ENT Flashcards
1
Q
what is the role of semicircular canals in the ear? what are they filled with?
A
- to sense head movement
- endolymph
2
Q
what is the eustachian tube? what are its 2 roles?
A
- tube connecting middle ear with the throat
- equalises pressure in the middle ear
- drains fluid from middle ear
3
Q
role of the cochlea?
A
converts sound vibration into nerve signal
4
Q
when is hearing loss classed as “sudden onset”?
A
when it occurs in less than 72 hours
5
Q
what might hearing loss with associated pain / discharge indicate?
A
outer / middle ear infection
6
Q
how is weber’s test performed?
A
- get tuning fork vibrating
- place in middle of pt’s forehead
- ask if they can hear the sound and which ear it is louder in
7
Q
what is the result for weber’s test in sensorineural hearing loss?
A
sound is louder in the normal (unaffected) ear
8
Q
what is the result for weber’s test in conductive hearing loss?
A
- sound is louder in the affected ear
- deaf ear feels the need to “turn up the volume”
9
Q
how is rinne’s test performed?
A
- get tuning fork vibrating
- put it on the mastoid process and ask if they can hear it (bone conduction)
- when they can no longer hear it, move the tuning fork 1cm from their ear and ask again (air conduction)
- repeat for opp ear
10
Q
what is a normal rinne’s test result?
A
- pt can hear the sound again when fork lifted off the mastoid process
- air conduction is better than bone conduction normally
11
Q
what is the finding of an abnormal (negative) rinne’s test? what might this indicate
A
- sound NOT heard again once tuning fork moved off of bone (bone > air)
- conductive hearing loss
12
Q
causes of adult onset sensorineural hearing loss?
A
- presbycusis
- noise exposure
- meniere’s disease
- labyrinthitis
- acoustic neuroma
- neuro conditions
- infection (e.g. meningitis)
- drugs
13
Q
neurological causes of sensorineural hearing loss?
A
- stroke
- MS
- brain tumours
14
Q
drug causes of sensorineural hearing loss?
A
- furosemide
- gentamicin
- chemotherapy (e.g. cisplatin)
15
Q
causes of adult-onset conductive hearing loss? hint: blockage
A
- ear wax
- foreign body in ear canal
- infection (otitis media / externa)
- middle ear effusion
- eustachian tube dysfunction
- perforated tympanic membrane
- osteosclerosis
- cholesteatoma
- exostoses
- tumours
16
Q
what are exostoses?
A
benign bone growths in the ear
17
Q
what is presbycusis?
A
age-related sensorineural hearing loss
18
Q
pathophysiology of presbycusis?
A
loss of hair cells and neurones in cochlea
19
Q
risk factors for presbycusis?
A
- ageing
- male sex
- FHx
- loud noise exposure
- DM
- HTN
- ototoxic drugs
- smoking
20
Q
presentation of presbycusis?
A
- gradual, insidious hearing loss
- high pitched sounds go first
- associated tinnitus
21
Q
how is presbycusis diagnosed?
A
audiometry
22
Q
management of presbycusis?
A
- optimise environment (reduce ambient noise)
- hearing aids
- cochlear implants (2nd line)
23
Q
what is sudden sensorineural hearing loss (SSNHL)? commonest cause?
A
- hearing loss over less than 72 hours unexplained by other causes
- emergency!!!
- 90% cases are idiopathic
24
Q
conductive causes of sudden-onset hearing loss?
A
- ear wax / foreign body blocking canal
- otitis media / externa
- middle ear effusion
- eustachian tube dysfunction
- perforated tympanic membrane
25
causes of SSNHL?
- idiopathic
- infection
- meniere's disease
- drugs
- MS
- migraine
- stroke
- acoustic neuroma
- cogan's syndrome
26
diagnostic criteria on audiometry in SSNHL?
at least 30 dL in 3 consecutive frequencies
27
investigations in SSNHL?
- audiometry
| - MRI / CT head to rule out stroke / acoustic neuroma
28
management of SSNHL?
- immediate referral to ENT
- treat underlying cause (e.g. ABx for infection)
- steroids if idiopathic (PO, intra-tympanic injection)
29
which other conditions might eustachian tube dysfunction be related to?
- URTI
- allergies (e.g. hayfever)
- smoking
30
presentation of eustachian tube dysfunction?
- reduced / altered hearing
- popping / fullness sensations in ear
- pain
- discomfort
- tinnitus
31
when does eustachian tube dysfunction worsen? give some examples
- when external air pressure changes
- air travel
- on a mountain
- scuba diving
32
investigations for eustachian tube dysfunction?
- not needed if obvious
- tympanometry
- audiometry
- nasopharyngoscopy
- otoscopy (r/o otitis media)
- CT
33
management of eustachian tube dysfunction?
- no Tx (e.g. wait for URTI to resolve)
- valsalva manoeuvre
- decongestant nasal sprays
- antihistamines / steroid nose spray (allergies)
- otovent
- surgery
34
surgical options for eustachian tube dysfunction?
- adenoidectomy
- grommets
- balloon dilatation eustachian tuboplasty
35
what is otosclerosis? what does it result in?
- remodelling of small bones in middle ear
| - conductive hearing loss
36
risk factors for otosclerosis?
- female sex
- age <40
- FHx
37
presentation of otosclerosis?
- bilateral hearing loss (low-pitched lost first)
- bilateral tinnitus
- reports own voice sounding louder, so speaks quietly
38
findings O/E in otosclerosis?
- normal otoscopy
- normal weber's (if bilateral)
- negative rinne's (bone > air)
39
investigation of choice (and findings) in otosclerosis?
audiometry shows hearing loss at lower frequencies
40
management of otosclerosis?
- hearing aids
| - stapedectomy / stapedotomy
41
what is otitis media often preceded by?
URTI
42
commonest causative organism(s) of otitis media? hint: think pneumonia
- streptococcus pneumoniae (pneumococcus)
| - then: H. influenzae
43
presentation of otitis media in adults?
- ear pain
- reduced hearing in affected ear
- fever, fatigue
- URTI symptoms
- vertigo (if vestibular involvement)
- discharge (burst membrane)
44
otoscopy findings in otitis media?
- bulging, red tympanic membrane
| - discharge in ear canal if membrane has burst
45
management of otitis media?
- most resolve spontaneously over 3 days
- paracetamol / ibuprofen for pain / fever
- consider ABx (immediate or delayed)
46
when should you consider immediate ABx in otitis media?
- significant comorbidities
- systemically unwell
- immunocompromised
47
when should you consider delayed ABx in otitis media? when can these be claimed?
- 3d after prescribing
| - when you suspect they'll worsen soon
48
ABx of choice for otitis media? hint: remember allergies!
- 5-7d course of amoxicillin
| - clarithromycin if penicillin allergic
49
give a common and a rare example of a complication in otitis media?
- otitis media with effusion
| - mastoiditis (palpate mastoid process for this)
50
describe the pathophysiology of otitis externa
inflammation of the skin of the external ear canal
51
causes of otitis externa?
- bacterial / fungal infection
- eczema
- contact dermatitis
52
give 2 bacterial causes of otitis externa?
- pseudomonas aeruginosa
| - staph aureus
53
presentation of otitis externa?
- ear pain
- discharge
- itchiness
- conductive hearing loss
54
signs O/E of otitis externa?
- erythema, swelling and tenderness of ear canal
- pus / discharge in ear
- neck lymphadenopathy
55
when might pus in the external ear canal be due to otitis media rather than otitis externa?
when the tympanic membrane has been perforated
56
investigations for otitis externa?
- otoscopy
| - ear swab (not used often)
57
management of mild otitis externa?
acetic acid 2%
58
treatment for moderate otitis externa?
- add topical ABx + steroid
| - e.g. neomycin + betamethasone + acetic acid 2% (called "otomize")
59
what must you exclude before treating moderate otitis externa? hint: ABx SEs
- must check the tympanic membrane is not perforated
| - because it needs macrolides which can be ototoxic
60
treatment of severe otitis externa?
- oral ABx
- e.g. flucloxacillin or clarithromycin
- if very severe, admission and IV ABx
61
management of fungal otitis externa?
clotrimazole ear drops
62
what is malignant otitis externa? main complication of this?
- infection which has spreads to bones outside of ear canal
| - osteomyelitis of temporal bone
63
risk factors for malignant otitis externa? hint: immunocompromise
- DM
- immunosuppressants (e.g. chemo)
- HIV
64
presentation of malignant otitis externa?
- more severe version of otitis externa signs
- persistent headache
- fever
- severe pain
65
key finding of malignant otitis externa?
granulation tissue at junction between bone and cartilage
66
management of malignant otitis externa?
- admission under ENT team
- IV ABx
- CT / MRI head
67
presentation of impacted ear wax?
- conductive hearing loss
- discomfort / fullness in ear
- pain
- tinnitus
68
how is impacted ear wax diagnosed?
seen on otoscope covering tympanic membrane
69
management of impacted ear wax?
- most cases need nothing
- ear drops (olive oil)
- ear irrigation (water)
- microsuction
70
what is primary tinnitus associated with?
sensorineural hearing loss
71
causes of secondary tinnitus? hint: there's a LOT
- impacted ear wax
- ear infection
- meniere's disease
- noise exposure
- drugs
- acoustic neuroma
- MS
- trauma
- depression
72
drug causes of tinnitus?
- furosemide
- gentamicin
- cisplatin
73
systemic signs associated with tinnitus?
- anaemia
- DM
- thyroid dysfunction (hypo or hyper)
- hyperlipidaemia
74
what is objective tinnitus?
sound is demonstrable O/E (it is actually there)
75
examples of causes of objective tinnitus?
- carotid artery stenosis (causing a bruit)
- aortic stenosis
- AVM
- eustachian tube dysfunction (popping / clicking sounds)
76
red flag features of tinnitus?
- unilateral
- pulsatile
- associated sudden-onset hearing loss
- associated vertigo / dizziness
- headaches / visual changes
- suicidal ideation
77
prognosis of tinnitus?
tends to improve alone without any intervention
78
management of tinnitus?
- treat underlying cause (wax removal)
- hearing aids
- sound therapy
- CBT
79
what is vertigo?
the sensation that either the patient or their environment is moving
80
vestibular causes of vertigo?
- BPPV
- meniere's disease
- vestibular neuronitis
- labyrinthitis
81
pathophysiology of benign paroxysmal positional vertigo (BPPV)?
- calcium carbonate crystals (otoconia) displaced into semicircular canals
- disrupts endolymph flow
82
course of disease in BPPV?
- onset over several weeks
- then resolves
- then recurs months later
83
diagnostic test for BPPV?
dix-hallpike manoeuvre
85
pathophysiology of meniere's disease?
build-up of excessive endolymph in semicircular canals
85
treatment of BPPV?
- epley manoeuvre
| - brandt-daroff exercises
86
presentation of meniere's disease?
- hearing loss
- tinnitus
- vertigo
- fullness in ear feeling
- "drop attacks" (unexplained falls)
- unidirectional nystagmus
87
pathophysiology of acute vestibular neuritis?
viral infection (usually URTI) causing inflammation of the vestibular nerve
88
what is ramsay-hunt syndrome? how does it present?
- herpes-zoster infection with associated symptoms
- facial nerve weakness
- vesicles around ear
89
central causes of vertigo?
anything affecting cerebellum or brainstem:
- posterior stroke
- tumour
- MS
- vestibular migraine
90
how does vertigo from a central cause present?
it will be sustained and non-positional
91
presentation of vestibular migraine?
- vertigo
- visual aura
- headaches
92
give an example of a trigger for BPPV
turning over in bed
93
presentation of meniere's disease? hint: triad
- hearing loss
- vertigo
- tinnitus
94
pathophysiology of meniere's disease?
excessive buildup of endolymph in the labyrinth of the inner ear
95
typical patient history in meniere's disease?
- 40-50 year old
| - unilateral episodes of vertigo, hearing loss and tinnitus
96
how does the vertigo in meniere's disease present?
- episodic
- lasts 20 mins - few hours
- not triggered by movement or posture
97
what type of hearing loss is seen in meniere's disease?
- unilateral
- sensorineural
- low frequencies affected first
98
how is meniere's disease diagnosed?
- clinically
| - followed up by audiology assessment
99
management of acute attacks of meniere's disease?
- prochlorperazine
| - antihistamines (e.g. cyclizine)
100
prophylaxis in meniere's disease?
betahistine
101
what is an acoustic neuroma?
benign tumour of schwann cells surrounding the vestibulocochlear nerve
102
in which condition are bilateral acoustic neuromas seen?
neurofibromatosis type II
103
where do acoustic neuromas grow?
cerebellopontine angle
104
typical history of acoustic neuroma?
- unilateral SN hearing loss (first symptom)
- unilateral tinnitus
- dizziness / imbalance
- sensation of fullness in ear
105
which palsy might be associated with acoustic neuroma?
facial nerve palsy
106
how is acoustic neuroma diagnosed?
- MRI or CT
| - MRI is more detailed so preferred
107
management of acoustic neuroma?
- conservative (monitoring)
- surgical removal
- radiotherapy
108
complications of treating meniere's disease?
- CN8 damage (permanent HL, dizziness)
| - CN7 injury (facial weakness)
109
what is a cholesteatoma?
abnormal collection of squamous epithelial cells in the middle ear
110
is a cholesteatoma worrying?
- not malignant
| - can erode middle ear bones, predisposing to infection
111
early presentation of cholesteatoma?
- foul ear discharge
| - unilateral conductive hearing loss
112
later features of cholesteatoma?
all caused by expansion:
- infection
- pain
- vertigo
- CN7 palsy
113
investigations and findings for cholesteatoma?
- CT head is diagnostic
- otoscopy
- shows build up of whitish debris / crust in upper tympanic membrane
114
management of cholesteatoma?
surgical removal
115
presentation of facial nerve palsy?
unilateral facial weakness
116
important differential for facial nerve palsy?
stroke!
117
is there forehead sparing in CN7 palsy? why / why not?
- it is an LMN lesion
| - therefore no, the forehead is not spared
118
is there forehead sparing in stroke? why / why not?
- it is an UMN lesion
| - therefore, yes the forehead is spared
119
what is bell's palsy?
idiopathic unilateral LMN CN7 palsy
120
prognosis for bell's palsy?
- most patients recover in weeks
| - some have residual weakness
121
management of bell's palsy?
- if presented within 72h of symptom onset, then prednisolone
- lubricating eye drops
122
eye complication from bell's palsy? how is it prevented?
- exposure keratopathy
- tape the eye shut at night
- use eye drops
123
which organism causes ramsay-hunt syndrome?
herpes zoster
124
presentation of ramsay-hunt syndrome?
- unilateral CN7 LMN lesion
- painful, tender vesicular rash
- in ear canal, pinna, around ear
125
treatment for ramsay-hunt syndrome?
ideally within 72h:
- prednisolone
- aciclovir
also lubricating eyedrops
126
which systemic diseases can give a CN7 palsy?
- DM
- sarcoidosis
- leukaemia
- MS
- GBS
127
what is the most likely site of bleed in epistaxis?
little's area
128
causes of nosebleeds?
- nose picking
- colds, sinusitis
- vigorous nose-blowing
- trauma
- weather changes
- cocaine snorting
- tumours
- bleeding disorders
129
management of nosebleeds?
- sit up, tilt head forwards
- squeeze soft part of nostrils together for 15 mins
- spit out any blood in mouth
- after 10-15 mins: nasal packing (tampons) or nasal cautery (with silver nitrate)
130
what can be prescribed after a nosebleed? why is this useful?
- naseptin cream (chlorhexidine and neomycin)
| - stops crusting and infection
131
when is sinusitis classed as chronic?
when it lasts >12 weeks
132
what are the 4 types of paranasal sinus?
- frontal
- maxillary
- ethmoid
- sphenoid
133
causes of sinusitis?
- infection (typically post-viral URTI)
- allergies (allergic rhinitis)
- obstruction of drainage
- smoking
- asthma = RF
134
what could cause obstruction of drainage from the paranasal sinuses?
- foreign body
- trauma
- polyps
- deviated septum
135
presentation of acute sinusitis?
- recent viral URTI
- nasal congestion, discharge
- facial pain
- facial pressure
- facial swelling over affected regions
- headache
- loss of smell (anosmia)
136
findings O/E in sinusitis?
- affected areas are tender to touch
- inflammation and oedema of nasal mucosa
- discharge
- fever
- other signs of systemic infection (e.g. raised HR)
137
key condition associated with chronic sinusitis?
nasal polyps
138
investigations in sinusitis?
- not needed in most cases
- nasal endoscopy
- CT
139
management of acute sinusitis?
- if systemic infection / septic then hosp admission
- no Tx for first 10 days
- after this:
- mometasone nasal spray 200mcg BD for 14d
- delayed ABx prescription if no improvement in 7d after steroid
140
prognosis for most cases of acute sinusitis?
- good
| - self-resolving in 2-3 weeks
141
management of chronic sinusitis?
- saline nasal irrigation
- mometasone / fluticasone nasal sprays
- FESS (type of surgery)
142
describe correct administration of a nasal spray
- tilt head slightly forward
- use opp hand to spray into opp nostril
- do not sniff hard during spray
- inhale very gently afterwards
- spray should not be tasted in mouth afterwards
143
what is a nasal polyp? where is it found?
- growth of nasal mucosa
| - nasal cavity or sinuses
144
are nasal polyps typically uni or bilateral? do they grow fast or slow?
- bilateral and slow growing
| - unilateral polyps are a red flag for Ca!!!
145
which other conditions are associated with nasal polyps?
- chronic sinusitis
- asthma
- samter's triad
- CF
- eosinophilic granulomatosis with polyangiitis (churg-strauss)
146
what is samter's triad?
1. nasal polyps
2. asthma
3. aspirin intolerance / allergy
147
presentation of nasal polyps?
- chronic sinusitis symptoms
- difficulty breathing through nose
- snoring
- nasal discharge
- anosmia
148
which types of examination are useful in nasal polyps?
- nasal speculum
| - nasal endoscopy (done by specialist)
149
management of nasal polyps?
- unilateral polyps always need specialist referral to r/o Ca
- intranasal steroid drops / spray
- intranasal polypectomy
- endoscopic nasal polypectomy (if further up nose / in sinuses)
150
pathophysiology of obstructive sleep apnoea (OSA)?
collapse of pharyngeal airway during sleep
151
typical history in OSA?
- pt's partner reports that the pt stops breathing for up to a few mins at night
- pt unaware of this
152
risk factors for OSA?
- male
- middle age
- obesity
- alcohol
- smoking
153
features of OSA?
- apnoea episodes during sleep (reported by partner)
- snoring
- morning headache
- waking up unrefreshed from sleep
- daytime sleepiness
- low concentration
- reduced O2 sats during sleep
154
complications of severe OSA?
- HTN
- HF
- MI
- stroke
155
what is the epworth sleepiness scale used for?
to assess symptoms of sleepiness in OSA
156
what should you check in anyone with OSA?
- occupation
| - sleepiness could make them dangerous at work, e.g. lorry driver
157
management of OSA?
- ENT referral
- correct reversible risk factors
- CPAP
- UPPP surgery
158
most common causative organism in bacterial tonsillitis? second most common one?
- group A strep (strep pyogenes)
| - pneumococcus
159
commonest cause of tonsillitis?
viral infection
160
which tonsils are most likely to be affected in tonsillitis?
palatine tonsils
161
presentation of acute tonsillitis?
- sore throat
- fever >38C
- pain on swallowing
162
(potential) findings O/E of tonsillitis?
- red, inflamed enlarged tonsils
- exudate
- anterior cervical lymphadenopathy
163
which 2 scoring systems can be used to work out whether tonsillitis is viral or bacterial?
- centor criteria
| - feverPAIN score
164
criteria in the feverPAIN score?
- fever in last 24h
- purulent tonsils
- attended within 3d of symptom onset
- inflammation, severe
- no cough / coryza
165
when should you consider admitting a patient with tonsillitis?
for any of the following:
- immunocompromised
- systemically unwell
- dehydrated
- stridor
- resp distress
- evidence of quinsy / cellulitis
166
when should ABx be considered in tonsillitis?
- centor score: 3 or more
- feverPAIN score: 4 or more
- immunocompromised
- Hx of rheumatic fever
- significant comorbidities
167
first line antibiotic in bacterial tonsillitis?
- penicillin V (phenoxymethylpenicillin)
| - if penicillin allergic: clarithromycin
168
safety netting advice in viral tonsillitis?
return if:
- pain has not settled in 3d
- fever >38.3C after 3d
169
complications of tonsillitis?
- peritonsillar abscess
- otitis media
- scarlet fever
- rheumatic fever
- post-strep GN
- post-strep reactive arthritis
170
what is a quinsy? how could it occur?
- peritonsillar abscess due to bacterial infection with trapped pus
- may be complication of untreated tonsillitis
171
demographic most commonly affected by tonsillitis?
children
172
presentation of quinsy?
- sore throat
- painful swallowing
- fever
- neck pain
- referred ear pain
- swollen, tender lymph nodes
- trismus
- "hot potato voice"
173
most common causative organism of quinsy?
group A strep (strep pyogenes)
174
management of quinsy?
- admit under ENT
- incision and drainage, done under GA
- co-amox before and after surgery
- dexamethasone for inflammation
175
indications for tonsillectomy?
based on no. of cases of tonsillitis:
- 7+ in 1y
- 5+ per year for 2y
- 3+ per year for 3y
other indications
- 2 episodes of quinsy
- enlarged tonsils causing difficulty breathing, swallowing or snoring
176
complications of tonsillectomy?
- post-tonsillectomy bleeding
- sore throat for up to 2w
- damage to teeth
- infection
- risks with GA
177
how could a post-tonsillectomy bleed be life-threatening?
if blood is aspirated
178
management of post-tonsillectomy bleeding?
- get IV access and send off bloods including G+S and X-match
- encourage pt to spit out blood
- make pt NBM in case surgery needed
- hydrogen peroxide gargle
- topical adrenaline soaked swab
179
differentials for a neck lump in an adult? hint: there's a LOT
- normal structures (e.g. bony prominence)
- skin abscess
- lymphadenopathy
- tumour (thyroid, carotid body)
- lipoma
- salivary gland stones
- thyroglossal cysts
- branchial cysts
180
additional differentials for neck lump in a young child?
- cystic hygroma
- dermoid cyst
- haemangiomas
- venous malformation
181
what are the 2WW criteria for referral of a neck lump?
- unexplained neck lump in anyone aged >45
| - persistent, unexplained neck lump at any age
182
when should an urgent USS be performed on a neck lump? timeframes for this scan?
- when it is growing in size
- within 2w if over 25
- within 48h if under 25
- referral to 2WW depending on USS findings
183
which blood tests may be requested for a neck lump? why?
- FBC, blood film (leukaemia, infection)
- HIV test
- monospot test (EBV antibodies)
- TFTs
- ANA (SLE)
- LDH (hodgkin's lymphoma, very non-specific)
184
investigations for a neck lump?
- bloods
- USS (1st line imaging)
- nuclear medicine scan
- biopsy
185
causes of lymphadenopathy? give examples of each
- reactive (viral infection)
- infection (TB, HIV, mononucleosis)
- inflammation (SLE, sarcoidosis)
- malignancy (lymphoma, leukaemia, mets)
186
features of lymphadenopathy suggestive of Ca?
- unexplained
- persistently enlarged >3cm in size
- abnormal shape
- hard / "rubbery"
- non-tender
- tethered to skin / underlying tissue
- any associated B symptoms
187
causative organism in infectious mononucleosis?
epstein barr virus (EBV)
188
how does EBV spread?
through saliva (kissing, sharing cups, toothbrushes)
189
presentation of infectious mononucleosis?
- fever
- sore throat
- fatigue
- lymphadenopathy
- maculopapular rash if amoxicillin given
190
first line investigation of infectious mononucleosis?
monospot test
191
which immunoglobuin indicates acute infection with infectious mononucleosis? which indicates immunity?
- IgM = acute infection
| - IgG = immunity
192
management of infectious mononucleosis?
- supportive
- avoid alcohol (liver impairment)
- avoid contact sports (splenic rupture)
193
typical demographics affected by hodgkin's lymphoma?
- bimodal age distribution
- one peak around age 20
- another around age 75
194
key presenting feature of lymphoma? where might this be found?
- lymphadenopathy
- "rubbery" nodes
- pain in the nodes upon drinking alcohol
- neck
- axillary nodes
- inguinal nodes
195
features of lymphoma?
quite non-specific:
- fatigue
- lymphadenopathy
- pallor (anaemia)
- petechiae / abnormal bruising (thrombocytopenia)
- abnormal bleeding
- hepatosplenomegaly
- B symptoms
196
finding on lymph node biopsy in hodgkin's lymphoma?
reed-sternberg cells
197
how is lymphoma staged?
ann arbor staging system
198
list the 3 B symptoms
- fever
- weight loss
- night sweats
199
causes of goitre?
- graves disease (hyper)
- toxic multinodular goitre (hyper)
- hashimoto's thyroiditis (hypo)
- iodine deficiency (rare)
- lithium
200
what is a goitre?
generalised swelling of the thyroid
201
differentials for individual lumps in the thyroid?
- benign hyperplastic nodules
- thyroid cysts
- thyroid adenomas
- thyroid Ca
- parathyroid tumour
202
causes of enlarged salivary glands?
- stones
- infection
- tumours
203
describe the lump found in a carotid body tumour
- lump in anterior triangle of neck
- painless
- pulsatile
- bruit on auscultation
- mobile side-to-side, but not up and down
204
how might a carotid body tumour give horner's syndrome?
by compressing on the vagus nerve (CN10)
205
finding on imaging of carotid body tumour?
- "splaying" of internal and external carotids
| - called lyre's sign
206
what is a lipoma?
benign fat tumour
207
findings O/E of a lipoma?
- soft
- painless
- mobile
- no skin changes
208
management of carotid body tumours?
surgical removal
209
management of lipomas?
- reassurance
| - may be surgically removed
210
pathophysiology of thyroglossal cyst?
- thyroglossal duct persists after birth (it normally disappears)
- gets filled with fluid
- becomes a cyst
211
key differential of a thyroglossal cyst?
ectopic thyroid tissue
212
findings O/E of a thyroglossal cyst?
- lump in midline of neck
- mobile
- non-tender
- soft
- fluctuant (move up and down with tongue movement)
213
management of thyroglossal cysts?
surgical removal
214
main complication of thyroglossal cysts?
- infection
| - lump becomes hot, tender and painful
215
presentation of a branchial cyst?
- swelling between angle of jaw and SCM muscle in anterior triangle of neck
- round and soft
- transilluminates
216
typical demographic affected by branchial cysts?
- young adulthood
217
management of branchial cysts?
- conservative
| - surgical excision if problematic
218
where could a head and neck Ca grow?
- nasal cavity
- paranasal sinuses
- mouth
- salivary glands
- pharynx
- larynx
219
risk factors for head and neck Ca?
- smoking
- chewing tobacco
- paan!
- alcohol
- HPV (esp strain 16)
- EBV infection
220
red flag features suggestive of head and neck Ca?
- lump in mouth / on lip
- unexplained mouth ulcers lasting >3m
- erythroplakia (unexplained red lesion)
- persistent neck lump
- unexplained hoarse voice
- unexplained thyroid lump
221
management of head and neck Ca?
- MDT input
- TNM staging
- chemo
- radio
- surgery
- cetuximab (monoclonal antibody)
- palliative care
222
what cell type are most head and neck cancers?
squamous cell carcinoma
223
causes of glossitis?
- Fe def anaemia
- B12 def
- folate def
- coeliac disease
- injury / irritant exposure
224
3 key causes of angioedema?
- allergic reactions
- ACE-i
- hereditary
225
risk factors for oral candiaisis?
- inhaled corticosteroids (not rinsing mouth afterwards)
- ABx
- DM
- immunodeficiency (HIV)
- smoking
226
management of oral candidiasis?
- miconazole gel
- nystatin suspension
- fluconazole tablets (if severe / recurrent)
227
describe geographic tongue
irregularly shaped patches form on tongue from loss of papillae
228
causes of geographic tongue?
- stress, mental illness
- psoriasis
- atopy
- DM
229
2 key causes of strawberry tongue?
- scarlet fever
| - kawasaki disease
230
causes of black hairy tongue?
- dehydration
- dry mouth
- poor oral hygiene
- smoking
231
what is leukoplakia?
- precancerous condition
| - gives white patches on tongue / inside cheeks
232
describe the patches found in leukoplakia
- asymptomatic
- irregular
- slightly raised
- fixed in place (can't be scraped off)
233
investigation for leukoplakia?
biopsy to look for dysplasia / Ca
234
management of leukoplakia?
- stop smoking
- cut down alcohol
- close monitoring
- laser removal
- surgical excision
235
describe the lesions seen in lichen planus
- shiny
- purplish
- flat-topped raised areas
- white lines across surface (wickham's striae)
236
which demographics are more likely to be affected by lichen planus?
- those >45
| - women
237
management of oral lichen planus?
- good oral hygiene
- stop smoking
- topical steroids
238
presentation of gingivitis?
- bleeding after brushing
- painful gums
- bad breath
239
what is periodontitis? what is its main complication?
- chronic and severe inflammation of gums around teeth
| - tooth loss!
240
RFs for gingivitis?
- plaque build up (tartar)
- smoking
- DM
- malnutrition
- stress
241
management of gingivitis?
- good oral hygiene
- stop smoking
- "scale and polish" to remove tartar
- chlorhexidine mouthwash
- metronidazole / dental surgery if needed
242
causes of gingival hyperplasia?
- gingivitis
- pregnancy
- vit C def (scurvy)
- acute myeloid leukaemia (AML)
- drugs
243
drug causes of gingival hyperplasia?
- CCBs
- phenytoin
- ciclosporin
244
which conditions can give rise to aphthous ulcers?
- IBD
- coeliac disease
- behcet's disease
- vitamin / mineral deficiency
- HIV
245
which vitamin / mineral deficiencies could cause aphthous ulcers?
- iron
- B12
- folate
- vit D
246
management of simple aphthous ulcers?
- most self-resolve in 2w
- bonjela
- difflam spray
- lidocaine
247
management of severe aphthous ulcers?
- hydrocortisone buccal tablets
| - betamethasone tablets / inhaler
248
what is the 2WW criteria with regard to aphthous ulcers?
pts with unexplained ulceration lasting >3w need a referral
249
when should you consider giving ABx in tonsillitis?
- centor score >3
| - feverPAIN score >4
