ENT Flashcards
1
Q
What is the pathophysiology of benign paroxysmal positional vertigo?
A
calcium carbonate crystals called otoconia become displaced in the semicircular canals which disrupt the usual flow of endolymph triggering vertigo
2
Q
what are the 4 possible causes of BPPV?
A
viral infection
trauma
aging
idiopathic
3
Q
what are 3 features of BPPV?
A
20-60 second duration
triggered by movement
no hearing loss or tinnitus
4
Q
what does the Dix-Hallpike manouver test for?
A
Benign paroxysmal positional vertigo
5
Q
what is a positive Dix-Hallpike?
A
nystagmus is observed - beating is towards affected ear
6
Q
what manoeuvre is used to treat BPPV?
A
epley manoeuvre
7
Q
what manoeuvre is used to test for BPPV?
A
Dix-Hallpike manoeuvre
8
Q
what exercises can be done by patients to improve BPPV?
A
Bradt-daroff exercises
9
Q
what are the 4 most common causes of peripheral (vestibular) vertigo?
A
Benign paroxysmal positional vertigo
Menieres disease
vestibular neuritis
labrinthitis
10
Q
what kind of nystagmus is seen in BPPV?
A
rotational nystagmus
11
Q
How do you perform the dix-hallpike manouver?
A
Patients sat on flat exam couch with head turned 45 degrees to side of ear being tested
Rapidly lower patient backwards until head hanging off couch while holding head at 45 degrees
Hold head still 20-30 degrees below couch and at 45 degrees
Watch eyes for 30-60s for nystagmus
repeat on other side
12
Q
How do you perform the epley manouver?
A
Patient sat on couch with head at 45 degrees towards affected side
Lie patient with head of the bed
Rotate their head 90 degrees past central point with head off couch
Have patient roll onto side with head still in position
Have patient sit up with legs off side of couch
position head centrally with neck flexed and chin to chest
at each stage support patients head in place for 30s and wait for nystagmus/dizziness to pass
13
Q
when should patients with BPPV be referred to ENT?
A
Repeat symptoms despite repositioning procedures
Not resolved in 4 weeks
atypical symptoms or signs
3+ periods of vertigo
14
Q
What is Meniere’s disease?
A
excessive build up of endolymph in membranous labyrinth which causes high pressure and sensory signals
15
Q
what is the classic triad of Meniere’s disease?
A
Hearing loss
Vertigo
Tinnitus
16
Q
what are 8 features of menieres disease?
A
hearing loss
tinnitus
vertigo
sensation of fullness in ear
Nystagmus during attack
last several hours
not associated with movement
unilateral hearing loss
drop attacks
17
Q
what are vertigo attacks like in Meniere’s disease?
A
Episodes lasting 20 mins to hours that can come in clusters with long periods of remssion
18
Q
what is the hearing loss like in Meniere’s disease?
A
fluctuant at first associated with vertigo attacks then becoming permanent
unilateral sensorineural hearing loss starting with low frequencies
19
Q
what is the acute management of meniere’s disease?
A
Prochlorperazine - 5mg TDS
antihistamines
20
Q
what is the prophylaxis for Meniere’s disease?
A
Betahistine - 16mg TDS taken with food
21
Q
what are 4 risk factors for Meniere’s disease?
A
FHx
Caucasian
Migraines
Autoimmune diseases
22
Q
what is acute vestibular neuritis?
A
inflammation of the vestibular nerve usually due to viral infection. Typically presents as acute onset vertigo which improves within a few weeks. NO HEARING LOSS OR TINNITUS
23
Q
what kind of nystagmus is usually seen in vestibular neuritis?
A
Horizontal
24
Q
what is labrynthitis?
A
inner ear inflammation usually due to viral infection which causes acute onset vertigo which improves within a few weeks and CAN CAUSE HEARING LOSS and nausea
25
what is the management of labyrinthitis AND vestibular neuritis ?
Prochlorperazine - for immediate relief, can be given buccally/IM
3 day course of Prochlorperazine or
an Antihistamine - Cyclizine/cinnarizine
vestibular rehab for recurrent cases
26
what is the HINTS examination?
Head Impulse test
Nystagmus
Test of Skew
to determine peripheral or central cause of vertigo
27
How can prochlorperazine be administered to provide rapid relief to labyrinthine disorders?
Buccal or IM
28
what are the 4 most common central causes of vertigo?
posterior circulation stroke
tumour
MS
vestibular migraine
29
what kind of vertigo do you get with central casues?
non-positional
doesn't affect hearing
no tinnitus
30
what is a test that can be used to determine a peripheral cause of vertigo?
the head impulse test - +ve in peripheral
31
what is the head impulse test?
for peripheral causes of vertigo
ask patient to fix eyes on nose, move head rapidly 10-20 degrees to one side then slowly back to middle then to other side
Positive if eyes saccade (rapidly move back and forth) before fixing back on nose
32
what is the test of skew?
tests for central cause of vertigo
ask patient to look at nose, cover one of their eyes then the other alternating, if eye has to refix on nose after being uncovered - may indicate central vertigo
33
what test can be used to determine a central cause of vertigo?
the test of skew
34
what medications can be used to manage peripheral vertigo acutely?
prochlorperazine 5-30mg TDS
antihistamines
35
what medication can be used prophylactically for Menieres disease?
Betahistine
36
what is the classical triad of menieres disease?
hearing loss
vertigo
tinnitus
37
where does anterior epistaxis usually occur from?
kiesselbach's plexus located in little's area
38
what is are 10 risk factors for epistaxis?
nose picking
colds
sinusitis
vigorous nose blowing
trauma
changes in weather
Coagulation disorders
anticoagulant meds
snorting cocaine
tumours
39
what do posterior nose bleeds increase risk of?
aspiration of blood
may bleed from both nostrils
40
what is a benign tumour that can cause epistaxis?
juvenile angiofibroma - benign tumour that is highly vascularised - seen an adolescent males
41
How is epistaxis managed in first aid?
Sit leant forwards with mouth open and pinch soft area of nose firmly
at least 20 mins!
42
what can be given if first aid management of epistaxis IS successful after bleeding has stopped?
Naseptin (chlorhexidine and neomycin) - topical aseptic QDS for 10 days - reduces crusting, inflammation and infection
43
Who should not be given naseptin?
Peanut, soy or neomycin allergy
44
what should be done I epistaxis does not stop after 10-15 mins of first aid?
1 - Cautery using silver nitrate sticks if source of bleeding visible
2 - Packing - if bleeding point not visualised - ent review
45
what surgery can be used for failed initial management of epistaxis?
sphenopalatine ligation
46
what anaesthetic can be used for cautery in epistaxis?
co-phenylcaine
47
what is hereditary haemorrhage telangiectasia?
autosomal dominant condition causing telangiectasis (dilated blood vessels), epistaxis, GI haemorrhage and anaemia
48
what can be used for nasal packing in epistaxis?
Morocel nasal tampons
Rapid Rhinos
ribbon gauze impregnated with bismuth iodoform paraffin paste (BIPP)
49
what are 4 contraindications to nasal packing?
basal skull fracture
facial or nasal fracture
airway emergency/haemodynamic instability
50
Where do posterior nosebleed occur from usually?
sphenopalatine artery or terminall branches of maxillary artery
51
what is the second line measure for post epistaxis care?
Mupirocin nasal ointment
52
what are 4 complications of nasal packing?
bacterial sinusitis
staphylococcal toxic shock syndrome - with prolonged use
asphyxiation
necrosis of nasal septum
53
what are 5 bits of advice for patients post epistaxis?
Avoid:
Blowing or picking the nose
Heavy lifting
Strenuous exercise.
Lying flat
Drinking alcohol or hot drinks
54
what is the middle ear?
between tympanic membrane and inner ear (cochlea, vestibular apparatus and nerves)
55
what are 6 risk factors for otitis media?
Eistachian tube dysfunction
Age - children
Immunodeficiency
Allergies
Smoking
CF
56
what is the most common causative organism for otitis media?
strep pneumoniae
57
what are 3 other common causative organisms for otitis media?
H. Influenzae
Moraxella catarrhalis
Staph aureus
58
why are children predisposed to otitis media?
Narrower Eustachian tube
more horizontal eustachian tube
Less developed immune system
59
what are 5 presenting features of otitis media?
ear pain
reduced hearing
feeling generally unwell - fever
URTI symptoms
balance issues, vertigo
60
what might be seen O/E in otitis media?
Bulging, red, inflamed tympanic membrane
61
what are 8 complications of otitis media?
hearing loss
perforated tympanic membrane
labrynthitis
mastoiditis
abcess
fascial nerve palsy
meningitis
62
how long do most otitis media infections last?
5 days
63
what classes as recurrent acute otitis media?
3+ separate episodes of otitis media in past 6 months or 4 in 1 year
64
what is the first line treatment for otitis media?
1 - consider no Abx
amoxicillin 5-7 days PO
- 1-11 months - 125mg TDS
- 1-4 years - 250mg TDS
- 5-17 years - 500mg TDS
- Adults - 500mg TDS
clarithromycin - in penicillin allergy
- Adults - 250mg BD
erythromycin - pregnancy
- 250-500mg QDS
65
what is the management of otitis media in pregnant women allergic to penicillins?
erythromycin
66
when should you consider immediate abx prescription in otitis media?
Symptoms >4 days and not improving
Systemically unwell
Immunocompromised or high risk comorbidities
<2 years with b/l
Perforation and/or discharge in canal
67
what is chronic suppurative otitis media?
chronic inflammation >2 weeks of the middle ear and mastoid cavity that presents with recurrent ear discharges through a tympanic membrane perforation
usually hearing loss in affected ear with a Hx of otitis media
68
what are the two most common causes of otitis externa?
Pseudomonas aeruginosa
Staph aureus
69
what kind of bacteria is pseudomonas aeruginosa?
gram neg aerobic bacilli
naturally resistant to many antibiotics - tx with aminoglycosides (gent) or quinolones (ciproflox)
70
what are 5 conditions that can cause inflammation in the external auditory cannal?
bacterial infection
fungal infection
eczema
seborrhoeic dermatitis
Contact dermatitis
71
what are 4 typical symptoms in otitis externa?
ear pain
discharge
itchiness
conductive hearing loss - if ear blocked
72
what 4 things can be seen o/e in otitis externa?
Erythema and swelling of ear canal
Tender tragus/pinna
Debris in ear canal
Cellulitis on pinna
Lymphadenopathy
73
what are 4 things that can be seen o/e in chronic otitis externa?
lack of earwax in canal
dry scaly skin in ear canal
canal stenosis
fluffy cotton like black debris in canal - fungal infection
Conductive hearing loss
74
what is the treatment for mild otitis externa?
acetic acid 2% (earcalm)
can also be used prophylactically
75
what is advice for otitis externa?
do not use cotton buds to clean ear canal
keep ears clean and dry
use cotton wool in vaseline for bathing and ear plugs for swimming
76
what is the management of moderate otitis externa?
topical Abx + steroid
neomycin + dexamethasone and acetic acid (OTOMISE)
Gentamicin and hydrocortisone
ciproflaxacin and dexamethasone
77
what is a contraindication to using gentamicin/neomycin in otitis externa?
perforated tympanic membrane - they are ototoxic
78
what is the management of sever/systemic otitis externa?
oral Abx - fluclox/clarithromycin
79
what is the treatment for fungal otitis externa?
clotrimazole ear drops
80
what is the management of otitis externa if tympanic membrane cannot be visualised?
ENT referral for microsuction or wick insertion
81
what is the management of necrotising otitis externa?
Admission under ENT
IV ceftazidime for 6 weeks
82
what are 3 complications of otitis externa?
Regional spread - cellulitis, perichondritis, parotitis
Fibrosis and stenosis of ear canal
Malignant otitis externa
83
what is malignant otitis externa?
severe otitis externa where infection spreads to temporal bone. Causes severe persistent headache, fever, vertigo
granulation tissue is found at junction between bone and cartilage in ear canal
84
what increases the risk of malignant otitis externa?
Diabetes
Immunocompromise
Older age
radiotherapy to head, neck, ear
Previous ear surgery/irrigation
85
what is the most common pathogenic cause of malignant otitis externa?
pseudomonas aeruginosa
86
what abx should be used in malignant otitis externa?
Ciprofloxacin
87
what is the most common causative organism of bacterial tonsilitis?
Group A strep - strep pyogenes
88
What is the treatment for bacterial tonsilitis?
1st - penicillin V (phenoxymethylpenicillin) 10 days
<11mon - 62.5mg QDS
1-5 years - 125mg QDS
6-11years - 250mg QDS
12+ - 500mg QDS
PENICILLIN ALLERGY- Clarithromycin
12+ - 250-500mg BD
PREGNANCY + PEN ALLERGY
Erythromycin
250-500mg QDS
89
what are 2 groups who need an FBC when presenting with tonsilitis?
On DMARDs - also hold DMARD till results
On carbimazole - due to risk of idiosyncratic neutropenia - also hold drug
90
what is the most common viral cause of tonsillitis?
Adenovirus
91
what is the second most common bacterial cause of tonsilitis?
strep pneumnoniae
92
what 2 criteria can be used to determine the probability that tonsilitis is bacterial?
Centor criteria
FeverPAIN score
93
what is the centor criteria?
for bacterial tonsilitis
fever >38
tonsillar exudates
absence of cough
tender anterior cervical lymph nodes
SCORE >3 => offer Abx
94
what is the feverPAIN score
for bacterial tonsilitis
Fever in last 24 hours
Purulence
Attended in 3 days of onset
Inflamed tonsils
No cough or coryza
SCORE >4 - consider Abx
95
what are 2 investigations that can be used for tonsillitis?
Throat culture - gold
Rapid group A streptococcal antigen test
96
what are 6 complications of bacterial tonsilits?
Peritonsillar abcess (quinsey)
Otitis media
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
97
what are the criteria for tonsillectomy?
7 episodes in 1 year
OR
5 episodes in 2 years
OR
3 episodes in 3 years
episodes must disabling and prevent normal functioning
Recurrent febrile convulsions secondary to tonsillitis
OSA, stridor or dysphagia due to enlarged tonsils
Unresponsive peritonsillar abscess
98
what are 2 primary (<24h) complications of tonsillectomy?
Haemorrhage - due to inadequate haemostasis
Pain
99
what are 2 secondary (>24h) complications of tonsillectomy?
Haemorrhage - usually due to infection
Infection
Pain
100
what is the most common bacterial cause of peritonsillar abscess?
strep pyogenes
101
what is the most common age range for peritonsillar abscess?
20-30 years
102
what are 6 features of peritonsillar abscess?
Severe sore throat pain lateralising to one side
difficulty swallowing and talking (hot potato voice
Deviation of uvula to unaffected side
Trismus
Reduced neck motility
Systematic features - fever, chills, malaise
103
what is the management of peritonsillar abscess?
Abx - a penicillin + beta lactamase
Analgesia
Steroids
Needle aspiration
Intraoral incision and drainage
Quinsy tonsillectomy
104
what is acute sinusitis?
<12 weeks
105
what is chronic sinusitis?
>12 weeks
106
what are the 4 pairs of paranasal sinuses?
frontal - above eyebrows
maxillary - either side of nose
ethmoid - in middle of nasal cavity
sphenoid - in back of nasal cavity
107
what are 4 causes of sinusitis?
infection
allergies
obstruction of drainage - foreign body, polyps
smoking
108
what is the typical presentation of acute sinusitis? 5
nasal congestion and discharge
facial pain/headache
facial pressure
facial swelling
loss of smell
109
what 5 things may be seen o/e of sinusitis?
tenderness to palpation
inflammation and oedema of nasal mucosa
discharge
fever
signs of systemic infection
110
how long should you wait to give abx for sinusitis?
10 days
111
what is the management of sinusitis?
After 10 days conservative management
high dose steroid nasal spray for 14 days - 200mcg Mometasone BD
Delayed till day 17 phenoxymethylpenicillin
112
what is the most common cause of acute sinusitis?
viral URTI
113
what are 4 risk factors for sinusitis ?
Nasal obstruction - septal deviation/polyps
Recent local infection - dental, rhinitis
Swimming/diving
Smoking
114
what are 2 investigations for chronic sinusitis?
Nasal endoscopy
Imaging - CT paranasal sinuses
115
what is the management of chronic sinusitis?
Nasal saline irrigation, topical corticosteroids, Abx if indicated
Surgery - functional endoscopic sinus surgery, balloon sinuplasy
116
what can be used as a nasal decongestant in sinusisitis?
Pseudoephedrine - 60mgQDS
Phenylephrine
117
what is the other name for an acoustic neuroma?
Vestibular schwannoma
118
what is an acoustic neuroma?
a benign tumour of the of the schwann cells surrounding the vestibulocochlear nerve
119
what are bilateral acoustic neuromas associated with?
neurofibromatosis type II
120
what are 6 presentations of acoustic neuroma?
gradual onset of:
Unilateral sensorineural hearing loss
Unilateral tinnitus
Dizziness or imbalance/vertigo
Sensation of fullness in ear
Facial nerve palsy - forehead not spared in LMN
Headache, nausea, vomiting
121
what are 2 investigations for acoustic neuroma?
Audiometry
Gadolinium enhanced MRI head
122
what are 3 complications of acoustic neuroma management?
Vestibulocochlear nerve injury - permanent hearing loss and dizziness
Facial nerve injury
CSF leak
123
where are acoustic neuromas most commonly found?
cerebellopontine angle
124
what is the management of acoustic neuroma?
Watch and wait - MRI annually for first 5 years
Stereotatic radiosurgery/radiotherapy
Surgical removal
125
what virus is infectious mononucleosis caused by?
epstein-barr virus (EBV)
126
what is the classical triad of infectious mononucleosis?
Sore throat
lymphadenopathy - anterior or posterior triangles of neck
pyrexia
127
what are 10 features of infectious mononucleosis?
Malaise, fatigue, headache
Fever
Sore throat
Lymphadenopathy
Palatal petechiae
Splenomegaly
Hepatitis - transient ALT rise
Lymphocytosis
Haemolytic anaemia
maculopapular rash with ampicillin/amox ise
128
what can be seen on FBC in infectious mononucleosis?
lymphocytosis
129
what does NICE suggest for confirmation of infectious mononucleosis?
FBC + Monospot in second week of illness to confirm diagnosis
130
what is the management of infectious mononucleosis?
Analgesia
+ Hydration
131
what advice needs to be given to those with infectious mononucleosis?
Avoid contact sport for 1 month due to risk of spleen rupture
May have post viral fatigue for several weeks to months
132
what are 5 complications of infectious mononucleosis?
Haemolytic anaemia
Splenic rupture
Hepatitis
GBS
Secondary bacterial infection
133
what is tested for in the monospot test?
Heterophile antibodies for EBV
134
What cancer is EBV associated with?
Burkitt's lymphoma
135
what is the cause of haemolytic anaemia in infectious mononucleosis?
secondary to cold agglutins (IgM)
136
what are 6 risk factors for OSA?
Obesity
Age + post menopause
Male
FHx
Smoking
Medical conditions - hypothyroid, aromegaly, PCOS
137
what are 7 features of OSA?
episodes of apnoea during sleep
snoring
morning headache
waking up unrefreshed
daytime sleepiness
concentration problems
reduced O2 sats during sleep
138
what are 4 complications of OSA?
HTN
Heart failure
MI
Stroke
139
What 2 scoring systems can be used to assess for OSA?
Epworth sleepiness scale
STOP BANG
140
what is the management of OSA?
Weight loss + lifestyle management
CPAP
Inform DVLA - must not drive if have excessive daytime sleepiness
141
what are 2 investigations of OSA?
screening questionnaires
Sleep studies
142
what antibiotic causes ototoxicity?
Aminoglycosides - gentamicin, neomycin
143
what is a cholesteatoma?
A non-cancerous abnormal collection of squamous epithelial cells in the middle ear
144
what is the pathophysiology of cholesteatoma?
theory
there is negative pressure in the middle ear due to eustachian tube dysfunction which causes a pocket of the tympanic membrane to retract into the middle ear forming a pocket where squamous epithelial cells continue to proliferate and grow into the surrounding spaces
145
what are 2 presentations of cholesteatoma?
Foul ear discharge
unilateral conductive hearing loss
Also vertigo, facial nerve palsy
146
what is used to confirm diagnosis of cholesteatoma?
CT/MRI head
147
what can be seen on otoscopy in cholesteatoma?
Abnormal build up of whitish debris or crust under tympanic membrane
148
what are 4 complications of cholesteatoma?
Ossicular chain erosion - leading to conductive hearing loss
Labyrinthine fistula
Intracranial extension - meningitis, brain abscess, lateral sinus thrombosis
Mastoiditis
149
what is the management of cholesteatoma?
Canal wall up mastoidectomy
Canal wall down mastoidectomy
150
what is the presentation of oral candidiasis?
Curd-like white or yellowish plaques in mouth on cheeks, gums, palate, tongue
151
what are 5 risk factors for oral candida?
Inhaled Corticosteroids
ABx
Diabetes
Immunodeficiency -HIV
Smoking
152
what is the management of oral candidiasis?
1 - Miconazole oral gel 7 days
2 - Nystatin suspension
OR
Oral Fluconazole 50mg OD 7 days
153
what is the management of oesophageal candidiasis?
Oral fluconazole 100mg 7 days
154
what are the 3 most common causes of transient hearing loss?
Ear wax
otitis media
otitis externa
155
what is presbycusis?
age related sensorineural hearing loss
Typically slow progressive loss of bilateral high frequency hearing due to atrophy of sensory hair cells and neurons in cochlear
156
what are 6 risk factors for Presbycusis?
Arterioscelrosis to cochlear
Diabete
Accumulative noise exposure
Drug exposure - salicylates, chemo
Stress
Genetics
157
what are 4 investigations for Presbycusis?
Otoscopy - should be normal
Tympanometry - should be normal
Audiometry - b/l sensorineural pattern hearing loss
Bloods - normal
158
what is otosclerosis?
Autosomal dominant condition that causes the replacement of normal bone by vascular spongy bone causing progressive conductive hearing loss due to fixation of stapes at oval window
159
what is the typical presentation of Otosclerosis?
20-40 years old
conductive hearing loss
tinnitus
10% have flamingo tinge to tympanic membrane
+ve family Hx
160
what is the management of Otosclerosis?
hearing aid
stapedectomy
161
what are 6 risk factors for otitis media with effusions?
male
sibling with glue ear
winter/spring time
bottle feeding
day care attendance
parental smoking
162
what age does otitis media with effusion peak?
2 years
163
what is the presentation of otitis media with effusions?
conductive hearing loss
speech and language delay, behavioural or balance problems
164
what is the management of otitis media with effusions?
observation - 3 months
grommet insertion - majority stop functioning at 10 months
adenoidectomy
165
what is the management of unilateral glue ear?
2ww referal to ENT - could be sign of posterior nasal space tumour
166
what is rinne's test?
tuning fork places on mastoid process until sound is no longer heard followed by repositioning over external aucustic meatus
+ve if air conduction better than bone = normal
-ve if Bone>air = conductive deafness
167
what is weber's test?
tuning fork in middle of forehead
asked which side is loudest
unilateral sensorineural deafness - localises to unaffected side
unilateral conductive deafness - localises to affected side
168
what is the criteria for cochlear implant in children?
audiological assessment and/or difficulty developing basic auditory skills
169
what is the criteria for cochlear implant in adults?
completed trial of appropriate hearing aids for at least 3 months which have objectively given them little/no benefit
170
what are 4 causes of profound deafness in children ?
genetic
congenital
idiopathic
infectious - post meningitis
171
what are 5 causes of profound deafness in adults?
viral induced sudden hearing loss
Ototoxicity
otosclerosis
Meniere disease
trauma
172
what are 3 contraindications to cochlear implant?
lesions of cranial nerve VIII or brain stem causing deafness
chronic infective otitis media, mastoid cavity or tympanic membrane perforation
cochlear aplasia
173
what are 3 congenital infections that can cause deafness?
Rubella
Cytomegalovirus
Varicella zoster
174
what are 5 features of a nasal septum haematoma?
may be due to minor trauma
sensation of nasal obstruction
Pain and rhinorrhoea
bilateral red swellings from nasal septum
feel boggy on palpation
175
what is the management of nasal septum haematoma?
surgical drainage
IV Abx
if untreated nasal septal necrosis may occur within 3-4 days resulting in saddle nose deformity
176
what are the borders of the anterior triangle of the neck?
Mandible - superior
Midline of neck - medial
sternocleidomastoid - lateral
177
what are the borders of the posterior triangle of the neck?
Clavicle - inferior
trapezius - posterior
sternocleidomastoid - lateral
178
what are 4 causes of neck lumps in young children?
cystic hygromas
dermoid cyst
haemangiomas
venous malformations
179
what are 11 causes of neck lumps?
Normal structures - boney prominence
skin abscess
lymphadenopathy
lipoma
goitre or thyroid nodule
salivary gland or infection
carotid body tumour
haematoma
thyroglossal cyst
branchial cyst
180
what are the 2ww criteria for neck lumps?
unexplained neck lump >45 years
persistent unexplained neck lump at any age
urgent US in patient with lump growing in size within 2weeks >25 years or 48h <25 years => look for soft tissue sarcoma
181
what are 4 causes of lymphadenopathy?
reactive lymph nodes due to infection
Infected lymph nodes - TB, HIV, EBV
inflammatory conditions - SLE, Sarcoidosis
Malignancy
182
what shape are lymph nodes normally?
oval with length usually >2x width
183
what can happen when amoxicillin or cephalosporins are given in infectious mononucleosis?
maculopaplar rash
184
what are 5 things that can cause goitre?
Grave's disease
toxic multinodular goitre
hashimotos
iodine deficiency
Lithium
185
what are 6 causes of individual lumps on the thyroid?
benign hyperplastic nodules
thyroid cysts
thyroid adenoma
thyroid cancer
parathyroid tumour
186
what are 3 causes of salivary gland swelling?
stones
infection
tumours
187
what are carotid body tumours?
at carotid bifurcation where glomus cells detect O2, CO2 and pH of blood
glomus cells can become excessively proliferate forming paragangliomas - most are benign
cause slow growing painless, pulsatile lump in upper anterior triangle with bruit on auscultation. Mobile side to side but not up and down
188
what nerves can carotid body tumours compress?
glossopharyngeal, vagus, acessory, hypoglossal
May cause horner's syndrome
189
what sign is seen on imaging in carotid body tumours?
splaying of internal and external carotic - lyre sign
190
what do lipomas feel like on palpation?
soft
painless
mobile
do not cause skin chanes
191
what is a thyroglossal cyst?
embryological remnant from thyroglossal duct which fills with fluid and becomes cyst
192
what do thyroglossal cysts appear like on examination?
mobile
non-tender
fluctuant
soft
in midline
move with tongue movement
193
what is the management of thyroglossal cysts?
surgical removal to precent infection
194
what is a branchial cyst?
congenital abnormality where second branchial cleft fails to form properly leaving space surrounded by epithelial. tissue in lateral neck - this fills with fluid to form a branchial cyst
195
what is the presentation of a branchial cyst?
round
soft
cystic swelling
between angle of jaw and sternocleidomastoid in anterior triangle
most common in young adulthood
