Ear, Nose and Throat Flashcards

1
Q

What does the outer ear consist of?

A
  • Auricle-> cartilage (helix, tragus, concha) + lobule to capture + direct sound
  • External auditory canal-> concha to tympanic membrane, outer 1/3 cartilage + produces wax, inner 2/3 bone
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2
Q

What is cauliflower ear?

A
  • Blood accumulates between cartilage and perichondrium
  • Disrupts blood supply
  • Avascular necrosis
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3
Q

What is the tympanic membrane?

A
  • Boundary between external + middle ear
  • Umbo meets lateral process of malleus bone
  • Pars flaccida (weak) + pars tensa
  • Light reflex-> at 5’oclock (right ear) or 7 oclock (left)
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4
Q

What does the middle ear consist of?

A
  • 1 nerve-> facial (CNVII)
  • 2 muscles-> tensor tympani + stapedius (restrict ossicle movement + protect from loud noise)
  • 3 bones/ossicles-> malleus + incus + stapes (from tympanic membranes to oval window + pass vibrations to inner ear)
  • Mastoid process
  • Eustachian tube
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5
Q

What is the mastoid process?

A
  • Area of temporal bone behind ear

- Air cells protect ear + equalise air pressure

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6
Q

What is the role of the Eustachian tube?

A
  • Middle ear has no direct contact with the atmosphere
  • Pressure differences between outer + middle ear
  • ET-> opens + allow equalisation
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7
Q

What does the inner ear consist of?

A
  • Vestibular-> 3 semi-circular canals, utricle + saccule, messages to CNVIII
  • Cochlear-> oval window, scala media + tympani + vestibuli (transmit into signals via organ of Corti)
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8
Q

How do the semicircular canals work?

A
  • Endolymph + sensory hair cells
  • Detect direction + flow when move
  • Sends messages to CNVIII
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9
Q

What are the functions of the nose?

A
  • Ventilation
  • Humidify air
  • Smell via olfactory nerve
  • Protect airway from pathogens-> mucous + hairs
  • Drainage from sinuses + tear ducts
  • Middle ear ventilation via Eustachian tube
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10
Q

What is the anatomy of the nose?

A
  • Cartilage, septum + bone
  • Cavity-> vestibule to nasopharynx with CNI on superior aspect
  • Superior, middle + inferior turbinates-> on lateral walls to increase surface area + improve humidity
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11
Q

What is the arterial blood source of nose?

A
  • Little’s area-> Keisselbach’s plexus, anterior, source of epistaxis
  • Woodruff’s plexus-> cause posterior nose bleeds
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12
Q

Who is at risk of posterior nose bleeds?

A

Older, HTN, atherosclerosis

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13
Q

Where do anterior nose bleeds usually come from?

A

Little’s area-> Keisselbach’s plexus

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14
Q

Where do posterior nose bleeds come from?

A

Woodruff’s plexus

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15
Q

What is the anterior triangle of the neck?

A
  • Mandible (superior)
  • Midline of neck (medial)
  • Sternocleidomastoid (lateral)
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16
Q

What structures are in the anterior triangle of the neck?

A
  • Thyroid + parathyroid
  • CNs IX, X and XII
  • Carotid artery
  • Internal jugular vein
  • Salivary glands
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17
Q

What is the posterior triangle of the neck?

A
  • Sternocleidomastoid (anterior)
  • Clavicle (inferior)
  • Trapezius (posterior)
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18
Q

What structures are in the posterior triangle of the neck?

A
  • Subclavian artery and vein
  • External jugular vein
  • CN XI
  • Brachial plexus
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19
Q

Where are branchial cysts usually located?

A

Anterior triangle of the neck

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20
Q

Where are cystic hygromas usually located?

A

Posterior triangle of the neck

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21
Q

What anatomical structures are in the throat?

A

Hard + soft palate, uvula, palatine tonsils, tongue

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22
Q

Where are salivary tumours usually located?

A

Parotid gland

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23
Q

What runs through the parotid gland?

A

CN VII (facial nerve)

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24
Q

What is Stensen’s duct and where can it be found?

A
  • Where saliva secreted from the parotid gland

- Feel as bulge on cheek opposite the second molar

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25
Q

What gland produces the most saliva when not eating?

A

Submandibular gland

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26
Q

What salivary gland produces the most mucous secretions and why?

A

Sublingual-> allow smooth food passage down oesophagus

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27
Q

What pathology is common in the sublingual glands?

A

Mucoceles

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28
Q

Where is the lymphatic drainage (including nodes) of the head and neck?

A
  • Submental
  • Submandibular
  • Tonsillar
  • Parotid
  • Preauricular
  • Deep cervical
  • Superior + posterior cervical
  • Supraclavicular
  • Post auricular
  • Occipital
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29
Q

What is conductive hearing loss?

A

Sound not conducted at ear canal to inner ear-> due to external or middle ear problem

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30
Q

What can cause conductive hearing loss?

A

Fluid, foreign object, allergies, ruptured tympanic membrane, impacted earwax

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31
Q

What is sensorineural hearing loss?

A

Sound is received at the inner ear but sensory problem-> due to cochlear or CNVIII problem

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32
Q

What causes sensorineural hearing loss?

A

Age related, noise damage, drug side effects, auditory tumours, blast/explosions

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33
Q

What can caused mixed hearing loss?

A

Genetics, infection, head trauma

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34
Q

What Rinne’s and Weber’s test results do you get in normal hearing?

A
  • Weber-> equal on both sides

- Rinne’s-> air conduction>bone (ie louder when next to ear)

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35
Q

What Rinne’s and Weber’s test results do you get in sensorineural loss?

A
  • Rinne’s-> air>bone conduction

- Weber’s-> lateralise to unaffected ear

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36
Q

What Rinne’s and Weber’s test results do you get in conductive loss?

A
  • Rinne’s-> bone conduction>air

- Weber’s-> lateralised to affected ear

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37
Q

What causes otitis externa?

A
  • External canal’s protective mechanism disrupted + bacteria trapped
  • EG due to water, humidity, cotton buds, hearing aids, immunocompromised
  • Pseudomonas aeruginosa
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38
Q

What pathogens usually cause otitis externa?

A

Pseudomonas aeruginosa, staph aureus, candida

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39
Q

How does otitis externa present?

A

Otalgia, otorrhoea, swollen + red ear, itching, tender pinna

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40
Q

How is otitis externa managed?

A
  • Topical antibiotics + steroids
  • Aural toilet
  • Microsuction
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41
Q

What is necrotising/malignant otitis externa?

A
  • Infection spreads to mastoid and temporal bones-> skull base osteomyelitis
  • Can cause CN palsies and death if untreated
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42
Q

How is necrotising/malignant otitis externa managed?

A

Prolonged antibiotics

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43
Q

What is the pathophysiology of acute otitis media?

A
  • URTIs migrate to eustachian tube into middle ear
  • Kids-> shorter tube + easier transmission
  • Viral-> RSV, rhinovirus, enterovirus
  • Bacterial-> s.pneumoniae
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44
Q

What pathogens cause acute otitis media?

A
  • Viral-> RSV, rhinovirus, enterovirus

- Bacterial-> s.pneumoniae

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45
Q

How does acute otitis media present?

A

Otalgia, inflamed tympanic membrane, malaise

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46
Q

How is acute otitis media managed?

A
  • Self resolving with analgesia
  • Amoxicillin if unwell
  • Grommets-> in recurrent
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47
Q

What are the complications of acute otitis media?

A
  • Perforated tympanic membrane-> discharge + sudden pain relief
  • Hearing loss
  • Mastoiditis
  • CNVII palsy
  • Intracranial infection
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48
Q

What is otitis media with effusion?

A
  • Glue ear

- Non infective fluid in middle ear

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49
Q

What causes otitis media with effusion?

A
  • Eustachian tube dysfunction-> wider + shorter in kids
  • Congenital structural malformations eg cleft palate
  • Allergies
  • Adults-> consider malignant (obstruction of tube)
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50
Q

What are the symptoms and signs of otitis media with effusion?

A
  • Hearing loss, speech delay in kids

- Exam-> dull tympanic membrane, upward reflecting/absent light reflex

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51
Q

How is otitis media with effusion managed?

A
  • 50% resolve in 3 months
  • Hearing aids
  • Grommets
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52
Q

What is the pathophysiology of chronic otitis media?

A
  • Tympanic membrane perforations after recurrent OM

- Non infective-> trauma or iatrogenic (eg grommets)

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53
Q

How does chronic otitis media present?

A

6+ weeks of hearing loss + ottorhoea-> not infection

54
Q

How is chronic otitis media managed?

A
  • Aural toilet
  • Topical antibiotics + steroids-> allow healing
  • Surgery-> myringoplasty using tragus to fill hole
55
Q

What are the complications of chronic otitis media?

A

Hearing loss, mastoiditis, CNVII palsy, intracranial

56
Q

What is a cholesteatoma?

A
  • Destructive hyperproliferating growth of keratinising squamous epithelial cells
  • In the middle ear
57
Q

What is the pathophysiology of cholesteatoma?

A
  • Destructive hyperproliferating growth of keratinising squamous epithelial cells
  • In the middle ear
  • Retraction pocket-> space behind tympanic membrane prone to trapping epithelium
  • Expansile-> can erode to other structures
58
Q

What are the risk factors for developing cholesteatoma?

A

Recurrent acute OM, Eustachian tube dysfunction, previous ear surgery

59
Q

What are the symptoms of cholesteatoma?

A
  • Chronic otorrhoea-> brown, no otalgia or fever
  • Hearing loss-> conductive (ossicle damage) or sensorineural (cochlea invasion)
  • Dizziness (semicircular canals)
  • CNVII palsy
60
Q

How is cholesteatoma managed?

A
  • CT head of temporal bone to confirm
  • Otoscopy-> pearly grey/white + painless brown discharge
  • Complete surgical removal
61
Q

What are the complications of cholesteatoma?

A

Intracranial invasion + infection

62
Q

What is true vertigo?

A

Inappropriate sensation of movement of surroundings (eg room spinning)

63
Q

What can cause true vertigo?

A

BPPV, stroke, MS, migraine

64
Q

What is benign positional paroxysmal vertigo?

A

Non-malignant temporary vertigo from moving head

65
Q

What is the pathophysiology of benign positional paroxysmal vertigo?

A
  • Crystals (canaliths) in semicircular canals (utricle)
  • Dislodge due to age, infection, injury, DM
  • Abnormal endolymph movement in canals-> few seconds of vertigo
66
Q

How is benign positional paroxysmal vertigo investigated?

A

Dix-Hallpike test-> sit up with head at 45 degrees, lie down overhanging the bed, look for nystagmus

67
Q

How is benign positional paroxysmal vertigo treated

A

Epley manoeuvre

  • Sit with head at 45 degrees + lie down with head overhanging bed
  • Stay for 1-2 minutes
  • Rotate head 90 degrees and stay for 1-2 minutes
  • Roll onto shoulder + rotate head 90 degrees (ie at downward 45 degree angle) for 1-2 minutes
  • Slowly sit up with 45 degree head angle for 30 second
68
Q

What is Meniere’s disease?

A

Increased endolymphatic pressure in the semicircular canals

69
Q

What are the symptoms of Meniere’s disease?

A

Vertigo, tinnitus, sensorineural hearing loss-> lasts minutes to hours

70
Q

How is Meniere’s disease managed?

A
  • Self resolves
  • Reduce salt + caffiene
  • Intratympanic steroid/antibiotic injection if persistent
71
Q

What is vestibular neuronitis?

A

Inflammation of the vestibular nerve due to viral infection

72
Q

What are the symptoms of vestibular neuronitis?

A

Severe vertigo + viral symptoms for a few days

73
Q

How is vestibular neuronitis managed?

A
  • Self resolves
  • Anti-emetics
  • Fluids if vomiting
  • Long term damage-> rehab exercises
74
Q

What might cause referred ear pain?

A
  • CNV-> teeth, TMJ (excess grinding), prarotid
  • CNVII-> herpes zoster, Bell’s palsy
  • CNXI-> throat (tonsillitis), oropharyngeal malignancy
  • Cervical nerves-> arthritis
75
Q

What causes rhinosinusitis?

A
  • Inflammation of mucosal lining of nose + paranasal sinuses
  • Viral infection-> rhinovirus, RSV, parainfluenza
  • Bacterial infection-> s.pneumoniae, H.influenzae
  • Allergies-> IgE mediated type I hypersensitivity, hay fever
  • Other-> smoking, environment (cold + dry air), pollution, exercise
76
Q

What are the symptoms of rhinosinusitis?

A

Rhinorrhoea, nasal congestion, reduced sense of smell, facial pain, headache

77
Q

How is rhinosinusitis managed?

A
  • Self resolves
  • Avoid triggers
  • Nasal decongestants + antibiotics or steroids if severe
78
Q

What are the complications of rhinosinusitis?

A

Intracranial infection, osteomyelitis, periorbital or orbital abscess

79
Q

What is the most common facial bone fracture?

A

Nasal

80
Q

What is septal haematoma and how might is present?

A
  • Can happen after nasal fractures
  • Collection of blood within septum
  • Cuts off blood flow to cartilage
  • Can cause saddle nose deformity-> (avascular necrosis of septal cartilage)
81
Q

When are nasal fractures corrected?

A

1 week after injury when swelling gone down

82
Q

What pathogens cause tonsillitis?

A
  • Viral (70%)-> adenovirus, influenza, rhinovirus, parainfluenza
  • Bacterial (30%)-> group A beta-haemolytic strep (eg s.pyogenes)
83
Q

What are the symptoms of tonsillitis?

A

Pain, fever, dysphagia

84
Q

What are the Centor criteria for tonsillitis?

A
  • Pyrexia, exudates on tonsil, absence of cough, tender cervical LNs
  • Consider antibiotics if 2+
85
Q

What are the criteria for receiving a tonsillectomy?

A
  • 7 episodes in last 1 year
  • 5 episodes in each of last 2 years
  • 3 episodes in each of last 3 years
  • Swelling affecting function
86
Q

What is a quincy?

A

Peritonsillar abscess-> rare + severe complication of bacterial tonsillitis

87
Q

What are the signs and symptoms of quincy?

A
  • Severe tonsillitis
  • Trismus (can’t open jaw)
  • Unilateral symptoms
  • Hot potato voice
  • Deviated uvula (away)
88
Q

How is quinsy managed?

A

Admission, IV antibiotics (eg metronidazole), drainage (needle or incision)

89
Q

What can happen if a quinsy isn’t treated?

A

Deep neck infection or upper airway obstruction

90
Q

What type of cancers most commonly affect the head and neck?

A

Squamous cell cancers (90%)

91
Q

Who are nasopharynx cancers common in?

A
  • Asians

- EBV infection

92
Q

What are the reg flag symptoms of nasopharynx cancer?

A

Otalgia, hearing loss, smell change

93
Q

What are the risk factors for oral cavity cancers?

A
  • Recurrent dental infection

- Sun exposure (lips)

94
Q

What are the symptoms of oral cavity cancers?

A
  • Ulcer for 3+ weeks

- Jaw swelling

95
Q

What can cause pharynx cancers?

A

HPV

96
Q

What are the symptoms of a pharynx cancer?

A
  • Peristent neck lump
  • Dysphagia
  • Otalgia
97
Q

What is the biggest risk factor for laryngeal cancer?

A

Smoking

98
Q

What are the symptoms of laryngeal cancer?

A

Hoarse voice, persistent lump, dysphagia, stridor

99
Q

How are head and neck cancers managed?

A
  • Fine needle aspiration

- Chemo, radiotherapy, surgery

100
Q

What might cause secondary hyperthyroidism?

A

TSH-secreting pituitary adenoma

101
Q

What might cause secondary hypothyroidism?

A

Pituitary adenoma

102
Q

What is the most common type of thyroid cancer?

A

Papillary

103
Q

What are the types of thyroid cancer?

A
  • Papillary
  • Follicular
  • Medullary
  • Anaplastic
104
Q

Which is the most aggressive type of thyroid cancer?

A

Anaplastic

105
Q

How does thyroid cancer present?

A

Neck lump + not typically any thyroid symptoms

106
Q

How is thyroid cancer managed?

A
  • Thyroidectomy

- Radioactive iodine if advanced

107
Q

When is foreign body in the ear considered an emergency?

A
  • Bugs

- Button battery-> can burn + damage tissues

108
Q

How might foreign body in the ear present?

A

pain, hearing loss, discharge

109
Q

How are foreign bodies in the ear removed?

A
  • Crocodile forceps

- Microsuction

110
Q

What can cause epistaxis?

A

Spontaneous, trauma, hypertension, blood thinners

111
Q

How is epistaxis managed?

A
  • ABCDE
  • Pinch cartilage + lean forward for 20 minutes
  • Cauterise with silver nitrate
  • Pack (anterior/posterior)
  • May need surgical ligation
112
Q

What can cause airway obstruction?

A
  • Cancers-> oropharynx, laryngeal, tongue
  • Epiglottitis
  • Deep neck space infections
  • Foreign bodies
113
Q

What are the red flag symptoms/features of airway obstruction?

A

Stridor, cyanosis, agitation, respiratory distress, wheeze, decreased breath sounds

114
Q

How might airway obstruction be managed?

A
  • ABCDE
  • Oxygen
  • Salbutamol/adrenaline nebs
  • Tracheostomy
115
Q

What is epiglottitis?

A

-Infection of the supraglottic tissue

116
Q

What usually causes epiglottitis?

A

H.influenzae type B

117
Q

What are the symptoms and signs of epiglottitis?

A
  • Drooling, distress, dysphagia
  • Swollen epiglottis
  • Thumb print sign on lateral C-spine X ray
118
Q

How is epiglottitis managed?

A

Intubation + IV antibiotics

119
Q

What is a lump that moves when the patient sticks out their tongue likely to be?

A

Thyroglossal cyst

120
Q

What is periorbital cellulitis?

A
  • A complication of acute rhinosinusitis

- Graded depending on location

121
Q

What are the grades of periorbital cellulitis?

A
  • Preseptal
  • Post septal
  • Subperiosteal or orbital
  • Cavernous sinus thrombosis
122
Q

What are the potential complications of periorbital cellulitis?

A

Vision impairment or loss, Horner’s syndrome (CNIII)

123
Q

How is periorbital cellulitis managed?

A
  • Preseptal-> medical
  • Post septal-> medical
  • Subperiosteal or orbital-> surgical
  • Cavernous sinus thrombosis-> neurosurgery
124
Q

What are the red flag symptoms of periorbital cellulitis?

A
  • Chemosis (oedema of sclera)
  • Proptosis
  • Ophthalmoplegia
125
Q

Why are amoxicillin and co-amoxiclav contraindicated in tonsillitis?

A

If glandular fever not ruled out may cause Steven-Johnson syndrome

126
Q

Why are amoxicillin and co-amoxiclav contraindicated in glandular fever?

A

Can cause Steven-Johnson syndrome

127
Q

What causes glandular fever?

A

EBV

128
Q

What are the symptoms of glandular fever?

A

High fever, lethargy, bulky lymphadenopathy, splenomegaly

129
Q

What blood results will be apparent in glandular fever?

A
  • Lymphocytosis

- Deranged LFTs

130
Q

How is glandular fever managed?

A

No contact sports for 3 months