Clinical Flashcards
1
Q
What are the main functions of the ear ?
A
1- Hearing.
2- Balance
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”.
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.
4
Q
What are the types of hearing loss?
A
1- Conductive.
2- Sensory/neural.
3- Mixed.
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.
6
Q
What are the main symptoms of ear disease ?
A
1- HL. 2- Otalgia. 3- Otorrhea. 4- Tinnitus. 5- Dizziness.
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.
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.
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”.
10
Q
What is the definition of Myringoplasty?
A
It’s the closure of the perforation of pars tensa of the tympanic membrane.
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.
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.
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.
14
Q
What is perichondritis ?
A
It is inflammation of the perichondrium, a layer of connective tissue which surrounds cartilage.
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.
16
Q
What is presbycusis ?
A
A lessening of hearing acuteness resulting from degenerative changes in the ear that occur especially in old age
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.
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.
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.
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.
21
Q
What is the best treatment of tinnitus associated with sensory/neural HL?
A
Hearing aid.
22
Q
Name the drugs that causes Tinnitus.
A
1- Tricyclic antidepressants. 2- Beta-blockers. 3- Aspirin. 4- Quinine. 5- Diuretics.
23
Q
What is a Tinnitus masker?
A
It’s an electronic device that produces artificial noise to mask the original tinnitus.
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”.
25
What is the definition of Light-headedness ?
It's the loss of equilibrium within one's head.
26
What is the definition of unsteadiness?
It's the loss of equilibrium in relation to one's environment.
27
What is the definition of Blackouts ?
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.
28
What are the otological causes of dizzy patient ?
```
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.
```
29
What are the non-otological causes of dizzy patient ?
```
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.
```
30
what is the function of wax?
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.
31
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?
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.
32
How can you soften the hard impacted wax ?
1- Ceruminolytic ear drops.
2- warm olive oil.
3- sodium bicarbonate ear drops.
33
what are the methods used to remove wax ?
1- Suction by using the microscope.
2- wax hook/probe using good head light.
3- ear syringing.
34
What are the indications of ear syringing?
1- Removal of wax after softening.
2- Removal of foreign bodies.
3- Removal of a mass of debris.
35
What are the contraindications of ear syringing?
```
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.
```
36
What are the complications of ear syringing ?
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.
37
What are the allergic causes of OE ?
```
1- Contact dermatitis.
2- Eczema.
3- Psoriasis.
4- Neurodermatitis.
5- Seborrheic dermatitis.
```
38
Wat are the infective causes of OE ?
1- Localized infection: Furunclosis.
| 2- Diffuse infection : Bacterial - Viral- Fungal "otomycosis".
39
What are the disposing factors of OE ?
```
1- Moist humid environment.
2- Swimming.
3- Local trauma.
4- Irritants.
5- Primary skin condition.
6- Secondary to OM.
7- Failure of epithelial migration.
```
40
What are the common causative organisms of OE?
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.
41
when does conductive HL occurs in OE ?
1- Edema of EAC.
| 2- Debris blocked the EAC.
42
What are the investigations of OE ?
1- Swab for culture and sensitivity.
| 2- Fungal staining for resistant cases.
43
How de we treat OE ?
```
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.
```
44
What is Furunculosis "in ears" ?
It's a staphylococcal infection of a hair follicle in the outer cartilaginous 1/3 of the EAC.
45
What are the symptoms of Furunculosis "in ears" ?
1- Sever throbbing pain.
| 2- Pyrexia before rupture of the abscess.
46
What is the treatment of Furunculosis "in ears" ?
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.
47
What is malignant OE ?
It's a lethal aggressive inflammatory condition of the EAC with osteitis or osteomyelitis of the bone usually in elderly diabetic patients.
48
What is the causative organism of malignant OE ? and What is the drug of choice ?
Pseudomonas aeruginosa - Quinolones is the drug of choice.
49
How to treat Malignant OE ?
```
1- Analgesia.
2- Local antibiotics after cleaning.
3- IV/oral antibiotics "Quinolones".
4- control DM.
5- Treatment of immunodeficiency.
```
50
What is Bullous Myringitis ?
It's an inflammation of the TM, bloody blisters develop between outer and middle layer of TM.
51
Name the organism that causes Bullous Myringitis .
Coxsacki B virus.
52
Why we should treat Perichondritis vigorously with systemic antibiotics?
to prevent necrosis of the cartilage which may lead to permanent deformity of the auricle " Cauliflower ear".
53
What is Bat ear ?
It's a congenital anomaly of the Auricle due to the absence of Antihelex.
54
What is the name of the surgical procedure for correcting Bat ear ?
Pinnaplasty / otoplasty.
55
What are the common causative organisms of Acute OM ??
1- Streptococcus pneumonia.
2- Haemophilus influenzae.
3- Moraxella catarrhalis.
and other gram positive organisms.
56
What are the symptoms of acute OM ?
```
1- Otalgia.
2- Otorrhea.
3- HL.
4- Pyrexia.
5- systemic upset.
```
57
What are the signs of acute OM ?
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
What is the treatment of acute OM ?
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
What are the complications of Acute OM ?
```
1- OM with effusion.
2- CSOM.
3- Tympanosclerosis.
4- Facial nerve paralysis.
5- Labyrinthitis.
6- Acute mastoiditis.
7- intracranial complications.
```
60
What is Tympanosclerosis?
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
What is the pathogenesis of OM with effusion ?
1- Sequel of acute OM.
2- Eustachian tube dysfunction.
3- Allergy or infection of the middle ear mucosa.
62
What is the differential diagnosis of nasal obstruction?
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
What is Rhinitis medicamentosa ?
It's a condition of nasal congestion due to long-term use of topical decongestants nasal drops,spray or gel.
64
What is crusting of atrophic rhinitis ?
It's a form of chronic rhinitis it could be primary "idiopathic" or secondary to surgery or chronic specific infection of the nose.
65
How to treat nasal obstruction?
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
Define sneezing.
It's a reflex to expel a foreign body or inhaled irritants from the nose.
67
What is the blood supply for Little's area "Kiesselbach's plexus"?
1- Anterior Ethmoidal artery.
2- Sphenopalatine Artery.
3- Greater Palatine Artery.
4- Superior labial Artery.
68
What is Anosmia?
complete loss of smell.
69
What is Hyposmia?
Reduced sense of smell.
70
What is Cacosmia ?
Unpleasant odor usually detected by others due to chronic nasal/sinus sepsis , foreign body or tumors.
71
What is young's operation?
It's the closure of the nostrils by circumferential flap of the nasal vestibule to treat Atrophic rhinitis.
72
What is Choanal Atresia ?
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
What is Vestibulitis ?
It's an inflammation of the skin if the nasal vestibule, could be associated with rhinitis or rhino-sinusitis.
74
What is Furunculosis "in nose" ?
It's a staphylococcal/streptococcal infection of the hair follicles in the nasal vestibule, usually associated with hair removal.
75
How to treat Furunculosis in the nose?
local and systemic penicillinase-resistatnt antibiotics.
| could require incision and drainage after antibiotic cover for at least 24 hours.
76
Why furunculosis in nose can be dangerous ?
Because the venous communication between the nasal venous drainage and the cavernous sinuses are valve-less which may lead to cavernous sinus thrombosis.
77
What are the most common cases of Rhino-sinusitis ?
Acute viral rhino-sinusitis - Allergic rhino-sinusitis.
78
What are symptoms and signs of common cold?
```
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
What are symptoms and signs of Allergic rhino-sinusitis?
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
What is the management of Allergic rhino-sinusitis ?
```
1- Prophylactic: Avoidance of allergens.
2- Symptomatic:
- Oral Antihistamine.
- Intranasal Antihistamine sprays.
-Topical steroid nasal sprays.
```
81
What are the predisposing factors of Acute bacterial Rhino-sinusitis?
```
1- Recurrent viral URTI.
2- Allergy.
3- Foreign body/trauma.
4- Dental procedure.
5- Baro-trauma.
6- Iatrogenic.
```
82
What are the causative organisms of Acute bacterial rhino-sinusitis?
most common :
1- Streptococcus pneumonia.
2- Haemophilus influenzae.
In children : Moraxilla catarhalis is responsible of 20% of cases.
Dental origin : Anaerobic organisms.
83
What are symptoms and signs of Acute bacterial rhino-sinusitis?
```
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
How to treat acute bacterial rhino-sinusitis ?
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
What are the complication of acute bacterial rhino-sinusitis?
```
1-Orbital cellulitis and abscess.
2- Meningitis.
3- Brain abscess.
4- Osteomyelitis.
5- Cavernous sinus thrombosis.
```
86
What are the causative organisms of Chronic bacterial rhino-sinusitis?
```
1- Streptococcus pneumonia.
2- Haemophilus influenzae.
3- Moraxilla catarhalis.
4- Anaerobic organisms "dental origin".
5- Staphylococcus aureus.
6- coagulase- negative staphylococcus.
7- anaerobes.
```
87
What is the symptoms and signs of chronic rhino-sinusitis?
```
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
What is the treatment of Chronic rhino- sinusitis ?
```
- 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
What is Functional Endoscopic Sinus Surgery "FESS" ?
It's the removal of the diseased area to relieve the obstruction and so restore natural sinus drainage, ventilation and normal physiology.
90
What are the important factors involved in the patho-physiology of sinus disease?
1- Patency of the ostia.
2- Function of the cilia.
3- Quality of the nasal secretions.
91
What are the complications of the FESS ?
```
1- Bleeding.
2- Injury to nasolacrimal duct.
3- orbital injury.
4- CSF leak.
5- Intracranial injury.
6- Optic nerve injury.
```
92
What is Samter's Triad ?
It's a chronic medical condition that consist of Asthma, nasal polyposis and Aspirin allergy.
93
What is a nasal polyposis ?
It's a swollen respiratory mucosa, it's yellowish- grey in color, smooth and moist, pedunculated and move on probing.
94
How to treat Nasal polyposis ?
Medical :
corticosteroid : oral and topical nasal.
Surgery:
1- Nasal polypectomy.
2- ESS
95
What is the lymphatic drainage of the pharynx ?
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
What is the Nerve supply of the pharynx ?
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
What is the lymphatic drainage of the Larynx ?
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
What is the Nerve supply of the Larynx?
```
vagus nerve through :
1- Superior laryngeal N:
- Internal laryngeal N.
- External laryngeal N.
2- Recurrent laryngeal N.
```
99
What are the causes of xerostomia ?
```
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
What is Hoarseness ?
It's the change of voice from a higher to a lower pitch.
101
What is Aphonia ?
Complete loss of voice.
102
What are the causes of Hoarseness ?
```
1- Congenital web.
2- Trauma.
3-Foreign bodies.
4- Vocal cord paralysis.
5-Tumors
6-Inflammatory conditions.
```
103
What are the causes of Stridor in newborns ?
```
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
What is the definition of Cough ?
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
What is Stomatitis?
Inflammatory condition of the oral mucosa.
106
What is recurrent aphthous stomatitis?
Recurrent painful, single/multiple necrotizing ulcers of the oral cavity mucosa.
107
What are the causes of Recurrent aphthous stomatitis?
```
unknown , but the suspected predisposing factors are:
1- Trauma.
2- stress.
3- Hormonal changes.
4- Vitamins deficiency.
```
108
What is the treatment of Recurrent aphthous stomatitis?
It's a self limited disease "7-10 days"
| could use local paste of corticosteroids or cautery with silver nitrate.
109
What is candidiasis and how to treat it ?
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
What is nicotine stomatitis ?
It's white patches over the palate mucosa with multiple small papules seen in smokers, no treatment except stopping smoking.
111
What is leukoplakia ?
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
What is the comments causes of Otorrhea?
1- Otitis Externa.
2- Acute OM after TM perforation.
3-CSOM.
113
Who is at risk for hearing loss and should be tested immediately after birth?
```
1- Pre-maturity.
2-Low birth-wight.
3- Neonatal jaundice.
4- Perinatal hypoxia.
5- Intrauterine infection.
6- Hereditary HL.
7- Failed distraction test.
```
114
What is the most common cause of conductive HL in adults?
Impacted wax , which lead to at most 30-40 dB of HL.
115
What is the most common cause of conductive HL in adults?
OM with effusion.
116
Under which circumstances we should repair the perforated TM ?
1- Persistent otorrhea.
2- Recurrent infection.
3- HL
and ears must be dry before surgery.
117
What is Acoustic neuroma?
vestibular schwanoma which is a benign tumor of the 8th cranial nerve.
118
The Rinne test is positive in ………… or …………… .
normal hearing - sensory/neural hearing loss.
