Week 1

Question 1

What is the tympanic membrane : oval window ratio?

Answer 1

18:1 (impedance matching air to liquid) - leads to pressure gain of x22

Question 2

What two muscles open the resting state of the eustachian tube?

Answer 2

1. Tensor veli palatini

2. Levator palatine

Question 3

What does dysfunction of the eustachian tube lead to?

Answer 3

Middle ear negative pressure

Question 4

What are the two openinsg of the chochlea to the middle ear?

Answer 4

Oval and round window

Question 5

What do the oval and round windows permit?

Answer 5

Transmission of pressure wave in enclosed canal and vibration of teh basilar membrane

Question 6

Give two features of the inner ear as a receiver and transducer?

Answer 6

Curved spiral lamina

2 half turns around central modiolus

Question 7

What is scala media in the cochlea?

Answer 7

Endolymph

Question 8

What is scala tympani and scala vestibuli?

Answer 8

Perilymph

Question 9

Name the structure in the cochlea of the inner ear which produces nerve impulses in response to sound vibrations?

Answer 9

Organ of corgi (has hair cells)

Question 10

What do the hair cells in the organ of corgi do?

Answer 10

Transduction - conversion of mechanical bending force into electrical impulse

Question 11

In relation to hair cell function when does depolarisation occur?

Answer 11

When deflected towards longest

Hyperpolarisation occurs when deflected away

Question 12

How is the cochlea organised?

Answer 12

Tonotopically

Question 13

Where is the primary auditory cortex?

Answer 13

Superior temporal gyrus,

brodman areas 41/42

Question 14

What do the superior canal and posterior canal of the labrynth connect to?

Answer 14

Common orus

Question 15

What are the vestibular end organs?

Answer 15

Maculae of the utricle and saccule - otolith organs

Ampullae of lateral, posterior and superior semicircular canals

Question 16

What do the maculae of utricle and saccule (otolith organs) have?

Answer 16

Stereocilia projecting upwards into a gelatinous matrix with otoconia

Question 17

What direction are the stereocilia orientated?

Answer 17

In all directions so all movements perceived by depolarisation/hyperpolarisation

Question 18

What are otoconia?

Answer 18

Calcium carbonate crystals

Question 19

Where does the cupula sit?

Answer 19

In the ampulla of a semiciorcular canal

Question 20

What is deflection of the cupula caused by?

Answer 20

Movement of perilymph - bending causes stereocilia to deflect

Question 21

What is the term for when the eyes move without a cognitive, visual or vestibular stimulus?

Answer 21

Spontaneous nystagmus

Question 22

What is a vestibular schwannoma?

Answer 22

Tumour of VIII nerve sheath (schwann) cells - imbalance due to slowly progressive loss of function

Question 23

What type of receptors are receptors for taste and smell?

Answer 23

Chemoreceptors which are stimulated by binding to particular chemicals

Question 24

What is taste perception influenced by?

Answer 24

Information from smell receptors

Question 25

What are the sense organs of taste?

Answer 25

Taste buds

Question 26

What do taste buds consist of that are arranged like slices of orange?

Answer 26

Sensory receptor cells and support cells

Question 27

What is the life span of taste receptor cells?

Answer 27

10 days

Question 28

What are taste receptor cells replaced from?

Answer 28

Basal cells within the taste buds

Question 29

Name four places taste buds are present?

Answer 29

Tongue Palate Epiglottis Pharynx

Question 30

Where do the majority of taste buds sit?

Answer 30

In the papillae in the tongue

Question 31

What are the four types of papillae?

Answer 31

Filliform - do not contain taste buds Fungiform Vallate Foliate

Question 32

Where do taste signals conveyed by cranial nerves via the brainstem and thalamus go?

Answer 32

To cortical gustatory areas

Question 33

What are the five primary tastes?

Answer 33

1. Salty 2. Sour 3. Sweet 4. Bitter 5. Umani (meat or savory) - triggered by glutamate

Question 34

What is ageusia?

Answer 34

Loss of taste function

Question 35

What is dysgeusia?

Answer 35

Distortion of taste function

Question 36

What three cell types does olfactory mucosa contain?

Answer 36

Olfactory receptor cells Supporting cells Basal cells - secrete mucus

Question 37

What does each neuron in olfactory receptors have?

Answer 37

Thick short dendrite and an expanded end called an olfactory rod

Question 38

What do odorants bind to?

Answer 38

Cilia

Question 39

What is the life span of olfactory receptors?

Answer 39

2 months - basal cells act as precursors for new olfactory receptor cells

Question 40

What do afferent fibres of olfactory nerve pierce?

Answer 40

Cribiform plate of ethmoid bone and enter the olfactory bulbs

Question 41

During quiet breathing how do odorants reach smell receptors?

Answer 41

By diffusion

Question 42

What might hyposmia be an early sign of?

Answer 42

Parkinson's disease

Question 43

How do you diagnose infections of the throat and pharynx?

Answer 43

Well taken throat swab

Question 44

What are the vast majority of sore throat causes?

Answer 44

Viral - do not need antibiotics

Question 45

What is the most common cause of bacterial sore throat?

Answer 45

Streptococcus pyogenes (group A streptococcus)

Question 46

How do you treat acute follicular tonsilitis (bacterial sore throat)?

Answer 46

Oral penicillin - clarithromycin if allergic

Question 47

Give three complications of streptococcal sore throat?>

Answer 47

1. Peritonsillar abscess (quinsy) 2. Sinusitis/otitis media 3. Scarlet fever

Question 48

What are 2 late complications of streptococcal sore throat?

Answer 48

1. Rheumatic fever | 2. Glomerulonephritis

Question 49

After streptococcal sore throat what are the signs of rheumatic fever complication?

Answer 49

3 weeks post sore throat | Fever, arthritis and pancarditis

Question 50

After streptococcal sore throat what are the signs of glomerulonephritis?

Answer 50

1-3 weeks post sore throat | Haematuria, albuminuria and oedema

Question 51

What condition has a severe sore throat with a grey white membrane across the pharynx The organism produces a potent exotoxin which is cardiotoxic and neurotoxic?

Answer 51

Diphtheria

Question 52

How do you treat diphtheria?

Answer 52

Antitoxin and supportive and penicillin/erythromycin

Question 53

What condition presents with white patches on red, raw mucous membranes in throat/muth?

Answer 53

Thrush Nystatin suspension topically

Question 54

What is the term for an upper respiratory tract infection involving the middle ear by extension up the eustachian tube?

Answer 54

Acute otitis

Question 55

What does otitis media present with?

Answer 55

Earache - predominantly infants and children

Question 56

What are the three most common bacteria to infect the middle ear?

Answer 56

Haemophilus influenzae Streptococcus pneumonia Streptococcus pyogenes

Question 57

What is the treatment of infections of the middle ear?

Answer 57

80% resolve in 4 days with no antibiotics Amoxocillin if bilateral under 2 years of age and AOM with otorrhoea

Question 58

How is acute sinusitis treated?

Answer 58

If uncomplicated avoid antibiotics as 80% resolves in 14 days Otherwise 1st line penicillin V, 2nd line deoxycycline but not in chilren

Question 59

What condition involves redness and swelling of skin of outer ear canal, may be itchy, can become sore and painful, may be discharge or increased ear wax?

Answer 59

Otitis externa

Question 60

Give three bacterial causes of otitis externa?

Answer 60

1. Staphylococcus aureus 2. Proteuis spp 3. Pseudomoas aeruginosa

Question 61

Give two fungal causes of otitis externa?

Answer 61

1. Aspergillus niger | 2. Candida albicans

Question 62

How is otitis externa treated?

Answer 62

Topical aural toilet. or if cultured - topical clotrimazole for fungal or topical gentamicin for pseudomonas infection

Question 63

What condition presents with fever, pharyngitis and lymphadenopathy?

Answer 63

Glandular fever - infectious mononucleosis

Question 64

What do half of patients with glandular fever present with>

Answer 64

Splenomegaly

Question 65

What two blood conditions are seen in glandular fever?

Answer 65

Anemia and thrombocytopenia

Question 66

Why should sport be avoided in glandular fever?

Answer 66

Risk of splenic rupture

Question 67

What virus causes glandular fever?

Answer 67

Epstein-Barr virus

Question 68

What are the two phase sof primary infection with EBV?

Answer 68

Primary infection in early childhood rarely results in infectious mononucleosis Primary infection in those greater than 10 often causes infectious mononucleosis

Question 69

What is the kissing disease?

Answer 69

Glandular fever

Question 70

How is glandular feve confirmed in the lab?

Answer 70

Epstei-Barr virus IgM Heterophile antibody - PaulBunnel test, Monospot test Blood count and film LFTS

Question 71

aFTER PRIMARY INFECTION WHat happens to HSV-1?

Answer 71

latent - in trigeminal ganglia

Question 72

What is herpetic whitlow?

Answer 72

Abscess at end of finger

Question 73

What causes herpangina?

Answer 73

Coxsackie viruses

Question 74

What are non viral, selflimiting recurring painful ulcers of the mouth that are round or ovoid and have inflammatory halos?

Answer 74

Apthous ulcers

Question 75

What condition causes recurrent oral ulcers, genital ulcers, uveitis, can involve visceral organs such as GI tract, pulmonary, MSK, CVS and neurological systems and it is commonest in middle east and asia?

Answer 75

Behcets disease

Question 76

What term is given to chronic otitis media and perforated tympanic membrane?

Answer 76

Cholesteatoma

Question 77

What is the normal lining of the middle ear?

Answer 77

Cuboidal or columnar glandular epithelium

Question 78

What should you consider if there are bilateral vestibular schwannomas?

Answer 78

NF type 2

Question 79

Name three other features of NF type 2 other than vestibular schwannomas?

Answer 79

Multiple meningiomas Gliomas Cafe au lait spots

Question 80

What should you consider if a young patient presents with nasal polyps?

Answer 80

Cystic fibrosis

Question 81

What carcinoma has a strong association with Epstein Barr virus?

Answer 81

Nasopharyngeal carcinoma

Question 82

What tumour is related to HPV exposure types 6 and 11 and has peaks of incidence at less than 5 years and between 20 and 40?

Answer 82

Squamous papilloma

Question 83

What is a paraganglioma?

Answer 83

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body

Question 84

Give two biggest risk factors for squamous cell carcinoma?

Answer 84

Smoking and alcohol

Question 85

What tumour is benign, common in parotid gland, more common in over 50 ladies and are poorly circumsised?

Answer 85

Pleomorphic adenoma

Question 86

Name a benign tumour which is common in parotid gland, associated with smoking in older males and is a mixture of bilayer of oncocytic epithelium with dense lymphoid infiltrate?

Answer 86

Warthins tumour

Question 87

What is the most common ENT malignancy?

Answer 87

Mucoepidermoid carcinoma