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)
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
3
Q
what investigations would you perform for vertigo
A
Full neuro exam
pure tone audiometry to determine hearing loss
Dix-Hallpike test
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
5
Q
how does excessive earwax present
A
hearing loss
blocked feeling
wax on otoscope
6
Q
how does otitis media with effusion present
A
hearing loss
popping, clicking/ pressure
dull tympanic membrane, bubbles on otoscope
7
Q
how does tympanic membrane perforation present
A
hearing loss
may have middle ear discharge if active infection
8
Q
how does otosclerosis present
A
hearing loss
unilateral or bilateral- progressive
associated tinnitus (
no other signs
advanced can cause dizziness
9
Q
how does cholesteatoma present
A
hearing loss
chronic smelly discharging ear
insidious and slowly progressive symptoms
visible in otoscope
10
Q
how does presbycusis
A
bilateral gradual onset hearing loss over many years
normal otoscope
11
Q
how does vestibular schwannoma
A
aka acoustic neuroma
presents with asymmetric hearing loss over months
tinnitus
normal otoscopy
12
Q
how do you treat hearing loss
A
hearing aids if mild
depends on cause:
tympanoplasty to repair TM
cochlear implantation
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)
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)
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
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
17
Q
what is facial palsy
A
temporary or permanent paralysis of the facial nerve
most commonly caused by bell’s palsy
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
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
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
21
Q
how do you treat facial palsy
A
eye care- tape eyelids shut
oral steroids for bells palsy
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
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
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
25
what is the likely diagnosis when you see pain anterior to tragus and worse when eating
normal eardrum, tender jaw
TemporoMandibular Joint dysfunction
26
what is otorrhoea
any fluid discharged from the ear
e.g. wax, pus, blood, mucous
often caused by infection
27
which infections most commonly cause otorrhoea
pseudomonas aeruginosa
staph. aureus
strep. pneumonia
28
how does fungal otitis external present
otorrhoea
itchy ear canal
fluffy coating of the canal
29
how does acute otitis media present
recent URTI
deep severe ear pain which precedes discharge and improves after discharge disappears
mucoid ear discharge
30
how does bacterial otitis external presentation differ from fungal otitis externa
both present with itchy ear canal and pain
bacterial presents with thin watery discharge
fungal present with fluffy coating
31
what are some risk factors for otitis externa
swimming
warm/ humid climates
underlying skin condition e.g.
eczema
immunosupression
trauma
32
what are the common bacterial causes of otitis externa
pseudomonas aeruginosa
Staph. epidermis
Staph. aureus
note that it can be fungal also
33
how does otitis externa present
```
otalgia
pruritis
discharge
hearing loss if canal is stenosed
pain on moving pinna/ tragus
external auditory meatus swelling
```
34
how do you treat otitis externa
micro suction
topical antibiotic and steroid ear drops.g. ciprofloxacin or Acetic acid 2%
35
what are some risk factors for otitis media
```
lack of breastfeeding
attending nursery
positive family history
6-18 months
exposure to smoking
```
36
what causes otitis media (mechanism)
URTI results in inflammation of the upper airways and the subsequent swelling blocks the Eustachian tube
37
what are the common causes of otitis media
viral infections 2/3rds:
- respiratory syncytial virus
- rhinovirus (cold)
- enterovirus
Bacterial:
- strep. pneumoniae
- haemophilus influenza
- moraxella catarrhalis
38
how does otitis media present
rapid onset otalgia, fever, irritability
after upper RTI
anorexia, vomiting
fever
ear pulling and irritability (children)
vomiting
otalgia
39
how do you treat otitis media
analgesia e.g. ibuprofen
antipyretic e.g. paracetamol
oral antibiotics if no improvement within 2 days e.g. Amoxicillin
40
what is the difference between otitis media and otitis media with effusion
OME presents with fluid without signs of infection
aka glue ear
41
what causes otitis media with effusion
Eustachian tube dysfunction
often follows acute otitis media
42
how do you treat otitis media with effusion
watch and wait (50% resolves)
hearing aid in the meantime
antibiotics not advised
43
what are the two types of chronic otitis media
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
how do you manage epistaxis
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
what are the symptoms of rihinitis vs rhinosinusitis
Both:
- runny nose
- post nasal drip
- nasal congestion
rhinitis:
- sneezing
- itching
rhinos sinusitis:
- facia headache
- hyposmia
46
what type of hypersensitivity reaction is allergic rhinitis
Type 1
IgE mediated
47
how does allergic rhinitis show on flexible nasendoscopy
inflamed nasal turbinates and mucosa
bluish, pale hue to the turbinate mucosa
watery nasal discharge
gross turbinate hypertrophy
48
how do you investigate allergic rhinitis
skin-prick allergy test
histamine (positive) and saline (negative) controls are inserted into dermis along with various allergens
49
how would you treat allergic rhinitis
avoid allergen exposure
nasal douching
oral antihistamine e.g. loratidine
Intra-nasal steroids (sprays) e.g. Beclomethasone, Fluticasone
50
how do nasal polyps present
very common
symptoms of nasal blockage
+/- change in smell perception
typically bilateral
51
how do you treat nasal polyps
short course of oral steroids e.g. prednisolone
then intra-nasal steroid drop
then intra-nasal steroid spray e.g. Mometasone
52
how do Sino-nasal malignancies present
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
what are the most common types of Sino-nasal cancer
squamous cell carcincoma
adenocarcinoma
54
what is a cleft lip/ palate
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
how does a cleft lip/ palate present
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
what is the function of orbiculares oris
closes the lips
think whistling
57
what is the function of the buccinator muscle
deepest face muscle
function is suckling in kids
lies between the mandible and the maxilla
58
what is the function of platysma
depresses the mandible
shaving muscle
59
what is the function of orbiulcaris oculi
closes eye
60
what is the function of the temporals muscle
mastication
elevates the mandible closing and retracting the mouth
61
what is the function of the masseter muscle
elevation of the mandible
closes the mouth
62
what is the function of the medial and lateral pterygoid muscles
lateral= protrusion, depression, medial movement of the mandible (fibres horizontal)
medial= elevation and protrusion of the mandible (fibres are vertical)
63
which branch of which nerve innervates all the muscles of mastication
the mandibular branch of the trigeminal nerve
64
what are the 3 branches of the trigeminal nerve
opthalmic
maxillary
mandibular
65
which is the most powerful muscle of mastication?
masseter
elevates the mandible
66
what are the 3 main salivary glands, what do they produce and where are they
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
what are the 3 types of papillae that cover the surface of the tongue
filiform- keratinocytes (white)
fungiform (contain taste buds)
circumvallate papillae (aligned in a V shape dividing anterior 2/3rds tongue from post
68
where is the embryological site of the thyroid gland
apex of the circumvallate papillae
| one of the 3 types of papillae that cover the surface of the tongue
69
What are the 3 phases of swallowing
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
how would you investigate a neck lump
neck ultrasound
fine needle aspiration
71
how do you investigate dysphagia
full blood count for iron deficiency anaemia
chest X-ray
CT/ MRI neck (if suspect malignancy)
Barium swallow
72
how do you investigate dysphonia
flexible nasendoscopy to check larynx
blood tests e.g. thyroid function if appropriate
73
what are some red flag symptoms of a patient with dysphonia
history of smoking/ drinking
neck mass
weight loss
persistent and worsening hoarseness
immunocompromised
74
what is the most common cause of bacterial tonsilitis
Group A beta haemolytic streptococci
aka strep pyogenes
other examples are haemophilia influenza, strep pneumonia
75
how does tonsillitis present
- sore throat
- odynophagia (painful swallowing)
- dysphagia
- otalgia
- malaise and headache
- pyrexia (fever)
- swollen tonsils +/- exudate
- thick, hot potato voice
76
how do you manage tonsillitis
resolves after 5-7 days
if it is bad then antibiotics or tonsillectomy (recurrent sore throat due to tonsillitis)
77
what is a pharyngeal pouch
aka Zenker's diverticulum
out-pouching of the mucosa/ submucosa in the pharynx (posterior)
between cricopharyngeus and thyropharyngeus muscles
78
who gets pharyngeal pouches
not many people
old men
79
what is the cause of a pharyngeal pouch
unknown
possibly due to incoordination of opening of cricopharyngeus muscle and peristaltic contractions moving food down
80
how does a pharyngeal pouch present
can be asymptomatic if small
progressive dysphagia
sensation of lump in throat
regurgitation of undigested food
81
how do you investigate for a pharyngeal pouch
barium swallow is definitive
82
how do you treat a pharyngeal pouch
if symptomatic endoscopic stapling
manage conservatively if not
83
what is globus pharyngeus
the sensation of a lump, discomfort or foreign body in the throat without obvious cause
84
how do you investigate globus pharyngeus
thorough ENT exam including flexible naropharyngolaryngoscopy
consider barium swallow if smoker/ alcoholic
85
how do you investigate thyroid masses
first line= USS of the neck
suspicious nodules should undergo Fine Needle Aspiration Cytology
thyroid function tests
86
what is a thyroglossal cyst
cyst formed from the epithelial remnants of the thyoglossal tract (where thyroid gland travelled from the tongue
87
what causes a multi nodular goitre
goitre= swelling of thyroid gland
unknown eitiology
result of continuous change in thyroid activity
88
how does multinodular goitre present
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
how do you treat a multi nodular goitre
non-operative
watch and wait
if hyperthyroid anti-thyroid drugs
suspect cancer
90
How do you classify a thyroid nodule after fine needle aspiration
THY1= non diagnostic (not enough cells)
THY2= non-neoplastic
THY3= follicular lesion-> surgical resection
THY4= suspicious but non-diagnostic of malignancy
THY5= malignancy
91
what are the 2 most common types of thyroid cancer
Papillary= most common (85%)
Follicular= second most common( 5-15%)
92
who gets papillary/ follicular thyroid cancer
papillary= adolescents, young adults
follicular= middle aged/ older
93
how do the presentations of papillary and follicular thyroid cancer differ
papillary= 1 or more painless nodules which are cold
follicular= slowly enlarging painless solitary nodule
basically very similar
94
what is the name for the commonest benign tumour of the salivary glands
pleomorphic adenoma
these can transform in 2-5% of cases
95
what are the 2 most common salivary gland tumours
mucoepidermoid carcinoma
metastasis from skin primary
96
how does a salivary gland tumour present
slowly growing painless mass
red flags for malignancy:
- facial palsy
- hardness
- rapid growth
- ulceration of skin
97
what is the most common type of cancer in the oral cavity
SCC
98
what are risk factors for oral cavity cancers
smoking
alcohol
betel nut
chronic dental infection
immunosupression
99
how does a cancer in the oral cavity present
painless ulcer/ lump
increasing size of tumour can affect speech/ swallowing
red, velvety mucous membrane
non-healing ulcer
100
how does a carcinoma of the nasopharynx present
cervical lymphadenopathy
otalgia, otitis media
epistaxis
discharge
changes in smell
nasal obstruction
101
how does a laryngeal cancer present
hoarse voice
noisy breathing/ stridor late
cough
haemoptysis
odynophagia
102
how does laryngopharyngeal reflux present
hoarsness
throat clearing
chronic cough
globus pharyngeus
dysphagia
103
how do you treat laryngopharyngeal reflux
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
what is the most common cause of sleep apnoea
obstruction e.g. nasal polyps, large tonsils, airway collapse due to obesity
105
how do you treat obstructive sleep apnoea
weight loss
alcohol
adapt sleeping position (not supine)
nasal dilators
106
what is a septal haematoma
when blood collects between the septa cartilage and its surrounding perichondrium
increases risk fo septal cartilage necrosis, perforation and deformity
107
how does a deep neck space infection present
```
pain
trismus (unable to fully open mouth)
dysphagia
dysphonia
stridor
drooling
```
pyrexic and malaise
