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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

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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
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3
Q

role of the cochlea?

A

converts sound vibration into nerve signal

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4
Q

when is hearing loss classed as “sudden onset”?

A

when it occurs in less than 72 hours

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5
Q

what might hearing loss with associated pain / discharge indicate?

A

outer / middle ear infection

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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
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7
Q

what is the result for weber’s test in sensorineural hearing loss?

A

sound is louder in the normal (unaffected) ear

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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”

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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
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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
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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
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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
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13
Q

neurological causes of sensorineural hearing loss?

A
  • stroke
  • MS
  • brain tumours
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14
Q

drug causes of sensorineural hearing loss?

A
  • furosemide
  • gentamicin
  • chemotherapy (e.g. cisplatin)
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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
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16
Q

what are exostoses?

A

benign bone growths in the ear

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17
Q

what is presbycusis?

A

age-related sensorineural hearing loss

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18
Q

pathophysiology of presbycusis?

A

loss of hair cells and neurones in cochlea

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19
Q

risk factors for presbycusis?

A
  • ageing
  • male sex
  • FHx
  • loud noise exposure
  • DM
  • HTN
  • ototoxic drugs
  • smoking
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20
Q

presentation of presbycusis?

A
  • gradual, insidious hearing loss
  • high pitched sounds go first
  • associated tinnitus
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21
Q

how is presbycusis diagnosed?

A

audiometry

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22
Q

management of presbycusis?

A
  • optimise environment (reduce ambient noise)
  • hearing aids
  • cochlear implants (2nd line)
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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
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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
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25
Q

causes of SSNHL?

A
  • idiopathic
  • infection
  • meniere’s disease
  • drugs
  • MS
  • migraine
  • stroke
  • acoustic neuroma
  • cogan’s syndrome
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26
Q

diagnostic criteria on audiometry in SSNHL?

A

at least 30 dL in 3 consecutive frequencies

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27
Q

investigations in SSNHL?

A
  • audiometry

- MRI / CT head to rule out stroke / acoustic neuroma

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28
Q

management of SSNHL?

A
  • immediate referral to ENT
  • treat underlying cause (e.g. ABx for infection)
  • steroids if idiopathic (PO, intra-tympanic injection)
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29
Q

which other conditions might eustachian tube dysfunction be related to?

A
  • URTI
  • allergies (e.g. hayfever)
  • smoking
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30
Q

presentation of eustachian tube dysfunction?

A
  • reduced / altered hearing
  • popping / fullness sensations in ear
  • pain
  • discomfort
  • tinnitus
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31
Q

when does eustachian tube dysfunction worsen? give some examples

A
  • when external air pressure changes
  • air travel
  • on a mountain
  • scuba diving
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32
Q

investigations for eustachian tube dysfunction?

A
  • not needed if obvious
  • tympanometry
  • audiometry
  • nasopharyngoscopy
  • otoscopy (r/o otitis media)
  • CT
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33
Q

management of eustachian tube dysfunction?

A
  • no Tx (e.g. wait for URTI to resolve)
  • valsalva manoeuvre
  • decongestant nasal sprays
  • antihistamines / steroid nose spray (allergies)
  • otovent
  • surgery
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34
Q

surgical options for eustachian tube dysfunction?

A
  • adenoidectomy
  • grommets
  • balloon dilatation eustachian tuboplasty
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35
Q

what is otosclerosis? what does it result in?

A
  • remodelling of small bones in middle ear

- conductive hearing loss

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36
Q

risk factors for otosclerosis?

A
  • female sex
  • age <40
  • FHx
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37
Q

presentation of otosclerosis?

A
  • bilateral hearing loss (low-pitched lost first)
  • bilateral tinnitus
  • reports own voice sounding louder, so speaks quietly
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38
Q

findings O/E in otosclerosis?

A
  • normal otoscopy
  • normal weber’s (if bilateral)
  • negative rinne’s (bone > air)
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39
Q

investigation of choice (and findings) in otosclerosis?

A

audiometry shows hearing loss at lower frequencies

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40
Q

management of otosclerosis?

A
  • hearing aids

- stapedectomy / stapedotomy

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41
Q

what is otitis media often preceded by?

A

URTI

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42
Q

commonest causative organism(s) of otitis media? hint: think pneumonia

A
  • streptococcus pneumoniae (pneumococcus)

- then: H. influenzae

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43
Q

presentation of otitis media in adults?

A
  • ear pain
  • reduced hearing in affected ear
  • fever, fatigue
  • URTI symptoms
  • vertigo (if vestibular involvement)
  • discharge (burst membrane)
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44
Q

otoscopy findings in otitis media?

A
  • bulging, red tympanic membrane

- discharge in ear canal if membrane has burst

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45
Q

management of otitis media?

A
  • most resolve spontaneously over 3 days
  • paracetamol / ibuprofen for pain / fever
  • consider ABx (immediate or delayed)
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46
Q

when should you consider immediate ABx in otitis media?

A
  • significant comorbidities
  • systemically unwell
  • immunocompromised
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47
Q

when should you consider delayed ABx in otitis media? when can these be claimed?

A
  • 3d after prescribing

- when you suspect they’ll worsen soon

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48
Q

ABx of choice for otitis media? hint: remember allergies!

A
  • 5-7d course of amoxicillin

- clarithromycin if penicillin allergic

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49
Q

give a common and a rare example of a complication in otitis media?

A
  • otitis media with effusion

- mastoiditis (palpate mastoid process for this)

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50
Q

describe the pathophysiology of otitis externa

A

inflammation of the skin of the external ear canal

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51
Q

causes of otitis externa?

A
  • bacterial / fungal infection
  • eczema
  • contact dermatitis
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52
Q

give 2 bacterial causes of otitis externa?

A
  • pseudomonas aeruginosa

- staph aureus

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53
Q

presentation of otitis externa?

A
  • ear pain
  • discharge
  • itchiness
  • conductive hearing loss
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54
Q

signs O/E of otitis externa?

A
  • erythema, swelling and tenderness of ear canal
  • pus / discharge in ear
  • neck lymphadenopathy
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55
Q

when might pus in the external ear canal be due to otitis media rather than otitis externa?

A

when the tympanic membrane has been perforated

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56
Q

investigations for otitis externa?

A
  • otoscopy

- ear swab (not used often)

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57
Q

management of mild otitis externa?

A

acetic acid 2%

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58
Q

treatment for moderate otitis externa?

A
  • add topical ABx + steroid

- e.g. neomycin + betamethasone + acetic acid 2% (called “otomize”)

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59
Q

what must you exclude before treating moderate otitis externa? hint: ABx SEs

A
  • must check the tympanic membrane is not perforated

- because it needs macrolides which can be ototoxic

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60
Q

treatment of severe otitis externa?

A
  • oral ABx
  • e.g. flucloxacillin or clarithromycin
  • if very severe, admission and IV ABx
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61
Q

management of fungal otitis externa?

A

clotrimazole ear drops

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62
Q

what is malignant otitis externa? main complication of this?

A
  • infection which has spreads to bones outside of ear canal

- osteomyelitis of temporal bone

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63
Q

risk factors for malignant otitis externa? hint: immunocompromise

A
  • DM
  • immunosuppressants (e.g. chemo)
  • HIV
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64
Q

presentation of malignant otitis externa?

A
  • more severe version of otitis externa signs
  • persistent headache
  • fever
  • severe pain
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65
Q

key finding of malignant otitis externa?

A

granulation tissue at junction between bone and cartilage

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66
Q

management of malignant otitis externa?

A
  • admission under ENT team
  • IV ABx
  • CT / MRI head
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67
Q

presentation of impacted ear wax?

A
  • conductive hearing loss
  • discomfort / fullness in ear
  • pain
  • tinnitus
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68
Q

how is impacted ear wax diagnosed?

A

seen on otoscope covering tympanic membrane

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69
Q

management of impacted ear wax?

A
  • most cases need nothing
  • ear drops (olive oil)
  • ear irrigation (water)
  • microsuction
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70
Q

what is primary tinnitus associated with?

A

sensorineural hearing loss

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71
Q

causes of secondary tinnitus? hint: there’s a LOT

A
  • impacted ear wax
  • ear infection
  • meniere’s disease
  • noise exposure
  • drugs
  • acoustic neuroma
  • MS
  • trauma
  • depression
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72
Q

drug causes of tinnitus?

A
  • furosemide
  • gentamicin
  • cisplatin
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73
Q

systemic signs associated with tinnitus?

A
  • anaemia
  • DM
  • thyroid dysfunction (hypo or hyper)
  • hyperlipidaemia
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74
Q

what is objective tinnitus?

A

sound is demonstrable O/E (it is actually there)

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75
Q

examples of causes of objective tinnitus?

A
  • carotid artery stenosis (causing a bruit)
  • aortic stenosis
  • AVM
  • eustachian tube dysfunction (popping / clicking sounds)
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76
Q

red flag features of tinnitus?

A
  • unilateral
  • pulsatile
  • associated sudden-onset hearing loss
  • associated vertigo / dizziness
  • headaches / visual changes
  • suicidal ideation
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77
Q

prognosis of tinnitus?

A

tends to improve alone without any intervention

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78
Q

management of tinnitus?

A
  • treat underlying cause (wax removal)
  • hearing aids
  • sound therapy
  • CBT
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79
Q

what is vertigo?

A

the sensation that either the patient or their environment is moving

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80
Q

vestibular causes of vertigo?

A
  • BPPV
  • meniere’s disease
  • vestibular neuronitis
  • labyrinthitis
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81
Q

pathophysiology of benign paroxysmal positional vertigo (BPPV)?

A
  • calcium carbonate crystals (otoconia) displaced into semicircular canals
  • disrupts endolymph flow
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82
Q

course of disease in BPPV?

A
  • onset over several weeks
  • then resolves
  • then recurs months later
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83
Q

diagnostic test for BPPV?

A

dix-hallpike manoeuvre

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85
Q

treatment of BPPV?

A
  • epley manoeuvre

- brandt-daroff exercises

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86
Q

presentation of meniere’s disease?

A
  • hearing loss
  • tinnitus
  • vertigo
  • fullness in ear feeling
  • “drop attacks” (unexplained falls)
  • unidirectional nystagmus
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87
Q

pathophysiology of acute vestibular neuritis?

A

viral infection (usually URTI) causing inflammation of the vestibular nerve

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88
Q

what is ramsay-hunt syndrome? how does it present?

A
  • herpes-zoster infection with associated symptoms
  • facial nerve weakness
  • vesicles around ear
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89
Q

central causes of vertigo?

A

anything affecting cerebellum or brainstem:

  • posterior stroke
  • tumour
  • MS
  • vestibular migraine
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90
Q

how does vertigo from a central cause present?

A

it will be sustained and non-positional

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91
Q

presentation of vestibular migraine?

A
  • vertigo
  • visual aura
  • headaches
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92
Q

give an example of a trigger for BPPV

A

turning over in bed

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93
Q

presentation of meniere’s disease? hint: triad

A
  • hearing loss
  • vertigo
  • tinnitus
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94
Q

pathophysiology of meniere’s disease?

A

excessive buildup of endolymph in the labyrinth of the inner ear

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95
Q

typical patient history in meniere’s disease?

A
  • 40-50 year old

- unilateral episodes of vertigo, hearing loss and tinnitus

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96
Q

how does the vertigo in meniere’s disease present?

A
  • episodic
  • lasts 20 mins - few hours
  • not triggered by movement or posture
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97
Q

what type of hearing loss is seen in meniere’s disease?

A
  • unilateral
  • sensorineural
  • low frequencies affected first
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98
Q

how is meniere’s disease diagnosed?

A
  • clinically

- followed up by audiology assessment

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99
Q

management of acute attacks of meniere’s disease?

A
  • prochlorperazine

- antihistamines (e.g. cyclizine)

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100
Q

prophylaxis in meniere’s disease?

A

betahistine

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101
Q

what is an acoustic neuroma?

A

benign tumour of schwann cells surrounding the vestibulocochlear nerve

102
Q

in which condition are bilateral acoustic neuromas seen?

A

neurofibromatosis type II

103
Q

where do acoustic neuromas grow?

A

cerebellopontine angle

104
Q

typical history of acoustic neuroma?

A
  • unilateral SN hearing loss (first symptom)
  • unilateral tinnitus
  • dizziness / imbalance
  • sensation of fullness in ear
105
Q

which palsy might be associated with acoustic neuroma?

A

facial nerve palsy

106
Q

how is acoustic neuroma diagnosed?

A
  • MRI or CT

- MRI is more detailed so preferred

107
Q

management of acoustic neuroma?

A
  • conservative (monitoring)
  • surgical removal
  • radiotherapy
108
Q

complications of treating meniere’s disease?

A
  • CN8 damage (permanent HL, dizziness)

- CN7 injury (facial weakness)

109
Q

what is a cholesteatoma?

A

abnormal collection of squamous epithelial cells in the middle ear

110
Q

is a cholesteatoma worrying?

A
  • not malignant

- can erode middle ear bones, predisposing to infection

111
Q

early presentation of cholesteatoma?

A
  • foul ear discharge

- unilateral conductive hearing loss

112
Q

later features of cholesteatoma?

A

all caused by expansion:

  • infection
  • pain
  • vertigo
  • CN7 palsy
113
Q

investigations and findings for cholesteatoma?

A
  • CT head is diagnostic
  • otoscopy
  • shows build up of whitish debris / crust in upper tympanic membrane
114
Q

management of cholesteatoma?

A

surgical removal

115
Q

presentation of facial nerve palsy?

A

unilateral facial weakness

116
Q

important differential for facial nerve palsy?

117
Q

is there forehead sparing in CN7 palsy? why / why not?

A
  • it is an LMN lesion

- therefore no, the forehead is not spared

118
Q

is there forehead sparing in stroke? why / why not?

A
  • it is an UMN lesion

- therefore, yes the forehead is spared

119
Q

what is bell’s palsy?

A

idiopathic unilateral LMN CN7 palsy

120
Q

prognosis for bell’s palsy?

A
  • most patients recover in weeks

- some have residual weakness

121
Q

management of bell’s palsy?

A
  • if presented within 72h of symptom onset, then prednisolone
  • lubricating eye drops
122
Q

eye complication from bell’s palsy? how is it prevented?

A
  • exposure keratopathy
  • tape the eye shut at night
  • use eye drops
123
Q

which organism causes ramsay-hunt syndrome?

A

herpes zoster

124
Q

presentation of ramsay-hunt syndrome?

A
  • unilateral CN7 LMN lesion
  • painful, tender vesicular rash
  • in ear canal, pinna, around ear
125
Q

treatment for ramsay-hunt syndrome?

A

ideally within 72h:
- prednisolone
- aciclovir
also lubricating eyedrops

126
Q

which systemic diseases can give a CN7 palsy?

A
  • DM
  • sarcoidosis
  • leukaemia
  • MS
  • GBS
127
Q

what is the most likely site of bleed in epistaxis?

A

little’s area

128
Q

causes of nosebleeds?

A
  • nose picking
  • colds, sinusitis
  • vigorous nose-blowing
  • trauma
  • weather changes
  • cocaine snorting
  • tumours
  • bleeding disorders
129
Q

management of nosebleeds?

A
  • 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
Q

what can be prescribed after a nosebleed? why is this useful?

A
  • naseptin cream (chlorhexidine and neomycin)

- stops crusting and infection

131
Q

when is sinusitis classed as chronic?

A

when it lasts >12 weeks

132
Q

what are the 4 types of paranasal sinus?

A
  • frontal
  • maxillary
  • ethmoid
  • sphenoid
133
Q

causes of sinusitis?

A
  • infection (typically post-viral URTI)
  • allergies (allergic rhinitis)
  • obstruction of drainage
  • smoking
  • asthma = RF
134
Q

what could cause obstruction of drainage from the paranasal sinuses?

A
  • foreign body
  • trauma
  • polyps
  • deviated septum
135
Q

presentation of acute sinusitis?

A
  • recent viral URTI
  • nasal congestion, discharge
  • facial pain
  • facial pressure
  • facial swelling over affected regions
  • headache
  • loss of smell (anosmia)
136
Q

findings O/E in sinusitis?

A
  • affected areas are tender to touch
  • inflammation and oedema of nasal mucosa
  • discharge
  • fever
  • other signs of systemic infection (e.g. raised HR)
137
Q

key condition associated with chronic sinusitis?

A

nasal polyps

138
Q

investigations in sinusitis?

A
  • not needed in most cases
  • nasal endoscopy
  • CT
139
Q

management of acute sinusitis?

A
  • 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
Q

prognosis for most cases of acute sinusitis?

A
  • good

- self-resolving in 2-3 weeks

141
Q

management of chronic sinusitis?

A
  • saline nasal irrigation
  • mometasone / fluticasone nasal sprays
  • FESS (type of surgery)
142
Q

describe correct administration of a nasal spray

A
  • 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
Q

what is a nasal polyp? where is it found?

A
  • growth of nasal mucosa

- nasal cavity or sinuses

144
Q

are nasal polyps typically uni or bilateral? do they grow fast or slow?

A
  • bilateral and slow growing

- unilateral polyps are a red flag for Ca!!!

145
Q

which other conditions are associated with nasal polyps?

A
  • chronic sinusitis
  • asthma
  • samter’s triad
  • CF
  • eosinophilic granulomatosis with polyangiitis (churg-strauss)
146
Q

what is samter’s triad?

A
  1. nasal polyps
  2. asthma
  3. aspirin intolerance / allergy
147
Q

presentation of nasal polyps?

A
  • chronic sinusitis symptoms
  • difficulty breathing through nose
  • snoring
  • nasal discharge
  • anosmia
148
Q

which types of examination are useful in nasal polyps?

A
  • nasal speculum

- nasal endoscopy (done by specialist)

149
Q

management of nasal polyps?

A
  • 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
Q

pathophysiology of obstructive sleep apnoea (OSA)?

A

collapse of pharyngeal airway during sleep

151
Q

typical history in OSA?

A
  • pt’s partner reports that the pt stops breathing for up to a few mins at night
  • pt unaware of this
152
Q

risk factors for OSA?

A
  • male
  • middle age
  • obesity
  • alcohol
  • smoking
153
Q

features of OSA?

A
  • 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
Q

complications of severe OSA?

A
  • HTN
  • HF
  • MI
  • stroke
155
Q

what is the epworth sleepiness scale used for?

A

to assess symptoms of sleepiness in OSA

156
Q

what should you check in anyone with OSA?

A
  • occupation

- sleepiness could make them dangerous at work, e.g. lorry driver

157
Q

management of OSA?

A
  • ENT referral
  • correct reversible risk factors
  • CPAP
  • UPPP surgery
158
Q

most common causative organism in bacterial tonsillitis? second most common one?

A
  • group A strep (strep pyogenes)

- pneumococcus

159
Q

commonest cause of tonsillitis?

A

viral infection

160
Q

which tonsils are most likely to be affected in tonsillitis?

A

palatine tonsils

161
Q

presentation of acute tonsillitis?

A
  • sore throat
  • fever >38C
  • pain on swallowing
162
Q

(potential) findings O/E of tonsillitis?

A
  • red, inflamed enlarged tonsils
  • exudate
  • anterior cervical lymphadenopathy
163
Q

which 2 scoring systems can be used to work out whether tonsillitis is viral or bacterial?

A
  • centor criteria

- feverPAIN score

164
Q

criteria in the feverPAIN score?

A
  • fever in last 24h
  • purulent tonsils
  • attended within 3d of symptom onset
  • inflammation, severe
  • no cough / coryza
165
Q

when should you consider admitting a patient with tonsillitis?

A

for any of the following:

  • immunocompromised
  • systemically unwell
  • dehydrated
  • stridor
  • resp distress
  • evidence of quinsy / cellulitis
166
Q

when should ABx be considered in tonsillitis?

A
  • centor score: 3 or more
  • feverPAIN score: 4 or more
  • immunocompromised
  • Hx of rheumatic fever
  • significant comorbidities
167
Q

first line antibiotic in bacterial tonsillitis?

A
  • penicillin V (phenoxymethylpenicillin)

- if penicillin allergic: clarithromycin

168
Q

safety netting advice in viral tonsillitis?

A

return if:

  • pain has not settled in 3d
  • fever >38.3C after 3d
169
Q

complications of tonsillitis?

A
  • peritonsillar abscess
  • otitis media
  • scarlet fever
  • rheumatic fever
  • post-strep GN
  • post-strep reactive arthritis
170
Q

what is a quinsy? how could it occur?

A
  • peritonsillar abscess due to bacterial infection with trapped pus
  • may be complication of untreated tonsillitis
171
Q

demographic most commonly affected by tonsillitis?

172
Q

presentation of quinsy?

A
  • sore throat
  • painful swallowing
  • fever
  • neck pain
  • referred ear pain
  • swollen, tender lymph nodes
  • trismus
  • “hot potato voice”
173
Q

most common causative organism of quinsy?

A

group A strep (strep pyogenes)

174
Q

management of quinsy?

A
  • admit under ENT
  • incision and drainage, done under GA
  • co-amox before and after surgery
  • dexamethasone for inflammation
175
Q

indications for tonsillectomy?

A

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
Q

complications of tonsillectomy?

A
  • post-tonsillectomy bleeding
  • sore throat for up to 2w
  • damage to teeth
  • infection
  • risks with GA
177
Q

how could a post-tonsillectomy bleed be life-threatening?

A

if blood is aspirated

178
Q

management of post-tonsillectomy bleeding?

A
  • 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
Q

differentials for a neck lump in an adult? hint: there’s a LOT

A
  • normal structures (e.g. bony prominence)
  • skin abscess
  • lymphadenopathy
  • tumour (thyroid, carotid body)
  • lipoma
  • salivary gland stones
  • thyroglossal cysts
  • branchial cysts
180
Q

additional differentials for neck lump in a young child?

A
  • cystic hygroma
  • dermoid cyst
  • haemangiomas
  • venous malformation
181
Q

what are the 2WW criteria for referral of a neck lump?

A
  • unexplained neck lump in anyone aged >45

- persistent, unexplained neck lump at any age

182
Q

when should an urgent USS be performed on a neck lump? timeframes for this scan?

A
  • when it is growing in size
  • within 2w if over 25
  • within 48h if under 25
  • referral to 2WW depending on USS findings
183
Q

which blood tests may be requested for a neck lump? why?

A
  • FBC, blood film (leukaemia, infection)
  • HIV test
  • monospot test (EBV antibodies)
  • TFTs
  • ANA (SLE)
  • LDH (hodgkin’s lymphoma, very non-specific)
184
Q

investigations for a neck lump?

A
  • bloods
  • USS (1st line imaging)
  • nuclear medicine scan
  • biopsy
185
Q

causes of lymphadenopathy? give examples of each

A
  • reactive (viral infection)
  • infection (TB, HIV, mononucleosis)
  • inflammation (SLE, sarcoidosis)
  • malignancy (lymphoma, leukaemia, mets)
186
Q

features of lymphadenopathy suggestive of Ca?

A
  • unexplained
  • persistently enlarged >3cm in size
  • abnormal shape
  • hard / “rubbery”
  • non-tender
  • tethered to skin / underlying tissue
  • any associated B symptoms
187
Q

causative organism in infectious mononucleosis?

A

epstein barr virus (EBV)

188
Q

how does EBV spread?

A

through saliva (kissing, sharing cups, toothbrushes)

189
Q

presentation of infectious mononucleosis?

A
  • fever
  • sore throat
  • fatigue
  • lymphadenopathy
  • maculopapular rash if amoxicillin given
190
Q

first line investigation of infectious mononucleosis?

A

monospot test

191
Q

which immunoglobuin indicates acute infection with infectious mononucleosis? which indicates immunity?

A
  • IgM = acute infection

- IgG = immunity

192
Q

management of infectious mononucleosis?

A
  • supportive
  • avoid alcohol (liver impairment)
  • avoid contact sports (splenic rupture)
193
Q

typical demographics affected by hodgkin’s lymphoma?

A
  • bimodal age distribution
  • one peak around age 20
  • another around age 75
194
Q

key presenting feature of lymphoma? where might this be found?

A
  • lymphadenopathy
  • “rubbery” nodes
  • pain in the nodes upon drinking alcohol
  • neck
  • axillary nodes
  • inguinal nodes
195
Q

features of lymphoma?

A

quite non-specific:

  • fatigue
  • lymphadenopathy
  • pallor (anaemia)
  • petechiae / abnormal bruising (thrombocytopenia)
  • abnormal bleeding
  • hepatosplenomegaly
  • B symptoms
196
Q

finding on lymph node biopsy in hodgkin’s lymphoma?

A

reed-sternberg cells

197
Q

how is lymphoma staged?

A

ann arbor staging system

198
Q

list the 3 B symptoms

A
  • fever
  • weight loss
  • night sweats
199
Q

causes of goitre?

A
  • graves disease (hyper)
  • toxic multinodular goitre (hyper)
  • hashimoto’s thyroiditis (hypo)
  • iodine deficiency (rare)
  • lithium
200
Q

what is a goitre?

A

generalised swelling of the thyroid

201
Q

differentials for individual lumps in the thyroid?

A
  • benign hyperplastic nodules
  • thyroid cysts
  • thyroid adenomas
  • thyroid Ca
  • parathyroid tumour
202
Q

causes of enlarged salivary glands?

A
  • stones
  • infection
  • tumours
203
Q

describe the lump found in a carotid body tumour

A
  • lump in anterior triangle of neck
  • painless
  • pulsatile
  • bruit on auscultation
  • mobile side-to-side, but not up and down
204
Q

how might a carotid body tumour give horner’s syndrome?

A

by compressing on the vagus nerve (CN10)

205
Q

finding on imaging of carotid body tumour?

A
  • “splaying” of internal and external carotids

- called lyre’s sign

206
Q

what is a lipoma?

A

benign fat tumour

207
Q

findings O/E of a lipoma?

A
  • soft
  • painless
  • mobile
  • no skin changes
208
Q

management of carotid body tumours?

A

surgical removal

209
Q

management of lipomas?

A
  • reassurance

- may be surgically removed

210
Q

pathophysiology of thyroglossal cyst?

A
  • thyroglossal duct persists after birth (it normally disappears)
  • gets filled with fluid
  • becomes a cyst
211
Q

key differential of a thyroglossal cyst?

A

ectopic thyroid tissue

212
Q

findings O/E of a thyroglossal cyst?

A
  • lump in midline of neck
  • mobile
  • non-tender
  • soft
  • fluctuant (move up and down with tongue movement)
213
Q

management of thyroglossal cysts?

A

surgical removal

214
Q

main complication of thyroglossal cysts?

A
  • infection

- lump becomes hot, tender and painful

215
Q

presentation of a branchial cyst?

A
  • swelling between angle of jaw and SCM muscle in anterior triangle of neck
  • round and soft
  • transilluminates
216
Q

typical demographic affected by branchial cysts?

A
  • young adulthood
217
Q

management of branchial cysts?

A
  • conservative

- surgical excision if problematic

218
Q

where could a head and neck Ca grow?

A
  • nasal cavity
  • paranasal sinuses
  • mouth
  • salivary glands
  • pharynx
  • larynx
219
Q

risk factors for head and neck Ca?

A
  • smoking
  • chewing tobacco
  • paan!
  • alcohol
  • HPV (esp strain 16)
  • EBV infection
220
Q

red flag features suggestive of head and neck Ca?

A
  • lump in mouth / on lip
  • unexplained mouth ulcers lasting >3m
  • erythroplakia (unexplained red lesion)
  • persistent neck lump
  • unexplained hoarse voice
  • unexplained thyroid lump
221
Q

management of head and neck Ca?

A
  • MDT input
  • TNM staging
  • chemo
  • radio
  • surgery
  • cetuximab (monoclonal antibody)
  • palliative care
222
Q

what cell type are most head and neck cancers?

A

squamous cell carcinoma

223
Q

causes of glossitis?

A
  • Fe def anaemia
  • B12 def
  • folate def
  • coeliac disease
  • injury / irritant exposure
224
Q

3 key causes of angioedema?

A
  • allergic reactions
  • ACE-i
  • hereditary
225
Q

risk factors for oral candiaisis?

A
  • inhaled corticosteroids (not rinsing mouth afterwards)
  • ABx
  • DM
  • immunodeficiency (HIV)
  • smoking
226
Q

management of oral candidiasis?

A
  • miconazole gel
  • nystatin suspension
  • fluconazole tablets (if severe / recurrent)
227
Q

describe geographic tongue

A

irregularly shaped patches form on tongue from loss of papillae

228
Q

causes of geographic tongue?

A
  • stress, mental illness
  • psoriasis
  • atopy
  • DM
229
Q

2 key causes of strawberry tongue?

A
  • scarlet fever

- kawasaki disease

230
Q

causes of black hairy tongue?

A
  • dehydration
  • dry mouth
  • poor oral hygiene
  • smoking
231
Q

what is leukoplakia?

A
  • precancerous condition

- gives white patches on tongue / inside cheeks

232
Q

describe the patches found in leukoplakia

A
  • asymptomatic
  • irregular
  • slightly raised
  • fixed in place (can’t be scraped off)
233
Q

investigation for leukoplakia?

A

biopsy to look for dysplasia / Ca

234
Q

management of leukoplakia?

A
  • stop smoking
  • cut down alcohol
  • close monitoring
  • laser removal
  • surgical excision
235
Q

describe the lesions seen in lichen planus

A
  • shiny
  • purplish
  • flat-topped raised areas
  • white lines across surface (wickham’s striae)
236
Q

which demographics are more likely to be affected by lichen planus?

A
  • those >45

- women

237
Q

management of oral lichen planus?

A
  • good oral hygiene
  • stop smoking
  • topical steroids
238
Q

presentation of gingivitis?

A
  • bleeding after brushing
  • painful gums
  • bad breath
239
Q

what is periodontitis? what is its main complication?

A
  • chronic and severe inflammation of gums around teeth

- tooth loss!

240
Q

RFs for gingivitis?

A
  • plaque build up (tartar)
  • smoking
  • DM
  • malnutrition
  • stress
241
Q

management of gingivitis?

A
  • good oral hygiene
  • stop smoking
  • “scale and polish” to remove tartar
  • chlorhexidine mouthwash
  • metronidazole / dental surgery if needed
242
Q

causes of gingival hyperplasia?

A
  • gingivitis
  • pregnancy
  • vit C def (scurvy)
  • acute myeloid leukaemia (AML)
  • drugs
243
Q

drug causes of gingival hyperplasia?

A
  • CCBs
  • phenytoin
  • ciclosporin
244
Q

which conditions can give rise to aphthous ulcers?

A
  • IBD
  • coeliac disease
  • behcet’s disease
  • vitamin / mineral deficiency
  • HIV
245
Q

which vitamin / mineral deficiencies could cause aphthous ulcers?

A
  • iron
  • B12
  • folate
  • vit D
246
Q

management of simple aphthous ulcers?

A
  • most self-resolve in 2w
  • bonjela
  • difflam spray
  • lidocaine
247
Q

management of severe aphthous ulcers?

A
  • hydrocortisone buccal tablets

- betamethasone tablets / inhaler

248
Q

what is the 2WW criteria with regard to aphthous ulcers?

A

pts with unexplained ulceration lasting >3w need a referral

249
Q

when should you consider giving ABx in tonsillitis?

A
  • centor score >3

- feverPAIN score >4

250
Q

pathophysiology of meniere’s disease?

A

build-up of excessive endolymph in semicircular canals

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