosal from midle meningeal a.
    • Internal auditory from AICA
    • Stylomastoid from posterior auricular a.
  22. Basal cell Ca is more common in the upper lip than lower lip.
  23. What is the most common non-squamous Ca of hypopharynx?
    adenoid cystic Ca
  24. which neck triangle is more common for cystic hygroma?
    posterior triangle
  25. Cytological features of cystic hygroma?
    • Endothelial cells
    • Lymphoid cells
    • Cholesterol crystals
    • Proteinaceous material
    • Red blood cells
  26. What are autoantibody against Ro (SSA) checked for?
    They are present in the serum of 50-80% of patients with Sjögren’s syndrome (SS), 30-40% of patients with systemic lupus erythematosus (SLE), and 3-5% of patients with rheumatoid arthritis (RA)
  27. What are autoantibody against La (SSB) checked for?
    .Autoantibodies to the La (SSB) antigen can be detected in the serum of up to 87% of patients with primary or secondary Sjögren’s syndrome
  28. In case of hypersensitivity type 1:
    Dose of intradermal adrenaline in adults?
  29. What is the sign?
    Possible diagnosis?
    • Hypopyon due to anterior uveitis
    • Behcet's disease
  30. What is Behcet's disease?
    • a rare immune-mediated systemic vasculitis
    • ocular, GI, neurologic, lungs, skin, genital syptoms/signs
  31. what is the best branch for retrograde serach for facial nerve?
  32. Ann-Arbor staging for NHL?
    • I) Involvement of a single lymph node region (I) or of a single extralymphatic organ or site (IE)
    • II) Involvement of two or more lymph node regions on the same side of the diaphragm (II) or localized involvement of extralymphatic organ or site and of one or more lymph node regions on the same side of the diaphragm (IIE)
    • III) Involvement of lymph node regions on both sides of the diaphragm (III), extranodal involvement (IIIE), splenic involvement (IIIS), or both (IIISE)
    • IV) Diffuse involvement of one or more extralymphatic organs; organs or tissues, associated lymph node enlargement.
  33. Histologic types of NHL (non-Hodgkin's Lymphoma)?
    • B-Cell phenotype (burkitt)
    • Pre T-Cell origin (lymphoblastic lymphoma)
    • T-Cell origin (anaplastic large cell lymphoma)
  34. What is the age group of Hodgkin's lymphoma (HL) patients?
    the first peak occurring between 15 and 40 years of age and the second peak occurring after age 50.
  35. What is the most common paediatric malignancy?
    ALL (Acute lymphocytic leukemia)
  36. What is the peak age and sex of NHL?
    between 7 and 11 years. Boys are preferentially affected in a 3 : 1 ratio.
  37. Lukes, Butler, and Rye classifications for histologic grading of Hodgkin Lymphoma?
    • lymphocytic predominance (LP)
    • mixed cellularity (MC)
    • nodular sclerosis (NS)
    • lymphocytic depletion (LD)
  38. What antivirus is injected for Recurrent Respiratory Papilloma?
    What is the method of injection?
    • Cidofovir
    • Intralesionally
  39. What muscles close the jaws?
    The masseter, temporalis, medial pterygoid, and superior head of the lateral pterygoid muscles.
  40. Delano classification of the relationship of sphenoid,ethmoids and optic nerve?
    • • In type 1: the optic nerves course adjacent to the sphenoid sinus without indentation of the wall or contact with the posterior ethmoid air cell. This type is most common and occurs in 76% of patients.
    • • In type 2: the nerves course adjacent to the sphenoid sinus, causing indentation of the sinus wall, without making contact with the posterior ethmoid air cell.
    • • In type 3: the nerves course through the sphenoid sinus with at least 50% surrounded by air.
    • • In type 4: the nerves course adjacent to the sphenoid sinus and posterior ethmoid sinus.
  41. What do Oral motor functions include?
    mastication, swallowing, respiration, and vocalization
  42. Requirements for decanulation of tracheostomy?
    • Patient no longer ventilator dependent
    • Patient comfortable on room air
    • Alert and able to obey commands
    • Does not need frequent suction
    • Able to cough and bring out secretions
  43. What is the name of incising the anterior attachment of the uncinate process with a sickle knife?
    Messerklinger infundiulotomy
  44. Wildervanck syndrome?
    A syndrome characterized by the combination of congenital deafness, Duane syndrome (eye retraction), and fusion of the neck vertebrae (Klippel-Feil anomaly). Wildervanck syndrome is limited, or almost completely limited, to females.
  45. Fraser test?
    • Following stapedectomy:
    • test positive if after 20 minutes with the affected ear uppermost, there is an improvement in the PTA and/or speech audiometry. The pathophysiological basis is an air bubble in the cochlea causing cochlear conductive hearing loss.
  46. circumscribed labyrinthitis?
    acute serous labyrinthitis in a discrete area, due to erosion of the bony wall of a semicircular canal with exposure of the membranous labyrinth; called also perilabyrinthitis.
  47. What are the tests for lateral sinus thrombosis?
    • Tobey ayer: the jugular vein on the side of the suspected thrombosis is compressed. A rise in spinal fluid pressure should occur; its absence indicates presence of thrombosis
    • Crowe-Beck: Doing the same, the retina foveal veins are detected, if no bulging noted, test is positive.
  48. What responses are detected in caloric test of ENG?
    • Symmetry of caloric response (Jongkee's formula)
    • Directional preponderance (Stockwell formula)
  49. What is Jongkee's formula for unilateral weakness in ENG?
  50. What is Stockwell's formula for directional preponderance in ENG?
  51. What is osteoradionecrosis?
    more common site?
    What to consider for diagnosis?
    • Osteoradionecrosis and chondroradionecrosis is late onset necrosis of bone/cartilage due to radiotherapy which fails to heal over 3 months. They may occur in various sites in the head and neck, despitethe relative radioresistance of bone and cartilage. This occurs far more commonly in the mandible.
    • underlying malignancy to rule out