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ENT > Conditions > Flashcards

Conditions Flashcards

1
Q

causes of vertigo

A

3 common causes:

  • benign paroxysmal positional vertigo
  • vestibular neuronitis (inflammation of vestibular nerve)
  • meniere’s disease (too much endolymph)
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2
Q

how do the sings and symptoms differentiate between the 3 causes of vertigo

A

Bening Paroxysmal Positional Vertigo:
- rotary vertigo on moving head

Meniere’s disease:

  • rotatory vertigo
  • associated with fluctuating hearing loss

Vestibular Neuritis:

  • continuous rotatory vertigo fro over 24
  • associated N+V
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3
Q

what investigations would you perform for vertigo

A

Full neuro exam

pure tone audiometry to determine hearing loss

Dix-Hallpike test

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4
Q

how do you treat vertigo (different depending on cause)

A

Benign Paroxysmal Positional Vertigo:
- Epley’s manoeuvre to reposition displaced crystal

Vestibular Neuronitis:
- anti-emetics for the N+V

Meniere’s Disease:

  • pressure reducing therapy e.g. low salt, diuretics
  • intratympanic steroid injection if fails
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5
Q

how does excessive earwax present

A

hearing loss
blocked feeling
wax on otoscope

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6
Q

how does otitis media with effusion present

A

hearing loss
popping, clicking/ pressure

dull tympanic membrane, bubbles on otoscope

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7
Q

how does tympanic membrane perforation present

A

hearing loss

may have middle ear discharge if active infection

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8
Q

how does otosclerosis present

A

hearing loss
unilateral or bilateral- progressive

associated tinnitus (

no other signs

advanced can cause dizziness

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9
Q

how does cholesteatoma present

A

hearing loss

chronic smelly discharging ear

insidious and slowly progressive symptoms

visible in otoscope

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10
Q

how does presbycusis

A

bilateral gradual onset hearing loss over many years

normal otoscope

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11
Q

how does vestibular schwannoma

A

aka acoustic neuroma

presents with asymmetric hearing loss over months

tinnitus

normal otoscopy

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12
Q

how do you treat hearing loss

A

hearing aids if mild

depends on cause:

tympanoplasty to repair TM

cochlear implantation

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13
Q

how do you treat excessive ear wax

A

topical eardrums to soften wax

micro suction to evacuate softened wax

syringing (water into ear)

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14
Q

what is tinnitus

A

perception of sound when no external sound is present

can be non-pulsatile (e.g. buzzing) or pulsatile (4%, synchronous with heart beat)

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15
Q

what causes pulsatile tinnitus

A

atherosclerosis of internal carotid artery

vascular malformations

glomus tumours (slow growing benign tumour of carotid after. middle ear)

possibly otosclerosis

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16
Q

how do you treat tinnitus

A

reassure that it is common and they will adapt to it

address underlying cause e.g. hypertension

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17
Q

what is facial palsy

A

temporary or permanent paralysis of the facial nerve

most commonly caused by bell’s palsy

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18
Q

what causes facial palsy

A

most commonly bell’s palsy

which is unknown cause but associated with viral infections e.g. herpes

higher risk if pregnant, URT, diabetes

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19
Q

how does facial palsy present

A

rapid onset

dry painful eye especially if eye closure is impaired

drooling from side of mouth, difficulty eating

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20
Q

how do you differentiate between an upper and lower motor neurone cause of facial palsy

A

upper motor neurone has sparing of the forehead

e.g. stroke

as umn the nerve from the other side can compensate

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21
Q

how do you treat facial palsy

A

eye care- tape eyelids shut

oral steroids for bells palsy

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22
Q

what is the probable diagnosis if you see a child with acute severe ear pain and preceding URTI with asociated erythema and fever

A

acute otitis media

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23
Q

what is the probable diagnosis for severe ear pain often with preceding itch and contact with water

tender, narrow external auditory meatus OE

A

otitis externa

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24
Q

what is the probable diagnosis if you see an elderly person with severe ear pain and diabetes and immunocompromised

floor of ear canal shows granulation

A

necrotising otitis externa

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25
Q

what is the likely diagnosis when you see pain anterior to tragus and worse when eating

normal eardrum, tender jaw

A

TemporoMandibular Joint dysfunction

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26
Q

what is otorrhoea

A

any fluid discharged from the ear

e.g. wax, pus, blood, mucous

often caused by infection

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27
Q

which infections most commonly cause otorrhoea

A

pseudomonas aeruginosa

staph. aureus
strep. pneumonia

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28
Q

how does fungal otitis external present

A

otorrhoea

itchy ear canal

fluffy coating of the canal

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29
Q

how does acute otitis media present

A

recent URTI

deep severe ear pain which precedes discharge and improves after discharge disappears

mucoid ear discharge

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30
Q

how does bacterial otitis external presentation differ from fungal otitis externa

A

both present with itchy ear canal and pain

bacterial presents with thin watery discharge

fungal present with fluffy coating

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31
Q

what are some risk factors for otitis externa

A

swimming

warm/ humid climates

underlying skin condition e.g.
eczema

immunosupression

trauma

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32
Q

what are the common bacterial causes of otitis externa

A

pseudomonas aeruginosa

Staph. epidermis

Staph. aureus

note that it can be fungal also

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33
Q

how does otitis externa present

A 
otalgia
pruritis
discharge 
hearing loss if canal is stenosed
pain on moving pinna/ tragus
external auditory meatus swelling
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34
Q

how do you treat otitis externa

A

micro suction

topical antibiotic and steroid ear drops.g. ciprofloxacin or Acetic acid 2%

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35
Q

what are some risk factors for otitis media

A 
lack of breastfeeding
attending nursery
positive family history
6-18 months
exposure to smoking
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36
Q

what causes otitis media (mechanism)

A

URTI results in inflammation of the upper airways and the subsequent swelling blocks the Eustachian tube

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37
Q

what are the common causes of otitis media

A

viral infections 2/3rds:

  • respiratory syncytial virus
  • rhinovirus (cold)
  • enterovirus

Bacterial:

  • strep. pneumoniae
  • haemophilus influenza
  • moraxella catarrhalis
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38
Q

how does otitis media present

A

rapid onset otalgia, fever, irritability

after upper RTI

anorexia, vomiting

fever
ear pulling and irritability (children)
vomiting
otalgia

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39
Q

how do you treat otitis media

A

analgesia e.g. ibuprofen

antipyretic e.g. paracetamol

oral antibiotics if no improvement within 2 days e.g. Amoxicillin

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40
Q

what is the difference between otitis media and otitis media with effusion

A

OME presents with fluid without signs of infection

aka glue ear

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41
Q

what causes otitis media with effusion

A

Eustachian tube dysfunction

often follows acute otitis media

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42
Q

how do you treat otitis media with effusion

A

watch and wait (50% resolves)

hearing aid in the meantime

antibiotics not advised

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43
Q

what are the two types of chronic otitis media

A

Mucosal- tympanic membrane perforation in the presence of recurrent/ persistent ear infection

squamous- gross retraction of the tympanic membrane with formation of keratin collection (cholesteatoma)

44
Q

how do you manage epistaxis

A

lean forward and hold soft bit of nose

suck ice cube/ on forehead

if this fails then endoscopic artery ligation is undertaken

possible septoplasty if displaced

45
Q

what are the symptoms of rihinitis vs rhinosinusitis

A

Both:

  • runny nose
  • post nasal drip
  • nasal congestion

rhinitis:

  • sneezing
  • itching

rhinos sinusitis:

  • facia headache
  • hyposmia
46
Q

what type of hypersensitivity reaction is allergic rhinitis

A

Type 1

IgE mediated

47
Q

how does allergic rhinitis show on flexible nasendoscopy

A

inflamed nasal turbinates and mucosa

bluish, pale hue to the turbinate mucosa

watery nasal discharge

gross turbinate hypertrophy

48
Q

how do you investigate allergic rhinitis

A

skin-prick allergy test

histamine (positive) and saline (negative) controls are inserted into dermis along with various allergens

49
Q

how would you treat allergic rhinitis

A

avoid allergen exposure

nasal douching

oral antihistamine e.g. loratidine

Intra-nasal steroids (sprays) e.g. Beclomethasone, Fluticasone

50
Q

how do nasal polyps present

A

very common

symptoms of nasal blockage

+/- change in smell perception

typically bilateral

51
Q

how do you treat nasal polyps

A

short course of oral steroids e.g. prednisolone

then intra-nasal steroid drop

then intra-nasal steroid spray e.g. Mometasone

52
Q

how do Sino-nasal malignancies present

A

they are rare but present late so poor prognosis

symptoms include:

  • unilateral nasal obstruction
  • unilateral glue ear
  • bleeding
  • pain
  • neck lumps
  • headache
  • weight loss
53
Q

what are the most common types of Sino-nasal cancer

A

squamous cell carcincoma

adenocarcinoma

54
Q

what is a cleft lip/ palate

A

split in the upper lip/ roof of mouth

results in an abnormal connection between the oral and nasal cavity

most common facial birth defect in the UK

55
Q

how does a cleft lip/ palate present

A

very variable

depends on severity:

submucous cleft (muscles of soft palate don’t fully join) is possibly asymptomatic

bilateral cleft lip and palate is immediately concerning at birth

56
Q

what is the function of orbiculares oris

A

closes the lips

think whistling

57
Q

what is the function of the buccinator muscle

A

deepest face muscle

function is suckling in kids

lies between the mandible and the maxilla

58
Q

what is the function of platysma

A

depresses the mandible

shaving muscle

59
Q

what is the function of orbiulcaris oculi

A

closes eye

60
Q

what is the function of the temporals muscle

A

mastication

elevates the mandible closing and retracting the mouth

61
Q

what is the function of the masseter muscle

A

elevation of the mandible

closes the mouth

62
Q

what is the function of the medial and lateral pterygoid muscles

A

lateral= protrusion, depression, medial movement of the mandible (fibres horizontal)

medial= elevation and protrusion of the mandible (fibres are vertical)

63
Q

which branch of which nerve innervates all the muscles of mastication

A

the mandibular branch of the trigeminal nerve

64
Q

what are the 3 branches of the trigeminal nerve

A

opthalmic

maxillary

mandibular

65
Q

which is the most powerful muscle of mastication?

A

masseter

elevates the mandible

66
Q

what are the 3 main salivary glands, what do they produce and where are they

A

Parotid gland- serous fluid- anterior and inferior to the ear

submandibular gland- mix of serous and mucous fluid- indents on the mandible

sublingual gland- mucous gland- under the floor of the mouth

67
Q

what are the 3 types of papillae that cover the surface of the tongue

A

filiform- keratinocytes (white)

fungiform (contain taste buds)

circumvallate papillae (aligned in a V shape dividing anterior 2/3rds tongue from post

68
Q

where is the embryological site of the thyroid gland

A

apex of the circumvallate papillae

one of the 3 types of papillae that cover the surface of the tongue

69
Q

What are the 3 phases of swallowing

A

1) Oral Stage (voluntary):
- tongue pushes bolus up against palate and then posteriorly into oropharynx

2) Pharyngeal Stage:
- soft palate elevates to close nasopharynx
- larynx closes and elevates causing the epiglottis to block the trachea

3) Oesophageal phase:
- bolus is forced inferiorly into the oesophagus
- the cricopharyngeus muscle relaxes when it meets the bolus to allow it into the oesophagus
- then contracts to prevent regurgitation
- peristalsis+ gravity pushes it down

70
Q

how would you investigate a neck lump

A

neck ultrasound

fine needle aspiration

71
Q

how do you investigate dysphagia

A

full blood count for iron deficiency anaemia

chest X-ray

CT/ MRI neck (if suspect malignancy)

Barium swallow

72
Q

how do you investigate dysphonia

A

flexible nasendoscopy to check larynx

blood tests e.g. thyroid function if appropriate

73
Q

what are some red flag symptoms of a patient with dysphonia

A

history of smoking/ drinking

neck mass

weight loss

persistent and worsening hoarseness

immunocompromised

74
Q

what is the most common cause of bacterial tonsilitis

A

Group A beta haemolytic streptococci

aka strep pyogenes

other examples are haemophilia influenza, strep pneumonia

75
Q

how does tonsillitis present

A
  • sore throat
  • odynophagia (painful swallowing)
  • dysphagia
  • otalgia
  • malaise and headache
  • pyrexia (fever)
  • swollen tonsils +/- exudate
  • thick, hot potato voice
76
Q

how do you manage tonsillitis

A

resolves after 5-7 days

if it is bad then antibiotics or tonsillectomy (recurrent sore throat due to tonsillitis)

77
Q

what is a pharyngeal pouch

A

aka Zenker’s diverticulum

out-pouching of the mucosa/ submucosa in the pharynx (posterior)

between cricopharyngeus and thyropharyngeus muscles

78
Q

who gets pharyngeal pouches

A

not many people

old men

79
Q

what is the cause of a pharyngeal pouch

A

unknown

possibly due to incoordination of opening of cricopharyngeus muscle and peristaltic contractions moving food down

80
Q

how does a pharyngeal pouch present

A

can be asymptomatic if small

progressive dysphagia

sensation of lump in throat

regurgitation of undigested food

81
Q

how do you investigate for a pharyngeal pouch

A

barium swallow is definitive

82
Q

how do you treat a pharyngeal pouch

A

if symptomatic endoscopic stapling

manage conservatively if not

83
Q

what is globus pharyngeus

A

the sensation of a lump, discomfort or foreign body in the throat without obvious cause

84
Q

how do you investigate globus pharyngeus

A

thorough ENT exam including flexible naropharyngolaryngoscopy

consider barium swallow if smoker/ alcoholic

85
Q

how do you investigate thyroid masses

A

first line= USS of the neck

suspicious nodules should undergo Fine Needle Aspiration Cytology

thyroid function tests

86
Q

what is a thyroglossal cyst

A

cyst formed from the epithelial remnants of the thyoglossal tract (where thyroid gland travelled from the tongue

87
Q

what causes a multi nodular goitre

A

goitre= swelling of thyroid gland

unknown eitiology

result of continuous change in thyroid activity

88
Q

how does multinodular goitre present

A

can be asymptomatic

neck lump which moves on swallowing

multiple irregular nodules

if large it causes pressure symptoms e.g. breathlessness, dysphagia

pain and acute swelling if ruptures

89
Q

how do you treat a multi nodular goitre

A

non-operative

watch and wait

if hyperthyroid anti-thyroid drugs

suspect cancer

90
Q

How do you classify a thyroid nodule after fine needle aspiration

A

THY1= non diagnostic (not enough cells)

THY2= non-neoplastic

THY3= follicular lesion-> surgical resection

THY4= suspicious but non-diagnostic of malignancy

THY5= malignancy

91
Q

what are the 2 most common types of thyroid cancer

A

Papillary= most common (85%)

Follicular= second most common( 5-15%)

92
Q

who gets papillary/ follicular thyroid cancer

A

papillary= adolescents, young adults

follicular= middle aged/ older

93
Q

how do the presentations of papillary and follicular thyroid cancer differ

A

papillary= 1 or more painless nodules which are cold

follicular= slowly enlarging painless solitary nodule

basically very similar

94
Q

what is the name for the commonest benign tumour of the salivary glands

A

pleomorphic adenoma

these can transform in 2-5% of cases

95
Q

what are the 2 most common salivary gland tumours

A

mucoepidermoid carcinoma

metastasis from skin primary

96
Q

how does a salivary gland tumour present

A

slowly growing painless mass

red flags for malignancy:

  • facial palsy
  • hardness
  • rapid growth
  • ulceration of skin
97
Q

what is the most common type of cancer in the oral cavity

A

SCC

98
Q

what are risk factors for oral cavity cancers

A

smoking

alcohol

betel nut

chronic dental infection

immunosupression

99
Q

how does a cancer in the oral cavity present

A

painless ulcer/ lump

increasing size of tumour can affect speech/ swallowing

red, velvety mucous membrane

non-healing ulcer

100
Q

how does a carcinoma of the nasopharynx present

A

cervical lymphadenopathy

otalgia, otitis media

epistaxis

discharge

changes in smell

nasal obstruction

101
Q

how does a laryngeal cancer present

A

hoarse voice

noisy breathing/ stridor late

cough

haemoptysis

odynophagia

102
Q

how does laryngopharyngeal reflux present

A

hoarsness

throat clearing

chronic cough

globus pharyngeus

dysphagia

103
Q

how do you treat laryngopharyngeal reflux

A

lifestyle modification:

  • don’t eat before sleep
  • stop smoking
  • obesity
  • cessate fizzy drinks
  • avoid throat clearing

PPIs commonly prescribed despite not being very good

104
Q

what is the most common cause of sleep apnoea

A

obstruction e.g. nasal polyps, large tonsils, airway collapse due to obesity

105
Q

how do you treat obstructive sleep apnoea

A

weight loss
alcohol
adapt sleeping position (not supine)
nasal dilators

106
Q

what is a septal haematoma

A

when blood collects between the septa cartilage and its surrounding perichondrium

increases risk fo septal cartilage necrosis, perforation and deformity

107
Q

how does a deep neck space infection present

A 
pain
trismus (unable to fully open mouth)
dysphagia
dysphonia
stridor 
drooling

pyrexic and malaise

ENT (1 decks)

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