U WORLD (STEP 1) – ENT (EDUCATIONAL OBJECTIVES)

Last Updated: Apr 10 2020

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NEWLY ADDED QUESTIONS (Since Oct 2019)

1. Mar 09 – 18584 – TM Disorders

1
 EAR

Chole Steatoma

11628
Cholesteatomas
• are collections of Squamous Cell Debris that form a mass behind the Tympanic Membrane.
• can be
✓ congenital or
✓ may occur as an acquired primary lesion or following infection, trauma, or surgery of the
middle ear.
• They can cause hearing loss due to erosion into auditory ossicles.

Hearing Loss

1633
• Prolonged exposure to Loud Noises
✓ causes hearing loss
✓ due to damage to the Stereo Ciliated Hair Cells of the Organ of Corti

8589
Weber Test
• In Conductive Hearing Loss,
✓ bone conduction will be greater than air conduction (Abnormal Rinne Test), and
✓ the Weber test will lateralize to the affected ear.
• In Sensori Neural Hearing Loss,
✓ air conduction will be greater than bone conduction (Normal Rinne Test), and
✓ the Weber test will lateralize to the unaffected ear.

Head & Neck Cancers

18627
Cancer – Naso Pharynx
• The Eustachian Tube connects the middle ear to naso pharynx
• Cancer located in nasopharynx
✓ can lead to obstruction of eustachian tube,
✓ causing a Middle Ear Effusion

2
Meniere Disease

308
Ménière disease
• Characterized by
✓ Tinnitus
✓ Vertigo
✓ Sensorineural Hearing Loss
• Its pathogenesis is related to an ↑ volume & pressure of Endolymph in Vestibular
Apparatus

Otitis Media

1102
• Non Typeable Strains (NTS) of Haemophilus influenzae
✓ are part of the normal upper respiratory tract flora and
✓ are a common cause of
➢ Acute Otitis Media
➢ Sinusitis
➢ Bronchitis
• Because NTS’s do not form a Polysaccharide Capsule,
immunity is not conferred by vaccination with the H influenzae type b vaccine.

Otitis Externa

1814
• Vagus Nerve
✓ Provides Cutaneous sensation to the Posterior External Auditory Canal
✓ via its small Auricular Branch.
• Sensation to the Rest of the canal is from the Mandibular Division of the Trigeminal Nerve

8342
Pseudomonas Aeruginosa
• Non Lactose-Fermenting, Oxidase-Positive, Motile, Gram-Negative Rod.
• It is the MCC of Malignant Otitis Externa (MOE),
✓ Serious infection of the ear seen in elderly diabetic patients.
✓ Presents with
➢ exquisite Ear Pain and Drainage, and
➢ Granulation Tissue is often seen within the ear canal.

3
 NOSE

Cleft Lip & Cleft Palate

1740
• Cleft Lip
✓ results when the Maxillary Prominence fails to fuse with the Inter Maxillary Segment
✓ during the 5th – 6th week of embryonic development.
• Cleft Palate
✓ occurs when the Palatine Shelves fail to fuse with one another or with primary palate.
• Cleft lip and palate can occur together or in isolation.

Epistaxis

11783
Epistaxis
• Commonly caused by irritation of Highly Vascular Mucosa at Anterior Nasal Septum
• The anterior nasal septum contains the Kiesselbach Plexus.
• … Anastomose in this region
✓ Anterior Ethmoidal Arteries
✓ Spheno Palatine Arteries
✓ Superior Labial Arteries

Non Allergic Rhinitis

1345
• Topical preparations of α-Adrenergic Agonists
✓ cause Vaso Constriction of the Nasal Mucosa Vessels
✓ are used as Decongestants.
• Overuse of these drugs causes Negative Feedback,
✓ resulting in ↓ Nor Epinephrine Synthesis & Release from nerve endings,
✓ which diminishes their effect (i.e., Tachy Phylaxis)

4
 THROAT
Muco Cutaneous Candidiasis

1195
Nystatin
• Polyene Anti Fungal
• DOC for Oro Pharyngeal Candidiasis in patients Without Advanced Immunodeficiency.
• It acts by
✓ binding to Ergosterol in the fungal cell membrane,
✓ causing the formation of Pores and Leakage of fungal cell contents.
• Nystatin
✓ Is not absorbed from GI tract
✓ Is administered as an Oral "Swish and Swallow" Agent

Thyroid Cancer

1686
Recurrent Laryngeal Nerve
• Travels in close proximity to the Inferior Thyroid Artery
• Can be injured during Thyroid Surgery, resulting in vocal cord paralysis (eg, Hoarseness).

Thyro Glossal (TG) Duct Cyst

15028
• TG Duct Cysts form from Epithelial Remnants of TG duct along path of Thyroid Descent
• They present as Midline Masses that Rise with Swallowing or Tongue Protrusion

Foreign Body Aspiration

8703
Internal Laryngeal Nerve
• Mediates the Afferent Limb of the Cough Reflex above the Vocal Cords.
• Foreign bodies (eg, chicken or fish bones)
✓ can become lodged in the Piriform Recess and
✓ may cause damage to the nerve, impairing the cough reflex.

5
Upper Respiratory Tract Infections

1373
• For a Purified RNA Molecule to induce viral protein synthesis in a host cell,
it must be able to act directly as mRNA using the host's intracellular machinery for
Translation.
• Therefore, in general,
✓ purified SS Positive-Sense RNA can be infectious
✓ SS Negative Sense or DS RNA is NOT.

Airway Emergency

8631
Crico Thyrotomy
• Is indicated when an Emergency Airway is required and Orotracheal / Nasotracheal
intubation is either unsuccessful or contraindicated.
• Crico Thyrotomy Incision passes through
✓ Superficial Cervical Fascia
✓ Pre Tracheal Fascia
✓ Cricothyroid Membrane

MISCELLANEOUS

Orbital Fracture

1698
• Blunt Trauma to the globe can cause Orbital Blowout Fractures.
• These fractures
✓ MC involve the Medial / Inferior orbital walls
✓ due to Thin Bone Bordering the ethmoid and maxillary sinuses.

Temporo Mandibular Disorders

18597
• TM Joint disorder is a/w
✓ Derangement of TM Joint
✓ Hyper sensitivity of mandibular nerve (CN V3)

18598
Lateral Pterygoid Muscles
• Are Only muscles of mastication that aid in Depressing the Mandible (Opening the Jaw)
• Spasm of lateral pterygoids
✓ prevents spontaneous reduction of an Anterior Dislocation of TM Joint