Saturday, April 18, 2015

Study group discussion: Tonsils and pharynx review questions

Most common organism causing tonsillitis?
Group B hemolytic streptococcus.

Most common artery which bleeds in tonsillectomy?
Facial artery. 
Paratonsillar vein also known as?
Denise brown vein.
What is facial artery also known as?
Artery of tonsillar hemorrhage.

Why is cleft palate a contraindication to tonsillectomy?
The tonsil is situated at the anterior end of oropharynx. So if the person already has cleft palate and you remove the tonsil.. You are removing an extra support to the palate. This can lead to velopharyngeal insufficiency, that is, nasal voice (rhinolaila aperta) and nasal regurgitation.

15 year old boy presents with recurrent epistaxis which can't be controlled by adrenaline douches. Diagnosis?
Nasopharyngeal fibroma.

Why adrenaline ain't working?
Vessels here are just endothelium lined with no muscle coat.

What are the parts of pharynx?
Oroparynx, nasopharynx and laryngopharynx.

70 year old guy comes with right upper lateral lymph node enlargement. On further questioning, he complains of recent onset reduced hearing on right side. Diagnosis?
Nasopharyngeal carcinoma.

Virus causing NPC?
EBV

What's the pathogenesis of hearing loss in nasopharyngeal carcinoma?
NPC arises from the fossa of rosenmuller.. It's the most common site of origin.  
This, if you remember, is just behind the nasal opening of eustachian tube. So due to blockage of ET.. You get serous otitis media. Which is the cause for deafness. 

While examining a newborn, you notice that there is a mass in the nasopharynx. What is the rationale for checking neural tube defects in such a patient?
Nasopharyngeal bursa represents the embryonic attachment of notochord. So if you see a mass in a newborn in the nasopharynx, the baby maybe suffering from a occult NTD.

A patient comes to you.. He has trismus, fever, and a swelling which is pushing the tonsil medially. Diagnosis? Past history: Molar extraction a few days back.
It's parapharyngeal abscess.

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