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Neuro and special senses > ENT > Flashcards

ENT Flashcards

1
Q

What is conductive hearing loss

A

Problem with sound travelling from environment to inner ear

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2
Q

What is sensorineural hearing loss

A

Problem with sensory system or vestibulocochlear nerve in inner ear

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3
Q

What might hearing loss be accompanied by

A

Tinnitus

Vertigo

Pain

Discharge

Neurological symptoms

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4
Q

What is found on Weber’s test in sensorineural hearing loss

A

Louder in normal ear

Quieter in affected ear

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5
Q

What is found on Weber’s test in conductive hearing loss

A

Louder in affected ear

Quieter in normal ear

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6
Q

What is a normal result on Rinne’s test (Rinne’s positive)

A

Still hear noise when fork moved from mastoid process to front of ear

Air conduction better than bone conduction

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7
Q

What is an abnormal result on Rinne’s test (Rinne’s negative)

A

Bone conduction better than air conduction

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8
Q

What are the causes of sensorineural hearing loss

A

Sudden sensorineural hearing loss

Presbycusis

Noise exposure

Meniere’s disease

Labyrinthitis

Acoustic neuroma

Neurological condition (stroke, multiple sclerosis, brain tumour)

Infection

Medications (furosemide, gentamicin, cisplatin)

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9
Q

What are the causes of conductive hearing loss

A

Ear wax

Infection

Effusion in middle ear

Eustachian tube dysfunction

Perforated tympanic membrane

Otosclerosis

Cholesteatoma

Exostoses

Tumour

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10
Q

What are audiograms

A

Charts that show the volume at which different tones can be heard

Show the quietest volume at which different frequencies can be heard

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11
Q

What is presbycusis

A

Age-related hearing loss

A type of sensorineural hearing loss

Affects high-pitched sounds first

Gradual and symmetrical

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12
Q

What are the mechanisms of presbycusis

A

Loss of hair cells in cochlea

Loss of neurones in cochlea

Atrophy of stria vascularis

Reduced endolymphatic potential

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13
Q

What are the risk factors for presbycusis

A

Age

Male

Family history

Loud noise exposure over time

Diabetes

Hypertension

Ototoxic medications

Smoking

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14
Q

How might presbycusis present

A

Gradual or insidious onset

Speech difficult to understand

May come in with concerns about dementia

Associated tinnitus

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15
Q

What would audiometry show in presbycusis

A

Sensorineural hearing loss

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16
Q

What is the management for presbycusis

A

Effects can not be reversed

Support to maintain function: optimise environment, hearing aids, cochlear implants

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17
Q

What is sudden sensorineural hearing loss

A

Hearing loss over < 72 hours

Not explained by other causes

Often unilateral

Some persistent, some resolve

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18
Q

What are the causes of sudden sensorineural hearing loss

A

Idiopathic (90%)

Infection

Meniere’s disease

Ototoxic medications

Multiple sclerosis

Migraines

Stroke

Acoustic neuromas

Cogan’s syndrome (autoimmune inflammation of eye and inner ear)

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19
Q

What are the investigations for sudden sensorineural hearing loss

A

Audiometry: loss of > 30 decibels in 3 consecutive frequencies

Consider CT/MRI head

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20
Q

What is the management for sudden sensorineural hearing loss

A

Immediate referral for ENT assessment

If cause found: treat

If idiopathic: steroids (oral/intra-tympanic)

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21
Q

What is eustachian tube dysfunction linked to

A

Viral upper respiratory tract infections

Allergies

Smoking

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22
Q

How might eustachian tube dysfunction present

A

Reduced/altered hearing

Popping noises/sensations

Fullness in ear

Pain

Tinnitus

Worse when external air pressure changes (flying, climbing, diving)

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23
Q

What are the investigations for eustachian tube dysfunction

A

Otoscopy (often normal)

Tympanometry

Audiometry

Nasopharyngoscopy

CT

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24
Q

What is the management for eustachian tube dysfunction

A

Often resolve spontaneously

Valsalva manoeuvre (hold nose and blow into it)

Decongestant nasal spray

Antihistamines

Steroid nasal spray

Surgery (adenoidectomy, grommets, balloon dilation of tube)

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25
Q

What is otosclerosis

A

Remodelling of small bones in middle ear, leading to conductive hearing loss

Genetic (autosomal dominant) or environmental

Sounds not transmitted effectively from tympanic membrane to cochlea

Usually in under 40s

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26
Q

How might otosclerosis present

A

Unilateral or bilateral

Hearing loss (low pitch first)

Tinnitus

Talk quietly (hear own voice louder)

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27
Q

What are the investigations for otosclerosis

A

Otoscopy

Rinne’s

Weber’s

Audiometry (conductive pattern)

Tympanometry (generally reduced admittance)

HRCT (detect bony changes)

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28
Q

What is the management for otosclerosis

A

Conservative: hearing aids

Surgical: stapedectomy (remove stapes, replace with prosthetic), stapedotomy (small part of stapes removed, base still attached to oval window)

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29
Q

What is otitis media

A

Infection in middle ear

Middle ear: space between tympanic membrane and inner ear (cochlea, vestibular apparatus, nerves)

Often after viral upper respiratory tract infection

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30
Q

What are the bacterial causes of otitis media

A

Strep pneumoniae (most common)

Haemophilus influenzae

Moraxella catarrhalis

Staph aureus

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31
Q

How might otitis media present

A

Ear pain

Reduced hearing

Fever

Symptoms of upper respiratory tract infection

Balance issues, vertigo (if vestibular system affected)

Discharge (if tympanic membrane ruptured)

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32
Q

What are the investigations for otitis media

A

Otoscopy (bulging, red, inflamed tympanic membrane)

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33
Q

How is otitis media managed

A

Often resolves without antibiotics in 3 days

Simple analgesia

Consider antibiotics: delayed prescriptions

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34
Q

Which antibiotics may be given for otitis media

A

Amoxicillin (first line)

Clarithromycin (penicillin allergy)

Erythromycin (pregnant and penicillin allergy)

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35
Q

What are the complications of otitis media

A

Otitis media with effusion

Hearing loss (usually temporary)

Perforation of membrane

Labyrinthitis

Mastoiditis

Abscess

Facial nerve palsy

Meningitis

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36
Q

What is otitis externa

A

Inflammation of skin in external ear canal

Can be localised or diffuse

Can be acute (< 3 weeks) or chronic

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37
Q

What are the causes of otitis externa

A

Swimming

Trauma to canal

Bacterial infection (pseudomonas aeruginosa, staph aureus)

Fungal infection

Eczema

Seborrhoeic dermatitis

Contact dermatitis

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38
Q

How might otitis externa present

A

Ear pain

Discharge

Itchiness

Conductive hearing loss

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39
Q

What might be found on examination in otitis externa

A

Erythema

Swelling

Tenderness

Discharge

Lymphadenopathy

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40
Q

What are the investigations for otitis externa

A

Otoscopy

Ear swab

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41
Q

What is the management for otitis externa

A

Mild: over the counter meds

Moderate: topical antibiotics, steroids

Severe: oral antibiotics (flucloxacillin, clarithromycin), possibly admit

Ear wicks: sponges of topical treatment, leave in canal for 48 hours

Fungal infection: clotrimazole

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42
Q

Give an overview of malignant otitis externa

A

Severe, potentially life-threatening

Can spread to surrounding bones/skull (osteomyelitis)

Severe symptoms: fever, pain, headaches

Key findings: granulation tissue at junction between bone and cartilage of ear canal

Need emergency management: admission, IV antibiotics, CT/MRI head

Complications: facial nerve palsy, meningitis, intracranial thrombosis, death

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43
Q

What is the medical name for ear wax

A

Cerumen

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44
Q

How might a patient present with impacted ear wax

A

Conductive hearing loss

Discomfort

Feeling of fullness

Pain

Tinnitus

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45
Q

What is the management for impacted ear wax

A

Ear drops

Ear irrigation

Microsuction

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46
Q

What is tinnitus

A

Persistent additional sound heard, but not present in environment

Ringing in ears

Due to background sensory signals produced by cochlea

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47
Q

What is primary tinnitus

A

No identifiable cause

Often found in sensorineural hearing loss

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48
Q

What is secondary tinnitus

A

Identifiable cause

Impacted ear wax, ear infection, Meniere’s disease, noise exposure, ototoxic medications, acoustic neuromas, multiple sclerosis, trauma, depression

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49
Q

What systemic conditions are associated with tinnitus

A

Anaemia

Diabetes

Thyroid disorders

Hyperlipidaemia

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50
Q

What is objective tinnitus

A

Actual sound heard in head

Carotid artery stenosis, aortic stenosis, arteriovenous malformations, eustachian tube dysfunction

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51
Q

What investigations are needed for tinnitus

A

Otoscopy

Bloods for underlying cause (FBC, glucose, TSH, lipids)

Audiology

CT/MRI

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52
Q

What are the red flags in tinnitus

A

Unilateral

Pulsatile

Hyperacusis (hypersensitivity to sound)

Associated unilateral hearing loss

Associated vertigo/dizziness

Headache

Visual symptoms

Associated neurological signs/symptoms

Suicidal ideation due to tinnitus

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53
Q

What is the management for tinnitus

A

Often improves over time

Treat underlying cause

Manage symptoms: hearing aids, sound therapy (background noise to mask tinnitus), CBT

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54
Q

What is vertigo

A

Sensation of movement between patient and environment (room spinning, they are moving)

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55
Q

What are the associated symptoms of vertigo

A

Nausea

Vomiting

Sweating

Feeling generally unwell

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56
Q

What are the 2 groups of causes of vertigo

A

Central (involving brainstem/cerebellum, get sustained, non-positional symptoms)

Peripheral (affecting vestibular system)

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57
Q

Which sensory inputs are needed for maintenance of balance

A

Vision

Proprioception

Signals from vestibular system

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58
Q

What are the causes of peripheral vertigo

A

Benign paroxysmal positional vertigo

Meniere’s disease

Vestibular neuronitis

Labyrinthitis

Trauma to nerve, acoustic neuromas, otosclerosis, hyperviscosity syndrome, herpes infection

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59
Q

What are the causes of central vertigo

A

Posterior stroke

Tumours

Multiple sclerosis

Vestibular migraines

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60
Q

What are the special tests for vertigo

A

Romberg’s test (proprioception/vestibular dysfunction)

Dix-Hallpike manoeuvre (diagnostic)

HINTS examination (peripheral/central causes)

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61
Q

What are the components of a HINTS examination for vertigo

A

Head Impulse (normal in central causes, abnormal in peripheral causes, look for rapid eye movements on certain head movements)

Nystagmus (unilateral in in peripheral causes, bilateral in central causes)

Test of Skew (deviation of eyes)

62
Q

What are the components of a cerebellar examination

A

Dysdiadochokinesia

Ataxic gait

Nystagmus

Intention tremor

Slurred speech

Heel-shin test

63
Q

What is the management for vertigo

A

Central cause: refer for imaging

Peripheral cause: prochlorperazine, antihistamines

Meniere’s disease: betahistine

Vestibular migraines: avoid triggers, triptans (acute symptoms), propranolol/amitriptyline/topiramate (prophylaxis)

64
Q

What is benign paroxysmal positional vertigo

A

Common cause of recurrent vertigo

Triggered by head movement

Peripheral cause of vertigo (problem with inner ear)

More common in older adults

65
Q

How might benign paroxysmal positional vertigo present

A

Triggered by head movement (often when turning in bed)

Symptoms last 20-60 seconds

Asymptomatic between attacks

Often over a few weeks, then go away for a few months

No changes to hearing

No tinnitus

66
Q

What is the pathophysiology of benign paroxysmal positional vertigo

A

Calcium carbonate crystals become displaced into semicircular canals

Disruption to flow of endolymph through canals

67
Q

How is benign paroxysmal positional vertigo diagnosed

A

Dix-Hallpike manoeuvre

Move head in a way that causes endolymph to move through the semicircular canals

Get rotational nystagmus and vertigo symptoms

68
Q

What is the management for benign paroxysmal positional vertigo

A

Epley manoeuvre

Move crystals into a position where they do not disrupt the flow of endolymph

69
Q

What is vestibular neuronitis

A

Inflammation of vestibular nerve (get vertigo)

Usually due to viral infection

Can lead to BPPV

70
Q

How might vestibular neuronitis present

A

Acute onset of vertigo

Recent viral upper respiratory tract infection

Most severe on first few days

Associated symptoms (nausea, vomiting, balance problems)

No hearing loss

No tinnitus

71
Q

What are the investigations for vestibular neuronitis

A

Head impulse test

For diagnosis of peripheral causes of vertigo

Nystagmus on certain eye movements

72
Q

How is vestibular neuronitis managed

A

Admit if dehydrated

Short term symptom control: prochlorperazine, antihistamine

Refer if symptoms do not: improve in 1 week, resolve in 6 weeks

73
Q

What is labyrinthitis

A

Inflammation of bone labyrinth of inner ear (semicircular canals, vestibule, cochlea)

Usually due to viral upper respiratory tract infection

74
Q

How might labyrinthitis present

A

Acute onset vertigo

Hearing loss

Tinnitus

Symptoms of viral infection

75
Q

How is labyrinthitis diagnosed

A

Head impulse test (for peripheral causes of vertigo)

76
Q

What is the management for labyrinthitis

A

Acute attacks: prochlorperazine, antihistamine

If bacterial, antibiotics

77
Q

What is Meniere’s disease

A

Long term inner ear disorder

Excessive buildup of endolymph in labyrinth of inner ear (high pressure disrupts sensory signals)

78
Q

What are the triad of symptoms of Meniere’s disease

A

Hearing loss

Vertigo

Tinnitus

79
Q

How might Meniere’s disease present

A

40 - 50

Vertigo (20 mins - several hours, clusters, not triggered by movement)

Hearing loss (fluctuating (then permanent), unilateral, sensorineural, low frequencies affected first)

Tinnitus (unilateral)

Fullness in ear

Unexplained falls without loss of consciousness

Spontaneous nystagmus during attacks

80
Q

What is the management for Meniere’s disease

A

Acute attacks: prochlorperazine, antihistamine

Prophylaxis: betahistine

81
Q

What are acoustic neuromas

A

Benign tumour of Schwann cells surrounding auditory nerve

Occur at cerebellopontine angle

Usually unilateral

82
Q

How might acoustic neuroma present

A

40 - 60

Gradual onset

Unilateral

Sensorineural hearing loss

Unilateral tinnitus

Dizziness/imbalance

Fullness in ear

May have facial nerve palsy

83
Q

What are the investigations for acoustic neuromas

A

Audiometry

CT/MRI brain

84
Q

What is the management for acoustic neuromas

A

Monitoring (if not causing major issues)

Surgery

Radiotherapy

Complications of treatment: vestibulocochlear/facial nerve injury

85
Q

What is cholesteatoma

A

Abnormal collection of squamous epithelial cells in the middle ear

Not cancerous

Can invade local tissues and nerves

Can erode bones of middle ear

86
Q

How might a cholesteatoma present

A

Foul discharge from ear

Unilateral conductive hearing loss

Symptoms of expansion (infection, pain, vertigo, facial nerve palsy)

87
Q

What are the investigations for cholesteatoma

A

Otoscopy (buildup of white debris on upper tympanic membrane)

CT head (definitive)

88
Q

What is the management for cholesteatoma

A

Surgical removal

89
Q

What are nosebleeds

A

Bleeding usually from Kiesselbach’s plexus (Little’s area)

Common in young children and older adults

Usually unilateral

If bilateral, more likely to be posterior (higher chance of aspiration)

90
Q

What are the triggers for nosebleeds

A

Nose picking

Colds

Sinusitis

Vigorous nose blowing

Trauma

Changes in weather

Coagulation disorders

Anticoagulant medication

Snorting cocaine

Tumours

91
Q

What is the management for nosebleeds

A

Usually resolve without intervention

Investigate if: recurrent, significant loss

Admit if: not stopped after 15 mins of compression, severe, bilateral, haemodynamically unstable

Nasal packing

Nasal cautery

Naseptin (topical cream to reduce infection

92
Q

What is sinusitis

A

Inflammation of paranasal sinuses in face

Acute: < 12 weeks

Chronic: > 12 weeks

Due to blockage of drainage from sinuses

93
Q

What are the 4 sets of paranasal sinuses

A

Frontal (above eyebrows)

Maxillary (either side of nose, below eyes)

Ethmoidal (in ethmoid bone, middle of nasal cavity)

Sphenoid (in sphenoid bone, at back of nasal cavity)

94
Q

What are the causes of sinusitis

A

Infection (often viral upper respiratory tract infections)

Allergies

Obstruction of drainage (foreign body, trauma, polyps)

Smoking

95
Q

How might acute sinusitis present

A

Recent viral upper respiratory tract infection

Nasal congestion/discharge

Facial pain/pressure

Headaches

Facial swelling on affected side

Loss of sense of smell

96
Q

How does chronic sinusitis compare to acute sinusitis

A

Longer duration

May have polyps

97
Q

What might be found on examination in sinusitis

A

Tenderness on palpation

Inflammation and oedema of nasal mucosa

Discharge

Fever

Signs of systemic infection

98
Q

What are the investigations for sinusitis

A

Only if persistent symptoms despite treatment

Nasal endoscopy

CT

99
Q

What is the management for acute sinusitis

A

Admit if septic

Most resolve in 2-3 weeks

If not improving after 10 days: high dose steroid nasal spray, delayed antibiotic prescription

100
Q

What is the management for chronic sinusitis

A

Saline nasal irrigation

Steroid nasal spray/drops

Functional endoscopic sinus surgery (remove/correct obstruction, balloon dilation)

101
Q

What are nasal polyps

A

Growths of nasal mucosa in nasal cavity/sinus

Associated with inflammation (chronic rhinitis, sinusitis, asthma, cystic fibrosis)

Slow growing (but eventually obstruct nasal passage)

Bilateral (red flag if unilateral)

102
Q

How might nasal polyps present

A

Chronic rhinosinusitis

Difficulty breathing through nose

Snoring

Nasal discharge

Loss of sense of smell

103
Q

What are the investigations for nasal polyps

A

Nasal speculum

Nasal endoscopy

Round pale yellow/grey growths on mucosal wall

104
Q

What is the management for nasal polyps

A

Unilateral: refer for exclusion of malignancy

Medical: intranasal topical steroids

Surgical: intranasal polypectomy, endoscopic nasal polypectomy

105
Q

What is obstructive sleep apnoea

A

Collapse of pharyngeal airway during sleep

Episodes of apnoea (stop breathing for a few minutes)

Assess using Epworth Sleepiness Scale

106
Q

What are the risk factors for obstructive sleep apnoea

A

Middle age

Male

Obesity

Alcohol

Smoking

107
Q

How might obstructive sleep apnoea present

A

Apnoea during sleep (reported by partner)

Snoring

Morning headaches

Waking unrefreshed from sleep

Daytime sleepiness

Concentration issues

Reduced O2 sats during sleep

If severe: hypertension, heart failure, increased risk of MI/stroke

108
Q

What is the management for obstructive sleep apnoea

A

Refer to sleep clinic

Correct reversible risk factors

CPAP

Surgery (reconstruction of soft palate and jaw - uvulopalatopharyngoplasty (UPPP))

109
Q

What is tonsillitis

A

Inflammation of tonsils

Usually due to viral infection

110
Q

What are the common bacterial causes of tonsillitis

A

Group A strep (strep pyogenes)

Strep pneumoniae

Haemophilus influenzae

Staph aureus

111
Q

What is Waldeyer’s ring

A

Ring of lymphoid tissue at back of throat

Adenoids, tubal tonsils, palatine tonsils, lingual tonsils

112
Q

How might tonsillitis present

A

Acute: sore throat, fever > 38, pain on swallowing

Red, inflamed, enlarged tonsils

May have exudate

May have anterior cervical lymphadenopathy

113
Q

What is the centor criteria for tonsillitis

A

Estimates probability that tonsillitis is bacterial (will benefit from antibiotics)

Give antibiotics if score > 3

Criteria:

  • Fever > 38
  • Tonsillar exudate
  • Absence of cough
  • Tender anterior cervical lymph nodes
114
Q

What is the FeverPAIN score for tonsillitis

A

Gives probability of bacterial tonsillitis and need for antibiotics

2-3: consider delayed prescription

4-5: immediate or delayed prescription

Criteria:

  • Fever in last 24 hours
  • Pus
  • Attend within 3 days of onset
  • Inflamed tonsils (severely)
  • No cough or coryza
115
Q

What is the management for tonsillitis

A

Viral: patient education

Bacterial: penicillin V (10 days), clarithromycin (true penicillin allergy)

116
Q

What are the complications of tonsillitis

A

Peritonsillar abscess

Otitis media

Scarlet fever

Rheumatic fever

Post-strep glomerulonephritis

Post-strep reactive arthritis

117
Q

What is quinsy

A

Aka peritonsillar abscess

Bacterial infection causing trapping of pus in region of tonsils

A complication of untreated/partially treated tonsillitis

Can arise without tonsillitis

118
Q

What are the bacterial causes of quinsy

A

Strep pyogenes

Staph aureus

Haemophilus influenzae

119
Q

How might quinsy present

A

Sore throat

Painful swallowing

Fever

Neck pain

Referred ear pain

Swollen tender lymph nodes

Trismus (unable to open mouth)

Changes in voice (hot potato voice)

Swelling and erythema near tonsils

120
Q

What is the management for quinsy

A

Incision and drainage

Antibiotics (before and after surgery)

Consider steroids

121
Q

What are the indications for tonsillectomy

A

Episodes of tonsillitis:

  • 7+ in 1 year
  • 5 per year for 2 years
  • 3 per year for 3 years

Recurrent tonsillar abscess (2 episodes)

Enlarged tonsils causing difficulty breathing/swallowing

122
Q

What are the complications of tonsillectomy

A

Sore throat (for 2 weeks)

Damage to teeth

Infection

Post-tonsillectomy bleeding

123
Q

What is post-tonsillectomy bleeding

A

Up to 2 weeks after surgery

Can be severe/life threatening (aspiration)

Management: involve ENT early, analgesia, cross match and group and save, encourage to spit blood out, make NBM, hydrogen peroxide gargles, adrenaline soaked swabs

124
Q

What are the borders of the anterior triangle

A

Superior - mandible

Medial - midline of neck

Lateral - SCM

125
Q

What are the borders of the posterior triangle

A

Inferior - clavicle

Posterior - trapezius

Lateral - SCM

126
Q

What are the differentials for neck lumps

A

Normal structure

Skin abscess

Lymphadenopathy

Tumour

Lipoma

Goitre

Salivary gland stone/infection

Carotid body tumour

Haematoma

Thyroglossal cyst

Branchial cyst

Specific to children cystic hygroma, dermoid cyst, haemangioma, venous malformation

127
Q

What should you look for on examination of neck lumps

A

Location

Size

Shape

Consistency

Mobile/tethered

Skin changes

Warm (infection)

Pulsatile (carotid body tumour)

Movement on swallowing

Movement on sticking tongue out

Transillumination (cystic hygroma)

128
Q

Explain the 2 week wait criteria for neck lumps

A

Unexplained neck lump in > 45

Persistent unexplained neck lump at any age

Urgent ultrasound criteria for growing lumps:

  • Within 2 weeks for > 25s
  • Within 48 hours for < 25s
129
Q

What investigations are needed for neck lumps

A

Bloods

Imaging

Biopsy

130
Q

Give an overview of infection mononucleosis

A

Infection with Epstein Barr virus

Causes lymphadenopathy

Spread through saliva

On presentation: fever, sore throat, fatigue, lymphadenopathy

Investigations: monospot test, IgM/IgG for EBV

Management: supportive

131
Q

What are the causes of thyroid goitres

A

Grave’s disease

Toxic multinodular goitre

Hashimoto’s thyroiditis

Iodine deficiency

Lithium

132
Q

What are the causes of individual thyroid lumps

A

Benign hyperplastic nodules

Thyroid cysts

Thyroid adenomas

Thyroid cancer

Parathyroid tumours

133
Q

What are the different salivary glands

A

Parotid

Submandibular

Sublingual

134
Q

Give an overview of carotid body tumours

A

Due to excessive growth of glomus cells (chemoreceptors)

May be benign

On presentation: slow growing, in upper anterior triangle, painless, pulsatile, associated with bruit, mobile

Can involve CN 9 - 12

Splaying of internal and external carotids on imaging

Management: surgical removal

135
Q

Give an overview of lipomas

A

Benign tumour of adipose tissue

On examination: soft, painless, mobile, no associated skin changes

Management: reassurance, surgical removal

136
Q

Give an overview of branchial cysts

A

Congenital abnormality

2nd branchial cleft doesn’t form properly

On presentation: round, soft, cystic swelling, in anterior triangle, mostly in young adulthood

Management: conservative (if not causing issues), surgical (recurrent, causing problems)

137
Q

Head and neck cancers are usually what type of cancers

A

Squamous cell carcinomas

138
Q

What are the risk factors for head and neck cancers

A

Smoking

Chewing tobacco

Chewing betel quid

Alcohol

HPV (16)

EBV

139
Q

What are the red flags for head and neck cancers

A

Lump in mouth/on lip

Unexplained ulceration for > 3 weeks

Erythroplakia, erythroleukoplakia

Persistent neck lump

Unexplained hoarseness of voice

Unexplained thyroid lump

140
Q

What is the management for head and neck cancers

A

Staging CT

Chemotherapy

Radiotherapy

Surgery

Targeted drug therapy

Palliative care

141
Q

Give an overview of glossitis

A

Inflamed tongue (red, sore, swollen)

Smooth appearance of tongue (papillae atrophy)

Causes: iron deficiency anaemia, B12 deficiency, folate deficiency, coeliac disease, injury, irritant exposure

Management: correct underlying cause

142
Q

Give an overview of angioedema

A

Fluid accumulation in tongue, face, lips, limbs

Causes: allergic reaction, ACE inhibitors, hereditary angioedemas

143
Q

Give an overview of oral candidiasis

A

Oral thrush

White spots/patches on tongue and palate

Risk factors: inhaled corticosteroids, antibiotics, diabetes, immunodeficiency, smoking

Management: antifungal gel/tablets

144
Q

Give an overview of geographic tongue

A

Patches on tongue surface lose epithelium and papillae

Irregular shapes on tongue

Remitting and relapsing course

Related to: stress, mental illness, psoriasis, atopy, diabetes

Management: usually does not need treatment, topical steroids, antihistamines

145
Q

What is strawberry tongue

A

Tongue red and swollen

Enlarged, white, prominent papillae

Key causes: scarlet fever, Kawasaki disease

146
Q

Give an overview of black hairy tongue

A

Due to decreased shedding of keratin from tongue surface

Papillae elongate, look like hair

Dark pigmentation due to food and bacteria

Associated features: sticky saliva, metallic taste in mouth

Management: good hydration, gentle brushing of tongue, stop smoking

147
Q

Give an overview of leukoplakia

A

White patches in mouth

Precancerous condition

Patches: asymptomatic, irregular, raised, fixed in place

Investigations: biopsy

Management: stop smoking, reduce alcohol intake, close monitoring, laser removal, surgical excision

148
Q

Give an overview of erythroplakia

A

Red lesions in mouth

High risk of squamous cell carcinoma

Refer urgently to exclude cancer

149
Q

Give an overview of lichen plexus

A

Autoimmune condition

Chronic localised inflammation of skin

Shiny, purple, flat top, raised area

Wickham’s striae (white lines across surface)

> 45s

F>M

Specific patterns: reticular (net-like), erosive (surface layer), plaque (large continuous area)

Management: good oral hygiene, stop smoking, topical steroids

150
Q

Give an overview of gingivitis

A

Inflammation of gums

On presentation: swollen gums, bleeding after brushing, painful gums, bad breath

Risk factors: plaque on teeth, smoking, diabetes, malnutrition, stress

Management: good oral hygiene, stop smoking, chlorhexidine mouth wash, consider dental surgery

Can get acute necrotising ulcerative gingivitis

151
Q

How might airway emergencies present

A

Noisy breathing (stridor, stertor)

Increased respiratory rate

Use of accessory muscles

Hoarseness of voice

Dysphagia

Drooling

Pain

Neuro and special senses (4 decks)

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