Target PG - TNPG 2001 to 2004 Book 2003 ENT Author: Dr.J.Mariano Anto Bruno Mascarenhas Question Stem 237) Sensory supply to Auricle is by all except Choices given A) Greater Auricular Nerve B) Auriculotemporal Nerve C) Auditory Nerve D) Facial nerve Answer C) Auditory Nerve Reference Diseases of Ear, Nose and Throat. - P.L.Dhingra - 3rd Edition Page 5 Question Analysis Based on Question Category Question Grade Question Type Books Target PG Opinion Fact Basic point MBBS Straight forward Given in all books Needs Memory Facts Sensory Nerves of The Auricle are o Great auricular nerve, (C23) supplying most of the cranial surface and the posterior part of the lateral surface (helix, antihelix, lobule) o Lesser occipital nerve, (C2) supplying the upper part of the cranial surface o Auricular branch of the vagus, supplying the concavity of the concha and posterior part of the eminentia o Auriculotemporal nerve, (V3) supplying the tragus, crus of the helix and the adjacent part of the helix o Facial nerve, which with the auricular branch of the vagus probably supplies small areas on both aspects of the auricle in the depression of the concha and over its eminence. The details of the cutaneous innervation by the facial nerve and whether the facial fibres reach the external acoustic meatus and tympanic membrane require further clarification. Interpretation Auditory Nerve supplies the Cochlea Remarks The external ear comprises the auricle, or pinna, and the external acoustic meatus. The auricle projects from the side of the head to collect sound waves, and the meatus leads inwards from the auricle to conduct vibrations to the tympanic membrane. These structures do not act merely as a simple ear-trumpet, for they are the first of a series of stimulus modifiers in the auditory apparatus. Tit Bits Auricular Cartilage is a single piece of elastic fibrocartilage. Question Stem 238) Otosclerosis affects Choices given A) Malleus B) Incus C) Stapes D) All of these Answer C) Stapes Reference Diseases of Ear, Nose and Throat. - P.L.Dhingra - 3rd Edition Page 114 to 116 Question Analysis Based on Question Category Question Grade Question Type Books Target PG Opinion Concept Basic point MBBS Straight forward Given in all books Needs Memory Facts Otosclerosis can affect Stapes also Interpretation This is easy to understand as Stapes is the Bone (of the 3 given above) related to Cochlea. And Otosclerosis is managed by Stapedectomy, which is the treatment of choice. Few patients who refuse surgery or are unfit for surgeries are managed by Hearing Aid. Remarks Let us see a Few points about Stapedectomy. In fixed Otosclerosis, the stapes is removed and a prosthetic is inserted between Incus and Oval Window. The prosthesis can be Teflon piston, stainless steel piston, tefwire or fat and stainless steel wire. In 90 % there is good improvement The indications are 1. AB Gap > 30 dB 2. Rinne Negative for 256 Hz and 512 Hz 3. Good cochlea The Steps of Stapedectomy are 1. Meatal Incision and Elevation of Tympanomeatal Flap 2. Exposure of Stapes - Removal of Posterosuperior bone overhanging of canal 3. Removal of Stapes superstructure 4. Creation of hole in Stapes foot plate - Stapedotomy or Removal of a part of foot plate - Stapedectomy 5. Placement of Prosthesis 6. Repositioning of Tympanomeatal Flap Few more points 1. 2 % there may be sensorineural loss 2. Stapes Mobilisation gives temporary results 3. Fenestration operation is an outdated procedure in which a window is created in the lateral semicircular canal Tit Bits Sodium Flouride is used to arrest the progress of the disease. This is an often asked question Question Stem 239) Receptor of hearing is Choices given A) Vomeronasal Organ B) Organ of Corti C) Rods D) Fungiform Papilla Answer B) Organ of Corti Reference Diseases of Ear, Nose and Throat. - P.L.Dhingra - 3rd Edition Page 16 Question Analysis Based on Question Category Question Grade Question Type Books Target PG Opinion Fact Basic point MBBS Straight forward Given in all books Needs Memory Facts The spiral Organ of Corti consists of a series of epithelial structures lying on the zona arcuata of the basilar membrane. The more central of these structures are two rows of cells, the internal and external rod cells (of Corti) or pillar cells. The bases or foot plates (crura) of the rod cells are expanded, resting contiguously on the basilar membrane but apically widely separated; the two rows incline to each other and come into contact above at the heads of the pillars, enclosing between them and the basilar membrane the cuniculum internum (tunnel of Corti), which has a triangular cross-section. Internal to the inner rods is a single row of inner hair cells and external to the outer rods three or four rows of outer hair cells, with supporting cells, phalangeal cells (of Deiters) and cellulae limitans externae (cells of Hensen). The free ends of the external hair cells and apical processes of phalangeal cells form a regular mosaic termed collectively the reticular lamina or reticular membrane. The organ is covered by the tectorial membrane, a shelf of stiff gelatinous proteinaceous material; a narrow gap separates this from the reticular lamina except where the apical stereocilia of the outer hair cells project to make contact with it. In addition to the inner tunnel (cuniculum internum or tunnel of Corti), other intercommunicating spaces exist around the outer hair cells also connected with the inner tunnel, including an outer tunnel (cuniculum externum) between the outermost hair cells and inner cells (of Hensen), under the reticular lamina, and also a cuniculum medium (space of Nuel) between the outer pillar (of Corti) and the outer hair cells. The latter tunnel is continuous with the extracellular spaces around the apical two-thirds of the outer hair cells. This complex of intercommunicating spaces is filled with perilymph which diffuses into it through the matrix of the basilar membrane. The fluid in these spaces is also sometimes called the cortilymph and it is possible that minor alterations in perilymphatic composition occur within it, as it is exposed to the activities of synaptic endings and specialized excitable cells. Interpretation A) Vomeronasal Organ is for smell and the receptors are olfactory neurons B) Organ of Corti is for hearing C) Rods is for Vision D) Fungiform Papilla is for taste and the receptor is Taste Buds Remarks Few Other Receptors Sensation Perceived Receptors Rotational Acceleration Hair Cells - Semicircular Canals Liner Acceleration Hair Cells - Utricle and Saccule Pain Naked nerve endings Touch Meissners and Pacinian Pressure o Rapidly Adapting Touch Receptors o Encapsulated Ending Merkel’s and Ruffini o Slowly Adapting Touch Receptors o Expanded Endings Warmth Free nerve Endings, ? Ruffini Cold Krause Joint Position Type I Endings of Ruffini Type Muscle length Muscle Spindle Muscle tension Golgi Tendon Organ Arterial Pressure Stretch Receptors in Carotid Sinus and Aortic Sinus Central Venous Pressure Stretch Receptors in the walls of Atria and Great Veins Inflation of Lung Stretch Receptors of Lung Parenchyma Temperature of Blood in Head Neurons of Hypothalamus Arterial PO2 Glomus Cells of Carotid and Aortic Bodiess pH of CSF Receptors on Ventral Medulla Osmotic Pressure of Plasma Cells in OVLT and other circumventricular organs Arterio Venous Blood Glucose Glucostats in Hypothalamus Difference Tit Bits Vision, Audition, Smell, Taste, Rotational Acceleration, Liner Acceleration, Pain, Touch, Pressure, Warmth, Cold and Joint Position are Conscious Sensations Question Stem 240) Choana means Choices given A) Anterior Nasal Aperture B) Posterior Nasal Aperture C) Primitive Buccal Cavity D) Primitive Anal Canal Answer B) Posterior Nasal Aperture Reference Fundamentals of Ear, Nose, Throat and Head and Neck Surgery - S.K.De - 6th Edition Page 201 Question Analysis Based on Question Category Question Grade Question Type Books Target PG Opinion Fact Basic point MBBS Straight forward Given in all books Needs Memory Facts Choana Means Posterior Nasal Aperture Interpretation A) Anterior Nasal Aperture is Nostrils B) Posterior Nasal Aperture is Choana C) Primitive Buccal Cavity is Stomodeum D) Primitive Anal Canal Proctodeum Remarks Choanal Atresia is an condition where Choana Fails to canalize there is no connection between Nose and nasopharynx and the child gets choked while being fed. In case of Unilateral Chonal Atresia A typical history will be the child being restless when fed on one side. Tit Bits This condition can be manages by McGrover’s Technique where by the child is fed with a nipple with a large hole and the atresia can be surgically corrected at 1½ years. Question Stem 241) Thudichum speculum is used for examination of Choices given A) Nose B) Ear C) Pharynx D) Larynx Answer A) Nose Reference Fundamentals of Ear, Nose, Throat and Head and Neck Surgery - S.K.De - 6th Edition Page 581 Text Book of Diseases of Ear, Nost and Throat. P.B.Rao Page 12 Question Analysis Based on Question Category Question Grade Question Type Books Target PG Opinion Fact Clinically Applied point MBBS Straight forward Given in all books Needs Memory Facts Thudichum’s nasal Speculum is used for Anterior Rhinoscopy Interpretation Self Explanatory Remarks Posterior Rhinoscopy is by St.Clair Thomson’s Post Nasal Mirror Tit Bits The Difference between the Laryngeal Mirror and Post nasal Mirror is that the Laryngeal Mirror has a straight handle and the post nasal mirror has angled handle Question Stem 242) Suprameatal Triangle represents Choices given A) Kidney B) Sixth Cervical Vertebrae C) Sternal Angle D) Mastoid Antrum Answer D) Mastoid Antrum Reference Diseases of Ear, Nose and Throat. - P.L.Dhingra - 3rd Edition Page 110 Question Analysis Based on Question Category Question Grade Question Type Books Target PG Opinion Fact Subtle Point MBBS Straight forward Given in Dhingra Needs Memory Facts Suprameatal Triangle is a landmark representing Lateral wall Mastoid Antrum. It is also called as MacEven’s Triangle. The landmarks are The triangle's superior side, Supramastoid crest, Level with the floor of the middle cranial fossa; Antero-inferior side, Forms Posterosuperior margin of the external acoustic meatus, Indicates approximately the position of the descending part of the facial nerve canal Posterior side, Formed by a posterior vertical tangent to the posterior margin of the external acoustic meatus, Anterior to the sigmoid sinus Interpretation A) Surface Marking for Kidney is represented by Morrison’s Parallelogram B) Sixth Cervical Vertebrae identified by the prominent transverse process of the sixth cervical vertebra also called as the Chassaignac's tubercle. C) Sternal Angle is also called as Angle of Louis or manubriosternal Angle D) Surface Marking for Mastoid Antrum is by MacEven’s Triangle or Suprameatal Triangle Remarks There are few other entities named after MacEven as well MacEwan’s Osteotomy - is a Supracondylar Osteotomy MacEwan’s Sign is seen in alcoholic coma where the pupils are contracted, but stimulation of the personby pinching or slapping causes them to dilate with slow return Tit Bits Though there is great variation in the appearance of the external ear, a fissure running obliquely downwards and backwards from the lobule may be present, especially with increasing age, and is associated with sudden death from cardiovascular disease (Frank's sign) Question Stem 243) Greisinger’s Sign is seen in Choices given A) Lateral Sinus Thrombosis B) Deep Vein Thrombosis of Lower Limb C) Migratory thrombophlebitis, D) Hepatic Vein Thrombosis Answer A) Lateral Sinus Thrombosis Reference Diseases of Ear, Nose and Throat. - P.L.Dhingra - 3rd Edition Page 110 Question Analysis Based on Question Category Question Grade Question Type Books Target PG Opinion Fact Subtle Point PG Entrance Straight forward Given in all books Needs Memory Facts Lateral Sinus Thrombosis (Sigmoid Sinus Thrombosis) occurs in a case of CSOM because the infection is transmitted by the Mastoid Emissary Vein. There is Oedema of Psot Auricular Region over the mastoid emissary vein Interpretation A) Lateral Sinus Thrombosis presents with Greisinger’s Sign B) Clinically, the classic features of DVT (Deep Vein Thrombosis) of Lower Limb. are calf swelling and tenderness, elevated temperature, and a positive Homans' sign (calf pain on dorsiflexion of the foot) C) Migratory thrombophlebitis, or repeated thrombosis at varying sites in superficial veins, most commonly occurs in the lower extremity. No definite etiologic factor has been confirmed; however, in 1856, Trousseau reported an association with carcinoma. This condition has been noted to be especially prevalent with carcinoma of the tail of the pancreas. And it is ironic that the person himself succumbed to that condition D) Hepatic Vein Thrombosis is seen in Budd-Chiari Syndrome Remarks Tobey Ayer’s Test is done to find Lateral Sinus Thrombosis Otitic Hydrocephalus (Symond’s Syndrome) is raised intracranial tension without any brain abscess Tit Bits Emissary veins traverse cranial apertures and make connections between venous sinuses and extracranial veins. Some are constant, others sometimes absent: These connections are significant in the spread of infection from extracranial foci to venous sinuses. The success of a ligature of the internal jugular vein, to limit the spread of some oral and pharyngeal pathologies, depends on the adequacy of the collateral drainage. EmissaryVein At Connects With Mastoid Mastoid Foramen Post Auricular, Sigmoid Sinus EmissaryVein Occipital Parietal Parietal Foramen Veins of Scalp Superior Sagittal EmissaryVein Sinus Venous plexus Hypoglossal Canal Internal jugular vein Sigmoid Sinus posterior Condylar Canal Suboccipital Triangle Sigmoid Sinus condylar EmissaryVein Plexus of Foramen Ovale Pterygoid Plexus Cavernous Sinus EmissaryVeins (venous plexus) Two or three Foramen Lacerum Pharyngeal veins Cavernous Sinus small veins Pterygoid plexus. EmissaryVein Emissary sphenoidal Pharyngeal veins Cavernous Sinus foramen (of Pterygoid plexus. Vesalius) Internal Carotid Carotid Canal Internal jugular vein Cavernous Sinus Venous plexus Petrosquamous External Jugular Vein Transverse Sinus Sinus foramen caecum Nasal Veins Superior Sagittal Sinus Occipital occipital occipital vein confluence of emissary vein protuberance sinuses Occipital diploic vein Occipital sinus Veins around the vertebral venous foramen magnum plexuses (marginal sinuses) Ophthalmic veins Question Stem 244) The margins of the Facial Recess are all except Choices given A) Vertical part of VIII Nerve B) Chorda Tympani C) Fossa Incudis D) Tympanic Membrane Answer D) Tympanic membrane Reference Diseases of Ear, Nose and Throat. - P.L.Dhingra - 3rd Edition Page 72 Question Analysis Based on Question Category Question Grade Question Type Books Target PG Opinion Fact Subtle Point PG Entrance Straight forward Given in Dhingra Needs Memory Facts Facial Recess is a depression in the posterior wall lateral to the pyramid. The Boundaries are Medial - Vertical part of VIII Lateral - Chorda Tympani Above - Fossa Incudis Interpretation Self Explanatory Remarks Direct Access to the Middle Ear can be made without disturbing the posterior meatal wall through this technique and this is called as Intact Canal Technique Tit Bits The aditus to the mastoid antrum, a large irregular aperture, leads back from the epitympanic recess into the upper part of the mastoid antrum. On the medial wall of the aditus is a rounded eminence, above and behind the prominence of the facial nerve canal, due to the underlying lateral semicircular canal. The pyramidal eminence is just behind the fenestra vestibuli and anterior to the vertical part of the facial nerve canal; it contains the stapedius muscle, its summit projecting towards the fenestra vestibuli; a small apical aperture transmits the muscle's tendon. Its cavity is prolonged down and back in front of the facial nerve canal and communicates with the latter by an aperture through which a small branch of the facial nerve passes to the stapedius (p. 1376). The fossa incudis, a small depression low and posterior in the epitympanic recess, contains the short process of the incus, fixed to the fossa by ligamentous fibres.
Pages to are hidden for
"ENT thrombosis"Please download to view full document