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MRCS - ENT Nov > MRCS ENT > Flashcards

MRCS ENT Flashcards

1
Q

What is Pendred’s syndrome?

A

AR syndrome involving SNHL + thyroid goitre

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2
Q

What is Treacher Collin’s syndrome?

A

AD syndrome resulting in underdevelopment of maxilla and mandible, microtia, other ear abnormalities

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3
Q

What is Pierre Robin syndrome?

A

AD syndrome involving hypoplastic mandible with cleft palate and ear deformities

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4
Q

What is Crouzon’s syndrome?

A

AD syndrome with hypoplastic mandible and maxilla, craniostenosis, exophthalmos and ear abnormalities

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5
Q

What is Alpert’s syndrome?

A

AD syndrome with syndactyly, cleft palate, maxillary underdevelopment, stapes footplate fixatoin

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6
Q

Which congenital conditions increase the risk of glue ear?

A

Down’s syndrome
Cleft palate
CF

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7
Q

what is the CHARGE association

A

Coloboma
heart disease
atresia of choana
retarded growth
genital abnormalities
ear abnormalities

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8
Q

what is the pathophysiology of choanal atresia?

A

failure of breakdown of bucconasal membrane in utero - bilaterally leads to breathing difficulty at birth as neonates are nasal breathers

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9
Q

list 5 indications for adenoidectomy

A

nasal obstruction
glue ear
recurrent acute otitis media
rhinosinusitis
OSA

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10
Q

List 3 types of hearing aid (Minimum)

A

In the ear
in the canal
completely in the canal
Body worn
BAHA
CROS (contralateral routing of signal)

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11
Q

which side is the microphone worn on a CROS hearing aid

A

wear the microphone on the side of the dead ear, receiver on the better side

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12
Q

what is the purpose of a tracheooesophageal puncture?

A

initially feeding tube, later can accomodate artificial speaking valve. A tracheooesophageal puncture is a communication between the posterior tracheal wall and oesophagus

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13
Q

if a patient with a laryngectomy needs oxygen, where do you place the mask?

A

over the laryngectomy stoma

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14
Q

which hormones does the thyroid produce

A
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15
Q

list 5 risks of total thyroidectomy

A

hypocalcaemia
recurrent laryngeal nerve palsy
bleeding, neck haematoma
infection
hypothyroidism
tracheomalacia
reucrrence

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16
Q

5 signs of graves disease

A

lid lag/retraction
pretibial myxoedema
thyroid acropachy
palmar erythema
tachycardia/AF
tremor

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17
Q

treatment of severe hypocalcaemia following thyroidectomy?

A

10ml 10% calcium gluconate
then alpha calcidol and sandocal

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18
Q

How does alfacalcidol work

A

vitamin D supplement, requires only one conversion to active form (calcitriol) so provides rapid increase of vitamin D

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19
Q

5 features of hypocalcaemia

A

perioral numbness
weakness/lethargy
carpopedal spasm
chvosteks sign (tapping over parotid causes twitching of facial muscles)

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20
Q

what is trousseaus sign

A

spasm of hand following brachial artery occlusion with BP cuff on due to hypocalcaemia

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21
Q

Label

A

a - optic chiasm
b oculomotor nerve
c trochlear nerve
d abducens nerve
e ophthalmic division trigeminal nerve
f maxillary division trigeminal nerve
g pituitary gland
h ICA
i sphenoid sinus
j cavernous sinus

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22
Q

nerve passing through infraorbital foramen and where it comes from

A

infraorbital nerve from maxillary division of trigeminal nerve

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22
Q

Nerve passing through supraorbital foramen and its origin?

A

supraorbital nerve from frontal nerve from ophthalmic division of trigeminal nerve

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23
Q

nerve passing through mental foramen and where it comes from

A

mental nerve from inferior alveolar nerve from mandibular division of trigeminal nerve

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24
Q

Which muscles are the muscles of mastication?

A

masseter
temporalis
medial pterygoid
lateral pterygoid

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25
Q

Which nerve supplies the muscles of mastication

A

mandibular division of trigeminal nerve

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26
Q

list the muscles supplied by the mandibular division of trigeminal nerve

A

muscles of mastication
mylohyoid
anterior belly digastric
tensor tympani muscle
tensor veli palatini muscle

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27
Q

what are the axis of a tympanogram

A

x - pressure in daPa
y - complicance ml

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28
Q

Which hormones are produced by follicular cells of the thyroid?

A

T3/T4

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29
Q

Which hormone is produced by parafollicular cells of the thyroid?

A

calcitonin

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30
Q

what is the emryological origin of the thyroid?

A

tongue base/thyroglossal duct

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31
Q

to what are thyroid hormones bound to in blood?

A

albumin/thyroglobulin

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32
Q

list one cause of a diffuse smooth goitre

A

graves disease

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33
Q

layers encountered in a thyroidectomy?

A

skin
fat
platysma
deep cervical fascia
strap muscles
pre tracheal fascia

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34
Q

structures at risk in a thyroidectomy

A

recurrent laryngeal nerve
superior laryngeal nerve
thyroid artery

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35
Q

commonest cause of a saddle deformity

A

septal trauma/perforation

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36
Q

systemic causes for saddle deformity (6)

A

GPA
Sarcoidosis
TB
syphilis
SLE
polyarteritis nodosa

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37
Q

ddx of unilateral high frequency SNHL

A

vestibular schwannoma

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38
Q

Risks of surgical management for CPA lesion

A

facial nerve injury
hearing loss (definitely if translabyrine approach)
intracranial haemorrhage
meningitis

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39
Q

6 nerves which pass through superior orbital fissure?

A

frontal nerve
nasociliary nerve
lacrimal nerve
CN 3 ocuclomotor
CN 4 trochlear
CN 6 abducens

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40
Q

2 muscles attached to mastoid tip

A

SCM
splenius capitis muscle
posterior belly of digastric muscle

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41
Q

5 structures attached to styloid process

A

stylohyoid ligament
stylomandibular ligament
styloglossus muscle
stylohyoid muscle
stylopharyngeus muscle

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42
Q

Innervation of styloglossus muscle

A

hypoglossal nerve

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43
Q

Innervation of stylohyoid muscle

A

facial nerve

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44
Q

innervation of stylopharyngeus muscle

A

glossopharyngeal nerve

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45
Q

6 structures which pass through internal auditory meatus

A

facial nerve
nervus intermedius
superior vestibular nerve
inferior vestibular nerve
cochlear nerve
labyrinthine artery
vestibular ganglion

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46
Q

describe the anatomy of a zenkers diverticulum

A

posterior diverticulum of the hypopharynx involving Killians dehiscence

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47
Q

5 symptoms of pharyngeal pouch

A

dysphagia
weight loss
regurgitation of undigested food
hallitosis
aspiration
cough

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48
Q

label

A
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49
Q

what is the helicotrema

A

the part where cochlear labyrunth where scala tympani and scala vestibule meet - the main component of the cochlear apex

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50
Q

which part of the cochlea does the oval window form

A

starting membrane of scala vestibuli

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51
Q

which part of the cochlea does the round window form

A

end of the scala tympani

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52
Q

label these neck levels

A

green - 1
orange - 2
purple - 3
red - 4
yellow - 5
white - 6

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53
Q

3 structures preserved in a modified radical neck dissection

A

spinal accessory
SCM
internal jugular

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54
Q

anatomical boundaries for level 3 neck dissection

A

middle internal jugular chain
hyoid to omohyoid

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55
Q

which nerves can be damaged in a level 3 neck dissection

A

greater auricular nerve
vagus nerve
hypoglossal nerve

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56
Q

symptoms of ramsay hunt syndrome

A

hearing loss
tinnitus
vertigo
pain in ear

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57
Q

signs of ramsay hunt syndrome

A

acute facial nerve palsy
loss of taste anterior 2/3 tongue
dry eyes/mouth
vesicular rash in ear canal/tongue/palate

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58
Q

CN at risk in ramsay hunt syndrome? (2)

A

7, 8 (hearing loss + disequilibrium)

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59
Q

treatment of ramsay hunt

A

pred
analgesia
eye care
+/- acyclovir

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60
Q

apart from ears, where else would you look for vesicles in ramsay hunt syndrome?

A

soft/hard palate
TM

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61
Q

list 4 causes of parotitis

A

sialadenitis
autoimmune - sjograns/sarcoid
infective - staph aureus, paramyxovirus

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62
Q

name the branches of the facial nerve BEFORE it leaves the stylomastoid foramen

A

nerve to stapedius
chorda tympani
greater petrosal nerve

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63
Q

what does the marginal mandibular nerve supply

A

depressor labii inferioris
depressor anguli oris
mentalis

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64
Q

why is the danger triangle of face significant?

A

can cause thrombophlebitis of facial vein - as no valves this can spread and cause cavernous sinus thrombosis

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65
Q

symptoms of cavernous sinus thrombosis?

A
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66
Q

what is a basal skull fracture?

A

which can involve temporal bone, occipital bone, sphenoid bone, ethmoid bone

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67
Q

what is the blood supply to the external ear?

A

posterior auricular and superficial temporal arteries

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68
Q

what is the nerve supply to the external ear?

A

posteromedial, posteriolateral and inferior auricle - greater auricular nerve which is a branch of cervical plexus C2 C3
anteriosuperior and anteromedial - auriculotemporal nerve which is branch of mandibular division of trigeminal nerve
EAC - branches of auriculotemporal, facial, vagus nerves

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69
Q

significance of auricular branch of vagus nerve?

A

referred pain from this nerve can indicate laryngeal cancer
can also cause cough when microsuctioning

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70
Q

what is the nerve responsible for cough during microsuctioning called?

A

Arnold’s nerve or the auricular branch of vagus nerve

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71
Q

describe the pathophysiology of cauliflower ear

A

collection of blood between perichondrium and auricular cartilage which compromises blood supply to cartilage > cartilage necrosis > fibrous tissue forms in overlying skin

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72
Q

List which nerves can be affected in NOE

A

VII, IX, X, XI, XII

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73
Q

list 4 complications of NOE

A

CN palsies
lateral and cavernous sinus thrombosis
meningitis
death

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74
Q

list blood supply of nasal cavity

A

SPA
anterior ethmoidal
posterior ethmoidal
greater palatine
superior labial

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75
Q

what is the innervation of the nasal cavity?

A

anterior-superior - anterior + posterior ethmoidal nerves (V1)
posterior-inferior -
maxillary nerve (v2)
Olfactory area - olfactory nerve

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76
Q

list the extrinsic muscles of the tongue

A

genioglossus
hypoglossus
styloglossus
palatoglossus

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77
Q

sensory supply to the tongue?

A

anterior 2/3 -
general sensation is via lingual nerve which is branch of V3
taste is via chorda tympani which is branch of 7
posterior 1/3 -
both general sensation and taste are from glossopharyngeal nerve

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78
Q

what are the 4 taste sensations of the tongue

A

sweetness (tip)
salty (lateral margins)
sour (posterior)
bitter (posterior)

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79
Q

motor supply of muscles of tongue?

A

all hypoglossal nerve except palatoglossus which is pharyngeal plexus

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80
Q

blood supply to tongue?

A

lingual artery from ECA

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81
Q

what are the four types of papillae on the tongue?

A

circumvallate papillae - anterior to terminal sulcus
foliate papillae - on lingual mucosa
filiform papillae - parallel to terminal sulcus
fungiform papillae - apex of tongue

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82
Q

where does the temporalis muscle originate

A

temporal fossa

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83
Q

where does temporalis insert

A

coronoid process of mandible

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84
Q

where does masseter originate

A

zygomatic arch

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85
Q

where does masseter insert

A

ramus of mandible

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86
Q

where does lateral pterygoid originate

A

skull and lateral surface of lateral pterygoid

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87
Q

where does lateral pterygoid insert

A

TMJ capsule

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88
Q

where does medial pterygoid originate

A

maxillar tuberosity/palatine process/medial surface of lateral pterygoif

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89
Q

where does medial pterygoid insert

A

TMJ angle of mandible

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90
Q

what are the branches of the facial artery

A

NECK
ascending palatine
tonsillar
submental
glandular
FACE
inferior labial
superior labial
lateral nasal
angular

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91
Q

describe a radical neck dissection

A

lymph nodes 1-5
sacrifice of spinal accessory, internal jugular vein, SCM

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92
Q

describe a modified radical neck dissection

A

lymph node dissection from 1-5
preservation of one or more of spinal accessory, internal jugular or SCM

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93
Q

describe a selective neck dissection

A

removal of 1 or more lymph node groups

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94
Q

describe an extended neck dissection

A

refers to removal of additional lymphatic or non lymphatic structures not routinely included in traditional neck dissections

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95
Q

name the different layers of deep cervical fascia

A

superficial
middle
deeper

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96
Q

name the subdivisions of the deep layer of the deep cervical fascia

A

pretracheal and prevertebral

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97
Q

describe the retropharyngeal space

A

space posterior to pharynx and oesophagus

98
Q

clinical significance of retropharyngeal space?

A

can extend from skull to T1-T2 so can cause mediastinitis

99
Q

what is the danger space

A

lies posteriorly to retropharyngeal space - spread of infection in this space tends to occur rapidly due to presence of loose areolar tissue

100
Q

zone 1 neck injury?

A

thoracic inlet up to cricothyroid membrane

101
Q

zone 2 neck injury?

A

between cricothyroid membrane and angle of mandible

102
Q

zone 3 neck injury

A

above angle of mandible

103
Q

signs of accessory nerve damage

A

limitation of abduction of shoulder

104
Q

how can carotid body tumours present?

A

usually asymptomatic palpable neck mass
may also have CN palsy or involvement of sympathetic chain
fever of unknown origin is an uncommon sign

105
Q

describe the cervical plexus

A

plexus of first 4 cervical spinal nerves C1-4

106
Q

what are 4 cutaneous branches of cervical plexus

A

C2 - lesser occipital nerve - lateral part of occipital region
C2 + C3 - greater auricular nerve - innervates skin near concha auricle, EAM, partoid region, post auricular region
C2 + C3 - transverse cervical nerve - anterior region of neck
C3 + C4 - supraclavicular nerves - innervate shoulder, upper thoracic region

107
Q

name 4 muscular branches of the cervical plexus

A

ansa cervicalis - from C1-3 - innervates sternohyoid, sternothyroid and omohyoid
phrenic - C3-5 but primarily C4, supplies diaphragm and pericardium
communicating branches C1 - supplies geniohyoid and thyrohyoid
segmental branches - C1-4 - supplying anterior and middle scalene muscles

108
Q

what is erb’s point and its significance?

A

cutaneous branches of cervical plexus emerge at middle of posterior border of SCM here
Can do a cervical plexus block here

109
Q

organism commonly implicated in orbital cellulitis?

A

staph aureus, strep penumoniae, haemophilus infulenzae

110
Q

components of eye examination to examine in orbital cellulitis

A

colour vision
visual acuity
eye movements
pupil reflexes

111
Q

complications of surgery for orbital abscess (orbital cellulitis)

A

enophthalmos
brain abscess
haemorrhage
diplopia
swelling

112
Q

ddx of a child in respiratory distress

A

laryngomalacia
infective - adenotonsillitis severe, epiglottitis, laryngotracheobronchitis (croup)
subglottic stenosis

113
Q

symptoms of AOM

A

fever
otalgia
irritability
reduced feeding

114
Q

bacteria associated with AOM

A

strep pneumonia
haemophilus influenza
moraxella catarrhalis
strep pyogenes
staph aureus

115
Q

complications of AOM

A

hearing loss
vertigo
facial nerve palsy
TM perf
mastoiditis
brain abscess
sigmoid sinus thrombosis
meningism
subdural empyema
bezold, citelli, luc abscess

116
Q

classification for pars tensa retraction

A

sade classification

117
Q

classification for pars flaccida retraction

A

tos’s classification

118
Q

level of hearing loss you would expect in chronic otitis media

A

20-60db

119
Q

describe sade classification

A

1 - retracted
2- retracted onto incus
3 - retraction onto promontory but not adherent
4 - adhesion onto promontory
5 - atelectatic TM with perf

120
Q

tos classification describe

A

1 - mild retraction, air is still present between pocket and malleus neck
2- retraction pocket touches malleus neck +/- erosion of neck
3 - retraction pocket causes erosion of outer attic wall
4 - depth of retraction pocket difficult to see

121
Q

4 blood tests for septal perforation

A

FBC
ESR
cANCA
pANCA
ACE

122
Q

what is special about septal perf due to syphilis

A

usually affects bony septum rather than cartilage

123
Q

how to test for syphilis

A

VDRL - venereal disease research laboratory

124
Q

types of flaps to fix septal perf

A

local nasal mucosa
buccal mucosa
composite septal cartilage and mucosa

125
Q

type of nystagmus with disorders affecting lateral SCC

A

horizontal nystagmus

126
Q

when do you see pendular/see-saw nystagmus

A

congenitally blind people

127
Q

what does HHT stand for and alternative name

A

hereditary haemorrhagic telangiectasia or rendu-osler-weber disease

128
Q

inheritance pattern of HHT

A

AD

129
Q

presentation of HHT

A

epistaxis
GI bleed
haemoptysis

130
Q

2 associated abnormalities with hht

A

AV malformations
aneurysms

131
Q

management of HHT epistaxis

A

conservative - monitioring, follow up
medical - oestrogens/progesterone
surgical - laser, septodermoplasty, modified young’s procedure

132
Q

which gene mutations associated with HHT?

A

endoglin ENG
activin like receptor kinase ALK-1
SMAD4

133
Q

management of pharyngeal pouch

A

conservative
medical - botox injection to cricopharyngeus
surgical - endoscopic stapling, open

134
Q

complications of surgery for pharyngeal pouch

A

oesophageal perforation
hoarseness
bleeding
infection
recurrence
injury to teeth

135
Q

what is boyce’s sign

A

seen in pharyngeal pouch, neck mass which gurgles on palpation

136
Q

investigations for VC palsy

A

CT skullbase to mediatinum
CXR
bloods for systemic disease

137
Q

why wait 6 months before attempting surgery to medialise vc in vc palsy

A

voice rehab can be trialled in the meanwhile and the contralateral cord may compensate so surgery might not be needed

138
Q

layers of VC superficial to deep

A

squamous epithelium
superficial lamina propria (reinkes space)
intermediate lamina propria
deep lamina propria
thyroarytenoid muscle complex

139
Q

organisms involved in acute rhinosinusitis

A

rhinovirus
parainfluenza virus
pneumococcus
haemophilus influenzae

140
Q

4 medical options to arrest post tonsillectomy bleeding

A

Resuscitation – ABCDE
Hydrogen peroxide gargles
Silver nitrate cautery to bleeding point using local anaesthetic spray
Application of adrenaline soaked gauze to the area

141
Q

antibiotics to avoid in EBV why

A

amoxicillin
ampicillin
type 4 hypersensitivity reaction

142
Q

3 other indications for tonsillectomy than recurrent tonsillitis

A

More than one quinsy/peritonsillar abscess
Suspected cancer
Obstructive sleep apnoea
As part of another procedure e.g. uvulopalatoplasty

143
Q

tonsillitis organisms

A

group A beta haemolytic strep

144
Q

methods of identifying facial nerve intraoperatively

A

Tragal pointer- triangular extension of cartilage inferiorly off the tragus and location of the facial nerve is approximately 1cm antero-inferiorly
Superior border of posterior belly of digastric, facial nerve runs superiorly and parallel
Root of styloid process: nerve lies laterally
Tympanomastoid suture 6-8mm deep to the nerve

145
Q

complications of tonsillitis

A

quinsy, retropharyngeal/parapharyngeal abscess, sepsis, endocarditis, mediastinitis, vincents angina

146
Q

complications of parotidectomy

A

freys syndromw
ear numbness due to greater auricular nerve injury
seroma
salivary fistula

147
Q

blood supply and drainage of parotid gland and lymphatic drainage

A

Arterial– external carotid branches (facial artery)
Vein– retromandibular vein
Lymphatic drainage– deep cervical nodes

148
Q

types of incision for parotidectomy

A

modified blair
facelift incision

149
Q

treatments for freys syndrome

A

Aluminium based deodorant
Topical glycopyrrolate
Botox
Jacobson nerve neurectomy

150
Q

what is semons law?

A

In a progressive lesion of the recurrent laryngeal nerve, the abductors are paralysed before the adductors. Therefore incomplete paralysis of the vocal cord results in the vocal cord being brought to the midline, but in complete paralysis the cord will be in the paramedian position.

151
Q

treatments for VC palsy

A

Speech and language – voice therapy
Surgery to medialise the affected vocal cord
Bulk injection e.g. bioplastique, collagen, fat
Thyroplasty

152
Q

treatment for pharyngeal pouch

A

Conservative- if small and asymptomatic
Medical– botox to cricopharyngeus
Surgical– endoscopic stapling (Weerda diverticuloscope and endoscopic stapler) or open procedure- risks, oesophageal perforation, infection, stricture, bleeding, mediastinitis, recurrence, hoarseness, damage to teeth, lips and gums.

153
Q

2 US features of U3 thyroid nodule

A

Homogenous, hyper-echoic (markedly), solid, halo (follicular lesion)#
hypo-echoic, equivocal echogenic foci, cystic change
mixed/central vascularity.

154
Q

which U scores need FNA

A

3-5

155
Q

which condition associated with raised TPO antibodies

A

hashimotos

156
Q

when should thyroid reach final position in utero?

A

7 weeks

157
Q

Joll’s triangle

A

midline, superior thyroid pedicle and straps- superior laryngeal nerve

158
Q

Beahr’s triangle

A

common carotid, trachea and inferior thyroid artery- RLN

159
Q

2 causes of primary hyperparathyroidism

A

parathyroid adenoma
parathyroid hyperplasia

160
Q

3 imaging modalities to help localise parathyroid lesions

A

Ultrasound scan neck
Technetium Tc 99m sestamibi parathyroid scintigraphy
SPECT (Single Photon Emission Computerized Tomography)

161
Q

4 indications for parathyroidectomy

A

Symptoms of hypercalcaemia such as thirst, frequent or excessive urination, or constipation
End-organ disease (renal stones, fragility fractures or osteoporosis)
An albumin-adjusted serum calcium level of 2.85 mmol/litre or above.
Age 50 years or younger
Suspicion of parathyroid carcinoma

162
Q

What is the embryological origin for the superior and inferior parathyroid glands?

A

Inferior parathyroid glands derive from third branchial arch
Superior parathyroid glands derive from fourth branchial arch

163
Q

genetic association with parathyroid adenomas

A

Multiple endocrine neoplasia (MEN) type 1 and 2b

164
Q

mumps virus name

A

paramyxovirus

165
Q

Investigations for salivary gland conditions

A

ESR, FBC, RF, ANA, electrophoresis, anti Ro and soluble liver antibodies, TFTs, BM, LFTs, urate, plain film, sialogram, CT/MRI if malignant disease suspected. FNA (don’t do incisional/trucut biopsy due to seeding)

166
Q

TNM staging for laryngeal ca - t component

A

T1 – Tumour confined to vocal cords and they are movile
T2 – Tumour extending beyond glottic larynx with or without mobile cords
T3 – Tumour limited to larynx with fixed cords and/or minor cartilage destruction and/or paraglottic space
T4- Tumour involves tissues boyond larynx

167
Q

presenting complaints of laryngeal cancer

A

Hoarseness
Shortness of breath
Stridor
Sore throat

168
Q

investigations for laryngeal cancer

A

Microlaryngoscopy and biopsy
CT neck and thorax

169
Q

management of laryngeal ca

A

mdt
laser resection
radiotherapy

170
Q

Name the different subsites for an oropharyngeal tumour.

A

Tonsils
Soft palate
Base of tongue
Posterior pharyngeal wall

171
Q

presenting complaints of oropharyngeal ca

A

Neck lump
Sore throat
Dysphagia
Referred otalgia

172
Q

what is p16 testing

A

Overexpression of p16 protein is a useful screening method for HPV infection as HPV-associated carcinomas show strong nuclear and cytoplasmic expression of p16 in over 70% of malignant cells.

173
Q

cause of referred otalgia in oropharyngeal tumours

A

Occurs due to irritations of glossopharyngeal sensory nerve fibres which connect to the middle ear via Jacobson’s nerve.

174
Q

What is the most common histological type of laryngeal cancer?

A

scc

175
Q

What is the male to female ratio for laryngeal cancer?

A

5:1 (Male: Female).

176
Q

What are the major risk factors for laryngeal cancer?

A

Smoking, alcohol, HPV types 16 and 18.

177
Q

What percentage of patients with laryngeal cancer have synchronous tumors?

A

5%`

178
Q

What are the typical presenting symptoms of laryngeal cancer?

A

Hoarseness, dysphagia or odynophagia, and dyspnoea.

179
Q

What simple tests are used in the investigation of laryngeal cancer?

A

Chest X-ray (CXR), full blood count (FBC), urea and electrolytes (U&E), liver function tests (LFTs).

180
Q

What advanced imaging is used in diagnosing laryngeal cancer?

A

MRI or CT of the thorax, abdomen, and pelvis (TAP).

181
Q

What endoscopic procedures are performed for laryngeal cancer?

A

Panendoscopy and microlaryngoscopy.

182
Q

How is early-stage laryngeal cancer (T1/T2) managed?

A

Radiotherapy (RT) or partial laryngectomy.

183
Q

What is the treatment for T3 laryngeal cancer

A

Total laryngectomy +/- postoperative radiotherapy.

184
Q

How is T4 laryngeal cancer treated?

A

A: Total laryngectomy + neck dissection.

185
Q

What post-surgical interventions may be needed after laryngectomy?

A

Voice restoration procedures, speech therapy, and thyroid and parathyroid hormone replacement.

186
Q

What characterizes a T1 tumor in laryngeal cancer?

A

Tumor confined to one site.

187
Q

What characterizes a T2 tumor in laryngeal cancer?

A

Tumor involving more than one site.

188
Q

What characterizes a T3 tumor in laryngeal cancer?

A

Fixed vocal cord or postcricoid invasion.

189
Q

What characterizes a T4 tumor in laryngeal cancer?

A

Tumor extending beyond the larynx.

190
Q

What is a cordectomy and when is it typically performed?

A

Cordectomy involves the removal of vocal cords, either open or endoscopic, often for benign tumors.

191
Q

What is hemilaryngectomy and when is it performed?

A

Hemilaryngectomy is the removal of half the thyroid cartilage and half the cricoid cartilage, often for tumors confined to the vocal fold.

192
Q

What is a supraglottic laryngectomy?

A

A procedure where the glottis is joined to the base of the tongue, leaving the vocal cords intact.

193
Q

What structures are removed in a total laryngectomy?

A

Thyroid, hyoid bone, cricoid cartilage, proximal trachea, and thyroid gland.

194
Q

What is required post-operatively after a total laryngectomy?

A

A tracheostomy with a speech valve.

195
Q

What are the histological subtypes of nasopharyngeal carcinoma?

A

Squamous cell, squamous keratinizing, non-keratinizing, or undifferentiated carcinoma.

196
Q

What dietary habit is associated with an increased risk of nasopharyngeal carcinoma, particularly in Hong Kong?

A

Consumption of salted fish.

197
Q

what is the fossa or rosenmuller also called

A

posterolateral recess

198
Q

What are common presenting symptoms of nasopharyngeal carcinoma?

A

Neck lump, otalgia, epistaxis.

199
Q

What characterizes a T1 tumor in nasopharyngeal carcinoma?

A

Tumor confined to the nasopharynx.

200
Q

What characterizes a T3 tumor in nasopharyngeal carcinoma?

A

Tumor invading bone or sinuses.

201
Q

What characterizes a T4 tumor in nasopharyngeal carcinoma?

A

Tumor extending into the cranial fossa, hypopharynx, orbit, or infratemporal fossa.

202
Q

What is the primary treatment for nasopharyngeal carcinoma?

A

Local radiotherapy (RT) +/- bilateral neck RT +/- radical neck dissections.

203
Q

What is an angiofibroma, and where does it commonly occur?

A

Angiofibroma is a benign tumor consisting of fibrous and vascular tissue, commonly involving the sphenopalatine foramen.

204
Q

What symptoms may indicate the presence of an angiofibroma?

A

Epistaxis, nasal obstruction, and bone erosion.

205
Q

What is the most common histological type of oropharyngeal cancer?

A

scc

206
Q

What are the risk factors for oropharyngeal cancer?

A

Smoking, alcohol, betel nut chewing, HPV (types 6, 11, 16, 18).

207
Q

What are the common presenting symptoms of oropharyngeal cancer?

A

Neck lump, sore throat, odynophagia, muffled speech, trismus (if pterygoid involvement).

208
Q

What premalignant lesion is associated with oropharyngeal cancer and is more common in smokers?

A

Leukoplakia (hyperkeratosis).

209
Q

What imaging techniques are used to assess oropharyngeal cancer?

A

MRI (for soft tissue definition), CXR, and liver ultrasound.

210
Q

What invasive investigations are performed for oropharyngeal cancer?

A

Fine needle aspiration (FNA) of the lump, panendoscopy + biopsy, and sometimes a blind biopsy of the tonsil and tongue base.

211
Q

How is early-stage (T1/T2) oropharyngeal cancer managed?

A

rt

212
Q

What surgical procedures may be required for T3/T4 oropharyngeal cancer?

A

Excision with a 1-2 cm margin, +/- neoadjuvant chemoradiotherapy, depending on size and site.

213
Q

What reconstruction options are available after excision for oropharyngeal cancer?

A

Anterolateral thigh (ALT) flap, pectoralis major (pec maj) flap, or forearm flap.

214
Q

What is the most common histological type of hypopharyngeal carcinoma?

A

Squamous cell carcinoma (90%)

215
Q

What are the common locations of hypopharyngeal carcinoma?

A

Postcricoid area, pyriform fossa, posterior pharyngeal wall.

216
Q

What are common presenting symptoms of hypopharyngeal carcinoma?

A

Neck lump, hoarseness, dysphagia, pneumonia.

217
Q

What characterizes a T1 tumor in hypopharyngeal carcinoma?

A

Tumor in one site and <2 cm.

218
Q

What characterizes a T3 tumor in hypopharyngeal carcinoma?

A

Tumor >4 cm or fixation of the hemilarynx.

219
Q

What is the treatment for early hypopharyngeal carcinoma?

A

rt

220
Q

What surgical procedures may be required for larger hypopharyngeal tumors?

A

Laryngectomy, pharyngectomy, and reconstruction.

221
Q

t2 hypopharyngeal ca

A

T2 – more than one site or 2-4cm

222
Q

t4 hypopharyngeal ca

A

invasion of adjacent structures

223
Q

name causes of grisel syndrome

A

lots of buzzing in adenoidectomy
alternative infection - e.g. retropharyngeal abscess

224
Q

level 1 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes

A
225
Q

level 2 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes

A
226
Q

level 3 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes

A
227
Q

level 4 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes

A
228
Q

level 5 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes

A
229
Q

level 6 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes

A
230
Q

why should hyoid bone be removed in sistrunk procedure

A

recurrence rate 85% if not removed

231
Q

5 systemic causes of saddle nose deformity

A

granulomatosis with polyangiitis
sarcoidosis
relapsing polychondritis
leprosy
syphilis
ectodermal dysplasia

232
Q

2 management options for saddle nose deformity

A

control systemic disease
SRP with reconstruction using autograft

233
Q

9 causes of saddle nose deformity

A

untreated septal haematoma/abscess
rhinoplasty
granulomatosis with polyangiitis
sarcoidosis
relapsing polychondritis
leprosy
syphilis
intranasal cocaine
T cell lymphoma

234
Q

examination of saddle nose deformity

A

loss of nasal dorsal height
loss of nasal tip support and definition
overrotation of nasal tip

235
Q

where does disease of the 2nd and 3rd molars spread to

A

submandibular space first because roots are below mylohyoid

236
Q

where does disease of teeth other than 2nd and 3rd molars spread to first

A

sublingual space first because roots are above mylohyoid

237
Q

conservative measures for a CSF leak

A

bed rest
head up bed 15-30 degrees
stool softeners
LD

238
Q

where is the thinnest part of the anterior skull base

A

lateral lamella of cribriform plate

239
Q

which fluid in the body contains beta2 transferrin

A

CSF ,perilymph, aqueous humour

240
Q

4 signs or symptoms which would be concerning for serious pathology in child with orbital cellulitis

A

visual loss
proptosis
ophthalmoplegia
meningism

241
Q

what is the orbital septum

A

in the upper eyelid - the fascia from the orbital rim periosteum to levator aponeurosis
in the lower eyelid - fascia from orbital rim periosteum to the inferior border of the tarsal plate

242
Q

when to perform urgent out of hours CT for orbital cellulitis

A

all paeds cases
suspicion of underlying abscess
suspicion of cavernous sinus thrombosis
evidence of meningism or intracranial abscess

243
Q

Submental triangle boundaries

A

inferiorly - hyoid
medially - midline of neck
laterally - anterior belly digastric

MRCS - ENT Nov (7 decks)

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