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1
Q

Enumerate the 6 features in the medial wall of the middle ear

A

Promontory: first basal turn of cochlea
Oval window
Round window
Transverse part of facial nerve
Sinus tympani (depression between oval and round window)
Process cochleariform

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2
Q

Give the treatment for Otomycosis

A

Local EAC cleaning with ear wash
Antifungal drops like Nystatin and Salicylic acid 2% + Alcohol 70%
Packing EAC with antifungal cream on gauze if resistant

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3
Q

Symptoms and signs of meningitis

A

Signs: neck rigidity, painful neck flexion, restlessness, photophobia, projectile vomiting, blurring of vision and severe headache that is persistent

Signs:
-Kernig’s sign: Patient is asked to lie in supine position; with hip and knee flexed–> He can not do extension
-Brudzinski’s sign: Flexion of the neck will be accompanied with reflex flexion of hip and knee

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4
Q

Investigations and treatment of meningitis

A

Investigations: CT to exclude brain abscess and Lumber puncture for CSF analysis

Treatment: Hospitalization in semi-dark room, Systemic antibiotics that cross BBB like 3rd or 4th gen cephalosporin IV, Dehydrating measure like mannitol to decrease ICT

Surgical: treatment of the cause—> if cholesteatoma; mastoidectomy

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5
Q

Compare between clinical pictures of UMNL and LMNL facial paralysis

A
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6
Q

Enumerate the cranial (4) and extracranial (6) complications of cholesteatoma

A

Cranial: Mastoiditis, Labyrinthitis, Petrositis, Facial paralysis

Intracranial: Extradural, Subdural, Brain abscess, Meningitis, Lateral sinus thrombosis, Otitic Hydrocephalus

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7
Q

Enumerate the indications (4) and contraindications (4) of the ear wash?

A

Wax deafness
Non impacted foreign body
Fungal mass
Caloric test

TM perforation
Vegetable foreign body
Bacterial otitis externa
Fistula between middle and inner ear

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8
Q

Investigations and treatment of nasal fracture

A

Investigations: X-ray

Control of epistaxis if present. Reduction of bone right away if no edema under general anesthesia.

If edema, wait a week.

If he came after 2 weeks, wait for 3 months and do rhinoplasty

After fixation, anterior nasal packing to stop any bleeding and support for 48hrs

Fixation from outside with aluminum sheet for 2 weeks

Anti biotics analgesics and anti-inflammatory

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9
Q

Oro-antral fistula, Symptoms, signs and investigations

A

Symptoms:
Unilateral regurgitation of food and fluid
Unilateral offensive nasal discharge
Discharge through the fistula to the mouth

Fistula is seen through oral cavity

CT shows sight of fistula

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10
Q

Treatment of Oro-antral fistula

A

Recent case (24 h after dental extraction): small fistula heals spontaneously and large fistula needs surgical closure

Old case: Radical antrum operation

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11
Q

Maxillary sinusitis symptoms and signs

A

History of dental operations, nasal discharge can be offensive
pain over cheeks referred to teeth and ears

Tenderness over cheeks, and discharge from posterior part of middle meatus

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12
Q

Sinusitis investigations

A

Xray sinus view shows opacity or fluid level
Culture and sensitivity of discharge
CT if chronic or recurrent case: mandatory preoperative investigation

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13
Q

Sinusitis treatment

A

Complete bed rest with plenty of warm fluids. Systemic antibiotics according to culture and sensitivity. Analgesic, antipyretic and decongestant nasal drops. Steam inhalation

If fail treatment then surgical: Functional endoscopic Sinus Surgery (FESS)

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14
Q

Causes of watery discharge 5

A

Acute non-specific rhinitis
Allergic rhinitis
Vasomotor rhinitis
Excessive lacrimation
CSF rhinorrhea

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15
Q

4 causes of water and food discharge

A

Perforated palate (syphilis)
Cleft palate
Paralysis of soft palate
Oro-antral fistula

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16
Q

3 causes of crusty nasal discharge

A

Atrophic rhinitis
All granulomas
Septal perforation

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17
Q

Discuss briefly the investigations and treatment of Choanal Atresia

A

Investigations: CT: differentiated bony from membranous atresia

Treatment
1. Unilateral: Operation is not urgent to be done in the neonatal age, so it is postponed for 2-3 years

2.Bilateral: It is an emergency situation
Saving the airway: keeping the mouth open by either:
- Plastic oral airway
- Endotracheal intubation

> Operation:
- Trans-nasal by endoscope

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18
Q

Enumerate local causes of Epistaxis (9)

A

Idiopathic: commonest cause
Trauma: Foreign bodies
Inflammations: Acute or chronic rhinitis
Neoplastic: malignant or benign tumors
Irritants: cigarette smoke
Medications: Topical cortisone
Septal deviation or perforation
Vascular malformations
Environmental factors: allergens, humidity

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19
Q

Enumerate systemic causes of Epistaxis 4

A

Systemic hematologic, hepatic, renal or genetic disease
Long term anti-coagulant use
Hypertension
Coagulation disorder like hemophilia

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20
Q

Explain the three stages of Rhinoscleroma

A

Atrophic stage: obstruction, discharge, epistaxis. Roomy cavity, atrophic mucosa and turbinates

Active nodular stage: Bilateral obstruction and discharge. Bilateral masses and Russel bodies and Mikulicz cells are detected

Fibrotic stage: Obstruction and deformity

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21
Q

Give the cause, incidence and treatment of rhinoscleroma

Study These Flashcards
A

Klebsiella Rhinoscleromatis

15-25 year old females

Medical: Rifampicin, Streptomycin and Alkaline nasal douche
Surgical: removal of mass

22
Q

Give the clinical picture of Plummer-Vinson’s syndrome

Study These Flashcards
A

More common in female

Dysphagia: due to chronic pharyngo-esophagitis + web

Angular stomatitis and glossitis

Achlorhydria: atrophy of gastric mucosa

Pallor: due to anemia

Koilonychia

Splenomegaly

23
Q

Investigations and treatment of Plummer-Vinson’s syndrome

Study These Flashcards
A

CBC (shows anemia).

X-ray barium swallow (shows web)

esophagoscopy (take biopsy)

Correction of anemia: iron

Repeated dilatation

Regular follow-up

24
Q

Acute Retropharyngeal abscess symptoms, signs and investigations

Study These Flashcards
A

Fever, headache and malaise. Dysphagia and odynophagia. Neck is flexed forward. Collection of pus behind nasopharynx and hypopharynx

Enlarge firm tender neck. Pain causes spasm of prevertebral muscles. Welling in posterior pharyngeal wall to one side of mid-line.

X-ray lateral neck view showing widening of prevertebral space and CT to diagnose

25
Treatment of acute retropharyngeal abscess
Hospitalization with parenteral antibiotics + analgesics antipyretics Incision and drainage under general anesthesia. Internal incision vertical over abscess with head low, using suction apparatus and cuffed endotracheal intubation to avoid aspiration of pus
26
Indication 3 and contraindications 6 of tonsillectomy
Marked tonsillar hypertrophy Recurrent acute tonsillitis (7 times in one year, 5 times in two successive years) Suspected tumor Bleeding disorders Acute tonsilitis Acute upper RTI Active systemic disease Active rheumatic fever Menstruation
27
Preoperative care preparation in tonsillectomy
History to exclude contraindications Examination of tonsils to make sure its chronic Investigations: ESR, blood picture, coagulation profile: bleeding time, prothrombin time, clotting time ect... Preoperative instruction: fast for 6 hours Preoperative medications: Antibiotics to prevent infections, atropine to decrease oral secretions. ASPRIN to be AVOIDED 10 days pre operation
28
Post operative care for tonsillectomy
Lie on side with head down to prevent aspiration of blood or vomit or falling of tongue Extubation after return of cough reflex Observe respiration and color of lips and nose Observe bleeding via pulse rapidness and weakness and frequent swallowing of blood Antibiotics to prevent infection and analgesic Ice soft semi solid food to stop bleeding
29
Complications of Quinzy 3
- Laryngeal Edema - Pyemia and Septicemia - Parapharyngeal Abscess
30
Complications of acute tonsilitis 5
Quinzy Retropharyngeal abscess Parapharyngeal abscess Acute rheumatic fever Acute glomerulonephritis
31
Discuss the treatment of corrosive esophagitis
Milk and egg white Management of dehydration, shock and electrolyte imbalance Tracheostomy if severe obstruction or stridor Parenteral antibiotics to prevent chest infections Cortisone to decrease laryngeal edema and fibrosis Rubber nasogastric tube is inserted in few days to feed and maintain lumen Neutralization of corrosive to prevent further perforation of lumen
32
Clinical signs and symptoms of Acute non specific laryngitis and treatment
Hoarseness of voice in adult or stridor in children Diffuse congestion and edema of VC and laryngeal mucosa Complete bed rest + plenty of warm fluids. Systemic antibiotics + analgesics. Complete voice rest and steam inhalation with benzoine
33
Give 4 reasons why acute non specific laryngitis is dangerous in children
Small larynx (easy obstruction) Submucosa is loose (easy edema) Subglottic area is narrow and funnel shape (easy obstruction) Soft laryngeal cartilages of infantile larynx (easy collapse)
34
Discuss the causes of Stridor in children
- Congenital: congenital web and laryngomalacia - Traumatic: inhaled foreign body and corrosives - Inflammatory: acute nonspecific laryngitis and laryngotracheobronchitis - Neoplastic: recurrent multiple laryngeal papillomatosis - Miscellaneous: laryngeal edema and laryngeal spasm
35
Give a short account on Laryngeal Papillomata
36
Enumerate the indications of Tracheostomy
Upper airway (mechanical) obstruction: Stridor, OSA When severe and complicated Lower airway (secretory) obstruction - Chronic aspiration - Depression of cough reflex - Prolonged coma - Severe chest injury - Paralysis of the respiratory muscles Prophylactic: Before bloody major operation on the mouth, pharynx, larynx Value: To avoid blood inhalation during surgery Prolonged intubation: (commonest cause nowadays) Value: to safeguard against occurrence of subglottic stenosis, and for better oral and pulmonary hygiene .Timing: 7-10 days of intubation.
37
Enumerate complications of tracheostomy 15
Shock Stenosis: Subglottic, Tracheal Hemorrhage: Reactionary, 2ry Infection: Wound infection and Respiratory infection Respiratory complications -Surgical emphysema - Obstruction - Apnea - Pneumothorax & Pneumomediastinum -To cricoid cartilage (above) - To apex of pleura (below) - To vessels of neck (lateral) - To esophagus (behind) Fistula: tracheocutaneous or tracheoesophageal Difficult Extubation Embolism
38
Treatment of Meniere's disease
During Attack: Anti-vertigo *Between Attacks: Salt restriction, Diuretics - In severe bilateral SNHL: Streptomycin in toxic doses -Vasodilators (Betahistidine) Surgical - If good hearing: 1. Endolymphatic Sac Decompression; 2. If failed, Vestibular Neurectomy - If bad hearing: 1. Injection of Aminoglycoside 2. Labyrinthectomy
39
Malignant Otitis Externa investigations
- Culture and sensitivity tests from granulations to exclude tumor ( biopsy ) - Blood glucose level (low immunity - DM ) - CT scan & MRI -PTA - Gallium and Tecntium bone scan
40
Malignant Otitis Externa treatment
- Hospitalization and Management of blood sugar level -Systemic antibiotics: Quinolones - Local Ciprofloxacin ear drops - EAC wash by suction - Analgesic
41
Left Secretory Otitis Media
> PTA CHL > Tympanometry: Type B Curve (flat curve) > X-ray lateral view of nasopharynx (in case of adenoid)
42
Left Secretory Otitis Media
-TTT of cause - Antibiotics - Steroids - Decongestant - Mucolytics - Valsalva Maneuver Surgical (if medical treatment failed) - Myringotomy + Ventilation tube insertion
43
Enumerate causes of conductive hearing loss?
Congenital: anomalies Traumatic: foreign body Inflammatory: infections & acute inflammatory Neoplastic: Benign and malignant tumors Miscellaneous: Wax Tympanic membrane causes of CHL: Perforation of tympanic membrane Middle ear causes of CHL: Congenital: anomalies Traumatic: otitis barotrauma Inflammatory: All types of otitis media and Eustachian tube dysfunction leading to retracted tympanic membrane Neoplastic: Middle ear tumors... Miscellaneous: Otosclerosis.
44
CSF Rhinorrhea investigations
1. Biochemical Testing: Clear, Watery, Salty taste, Reduce Fehling Solution Contains >30mg % glucose Contains B2 transferrin 2. CT with intrathecal metrizamide (to detect site of leakage) 3. MRI 4. Endoscopic Nasal Examination to see the defect
45
Investigations of Allergic Rhinitis and Nasal Polyp and treatment
- Cytology: ++ eosinophils - ++Serum IgE - RAST - Nasal Challenge Test - Skin Pricking Test 1. Avoid exposure to antigen 2. Medical Treatment -Anti-histaminic - Mast cell stabilizer - Cortisone - Decongestant 3. Hypo sensitization 4. Surgical - Reduction of enlarged turbinate - ESS for polyps
46
Give a short account (clinical picture) on the Orbital complications of Sinusitis
1. Orbital Edema: Due to venous obstruction 2. Orbital Cellulitis No pus formation Edema of upper eyelid Pain in the eye Chemosis; Proptosis Ophthalmoplegia Reversible diminution of vision 3. Extra-periosteal abscess: Collection of pus outside orbital periosteum. 2+ throbbing pain 4. Orbital Abscess: Collection of pus within the orbit due to rupture of orbital periosteum - 2+ diminution of vision is irreversible 5. Cavernous Sinus Thrombosis: Extension of thrombosis through ophthalmic veins
47
Causes of esophageal dysphagia (cause in the wall) 13
1. Congenital diseases: Congenital atresia or stenosis 2. Inflammatory: Acute ulcerations 3. Traumatic: Esophagoscopy or foreign body 4. Ingestion of corrosives. 5. Persistent vomiting 6. Reflux esophagitis 7. Plummer Vinson syndrome. 8. Neoplastic: Benign tumors or malignant 9. Neurological: paralysis of the pharyngeal 10. Pharyngeal pouch 11. Achalasia of the cardia 12. Diffuse esophageal spasm 13. Scleroderma (causes of fibrosis) 14. Drugs, and specific fevers
48
Causes of dysphagia (pressure on the esophagus from outside) 11
-In the cervical region (upper 1/3): Malignant thyroid tumor. Huge multinodular goiter. Enlarged cervical lymph nodes e.g. metastasis, and lymphoma. - In the thorax (middle 1/3) Mediastinal tumors. Pericardial effusion. Enlarged left atrium. Bronchogenic carcinoma. Aneurysm of the aorta. - In the abdomen (lower 1/3) Enlarged left lobe of liver Para-esophageal hiatus hernia
49
Complications of corrosive esophagitis
1- Shock, dehydration, electrolyte imbalance. 2- Esophageal perforation. 3 - Esophageal stricture. 4- T.O.F . 5- Stridor. 6- Chest infection.
50
16 causes of unilateral vocal cord paralysis
Central -Traumatic: head trauma - Inflammatory: meningitis, encephalitis - Neoplastic: brain tumor - Vascular: thrombosis, hemorrhage, embolism - Degenerative: multiple sclerosis Cranial -Traumatic: fracture base of skull - Inflammatory: malignant otitis externa - Neoplastic: nasopharyngeal carcinoma Extracranial - Neck -Thyroid operation/cancer - Esophageal cancer - Malignant LNs - Neck injury > Chest (on left side only) - Cardiothoracic surgery - Bronchogenic carcinoma Idiopathic (25% of cases)
51
Bilateral VC abductor management plan 7
1. Position : Semi-sitting to facilitate cough 2. Observe Respiration If obstruction: Noise reappears, Voice reappears, Air not felt on tube 3. Observe Bleeding 4. Antibiotics 5. Analgesics 6. Feeding 7. Extubation: After ttt of cause, Done gradually

ENT (3 decks)

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