Disease Profiles Flashcards
Otitis Externa
Inflammation of the outer ear canal
Otitis Externa: Bacterial Causes (3)
Staphylococcus aureus
Proteus species
Pseudomonas aeruginosa
Otitis Externa: Fungal causes (2)
Aspergillus niger
Candida albicans
Otitis Externa: Common triggers (2)
Water exposure
Cotton buds
Otitis Externa: Clinical Presentation - Ear Canal
Redness and swelling of the skin of the ear canal that may be itchy and painful
Otitis Externa: Clinical Presentation - What may be produced? (2)
Discharge
Excess ear wax
Otitis Externa: Management - First line
Topical aural toilet (ear clean)
Otitis Externa: Management - When is microbiology and antimicrobials used?
In unresponsive cases
Otitis Externa: Management - Fungal unresponsive treatment
Topical clotrimazole
Otitis Externa: Management - Bacterial unresponsive treatment
Gentamicin ear drops
Otitis Externa: Management - When may systemic antibiotics be required?
If cellulitis develops in the pinna or parotid region
Otitis Externa: Management - In cases of eczematous otitis externa
Steroid without antibiotics
Acute Otitis Media
Acute inflammation of the middle ear with or without an accumulation of fluid
Acute Otitis Media: Commonly associated with what other pathophysiology?
Upper Respiratory Tract Infection
Acute Otitis Media: Most common bacterial causes (3)
Haemophilus influenzae
Streptococcus pneumoniae
Streptococcus pyogenes
Acute Otitis Media: Aetiologies of chronic cases (3)
Pseudomonas aeruginosa
Staphylococcus aureus
Fungus
Acute Otitis Media: Pathophysiology
Infection extends from the throat to the ear via the Eustachian Tube
Acute Otitis Media: Symptoms (3)
Ear Pain
Fever
Irritability
Acute Otitis Media: Signs - What may present in the middle ear?
Effusion
Acute Otitis Media: Signs - Tympanic membrane appearance
Opaque
Bulging
May have impaired mobility
Acute Otitis Media: Diagnosis -What is required if the eardrum perforates?
A swab of pus
Acute Otitis Media: Management - First line
Self-limiting - 80% resolve in 4 days
Acute Otitis Media: Management - What antibiotics if indicated? (2)
Amoxicillin
Erythromycin
Acute Otitis Media: Complications - How may an abscess form?
Spread via the mastoid causes bone breakdown behind the ear and forms an abscess
Acute Otitis Media: Complications (7)
Sensorineural hearing loss
Tinnitus
Acute mastoiditis
Brain abscess or meningitis
Vertigo
Facial palsy
Venous sinus thrombosis
Acute Mastoiditis
Complication of acute otitis media involving infection of mastoid air cells
Acute Mastoiditis: Most common bacterial aetiologies
Streptococcus pneumoniae
Haemophilus influenzae
Acute Mastoiditis: Why are mastoid air cells suitable for infection?
Porous nature makes them suitable for pathogenic replication
Acute Mastoiditis: Clinical Presentation (3)
Pain, Tenderness and Swelling behind the ear
Acute Mastoiditis: Management
IV antibiotics
Surgical drainage for severe cases
Acute Mastoiditis: Main complication
Meningitis - by spreading to the middle cranial fossa and thus the brain
Referred Otalgia: Auriculo-temporal Branch of the Trigeminal Nerve - Aetiologies associated with the lower mandibular (3)
Dental abscess
Dental caries
Impacted molar teeth
Referred Otalgia: Auriculo-temporal Branch of the Trigeminal Nerve - Aetiologies of Salivary Gland Disease (3)
Infection e.g. mumps
Stones
Neoplasm
Referred Otalgia: Auriculo-temporal Branch of the Trigeminal Nerve - Aetiologies associated with stress
Tooth grinding
Referred Otalgia: Auriculo-temporal Branch of the Trigeminal Nerve - Aetiologies associated with Temporomandibular Joint Lesions
Costen’s Syndrome
Referred Otalgia: Sensory Branch of the Facial Nerve - Aetiologies (4)
Geniculate herpes
Ramsay Hunt Syndrome
Sphenoid or Ethmoidal Sinus Pathology
Nasal Pathology
Referred Otalgia: Tympanic Branch of the Glossopharyngeal Nerve - Aetiologies (4)
Tonsillitis or Quinsy
Post-tonsillectomy
Carcinoma of the posterior third of the tongue or tonsil
Neuralgia of the glossopharyngeal nerve
Referred Otalgia: Vagus Nerve - Aetiologies (5)
Foreign body in the piriform fossa
Carcinoma of the piriform fossa
Carcinoma of the larynx
Post-cricoid carcinoma
Sepsis - piriform abscess
Referred Otalgia: Greater auricular nerve (C2/3) - Aetiologies (2)
Cervical neuritis
Herpes zoster
Referred Otalgia: Lesser occipital nerve (C3) - Aetiologies (3)
Cervical spondylitis
Cervical neuritis
Herpes zoster
Cholesteatoma
Growth consisting of keratinising squamous epithelium in the middle ear and or mastoid process
Cholesteatoma: Acquired Aetiologies (2)
Chronic otitis media
Perforated tympanic membrane
Cholesteatoma: Congenital Aetiology
Proliferation of the embryonic crest
Cholesteatoma: What is a key risk factor?
Frequent ear surgery in history
Cholesteatoma: Pathophysiology
Keratin becomes trapped and builds up within the ear that expands to erode surrounding bone
Cholesteatoma: Histology
Squamous epithelium with abundant keratin production and associated with inflammation
Cholesteatoma: Common Clinical Presentation
Unilateral discharge that is persistent or recurrent that is often foul-smelling
Cholesteatoma: Symptoms may progress to what? (4)
Vertigo
Sensorineural hearing loss
Facial nerve palsy
Intracranial abscess or Meningitis
Cholesteatoma: What diagnostic test is used?
Otoscopy
Cholesteatoma: Description of Otoscopy findings (2)
Retraction of the tympanic membrane
Defect in the tympanic membrane full of white material
Cholesteatoma: Management
Mastoid surgery to remove the sac of debris with reconstruction
Cholesteatoma: Complications - Medial (5)
Sensorineural Hearing Loss
Tinnitus
Vertigo
Facial Palsy
Cholesteatoma: Complications - Superior (2)
Brain Abscess
Meningitis
Cholesteatoma: Complications - Posterior
Venous Sinus Thrombosis
Alternate Name for Otitis Media with Effusion
Glue Ear
Otitis Media with Effusion
Inflammation of the middle ear accompanied by accumulation of fluid without the signs of acute inflammation
Otitis Media with Effusion: Most common in what patient group?
2-8 year old children
Otitis Media with Effusion: Associated with what pathology?
Eustachian tube dysfunction or obstruction
Otitis Media with Effusion: More common in what sex?
Males
Otitis Media with Effusion: Most common aetiologies (3)
Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
Otitis Media with Effusion: Aetiologies in Adults (3)
Rhinosinusitis
Nasopharyngeal carcinoma
Nasopharyngeal lymphoma
Otitis Media with Effusion: Clinical Presentation (2)
Deafness
Problems associated with hearing loss - poor performance or behavioural problems or speech delay
Otitis Media with Effusion: Clinical Presentation -Main sign
Middle ear effusion - showing fluid or bubbles
Otitis Media with Effusion: Clinical Presentation -Signs of Tympanic Membrane (3)
Altered colour
Retracted
Impaired mobility
Otitis Media with Effusion: Diagnosis - 3 possible assessments
Otoscopy
Tuning fork tests
Age-appropriate hearing assessment - Audiometry or Tympanometry
Otitis Media with Effusion: Diagnosis - Tuning fork tests show what?
Conductive hearing loss
Otitis Media with Effusion: Diagnosis - Audiometry shows what?
Conductive hearing loss
Otitis Media with Effusion: Diagnosis - Tympanometry shows what?
Flat tracing
Otitis Media with Effusion: Management - First Line
Watch and wait - 90% resolve in 3 months
Otitis Media with Effusion: Management - When is the case reviewed if watchful waiting?
3 months
Otitis Media with Effusion: Management - When to refer to surgery (4)
Persistent (>3 months) bilateral Otitis Media with effusion
Conductive Hearing Loss >25 dB
Speech or language problems
Developmental or behavioural problems
Otitis Media with Effusion: Management - <3 years surgical approach
Grommets - vent the eardrum to allow for fluid drainage
Otitis Media with Effusion: Management - >3 years first line surgical approach
Grommets
Otitis Media with Effusion: Management - >3 years if grommet doesn’t work?
Adenoidectomy
Otitis Media with Effusion: Management - When may adenoidectomy be considered early?
If nasal symptoms are present
Otitis Media with Effusion: Complications of Grommets (4)
Infection or discharge
Early extrusion
Retention
Persistent perforation
Perforated Tympanic Membrane: Mainly associated with what?
Acute Otitis Media in young individuals
Perforated Tympanic Membrane: Possible aetiologies (2)
Sudden negative pressure
Objects within the ear
Perforated Tympanic Membrane: Clinical Presentation (4)
Sudden severe pain
Possible - bleeding, hearing loss and tinnitus
Perforated Tympanic Membrane: Diagnostic tests of choice (2)
Otoscopy
Audiometry
Perforated Tympanic Membrane: Audiometry shows what?
Conductive Hearing Loss
Perforated Tympanic Membrane: Management -First line
Normally heals spontaneously
Perforated Tympanic Membrane: Management - When is surgical repair indicated?
If the patient is symptomatic with recurrent discharge
Otosclerosis
Hereditary disorder in which new bony deposits occur within the stapes footplate and cochlear resulting in gradual hearing loss
Otosclerosis: Most common age
20-30 years old
Otosclerosis: More common in what sex?
Women
Otosclerosis: Why is it more common in women?
High oestrogen is linked to otosclerosis
Otosclerosis: Clinical Presentation
Gradual onset hearing loss
Otosclerosis: Diagnostic Test
Audiometry
Otosclerosis: Audiometry shows what?
Conductive or mixed hearing loss
Otosclerosis: Classic feature on audiometry
Carhart’s Notch at 2KHz
Otosclerosis: Management (2)
Hearing Aids
Stapedectomy
Prebycusis
Degenerative disorder of the cochlear resulting in hearing loss
Prebycusis: Pathophysiology (3)
Can be due to:
- Loss of outer hair cells - environmental noise toxicity over time
- Loss of ganglion cells
- Strial atrophy
Prebycusis: Clinical Presentation
Gradual onset hearing loss
Prebycusis: Diagnostic Test of Choice
Audiometry
Prebycusis: Audiometry - Which frequencies are affected most?
Higher frequencies
Prebycusis: Audiometry - Usually shows what type of hearing loss?
Sensorineural
Prebycusis: Management
High-frequency specific hearing aid
Noise-Induced Hearing Loss: Pathophysiology
Cochlear Damage - due to e.g. shooting or industrial noise
Noise-Induced Hearing Loss: Test of choice
Audiometry
Noise-Induced Hearing Loss: Audiometry - What type of hearing loss is there?
Sensorineural
Noise-Induced Hearing Loss: Audiometry - Characteristic dip where?
4kHz
Drug-Induced Hearing Loss: What drugs can cause hearing loss? (5)
Gentamicin - an other aminoglycosides
Cisplatin
Vincristine
Aspirin
NSAID overdose
Vestibular Schwannoma
Benign tumour of the CN VIII nerve sheath that arises in the internal auditory meatus
Vestibular Schwannoma: May be associated with what risk factor?
Extensive exposure to excessive loud noise
Vestibular Schwannoma: If it is bilateral and in a young patient what must be considered?
Neurofibromatosis Type 2
Vestibular Schwannoma: Location
Temporal bone - 80-90% are cerebellopontine angle tumours
Vestibular Schwannoma: Gross appearance
Circumscribed tan/white/yellow mass
Vestibular Schwannoma: Histology
Encapsulated mass with two possible growth patterns - Antoni A or B
Vestibular Schwannoma: Clinical Presentation - (3)
Progressive sensorineural unilateral hearing loss
Tinnitus
Facial Numbness
Vestibular Schwannoma: Clinical Presentation - Common presentation in larger tumours
Imbalance
Vestibular Schwannoma: Clinical Presentation - Pathophysiology of Facial Numbness
Compression of the trigeminal nerve as the tumour enlarges
Vestibular Schwannoma: Diagnostic Test
MRI
Vestibular Schwannoma: Gold standard management
Surgical excision
Vestibular Schwannoma: Management - Small lesions require what management?
Monitoring by MRI within a 6 month interval
Allergic Rhinitis: Pathophysiology
IgE-mediated allergic reaction - Type I Hypersensitivity - that causes the generation of histamine and leukotrienes
Allergic Rhinitis: Definition of Intermittent
Symptoms <4 days per week or symptoms for <4 weeks
Allergic Rhinitis: Definition of Persistent
Symptoms >4 days per week AND >4 weeks of duration
Allergic Rhinitis: What classification system is used?
ARIA Classification
Allergic Rhinitis: ARIA Classification - Mild definition
Normal sleep with symptoms that do not affect the patients day to day life
Allergic Rhinitis: ARIA Classification - Moderate-Severe definition
Involves >1 - abnormal sleep, impaired activities and missed school or work
Allergic Rhinitis: ARIA Classification - Clinical presentation (4)
Sneezing
Nasal itching
Nasal discharge and congestion
Allergic crease indicates repeated itching of the nose
Allergic Rhinitis: Management - First Line
Allergen Avoidance
Allergic Rhinitis: Management - Second Line Options (3)
Anti-histamines e.g. Cetrizine
Topical Corticosteroids e.g. Beclomethasone
Anti-histamines + Corticosteroids
Allergic Rhinitis: Management - Third Line
Immunotherapy e.g. Montelukast
Allergic Rhinitis: Management - Option for mucosal hypertrophy
Diathermy
Non-Allergic Rhinitis
Inflammation of the inside of the nose that is not due to allergy
Non-Allergic Rhinitis: Aetiologies (5)
Infection
Vasomotor rhinitis
Occupational rhinitis
Hormonal rhinitis
Drug-induced rhinitis
Non-Allergic Rhinitis: Pathophysiology - Vasomotor Rhinitis
Parasympathetic overdrive within the nose
Non-Allergic Rhinitis: Pathophysiology - Aetiologies of Vasomotor Rhinitis (5)
Chemical irritants
Changes in weather
Excess humidity
Dry atmosphere
Stress
Non-Allergic Rhinitis: Pathophysiology - Associations with Hormonal Rhinitis (2)
Pregnancy
Hormonal medication - HRT or Contraceptive Pill
Non-Allergic Rhinitis: Pathophysiology - Examples of Drug-induced Rhinitis (4)
ACE Inhibitors
Beta Blockers
NSAIDs
Cocaine
Non-Allergic Rhinitis: Pathophysiology
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
Non-Allergic Rhinitis: Clinical Presentation (4)
Rhinorrhoea
Sneezing
Itchy nose
Nasal congestion
Non-Allergic Rhinitis: Management for vasomotor rhinitis
Ipratropium (anti-cholinergic)
Non-Allergic Rhinitis: Complications (2)
Sinusitis
Nasal polyps
Acute Sinusitis
Symptomatic inflammation of the paranasal sinuses with symptoms that last for less than 12 weeks
Acute Sinusitis: Usually followed by what?
Viral respiratory tract infection
Acute Sinusitis: Most commonly preceded by what?
Rhinitis
Acute Sinusitis: Preceding rhinitis can spread from what?
Dentition
Acute Sinusitis: Most common organisms (3)
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Acute Sinusitis: In adults it is diagnosed by what?
Presence of nasal blockage or discharge with facial pain/pressure/headache and/or reduction of the sense of smell
Acute Sinusitis: What indicates secondary bacterial infection?
Severe pain and tenderness with purulent nasal discharge
Acute Sinusitis: Management - First Line
Analgesics and Nasal Decongestants
Acute Sinusitis: Management - Consider prescribing what if symptoms are around for 10 days with no improvement?
High dose nasal corticosteroid
Acute Sinusitis: Management - Consider what management for severe cases of >10 days duration?
First line - Phenocymethylpenicillin
Second Line - Doxycycline (not in children)
Acute Sinusitis: Main Complications (2)
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
Nasal Polyps
Soft painless non-cancerous growths on the lining of nasal passages
Nasal Polyps: Aetiologies - Often associated with what pathology?
Non-allergic asthma
Nasal Polyps: Aetiologies (4)
Allergy
Infection
Aspirin sensitivity
Nickel exposure
Nasal Polyps: Aetiologies - If they are young what may be the cause?
Cystic Fibrosis
Nasal Polyps: Pathophysiology
Inflammation and oedema of the sinus nasal mucosa that prolapses into the nasal cavity to cause significant obstruction
Nasal Polyps: Histology
Lined by respiratory or squamous epithelium and oedematous stroma containing mixed inflammatory cells +/- eosinophils
Nasal Polyps: Clinical Presentation (3)
Blocked nose
Runny nose
Reduced sense of taste or smell
Nasal Polyps: What investigation is done?
Nasoendoscopy
Nasal Polyps: Management
Oral then topical steroids
Nasal Polyps: Management if polyps are large
Surgical removal
Granulomatosis with Polyangiitis
Inflammation of small and medium-sized blood vessels that results in damage to organ systems within the body
Granulomatosis with Polyangiitis: Normal age
> 40 years old
Granulomatosis with Polyangiitis: Pathophysiology
Autoimmune disorder characterised by small vessel vasculitis and necrosis limited to the respiratory system and kidneys
Granulomatosis with Polyangiitis: Clinical Presentation (6)
Sinusitis
Nasal crushing - saddle nose
Epistaxis
Oral ulcers
Sensorineural deafness
Otitis media
Granulomatosis with Polyangiitis: Why does saddle nose occur?
Cartilage damage from ischaemia
Granulomatosis with Polyangiitis: Diagnosis
Characterised by high frequency ANCA antibodies
- cANCA - GPA
- pANCA - microscopic polyangiitis
Granulomatosis with Polyangiitis: Management
IV steroids and Cyclophosphamide
Tumours of the Nose: Benign Lesions - Most common
Squamous Cell Papillomas
Tumours of the Nose: Benign Lesions - Examples (3)
Sinonasal Papillomas
Recurrent Respiratory Papillomatosis
Angiofibromas
Sinonasal Papillomas: Aetiology (2)
HPV
Organic Solvents
Sinonasal Papillomas: More common age
> 50 years old
Sinonasal Papillomas: More common in what sex?
Males
Sinonasal Papillomas: Histology - Three types
Inverted
Exophytic
Oncocytic
Sinonasal Papillomas: Histology - Location of inverted types
Lateral walls and paranasal sinuses
Sinonasal Papillomas: Histology - Location of oncocytic types
Lateral walls and paranasal sinuses
Sinonasal Papillomas: Histology - Locatio of exophytic types
Nasal Septum
Sinonasal Papillomas: Recurrent Respiratory Papillomatosis
Rare condition in which papillomas form along the aerodigestive tract
Sinonasal Papillomas: Recurrent Respiratory Papillomatosis - Associated with what?
HPV
Sinonasal Papillomas: Recurrent Respiratory Papillomatosis - Clinical presentation in children
Hoarse voice and progressive SOB
Tumours of the Nose: Malignant Lesion Examples (5)
Squamous Cell Carcinoma
Nasopharyngeal Carcinoma
Primary Adenocarcinoma
Neuroblastoma
Lymphoma
Most common malignant lesion of the nose
Squamous Cell Carcinoma
Nasopharyngeal Carcinoma: High incidence where?
Far east
Nasopharyngeal Carcinoma: More common in what sex?
Males
Nasopharyngeal Carcinoma: Associated with what? (2)
EBV
Volatile Nitrosamines in food
Nasopharyngeal Carcinoma: Histology
Keratinising SCC + Non-keratinising SCC + Baseloid SCC