ENT Reviewer.pdf
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METASTASIS 1. CA of tongue: jugulodigastric 2. CA of buccal mucosa: submental and submandibular 3. CA of gingival and hard palate: mandibular and subdigastric 4. CA of lips: submental and submandibular 5. CA of floor of mouth: mandibular and subdigastric 1. epstein’s pearl or bohn’s nodules: GINGIVAL CYST 2. rodent ulcer: BCC 3. large vessel type of hemangioma: cavernous hemangiomas 4. immature forms of capillary hemangioma: hypertrophic hemangioma 5. with spindle-‐shaped cells surrounding capillaries: hemangiopericytoma 6. bryces sign: laryngocoele 7. cold abscess: lymphadenitis 8. horner syndrome: laryngocoele 9. location of koch’s nodule: posterior triangle 1. chorda tympani: CN VII 2. tensor tympani: CN V 3. tympanic plexus: CN IX 4. stapedius: CN VII 1. hypotympanium: floor 2. opening to tympanic membrane: medial wall 3. Eustachian tube opening: anterior wall 4. canal for tensor tympani muscle: anterior wall 5. epitympanium: roof 6. ossicles: medial wall 7. lateral semicircular 8. aditus: posterior wall 1. ampulla: crista ampullaris 2. macula: otoliths 3. organ of corti: hair cells for shearing 1. hot potato voice: PERITONSILLAR ABSCESS 2. chronic mouth breathing, snoring, hyponasal speech: ADENOIDS 3. mesopharynx: OROPHARYNX 4. epipharynx: NASOPHARYNX 5. psueudomembrane: DIPHTHERIA 6. trench mouth: VINCENT’s / PLAUT’S ANGINA 1. below cricopharyngeus posteriorly where the longitudinal esophageal fibers separate: LAIMER-‐HACKERMANN AREA 2. below lowest fibers of the cricopharyngeus and upper circular fiber of the esophagus on lateral aspect :KILLIAN-‐ JAMIESON AREA 3. between alar and prevertebral sheaths: SPACE OF 4 or DEGREE SPACE 4. space between the base of the skull and the superior constrictor thru w/c the Eustachian tube passes: SINUS OF MORGAGNI
1. 2. 3.
butterfly rash: LUPUS ERYTHEMATOSUS encephalocoele: NASAL GLIOMA failure of nasobuccal membrane to canalize: CHOANAL ATRESIA 4. sebaceous gland hypertrophy: RHINOPHYMA 5. apple jelly nodules: LUPUS VULGARIS 6. pre-‐malignant lesion: SENILE KERATOSIS 7. excoriation and infection of vestivule: VESTIBULITIS 8. MC acute infection: FURUNCULOSIS 9. acute inflammation of skin and subcutaneous tissue: ERYSIPELAS 10. esicupusular formation w/ yellow crust: IMPETIGO 1. 2. 3. 4. 5. 6. 7. 8. 9.
chemical-‐respiratory sensitizers: OCCUPATIONAL RHINITIS greenish nasal secretion and crust: ATROPHIC RHINITIS hallmark of inflammation: NASAL POLYPS non-‐allergic rhinitis: IDIOPATHIC RHINITIS CN II-‐VI: ORBITAL APEX SYNDROME common cold: AINFECTIOUS RHINITIS IgE-‐mediated inflammation: ALLERGIC RHINITIS pott’s puffy tumor: OSTEOMYELITIS pregnancy rhinitis: HORMONAL RHINITIS
1. 2. 3. 4. 5.
sphenopalatine vessels: POSTEROINFERIOR BLEEDING jarjavay type: SEPTAL DEVIATION (LATERAL) chevallet fracture: CLASS 1 FRACTURE foster-‐kennedy syndrome: FRONTAL LOBE TUMOR pig-‐nose appearance: CLASS 3 FRACTURE
FLAPS VS GRAFTS 1. can bridge defect: FLAPS 2. requires pressure dressing: FLAPS 3. more likely to contract: GRAFTS 4. depends on recipient site for nutrition: GRAFTS 5. less adaptable to weight bearing: GRAFTS 1. proptosis and lateral rectus palsy: PTERYGOID / TEMPORAL SPACE INFECTION 2. torticollis: CAROTID SPINE ABSCESS 3. horner’s syndrome: CAROTID SPINE ABSCESS 4. hot potato voice: RETROPHARYNGEAL SPACE ABSCESS 5. respiratory distress: PARAPHARYNGEAL SPACE INFECTION 6. osteomyelitits: MASSETER SPACE INFECTION 1. fissures of santorini: DEFICIENCY IN CARTILAGENOUS EAC 2. foramen of huschke: DEFICIENCY IN BONY EAC 3. pars flaccida: SHRAPNELL’S MEMBRANE 4. notch of rivinus: AREA DEFICIENT OF ANNULUS FIBROSUS 5. otitis externa circumscripta: STAPHYLOCOCCUS 6. diffuse otitis externa: PSEUDOMONAS 7. epistaxis: KIESSELBACH’S PLEXUS 8. tripod fracture: ZYGOMA 9. blow out fracture of orbit: FORCED DUCTION TEST 10. temporal bone fracture: BATTLE’S SIGN
1. 2. 3. 4. 5. 6.
bactidol: HEXITIDINE docusate: OTOSOL nystatin, gramicidin: POSTOTOC, APLOSYN OTIC lidocaine, benzoxonium: OROFAR-‐L antipyrine: AURALGAN OTIC neomycin, polymyxin: KENACOMB OTIC
1. 2. 3. 4. 5.
syphilis: PENICILLIN ludwig’s angina: INCISION AND DRAINAGE salpingitis: PENICILLIN herpes: ACYCLOVIR candida: NYSTATIN
1. 2. 3. 4.
aerotitis media: BAROTRAUMA apical petrositis: GRADENIGO SYNDROME lateral sinus thrombophlebitis: PICKET FENCE SYNDROME otitic hydrocephalus: QUECKENSTEDT
11. 12. 13. 14. 15. 16. 17. 18.
RHINITIS 1. IgE mediated : ALLERGIC RHINITIS 2. tuberculosis: CHRONIC RHINITIS 3. prolonged use of decongestant: RHINITIS MEDICAMENTOSA 4. pregnancy-‐related: NOTA 5. with dryness: ATROPHIC RHINITIS 6. emotional stress: VASOMOTOR RHINITIS 7. infectious/inflammation: ACUTE RHINITIS 1. unilateral hearing loss: NOTA 2. bilateral hearing loss: NOTA 3. benign paroxysmal positional vertigo: CULPOLITHIASIS 4. meniere’s dse: TINNITUS 1. staphylococcus: CLOXACILLIN 2. streptococcus: AMOXICILLIN 3. herpes ACYCLOVIR 4. candida: NYSTATIN 5. psueomonas: OFLOXACIN GRADENIGO VS MENIERE 1. diplopia: GRADENIGO 2. hearing loss: MENIERE 3. ear fullness: MENIERE 4. dizziness: MENIERE 5. tinnitus: MENIERE 6. ear discharge: GRADENIGO 1. frontal sinus – MIDDLE MEATUS 2. anterior ethmoid sinus – MIDDLE MEATUS 3. posterior ethmoid sinus – SUPERIOR MEATUS 4. sphenoid sinus – SPHENOETHMOIDAL RECESS 5. mastoid – ADITUS AD ANTRUM 6. maxillary sinus – MIDDLE MEATUS 7. cavernous sins – OPHTHALMIC VEIN 8. middle meningeal sinus – FORAMEN SPINOSUM 9. highmore of antrum – AD IC ANTRUM 10. middle ear – EUSTACHIAN TUBE
nasolacrimal duct – INFERIOR MEATUS tensor tympani -‐ ROOF bony ear canal – EXTERNAL CAROTID jugular vein -‐ FLOOR CN VII -‐ AICA Eustachian tube: MIDDLE EAR lacrimal gland: INFERIOR MEATUS ethmoid hair cells
1.
Sheehan syndrome: ISCHEMIC NECROSIS OF THE ANTERIOR PITUITARY 2. cavernous sinus syndrome: MC CAUSE IS ETHMOIDITIS 3. charcot’s triad: NYSTAGMUS, SCANNING SPEECH AND INTENTION TREMOR SEEN IN MULTIPLE SCLEROSIS 4. digeorge syndrome: THYMUS AGENESIS 5. frey’s syndrome: AURICULOTEMPORAL NERVE SENDS ITS PARASYMPATHETIC FIBERS TO INNERVATE THE SWEAT GLANDS 6. carotid sinus syndrome: NOTA 7. gilles de la tourette’s syndrome: CHOREA, COPROLALIA, TICS 8. markus-‐gunn syndrome JAW WINKING 9. campomelic syndrome: DWARFISM, CRANIOFACIAL ANOMALIES, BOWING OF TIBIA AND FEMUR 10. zaufal’s syndrome: SADDLE NOSE 11. ortner’s syndrome: CARDIOMEGALY ASSOCIATED W/ LARYNGEAL PARALYSIS SECONDARY TO COMPRESSION 12. bezold’s abscess: SECONDARY TO PERFORATION OF THE TIP OF THE MASTIOD BY INFECTION 13. carcinoid syndrome: TUMOR SECRETES SEROTONIN 14. semon’s law: PARALYSIS OF THE CRICOARYTENOID POSTICUS BEFORE PARALYSIS OF THE ADDUCTORS 15. ondine’s curse: FAILURE OF RESPIRATORY CENTER AUTOMATICITY W/ APNEA ESPECIALLY EVIDENT DURING SLEEP SALIVARY GLANDS 1. U-‐shaped bend on mylohyoid: SUBMANDIBULAR GLAND 2. Wharton duct: SUBMANDIBULAR GLAND 3. rivinus duct: SUBLINGUAL GLAND nd 4. stensen duct: PAROTID GLAND – drains opposite/upper 2 molar 5. MC tumor occur: PAROTID GLAND 6. most sialolithiasis occur: SUBMANDIBULAR GLAND 7. mixed glands: PAROTID and SUBMANDIBULAR 8. serous glands: PAROTID 9. mucous glands: SUBLINGUAL AREAS OF INJURY 1. I: intracranial penetration 2. II: orbital and globe injury 3. III: head and neck injuries EPITHELIAL COVERING 1. lips: NONKERATINIZING SQUAMOUS 2. cheeks: NONKERATINIZING SQUAMOUS 3. nasopharynx: CILIATED
4. 5. 6. 7. 8. 9. 10.
oropharynx: NONKERATINIZING SQUAMOUS hypopharynx: NONKERATINIZING SQUAMOUS pharyngeal tonsil: CILIATED palatine tonsil: NONKERATINIZING SQUAMOUS lingual tonsil: NONKERATINIZING SQUAMOUS middle ear: CILIATED external ear: KERATINIZING SQUAMOUS
LYMPHATIC DRAINAGE 1. lips: LEVEL I 2. cheeks: LEVEL I 3. tongue: LEVEL I 4. palatine tonsil: LEVEL II 5. middle: LEVEL II ORAL MANIFESTATION OF SYSTEMIC DSE 1. syphilis: GUMMAS and ENANTHEMS 2. melkersson-‐rosenthal syndrome: FISSURED TONGUE 3. anaphylaxis: ANGIOEDEMA 4. pernicious anemia: HUNTER’S GLOSSITIS
NOTES •
•
•
EXTERNAL EAR 1. auricle/pinna 2. external auditory canal 3. tympanic membrane MIDDLE EAR 1. tympanum/middle cavity 2. antrum and mastoid air cells 3. eustachian tube INNER EAR 1. bony labyrinth 2. membranous labyrinth
MIDDLE EAR BOUNDARIES • roof – tegmen tympani • lateral – tympanic membrane • anterior – eustachain tube opening • posterior – aditus / opening into tympanic membrane • floor – hypotympoanum • medial – promontory, labyrinthine windows, horizontal part of CN VII, lateral semicircular canal BOUNDARIES • superior – tegmen antri • posterior – sigmoid sinus • anterior – posterior wall of external auditory canal • inferior – digastrics ridge CENTRAL PATHWAY • dorsal and ventral cochlear nucleus i. superior olivary complex ii. lateral lemniscus iii. inferior quadrigeminal body iv. medial geniculate v. auditory complex
AUDIOGRAM KEY / AUDIOMETRY right left AC unmasked O X AC masked triangle square BC mastoid unmasked < > BC mastoid masked [ ] red blue DEGREE OF HEARING LOSS • 0-‐25 dB – normal hearing threshold • 26-‐40 – mild hearing loss • 41-‐60 – moderate hearing loss • 56-‐70 -‐ moderately severe hearing loss • 71-‐90 – severe hearing loss • >90 – profound hearing loss BERKESY TEST TYPE FINDINGS INTERPRETATION I pulsed and continuous across all normal or middle ear frequencies dse II pulsed and continuous cochlear dse interweave in low and mid (meniere’s) frequencies but at 1000Hz continuous drop but no more than 20 dB III similar to type II, but the drop is retrocochlear more than 20 dB pathology (acoustic schwannoma IV pulsed and continuous tones do retrocochlear not interweave pathology V pulsed drops below the non-‐organic hearing continuous ones loss WAVES • I – distal portion of auditory nerve • II – proximal portion of auditory nerve • III – cochlear nucleus • IV – superior olivary complex • V – lateral lemniscus as it teminates at interior colliculus OTITIS MEDIA VS OTITIS EXTERNA OTITIS EXTERNA OTITIS MEDIA pain very severe not severe tenderness on pinna (+) (-‐) manipulation fever usually (-‐) usually (+) hx of URTI usually (-‐) usually (+) hx of scratching or (+) usually (-‐) cleaning of ear hearing not impaired unless impaired canal obliterated matoid xray normal mastoiditis COMPLICATIONS OF OTITIS MEDIA AND MASTOIDITIS • extracranial o facial nerve paralysis o labyrinthitis o subperiosteal abscess o apical petrositis (gradenigo)
•
o sensorineural hearing loss intracranial o extradural abscess o subdural abscess o lateral sinus thrombophlebitis o meningitis o brain abscess o otitic hydrocephalus
LABYRINTHITIS TYPE VERTIGO circumscribed mild
HEARING LOSS conductive
serous
moderate
mixed
suppurative
severe
sensorineural then total
COCHLEAR DISEASES ONSET presbycussis infection noise-‐ induced ototoxicity trauma barotrauma systemic dse meniere’s
LATERALITY
gradual sudden gradual
bilateral uni or bi uni or bi
sudden sudden sudden gradual fluctuant
bilateral unilateral unilateral bilateral unilateral (bilateral 30%)
VESTIBULAR DISORDERS VERTIGO (DURATION) meniere’s episodic (20mins-‐hour) vestibular neuronitis
acute labyrinthitis benign positional
acoustic neuroma or vestibular schwannoma vertebrobasilar insufficiency
PATHOLOGY erosion w/o actual erosion of the labyrinth w/ a fistula localized invasion to severe w/ toxins of the organism actual penetration and invasion by the organisms
VESTIBULAR SYMPTOMS -‐ + -‐ +/-‐ + + -‐ +
HEARING LOSS fluctuant (low freq in early stage) no loss
VESTIBULAR STATUS decreased
severe SNHL
decreased
recurrent; related to position and aggravated by head mov’t (seconds) progressive
no loss
normal
progressive SNHL
decreased
acute and aggravated by head mov’t (variable)
compatible
normal
acute; aggravated by head mov’t (>24hrs) acute (>24hrs)
decreased
PERMISSIBLE NOISE EXPOSURE DURATION/DAY SOUND LEVEL 8 hrs/day 90 dBA 6 92 4 95 3 97 2 100 1.5 102 1 105 0.5 110 1 pack/day x 15-‐ factor nodules) 20yrs sex female male predilection s & s/x hoarseness, hoarseness, neck mass, discomfort, no cervical lymphadenopathy, bleeding, no cervical bleeding, stridor, lymphadenopathy respiratory distress, sensation of rawness management surgery; remove only surgery – radical the tumor; preserve laryngectomy w/ neck all normal tissues & node dissection, laryngeal function reconstruct w/ trachaeoesophageal shunt to restore speech; RT, chemo NASAL POLYPS GRADING 0 -‐ no polyps I – polyps do not prolapse beyond middle turbinate & may require endoscopy for visualization II – polyps extend below middle turbinate. visible w/ nasal speculum III – polyps touch nasal floor. may occlude entire nasal cavity. seen thru vestibule w/o aid of nasal speculum NASAL POLYP VS TURBINATES NASAL POLYP TURBINATES color skinned/seedless pink to red grapes decongestant (-‐) (+) effect mobility mobile fixed sensation (-‐) (+) location osteomeatal complex along entire lateral nasal wall consistency soft hard
TRIANGLES OF THE NECK • POSTERIOR TRIANGLE: o supraclavicular o occipital • ANTERIOR TRIANGLE o muscular o digastrics/submandibular/submaxillary o submental/suprahyoid o carotid FLAP VS GRAFT pp FLAP limited to transplantation of skin can carry other tissues depends on recipient site for has own blood supply nutrition may discolour; likely to contract better color; less likely to contract less adaptable to weight bearing more adaptable to weight bearing less able to survive on a bed w/ can be used on a bed w/ questionable nutrition questionable nutrition requires pressure dressing not require pressure dressing cannot bridge defect can bridge defect HEMOLYTIC STREP / S.AUREUS -‐ MC pathogenic organism of the head and neck POTT’S DSE -‐ retropharyngeal space infection in adults OROPHARYNX • soft palate to dorsum of tongue inferiorly • lateral – palatine arches (fauces) • waldeyer’s ring: o lingual tonsils – base of tongue o faucial tonsils – paired and w/in palatine fauces o adenoids o lateral pharyngeal bands o tonsils of gerlach – w/in tip of fossa of rosenmuller NASOPHARYNX • boundaries: o superior – base of skul o anterior – nasal cavity o inferior – oropharynx and soft palate o lateral – opening of Eustachian tubes o posterior – cervical vertebrae • pharyngeal bursa o saclike depression in posterior wall o remnant of notochord o site of thornwaldt’s cyst
DIFFERENTIATION S & S/X ANGIOFIBROM A JUVENILE TYPE age 1-‐18yrs sex male bleeding profuse
NASOPHARYNGEA L MALIGNANCY 30-‐60yrs more male scanty to mild
nasal passage obstructio n neck nodes
minimal to severe
minimal to the beginning
(-‐)
cranial nerve
Nil
early, bilateral & large CN VI initially, then V, IX, X
ear
occasional
treatment
surgery
can be an early sign radiation /che& mo
NASAL MALIGNANC Y 40-‐70yrs female minimal to moderate moderate to severe
late CN V for advanced cases (-‐) surgery & RT and/or chemo
ACUTE TONSILLITIS CAUSES • GABHS, H.influenza, S.pneumonia • tx: penicillin CHRONIC TONSILITTIS • tx: tonsillectomy • tonsillitis occurrence to be candidate for tonsillectomy: o 3/yr for 3yrs o 5/yr for 2yrs o 7 or more for 1yr o >2wks school/work missed in 1 yr INDICATIONS FOR TONSILLECTOMY • ABSOLUTE o obstruction causing dysphagia, airway obstruction o pharyngeal or peritonsillar abscess o suspected mignancy • RELATIVE o recurrent GABHS infection o tonsil hyperplasia w/ functional obstruction, such as dysphagia or sleep apnea o rheumatic fever w/ heart damage w/ recurrent tonsillitis & poor antibiotic control INDICATIONS FOR ADENOIDECTOMY • obstruction dse – nasal obstruction • middle ear dse due to adenoid hypertrophy • suspicion of malignancy CONTRINDICATIONS TO TONSILLECTOMY & ADENOIDECTOMY • cleft palate • blood dyscrasias • medical contraindications
LARYNGEAL CARTILAGES • thyroid -‐ biggest • cricoids – only complete cartilaginous ring • arytenoids – paired; hitching posts for vocal cords • corniculate – paired; on top of arytenoids • cuneiform – paired; lateral to corniculate on aryepiglottic folds • epiglottis EXTRINSIC MUSCLES OF LARYNX • depressors: omohyoid, sternohyoid, sternothyroid • elevators: mylohyoid, geniohyoid, genioglossus, hyoglossus, digastrics stylohyoid • pharyngeal constrictor, inferior pharyngeal constrictor INTRINSIC MUSCLES OF LARYNX • adductors: lateral cricoarytenoid, thyroarytenoid, transverse arytenoid, oblique arytenoid • abductors: posterior cricoarytenoid • tensors: cricothyroid, thyroarytenoid, vocalis INFERIOR LARYNGEAL NERVE – motor supply of all intrinsic laryngeal muscles except cricothyroid SUBMANDIBULAR NODES • most significant and largest • 6-‐12 nodes SUBMANDIBULAR INFECTION • haemolytic streptococci – MC pathologic organism • ludwig’s angina – MC etiology is from dental cries MANDIBULOTOMY – cutting thru the mandible temporarily JUVENILE NASOPHARYNGEAL ANGIOFIBROMA • benign • male; adolescent EBV -‐ viral etiology of nasopharyngeal carcinomas MOST COMMON TUMORS a) BCC o MC epidermal tumor of the head and neck o rodent ulcer b) SCC o MC malignancy in the oral cavity o lip: lower lip = 95%; upper lip = 5% o tonue o MC malignancy in the phrynx o MC malignancy in the larynx o MC malignancy in the esophagus o MC carcinoma of the pranasal sinuses o followed by adenocarcinoma c) papillary carcinoma o MC thyroid carcinoma o psamomma bodies o orphan annie eye o adenocarcinoma o MC benign tumor of larynx – HPV 16 (18) d) follicular carcinoma o pericapsular vascular invasion
o hurthle cell – cord-‐like pleomorphic adenoma o benign mixed tumor o MC benign tumor of salivary glands o orphan annie eye f) warthin’s tumor o papillary cystadenoma lymphomatosum o MC bilateral parotid gland tumor g) acinic carcinoma – parotid (MC at tail) h) medullary carcinoma o C-‐cells o pheochromocytoma i) adenoma – MC thyroid neoplasm j) hemangioma -‐ MC benign tumor of salivary glands in children k) adenoid cystic carcinoma o MC tumor of submandibular gland o MC minor salivary gland malignancy l) nodal type / reed Sternberg – Hodgkin lymphoma m) extranodal / nodal dse – non-‐hodgkin n) mucoepidermoid carcinoma o MC malignancy of salivary gland in children o MC malignant tumor of salivary glands o MC malignancy in the parotid gland/hard palate nd o 2 MC of the submandibular gland o) neurofibroma – von Recklinghausen ANAPLASTIC CA – rapid growth and fixation to underlying structures MIXED – follicular tumors behave like papillary tumors BENIGN TUMORS IN THE PAROTID GLAND – 80% e)
PAROTID -‐ MC site of all salivary gland tumor nd MINOR SALIVARY GLANDS -‐ 2 MC site of all salivary gland tumor rd SUBMANDIBULAR GLAND -‐ 3 MC site of all salivary gland tumor nd
LATERAL BORDERS OF TONGUE – 2 MC tumor of the oral cavity rd CARCINOMA OF FLOOR OF MOUTH – 3 MC oral cavity tumor PERIAPICAL CYST – MC odontogenic cyst RETROPHARYNGEAL NODES/NODES OF RANVIER – first nodes affected in nasopharyngeal and maxillary carcinoma NASOPALATINE FISSURAL CYST –MC fissural cyst MELANOMA – MC site is the cheek, scalp, ear and neck THYROGLOSSAL DUCT CYST • MC found at the level of the hyoid bone • sistrunk procedure – part of the hyoid bone is removed to prevent recurrence CARCINOMA OF THE LARYNX • HPV 6, 11 • clinical picture: o glottic -‐ hoarseness -‐ MC early symptom o floor of ventricle including TVC o supraglottic – dysphagia o tip of epiglottis including false VC o subglottic – dyspnea – late o 1cm below TVC to cricoid o transglottic – advance and large tumors
o
lesions that cross the ventricle or involves larynx above and below TVC
CORNICULATE CARTILAGE – cartilage of santorini CUNEIFORM CARTILAGE – cartilage of wrisberg BILATERAL ABDUCTOR PARALYSIS – MC form of bilateral motor paralysis LARYNGOMALACIA – MC congenital anomaly of larynx INSPIRATORY STRIDOR – major symptom of laryngomalacia PTYALISM SIALORRHEA – excessive saliva production XEROSTOMIA – dry mouth SJOGREN -‐ absence of saliva production TB – cols abscess SCARLET FEVER / KAWASAKI – strawberry tongue DIPHTHERIA – bull’s neck 2:1 – incidence of oral CA FREY SYNDROME – gustatory sweating after parotidectomy S.AUREUS: MC cause of acute sialodenitis EXTERNAL AUDITORY CANAL • outer 1/3 cartilaginous • inner 2/3 bony • fissures of santorini – deficiency in cartilaginous portion à infection spread to parotid • foramen of huschke – deficiency in bony meatus à infection spread to periauricular and parotid TYMPANIC MEMBRANE • pars flaccid o shrapnell’s membrane § triangular § above malleolar fold § common site of retraction pockets • pars tensa – below ACUTE CIRCUMSCRIBED OTITIS EXTENA / FURUNCULOSIS • s.aureus • s and s/x: earache, tender pinna/tragus, hearing decreased, purulent ear discharge, circumscribed swelling/abscess MALIGNANT OTITIS EXTERNA / SKULL BASE OSTOMYELITIS NECROTIZING OTITIS EXTERNA-‐ p.aeruginosa ACUTE NECROTIZING OTITIS MEDIA – beta haemolytic streptococcus MENIERE’S DSE / IDIOPATHIC ENDOLYMPHATIC HYDROPS • intermittent SNH, tinnitus, vertigo, ear fullness • cochlea hydrops – fluctuating sensorineural hearing loss and tinnitus • vestibular hydrops – episosdic vertigo and aural fullness • lermoyez hydrops – increasing tinnitus, hearing loss, and aural fullness • crisis of tumarkin / drop attack – loss of extensor power BENIGN PAROXYSMAL POSITIONAL VERTIGO • canaliths • cupulolithiasis • confirmed by hallpike test – positional nysgatmus w/ latency
• cause: canaliths – free-‐floating abnormally dense particles RAMSAY HUNT SYNDROME • herpes zoster oticus of CN VII • vascular eruption and facial paralysis CN X • Arnold’s/alderman’s nerve • cough reflex when external canal is stimulated • laryngeal pain in cancer CN IX • jacobson’s nerve • oropharyngeal pain in cancer EUSTACHIAN TUBE • upper 1/3 bony • anteromedial 2/3 cartilaginous SWIMMER’S EAR • diffuse otitis externa • pseudomonas CAULIFLOWER EAR • hematoma auris • severe perichondritis • abscess APICAL PETROSITIS / GRADENIGO SYNDROME • discharging ear • retroorbital pain • diplopia MELKERSSON’S SYNDROME • peripheral palsy • jewish • postulated hypersensitivity JERVELL and LANGE-‐NIELSEN SYNDROME • autosomal recessive • SNHL with prolonged QT interval GJB2 / CONNEXIN 26 -‐ MC cause of SNHL st ETHMOID BULLA -‐ 1 ethmoid cell RHINOLOGIST ARTERY -‐ largest vessel supplying the nose LUPUS VULGARIS • TB in the nose • apple jelly nodules LUPUS ERYTHEMATOSUS -‐ butterfly rash CHOANAL ATRESIA • bony / membranosseous 80-‐90% • membranous 10-‐20% RHINITIS 1) infections – most prevalent; common cold 2) allergic – IgE mediated, high socioeconomic class 3) non-‐allergic a. vasomotor − idiopathic rhinitis − cholinergic glandular activity − heightened sensitivity b. gustatory – eating; vagally-‐mediated c. non-‐allergic rhinitis with eosinophilia syndrome) − unknown etiology − paroxysmal exacerbations of sx
4)
occupational a. protein and chemical allergies – IgE mediated b. chemical respiratory sensitizers – uncertain immune mechanism c. work – aggravated rhinitis 5) hormonal – pregnancy / menstrual cycles 6) drug-‐induced – rhinitis medicamentosa 7) atrophic rhinitis – thinning and drying of nasal mucosa EPISTAXIS • mucositis – MC in children • HPN – mc in adults • keisselbach’s plexus – 90% of epistaxis HYPEROSMIA • hypersensitive sense of smell • cystic fibrosis PAROSMIA • perverted smell • streptomycin HYPOSMIA • impaired smell • smoking ANOSMIA – loss of smell ACUTE PHARYNGITIS • viral • sore throat • colds and conjunctivitis ENDOSCOPY • rod telescope – clinic • rigid – O.R. o direct laryngoscopy o bronchoscopy o esophagoscopy • flexible – office EOPHAGEAL DISORDERS • achalasia – degeneration of auerbach plexus • diffuse esophageal spasm – spiral/corkscrew • scleroderma – atrophy of smooth muscle • presbyoesophagus – abnormal esophageal motor function d/t aging CLEFT DEFECT • 90% unilateral, 20% bilateral • 2/3 left sided, 1/3 right sided CLEFT PALATE • 70% unilateral, 30% bilateral • MC in females NASOPHARYNX – base of skull/posterior choanae to soft palate ORAL CAVITY • vermillion border to junction of soft and hard palate • except soft palate and base of tongue oropharynx – soft palate to hyoid hypopharynx – hyoid to cricoids esophagus – cricoids to cardia of stomach STAPHYLOCOCCI – first oral microbe in neonate
PLAUT’S ANGINA/TRENCH MOUTH/VINCENT’S ANGINA • acute necrotizing ulcerative gingivitis • B. vincente • tx: penicillin THORNWALDT’S DSE – nasopharyngeal bursitis QUINSY • peritonsilar abscess • tx: clindamycin PAROTID ABSCESS • MC organism is staph • MC cause is salivary stone ANKYLOGLOSSIA – tongue tie FISSURED/SCROTAL TONGUE • trisomy 21 • melkerson Rosenthal syndrome LEUKOPLAKIA – whitish patches in oral cavity ERYTHROPLAKIA – red plaques NODULAR LEUKOPLAKIA – mixed white and red plaques LATERAL WALL/FOSSA OF ROSENMULLER – MC site for nasopharyngeal carcinoma posterior suspensory ligament of thyroid -‐ LIGAMENT OF BERRY hypothyroidism -‐ MYXEDEMA, INCREASED TSH, DECREASED TH hyperthyroidism -‐ THYROTOXICOSIS MC cause of thyroiditis and goiter -‐ HASHIMOTO’S DSE MC single thyroid dse -‐ HASHIMOTO’S DSE MC cause of painful thyroid -‐ SUBACUTE GRANULOMATOUS THYROIDITIS (DE QUERVAIN’S THYROIDITIS) lymphocytic thyroiditis -‐ SILENT/PAINLESS/POSTPARTUM THYROIDITIS HYPERTHYROIDISM VS HYPOTHYROIDISM HYPERTHYROIDISM HYPOTHYROIDISM nervousness fatigue, lethargy wt loss wt gain excessive sweating cool, dry, coarse skin; hair loss warm, smooth, moist skin swelling face, hands, legs, non-‐pitting edema heat intolerance cold intolerance muscular weakness, tremor weakness, muscle cramps, arthralgia, paresthesia lid lag, exophthalmos, stare periorbital puffiness palpitations, hyperdynamic cardiac dec heart sound intensity pulsations, accentuated S1 tachycardia bradycardia inc SBP, dec DBP dec SBP, inc DBP frequent bowel mov’t constipation
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