ENT notes Flashcards
What is the thinnest part of the skull
Pterion
Which bones make up the pterion
Temporal, Sphenoid, Frontal, Parietal
Anterior cranial fossa bones
Frontal
Ethmoid
Sphenoid
Middle cranial fossa bones
Sphenoid
Temporal
Posterior cranial fossa bones
Temporal
Occipital
Innervation of superior EAM
CN V3
Innervation of inferior EAM
CN X
How does the avascular elastic cartilage of the ear acquire nutrients
From skin
Does the pars tensa sit inferiorly or superiorly
Posteroinferiorly
What supplies the tympanic membrane (external and internal surfaces)
External - CN V3 (auriculotemporal branch)
Internal - CN IX
What is the stapedius
Muscle which reduces stapes movement
Protects inner ear from excessive noise
What type of tissue is present in the middle ear
Columnar-lined mucosa
What type of tissue is present in the nasal vestibule
Squamous
What is Schneiderian epithelium and where is it present
Pseudostratified ciliated columnar
(respiratory epithelium)
Nose & sinus
Which cells in the salivary glands contain digestive amylase
Serous cells
Which cells in the salivary glands are contractile
Peripheral myoepithelial cells
How does a cholesteatoma usually arise
Chronic otitis media with a perforated tympanic membrane
Which gene is mutated in NF type 2 and which protein does it code for
NF 2 gene
Merlin protein
What should you include in your Ddx if a young person has nasal polyps
Cystic Fibrosis
Which GI disease can cause a contact ulcer in the throat
GORD
What is paramyxovirus of the salivary glands
Mumps + Bilateral parotitis
With associated orchitis
What is the most common salivary gland tumour and how does it present
Pleomorphic adenoma
Usually in females over 60 in the parotid gland
What is the 2nd most common salivary gland tumour(associated with smoking) and how does it present
Warthin’s tumour
usually in males over 50 (bilateral and multicentric)
What is the most common malignant tumour of the salivary glands in the UK and the world
Adenoid Cystic Carcinoma - UK
Mucoepidermoid carcinoma - World
Which amino acid in particular triggers an umami/meaty/savoury taste
Glutamate
What kind of deficiency can cause Dysguesia (altered taste)
Zinc deficiency
Which cell type in the olfactory mucosa secrete mucus
Basal cells
Which brain surface are the olfactory bulbs on
Inferior brain surface
Name the 4 components of the Centor score
Tonsillar exudate
Fever
Tender anterior cervical lymphadenopathy
The absence of a cough
What is the most common cause of bacterial tonsilitis
Strep. Pyogenes
What are 2 late complications of bacterial tonsilitis
Rheumatic fever
Glomerulonephritis
What antibiotic is first line for the treatment of otitis media
Amoxicillin
Clarithromycin if allergic (2nd line - erythromycin)
What antibiotic is first line for the treatment of bacterial sinusitis
Penicillin V
Doxycycline if allergic (not in children)
Name 4 complications of Infectious Mononucleosis
Splenic rupture
Increased risk of lymphoma
Airway obstruction
Anaemia
Where does necrosis in the brain occur, with regards to untreated herpes simplex encephalitis
Temporal lobe necrosis
What is the range of human hearing
20- 20,000Hz
What is the ratio and pressure gain between the tympanic membrane and oval window
18: 1
Pressure gain of x22
What are the 4 inputs to regulate balance
Visual
Proprioceptive
Cardiovascular
Vestibular
What are the 5 key vestibular end-organs
Macula of Utricle Macula of Saccule Ampulla of Lateral Semi-Circular Canal Ampulla of Superior Semi-Circular Canal Ampulla of Posterior Semi-Circular Canal
What is the name of the special calcium carbonate crystals on the ends of the stereocilia in the otolith organs
Otoconia
Which salivary gland secretes 90% of the saliva
Parotid
Which major artery is the lingual artery a branch of
External carotid
Name the 5 muscles of the soft palate
Tensor Veli Palatini Levator Veli Palatini Palatoglossus Palatopharyngeus Musculus Uvulae
What is the medical term for the Adam’s apple
The laryngeal prominence of the thyroid cartilage
What are the attachments of the true vocal cords
Vocal process of arytenoid to thyroid cartilage
What are the attachments of the false vocal cords
Arytenoid cartilage to the epiglottis
What does the quadrangular membrane connect
Vestibular ligament & epiglottis
What does the vocal ligament connect
Vocal process & thyroid
What does the conus elasticus connect
Cricoid and vocal ligament
What is the Hippocratic method and what is it used for
The position adopted for epistaxis
Squeeze nose low and lean forward
What is pinna haematoma
Sub-perichondral haematoma
What does a ‘proper’ penetrating neck injury mean
An injury which penetrates the Platysma muscle
How many Hz is the tuning fork used in Rinne’s and Weber test
512Hz
How can you differentiate between CSF and other discharge from the ear
Glucose testing strip
What is the name of the classification system used for retraction of the tympanic membrane
The Sade classification
What is the immediate management of Otitis Externa to provide symptomatic relief
Suction Cleaning
Compare the biochemistry of the Perilymph and the Endolymph in terms of Na & K concentrations, and explain why this is
Endolymph has low [Na] and high [K]
These concentrations drive the vibrations and allow depolarisation via Na influx
What is the name of the special membrane which covers the organ of Corti
Basilar Membrane
How do you test the vestibulo-ocular reflex
VNG
Videonystagmography
How do you differentiate between BPPV & Vertebrobasilar insufficiency
Vertebrobasilar insufficiency presents with other symptoms apart from vertigo e.g visual disturbances, weakness, numbness
Name 3 treatments for BPPV
Epley Manoeuvre (main one)
Semont Manoeuvre
Brandt- Daroff exercises
What can Buccal Prochlorperazine be given for and why
Vestibular neuronitis
Labyrinthitis
(given to decrease vertigo
Which disease out of vestibular neuronitis and labyrinthitis has associated tinnitus & hearing loss
Labyrinthitis
What is phonophobia
Fear of loud sounds
Which head and neck cancer is hardwood associated with
Sinus cancer
What structures does the recurrent laryngeal nerve wrap around on the right and left
Right - right subclavian artery
Left - arch of aorta
What is the difference between dysphagia and odynophagia
Dysphagia - difficulty swallow
Odynophagia - pain on swallowing
What are gabapentin and pregabalin normally used for
Anit-Convulsants
What 2 pro-inflammatory molecules do mast cells release when activated
Histamine
Leukotrienes
Name a nasal decongestant drug
Pseudoephedrine
Name an anti-histamine drug
Cetirizine
According to the ARIA classification, how is intermittent rhinitis defined
Symptoms < 4 days/week
OR symptoms < 4 weeks
According to the ARIA classification, how is persistent rhinitis defined
Symptoms > 4 days/week
AND symptoms > 4 weeks duration
What is the treatment ladder for allergic rhinitis (including the background continuous management)
Anti-histamine
Topical steroid
Anti-histamine + Topical steroid
(Allergen avoidance constant)
What is Samter’s triad
Asthma, Nasal Polyps, Aspirin sensitivity
What is the purpose of giving a topical cholinergic drug in non-infective rhinitis
Supresses rhinorrhoea
What are the differentials from a presentation of unilateral nasal discharge and what is the next step
Foreign Body or Neoplasia
Refer urgently
Which tonsils make up Waldeyer’s ring of lymphoid tissue
Palatine tonsils
Adenoid tonsils
Lingual tonsils
Which tonsils have a transitional layer and what is the function of it
Adenoid tonsils
Antigen processing layer
Which tonsils have stratified squamous epithelium on its luminal surface
Palatine tonsils
What kind of epithelium is present on the surface of the adenoid tonsils
Ciliated pseudostratified columnar
What two things will be seen in the blood which could aid in the diagnosis of Infectious Mononucleosis
Low CRP
Atypical lymphocytes
When should you refer otitis media with effusion
Persistent >3 months
Bilateral
Speech/ language problems
Developmental delay
What would a mass found in the tail of the parotid gland make you think of
Pleomorphic adenoma
How can a cholesteatoma cause hearing loss and vertigo
A large enough one can invade the otic capsule
Which systemic autoimmune disease could cause bilateral parotid gland swelling and facial nerve palsies
Sarcoidosis
What would halitosis + a painless neck mass make you think of
Pharyngeal pouch
Which abnormality is fixed using the Sistrunk procedure
Thyroglossal cyst
Which growth has a typically biphasic growth on histology and why is this
Pleomorphic adenoma
due to stromal & epithelial elements
What is a side effect of using topical decongestants for a prolonged period
Tachyphylaxis
Greater doses are needed to produce the same effect
What should you do on the first presentation of a perforated eardrum
Watch and wait for 6 weeks
What can be given for acute attacks of Meniere’s
Buccal or IM Prochlorperazine
What can be given for prevention of Meniere’s
Betahistine
What test will be positive for Meniere’s and BPPV respectively
Meniere’s –> Romberg
BPPV –> Dix-Hallpike
What are crista galli
A special feature of cribriform plate of ethmoid
What makes up the nasal septum
Perpendicular plate of ethmoid
Which bones make up the medial wall of the nasal septum
Ethmoid and Vomer
What are vibrissae and where are they found
Small hairs found in the stratified keratinised epithelium in the nasal vestibule
Filter the air we breathe in
What is a microscopic feature of vestibular schwannomas
Verocay bodies
Describe the 2 ends of an olfactory neurone
Thick short dendrite and expanded olfactory rod
What causes oral thrush and what is the treatment
Candida Albicans
Topical Nystatin suspension
What is the causative organism of herpangina
Coxsackie
What is thought to be the pathology of Meniere’s
Membrane separating perilymph and endolymph tears, resulting in mixing of the two fluids
