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ENT Secrets > Top 100 Examination Pearls > Flashcards

Top 100 Examination Pearls Flashcards

1
Q

Best imaging modality for looking at temporal bone fractures & lesions

A

CT Scan

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2
Q

Best imaging modality for looking at acoustic neuromas

A

MRI of IAC w/ contrast

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3
Q

Best imaging modality to evaluate thyroid nodules

A

Ultrasound

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4
Q

Who most commonly gets malignant otitis externa?

A

Immunocompromised patients

Diabetics

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5
Q

What is the most common pathogen for malignant otitis externa?

A

Pseudomonas aerugeinosa

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6
Q

What is Ludwig’s Angina?

A

Odontogenic infection of submental & submandibular spaces

Leads to:
Progressive swelling of FOM
Upper airway obstruction

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7
Q

How do you diagnose invasive fungal sinusitis?

A

Histopathology:

Fungal invasion into submucosal tissues & vessels w/ associated necrosis

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8
Q

Which infections can extend into the danger space?

A

Parapharyngeal space infections
Prevertebral space infections
Retropharyngeal space infections

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9
Q

What happens in the danger space?

A

Unrestricted spread of infection into the mediastinum

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10
Q

Classic PTA presentation

A

Trismus
Uvular deviation
Muffled voice
Soft palatal edema

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11
Q

Elevated risk factors for OSA

A 
Age > 65 years old
BM > 30
Male or Postmenopausal
African American or Asian
Neck circumference (>17” in men, >16” in women)
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12
Q

Histology of mucormycosis

A

Nonseptate wide-angled branching hyphae

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13
Q

Histology of Aspergillus

A

Septate hyphae with 45-degree branching angles

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14
Q

Most common type of headache/facial pain

A

Tension-type headache

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15
Q

First-line treatment of persistent idiopathic facial pain

A

Tricyclic antidepressants

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16
Q

Types of papillae on the tongue

A

Fungiform
Foliate
Circumvallate
Filliform

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17
Q

Which type of tongue papillae don’t contain taste buds?

A

Filliform

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18
Q

Most common bronchial cleft to develop an anomaly

A

Second

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19
Q

Most important prognostic factor in melanoma

A

Depth of invasion

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20
Q

What must be preserved in conservation laryngeal surgery?

A

At least one cricoarytenoid joint

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21
Q

What is notable about hypopharyngeal cancer?

A

Frequent submucosal spread

Worse prognosis than cancer of the larynx

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22
Q

Most common benign salivary gland tumor

A

Pleomorphic adenoma

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23
Q

Most common malignant salivary gland tumor

A

Mucoepidermoid carcinoma

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24
Q

Most common malignancy of the thyroid

A

Papillary carcinoma

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25
Q

Most common neoplasm of the thyroid

A

Follicular adenoma

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26
Q

Factors that can increase risk of regional lymphatic involvement of a tumor

A 
Tumor site
Stage
Thickness
Perineural invasion
Angiolymphatic invasion
Tumor differentiation
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27
Q

Most common head and neck paragangliomas

A

Carotid body tumors

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28
Q

Presentation of carotid body tumor

A

Pulsatile neck mass

Splaying of external & internal carotids on CT, MRI or angiography (Lyre’s sign)

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29
Q

Lyre’s Sign

A

Splaying of external and internal carotids on CT, MRI or angiography
Characteristic of carotid body tumor

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30
Q

Typical presentation of juvenile nasopharyngeal angiofibroma

A

Teenage boy
Unilateral nasal obstruction
Epistaxis
Bluish mass filling nasal cavity

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31
Q

Classic radiographic findings for juvenile nasopharyngeal angiofibroma

A

Expansion of the PPF on axial view (Holman-Miller sign)
Widening of the sphenopalatine & vidian formina
Bony destruction of the pterygoid process

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32
Q

Holman-Miller Sign

A

Expansion of the PPF on axial radiography
Classic for juvenile nasopharyngeal angiofibroma
Often seen with widening of the sphenopalatine & vidian foramina, as well as bony destruction of the pterygoid process

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33
Q

Exposures linked to adenoma rhino a of the paranasal sinuses

A

Wood

Leather dust

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34
Q

Exposures associated with squamous cell carcinoma of the paranasal sinuses

A

Chromium
Nickel
Mustard gas
Aflatoxin

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35
Q

Ohngren’s line

A

From the medial canthus to the angle of the mandible

Maxillary sinus tumors above this line on presentation carry poorer prognosis

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36
Q

Structures within the cavernous sinus

A 
III
IV
V1
V2
IV
Internal carotid arteries & venous channels
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37
Q

Most medial nerve in the cavernous sinus

A

VI

It is the most commonly injured nerve in this space

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38
Q

Normal rate of CSF production

A

20 mL/hr

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39
Q

Microbes usually responsible for symptoms in acute rhinosinusitis

A

Viruses, not bacteria

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40
Q

Chandler classification for orbital infection

A 
I - Preseptal cellulitis
II - Orbital cellulitis
III - Subperiosteal abscess
IV - Orbital abscess
V - Cavernous sinus thrombosis
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41
Q

Major nasal tip support mechanisms

A

Attachments between the following structures:
Septum
Lower lateral cartilages
Upper lateral cartilages

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42
Q

Minor nasal tip support mechanisms

A 
Intermodal ligament
Dorsal septum
Sesamoid complex
Skin and subcutaneous tissue of nasal tip
Maxillary spine
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43
Q

Nose anomalies in a unilateral cleft lip/palate

A

Ipsilateral lower lateral cartilage displaced:
Inferiorly
Posteriorly
Laterally

Structures displaced toward noncleft side:
Nasal tip
Caudal septum
Columella

Structures deviated toward cleft side:
Bony septum

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44
Q

Most common complications of untreated septal hematoma

A

Septal perforation

Saddle nose deformity

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45
Q

Toxic shock syndrome

A

Rare complication of S. Aureus infection

High fever
Rash
Hypotension
Vomiting
Diarrhea
Multiorgan failure
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46
Q

Treatment for toxic shock syndrome

A

Remove nasal packing
IV antibiotics
Supportive/Rescuscitative care

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47
Q

Keros classification of olfactory fossa depth

A

Class I - 1 to 3 mm
Class II - 4 to 7 mm
Class III - 8mm and greater

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48
Q

Most common site of iatrogenic CSF leak during FESS

A

Lateral lamella of cribriform

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49
Q

Spontaneous CSF leak

A

Likely associated with IIH

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50
Q

Cause of thyroid eye disease

A

Autoimmune inflammation of muscle and fat

Autoantigen is TSH receptor

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51
Q

Physical properties of cochlear basilar membrane

A

Base:
Thick
Stiff
Narrow

Apex:
Thin
Flexible
Wide

These are responsible for tonotopic properties

52
Q

What greatly affects severity of cochlear deformities?

A

Gestational age at growth arrest or disruption

53
Q

Top causes of conductive hearing loss

A

Cerumen impaction
Otitis media with effusion (most common cause in children)
TM perforation
Otosclerosis

54
Q

Top causes of sensorineural hearing loss

A

Presbycusis
Noise exposure
Hereditary

55
Q

Most common ototoxic medications

A

Aminoglycosides
Cisplatin
Loop diuretics
Salicylates

56
Q

Most common radiographic finding in pediatric SNHL

A

Enlarged vestibular aqueduct

57
Q

Pure tone average

A

Average air conduction hearing threshold at frequencies associated with speech:

500 Hz
1000 Hz
2000 Hz

58
Q

Masking

A

Simultaneous presentation of of sound to nontest ear while testing the other ear with the stimulus

59
Q

Alexander’s Law

A

Peripheral nystagmus becomes faster and more apparent when the patient gazes in the direction of the fast phase

60
Q

Four main components of conventional hearing aid

A

Microphone
Amplifier
Receiver
Battery

61
Q

When does acoustic feedback occur with a hearing aid?

A

When amplified sound leaks out of the receiver, back into the microphone

62
Q

Most common bacterial pathogens in acute otitis media

A 
Streptococcus pneumoniae (35 - 40%)
Haemophilus influenza (30 -35%)
Moraxella catarrhalis (15 - 25%)
63
Q

First-line therapy for acute otitis media

A

Amoxicillin

80% of bacterial isolates remain susceptible

64
Q

Requirements for diagnosis of otitis media

A

Middle ear effusion present

Confirmed by pneumatic otoscopy or tympanometry

65
Q

Indications for a canal wall down mastoidectomy

A

Semicircular canal fistula
Posterior canal wall damage due to cholesteatoma
Sclerotic mastoid prevents visualization with a wall up mastoidectomy
Patient is unable to follow up or undergo additional surgeries for proper monitoring of recurrent cholesteatoma

66
Q

Most common presentation of otosclerosis

A

Progressive conductive hearing loss

Can rarely present with SNHL
Many patients will have positive family history

67
Q

Classifications of cholesteatomas

A

Congenital
Primary acquired
Secondary acquired

68
Q

Mechanisms of upper eyelid closure

A

Activation of VII
Relaxation of III (Levator palpebrae)

Upper eye closure can not be relied upon as indicative of intact facial nerve

69
Q

Area of VII most susceptible to entrapment neuropathy during nerve swelling

A

Labyrinthine segment

It is in the narrowest portion of fallopian canal

70
Q

How might superior semicircular canal dehiscence mimic otosclerosis?

A

Conductive hearing loss

71
Q

How might superior semicircular canal dehiscence mimic a patulous Eustachian tube?

A

Ear fullness and autophony

72
Q

How might superior semicircular canal dehiscence mimic Meniere’s?

A

Vertigo

73
Q

Hitzelberger Sign

A

Numbness of the medial, posterior or superior EAC

Caused by acoustic neuroma compressing VII

74
Q

Raccoon eyes

A

Periorbital ecchymoses following basal skull fracture

75
Q

Battle sign

A

Mastoid ecchymoses following basal skull fracture

76
Q

CSF leak in the setting of temporal bone fracture

A

Common

Usually resolves within 7 days

77
Q

Pediatric vs. Adult airway

A

Significantly smaller

The same degree of inflammation and edema can be much more clinically significant in an infant

78
Q

Respiratory distress and cyanosis at birth, resolves with crying

A

Bilateral choanal atresia

79
Q

Most common cause of stridor in an infant

A

Laryngomalacia

80
Q

Most common cause of UVFP in children

A

Iatrogenic

Second most common cause of stridor

81
Q

Most common cause of subglottic stenosis

A

Iatrogenic scarring related to endotracheal intubation

82
Q

Most common tumors of infancy

A

Infantile hemangiomas

Majority are found within head & neck

83
Q

Beard distribution of hemangioma in a stridulous child

A

Raises suspicion for subglottic hemangioma

84
Q

What distinguishes hemangiomas from vascular malformations?

A

GLUT-1 positivity

85
Q

First-line treatment for infantile hemangiomas

A

Propranolol

86
Q

Submucosal cleft palate

A

Higher incidence of postadenoidectomy VPI

87
Q

Medication to avoid if mono is suspected

A

Amoxicillin (may cause salmon-colored rash)

88
Q

Pattern of branchial cleft anomalies

A

Track deep to structures of their own arch

Track superficial to structures of the subsequent arch

89
Q

Differential for pediatric midline nasal mass

A

Glioma
Dermoid
Encephalocele

Always get imaging prior to excision to rule out intracranial extension

90
Q

What is rate of concordance between cleft lip & cleft palate?

A

50% have both
35% have cleft palate alone
15% have cleft lip alone

Left unilateral cleft lip and palate is the most common

91
Q

Most common indication for tonsillectomy

A

Sleep disordered breathing

Recurrent tonsillitis is second most common indication

92
Q

Where do facial mimetic muscles receive their innervation?

A

From their deep surface, as they are superficially situated

93
Q

Nasal projection

A

How far the tip projects from the face

94
Q

Nasal Rotation

A

Movement of the tip along an arc from the EAC

95
Q

What structures comprise the internal nasal valve?

A

Upper lateral cartilage
Nasal septum
Nasal floor

96
Q

Cottle Maneuver

A

Helps diagnose internal nasal valve collapse

97
Q

Pollybeak Deformity

A

Complication of rhinoplasty
Supratip fullness results in parrot’s beak appearance

Due to:
Loss of tip support
OR
Supratip scar tissue

98
Q

Layers of the eyelid (Anterior to posterior)

A 
Skin
Orbicularis Oculi
Orbital Septum
Preaponeurotic Fat
Levator Aponeurosis
Muller’s Muscle
Conjunctiva
99
Q

Baker-Gordon Formula

A

Phenol 88%
Croton Oil
Septisol
Distilled Water

100
Q

What does the Baker-Gordon formula’s depth of penetration depend on?

A

More dependent on croton oil than the concentration of phenol

101
Q

Danger of phenol chemical peels

A

Cardiac toxicity

Apply to individual facial subunits in 15-minute intervals, for safety

102
Q

Most common complication from facelift surgery

A

Hematoma
Up to 10% of cases
More common in men

103
Q

Most commonly injured nerve in facelift surgery

A

Great auricular nerve

Most commonly injured MOTOR nerve is the marginal mandibular

104
Q

How does botulinum toxin work?

A

Presynaptic neuromuscular junction
Prevents acetylcholine release
Leads to temporary muscle paralysis

105
Q

What are the benefits of full-thickness skin graft, compared to other graft options?

A

Limits graft contraction
Improved texture
Improved color match

106
Q

Early clinical finding of optic nerve injury

A

Loss of red color vision

107
Q

Most common facial bone fractured

A

Nasal bone

108
Q

Most common site of mandible fracture

A

Angle

109
Q

Abductor muscle of the true vocal folds

A

Posterior cricoarytenoid

110
Q

Which intrinsic laryngeal muscle is not innervated by the RLN?

A

Cricothyroid

111
Q

What innervates the cricothyroid?

A

Superior Laryngeal Nerve

112
Q

Which intrinsic laryngeal muscle has bilateral innervation?

A

Interarytenoid

113
Q

What causes recurrent respiratory papillomatosis?

A

HPV type 6 and 11

114
Q

Primary management for vocal fold nodules

A

Voice therapy

115
Q

What does Laryngeal EMG measure?

A

Motor unit recruitment in the larynx

116
Q

Laryngeal EMG findings of denervated muscle

A

Fibrillation potentials

Positive waves

117
Q

Laryngeal EMG findings when reinnervation occurs

A

Polyphasic motor units

118
Q

Management of an airway fire

A

Turn off flow of O2
Douse fire with saline
Remove damaged tube
Reintubate (as atraumatically as possible)
Administer IV steroids and antibiotics
Bronchoscopy before leaving the OR (remove charred tissue or debris & evaluate extent of airway injury)
Delayed extubation w/ repeat endoscopic airway examinations

119
Q

Hearing loss w/ enlarged vestibular aqueduct or Mondini dysphasia on imaging

A

Test for mutations in SLC26A4

Associated with Pendred Syndrome

120
Q

Key to a Sistrunk procedure

A

Don’t just resect central portion of the hyoid bone

Resect tongue musculature between hyoid bone & foramen cecum in the tongue

121
Q

Antibiotics associated with increased risk of C. Diff Colitis

A

Clindamycin
Fluoroquinolones
Cephalosporins
Carbapenems

Less frequently:
Macrolides
Penicillins
Sulfonamides

122
Q

Difference between radical, modified radical, and selective or functional neck dissections

A

Radical:
Modified Radical:
Selective or Functional:

123
Q

Where and how can sinus disease spread?

A

Orbit
Intracranial Cavity

Can spread via vascular channels

124
Q

Care for a patient requiring posterior nasal packing

A

Must be admitted to the hospital
Telemetry
Continuous pulse ox

125
Q

How long should you counsel patients to wait before undergoing scar revision surgery?

A

6 - 12 months at least

Most improve without revision within 1 - 3 years

Exception: If there are obvious scar characteristics that aren’t expected to improve

ENT Secrets (4 decks)

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