ENT

Question 1

Nerves that innervate the external auditory canal

Answer 1

3, 5, 7, 10
C3 (Great auricular)
10 (Arnold’s nerve. Arnold’s reflex is when someone coughs during manipulation of their ear)

Question 2

How is the footplate of the stapes kept in place?

Answer 2

The annular ligament

Question 3

What dilates the eustachian tube. What nerve innervates this muscle?

Answer 3

Mainly the tensor veli palatini

-Innervated by CN V3

Question 4

Numbers of your top front two teeth

-total teeth?

Answer 4

8 and 9

32

Question 5

Finding the facial n

Answer 5

1) Tragal cartilage (pointer): 1 cm inferior and 1cm deep
2) 1cm deep to the medial attachment of the posterior belly of the digastric
3) Find the posterior facial vein at the inferior portion of the parotid. The marginal branch crosses here superficially
4) 0.6-0.8cm distal to the tempanomastoid fissure

Question 6

Nasolacrimal duct. Where does it end and what valve?

Answer 6

• Ends in the inferior meatus

- Valve of Hasner at the bottom

Question 7

Layers overlying the cranium

Answer 7

SCALP

Skin, Connective tissue, Aponeurosis, Loose connective tissue and Periosteum

Question 8

Great superficial petrosal n

-what CN is it from and what does it do?

Answer 8

• CN VII

- Secretomotor neurons involved in lacrimation. becomes the n of the pterygoid canal (aka vitean n)

Question 9

Otosclerosis

Answer 9

Stapes loses mobility by excessive bony growth at the oval window

• you’ll see a dip at 2 kHz (Carhart’s notch)
• bimodal: early 20s or late 50s
• tx: early= fluoride supplementation. Late= stapedectomy or stapedotomy

Question 10

Where is the noise notch?

Answer 10

4 kHz

Question 11

TMJ tx

Answer 11

• Ibuprofen for 4 wks and soft diet.

- No gum chewing. Possibly night guard splints

Question 12

KTP “laser”

Answer 12

• light amplification through stimulated emission of radiation
• Potassium Titanyl Phosphate
• Basically the laser passes through this potassim titanic phosphate crystal that doubles the frequency which halves the wavelength from 1064 to 532 nm.
• For whatever reason this makes it better able to be operated w/ a microscope or endoscope and works through a fiberoptic cable.
• Light is GREEN

Question 13

Tonsillectomy indications

Answer 13

• 3/yr for 3 yrs, 5/yr for 2 yrs, 7/yr
• big tonsils with an upper airway obstruction
• severe dysphagia
• sleep disorder b/c big tonsils
• peritonsillar abscess unresponsive to medical tx
• tonsillitis resulting in febrile convulsions
• neoplasia (unilateral hypertrophy)

Question 14

Adenoidectomy indications

Answer 14

• OSA
• recurrent/persistent otitis media in kids over 3yo
• nasal airway obstruction
• chronic mouth breathing
• recurrent/chronic sinusitis

Question 15

PE tube indications

Answer 15

• persistent OM that doesn’t respond to 6-12 wks of meds
• recurrent AOM: 3 episodes in 6mo or 4 in 12mo
• complications of AOM (mastoiditis, meningitis, facial n weakness, brain abscess)
• complications of eustachian tube dsfxn like TM retraction with hearing loss

Question 16

Kesselbach’s plexus (4 arteries)

Answer 16

• anterior ethmoid (from ophthalmic a)
• sphenopalatine
• greater palatine (both from maxillary a)
• superior labial (from facial a)

Question 17

Length to width ratio for face and neck flaps

Answer 17

Face: 4:1
Neck: 2:1

Question 18

Parotid duct injury

Answer 18

Consider if deep wound posterior to posterior border of masseter and in a line from the tragus to corner of lip
Cannulate duct and look for it in wound
Stent duct for 10-14 days and anastomose
Or tie off duct and inject with botulinum toxin which causes parotitis and then burnout

Question 19

Eyelid lacerations

Answer 19

Less then or equal to 1/4 can close primarily
Lateral canthotomy can give you another centimeter
Lacrimal duct injury = cannulate duct and anastomose

Question 20

Lip defects

Answer 20

Can close primarily of less than 1/2

Question 21

Hematoma

Answer 21

Gelatinous at first (requires OR drainage) but after one week liquified and can be evacuated in clinic