ENT thrombosis by mikeholy

VIEWS: 18 PAGES: 7

									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.

								
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