ENT Key Points: Diagnosis and Treatment
Key Concepts in ENT
Focus on Solving
- All or None
- True or False
- Subject by Subject
Differential Answers
- Moderate allergy Tx: (C)
- Asphyxia: (ER Tracheostomy)
- Larynx abd: (C-A-P)
- Allergy: Pale mucosa!
- Septal Resection Does not Cause: Nasal Polyp
- Photoan: weak VC
- Contact ulcer: Vocal abuse!
- VC lateral: paralysis
- VC constriction: functional aphonia!
- Bullous myringitis: PS Aeruginosa!
- Normal skin: Except diphtheria!
- Swelling of inner orbital: ALL
- : Serous otitis media
- Headache: Aggravated by exertion
- High Pitch: high and thick VC
- Fibroma: ALL
Sinuses
- Posterior Ethmoid: (Superior meatus)
- Max sinus: Middle meatus
- Max sinus: at nose level
- Complication of sinus disease: ALL
- Lateral sinus thrombosis Tx: ALL
- Temporal bone except: Retrofacial
- Sphenoid sinus: Sphinoethmoid Recess!
Coryza
- Cause: Viral
- Organism: rhinovirus
- Prolonged by: streptococci
Tonsillitis
- Acute (NOT): Nasopharyngeal obstruction
- Chronic (Not): bad smell!
- Acute (Not): epistaxis
- Hypertrophy (complication): Otitis media + Hearing loss
- Chronic (except): systemic features!
- Chronic (except): A/B
- 1st Line Non-Allergic Child with Acute: Penicillin V
- Paratonsillitis Dx (NOT): CT scan
- Not pharyngotonsillitis: peritonitis!
Laryngitis
- GERD affects: VC
- Chronic Forms: 3 (cat/atrophic/hypertrophic)
- Larynx abd: (C-A-P)
- Larynx: (100-1000 HZ)
- Larynx TB: All
- Cancer mts: Glottis?
- Cystitis: any region!
- Larynx Stenosis: Vocal Cracks
- Examination + general anesthesia: Direct Microlaryngoscopy!
- Uncompensated laryngeal paralysis: only phonation
Tonsillectomy
- Except: (2W)
- Indication: (Pain after Peritonsillitis!)
- Indication: (ALL)
- Indication: (All Except C)
- Indication: (freq >4/year!)
- Not Indication: (Meningitis after Peritonsillitis)
- Is: (Removal of palatine tonsils)
Pharyngitis
- Chronic (not Dx): Oral Cavity exam
- Acute Viral (NOT): Plaques on tonsil
- First line Ax for Acute Tx: Ax not Necessary
- Chronic Hypertrophic: LNadenoidal granule…posterior pharyngeal wall
- Chronic Etiology (NOT): Deviated Septum
- Acute Cause: (All)
- Chronic Atrophic Tx: BOTH (Oil+Kines)
Rhinitis
- Not Dx: Rhinomanometry
- Acute: red nasal Mucosa, mucopurulent
- Allergic: obstruct nasal breathing (longest)
- Acute (Not Tx): Op Ax
- Allergic: Pale Mucosa!
- Allergic: All of the above!
- Allergic mild Tx: systemic H1
- Moderate Allergic Tx: (C)
- Permanent Allergic (non Specific): tearing!
- Medicamentosa: Intranasal Steroid!
- Acute (Cause): Rhino/Corona
- Acute Viral Tx: Decongestant
- Hormonal rhinitis: Pregnancy!
- Chronic Hypertrophic except: in children..
- Chronic Hypertrophic except: Nasal obstruction relieved (D)
- Atrophic (Except): common in children
- Atrophic Rhinitis: more in males!
- Atrophic (Tx): Administration of Systemic estrogen!
- Vasomotor: (None)
- Hyperplastic: chemical Irritation!
- Chronic Tx: Long term use of Topical Decongestant
- Dry stage of Acute (DONT give): OP Ax!
- Not used for Dx: rhinometry
- Moderate allergic Tx: local (nasal Steroid)
Rhinosinusitis
- Acute Tx: Conservative Tx
- Chronic: (2 options: open + something)
- Not Surgery indication: preseptal cellulitis!
- Chronic (NOT): Cough!
- A complication of acute intracranial: meningitis + epidural abscess!
Laryngitis (Repeated)
- GERD affects: VC
- Chronic Forms: 3 (cat/atrophic/hypertrophic)
- Larynx abd: (C-A-P)
- Larynx: (100-1000 HZ)
- Larynx TB: All
- Cancer mts: Glottis?
- Cystitis: any region!
- Larynx Stenosis: Vocal Cracks
- Examination + general anesthesia: Direct Microlaryngoscopy!
- Uncompensated laryngeal paralysis: only phonation
Cyst
- Larynx: Any part of It!
- VC cystitis: Any region of larynx!
- Maxillary sinus: dental origin!
Polyp
- Ethmoidal polyp: Idiopathic
- Ethmoidal polyp: Rate of Recurrence high!
- Ethmoidal polyp: multiple + bilateral!
- Location: Anterior 1/3
- A-C polyp: Single + unilateral
- Laryngeal polyp: Both
- Nasal (except): Sensitive to touch
Meniere’s Disease
- Except: Rinne Test -ve
- Tx: Shunt operation
Vocal Cords (VC)
- 1 VC in paramedian: unilateral incomplete
- 1 VC in cadaveric: unilateral incomplete
- Both VC in paramedian: bilateral incomplete
Cancer
- Larynx (False): = in both sexes!
- Larynx: 3rd + 4th decade!
- Larynx Sx: Hoarseness!
- Larynx site: glottis!
- Larynx mts: hypopharyngeal!/Cervical LN (2Q)
- Larynx mts: Cervical LN
- Commonest Larynx tumor: Squamous cell Carcinoma
- Subglottic Cancer (except): is Most common Type of cancer…
- Larynx Stage I+II (atypical): Inspiration dyspnea!
- Localized Larynx recommended: hemilaryngectomy with Regional LNectomy
- Larynx Min stage of mts: III
- VC pathology + Precancer: Chronic Hypertrophic Laryngitis + Keratosis
- Subglottic: A+D (Respiratory Difficulty + SCC)
- Precancer condition: Chronic hypertrophic laryngitis!
Nerve
- Unilateral recurrent Laryngeal Tx: C+M
- Left Recurrent Laryngeal: around Aorta!
- Inferior Laryngeal (except): cricothyroid
- Bilateral recurrent laryngeal Tx: lateralization of VC
- Bilateral Caused: Tracheostomy!
- Superior Laryngeal: cricothyroid!
- Unilateral VC paralysis: hoarseness!
- External laryngeal nerve: superior thyroid artery
- Recurrent laryngeal nerve: inferior thyroid artery
- Chorda tympani: First Arch (C)
- Infraorbital nerve: From maxillary!
- Tonsil nerve supply: both (S+G)
- Tensor Tympani: by facial nerve
- Stapedius: By (C)
- Olfactory nerve: 10 filaments
- Olfactory nerve: Fourth of the nasal septum!
Nasal Septum
- Abscess: Traumatic Hematoma!
Otitis Media
- Secretory: Inflammatory effusion….
- Early features of acute suppurative: All
- Suppurative rupture: None
- Suppurative sign (except): Tragus (+ve)
- Cause: Strept/Pn/ H Influenza!
- Acute Sx: Ear pain, hearing loss, pain!
- Chronic Tx: Tympanostomy
- Hypertrophic Not: Smell
- Secretory: inflammatory effusion/…
- Children: Streptococcus / Influenza
- Incision: Myringotomy/Paracentesis
- Early acute serous Sx: Autophony!
- Acute Sx (newborn): B+C
- Serous (Not): bulging ear drum/N+ NP are Normal!
- Acute (False): Retracted ear drum
- Acute Serous (except): Nose + Nasopharynx are Normal
- Acute serous (except): Purulent discharge present
- Acute serous Tx (Except): Topical Decongestant
- Purulent otitis complain: Bad Hearing/crackles…..
- Middle phase: purulent discharge
- Exudative otitis tympanogram: Type B
- Acute otitis NOT perform?: Audiogram!
- Exudative characteristic: TM rupture/perforation!
- Intracranial complication (except): Perotitis!
- Ax (cefuroxime, Ceftriaxone): ALL
Sensorineural Hearing Loss
- Not Audiological Test: Type B tympanogram!
- Tx: only after Audiogram is done!
Pharyngitis (Repeated)
- Chronic Atrophic Tx: Both (Oil+Kines)
Case
- 5yo + III palate hypertrophic + OMAS: Bilateral tonsillectomy!
Sinusitis
- Maxillary: middle meatus!
- Chronic (Not): Cough!
- Headache: Aggravated by stooping/exertion!
- Chronic: >12 W
- Not Complication: Epistaxis!
- Acute non Complicated (Not): Proptosis!
Adenoiditis
- Except: (anorexia)
- 2nd degree: cover 2/3 choana!
- Not Sx: (Diarrhea(E))
- Grades during mirror exam: (4)
- Not Sx: headache
- Not Sx: Anorexia
- True Except: No Crypts!
Tonsillectomy (Repeated)
- Except: (2W)
- Indication: (Pain after Peritonsillitis!)
- Indication: (ALL)
- Indication: (All Except C)
- Indication: (freq >4/year!)
- Not Indication: (Meningitis after Peritonsillitis)
- Is: (Removal of palatine tonsils)
Epiglottitis
- Children: Influenza B
- Ax of choice: ampicillin!
Otosclerosis
- Sx: intact Tympanic membrane…
- : Gradual hearing loss & Tinnitus
- (except): Common in males!
- Not True: No Relationship with puberty!
- Absorption of: Spongy bone
- Sx: Deafness without tinnitus!
- Audiometry: Negative Pressure Normal Compliance!
Mucocele
- Frontal sinus (except): Swelling elastic!
Supraglottis
- : Fold/Arytenoid!
- Tx: Ampicillin!
Meniere’s Disease (Repeated)
- (Except): hyperactive caloric response!
- Sx: Cochlear sx before vestibular!
- Tx: ALL
Mastoiditis
- Acute Types: ALL
- Radiological Finding: All
- Radiological: erosion of dural sinus!
- Acute Except: Perceptive deafness!
- Except: low Fever/Purulent drainage?
- Finding in surgical mastoiditis: erosion of dural sinus!
- Dx confirmation: Temporal CT
- Dx (Except): Xray of paranasal sinus!
- Except: ↑ Earache !
- Types: All
- Acute (except): Auricle is Normal
- Surgery radio finding: rarefaction and loss of distinction…
- Xray Reveal (COSM): sclerotic mastoid!
- RADIOLOGICAL
Tympanic Membrane Perforation (TMP)
- Chronic (Not): sudden hearing loss!
- Normal membrane: Secretory OM
- Suppurative otitis media rupture: None!
Tonsillitis (Repeated)
- Acute Follicular: Staphylococcus
- Most common Sx: NO obstruction!
Varies
- Carcinoma: Glottis!
- Intubation: 3-6 days!
- Intubation (NOT): Laryngeal carcinoma!
- Mucocele: Frontal Sinus!
- Children Hearing: 0-20!
- Myringotomy: bulging stage AOM
- Hair line autoscopy: Serous otitis media
- Congenital anomaly: laryngomalacia
- Epiglottis (Long + tube): Children
- Piriform fossa: Lowest part of laryngopharynx!
- High pitch: Short and thick VC
Maxillary Sinus
- : Middle meatus
- Floor: level of nose!
Myringotomy
- Indication: ALL
- Indication (except): Secretory otitis media/Bullosa
- As Suppurative otitis media Indicated: early stage ASOM
- Complication: All!
Vincent’s Angina
- (Spirochete + Fusiform)
- : Ulcerative
- Tx: Penicillin
Diphtheria
- (Grey membrane)
- (Toxin..Corynebacterium)
- Tx: (All)
- Tx: (Penicillin + Antitoxin)
- Laryngeal: (Bull neck)
Surgery
- : (Periorbital cellulitis)
- : (Orbital Cellulitis!)
- Surgery for endoscopic resection: (endoscopic sinus surgery)
- Biopsy forbidden: laryngeal contact CT
- Endolaryngeal surgery: CCL
- S.M.R: Deviated septum…Obstruction!
- …To Antrum: Supra spine henle!
- Drainage of Ludwig angina: Mylohyoid muscle!
- Esophageal perforation location: in region of cricoid muscle
- Foreign body in esophagus: (A)
- During laryngoscopy: (B) anterior + posterior reversed!
Ozena
- Except: (Not Unilateral!)
- : (All)
All/Any
- Wax!
- Herpangina!
- Early feature of Suppurative otitis media
- Posterior Rhinoscopy
- Structure of Ethmoid air cells
- Nasal Turbinate role!
- Retropharyngeal abscess!
- Pharyngeal diphtheria include
- Peritonsillar abscess
- Fibroma of nasopharynx!
- Indication for tonsillectomy!
- Diphtheria Tx (1 of 3 Q)
- Swelling of Inner orbital reflects:
- Allergic Rhinitis (Hay Fever)
- Infection of nose + paranasal sinus
- Ozena characteristics
- Complication of Sinus Disease:
- Choanal Atresia Sx
- Tonsillectomy Indication
- Tonsillectomy method management
- Post Tonsillectomy bleeding provoked!
- Ax for otitis media
- Papillomatosis characteristic!
- Factors for VC closure!
- Myringotomy Indication:
- Tx of Meniere’s Disease
- Acute pharyngitis may cause!
- Ear Wax!
- Types of Acute mastoiditis
- Early feature of Acute Otitis media
- Lateral sinus thrombosis Tx!
- Acute infective Laryngotracheobronchitis!
- True about otitic barotrauma (except)
- Perforation of nasal septum!
- Herpangina
- Ozena
- Swelling of inner disease include:
- Complication of sinus disease!
- Common sx of choanal atresia:
None
- Olfactory area!
- Acute follicular tonsillitis!
- Vasomotor Rhinitis!
- Tx of Mononucleotic Angina!
- Cochlear otosclerosis!
- Internal auditory artery is branch
- Complication of Myringotomy!
- Malignant otitis externa!
Abscess
- Zygomatic: external auditory canal
- Bezold: beneath sternomastoid
- Mastoid: post-aural subperiosteal
- Luc’s: over zygoma!
- Cerebellar (except): head Tilt!
- Retropharyngeal abscess: (ALL)
- Retropharyngeal Except: (TB)
- Parapharyngeal: Long
- Parapharyngeal Except: (B) Longest!
- Parapharyngeal Except: accompanied by Trismus!
- Peritonsillar abscess (except): head backward
- Paratonsillar Tx: Drainage!
- Peritonsillar abscess: in both fossa
- Brain abscess no affected: Meniere’s Disease exacerbation
- Supraorbital abscess Impair vision: YES!
- Orbital abscess 2nd + suppression: widening of palpebral fissure!
True
- Inferior turbinate is separate bone!
- Incisors + premolar teeth to maxillary sinus
- Tonsil + adenoids have Efferent not Afferent!
- Parapharyngeal abscess: Necrosis!
- Parapharyngeal abscess: thrombosis of Internal jugular vein!
- Peritonsillar abscess: Diffuse, Tender, swelling!
- Osteosarcoma most common benign tumor
- Maxillary sinus carcinoma, rarely produces Sx!
- Most serious complication of maxillary antral wash is embolism!
- Each fiber of auditory nerve ends in one inner cell…
- Tegmen Tympani separates the attic!
False
- VC have no LN
- Middle turbinate is Separate bone!
- Laryngeal Cancer is not equal in both Sexes!
- Inflammation/Trauma of olfactory area…temporary smell loss
- Septal hematoma causes one side swelling!
- Unilateral nasal discharge is Vasomotor rhinitis
- Malignant tumor from posterior-superior part
- Deafness is rarely produced by lesion in cortex
- Tympanic plexus supplies the tensor tympani muscle
Coryza (Repeated)
- : viral infection
- Organism: Rhinovirus
- Prolonged: Streptococci!