Extra

Question 2

Enumerate the 6 features in the medial wall of the middle ear

Answer 2

Promontory: first basal turn of cochlea
Oval window
Round window
Transverse part of facial nerve
Sinus tympani (depression between oval and round window)
Process cochleariform

Question 3

Symptoms and signs of meningitis

Answer 3

Signs: neck rigidity, painful neck flexion, restlessness, photophobia, projectile vomiting, blurring of vision and severe headache that is persistent

Signs:
-Kernig’s sign: Patient is asked to lie in supine position; with hip and knee flexed–> He can not do extension
-Brudzinski’s sign: Flexion of the neck will be accompanied with reflex flexion of hip and knee

Question 4

Investigations and treatment of meningitis

Answer 4

Investigations: CT to exclude brain abscess and Lumber puncture for CSF analysis

Treatment: Hospitalization in semi-dark room, Systemic antibiotics that cross BBB like 3rd or 4th gen cephalosporin IV, Dehydrating measure like mannitol to decrease ICT

Surgical: treatment of the cause—> if cholesteatoma; mastoidectomy

Question 5

Investigations and treatment of nasal fracture

Answer 5

Investigations: X-ray

Control of epistaxis if present. Reduction of bone right away if no edema under general anesthesia.

If edema, wait a week.

If he came after 2 weeks, wait for 3 months and do rhinoplasty

After fixation, anterior nasal packing to stop any bleeding and support for 48hrs

Fixation from outside with aluminum sheet for 2 weeks

Anti biotics analgesics and anti-inflammatory

Question 6

Give the cause, incidence and treatment of rhinoscleroma

Answer 6

Klebsiella Rhinoscleromatis

15-25 year old females

Medical: Rifampicin, Streptomycin and Alkaline nasal douche
Surgical: removal of mass

Question 7

Give the clinical picture of Plummer-Vinson’s syndrome

Answer 7

More common in female

Dysphagia: due to chronic pharyngo-esophagitis + web

Angular stomatitis and glossitis

Achlorhydria: atrophy of gastric mucosa

Pallor: due to anemia

Koilonychia

Splenomegaly

Question 8

Investigations and treatment of Plummer-Vinson’s syndrome

Answer 8

CBC (shows anemia).

X-ray barium swallow (shows web)

esophagoscopy (take biopsy)

Correction of anemia: iron

Repeated dilatation

Regular follow-up

Question 9

Acute Retropharyngeal abscess symptoms, signs and investigations

Answer 9

Fever, headache and malaise. Dysphagia and odynophagia. Neck is flexed forward. Collection of pus behind nasopharynx and hypopharynx

Enlarge firm tender neck. Pain causes spasm of prevertebral muscles. Welling in posterior pharyngeal wall to one side of mid-line.

X-ray lateral neck view showing widening of prevertebral space and CT to diagnose

Question 10

Treatment of acute retropharyngeal abscess

Answer 10

Hospitalization with parenteral antibiotics + analgesics antipyretics

Incision and drainage under general anesthesia. Internal incision vertical over abscess with head low, using suction apparatus and cuffed endotracheal intubation to avoid aspiration of pus

Question 11

Preoperative care preparation in tonsillectomy

Answer 11

History to exclude contraindications

Examination of tonsils to make sure its chronic

Investigations: ESR, blood picture, coagulation profile: bleeding time, prothrombin time, clotting time ect…

Preoperative instruction: fast for 6 hours

Preoperative medications: Antibiotics to prevent infections, atropine to decrease oral secretions. ASPRIN to be AVOIDED 10 days pre operation

Question 12

Post operative care for tonsillectomy

Answer 12

Lie on side with head down to prevent aspiration of blood or vomit or falling of tongue

Extubation after return of cough reflex

Observe respiration and color of lips and nose

Observe bleeding via pulse rapidness and weakness and frequent swallowing of blood

Antibiotics to prevent infection and analgesic

Ice soft semi solid food to stop bleeding

Question 13

Complications of Quinzy 3

Answer 13

• Laryngeal Edema
• Pyemia and Septicemia
• Parapharyngeal Abscess

Question 14

Complications of acute tonsilitis 5

Answer 14

Quinzy
Retropharyngeal abscess
Parapharyngeal abscess
Acute rheumatic fever
Acute glomerulonephritis

Question 15

Clinical signs and symptoms of Acute non specific laryngitis and treatment

Answer 15

Hoarseness of voice in adult or stridor in children
Diffuse congestion and edema of VC and laryngeal mucosa

Complete bed rest + plenty of warm fluids. Systemic antibiotics + analgesics. Complete voice rest and steam inhalation with benzoine

Question 16

Give 4 reasons why acute non specific laryngitis is dangerous in children

Answer 16

Small larynx (easy obstruction)
Submucosa is loose (easy edema)
Subglottic area is narrow and funnel shape (easy obstruction)
Soft laryngeal cartilages of infantile larynx (easy collapse)