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ENT Flashcards

1
Q

Name the types of hearing loss

A

conductive
sensorineural

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2
Q

Describe conductive hearing loss

A

problem with sound travelling from the environment to the inner ear. The sensory system may be working correctly, but the sound is not reaching it.

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3
Q

Describe sensorineural hearing loss

A

problem with the sensory system or vestibulocochlear nerve in the inner ear

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4
Q

Name 3 parts of the ear

A

outer ear
middle ear
inner ear

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5
Q

name the structures of the ear

A
  • The pinna is the external portion of the ear
  • The external auditory canal is the tube into the ear
  • The tympanic membrane is the eardrum
  • The Eustachian tube connects the middle ear with the throat to equalise pressure
  • The malleus, incus and stapes are the small bones in the middle ear that connect the tympanic membrane to the structures of the inner ear
  • The semicircular canals sense head movement (the vestibular system)
  • The cochlea converts the sound vibration into a nervous signal
  • The vestibulocochlear nerve transmits nerve signals from the semicircular canals and cochlea to the brain
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6
Q

Associated sx with hearing loss

A
  • tinnitus
  • vertigo
  • pain
  • discharge
  • neurological sx
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7
Q

Causes of sensorineural hearing loss

A
  • sudden sensorineural hearing loss
  • presbycusis (age related)
  • noise exposure
  • meniere’s disease
  • labyrinthitis
  • acoustic neuroma
  • neurological conditions (stroke, MS, brain tumours)
  • infections (meningitis)
  • medications (loop diuretic, gentamicin, chemotherapy drugs)
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8
Q

Causes of conductive hearing loss

A
  • ear wax
  • infection (otitis media/externa)
  • fluid in the middle ear (effusion)
  • eustachian tube dysfunction
  • perforated tympanic membrane
  • osteosclerosis
  • cholesteatoma
  • exostoses
  • tumours
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9
Q

Describe audiogram in sensorineural hearing loss

A

both air and bone conduction readings more than 20dB below the 20dB line on the chart

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10
Q

Describe audiogram in conductive hearing loss

A

bone conduction readings will be normal but air conduction will be greater than 20dB below the 20dB line.

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11
Q

Define presbycusis

A

age related hearing loss

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12
Q

what type of hearing loss is prescbycusis

A

sensorineural - affects higher pitched first and more

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13
Q

RFs for presbycusis

A
  • age
  • male
  • FH
  • loud noise exposure
  • diabetes
  • hypertension
  • ototoxic medications
  • smoking
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14
Q

how to diagnose presbycusis

A

audiometry

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15
Q

Mx of presbycusis

A
  • optimise environment
  • hearing aids
  • cochlear implants
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16
Q

Describe sudden sensorineural hearing loss (SSNHL)

A

hearing loss <72hrs unexplained by other causes
EMERGENCY

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17
Q

Causes of SSNHL

A
  • 90% idiopathic
  • infection (meningitis, HIV, mumps)
  • meniere’s disease
  • ototoxic medications
  • MS
  • migraine
  • stroke
  • acoustic neuroma
  • Cogan’s syndrome (rare)
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18
Q

Ix for SSNHL

A

audiometry
MRI/CT head if suspecting stroke or acoustic neuroma

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19
Q

Mx SSNHL

A

immediate ENT referral within 24hrs
idiopathic- steroids (oral or intra-tympanic)
other: treat cause

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20
Q

Define eustachian tube dysfunction

A

When the tube between the middle ear and throat is not functioning properly

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21
Q

function of eustachian tube

A

equalise air pressure in the middle ear and drain fluid from the middle ear

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22
Q

What can eustachian tube dysfunction be related to?

A

viral URTI
allergies (hayfever)
smoking

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23
Q

Presentation of eustachian tube dysfunction

A
  • reduced/altering hearing
  • popping noises/sensation in ear
  • fullness sensation in ear
  • pain/discomfort
  • tinnitus
  • sx worsen when flying, climb, diving
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24
Q

Ix in eustachian tube dysfunction

A
  • otoscopy may appear normal
    If persistent
  • tympanometry
    audiometry
    nasopharyngoscopy
  • CT
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25
Q

What is tympanometry

A

put device into ear canal and test different pressures

In ETB, new air cannot get through the tympanic membrane to equalise pressures so will show peak admittance (most sound absorbed) and negative ear canal pressure

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26
Q

Mx of eustachian tube dysfunction

A
  • self-limiting
  • valsalva manoeuvre
  • decongestant nasal spray (1 week)
  • antihistamines and steroid nasal spray
  • surgery
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27
Q

Surgical mx for ETB

A
  • Treat any pathology that might be causing sx, e.g. adenoidectomy (removal of the adenoids)
  • Grommets
  • Balloon dilatation Eustachian tuboplasty
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28
Q

Define otosclerosis

A

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

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29
Q

demographic for otosclerosis

A

<40 y/o
Autosomal dominant inheritance
cause mix of genetic/environment
F>M
can be precipitated by pregnancy

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30
Q

pathophysiology of otosclerosis

A

abnormal bone formation in usually stapes causing stiffness –> prevent transmission of sound through cochlea

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31
Q

presentation of otosclerosis

A

< 40 y/o
bilateral hearing loss
tinnitus
affects lower-pitched sounds more than higher (reverse of presbycusis)
conductive loss therefore perceive voice louder than env. so talk quietly

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32
Q

Mx of otosclerosis

A

Conservative: hearing aids
Surgery: stapedectomy/sapedotomy

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33
Q

Define otitis media

A

infection of the middle ear (between tympanic membrane and inner ear)

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34
Q

Causes of otitis media

A

2/3 cases viral
1/3 bacteria (strep pneuomniae MC, but also haemophilus influenzae, staph A)

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35
Q

presentation of otits media

A
  • pain
  • reduced hearing in affected ear
  • unwell: fever
  • URTI
  • balance issues and vertigo if affects vestibular system
  • discharge if TM is perforated
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36
Q

Otoscopy in otitis media

A

bulging red inflamed TM
discharge/hole in perforation

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37
Q

Mx of otitis media

A

self-resolving 3/7-7/7
analgesia
antibiotics if systemically unwell
delayed prescription if no improvement
abx (amoxicillin, calrithromycin, erythromycin)

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38
Q

complications of otitis media

A
  • mastoiditis (rare)
  • otitis media with effusion
  • temporary hearing loss
  • perforated TM
  • labyrinthitis
  • abscess
  • facial nerve palsy
  • meningitis
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39
Q

define otitis externa

A

inflammation of the skin in the external ear canal

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40
Q

causes of otitis externa

A
  • swimming
  • trauma
  • bacterial infection (pseudomonas, staph A)
  • fungal infection (asperg., candida)
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41
Q

Presentation of otitis externa

A
  • ear pain
  • discharge
  • itching
  • conductive hearing loss
  • erythema, tenderness, pus in ear canal
  • lymphadenopathy in neck/ear
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42
Q

Mx of otitis externa

A
  • acetic acid 2%
  • topical antibiotics and steroid drops (cipro and dex)
  • can use ear (pope) wick if canal is stenosed
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43
Q

Life threatening form of otitis externa

A

malignant otitis externa
related to diabetes, HIV, chemo

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44
Q

signs of malignant otitis externa

A
  • persistent headache, severe pain and fever
  • Granulation tissue at the junction between the bone and cartilage in the ear canal

Emergency
- IV abx, CT/MRI, admission

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45
Q

complications of malignant otitis externa

A

facial nerve palsy
CN involvement
meningitis
intracranial thrombosis
death

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46
Q

signs of impacted ear wax

A
  • Conductive hearing loss
  • Discomfort in the ear
  • A feeling of fullness
  • Pain
  • Tinnitus
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47
Q

Mx of ear wax

A
  • usually nothing
  • ear drops
  • ear irrigation
  • microsuction
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48
Q

define tinnitus

A

persistent addition sound that is heard but is not present in the surrounding environment
ringing, buzzing, hissing, humming

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49
Q

causes of tinnitus

A

primary- nil
secondary
- Impacted ear wax
- Ear infection
- Ménière’s disease
- Noise exposure
- Koop diuretics, gentamicin and chemotherapy drugs
- Acoustic neuroma
- Multiple sclerosis
- Trauma
- Depression

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50
Q

systemic conditions associated with tinnitus

A
  • Anaemia
  • Diabetes
  • Hypothyroidism or hyperthyroidism
  • Hyperlipidaemia
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51
Q

objective tinnitus causes

A
  • Carotid artery stenosis (pulsatile carotid bruit)
  • Aortic stenosis (radiating pulsatile murmur sounds)
  • Arteriovenous malformations (pulsatile)
  • Eustachian tube dysfunction (popping or clicking noises)
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52
Q

Red flags for tinnitus

A
  • Unilateral tinnitus
  • Pulsatile tinnitus
  • Hyperacusis (hypersensitivity, pain or distress with environmental sounds)
  • Unilateral hearing loss
  • Sudden onset hearing loss
  • Vertigo or dizziness
  • Headaches or visual symptoms
  • Neurological symptoms or signs (e.g., facial nerve palsy or signs of stroke)
  • Suicidal ideation related to the tinnitus
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53
Q

Mx of tinnitus

A
  • self limiting
  • hearing aids
  • sound therapy
  • CBT
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54
Q

define vertigo

A

movement between the patient and their environment

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55
Q

what is vertigo associated with

A

nausea, vomiting, sweating and feeling generally unwell

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56
Q

causes of vertigo

A

peripheral: vestibular system
central: brainstem/cerebellum

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57
Q

peripheral (vestibular) causes of vertigo

A

Benign paroxysmal positional vertigo
Ménière’s disease
Vestibular neuronitis
Labyrinthitis

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58
Q

what is BPPV

A

crystals of calcium carbonate called otoconia that become displaced into the semicircular canals
Often symptoms occur over several weeks and then resolve, then can reoccur weeks or months later.

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59
Q

Test to diagnose BPPV

A

Dix-Hallpike manoeuvre
(also see rotary nystagmus)

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60
Q

Mx of BPPV

A

Epley manoeuvre

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61
Q

what is ménière’s disease

A

excessive buildup of endolymph in the semicircular canals causing a higher pressure than normal, disrupting sensory signals

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62
Q

sx of meniere’s

A

attacks (couple of hours) of triad:
1. hearing loss
2. tinnitus
3. unilateral vertigo and a sensation of fullness in the ear

  • 40-50
  • not associated with movement
  • spontaneous unidirectional nystagmus
  • gradual deterioration in hearing
  • unexplained falls without LOC
  • imbalance after vertigo resolves
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63
Q

what is acute vestibular neuronitis

A

inflammation of the vestibular nerve

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64
Q

sx of acute vestibular neuronitis

A
  • due to viral infection
  • acute onset of vertigo that improves within a few weeks
  • nausea and vomiting
  • balance problems
  • eyes will saccade (horizontal nystagmus)
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65
Q

what is Labyrinthitis

A

inflammation of the structures of the inner ear

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66
Q

sx of labyrinthitis

A
  • attributed to a viral infection
  • acute onset of vertigo that improves within a few weeks.
  • Labyrinthitis can cause hearing loss, which distinguishes it from vestibular neuronitis
  • tinnitus
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67
Q

causes of central cause of vertigo

A
  • Posterior circulation infarction (stroke)
  • Tumour
  • Multiple sclerosis
  • Vestibular migraine
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68
Q

what is posterior circulation infarction

A

sudden onset and may be associated with other symptoms, such as ataxia, diplopia, cranial nerve defects or limb symptoms

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69
Q

symptoms of vestibular migraine

A

sx lasting minutes to hours
associated with aura and headache
attacks triggered by:
- Stress
- Bright lights
- Strong smells
- Certain foods (e.g. chocolate, cheese and caffeine)
- Dehydration
- Menstruation
- Abnormal sleep patterns

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70
Q

ways to differentiate causes of vertigo

A
  • Recent viral illness (labyrinthitis or vestibular neuronitis)
  • Headache (vestibular migraine, cerebrovascular accident or brain tumour)
  • Typical triggers (vestibular migraine)
  • Ear symptoms, such as pain or discharge (infection)
  • Acute onset neurological symptoms (stroke)
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71
Q

what do you need to rule out with vertigo

A

stroke

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72
Q

Mx of central vertigo

A

Imaging (CT/MRI)

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73
Q

Mx peripheral vertigo

A
  • prochlorperazine for 3 days
  • antihistamines
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74
Q

Mx of Meniere’s

A

Acute:
- Prochlorperazine
- Antihistamines

Prophylaxis
betahistine

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75
Q

Mx of vestibular neuronitis and labyrinthitis

A
  • Prochlorperazine (3 days)
  • Antihistamines (e.g., cyclizine, cinnarizine and promethazine)
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76
Q

What can develop after vestibular neuronitis

A

BPPV

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77
Q

what is the bony labyrinth made up of?

A

inner ear ( semicircular canals, vestibule)
cochlea

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78
Q

Complication of meningitis

A

hearing loss

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79
Q

what is an acoustic neuroma

A

benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear

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80
Q

what are acoustic neuromas also called

A

vestibular schwannoma

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81
Q

where do acoustic neuromas occur?

A

cerebellopontine angle

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82
Q

what does Bilateral acoustic neuromas indicate?

A

neurofibromatosis type II

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83
Q

presentation of acoustic neuroma

A

40-60 y/o
gradual onset of:
- Unilateral sensorineural hearing loss (often the first symptom)
- Unilateral tinnitus
- Vertigo
- A sensation of fullness in the ear
- can also be assoc w FN palsy
- absent corneal reflex

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84
Q

how to diagnose acoustic neuroma

A

MRI/CT

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85
Q

Mx of acoustic neuroma

A
  • Conservative: monitor if no sx or treatment inappropriate
  • Surgery: partial or total removal
  • Radiotherapy: reduce growth
86
Q

Complications of treatment of acoustic neuroma

A
  • Vestibulocochlear nerve injury, with permanent hearing loss or dizziness
  • Facial nerve injury, with facial weakness
87
Q

define cholesteatoma

A

benign collection of skin (squamous eip cells) in middle ear

88
Q

Presentation of cholesteatoma

A
  • FOUL discharge from the ear
  • Unilateral conductive hearing loss
89
Q

Ix for cholesteatoma

A

CT head
MRI

90
Q

Branches of the facia nerve

A
  • temporal
  • zygomatic
  • Buccal
  • Marginal
  • mandibular
  • Cervical
91
Q

Function of the facial nerve

A

Motor: muscles of facial expression, the stapedius in the inner ear and the posterior digastric, stylohyoid and platysma muscles in the neck.

Sensory: taste from the anterior 2/3 of the tongue.

Parasympathetic supply to the:
Submandibular and sublingual salivary glands
Lacrimal gland (stimulating tear production)

92
Q

UMN v LMN lesion

A

UMN= forehead sparing

93
Q

Where do unilateral upper motor neurone lesions occur?

A
  • Cerebrovascular accidents (strokes)
  • Tumours
94
Q

Where do bilateral upper motor neurone lesions occur? (rare)

A
  • Pseudobulbar palsies
  • Motor neurone disease
95
Q

What is Bell’s Palsy?

A
  • idiopathic
  • unilateral lower motor neurone facial nerve palsy
96
Q

how long to recover from Bell’s palsy

A
  • majority of patients fully recover over several weeks, but recovery may take up to 12 months.
  • A third are left with some residual weakness
97
Q

mx of Bell’s Palsy

A

Present within 72 hours = prednisolone
50mg for 10 days
OR
60mg for 5 days followed by a 5-day reducing regime of 10mg a day
- lubricating eye drops and tape to prevent corneal ulceration

98
Q

what is Ramsay-Hunt Syndrome

A
  • varicella zoster virus (VZV)
  • unilateral lower motor neurone facial nerve palsy
  • painful and tender vesicular rash in the ear canal, pinna and around the ear on the affected side. ca extend to anterior two-thirds of the tongue and hard palate
99
Q

Mx of Ramsay Hunt syndrome

A

Initiate within 72 hours.
- Prednisolone
- Aciclovir
- lubricating eye drops

100
Q

Other causes of LMN facial nerve palsy

A

Infection:
- Otitis media/ Malignant otitis externa
- HIV & Lyme’s disease

Systemic disease:
- Diabetes
- Sarcoidosis
- Leukaemia
- MS & GBS

Tumours:
- Acoustic neuroma
- Parotid tumours
- Cholesteatomas

Trauma:
- Direct nerve trauma
- Base of skull fractures

101
Q

Where does epistaxis originate?

A

Kiesselbach’s plexus, located in Little’s area

102
Q

Causes of epistaxis

A
  • Nose picking
  • Colds & Sinusitis
  • Trauma
  • Changes in the weather
  • Coagulation disorders (thrombocytopenia or VWD)
  • Anticoagulant medication (aspirin, DOACs, warfarin)
  • Snorting cocaine
  • Tumours (e.g., squamous cell carcinoma)
  • nasal cannulae
103
Q

Bleeding pattern in epistaxis

A

usually unilateral. Bleeding from both nostrils may indicate bleeding posteriorly in the nose

104
Q

Mx of epistaxis

A
  • self-resolve
  • pinch end of nose
  • cauterise with silver nitrate sticks
  • pack with tampon/inflatable pack
  • naseptin cream post blood QDS 10 days
105
Q

what is sinusitis

A

inflammation of the paranasal sinuses in the face

106
Q

what is rhinosinusitis

A

inflammation of the nasal cavity

107
Q

name the paranasal sinuses

A
  • Frontal sinuses
  • Maxillary sinuses
  • Ethmoid sinuses
  • Sphenoid sinuses
108
Q

Causes of sinusitis

A
  • Infection: viral URTI
  • Allergies
  • Foreign body
  • Trauma or polyps
  • Smoking
109
Q

who is more likely ot suffer from sinusitis

A

asthma pts

110
Q

Presentation of sinusitis

A
  • Nasal congestion
  • Nasal discharge
  • Facial pain/headache
  • Facial pressure
  • Facial swelling over the affected areas
  • Loss of smell
  • worse leaning forward
111
Q

Ix for sinusitis

A
  • nil
  • persistent= nasal endoscopy and CT
112
Q

Mx acute sinusitis

A
  • systemic= admission
  • after 10 days can give steroid nasal spray and delayed antibiotic prescriptoin
113
Q

Mx chronic sinusitis

A
  • Saline nasal irrigation
  • Steroid nasal sprays or drops (e.g., mometasone or fluticasone)
  • Functional endoscopic sinus surgery (FESS)
114
Q

Define nasal polyp

A

growths of the nasal mucosa that can occur in the nasal cavity or sinuses
assoc w inflammation

115
Q

presentation of nasal polyps

A
  • bilateral
  • snoring
  • chronic rhinosinusitis
  • discharge
  • anosmia
  • difficulty breathing through the nose
  • pale grey/yellow growths
116
Q

red flags for nasal polyps

A

unilateral

117
Q

associations of nasal polyps

A
  • Chronic rhinitis or sinusitis
  • Asthma
  • Samter’s triad (nasal polyps, asthma and aspirin intolerance/allergy)
  • Cystic fibrosis
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
118
Q

Mx of nasal polyps

A
  • intranasal topical steroid drops or spray

Surgical if medical fails:
- Intranasal polypectomy
- Endoscopic nasal polypectomy

119
Q

Define OSA

A
  • collapse of the pharyngeal airway
  • episodes of apnoea
120
Q

RFs for OSA

A
  • Middle age
  • Male
  • Obesity
  • Alcohol
  • Smoking
121
Q

Presentation of OSA

A
  • Episodes of apnoea during sleep
  • Snoring
  • Morning headache
  • Waking up unrefreshed from sleep
  • Daytime sleepiness
  • Concentration problems
  • Reduced oxygen saturation during sleep
122
Q

how to assess OSA

A

Epworth Sleepiness Scale

123
Q

Mx of OSA

A
  • refer to ENT specialist or sleep clinic for sleep studies
  • CPAP
  • Surgery: uvulopalatopharyngoplasty (UPPP
124
Q

Define tonsillitis

A

inflammation of the tonsils

125
Q

causes of tonsillitis

A
  • most common= viral
    bacterial:
  • group A streptococcus (MC)
  • streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Staph aureus
126
Q

which tonsils are usually affected in tonsillitis

A

palatine tonsils

127
Q

presentation of tonsillitis

A
  • Sore throat
  • Fever (above 38°C)
  • Pain on swallowing
  • red. enlarged tonsils
  • +/- exudate
  • cervical lymphadenopathy
  • NO COUGH
128
Q

how to diagnose tonsillitis

A

Centor or FeverPAIN score

129
Q

Mx of tonsillitis

A
  • viral: nothing
  • prescribe abx of Centor= 3 or above or FeverPAIN= 4 or more
  • admit if very unwell
130
Q

Abx for tonsillitis

A

Penicillin V for 10 days
Clarithromycin if allergy

131
Q

Complications of tonsillitis

A
  • Peritonsillar abscess (quinsy)
  • Otitis media
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Post-streptococcal reactive arthritis
132
Q

Define Quinsy

A

Peritonsillar abscess arises when there is a bacterial infection with trapped pus, forming an abscess in the region of the tonsils

133
Q

Presentation of Quinsy

A

similar sx to tonsillitis
- Sore throat
- Painful swallowing
- Fever
- Neck pain
- Referred ear pain
- Swollen tender lymph nodes

134
Q

Triad for Quinsy

A
  • trismus (unable to open their mouth more than 3 fingers)
  • hot potato voice
  • swelling and erythema behind tonsils
135
Q

Uvula in quinsy

A

deviated away fro abscess

136
Q

causes of quinsy

A

bacterial (streptococcus pyogenes)

can also be staph A and haemophilus influenzae

137
Q

ho does quinsy form

A

tonsillitis –>peritonsillar cellulitis –> quinsy

138
Q

Mx of quinsy

A
  • needle aspiration/surgical incision and drainage
  • Abx before and after (co-amoxiclav)
139
Q

indication for tonsillectomy

A

No. of times pt has had tonsillitis:
- 7 or more in 1 year
- 5 per year for 2 years
- 3 per year for 3 years

  • recurrent tonsillar abscesses (2)
  • airway obstruction
140
Q

complications of tonsillectomy

A
  • Sore throat where the tonsillar tissue has been removed (this can last 2 weeks)
  • Damage to teeth
  • Infection
  • Post-tonsillectomy bleeding
  • Risks associated with a general anaesthetic
141
Q

Mx of post-tonsillectomy bleeding

A
  • ENT registrar
  • V access and send bloods including an FBC, clotting screen, group and save and crossmatch
  • sit up
  • nil by mouth
  • IV fluids
  • hydrogen peroxide gargle
  • adrenalin soaked swab
142
Q

Risk of post-tonsillectomy bleed

A

aspiration, can be life threatening

143
Q

Borders of anterior triangle of the neck

A
  • Mandible (superior border)
    Midline of the neck (medial border)
    Sternocleidomastoid (lateral border)
144
Q

Borders of the posterior triangle of the neck

A
  • Clavicle (inferior border)
    Trapezius (posterior border)
    Sternocleidomastoid (lateral border)
145
Q

DDx of neck lumps in adults

A
  • Normal structures (e.g., bony prominence)
  • Skin abscess
  • Lymphadenopathy
  • Tumour (e.g., squamous cell carcinoma or sarcoma)
  • Lipoma
  • Goitre or thyroid nodules
  • Salivary gland stones or infection
  • Carotid body tumour
  • Haematoma
  • Thyroglossal cysts
  • Branchial cysts
146
Q

DDx of neck lumps in children

A
  • Cystic hygromas
  • Dermoid cysts
  • Haemangiomas
  • Venous malformation
147
Q

Neck lump red flags

A
  • An unexplained neck lump in someone aged 45 or above
  • A persistent unexplained neck lump at any age
  • Need urgent USS
148
Q

Cause of infectious mononucleosis

A

EBV

149
Q

presentation of infectious mononucleosis

A

Fever
Sore throat
Fatigue
Lymphadenopathy
Itchy maculopapular rash

150
Q

Mx of infectious mononucleosis

A

supporive
avoid alcohol and contact sports

151
Q

Staging for lymphoma

A

Ann Arbor staging

152
Q

Histology in Hodgkin’s lymphoma

A

reed-sternberg cells

153
Q

locations of the salivary glands

A
  • Parotid glands
  • Submandibular glands
  • Sublingual glands
154
Q

what is a branchial cyst

A

congenital abnormality that arises when the second branchial cleft fails to form properly during fetal development

155
Q

Presentation of branchial cyst

A

round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck.

156
Q

Mx of branchial cyst

A

Conservative
Surgical excision if recurrent infections

157
Q

Most common type of head and neck cancer

A

squamous cell carcinoma

158
Q

potential areas for H&N cancer

A
  • Nasal cavity
  • Paranasal sinuses
  • Mouth
  • Salivary glands
  • Pharynx (throat)
  • Larynx (epiglottis, supraglottis, vocal cords, glottis and subglottis)
159
Q

RFs for H&N cancer

A
  • Smoking
  • Chewing tobacco
  • Chewing betel quid (paan)
  • Alcohol
  • HPV 16
  • Epstein–Barr virus
160
Q

Red lags of H&N cancer

A
  • Lump in the mouth or on the lip
  • Unexplained ulceration in the mouth lasting more than 3 weeks
  • Erythroplakia or erythroleukoplakia
  • Persistent neck lump
  • Unexplained hoarseness of voice
  • Unexplained thyroid lump
161
Q

Monoclonal antibody to treat squamous cell carcinoma

A

Cetuximab

162
Q

Define glottitis

A

inflamed tongue

163
Q

Presentation of glottitis

A
  • red, sore and swollen tongue
  • The papillae of the tongue atrophy, giving the tongue a smooth appearance. - It is sometimes described as “beefy”
164
Q

Causes of glottitis

A
  • Iron deficiency anaemia
  • B12 deficiency
  • Folate deficiency
  • Coeliac disease
  • Injury or irritant exposure
165
Q

define angioedema

A

fluid accumulating in the tissues, resulting in swelling

166
Q

causes of angioedema

A
  • Allergic reactions
  • ACE inhibitors
  • C1 esterase inhibitor deficiency (hereditary angioedema)
167
Q

define oral candidiasis

A

oral thrush
overgrowth of candida

168
Q

RFs for candidiasis

A
  • Inhaled corticosteroids
  • Antibiotics (disrupt the normal bacterial flora giving candida a chance to thrive)
  • Diabetes
  • Immunodeficiency (consider HIV)
  • Smoking
169
Q

Mx of candidiasis

A
  • Miconazole gel
  • Nystatin suspension
  • Fluconazole tablets (in severe or recurrent cases)
170
Q

Define geographic tongue

A

inflammatory condition where patches of the tongue’s surface lose the epithelium and papillae. The patches form irregular shapes on the tongue, resembling a map, with countries and oceans bordering each other

171
Q

causes of geographic tongue

A

unknown
could be related to:
- Stress and mental illness
- Psoriasis
- Atopy (asthma, hayfever and eczema)
- Diabetes

172
Q

Define strawberry tongue

A

ongue becomes swollen and red, and the papillae become enlarged, white and prominent.

173
Q

Causes of strawberry tongue

A
  • Scarlet fever
  • Kawasaki disease
174
Q

define black hairy tongue

A

decreased shedding (exfoliation) of keratin from the tongue’s surface.
bacteria and food cause dark pigmentation

175
Q

Causes of black hairy tongue

A

dehydration, a dry mouth, poor oral hygiene and smoking.

176
Q

Mx of black hairy tongue

A

adequate hydration, gentle brushing of the tongue and stopping smoking

177
Q

Define leukoplakia

A

white patches in the mouth, often on the tongue or insides of the cheeks (buccal mucosa)
precancerous

178
Q

Presentation of leukoplakia

A

patches are asymptomatic, irregular and slightly raised. They are fixed in place, meaning they cannot be scraped off.
need biopsy

179
Q

Mx of leukoplakia

A

stopping smoking, reducing alcohol intake, close monitoring and potentially laser removal or surgical excision

180
Q

define erythroplakia

A
  • similar to leukoplakia
  • lesions that are a mixture of red and white
  • Both erythroplakia and erythroleukoplakia are associated with a high risk of squamous cell carcinoma and should be referred urgently to exclude cancer.
181
Q

Define lichen planus

A

autoimmune condition that causes localised chronic inflammation of the skin

182
Q

Presentation of lichen planus

A
  • skin has shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.
  • > 45 y/o
  • F>M
183
Q

Mx of lichen planus

A

good oral hygiene, stop smoking and topical steroids

184
Q

define gingivitis

A

inflammation of the gums

185
Q

Presentation of gingivitis

A
  • swollen gums
  • bleeding after brushing
  • painful gums
  • bad breath (halitosis)
  • Gingivitis can lead to periodontitis if not adequately managed.
186
Q

What is peridontitis

A

severe and chronic inflammation of the gums and the tissues that support the teeth. This often leads to loss of teeth.

187
Q

RFs for gingivitis

A
  • Plaque build-up on the teeth (inadequate brushing)
  • Smoking
  • Diabetes
  • Malnutrition
  • Stress
188
Q

Mx for gingivitis

A
  • Good oral hygiene
  • Stopping smoking
  • Remove plaque and tartar
  • Chlorhexidine mouth wash
  • Antibiotics for acute necrotising ulcerative gingivitis (e.g., metronidazole)
  • Dental surgery if required
189
Q

What is gingival hyperplasia

A

abnormal growth of the gums

190
Q

causes of gingival hyperplasia

A
  • Gingivitis
  • Pregnancy
  • Scurvy
  • Acute myeloid leukaemia
  • Medications, particularly calcium channel blockers, phenytoin and ciclosporin
191
Q

What are aphthous ulcers

A
  • very common, small, painful ulcers of the mucosa in the mouth
  • well-circumscribed, punched-out, white appearance.
192
Q

causes of aphthous ulcers

A
  • stress
  • trauma
  • food
  • IBD
  • Coeliac disease
  • Behçet disease
  • Vitamin deficiency (e.g., iron, B12, folate and vitamin D)
  • HIV
193
Q

Mx of aphthous ulcers

A
  • self-limiting for 2 weeks

Topical treatments:
- Bonjela
- Benzydamine
- lidocaine

Topical steroids
- Hydrocortisone buccal tablets applied to the lesion
- Betamethasone soluble tablets applied to the lesion
- Beclomethasone inhaler sprayed directly onto the lesion

194
Q

are most parotid tumours benign or malignant?

A

80% benign

195
Q

name benign tumours of the parotid glands?

A
  • Benign pleomorphic adenoma or benign mixed tumour
  • Warthin tumor (papillary cystadenoma lymphoma or adenolymphoma)
  • Monomorphic adenoma
  • haemangioma
196
Q

name malignant tumours of the parotids

A
  • Mucoepidermoid carcinoma
  • Adenoid cystic carcinoma
  • Mixed tumours
  • Acinic cell carcinoma
  • Adenocarcinoma
  • Lymphoma
197
Q

what is Benign pleomorphic adenoma or benign mixed tumour?

A
  • Most common parotid neoplasm (80%)
  • Proliferation of epithelial and myoepithelial cells of the ducts and an increase in stromal components
  • Slow growing, lobular, not well encapsulated
    Recurrence rate of 1-5% with parotidectomy
    Mx- routine surgical excision
198
Q

what is Warthin tumour?

A
  • Second most common benign parotid tumour (5%)
  • strongly associated with smoking
  • Most common bilateral benign neoplasm of the parotid
  • M > F
  • Occurs later in life (6th-7th decades)
  • lymphocytic infiltrate and cystic epithelial proliferation
  • Malignant transformation rare
199
Q

what is Monomorphic adenoma?

A
  • < 5% of tumours
  • Slow growing
  • only one cell type
  • Include; basal cell adenoma, canalicular adenoma, oncocytoma, myoepitheliomas
200
Q

what is haemangioma?

A
  • 90% of parotid tumours in children <1 y/o
  • Hypervascular on imaging
  • Spontaneous regression may occur and malignant transformation rare
201
Q

what is Mucoepidermoid carcinoma

A
  • 30% of all parotid malignancies
  • low potential for local invasiveness and metastasis
202
Q

what is Adenoid cystic carcinoma

A
  • Unpredictable growth pattern
  • Tendency for perineural spread
  • May have skip lesions resulting in incomplete excision
  • Distant metastasis more common (visceral rather than nodal spread)
  • 5 year survival 35%
203
Q

what is mixed tumours?

A
  • Often a malignancy occurring in a previously benign parotid lesion
204
Q

what is Acinic cell carcinoma

A
  • Intermediate grade malignancy
  • May show perineural invasion
  • Low potential for distant metastasis
  • 5 year survival 80%
205
Q

what is adenocarcinoma?

A
  • Develops from secretory portion of gland
  • Risk of regional nodal and distant metastasis
206
Q

what is lymphoma?

A
  • Large rubbery lesion, may occur in association with Warthins tumours
  • Diagnosis should be based on regional nodal biopsy rather than parotid resection
  • Mx is chemotherapy (+radiotherapy)
207
Q

Sensitivity to what medication is assoc with nasal polyps?

A

aspirin

208
Q

what is Samter’s triad

A
  • asthma
  • aspirin sensitivity
  • nasal polyps
209
Q

what is sialadenitis

A

inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct.

210
Q

presentation of sialadenitis?

A
  • foul taste in mouth
  • usually submandibular mass
211
Q

Mx of meniere’s

A

acute- prochlorperazine
prevention- betahistine and vestibular rehabilitation

Finals (10 decks)

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