Q: Complete answer this without photos A: Q.1 Fill in the blanks a Tensor tympani muscle is supplied by mandibular division of trigeminal nerve V3. b Nasolacrimal duct opens at inferior meatus in nose. c Facial artery is second branch from the external carotid artery in anterior group. d Anterior most part of lateral nasal wall is vestibule. e Carhart notch is seen in otosclerosis. f Posterior belly of digastric muscle is supplied by facial nerve. --- Q.2 Answer the following a Sensory supply of posterior 1/3 of tongue: Glossopharyngeal nerve Option 3 b Not a part of Samter’s triad: Hypertrophic mucosa Option 2 c Tympanogram in eustachian tube dysfunction: Type C Option 4 d Structures preserved in modified radical neck dissection: Spinal accessory nerve, internal jugular vein, sternocleidomastoid Option 2 --- Q.3 Clinical case study Given: 30-year-old female, right ear discharge since childhood, scanty purulent foul-smelling discharge, posterosuperior quadrant perforation. 1 Diagnosis Unsafe CSOM atticoantral disease with acquired cholesteatoma of right ear. 2 Pathophysiology and types Pathophysiology: - Retraction pocket usually pars flaccida/posterosuperior pars tensa due to ET dysfunction - Accumulation of keratin debris in pocket - Formation of cholesteatoma sac matrix - Enzymatic osteitis and pressure necrosis cause bone erosion ossicles, scutum, canal wall, etc. - Persistent foul-smelling scanty discharge Types of cholesteatoma: 1. Congenital 2. Acquired - Primary acquired from retraction pocket - Secondary acquired migration through perforation / implantation / metaplasia 3 Complications Extracranial/intratemporal: - Mastoid abscess - Facial nerve palsy - Labyrinthine fistula - Petrositis Intracranial: - Meningitis - Extradural abscess - Brain abscess temporal/cerebellar - Lateral sinus thrombosis - Otitic hydrocephalus 4 Management - Aural toilet, keep ear dry - Culture-directed topical/systemic antibiotics for active infection - Audiological assessment PTA, HRCT temporal bone - Definitive surgery: mastoid exploration and cholesteatoma clearance - Canal wall down or canal wall up mastoidectomy depending on extent - Tympanoplasty/ossiculoplasty as indicated - Follow-up for residual/recurrent disease --- Q.4 Short notes a Gradenigo syndrome Triad due to petrous apicitis: 1. Persistent otorrhea otitis media/mastoid source 2. Deep facial/retro-orbital pain trigeminal involvement 3. Lateral rectus palsy with diplopia VI nerve palsy Management: IV antibiotics, myringotomy/ventilation, mastoid surgery ± petrous apex drainage if needed. b Kiesselbach’s plexus Little’s area - Vascular plexus in anteroinferior nasal septum - Commonest site of anterior epistaxis - Arterial contributions: septal branches of anterior ethmoidal, sphenopalatine, greater palatine, superior labial arteries - Clinical importance: cauterization/pressure usually controls bleed c Right tympanic membrane description in place of diagram - Oval, pearly gray, 9–10 mm vertical - Parts: pars tensa major and pars flaccida above lateral process - Handle of malleus descends downward and backward to umbo - Cone of light in anteroinferior quadrant 5 o’clock in right ear - Quadrants: AS, AI, PS, PI by line along malleus handle and perpendicular through umbo d Lymphatic drainage of tongue - Tip: submental nodes bilateral possible - Lateral anterior 2/3: submandibular nodes - Central anterior 2/3: deep cervical nodes directly especially jugulo-omohyoid - Posterior 1/3: upper deep cervical nodes jugulodigastric, bilateral drainage common Clinical point: tongue carcinoma often metastasizes bilaterally. e Treacher Collins syndrome - Also mandibulofacial dysostosis 1st arch syndrome - AD mutation commonly TCOF1 - Features: malar and mandibular hypoplasia, down-slanting palpebral fissures, coloboma lower lid, malformed external ear, conductive hearing loss, cleft palate possible - Airway and feeding issues in severe cases - Management: multidisciplinary reconstruction, hearing rehabilitation, speech support f Blood supply of tonsil - Main: Tonsillar branch of facial artery - Others: ascending palatine facial, dorsal lingual lingual, ascending pharyngeal, greater/lesser palatine branches maxillary - Venous drainage to peritonsillar plexus → pharyngeal/facial veins paratonsillar vein important in tonsillectomy bleeding --- Q.5 Explain briefly a Secretory otitis media OME - Non-purulent fluid in middle ear due to ET dysfunction - Common in children; hearing loss, aural fullness, speech delay - Otoscopy: dull/retracted TM, fluid level/air bubbles - Tympanogram type B, conductive hearing loss - Treatment: treat nasal pathology, autoinflation, watchful waiting; persistent cases need grommet ± adenoidectomy b Atrophic rhinitis - Chronic rhinitis with atrophy of nasal mucosa and turbinate bone - Roomy nasal cavity, crusting, fetor, epistaxis, anosmia - Primary or secondary infection, surgery, granulomatous disease - Management: nasal douching, alkaline drops, topical antibiotics/lubricants, estrogen therapy in selected cases, surgery to narrow cavity in refractory disease c Singer’s nodule - Bilateral small nodules at junction of anterior 1/3 and posterior 2/3 of vocal cords phonotrauma - Hoarseness and voice fatigue - Management: voice rest, speech therapy, anti-reflux/hygiene; microlaryngeal excision if persistent d Tracheostomy - Surgical creation of opening in trachea for airway - Indications: upper airway obstruction, prolonged ventilation, secretion management - Types: emergency/elective, temporary/permanent - Complications: bleeding, surgical emphysema, tube block/displacement, pneumothorax, infection, tracheal stenosis, tracheoesophageal fistula - Requires meticulous postoperative care and humidification --- Q.6 Structured essay with clinical interpretation a 5-year-old with severe earache, cold, congested TMs, mucopurulent nasal discharge, crowded teeth 1 Probable diagnosis: Acute otitis media following acute rhinosinusitis/adenoid hypertrophy URTI-related ET dysfunction. 2 Etiopathogenesis: - Viral URTI causes nasopharyngeal mucosal edema - ET obstruction leads to negative middle-ear pressure - Reflux/aspiration of infected nasopharyngeal secretions into middle ear - Common bacteria: S. pneumoniae, H. influenzae, Moraxella - Adenoid hypertrophy suggested by mouth breathing/crowding predisposes recurrent episodes --- b 54-year-old smoker with change of voice 20 days + breathing difficulty 5 days 1 Probable diagnosis: Carcinoma larynx likely glottic/supraglottic with impending airway compromise. 2 Management: - Airway first: oxygen, nebulization, urgent tracheostomy if stridor/severe obstruction - Indirect/flexible laryngoscopy - Direct laryngoscopy with biopsy histopathology confirmation - Staging: CECT/MRI neck ± chest imaging - Definitive treatment by stage: radiotherapy, partial/total laryngectomy, chemoradiation - Smoking cessation, nutrition, speech and swallowing rehabilitation --- c 13-year-old male, unprovoked profuse epistaxis, reddish nasopharyngeal mass 1 Differential diagnosis: - Juvenile nasopharyngeal angiofibroma most likely - Antrochoanal polyp - Rhabdomyosarcoma/nasopharyngeal malignancy - Hemangioma 2 Management: - Avoid biopsy highly vascular lesion - Diagnostic nasal endoscopy + contrast CT/MRI - Angiography and preoperative embolization - Definitive treatment: endoscopic/open surgical excision depending on stage - Radiotherapy for unresectable/residual/recurrent disease --- d 30-year-old female, midline neck swelling moving with deglutition and tongue protrusion 1 Probable diagnosis: Thyroglossal duct cyst 2 Management: - USG neck ± thyroid scan if needed - Treat infection first if present antibiotics/incision if abscess - Definitive surgery: Sistrunk operation cyst + tract + central hyoid excision - Histopathology and follow-up --- Q.7 Explain why any five a Weber lateralizes to normal ear in SNHL because affected cochlea/nerve has reduced perception of bone-conducted sound. b DNS predisposes to sinusitis due to obstruction of osteomeatal complex and poor sinus drainage/ventilation. c Acute epiglottitis is emergency because rapidly progressive supraglottic edema can cause sudden fatal airway obstruction. d Parotid tumors may cause facial palsy due to infiltration/compression of facial nerve traversing parotid gland suggests malignancy. e Cholesteatoma causes bone erosion by pressure necrosis plus osteolytic enzymes/inflammatory mediators. f Long-term decongestant drops are avoided due to rhinitis medicamentosa rebound congestion, mucosal damage, and dependence. --- Q.8 Explain briefly any four a Medico-legal importance of proper documentation in ENT - Establishes standard of care and timeline - Supports diagnosis, consent, procedures, complications management - Crucial in assault, foreign body, hearing disability, medicolegal injury cases - Protects doctor in litigation; improves continuity and audit b Allergic rhinitis - IgE-mediated nasal mucosal inflammation due to allergens - Symptoms: sneezing, rhinorrhea, itching, obstruction - Signs: pale boggy turbinates, allergic salute/shiners - Management: allergen avoidance, antihistamines, intranasal steroids, leukotriene antagonists, immunotherapy selected cases c Tonsillectomy - Indications: recurrent tonsillitis Paradise criteria, obstructive sleep apnea, peritonsillar abscess recurrence, suspicion malignancy - Methods: cold steel, electrocautery, coblation etc. - Complications: reactionary/secondary hemorrhage, pain, dehydration, infection d Tympanoplasty - Reconstruction of TM ± ossicles to eradicate disease and improve hearing - Types Wullstein I-V based on ossicular status - Grafts: temporalis fascia/cartilage - Can be combined with mastoidectomy where required - Contraindications include active uncontrolled infection/poor ET function relative e Septoplasty - Surgical correction of deviated nasal septum - Indications: nasal obstruction, recurrent sinusitis, epistaxis from spur, contact headache, access for endoscopic surgery - Steps: mucoperichondrial flap elevation, correction/resection, repositioning, splint/packing - Complications: bleeding, septal hematoma/perforation, adhesions, residual deviation --- If you want, I can also convert this into a clean exam-style handwritten format point-wise with headings exactly as expected for MBBS marking.
