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MRCS - ENT Nov > MRCS ENT > Flashcards

MRCS ENT Flashcards

1
Q

Define nystagmus

A

involuntary
rhythmic
oscillation
of the eyes

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2
Q

Describe what a true vestibular nystagmus will look like

A

slow movement of eyes in one direction with quick corrective movement in the opposite direction

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3
Q

Describe how caloric tests work

A

water at temps of 30 and 44 degrees (or air) - generates convection currents in the endolymph on that side, so will elicit a vestibular response in the form of nystagmus if the vestibule is functioning correctly.
Cold water leads to nystagmus with fast phase towards opposite side
Cold - opposite, warm - same COWS - the expected response to the rest. Lack of response may indicate a peripheral vestibular failure on one side

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4
Q

what is rombergs test

A

patient stands still with arms by side and eyes closed, if there is an uncompensated vestibular lesion on one side, the patient will show tendency to fall on that side

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5
Q

what is unterbergers test

A

patient marches on the spot with arms outstretched and eyes closed for 30 seconds. Abnormal response is rotation of at least 30 degrees or a forwards or backwards movement of at least 1m. Rotation will be towards the side of the lesion.

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6
Q

risks of thyroid surgery?

A

pain
bleeding including haematoma
infection
seroma
scar
hoarseness
airway compromise
hypocalcaemia
long term thyroid replacement

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7
Q

name and describe the innervations of the branches of the superior laryngeal nerve

A

external branch - supplies cricothyroid
internal branch - sensory to laryngeal mucosa above VCs

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8
Q

what is the sensory innervation of the mucosa of larynx below VCs

A

recurrent laryngeal

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9
Q

blood supply to parathyroid glands?

A

inferior thyroid artery

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10
Q

how to investigate parathyroid enlargement?

A

serum ca and PTH
US neck
MIBI scan

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11
Q

name the tensors of the VCs and what the effect of tensing the vocal cords is

A

cricothyroid
raises pitch of voice

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12
Q

name the relaxors of the VCs

A

thyroarytenoid
vocalis

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13
Q

3 causes of VC palsy

A

malignancy (bronchus, oesophagus, thyroid, nasopharynx)
iatrogenic from thyroid/parathyroid/oesophageal/pharyngeal pouch/left lung surgery
stab wound/external trauma
idiopathic
neurological disorders

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14
Q

how may a unilateral VC palsy present

A

hoarseness
choking
coughing on food
recurrent chest infections
inability to raise voice

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15
Q

what is the effect of a superior laryngeal nerve palsy?

A

will change pitch of patients voice but if the recurrent laryngeal is intact, VC abduction and adduction remains unchanged

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16
Q

risks of parotid surgery?

A

pain
bleeding
infection
scar
facial nerve weakness
freys syndrome
recurrence of disease

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17
Q

most common type of parotid tumour

A

pleomorphic adenoma in 80%

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18
Q

what is freys syndrome

A

gustatory sweating in distribution of auriculotemporal nerve on eating/thinking/talking about food

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19
Q

where does the submandibular duct open?

A

lateral to lingual frenulum

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20
Q

name 3 nerves related to the submandibular gland

A

marginal mandibular
lingual
hypoglossal

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21
Q

where are the sublingual glands found

A

deep in floor of mouth between mandible and genioglossus muscle

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22
Q

describe the sublingual duct

A

numerous small sublingual ducts open into FOM along sublingual folds

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23
Q

Risk factors for SCC tonsil

A

smoking
alcohol
HPV
betel nut chewing

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24
Q

Investigations for SCC tonsil

A

FNAC neck nodes
MRI neck
CT thorax
panendoscopy and biopsy
HPV testing of biopsy specimen

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25
Q

TNM staging for tonsillar ca

A

T0 - no cancer
T1 - tumour <2cm in greatest dimension
T2 - tumour 2-4cm
T3 - >4cm
T4a invasion of larynx, tongue muscles, medial pterygoid, hard palate, mandible
T4b - lateral pterygoid, pterygoid plates, lateral nasopharynx, skull base, encases carotid artery

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26
Q

risks and benefits of fenestrated trache tubes

A

benefits - allow speaking by allowing airflow to pass superiorly through fenestrations and through VCs
risks - of aspiration

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27
Q

risks and benefits of cuffed tracheostomy tubes

A

benefits - prevent leaking of secretions around tubes into lungs, provide airtight seal to enable positive pressure ventilation
risks - prolonged use of a cuff can lead to trauma to tracheal wall, tracheal stenosis and tracheo-oesophageal fistula

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28
Q

when to use adjustable flange trache tube?

A

deep neck patients

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29
Q

Advantages of trache compared to ET intubation?

A

reduces risk of tracheal trauma/stenosis
reduces amount of dead space in respiratory system and effort of breathing - easier weaning
reduces need for sedation and permits speech and oral feeding when patient awake

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30
Q

Complications of tracheostomy?

A

infection
tracheal necrosis
tracheoarterial fistula
TOF
dysphagia
tracheal stenosis
tracheocutaneous fistula
dislodgement

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31
Q

describe the mechanism of freys syndrome

A

abberrant innervation of cutaneous sweat glands overlying the parotid gland by post ganglionic parasympathetic salivary nerves causing localised sweating during eating or salivation

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32
Q

diagnosis of freys syndrome?

A

clinical diagnosis mostly
can use minor iodine starch test

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33
Q

treatment options for freys syndrome

A

conservative
topical anticholinergics/antihydrotics
Botulinum A toxin
Surgical - excision of affected areas but limited success and put facial nerve at risk

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34
Q

signs of smoke inhalation injury

A

facial burns
blistering/oedema of oropharynx
hoarse voice
carbonaceous sputum
stridor
cough
wheeze
irritability
headaches
lethargy

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35
Q

management of suspected smoke inhalation injury

A

ABC
bronchodilators
low risk - monitor, discharge after 8-12 hours

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36
Q

what % of blood loss results in hypotension in a child

A

20-25%

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37
Q

how to estimate a childs blood volume?

A

80ml/kg

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38
Q

how to arrest post tonsillectomy bleed surgically

A

electrocautery of a specific bleeding point
tying off a specific bleeding point
suture tonsillar pillars together
pass NG tube at the end of procedure to aspirate any swallowed blood
Rarely - ligate ECA

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39
Q

paediatric fluid resuscitation?

A

20ml/kg as boluses

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40
Q

risk factors for apthous ulcers

A

haematinic deficiency
trauma
drug reactions (e.g. NSAIDS)
hiv
Neutropenia
IBD - crohns

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41
Q

Treatment of apthous ulcers?

A

supportive
treat any predisposing factors

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42
Q

what is ludwigs angina

A

rapidly progressive cellulitis of soft tissues of neck and FOM

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43
Q

why is ludwigs angina dangerous

A

progressive swelling of soft tissues and posterior displacement of tongue can lead to airway obstruction

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44
Q

which symptoms to ask about in a patient presenting with a thyroid swelling?

A

pain
dysphagia
voice change
aspiration
breathing difficulties
any FH of thyroid ca
history of radiation exposure
symptoms of hyper/hypo thyroidism

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45
Q

Cytological grading for thyroid lesions?

A

Thy1 - non diagnostic
Thy2 - non neoplastic
thy3- follicular lesion/suspected follicular neoplasm
thy4 - suspicious of malignancy (papillary, medullary, anaplastic, lymphoma)
thy 5- diagnostic of malignancy

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46
Q

in which thyroid cancers is it important to reduce TSH levels most and why

A

papillary and follicular, important to reduce TSH levels to <0.1mU/L as in medullary ca, the C cells are not thyroxine sensitive

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47
Q

main chemotherapy agents in thyroid cancer?

A

tyrosine kinase inhibitors

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48
Q

management of anaplastic thyroid ca

A

surgery if very small
otherwise chemoradiotherapy

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49
Q

what type of tumour is a warthins tumour

A

adenolymphoma

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50
Q

differential diagnosis of parotid lumps

A

pleomorphic adenoma
warthins tumour
intra/extra parotid lymph node
malignancy
mets
haemangioma

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51
Q

red flag features of a parotid lump

A

recent increase in size
skin involvement
fixed hard mass
facial nerve involvement

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52
Q

Which surgery for a pleomorphic adenoma?

A

superficial parotidectomy usually

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53
Q

what is the risk of malignant transformation of a pleomorphic adenoma?

A

2-10%

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54
Q

most common site of SCC larynx?

A

glottis 50%
supraglottis 40%
subglottis 10%

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55
Q

what is the name of the classification system used to divide the neck into zones

A

roon and christensens classification

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56
Q

describe the anatomical pathway of the nasolacrimal duct and clinical sinificance

A

drains tears from the lacrimal sac into inferior meatus of the nasal cavity
blockage can result in dacryocystitis or chronic tearing

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57
Q

label

A
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58
Q

management of saddle deformity of nose

A

nasal douching
nasal steroids
septoplasty

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59
Q

causes of saddle nasal deformity

A

GPA
relapsing polychondritis
iatrogenic (septoplasty)
trauma
intranasal cocaine use

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60
Q

bloods for saddle deformity

A

FBC
ESR
U&E
ACE
cANCA
pANCA

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61
Q

two causes of pansinusitis in a child

A

CF
Kartageners syndrome

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62
Q

unilateral nasal polyp in an elderly patient - concerns re?

A

malignancy?
meningioencephalocele

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63
Q

3 risks of button battery in nose

A

aspiration
tissue necrosis
septal perforation

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64
Q

2 risks of button battery in ear

A

ear canal stenosis
tissue necrosis

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65
Q

what is this and why does it matter

A

infraorbital ethmoidal air cell/Haller cell

if very large can narrow ostiomeatal complex
may get infected with extension into orbit
may not be expected in surgery and lead to inadvertent entry into orbit in endoscopic surgery

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66
Q

5 differentials of a solid nasal mass lesion

A

benign nasal polyp
inverted papilloma
antrochoanal polyp
glioma
SCC
meningocele

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67
Q

histological type of NPC?

A

SCC

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68
Q

Preferred imaging for NPC?

A

MRI

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69
Q

What are the components of Moffet’s solution

A

sodium bicarbonate
cocaine
adrenaline

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70
Q

safe dose of lidocaine with and without adrenaline

A

3mg/kg without
7mg/kg with

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71
Q

2 bacteria and 2 fungi responsible for otitis externa

A

staph aureus, pseudomonas aeruginosa
aspergillus niger
candida albicans

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72
Q

Bilateral acoustic neuromas are suggestive of?

A

Neurofibromatosis type 2

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73
Q

4 presenting complaints of cholesteatoma

A

hearing loss
otorrhoea
vertigo
tinnitus
facial nerve palsy

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74
Q

4 presenting complaints of acoustic neuroma

A

hearing loss
vertigo
tinnitus

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75
Q

where do cholesteatomas tend to originate from

A

attic - prussacks space/epitympanic space

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76
Q

symptoms of herpes zoster oticus

A

hearing loss
taste disturbance
otalgia
vertigo
tinnitus

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77
Q

where does the virus lay dormant in herpes zoster oticus

A

geniculate ganglion of facial nerve

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78
Q

2 types of graft for myringoplasty

A

tragal cartilage
temporalis fascia

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79
Q

Why does a thyroglossal cyst move with tongue protrusion?

A

attached to tongue via the embryological tract

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80
Q

why is doing imaging for a thyroglossal cyst helpful?

A

to see if any normal thyroid tissue is also present (otherwise removal will result in hypothyroidism)

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81
Q

3 presenting symptoms of mastoiditis

A

pyrexia
otalgia
otorrhoea

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82
Q

2 management options for mastoiditis

A

IV antibiotics
cortical mastoidectomy

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83
Q

most common organism implicated in mastoiditis

A

Strep pneumoniae, haemphilus influenza
then moraxella catarrhalis, strep pyogenes, staph aureus

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84
Q

bug which can cause postauricular lymphadenopathy in children?

A

rubella

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85
Q

what is Gradenigo’s syndrome?

A

complication of AOM due to spread to petrous apex of temporal bone - otorrhoea, trigeminal nerve pain and diplopia due to abducens nerve palsy

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86
Q

What is Luc’s abscess?

A

Complication of AOM - abscess under temporal muscle

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87
Q

What is Holman Miller sign

A

anterior bowing of posterior wall of maxillary antrum due to juvenile angiofibroma

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88
Q

where does a juvenile angiofibroma usually arise?

A

lateral wall of nasal cavity close to superior border of sphenopalatine foramen

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89
Q

name a staging system for juvenile angiofibroma

A

radkowski
andrews-fisch
sessions

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90
Q

Which investigations to request for a juvenile angiofibroma?

A

CT
MRI
Angiography

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91
Q

treatment of juvenile angiofibroma?

A

surgical resection with pre-op embolisation

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92
Q

omega shaped epiglottis is indicative of?

A

laryngomalacia

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93
Q

how may laryngomalacia present

A

mild tachypnoea
stridor on feeding

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94
Q

investigations for laryngomalacia? (2)

A

laryngotracheobronchoscopy
sleep study/overnight pulse oximetry

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95
Q

Treatment options for laryngomalacia

A

conservative
surgical - aryepiglottoplasty, rarely tracheostomy

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96
Q

how may subglottic haemangioma’s present?

A

stridor
cough
SOB

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97
Q

how are subglottic haemangiomas diagnosed?

A

microlaryngoscopy

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98
Q

management of subglottic haemangioma?

A

propranolol
steroids
small - laser
larger - surgical removal

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99
Q

why can children get laryngeal papillomatosis?

A

immature immune system

100
Q

which viruses cause laryngeal papillomatosis

A

HPV 6 and 11

101
Q

how does laryngeal papillomatosis present

A

hoarseness, stridor, SOB, weak cry, chronic cough

102
Q

Rx laryngeal papillomatosis?

A

debridement
adjuvent cidofovir

103
Q

why avoid tracheostomy in laryngeal papillomatosis

A

risk of seeding around trache site and into lungs

104
Q

pathophysiology of choanal atresia

A

failure of breakdown of bucconasal membrane in utero

105
Q

button battery in oesophagus management

A

immediate removal
follow up swallow imaging to review for complications

106
Q

2 anatomical causes of ‘bat’/protroding ears

A

deep conchal bowl
absence of antihelical fold

107
Q

management options for bat ear

A

conservative
ear spint in neonates
surgical - pinnaplasty via scoring technique (scoring a new fold anteriorly after exposure of posterior cartilage) or mustarde suturing method

108
Q

complications of pinnaplasty

A

bleeding
infection
scar
pinna haematoma
cartilage necrosis
patient dissatisfaction

109
Q

what condition is a bifid uvula associated with

A

submucous cleft

110
Q

why is an adenoidectomy contraindicated in a submucous cleft?

A

may result in velopharyngeal insufficiency, causing speech problems

111
Q

complications of adenoidectomy

A

bleeding, ascending pharyngeal/SPA bleed, hyponasal speech, nasal regurgitation, regrowth, damage to soft palate/teeth

112
Q

What is Grisel’s syndrome

A

atlantoaxial joint subluxation following suction diathermy (infection)

113
Q

surgical options for choanal atresia

A

transnasal puncture and stenting
endoscopic resection of posterior nasal septum

114
Q

why does a preauricular sinus occur?

A

incomplete fusion of hillocks of his

115
Q

2 techniques to ensure the whole tract intraoperatively (pre auricular sinus)

A

use of methylene blue to stain tract
use of lacrimal probe

116
Q

Pendred’s syndrome - type of hearing loss, genetics, association

A
117
Q

Treacher Collins syndrome - type of hearing loss, genetics, association

A
118
Q

Pierre Robin syndrome - type of hearing loss, genetics, association

A
119
Q

Crouzons disease - type of hearing loss, genetics, association

A
120
Q

Alperts syndrome - type of hearing loss, genetics, association

A
121
Q

CHARGE syndrome components

A
122
Q

Branchio-oto-renal syndrome genetics and components

A
123
Q

Treatment of microtia and anotia

A

bone conduction hearing aids (first soft band then BAHA)
cosmesis - prosthesis if neonate (will correct), reconstruction with rib cartilage 6-8 years

124
Q

bilateral SNHL and goitre suggests

A

pendred syndrome AR inheritance

125
Q

management of pendred syndrome

A

thyroxine, cochlear implants, MDT

126
Q

What is Waardenburg syndrome

A

congenital progressive hearing loss (70% unilateral) and heterochromia irides (different iris colours0, white forelock, skin pigmentation changes. AD inheritance

127
Q

label

A
128
Q

which semicircular canal is most commonly affected in BPPV

A

posterior semicircular canal

129
Q

characteristics of nystagmus in BPPV

A

torsional
geotropic
latency
fatiguable
lasts 20-60 seconds

130
Q

Manouevers for BPPV

A
131
Q

label

A

a - mould
b - connection tube
c - battery
d - on off switch
e - pull cord

132
Q

2 complications of behind ear hearing aid

A

wax build up
otitis externa
skin irritation

133
Q

2 causes of whistling when wearing a behind ear hearing aid

A

wax build up
loose fitting

134
Q

2 indications for BAHA

A

profound unilateral SNHL

135
Q

2 complications of BAHA

A

abutment site problems (loosening)
skin infection
skin overgrowth
discomfort/pain
failure to osseointegrate

136
Q

what are the 4 components of all hearing aids

A

microphone
amplifier
sounds transmitter
power source

137
Q

types of hearing aid

A
138
Q

what does Rinne’s positive mean

A

NORMAL

139
Q

PTA symbols
X
O

[
]

A
140
Q

3 rules of masking

A
141
Q

What is the stapedial reflex

A

contraction of stapedius and tensor tympani in response to noise >85dB

142
Q

what is stengers test

A
143
Q

type of hearing loss in meniere’s disease

A

low frequency SNHL - can be high in acute attacks

144
Q

pathophysiology of menieres disease

A

expansion of endolymphatic fluid volume, pressure of basilar membrane, rupture of reisners membrane

145
Q

tests for menieres

A

electrocochleography, caloric testing

146
Q

type of hearing loss in presbyacusis

A

high frequency SNHL

147
Q

type of hearing loss in noise induced hearing loss

A

SNHL at 4000Hz

148
Q

components of NF2

A
149
Q

label

A
150
Q

main ion in perilymph

A

sodium

151
Q

how many turns are there in a normal cochlear

A

2.5

152
Q

which part of the cochlear is thought to expand resulting in rupture of the membranous labyrinth in menieres disease

A

scala media

153
Q

label

A
154
Q

origin of malleus/incus/stapedius

A

1st pharyngeal arch

155
Q

origin of stapes/tensor tympani

A

2nd pharyngeal arch

156
Q

origin of middle ear

A

1st pharyngeal pouch

157
Q

muscle attachment ro pharyngeal tubercle

A

superior pharyngeal constrictor

158
Q

muscle attachments to mastoid

A

SCM
posterior digastric
splenius capitus
lonissimus capitis

159
Q

attachments to styloid process

A

stylomandibular ligament
stylohyoid ligament
stylohyoid muscle
stylopharyngeus
styloglossus

160
Q

how does superior orbital fissure syndrome present

A

double vision, ptosis due to 3rd nerve function, numbness to upper eyelid due to superior orbital nerve dysfunction

161
Q

causes of superior orbital fissure syndrome

A

trauma (blow out fracture), cancer, infection, inflammatory

162
Q

what is orbital apex syndrome

A

same as superior orbital fissure syndrome but with blindness due to dysfunction of orbital apex

163
Q

ECA branches and what they supply

A
164
Q

label

A
165
Q

label

A
166
Q

label

A
167
Q

label

A
168
Q

vocal cord layers (superficial to deep)

A
169
Q

VC abduction?

A

posterior cricoarytenoid

170
Q

VC adduction

A

lateral cricoarytenoid
transverse arytenoid
oblique arytenoid

171
Q

vocal cord tension

A

cricothyroid
thyroarytenoid

172
Q

what type of cartilage is thyroid/cricoid/arytenoid/corniculate/cuneiform

A

hyaline

173
Q

what type of cartilage is epiglottis

A

fibrocartilage

174
Q

2 tests used in national newborn hearing programme?

A

automated otoacoustic emission
automated auditory brainstem response

175
Q

what happens if hearing issue detected in newborn hearing programme tests?

A

referred for further investigations including diagnostic OAE, diagnostric ABR, tympanometry

176
Q

investigations to confirm hashimotos?

A

ESR
Anti thyroglobulin antibodies
TSH receptor antibodies to rule out graves
TPO antibodies

177
Q

when does a behind ear hearing aid whistle?

A

microphone too close to speaker
ear canal is impacted with wax

178
Q

aetiology of laryngeal papillomatosis

A

hpv 6 and 11

179
Q

how to treat laryngeal papillomatosis

A

microdebrider surgical debridement - laser will cause airway fire
+ alpha interferon + antivirals like intralesional cidofivir

180
Q

how to reduce risk of laryngeal papillomatosis

A

HPV vaccination using gardasil

181
Q

4 causes of enlarged inferior tubrbinate

A

infection
neoplasia
congenital
rhinitis medicamentosa
allergic rhinitis

182
Q

3 medications to treat enlarged inferior turbinate

A

steroids
antihistamines
leukotriene antagonists

183
Q

3 surgical techniques to treat enlarged inferior turbinate

A

outfracture of turbinates
submucous diathermy
turbinate trimming

184
Q

CNS lesions associated with NF2

A

vestibular schwannoma
ependymomas
meningiomas

185
Q

what is a pathonomonic sign of inheritance of NF2

A

juvenile subscapular cataract

186
Q

why are paediatric tracheostomy tubes uncuffed

A

reduce risk of subglottic stenosis

187
Q

complication of bilateral radical neck dissection

A

increased intracranial pressure due to removal of both internal jugular veins

188
Q

describe the neck trauma zones

A

1 - clavicle to cricoid
2 - cricoid to angle of mandible
3 - angle of mandible to skull base

189
Q

what sound level is required to elicit stapedial reflexes

A

85dB

190
Q

why do a US and radioiodine uptake scan for a thyroglossal duct cyst prior to excision?

A

may be active thyroid tissue in the cyst

191
Q

2 syndromes associated with anotia/microtia

A

goldenhar syndrome
treacher collins
pierre robin
CHARGE

192
Q

what is schwartz’s sign and what is it indicative of

A

pink tinge on cochlear promontry
indicative of otosclerosis

193
Q

embryological origin of pre auricular sinus

A

incomplete fusion of hillock of his

194
Q

which syndrome are pre auricular sinuses associated with

A

brachio-oto-renal syndrome

195
Q

management of submandibualr gland stones

A

lithotripsy
therapeutic sialendoscopy
excision of stone
excision of gland

196
Q

2 uses for BIPP

A

nasal packing
following ear surgery

197
Q

5 causes for a goitre

A

graves disease
infective thyroiditis
sarcoidosis
iodine deficiency
thyroid cancer
hashimotos
sarcoidosis

198
Q

which nerve is found in beahrs triangle

A

recurrent laryngeal nerve

199
Q

which nerve is found in Joll’s triangle

A

superior laryngeal nerve

200
Q

borders of jolls triangle

A

midline
superior thyroid
strap muscle

201
Q

borders of beahrs triangle

A

common carotid artery
trachea
inferior thyroid artery

202
Q

WHO classification of NPC?

A

keratinising SCC
non keratinising SCC
undifferentiated SCC

203
Q

5 drugs which can result in parotid enlargement

A

T - thiouracil
O - oral contraceptive pill
P - phenulbutazone
I - isoprenaline
C - CO proxamol

204
Q

where does retropharyngeal space extend to compared to parapharyngeal space

A

retropharyngeal - skull base to lower border of pharynx
parapharyngeal - skull base to hyoid

205
Q

normal thickness of prevertebral soft tissue between C2-4

A

7mm

206
Q

normal thickness of soft tissue between C4-T1

A

17mm

207
Q

2 syndromes associated with drooling

A

cerebral palsy
downs syndrome

208
Q

2 medical and 2 surgical treatments for drooling

A

medical - anticholinergic agents, botox
surgical - submandibular duct transposition, adenotonsilectomy, submandibular gland excision

209
Q

at what age is drooling considered a problem

A

aged 5

210
Q

factors other than developmental delay which may contribute to drooling

A

poor neck control
posture
nasal blockage
dental factors
anti epileptic agents

211
Q

initial management of drooling

A

oromotor exercises
improving posture
SLT

212
Q

why antibiotic to treat acute mastoiditis and why

A

co -amox because haemophilus influenza is a common bacteria for this condition and it is resistant to amoxicillin

213
Q

what to do for a child with mastoiditis who isn’t getting better with IV antibiotics?

A

request urgent CT with contrast to look for intracranial complications and subperisoteal abscess. may need cortical mastoidectomy and grommet

214
Q

causative organisms for mastoiditis

A

steptoccous pneumoniae
haemophilus influenzae
moraxella catarrhalis

215
Q

which structures are usually damaged in a transverse temporal bone fracture

A

cochlear and vestibular structures

216
Q

label letters

A
217
Q
A
218
Q

what is superior orbital fissure syndrome

A

ptosis due to 3rd nerve involvement
diplopia due to dysfunctional eye movement
numbness above upper eyelid due to superior orbital nerve dysfunction

219
Q

what is heterochromia irides and what does it suggest

A

different coloured eyes and waardenburg syndrome

220
Q

list 4 features of waardenberg syndrome and its inheritance pattern

A

heterochromia irides
hearing loss
white forelock
skin pigmentory changes
AD

221
Q

3 types of malignant melanoma

A

superficial spreading
acral lentiginous
lentigo maligna

222
Q

histological staging systems for melanoma

A

clark
breslow

223
Q

3 ways to identify facial nerve during parotid surgery

A

tympanomastoid suture
posterior belly of digastrics
tragal pointer

224
Q

4 cancer of parotid gland

A

adenoid cystic carcinoma
mucoepidermoid
accinic
metastatic lesion
lymphoma

225
Q

which artery which exits with facial nerve at stylomastoid foramen should you be aware of in parotid surgery

A

stylomastoid artery

226
Q

4 instructions for patient post epley manouver

A

avoid driving
avoid lying flat for 48h
avoid bending forwards
avoid lying on affected side

227
Q

5 differentials of a solid nasal lesion

A

inverted papilloma
antrochoanal polyp
nasal polyp
glioma
pyogenic granuloma
adenocarcinoma
SCC

228
Q

what does a RAST stand for

A

radioallergosorbent test

229
Q

syndrome associated with enlarged vestibular aqueduct

A

pendred syndrome

230
Q

what is pendred syndrome caused by

A

mutation in pendrin genes - codes for iodine/chloride transporter protein chromosome 7

231
Q

what is a cystic hygroma

A

low flow vascular malformation

232
Q

what to include in an op note

A

name of operation
hospital
date
time
patient name/DOB/hospital/theatre
surgeon
assistant
anaesthetist
scrub nurse
indication
antibiotics
anaesthesia
standard drape
findings
procedure
post op instructions
signature
print name
GMC number
contact number

233
Q
A

Noise induced hearing loss

234
Q
A

symmetrical hearing loss

235
Q
A

asymmetrical hearing loss

236
Q
A

Menieres disease - low frequency SNHL

237
Q

Concern with bilateral condylar process fractures

A

airway compromise

238
Q

commonest cause of congenital tracheal stenosis

A

complete congenital rings

239
Q

What is Cahart’s notch

A

reduction of air bone gap at 2000Hz, characteristic in otoscleorosis

240
Q

what type of tympanogram is typically seen in otosclerosis

A

As curve

241
Q

4 treatment options for otoscleorosis

A

conservative
conventional hearing aid
stapes surgery
bone conduction device/implant

242
Q

contraindication/relative contraindications to stapedectomy/stapedotomy

A

infection
only hearing ear (surgery has 1% risk of profound SNHL)

243
Q

Describe Sistrunk’s procedure

A

Excision of thyroglossal cyst, central portion of hyoid bone, extending dissection to base of tongue (foramen caecum) and excising a 1cm core of geniohyoid and genioglossus to ensure no tract left behind

244
Q

which structures detect angular acceleration

A

lateral, posterior and superior SCCs

245
Q

pathophysiology of BPPV

A

stimulation of posterior SCC by otoconia dislodged from macula of the utricle

246
Q

nerves which can be damaged in level V neck dissection

A

spinal accessory nerve
brachial plexus (roots and trunks)
phrenic nerve

247
Q

which nerves are damaged in level 3 neck dissection

A

greater auricular nerve
cagus nerve
hypoglossal nerve

MRCS - ENT Nov (7 decks)

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