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n Flashcards

1
Q

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

A

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

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2
Q

Give the treatment for Otomycosis

A

Local EAC cleaning with ear wash
Antifungal drops like Nystatin and Salicylic acid 2% + Alcohol 70%
Packing EAC with antifungal cream on gauze if resistant

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3
Q

Symptoms and signs of meningitis

A

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

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

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4
Q

Investigations and treatment of meningitis

A

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

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

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

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5
Q

Compare between clinical pictures of UMNL and LMNL facial paralysis

A
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6
Q

Enumerate the cranial (4) and extracranial (6) complications of cholesteatoma

A

Cranial: Mastoiditis, Labyrinthitis, Petrositis, Facial paralysis

Intracranial: Extradural, Subdural, Brain abscess, Meningitis, Lateral sinus thrombosis, Otitic Hydrocephalus

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7
Q

Enumerate the indications (4) and contraindications (4) of the ear wash?

A

Wax deafness
Non impacted foreign body
Fungal mass
Caloric test

TM perforation
Vegetable foreign body
Bacterial otitis externa
Fistula between middle and inner ear

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8
Q

Investigations and treatment of nasal fracture

A

Investigations: X-ray

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

If edema, wait a week.

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

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

Fixation from outside with aluminum sheet for 2 weeks

Anti biotics analgesics and anti-inflammatory

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9
Q

Oro-antral fistula, Symptoms, signs and investigations

A

Symptoms:
Unilateral regurgitation of food and fluid
Unilateral offensive nasal discharge
Discharge through the fistula to the mouth

Fistula is seen through oral cavity

CT shows sight of fistula

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10
Q

Treatment of Oro-antral fistula

A

Recent case (24 h after dental extraction): small fistula heals spontaneously and large fistula needs surgical closure

Old case: Radical antrum operation

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11
Q

Maxillary sinusitis symptoms and signs

A

History of dental operations, nasal discharge can be offensive
pain over cheeks referred to teeth and ears

Tenderness over cheeks, and discharge from posterior part of middle meatus

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12
Q

Sinusitis investigations

A

Xray sinus view shows opacity or fluid level
Culture and sensitivity of discharge
CT if chronic or recurrent case: mandatory preoperative investigation

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13
Q

Sinusitis treatment

A

Complete bed rest with plenty of warm fluids. Systemic antibiotics according to culture and sensitivity. Analgesic, antipyretic and decongestant nasal drops. Steam inhalation

If fail treatment then surgical: Functional endoscopic Sinus Surgery (FESS)

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14
Q

Causes of watery discharge 5

A

Acute non-specific rhinitis
Allergic rhinitis
Vasomotor rhinitis
Excessive lacrimation
CSF rhinorrhea

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15
Q

4 causes of water and food discharge

A

Perforated palate (syphilis)
Cleft palate
Paralysis of soft palate
Oro-antral fistula

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16
Q

3 causes of crusty nasal discharge

A

Atrophic rhinitis
All granulomas
Septal perforation

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17
Q

Discuss briefly the investigations and treatment of Choanal Atresia

A

Investigations: CT: differentiated bony from membranous atresia

Treatment
1. Unilateral: Operation is not urgent to be done in the neonatal age, so it is postponed for 2-3 years

2.Bilateral: It is an emergency situation
Saving the airway: keeping the mouth open by either:
- Plastic oral airway
- Endotracheal intubation

> Operation:
- Trans-nasal by endoscope

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18
Q

Enumerate local causes of Epistaxis (9)

A

Idiopathic: commonest cause
Trauma: Foreign bodies
Inflammations: Acute or chronic rhinitis
Neoplastic: malignant or benign tumors
Irritants: cigarette smoke
Medications: Topical cortisone
Septal deviation or perforation
Vascular malformations
Environmental factors: allergens, humidity

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19
Q

Enumerate systemic causes of Epistaxis 4

A

Systemic hematologic, hepatic, renal or genetic disease
Long term anti-coagulant use
Hypertension
Coagulation disorder like hemophilia

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20
Q

Explain the three stages of Rhinoscleroma

A

Atrophic stage: obstruction, discharge, epistaxis. Roomy cavity, atrophic mucosa and turbinates

Active nodular stage: Bilateral obstruction and discharge. Bilateral masses and Russel bodies and Mikulicz cells are detected

Fibrotic stage: Obstruction and deformity

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21
Q

Give the cause, incidence and treatment of rhinoscleroma

A

Klebsiella Rhinoscleromatis

15-25 year old females

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

22
Q

Give the clinical picture of Plummer-Vinson’s syndrome

A

More common in female

Dysphagia: due to chronic pharyngo-esophagitis + web

Angular stomatitis and glossitis

Achlorhydria: atrophy of gastric mucosa

Pallor: due to anemia

Koilonychia

Splenomegaly

23
Q

Investigations and treatment of Plummer-Vinson’s syndrome

A

CBC (shows anemia).

X-ray barium swallow (shows web)

esophagoscopy (take biopsy)

Correction of anemia: iron

Repeated dilatation

Regular follow-up

24
Q

Acute Retropharyngeal abscess symptoms, signs and investigations

A

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

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

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

25
Q

Treatment of acute retropharyngeal abscess

A

Hospitalization with parenteral antibiotics + analgesics antipyretics

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

26
Q

Indication 3 and contraindications 6 of tonsillectomy

A

Marked tonsillar hypertrophy
Recurrent acute tonsillitis (7 times in one year, 5 times in two successive years)
Suspected tumor

Bleeding disorders
Acute tonsilitis
Acute upper RTI
Active systemic disease
Active rheumatic fever
Menstruation

27
Q

Preoperative care preparation in tonsillectomy

A

History to exclude contraindications

Examination of tonsils to make sure its chronic

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

Preoperative instruction: fast for 6 hours

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

28
Q

Post operative care for tonsillectomy

A

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

Extubation after return of cough reflex

Observe respiration and color of lips and nose

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

Antibiotics to prevent infection and analgesic

Ice soft semi solid food to stop bleeding

29
Q

Complications of Quinzy 3

A
  • Laryngeal Edema
  • Pyemia and Septicemia
  • Parapharyngeal Abscess
30
Q

Complications of acute tonsilitis 5

A

Quinzy
Retropharyngeal abscess
Parapharyngeal abscess
Acute rheumatic fever
Acute glomerulonephritis

31
Q

Discuss the treatment of corrosive esophagitis

A

Milk and egg white
Management of dehydration, shock and electrolyte imbalance
Tracheostomy if severe obstruction or stridor
Parenteral antibiotics to prevent chest infections
Cortisone to decrease laryngeal edema and fibrosis
Rubber nasogastric tube is inserted in few days to feed and maintain lumen
Neutralization of corrosive to prevent further perforation of lumen

32
Q

Clinical signs and symptoms of Acute non specific laryngitis and treatment

A

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

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

33
Q

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

A

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

34
Q

Discuss the causes of Stridor in children

A
  • Congenital: congenital web and laryngomalacia
  • Traumatic: inhaled foreign body and corrosives
  • Inflammatory: acute nonspecific laryngitis and laryngotracheobronchitis
  • Neoplastic: recurrent multiple laryngeal papillomatosis
  • Miscellaneous: laryngeal edema and laryngeal spasm
35
Q

Give a short account on Laryngeal Papillomata

A
36
Q

Enumerate the indications of Tracheostomy

A

Upper airway (mechanical) obstruction: Stridor, OSA When severe and complicated

Lower airway (secretory) obstruction
- Chronic aspiration
- Depression of cough reflex
- Prolonged coma
- Severe chest injury
- Paralysis of the respiratory muscles

Prophylactic: Before bloody major operation on the mouth, pharynx, larynx
Value: To avoid blood inhalation during surgery

Prolonged intubation: (commonest cause nowadays)
Value: to safeguard against occurrence of subglottic stenosis, and for better oral and pulmonary hygiene .Timing: 7-10 days of intubation.

37
Q

Enumerate complications of tracheostomy 15

A

Shock
Stenosis: Subglottic, Tracheal
Hemorrhage: Reactionary, 2ry
Infection: Wound infection and Respiratory infection

Respiratory complications
-Surgical emphysema
- Obstruction
- Apnea
- Pneumothorax & Pneumomediastinum
-To cricoid cartilage (above)
- To apex of pleura (below)
- To vessels of neck (lateral)
- To esophagus (behind)

Fistula: tracheocutaneous or tracheoesophageal
Difficult Extubation
Embolism

38
Q

Treatment of Meniere’s disease

A

During Attack: Anti-vertigo

*Between Attacks: Salt restriction, Diuretics
- In severe bilateral SNHL: Streptomycin in toxic doses
-Vasodilators (Betahistidine)

Surgical
- If good hearing:
1. Endolymphatic Sac Decompression;
2. If failed, Vestibular Neurectomy

  • If bad hearing:
    1. Injection of Aminoglycoside
    2. Labyrinthectomy
39
Q

Malignant Otitis Externa investigations

A
  • Culture and sensitivity tests from granulations to exclude tumor ( biopsy )
  • Blood glucose level (low immunity - DM )
  • CT scan & MRI
    -PTA
  • Gallium and Tecntium bone scan
40
Q

Malignant Otitis Externa treatment

A
  • Hospitalization and Management of blood sugar level
    -Systemic antibiotics: Quinolones
  • Local Ciprofloxacin ear drops
  • EAC wash by suction
  • Analgesic
41
Q

Left Secretory Otitis Media

A

> PTA CHL
Tympanometry: Type B Curve (flat curve)
X-ray lateral view of nasopharynx (in case of adenoid)

42
Q

Left Secretory Otitis Media

A

-TTT of cause
- Antibiotics
- Steroids
- Decongestant
- Mucolytics
- Valsalva Maneuver

Surgical (if medical treatment failed)
- Myringotomy + Ventilation tube insertion

43
Q

Enumerate causes of conductive hearing loss?

A

Congenital: anomalies
Traumatic: foreign body
Inflammatory: infections & acute inflammatory
Neoplastic: Benign and malignant tumors
Miscellaneous: Wax

Tympanic membrane causes of CHL:
Perforation of tympanic membrane

Middle ear causes of CHL:
Congenital: anomalies
Traumatic: otitis barotrauma
Inflammatory: All types of otitis media and Eustachian tube dysfunction leading to retracted tympanic membrane
Neoplastic: Middle ear tumors…
Miscellaneous: Otosclerosis.

44
Q

CSF Rhinorrhea investigations

A
  1. Biochemical Testing: Clear, Watery, Salty taste, Reduce Fehling Solution
    Contains >30mg % glucose
    Contains B2 transferrin
  2. CT with intrathecal metrizamide (to detect site of leakage)
  3. MRI
  4. Endoscopic Nasal Examination to see the defect
45
Q

Investigations of Allergic Rhinitis and Nasal Polyp and treatment

A
  • Cytology: ++ eosinophils
  • ++Serum IgE
  • RAST
  • Nasal Challenge Test
  • Skin Pricking Test
  1. Avoid exposure to antigen
  2. Medical Treatment
    -Anti-histaminic
    - Mast cell stabilizer
    - Cortisone
    - Decongestant
  3. Hypo sensitization
  4. Surgical
    - Reduction of enlarged turbinate
    - ESS for polyps
46
Q

Give a short account (clinical picture) on the Orbital complications of Sinusitis

A
  1. Orbital Edema: Due to venous obstruction
  2. Orbital Cellulitis
    No pus formation
    Edema of upper eyelid
    Pain in the eye
    Chemosis;
    Proptosis
    Ophthalmoplegia
    Reversible diminution of vision
  3. Extra-periosteal abscess: Collection of pus outside orbital periosteum. 2+ throbbing pain
  4. Orbital Abscess: Collection of pus within the orbit due to rupture of orbital periosteum
    - 2+ diminution of vision is irreversible
  5. Cavernous Sinus Thrombosis: Extension of thrombosis through ophthalmic veins
47
Q

Causes of esophageal dysphagia (cause in the wall) 13

A
  1. Congenital diseases: Congenital atresia or stenosis
  2. Inflammatory: Acute ulcerations
  3. Traumatic: Esophagoscopy or foreign body
  4. Ingestion of corrosives.
  5. Persistent vomiting
  6. Reflux esophagitis
  7. Plummer Vinson syndrome.
  8. Neoplastic: Benign tumors or malignant
  9. Neurological: paralysis of the pharyngeal
  10. Pharyngeal pouch
  11. Achalasia of the cardia
  12. Diffuse esophageal spasm
  13. Scleroderma (causes of fibrosis)
  14. Drugs, and specific fevers
48
Q

Causes of dysphagia (pressure on the esophagus from outside) 11

A

-In the cervical region (upper 1/3):
Malignant thyroid tumor.
Huge multinodular goiter.
Enlarged cervical lymph nodes e.g. metastasis, and lymphoma.

  • In the thorax (middle 1/3)
    Mediastinal tumors.
    Pericardial effusion.
    Enlarged left atrium.
    Bronchogenic carcinoma.
    Aneurysm of the aorta.
  • In the abdomen (lower 1/3)
    Enlarged left lobe of liver
    Para-esophageal hiatus hernia
49
Q

Complications of corrosive esophagitis

A

1- Shock, dehydration, electrolyte imbalance.
2- Esophageal perforation.
3 - Esophageal stricture.
4- T.O.F .
5- Stridor.
6- Chest infection.

50
Q

16 causes of unilateral vocal cord paralysis

A

Central
-Traumatic: head trauma
- Inflammatory: meningitis, encephalitis
- Neoplastic: brain tumor
- Vascular: thrombosis, hemorrhage, embolism
- Degenerative: multiple sclerosis

Cranial
-Traumatic: fracture base of skull
- Inflammatory: malignant otitis externa
- Neoplastic: nasopharyngeal carcinoma

Extracranial
- Neck
-Thyroid operation/cancer
- Esophageal cancer
- Malignant LNs
- Neck injury

> Chest (on left side only)
- Cardiothoracic surgery
- Bronchogenic carcinoma

Idiopathic (25% of cases)

51
Q

Bilateral VC abductor management plan 7

A
  1. Position : Semi-sitting to facilitate cough
  2. Observe Respiration If obstruction: Noise reappears, Voice reappears, Air not felt on tube
  3. Observe Bleeding
  4. Antibiotics
  5. Analgesics
  6. Feeding
  7. Extubation: After ttt of cause, Done gradually

ENT (3 decks)

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