Tuesday, January 29, 2008

3 - Signs in ENT

*BATTLE SIGN- Bruising behind ear at mastoid region, due to petrous temporal bone# (middle fossa #).

*BOCCA'S SIGN - Absence of post cricoid crackle(Muir's crackle) in Carcinoma post. cricoid.

*BROWN SIGN - blanching of redness on increasing pressure more than systemic pressure see in glomus jugulare.

*BOYCE SIGN - Laryngocoele-Gurgling sound on compression of external laryngocoele with reduction of swelling.

*DODD’S SIGN/CRESCENT SIGN - X-ray finding-Crescent of air between the mass and posterior pharyngeal wall. positive in AC ployp. Negative in Angiofibroma

*FURSTENBERGERS SIGN-This is seen when nasopharyngeal cyst is communicating intracranially,there is enlargement of the cyst on crying and upon compression of jugular vein.

*HITSELBERGER'S SIGN - In Acoustic neuroma- loss of sensation in the ear canal suppllied by Arnold's nerve( branch of Vagus nerve to ear )

*HOLMAN MILLER SIGN, ANTRAL SIGN-it is seen in angiofibroma,the tumor pushes forward on the posterior wall of the maxillary sinus..

*HONDOUSA SIGN--X-ray finding in Angiofibroma, indicating infratemporal fossa involvement characterised by widening of gap between ramus of mandible and maxillary body.

*HENNEBERT SIGN- false fistula sign( cong.syphilis, Meniere's,)

*IRWIN MOORE’S SIGN-------- positive squeeze test in chronic tonsillitis

*LIGHT HOUSE SIGN--- seeping out of secretions in acute OTITIS media

*LYRE'S SIGN - splaying of carotid vessels in carotid body tumor

*MILIAN’S EAR SIGN- Erysipelas can spread to pinna(cuticular affection), where as cellulitis cannot.

*PHELP'S SIGN - loss of crust of bone between carotid canal and jugular canal in glomus jugulare

*RACOON SIGN-Indicate subgaleal hemorrhage,and not necessarly base of skull #

*STEEPLE SIGN- X-ray finding in Acute Laryngo tracheo bronchitis

*STANKIEWICK'S SIGN - indicate orbital injury during FESS. fat protrudes into nasal cavity on compression of eye ball from ouside

*THUMB SIGN --X-ray finding A/c epiglottitis

*TRAGUS SIGN- EXTERNAL OTITIS , Pain on pressing Tragus

*TEA POT SIGN is seen in CSF rhinorrhoea..

*WOODS SIGN----- palpable jugulodigastric lymphnodes.

Monday, January 14, 2008

2 - ENT mcqs - 11 to 16

11) Why is a vocal cord pale ?
a. Vocal cord is muscle, lack of blood vessels network
b. Absence of mucosa, no blood vessels
c. absence of sub mucosa, no blood vessels
d. absence of mucosa with blood vessels

Answer : c) absence of sub mucosa, no blood vessels
Reference: Gray 38th Edition Chapter on larynx

12) Presbycusis is
a. Age associated vision loss
b. Age associated hearing loss
c. Both
d. None

Answer : b) Age associated hearing loss
Reference: Dhingra 3rd Edition Page 47

13) Acoustic dip in audiogram in noise induced hearing loss is at
a. 4 KHz
b. 3 KHz
c. 2 KHz
d. 1 KHz

Answer : a) 4 KHz
Reference: Dhingra 3rd Edition Page 46

14) False positive fistula test
a. Perilymph fistula
b. Malignant sclerosis
c. Congenital syphilis
d. Cholesteatoma
Answer : c) Congenital Syphilis
Reference: Dhingra 3rd Edition Page 53

15) Reaction time for tymphanic reflex is
a. 20 to 30 ms
b. 30 to 40 ms
c. 40 to 160 ms
d. 600 to 800 ms

Answer : c) 40 to 160 ms
Reference: ganong 22nd Edition Page 179

16) Columella effect is seen in
a. Tympanoplasty
b. Septoplasty
c. Tracheostomy
d. None of the above

Answer : a) Tympanoplasty
Reference: Dhingra 3rd Edition Page 40

1 - ENT mcqs - 1 to 10

1) Maxillary Sinus Opens
a. Superior Meatus
b. Infundibulum
c. Inferior Meatus
d. None of the above

Answer : (b) Infundibulum
Reference: PL Dhingra 3rd Edition Page

2) Tensor of the Vocal cord
a. Cricothyroid
b. Posterior Crico arytenoids
c. Lateral crico arytenoids
d. Thyro arytenoids

Answer : (a) Cricothyroid
Reference: Gray 38th Edition Page 1645

*Action of Intrinsic Muscles of Larynx
- Varying the Rima Glottidis
- The posterior crico-arytenoids are the only laryngeal muscles which open the glottis, rotating the arytenoid cartilages laterally around an axis passing through the crico-arytenoid joints, thus separating the vocal processes and the attached vocal folds. They also pull the arytenoids backwards, assisting the cricothyroids to tense the vocal folds. The most lateral fibres draw the arytenoids laterally, so the rima glottidis becomes triangular when the posterior crico-arytenoid muscles contract.
- The lateral crico-arytenoids close the glottis by rotating the arytenoids medially, to approximate their vocal processes. The transverse arytenoid pulls the arytenoid cartilages towards each other, closing the posterior (intercartilaginous) part of the rima glottidis.
- Regulating Tension in the Vocal Ligaments
- The cricothyroids stretch the vocal ligaments by tilting the thyroid cartilage forwards and downwards on the cricoid. Because the arytenoid cartilages are anchored to the cricoid lamina, the sagittally directed rotation of the thyroid cartilage increases the distance between their vocal processes and the anterior angle of the thyroid, so lengthening the vocal ligaments. The cricoid is usually held immovably against the vertebral column by the cricopharyngeus during phonation so that under these conditions it is the thyroid cartilage which moves. During swallowing, however, the cricopharyngeus relaxes, allowing the cricoid to tilt forwards during laryngeal closure.
- The thyro-arytenoids draw the arytenoids towards the thyroid cartilage, shortening and relaxing the vocal ligaments. At the same time, they rotate the arytenoids medially to approximate the vocal folds. Their deeper fibres, the vocales, relax the posterior parts of the vocal ligaments, their anterior parts remaining tense and thus raising the vocal pitch. For details of arytenoid movements consult Sellars.
- Modifying the Laryngeal Inlet
- The oblique arytenoids and aryepiglottic act as a sphincter of the laryngeal inlet by adducting the aryepiglottic folds and approximating the arytenoid cartilages to the tubercle of the epiglottis.
- The thyro-epiglottic muscles widen the inlet by their action on the aryepiglottic folds.

3) Prime modality of Rx of Naso Pharyngeal Ca –
a. Radiotherapy
b. Surgery
c. Chemotherapy
d. None of these

Answer : (a) Radiotherapy
Reference: PL Dhingra 3rd Edition Page 305 and Bailey and Love 24th Edition Page 749, 750

4) Access to airway is gained during emergency by
a. Endotraceal tube
b. Emergency Tracheostomy
c. Crico thyroidotomy
d. All of these

Answer : (d) All of these
Reference: PL Dhingra 3rd Edition Page 386

5) Which of the following structure is seen in Oro Pharynx
a. Pharyngotympanic tube
b. Fossa of Rosenmuller
c. Palatine Tonsil.
d. Piriform Fossa

Answer : (C ) Palatine Tonsil
Reference: Gray 3rd Edition Page 1729

6) Organ of corti is situated in
a. Basilar membrane
b. Utricle
c. Saccule
d. None of the above

Answer : (a) Basilar Membrane
Reference: Gray 38th Edition Page 1387

7) The presenting symptoms in majority cases of Acoustic Neuroma is
a. Hearing Loss
b. Vertigo
c. Signs of Space occupying lesions
d. None of the above

Answer : (a) Hearing Loss
Reference: PL Dhingra 3rd Edition Page 144

8) The opening in case of Dacrocystorhinostomy is made in
a. Superior Meatus
b. Middle Meatus
c. Inferior Meatus
d. None of the above

Answer : (b) Middle Meatus
Reference: Basak 3rd Edition Page 302

9) The most common diagnosis in a young boy with history of profuse nasal bleeding is
a. Juvenile Naso pharyngeal angiofibroma
b. Nasal polyp
c. Deviated nasal septum
d. Cirrhosis

Answer : a) Juvenile Nasopharyngeal angiofibroma
Reference: Dhingra 3rd Edition Page 299

10) Left sided vocal cord palsy is commonly due to
a. Left hilar bronchial carcinoma
b. Mitral Stenosis
c. Thyroid Malignancy
d. Thyroid Surgey

Answer : a) Left hilar bronchial carcinoma
Reference: Dhingra 3rd Edition Page 360.

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