Multiple-choice Questions in Otolaryngology: With Explanatory Answers PDF
Preview Multiple-choice Questions in Otolaryngology: With Explanatory Answers
Multiple-choice Questions in Otolaryngology with explanatory answers Multiple-choice Questions in Otolaryngology with explanatory answers Ramindar S. Dhillon, FRCS (Eng) James W. Fairley, FRCS (Eng) Ferens Institute of Otolaryngology University College and Middlesex School of Medicine, London M MACMILLAN PRESS Scientific & Medical © R.S. Dhillon & J.W. Fairley 1989 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright Act 1956 (as amended), or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 33-4 Alfred Place, London WC1E 7DP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. First published 1989 Published by THE MACMILLAN PRESS LTD Houndmills, Basingstoke, Hampshire RG21 2XS and London Companies and representatives throughout the world Typeset by Ponting-Green Publishing Services, London ISBN 978-0-333-49109-6 ISBN 978-1-349-10805-3 (eBook) DOI 10.1007/978-1-349-10805-3 CONTENTS Foreword xii Preface xiii Section 1: The Ear 1 Foetal development 2 2 Development of the foetal ear 2 3 Development of the temporal bone 2 4 Development of the mastoid process 4 5 Anatomy of the external ear 4 6 In the adult 4 7 In the middle ear cleft 6 8 The anterior wall of the tympanic cavity 6 9 In the middle ear cleft 6 10 Mucosal folds, compartments and ligaments of the middle ear cleft 8 11 The middle ear cleft 8 12 Neurovascular supply of the middle ear cleft 8 13 In the labyrinth 10 14 In the inner ear 10 15 In the cochlear nerve 10 16 In the vestibular labyrinth 10 17 The vestibular nerve 12 18 Blood supply of the labyrinth 12 19 Anatomy of the internal auditory canal 12 20 Sensory nerve supply of the ear 14 21 The following lesions may cause referred otalgia 14 22 The following neoplasms may present with otalgia 14 23 In the physical examination of the ear 16 24 Radiological investigation of the petrous temporal bone 16 25 The following procedures are usually performed via a permeatal incision 18 26 In temporal bone surgery 18 27 Principles of temporal bone surgery 18 28 The seventh cranial nerve 20 29 Physical properties of sound 20 30 Sound transmission in the middle ear 20 31 Middle ear acoustic impedance 20 32 Abnormalities of middle ear function 22 33 Middle ear muscles 22 34 Hearing by bone conduction 22 v vi MCQs in OTOLARYNGOLOGY 35 In the cochlea 24 36 Theories of hearing 24 37 Localization of sound stimulus 24 38 In testing the hearing 24 39 In non-organic hearing loss 26 40 Audiological investigations 26 41 Impedance audiometry 28 42 Electric response audiometry 28 43 Assessment of hearing thresholds in young children 30 44 Electronic hearing aids 30 45 Vestibular labyrinthine physiology 32 46 Vestibular function tests 32 4 7 Bithermal caloric test 32 48 Electronystagmography 34 49 Congenital abnormalities of the external ear 34 50 Haematoma Auris 34 51 In otitis externa 36 52 In malignant otitis externa 36 53 Viral infections of the external ear 36 54 Neoplastic disease of the external ear 38 55 In the external auditory meatus 38 56 Congenital anomalies of the middle ear cleft 38 57 Surgery of congenital ear anomalies 40 58 Surgical correction of congenital atresia of the external auditory meatus 40 59 Traumatic perforation of the tympanic membrane 40 60 In basal skull fractures involving the petrous temporal bone 40 61 Otitic barotrauma 42 62 Acute suppurative otitis media 42 63 Acute petrositis 44 64 Complications of acute inflammation of the middle ear cleft include 44 65 Factors in the development and behaviour of chronic otitis media include 44 66 Tubotympanic chronic suppurative otitis media (CSOM) 46 67 Pathogenesis of acquired cholesteatoma 46 68 In attica-antral CSOM 46 69 Management of chronic suppurative otitis media with cholesteatoma 48 70 Management of cholesteatoma in children is difficult because 48 71 In an open mastoid cavity 48 72 Acute mastoiditis 48 73 Intracranial extension of suppurative otitis media 50 7 4 Complications of suppurative otitis media 50 75 Secretory otitis media (SOM) 50 76 Diagnosis and management of secretory otitis media 52 77 Late sequelae of otitis media 52 78 Tuberculous otitis media is 52 79 Malignant tumours of the middle ear cleft 54 80 Paragangliomas of the temporal bone 54 81 Osseous disorders of the temporal bone 54 Contents vii 82 Pathology of otosclerosis 56 83 Patients with otosclerosis 56 84 Diagnosis of otosclerosis 58 85 Treatment of otosclerosis 58 86 During stapedectomy 58 87 Complications of stapedectomy 60 88 Perilymph fistulae following stapedectomy 60 89 Van der Hoeve de Kleyn syndrome 62 90 In late syphilis in the temporal bone 62 91 Congenital deafness 62 92 Temporal bone fractures 64 93 In closed head injuries without fracture 64 94 Inner ear barotrauma 64 95 Excessive sound stimulation of the ear 66 96 lnfrasound 66 97 Hearing conservation programmes in industry 66 98 Otitic blast injury 68 99 Labyrinthine window rupture 68 168 Otitic labyrinthitis 68 10 1 In circumscribed labyrinthitis 70 10 2 In syphilitic labyrinthitis 70 103 Pathophysiology of Meniere's Disease 70 104 Clinical manifestations of Meniere's disease 72 105 Cogan's disease is characterized by 72 106 Investigation of Meniere's disease 72 107 Medical management of Meniere's disease 7 4 108 Surgical management of Meniere's disease 74 10 9 Pathology of presbyacusis 7 4 11 0 Management of presbyacusis 76 111 The ototoxic effects of 76 112 Objective tinnitus 76 113 Subjective tinnitus 78 Section 2: The Nose and Sinuses 114 Blood supply of the nose 82 115 Nasal anatomy 82 116 Examination of the nose and sinuses 82 117 Sinus X-rays 84 118 Operations on the nose and sinuses 84 119 Antral washouts 84 120 Sinus operations 86 121 Nasal respiration 86 122 The mucociliary 'conveyor belt' of the upper respiratory tract 86 123 Anosmia 86 124 Disorders of smell 88 125 Cleft lip and cleft palate 88 126 Congenital nasal malformations 88 127 Congenital choanal atresia 88 128 Management of maxillofacial injuries 88 129 Middle third facial fractures 90 viii MCQs in OTOLARYNGOLOGY 130 Blowout fracture of the orbit 90 131 Fractures involving the frontal or ethmoidal sinuses 90 132 Cerebrospinal fluid rhinorrhoea 90 133 Oro-antral fistula 92 134 Bullet wounds in the head and neck region 92 135 Sinus barotrauma 92 136 Nasal septal deformities 92 137 Septal haematoma 94 138 Septal abscess 94 139 Septal perforation 94 140 Foreign bodies in the nose 94 141 Rhinolith 96 142 Inflammation of the external nose 96 143 Acute infective rhinitis 96 144 Chronic non-specific rhinitis 96 145 Chronic hypertrophic rhinitis 98 146 Atrophic rhinitis 98 147 Wegener's granulomatosis 98 148 Syphilis and the nose 10 0 149 Nasal lupus vulgaris 10 0 150 Chronic specific rhinitis 10 0 151 Acute infective sinusitis 10 0 152 Acute infective sinusitis 10 2 153 Chronic non-specific sinusitis 10 2 154 Mixed infective and vasomotor chronic sinusitis 10 2 15 5 Acute maxillary sinusitis 10 4 156 Acute frontal sinusitis 10 4 157 Acute sphenoidal sinusitis 10 4 158 Treatment of chronic maxillary sinusitis 104 159 Treatment of chronic frontal sinusitis 106 160 Aetiology of sinusitis in children 10 6 161 Sinusitis in children 106 162 Spread of infection in suppurative sinusitis 10 8 163 Osteomyelitis of the frontal bone 10 8 164 Osteomyelitis of the frontal bone 10 8 165 Orbital complications of suppurative sinusitis 10 8 166 Orbital complications of suppurative sinusitis 11 0 167 Intracranial complications of suppurative sinusitis 11 0 168 Secondary effects of suppurative sinusitis 11 0 169 Transitional cell papilloma (Ringertz tumour) 112 170 Benign tumours of the paranasal sinuses 112 171 Malignant tumours of the nose and paranasal sinuses 112 172 Malignant tumours of the paranasal sinuses 114 173 Treatment of malignant tumours of the paranasal sinuses 114 17 4 Pituitary tumours 114 175 Maxillary cysts 116 176 Cysts of dental origin 116 177 Radiographic diagnosis of maxillary cysts 116 178 Odontogenic tumours 116 179 Causes of epistaxis 116 180 Sites of bleeding in epistaxis 118 Contents ix 181 Initial treatment of severe epistaxis 118 182 Surgical intervention in epistaxis 118 183 Epistaxis in hereditary haemorrhagic telangiectasia 120 184 Vasomotor rhinitis 120 185 Clinical features of vasomotor rhinitis include 120 186 Medical treatment of vasomotor rhinitis 120 187 Surgical treatment of vasomotor rhinitis 122 188 Aetiology of allergic rhinitis 122 189 Immunology of allergic rhinitis 122 190 Pathology of allergic rhinitis 124 19 1 Clinical features of allergic rhinitis 124 192 Treatment of allergic rhinitis 124 193 Surgical treatment of allergic rhinitis 124 19 4 Pathology of nasal polyps 126 19 5 Antrochoanal polyps 126 196 Treatment of simple nasal polyps 126 19 7 Epiphora 126 Section 3: The Larynx and Tracheobronchial Tree 19 8 Development of the larynx 130 19 9 The infantile larynx in comparison with the adult 130 200 Cartilaginous framework of the larynx 130 201 Laryngeal musculature 130 202 In the cavity of the larynx 132 203 Neurovascular supply and lymphatic drainage of the larynx 132 204 Physical examination of the larynx 132 205 Sphincteric functions of the larynx 134 206 During deglutition 134 207 In voice production 136 208 Symptoms and signs of laryngeal disease in the newborn include 136 209 Congenital laryngeal stridor (laryngomalacia) 136 21 0 Congenital laryngeal web 138 211 In closed laryngeal injuries 138 212 Laryngeal trauma 140 213 Abnormal voice production 140 214 Acute non-specific laryngitis in children 140 215 Acute epiglottitis 142 216 Acute laryngotracheobronchitis 142 217 Keratosis of the larynx 142 218 Juvenile respiratory papillomatosis 144 219 Benign lesions of the larynx 144 220 In the 19 87 UICC classification of malignant tumours of the larynx 146 221 Spread of malignant disease of the larynx 146 222 Total laryngectomy 148 223 Laryngocoeles 148 224 Oedema of the larynx 148 225 In episodes of stridor 150 226 Neural paralysis of the larynx 150 x MCQs in OTOLARYNGOLOGY 227 Management of laryngeal paralysis 150 228 Voice disorders 150 229 Development of the trachea and bronchi 152 230 In the trachea 152 231 In the neck 152 232 In the tracheobronchial tree 152 233 In the upper air passages 154 234 In performing a tracheostomy 154 235 In the postoperative care of tracheostomy 154 236 In a child with a tracheostomy 156 237 Congenital abnormalities of the tracheobronchial tree 156 238 The following are indications necessitating tracheostomy 156 239 Tracheobronchial foreign bodies 158 240 In the management of an inhaled foreign body 158 241 Inflammatory processes in the tracheobronchial tree 158 242 In carcinoma of the bronchus 160 243 Management of benign tracheal stenosis 160 Section 4: The Mouth, Pharynx and Oesophagus 244 Development of the mouth 164 245 Development of the tongue 164 246 Development of the pharynx 164 247 The second pharyngeal pouch 166 248 Anatomy of the mouth 166 249 Dental anatomy 166 250 Anatomy of the nasopharynx 166 251 Anatomy of the oropharynx 168 252 The pharyngeal constrictor muscles 168 253 Anatomy of the palatine tonsil 170 254 The parapharyngeal space 170 255 The retropharyngeal space 172 256 The glossopharyngeal nerve 172 257 Lymphatic drainage of the pharynx 172 258 Immunology of the pharyngeal lymphoid tissue 174 259 Anatomy of the parotid gland 174 260 Anatomy of the submandibular gland 176 261 The infratemporal fossa 176 262 The temporomandibular joint 176 263 The soft palate 178 264 Derivatives of the pharyngeal pouches 178 265 White lesions of the oral cavity 178 266 Mouth ulcers 180 267 Tumours of the oral cavity 180 268 Salivary gland tumours 180 269 Benign salivary gland disease 182 270 During deglutition 182 271 Pathophysiology of swallowing 184 272 Stertor 184 273 Sleep apnoea in children 184
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