Clinical Flashcards
what are the 6 D’s of ear disease?
- deafness
- discomfort
- discharge
- dizziness
- din din (tinnitus)
- defective movement of the face
what are the 4 types of deafness?
conductive
sensorineural
mixed
central
compare what the tympanic membrane would look like for AOM to OME?
AOM- bulging and red
OME- retracted and hypomobile/immobile
what is vertigo?
a sensation of movement, usually spinning
What is benign paroxysmal positional vertigo?
the feeling of vertigo due to the otoconia moving from the utricle (usual position) to the semicircular canals
what is the most common cause of vertigo on looking up?
BPPV
what is the vestibulo-ocular reflex?
a reflex which causes the eyes to move in the opposite direction that the head is turned in order to keep an image on the central visual field
in BPPV the otoconia are dislodged from the utricle into the semicircular canals, which one is particularly affected?
the posterior semicircular canals
what are the main causes of BPPV?
head trauma
ear surgery
what is the Dix Hallpike test?
a test to identify benign paroxysmal positional vertigo
what maneouvres can be used to improve BPPV?
Epley manoeuvres
what is the purpose of Epley manoeuvres?
to get the otoconia out of the semi-circular canals
what is vestibular neuronitis/labyrinthitis?
inflammation of the inner ear causing vertigo
what is likely to be the cause of vertibular neuronitis/labyrinthitis?
viral aetiology
what is the main difference between vestibular neuronitis and labyrinthitis?
no hearing loss or tinnitus with vestibular neuronitis
may have hearing loss or tinnitus with labyrinthitis
what is the duration of BPPV?
minutes
what is the duration of menieres?
hours
what is the duration of labyrinthitis?
days-weeks
what is the duration of vestibular neuronitis?
days-weeks
is BPPV associated with hearing loss or tinnitus?
no
is menieres associated with hearing loss or tinnitus?
yes
is labyrinthitis associated with hearing loss or tinnitus?
yes
is vestibular neuronitis associated with hearing loss or tinnitus?
no
is BPPV associated with aural fullness?
no
is menieres associated with aural fullness?
yes
is labyrinthitis associated with aural fullness?
no
is vestibular neuronitis associates with aural fullness?
no
does BPPV have a clear positional trigger?
yes
does menieres disease have a clear positional trigger?
no
does labyrinthitis have a clear positional trigger?
no
does vestibular neuronitis have a clear positional trigger?
no
respiration causes the vocal cords to carry out what movement?
abduction
what type of obligate breathers are neonates?
obligate nasal breathers
as the radius of a tube decreases, what happens to the work of breathing?
increases
which is why neonates with a small URTI find it very hard to breath
what is stertor?
snoring
low pitched noises arising from the nasopharyngeal airway
what is a papillomatosis?
HPV infection causing a benign growth
what is the most common cause of adult subglottic stenosis?
vasculitis
why don’t young children tend to break their nose?
because it is still cartilage waiting to ossify
what does the cartilage of the nose get it’s blood supply from?
perichondrium
why after a suspected nasal fracture should there be a 5-7 day wait before review in an ENT clinic?
need the swelling to go down to be able to assess bony contours
in a traumatic nose injury, what artery is most likely to bleed causing epistaxis?
anterior ethmoidal artery
what type of deafness will haemotympanum cause?
conductive deafness
what type of deafness will ossicular chain disruption cause?
conductive deafness
what type of deafness does fluid (effusion, blood or CSF) within the middle ear cause?
conductive hearing loss
what type of deafness does a TM perforation cause?
conductive hearing loss
what is stapes fixation?
otosclerosis of the stapes causing it to become fused to the oval window
what type of conductive hearing loss has a normal looking TM?
otosclerosis of stapes (stapes fixation)
what is the commonest zone of the neck to be injured?
zone 2
what is the zone of neck injury which is least likely to cause catastrophic injury? and why?
zone 2
because the structures are mobile
what is the most common midfacial fracture?
nose
what is the second most common midfacial fracture?
orbital floor
what does a tear drop sign on CT of the face show?
herniation of orbital contents through the infra-orbital groove
what does an air-bone gap on an audiogram suggest?
conductive hearing loss
if there is hearing loss, but no air-bone gap on audiogram what does this suggest?
sensorineural hearing loss
on an audiogram, a Carhart’s notch (at 2000Hz) is seen in what disease?
otosclerosis
what is diplopia?
double vision
what is Waldeyer’s ring?
ring of lymphoid tissue within the oropharynx and nasopharynx
what tonsils are involved in Waldeyer’s ring?
palatine tonsils
pharyngeal tonsils
lingual tonsils
what is the point of attachment of the palatine tonsils?
plica triangularis
what is the name of the space created lateral to the adenoids and posteromedial to the eustachian tube opening?
fossa of rosenmuller
where is Gerlach’s tonsil?
within the lip of fossa of Rosenmuller
what margin does the adenoid extend inferiorly to?
passavants ridge of the superior constrictor
compare the mucosa of the pharyngeal tonsils (adenoids) to palatine tonsils?
adenoids- ciliated pseudostratified columnar epithelium with deep folds
palatine tonsils- stratified squamous epithelium with deep crypts
what is the most common bacterial cause of acute tonsilitis?
GAS
why are throat swabs not recommended for acute tonsilitis?
majority is viral in cause
you will end up picking up natural flora
how do you empirically treat tonsilitis if it is believed to be bacterial in cause?
10 day course of penicillin 500mg QID
clarithromycin if allergic
what is peritonsilar abscess/quinsy?
a complication of acute tonsilitis when the space between the tonsil and muscle becomes infected and produces pus
what is the treatment of peritonsilar abscess/quinsy?
aspiration and antibiotics
what happens to the uvula in a peritonsilar abscess/quinsy?
displaced away from the midline
what is seen of the tonsils of a patient with glandular fever?
gross tonsilar enlargement with ‘cheese on toast’ appearance- white membranous exudate
why must you avoid contact sport for 6 weeks after glandular fever?
to prevent rupturing spleen
compare AOM and OME in terms of earache?
AOM- present
OME- absent
compare AOM and OME in terms of middle ear effusion?
AOM- may be present
OME- present
compare AOM and OME in terms of TM appearance?
AOM- bulging TM
OME- regressed TM
compare AOM and OME in terms of TM mobility?
AOM- may have impaired TM mobility
OME- impaired TM mobility
compare AOM and OME in terms of hearing loss?
AOM- may have hearing loss
OME- has hearing loss
when should you refer a patient with persistent OME with symptoms? (such as deafness, speech impaired, balance issues)
after 3 months
what is the surgical management plan for OME greater than 3 months?
3 years old, first intervention: grommets
> 3 years old, second intervention: grommets and adenoidectomy
compare the shape of normal lymph nodes to malignant lymph nodes?
normal: oval
malignant: round
which is the only full ring of cartilage around the trachea?
cricoid cartilage
what is the anterior commissure?
where the vocal cords meet
for imaging deafness, when is an MRI used compared to CT?
MRI- investigation of sensorineural deafness
CT- investigation of conductive deafness
compare the course of the facial nerve to the position of the malleus and incus?
medial to the malleus
lateral to the incus
what are the 4 core nasal symptoms?
Stuffy
Smell loss
Snot
Sore
what are the 4 other nasal symptoms that are important to ask about on top of the core symptoms?
- sneezing
- itch
- crusting
- epistaxis
why might a blocked nose give you a dry mouth and halitosis?
due to obligatory mouth breathing
dry mouth causes bacteria to build up
what causes an allergic crease on the nose?
rubbing and itching the nose
compare the treatment of allergic rhinitis for symptoms such as itching, sneezing and blocked nose?
itching, sneezing- antihistamines
blocked nose- topical steroid spray
what type of asthma are nasal polyps associated with?
non-allergic
how do you treat nasal polyps?
oral steroids, then topical steroids
if no imporvement: surgery
what are the 2 types of non-infective rhinitis?
allergic
non-allergic
what are the types of non-infective, non-allergic rhinitis?
vasomotor rhinitis
polyps
when someone has been punched, what way is there nasal septum most likely to deviate?
to the right
what strains of HPV are high risk for malignant cancer?
16 and 18
why do patients with a nasopharyngeal carcinoma often present with conductive hearing loss in one ear?
eustachian tube is blocked by cancer
fluid fills up within middle ear
