ent saqs Flashcards
W h a t is the nam e o f the area on the an terio r nasal septum w here
epistaxis com m only originates?
kiesselbach’s triangle
which arteries are in Kisselbach’s area?
the anterior ethmoidal, sphenopalatine
and facial arteries anastamose
W h a t is the nam e o f the lym ph node com m only found to be
enlarged in tonsillitis?
Jugulodigastric lymph node.
difficulty swallowing just solids =
difficulty swallowing both =
difficulty swallowing just solids = stricture
difficulty swallowing both = a motility disorder
W h ich cranial nerve is the recu rren t laryngeal nerve a branch of?
vagus
W h ich side is recu rren t laryngeal nerve palsy com m oner on and
why?
Left, as it has a longer course than the right; therefore, it is more
susceptible to damage.
W h a t is the only laryngeal m uscle n o t supplied by the recu rren t
laryngeal nerve, and w hat nerve is this m uscle supplied by?
Cricothyroid, superior laryngeal nerve.
causes of laryngeal nerve palsy
Tumours (thyroid/oesophageal/larynx/bronchial), surgery
(thyroid/parathyroid/oesophageal/cardiac), aortic arch aneurysm,
bulbar/pseudobulbar palsy, idiopathic.
G ive tw o o th e r sym ptom s o f vocal cord palsy o th e r th an
hoarseness.
Vocal fatigue, reduced volume of voice, shortness of breath,
cough.
W h a t procedure is used in the E N T o u tp atien t setting to visualise
the vocal cords?
Laryngoscopy
bilat-
eral vocal cord palsies may lead to
to airway occlusion, requiring urgent
tracheostomy
causes of unilateral facial weakness
Strokes, cerebellopontine angle lesions, tumours, acoustic
neuromas, otitis media, multiple sclerosis, Ramsay Hunt
syndrome, parotid tumours, trauma, Guillain-Barré syndrome,
Bell’s palsy.
branches of the facial nerve
Temporal branch of the facial nerve, zygomatic branch of
the facial nerve, buccal branch of the facial nerve, marginal
mandibular branch of the facial nerve, cervical branch of the facial
nerve
Describe the pathogenesis of BPPV
T h e re is displacement of an otolith /otoconia within the
semicircular canals. The heavier otolith causes abnormal
movement o f the endolymph within the canal, giving the
sensation o f vertigo.
H o w do ch ild ren ’s E ustachian tubes differ in shape to adults’, and
w hat is th e clinical consequence o f this?
Shorter, narrower and more horizontal - poor drainage, more
likely to suffer middle ear infections
N am e the tw o portions o f the eardrum
Pars flaccida, pars tensa
W h a t m ig h t you find on otoscopy?
Bulging eardrum, reddening or dull appearance, prominent blood
vessels, (+/- perforation)
W h ere is the tu n in g fork placed to elicit bone conduction in
R in n e’s test?
Mastoid process
H o w do you confirm th e diagnosis o f vestibular schw annom a?
MRI
W h a t is th e m ain differential diagnosis for vestibular schwannoma?
meningioma
What is a paranasal sinus?
- A n air-filled cavity in the facial bones w ith connection to the nasal
cavity
Name the paranasal sinuses
M axillary, ethm oidal, sphenoid, frontal sinus.
What epithelium lines the paranasal sinuses?
C iliated pseudostratified colum nar epithelium
Give two causes of maxillary sinusitis
M o st are secondary to bacterial infection (often follow ing a viral
infection), dental ro o t infection, diving/sw im m ing in infected
w ater, traum a, carcinoma
- What cranial nerve would you examine? (1)
- What are the other pairs of salivary glands? (2)
- What percentage of tumours within the salivary glands are found
in the parotid gland? (1) - What is the commonest tumour of the parotid gland? (1)
- What features would lead you to expect a carcinoma? (2)
- Where does the parotid duct enter the mouth? (1)
- Excluding tumours, what other conditions can lead to unilateral
swelling of the parotid gland? (2)
Facial nerve. (1)
Subm andibular, sublingual. (1 mark for each, max 2 marks)
80% . (1)
80% o f these are pleom orphic adenom as. (1)
Pain, fast grow th, fixing to o th e r structures, facial nerve palsy.
(1 mark for each, max 2 marks
6. Next to the second maxillary molar tooth. (1)
7. Parotitis, mumps (more commonly bilaterally), duct blockage
(salivary calculus).
high fever, severe sore throat and difficulty swallowing along with neck stiffness or swelling at back of neck (nuchal rigidity) =
Retropharyngeal abscess
severe sore throat that can cause difficulty in opening mouth (trismus), drooling, foul-smelling breath and deviation of uvula towards unaffected side due to swelling on one side of the throat =
Peritonsillar abscess (quinsy)
Mx of epistaxis?
- A to E
- Fluid resus, analgesia
- Pinch fleshy part of nose and lean forward
- Apply pressure for 20 min
3 treatment options for epistaxis?
- packing
- cauterisation
- foley catheter
Complications of epistaxis?
septam haematoma
sinusitis
deformity
vasovagal episode
aspiration
Signs of OME?
dull, retracted tympanic membrane with loss of light reflex
air bubbles/fluid level behind membrane
What predisposes children to OME?
Down’s/cleft palate
what is adjuvant therapy
Adjuvant therapy is given after the tumour has been removed surgically, with the aim of destroying any remaining tumour cells.
what pathophysiological change is seen in the ears in Meniere’s?
endolymphatic hydrops
Meniere’s Tx?
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit
complications of OM?
● Meningitis. ● Hearing loss. ● Mastoiditis. ● Tympanic membrane perforation. ● Intracranial abscess. ● Facial nerve palsy.
Stone in salivary gland - Dx?
● Fine-needle aspiration. ● CT. ● X-ray. ● Sialogram.
Clinical signs of quinsy?
● ‘Thick’ voice. ● Swelling adjacent to the tonsil. ● Trismus. ● Snoring. ● Bulging of the soft palate. ● Tonsillar arch pushed forward. ● Deviated uvula. ● Erythema of arch and palate.
definitive Mx of quinsy
aspiration of abscess, incision and drainage
complications of untreated quinsy
● Airway obstruction. ● Death. ● Deep neck-space infection. ● Mediastinitis.
swelling near ear + facial droop =
adenoid cystic carcinoma
Tx of benign parotid tumour?
Superficial parotidectomy to spare the facial nerve.
what is Frey’s syndrome?
Frey’s syndrome happens when you experience facial sweating and flushing when you eat. It’s often a side effect of parotid gland surgery and happens due to nerve damage and abnormal nerve regrowth.
How should septal haematoma be managed?
urgent incision and drainage
Nasal fracture management?
- Give 5-7 days for swelling to subside then see in clinic
- Manipulation under anesthetic 7-14 days after injury
Clear discharge from nose which tests positive for beta-2 transferrin - what is it? What should be done now?
CSF
Manage it conservatively
Pain + swelling in ear suggestive of pinna haematoma - Mx?
aspirate immediately, risk of avascular necrosis of cartilage
What is a cholesteatoma?
A cholesteatoma is an overgrowth of keratinised squamous epithelium in the middle ear, in the ‘attic’ of the ear.
Complications of a cholesteatoma?
● Facial nerve palsy. ● Meningitis. ● Abscess. ● Deafness. ● Recurrence. ● Mastoiditis. ● Sigmoid sinus thrombosis. ● Labyrinthine fistula. ● Osteomyelitis. ● Chondritis.
Signs of mastoiditis?
● Protrusion of the ear. ● Erythema and swelling over the mastoid process. ● Otorrhoea. ● Bulging tympanic membrane. ● Sagging of the posterosuperior ear canal wall.
What is mastoiditis?
OM infection extends to mastoid air cells –> osteolitis
