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DERM > ENT > Flashcards

ENT Flashcards

1
Q

in which bone are the organs of hearing and balance located

A

temporal bone

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2
Q

what is the pterion

A

h-shpaed suture between the temporal, parietal, frontal and sphenoid bones
thinnest part of the skull

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3
Q

where does the middle ear start and end

A

auricle to tympanic membrane

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4
Q

where does the inner ear start and end

A

oval window to internal acoustic meatus

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5
Q

where does the middle ear start and end

A

tympanic membrane to oval window

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6
Q

which nerves supply general sensory innervation to the external ear

A

C2,3
CNVII
CNV3
CNX

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7
Q

lymphatic drainage of the lateral surface of superior hand of auricle

A

parotid lymph nodes

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8
Q

lymphatic grange of cranial surface of superior half of auricle

A

mastoid lymph nodes

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9
Q

lymphatic drainage of inferior half of auricle

A

superficial cervical lymph nodes

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10
Q

where does lymphatic drainage from the ear eventually drain

A

deep cervical lymph nodes
thoracic duct or right lymphatic duct
venous angle

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11
Q

what type of glands secrete earwax

A

ceruminous

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12
Q

general sensory innervation of the external tympanic membrane

A

mostly CNV3

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13
Q

general sensory innervation of internal surface of tympanic membrane

A

CNIX

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14
Q

structures innervated by CNIX

A 
middle ear cavity 
Eustachian tube 
nasopharynx 
oropharynx 
tonsils
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15
Q

what are ossicles

A

middle ear bones

malleus, incus, stapes

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16
Q

what type of joints are between the ossicles

A

synovial joints

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17
Q

what structures are connected by the Eustachian tube

A

middle ear cavity and nasopharynx

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18
Q

where does the facial nerve connect to the CNS

A

junction between pons and medulla

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19
Q

chords tympani is a branch of which CN

A

CNVII

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20
Q

what does the chorda tympani innervate

A

taste buds of anterior 2/3rds of tongue

parasympathetic supply to submandibular and sublingual salivary glands

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21
Q

what is the stapedius

A

a muscle that reduces stapes movement to protect the internal ear from excessive noise

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22
Q

which nerve innervates the stapedius

A

CNVII

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23
Q

how to test the muscles of facial expression and motor function of CNVII

A

frown
close eye tightly
smile
puff out cheeks

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24
Q

what does the otic capsule contain

A

bony labyrinth

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25
Q

what sort of fluid is inside the bony labyrinth

A

perilymph

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26
Q

what is suspended within the perilymph of the bony labyrinth

A

membranous labyrinth

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27
Q

what sort of fluid does the membranous labyrinth contain

A

endolymph

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28
Q

what are the three types of epithelium/mucosa in the nasal cavities

A

keratinised stratifies squamous epithelium
respiratory epithelium
olfactory mucosa

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29
Q

somatic sensory innervation of the nasal cavities

A

anterosuperiorly - CNV1

posteroinferiorly - CNV2

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30
Q

blood supply to the nasal cavities arises from which three main arteries

A

facial
maxillary
ophthalmic

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31
Q

nasal branches of ophthalmic artery

A

anterior and posterior ethmoidal anteries

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32
Q

nasal branches of maxillary artery

A

sphenopalatine

greater palatine

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33
Q

nasal branches of facial artery

A

lateral nasal branch of facial

septal branch of superior labial artery

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34
Q

what is little’s area

A

an arterial anastomosis on the nasal septum

a common site of epistaxis

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35
Q

what are the four conchae in the lateral wall of the nasal cavity

A

sphenoethmoidal
superior
middle
inferior

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36
Q

how to confirm placement of an NG tube

A

x-ray
tube should remain in the midline
tip should be clearly visible
tip should be 10 cm beyond the GOJ

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37
Q

how many paranasal sinuses

A

2 x frontal sinuses
2 x maxillary sinuses
2 x ethmoidal air cells
2 x sphenoidal sinuses

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38
Q

what are the paranasal sinuses lined by

A

mucous secreting respiratory epithelium

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39
Q

where do the frontal sinuses drain

A

middle meatus

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40
Q

where do the ethmoidal air cells drain

A

superior and middle meatuses

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41
Q

where do the sphenoidal sinuses drain

A

sphenoethmoidal recess

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42
Q

where do the maxillary sinuses drain

A

middle meatus

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43
Q

what drains into the inferior meatus

A

lacrimal fluid

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44
Q

which sinuses are most commonly affected by sinusitis

A

maxillary sinuses

mucous drains against gravity

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45
Q

complication of extraction of tooth relating to sinuses

A

oro-antral fistula

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46
Q

where might pain from maxillary sinuses refer to

A

the maxilla/mandible

all the teeth

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47
Q

what kind of mucosa lines the middle ear

A

columnar lined mucosa

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48
Q

what is schneiderian epithelium

A

pseudo-stratified ciliated columnar epithelium

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49
Q

what kind of glands are salivary glands

A

exocrine

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50
Q

what is otitis media

A

inflammation of the middle ear

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51
Q

most common cause of otitis media

A

viral infection

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52
Q

what is cholesteatoma

A

abnormally situated squamous epthithelium in the ear canal

high cell turnover and abundant keratin production

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53
Q

bilateral vestibular schwannoma in a young patient may be associated with

A

neurofibromatosis type 2

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54
Q

nasal polyps in children may be a sign of

A

cystic fibrosis

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55
Q

what sort of hypersensitivity reaction is allergic rhinitis

A

type 1

IgE mediated

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56
Q

nasal signs of GPA

A

epistaxis
nasal crusting
congestion
septal perforation

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57
Q

which virus is associated with nasopharyngeal carcinoma

A

EBV

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58
Q

causes of laryngeal polyps

A

vocal abuse, infection, smoking

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59
Q

contact ulcers may be caused by

A

chronic throat
voice abuse
GORD

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60
Q

squamous papilloma/papillomatosis is associated with which virus

A

HPV types 6 and 11

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61
Q

paraganglioma may be associated with which condition

A

MEN2

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62
Q

commonest head and neck cancer

A

SCC

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63
Q

risk factors for head and neck SCC

A

smoking
alcohol
HPV

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64
Q

what is sialolithiasis

A

salivary gland stones

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65
Q

which condition is caused by paramyxovirus

A

mumps

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66
Q

what is the most common site of salivary gland tumours

A

parotid

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67
Q

what are the most common malignant salivary gland tumours in the uk and worldwide

A

UK - adenoid cystic carcinoma

worldwide - mucoepidermoid carcinoma

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68
Q

what are the organs of taste

A

taste buds

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69
Q

what cells are taste buds made up of

A

sensory receptor cells and support cells

70
Q

life span of taste receptor cells

A

10 days

71
Q

what are the four types of papillae on the tongue

A

filliform (no taste buds)
fungiform
vallate
foliate

72
Q

which nerves carry afferent taste fibres

A

CNVII (chorda tympani - anterior 2/3rds of tongue)
CNIX (posterior 1/3 of tongue)
CNX (areas other than tongue)

73
Q

what is aguesia

A

loss of taste function

74
Q

causes of aguesia

A

nerve damage, local inflammation, endocrine disorders

75
Q

what is hypoguesia

A

reduced taste function

76
Q

causes of hypoguesia

A

chemotherapy, medications

77
Q

what is dysguesia

A

distortion of taste function

78
Q

causes of dysguesia

A

glossitis, gum infections, tooth decay, reflex, URTI, medications, neoplasms, chemotherapy, zinc deficiency

79
Q

what types of cells are in the olfactory mucosa

A

olfactory receptor cells
supporting cells
basal cells

80
Q

structure of olfactory neurones

A

a thick short dendrite and an expanded end called an olfactory rod

81
Q

life span of olfactory receptors

A

2 months

82
Q

what are the two criteria a substance must fulfil to be able to be smelt

A

sufficiently volatile

sufficiently water soluble

83
Q

what is anosmia

A

no smell

84
Q

causes of anosmia

A

viral infection, allergy, nasal polyps, head injury

85
Q

what is hyposmia

A

reduced smell

86
Q

causes of hyposmia

A

viral infections, allergy, nasal polyps, head injury

87
Q

what is dysosmia

A

altered sense of smell

88
Q

complications of acute infectious pharyngitis

A

otitis media, peri-tonsillar abscess (quinsy), parapharyngeal abscess and mastoiditis

89
Q

common causes of pharyngitis

A

common cold
influenza
strep infection

90
Q

when to refer pharyngitis

A 
suspected throat cancer
sore or painful throat for 3-4 weeks 
odynophagia/dysphagia 3 weeks 
red, or red and white patches, or ulceration for more than 3 weeks 
stridor/respiratory difficulty
91
Q

what are the centor criteria

A

no cough
lymphadenopathy
fever
tonsillar exudate

92
Q

treatment of bacterial sore throat

A

penicillin (group A strep)

93
Q

complications of strep throat

A

rheumatic fever

glomerulonephritis

94
Q

what causes diphtheria

A

corynebacterium diphtheriae

95
Q

presentation of diphtheria

A

severe sore throat with a grey/white membrane across the pharynx

96
Q

treatment of diphtheria

A

antitoxin nd supportive and penicillin/erythromycin

97
Q

presentation of oral thrush

A

white patches on red, raw mucous membranes in throat/mouth

98
Q

treatment of oral thrush

A

nystatin

99
Q

presentation of AOM

A

discharge, hearing loss, fever, lethargy, associated with URTI

100
Q

bacterial causes of AOM

A

strep pneumoniae
h influenzae
strep pyogenes
moraxella

101
Q

antibiotic treatment of middle ear infections

A

1st line amoxicillin

2nd line erythromycin

102
Q

antibiotics for sinusitis?

A

in severe/deteriorating cases of >10 days duration

103
Q

treatment of acute sinusitis

A

1st line pen V

2nd line doxycycline

104
Q

presentation of otitis externa

A 
redness, swelling 
itchy 
pain
discharge or increased earwax 
loss of hearing
105
Q

what is malignant otitis

A

extension of otitis externa into bone surrounding ear canal (mastoid and temporal bones)

106
Q

why is malignant otitis fatal

A

it causes OM which can spread to the skull and meninges

107
Q

symptoms of malignant otitis

A

pain and headache

more severe than clinical signs would suggest

108
Q

signs of malignant otitis

A

granulation tissue at bone-cartilage junction of ear canal
exposed bone in ear canal
facial nerve palsy

109
Q

Ix malignant otitis

A

PV/CRO raised
x-ray
biopsy
culture

110
Q

most common cause of malignant otitis

A

pseudomonas aeruginosa

111
Q

risk factors for malignant otitis

A

diabetes

head/neck radiotherapy

112
Q

bacterial causes of otitis externa

A

staph aureus

pseudomonas aeruginosa

113
Q

fungal causes of otitis externa

A

aspergillus niger

Candida albicans

114
Q

treatment of otitis externa

A

topical clomitrazole for fungal

gentamicin 0.3% drops if bacterial

115
Q

presentation of infectious mononucleosis

A

fever
enlarged lymph nodes
sore throat, pharyngitis, tonsillitis
malaise, lethargy

116
Q

complications of mono

A

anaemia, thrombocytopenia
splenic rupture
upper airway obstruction
increased risk of lymphoma

117
Q

cause of mono

A

EBV

118
Q

treatment of mono

A

bed rest
paracetamol
avoid sport
antivirals not effective

119
Q

mono Ix

A

EBV IgM
Paul-bunnel/monospot test
blood count and film
LFTs

120
Q

treatment of HSV1 gingivostomatitis

A

acyclovir

121
Q

lab confirmation of HSV

A

swab of lesion in virus transport medium for detection of viral DNA by PCR

122
Q

causes of herpangina

A

coxsackie viruses

123
Q

what is herpangina

A

vesicles/ulcers on the soft palate

124
Q

causes of hand foot and mouth disease

A

coxsackie virus

125
Q

presentation of Behcet’s disease

A

recurrent oral ulcers
genital ulcers
uveitis
GI, pulmonary, MSK, CV neuro involvement

126
Q

what is chancre

A

painless indurated ulcer at site of entry of bacterium treponema palladium (syphilis)

127
Q

boundaries of the oral cavity

A

upper and lower teeth
floor of mouth/tongue
oropharynx
hard palate and soft palate

128
Q

3 pairs of salivary glands

A

parotid
submandibular
sublingual

129
Q

innervation of salivary glands

A

parotid - CNIX

other two - CNVII

130
Q

sensory innervation of anterior 2/3rds of tongue

A

general - CNV3

special - CNVII

131
Q

sensory innervation of posterior 1/3rd of tongue

A

general - CNIX

special - CNIX

132
Q

extrinsic muscles of the tongue

A

hyoglossus
palatoglossus
styloglossus
genioglossus

133
Q

clinical testing of CNXII

A

stick out tongue
if both are functioning normally the tongue tip remains in the midline
if unilateral damage the tongue points towards the injured side

134
Q

blood supply of the tongue

A

lingual artery

135
Q

muscles the soft palate

A

levator veli palatini
tensor palatini
palatoglossus
palatopharyneus

136
Q

innervation of the muscles of the tongue

A

CNXII apart from palatoglossus (CNX)

137
Q

innervation of the soft palate muscles

A

CNX apart from tensor veli palatini (CNV3)

138
Q

clinical testing of CNX and CNV3

A

ask patient to say ‘ahh’
if the nerves are functioning normally the uvulas should lift straight up the midline
if there is unilateral nerve pathology the uvula will pull away from the non-functioning side

139
Q

constrictor muscles of the pharynx

A

superior, middle and inferior constrictor muscles

140
Q

longitudinal muscles of pharynx

A

stylopharyngeus
palatopharyngeus
salpingopharyngeus

141
Q

innervation of pharyngeal muscles

A

all CNX apart from stylopharyngeus (CNIX)

142
Q

tonsils in Waldeyer’s ring of lymphoid tissue

A 
pharyngeal tonsil (adenoid)
tubal tonsil (Eustachian tube opening)
palate associated lymphoid tissue (mucosa of soft palate)
lingual tonsil (mucosa of posterior 1/3rd of tongue)
palatine tonsil (tonsil)
143
Q

lymph nodes in infection

A 
swollen
painful
soft 
smooth
not fixed 
improves with treatment
144
Q

lymph nodes in cancer

A 
swollen
not painful
hard 
irregular 
fixed 
do not improve with treatment
145
Q

vertebral levels of larynx

A

C4-C6

146
Q

what are the laryngeal cartilages

A

thyroid
cricoid
2 x arytenoid

147
Q

innervation of intrinsic muscles of the larynx

A

CNX

inferior laryngeal nerve (apart from cricothyroid - external laryngeal nerve)

148
Q

action of cricothyroid muscles and effect on pitch

A

‘nods’ thyroid cartilage

increases pitch of voice

149
Q

action of thyroarytenoid muscles and effect on pitch

A

relaxes vocal cords

decreases pitch

150
Q

action of lateral crico-arytenoid muscles and effect on voice

A

adducts/brings vocal ligaments together

makes voice quieter

151
Q

action of arytenoid muscles and effect on voice

A

adduct/brings vocal ligaments together

makes voice quieter (by closing rime glottidis)

152
Q

action of posterior crico-arytenoid muscles and effect on voice

A

abducts vocal cords

makes voice louder

153
Q

mucosa above the vocal folds is innervated by

A

internal laryngeal

154
Q

mucosa below the vocal folds is innervated by

A

inferior laryngeal

155
Q

when does the recurrent laryngeal nerve become the inferior laryngeal nerve

A

level of the cricothyroid joint

156
Q

nasal trauma history

A 
mechanism of injury (fight, sport, fall)
when
LOC
epistaxis 
breathing
157
Q

nasal trauma examination

A 
bruising/swelling/tenderness
deviation
epistxis 
infraorbital sensation 
CNs
158
Q

complications of septal haematoma

A

septal ischaemia/necrosis

159
Q

complications of nasal trauma

A

epistaxis
CSF leaks, meningitis
anosmia (cribriform plate fracture)

160
Q

what is a Pina haematoma

A

sub-perichondrial haematoma

161
Q

treatment of pinna haematoma

A

aspiration
incision and drainage
pressure draining

162
Q

temporal bone fracture history

A 
mechanism of injury 
hearing loss 
facial palsy
vertigo
CSF leak
163
Q

what is battle sign

A

brusing behind the ear

temporal bone fracture

164
Q

temporal bone fracture examination

A

bruising (battle sign)
condition of TM and ear canal
CNVII
hearing test

165
Q

longitudinal temporal bone fracture results in hearing loss

true/false

A

true

haemotypanum or ossicular chain disruption can result in conductive hearing loss

166
Q

transverse temporal fracture results in hearing loss

true/false

A

true

sensorineural loss due to CNVIII damage

167
Q

4 types of hearing loss

A

conductive
sensorineural
mixed
central

168
Q

what is otosclerosis

A

stapes fixation

169
Q

zone I of the neck

A 
trachea
oesophagus 
thoracic duct 
thyroid 
vessels (brachiocephalic, subclavian, thyrocervical trunk)
spinal cord
170
Q

zone II of the neck

A 
larynx
hypopharynx 
CN X, XI, XII
vessels (carotids, internal jugular)
spinal cord
171
Q

zone III of the neck

A

pharynx
cranial nerves
vessels (carotids, IJV, vertebral)
spinal cord

172
Q

tear drop sign of CT

A

blow out fracture

DERM (5 decks)

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