Last 15 minimum

Question 1

34. Management of choking patients – if intubation cannot be carried out

Answer 1

1. Cricothyrotomy – in the lack of time and appropriate tools: we find the cricothyroid ligament above the cricoid cartilage (using fingers), and after carrying out a transversal incision on the skin, we pierce the ligament with any instrument at hand, and insert a holed tool (e.g. outer tube of a pen).
2. Tracheotomy – After incising the skin and the platysma, we find (and if necessary - ligate) the isthmus of the thyroid gland, and - at the 2nd or 3rd tracheal cartilage - we make an incision on the anterior wall of trachea (in childhood) or remove a part of the cartilage (in adults). We insert a tube/cannula in order to maintain the free airway.

Question 2

33. Middle-aged, smoker patient presents with unilateral ear pain, but the examination of the ear does not reveal any disorders. What may be the cause, and what is obligatory to be examined?

Answer 2

Unilateral, referred ear pain is a typical finding in patients with hypopharyngeal (less commonly supraglottic and oropharyngeal) malignancies. This symptom and the tobacco use in the patient history make the examination of the oral cavity, oropharynx/hypopharynx, larynx and the neck obligatory.

Question 3

32. Causes of dyspnea in the upper respiratory tract

Answer 3

• Upper respiratory tract infections (tonsillitis, epiglottitis, laryngitis)
• Non-specific reactions of the upper respiratory mucosa: allergy, Reinke edema, hereditary angioneurotic edema
• Lumps in the upper respiratory tract: abscess, granulation tissue, malignancies
• Foreign body
• Stenosis
• Recurrent laryngeal nerve palsy.

Question 4

31. Evaluation of neck lumps – diagnostic steps

Answer 4

1. Correct registration of patient history: duration of symptoms, upper respiratory tract infections, dysphagia, hoarseness
2. ENT examination – with special attention to the neck: localization, consistency, sensibility of the lump, its relation to the surrounding structures
3. Blood tests: inflammation markers, serology
4. Imaging modalities: ultrasound, CT/MRI
5. US guided Fine Needle Aspiration Biopsy
6. For lymphadenomegaly, excision of the node is carried out only if the evaluation of the FNAB reveals lymphoma (or, if it is needed by the pathologist).

Question 5

30. Swollen neck lymph nodes – causes:

Answer 5

-Non-specific inflammations (e.g. upper respiratory tract infections)

-Specific inflammations
•	Bacterial: TB, syphilis, cat scratch disease, tularemia
•	Protozoal: toxoplasmosis
•	Viral: HIV-infection
•	Non-infectious: sarcoidosis

Lymphomas;
Metastases of head and neck cancers.

Question 6

29. Symptoms of laryngeal and hypopharyngeal cancers

Answer 6

Neck lump
Loss of body weight
Referred ear pain

Hoarseness
Hemoptoe
Dyspnea
Dysphagia
Globus feeling

Question 7

28. Causes of chronic hoarseness (Why is it necessary to visit an ENT specialist after 3 weeks of hoarseness?)

Answer 7

• Benign laryngeal lesions (cysts, granulation, Reinke edema, polyps, papillomatosis)
• Acute and chronic inflammations of the larynx
• Malignant laryngeal lesions
• Recurrent laryngeal nerve paresis, (which can be caused by: hypopharyngeal, thyroid gland, esophageal, pulmonary, mediastinal cancer, intracranial diseases)
• GERD

It is exceptionally important to diagnose a malignant lesion as soon as we can.

Question 8

27. Precancerous lesions of the oral cavity and oropharynx

Answer 8

Erythroplakia,
Leukoplakia,
Lichen planus
Naevus
Spongiosus albus mucosae

Question 9

26. Pathogens of tonsillitis and pharyngitis, indication of antibiotic treatment

Answer 9

Pathogens:
• Viral (80-90%)
-adenovirus, rhinovirus
-(EBV - infectious mononucleosis)

• Bacterial:

• Streptococcus pyogenes - follicular tonsillitis
• Group C and G Streptococci
• Mycoplasma, Chlamydia, Neisseria subspecies
• (Pneumococci)
• (Haemophilus influenzae)
• (Moraxella catarrhalis)
• (Staphylococcus subspecies)

Antibiotics: bacterial infection -

• physical findings,
• laboratory findings (blood count, CRP, ESR, rapid bacteriological test),
• acute or chronic infection,
• presence of immunosuppression.

Question 10

25. Clinical features, symptoms and complications of para- and retropharyngeal abscesses

Answer 10

Symptoms: 
• throat and neck pain, 
• foreign-body sensation, 
• difficulty in swallowing, 
• fever,
• trismus, 
• torticollis, 
• swelling of the lateral or posterior pharyngeal wall,
• thick speech, 
• laryngeal/oropharyngeal edema;

Complications: 
• oropharyngeal and laryngeal edema, 
• septicemia, 
• mediastinitis, 
• choking.

Question 11

24. Peritonsillar abscess – treatment

Answer 11

-Drainage of the abscess - puncture, incision, daily opening of the abscess cavity;

-Tonsillectomy:
• abscess-tonsillectomy;
• tonsillectomy 6 weeks after recovery;

-Antibiotics, decreasing edema, analgesics, administration of fluids.

Question 12

23. Clinical features and symptoms of peritonsillar abscess

Answer 12

• Throat pain, referred ear pain
• Difficulty in swallowing
• Trismus, the speech is thick and indistinct
• Oral fetor
• Fever, insomnia, loss of appetite
• Swelling, redness and protrusion of the tonsil, faucial arch, palate and uvula; the uvula is pushed towards the healthy side.

Question 13

22. Indications of tonsillectomy (absolute and relative)

Answer 13

Absolute indications:
• rheumatic fever
• peritonsillar abscess
• tonsillogenic sepsis

Relative indications:
• chronic tonsillitis
• recurrent tonsillitis
• tonsillogenic or posttonsillitis focal symptoms
• if a tonsillar tumor is suspected
• marked hypertrophy of the tonsils causing mechanical obstruction
• obstructive sleep-apnea syndrome or other obstructive sleep-related breathing disorders
• severe orofacial / dental disorders causing narrow upper airways