Irfan Masood aT NR La A Quick Review on Diseases of Ear Nose and Throat an Masood (DMC) | Dr. Muhammad Shahbaz ___ Dr. Arisha Ali | Dr. Areej RehmanIrfan Masood Oto-Rhino-Larynology Dr. Irfan Masood | Dr. Muhammad Shahbaz KhanIRFAN MASOOD - ENT a Copyright © 2022 All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, scanning, or other electronic ormechanical methods, without the prior written permission of the author. Lets: A) FAROOQ KITAB GHAR Shop No. 32, 33 Urdu Bazar, Karachi - Pakistan Mobile: 0346-0029860 Email: faroogkitabghar@gmail.com cease, CLASSIC BOOK SHOP Shop No. 35, New Urdu Bazar Karachi Tel: 021-32634791 »D Mobile: 0346-4453474 JAVED MEDICAL BOOK SHOP Shop No. 10, Jalal Centre 59-A Mazang Road Opp. Main Outdoor Gate, Near Ganga Ram Hospital, Lahore Mobile: 0345-2182017 Email: javedgaba92@gmail.com Z.GRAPHICS Kh. Zain Khalid 0300-9664373DR. M. SHAHBAZ KHAN (DR.SK) vn TABLE OF CONTENTS seme] cone Pe | SECTION 1 | 1 a Anatomy of ear 10 2. Peripheral receptors and physiology of auditory and vestibular systems 18 3. Audiology and acoustics 23 4. Assessment of hearing 27 5. Hearing loss 35 6. Assessment of vestibular functions 42 7. Disorders of vestibular system 46 8. _Diseases of external ear 51 a Eustachian tube and its disorders a Disorders of middle ear 76 Cholesteatoma and chronic otitis media 86 Complications of suppurative otitis media 100 Otosclerosis (syn. Otospongiosis) 121 Facial nerve and its disorders 129 Méniére's disease 143 Tumours of external ear 150 Tumours of middle ear and mastoid 154 Acoustic neuroma 159 The deaf child 164 aa Rehabilitation of the hearing impaired 170 Otalgia (earache) 172 Tinnitus 174 23. Anatomy of nose 188 24. Physiology of nose 193 25. Diseases of external nose and nasal vestibule 196 26. Nasal septum and its diseases 200 27. Acute and chronic rhinitis 214 28. Granulomatous diseases of nose 221 29, Miscellaneous disorders of nasal cavity 231 30. Allergic rhinitis 237 31. Vasomotor and other forms of nonallergic rhinitis 244 32, Nasal polypi 247 33. — Epistaxis 255 34. Trauma to the face 262 35, Anatomy and physiology of paranasal sinuses 268 36. Acute rhinosinusitis 271 37. — Chronic rhinosinusitis 280 38. — Complications of sinusitis 286 39. Benign and malignant neoplasms of nasal cavity Neoplasms of paranasal sinuses ProptosisAz. IRFAN MASOOD - ENT SECTION 3 DISEASES OF ORAL CAVITY AND SALIVARY GLAND 42. Anatomy of oral cavity 311 43. Common disorders of oral cavity 313 44, Tumours of oral cavity 321 45. Non-neoplastic disorders of salivary glands 329 46. Neoplasms of salivary glands 334 SECTION4 DISEASES OF PHARYNX 47. Anatomy and physiology of pharynx 338 48. Adenoids and other inflammations of nasopharynx 346 49. Tumours of nasopharynx 351 50. Acute and chronic pharyngitis 360 51. Acute and chronic tonsillitis 364 52. Head and neck space infections 377 53. Tumours of oropharynx 388 54. Tumours of the hypopharynx and pharyngeal pouch 392 55. Snoring and sleep apnoea 395 SECTION 5 | DISEASES OF LARYNX AND TRACHEA 56. Anatomy and physiology of larynx 400 57. Laryngotracheal trauma 405 58. Acute and chronic inflammations of larynx 408 59. Congenital lesions of larynx and stridor 420 60. Laryngeal paralysis 427 61. Benign tumours of larynx 434 62. Cancer larynx 442 63. Voice and speech disorders 452 64. Tracheostomy and other procedures for airway management 459 65. Foreign bodies of air passages 467 SECTIONG OPERATIVE SURGERY 66. Myringotomy 479 67. Cortical mastoidectomy 482 68. Radical mastoidectomy 484 69. Modified radical mastoidectomy 486 70. Myringoplasty 487 71. Proof puncture 489 72. — Intranasal inferior meatus 490 73. Caldwell luc operation 491 74. Submucous resection of nasal septum 493 75. Septoplasty 495 76. Endoscopic sinus surgery 498 77. Bronchoscopy 500 78. Oesophagoscopy 502 79. Tonsillectomy 504 80. Adenoidectomy 509 SECTION7 PAST UHS MCQS NUGGETS 511 SECTIONS OSPE SECTION 9 INSTRUMENTSDR. M. SHAHBAZ KHAN (DR.SK) ———__ PREFACE With the blessing of ALLAH Almighty, WHO's the most Merciful & Beneficient WHO Bestowed me to put all my efforts to compile & to bring out the “IRS) EDITION’ of Irfan Masood ENT. Oto-Rhino-laryngology commonly called ENT is full fledged subject of 4th year MBBS students. Mostly students find difficulty in understanding Irfan Masood ENT concepts and completing the syllabus according to their exam pattern, as the recommendation for Irfan Masood ENT to cover are not so vast, students always find trouble in sticking with the single & the most diverse book i;e DHINGRA. Its unnecessary detail makes them confused. Our basic aim in writing this book has been to build concepts of students for Irfan Masood ENT, supersaturated with students earlier knowledge of anatomy and physiology learnt in previous professionals. In a medical school, when we need to ace the exam, foremost thing is smart study, which basically comprises on the fact, always do exam oriented study, topics that are high yield for your exam are need to be covered first, they should be concise & to be prepared well. This will help u achieve higher in less time & also save your unnecessarily efforts & energies. For this, book covers disorders of Irfan Masood ENT, surgical instruments, treatments operative surgeries etc in a very concise and student friendly manner, This edition will definately fulfill the needs of MBBS students. | am profoundly thankful to Allah Almighty for blessing me with courage and patience to complete such an uphill task. | am indebted to SIR DR.SHERBAZ KHOSA SB (Assist Proff of ENT Department DGKMC and DHQ Teaching hospital Dera Ghazi Khan). & SIR DR WAQAR HUSSAIN (PGR of General Surgery DHQ Teaching hospital Dera Ghazi Khan) for thier Guidance and Motivation. | tried my best to make this review book, to cover each and every aspect briefly according to exams pattern & students will achieve excellents marks after Preparing Irfan Masood ENT from this Book In Shaa Allah. This book will Help students, cover their Vast subject in short time.. It surely gurantee your success & will helped u to ace the exam with remarkable grades.. In Shaa Allah. The authore will gratefully accept any suggestions and comments from learned teachers and students. Thanks © +92 315 6616229 DR. MUHAMMAD SHAHBAZ KHAN D.G Khan Medical College, rf) Shahbaz Book Series © Shahbaz Book Series Dera Ghazi KhanDR. M. SHAHBAZ KHAN (DR.SK)Ve ae IRFAN MASOOD - ENT The External Ear Ear and its division External surface of ear => ® Auricle or Pinna © Whole pinna (except outer part of external acoustic canal & lobule) is made up of Elastic cartilage. O No cartilage between tragus and crus of the helix, called Incisura Terminalis (Incision made for endaural approach for external acoustic canal & Mastoid surgery) O Pinna use for several graft material, Concha\ cartilage used for depressed nasal bridge correction. ® External Acoustic Canal From Bottom of concha to Tympanic Membrane . Length 24mm. O Cartilaginous Part 1/3 (8mm) Consist of hair, Ceruminous Gland, Sebaceous gland. It has 2 deficiencies present in it “Fissure of Santorini” (infection of parotid mastoid can occur)DR. M. SHAHBAZ KHAN (DR.SK) van O Bony Part 2/3 (6mm) devoid of hair,glands. Bony meatus become narrow, 6mm lateral to tympanic membrane, called |stimus. Beyond Isthmus anterior recess present which act as cesspool for discharge and debris. @ Tympanic Membrane O Partition between external & middle ear © Posteriosuperior (more lateral part), Anterioinferior part O Pars Tensa: Form most of the part tympanic membrane. It Periphery is thickened to form a fibrocartilaginous ring, called Annulus tympanicus. O Central part is tented inward at level of malleus,called Umbo. A bright light of cone seen radiating from tip of malleus to periphery, called Cone o/ light. © Pars flaccida: (Shrapnel Membrane) Above the lateral process of Malleus. Not so Taut, and appears slightly pinkish. @® Layers of Tympanic Membrane aq O Outer- Epithelial (Continuous with Meatus skin) O Middle - Fibrous layer O Inner - Mucosal layer (Continuous with Middle ear) Posterior malleal fold —Shrapnell’s membrane Lateral process of malleus Shadow of incudostapedial Anterior joint malleal Shadow of fold Shadow of eustachian tube Pars tensa round window Annulus tympanicus ‘Cone of light Landmarks of a normal tympanic membrane of right side. -—————__—_ iDR. M. SHAHBAZ KHAN (DR.SK) “5 (Vilth nerve) Pathways) Difference Between Conductive HL & Sensorineural HL Localized Localized to Poorer Ear to Normal Ear Air-bone em No Air-bone eed — j= Pees eer a |Loss of hearing Not more than 60 db More than 60 dbDR. M. SHAHBAZ KHAN (DR.SK) O Recruitment Phenomena is Positive © Sound become intolerable when Volume Raised © Tinnitus Hearing Aid Should have lesson in speech reading Through visual Clues Curtailment of Smoking, Stimulant like tea & coffee to decrease tinnius (OF SSS 1. A 75-year-old teacher comes to you with history of progressive hearing loss. There is no history of earache, ear discharge, ototoxic drugs intake or trauma to the ear. a) What is most likely diagnosis? b) Name four drugs that can lead to ototoxicity. ©) Enumerate atleast four causes of sudden sensorineural hearing loss. [Supple 2016 held in 2017] 2. In deafness: a) Name atleast three drugs which can cause reversible haring loss b) Name two vestibulotoxic drugs ©) Regarding sudden unilateral sensorineural loss, give atleast four etiological factors. [Supple 2014 held in 2015] 3. Enumerate the causes of conductive deafness. [Annual 2006] ——Cela PVA 8 IRFAN MASOOD - ENT Acute Suppurative Otitis Media Acute inflammation of middle ear cleft by pyogenic organism. Aetiology: © Common in Infants and childern of Lower Socioeconomic Group. O Disease Follows Viral infection of Upper Respiratory Tract then pyogenic Organism invade. Routes: O Via Eustachian Tube : In infants & young children this tube is shorter, Wider & more horizontal . Breast& bottle feeding may force fluid from Eustachian tube DD to middle ear. © Via External Ear : Traumatic Perforation of tympanic Membrane . O Blood Borne : Uncommon. Predisposing Factors: Recurrent Attack of Common Cold Infection of tonsils & adenoid Chronic rhinitis & sinusitis Nasal Allergy oo 0 0 Tumor of Nasopharynx Cleft palate ~ acter ooo. (From word SuPpurative u can remember) O Streptococcus Pneumoniae (30%) most commonDR. M. SHAHBAZ KHAN (DR.SK) va © Haemophilus influenzae (20%) © Moraxella Catarrhalis (12%) Pathology & Clinical Feature The diseases runs throw following stages: @ Stage of Tubal Occulusion | Oedema & hyperaemia of Nasopharyngeal end of eustachian tube + © the tube —+ Absorption of air —» Negative Intratympanic pressure —» > of Tympanic Membrane ©. 0 oms Deafness, Earache (but Not marked), No fever Signs: © Tympanic Membrane retracted, O Handle of Malleus more Horizontal O Prominent Lateral process of malleus, O Loss of light reflex @ ® Stage of Presuppration | Tubal obstruction Prolong —» Pyogenic organism invade tympanic membrane —> hyperaemia of lining, Inflammatory Exudate in middle ear —> tympanic Membrane Congested Symptoms: © Marked earache May distrub sleep, Throbbing Nature © Deafness & tinnitus O High grade Fever & restless (In child) Signs: © Congestion of Pars tensa © Leash of blood vessels along its Handle of malleus CART-WHEEL appearence _————IRFAN MASOOD - ENT PU Teli rela ary e300] ® Cholesteatoma | Normally , Middle Ear Cleft have different types of Epithelium O © ae6 Connor In Anterior & inferior Part O (004 inthe Middle part O Povemens ice in the Attic Not lined with Keratinizing Squamous Epithelium anywhere. “If Keratinized Squamous Epithelium is present in middle ear cleft, 0 0 0 (Skin in Wrong Place) ” Bone ewoma Two Parts NY 1. Matrix (Squamous Matrix \ Epithelium resting on thin —o f Stoma) 2. Keratin Debris (Center ‘i — White Mass) mass Schematic structure of a cholesteatoma. It is Also named as Epidermosis, or Keratoma It Neither contain Cholesterol Crystal, Nor it’s a tumourPathology IRFAN MASOOD - ENT Remain localized to Mucosa mostly of anterioinferior Part . O roe on OF Pars 7 \ 54: Central Perforation. Size & position varies O bo Fae ocoss. Normal (Inactive State). Edematous and Velvety (Actiive State) >. Pale, Smooth mass of edematous mucosa protude from perforation. O55 CUA Coa: Intact & mobile . May show slight necrosis Especially at long process of incus. O Fy rayosclenos.s. Hyalinization & Subsequent Calcification of subeipthelial Connective tissue. OF 88O51S & ADHESION: Result From healing Anterior matieoiar Lateral Pars process fos flaccida males Posterior malieolar a fois — Umbo f tensa a | ) perforation Fett amie 6) & ~ , Attic perforation = ort = @ P) ” "hei type of a Total perforation (Chromic suppurative otis media) with granulavons: fi ; 2 <DR. M. SHAHBAZ KHAN (DR.SK) 1. A 25-year-old male presented with complains of unilateral ear blockage and intermittent ear discharge. On examination, there is aural mass. There is history of ear surgery in the last six years. a) What is the most likely diagnosis? (1) b) What are the most common causes of recurrence? (2) ©) What is appropriate treatment of this patient? (2) [Supple 2018 held in 2019] a) Define cholesteatoma. What are theories of origin of cholesteatoma? (2.5) b) How will you proceed to manage a case of CSOM atticoantral type? (2.5) [Annual 2019] 3. A 25-year-old male patient presented with chronic foul-smelling ear discharge from right ear for last three years. On examination, he had posterosuperior attic perforation. a) What is your diagnosis? (1) b) What are treatment options in this case? (2) ©) Enumerate the causes of chronic ear discharge. (2) [Annual 2018] 4. A 20-year-old male is having discharging left ear since childhood. The ear discharge is foul smelling, scanty in amount and at times blood stained. He has been brought in the emergency room with altered state of consciousness. a) What is the diagnosis? (1) b) How will you investigate this patient? (2) ©) How will you manage this patient? (2) [Annual 2017]i ——m— — IRFAN MASOOD - ENT NOSE Dr. Muhammad Shahbaz Khan (188)DR. M. SHAHBAZ KHAN (DR.SK) CHAPTER Ie rvarlel mA okt) Pyramidal in shape with its root up and base directed downward. ° Osteocartilaginous Framework Bony Part Upper 1/3 is bony (two nasal bone) while lower 2/3 is cartilaginous. Cartilaginous Part Upper lateral Cartilage: Extend from the under surface of the nasal bone above, to alar Cartilage below Lower Lateral Cartilage (ALAR Cartilage): Each Alar cartilage is U shaped Lesser Alar Cartilage (Sesamoid Cartilage): 2 or in number, lie above and lateral to alar Cartilage Septal Cartilage: Nasal bone to nasal tip. @ Nasal Muscles Procerus oO Nasalis Levator labii superioris alaeque Nasal Skin Thin over nasal bone and upper cartilage, thick on Alar cartilage. - ——— - - a a = <= 7. { Naris = Columetia Columelia ee —— Nasolabial Nasolabial fold angle (189)IRFAN MASOOD - ENT Anatomy Nasal septum consists of three parts: 1. Columellar septum It containing the medial crura of alar cartilages. 2. Membranous septum. It consists of double layer of skin with no bony or cartilaginous support. 3. Septum proper. It consists of osseocartilaginous framework. Its principal constituents are: Rp (a) the perpendicular plate of ethmoid (b) the vomer () alarge septal (quadrilateral) cartilage. Other bones include nasal bones, nasal spine of frontal bone, rostrum of sphenoid, crest of palatine bones and the crest maxilla, and the anterior nasal spine of maxilla. Septal cartilage not only forms a partition between the right and left nasal cavities but also provides support to the tip and dorsum of cartilaginous part of nose. Its destruction injuries, leads to depression of lower part of nose and drooping of the nasal tip. During trauma, it may get dislocated from anterior nasal spine or vomerine groove.DR. M. SHAHBAZ KHAN (DR.SK) vs Septal Haematoma Aetiology © It is collection of blood under the perichondrium or periosteum of the nasal septum. O It often results from nasal trauma or septal surgery. © Inbleeding disorders, it may occur spontaneously. Clinical Features © Bilateral nasal obstruction is the commonest presenting symptom. © Frontal headache and a sense of pressure over the od nasal bridge. © Examination reveals smooth rounded swelling of the septum in both the nasal fossae. Septal haematoma © Palpation may show the mass to be soft and fluctuant. @ Treatment ; ° © Small haematomas can be aspirated with a wide bore sterile needle. © Larger haematomas are incised and drained by a small anteroposterior incision parallel to the nasal floor. O Excision of a small piece of mucosa from the edge of incision gives better drainage. © Following drainage, nose is packed on both sides to prevent reaccumulation. O Systemic antibiotics should be given to prevent septal abscess. Complications ° ° Septal haematoma, if not drained, may organize into fibrous tissue leading to a permanently thickened septum. If secondary infection supervenes, it results in septal abscess with necrosis of cartilage Depression of nasal dorsum.DR. M. SHAHBAZ KHAN (DR.SK) “47 | @ Pharynx In General © Pharynx is a conical fibromuscular tube forming upper part of the air and food passage. Oo Itis 12-14cm long. O It extends from base of skull to lower border of cricoid cartilage where It becomes continuous with oesophagus. Structure of pharyngeal wall: From within outwards It consists of four layers: 1, Mucous membrane Oo 2. Pharyngeal aponeurosis 3. Muscular coat 4. Buccopharyngeal fascia @ Killian's Dehiscence © Inferior constrictor muscle has two parts; thyropharyngeous with oblique fibres and cricopharyngeous with transverse fibres. © Between these two parts exists a potential gap called Killian’s Dehiscence. © Itis also called the “gate way of tears” as perforation can occur at this site during esophagoscopy. —$ $539CHAPTER IRFAN MASOOD - ENT @ Adenoids 1- Anatomy And Physiology The nasopharyngeal tonsil Called “Adenoids “ situated at junction of Roof and Posterior wall of nasopharynx. Covering Epithelium is of three types © Ciliated pseudostratified columar O Stratified Squamous © Transitional. Adenoid have no crypts or capsule. Present at Birth Enlarge by 6 years, Atrophy at > puberty disappear at 20 Years of age. Blood supply: ©. Ascending Palatine branch of facial © Ascending pharyngeal of External Carotid © Pharyngeal branch of Maxillary Artery © Ascending Cervical Branch Lymphatic: Upper Jugular nodes Nerve Supply: CN IX and X. Referred pain to ear due to Adenoiditis. 2- Aetiology ©. Childern have a tendency of Generalized lymphoid hyperplasia © Recurrent attack of rhinitis, sinusitis. ©. Allergy of Upper Respiratory tract.DR. M. SHAHBAZ KHAN (DR.SK) Clinical Features Nasal Symptoms a) b) O d) e) Nasal obstruction ( leads to mouth breathing) Nasal Discharge Sinusitis (Chronic Maxillary sinusitis) Epistaxis Voice Change Aural Symptoms a) b) ° d) Tubal Obstruction (Block Eustachian tube, retract Tympanic Membrane, Conductive deafness) Recurrent Attack of Acute Otitis Media Chronic suppurative @ Otitis media with Effusion General Symptoms a) Adenoid Facies: Elongated Face, dull expresssion, Open mouth, Prominent and Crowding upper teeth and Hitched Up upper lips. Hard palate High Arched. b) Pulmonary Hypertension ©) APROSEXIA: lack of Concentration. Diagnosis © Examination of Postnasal Space with a mirror in young Children © Rigid and Flexible nasopharyngoscope in Cooperative Child. O Soft Tissur lateral Radiography ( Reveal the size and extent in nasopharynx) OQ Detailed Nasal Examination. esIRFAN MASOOD - ENTDR. M. SHAHBAZ KHAN (DR.SK) vn ea PV aid natomy of Larynx Infront of Hypopharynx opposite to third third and Sixth vertebra. @ Laryngeal Cartilage ) Thyroid: © Forming an angle of 90° in male & 120° in female. Cricoid: © Form Complete Ring. Lamina & Arch. Epiglottis: O Leaf like. Elastic cartilage. Attach to body of hyoid (Hyoidepiglottic ligament). Anterior surface : pre- epiglottis Space. Posterior Surface : tubercle of Epiglottis. Arytenoids Cartilage O Paired. Pyramidal. Has base, muscular process, vocal process, apex. Corniculate Cartilage Opening for superior laryngeal Epigiottis . . vessels and intemal O Paired. At Arytenoids Apex. branch of superior laryngeal nerve Cuneiform Cartilage t te Hold bone ‘Superior u Tryrohyoks ot membrane O Rod Shaped. ony Thyroid cartilage Thyroid, Cricoid, most of arytenoid Inferior Ciothyrois - ; capaaiay of membrane are Hyaline Cartilage. Epiglottis, thyroid — Cricoid cartilage corniculate cuneiform tip or arytenoic } Cricotracheal —_—_ membrane is elastic fibro Cartilage. Laryngeal frameworkIRFAN MASOOD - ENT CHAPTER A Acute Larngitis | Aetiology: © Infectious type : viralin origin but soon bacterial invasion. O Non infectious Type : Vocal Abuse, thermal or chemical burns. Clinical features © Hoarseness O Discomfort O Dry, irritating cough LL © Larynx appear erythema, oedema. Treatment © Vocal rest © Avoidance of Smoking and alcohol O Steam Inhalation O Cough Sedative O Antibiotics O Analgesics O Steriod ® Acute Epiglottitis ( Syn. Supraglottic Laryngitis) } Supra Glottis Structure i.e Epiglottiw, Aryepiglottic fold, arytenoids. Aetiology: O Children of 2-7 years © H. Influenza BDR. M. SHAHBAZ KHAN (DR.SK) 1. You are called to the emergency department to see a six-year-old boy sent back from school as he was having fever and shortness of breath. You see him stilling with both arms forward making a tripod position. a) What is your diagnosis? (2) b) What is the treatment? (3) [Supple 2019 held in 2020] 2. What is acute epiglottitis and what is its management? (3) [Annual 2019] 3. A 65-year-old thin emaciated patient came with complaints of dysphonia since last three months. He has history of intermittent cough with yellowish purulent expectoration. He also has history of weight loss and is lethargic. On fiber-optic nasopharyngoscopy, examination showed ulceration on both vocal cords. a) What is the most likely diagnosis? (1) b) What investigations you suggest to confirm your diagnosis and give logic? (2) ©) What surgical procedure you suggest to confirm laryngeal disease and treatment? [Supple 2018 held in 2019] 4. A 4 years old boy after short history of sore throat developed marked difficulty in breathing. There is protrusion of tongue with drooling of saliva and high-grade fever. a) What are possible causes of this condition? (1) b) How will you manage this case? [Annual 2018] a ooDR. M. SHAHBAZ KHAN (DR.SK) 479IRFAN MASOOD - ENT It is incision of the tympanic membrane with the purpose ° ° Indications | To drain suppurative or nonsuppurative effusion of the middle ear To provide aeration in case of malfunctioning eustachian tube Acute suppurative otitis Otitis media with effusion. Aero-otitis media Atelectatic ear Steps Of Operation | Ear canalis eone0 Operation is ideally performed using a sharp myringotome In acute suppurative otitis media, circumferential incision in the posteroinferior quadrant of tympanic membrane In otitis media with effusion, a small radial incision in the posteroinferior or anteroinferior quadrant all the effusion sucked out Ventilation tube is to be placed in the anterosuperior quadrant for longer retention — @30—_—a> _ $$ NmDR. M. SHAHBAZ KHAN (DR.SK) @ Complications 1. Injury to incudostapedial joint or stapes. 2. Injury to jugular bulb with profuse bleeding, if jugular bulb is high and bony floor of the middle ear dehiscent. 3. Middle ear infection (A) Circumferential incision used in acute suppurative otitis media. (8) Radial incision used in serous otitis media.PAST UHS MCQS a NUGGETS2 10. iit 12, IRFAN MASOOD - ENT . Best test for testing vestibular function - Caloric test . To detect threshold of hearing - Audiometry . In tuberculosis - central perforation is seen . In CSOM - Marginal perforation . In Atrophic rhinitis obstruction is caused by — Crusting . The only Abductor of vocal cords - posterior crico arytenoid MCC of Deviated nasal septum - Birth trauma SOC - Septoplasty . MC Antrochoanal polyp in children - Maxillary sinus Glossopharyngeal nerve supplies - Stylopharangeus muscle . Rhinoplasty done for - DNS Vertigo is defined as - Subjective sense of imbalance Sinuses open in middle meatus - Frontal/Anterior/Maxillary sinus . MC malignancy seen in which paranasal sinus — Maxillary . MCC of bacterial sinusitis in age less than 3 yrs-ethmoid sinusitis . MCC of bacterial sinusitis in age more than 3yrs - Maxillary sinusitis . MCC of unilateral mucopurulent nasal discharge in child is - Foreign body in nose 17. Clear watery discharge i history of trauma - CSF rhinorhea 18. Clear nasal discharge - allergic rhinitis 19. Unilateral foul smelling nasal discharge - foreign body must be excluded 20. MC form of facial nerve palsy - Bells palsy 21 . TOC for cholesteatoma - modified radical mastoidectomy 2—$ $$ $$_$_—DR. M. SHAHBAZ KHAN (DR.SK) ——__-z 238.Facial nerve palsy due to trauma TOC is - Decompression 239.Threshold for bone conduction is decreased & that of air conduction is increased in disease of - Middle ear 240.Commonest presentation of Nasopharyngeal Ca is - Cervical adenopathy 241.Schwartz operation is called - cortical mastoidectomy/simple mastoidectomy 242.Schwartz sign is seen in - otosclerosis 243.Narrowest part of middle ear - Mesotympanum 244.Material used in tympanoplasty - temporalis fascia 245.Inner ear is present in which bone - petrous part of temporal bone 246.Hyperaccusis - normal sounds are heard as loud & painfull 247.Cahart's notch is characteristically seen at - 2000Hz(2khz) 248.In blast injury MC organ affected - Eardrum wa 249.Pulsatile otorhea is seen in- ASOM 250.Commonest cause of deafness is - Wax 251.Mc evans triangle is the landmark for Mastoid antrum 252.Commonest site of ivory osteoma - fronto-ethmoidal region 253.Allodynia is - increased perception of painful stimulus 254.Atrophic rhinitis - females-50-60yrs of life-anosmia 255.Rhinosporidiosis - bleeding polyp-oral dapsone usefull-excision i knife is Rx 256.Bells palsy not responded to steroid, further Rx - surgical decompression 257.10yr old boy having sensory neural deafness,not benefited by hearing aids further Rx - cochlear implant xs iyDR. M. SHAHBAZ KHAN (DR.SK) 278. Inferior turbinate is a - separate bone 279.Laryngo fissure is - opening the larynx in midline 280.Commonest site of origin of nasopharyngeal Ca - tonsillar bed 281.Ear is sensitive to which frequency of sound - 500-3500Hz 282.TB otitismedia-multiple perforations/pale granulations/thin odourless fluid 283.Palatal myoclonus is seen in - cerebellar infarction 284 Steeple sign is seen in - croup 285.Craniofacial dissociation is seen in - Le forts-3 # 286.Complication of Total thyroidectomy - hoarseness/airway obstruction/hemorhage 287.Ceruminous glands present in the ear are - modified apocrine glands 288.Maxilla achieves max.size at - 2ry dentition 289.Surface area of tympanic membrane - 7Omsquare 290.Cauliflower ear is - perichondritis in boxers.Am. STATION 2: — Carefully examine the given photograph and answer the following questions: IRFAN MASOOD - ENT 1. What is the diagnosis? 2. How will you treat it? 3. What are the complications of Chronic Suppurative Otitis Media? KEY: 1. Subperiosteal abscess 2. | and D+ antibiotics, mastoid surgery at a later date if required 3. Bezold abscess, facial nerve palsy, lateral sinus Thrombosis, labrynthitis, meningitis, extradural abscess, subdural abscess, brain abscessa STATION 4: — 1. What procedure has been done in this patient? | IRFAN MASOOD - ENT 2. What are various groups of indications for this? 3. Name two types of incisions given in this procedure? 4. Give three main early complications of this procedure? KEY: Q.1. Tracheostomy Q.2. Respiratory obstruction Respiratory insufficiency Bronchial toilet protection of lower airway Q.3 Horizontal and vertical Q.4. Blockade, dislodgement and infection etc —<$ i —% i DR. M. SHAHBAZ KHAN (DR.SK) ee UlUmUUUCO Please look at the photograph and answer the following questions: 1, Enumerate the clinical findings? 2. What is the most probable clinical diagnosis? 3. What microorganisms produce this condition? KEY: 1. Clinical findings O Protrusion of tongue . O. Raised floor of mouth OQ Submandibular swelling 2. Ludwig's angina 3. Organisme © Streptococcus viridians OQ. Escherichia coli $sIRFAN MASOOD - ENT Instruction to the candidate: Carefully examine the instrument and answer the following questions on the sheet provided. Put the sheet in the d before moving to next station. Question to be asked: 1, Name the instrument provided? 2. What is the use of this instrument? Name at least four indications for the procedure Name at least four points in post operative care after surgery? nu PF w Name at least four complications after the surgery KEY: Q.1. Cricoid hook Q.2. To stabilize the trachea/ cricoid during tracheostomy. Q.3. Bilateral choanal atresia; Laryngeal web; Laryngeal cyst Cut throat; FB. larynx: Epiglottitis; laryngeal diphtheria etc. Q.4. Suction; humidification; wound dressing; care of the tube; paper and pen etc Q.5. Apnoea: Surgical emphysema; tube displacement; tubal blockage: Necrosis: Stenosis etc. | 0IRFAN MASOOD - ENT Carefully examine the given photograph and answer the following questions: 1. What is this? 2. Name one indication of intubation. 3. Name two complication of intubation. 4. In pharyngeal diphtheria would you like to intubate the patient or not and why? KEY: 1. Endotracheal tube with cuff. To maintain air way in operation under general anesthesia. Failure/trauma to nearby structures/ collapse of one Lung/bleeding. - wD No, | would not like to intubate the patient as intubation may displace the membrane to lower down in the lungs. So it is better to do tracheostomy than intubation.DR. M. SHAHBAZ KHAN (DR.SK)ABOUT THE AUTHOR IRFAN MASOOD - ENT Dr. MUHAMMAD SHAHBAZ KHAN is a well known, multitalented person, an author of different medical books who's graduated from DG.Khan medical college, currently working in DHQ Teaching Hospital, Dera Ghazi Khan. Though writing a book may sound trendy, but it's actually a very hard job to compile all that stuff keeping in mind all that exam orientation & according to student’s need. It’s actually a very hard nut to crack as being during our medical journey, it’s our testing time to gain enough knowledge so that can help us in day to day working as young physician. And the foremost thing, that i would like to appreciate about author is being consistent, honesty & devotion towards his work which is the most |) important thing that led him to have such an amazing & comprehensive collection of books such as Shahbaz Morphology of Special Pathology, Shahbaz One Hour Toxicology, Shahbaz Medical Histology, Compendium of First Aid, Shahbaz General Anatomy, Shahbaz Behavioural Sciences & many more to come In Shaa Allah. (@ +92315 6616229 @ Shahbaz Book Series © Shahbaz Book Series