ENT HUBs

141.Explanation Correct Answer - D Ans. is 'd' i.e., Reduction of impedance to sound transmission The ear canal (auditory canal) acts as a resonator, i.e. it resonates (amplifies frequencies) between 2000 and 5000 (average 3000) cycles per second and therefore most energy will be transmitted to the cochlea in these frequencies. However, if this sound energy hits the inner ear fluid directly most of the energy would be reflected, resulting in hearing loss (as all the sound wave is reflected and nothing is a transmitted as electrical impulse). Therefore, there is a need for a transformer mechanism, a need that is fullfilled by middle ear → middle ear converts sound of greater amplitude but lesser force to that of lesser amplitude but greater force. This function of the middle ear is called impedence matching mechanism or the transformer action. @ENThubs

140.Explanation Correct Answer - C Ans. is 'c' i.e., Klebsiella azaenae Laryngitis sicca (Atrophic laryngitis or laryngitis atrophica) It is a rare entity characterized by atrophic changes in the respiratory mucosa with loss of the mucus - producing glands. It is usually associated with atrophic rhinitis and pharyngitis caused by klebsiella ozaenae. The most common sites involved in larynx are the false cords (vestibular folds), the posterior region and the subglottic region. More common in women. Clinical features Irritable cough and hoarseness Excessive crusts formation which are sometimes bloodstained (hemorrhagic) with foul odour. Crusts are the most important diagnostic feature. Treatment Elimination of causative factors and humidification. Laryngeal sprays with glucose in glycerine or oil of pine helps in crust removal. Expectorants containing ammonium chloride or iodides also help to loosen the crust. Microlaryngoscopic removal of crust in laryngitis sicca is the new modality of treatment Join @ENThubs

139.Explanation Correct Answer - D Ans. is 'd' i.e., Halitosis The clinical symptoms of acute sinusitis have been classified into major and minor Join @ENThubs

136.Explanation Correct Answer - B Ans. is 'b' i.e., Septal cartilage Steps in septoplasty A unilateral incision is made in the mucoperichodrial flap at the lower border of septal cartilage on the left side in right handed persons. The mucoperichondrial flap is elevated on one side making an anterior tunnel. Another incision is made in the mucoperiosteum over the nasal spine on the same side, elevating the mucoperiosteum from nasal spine on both sides thus making two more tunnels called inferior tunnels. Two tunnels are joined by sharp dissection. Septal cartilage is then separated from vomero-ethmoid bones posteriorly and nasal spine inferiorly. Maxillary crest is removed to realign septal cartilage. Bony septal deformity is corrected by removing deformed part. Deformed septal cartilage is corrected. Trans-septal sutures are put to coapt mucoperichondrial flaps. Nasal pack is put. Thus (coming to question) Mucoperichondrial flap (and tunnel) are made on septal cartilage. Mucoperiosteal flap (and tunnels) are made on nasal spine. Join @ENThubs

137.Explanation Correct Answer - C Ans. is 'c' i.e., Vocal abuse Vocal nodule (singer's or screamer's nodule) Vocal nodule are benign noneoplastic growth on free edge of both the vocal cords at the junction of anterior 1/ 3 with posterior 2/3. This area is particularly vulnerable to trauma as this is the area of maximum vibration of the cord. The major cause is voice abuse, therefore it is most commonly seen in singers, actors, teachers, and howkers. Hoarseness is the most common symptom. Vocal fatigue and pain in neck on prolonged phonation are other symptoms. Treatment Early cases of vocal nodules can be treated conservatively by educating the patient in proper use of voice. Many nodules especially in children, disappear with this treatment. Surgery is required for large nodules or long standing nodules in adults. Microscopic (micorlaryngoscopic) excision is the treatment of choice. Join @ENThubs

136.Explanation Correct Answer - D Ans. is 'd' i.e., Aortic aneurysm Join @ENThubs

135.Explanation Correct Answer - B Ans. is 'b' i.e., CSF rhinorrhea Detection of CSF Leak 1. Biochemical tests Concentrations of Glucose are higher in CSF than in nasal discharge. Glucose value > 30-40 mg% and protein value < 100 mg % (max 200 mg %) support a diagnosis of CSF leak. Presence of I3,transferrin is the most definitive test for detection of CSF and I32transferrin assay is the test of choice when a confirmatory test is needed, because of high sensitivity as well as specificity. I3-trace protein (prostaglandin D synthase) is also used, however it is nonspecific as it is also present in human testes, heart and seroma. 2. Basic clinical tests Tissue test (Handker chief test) : - Unlike nasal mucous, CSF does not cause a tissue to stiffen. Filter paper test : - Sample of nasal discharge on a filter paper exhibits a light CSF border and a dark central area of blood, i.e., double ring sign or halo sign. Queckensted test : - Compression of the jugular vein leas to increased CSF leak due to increase in ICP. Rhinoscopy : - Visualization of CSF leak from paranasal sinus 3. CSF tracers Intrathecal fluorescein dye adminstration, radionuclide cisternography, CT cisternography Join @ENThubs

134.Explanation Correct Answer - B Ans. is 'b' i.e., Maxillary Most common sinus affected by sinusitis overall Maxillary Most common sinus affected in adult Maxillary Most common sinus affected in children Ethmoid Least common sinus affected Sphenoid Sinuses involved in order of frequency Maxillary > Frontal > Ethmoid > Sphenoid Join @ENThubs

133.Explanation Correct Answer - A Ans. is 'a' i.e., Posterior rhinoscopy Join @ENThubs

132.Explanation Correct Answer - C Ans. is 'c' i.e., Bacterial infection Samter's triad Samter's triad is a medical condition consisting of asthma, aspirin sensitivity, and nasaL'ethmoidal polyposis. It occurs in middle age (twenties and thirties are the most common onset times) and may not include any allergies. o Most commonly, the first symptom is rhinitis. The disorder typically progeses to asthma, then polyposis, with aspirin sensitivity coming last. The aspirin reaction can be severe, including an asthma attack, anaphylaxis, and urticaria in some cases. Patients typically react to other NSAIDS such as ibuprofen, although paracetamol is generally considered safe. Anosmia (lack of smell) is also typical, as the inflammation reaches the olfactory receptors in the nose. Join @ENThubs