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Oto-rhino-laryngology head & neck surgery > Clinical > Flashcards

Clinical Flashcards

1
Q

What are the main functions of the ear ?

A

1- Hearing.

2- Balance

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2
Q

The balance of the body is maintained by the input to the brain from ………. .

A

1- Vestibular Apparatus.
2- Eye.
3- Proprioceptive organs “neck”.

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3
Q

What is the definition of Audiology?

A

Audiology is the new art and science which covers the diagnosis and rehabilitation aspects of hearing and balance disorders in adults and children.

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4
Q

What are the types of hearing loss?

A

1- Conductive.
2- Sensory/neural.
3- Mixed.

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5
Q

What is Otosclerosis ?

A

It is a new bone formation of the temporal bone with fixation of the footplate of the stapes. It will lead to conductive hearing loss but my lead to sensory/neural HL if it involves the cochlea.

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6
Q

What are the main symptoms of ear disease ?

A 
1- HL.
2- Otalgia.
3- Otorrhea.
4- Tinnitus.
5- Dizziness.
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7
Q

What’s an Audiogram?

A

It’s a subjective test and performed in a soundproof room , It will reliably assess the severity of hearing loss if present, detect and quantify the threshold of hearing, and identify the type of hearing loss.

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8
Q

How hearing is tested?

A 
1-Voice and whisper test.
2- Weber test.
3- Rinne Test.
4- Audiogram.
5- Tympanogram.
6- ABR.
7- Otoacoustic emission tests.
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9
Q

What is the definition of Myringotomy ?

A

It’s a surgical incision into the eardrum, to relieve pressure or drain fluid “otitis media with effusion”.

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10
Q

What is the definition of Myringoplasty?

A

It’s the closure of the perforation of pars tensa of the tympanic membrane.

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11
Q

What is the definition of Tympanoplasty?

A

It’ the closure of the perforation of pars tensa of the tympanic membrane combined with ossicular reconstruction.

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12
Q

What is Cochlear implantation?

A

It’s the insertion of the electrode array into the cochlea to stimulate the auditory nerve. It’s only appropriate for bilateral profound sensory/neural HL.

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13
Q

What is Hearing Aids?

A

It’s an assistance device which amplify sound and make it louder for the deaf persons so they can hear.

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14
Q

What is perichondritis ?

A

It is inflammation of the perichondrium, a layer of connective tissue which surrounds cartilage.

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15
Q

What are the otological causes of Otalgia ?

A 
1- Acute O.E.
2- Acute O.M.
3- O.M with effusion.
4- Furunculosis.
5- Perichondritis.
6- Trauma to the EAC or T.M.
7- Malignancy of the ear.
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16
Q

What is presbycusis ?

A

A lessening of hearing acuteness resulting from degenerative changes in the ear that occur especially in old age

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17
Q

What is Ménière’s disease ?

A

It’s a disorder of the membranous labyrinth of the inner ear that is marked by recurrent attacks of dizziness, tinnitus, and hearing loss.

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18
Q

What is the subjective causes of Tinnitus?

A 
1- Presbycusis.
2- Wax in the EAC.
3- Middle ear effusion.
4- Noise induced hearing loss.
5- Ototoxic drugs.
6- Ménière's disease.
7- Otosclerosis.
8- Labyrinthitis.
9- Acoustic neuroma.
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19
Q

What is Palatal myoclonus ?

A

It is a rapid spasm of the palatal (roof of the mouth) muscles, which results in clicking or popping in the ear.

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20
Q

What is the Objective causes of Tinnitus?

A 
1- TMJ dysfunction.
2- Carotid body tumors.
3- Glomus tumors of the ear.
4- Insect in the EAC.
5- Palatal myoclonus.
6- Arteriovenous malformation "Aneurysm".
7- Patulous Eustachian tube.
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21
Q

What is the best treatment of tinnitus associated with sensory/neural HL?

A

Hearing aid.

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22
Q

Name the drugs that causes Tinnitus.

A 
1- Tricyclic antidepressants.
2- Beta-blockers.
3- Aspirin.
4- Quinine.
5- Diuretics.
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23
Q

What is a Tinnitus masker?

A

It’s an electronic device that produces artificial noise to mask the original tinnitus.

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24
Q

What is the definition of True Vertigo?

A

It’s the hallucination of movement of the patient’s body or the patient’s environment “sense of rotation”.

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25
Q

What is the definition of Light-headedness ?

A

It’s the loss of equilibrium within one’s head.

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26
Q

What is the definition of unsteadiness?

A

It’s the loss of equilibrium in relation to one’s environment.

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27
Q

What is the definition of Blackouts ?

A

The patient loses extensor powers and falls to the ground suddenly, severely and with no warning.There is no loss of consciousness and complete recovery occurs almost immediately.

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28
Q

What are the otological causes of dizzy patient ?

A 
1- BPPV.
2-Ménière's disease.
3- Vestibular neuronitis.
4- Acoustic neuroma.
5- CSOM with cholesteatoma.
6- Trauma to the inner ear.
7- Rupture of round or oval window.
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29
Q

What are the non-otological causes of dizzy patient ?

A 
1- Medications.
2- cervical problems.
3- vertebrobasilar ischemia.
4- postural hypotension.
5- migraine.
6- anxiety.
7- multiple sclerosis.
8- Transient ischemia attacks.
9- Uncontrolled disease.
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30
Q

what is the function of wax?

A

1- It prevent entry of particulate matter into the deeper meatus.
2- It has a surface immuno-protective function.
3- It protects the skin of the EAC from water penetration.
4- Its low pH discourage microbial growth.

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31
Q

what is the unique property of the skin of the inner 2/3 of EAC in comparison to the skin of the rest of the body?

A

It migrates laterally and this active process starts near the center of the TM and progresses laterally to the outside of the EAC at a rate of 2mm a month, which provide a natural cleaning mechanism for desquamated tissue and wax.

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32
Q

How can you soften the hard impacted wax ?

A

1- Ceruminolytic ear drops.
2- warm olive oil.
3- sodium bicarbonate ear drops.

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33
Q

what are the methods used to remove wax ?

A

1- Suction by using the microscope.
2- wax hook/probe using good head light.
3- ear syringing.

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34
Q

What are the indications of ear syringing?

A

1- Removal of wax after softening.
2- Removal of foreign bodies.
3- Removal of a mass of debris.

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35
Q

What are the contraindications of ear syringing?

A 
1- History of TM perforation.
2- Acute O.E.
3- Vegetable or impacted foreign bodies.
4- The only hearing ear.
5- Previous ear surgery.
6- Recent trauma.
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36
Q

What are the complications of ear syringing ?

A

1- Injury to the skin of the EAC.
2- Rupture of TM.
3- Infections.
4- Stimulation of inner ear causing nystagmus and vertigo.
5- Stimulation of vagus nerve lead to reflex cough or vasovagal attack.

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37
Q

What are the allergic causes of OE ?

A 
1- Contact dermatitis.
2- Eczema.
3- Psoriasis.
4- Neurodermatitis.
5- Seborrheic dermatitis.
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38
Q

Wat are the infective causes of OE ?

A

1- Localized infection: Furunclosis.

2- Diffuse infection : Bacterial - Viral- Fungal “otomycosis”.

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39
Q

What are the disposing factors of OE ?

A 
1- Moist humid environment.
2- Swimming.
3- Local trauma.
4- Irritants.
5- Primary skin condition.
6- Secondary to OM.
7- Failure of epithelial migration.
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40
Q

What are the common causative organisms of OE?

A

1- Acute bacterial: Pseudomonas aeruginosa - staphylococcus- Proteus - gram negative organisms.
2- Chronic bacterial : Gram negative bacilli “Proteus”.
3- Acute viral : Varicella zoster virus.
4- Fungal infection: Aspergillus - candida.

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41
Q

when does conductive HL occurs in OE ?

A

1- Edema of EAC.

2- Debris blocked the EAC.

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42
Q

What are the investigations of OE ?

A

1- Swab for culture and sensitivity.

2- Fungal staining for resistant cases.

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43
Q

How de we treat OE ?

A 
1- Aural toilet.
2- Analgesia in Acute cases.
3- Antibiotics for bacterial infection "local/systemic" U can use ear wick.
4- Antifungal.
5-Antihistamine for itching.
6- control DM.
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44
Q

What is Furunculosis “in ears” ?

A

It’s a staphylococcal infection of a hair follicle in the outer cartilaginous 1/3 of the EAC.

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45
Q

What are the symptoms of Furunculosis “in ears” ?

A

1- Sever throbbing pain.

2- Pyrexia before rupture of the abscess.

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46
Q

What is the treatment of Furunculosis “in ears” ?

A

1- systemic antibiotics.
2- analgesia.
3- Wick of ribbon gauze soaked in a steroid/antibiotic ointment. “change 24-48 hours”.
4- If treatment failed use drainage under general anesthesia.

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47
Q

What is malignant OE ?

A

It’s a lethal aggressive inflammatory condition of the EAC with osteitis or osteomyelitis of the bone usually in elderly diabetic patients.

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48
Q

What is the causative organism of malignant OE ? and What is the drug of choice ?

A

Pseudomonas aeruginosa - Quinolones is the drug of choice.

49
Q

How to treat Malignant OE ?

A 
1- Analgesia.
2- Local antibiotics after cleaning.
3- IV/oral antibiotics "Quinolones".
4- control DM.
5- Treatment of immunodeficiency.
50
Q

What is Bullous Myringitis ?

A

It’s an inflammation of the TM, bloody blisters develop between outer and middle layer of TM.

51
Q

Name the organism that causes Bullous Myringitis .

A

Coxsacki B virus.

52
Q

Why we should treat Perichondritis vigorously with systemic antibiotics?

A

to prevent necrosis of the cartilage which may lead to permanent deformity of the auricle “ Cauliflower ear”.

53
Q

What is Bat ear ?

A

It’s a congenital anomaly of the Auricle due to the absence of Antihelex.

54
Q

What is the name of the surgical procedure for correcting Bat ear ?

A

Pinnaplasty / otoplasty.

55
Q

What are the common causative organisms of Acute OM ??

A

1- Streptococcus pneumonia.
2- Haemophilus influenzae.
3- Moraxella catarrhalis.
and other gram positive organisms.

56
Q

What are the symptoms of acute OM ?

A 
1- Otalgia.
2- Otorrhea.
3- HL.
4- Pyrexia.
5- systemic upset.
57
Q

What are the signs of acute OM ?

A

congestion of the vessels over the handle of the malleus —>TM loses its transparency and become dull—> bulging and loss of its normal landmark —> pressure necrosis of the most bulging area —> rupture of TM —> release of ear discharge.

58
Q

What is the treatment of acute OM ?

A

1- Analgesic.
2- Antipyretic.
3-Oral antibiotic: first line =Amoxicillin. - second line Amoxicillin + clavulanic acid.
4- Decongestant nasal drops.
5- Regular ear cleaning if TM ruptures.
6- Vaccine for S.pneumonia and H.influenza.

59
Q

What are the complications of Acute OM ?

A 
1- OM with effusion.
2- CSOM.
3- Tympanosclerosis.
4- Facial nerve paralysis.
5- Labyrinthitis.
6- Acute mastoiditis.
7- intracranial complications.
60
Q

What is Tympanosclerosis?

A

It’s an Abnormal process of healing after infection or trauma or insertion of grommet, leading to chalky white patches in the TM + middle ear space.

61
Q

What is the pathogenesis of OM with effusion ?

A

1- Sequel of acute OM.
2- Eustachian tube dysfunction.
3- Allergy or infection of the middle ear mucosa.

62
Q

What is the differential diagnosis of nasal obstruction?

A

A- Mechanical:

1- Allergy causes mucosal/turbinate swelling.
2- Infection causes mucosal/turbinate swelling.
3- Rhinitis medicamentosa.
4- Deviated nasal septum.
5- Nasal masses.
6- Adenoid hypertrophy.
7- Nasopharyngeal tumors.
8- Congenital choanal atresia.
9- Crusting of atrophic rhinitis.

B- Functional.

63
Q

What is Rhinitis medicamentosa ?

A

It’s a condition of nasal congestion due to long-term use of topical decongestants nasal drops,spray or gel.

64
Q

What is crusting of atrophic rhinitis ?

A

It’s a form of chronic rhinitis it could be primary “idiopathic” or secondary to surgery or chronic specific infection of the nose.

65
Q

How to treat nasal obstruction?

A

A-Medically:
1- Topical nasal decongestant for 3-5 days.
2- Topical/systemic Antihistamine for allergy.
3- Topical nasal steroids.

B- Surgically:
1- Septoplasty for DNS.
2-Surgery for coanal atresia.
3- Turbinate surgery.
4- Polypectomy.
5- Adenoidectomy.
66
Q

Define sneezing.

A

It’s a reflex to expel a foreign body or inhaled irritants from the nose.

67
Q

What is the blood supply for Little’s area “Kiesselbach’s plexus”?

A

1- Anterior Ethmoidal artery.
2- Sphenopalatine Artery.
3- Greater Palatine Artery.
4- Superior labial Artery.

68
Q

What is Anosmia?

A

complete loss of smell.

69
Q

What is Hyposmia?

A

Reduced sense of smell.

70
Q

What is Cacosmia ?

A

Unpleasant odor usually detected by others due to chronic nasal/sinus sepsis , foreign body or tumors.

71
Q

What is young’s operation?

A

It’s the closure of the nostrils by circumferential flap of the nasal vestibule to treat Atrophic rhinitis.

72
Q

What is Choanal Atresia ?

A

It’s the blockage of the posterior choana unilaterally/bilaterally either by bone or membrane due to failure of canalization of the bucconasal membrane.

73
Q

What is Vestibulitis ?

A

It’s an inflammation of the skin if the nasal vestibule, could be associated with rhinitis or rhino-sinusitis.

74
Q

What is Furunculosis “in nose” ?

A

It’s a staphylococcal/streptococcal infection of the hair follicles in the nasal vestibule, usually associated with hair removal.

75
Q

How to treat Furunculosis in the nose?

A

local and systemic penicillinase-resistatnt antibiotics.

could require incision and drainage after antibiotic cover for at least 24 hours.

76
Q

Why furunculosis in nose can be dangerous ?

A

Because the venous communication between the nasal venous drainage and the cavernous sinuses are valve-less which may lead to cavernous sinus thrombosis.

77
Q

What are the most common cases of Rhino-sinusitis ?

A

Acute viral rhino-sinusitis - Allergic rhino-sinusitis.

78
Q

What are symptoms and signs of common cold?

A 
Symptoms: 
1- Nasal Obstruction.
2- Itching.
3- Sneezing.
4- Clear Rhinorrhea.
5- Facial pain.
6- Body-ache.
Signs: 
1- Mucosal congestion.
2- Pyrexia.
3- Nasal Discharge.
79
Q

What are symptoms and signs of Allergic rhino-sinusitis?

A

symptoms:
1- Nasal obstruction due to mucosal edema.
2-Decreased sense of smell.
3- Rhinorrhea due to increased glandular activity.
4- Post nasal drip.
5- Sneezing due to mucosal irritation and itching.
6- Headache or facial pain if sinuses are involved.

Signs:
1- Edematous pale mucosa.
2- Clear watery rhinorrhea

80
Q

What is the management of Allergic rhino-sinusitis ?

A 
1- Prophylactic: Avoidance of allergens.
2- Symptomatic: 
- Oral Antihistamine.
- Intranasal Antihistamine sprays.
-Topical steroid nasal sprays.
81
Q

What are the predisposing factors of Acute bacterial Rhino-sinusitis?

A 
1- Recurrent viral URTI.
2- Allergy.
3- Foreign body/trauma.
4- Dental procedure.
5- Baro-trauma.
6- Iatrogenic.
82
Q

What are the causative organisms of Acute bacterial rhino-sinusitis?

A

most common :
1- Streptococcus pneumonia.
2- Haemophilus influenzae.

In children : Moraxilla catarhalis is responsible of 20% of cases.

Dental origin : Anaerobic organisms.

83
Q

What are symptoms and signs of Acute bacterial rhino-sinusitis?

A 
Symptoms: 
1- Nasal obstruction.
2- Nasal discharge.
3- Facial pain "depends on the sinus involved".
4- Headache.
5- Pyrexia.
Signs: 
1- Nasal mucosal congestion.
2- Nasal mucosal edema.
3- Tenderness over the involved sinus.
4- Muco-purulent nasal discharge.
5- post nasal discharge.
84
Q

How to treat acute bacterial rhino-sinusitis ?

A

1- Rest.
2- Analgesic for pain.
3- Decongestant nose drops to help drainage of the sinuses.
4- Local corticosteroid.
5- Surgical intervention : endoscopic sinus surgery - antral washout to drain the pus from maxillary sinuses.

85
Q

What are the complication of acute bacterial rhino-sinusitis?

A 
1-Orbital cellulitis and abscess.
2- Meningitis.
3- Brain abscess.
4- Osteomyelitis.
5- Cavernous sinus thrombosis.
86
Q

What are the causative organisms of Chronic bacterial rhino-sinusitis?

A 
1- Streptococcus pneumonia.
2- Haemophilus influenzae.
3-  Moraxilla catarhalis.
4- Anaerobic organisms "dental origin".
5- Staphylococcus aureus.
6- coagulase- negative staphylococcus.
7- anaerobes.
87
Q

What is the symptoms and signs of chronic rhino-sinusitis?

A 
symptoms: 
1- Nasal obstruction.
2- Hyposmia / Anosmia.
3- Cacosmia.
4- Facial pain.
5- Nasal / post nasal discharge.
signs: 
1- Congested nasal mucosa / pale and boggy.
2- Muco-purulent discharge.
3- DNS.
4- nasal polyp may be present.
88
Q

What is the treatment of Chronic rhino- sinusitis ?

A 
- Medically: 
1- Broad spectrum of antibiotics.
2- Decongestant nose drops "no more than 7 days".
3- Nasal irrigation with normal saline.
4- Oral antihistamine.
5- Steroid nasal spray.
6- Oral steroid.

-Surgical :
1- Functional Endoscopic Sinus Surgery “FESS”
2- Open Sinus surgery.

89
Q

What is Functional Endoscopic Sinus Surgery “FESS” ?

A

It’s the removal of the diseased area to relieve the obstruction and so restore natural sinus drainage, ventilation and normal physiology.

90
Q

What are the important factors involved in the patho-physiology of sinus disease?

A

1- Patency of the ostia.
2- Function of the cilia.
3- Quality of the nasal secretions.

91
Q

What are the complications of the FESS ?

A 
1- Bleeding.
2- Injury to nasolacrimal duct.
3- orbital injury.
4- CSF leak.
5- Intracranial injury.
6- Optic nerve injury.
92
Q

What is Samter’s Triad ?

A

It’s a chronic medical condition that consist of Asthma, nasal polyposis and Aspirin allergy.

93
Q

What is a nasal polyposis ?

A

It’s a swollen respiratory mucosa, it’s yellowish- grey in color, smooth and moist, pedunculated and move on probing.

94
Q

How to treat Nasal polyposis ?

A

Medical :
corticosteroid : oral and topical nasal.

Surgery:
1- Nasal polypectomy.
2- ESS

95
Q

What is the lymphatic drainage of the pharynx ?

A

1- Naso-pharunx : retropharyngeal –> upper deep cervical LN.
2- Oro-pharynx : Upper deep cervical LN.
3- Hypo-pharynx: upper and lower deep cervical LN

96
Q

What is the Nerve supply of the pharynx ?

A

1- Naso-pharynx: Branch of Maxillary N–> Branch from Trigeminal N.
2- Oro-pharynx: Glossopharyngeal N.
3- Hypo-pharynx: Branch of Internal laryngeal N –>Branch of Vagus.

97
Q

What is the lymphatic drainage of the Larynx ?

A

1- Supra-glottic : upper deep cervical LN.
2- Glottic : no LN.
3-Sub-glottic: Pre-laryngeal and para-tracheal LN—> Lower deep cervical LN.

98
Q

What is the Nerve supply of the Larynx?

A 
vagus nerve through : 
1- Superior laryngeal N: 
- Internal laryngeal N.
- External laryngeal N.
2- Recurrent laryngeal N.
99
Q

What are the causes of xerostomia ?

A 
1- Excessive speaking.
2- Dehydration. 
3- Uncontrolled DM.
4- Some drugs.
5- Mouth breathing.
6- Fevers.
7- During exercise .
8- Heavy smoking.
9- After irradiation.
10- Aging.
100
Q

What is Hoarseness ?

A

It’s the change of voice from a higher to a lower pitch.

101
Q

What is Aphonia ?

A

Complete loss of voice.

102
Q

What are the causes of Hoarseness ?

A 
1- Congenital web.
2- Trauma.
3-Foreign bodies.
4- Vocal cord paralysis.
5-Tumors
6-Inflammatory conditions.
103
Q

What are the causes of Stridor in newborns ?

A 
1- Laryngomalacia/Tracheomalacia.
2- Sub-glottic stenosis.
3- Vocal cord palsy.
4- Laryngeal web.
5- cyst.
6- Vascular anomaly "subglottic haemangioma"
7- Partial atresia.
104
Q

What is the definition of Cough ?

A

It’s a reflex response to irritation of the cough receptors in the airway mucosa. it is forcing air out of the lungs through the mouth with a short loud sound. “forcible expiration against closed glottis”.

105
Q

What is Stomatitis?

A

Inflammatory condition of the oral mucosa.

106
Q

What is recurrent aphthous stomatitis?

A

Recurrent painful, single/multiple necrotizing ulcers of the oral cavity mucosa.

107
Q

What are the causes of Recurrent aphthous stomatitis?

A 
unknown , but the suspected predisposing factors are: 
1- Trauma.
2- stress.
3- Hormonal changes.
4- Vitamins deficiency.
108
Q

What is the treatment of Recurrent aphthous stomatitis?

A

It’s a self limited disease “7-10 days”

could use local paste of corticosteroids or cautery with silver nitrate.

109
Q

What is candidiasis and how to treat it ?

A

It’s a white lesion with an erythematous base of the oral mucosa which is easily removed, caused by Candida albicans fungi, treated with anti-fungal medications.

110
Q

What is nicotine stomatitis ?

A

It’s white patches over the palate mucosa with multiple small papules seen in smokers, no treatment except stopping smoking.

111
Q

What is leukoplakia ?

A

It is a white lesion which cannot be scrapped off, usually benign but it can be pre-malignant or early malignant when it’s on lateral tongue , floor of the mouth and lower lip.

112
Q

What is the comments causes of Otorrhea?

A

1- Otitis Externa.
2- Acute OM after TM perforation.
3-CSOM.

113
Q

Who is at risk for hearing loss and should be tested immediately after birth?

A 
1- Pre-maturity.
2-Low birth-wight.
3- Neonatal jaundice.
4- Perinatal hypoxia.
5- Intrauterine infection.
6- Hereditary HL.
7- Failed distraction test.
114
Q

What is the most common cause of conductive HL in adults?

A

Impacted wax , which lead to at most 30-40 dB of HL.

115
Q

What is the most common cause of conductive HL in adults?

A

OM with effusion.

116
Q

Under which circumstances we should repair the perforated TM ?

A

1- Persistent otorrhea.
2- Recurrent infection.
3- HL
and ears must be dry before surgery.

117
Q

What is Acoustic neuroma?

A

vestibular schwanoma which is a benign tumor of the 8th cranial nerve.

118
Q

The Rinne test is positive in ………… or …………… .

A

normal hearing - sensory/neural hearing loss.

Oto-rhino-laryngology head & neck surgery (1 decks)

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