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MS ENT Basic sciences MGR university September 2009 question paper with solution

MS ENT Basic sciences MGR university September 2009 question paper with solution

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This e book contains MS ENT question paper of Basic sciences examination of Tamilnadu Dr MGR Medical University September 2009 with solution
This e book contains MS ENT question paper of Basic sciences examination of Tamilnadu Dr MGR Medical University September 2009 with solution

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Published by: Dr. T. Balasubramanian on Nov 25, 2010
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05/02/2014

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 September 2009M.S. DEGREE EXAMINATIONBranch IV – E.N.T.(For candidates admitted from 2004-2005 to 2008-2009 onwards)Paper I – APPLIED BASIC SCIENCES INOTO RHINOLARYNGOLOGY
I. ANATOMY – Answer any FOUR: (4 x 5 = 20)
1. Pyriform fossa.It is
a potential space that lies on either side of the larynx. They are two innumber. It is shaped like a pyramid with the base pointing above and the apexbelow. They belong to the hypopharyngeal area of the pharynx. It has two parts;the shallow upper part and a deeper lower part.Boundaries: The pyriform fossa is bounded laterally by the mucosa covering thelamina of the thyroid cartilage. Medially it is bounded by the aryepiglottic fold andarytenoid cartilages above and the cricoid cartilage below. Superiorly it isbounded by the lateral glosso epilglottic fold (Pharyngoepiglottic fold), inferiorly itcontinues with the oesophagus.
 
Deep to the mucous membrane of the lateral wall of the pyriform fossa lies theinternal laryngeal branch of the superior laryngeal nerve. It supplies sensorifibres to this area.Clinical importance of pyriform fossa:1. Anatomically it is a hidden area. Any malignancy in this area will initiallycause fewer symptoms and has a tendency to present very late.2. This area is richly endowed with lymphatics. They drain into the upper deepcervical group of lymph nodes. Any malignancy in this area has a tendency fornodal metastasis.3. Foreign bodies in the throat commonly get lodged here.4. Since superior laryngeal nerve lies superficially in this area, it can be topicallyblocked by placing cotton plegets soaked in 4% xylocaine in this area. This isknown as the pyriform fossa block.Examination of the pyriform fossa:The superficial shallow portion of the pyriform fossa is easily visible in alaryngeal mirror. This portion will be visible in the indirect laryngoscopyexamination. The deeper portion of the pyriform fossa is hidden and is notvisible to the IDL mirror. Only a direct examination using a upper oesophagealspeculum will reveal this portion.Tumors involving the pyriform fossa commonly arise from its deep portion.This may escape detection during a IDL scopy examination. But if one looks forpooling of saliva in the involved pyriform fossa the underlying growth can besuspected. Hence pooling of saliva is an important clinical sign indicating aunder lying tumor in the deep portion of the pyriform fossa, or the presence of a foreign body can also be suspected by this sign.Causes for pooling of saliva in the pyriform fossa:
 
Pooling of saliva in the pyriform fossa is not only caused by growth affectingthis area causing obstruction to saliva being swallowed, but also due to intensecricopharyngeal muscle spasm.1. Malignant growth involving the deep portion of the pyriform fossa2. Foreign body being lodged in the pyriform fossa.3. Growth involving the crico pharynx or upper oesophagus can also causepooling of saliva.2. Sphenoid sinus.
Sphenoid sinus is located in the skull base at the junction of the anterior andmiddle cranial fossa. Pneumatisation of sphenoid starts during the 4th year of childhood and gets completed by the 17th year. The sphenoid sinuses vary in sizeand may be asymmetric.They drain through the superior meatus via a small ostium about 4mm in diameterlocated disadvantageously 20mm above the sinus floor.This sinus is related to several important vital structures. They are:1. Pituitary gland lies above the sphenoid sinus.2. Optic nerve and internal carotid arteries traverse its lateral wall.3. The nerve of pterygoid canal lies in the floor of the sinus.Hence infections of sphenoid sinus may involve the optic nerve if the canal of theoptic nerve is dehiscent.

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