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Otorhinolaryngology > ORL Must Knows > Flashcards

ORL Must Knows Flashcards

1
Q

Left-sided enlargement of a supraclavicular node is suggestive of:

A

Abdominal malignancy

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2
Q

Right-sided enlargement of a supraclavicular node may

indicate

A

malignancy of the mediastinum, lungs, or esophagus

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3
Q

Occipital and/or posterior auricular node enlargement may indicate

A

rubella

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4
Q

Functions of Facial Nerve

A

“Ears, Tears, Face, Taste”

Ears- stapedius muscle
Tears -lacrimation (lacrimal gland) and
salivation (parotid)
Face - muscles of facial expression
Taste - sensory anterior 2/3 of tongue
(via chorda tympani)
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5
Q

Drainage into Nasal Cavity

Superior meatus: ____

A

sphenoid (via sphenodethmoidal recess), posterior ethmoid sinuses

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6
Q

Drainage into Nasal Cavity

Middle meatus: ____

A

frontal, maxillary, anterior ethmoid sinuses

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7
Q

Drainage into Nasal Cavity

Inferior meatus: ____

A

nasolacrimal duct

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8
Q

Borders of the nasopharynx, oropharynx, and laryngopharynx

A

Nasopharynx: skull base to soft palate
Oropharynx: soft palate to hyoid bone
Laryngopharynx: hyoid bone to inferior
cricoid cartilage

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9
Q

Boundaries of the anterior triangle of the neck

A

anterior border of SCM
midline of neck
lower border of mandible

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10
Q

Boundaries of the submental triangle

A

bounded by both anterior bellies of digastric and hyoid bone

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11
Q

Digastric triangle boundaries

A

anterior and posterior bellies of digastric

inferior border of mandible

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12
Q

Carotid triangle boundaries

A

sternocleidomastoid
anterior belly of omohyoid
posterior belly of digastric

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13
Q

The carotid triangle contains which structures?

A

tail of parotid, submandibular gland, hypoglossal nerve, carotid bifurcation, and lymph nodes

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14
Q

The posterior triangle is bounded by:

A

posterior border of sternocleidomastoid
anterior border of trapezius
middle third of clavicle

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15
Q

Left lower level IV supraclavicular node

A

Virchow node

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16
Q

True or False.

True nystagmus and vertigo caused by a peripheral lesion will never last longer than a couple of weeks because of compensation. Central lesions do not compensate, hence nystagmus and vertigo will persist.

A

True

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17
Q

5 D’s of Vertebrobasilar Insufficiency

A 
Drop attacks
Diplopia
Dysarthria
Dizziness
Dysphagia
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18
Q

Tinnitus is most commonly associated with conductive or sensorineural HL?

A

SNHL

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19
Q

Signs and Symptoms of

Glomus Tympanicum/Jugulare Tumour

A
  • Pulsatile tinnitus
  • Hearing loss
  • Blue mass behind TM
  • Brown’s sign (blanching of the TM with pneumatic otoscopy)
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20
Q

Most common cause of vocal cord paralysis

A

lung malignancy

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21
Q

Two types of tinnitus

A

Subjective and objective

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22
Q

Order of the Neural Pathway (with corresponding waves on ABR)

A 
E COLI
Eighth cranial nerve (I- II)
Cochlear nucleus (Ill)
Superior Olivary nucleus
Lateralleminiscus (IV- V)
Inferior colliculus
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23
Q 
Normal hearing physiology
Conductive pathway (external auditory canal to cochlea)
A

Air conduction of sound energy down the EAC -> vibration of the tympanic membrane (area effect) -> sequential vibration of the middle ear ossicles: malleus, incus, stapes (lever effect) -> transmission of amplified vibrations from the stapes footplate in the middle ear to the oval window of the cochlea in the inner ear -> pressure differential on cochlear fluid creates movement along the basilar membrane within the cochlea from base to apex

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24
Q 
Normal hearing physiology
Neural pathway (nerve to brain)
A

basilar membrane vibration stimulates overlying hair cells
in the organ of Corti -> stimulation of bipolar neurons in the spiral ganglion of the cochlear division of CN VIII -> cochlear nucleus -> superior olivary nucleus -> lateral lemniscus -> inferior colliculus -> Sylvian fissure of temporal lobe

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25
Q

Annular arrangement of lymphoid tissue in the pharynx

A

Waldeyer’s ring

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26
Q

Tuning fork used in Weber and Rinne tests

A

512 Hz

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27
Q

What is a positive Rinne?

A

AC >BC

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28
Q

How do you report Weber’s test?

A 
heard centrally (Weber negative)
lateralized to one side (Weber right, Weber left)
29
Q

Weber Test Lateralization

A

ipsilateral conductive hearing loss or

contralateral sensorineural hearing loss

30
Q

True or False.

When conductive hearing loss is present, the Weber test is more sensitive in detecting the CHL than the Rinne test.

31
Q

Interpretation of tuning fork tests:
Weber central
AC > BC ( +) bilaterally

A

Normal or bilateral sensorineural hearing loss

32
Q

Interpretation of tuning fork tests:
Weber Lateralizes to Right
Rinne BC > AC (-) right

A

Right-sided conductive hearing loss, normal left ear

33
Q

Interpretation of tuning fork tests:
Weber Lateralizes to Left
Rinne AC > BC ( +) bilaterally

A

Right-sided sensorineural hearing loss, normal left ear

34
Q

Interpretation of tuning fork tests:
Weber Lateralizes to Left
Rinne BC > AC (-) right*

A

Right-sided severe sensorineural hearing loss or dead right
ear, normal left ear

*a vibrating tuning fork on the mastoid stimulates the cochlea bilaterally, therefore in this case, the left cochlea is stimulated by the Rinne test on the right, i.e. a false
negative test. These tests are not valid if the ear canals are obstructed with cerumen (i.e. will create conductive loss)

35
Q

Pure Tone Patterns in conductive hearing loss?

A
  • BC in normal range
  • AC outside of normal range
  • gap between AC and BC thresholds > 10 dB (an air-bone gap)
36
Q

Pure Tone Patterns in sensorineural hearing loss?

A
  • both air and bone conduction thresholds below normal

* gap between AC and BC <10 dB (no air-bone gap)

37
Q

Pure Tone Patterns in mixed hearing loss?

A
  • both air and bone conduction thresholds below normal

* gap between AC and BC thresholds >10 dB (an air-bone gap)

38
Q

Degrees of Hearing Loss?

A 
Decibel loss / Degree of Hearing loss
0 to 20 dB Normal
21 to 40 dB Mild
41 to 55 dB Moderate
56 to 70 dB Moderate- Severe
71 to 90 dB Severe
=/>91 dB Profound
39
Q

Peripheral vs Central Vertigo

Imbalance is usually more severe in which?

40
Q

Peripheral vs Central Vertigo

Nausea and vomiting is usually more severe in which?

A

Peripheral

41
Q

Peripheral vs Central Vertigo

Auditory symptoms is usually more common in which?

A

Peripheral

42
Q

Peripheral vs Central Vertigo

Compensation is usually more rapid in which?

A

Peripheral

43
Q

Characteristic of nystagmus in central vs peripheral vertigo

A

Peripheral - Horizontal, rotatory, unidirectional

Central - bidirectional, horizontal or vertical

44
Q

Which semicircular canal is usually affected in BPPV?

45
Q

Most common cause of episodic vertigo.

46
Q

5 Signs of BPPV Seen with Dix-Hallpike Maneuver

A
  • Geotropic rotatory nystagmus (nystagmus MUST be present for a positive test)
  • Fatigues with repeated maneuver
  • Reversal of nystagmus upon sitting up
  • Latency of -20 sec
  • Crescendo/decrescendo vertigo lasting 20 sec
47
Q

Lenses that the patients can wear during the Dix-Hallpike

maneuver, which inhibit visual fixation and allow for better visualization of the eyes.

A

Frenzel’s magnifying eyeglasses

48
Q

How is the Dix-Hallpike Positional Testing performed?

A
  • the patient is rapidly moved from a sitting position to a supine position with the head hanging over the end of the table, turned to one side at 45° holding the position for 20s
  • onset of vertigo is noted and the eyes are observed for nystagmus
49
Q

Particle repositioning maneuvers in BPPV

A
  • Epley maneuver (performed by MD)

* Brandt-Daroff exercises (performed by patient)

50
Q

Other name for Meniere’s Disease

A

Endolymphatic Hydrops

51
Q

Etiology of BPPV

A

due to canalithiasis (migration of free floating otoliths within the endolymph of the semicircular canal) or cupulolithiasis (otolith attached to the cupula of the semicircular canal)

52
Q

Definition of Meniere’s

A

episodic attacks of tinnitus, hearing loss, aural fullness, and vertigo lasting minutes to hours

53
Q

Proposed etiology of Meniere’s

A

inadequate absorption of endolymph leads to endolymphatic hydrops (over accumulation) that distorts the membranous labyrinth

54
Q

narrowest anterior air channel and is a common site of inflammation

A

Frontal recess

55
Q

Muscles of mastication

A

Temporalis, Lateral and Medial Pterygoids,

56
Q

Crescent shaped gap between uncinate and ethmoid bulla

A

Hiatus semilunaris

57
Q

Demarcates from anterior versus posterior ethmoid air ce,lls

A

Basal lamella

58
Q

Dividing line between anterior and posterior epistaxis

A

maxillary sinus ostium

59
Q

Most common cause of vocal cord paralysis

A

Lung malignancy

60
Q

Proper tuning fork fequency to be used in weber’s and rinne’s

61
Q

Mild hearing loss

62
Q

Moderate hearing loss

63
Q

Moderate to severe hearing loss

64
Q

Severe hearing loss

65
Q

Profound hearing loss

A

more than or equal to 91 dB

66
Q

Type C tympanogram is indicative of

A

Negative pressure peak
Indicative of eustachian tube dysfunction
Or early otitis media without effusion

67
Q

Acoustic reflex threshold

A

70 to 100 dB greater than hearinh threshold

68
Q

Most common cerebellopontine angle tumor

A

Acoustic neuroma

Otorhinolaryngology (1 decks)

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