Ent Flashcards
(193 cards)
1
Q
Where should you divide the superior and inferior thyroid artery and why?
A
Superior thyroid artery > close to the gland to avoid the external branch of superior laryngeal nerve
Inferior thyroid artery > Far away from the gland to avoid the recurrent laryngeal nerve
2
Q
Name the eight branches of the external carotid artery
A
Superior thyroid, ascending Pharyngeal, lingual, facial, occipital, posterior auricular, maxillary, superfical temporal
3
Q
What is at the C six vertebral level
A
Cricoid cartilage
Trachea begins (end of larynx)
Oesophagus begins (end of pharynx)
4
Q
At what anatomical level does the common carotid bifurcate?
A
C4
Upper border of the thyroid cartilage
5
Q
At what anatomical level is the hyoid bone
A
C3
6
Q
Name the 4 infrahyoid muscles, their innervation and their action and the clinical significance of their innervation
A
Sternohyoid, Sternothyroid, Thyrohyoid (c1 via hypoglossus), Omohyoid
Innervation: Ansa Cervicalis (c1,2,3)
Action: Opening mouth against resistance
Significance: innervated from bottom so therefore if need to cut do on upper half to preserve nerve supply
7
Q
Please describe sections and branches of the facial nerve
A
Nucleus sits within pontine-medullary junction
Cisternal - no branches
Meatal - no branches
Labyrinthine - internal auditory meatus to geniculate ganglian. Enters middle ear at superior medial anterior part of middle ear. First genu (turn). Turns posteriorly. Greater petrosal branch
Tympanic - geniculate ganglion to pyrimidal eminence. 2nd genu, turns horizontal. No branches
Mastoid - 2nd genu to stylomastoid foramen. Nerve ti stapedius, chorda tympani, fibres from auricular branch of X
Extratemporal - Stylomastoid to main branches. Temporal, zygomatic, buccal, marginal mandibular, cervical. Also has branches to posterior auricular nerve, nerve to post belly of digastric and nv to stylohyoid
8
Q
Type B (flat) tympanogram. Differentials? What test to distinguish?
A
OME (normal ECV)
TM perf (high ECV)
Wax (low ECV)
Ecv - 0.6-1.5ml adults, 0.4-0.9ml children
9
Q
Describe the management for acute tonsilitis
A
Analgesia, IVF, Benzydamine gargles, IV Benpen (clarithromycin if pen) or oral PenV, IV ddx
10
Q
Name the 5 supra hyoid muscles, their innervation & their actions
A
Stylohyoid - VII
Mylohyoid - Mylohoid nerve from inferior alveolar from V3
Ant belly of digastric - Mylohyoid nerve from inferior alveolar from V33
Post belly of digastric - VII
Geniohyoid - C1 via hypoglossal
Action - To elevate the hyoid and pull it forwards during swallowing
11
Q
Describe the management options for nasopharyngeal carcinoma
A
Conservative
Radiotherapy
Chemotherapy
Surgery (Nasophayngectomy +-ND)
Can do HA or grommets if conductive HL
12
Q
List some causes of a goitre
A
Iodine deficiency
Autoimmune: Graves disease, Hashimotos thyroiditis
Thyroiditis: Subacute granulomatous (de Quervains), Subacute lymphacitis, Silent Riedels thyroiditis, Acute infective
Granulomatous: Sarcoidosis, TB
Physiological: Puberty, Pregnancy
Idiopathic
13
Q
List some structures passing via the foramen lacerum
A
Ascending pharyngeal artery
Greater petrosal nerve
14
Q
What are the components of Moffetts Solution
A
1 ml of 10% cocaine
1ml of 8.4% sodium bicarbonate
1ml of 1:1000 adrenaline
3 ml of N. Saline
Max - 1.5-3mg/kg
15
Q
What is the max concentration of Lignocaine
A
3mg/kg
7mg/kg (adrenaline)
16
Q
Name some differentials for a lump in the posterior triangle of the neck
A
Common
Lymph node, Lipoma, Epidermoid Cyst
Specific
Pharyngeal pouch, Branchial cyst, Cystic hygroma, Subclavian artery aneurysm, Mass in tail of Parotid
17
Q
List 3 absolute (not relative) indications for tonsillectomy
A
Suspected Malignancy
Severe OSA
Streptoccus carrier with recc. endocarditis
Tonsillitis causing febrile convulsions, Peritonsillar abscess unresponsive to meds + drainage
18
Q
What structures are in the first branchial arch and pouch and its nerve supply
A
Arch: Tensor tympani, Tensor veli palatini, Muscles of mastication, Mylohyoid, Ant Belly of digastric
Pouch: Eustachian tube, Malleus, Incus
Nerve: Trigeminal
19
Q
Name some indications for Bone conduction HA & some complications from BAHA insertion
A
Indications: Single sided deafness, Congenital/Acquired middle ear deformity, Microtia, Canal stenosis, Chronic ottorhoea
Complications of BAHA: Bleeding from dural sinus, CSF leak, Early postoperative infx (meningitis, Late post operative infx, skin infection, scar, numbness, failure, detachment
20
Q
List the structures passing through the stylomastoid foramen
A
Facial nerve
Stylomastoid artery
21
Q
Name the nerve innervations of the 3 muscles attached to the styloid process
A
Stylohyoid - Facial (VII)
Stylopharyngeus - Glossopharyngeal (IX)
Styloglossus - Hypoglossal (XII)
22
Q
List the 4 muscular attachments to the mastoid process
A
Sternocleidomastoid
Post belly of digastric
Splenius capitis
Longissimus capitis
23
Q
In a facial nerve palsy that is House-Brackmann grade 4 or above which phenomenon may you see & what is it
A
Bells phenomenon - ‘ An upward & outward movement of the eye when an attempt is made to close the eye’
24
Q
Describe the innervation of the lacrimal gland & the nucleus
A
Greater petrosal (VII) via the pterygopalatine ganglion & lacrimal nerve (V1)
Nucleus -> Superior Salivatory nucleus
- From the pterygopalatine ganglion also supplies nasal mucosal glands & minor palatine salivary glands
25
Arterial blood supply to Tonsils
*Tonsillar branch of facial artery - lower pole*
Lingual
Ascending palatine
Ascending pharyngeal
26
What structures are removed in a level 1 neck dissection
Lymph nodes
Submandibular gland
27
What gets damaged in level IV of the neck
Common carotid
Internal jugular
Phrenic nerve
Lymphatic trunk
28
What structures can be damaged in level I of the neck
Ant jugular vein
Submandibular gland
Hypoglossal nerve
Mylohyoid nerve
Facial, Submental and mylohyoid vessels
29
Describe how to differentiate the degree of nystagmus
1st degree - Nystagmus only on gaze in direction of fast phase
2nd degree - 1st + nystagmus on looking ahead
3rd degree - Nystagmus on gazing in all three directions
Alexanders law: The amplitude of nystagmus increases as gaze increases in the direction of the fast phase
30
Why is a rash seen in mouth in Ramsey Hunt
Branch of facial nerve from geniculate ganglion supplies some sensation to the oropharynx
31
List the 5 structures that pass through in the internal auditory meatus
Facial nerve
Cochlear nerve
Sup division of vestibular nerve
Inf devision of vestibular nerve
Labyrinthine artery
32
What are the complications of tracheostomy
Early - Bleeding, Infx, Recc laryngeal nerve inj, surgical emphysema, pneumothorax, tube displacement, tube obstruction
Late - Tracheocutaneous fistula, Tracheoesophageal fistula, Tracheal stenosis, Tracheoinnominate artery fistula
33
Name some symptoms that may present with nasal polyps
Nasal obstruction
Nasal discharge
Anosmia
Snoring
Halitosis
Headaches
34
List some systemic & some local causes of bilateral benign polyps
Systemic
Asthma, Aspirin exacerbated resp disease, Cystic fibrosis, Primary Ciliary Dyskinesia, Young syndrome (CRS, nasal polyps, azoospermia), Churg Strauss (E-GPA)
Local - Allergic fungal sinusitis, Chronic rhinosinusitis, Allergic RS, Non allergic rhinitis with eosinophilia syndrome (NARES)
35
Name some complications from a neck dissection
Numb skin
Stiff neck
Haematoma
Chyle leak
Accessory nerve damage
Hypoglossal nerve damage
Marginal mandibular nerve damage
Recurrance
36
Name some complications of prominent ear surgery
Bleeding
Infection/ Perichondritis
Pinna haematoma + cartilage necrosis
Asymmetry, Patient dissatisfaction
Telephone ear deformity
Keloid scar
Anaesthesia/ paraesthesia
Suture extrusion
Recurrence
Ear canal stenosis
37
List some blood tests that you may request to investigate a septal perforation
Fbc, esr, C-anca, panca, ace, vdrl, anti rheumatoid factor
38
Describe the management for Menieres disease
Conservative - eat and drink at even intervals, low salt diet, low caffeine, reduce stress, stop smoking
Medical - vestibular sedatives (prochlorperazine) during attackes, thiazide diuretics (indapamide), hearing aids, masking device for tinnitus
Surgical - grommet + menniet, intratympanic steroids/gentamicin, endolymphatic sac surgery, vestibular nerve section
39
Describe the management of OME in
a) children
b) children with Downs
c) children with cleft palate
d) adults
A) watch and wait 3/12, Grommets, HA 2nd line
B) W&W 3/12, HA 1st, Grommets 2nd
C) W&W 3/12, HA 1st, Grommets and primary closure of cleft 2nd
D) Nasopharyngoscopy + CT/MRI
Medical: Toynbee manouvre, Otovent balloon, IN steroids
Surgical: Post nasal space biopsy, Grommet/T-tube
40
Describe the complications of a stapedectomy
Early - Bleeding, Dead ear, VII palsy, perilymph fistula, vertigo, tinnitus, displacement of prosthesis from incus
Late - secondary perilymph fistula, necrosis of long process of incus
41
List some complications secondary to surgery for a pharyngeal pouch
Immediate - Primary haemorrhage, Oesophageal perforation +- conversion to open, RLN damage, damage to teeth
Early: 2 haemorrhage, wound infx, hoarseness, pharyngocutaneous fistula, mediastinitis
Late: Stricture, Oesophageal stenosis, recurrence (10%)
42
Management options for a CPA tumour
Watchful waiting (if asymptomatic)
Sterotactic radiosurgery (GAmma knife)
Surgical resection (translabyrinthine, middle fossa or rectosigmoid)
43
List some differences between a haemangioma and a vascular malformation
Haemangiomas are usually absent at birth. They grow rapidly and involute spontaneously by 18 months
44
What is the make up of Men1, men 2a and men 2b
MEN1: Parathyroid, Pancreas, Pituitary
MEN2A: Parathyroid, Medullary cell, Phaechromocytoma
MEN2B: Medullary cell, Phaochromocytoma, Multiple neuromas
45
What are some suspicious characteristics on uss for thyroid malignancy
Solid
Hypoechoic
Disrupted peripheral calcification
Lobulated
46
How would you differentiate between mastoiditis & post auricular lymphadenopathy
+
Name which childhood disease the post auricular lymph node is commonly affected
Acute mastoiditis: Corysal symptoms, fever, pain, red bulging tm, proptosis of auricle, abscess of post auricular sulcus
Rubella
47
List 5 complications of a deep neck space infection
Septicaemia
Endocarditis
Mediastinitis
Thrombosis of great vessels of the neck
Pyopneumonitis
Purulent pericarditis
Bronchial erosion
Aspiration pneumonia
Grisel syndrome (non traumatif subluxation of atlanto-axial joint)
48
What structures pass via the inferior orbital fissure
Infraorbital nerve (v2)
Zygomatic nerve (v2)
Infraorbital artery
49
List the structures passing via the foramen spinosum
Middle meningeal artery + vein
Meningeal branch of mandibular nerve (v3)
50
Name some differentials of a lump in the anterior neck triangle
Superficial: lymph node, lipoma, epidermoid cyst, branchial cyst
Deep: submandibular gland swelling (stone, neoplasm), largngocele, carotid artery aneurysm, carotid body tumour
51
Management of hyperthyroidism
Antithyroid medications (carbimazole or propythiouracil)
Radioiodine therapy
Thyroidectomy
52
What structure are in the 4th branchial arch and pouch and nerve supply?
Arch: Cricothyroid, All intrinsic muscles of soft palate, Thyroid cartilage, Epiglottis
Pouch: Superior parathyroid
Nerve: Vagus (Superior laryngeal nerve)
53
List 3 symptoms and 2 associated abnormalities found in Hereditary Haemorrhagic Telangiectasias
Symptoms: Epistaxis, GI bleeding, Haemoptysis
Ass abnormalities: AV malformations (lung, liver, brain, spine), Aneurysms
54
Name some causes of a saddle nose
Trauma: Septal haematoma
Iatrogenic: Rhinoplasty, Cautery
Systemic: Wegeners granulomatosis (GPA), Sarcoidosis, SLE, Relapsing polychondritis
Infective: Leprosy, Syphillis
Drugs: Cocaine
Neoplasia: T cell lymphoma
55
What vessel is usually involved in traumatic epistaxis
Anterior ethmoidal artery
56
Management options for Septal Perforation
Conservative (asymptomatic)
Medical - crusting -> regular douching & nasal cream
Surgical -> Whistling - make bigger
Surgical closure with septal button or flap
57
State the inheritance and describe the management of HHT
Autosomal Dominant
Conservative (monitoring)
Acute bleeds (Adrenaline soaked sponges & epistaxis balloons)
Medical - Oestrogens (HRT/OCP/topical), Antifibronolytic (TXA), Anti-angiogenic (bevacizumab, thalidomide)
Surgical - Laser photocoagulation, Youngs procedure (surgical closure of nares)
58
Describe the innervation of the parotid gland + nucleus
Lesser petrosal (IX) via the otic ganglion & travelling via the auriculotemporal (V3)
Nucleus -> Inferior Salivary Nucleus
59
Which arteries make up Kiesselbachs plexus
LEGS
Superior Labial artery
Anterior Ethmoidal artery
Greater palatine artery
Spenopalatine artery
60
Describe the difference between exostoses & osteomas
Exostoses - Bilateral multiple broad based masses in anterior & posterior EAC. 2nd to cold water exposure
Osteomas - Unilateral solitary pedunculate mass at bony-cartilaginous junction
61
What structures can be damaged in level V of the neck
Accessory nerve
Cervical plexus branches
Branchial plexus trunks
Occipital/transverse cervical/suprascapular/subclavian artery
Transverse cervical/suprascapular/external jugular vein
62
Common organisms found in OE
Pseudomonas aeriginosa
Staphylococcus aureus
Fungal: Aspergillus niger, Candida albicans
63
What are 3 medications used to treat enlarged nasal turbinates
Steroids
Antihistamines
Leukotriene antagonists
64
Give the medical name for
a) Underdeveloped pinna
b) Total absence of pinna
c) Absence of EAC
a) Microtia
b) Anotia
c) Canal atresia
65
What does each sinus drain into?
Frontal - frontonasal duct opening to hiatus semilunaris in middle meatus
Sphenoid - Sphenoethmoidal recess
Anterior ethmoids - Hiatus semilunaris (middle meatus)
Middle ethmoids - Lateral wall of middle meatus (ethmoid bulla)
Posterior ethmoids - Lateral wall of superior meatus
Maxillary - Hiatus semilunaris (middle meatus)
66
Describe the management of protruding ears
Conservative - Camouflaging or Splinting (<6/12)
Surgical - either pre school or >5
Pinnaplasty (Anterior scarring of cartilage, Posterior cartilaginous trenches made with diamond burr, Mustarde suturing method)
67
What is the embryological defect responsible for cleft lip
Failure of fusion of the maxillary prominence & the medial nasal processes
68
List & categorise some complications of FESS
Local: Bleeding, Infection, Hyposmia/Anosmia, Adhesions, Facial pain, Periorbital ecchymosis/emphysema, Nasolacrimal duct injury, Recurrence
Orbital: Diplopia, Blindness
Cranial: CSF leak, meningitis, brain abscess, headache, bleed, stroke, pneumocephalus
69
Describe the symptoms that may present with vocal cord papillomatosis
Hoarse voice
Stridor
SOB
Children: Weak cry, Chronic cough, Noisy breathing
70
Name some childhood systemic diseases associated with allergic rhinitis
Asthma
Atopic dermatitis
Allergic conjunctivitis
OSA (lymphoid hypertrophy)
OME (ETD)
Acute & chronic rhino sinusitis
Nasal polyps
Sleep disorders
71
Describe the management of Otosclerosis
Conservative: HA
Surgery: Stapedectomy
Unproven: Fluoride
72
Name some signs & symptoms of laryngomalacia
High pitched inspiratory stridor
Worse when supine/crying/peri-feeding
Normal cry
Nasal congestion with no secretions
Feeding ok
Developmentally normal
Snoring/Sleep disordered breathing
Normal saturations
Omega shaped epiglottis
Enlarged arytenoids
73
How much of a drug is in it if it states its 2%
2% = 20 miligrams/ml
74
List some indications for a tracheostomy
Mechanical obstruction (e.g. cancer, trauma, RLN palsy)
Protection of airway (unable to control secretions due to paralysis/neurological)
Reduce dead space/wean from ventilator
Part of another procedure (e.g. total laryngectomy)
75
List 3 complications of Haemangiomas
Bleeding
Infection
Platelet depletion (Kasabach - Merritt Syndrome)
Stridor (depending on location)
76
Describe the management of a post tonsillectomy bleed
A-E assessment
Adrenaline soaked sponge on long clamp
Electrocautery
Silver nitrate cautery
Tranexamic acid
H2O2 gargles
?Abx
Admit overnight
77
Name some structures that could be damaged during an operation on a branchial cyst
Carotid artery
Facial nerve (VII)
Vagus (X)
Hypoglossal (XII)
Lingual nerve
78
Describe the management of a branchial cyst
Conservative - Observation
Medical - Abx if infected
Surgical - At least 3/12 post infected episode - Transverse cervical step-ladder incision or endoscopic retroauricular approach
Radiological - US guided sclerotherapy
79
Name the 4 muscles of mastication +
Which one opens the mouth and protrudes the jaw
Masseter
Temporalis
Lateral pterygoid
Medial Pterygoid
Lateral pterygoid is only one that aids in opening jaw and protrudes jaw
80
What is the mechanism of action of the following
a) Chlorphenamine
b) Beclometasone
c) Pseudoephedrine
d) Xylometazoline
e) Ceterizine
f) Montelukast
a) H1 histamine antagonist
b) Corticosteroid
c) alpha adrenergic receptor agonist
d) alpha adrenergic receptor agonist (Otrivine)
e) H1 histamine antagonist
f) Leukotriene receptor antagonist
81
What structures are in the 2nd branchial arch and pouch and its nerve supply
Arch: Stapes, Buccinator, Stapedius , Facial expression muscles, Lesser horn and part of body of hyoid
Pouch: Supratonsillar fossa
Nerve: VII
82
The direction of nystagmus is given by the direction of ???
And what does it mean?
Fast phase
Higher relative afferent activity or towards ampullae endolymph flow
83
Describe the management of enlarged nasal turbinate
Medical: Steroids, Antihistamines, Leukotriene antagonists
Surgical: Outfracture of turbinate, Submucous diathermy, Turbinate trimming
84
What is Gradenigo's Syndrome?
It is a complication of OM and mastoiditis involving the apex of the petrous temporal bone: its synpyoms are:
Retro orbital pain in area supplied by V1
VI nerve palsy
OM/Mastoiditis
85
Give 2 medical & 2 surgical options for managing drooling
Medical: Anticholinergic agents, Botox injection under USS guidance
Surgical: Submandibular duct transposition, Adenotonsillectomy, Submandibular gland excision
86
Common organisms found in Acute Mastoiditis
Streptococcus pneumoniae
Group A streptococcus progenies
Haemophilus influenza
Psuedomonas aeriginosa
Moraxella catarrhalis
Chronic: Staphylococcus aureus
87
Describe management for acute OM
Conservative: warm well humidified rest, analgesia, antipyretics
Medical: Abx (amoxicillin, trimethoprim))
Surgical: Grommet insertion (>6 episodes)
88
Name some organisms commonly found in AOM
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella Catarrhalis
Streptococcus pyroxenes
Staphylococcus aureus
89
Describe some features of Nystagmus found in BPPV
Geotropic with problem ear down during provocation
Latency
Limited duration
Fatiguability
Reversal of nystagmus upon return to upright position
90
List 3 surgical techniques to treat enlarged nasal turbinates
Outfracture
Submucous diathermy
Turbinate trimming
91
What are the intensities of sound used in tympanograms for
a) 3 month old baby
b) 3 year old child
a) 1000Hz
b) 226Hz
92
Name the cause and describe the management of VC papillomatosis
HPV 6 & 11
Medical: Indole-3-carbinol, Immunostumalants
Surgical: Debridement using microdebrider or laser
Adjuvant: Alpha interferon & intralesional antivirals (cidofivir)
93
Name some differentials for a midline neck lump
Superficial: Lymph node, Lipoma, Epidermoid cyst, Dermoid cyst
Deep: Thyoid gland/nodule, Thyroglossal cyst, Laryngocele
94
List the structures passing via the foramen magnum
Medulla oblongata
Vertebral arteries
Spinal arteries
Accessory nerve
Meninges
95
List 2 treatment options for vascular malformations
Camouflage with make up
Laser therapy
96
Name some causes of epistaxis
Local: Trauma, Iatrogenic, Neoplasia, Idiopathic
Systemic: AC, HTN, HHT
97
Name the 5 attachments of the styloid process
Stylohyoid ligament
Stylohyoid muscle
Stylomandibular ligament
Stylopharyngeus muscle
Styloglossus muscle
98
Name and describe the categorisation system for VII palsy
House Brackmann grading system
I - Normal
II - Slight weakness on close inspection
III - Marked asymmetry on movement. Eye closure intact
IV - Marked asymmetry. Eye closure compromised
V - Motion barely perceptible
VI - No movement
99
Name the organism and the management of Ramsey Hunt
Organism: Varicella Zoster
Management: Analgesia, Steroids + PPI, Antiviral (acyclovir 800 QDS 7/7), Eye lubrication/care
100
What structures can be damaged in level III of the neck
Common Carotid artery
Internal jugular vein
Superior Thyroid vein
Internal laryngeal nerve
External laryngeal nerve
101
List the structures passing via the foramen rotundum
Maxillary (V2) division of Trigeminal
102
List some differential diagnoses for an antrochoanal polyp
Juvenile angiofibroma
Nasal glioma
Meningoencephalocele
Inverted papilloma
Mucocele
Grossly enlarged adenoids
Nasopharyngeal malignancy (e.g. lymphoma)
103
Anatomical level of the site most commonly where FB get stuck when swallowed and distance from incisors
Usually at cricopharynxgeus
C6
14-16cm from incisors
104
Name some differential diagnoses for acute tonsillitis
Glandular fever
Scarlet fever
Acute hepatic pharyngitis
Pharyngoconjunctival fever
105
Describe the lymphatic drainage of the larynx
Above VC - Upper deep cervical nodes
Below VC - Lower deep cervical nodes
106
What condition could be present if the patient has bilateral CPA tumours
b) what chromosome & inheritance pattern
Neurofibromatosis type 2
b) AD, Chromosome 22
107
List some differential diagnoses of cerebellopontine angle lesion
Acoustic neuroma/Vestibular schwanomma
Meningioma
Epidermoid cyst
Cholesteotoma
VII schwanomma, Ependymoma, Met
108
What is the difference between a T1 and T2 MRI
T1 - water black
T2 - Water white
109
Describe the PTA in otosclerosis
Conductive hearing loss with decreased air-bone gap (Caharts notch) around 2000Hz
110
At what anatomical level is
a) Hyoid bone/Epiglottis
b) Cricoid/transition of laryngopharynx to oesophagus
a) C3
b) C6
111
Name 4 benefits of braided over monofilament
Greater tensile strength
Better pliability & flexibility
Handles & ties well
Less likely to be crushed/crimped
112
What stitch types are braided
Vicryl
Vicryl Rapide
Silk
113
What stitch types are non-absorbable
Silk
Ethilon/Monosof (Nylon)
Prolene
Novafil
114
Why does cartilage necrosis occur if untreated pinna haematoma
Cartilage blood supply from perichondrium only
115
Name 2 other central nervous system lesions (other than b/l acoustic neuromas) that may be ass. with NF2
Ependymomas, gliomas
Meningiomas
(juvenile sub-capsular cataract)
116
What is Samlers Triad
Recurrent Nasal polyps
Asthma
Aspirin/NSAID hypersensitivity
117
What nerves are involved in the stapedius reflex
Facial and Vestibulocochlear
118
Why are paediatric tracheostomy tubes uncuffed
To reduce the risk of subglottic stenosis
119
How would you measure the stapedial reflex & what is a normal threshold
Tympanometry
70dB (70-100)
120
What structures can be damaged in level II of the neck
Internal jugular vein
Internal carotid artery + External carotid artery + branches
Lingual + Facial veins
Hypoglossal nerve
Internal + External laryngeal nerves
Superior root of ansa cervicalis
121
Describe the PTA in Menieres disease
Low frequency SNHL
122
List the 5 types of malignant salivary gland tumours
Adenoid cystic carcinoma
Mucoepidermoid carcinoma
Acinic cell carcinoma
Carcinoma ex-pleomorphic adenoma
SCC
Adenocarcinoma
123
What is the embryological defect responsible for a bifid uvula
Incomplete fusion of the palatine shelves
124
Name 5 causes of enlarged nasal turbinates
Allergic rhinitis
Infection
Neoplasia
Congenital
Rhinitis medicamentosa
125
Name 2 benefits of monofilament over braided
More resistant to harbouring microorganisms
Less resistant to passage through tissue
126
List 2 medical treatments for haemangiomas
B blockers
Steroids
127
Paralysis of left lateral semi-cercular canal
what would nystagmus look like
Horizontal nystagmus to the right
128
What is the max concentration of
a) Prilocaine
b) Bupivocaine
c) Levobupivocaine
a) 6mg/kg
b) 2mg/kg
c) 2mg/kg
129
What is the management of antrochoanal polyps
Surgery - FESS
130
Describe the PTA in noise induced hearing loss
SNHL reduced hearing at 4000Hz (Aviators Notch))
131
Name 4 medical & 1 surgical management option of CRS
Nasal decongestants
Nasal steroids
Systemic steroids
Abx
FESS
132
Characteristics of stridor in laryngomalacia
High pitched
Inspiratory
Worse when supine, crying, agitated or peri-feeding
Normal cry
133
Describe the innervation of the submandibular gland + the nucleus
Chorda tympani (VII) via the lingual nerve (V3) synapsing in the submandibular ganglion
Nucleus - Superior Salivary Nucleus
134
List the attachments to the pharyngeal tubercle
Superior pharyngeal constrictor muscle
Fibrous raphe of the pharynx (pharyngeal raphe)
135
Name 4 non allergic causes of enlarged nasal turbinates
Infection
Neoplasia
Congenital
Rhinitis Medicamentosa
136
List some RF for cancer of the tongue
Alcohol
Smoking
HPV
Previous RT
Betel nut chewing
Sharp teeth
Spicy food
137
List the structures passing via the jugular foramen
Internal jugular vein (from sigmoid sinus)
Inferior petrosal sinus
Glossopharyngeal nerve (IX)
Vagus (X)
Accessory (XI)
Posterior meningeal artery
138
Describe how to do PTA
Otoscopy + explain procedure
Start at 1000Hz at 60dB
Turn down 10dB until no response
then up 5dB until 3 out of 5 responses
Same for bone conduction
139
At which site do most vocal cord nodules arise + why
Mid membranous region of the vocal cord - junction of anterior 1/3 and posterior 2/33
Why: Thought to arise due to impact stress caused by collision of VCs during vibration. At this point stress in maximal
140
Which stitch types are absorbable?
Vicryl
Vicryl Rapide
PDS
Monocryl
141
What are 3 essential properties of the light from a LASER and what can you vary
Monochromacity
Coherence
Directionality
Can vary the wavelength & the chromophore
142
Presentation of patient with bilateral choanal atresia
Severe airway obstruction
Cycylical cyanosis
Crying alleviates distress (obligate nasal breather)
143
If immunocompromised with Ramsey Hunt what can develop
Disseminated infection across multiple dermatomes
Meningitis
Encephalitis
Atypical pneumonia
144
What would you do to your post auricular incision for a child and why
Incision more posterior and away from mastoid tip
In children (esp <3) mastoid tip not fully developed and protects VII
145
List some symptoms of septal perforation
Whistling
Epistaxis
Nasal crusting
Nasal obstruction
Rhinolalia
Can be asymtomatic
146
What is the embryological defect responsible for cleft palate
Failure of fusion of the lateral palatine processes, the nasal septum or the median palatine process
147
Name the muscle that
a) Abducts the vocal cords + nerve supply
b) Relaxes the VC
c) Adducts the vocal cords (2)
d) Tenses the VC + nerve supply
a) Posterior cricoarytenoid - RLN
b) Thyroarytenoid/ Vocalis
c) Transverse arytenoid + Lateral cricoarytenoid
d) Cricothyroid - External branch of superior laryngeal nerve
148
List the ddx for high frequency hearing loss
Presbyacusis
Drug induced (amikacin, furosemide, cisplatin)
Congenital syphilits, Pagets, CV disease, Congenital hypothyroidism
149
List 8 symptoms of Ramsey Hunt
Vesicular lesions in pinna/palate/tongue
VII LMN palsy
Otalgia
Tinnitis
HL
Vertigo
Altered taste
Dry mouth
150
List the differentials for the following PTA descriptions
a) Assymetrical HL
b) Cookie bite pattern
c) Poor speech discrimination
a) CPA tumour/Acoustic neuroma, Vestibular syndrome (Menieres), Childhood meningitis/mumps/measles, Unilateral NIHL, Temporal bone fracture, Aminoglycoside toxicity
b) Congenital hearing loss, rarely Menieres
c Retrocochlear cause
151
What structures are in the 6th branchial arch & its nerve supply?
Arch: Cricoid cartilage, Intrinsic muscles of larynx other than cricothyroid
Nerve: Vagus (RLN)
152
Injury to which area leads to Battle's sign
Basilar Skull fracture (middle cranial fossa)
153
Name 2 syndromes ass with drooling
CP
Down syndrome
154
What are some of the anatomical abnormalities that lead to a protruding ear
Lack of anti helical fold
Deep conceal bowl
Protruding lobule
155
Where should you divide the superior and inferior thyroid artery and why?
Superior thyroid artery - close to the gland to avoid external branch of superior laryngeal nerve
Inferior thyroid artery - far away from the gland to avoid the RLN
156
Name the 8 branches of the external carotid artery
Superior thyroid artery
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
157
What is at the C6 vertebral level
Cricoid cartilage
Trachea ends (end of larynx)
Oesophagus begins (end of pharynx)
158
At what anatomical level does the common carotid bifurcate?
C4
Upper border of the thyroid cartilage
159
At what anatomical level is the hyoid bone
C3
160
List some ways of identifying the facial nerve intra-operatively
Retrograde dissection
Tragal pointer - 1cm anteroinferomedial
Posterior belly of digastric - Superior & parallel
Tympanomastoid suture - 6-8mm deep
161
Name the 4 most common benign salivary gland tumours
Pleomorphic adenoma
Warthin tumour
Oncocytoma
Monomorphic adenoma
162
What structures are 'always' preserved during a neck dissection
Carotid artery
Brachial plexus
Phrenic nerve
Vagus nerve
Cervical sympathetic chain
Marginal mandibular nerve
Lingual nerve
Hypoglossal nerve
163
Describe the name and cut-offs used to describe the degree of hearing loss
Normal -> 0-20dB
Mild -> 20-40dB
Moderate -> 40-70dB
Severe -> 70-90dB
Profound -> >90dB
164
Contents of Cavernous sinus & position
O TOM CAT
Superior to Inferior (lateral)
Occulomotor nerve (III)
Trochlear nerve (IV)
Ophthalmic nerve (V1)
Maxillary nerve
Medial
Carotid artery
Abducens nerve (VI)
165
Name some ENT related features present in Downs Syndrome
OSA (Adenotonsillary hypertrophy)
OME
Chronic ear infections
SNHL
Hypothyroidism
Chronic rhinitis & sinusitis
166
List 5 symptoms on presentation of a deep neck space infection
Pyrexia
Poor Feeding
Irritability
Drooling
Stridor
167
Name 1 test which is diagnostic for CSF
Beta-2-transferrin
other tests: Halo test, Glucose test
168
What non-random association is found with choanal atresia
CHARGE
-Coloboma of iris
- Heart defect
- Atresia of choanae
-Retarded growth
- Genitourinary abnormalities
- Ear defect
169
List some RF for nasopharyngeal cancer
Southern Chinese
EBV
Woodworker
Salted fish
>50
Male
170
List the structures passing via the superior orbital fissure
Occulomotor nerve (III)
Trochlear nerve (IV)
Abducens nerve (VI)
Lacrimal, Frontal and nasocillary branches of ophthalmic division of trigeminal (V1)
Superior ophthalmic veins
171
Which three structures are sometimes preserved in a modified radical neck dissection compared to a radical neck dissection
Spinal accessory nerve
SCM
Internal jugular vein
172
Name some genetic causes of hearing loss (syndromic)
AD
Waardenburgs, Brachiotorenal, NF2, Treacher collins, Pierre Robin, Crouzon, Aperts
AR
Usher, Pendred, Jervell Lange-Nielson
X-linked
Alports
173
Name 2 features & 3 associated of Pendred Syndrome
Features: B/L SNHL + MNG
Ass: Enlarged vestibular aquaduct, Enlarged endolymph system, Mondini deformity
174
Name some causes of newborn hearing loss (non-genetic)
Prenatal
FH, Maternal alcohol/drug use, Ototoxic medication
Infection (TORCH - toxoplasmosis, rubella, cytolomegalovirus, herpes)
Perinatal
Extreme prematurity, Low birth weight, hypoxia, prolonged ventilation, sepsis
Postnatal
Infection (meningitis, cmv, measles), jaundice, ototoxic medications, head injury
175
Name the newborn hearing screening tests
Automatic otoacoustic emissions
Automated auditory brainstem response
176
Name some CI for PTA
Too young (<4)
Unable to consent/non-compliance
Occluding wax
Blood in EAM
Acute Infection
177
What is the name of the area most commonly implicated in pharyngeal pouch + between which structures is it
Killians dehiscence
Thyrophayngeus + Cricopharyngeus
178
Name 4 functions of the paranasal sinuses
Lighten the weight of the facial skeleton
Assist in warming & humidifying inspired air
Add resonance to voice
Drain mucus secretions into the nasal cavities
179
Describe the management of pharyngeal pouch
Conservative
Medical (botox)
Surgical (endoscopic - dolmans procedure, open myotome)
180
What does LASER stand for and name some adv and disadv
LASER - Light amplification by Stimulated emission of radiation
Adv: Precision, Unobstructed view of operating field, minimal tissue manipulation, better haemostats, increased sterility, cost-effective
Disadv: Increased staff numbers, opportunity cost of equipment & repairs, increased training, increased safety requirements
181
Which nerve is involved in Frey's syndrome & what is its management and investigation
Nerve: Parasympathetic fibres on auriculotemporal nerve (V3) from lesser petrosal via otic ganglion
Ix: Iodine starch test
Mx: *Botox injection*
Aluminium based deodrant
Topical glycopyrolate
Neuonectomy
182
List some causes of parotid enlargement
Infective: Mumps, HIV
Autoimmune: Sjogrens
Granulomatous: Sarcoidosis, TB
Drugs: Thiouracil, OCP, Phenylbutazone, Isoprenaline, Co-proxamol
Neoplastic: Benign/Malignant
Pseuohypertrophy of masseter muscle
183
List 4 associated syndromes with microtia
Treacher Collins
Pierre Robin
CHARGE syndrome
Goldenhar
184
Which muscles make up the anterior and posterior pillars of the tonsils
Anterior: Palatoglossus
Posterior: Palatopharyngeus
185
List the structures passing via the foramen ovale
V3 - Mandibular branch of Tirigeminal nerve
Accessory meningeal artery
Lesser petrosal nerve
Emmissary veins
186
List the components of the Centor criteria + describe mx of acute tonsillitis
Centor criteria: Pyrexia, Tonsillar exudate, Tender anterior cervical lymph nodes, abscence of cough
Mx: Pen V, Analgesia, Hydration, IV dex, Difflam (Benzydamine)
187
Name some causes of acute tonsillitis
Group A beta haemolytic streptococcus (pyogenes
EBV
Influenza
Parainfluenza
Adenovirus
188
List some causes of Septal perforation
Trauma - Iatrogenic, Self-inflicted (FB)
Infection - Septal abscess, Syphilis, TB
Inflammatory - Wegeners granulomatosis (GPA), Sarcoidosis, Relapsing polychondritis, SLE, RA
Neoplastic - SCC, Adenocarcinoma, Melanoma
Surface irritants - Cocaine, Heroine, Arsenic
189
What is the name of and describe the categories of the classification system for peri-orbital cellulitis
Chandlers Grading system
I - Pre-septal
II - Orbital cellulitis without abscess
III - Orbital cellulitis with sub-periosteal abscess
IV - Orbital abscess
V - Cavernous sinus thrombosis
190
Name some red flag symptoms for peri-orbital cellulitis
Proptosis
Opthalmoplegia
Reduced visual acuity
Meningism
Decreased consciousness
191
What structures are in the 3rd branchial arch and pouch and its nerve supply?
Arch: Stylopharyngeus
Greater horn and part of body of hyoid
Pouch: Thymus, Inferior parathyroid
Nerve: Glossopharyngeal (IX)
192
What are the units and normal values of the x and y axis on a tympanogram
x= daPa
Normal value: -50 to +50 in adults
-150 to +50 in children
y = ml
Normal value 0.3 to 1.6
193
What are the USS and aspiration findings of a branchial cyst
USS: Smooth, well defined, uniform, anechoic, posterior enhancement
FNAC: Viscous, turbid, yellow green fluid, cholesterol crystals on microscopy
