Arab Board ENT Final Clinical & Oral cheat sheet

Rinne test: air conduction > bone conduction = positive (normal or sensorineural loss); bone > air = negative (conductive loss).

Weber lateralizes to the affected side in conductive loss and to the better ear in sensorineural loss.

Tuning fork frequency for Weber/Rinne screening is 512 Hz; 256 Hz risks vibrotactile artifact.

Acoustic neuroma (vestibular schwannoma) most commonly arises from the inferior vestibular nerve at the internal auditory canal; MRI with gadolinium is the confirmatory test.

Benign paroxysmal positional vertigo is diagnosed by the Dix-Hallpike maneuver; posterior canal variants are treated with the Epley canalith repositioning maneuver.

Meniere disease triad: episodic vertigo lasting 20 minutes to hours, fluctuating sensorineural hearing loss, and tinnitus/fullness; endolymphatic hydrops is the proposed mechanism.

Cholesteatoma is keratinizing squamous epithelium in the middle ear; it is locally destructive and does not respond to medical therapy - surgical removal is required.

Sudden sensorineural hearing loss: ≥30 dB across three contiguous frequencies within 72 hours; treat with high-dose corticosteroids and urgent MRI.

Vestibular neuritis spares hearing; labyrinthitis includes hearing loss. Head impulse test is abnormal in vestibular neuritis.

Lund-Mackay CT scoring: each of 5 sinus groups scored 0-2; ostiomeatal complex scored 0 or 2; maximum total 24.

Chronic rhinosinusitis requires ≥12 weeks of symptoms plus endoscopic or CT evidence of inflammation.

Allergic fungal rhinosinusitis: type I hypersensitivity, eosinophilic mucin, double-density sign on CT, and polyposis; treatment is surgical plus steroids.

Epistaxis: anterior bleeds arise from Kiesselbach plexus; posterior bleeds from sphenopalatine artery branches and may require sphenopalatine artery ligation or embolization.

Cerebrospinal fluid leak: beta-2 transferrin is highly specific; high-resolution CT and beta-2 transferrin testing on fluid guide repair.

Inverted papilloma arises from lateral nasal wall; unilateral obstruction and bleeding; has malignant transformation potential and requires complete excision.

Juvenile nasopharyngeal angiofibroma occurs in adolescent males; presents with epistaxis and nasal obstruction; preoperative embolization reduces operative blood loss.

Endoscopic sinus surgery landmark: middle turbinate, uncinate process, and maxillary ostium define the ostiomeatal complex.

TNM staging of oral cavity: T1 ≤2 cm, T2 >2-4 cm, T3 >4 cm, T4 invades adjacent structures; nodal staging depends on size, number, and extranodal extension.

Extranodal extension in a cervical node upgrades nodal category to N3b and worsens prognosis.

Most common oral cavity malignancy is squamous cell carcinoma; floor of mouth and lateral tongue are most frequent sites.

Papillary thyroid carcinoma spreads via lymphatics; follicular carcinoma spreads hematogenously to bone and lung.

Fine-needle aspiration is the first-line diagnostic test for a thyroid nodule; Bethesda categories guide management.

Neck levels: I submental/submandibular, II upper jugular, III mid jugular, IV lower jugular, V posterior triangle, VI anterior compartment.

Radical neck dissection removes levels I-V with sternocleidomastoid, internal jugular vein, and spinal accessory nerve; modified radical preserves one or more non-lymphatic structures.

Parotid malignancy: facial nerve preservation is attempted unless directly invaded; high-grade tumors warrant postoperative radiotherapy.

Vocal fold nodules are bilateral, at the junction of anterior and middle thirds (point of maximal vibration); first-line treatment is voice therapy.

Recurrent laryngeal nerve injury causes vocal fold paresis in the paramedian position; superior laryngeal nerve injury affects pitch and is tested with a high-pitch phonation.

Flexible laryngoscopy is the standard for assessing vocal fold mobility and laryngeal lesions.

Spasmodic dysphonia: adductor type is most common; treatment is botulinum toxin injection into the thyroarytenoid muscles.

Laryngopharyngeal reflux presents with globus, throat clearing, and posterior laryngeal erythema; treatment is lifestyle modification plus proton pump inhibitor therapy.

Laryngeal cancer staging: glottic tumors present early with hoarseness; supraglottic tumors present late with nodal spread.

Paradoxical vocal fold motion causes inspiratory stridor; diagnosis is confirmed by laryngoscopy during an attack.

Tracheostomy: cricothyrotomy is preferred for emergent airway in adults; tracheostomy is preferred in children and for prolonged ventilation.

Acute otitis media diagnosis requires middle ear effusion plus acute signs of inflammation; watchful waiting is appropriate in selected children ≥6 months with mild disease.

Tympanostomy tube insertion is indicated for recurrent acute otitis media (≥3 episodes in 6 months or ≥4 in 12 months) or persistent effusion with hearing loss.

Croup (laryngotracheobronchitis) presents with barking cough and inspiratory stridor; treatment is corticosteroids and nebulized epinephrine for severe cases.

Epiglottitis presents with drooling, tripod posture, and muffled voice; avoid throat examination and secure the airway in the operating room.

Bacterial tracheitis presents with toxic appearance and purulent secretions; treatment is antibiotics and airway protection.

Juvenile nasopharyngeal angiofibroma and laryngeal papillomatosis are key pediatric airway tumors; recurrent respiratory papillomatosis is caused by HPV 6 and 11.

Congenital laryngomalacia is the most common cause of stridor in infants; it typically resolves by 12-18 months.

Choanal atresia presents with cyclical cyanosis relieved by crying; confirm with CT and treat with surgical opening.

Facial nerve branches: temporal, zygomatic, buccal, marginal mandibular, cervical; the marginal mandibular branch is at risk in submandibular and parotid surgery.

The facial nerve exits the stylomastoid foramen and divides within the parotid gland; the nerve is deep to the superficial lobe.

Skin graft survival depends on plasmatic imbibition for the first 48 hours, then inosculation and capillary ingrowth.

Local flap design: rhomboid flap transposes adjacent tissue; rotation flaps redistribute tension along relaxed skin tension lines.

Cleft lip repair is typically performed at 3-6 months; cleft palate repair at 9-12 months to optimize speech and facial growth.

Nasal reconstruction: paramedian forehead flap is the workhorse for large nasal defects; it is a staged procedure with division at 3-4 weeks.

Blepharoplasty: the levator aponeurosis is the primary elevator of the upper eyelid; the orbicularis oculi is innervated by the facial nerve.

Wound healing: primary intention occurs with approximated edges; secondary intention by granulation; tertiary by delayed closure.

Obstructive sleep apnea diagnosis requires polysomnography; apnea-hypopnea index ≥5 with symptoms or ≥15 regardless of symptoms defines OSA.

The Epworth Sleepiness Scale scores 0-24; scores >10 suggest excessive daytime sleepiness.

First-line therapy for moderate-to-severe OSA is CPAP; adherence is defined as ≥4 hours per night on ≥70% of nights.

Drug-induced sleep endoscopy identifies sites of airway collapse to guide surgical planning.

Uvulopalatopharyngoplasty is the most common surgical procedure for OSA; it addresses retropalatal collapse.

Pediatric OSA is most often due to adenotonsillar hypertrophy; adenotonsillectomy is first-line surgical treatment.

Mallampati classification grades oropharyngeal visibility I-IV; higher grades correlate with difficult intubation and OSA risk.

Tracheostomy is the definitive surgical airway for life-threatening upper airway obstruction when other measures fail.

Type I hypersensitivity is IgE-mediated; type IV is delayed, T-cell mediated (e.g., contact dermatitis).

Skin prick testing is the preferred initial test for inhalant allergy; a wheal ≥3 mm greater than negative control is positive.

Serum specific IgE (ImmunoCAP) is useful when skin testing is contraindicated (e.g., severe dermatographism, antihistamine use).

Allergic rhinitis management: intranasal corticosteroids are the most effective single agent for moderate-to-severe disease.

Anaphylaxis treatment is intramuscular epinephrine 0.01 mg/kg (max 0.5 mg) into the anterolateral thigh; antihistamines and steroids are adjuncts only.

Immunotherapy (subcutaneous or sublingual) is the only disease-modifying treatment for allergic rhinitis.

Hereditary angioedema is due to C1 inhibitor deficiency; it does not respond to epinephrine or antihistamines; treat with C1 inhibitor concentrate or icatibant.

Nasal provocation testing is used when skin and serum tests are discordant with clinical history.

Airway priority in facial trauma: assess for obstruction, hemorrhage, and cervical spine injury before facial fracture repair.

Le Fort fractures: I is low transverse (palate), II is pyramidal (nasal-zygomatic), III is craniofacial disjunction (zygomatic arch separation).

Zygomaticomaxillary complex fracture: malar depression, diplopia, and infraorbital nerve numbness; treat with open reduction and internal fixation.

Mandibular fracture: most common site is the angle; assess for malocclusion and inferior alveolar nerve injury.

Nasal bone fracture is the most common facial fracture; reduce within 7-10 days before fibrous union.

Laryngeal trauma: suspect with hoarseness, subcutaneous emphysema, and neck tenderness; CT and flexible laryngoscopy guide management.

Caustic ingestion: avoid emesis and gastric lavage; perform early endoscopy to grade injury.

Epistaxis emergency: posterior bleeds may require posterior packing, sphenopalatine artery ligation, or embolization.

Cochlear hair cells: outer hair cells amplify (electromotility); inner hair cells are the primary afferent sensory cells.

The organ of Corti sits on the basilar membrane; high frequencies are encoded at the base and low frequencies at the apex.

The vestibular system: semicircular canals detect angular acceleration; utricle and saccule detect linear acceleration and gravity.

Olfactory receptor neurons are unique among cranial nerves in regenerating throughout life.

The facial nerve carries special visceral efferent fibers to muscles of facial expression and special sensory fibers for taste from the anterior two-thirds of the tongue via the chorda tympani.

The parathyroid glands derive from the third (inferior) and fourth (superior) pharyngeal pouches.

Thyroid gland develops from the thyroglossal duct, which descends from the foramen cecum; remnants cause thyroglossal duct cysts.

Middle ear ossicles: malleus, incus, stapes; the stapes footplate sits in the oval window and transmits to the cochlea.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, and voluntariness; it is a process, not a signature.

Confidentiality may be breached only when required by law, to prevent serious harm, or with patient consent.

A competent adult may refuse life-sustaining treatment even if the decision seems unwise.

Advance directives and healthcare proxies guide care when the patient lacks capacity.

Research ethics: institutional review board approval, informed consent, and equipoise are required for human subjects research.

Conflict of interest must be disclosed; financial relationships with industry should not influence clinical decisions.

Medical errors should be disclosed to patients honestly; error reporting supports system improvement.

Professional boundaries: dual relationships and gifts that could influence care should be avoided or managed transparently.