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MRCS - ENT Nov > Manjaly > Flashcards

Manjaly Flashcards

1
Q

Most common cause of septal perforation

A

trauma

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2
Q

5 investigations for septal perforation

A

Routine bloods - FBC/U+E/ESR
c-ANCA
ACE
RF (RA, SLE, scleroderma)
Biopsy (r/o malignancy)

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3
Q

3 management options for septal perforation

A

nasal hygeine
nasal septal prosthesis (e.g. silicone button obturator)
surgical repair with local or free flap

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4
Q

describe the structure of the nasal septum

A

3 layered structure of bilateral mucoperichondrium over middle layer made up of quadrangular cartilage/perpendicular plate of ethmoid/vomer.

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5
Q

Infections which could cause septal perforation?

A

Syphilis, TB, fungal disease

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6
Q

Types of flap which could be used for septal perforation repair

A

mucoperichondrium
inferior turbinate
auricular cartilage

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7
Q

5 symptoms of cholesteatoma

A

hearing loss
discharge
vertigo
tinnitus
facial weakness

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8
Q

What frequency is Cahart’s notch seen at

A

2000Hz

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9
Q

4 treatment options for otosclerosis?

A

observation
conventional hearing aid
stapes surgery
bone conduction device/implant

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10
Q

what type of tympanogram will be seen in otosclerosis and why

A

As curve - normal middle ear volume and pressure but reduced compliance

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11
Q

3 audiometric tests for herpes zoster oticus

A

PTA
Acoustic reflexes
Electroneurography

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12
Q

4 treatments for herpes zoster oticus

A

analgesia
eye care
corticosteroids
aciclovir

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13
Q

4 symptoms of herpes zoster oticus

A

otalgia
hearing loss
pharyngeal ulceration
CN palsies

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14
Q

serological test for herpes zoster oticus

A

varicella zoster IgG

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15
Q

3 organisms involved in otomycosis

A

aspergillus niger
candida albicans
actinomyces

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16
Q

4 risk factors for otomycosis

A

topical antibiotics
water exposure
canal trauma
diabetes

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17
Q

2 radiological investigations for a vocal cord palsy

A

CXR
Computed tomography of skull base to mediastinum

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18
Q

2 treatments for an idiopathic VC palsy

A

SLT
Surgery to medialise affected VC

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19
Q

Causes of VC palsy

A

direct trauma to VC (e.g. intubation)
damage to RLN (cancer, trauma, surgery)

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20
Q

Surgical options for VC palsy

A

VC injections
thyroplasty
laryngeal reinnervation procedures

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21
Q

Presentation of laryngomalacia

A

stridor
mild tachypnoea

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22
Q

omega shaped epiglottis

A

laryngomalacia

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23
Q

investigations for laryngomalacia

A

laryngotracheobronchoscopy
polysomnography

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24
Q

treatment options for laryngomalacia

A

conservative
oxygen administration
surgery

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25
Q

surgical options for laryngomalacia

A

supraglottoplasty
tracheostomy

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26
Q

Laryngomalacia pathophysiology

A

collapse of supraglottic structures on inspiration

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27
Q

What happens to stridor on crying in laryngomalacia

A

WORSENS on crying on lying flat

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28
Q

What is the conservative management advice for laryngomalacia?

A

encouraging upright position on feeding
pacing feeding with frequent burping
feed thickening
reflux treatment to reduce any layngeal oedema

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29
Q

When should surgical treatment for laryngomalacia be considered

A

when failure to thrive

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30
Q

what to consider in patients with temporal bone fractures?

A

hearing
balance
facial nerve
CSF leak

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31
Q

How can temporal bone fractures be classified

A

otic capsule sparing or otic capsule involved
transverse or longitudinal

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31
Q

which temporal bone fracture is more likely to involve a CSF leak and which otic capsule

A

longitudinal - blow from side, CSF leak more common
transverse - from front/behind with otic capsule involved

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32
Q

management of facial nerve palsies following temporal bone fracture

A

complete, immediate onset - surgical exploration
incomplete, delayed onset - steroids

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32
Q

What would a glue ear audiogram demonstrate

A

Conductive hearing loss, particularly at low frequencies

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33
Q

Four management options for glue ear

A

watchful waiting
hearing aid
grommets
adenoidectomy

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34
Q

Two sequelae of glue ear

A

speech and language delay
AOM

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35
Q

name 5 factors which predispose to glue ear

A

downs syndrome
cleft palate
ciliary dyskinesia
cranial anomolies
history of radiotherapy

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36
Q

3 medical causes for oral candidiasis

A

systemic/inhaled corticosteroids
systemic antibiotics
chemo/radiotherapy

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37
Q

list 2 disease for oral candidiasis

A

diabetes
AIDS

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38
Q

Which bug is responsible for oral candidiasis

A

candida albicans

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39
Q

Treatment of oral candidiasis

A

nystatin oral suspension
fluconazole
itraconazole

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40
Q

Differential diagnosis of anterior triangle neck lumps

A

infective lymphadenopathy
branchial cyst
lymphoma
metastatic SCC

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41
Q

what does FNA reveal in a branchial cyst

A

cholesterol rich fluid

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42
Q

What is the embryological origin of a branchial cyst

A

2nd branchial cleft

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43
Q

5 indications for a tonsillectomy

A

recurrent tonsillitis
OSA
tonsilar malignancy
recurrent quinsy
snoring

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44
Q

Which tonsilar tissue does waldeyers ring contain

A

adenoid tissue
tubal tonsils
lingual tonsils
palatine tonsils

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45
Q

Complications of tonsillitis

A

peritonsillar abscess
retropharyngeal abscess
parapharyngeal abscess
scarlet fever
rheumatic fever
post strep glomerulonephritis

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46
Q

Complications of tonsillectomy

A

pain
bleeding
infection
dental/oral injury

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47
Q

6 measures for epistaxis

A

conservative
cautery
anterior nasal packing - rapid rhino/nasopore/merocel
floseal
foley catheter/BIPP
surgery

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48
Q

How many VC SCC present

A

stridor
change in voice

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49
Q

2 investigations for laryngeal ca

A

CT head/neck/chest
Microlaryngoscopy and biopsy

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50
Q

Surgical options for laryngeal papillomatosis

A

microdebrider
cold steel
carbon dioxide laser

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51
Q

When to offer adjuvent therapy in laryngeal papillomatosis and what adjuvent therapies?

A

gardasil vaccine
cidofovir (prevents HPC DNA synthesis, requires multiple injections into the papilloma)
Use when have over 4 procedures per year

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52
Q

How may vestibular schwannomas present

A

unilateral hearing loss
unialteral tinnitus
sensation changes in trigeminal nerve distribution

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53
Q

6 differential diagnosis of a CPA lesion

A

vestibular schwannoma
meningioma
cholesterol granuloma
facial schwannoma
epidermoid cyst
arachnoid cyst

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54
Q

4 treatment options for pharyngeal pouch

A

conservative
laser myotomy
endoscopic stapling
open surgical resection

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55
Q

2 features which would concern you about malignancy in a parotid lump

A

facial nerve palsy
pain

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56
Q

2 benign parotid lumps

A

pleomorphic adenoma
warthins

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57
Q

2 malignant parotid lumps

A

mucoepidermoid
acinic cell
adenoid cystic

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58
Q

management of benign vs malignant parotid lumps

A

benign - surgical excision
malignant - surgical excision +/- neck dissection +/- CRT

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59
Q

2 risks of CRT in oral cancer

A

mucostitis
osteoradionecrosis

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60
Q

name the point where the scala vestibuli and scala tympani meet

A

helicotrema

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61
Q

what is the modiolus

A

conical shaped central axis of cochlea

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62
Q

3 treatment options for salivary gland stones

A

symptomatic - increased fluid intake/analgesia
sialendoscopy and basket retrival of stone
surgical removal of gland

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63
Q

4 presenting symptoms of nasal polyps

A

sensation of nasal obstruction
rhinorrhoea
anosmia
catarrh

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64
Q

6 causes of hypothyroidism

A

hashimotos thyroiditis
iodine deficiency
drugs - amiodarone
radiotherapy
thyroid surgery
pituitary disease

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65
Q

2 causes of hyperthyroidism

A

graves disease
toxic multinodular goitre

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66
Q

treatment of hyperthyroidism

A

beta blockers
carbimazole
radioactive iodine
total thyroidectomy

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67
Q

Presentation of glomus tympanicum (paraganglioma)

A

CHL
pulsatile tinnitus
mass in ear or neck for other types of paraganglioma

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68
Q

name of classification system for paraganglioma

A

fisch classification

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69
Q

tissue origin of paraganglioma

A

neuroendocrine

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70
Q

List the 4 types of paraganglioma

A

glomus tympanicum
glomus vagale
glomus jugulare
carotid body tumour

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71
Q

Management of paragangliomas

A

monitor
radiotherapy
subtotal resection
radical tympanomastoid/neck surgery

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72
Q

Nerves passing through cribriform plate

A

CN 1 - olfactory nerve (with bulb lying above)
Anterior ethmoidal nerves

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73
Q

nerves passing through optic canal

A

CN 2 - optic nerve

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74
Q

vessels passing through optic canal

A

ophthalmic artery

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75
Q

nerves passing through superior orbital fissure

A

CN3 - Oculomotor
4 - trochlear nerve
V1 - ophthalmic division of trigeminal - lacrimal, frontal, nasociliary branches
6 - trochlear nerve

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76
Q

Vessels passing through superior orbital fissure

A

superior ophthalmic vein
branch of inferior ophthalmic vein

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77
Q

nerves passing through foramen rotundum

A

V2 - maxillary division of trigeminal nerve

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78
Q

vessels passing through foramen rotundum

A

atery of foramen rotunudm
emissary veins

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79
Q

nerves passing through foramen ovale

A

V3 - mandibular division of trigeminal nerve
lesser petrosal nerve

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80
Q

vessels passing through foramen ovale

A

accessory meningeal artery
emissary veins

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81
Q

other structures passing through foramen ovale

A

otic ganglion

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82
Q

nerve passing through foramen spinosum

A

meningeal branch of V3

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83
Q

Vessels passing through foramen spinosum

A

Middle meningeal artery and vein

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84
Q

Nerve passing through foramen lacerum

A

greater and lesser petrosal

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85
Q

Nerves passing through IAM

A

7 - facial nerve
8 - vestibulocochlear nerve

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86
Q

vessels passing through IAM

A

Labyrinthine artery

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87
Q

other structures passing through IAM

A

vestibular ganglion

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88
Q

nerves passing through jugular foramen

A

IX - glossopharyngeal
X - vagus
XI - accessory

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89
Q

vessels passing through jugular foramen

A

inferior petrosal sinus joining sigmoid sinus to form jugular bulb and become external jugular vein
meningeal branches of occipital and ascending pharyngeal arteries

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90
Q

nerves passing through hypoglossal canal

A

12 - hypoglossal nerve

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91
Q

nerves passing through foramen magnum

A

spinal cord
Spinal part of accessory nerve

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92
Q

vessels passing through foramen magnum

A

vertebral arteries
anterior and posterior spinal arteries
dural veins

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93
Q

other structures passing through foramen magnum

A

meninges

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94
Q

CRS diagnostic criteria

A

nasal obstruction +/- discoloured nasal discharge, plus at least one of
* facial pain/pressure
* reduction or loss of smell
For >12 weeks

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95
Q

Indications for FESS

A

CT demonstrating blocked osteomeatal complexes +/- polyps

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96
Q

Which nerves should be infiltrated with lignospan in MUA nasal bones

A

infraorbital
infratrochlear
dorsal nasal
nerves

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97
Q

which instruments can you use to elevate nasal bones

A

hills elevator
walsham forceps

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98
Q

6 symptoms of hypopharyngeal ca

A

weight loss
dysphagia
odynophagia
referred otalgia
bleeding
neck lump

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99
Q

investigations for hypopharyngeal ca

A

pharyngoscopy + biopsy
MRI/CT neck
CT chest

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100
Q

Which instrument is used to remove inhaled FB

A

ventilating bronchoscope

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101
Q

which instrument is used to remove oesophageal FB

A

rigid oesophagoscope

102
Q

Which instruments can you use to remove FB in ear

A

Jobson horne probe
wax hook

103
Q

Difference between osteoma and exostoses

A

osteoma - singular, pedunculated over bony suture lines
exostoses - multiple, bilateral, broad based bony protuberances

104
Q

how may osteomas and exostoses present

A

hearing loss
wax impaction
recurrent infection

105
Q

3 complications of mastoiditis

A

sigmoid sinus thrombosis
intracranial abscess
meningitis

106
Q

XR soft tissue neck signs of a FB

A

loss of cervical lordosis
air fluid level
widended pre vertebral shadow
subcutaneous emphysema

107
Q

which fishbones are radiolucent

A

mackerel, trout, pike

108
Q

what do you use a blom singer valve for

A

transoesophageal voice prosthesis, for speech production in laryngectomy patients

109
Q

What is compliance in tympanometry?

A

Ability of sound to pass into middle ear and beyond - i.e. ability of TM and bones to move in response to air pressure changes

110
Q

How to grade sinusitis on a CT scan

A

Using the Lund-Mackay Grading System:
Each of the sinuses (frontal, maxillary, anterior ethmoids, posterior ethmoids, sphenoidal) is given a grade between 0-2 where 0 is clear, 1 is partially opacified, 2 is completely opacified.
The osteomeatal complex are graded separately where 0 is clear and 2 is blocked.
The total score is out of 24.

111
Q

which systemic diseases are associated with rhinitis

A

CF
primary ciliary dyskinesia
Young syndrome
Samters triad

112
Q

management of allergic rhinitis

A
  1. allergen avoidance
  2. nasal saline irrigation
  3. intranasal steroids
  4. intranasal antihistamines
  5. oral antihistamines
113
Q

Complications of FESS

A

nasal - epistaxis, adhesions, anosmia, nasolacrimal duct injury
orbital - dipolipa, injury to orbit, orbital haemorrhage, visual loss
intracranial - CSF leak, meningitis, abscess

114
Q

ddx inferior turbinate hypertrophy

A

physiological
acute rhinitis
allergic rhinitis
neoplasia

115
Q

3 options for management of inferior turbinate hypertrophy

A

turbinoplasty
turbinate outfracture
high frequency ablation

116
Q

describe the drainage of lacrimal system

A

Lacrimal gland is positioned in the superolateral aspect of the globe, the tears are drained by the upper and lower canaliculus which form the lacrimal sac. This drains into the nasolacrimal duct which opens into the inferior meatus.

117
Q

inheritance pattern of HHT

A

AD

118
Q

MRI pattern of inverted papilloma

A

cerebriform pattern

119
Q

anterior bowing of posterior maxillary wall on saggital CT scan

A

holman miller sign - juvenile angiofibroma

120
Q

cookie bite pattern on PTA

A

hereditary hearing loss

121
Q

type As tymp causes

A

otosclerosis
tympanosclerosis

122
Q

two causes of type c tymp

A

ETD
OME

123
Q

three causes of type B tymp

A

wax/FB
OME
Grommet
TM perf

124
Q

masking rules

A

Masking is required when:

Rule 1
Difference in air conduction between each ear, equal to or greater than 40dB

Rule 2
Difference in bone conduction threshold and the air conduction threshold of either ear is greater than 10dB.

Rule 3
When rule 1 has not been applied, but where the bone conduction threshold of one ear is better by 40dB than the air conduction threshold of the contralateral ear.

125
Q

Name FIVE differentials for a child presenting with a nasal polyp ?

A

Cystic Fibrosis. Meningocephalocele. Encephalocele. Juvenile Angiofibroma. Mucocele. Antrochonal polyp.

126
Q

What is Furstenberg sign ?

A

A sign used to differentiate encephaloceles and meningoceles, from intranasal masses. On crying - effectively performing a valsalva manoeuvre - encephaloceles and meningoceles will expand, whereas an intranasal mass will not.

127
Q

What causes velopharyngeal insufficiency ?

A

Failure of closure of the sphincter created by the soft palate and pharyngeal walls. This results in air escape through the nose causing hypernasal speech and intermittent passage of liquids.

128
Q

What are the treatment options for a cystic hygroma ?

A

Conservative, Sclerotherapy, Surgical Excision

129
Q

What is the treatment for choanal atresia ?

A

Acute:
- Intubation

Elective:
- Transpalatal repair
- Endonasal repair
- Stent vs. Flap

130
Q

Name FIVE associations with choanal atresia presence ?

A

Maternal Vitamin D Deficiency, Coffee, Smoking, Thyroid medication, Syndromes (CHARGE, Treacher Collins, Crouzans)

131
Q

What is Jackson’s Sign ?

A

Pooling of saliva in the piriform fossa.

132
Q

Name FIVE muscles that make up the pharynx ?

A

Superior, middle, inferior constrictor, stylopharyngeus and salpingopharyngeus

133
Q

Name THREE surgical treatment options for a unilateral vocal cord palsy ?

A

Temporary injection with Hyaluronic acid / Calcium hydroxyapatite. Permanent injection with fat. Thyroplasty.

134
Q

Name FOUR treatment options for a bilateral vocal cord palsy ?

A

Laser arytenoidectomy, arytenoid suture lateralisation, bilateral selective reinnervation, laryngeal pacing, tracheostomy

135
Q

What are your differentials for a cholesteatoma ?

A

Cholesterol Granuloma, Keratin Debris, Squamous Cell Carcinoma, Keratosis Obturans, Rhabdomyosarcoma, Meningoencephalocele

136
Q

Name THREE tumours of the middle ear ?

A

Paraganglioma (Glomus Tympanicum, Jugulare, Vagale).
Sqaumous Cell Carcinoma.
Middle Ear Schwannoma (usually from the facial nerve)

137
Q

What are the layers of the tympanic membrane ?

A

Outer epithelial layer.
Middle fibrous layer.
Inner mucosa layer.

138
Q

Name FIVE differentials for a pinna swelling ?

A

Pinna seroma, haematoma, abscess, lipoma, sebaceous cyst, perichondritis

139
Q

What is the Sade Classification ?

A

Classification for Pars Tensa Retraction.
1. Retraction of TM over annulus
2. Retraction of TM along long process of incus
3. Retraction of TM onto promontory
4. Adhesion of TM to promontory

140
Q

What is the Tos Classification ?

A

Classification for Pars Flaccida retraction.
1. Dimple in the attic
2. Retraction and draped TM over the malleus
3. Draped TM with erosion of the scutum
4. Deep retraction with unreachable accumulated keratin

141
Q

What is the sequence of the auditory pathway ?

A

ECOLI: Eight Nerve -> Cochlear nucleus -> (superior) Olivary complex -> Lateral Lemniscus -> Inferior Colliculus

142
Q

What is Eagle Syndrome ?

A

A condition that results in the elongation of the styloid process or calcification of the stylohyoid ligament.

143
Q

What are the symptoms of Eagle Syndrome ?

A

Presentation: unilateral neck or ear pain with symptoms worsening on neck movement.

144
Q

What are the EIGHT branches of the External Carotid Artery ?

A
  1. Superior Thyroid Artery
  2. Ascending Pharyngeal Artery
  3. Lingual Artery
  4. Facial Artery
  5. Occipital Artery
  6. Posterior Auricular Artery
  7. Maxillary Artery
  8. Superficial Temporal Artery
145
Q

Name THREE head and neck cancers that are associated with Ebstein-Barr virus.

A

Burkitts Lymphoma. Hodgkin’s Lymphoma. Nasopharyngeal Carcinoma.

146
Q

Name THREE differentials for a basal cell carcinoma of the skin.

A

Squamous Cell Carcinoma. Keratoacanthoma. Dermatofibroma. Malignant Melanoma.

147
Q

What is the Le Fort Classification ?

A

Le-Fort 1 involving only the alveolar ridge of the maxilla.
Le-Fort 2 - pyramidal fracture and involving nasofrontal suture line.
Le-Fort 3 - Horizontal fracture causing craniofacial disjunction.

148
Q

What are the boundaries of the trauma neck zones ?

A

Zone 1 : Upper Clavicle to Cricoid
Zone 2 : Cricoid to Mandible
Zone 3 : Mandible to Skullbase

149
Q

What are your differentials for a white lesion in the oral cavity ?

A

Canidia, Leukoplakia, Lichen planus, aphthous ulcer, squamous cell carcinoma

150
Q

How would you investigate a patient with a thyroid lump ?

A

Baseline TFTs, Thyroid auto-antibodies, USS Neck + FNA, Cross sectional imaging if evidence of retrosternal extension

151
Q

What is a Ranula ?

A

Ranula is a mucus extravasation pseudocyst in the floor of mouth.

152
Q

Name FIVE differentials for an oral ulcer ?

A

Aphthous ulcer
Herpes simplex
Behcets syndrome
SCC
Pemphigoid vulgaris

153
Q

Name THREE nerves that can be injured in a Level 2 neck dissection ?

A

Accessory, Hypoglossal, Marginal Mandibular Nerves

154
Q

Name SIX structures within the Cavernous Sinus ?

A

O: oculomotor nerve
T: trochlear nerve
O: ophthalmic branch of trigeminal nerve
M: maxillary branch of trigeminal nerve
C: internal carotid artery
A: abducens nerve
T: trochlear nerve

155
Q

What divides Level V in the neck ?

A

Lower border of cricoid.

156
Q

Name 2 situations where a bone anchored hearing aid is more appropriate than a conventional hearing aid

A

congenital malformations of middle/external ear
microtia
chronically discharging ear

157
Q

which thyroid ca gives an elevated calcitonin

A

medullary

158
Q

How to proceed with Thy1 result

A

repeat FNA - inadequate sample

159
Q

Which thyroid ca do we not use radioiodine in

A

medullary

160
Q

how does a FESS lead to epiphoria

A

nasolacrimal duct injury because middle meatal antrostomy has been extended too far

161
Q

Causes of epiphoria

A

FESS nasolacrinmal duct injury
dacrocystitis
nasolacrimal duct obstruction (blockage, strictures)

162
Q

Management of epiphoria

A

conservative - massage, compression, probing nasolacrimal duct
endoscopic dacrocystorhinostomy

163
Q

go through CT sinuses anatomy

A

CT anatomy

164
Q

two reasons for speech delay in children with downs

A

hearing difficulties
high arched palate
lower facial muscle tone

165
Q

4 reasons for OSA in children with downs

A

hypotonia
obesity
tonsillar/adenohypertrophy
macroglossia
midface hypoplasi

166
Q

3 complications of button battery in nose

A
  • mucosal ulceration/erosion/inhalation
  • septal perforation
  • Late nasal stenosis/adhesions
167
Q

3 complications of button battery in ear

A
  • chemical burn/OE
  • TM perforation
  • granulation formation/ulceration
  • Hearing loss
168
Q

Investigations for suspected button battery ingestion

A

Lateral soft tissue neck Xray
AP chest xray
Abdominal xray

169
Q

Management of button battery in cervical oesophagus

A

urgent endoscopic removal under GA

170
Q

Complications of ingested button battery

A

Oesophageal perforation
Mediastinitus
Stenosis/tracheo-oesophageal fistula

171
Q

5 examination findings of nasal fracture

A

bony deviation to L/R
wide nasal bridge
external lacerations
bilateral ecchymosis
epistaxis

172
Q

management of septal haematoma

A

immediate incision and drainage

173
Q

Management of nasal bone fracture

A

MUA/reduction within 3 weeks

174
Q

Sequelae of SRP

A

periorbital bruising/ecchymosis
septal perforation
saddling/supratip depression
numbness
revision surgery/residual deformity
septal haematoma/abscess
epistaxis
nasal obstruction

175
Q

Muscles attached to styloid process

A

stylohyoid
stylopharyngeus
styloglossus

176
Q

ligaments attached to styloid process

A

stylohyoid ligament
stylomandibular ligament

177
Q

Tonsil/tongue base tumour mass investigations

A

panendscopy
biopsy/tonsillectomy
FNAC of lymph nodes

178
Q

Risk factors for oropharyngeal ca

A

smoking
HPV
alcohol
previous radiotherapy

179
Q

Presenting symptoms of oropharyngeal ca

A

trismus
sore throat
otalgia
odonophagia/dysphagia
neck lump
mass in throat (globus)
weight loss

180
Q

Causes of unilateral SNHL

A

CPA lesion
viral
idiopathic
autoimmune
trauma

181
Q

4 management options for hearing loss

A

do nothing
CROS hearing aid
BAHA
Hearing therapy

182
Q

Why is choanal atresia when bilateral a neonatal emergency

A

neonates are obligate nasal breathers

183
Q

Presentation of neonate with bilateral choanal atresia

A

respiratory distress with sternal recession/intercostal recession
cyanosis

184
Q

immmediate management of bilateral choanal atresia

A

oropharyngeal airway/ET tube

185
Q

Confirm diagnosis of choanal atresia

A

nasal catheter
Nasendoscopy
Check for misting

186
Q

Definitive management for choanal atresia

A

surgical opening of choanae via transnasal or transpalatal route

187
Q

Investigations for CHARGE syndrome

A

cardiac assessment with echo
renal US, renal function test
Ophthalmology assessment
audiological assessment

188
Q

How may unilateral choanal atresia present

A

usually later in life with unilateral nasal obstruction
or unilateral nasal discharge

189
Q

If you see a tongue/oral cavity lesion where else must you examine

A

neck
throat/oharynx/larynx/nasendoscopy

190
Q

risk factors for oral cavity ca

A

smoking
chewing tobacco
chewing betel nut
alcohol
previous radiotherapy/radiation

191
Q

investigations for oral cancers

A

biopsy
CT neck
CT thorax
MRI

192
Q

Management of oral ca

A

surgery
CRT

193
Q

Presenting symptoms of a quinsy

A

pain/odonophagia
fever
trismus
altered voice
dysphagia

194
Q

Management of quinsy (4)

A

IV abx
needle aspiration
I+d
Acute tonsillectomy

195
Q

ddx of unilateral pharyngeal swelling

A

tonsillar cancer
deep lobe of partoid tumour
lymphoma
abberrant blood vessel
paraphayrngeal abscess

196
Q

What type of rash is seen in varicella zoster oticus

A

vesicular rash

197
Q

Where is VZV found when dormant

A

geniculate ganglion of facial nerve

198
Q

describe distribution of rash in herpes zoster oticus

A

distribution follows greater petrosal nerve

199
Q

what to use to measure stapedial responses

A

tympanometer with stimulus above 80dB threshold

200
Q

Treatment of herpes zoster oticus

A

urgent initiation of steroids, antivirals, analgesia, + eye care and advice

201
Q

2 audiometric tests for otosclerosis

A

tympanometry
stapedial reflexes

202
Q

management otosclerosis

A

no treatment
hearing aid
stapes surgery (stapedectomy/stapedotomy)
BAHA

203
Q

Examination findings of glue ear

A

retracted TM
Middle ear effusion
dull
intact drum
bubbles

204
Q

Describe the tympanogram expected in glue ear

A

flat trace with normal ear canal volume

205
Q

Management of glue ear (medical)

A

otovent
hearing aid
conservative/watchful waiting

206
Q

risks of grommet insertion

A

ear infection
pain
bleeding
persistent perforation
tympanosclerosis

207
Q

risk factors for glue ear

A

parental smoking
overcrowding
nursery
lower socioeconomic class

208
Q

OP note salient points e.g. grommets and adenoids

A

Patient details (name, DOB, MRN)
Op date
Surgeons name
Anaesthetists name
Operation title
indication for surgery
Findings
Procedure
Haemostasis
Post op instructions (how long to observe for, when to discharge, when will be followed up)
Signature
Printed name and GMC
Legibility

209
Q

Complications of AOM

A

sub-periosteal abscess
inctracranial abscess
sigmoid sinus thrombosis

210
Q

presentation of a child with AOM and complications

A

confusion/irritability/seizures
earache/headache
fever
deafness
vertigo
ataxia

211
Q

Management of mastoiditis

A

urgent drainage/mastoidectomy of affected side + IV antibiotics

212
Q

why does a saddle deformity occur

A

loss of septal support

213
Q

systemic conditions causing saddle nose

A

leprosy
lymphoma
granulomatosis with polyangiitis
sarcoidosis
vasculitis
SLE
rheumatoid arthritis
polyarteritis nodosa
Tuberculosis
syphilis
relapsing polychondritis

214
Q

surgical cause of saddle nose

A

septoplasty

215
Q

management of septal haematoma/abscess

A

antibiotics
I+D/aspiration
quilting suture
nasal packing

216
Q

materials which can be used for septoplasty

A

ear cartilage
rib cartilage
permacol
teflon
bone graft
gortex

217
Q

early complications of septoplasty

A

bleeding
infection
deformity
skin ulceration
adhesions

218
Q

US features suggestive of thyroid ca

A

hypoechogenicity
microcalcifications
increased vascularity
irregular margins
invasion into local structures
loss of elasticity
absence of halo effect

219
Q

4 treatments for differentiated thyroid ca

A

surgery (total/hemi thyroidectomy)
post op radioactive iodine
suppressive thyroxine treatment
external radiotherapy

220
Q

3 blood tests to monitor recurrence of differentiated thyroid ca

A

serum thyroglobulin level
serum thyroglobulin antibody
serum TSH
CEA
Calcitonin

221
Q

risk factors for thyroid ca

A

radiation
MEN syndrome
hypothyroidism
Hashimotos thyroiditis

222
Q

where do vocal cord nodules occur and why

A

at the junction between the anterior third and posterior 2 thirds of the vocal cords because this is the position where there is maximal vibration of the vocal cords

223
Q

management of vocal cord nodules

A

SLT
Surgery

224
Q

Causes of Reinke’s oedema

A

smoking
hypothyroidism
GORD
voice misuse

225
Q

Management of Reinke’s oedema

A

smoking cessation
PPI/thyroxine/antireflux
SLT
surgery (Microlaryngoscopy, decompression conserving epithelium)

226
Q

initial management of TM perf

A

analgesia if needed
Keep ear dry

227
Q

be able to identify chorda tympani, umbo, promontory, long process incus, lateral process malleus, round window niche on image

A
228
Q

be able to label cribriform plate, medial rectus, ethmoid sinus, lamina paprycea, uncinate process, middle turbinate, septum, maxillary sinus, maxilla on CT sinuses

A
229
Q

Complications of breach of lamina paprycea

A

surgical emphysema of orbit
diplopia
loss of vision
haematoma

230
Q

which structure needs to be removed to gain visualisation of maxillary ostium

A

uncinate process

231
Q

complications of breach of cribriform plate

A

unilateral clear rhinorrhoea
headache
photophobia
neck stiffness/meningitis

232
Q

be able to label handle of malleus, long process of incus, promontory (basal turn of cochlea), round window, lateral process of malleus, attic/pars flaccida, stapedius tendon, annulus

A
233
Q

CT with SCC fistula

A
234
Q

Normal soft tissue neck XRAY labelled

A
235
Q

ct neck labelled

A
236
Q

Underlying chromosome NF1 NF2

A

NF1 - 17

NF2 - chromosome 22

237
Q

Management of NF2 vestibular schwannomas

A

surveillance
Small tumours - serial MRI
Surgery for large symptomatic tumour
stereotactic radiosurgery

238
Q

3 symptoms pinna haematoma

A

sensation of fullness
pain
paraesthesia

239
Q

3 signs pinna haematoma

A

swelling with loss of typocal auricular landmarks
discolouration
tenderness on palpation

240
Q

3 complications if pinna haematoma left untreated

A

infection
cartilage necrosis
cauliflower ear deformity

241
Q

which medication to avoid in Churg Strauss

A

Montelukast

242
Q

eye socket anatomy

A
243
Q

post op laryngectomy care

A

Monitor for signs of respiratory distress or bleeding
Chest physio as required
Regular suctioning as required
Stoma care BD at least - remove any crusts gently with saline if required
Monitor wound for bleeding, swelling, infection, breakdown
Humidified O2 as per protocol
Nebulised saline as needed
NG feeding
Remove stoma sutures after 7-10 days

244
Q

Voice options available to stoma patients

A

surgical voice restoration - voice prosthesis into a tracheoesophageal fistula. Provox and Blom Singer valve.
Oesophageal speech
Artificial larynx

245
Q

Intraop chyle leak identified - management

A

ligation of thoracic duct with clips or oversewing with non absorbable suture
sclerosing agents

246
Q

Sequelae of chyle leak

A

infection
poorer wound healing
flap necrosis
chylothorax

247
Q

identification of chyle leak intraop

A

creamy/milky fluid seen
can use manouevers to increase intrathoracic or intraabdominal pressure to help - ask anaesthetist to trendelenburg position or valsalva

248
Q

post op chyle leak management

A

Conservative - bedrest, stool softeners, elevate bed to 30 degrees, dietician input for a low or non fat diet, monitor electrolytes, may need TPN, suction drainage
Medical - somatostatin, octreotide
Surgical rexploration

249
Q

Radiological investigation for chyle leak

A

Lymphangiography

250
Q

IR option for chyle leak

A

thoracic duct embolisation

251
Q

what to remove to prevent recurrence of thyrglossal cyst

A

remaining thyroglossal tract
middle third of hyoid bone

252
Q

Clinical tests to confirm trache position after trache change

A

auscultation of lungs
chest rise
misting of the tube
FNE

253
Q

why do paediatric trache’s block more than adult

A

childs trachea is shorter, narrower, smaller cross sectional area
childs airway cartilage is softer, more likely to collapse under pressure
mucous membranes in children covering supraglottic and subglottic areas are looser in children and more susceptible to oedema when injured/inflamed
Epiglottis is U shaped and may obstruct laryngeal inlet
immature cilia so secretions so poorer secretion clearance than adults
more mucous cells - more secretions than adults

254
Q

INSTRUMENTS

A
255
Q

oral lesions

A

MRCS - ENT Nov (7 decks)

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