Precise ENT

1.Identify the instrument. 2.Give various diagnostic indications. 3.Name any one contraindication for the above instrument.

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✔️A/false. Asthma is a cause of wheezing not stridor.The best way to approach this question is to imagine the basic anatomy of the region. Stridor is caused by upper airway narrowing at or below the level of the larynx.As a result , all of the structures above the larynx and in the lower airway will not cause stridor. ✔️B/true. The epiglottitis is at the level of the larynx and therefore causes stridor. ✔️C/true. Croup is also known as laryngotracheobronchitis.It is a viral infection that affects the upper airways of babies. ✔️D/false. This is a cause of stertor, as the adenoids are above the level of the larynx. ✔️E/true. Laryngeal cancer is a cause of stridor, as it is at the level of the larynx.

✔️A/false. Stridor is a type of noisy breathing that is typically high pitched and the noise is created in or just below the larynx. While stertor is a type of noisy breathing that is typically low pitched and the noise is created in the nose or the back of the throat. ✔️B/false. It may be inspiratory (most common), expiratory or biphasic, depending on its timing in the respiratory cycle and the three forms each suggest different causes. •An inspiratory stridor suggests airway obstruction above the glottis. •An expiratory stridor is indicative of obstruction in the lower trachea. •A biphasic stridor suggests a glottic or subglottic lesion. ✔️C/true. ✔️D/false. Is usually most prominent during the inspiration phase.  ✔️E/false.

✔️A/true. Is a relative or elective indication. ✔️B/false. Is a contraindication. ✔️C/true. Massively enlarged tonsils can cause episodes of cessation of breathing known as obstructive sleep apnea. ✔️D/false. Patients with an elevated BMI of 30 or more may experience more postsurgical complications including post-surgical wound infection so should be encouraged to lose weight further prior to seeking surgery. ✔️E/true. Is an absolute indication.

✔️A/true. There may be difficulty in swallowing, due to the space occupying nature of the cancer. ✔️B/false. Laryngeal cancer may present with weight loss.This is partly due to the catabolic effects of the cancer itself, but it is also due to the resultant dysphagia ultimately reducing food intake. ✔️C/true. Feelings of fatigue and tiredness are very common in cancer.They are caused by the catabolic effects of the growth of the cancer. ✔️D/true. The cancer may be seen as a palpable swelling in the neck. ✔️E/true. Laryngeal cancer can invoke the process of angiogenesis (the formation of new blood vessels).These blood vessels may bleed as they develop. Bleeding may also result from the effects of the cancer itself, which compresses and damages local blood vessels as it grows.

✔️A/true. Excess alcohol intake is a predisposing factor for the development of laryngeal cancer. ✔️B/false. ✔️C/false. There is no link between eating spicy food and developing laryngeal cancer.However, high intakes of dietary fats and salted meat have been indicated to be risk factors. ✔️D/true. As with many other cancers, smoking is a risk factor for laryngeal cancer. ✔️E/true. Men are at higher risk of developing laryngeal cancer than women.

✔️A/true. Vocal nodules are more common in individuals who strain their voice on a regular basis (e.g. singers). ✔️B/true. The presence of a vocal node prevents smooth closure of the vocal cords and thus affects the sound generated. ✔️C/false. Vocal cord node surgery can result in fibrosis and subsequent distortion of the vocal cords.This will result in an irreversible voice change, for this reason that surgical intervention should not be chosen in the first instance. Conservative measures are the mainstay of treatment.Irritants such as alcohol and smoking should be avoided.Surgery should be reserved for those cases that do not respond to conservative management. ✔️D/false. The patient should be advised to rest his voice and avoid irritants such as alcohol and smoking. ✔️E/false. There is no genetic inheritance of this condition.It is an acquired condition, mainly due to vocal misuse.

✔️A/true. Congenital glottic stenosis arises from embryological failure of the larynx to form a completely patent tube, leaving webs or atresia. ✔️B/false. Glottic stenosis refers to narrowing at the level of the vocal cords. ✔️C/true. Intubation is a traumatic experience for the tissues of the larynx, as a result inflammation occurs and causes fibrous to start remodeling.This can result in atresia and glottic stenosis. ✔️D/true. The narrowing is at the level of the vocal cords, so sound manipulation is affected.As a result the patient may have a hoarse voice. ✔️E/false. Glottic stenosis is not related to epistaxis.

✔️A/true. Acid tracking up the oesophagus into the larynx can stimulate late cough receptors and cause a chronic cough, the cough may improve following a course of proton pump inhibitors. ✔️B/true. This may be alleviated by replacing the medicine with an angiotensin II receptor antagonist. ✔️C/true. The timing of the cough should be elicited, as should any history of chest tightness or shortness of breath. ✔️D/true. This is the most common cause of chronic cough, patients may benefit from a course of antihistamines, as allergic rhinitis may be the root cause of this condition. ✔️E/true.

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