Clinical Flashcards

1
Q

what are the 6 D’s of ear disease?

A
  • deafness
  • discomfort
  • discharge
  • dizziness
  • din din (tinnitus)
  • defective movement of the face
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2
Q

what are the 4 types of deafness?

A

conductive
sensorineural
mixed
central

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3
Q

compare what the tympanic membrane would look like for AOM to OME?

A

AOM- bulging and red

OME- retracted and hypomobile/immobile

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4
Q

what is vertigo?

A

a sensation of movement, usually spinning

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5
Q

What is benign paroxysmal positional vertigo?

A

the feeling of vertigo due to the otoconia moving from the utricle (usual position) to the semicircular canals

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6
Q

what is the most common cause of vertigo on looking up?

A

BPPV

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7
Q

what is the vestibulo-ocular reflex?

A

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

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8
Q

in BPPV the otoconia are dislodged from the utricle into the semicircular canals, which one is particularly affected?

A

the posterior semicircular canals

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9
Q

what are the main causes of BPPV?

A

head trauma

ear surgery

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10
Q

what is the Dix Hallpike test?

A

a test to identify benign paroxysmal positional vertigo

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11
Q

what maneouvres can be used to improve BPPV?

A

Epley manoeuvres

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12
Q

what is the purpose of Epley manoeuvres?

A

to get the otoconia out of the semi-circular canals

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13
Q

what is vestibular neuronitis/labyrinthitis?

A

inflammation of the inner ear causing vertigo

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14
Q

what is likely to be the cause of vertibular neuronitis/labyrinthitis?

A

viral aetiology

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15
Q

what is the main difference between vestibular neuronitis and labyrinthitis?

A

no hearing loss or tinnitus with vestibular neuronitis

may have hearing loss or tinnitus with labyrinthitis

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16
Q

what is the duration of BPPV?

A

minutes

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17
Q

what is the duration of menieres?

A

hours

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18
Q

what is the duration of labyrinthitis?

A

days-weeks

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19
Q

what is the duration of vestibular neuronitis?

A

days-weeks

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20
Q

is BPPV associated with hearing loss or tinnitus?

A

no

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21
Q

is menieres associated with hearing loss or tinnitus?

A

yes

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22
Q

is labyrinthitis associated with hearing loss or tinnitus?

A

yes

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23
Q

is vestibular neuronitis associated with hearing loss or tinnitus?

A

no

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24
Q

is BPPV associated with aural fullness?

A

no

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25
Q

is menieres associated with aural fullness?

A

yes

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26
Q

is labyrinthitis associated with aural fullness?

A

no

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27
Q

is vestibular neuronitis associates with aural fullness?

A

no

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28
Q

does BPPV have a clear positional trigger?

A

yes

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29
Q

does menieres disease have a clear positional trigger?

A

no

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30
Q

does labyrinthitis have a clear positional trigger?

A

no

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31
Q

does vestibular neuronitis have a clear positional trigger?

A

no

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32
Q

respiration causes the vocal cords to carry out what movement?

A

abduction

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33
Q

what type of obligate breathers are neonates?

A

obligate nasal breathers

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34
Q

as the radius of a tube decreases, what happens to the work of breathing?

A

increases

which is why neonates with a small URTI find it very hard to breath

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35
Q

what is stertor?

A

snoring

low pitched noises arising from the nasopharyngeal airway

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36
Q

what is a papillomatosis?

A

HPV infection causing a benign growth

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37
Q

what is the most common cause of adult subglottic stenosis?

A

vasculitis

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38
Q

why don’t young children tend to break their nose?

A

because it is still cartilage waiting to ossify

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39
Q

what does the cartilage of the nose get it’s blood supply from?

A

perichondrium

40
Q

why after a suspected nasal fracture should there be a 5-7 day wait before review in an ENT clinic?

A

need the swelling to go down to be able to assess bony contours

41
Q

in a traumatic nose injury, what artery is most likely to bleed causing epistaxis?

A

anterior ethmoidal artery

42
Q

what type of deafness will haemotympanum cause?

A

conductive deafness

43
Q

what type of deafness will ossicular chain disruption cause?

A

conductive deafness

44
Q

what type of deafness does fluid (effusion, blood or CSF) within the middle ear cause?

A

conductive hearing loss

45
Q

what type of deafness does a TM perforation cause?

A

conductive hearing loss

46
Q

what is stapes fixation?

A

otosclerosis of the stapes causing it to become fused to the oval window

47
Q

what type of conductive hearing loss has a normal looking TM?

A

otosclerosis of stapes (stapes fixation)

48
Q

what is the commonest zone of the neck to be injured?

A

zone 2

49
Q

what is the zone of neck injury which is least likely to cause catastrophic injury? and why?

A

zone 2

because the structures are mobile

50
Q

what is the most common midfacial fracture?

A

nose

51
Q

what is the second most common midfacial fracture?

A

orbital floor

52
Q

what does a tear drop sign on CT of the face show?

A

herniation of orbital contents through the infra-orbital groove

53
Q

what does an air-bone gap on an audiogram suggest?

A

conductive hearing loss

54
Q

if there is hearing loss, but no air-bone gap on audiogram what does this suggest?

A

sensorineural hearing loss

55
Q

on an audiogram, a Carhart’s notch (at 2000Hz) is seen in what disease?

A

otosclerosis

56
Q

what is diplopia?

A

double vision

57
Q

what is Waldeyer’s ring?

A

ring of lymphoid tissue within the oropharynx and nasopharynx

58
Q

what tonsils are involved in Waldeyer’s ring?

A

palatine tonsils
pharyngeal tonsils
lingual tonsils

59
Q

what is the point of attachment of the palatine tonsils?

A

plica triangularis

60
Q

what is the name of the space created lateral to the adenoids and posteromedial to the eustachian tube opening?

A

fossa of rosenmuller

61
Q

where is Gerlach’s tonsil?

A

within the lip of fossa of Rosenmuller

62
Q

what margin does the adenoid extend inferiorly to?

A

passavants ridge of the superior constrictor

63
Q

compare the mucosa of the pharyngeal tonsils (adenoids) to palatine tonsils?

A

adenoids- ciliated pseudostratified columnar epithelium with deep folds
palatine tonsils- stratified squamous epithelium with deep crypts

64
Q

what is the most common bacterial cause of acute tonsilitis?

A

GAS

65
Q

why are throat swabs not recommended for acute tonsilitis?

A

majority is viral in cause

you will end up picking up natural flora

66
Q

how do you empirically treat tonsilitis if it is believed to be bacterial in cause?

A

10 day course of penicillin 500mg QID

clarithromycin if allergic

67
Q

what is peritonsilar abscess/quinsy?

A

a complication of acute tonsilitis when the space between the tonsil and muscle becomes infected and produces pus

68
Q

what is the treatment of peritonsilar abscess/quinsy?

A

aspiration and antibiotics

69
Q

what happens to the uvula in a peritonsilar abscess/quinsy?

A

displaced away from the midline

70
Q

what is seen of the tonsils of a patient with glandular fever?

A

gross tonsilar enlargement with ‘cheese on toast’ appearance- white membranous exudate

71
Q

why must you avoid contact sport for 6 weeks after glandular fever?

A

to prevent rupturing spleen

72
Q

compare AOM and OME in terms of earache?

A

AOM- present

OME- absent

73
Q

compare AOM and OME in terms of middle ear effusion?

A

AOM- may be present

OME- present

74
Q

compare AOM and OME in terms of TM appearance?

A

AOM- bulging TM

OME- regressed TM

75
Q

compare AOM and OME in terms of TM mobility?

A

AOM- may have impaired TM mobility

OME- impaired TM mobility

76
Q

compare AOM and OME in terms of hearing loss?

A

AOM- may have hearing loss

OME- has hearing loss

77
Q

when should you refer a patient with persistent OME with symptoms? (such as deafness, speech impaired, balance issues)

A

after 3 months

78
Q

what is the surgical management plan for OME greater than 3 months?

A

3 years old, first intervention: grommets

> 3 years old, second intervention: grommets and adenoidectomy

79
Q

compare the shape of normal lymph nodes to malignant lymph nodes?

A

normal: oval
malignant: round

80
Q

which is the only full ring of cartilage around the trachea?

A

cricoid cartilage

81
Q

what is the anterior commissure?

A

where the vocal cords meet

82
Q

for imaging deafness, when is an MRI used compared to CT?

A

MRI- investigation of sensorineural deafness

CT- investigation of conductive deafness

83
Q

compare the course of the facial nerve to the position of the malleus and incus?

A

medial to the malleus

lateral to the incus

84
Q

what are the 4 core nasal symptoms?

A

Stuffy
Smell loss
Snot
Sore

85
Q

what are the 4 other nasal symptoms that are important to ask about on top of the core symptoms?

A
  • sneezing
  • itch
  • crusting
  • epistaxis
86
Q

why might a blocked nose give you a dry mouth and halitosis?

A

due to obligatory mouth breathing

dry mouth causes bacteria to build up

87
Q

what causes an allergic crease on the nose?

A

rubbing and itching the nose

88
Q

compare the treatment of allergic rhinitis for symptoms such as itching, sneezing and blocked nose?

A

itching, sneezing- antihistamines

blocked nose- topical steroid spray

89
Q

what type of asthma are nasal polyps associated with?

A

non-allergic

90
Q

how do you treat nasal polyps?

A

oral steroids, then topical steroids

if no imporvement: surgery

91
Q

what are the 2 types of non-infective rhinitis?

A

allergic

non-allergic

92
Q

what are the types of non-infective, non-allergic rhinitis?

A

vasomotor rhinitis

polyps

93
Q

when someone has been punched, what way is there nasal septum most likely to deviate?

A

to the right

94
Q

what strains of HPV are high risk for malignant cancer?

A

16 and 18

95
Q

why do patients with a nasopharyngeal carcinoma often present with conductive hearing loss in one ear?

A

eustachian tube is blocked by cancer

fluid fills up within middle ear