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1
Q

what is peripheral vertigo due to?

A

damage to the vestibular apparatus or to the vestibular nerve

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2
Q

what is central vertigo due to?

A

damage to the vestibular structures in the brain stem or cerebellum

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3
Q

what is the most common cause of peripheral vertigo?

A

BPPV

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4
Q

explain the pathophysiology of BPPV

A

calcium carbonate crystals become dislodged into the semicircular canals (usually the posterior semicircular canal) and this disrupts the flow of endolymph meaning the semicircular canals cannot properly detect angular circulation causing vertigo

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5
Q

what is vestibular neuritis?

A

inflammation of the vestibular portion oft the 8th cranial nerve

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6
Q

when does vestibular neuritis usually occur?

A

following an upper resp tract infection that has caused an ear infection (usually caused by viruses)

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7
Q

what is menieres disease due to?

A

excess endolymph in the semicircular canals due to impaired resorption of endolymphatic fluid

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8
Q

what is an acoustic neuroma?

A

a schwannoma of the 8th CN

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9
Q

what is the difference between vestibular neuritis and labyrinthitis ?

A

vestibular neuritis = no hearing loss

labyrinthitis = hearing loss

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10
Q

how long do vestibular neuritis and labyrinthitis cause vertigo for?

A

days

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11
Q

what is the rule of 3 for vestibular neuritis?

A

3 days in bed
3 weeks off work
3 months off balance

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12
Q

what is the likely diagnosis for someone who has short periods of vertigo when turning over in bed?

A

BPPV

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13
Q

what is the most likely diagnosis for someone who has a 5 day history of nausea and vomiting and vertigo?

A

vestibular neuritis

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14
Q

what is the most likely diagnosis for someone who has a 5 day history of nausea and vomiting, vertigo and hearing loss?

A

labyrinthitis

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15
Q

what is the diagnostic test for BPPV?

A

hallpike test

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16
Q

what is the treatment for BBPV?

A

epley manoeuvre

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17
Q

what is the most likely diagnosis for someone who is experiencing dizzy spells and hearing changes / ear feeling full at the same time?

A

menieres disease

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18
Q

what is the triad of symptoms for meniers disease?

A

episodic vertigo
tinnitus / ear fullness / pain
sensorineural hearing loss

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19
Q

what is waldeyers tonsillar ring?

A

a ring like arrangement of lymphoid tissue in both the nasopharynx and oropharynx

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20
Q

what is a nasal polyp?

A

a clump of epithelial tissue that undergoes hyperplasia and forms a growth of tissue in the wall of the nasal cavity

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21
Q

where do nasal polyps usually form?

A

in the ethmoid or maxillary sinuses

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22
Q

give 4 symptoms of nasal polyps?

A

hyposmia (loss of sense of smell)
foreign body feeling
nasal breathing difficulty
fever and headaches (due to recurrent infections)

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23
Q

why are nasal polyps dangerous in children?

A

because they are obligate nasal breathers and so a nasal obstruction can cause hypoxia

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24
Q

how are nasal polyps diagnosed?

A

nasal endoscopy or CT

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25
how are nasal polyps treated?
nasal steroids (reduce the inflammation and swelling of the polyp)
26
for a pt who has nasal polyps that are unresponsive to steroids what is the management?
removal via sinus surgery
27
what is rhinitis?
inflammation and irritation of the mucus membrane inside the nose
28
which kind of hypersensitivity reaction is allergic rhinitis?
type 1
29
what is sinusitis / rhino-sinusitis?
inflammation and irritation of the mucosal lining inside the nasal cavity and the paranasal sinuses (esp maxillary)
30
which 2 things are not recommended in those w/ sinusitis?
radiograph | secretion culture
31
where does anterior epistaxis originate from?
kiesselbachs plexus
32
where does posterior epistaxis originate from and which artery is this a branch of?
the sphenopalatine artery and this is a branch of the maxillary artery
33
what is the most common cancer originating in the nasopharynx?
nasopharyngeal carcinoma
34
where does nasopharyngeal carcinoma originate from?
the epithelial cells lining the nasopharynx
35
nasopharyngeal cancer is often assoc. w/ which infection?
EBV
36
where is oropharyngeal carcinoma usually located?
soft palate palatine tonsillar fossa and pillars lateral and posterior pharyngeal wall base of the tongue
37
give the 3 main causes of oropharyngeal carcinoma?
tobacco alcohol human papilloma virus
38
which 2 structures make up the outer ear?
the pinna and the external canal
39
which structures make up the middle ear?
the ear bones : - malleus - incus - stapes
40
where does the cochlea lie in relation to the vestibule?
anterior (towards the front of the head)
41
where do the semi-circualr canals lie in relation to the vestibule?
posterior (towards the back of the head)
42
which structure lies between the outer and middle ear?
tympanic membrane (ear drum)
43
which 2 strucutures lies between the middle and inner ear?
``` ovAl window (Above) round window (below) ```
44
which bone of the middle ear is attached to the tympanic membrane?
the malleus
45
the foot of which bone of the middle ear rests on the oval window?
the foot of the stapes
46
which part of the inner ear transforms sound waves into electrical impulses?
the cochlea
47
where is perilymph fluid contained?
in the outer bony shell of the cochlea
48
where is endolymph fluid contained?
the cochlear duct
49
what is the importance of the flexibility of the vestibular membrane?
it allows sound waves to transmit from the perilymph to the endolymph
50
what is the organ of corti stimulated by?
vibration of the basal membrane
51
inner ear pathology causes what kind of hearing loss?
sensorineural hearing loss
52
outer and middle ear pathology causes what kind of hearing loss?
conductive hearing loss
53
how are pinna haematomas managed?
incision w/ primary closure
54
what is the step wise progression of the management of epistaxis?
direct compression (10-15mins) > cautery > nasal packing > aggressive therapies
55
how does otosclerosis affect hearing?
causes a bilateral conductive hearing loss that is better w/ background noise and highly assoc w/ tinnitus
56
give 2 risk factors for otosclerosis
onset in early adulthood | exacerbated by pregnancy
57
what is the inheritance of otosclerosis?
autosomal dominant
58
what is the purpose of tensor tympani?
to dampen loud sounds that might otherwise cause damage to the ear
59
what is the innervation of tensor tympani?
CN V3 (mandibular division of the trigeminal nerve)
60
what does air conduction being louder than bone conduction indicate?
that there is no conductive hearing loss
61
what is swimmers ear?
otitis externa
62
what is the most common tumour in the parotid gland?
pleomorphic adenoma
63
what is the most common type of head and neck cancer?
squamous cell carcinoma
64
which antibiotics are given in the treatment of bacterial tonsillitis?
phenoxymethylpenicillin | clarithromycin if penicillin allergic
65
what does a flat tympanogram trace (type B) indicate?
fluid behind the tympanic membrane (middle ear congestion)
66
what is tympanosclerosis?
chronic inflammation and scarring of the tympanic membrane leading to calcification of the tympanic membrane
67
give 2 factors assoc w/ tympanosclerosis?
long term otitis media grommet insertion
68
what are the findings of the special tests in sensorineural hearing loss?
weber test - lateralisation to the UNAFFECTED ear | rinne test - air conduction > bone conduction
69
what are the special test findings in conductive hearing loss?
webe test - lateralisation to the AFFECTED ear | rinne test - bone conduction > air condition
70
what is a classic finding of acute mastoiditis?
the ear protruding forward
71
what is the imaging modality of a neck mass?
an US
72
what is the most common kind of oral cancer?
squamous cell carcinoma
73
what is the most common cause of epiglottitis?
haemopghilus influenza type b
74
where do most nose bleeds originate from?
littles area w/in kisselbachs plexus
75
what is the first line treatment of anterior epistaxis?
cautery
76
what is the second line treatment of anterior epistaxis ?
anterior nasal packing
77
what is the first line treatment of posterior epistaxis?
packing
78
apart from the eply manoeuvre what can be done for BBPV?
brandt-daroff exercises
79
what is the management of vestibular neuronitis?
a short course of buccal or IM prochlorperazine if symptoms last longer than a week then refer urgently to a balance specialist for vestibular rehabilitation
80
what is the first line treatment for nasopharyngeal carcinoma?
radiotherapy
81
what are the two principal risk factors for tonsils squamous cell carcinoma?
tobacco use human papilloma virus
82
what is the management of unilateral glue ear in adults?
all adults w/ unilateral glue ear should be urgently referred to ENT for evaluation of posterior nasal space tumour
83
what is the management for idiopathic sudden onset sensorineural hearing loss?
high dose corticosteroids oral prednisolone for 7 days
84
what is the management of acute otitis media w/ perforation?
oral antibiotics amoxicillin first line erythromycin if allergic
85
what is the management of primary haemorrhage after tonsillectomy?
immediate return to theatre
86
what infection is associated with nasopharyngeal carcinoma?
EBV
87
what is the prevalence of nasopharyngeal carcinoma?
rare in most parts of the world except southern china
88
what is the first line antibiotic for tonsillitis?
phenoxymethylpenicillin
89
what is a branchial cyst?
a benign lesion situated in the lateral neck superficial to the sternocleidomastoid muscle
90
what is the classic pathological finding of a branchial cyst?
acellular fluid w/ cholesterol crystals
91
how does a thyroglossal cyst present?
typically midline and moves w/ tongue protrusion
92
what is the treatment of Ramsay hunt syndrome?
oral acyclovir and corticosteroids
93
what is the management of malignant otitis externa and why?
ciprofloxacin to provide cover for pseudomonas
94
what is the likely diagnosis of an elderly pt who gets dizzy on extending their neck?
vertenbobasilar ischaemia
95
what is the management of chronic rhinosinusitis?
avoid the allergen intranasal corticosteroids nasal irritation w/ saline solution
96
which side will sound localise to in webers test if there is a conductive hearing loss?
localise to the side of the conductive hearing loss
97
which side will sound localise to in webers test if there is a sensorineural hearing loss?
localise to the contralateral side of the hearing loss
98
what is the management of unilateral nasal polyps and why?
urgent referral to ENT because unilateral nasal polyps are a red flag symptom of nasopharyngeal carcinoma
99
what is the recommended initial management of uncomplicated otitis externa?
topical antibiotics +/- topical steroid
100
what does post auricular swelling indicate?
mastoiditis
101
sensitivity to which medication is associated w/ nasal polyps?
aspirin
102
what is the likely diagnosis of a slow growing painless mobile lump in the parotid gland of an older female?
pleomorphic adenoma
103
what is the most common tumour of the parotid gland?
pleomorphic adenoma
104
what is the management of children w/ glue ear on the background of downs syndrome or cleft palate?
refer to ENT
105
what is done if a perforated tympanic membrane has not healed by itself?
myringoplasty
106
what is the management of quinsy?
IV abs, surgical drainage and consideration of tonsillectomy in 6 wks to prevent recurrence
107
108
what is the requirement for adults to be eligible for cochlear implants?
have trialled hearing aids for at least 3 months
109
what is the cause of the majority of cases of sudden onset of sensorineural hearing loss?
idiopathic
110
what can be used to differentiate between vestibular neuronitis and posterior circulation stroke?
HiNTS exam
111
what can be used to prevent attacks of meniers disease?
betahistine
112
what is the initial first aid management of epistaxis?
pinch the nostrils and lean forwards for 20 mins
113
normally is air or bone conduction better?
normally air conduction is better than bone conduction
114
what is a normal result of the Rennie test?
air conduction is better than bone conduction
115
what are the findings of a Rennie test in a conductive hearing loss?
bone conduction is better than air conduction
116
what is a normal result of the webber test?
sound is heard in both ears / equally in the midline
117
what are the findings of a webber test in a sensorineural hearing loss?
webber test will lateralise to the unaffected ear
118
how does a thyroglossal cyst present?
usually in the midline moves upwards on protrusion of the tongue
119
how does a pharyngeal pouch present?
usually in older men usually not seen but if large enough then a midline lump in the neck that gurgles on palpation
120

ENT (1 decks)

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