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otolaryngology > Disease Profiles > Flashcards

Disease Profiles Flashcards

1
Q

Otitis Externa

A

Inflammation of the outer ear canal

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2
Q

Otitis Externa: Bacterial Causes (3)

A

Staphylococcus aureus
Proteus species
Pseudomonas aeruginosa

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3
Q

Otitis Externa: Fungal causes (2)

A

Aspergillus niger
Candida albicans

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4
Q

Otitis Externa: Common triggers (2)

A

Water exposure
Cotton buds

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5
Q

Otitis Externa: Clinical Presentation - Ear Canal

A

Redness and swelling of the skin of the ear canal that may be itchy and painful

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6
Q

Otitis Externa: Clinical Presentation - What may be produced? (2)

A

Discharge
Excess ear wax

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7
Q

Otitis Externa: Management - First line

A

Topical aural toilet (ear clean)

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8
Q

Otitis Externa: Management - When is microbiology and antimicrobials used?

A

In unresponsive cases

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9
Q

Otitis Externa: Management - Fungal unresponsive treatment

A

Topical clotrimazole

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10
Q

Otitis Externa: Management - Bacterial unresponsive treatment

A

Gentamicin ear drops

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11
Q

Otitis Externa: Management - When may systemic antibiotics be required?

A

If cellulitis develops in the pinna or parotid region

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12
Q

Otitis Externa: Management - In cases of eczematous otitis externa

A

Steroid without antibiotics

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13
Q

Acute Otitis Media

A

Acute inflammation of the middle ear with or without an accumulation of fluid

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14
Q

Acute Otitis Media: Commonly associated with what other pathophysiology?

A

Upper Respiratory Tract Infection

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15
Q

Acute Otitis Media: Most common bacterial causes (3)

A

Haemophilus influenzae
Streptococcus pneumoniae
Streptococcus pyogenes

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16
Q

Acute Otitis Media: Aetiologies of chronic cases (3)

A

Pseudomonas aeruginosa
Staphylococcus aureus
Fungus

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17
Q

Acute Otitis Media: Pathophysiology

A

Infection extends from the throat to the ear via the Eustachian Tube

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18
Q

Acute Otitis Media: Symptoms (3)

A

Ear Pain
Fever
Irritability

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19
Q

Acute Otitis Media: Signs - What may present in the middle ear?

A

Effusion

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20
Q

Acute Otitis Media: Signs - Tympanic membrane appearance

A

Opaque
Bulging
May have impaired mobility

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21
Q

Acute Otitis Media: Diagnosis -What is required if the eardrum perforates?

A

A swab of pus

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22
Q

Acute Otitis Media: Management - First line

A

Self-limiting - 80% resolve in 4 days

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23
Q

Acute Otitis Media: Management - What antibiotics if indicated? (2)

A

Amoxicillin
Erythromycin

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24
Q

Acute Otitis Media: Complications - How may an abscess form?

A

Spread via the mastoid causes bone breakdown behind the ear and forms an abscess

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25
Q

Acute Otitis Media: Complications (7)

A

Sensorineural hearing loss
Tinnitus
Acute mastoiditis
Brain abscess or meningitis
Vertigo
Facial palsy
Venous sinus thrombosis

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26
Q

Acute Mastoiditis

A

Complication of acute otitis media involving infection of mastoid air cells

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27
Q

Acute Mastoiditis: Most common bacterial aetiologies

A

Streptococcus pneumoniae
Haemophilus influenzae

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28
Q

Acute Mastoiditis: Why are mastoid air cells suitable for infection?

A

Porous nature makes them suitable for pathogenic replication

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29
Q

Acute Mastoiditis: Clinical Presentation (3)

A

Pain, Tenderness and Swelling behind the ear

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30
Q

Acute Mastoiditis: Management

A

IV antibiotics
Surgical drainage for severe cases

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31
Q

Acute Mastoiditis: Main complication

A

Meningitis - by spreading to the middle cranial fossa and thus the brain

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32
Q

Referred Otalgia: Auriculo-temporal Branch of the Trigeminal Nerve - Aetiologies associated with the lower mandibular (3)

A

Dental abscess
Dental caries
Impacted molar teeth

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33
Q

Referred Otalgia: Auriculo-temporal Branch of the Trigeminal Nerve - Aetiologies of Salivary Gland Disease (3)

A

Infection e.g. mumps
Stones
Neoplasm

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34
Q

Referred Otalgia: Auriculo-temporal Branch of the Trigeminal Nerve - Aetiologies associated with stress

A

Tooth grinding

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35
Q

Referred Otalgia: Auriculo-temporal Branch of the Trigeminal Nerve - Aetiologies associated with Temporomandibular Joint Lesions

A

Costen’s Syndrome

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36
Q

Referred Otalgia: Sensory Branch of the Facial Nerve - Aetiologies (4)

A

Geniculate herpes
Ramsay Hunt Syndrome
Sphenoid or Ethmoidal Sinus Pathology
Nasal Pathology

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37
Q

Referred Otalgia: Tympanic Branch of the Glossopharyngeal Nerve - Aetiologies (4)

A

Tonsillitis or Quinsy
Post-tonsillectomy
Carcinoma of the posterior third of the tongue or tonsil
Neuralgia of the glossopharyngeal nerve

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38
Q

Referred Otalgia: Vagus Nerve - Aetiologies (5)

A

Foreign body in the piriform fossa
Carcinoma of the piriform fossa
Carcinoma of the larynx
Post-cricoid carcinoma
Sepsis - piriform abscess

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39
Q

Referred Otalgia: Greater auricular nerve (C2/3) - Aetiologies (2)

A

Cervical neuritis
Herpes zoster

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40
Q

Referred Otalgia: Lesser occipital nerve (C3) - Aetiologies (3)

A

Cervical spondylitis
Cervical neuritis
Herpes zoster

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41
Q

Cholesteatoma

A

Growth consisting of keratinising squamous epithelium in the middle ear and or mastoid process

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42
Q

Cholesteatoma: Acquired Aetiologies (2)

A

Chronic otitis media
Perforated tympanic membrane

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43
Q

Cholesteatoma: Congenital Aetiology

A

Proliferation of the embryonic crest

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44
Q

Cholesteatoma: What is a key risk factor?

A

Frequent ear surgery in history

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45
Q

Cholesteatoma: Pathophysiology

A

Keratin becomes trapped and builds up within the ear that expands to erode surrounding bone

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46
Q

Cholesteatoma: Histology

A

Squamous epithelium with abundant keratin production and associated with inflammation

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47
Q

Cholesteatoma: Common Clinical Presentation

A

Unilateral discharge that is persistent or recurrent that is often foul-smelling

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48
Q

Cholesteatoma: Symptoms may progress to what? (4)

A

Vertigo
Sensorineural hearing loss
Facial nerve palsy
Intracranial abscess or Meningitis

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49
Q

Cholesteatoma: What diagnostic test is used?

A

Otoscopy

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50
Q

Cholesteatoma: Description of Otoscopy findings (2)

A

Retraction of the tympanic membrane
Defect in the tympanic membrane full of white material

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51
Q

Cholesteatoma: Management

A

Mastoid surgery to remove the sac of debris with reconstruction

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52
Q

Cholesteatoma: Complications - Medial (5)

A

Sensorineural Hearing Loss
Tinnitus
Vertigo
Facial Palsy

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53
Q

Cholesteatoma: Complications - Superior (2)

A

Brain Abscess
Meningitis

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54
Q

Cholesteatoma: Complications - Posterior

A

Venous Sinus Thrombosis

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55
Q

Alternate Name for Otitis Media with Effusion

A

Glue Ear

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56
Q

Otitis Media with Effusion

A

Inflammation of the middle ear accompanied by accumulation of fluid without the signs of acute inflammation

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57
Q

Otitis Media with Effusion: Most common in what patient group?

A

2-8 year old children

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58
Q

Otitis Media with Effusion: Associated with what pathology?

A

Eustachian tube dysfunction or obstruction

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59
Q

Otitis Media with Effusion: More common in what sex?

A

Males

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60
Q

Otitis Media with Effusion: Most common aetiologies (3)

A

Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis

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61
Q

Otitis Media with Effusion: Aetiologies in Adults (3)

A

Rhinosinusitis
Nasopharyngeal carcinoma
Nasopharyngeal lymphoma

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62
Q

Otitis Media with Effusion: Clinical Presentation (2)

A

Deafness
Problems associated with hearing loss - poor performance or behavioural problems or speech delay

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63
Q

Otitis Media with Effusion: Clinical Presentation -Main sign

A

Middle ear effusion - showing fluid or bubbles

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64
Q

Otitis Media with Effusion: Clinical Presentation -Signs of Tympanic Membrane (3)

A

Altered colour
Retracted
Impaired mobility

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65
Q

Otitis Media with Effusion: Diagnosis - 3 possible assessments

A

Otoscopy
Tuning fork tests
Age-appropriate hearing assessment - Audiometry or Tympanometry

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66
Q

Otitis Media with Effusion: Diagnosis - Tuning fork tests show what?

A

Conductive hearing loss

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67
Q

Otitis Media with Effusion: Diagnosis - Audiometry shows what?

A

Conductive hearing loss

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68
Q

Otitis Media with Effusion: Diagnosis - Tympanometry shows what?

A

Flat tracing

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69
Q

Otitis Media with Effusion: Management - First Line

A

Watch and wait - 90% resolve in 3 months

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70
Q

Otitis Media with Effusion: Management - When is the case reviewed if watchful waiting?

A

3 months

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71
Q

Otitis Media with Effusion: Management - When to refer to surgery (4)

A

Persistent (>3 months) bilateral Otitis Media with effusion
Conductive Hearing Loss >25 dB
Speech or language problems
Developmental or behavioural problems

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72
Q

Otitis Media with Effusion: Management - <3 years surgical approach

A

Grommets - vent the eardrum to allow for fluid drainage

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73
Q

Otitis Media with Effusion: Management - >3 years first line surgical approach

A

Grommets

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74
Q

Otitis Media with Effusion: Management - >3 years if grommet doesn’t work?

A

Adenoidectomy

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75
Q

Otitis Media with Effusion: Management - When may adenoidectomy be considered early?

A

If nasal symptoms are present

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76
Q

Otitis Media with Effusion: Complications of Grommets (4)

A

Infection or discharge
Early extrusion
Retention
Persistent perforation

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77
Q

Perforated Tympanic Membrane: Mainly associated with what?

A

Acute Otitis Media in young individuals

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78
Q

Perforated Tympanic Membrane: Possible aetiologies (2)

A

Sudden negative pressure
Objects within the ear

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79
Q

Perforated Tympanic Membrane: Clinical Presentation (4)

A

Sudden severe pain
Possible - bleeding, hearing loss and tinnitus

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80
Q

Perforated Tympanic Membrane: Diagnostic tests of choice (2)

A

Otoscopy
Audiometry

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81
Q

Perforated Tympanic Membrane: Audiometry shows what?

A

Conductive Hearing Loss

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82
Q

Perforated Tympanic Membrane: Management -First line

A

Normally heals spontaneously

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83
Q

Perforated Tympanic Membrane: Management - When is surgical repair indicated?

A

If the patient is symptomatic with recurrent discharge

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84
Q

Otosclerosis

A

Hereditary disorder in which new bony deposits occur within the stapes footplate and cochlear resulting in gradual hearing loss

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85
Q

Otosclerosis: Most common age

A

20-30 years old

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86
Q

Otosclerosis: More common in what sex?

A

Women

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87
Q

Otosclerosis: Why is it more common in women?

A

High oestrogen is linked to otosclerosis

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88
Q

Otosclerosis: Clinical Presentation

A

Gradual onset hearing loss

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89
Q

Otosclerosis: Diagnostic Test

A

Audiometry

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90
Q

Otosclerosis: Audiometry shows what?

A

Conductive or mixed hearing loss

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91
Q

Otosclerosis: Classic feature on audiometry

A

Carhart’s Notch at 2KHz

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92
Q

Otosclerosis: Management (2)

A

Hearing Aids
Stapedectomy

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93
Q

Prebycusis

A

Degenerative disorder of the cochlear resulting in hearing loss

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94
Q

Prebycusis: Pathophysiology (3)

A

Can be due to:
- Loss of outer hair cells - environmental noise toxicity over time
- Loss of ganglion cells
- Strial atrophy

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95
Q

Prebycusis: Clinical Presentation

A

Gradual onset hearing loss

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96
Q

Prebycusis: Diagnostic Test of Choice

A

Audiometry

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97
Q

Prebycusis: Audiometry - Which frequencies are affected most?

A

Higher frequencies

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98
Q

Prebycusis: Audiometry - Usually shows what type of hearing loss?

A

Sensorineural

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99
Q

Prebycusis: Management

A

High-frequency specific hearing aid

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100
Q

Noise-Induced Hearing Loss: Pathophysiology

A

Cochlear Damage - due to e.g. shooting or industrial noise

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101
Q

Noise-Induced Hearing Loss: Test of choice

A

Audiometry

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102
Q

Noise-Induced Hearing Loss: Audiometry - What type of hearing loss is there?

A

Sensorineural

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103
Q

Noise-Induced Hearing Loss: Audiometry - Characteristic dip where?

A

4kHz

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104
Q

Drug-Induced Hearing Loss: What drugs can cause hearing loss? (5)

A

Gentamicin - an other aminoglycosides
Cisplatin
Vincristine
Aspirin
NSAID overdose

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105
Q

Vestibular Schwannoma

A

Benign tumour of the CN VIII nerve sheath that arises in the internal auditory meatus

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106
Q

Vestibular Schwannoma: May be associated with what risk factor?

A

Extensive exposure to excessive loud noise

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107
Q

Vestibular Schwannoma: If it is bilateral and in a young patient what must be considered?

A

Neurofibromatosis Type 2

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108
Q

Vestibular Schwannoma: Location

A

Temporal bone - 80-90% are cerebellopontine angle tumours

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109
Q

Vestibular Schwannoma: Gross appearance

A

Circumscribed tan/white/yellow mass

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110
Q

Vestibular Schwannoma: Histology

A

Encapsulated mass with two possible growth patterns - Antoni A or B

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111
Q

Vestibular Schwannoma: Clinical Presentation - (3)

A

Progressive sensorineural unilateral hearing loss
Tinnitus
Facial Numbness

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112
Q

Vestibular Schwannoma: Clinical Presentation - Common presentation in larger tumours

A

Imbalance

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113
Q

Vestibular Schwannoma: Clinical Presentation - Pathophysiology of Facial Numbness

A

Compression of the trigeminal nerve as the tumour enlarges

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114
Q

Vestibular Schwannoma: Diagnostic Test

A

MRI

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115
Q

Vestibular Schwannoma: Gold standard management

A

Surgical excision

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116
Q

Vestibular Schwannoma: Management - Small lesions require what management?

A

Monitoring by MRI within a 6 month interval

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117
Q

Allergic Rhinitis: Pathophysiology

A

IgE-mediated allergic reaction - Type I Hypersensitivity - that causes the generation of histamine and leukotrienes

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118
Q

Allergic Rhinitis: Definition of Intermittent

A

Symptoms <4 days per week or symptoms for <4 weeks

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119
Q

Allergic Rhinitis: Definition of Persistent

A

Symptoms >4 days per week AND >4 weeks of duration

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120
Q

Allergic Rhinitis: What classification system is used?

A

ARIA Classification

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121
Q

Allergic Rhinitis: ARIA Classification - Mild definition

A

Normal sleep with symptoms that do not affect the patients day to day life

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122
Q

Allergic Rhinitis: ARIA Classification - Moderate-Severe definition

A

Involves >1 - abnormal sleep, impaired activities and missed school or work

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123
Q

Allergic Rhinitis: ARIA Classification - Clinical presentation (4)

A

Sneezing
Nasal itching
Nasal discharge and congestion
Allergic crease indicates repeated itching of the nose

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124
Q

Allergic Rhinitis: Management - First Line

A

Allergen Avoidance

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125
Q

Allergic Rhinitis: Management - Second Line Options (3)

A

Anti-histamines e.g. Cetrizine
Topical Corticosteroids e.g. Beclomethasone
Anti-histamines + Corticosteroids

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126
Q

Allergic Rhinitis: Management - Third Line

A

Immunotherapy e.g. Montelukast

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127
Q

Allergic Rhinitis: Management - Option for mucosal hypertrophy

A

Diathermy

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128
Q

Non-Allergic Rhinitis

A

Inflammation of the inside of the nose that is not due to allergy

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129
Q

Non-Allergic Rhinitis: Aetiologies (5)

A

Infection
Vasomotor rhinitis
Occupational rhinitis
Hormonal rhinitis
Drug-induced rhinitis

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130
Q

Non-Allergic Rhinitis: Pathophysiology - Vasomotor Rhinitis

A

Parasympathetic overdrive within the nose

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131
Q

Non-Allergic Rhinitis: Pathophysiology - Aetiologies of Vasomotor Rhinitis (5)

A

Chemical irritants
Changes in weather
Excess humidity
Dry atmosphere
Stress

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132
Q

Non-Allergic Rhinitis: Pathophysiology - Associations with Hormonal Rhinitis (2)

A

Pregnancy
Hormonal medication - HRT or Contraceptive Pill

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133
Q

Non-Allergic Rhinitis: Pathophysiology - Examples of Drug-induced Rhinitis (4)

A

ACE Inhibitors
Beta Blockers
NSAIDs
Cocaine

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134
Q

Non-Allergic Rhinitis: Pathophysiology

A

Lining of the nose becomes swollen and inflamed due to vasodilated blood vessels and build up of fluid in the nose causing blockage of nasal passages

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135
Q

Non-Allergic Rhinitis: Clinical Presentation (4)

A

Rhinorrhoea
Sneezing
Itchy nose
Nasal congestion

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136
Q

Non-Allergic Rhinitis: Management for vasomotor rhinitis

A

Ipratropium (anti-cholinergic)

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137
Q

Non-Allergic Rhinitis: Complications (2)

A

Sinusitis
Nasal polyps

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138
Q

Acute Sinusitis

A

Symptomatic inflammation of the paranasal sinuses with symptoms that last for less than 12 weeks

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139
Q

Acute Sinusitis: Usually followed by what?

A

Viral respiratory tract infection

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140
Q

Acute Sinusitis: Most commonly preceded by what?

A

Rhinitis

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141
Q

Acute Sinusitis: Preceding rhinitis can spread from what?

A

Dentition

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142
Q

Acute Sinusitis: Most common organisms (3)

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

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143
Q

Acute Sinusitis: In adults it is diagnosed by what?

A

Presence of nasal blockage or discharge with facial pain/pressure/headache and/or reduction of the sense of smell

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144
Q

Acute Sinusitis: What indicates secondary bacterial infection?

A

Severe pain and tenderness with purulent nasal discharge

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145
Q

Acute Sinusitis: Management - First Line

A

Analgesics and Nasal Decongestants

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146
Q

Acute Sinusitis: Management - Consider prescribing what if symptoms are around for 10 days with no improvement?

A

High dose nasal corticosteroid

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147
Q

Acute Sinusitis: Management - Consider what management for severe cases of >10 days duration?

A

First line - Phenocymethylpenicillin
Second Line - Doxycycline (not in children)

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148
Q

Acute Sinusitis: Main Complications (2)

A

Spread of infection from sinuses to the orbit - cellulitis, periosteal abscess or orbital abscesses

Thrombosis of retinal vein or cavernous sinus - spread into the superior sagittal sinus

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149
Q

Nasal Polyps

A

Soft painless non-cancerous growths on the lining of nasal passages

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150
Q

Nasal Polyps: Aetiologies - Often associated with what pathology?

A

Non-allergic asthma

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151
Q

Nasal Polyps: Aetiologies (4)

A

Allergy
Infection
Aspirin sensitivity
Nickel exposure

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152
Q

Nasal Polyps: Aetiologies - If they are young what may be the cause?

A

Cystic Fibrosis

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153
Q

Nasal Polyps: Pathophysiology

A

Inflammation and oedema of the sinus nasal mucosa that prolapses into the nasal cavity to cause significant obstruction

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154
Q

Nasal Polyps: Histology

A

Lined by respiratory or squamous epithelium and oedematous stroma containing mixed inflammatory cells +/- eosinophils

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155
Q

Nasal Polyps: Clinical Presentation (3)

A

Blocked nose
Runny nose
Reduced sense of taste or smell

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156
Q

Nasal Polyps: What investigation is done?

A

Nasoendoscopy

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157
Q

Nasal Polyps: Management

A

Oral then topical steroids

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158
Q

Nasal Polyps: Management if polyps are large

A

Surgical removal

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159
Q

Granulomatosis with Polyangiitis

A

Inflammation of small and medium-sized blood vessels that results in damage to organ systems within the body

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160
Q

Granulomatosis with Polyangiitis: Normal age

A

> 40 years old

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161
Q

Granulomatosis with Polyangiitis: Pathophysiology

A

Autoimmune disorder characterised by small vessel vasculitis and necrosis limited to the respiratory system and kidneys

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162
Q

Granulomatosis with Polyangiitis: Clinical Presentation (6)

A

Sinusitis
Nasal crushing - saddle nose
Epistaxis
Oral ulcers
Sensorineural deafness
Otitis media

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163
Q

Granulomatosis with Polyangiitis: Why does saddle nose occur?

A

Cartilage damage from ischaemia

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164
Q

Granulomatosis with Polyangiitis: Diagnosis

A

Characterised by high frequency ANCA antibodies
- cANCA - GPA
- pANCA - microscopic polyangiitis

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165
Q

Granulomatosis with Polyangiitis: Management

A

IV steroids and Cyclophosphamide

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166
Q

Tumours of the Nose: Benign Lesions - Most common

A

Squamous Cell Papillomas

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167
Q

Tumours of the Nose: Benign Lesions - Examples (3)

A

Sinonasal Papillomas
Recurrent Respiratory Papillomatosis
Angiofibromas

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168
Q

Sinonasal Papillomas: Aetiology (2)

A

HPV
Organic Solvents

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169
Q

Sinonasal Papillomas: More common age

A

> 50 years old

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170
Q

Sinonasal Papillomas: More common in what sex?

A

Males

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171
Q

Sinonasal Papillomas: Histology - Three types

A

Inverted
Exophytic
Oncocytic

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172
Q

Sinonasal Papillomas: Histology - Location of inverted types

A

Lateral walls and paranasal sinuses

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173
Q

Sinonasal Papillomas: Histology - Location of oncocytic types

A

Lateral walls and paranasal sinuses

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174
Q

Sinonasal Papillomas: Histology - Locatio of exophytic types

A

Nasal Septum

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175
Q

Sinonasal Papillomas: Recurrent Respiratory Papillomatosis

A

Rare condition in which papillomas form along the aerodigestive tract

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176
Q

Sinonasal Papillomas: Recurrent Respiratory Papillomatosis - Associated with what?

A

HPV

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177
Q

Sinonasal Papillomas: Recurrent Respiratory Papillomatosis - Clinical presentation in children

A

Hoarse voice and progressive SOB

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178
Q

Tumours of the Nose: Malignant Lesion Examples (5)

A

Squamous Cell Carcinoma
Nasopharyngeal Carcinoma
Primary Adenocarcinoma
Neuroblastoma
Lymphoma

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179
Q

Most common malignant lesion of the nose

A

Squamous Cell Carcinoma

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180
Q

Nasopharyngeal Carcinoma: High incidence where?

A

Far east

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181
Q

Nasopharyngeal Carcinoma: More common in what sex?

A

Males

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182
Q

Nasopharyngeal Carcinoma: Associated with what? (2)

A

EBV
Volatile Nitrosamines in food

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183
Q

Nasopharyngeal Carcinoma: Histology

A

Keratinising SCC + Non-keratinising SCC + Baseloid SCC

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184
Q

Sub-glottic Stenosis

A

Narrowing of the airway below the vocal cords and above the trachea

185
Q

Sub-glottic Stenosis: In adults it is seen in association with what?

A

Vasculitis

186
Q

Sub-glottic Stenosis: Clinical Presentation

A

Progressive breathing difficulty that is exacerbated by exertion

187
Q

Hand, Foot and Mouth Disease

A

Clinical syndrome characterised by an oral enanthem and a macular, maculopapular or vesicular rash of the hands and feet

188
Q

Hand, Foot and Mouth Disease: Aetiology

A

Coxsackie Viruses

189
Q

Hand, Foot and Mouth Disease: Diagnostic Test

A

Clinical or PCR test of swab

190
Q

Oral Ulcers: Primary Syphillis - How is this acquired?

A

Direct sexual contact with infectious lesions of another person

191
Q

Oral Ulcers: Primary Syphillis - Clinical presentation

A

Genital, Oral and Pharyngeal lesions that are painless and indurated

192
Q

Oral Ulcers: Primary Syphillis - Bacteria

A

Treponema pallidum

193
Q

Oral Ulcers: Mucosal Leishmaniasis - Pathophysiology

A

Involvement of mucosal tissue of the nose, oral cavity and pharynx by Leishmania species

194
Q

Oral Ulcers: Mucosal Leishmaniasis - Common in what locations? (2)

A

Africa
America

195
Q

Oral Ulcers: Behcet’s Disease - Most common clinical presentation

A

Recurrent oral ulcers - can develop genital ulcers and uveitis too

196
Q

Oral Ulcers: Behcet’s Disease - Most common where? (2)

A

Middle East
Asia

197
Q

Oral presentation of Coeliac Disease or IBD

A

Recurrent apthous ulcers

198
Q

What drug reactions can cause oral ulcers? (3)

A

NSAIDs
Beta Blockers
Sulfonamides

199
Q

Oral Ulcers: What skin diseases can also present with oral ulcers? (3)

A

Lichen planus
Pemphigus
Pemphigoid

200
Q

Squamous Cell Papilloma: Arises from what epithelium?

A

Stratified squamous epithelium

201
Q

Squamous Cell Papilloma: Two peaks of incidence

A

<5 years old
20-40 years old

202
Q

Squamous Cell Papilloma: Related to what types of HPV?

A

-6 and -11

203
Q

Squamous Cell Papilloma: Clinical Presentation

A

Painless lesion of the mucosa of the hard and soft palate - can also occur at the tongue, lips, tonsils, skin, oesophagus or cervix

204
Q

Squamous Cell Papilloma: Histology - Macroscopic appearance

A

Exophytic, Sessile or Pedunculated Mass

205
Q

Squamous Cell Papilloma: Histology - Microscopic appearance

A

Finger-like projection with a fibrovascular core that is covered by stratified squamous epithelium

206
Q

Squamous Cell Papilloma: Management Options (3)

A

Cryotherapy
Topical Salicyclic Acid
Surgical excision

207
Q

Salivary Gland Tumours: Two Examples of Benign Tumours

A

Pleomorphic Adenoma
Warthin’s Tumour

208
Q

Salivary Gland Tumours: Two Examples of Malignant Lesions

A

Mucoepidermoid Carcinoma
Adenoid Cystic Carcioma

209
Q

Most common benign tumour of the salivary glands

A

Pleomorphic Adenoma

210
Q

Pleomorphic Adenoma: More common in what sex?

A

Females

211
Q

Pleomorphic Adenoma: Most common age for parotid tumour

A

30-60 years old

212
Q

Pleomorphic Adenoma: Known link to what?

A

Radiation

213
Q

Pleomorphic Adenoma: Macroscopic appearance

A

Well-circumscribed light tan to grey mass

214
Q

Pleomorphic Adenoma: Microscopic Appearance

A

Highly variable epithelial and myoeptihelial cells in chondromyxoid stroma

215
Q

Warthin’s Tumour: More common in what sex?

A

Males

216
Q

Warthin’s Tumour: Most common age

A

> 50 years old

217
Q

Warthin’s Tumour: Strongly associated with what?

A

Smoking

218
Q

Warthin’s Tumour: Macroscopic appearance

A

Well-circumscribed light grey cystic mass

219
Q

Warthin’s Tumour: Microscopic appearance

A

Bilayered oncocytic epithelium with lymphoid stroma

220
Q

Most common malignant salivary tumour worldwide

A

Mucoepidermoid Carcinoma

221
Q

Most common malignant salivary gland tumour in the UK

A

Adenoid Cystic Carcinoma

222
Q

Mucoepidermoid Carcinoma: Low grade

A

> 90% 5 years survival

223
Q

Mucoepidermoid Carcinoma: High grade

A

<60% 5 year survival

224
Q

Mucoepidermoid Carcinoma: Associated with what genetic mutation?

A

MECT1-MAML2 Fusion

225
Q

Mucoepidermoid Carcinoma: Microscopic Appearance

A

Variable mix of squamous, mucous and intermediate cells with solid and cystic components

226
Q

Adenoid Cystic Carcinoma: Most common age

A

> 40 years old

227
Q

Adenoid Cystic Carcinoma: Most common malignant tumour of what structure?

A

Palate

228
Q

Adenoid Cystic Carcinoma: Where does this commonly present in the salivary glands?

A

Parotids

229
Q

Adenoid Cystic Carcinoma: Why may there be associated pain or loss of function symptoms?

A

Due to frequent perineural invasion

230
Q

Adenoid Cystic Carcinoma: Macroscopic appearance

A

Grey or white infiltrative mass

231
Q

Adenoid Cystic Carcinoma: Microscopic appearance

A

Small uniform cells with little cytoplasm within a solid, tubular or cribriform plate

232
Q

Facial nerve palsy suggests what?

A

CN VII damage - common in parotid tumours

233
Q

Salivary Gland Tumours: Management

A

Superficial or total paroidectomy

234
Q

Salivary Gland Tumours: If not removed what is there a risk of?

A

Malignant transformation into an adenoma

235
Q

Salivary Gland Tumours: What is at risk during a parotidectomy? (3)

A

Facial nerve
Retromandibular vein
External carotid artery

236
Q

Sialadenitis

A

Salivary gland infection

237
Q

Sialolithiasis

A

Salivary gland stones

238
Q

Acute Tonsillitis: Main cause

A

Viral

239
Q

Acute Tonsillitis: Viral causes (6)

A

EBV
Rhinovirus
Influenza Virus
Parainfluenza
Enterovirus
Adenovirus

240
Q

Acute Tonsillitis: Most common bacterial cause

A

Streptococcus pyogenes

241
Q

Acute Tonsillitis: Bacterial causes other than Streptococcus pyogenes (2)

A

Haemophilus influenzae
Staphylococcus aureus

242
Q

Acute Tonsillitis: 40% of cases have bacteria that produce what?

A

Beta-lactamase

243
Q

Acute Tonsillitis: Viral Tonsillitis - Time period

A

3-4 days

244
Q

Acute Tonsillitis: Viral Tonsillitis - Clinical Presentation (5)

A

Malaise
Sore throat
Temperature
Able to undertake normal activity
Possible lymphadenopathy

245
Q

Acute Tonsillitis: Bacterial Tonsillitis - Time period

A

1 week

246
Q

Acute Tonsillitis: Bacterial Tonsillitis - Clinical Presentation (6)

A

Systemic upset
Fever
Odynophagia
Halitosis
Unable to work
Lymphadenopathy

247
Q

Acute Tonsillitis: Bacterial Tonsillitis - How is this assessed?

A

FeverPAIN to determine if antibiotics are required for Streptococcus pyogenes

248
Q

Acute Tonsillitis: Bacterial Tonsillitis - FeverPAIN factors

A

Fever
Purulence
Attend rapidly - within 3 days
Very inflamed tonsils
No cough

249
Q

Acute Tonsillitis: When should mononucleosis be suspected?

A

If a sore throat and lethargy persists into the second week and aged 15-25

250
Q

Acute Tonsillitis: Management - What is the first line antibiotic?

A

Penicillin

251
Q

Acute Tonsillitis: Management - What is the first line antibiotic if penicillin allergic?

A

Clarithromycin

252
Q

Acute Tonsillitis: Management - When to refer (6)

A

Stridor
Breathing difficulty
Clinical dehydration
Sore throat for 3-4 weeks
Dysphagia for 3+ weeks
Red/White Patches or Ulceration that persists for 3+ weeks

253
Q

Acute Tonsillitis: Management - When are investigations for throat cancer required?

A

Persistent sore throat with a neck mass

254
Q

Acute Tonsillitis: Management - Infection control for acute Streptococcus pyrogenes infection

A

Isolation for the first 48 hours of treatment
Standard infection control with risk assessment for droplet precaution

255
Q

Acute Tonsillitis: Complications (4)

A

Otitis media
Peritonsillar abscess
Parapharyngeal abscess
Lemierre Syndrome

256
Q

Lemierre Syndrome

A

Suppurative thrombophlebitis of the jugular vein

257
Q

Acute Tonsillitis: Complications - Late complications of Streptococcus pyogenes (2)

A

Rheumatic fever - 3 weeks post throat has fever, arthritis and pericarditis
Glomerulonephritis - haematuria, albuminuria and oedema 1-3 weeks post throat

258
Q

Alternate name for a Peritonsillar Abscess

A

Quinsy

259
Q

Peritonsillar Abscess: Main aetiology

A

Main complication of acute tonsillitis

260
Q

Peritonsillar Abscess: Pathophysiology

A

Bacteria between the muscle and tonsils produce pus

261
Q

Peritonsillar Abscess: Clinical Presentation - Preceded by what?

A

3-7 days of acute tonsillitis

262
Q

Peritonsillar Abscess: Clinical Presentation - Symptoms (4)

A

Unilateral throat pain
Odynophagia
Trismus - muscles spasms into the TMJ
Altered speech

263
Q

Peritonsillar Abscess: Clinical Presentation - Signs (2)

A

Medial displacement of the tonsil and uvula
Concavity of the palate is lost

264
Q

Peritonsillar Abscess: Management

A

Aspiration and IV antibiotics

265
Q

Chronic Tonsillitis

A

Persistent infection of the tonsils with symptoms that persist beyond two weeks

266
Q

Chronic Tonsillitis: Clinical Presentation - Symptom

A

Chronic sore throat

267
Q

Chronic Tonsillitis: Clinical Presentation - Signs (4)

A

Malodourous breath
Presence of tonsilliths
Peritonsillar erythema
Persistent cervical lymphadenopathy

268
Q

Diptheria

A

Contagious bacterial infection that mainly affects the nose and throat

269
Q

Diptheria: Pathophysiology

A

Corynebacterium diptheria produces a potent exotoxin that is cardiotoxic and neurotoxic

270
Q

Diptheria: Clinical Presentation

A

Severe sore throat with a grey-white membrane across the pharynx

271
Q

Diptheria: Management - Severe Cases

A

Antibiotics with Diptheria Anti-toxin

272
Q

Diptheria: First line management

A

Antibiotics - Penicillin or Erythromycin

273
Q

Diptheria: Prevention

A

Toxoid vaccine made from a cell-free purified toxin extracted from a strain of C. diptheriae

274
Q

Infectious Mononucleosis: Alternate Name

A

Glandular Fever

275
Q

Infectious Mononucleosis: Causative Organism

A

Ebstein-Barr Virus

276
Q

Infectious Mononucleosis: Pathophysiology

A

EBV establishes a persistent infection in epithelial cells - particularly the pharynx

277
Q

Infectious Mononucleosis: Clinical Presentation Triad

A

Fever
Pharyngitis
Lymphadenopathy

278
Q

Infectious Mononucleosis: Symptoms (3)

A

Fever
Malaise
Sore throat - tonsillitis and pharyngitis

279
Q

Infectious Mononucleosis: Signs (6)

A

Gross tonsillar enlargement with membranous exudates
Marked cervical and generalised lymphadenopathy
Palatal petchial haemorrhages
Hepatosplenomegaly
Rash

280
Q

Infectious Mononucleosis: What must these patients avoid and why?

A

Avoid contact sports - prevent rupture

281
Q

Infectious Mononucleosis: Diagnosis - Blood results (3)

A

Atypical lymphocytes and lymphocytosis
Low CRP
Deranged liver function tests

282
Q

Infectious Mononucleosis: Diagnosis - What may blood results mimic?

A

Sepsis

283
Q

Infectious Mononucleosis: Diagnosis - Most accurate test

A

EBV serology test

284
Q

Infectious Mononucleosis: Management - First line

A

Self-limiting - rest and paracetamol

285
Q

Infectious Mononucleosis: Management - When and what antibiotics used?

A

To prevent secondary infection - Penicillin

286
Q

Infectious Mononucleosis: Management - Do not prescribe what and why?

A

Ampicillin or Amoxicillin - can cause a generalised macular rash

287
Q

Infectious Mononucleosis: Management - What if it does not improve?

A

Systemic steroids

288
Q

Laryngeal Nodules and Polyps

A

Non-inflammatory response to laryngeal injury caused by vocal cord abuse and irritation

289
Q

Laryngeal Nodules and Polyps: Aetiologies (3)

A

Vocal abuse
Infection
Smoking

290
Q

Laryngeal Nodules and Polyps: May be associated to what disorder?

A

Hypothyroidism

291
Q

Laryngeal Nodules and Polyps: Pathophysiology - Most common Nodule location

A

Bilaterally on the middle 1/3 to posterior 1/3 of the vocal cord

292
Q

Laryngeal Nodules and Polyps: Pathophysiology - Nodules most common in what sex?

A

Women

293
Q

Laryngeal Nodules and Polyps: Pathophysiology - Appearance of Polyps

A

Unilateral and Pedunculated

294
Q

Laryngeal Nodules and Polyps: Clinical Presentation (3)

A

Voice changes - hoarse or raspy voice
Pain
Frequent coughing or throat clearing

295
Q

Laryngeal Nodules and Polyps: Investigation of choice

A

Biopsy

296
Q

Laryngeal Nodules and Polyps: Biopsy appearance

A

Stratified squamous epithelium with oedematous, fibrous or myxoid stroma

297
Q

Contact Ulcer

A

Raw sores on the mucous membrane covering the cartilage to which the vocal cords are attached

298
Q

Contact Ulcer: Aetiologies (4)

A

Chronic throat clearing
Voice abuse
GORD
Intubation

299
Q

Contact Ulcer: Pathophysiology

A

Benign response to injury to the posterior vocal cord

300
Q

Contact Ulcer: Clinical Presentation (2)

A

Mild pain - during speaking or swallowing
Degrees of hoarsness

301
Q

Epiglottitis

A

Inflammation of the epiglottis

302
Q

Epiglottitis: Most common causes (4)

A

Streptococcus pneumoniae
Streptococcus pyogenus
Staphylococcus aureus
Haemophilus influenza Type B

303
Q

Epiglottitis: Symptoms (3)

A

Severe sore throat
Drooling saliva
Pyrexia

304
Q

Epiglottitis: Signs (2)

A

Normal oral cavity
May have stridor

305
Q

Epiglottitis: Management in mild cases (3)

A

Antibiotics
Nebulisers - Adrenaline or Saline
Corticosteroids

306
Q

Epiglottitis: Management in severe cases options (3)

A

Antibiotics
Intubation and ventilation OR Tracheostomy

307
Q

Reinke’s Oedema

A

Swelling of the vocal cords due to fluid collected within the Reinke’s space

308
Q

Reinke’s Oedema: Most common cause

A

Smoking

309
Q

Reinke’s Oedema: Clinical Presentation (3)

A

Hoarse Voice
Dysphonia
Throat Discomfort

310
Q

Reinke’s Oedema: Main Investigation

A

Otoscopy

311
Q

Obstructive Hyperplasia of the Tonsils and Adenoids: Most common cause of what?

A

Obstructive Sleep Apnoea in Children

312
Q

Obstructive Hyperplasia of the Tonsils and Adenoids: Tonsils and Adenoids have greatest increase in size when?

A

Aged 2 to 8 years

313
Q

Obstructive Hyperplasia of the Tonsils and Adenoids: Pathophysiology

A

The disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in a narrower airway

314
Q

Obstructive Hyperplasia of the Tonsils and Adenoids: Clinical Presentation for Adenoids (4)

A

Obligate mouth breathing
Hyponasal voice
Snoring and signs of sleep disturbance
Obstructive Sleep Apnoea

315
Q

Obstructive Hyperplasia of the Tonsils and Adenoids: Clinical Presentation for tonsils (3)

A

Snoring and signs of sleep disturbance
Muffled voice
Visibly enlarged tonsils without symptoms

316
Q

Obstructive Hyperplasia of the Tonsils and Adenoids: Management and when it is required?

A

If there is recurrent or persistent obstructive or infectious symptoms related to adenoid hypertrophy - Removal of tonsils and adenoids

317
Q

Nasopharyngeal Carcinoma: Linked to what?

A

EBV

318
Q

Laryngeal Carcinoma: Most common aetiologies (2)

A

Cigarettes
Alcohol

319
Q

Oropharyngeal Carcinoma: Commonly associated with what?

A

HPV

320
Q

Oral Cavity Carcinoma: Associated with what?

A

Chewing tobacco

321
Q

Head and Neck Cancer: When is a laryngoscope referral indicated?

A

Dysphonia lasting 3 weeks

322
Q

Head and Neck Cancer: Nasopharyngeal Cancer - Ear Symptoms

A

Unilateral Conductive Hearing Loss

323
Q

Head and Neck Cancer: Nasopharyngeal Cancer - Nasal Symptoms (3)

A

Unilateral epistaxis
Nasal blockage
Mass within the nasopharynx

324
Q

Head and Neck Cancer: Nasopharyngeal Cancer - Involves what nerves? (5)

A

III
IV
V2
V3
VI

325
Q

Head and Neck Cancer: Pathophysiology of Neck Lumps - Midline Swelling Differentials (3)

A

Thyroid
Thyroglossal Cyst
Dermoid Cyst

326
Q

Head and Neck Cancer: Pathophysiology of Neck Lumps - Thyroglossal Cysts arise where?

A

Any part of the thyroglossal tract

327
Q

Head and Neck Cancer: Pathophysiology of Neck Lumps - Thyroglossal Cysts clinical presentation

A

Moves with the tongue

328
Q

Head and Neck Cancer: Pathophysiology of Neck Lumps - Thyroglossal Cysts Presents in what patients?

A

Teenage years

329
Q

Head and Neck Cancer: Pathophysiology of Neck Lumps - Differential for Anterior Triangle Swellings (5)

A

Lymph nodes
Branchial Cyst
Saliary glands
Carotid Body Tumour
Cystic Hydroma

330
Q

Head and Neck Cancer: Pathophysiology of Neck Lumps - Clinical Presentation of Branchial Cyst

A

Benign lump persisting on the second brachial arch that arises in the upper part of the anterior triangle

331
Q

Head and Neck Cancer: Pathophysiology of Neck Lumps - Most common age of presentation for Branchial Cyst

A

Teenagers

332
Q

Head and Neck Cancer: Metastasis - Supra-glottic Tumours drain into where?

A

Superior deep cervical nodes

333
Q

Head and Neck Cancer: Metastasis - Glottic Tumours present where?

A

On the cords

334
Q

Head and Neck Cancer: Metastasis - Glottic Tumours Presentation

A

Voice change and Airway Obstruction

335
Q

Head and Neck Cancer: Metastasis - Sub-Glottic Tumours metastatises to where?

A

Paratracheal Nodes

336
Q

Head and Neck Cancer: Metastasis - Sub-Glottic Tumours Clinical Presentation (2)

A

Voice Change
Airways Obstruction

337
Q

Head and Neck Cancer: How to confirm it is a tumour?

A

Panendoscopy and Biopsy from primary site and suspected metastases

338
Q

Head and Neck Cancer: Staging Techniques

A

CT Neck and Chest

339
Q

Head and Neck Cancer: Imaging - US Detects what?

A

Lymph Nodes and Thyroid

340
Q

Head and Neck Cancer: Imaging - CT Detects

A

Detection of Lymph Nodes and Larynx

341
Q

Head and Neck Cancer: Imaging - MRI Detects

A

Deep lobe of the parotid
Base of the tongue
Nasopharynx

342
Q

Head and Neck Cancer: Imaging - PET Detects

A

Metastatic Nodes

343
Q

Head and Neck Cancer: Management - Early T1/T2 Laryngeal Cancer

A

Transoral Laser Surgery and Radiotherapy

344
Q

Head and Neck Cancer: Management - Advanced T3/T4 Laryngeal Cancer

A

Partial or Total Laryngectomy + Chemotherapy + Radiotherapy

345
Q

Head and Neck Cancer: Management - Early T1/T2 Oropharyngeal Cancer

A

Chemotherapy + Transoral Robotic Surgery

346
Q

Head and Neck Cancer: Management - Advanced T3/T4 Oropharyngeal Cancer

A

Chemoradiotherapy

347
Q

Head and Neck Cancer: Management - Nasopharyngeal Cancer

A

Chemoradiotherapy

348
Q

Head and Neck Cancer: Management - Parotid Gland Cancer

A

Superficial or Total Parotidectomy

349
Q

Paraganglioma

A

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body

350
Q

Paraganglioma: Aetiology - Most common age

A

> 50 years old

351
Q

Paraganglioma: Aetiology - Associated with what genetic syndromes (3)

A

MEN2
Von Hippel-Lindau Syndrome
NF-1

352
Q

Paraganglioma: Aetiology - Most common genetic mutation

A

Mutations in succinate dehydrogenase subunit

353
Q

Paraganglioma: Pathophysiology - Sympathetic arise from where?

A

Paraganglia below the level of the neck - Organ of Zuckerandl or Bladder

354
Q

Paraganglioma: Pathophysiology - Parasympathetic arise from where?

A

Great vessels of the head and neck

355
Q

Paraganglioma: Histology

A

Nests of round or oval cells surrounded by delicate vascular septae

356
Q

Paraganglioma: Clinical Presentation - Sympathetic Paragangliomas (4)

A

Features of Catacholamine Excess - Headaches, Palpitations, Diaphoresis and Hypertension

357
Q

Paraganglioma: Clinical Presentation - Parasympathetic Paragangliomas (3)

A

Cranial nerve palsies
Neck mass
Tinnitus

358
Q

Paraganglioma: Management Options (2)

A

Surgical resection
radiothearpy

359
Q

Nasal Trauma: Must exclude what?

A

Septal Haematoma

360
Q

Nasal Trauma: Management of Septal Haematoma

A

Drained to prevent nasal collapse

361
Q

Nasal Trauma: Problem with septal haematoma

A

Stops blood supply getting to the cartilage

362
Q

Nasal Trauma: Management - Unilateral Discharge

A

Refer urgently
- Suspected foreign body in the nose of children
- Nasal or Paranasal tumour in adults

363
Q

Nasal Trauma: Management - Nasal Fractures

A

Review in the ENT clinic in 5-7 days post-injury
Then digital manipulation in <3 weeks

364
Q

Nasal Trauma: Complications (3)

A

CSF leak
Meningitis
Anosmia

365
Q

CSF Leak: Aetiology

A

Fracture through the cribiform plate

366
Q

CSF Leak: Clinical Presentation (2)

A

Persistent clear rhinorrhoea
Headache

367
Q

CSF Leak: Management Pathway

A
  1. Most are self-resolving
  2. Requires repair does not resolve within 10 days
368
Q

CSF Leak: Must not give what drugs and why?

A

Antibiotics - can mask meningitis

369
Q

Epistaxis

A

Nose bleed

370
Q

Epistaxis: Local Aetiologies (4)

A

Trauma
Foreign Bodies
Inflammation
Tumour

371
Q

Epistaxis: Systemic Aetiologies - Drugs (2)

A

Warfarin
Aspirin

372
Q

Epistaxis: Systemic Aetiologies - Haematological Causes (4)

A

Clotting abnormalities
Haemophilia
Leukaemia
Thrombocytopenia

373
Q

Epistaxis: Systemic Aetiologies - GI cause

A

Liver disease

374
Q

Epistaxis: Systemic Aetiologies - Cardiovascular causes (3)

A

Arteriosclerosis
Hereditary Haemorrhagic Telangectasia
Hypertension

375
Q

Epistaxis: Systemic Aetiologies - Inflammatory disorder

A

Wegner’s Granulomatosis

376
Q

Epistaxis: Pathophysiology - Most common area

A

Little’s Area on the anterior septum

377
Q

Epistaxis: Pathophysiology - What blood vessels are in the Little’s Area? (5)

A

Anterior ethmoid artery
Posterior ethmoid artery
Sphenopalatine artery
Great Palatine Artery
Superior labial artery

378
Q

Epistaxis: Management - First Line

A

First Aid Measures - Pinch the fleshy part of the anterior part of the nose and lean forward with ice pack compression

379
Q

Epistaxis: Management - Secondary care management

A

Arrest and slow flow - via topical vasoconstrictor or ice
Anterior rhinoscopy or Nasal Endoscopy to investigate the source of bleeding

380
Q

Epistaxis: Management - Direct therapy

A

Silver nitrate cautery if there is an identifiable anterior bleeding point

381
Q

Epistaxis: Management - Indirect therapy options

A

Nasal packs or Foley Catheters to compress difficult to identify bleeding points or heavy bleeding points

382
Q

Epistaxis: Management - Surgical Options

A

Sphenopalatine artery ligation - endoscopic

383
Q

Pinna Haematoma: Most commonly seen in what patients? (2)

A

Boxers
Rugby Players

384
Q

Pinna Haematoma: Pathophysiology

A

Initial trauma causes the peri-chondral blood vessels tear causing a haematoma between the auricular cartilage and overlying perichondrium

385
Q

Pinna Haematoma: Pathophysiology - If pinna haematomas are left untreated what would happen?

A

Disrupted blood supply would cause avascular necrosis of the pinna

386
Q

Pinna Haematoma: Pathophysiology - How does cauliflower ear develop?

A

Fibrocartilage overgrowth

387
Q

Pinna Haematoma: Management (3)

A

Aspiration
Incision and Drainage
Pressure dressing

388
Q

Temporal Bone Fracture: Two classifications

A

Longitudinal
Transverse

389
Q

Temporal Bone Fracture: Aetiology - Longitudinal Fractures

A

Lateral blow to the head

390
Q

Temporal Bone Fracture: Aetiology - % of cases that are longitudinal fractures

A

80%

391
Q

Temporal Bone Fracture: Longitudinal Fracture description

A

Fracture line is parallel to the long axis of the petrous pyramid

392
Q

Temporal Bone Fracture: Aetiology - Transverse Fractures

A

Fronto-occipital head trauma

393
Q

Temporal Bone Fracture: Transverse Fracture % of cases

A

20%

394
Q

Temporal Bone Fracture: Transverse Fracture Description

A

Fracture at right angles to the long axis of the petrous pyramid

395
Q

Temporal Bone Fracture: Transverse Fracture likely to damage what?

A

Facial nerve

396
Q

Temporal Bone Fracture: Clinical Presentation - Main Sign

A

Battle sign - bruising over the mastoid that indicates a base of the skull fracture

397
Q

Temporal Bone Fracture: Diagnostic Test

A

CT

398
Q

Temporal Bone Fracture: Complications - Longitudinal Fracture (5)

A

Bleeding from the external canal due to laceration of the skin and drum of the ear
Haemotympanum - conductive deafness
Ossicular chain disruption
Facial palsy
CSF Otorrhoea - leaking from the ear

399
Q

Temporal Bone Fracture: Complications - Transverse Fracture (4)

A

Can cross the internal acoustic meatus to cause damage to the auditory and facial nerves
Sensorineural hearing loss due to CN VIII damage
Facial palsy
Vertigo

400
Q

Hearing Loss Following Trauma: Management of Conductive Hearing Loss - Why is it often delayed?

A

Polytrauma

401
Q

Hearing Loss Following Trauma: Management of Conductive Hearing Loss - May require what three things?

A

Facial nerve decompression
Management of CSF leak
Hearing Restoration - hearing aid or ossiculoplasty

402
Q

Hearing Loss Following Trauma: Management of Sudden Sensorineural Hearing Loss

A

Weber Test - sound will heard in good ear
High dose steroids
Consider intra-tympanic treatment

403
Q

Neck Trauma: Higher incidence in what sex?

A

Men

404
Q

Neck Trauma: Pathophysiology - Zone I regions (5)

A

Trachea
Oesophagus
Thoracic Duct
Thyroid
Spinal Cord

405
Q

Neck Trauma: Pathophysiology - Blood Vessels of Zone I (4)

A

Brachiocephalic
Subclavian
Common carotid
Thyrocervical Trunk

406
Q

Neck Trauma: Pathophysiology - Structures of Zone II (6)

A

Larynx
Hypopharynx
CN X
CN XI
CN XII
Spinal Cord

407
Q

Neck Trauma: Pathophysiology - Vessels of Zone II (2)

A

Carotid
Internal Jugular

408
Q

Neck Trauma: Pathophysiology - Structures of Zone III (3)

A

Pharynx
Cranial Nerves
Spinal Cord

409
Q

Neck Trauma: Pathophysiology - Vessels of Zone III (3)

A

Carotid
Internal Jugular Vein
Vertebral Arteries

410
Q

Neck Trauma: Clinical Presentation - Symptoms that are important to the aerodigestive tract (5)

A

Dyspnoea
Hoarseness
Dysphonia
Dysphagia
Haemoptysis

411
Q

Maxillary Fractures: Maxilla functionally forms a bridge between what?

A

The cranial base and dental occlusion plane

412
Q

Maxillary Fractures: Mechanism of Injury

A

High-energy blunt trauma to the facial skeleton

413
Q

Orbital Floor Fractures: Diagnostic Investigation

A

CT tear drop sign - indicates blow out fracture

414
Q

Orbital Floor Fractures: Management when?

A

Surgical repair of the bony walls if there is entrapment, large defects or enopthalmos (eyes are sunken in)

415
Q

Deep Neck Space Infection

A

Extension of infection from the tonsil or oropharynx into deeper tissue

416
Q

Deep Neck Space Infection: Symptoms (2)

A

Sore throat
Limited neck movements

417
Q

Deep Neck Space Infection: Signs (3)

A

Febrile
Trismus - muscle spasms in the TMJ
Red and Tender Neck

418
Q

Deep Neck Space Infection: Management (2)

A

IV Access for bloods and rehydration
IV antibiotics - Co-amoxiclav or Clindamycin

419
Q

Deep Neck Space Infection: Complications

A

Infection may extend to the mediastinum via the pre-vertebral space through fascial compartments - leads to infection of the heart and lungs

420
Q

What is a major concerning foreign body in the ear or nose?

A

Watch batteries

421
Q

BPPV

A

Benign Positional Paroxysmal Vertigo

422
Q

Benign Positional Paroxysmal Vertigo

A

Vertigo caused by the presence of otoliths in the semi-circular canal instead of the utricle

423
Q

Benign Positional Paroxysmal Vertigo: Aetiology (2)

A

Head trauma
Ear surgery

424
Q

Benign Positional Paroxysmal Vertigo: Most common cause of vertigo on doing what?

A

Looking up

425
Q

Benign Positional Paroxysmal Vertigo: Pathophysiology

A

Otoliths within the canal move on movement of the patients head causing abnormal movement of endolymph resulting in vertigo

426
Q

Benign Positional Paroxysmal Vertigo: Other symptoms

A

Nausea and Vomiting

427
Q

Benign Positional Paroxysmal Vertigo: Time period

A

Seconds

428
Q

Benign Positional Paroxysmal Vertigo: Vertigo on doing what? (3)

A

Looking up
Turning or lying down in bed
Bending forward

429
Q

Benign Positional Paroxysmal Vertigo: Diagnostic test

A

Dix-Hallpike Maoeuvre - invokes symptoms and torsional nystagmus

430
Q

Benign Positional Paroxysmal Vertigo: Management (3)

A

Epley Manoeuvre
Selmont Manoeuvre
Brandt-Daroff Exercises

431
Q

Vestibular Neuritis

A

Inflammation of the vestibular nerve

432
Q

Labyrinthitis

A

Inflammation of the labyrinth

433
Q

Vestibular Neuritis and Labyrinthitis: Main aetiology

A

Viral

434
Q

Vestibular Neuritis and Labyrinthitis: Clinical presentation of First Attack

A

Vertigo with hours of Nausea and Vomiting

435
Q

Vestibular Neuritis and Labyrinthitis: Time period

A

Prolonged - Days

436
Q

Vestibular Neuritis and Labyrinthitis: May be associated with what symptoms? (3)

A

Viral Symptoms - Malaise, Headache and Nausea and Vomiting

437
Q

Vestibular Neuritis and Labyrinthitis: Labyrinthitis is associated with what symptoms?

A

Tinnitus or Hearing loss - not seen in VN

438
Q

Vestibular Migraine

A

Episode of vertigo in someone who has history of migraines

439
Q

Vestibular Migraine: Clinical Presentation (4)

A

Light-sensitivity during dizzy spells
Phonophobia
Fluctuating hearing loss
Motion sensitivity with bouts of motion sickness

440
Q

Vestibular Migraine: Management

A

Abortive Agents - triptans
Prophylaxis - Propanolol and Amitryptiline

441
Q

Meniere’s Disease

A

Idiopathic disorder causing vertigo

442
Q

Meniere’s Disease: Pathophysiology

A

Excess endolymph within the membranous labyrinth and increasing pressure results in symptoms due to dysfunctioning sodium channels

443
Q

Meniere’s Disease: Clinical Presentation - Triad

A

Severe paroxysmal vertigo
Sensorineural hearing loss
Tinnitus

444
Q

Meniere’s Disease: Clinical Presentation - Vertigo

A

Recurrent spontaneous rotational vertigo with at least 2 episodes >20 minutes

445
Q

Meniere’s Disease: Clinical Presentation - Time

A

> 20 minutes - often last hours

446
Q

Meniere’s Disease: Clinical Presentation - Sensation of what?

A

Ear being full

447
Q

Meniere’s Disease: Audiology result

A

Low frequency sensorineural hearing loss

448
Q

Meniere’s Disease: Management Options (3)

A

Tinnitus therapy
Hearing aids
Lifestyle - Reduce salt, avoid chocolate and caffeine and avoid stress

449
Q

Vertebrobasilar Insufficiency

A

Temporary set of symptoms due to ischaemia in the posterior circulation of the brain

450
Q

Vertebrobasilar Insufficiency: Most common Aetiology

A

Arteriosclerosis in the posterior circulation arteries

451
Q

Vertebrobasilar Insufficiency: Clinical Presentation - Causes vertigo when?

A

When looking up

452
Q

Vertebrobasilar Insufficiency: Clinical Presentation - What other symptom is required for diagnosis?

A

Visual disturbance
Weakness
Numbness

453
Q

Acute Infective Rhinosinusitis

A

Symptomatic inflammation of the paranasal sinuses

454
Q

Acute Infective Rhinosinusitis: Symptom time period

A

Less than 12 weeks

455
Q

Acute Infective Rhinosinusitis: Is typically followed by what?

A

Viral respiratory tract infection

456
Q

Acute Infective Rhinosinusitis: Most commonly preceded by what?

A

Rhinitis that has spread from dentition

457
Q

Most common causative organisms (3)

A

Streptococcus penumoniae
Haemophilus influenzae
Moraxella catarrhalis

458
Q

Acute Infective Rhinosinusitis: Diagnosed in patients by what?

A

Presence of nasal blockage or nasal discharge with facial pain or head aches and/or a reduced sense of smell

459
Q

Acute Infective Rhinosinusitis: What indicates secondary bacterial infection?

A

Severe pain and tenderness with purulent nasal discharge

otolaryngology (4 decks)

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