ENT 2 Flashcards
1
Q
GO REVISE SEM 3: HEAD & NECK ANATOMY OF MOUTH & NOSE
A
2
Q
Label the following structures on the diagram:
- Nares
- Septum (body & cartilaginous)
A
3
Q
Label the following structures on the diagram:
- Superior, middle & inferior conchae/turbinates
- Sinuses (frontal, maxillary, sphenoid, ethomoid)
- Hard & soft palate
- Post-nasal space/nasopharynx
- Cribriform plate
- Opening of Eustachain tube
A
4
Q
Where is Little’s/Keisselbach’s area?
Why is it clinically relevant?
A
Anastomoses of 5 arteries- common site of bleeding for anterior nasal bleeds
5
Q
Label the following on the diagram:
- Anterior & posterior pillars
- Tonsils
- Uvula
- Posterior pharyngeal wall
A
6
Q
Label the following on the diagram:
- Parotid salivary galnds
- Submandibular salivary glands
- Sublingual salivary gland
- SCM
- Hyoid bone
*
A
7
Q
Label the following on the diagram:
- Cricoid cartilage
- Thyroid cartilage
- Thyroid gland
- Parathyroid galnds
A
8
Q
Discuss how you would examine the nose
A
- Inspect external nose: inspect for skin changes, deformity
- Nasal cavity inspection: ask pt to look forward keeping their head in neutral position, elevate tip of nose with thumb so that nasal cavity becomes visible and use a light to illuminate cavity. Inspect muscosa and septum
- Further inspection of internal nose: use otoscope with large speculum attached or nasal speculum with a light to look further into nose. Assess nasal vestibule for inflammation, ucleration, oedea. Inspect nasal septum for polyps, deviation, perforation, haematoma. Inspect inferior turubinates for any asymmetry, inflammation or polyps.
- Palpate nasal bone & cartilage: palpate nasal bones assessing for alignment, tenderness, irregularity. Palpate nasal cartilage assessing for alignment and tenderness. Palpate infraorbital ridges and assess eye movement if there is history of orbital blow out fracture.
- Assess air flow of both nostrils:either feel for air with your finger or use metal prong and look for misting as pt breathes out
** SEE GEEKY MEDICS FOR FULL
9
Q
Discuss how you would examine the throat/oral cavity
A
- General inspection: inspect face for any swelling e.g. parotid, submandibular
- Closer inspection: ask pt to open mouth and use light source to illuminate. Inspect lips for angular stomatitis, hyperpigmentated macules, ulceration. Inspect teeth for any missing teeth, decay, nicotine staining. Inspect gums for gingivitis, periodonitis, ulceration. Inspect tongue for oral candidiasis, glossitis, ulceration, hairy leukoplakia. Inspect buccal mucosa for apthous ulcers or other ulcers, parotid duct. Inspect palate and uvula for candiadiasis, ulceration, papillomas. Inspect tonsils enlargement, asymmetry, ulceration, stones. Inspect pharyngeal arches. Inspect uvula for deviation. Ask pt to life tongue and insepct floor of mouth for further ulceration & salivary gland pathology.
- Palpation: palpate any lumps, the paraotid gland, sublingual and submandibular gland. Note size, thickness, colour, consistency & tenderness of any lumps.
**SEE GEEKY MEDICS FOR FULL
10
Q
Discuss how you would examine the neck
A
- General inspection: scars, cachexia, hoarse voice, dyspnoea or stridor, behaviour, clothing, exophthalmos
- Inspect neck lump from front and side noting its location
- If lump is in midline, do some further tests: ask pt to swallow, ask pt to protrude tongue
- Palpate neck lump: assess for size, shape, consistency, mobility, flucutance, temperature, overling skin changes, pulsatility, tenderness, transillumination, vascular bruit
- Assess lymph nodes: palpate all cervical lymph nodes noting size, shape, consistency, tenderness, mobility, overlying skin changes
- Palpate thyroid: stand behind pt, ask to tilt chin slightly down, place 3 middle fingers of each hand along midline below chin. Start at thyroid cartilage, move down to cricoid cartilage, then move down to first 2 rings of trachea to find isthmus. Palpate isthmus then move out laterally to palpate lobes. Ask pt to swallow and feel for symmetrical elevation of thyroid gland. Ask pt to stick out their tongue. Note size, symmetry, consistency, any massess of thyroid, any thrills. Listen for thyroid bruits
11
Q
What 3 sensory inputs aid the balance system?
A
- Vision
- Proprioception
- Vestibular system
These sensory inputs are processed by brain and the efferent pathways then act on extra-occular muscles to adjust eye position and limb & trunk muscles to maintain body position.
12
Q
Define vertigo
A
Feels like you, or everything around you, is spining
13
Q
Define syncope
Define pre-syncope
A
- Syncope, also known as fainting, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery
- Pre-syncope: sensation that you are going to faint/syncope
14
Q
Define nystagmus
Explain what is meant by the slow phase and fast phase of jerk nystagmus
A
- Nystagmus= involuntary eye movements
- Jerk nystagmus is a rhythmic eye oscillation characterized by a slow drift of the eyes in one direction that is repeatedly corrected by fast movements in the reverse direction. Slow phase is when eyes drift in one direction, fast phase is fast movement of eyes to correct the slow drift. We refer to nystagmus by describing the direction of the fast phase
15
Q
For acute sinusitis, discuss:
- What it is
- Causes
- Symptoms & signs
A
- Sinusitis= symptomatic inflammation of paranasal sinuses
- Usually triggered by viral upper respiratory tract infection however can also be bacterial sinusitis
- Signs & symptoms:
- Nasal blockage or discharge
- Facial pain/pressure/headahce
- Reduction in sense of smell (adults)
- Cough (child)
- Nasal inflmmation
- Mucosal oedema
- Mucopurulent nasal discharge
16
Q
Discuss how to differentiate between viral and bacterial sinusitis/when so to suspect bacterial sinusitis
A
Suspect acute bacterial sinusitis when symptoms:
- Last longer than 10 days
- Include discoloured or prurulent nasal discharge
- Severe local pain
- Fever greater than 38 degrees celcius
- Deterioration after an initial mild illness
17
Q
State the ‘time frames’ for acute and chronic sinusitis
A
- Acute <12 weeks
- Chronic >12 weeks
18
Q
Discuss the management of acute sinusitis in primary care
A
Usually self-limiting therefore:
- Advice that will get better on its own (2-3 weeks)
- Analgesia for fever or pain
- Consider need for antibiotics if suspect bacterial- phenoxymethylpenicillin or doxycycline if penicillin allergic. If symptoms still worsening can try co-amoxiclav
- Consider high dose intranasal corticosteroids in adults with severe or more prolonged symptoms (>10 days)
- Safety net: if symptosm worsen rapidly or significantly or become systemcially unwell seek medical attention
19
Q
Discuss the management of chronic sinusitis
A
- Advise that chronic sinusitis may last several months
- Control any associated conditions e.g. allergic rhinitis, asthma
- Other advise:
- Avoid allergic triggers
- Stop smoking
- Good dental hygience (reduce risk of dental infection- which is associated with chronic sinusitis)
- Consider nasal irrigation
- Consider course of intranasal steroids e.g. mometasone, fluticasone for 3 months (particularly if allergic cause)
- Consider need for long-term antibiotics; only start after consultation with specialist
20
Q
When would arrange urgent hospital admission for someone with sinusitis?
A
- Severe systemic infection
- Complications developed e.g. orbital or intracranial involvement
21
Q
State some predisposing factors for sinusitis
A
- Asthma
- Allergic rhinitis
- Smoking
- Anatomical variations e.g. deviated nasal septum, nasal polyps, trauma, foreign body
- Impaired ciliary motility e.g. cystic fibrosis
- Immunocompromised
22
Q
Discuss how thyroid nodules may present
A
Usually asymptomatic hoever if nodules become large enough patient may present with:
- Visible swelling
- SOB (compression of trachea)
- Dysphagia (compression of oesophagus)
If nodules are producing thyroxine may present with features of hyperthyroidism e.g:
- Unexplained weight loss
- Tremor
- Sweating
- Diarrhoea
- Tachycardia/palpitations
- Oligo- or amenorrhoea
- Loss of libido
23
Q
What investigations would you do if you suspect thyroid nodule (in a patient that doesn’t need urgent referral)?
A
- TFTs
- Referral to endocrinology for further investigations e.g. USS, needle aspiration biopsy
24
Q
When would you arrange emergency admission to hospital for thyroid lump?
When you would arrange urgent referral to specialist for a thyroid lump?
A
- Emergency hospital admission= airway obstruction
- Urgent referral to specialist (within 2 weeks):
- An unexplained thyroid lump.
- A thyroid mass associated with unexplained hoarseness or voice change.
- A thyroid mass associated with cervical lymphadenopathy or supraclavicular lymphadenopathy.
- Sudden onset of a rapidly expanding painless thyroid mass, significantly increasing in size over days and weeks.
- A suspected thyroid nodule with other red flags or risk factors for malignancy.
- Child
34
Q
What is benign paroxysmal positional vertigo (BPPV)?
Discuss the pathophysiology of BPPV
A
- Disorder of the inner ear characterized by repeated episodes of positional vertigo that lasts a few seconds and is often triggerd by head movement or bending down
- Otoconia are biocrystals present in the utricle and saccule of vestibular apparatus. They are located above stereocilia and kinocilia (hair cells that detect movement) and are displaced in response to movement; this causes depolarisation of hair cells and is perceived as movement. When these otoconia get into the semi-circular canals- most commonly the posterior canal- the detached otoconial debris, in addition to the endolymph, may continue to stimulate hair cells even after head movements have ceased. This leads to an abnormal sensation of vertigo and nystagmus when the head moves in the plane of the affected semi-circular canal. Process called canalolithiasis.
39
Q
Discuss how to diagnose BPPV
A
Dix-Hallpike manoeuvre
- Get patient to sit facing forwards, stand at side of them
- Turn their head 45 degrees towards you and observe eyes for 30 seconds
- Lie them down so that head is extended 20-30 degrees and observe eyes for up to 1 minute to see if nystagmus is present
- Do this on both sides
41
Q
Describe the Epley manoeuvre
A
- Turn head 45 degrees towards affected side
- Lie pt down and extend by 20-30 degrees
- After 30-60secs turn head to other side and hold for same amount of time
- Turn pt onto side and turn head 45 degrees from horizontal
- Have patient sit up
*Trying to manipulate crystal to move towards canal opening
54
Q
For tonsillitis, discuss:
- What it is
- Common causes
- Who is it common in
- Symptoms & signs
A
- Inflammation of tonsils
- Most commonly caused by viral infection but can be caused by bacteria. Most common causative bacteria is group A Streptococcus (Streptococus pyogenes). Second most common bacterial cause= Streptococcus pneumoniae.
- Children aged 5-10yrs, then another peak aged 15-20yrs
- Symptoms & signs:
- Sore throat
- Painful swallowing
- Fever
- Headache
- Red, inflamed & enlarged tonsils
- May see exudate on tonsils
- Note: younger children may present with vague symptoms
