Embed Size (px)
Citation preview
DOHNS Mock Exam
l Get comfy l Each slide lasts 5 minutes l Instructions are on the question sheet l Do not talk to each other l Discuss your answers with your peers and your
seniors l Any comments, questions or additions email us via the
website
C Mamais, A Lau http://entsho.com
1
By C Mamais (Own work) Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0) (http://creativecommons.org/licenses/by-nc-sa/3.0/) , derivative work from Marekp (Own work) [Public domain], via Wikimedia Commons (file location http://upload.wikimedia.org/wikipedia/commons/2/22/Normal_hearing_audiogram.jpg)
A B C D
1
l Which patients could benefit from a BAHA? l A contraindications to in the ear hearing aid e.g. CSOM l B as A or child with Down’s syndrome l D to allow sounds from left side to reach right ear
l What other hearing devices do you know?
l Behind the ear, in the ear, body worn (analogue or digital) (cross over)
l Bone conduction (soft-band, BAHA) l Cochlear implant l Hearing trumpet
2
By Adrian L James (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
2
l Diagnosis l Otitis media with effusion, glue ear
l Management l Watch and wait 3/12, grommets, EUA PNS
l Significance of Hong Kong l Nasopharyngeal Ca
3
By C Mamais (Own work) Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0) (http://creativecommons.org/licenses/by-nc-sa/3.0/)
3
l Saddle deformity l http://emedicine.medscape.com/article/840910-overview l Causes
- Congenital, acquired (trauma, iatrogenic, infection (syphilis), inflammatory (wegeners, relapsing polychondritis), cocaine use,
l Management - Conservative, septorhinoplasty / reconstruction
4
By Dr.J.S.Bhandari, India (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons
4
l Diagnosis l Septal perforation
l Commonest causes l Traumatic / iatrogenic l But beware granulomatous disease etc.
l Management l Conservative, silastic button, septorhinoplasty
5
Image courtesy of Dr Erik Ranschaert, http://radiopaedia.org (original file http://radiopaedia.org/images/612449) Creative Commons BY-SA-NC (http://radiopaedia.org/licence)
5
l Test l Contrast swallow
l Diagnosis l Pharyngeal pouch
l Management l Conservative, stapling, external approach
l Pathogenesis l Killian’s Dehiscence (cricopharyngeus and thyropharyngeus)
6
C Mamais under CC BY-NC-SA 3.0 (http://creativecommons.org/licenses/by-nc-sa/3.0/) derivative work of Krzysztof Woźnica - KyloDee (Own work) (http://commons.wikimedia.org/wiki/File%3ABattery-lithium-cr2032.jpg) [Public domain], via Wikimedia Commons and Kristian Alfsvåg (
http://commons.wikimedia.org/wiki/File:Child_nose.jpg?uselang=en-gb) [Public domain]
6
l What is the significance of this? l Nasal foregn bodies should be removed promptly especially
batteries which can cause local necrosis and septal perforation
7
Image courtesy of Dr Frank Gaillard, http://radiopaedia.org (original file http://radiopaedia.org/images/15616) Creative Commons BY-SA-NC (http://radiopaedia.org/licence)
7
l Investigation l Coronal CT of paranasal sinuses
l Diagnosis l Left maxillary and ethmoidal sinusitis / rhinosinusitis
l Management l Medical (macrolides, nasal steroids, nasal douching),
surgical (FESS, antral washout)
8
By Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center (The Eyes Have It) [CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons
8
l Diagnosis l Periorbital cellulitis (notice ?insect bites)
l Chandler’s Classification l Stage I - preseptal cellulitis l Stage II - orbital cellulitis l Stage III - subperiosteal abscess l Stage IV - orbital abscess l Stage V - cavernous sinus thrombosis and infection
l Management l Antibiotics, ophthalmology refefral, CT scanning, surgical
drainage
9
A B C D
Unknown sources
9
l Identify instruments by function l A adenoid curette for adenoidectomy l B Boyle-Davies mouth gag for tonsillectomy l C rigid bronchoscope l D Negus knot pusher for tonsilectomy
10
By Ijustam (Own work) [Public domain], via Wikimedia Commons (file location at http://tinyurl.com/cwshcer)
By C Mamais Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0) (http://creativecommons.org/licenses/by-nc-sa/3.0/) , derivative work from Marekp (Own work) [Public domain], via Wikimedia Commons (file location http://upload.wikimedia.org/wikipedia/commons/2/22/Normal_hearing_audiogram.jpg)
A B C D
10
l Diagnosis l A right sided asymmetrical sensorineural hearing loss
(acoustic neuroma, viral) l B early noise induced hearing loss l C bilateral symmetrical high frequency hearing loss
(presbyacusis) l D Ménière's disease
11
By welleschik (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC-BY-SA-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/2.5-2.0-1.0)], via Wikimedia Commons, (file location http://tinyurl.com/ckehr5f)
11
l Identify pathology and give management l Cholesteatoma: CSOM, retraction pocket, attic crusting l “Never trust an attic crust”
l Management l Treat acute infection, needs mastoidectomy / tympanoplasty
12
By C Mamais (Own work) Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0) (http://
creativecommons.org/licenses/by-nc-sa/3.0/
12 l Label parts
l A spiral ganglion l B stria vascularis l C scala tympani (filled with perilymph) l D scala vestibuli (filled with perilymph) l E scala media (filled with endolymph) l F Basilar membrane l G Reissner's membrane l H outer hair nerve cells l I tectorial membrane l J inner hair nerve cells l K temporal bone
13
By de:Benutzer:Uwe Gille [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons (file at http://upload.wikimedia.org/wikipedia/commons/b/b6/
Kehlkopf_Pferd.jpg)
13 l Cut through the larynx of a horse
l 1 hyoid bone
l 2 epiglottis
l 3 vestibular fold, false vocal fold/cord, (Plica vestibularis)
l 4 vocal fold, true vocal fold, (Plica vocalis)
l 5 Musculus ventricularis
l 6 ventricle of larynx (Ventriculus laryngis)
l 7 Musculus vocalis
l 8 thyroid cartilage
l 9 cricoid cartilage
l 10 Cavum infraglotticum
l 11 first tracheal cartilage
l 12 Trachea
14
By Hörmann, Till (from Hörmann, Till, Dissertation Univ. Leipzig) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons (file at http://upload.wikimedia.org/wikipedia/commons/f/f4/Auditory_ossicles_%28bovine%29.jpg)
14
l Opened tympanic cavity with auditory ossicles in the bovine (microphotograph). l 1 Malleus l 2 Incus, l 2' Proc. lenticularis l 3 Stapes l 4 tympanic membrane l 5 oval window l 6 tensor tympani muscle, l 7 stapedius muscle
15
By James Heilman, MD (Own work) [CC-BY-SA-3.0 (www.creativecommons.org/licenses/by-sa/3.0) or GFDL (www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons (file at http://upload.wikimedia.org/wikipedia/commons/4/4a/Pos_strep.JPG)
15
l Diagnosis l tonsillitis
l Commonest organism l Viral (adenovirus, rhinovirus, influenza, coronavirus,
respiratory syncytial virus, EBV) l Bacterial (Group A β-hemolytic streptococcus)
l Management l Antibiotics, analgesia, IV fluids
16
Have a 5 minutes break!
This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license. File location http://commons.wikimedia.org/wiki/File:Pocket_watch_with_chain.jpg.
17
By Paweł Kuźniar (Jojo_1, Jojo) (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons (file at http://tinyurl.com/curlluy)
17
l Diagnosis l Laryngeal cancer
18
Copyright Bechara Y. Ghorayeb, MD, Attribution-NonCommercial-NoDerivs 2.5 Generic (CC BY-NC-ND 2.5) (http://creativecommons.org/licenses/by-nc-nd/2.5/) (file location http://www.houstonoto.com/TympanicPerforation.html)
18
Copyright Bechara Y. Ghorayeb, MD, Attribution-NonCommercial-NoDerivs 2.5 Generic (CC BY-NC-ND 2.5) (http://creativecommons.org/licenses/by-nc-nd/2.5/) (file location http://www.houstonoto.com/TympanicPerforation.html)
19
l Write an operation note for grommets and adenoidectomy
19 l Date / time
l Surgeons and Anaesthetists
l Surgery: Cold steel tonsillectomy and adenoidectomy
l Indication: recurrent tonsillitis and otitis media
l Findings: large adenoids, grade 3 tonsils
l Procedure: cold steel adenoidectomy, haemostasis with packs. Cold steel tonsillectomy, haemostasis with packs and bipolar diathermy (setting 20)
l Post Op: eat and drink after 2 hours, overnight stay
l Write in clear capitals
20
Image courtesy of Dr Frank Gaillard, http://radiopaedia.org (original file http://tinyurl.com/cnufwuw) Creative Commons BY-SA-NC (http://radiopaedia.org/licence).
20
l Diagnosis l Submandibular duct stone (submandivular sialogram)
l Management l Lithotripsy, sialendoscopy, submandibular gland excision
21
Image courtesy ofDr Maulik S Patel, http://radiopaedia.org (original file http://tinyurl.com/cpqg3sw) Creative Commons BY-SA-NC (http://radiopaedia.org/licence).
21
l Diagnosis l Retropharyngeal abscess l Straight neck sign (muscle spasm); increased soft tissue
width l Management
l ALS principles secure airway, IV antibiotics, surgical drainage
22
What does BIPP stand for? Which instruments would you use for epistaxis
management?
22
l Bismuth Iodoform Paraffin Paste l Tilleys forceps, BIPP-impregnated ribbon gauze, catheter,
local anaesthetic/decongestant, Thudichum's nasal speculum, silver nitrate, cotton wool pledgets, headlight, specialized nasal packs…
23
By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5) or CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons (file location http://tinyurl.com/3vjttp7)
23 l Diagnosis
l Oral / tongue cancer l Management
l Confirm diagnosis with biopsy, stage with MRI neck / CT chest, procede to resection and reconstruction with flap
24
By Shantoo (Own work) [CC0], via Wikimedia Commons. This file is made available under the
Creative Commons CC0 1.0 Universal Public Domain Dedication. (file location http://
tinyurl.com/d25ngg3)
By James Heilman, MD (Own work) [CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons. (file location http://upload.wikimedia.org/
wikipedia/commons/9/94/OtitisExterna10.JPG)
A
B
24
l A otitis externa l B facial nerve palsy so could be malignant otitis
externa or Ramsey Hunt Syndrome
25
This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license. (File location http://tinyurl.com/c9np4s9)
25
l Histological section through the thyroid l 1 follicles with colloid l 2 follicular epithelial cells l 3 endothelial cells
l Papillary, follicular, medullary, anaplastic, others (lymphoma, scc, sarcoma)
26
By Winxptwker (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons (file location http://upload.wikimedia.org/wikipedia/commons/c/cb/BTEhearingaids.png)
A
B
A E
C
D
26
By Winxptwker (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons (file location http://upload.wikimedia.org/wikipedia/commons/c/cb/BTEhearingaids.png)
On / Off
Ear hook
Battery
Mould
Volume
27
By C Mamais (Own work) Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0) (http://creativecommons.org/licenses/by-nc-sa/3.0/)
27
l Epley Manuever l Left ear (points down at the start) l Benign Positional Paroxysmal Vertigo
28
By C Mamais (Own work) Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0) (http://creativecommons.org/licenses/by-nc-sa/3.0/)
28
l What is the differential diagnosis l left vocal cord palsy (idiopathic, trauma including
iatrogenic, cancer including thyroid, larynx or lung) l Wait for 6/12 to a year in case it resolves or any occult
malignancy to manifest
29
By User Doctormichael. (Originally from English Wikipedia, [1]) [Public domain], via Wikimedia Commons (file at http://tinyurl.com/6ulchtr)
29
l Diagnosis l Laryngomalacia
l Management l Multidisciplinary team (paediatrics, dieticians etc)
advice to parents re sleep position, observation and conservative management. Tracheostomy or supraglottoplasty in 10% of ases
30
This reproduction of a lithograph plate from the 20th U.S. edition of Gray's Anatomy of the Human Body is in the public domain because its copyright has expired. This applies worldwide. (http://commons.wikimedia.org/wiki/File:Gray137.png)
A
B C B
D
E
F
G H
I
J
K
30
Bonus
This work has been released into the public domain by its author, Covalent at the English Wikipedia project. This applies worldwide. In case this is not legally possible:Covalent grants anyone the right to use this work for any purpose, without any conditions, unless such conditions are required by law. (file is at http://commons.wikimedia.org/wiki/File:Earcov.JPG#file)
B A
C
D
E F
G
H
I
Bonus
This work has been released into the public domain by its author, Covalent at the English Wikipedia project. This applies worldwide. In case this is not legally possible:Covalent grants anyone the right to use this work for any purpose, without any conditions, unless such conditions are required by law. (file is at http://commons.wikimedia.org/wiki/File:Earcov.JPG#file)
Concha
Lobule
Tragus
Crus of Helix
Fossa triangularis
Scaphoid fossa
Helix
Anti-helix
Anti-tragus
The End
DOHNS Mock Exam 1 Questions by Mr Costas Mamais http://entsho.com
