ENT Flashcards
(172 cards)
1
Q
in which bone are the organs of hearing and balance located
A
temporal bone
2
Q
what is the pterion
A
h-shpaed suture between the temporal, parietal, frontal and sphenoid bones
thinnest part of the skull
3
Q
where does the middle ear start and end
A
auricle to tympanic membrane
4
Q
where does the inner ear start and end
A
oval window to internal acoustic meatus
5
Q
where does the middle ear start and end
A
tympanic membrane to oval window
6
Q
which nerves supply general sensory innervation to the external ear
A
C2,3
CNVII
CNV3
CNX
7
Q
lymphatic drainage of the lateral surface of superior hand of auricle
A
parotid lymph nodes
8
Q
lymphatic grange of cranial surface of superior half of auricle
A
mastoid lymph nodes
9
Q
lymphatic drainage of inferior half of auricle
A
superficial cervical lymph nodes
10
Q
where does lymphatic drainage from the ear eventually drain
A
deep cervical lymph nodes
thoracic duct or right lymphatic duct
venous angle
11
Q
what type of glands secrete earwax
A
ceruminous
12
Q
general sensory innervation of the external tympanic membrane
A
mostly CNV3
13
Q
general sensory innervation of internal surface of tympanic membrane
A
CNIX
14
Q
structures innervated by CNIX
A
middle ear cavity Eustachian tube nasopharynx oropharynx tonsils
15
Q
what are ossicles
A
middle ear bones
malleus, incus, stapes
16
Q
what type of joints are between the ossicles
A
synovial joints
17
Q
what structures are connected by the Eustachian tube
A
middle ear cavity and nasopharynx
18
Q
where does the facial nerve connect to the CNS
A
junction between pons and medulla
19
Q
chords tympani is a branch of which CN
A
CNVII
20
Q
what does the chorda tympani innervate
A
taste buds of anterior 2/3rds of tongue
parasympathetic supply to submandibular and sublingual salivary glands
21
Q
what is the stapedius
A
a muscle that reduces stapes movement to protect the internal ear from excessive noise
22
Q
which nerve innervates the stapedius
A
CNVII
23
Q
how to test the muscles of facial expression and motor function of CNVII
A
frown
close eye tightly
smile
puff out cheeks
24
Q
what does the otic capsule contain
A
bony labyrinth
25
what sort of fluid is inside the bony labyrinth
perilymph
26
what is suspended within the perilymph of the bony labyrinth
membranous labyrinth
27
what sort of fluid does the membranous labyrinth contain
endolymph
28
what are the three types of epithelium/mucosa in the nasal cavities
keratinised stratifies squamous epithelium
respiratory epithelium
olfactory mucosa
29
somatic sensory innervation of the nasal cavities
anterosuperiorly - CNV1
| posteroinferiorly - CNV2
30
blood supply to the nasal cavities arises from which three main arteries
facial
maxillary
ophthalmic
31
nasal branches of ophthalmic artery
anterior and posterior ethmoidal anteries
32
nasal branches of maxillary artery
sphenopalatine
| greater palatine
33
nasal branches of facial artery
lateral nasal branch of facial
| septal branch of superior labial artery
34
what is little's area
an arterial anastomosis on the nasal septum
| a common site of epistaxis
35
what are the four conchae in the lateral wall of the nasal cavity
sphenoethmoidal
superior
middle
inferior
36
how to confirm placement of an NG tube
x-ray
tube should remain in the midline
tip should be clearly visible
tip should be 10 cm beyond the GOJ
37
how many paranasal sinuses
2 x frontal sinuses
2 x maxillary sinuses
2 x ethmoidal air cells
2 x sphenoidal sinuses
38
what are the paranasal sinuses lined by
mucous secreting respiratory epithelium
39
where do the frontal sinuses drain
middle meatus
40
where do the ethmoidal air cells drain
superior and middle meatuses
41
where do the sphenoidal sinuses drain
sphenoethmoidal recess
42
where do the maxillary sinuses drain
middle meatus
43
what drains into the inferior meatus
lacrimal fluid
44
which sinuses are most commonly affected by sinusitis
maxillary sinuses
| mucous drains against gravity
45
complication of extraction of tooth relating to sinuses
oro-antral fistula
46
where might pain from maxillary sinuses refer to
the maxilla/mandible
| all the teeth
47
what kind of mucosa lines the middle ear
columnar lined mucosa
48
what is schneiderian epithelium
pseudo-stratified ciliated columnar epithelium
49
what kind of glands are salivary glands
exocrine
50
what is otitis media
inflammation of the middle ear
51
most common cause of otitis media
viral infection
52
what is cholesteatoma
abnormally situated squamous epthithelium in the ear canal
| high cell turnover and abundant keratin production
53
bilateral vestibular schwannoma in a young patient may be associated with
neurofibromatosis type 2
54
nasal polyps in children may be a sign of
cystic fibrosis
55
what sort of hypersensitivity reaction is allergic rhinitis
type 1
| IgE mediated
56
nasal signs of GPA
epistaxis
nasal crusting
congestion
septal perforation
57
which virus is associated with nasopharyngeal carcinoma
EBV
58
causes of laryngeal polyps
vocal abuse, infection, smoking
59
contact ulcers may be caused by
chronic throat
voice abuse
GORD
60
squamous papilloma/papillomatosis is associated with which virus
HPV types 6 and 11
61
paraganglioma may be associated with which condition
MEN2
62
commonest head and neck cancer
SCC
63
risk factors for head and neck SCC
smoking
alcohol
HPV
64
what is sialolithiasis
salivary gland stones
65
which condition is caused by paramyxovirus
mumps
66
what is the most common site of salivary gland tumours
parotid
67
what are the most common malignant salivary gland tumours in the uk and worldwide
UK - adenoid cystic carcinoma
| worldwide - mucoepidermoid carcinoma
68
what are the organs of taste
taste buds
69
what cells are taste buds made up of
sensory receptor cells and support cells
70
life span of taste receptor cells
10 days
71
what are the four types of papillae on the tongue
filliform (no taste buds)
fungiform
vallate
foliate
72
which nerves carry afferent taste fibres
CNVII (chorda tympani - anterior 2/3rds of tongue)
CNIX (posterior 1/3 of tongue)
CNX (areas other than tongue)
73
what is aguesia
loss of taste function
74
causes of aguesia
nerve damage, local inflammation, endocrine disorders
75
what is hypoguesia
reduced taste function
76
causes of hypoguesia
chemotherapy, medications
77
what is dysguesia
distortion of taste function
78
causes of dysguesia
glossitis, gum infections, tooth decay, reflex, URTI, medications, neoplasms, chemotherapy, zinc deficiency
79
what types of cells are in the olfactory mucosa
olfactory receptor cells
supporting cells
basal cells
80
structure of olfactory neurones
a thick short dendrite and an expanded end called an olfactory rod
81
life span of olfactory receptors
2 months
82
what are the two criteria a substance must fulfil to be able to be smelt
sufficiently volatile
| sufficiently water soluble
83
what is anosmia
no smell
84
causes of anosmia
viral infection, allergy, nasal polyps, head injury
85
what is hyposmia
reduced smell
86
causes of hyposmia
viral infections, allergy, nasal polyps, head injury
87
what is dysosmia
altered sense of smell
88
complications of acute infectious pharyngitis
otitis media, peri-tonsillar abscess (quinsy), parapharyngeal abscess and mastoiditis
89
common causes of pharyngitis
common cold
influenza
strep infection
90
when to refer pharyngitis
```
suspected throat cancer
sore or painful throat for 3-4 weeks
odynophagia/dysphagia 3 weeks
red, or red and white patches, or ulceration for more than 3 weeks
stridor/respiratory difficulty
```
91
what are the centor criteria
no cough
lymphadenopathy
fever
tonsillar exudate
92
treatment of bacterial sore throat
penicillin (group A strep)
93
complications of strep throat
rheumatic fever
| glomerulonephritis
94
what causes diphtheria
corynebacterium diphtheriae
95
presentation of diphtheria
severe sore throat with a grey/white membrane across the pharynx
96
treatment of diphtheria
antitoxin nd supportive and penicillin/erythromycin
97
presentation of oral thrush
white patches on red, raw mucous membranes in throat/mouth
98
treatment of oral thrush
nystatin
99
presentation of AOM
discharge, hearing loss, fever, lethargy, associated with URTI
100
bacterial causes of AOM
strep pneumoniae
h influenzae
strep pyogenes
moraxella
101
antibiotic treatment of middle ear infections
1st line amoxicillin
| 2nd line erythromycin
102
antibiotics for sinusitis?
in severe/deteriorating cases of >10 days duration
103
treatment of acute sinusitis
1st line pen V
| 2nd line doxycycline
104
presentation of otitis externa
```
redness, swelling
itchy
pain
discharge or increased earwax
loss of hearing
```
105
what is malignant otitis
extension of otitis externa into bone surrounding ear canal (mastoid and temporal bones)
106
why is malignant otitis fatal
it causes OM which can spread to the skull and meninges
107
symptoms of malignant otitis
pain and headache
| more severe than clinical signs would suggest
108
signs of malignant otitis
granulation tissue at bone-cartilage junction of ear canal
exposed bone in ear canal
facial nerve palsy
109
Ix malignant otitis
PV/CRO raised
x-ray
biopsy
culture
110
most common cause of malignant otitis
pseudomonas aeruginosa
111
risk factors for malignant otitis
diabetes
| head/neck radiotherapy
112
bacterial causes of otitis externa
staph aureus
| pseudomonas aeruginosa
113
fungal causes of otitis externa
aspergillus niger
| Candida albicans
114
treatment of otitis externa
topical clomitrazole for fungal
| gentamicin 0.3% drops if bacterial
115
presentation of infectious mononucleosis
fever
enlarged lymph nodes
sore throat, pharyngitis, tonsillitis
malaise, lethargy
116
complications of mono
anaemia, thrombocytopenia
splenic rupture
upper airway obstruction
increased risk of lymphoma
117
cause of mono
EBV
118
treatment of mono
bed rest
paracetamol
avoid sport
antivirals not effective
119
mono Ix
EBV IgM
Paul-bunnel/monospot test
blood count and film
LFTs
120
treatment of HSV1 gingivostomatitis
acyclovir
121
lab confirmation of HSV
swab of lesion in virus transport medium for detection of viral DNA by PCR
122
causes of herpangina
coxsackie viruses
123
what is herpangina
vesicles/ulcers on the soft palate
124
causes of hand foot and mouth disease
coxsackie virus
125
presentation of Behcet's disease
recurrent oral ulcers
genital ulcers
uveitis
GI, pulmonary, MSK, CV neuro involvement
126
what is chancre
painless indurated ulcer at site of entry of bacterium treponema palladium (syphilis)
127
boundaries of the oral cavity
upper and lower teeth
floor of mouth/tongue
oropharynx
hard palate and soft palate
128
3 pairs of salivary glands
parotid
submandibular
sublingual
129
innervation of salivary glands
parotid - CNIX
| other two - CNVII
130
sensory innervation of anterior 2/3rds of tongue
general - CNV3
| special - CNVII
131
sensory innervation of posterior 1/3rd of tongue
general - CNIX
| special - CNIX
132
extrinsic muscles of the tongue
hyoglossus
palatoglossus
styloglossus
genioglossus
133
clinical testing of CNXII
stick out tongue
if both are functioning normally the tongue tip remains in the midline
if unilateral damage the tongue points towards the injured side
134
blood supply of the tongue
lingual artery
135
muscles the soft palate
levator veli palatini
tensor palatini
palatoglossus
palatopharyneus
136
innervation of the muscles of the tongue
CNXII apart from palatoglossus (CNX)
137
innervation of the soft palate muscles
CNX apart from tensor veli palatini (CNV3)
138
clinical testing of CNX and CNV3
ask patient to say 'ahh'
if the nerves are functioning normally the uvulas should lift straight up the midline
if there is unilateral nerve pathology the uvula will pull away from the non-functioning side
139
constrictor muscles of the pharynx
superior, middle and inferior constrictor muscles
140
longitudinal muscles of pharynx
stylopharyngeus
palatopharyngeus
salpingopharyngeus
141
innervation of pharyngeal muscles
all CNX apart from stylopharyngeus (CNIX)
142
tonsils in Waldeyer's ring of lymphoid tissue
```
pharyngeal tonsil (adenoid)
tubal tonsil (Eustachian tube opening)
palate associated lymphoid tissue (mucosa of soft palate)
lingual tonsil (mucosa of posterior 1/3rd of tongue)
palatine tonsil (tonsil)
```
143
lymph nodes in infection
```
swollen
painful
soft
smooth
not fixed
improves with treatment
```
144
lymph nodes in cancer
```
swollen
not painful
hard
irregular
fixed
do not improve with treatment
```
145
vertebral levels of larynx
C4-C6
146
what are the laryngeal cartilages
thyroid
cricoid
2 x arytenoid
147
innervation of intrinsic muscles of the larynx
CNX
| inferior laryngeal nerve (apart from cricothyroid - external laryngeal nerve)
148
action of cricothyroid muscles and effect on pitch
'nods' thyroid cartilage
| increases pitch of voice
149
action of thyroarytenoid muscles and effect on pitch
relaxes vocal cords
| decreases pitch
150
action of lateral crico-arytenoid muscles and effect on voice
adducts/brings vocal ligaments together
| makes voice quieter
151
action of arytenoid muscles and effect on voice
adduct/brings vocal ligaments together
| makes voice quieter (by closing rime glottidis)
152
action of posterior crico-arytenoid muscles and effect on voice
abducts vocal cords
| makes voice louder
153
mucosa above the vocal folds is innervated by
internal laryngeal
154
mucosa below the vocal folds is innervated by
inferior laryngeal
155
when does the recurrent laryngeal nerve become the inferior laryngeal nerve
level of the cricothyroid joint
156
nasal trauma history
```
mechanism of injury (fight, sport, fall)
when
LOC
epistaxis
breathing
```
157
nasal trauma examination
```
bruising/swelling/tenderness
deviation
epistxis
infraorbital sensation
CNs
```
158
complications of septal haematoma
septal ischaemia/necrosis
159
complications of nasal trauma
epistaxis
CSF leaks, meningitis
anosmia (cribriform plate fracture)
160
what is a Pina haematoma
sub-perichondrial haematoma
161
treatment of pinna haematoma
aspiration
incision and drainage
pressure draining
162
temporal bone fracture history
```
mechanism of injury
hearing loss
facial palsy
vertigo
CSF leak
```
163
what is battle sign
brusing behind the ear
| temporal bone fracture
164
temporal bone fracture examination
bruising (battle sign)
condition of TM and ear canal
CNVII
hearing test
165
longitudinal temporal bone fracture results in hearing loss
| true/false
true
| haemotypanum or ossicular chain disruption can result in conductive hearing loss
166
transverse temporal fracture results in hearing loss
| true/false
true
| sensorineural loss due to CNVIII damage
167
4 types of hearing loss
conductive
sensorineural
mixed
central
168
what is otosclerosis
stapes fixation
169
zone I of the neck
```
trachea
oesophagus
thoracic duct
thyroid
vessels (brachiocephalic, subclavian, thyrocervical trunk)
spinal cord
```
170
zone II of the neck
```
larynx
hypopharynx
CN X, XI, XII
vessels (carotids, internal jugular)
spinal cord
```
171
zone III of the neck
pharynx
cranial nerves
vessels (carotids, IJV, vertebral)
spinal cord
172
tear drop sign of CT
blow out fracture
