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Surgery > ENT > Flashcards

ENT Flashcards

1
Q

Which bone directly contacts the Tympanic Membrane?

A

Malleus

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2
Q

During examination, how may you test hearing?

A

Gross hearing

Weber’s Test (512Hz): central forehead

Rinner’s Test (512Hz): mastoid process until stopped, then 1cm from external auditory canal

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3
Q

Give 5 differentials for Sensorineural Hearing Loss.

A 
Presbyacusis 
Noise exposure
Meniere's Disease
Labyrinthitis 
Acoustic neuroma 
Neurological conditions 
Infections (e.g. meningitis)
Medications (loop diuretics; Aminoglycoside antibiotics; Chemotherapy drugs)
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4
Q

Which drugs may cause sensorineural hearing loss?

A

Loop diuretics

Aminoglycosides

Chemotherapy drugs

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5
Q

Give 5 differentials of conductive hearing loss.

A 
Ear wax
Infection (AOM; OE)
Effusion
Eustachian tube dysfunction 
Perforated TM 
Otosclerosis 
Cholesteatoma
Exostoses
Tumours
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6
Q

what investigation may be used to examine a patient’s hearing?

A

Audiometry

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7
Q

How does Audiometry work?

A

Variety of tones and volumes played via air conduction (headphones) and bone conduction (oscillator).

Recorded on an audiogram which helps differentiate conductive and sensorineural hearing loss

Audiogram charts the volume at which a patient can hear different tones.

Frequency (Hz) on X-axis and Volume (dB) on y-axis

Hearing is tested to find quietest volume patient can hear each frequency.

Note: Best hearing (lowest dB) will be highest on a chart. It is a test of hearing, so dB is placed inversely on the graph.

X = LS air conduction

O = RS air conduction

[ = R sided bone conduction

] = L sided bone conduction

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8
Q

What is the healthy range of hearing shown on an audiogram?

A

0-20dB

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9
Q

In sensorineural hearing loss, what will an audiogram show?

A

Both air and bone conduction is greater than 20dB

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10
Q

In conductive hearing loss, what will an audiogram show?

A

Air conduction readings >20dB thus below normal range line and lower on audiogram

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11
Q

In mixed hearing loss, what will an audiogram show?

A

Both air conduction and bone conduction will be >20dB however there will be a >15dB difference between the two values

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12
Q

What are the clinical features of Presbyacusis?

A

Hearing loss: Gradual, Higher pitch sounds lost first; symmetrical

May be associated tinnitus

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13
Q

How is Presbycusis treated?

A

Supportive: Optimising environment; Hearing aids

or
Surgery: Cochlear implant surgery

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14
Q

What would Audiometry show in Presbycusis?

A

Age-related hearing loss is a sensorineural hearing loss.

Both air and bone conduction will be reduced thus >20dB and move inferiorly

Will be symmetrical, affecting both ears

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15
Q

What is the definition of Sudden Sensorineural hearing loss?

A

Hearing loss that is sensorineural <72 hours which is unexplained by other causes

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16
Q

What is the most common cause of Sudden Sensorineural Hearing Loss?

A. Acoustic neuroma

B. Cogan’s syndrome

C. Migraine

D. Idiopathic

A

D - 90%

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17
Q

What is the audiometry criteria required to establish a diagnosis of sudden sensorineural hearing loss?

A

> 30dB loss at 3 consecutive frequencies

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18
Q

How is Sudden Sensorineural Hearing Loss managed?

A

Referral to ENT (24 hours)
+
Steroids: Intra-tympanic or PO

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19
Q

A patient presents with a reduced hearing in their L ear over the past 2 months; there is a feeling of fullness in the ear with some discomfort. They are hearing some popping noises in the ear. Symptoms get worse when walking up hills of flying.

Otoscopy shows nothing abnormal.

What investigations may you wish to undertake?

A

Tympanometry

Audiometry

Nasopharyngoscopy

CT scan

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20
Q

A patient presents with a reduced hearing in their L ear over the past 2 months; there is a feeling of fullness in the ear with some discomfort. They are hearing some popping noises in the ear. Symptoms get worse when walking up hills of flying.

Otoscopy shows nothing abnormal.

Tympanometry shows a peak admittance with negative ear canal pressures.

What is your diagnosis?

A

Eustachian Tube Dysfunction

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21
Q

A patient presents with a reduced hearing in their L ear over the past 2 months; there is a feeling of fullness in the ear with some discomfort. They are hearing some popping noises in the ear. Symptoms get worse when walking up hills of flying.

Otoscopy shows nothing abnormal.

Tympanometry shows a peak admittance with negative ear canal pressures.

What is your management?

A

Supportive: Watch and wait; Valsalva manoeuvre; Decongestant nasal sprays; Otovent

±
Surgery: Tx cause; Grommets (tiny tubes into TM); Balloon dilation Eustachian tuboplasty

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22
Q

How is otosclerosis inherited?

A

Autosomal dominant

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23
Q

What is the pathophysiology involved in otosclerosis?

A

Middle ear bones undergo sclerosis e.g. stapes which attaches to oval window (fenestra ovalis) of cochlea thus reduced sound transmission

This is a form of conductive hearing loss

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24
Q

What is the epidemiology of Otosclerosis?

A

Female

<40

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25
Q

What would the Rinne’s and Weber’s test show in a patient with R ear Otosclerosis?

A

Rinne’s negative in affected ear as conductive, thus hear bone better

Sound heard better in the R ear (affected ear)

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26
Q

Which investigations may you conduct in a patient with suspected Otosclerosis?

A

Audiometry - conductive hearing loss thus will show a pattern of air conduction being worse than bone conduction.

Tympanometry - reduced admittance, less is absorbed, more is reflected back

High-resolution CT: Bony changes associated with otosclerosis

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27
Q

What is the management for Otosclerosis?

A

Conservative: Hearing aids

±

Surgical: Stepedectomy; Stepedotomy

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28
Q

What is the most common cause of AOM?

A

S pneumoniae

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29
Q

What are the common causes of AOM?

A

S pneumoniae

H influenzae
M catarrhalis
S aureus

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30
Q

A 17 year old patient presents with reduced hearing in their R ear. The ear feels full, like a pressure is present. There is no discharge. They have been feeling generally under the weather with a fever and cough in the last few days.

On otoscope, there is a bulging TM that is red and non-reflecting.

What is your DDx?

A

AOM

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31
Q

A 17 year old patient presents with reduced hearing in their R ear. The ear feels full, like a pressure is present. There is no discharge. They have been feeling generally under the weather with a fever and cough in the last few days.

On otoscope, there is a bulging TM that is red and non-reflecting.

What is your management?

A

Supportive: Analgesia; Rest

Often resolves within 3 days

OR >4 days; Severely unwell; significant comorbidities; systemically unwell
Medical: ABX - Amoxicillin 5-7 days

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32
Q

What are the potential complications of AOM?

A

TM Perforation
Chronic suppurative otitis media
Hearing loss
Labyrinthitis

Mastoiditis
Meningitis
Brain abscess
Facial nerve palsy

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33
Q

What is glue ear?

A

Otitis media with an effusion (Serous otitis media)

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34
Q

What is the management for a perforated tympanic membrane?

A

Supportive: Avoid water in ear; analgesia; avoid pressure changes

± No healing in 6-8 weeks
Surgery: Myringoplasty

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35
Q

What is the most common cause of Otitis externa?

A

P aeurgionsa

S aureus

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36
Q

How is Otitis Externa managed?

A

Medical:
Topical ABX (or via ear wick)
+
Topical steroid

E.g. Otomize ear spray (Neomycin + Dexamethasone + Acetic acid)

If TM ruptured, do not use aminoglycosides

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37
Q

In what patient group is Malignant Otitis Externa more common?

A

Elderly diabetics

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38
Q

What is malignant otitis externa?

A

infection spreads into bony ear canal and soft tissues deep to bony canal - osteomyelitis of temporal bone

IV ABX required and imaging

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39
Q

What are the common causes of otitis externa?

A 
Infection
Eczema
Seborrheic dermatitis
Contact dermatitis 
Recent swimming
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40
Q

what is the management of Cerumen impaction?

A

Supportive: Ear drops (sodium bicarbonate 5%); ear irrigation; micro-suction

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41
Q

What are the causes of Tinnitus?

A

Primary Tinnitus

Meniere's Disease 
Otosclerosis 
SSNHL
Presbycusis 
Drugs (NSAIDs; Loop diuretics; Quinine; Aminoglycosides)
Impacted ear wax 
Acoustic neuroma 
Multiple sclerosis 
Noise exposure 
Systemic conditions: Anaemia; Diabetes; Thyroid disease; Dyslipidaemia
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42
Q

What is objective tinnitus?

Give 3 causes

A

Hearing an extra sound within their head which can be confirmed when auscultating the stethoscope around the ear.

Eustachian tube dysfunction 
Carotid artery stenosis 
Carotid Cavernous Fistula
Aortic stenosis 
AV malformations
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43
Q

What are the red flags of tinnitus to ask?

A 
Unilateral
Hyperacusis 
Unilateral hearing loss
Vertigo
Visual changes
Neurological signs 
Suicidal ideation (related to tinnitus)
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44
Q

Outline how balance is determined in the vestibulocochlear system.

A

The semicircular canals of the ear are filled with endolymph which shifts within the canals when the head is moved. The endolymph fluid shift is detected by stereocilia in the ampulla of the canal. This is transmitted by the vestibular nerve (CN VIII) to the vestibular nucleus in the brainstem and cerebellum.

This nucleus then sends signals to CN III, CN IV and CN 6 nuclei which control eye movements, thalamus, spinal cord and cerebellum

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45
Q

How can vertigo be classified?

A

Peripheral vs Central

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46
Q

A patient presents with a vertigo triggered by changing head position. They feel nauseous. Each episode lasts for 10-20 seconds.

There is a positive Dix-Hallpike manoeuvre showing rotatory nystagmus.

What is the management?

A

Supportive: Vestibular rehab; Epley manoeuvre

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47
Q

What is the cause of BPPV?

A

Otoconia become displaced in the semicircular canals which disrupt endolymph flow and cause aberrant stimulation of vestibular system

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48
Q

What are the clinical features of Meniere’s disease?

A

Tinnitus + Hearing loss + Vertigo

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49
Q

How do you differentiate between Peripheral vertigo and Central vertigo?

A

1) History

Peripheral:

  • Sudden
  • Short duration
  • Hearing loss
  • Coordination
  • Nausea

Central:

  • Gradual
  • Persistent
  • No hearing loss
  • Impaired coordination
  • Mild nausea

2) Clinically - Mnemonic: HINTS

Head Impulse: upright and gaze at examiner nose; rapidly jerk head 10-20 degrees in one direction - check to see if saccade (peripheral if positive)

Nystagmus - horizontal (peripheral) vs vertical (central)

Test of Skew: cover eye and see if vertical correction (central cause)

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50
Q

How do you conduct a cerebellar exam?

A

D – Dysdiadochokinesia
A – Ataxic gait (ask the patient to walk heel-to-toe)
N – Nystagmus (see below for more detail)
I – Intention tremor
S – Speech (slurred)
H – Hypotonia

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51
Q

How do you manage vertigo?

A

Tx cause
+

Inform DVLA - if liable to sudden, unprovoked or unprecipitated episodes of disabling dizziness

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52
Q

How do you conduct a Brandt-Daroff exercise?

A

These involve sitting on the end of a bed and lying sideways, from one side to the other, while rotating the head slightly to face the ceiling. The exercises are repeated several times a day until symptoms improve.

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53
Q

A 34 year old female presents due to recurrent vertigo attacks. The attacks last for several hours or days. During them she has nausea and vomiting.

There is no hearing loss. There is no tinnitus.

She is generally well other than a URTI she had for 4/7 about a week ago.

What is your diagnosis?

A

Vestibular neuronitis

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54
Q

A 34 year old female presents due to recurrent vertigo attacks. The attacks last for several hours or days. During them she has nausea and vomiting.

There is no hearing loss. There is no tinnitus.

She is generally well other than a URTI she had for 4/7 about a week ago.

What is your management?

A

Prochlorperazine

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55
Q

What condition may develop following vestibular neuronitis?

A. Otosclerosis

B. Labyrinthitis

C. BPPV

D. Meniere’s disease

A

C

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56
Q

What is the key difference between Labyrinthitis and Vestibular neuronitis?

A

No hearing loss in VN vs Hearing loss in Labyrinthitis

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57
Q

A 50 year old male presents with vertigo which began suddenly. The vertigo episodes last several hours and occur again and again. They report having to turn the TV up louder than usual.

They are generally well other than a recent URTI 4/7 and their glycaemic control has been off.

Otoscopy shows nothing. Weber’s test shows soudn louder in the ear with fine hearing. Rinne’s negative in the L ear. Head impulse test shows impaired vestibule-ocular reflex in L eye.

What is your diagnosis?

A

Labyrinthitis

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58
Q

A 50 year old male presents with vertigo which began suddenly. The vertigo episodes last several hours and occur again and again. They report having to turn the TV up louder than usual.

They are generally well other than a recent URTI 4/7 and their glycaemic control has been off.

Otoscopy shows nothing. Weber’s test shows soudn louder in the ear with fine hearing. Rinne’s negative in the L ear. Head impulse test shows impaired vestibule-ocular reflex in L eye.

What is your management?

A

Self-limiting

Prochlorperazine can reduce sensation of dizziness

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59
Q

How long does it take for Meniere’s Disease to resolve?

A

5-10 years

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60
Q

What is the driving advice given to a patient with Meniere’s disease?

A

Cease driving until symptoms are controlled

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61
Q

What is the age of onset for Meniere’s disease?

A

40-50 years

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62
Q

What is the management for Meniere’s disease?

A

Acute attacks:
- Prochlorperazine

Prophylaxis:
- Betahistine

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63
Q

In which condition are bilateral vestibular schwannomas seen in?

A

NF 2

64
Q

Where do Vestibular Schwannomas tend to occur?

A

Cerebellopontine angle

65
Q

A 50 year old male presents with hearing loss in his L ear. The ear is ringing constantly. Additionally, he feels a fullness in his ear. This has began several months ago and worsened with time.

O/E you elucidate it likely a sensorineural hearing loss. You see a facial nerve palsy on the LHS. Furthermore, there is an absent corneal reflex.

Audiometry shows both air and bone conduction reduced by more than 20dB.

What is your DDx?

A

Acoustic neuroma

66
Q

A cholesteatoma is an accumulation of which type of cells?

A

Squamous epithelial cells

67
Q

A 15 year old patient presents with foul-smelling, non-resolving discharge from the R ear. The R ear has also experienced some hearing loss.

Otoscopy shows attic crust in the upper part of the eardrum.

What is your DDx?

A

Cholesteatoma

68
Q

Which condition increases your risk of developing a Cholesteatoma?

A

Eustachian tube dysfunction

69
Q

What does the facial nerve supply?

A

Mnemonic: Face, ear, taste, tear

face: muscles of facial expression
ear: nerve to stapedius
taste: supplies anterior two-thirds of tongue
tear: parasympathetic fibres to lacrimal glands, also salivary glands

70
Q

Give 3 causes of lower motor neurone facial nerve palsy.

A

Bell’s Palsy

Acoustic Neuroma
Parotid tumour
Cholesteatoma

Ramsay-Hunt Syndrome
Otitis media
Malignant otitis externa
HIV
Lymes disease
MS
Diabetes Mellitus 
Guillain-Barre Syndrome 
Leukaemia
Sarcoidosis

Direct trauma
Iatrogenic
Base of skull fractures

71
Q

What are the 3 branches of the facial nerve?

A
  1. greater petrosal nerve
  2. nerve to stapedius
  3. chorda tympani

Mnemonic: GCS

72
Q

Give 5 causes of Epistaxis.

A 
Trauma 
Colds
Nose picking 
Sinusitis 
Changes in weather
Snorting cocaine 
Coagulopathies
Tumours 
Anticoagulation
73
Q

Which type of nosebleed holds a higher chance of aspiration?

A

Posterior epistaxis

74
Q

How do you manage a nosebleed?

A

Haemodynamically stable

Supportive: Lean forward with mouth open; pinch nose firmly for 20 minutes

± Does not stop
Supportive: Cautery (if visible) + Naseptin + Silver nitrate; Packing

± Failed all emergency management
Surgery: Sphenopalatine ligation

75
Q

Which allergy means Naseptin is contraindicated?

A

Peanut/Soya allergy

76
Q

Outline the different paranasal sinuses present in the head.

A

Frontal
Ethmoid
Sphenoid
Maxillary

77
Q

What pathogen is the commonest cause of sinusitis?

A

S pneumoniae
H influenzae
Rhinoviruses

78
Q

How is acute sinusitis managed?

A

Supportive: Analgesia; Intranasal decongestants

Should resolve within 2-3 weeks

± Symptoms more than 10 days
Intranasal corticosteroids for 14 days

± Systemically unwell
Medical: Co-amoxiclav

79
Q

What is the definition of chronic sinusitis?

A

> 3 months of sinusitis

80
Q

Explain to a patient how to take a nasal spray.

A

Tilting the head slightly forward
Using the left hand to spray into the right nostril, and vice versa (this directs the spray slightly away from the septum)
NOT sniffing hard during the spray
Very gently inhaling through the nose after the spray

81
Q

What surgical procedure may be used in recurrent sinusitis due to anatomical variations resulting in obstruction?

A

Functional endoscopic sinus surgery (FESS)

82
Q

In which population group are nasal polyps more common?

A

Males

83
Q

Which conditions are nasal polyps associated with?

A 
Asthma 
Aspirin sensitivity 
Sinusitis 
Cystic fibrosis 
Kartagener's Syndrome 
Churg-Strauss Syndrome
84
Q

The association of asthma, aspirin sensitivity and nasal polyps is known as?

A

Samter’s triad

85
Q

What is the management for Nasal polyps?

A

Conservative: ENT referral; Topical corticosteroids

±
Surgery: Endoscopic nasal polypectomy

86
Q

Give 3 RFs for OSA.

A 
Middle age
Male
Obesity
Alcohol
Smoking
87
Q

What screening scale is used to assess symptoms of OSA?

A

Epworth Sleepiness Scale

88
Q

What is the management for OSA?

A

Conservative: ENT referral; CPAP; RF modification
+
Surgery: Uvulopalatopharyngoplasty (UPPP)

89
Q

What is the most common cause of tonsillitis?

A

Viral causes - adenovirus; rhinovirus; CMV; Covid

90
Q

What is the most common cause of bacterial tonsillitis?

A

GAS

91
Q

Which groups make up Waldeyer’s ring?

A

Starting at 12 o’clock:

Adenoid -> Tubal -> Palatine -> Lingual

92
Q

Which scoring criteria can be used to assess the risk of bacterial tonsillitis?

A

CENTOR Score

Cough (absence)
Exudate 
Nodes
Temperature 
Age category
93
Q

How do you manage tonsillitis?

A

Calculate Centor score

Conservative: Patient education; safety net (<3 days and temperature below 38.3C); analgesia
+
Medical: Penicillin-V 10 days

94
Q

What are the complications of Tonsillitis?

A 
Peritonsillar abscess 
Otitis media
Scarlet fever
Rheumatic fever 
Post-streptococcal glomerulonephritis 
Post-streptococcal reactive arthritis
95
Q

How do you manage a quinsy?

A

Medical: Co-amoxiclav
+
Surgery: Incision and drainage

96
Q

What are the indications for a tonsillectomy?

A

Rule of 7…

7 in 1 year

5 per year for 2 years

3 per year for 3 years

Recurrent tonsillar abscesses (2 episodes)
Obstructive tonsills

97
Q

What proportion of tonsillectomy patients may experience a significant bleed?

A

5%

98
Q

You identify a neck lump, how can you describe it?

A 
Distribution/Location 
Size
Colour
Associated change
Morphology

Location: Anterior triangle/Posterior triangle/Midline

99
Q

What are the borders of the anterior triangle?

A

Mandible
Midline
SCM

100
Q

What are the borders of the posterior triangle?

A

Clavicle
Trapezius
SCM

101
Q

When examining a patient with a neck lump, what are you checking for?

A 
Distribution/Location
Size
Colour
Associated changes
Morphology 
Movement

Warmth
Tenderness
Pulsatile

Movement with swallowing
Transilluminates with light

General examination

102
Q

When should you refer for a neck lump?

A

Unexplained lump in someone >45 years

Persistent unexplained neck lump

103
Q

What investigations may you conduct in someone presenting with a neck lump?

A 
FBC
U+Es 
LFTs
TFTs
Abs
EBV/Monospot test 
HIV test
LDH

US-Neck
CT/MRI-Neck
PET

Fine needle aspiration
Core biopsy
Incision biopsy
Removal of the lump

104
Q

What are the general causes of lymphadenopathy?

A

Infective
Reactive
Inflammatory
Malignancy

105
Q

Which pathogen causes Infectious Mononucleosis?

A

EBV

106
Q

What is the first line test for Infectious Mononucleosis?

A

Monospot test

107
Q

What advice is given to a patient with Infectious Mononucleosis?

A

Supportive: Rest; Avoid alcohol; Avoid contact sports

108
Q

What ages do Hodgkin’s lymphoma tend to present?

A

Bimodal age distribution; 20 and 75

109
Q

What are the clinical features of Hodgkin’s Lymphoma?

A 
Fever
Weight loss
Night sweats
Itch 
Lymphadenopathy: hard, fixed, rubbery

Reed-Sternberg cells

110
Q

The presence of Reed-Sternberg cells are suggestive of what condition?

A

Hodgkin’s Lymphoma

111
Q

What are the clinical features of a leukaemia?

A 
Fatigue 
Fever
Pallor (secondary to anaemia)
Bruising 
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
112
Q

What is the term for an enlarged Thyroid gland?

A

Goitre

113
Q

What are the 3 salivary glands?

A

Parotid
Submandibular
Sublingual

114
Q

What cells are contained in the carotid body?

A

Chemoreceptors (Glomus cells) - forming paraganglia

115
Q

What are the clinical features of a Paraganglioma?

A 
In the upper anterior triangle of the neck (near the angle of the mandible)
Painless
Pulsatile
Associated with a bruit on auscultation
Mobile side-to-side but not up and down
116
Q

What CT/MRI-Neck sign is shown in a Paraganglioma?

A

Lyre Sign (splaying of internal and external carotid arteries)

117
Q

What are the clinical features of a lipoma?

A

Soft (not fluid-filled)
Painless
Mobile
Do not cause skin changes

118
Q

How is a thyroglossal cyst formed?

A

During embryological development, the thyroid migrates from the base of the tongue to become anterior of the trachea.

The migration leaves a track called the thyroglossal duct - which can become filled with a cyst called a thyroglossal cyst.

119
Q

What are the clinical features of a thyroglossal cyst?

A 
Found in the midline 
Mobile: Move up and down with tongue movement due to connection of thyroglossal duct and tongue base 
Non-tender
Soft 
Fluctuant
120
Q

What is the management of a thyroglossal cyst?

A

Surgical removal - may cause infection if left

121
Q

How is a Branchial cyst formed?

A

Failure of second branchial cleft to form leaving space surrounded by epithelial tissue in lateral aspect of neck which a cyst may form.

122
Q

What are the clinical features of a branchial cyst?

A

Round
Soft
Cystic swelling
Located between angle of jaw and SC in anterior triangle

Present at 10 years old and young childhood

123
Q

How is a branchial cyst managed?

A

Conservative: Watch and wait

or

Surgery: Surgical excision

124
Q

What is the most common type of cancer occurring on the head or neck?

A

Squamous cell carcinomas

125
Q

Give 5 RFs for head and neck cancers.

A 
Smoking
UV
Chewing betel quid 
Alcohol
EBV
HPV 
Genetic
126
Q

What is the MOA of Cetuximab?

A

Anti-EGFR mAb

127
Q

Give 3 causes of glossitis.

A 
Folate deficiency
B12 deficiency
Iron deficiency anaemia 
Coeliac diease
Injury or irritant exposure
128
Q

What may cause angiooedema?

A

Allergic reactions
ACEi
Hereditary angiooedema (C1 esterase deficiency)
NSAIDs

129
Q

Describe Geographic Tongue.

What conditions is it associated with?

A

Inflammatory condition whereby tongue loses epithelium and papillae with irregular patches forming resembling a map

Idiopathic
Stress/mental illness
Psoriasis
Atopy
Diabetes
130
Q

What are the two common causes of strawberry tongue?

A

Scarlet Fever

Kawasaki disease

131
Q

How is Black Hairy Tongue caused?

A

Reduced shedding of keratin from tongue’s surface thus papillae elongate - resembling hairs. Bacteria and food cause dark pigmentation.

132
Q

White patches, that are fixed in the buccal mucosa is termed what?

What condition is it associated with?

A

Leukoplakia

Pre-cancerous to SCC

133
Q

Red fixed lesions in the oral mucosa are termed?

A

Erythroplakia

134
Q

Purple, polygonal, pruritic, planar plaques with white lines across in the oral mucosa are termed?

What is the name of the white lines?

A

Lichen Planus

Wickham’s Striae

135
Q

How is Gingivitis managed?

A

Supportive: Good oral hygiene; stop smoking; dental treatment; chlorhexidine mouthwash
±
Surgery: Dental surgery

136
Q

How does an aphthous ulcer appear in the mouth?

A

Well-circumscribed, discrete, punched-out white appearance

137
Q

What are some causes of aphthous ulcers?

A 
Idiopathic
CD
UC
Coeliac disease
Behcet's Disease
B12 deficiency
Folate deficiency
Iron deficiency 
HIV
138
Q

How may aphthous ulcers be managed?

A

Medical: Choline salicylate (Bonjela); Hydrocortisone buccal tablets; Betamethasone soluble tablet

139
Q

Which pathogens may cause sinusitis?

A

S pneumoniae

H influenzae

Rhinovirus

140
Q

Give 5 associations of nasal polyps.

A 
Asthma 
Aspirin sensitivity 
Sinusitis 
Kartagener's Syndrome 
Churg-Strauss Syndrome
141
Q

What is the management of a nasal septum haematoma?

A

Surgical drainage

142
Q

What is the main risk factor for a nasal septal haematoma?

A

Trauma

143
Q

What allergy should you check before prescribing Naseptin (chlorhexidine and neomycin) cream?

A

Peanut, soy or neomycin allergy.

144
Q

Give 3 potential complications of tonsillitis.

A

Quinsy
AOM
RF
GN

145
Q

What is the diagnostic test for OSA?

A

Polysomnography

146
Q

What is the sensory innervation of the facial nerve (CN 7)?

A

Anterior 2/3 of the tongue

147
Q

What is the parasympathetic function of the facial nerve (CN 7)?

A

Submandibular, sublingual glands

Lacrimal glands

148
Q

What are the branches of the facial nerve (CN 7)?

A

Mnemonic: Tall Zulus Bear Many Children

Temporal

Zygomatic

Buccal

Marginal mandibular

Cervical

149
Q

What does C1 esterase deficiency result in?

A

Hereditary angiooedema

150
Q

Which medications may cause gingival hyperplasia?

A

Ciclosporin
Phenytoin
CCBs

151
Q

What are the clinical features of Sialolithiasis?

A

Colicky pain in the submandibular gland
Swelling
Worse after meals

152
Q

What are the clinical features of Sialadenitis?

A

Erythema

Pus (or abscess) - may cause deep neck infection

153
Q

What are the clinical features of a pleiomorphic adenoma?

A

Features epithelial and myoepithelial ductal component proliferation

Parotid mass

Most common parotid neoplasm

154
Q

What are the clinical features of a Haemangioma?

A

Children

Hypervascular

Supportive management

155
Q

What are the clinical features of a Warthin (adenolymphoma) tumour?

A

bilateral parotid swelling

M > F

Presents later in life

156
Q

What is the most common salivary gland tumour?

A. Warthin’s

B. Mucoepidermoid carcinoma

C. Adenoid cystic carcinoma

D. Adenocarcinoma

A

B - 30%

Slow growing

157
Q

Which parotid tumour features perineural spread?

A

A. Warthin’s

B. Mucoepidermoid carcinoma

C. Adenoid cystic carcinoma

D. Adenocarcinoma

Surgery (10 decks)

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