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x 2nd Year Medicine > ENT > Flashcards

ENT Flashcards

1
Q

What are pharyngeal arches?

A

embryonic structures that contribute to much of the face and neck

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2
Q

At what day does arch 1 develop?

A

22

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3
Q

At what day do arches 2+3 develop?

A

24

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4
Q

At what day do arches 4+6 develop?

A

29

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5
Q

What does each arch consist of?

A

Core of mesenchyme
Neural crest cells
Cranial nerve component
Artery (aortic arches)

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6
Q

What externally separates the arches?

A

Deep pharyngeal clefts with an ectodermal lining

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7
Q

What internally separates the arches?

A

Pharyngeal pouches with an endodermal lining

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8
Q

What nerve supplies arch I?

A

Trigeminal (maxillary and mandibular divisions)

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9
Q

What nerve supplies arch II?

A

Facial

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10
Q

What nerve supplies arch III?

A

Glossopharyngeal

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11
Q

What nerve supplies arch IV?

A

Vagus - superior laryngeal branch

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12
Q

What nerve supplies arch VI?

A

Vagus - recurrent laryngeal branch

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13
Q

What skeletal components arise from the 1st arch?

A 
Maxilla
zygomatic process
part of the temporal bone
Incus
Malleus
Mandible
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14
Q

What muscles and nerves arise from the 1st arch?

A 
Muscles of mastication
anterior belly of digastric
mylohyoid
tensor tympani
tensor palatini
Sensory supply to skin on face - trigeminal nerve
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15
Q

What skeletal components arise from the 2nd arch?

A

Stapes
Styloid process
Stylohyoid ligament
Lesser horn and upper part of hyoid

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16
Q

What muscles and nerves arise from the 2nd arch?

A 
Muscles of facial expression
stapedius
stylohyoid
posterior belly of digastric
auricular muscles
All supplied by the facial nerve
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17
Q

What structures arise from the 3rd arch?

A

Greater horn and lower part of hyoid
stylopharyngeus muscle
glossopharyngeal nerve

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18
Q

What structures arise from the 4th arch

A

cricothyroid
levator palatini
pharyngeal constrictors

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19
Q

What structures arise from the 6th arch?

A

intrinsic laryngeal muscle

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20
Q

What structures arise from the 1st pouch?

A

middle ear
eustachian tube
tympanic membrane

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21
Q

What structures arise from the 2nd pouch?

A

palatine tonsil

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22
Q

What structures arise from the 3rd pouch?

A

inferior parathyroid gland

thymus

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23
Q

What structures arise from the 4th pouch?

A 
superior parathyroid gland
ultimobranchial body (C cells of thyroid gland)
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24
Q

What structures arise from the 1st cleft?

A

external auditory meatus

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25
Q

What are otic placodes?

A

thickening of the ectoderm on the outer surface, from which the ear develops

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26
Q

otic placodes turn into otic vesicles - what process does this closely resemble

A

endocytosis

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27
Q

Where do the semicircular canals originate?

A

flattened outpocketings of the otic vesicles

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28
Q

What are the 3 semicircular canals?

A

Superior
Posterior
Lateral

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29
Q

What is the dilated end of the semicircular canals called?

A

Crus Ampullare

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30
Q

What is the non-dilated end of teh semicircular canals called?

A

Crus Nonampullare

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31
Q

what is the function of the crista ampullaris within the semicircular canals?

A

They have sensory cells which aid with balance

Also contain the vestibular fibres of CN VIII

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32
Q

Where does the cochlea arise from?

A

Saccular portion of the otic vesicles

Cochlear duct grows in spirals between weeks 6-8 and the surrounding mesenchyme becomes cartilaginous

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33
Q

What surrounds the cochlear duct?

A

Scala vestibuli and the scala tympani (both air spaces)
Spiral ganglion
Spiral ligament

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34
Q

Where does the organ of Corti arise from?

A

Cochlear duct on the basillar membrane

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35
Q

What is the organ of corti made up of?

A

Mechanosensory cells known as hair cells

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36
Q

What is the function of the tympanic cavity?

A

Amplification of sound

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37
Q

During development what happens in the EAM?

A

Month 3 - epithelial cells proliferate to form a meatal plug

Month 7 - this has dissolved and cells have become some of the tympanic membrane

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38
Q

What does the auricle of the ear originate from?

A

6 mesenchymal proliferactions (hillocks) surrounding the 1st pharyngeal cleft - 3 from arch 1 and 3 from arch 2
The hillock fuse to become the completed auricle

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39
Q

Where does the external ear travel from to get to its birth position?

A

Lower neck - must move due to development of mandible

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40
Q

What is anotia?

A

No development of ear buds

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41
Q

What is micronotia?

A

Small ears

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42
Q

What are preauricular appendages?

A

Extra tissue anterior to the ear proper

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43
Q

What is a preauricular pit?

A

Dent/dimple located anywhere adjacent to the ear proper

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44
Q

What is the range of sound in human hearing?

A

20-20,000Hz

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45
Q

What is the basic role of the external ear?

A

A reciever

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46
Q

What is the basic role of the middle ear?

A

An amplifier

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47
Q

How many times is sound amplified by in the tympanic cavity?

A

x22

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48
Q

What is the basic role of the eustachian tube?

A

ventilation for the middle ear

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49
Q

What muscles open the cartilaginous eustachian tube?

A

tensor veli palatini

levator palatine

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50
Q

What is the basic role of the inner ear?

A

receiver/transducer

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51
Q

What is the basic composition of the inner ear?

A

curved spiral lamina

2.5 turns around a central mediolus

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52
Q

What is contained in the scala media?

A

Endolymph

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53
Q

What is contained in the scala tympani and the scala vestibuli?

A

Perilymph

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54
Q

Where is high frequency sound transmitted on the cochlea?

A

Lower end

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55
Q

Where is low frequency sound transmitted on the cochlea?

A

Upper end

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56
Q

What is the organ of corti made up of?

A

inner and outer hair cells and a highly varied strip of epithelial cells

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57
Q

What is the purpose of the organ of corti?

A

transduction of auditory signals through vibrations of the inner ear structures, which causes displacement of the cochlear fluid and movement of the hair cells to produce APs

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58
Q

How do hair cells of the ear produce an electrical impulse?

A

Conversion of a mechanical bending force into an electrical signal

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59
Q

How are the hair cells arranged?

A

Stereocilia are arranged in height order, with tip links connecting them

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60
Q

What causes depolarisation of hair cells?

A

Cells deflected towards the longest one

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61
Q

What causes hyperpolarisation of the hair cells?

A

Cells deflected away from the longest one

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62
Q

Where in the brain is the primary auditory cortex located?

A

Superior temporal gyrus

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63
Q

What does 60% of our balance come from?

A

Eyes

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64
Q

How much of our balance comes from our ears?

A

15%

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65
Q

How much of our balance is mediated by the CNS?

A

10%

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66
Q

How much of our balance comes from proprioception?

A

15%

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67
Q

As well as all the factors and systems that contribute to our ability to balance, what other system plays a part? What role does it have?

A

Cardiac functions keep everythign runnign smoothly

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68
Q

What pathology of the eyes can affect our ability to balance?

A

Cataracts

DM eye disease

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69
Q

What pathology of the ears can affect our ability to balance?

A

AVN
Meniere’s disease
Migraine
BPPV - benign paroxysmal positional vertigo

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70
Q

What pathology affecting the CNS can affect our ability to balance?

A

Stress
Migraines
MS
Space-occupying lesion in the cranial vault

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71
Q

What pathology of proprioception can affect our ability to balance?

A

DM
Arthritis
Neuropathy

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72
Q

What cardiac pathology can affect our balance, and why?

A

Arrhythmias and postural hypotension can cause lightheadedness, being off-balance and feeling dissociated

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73
Q

What is the complex structure of the ear also referred to?

A

The labyrinth

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74
Q

What are the 5 key vestibular organs of the inner ear?

A

3 semicircular canals

2 otolith organs (utricle and saccule)

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75
Q

What lies within the maculae of the otolith organs?

A

Stereocilia projecting up into a gelatinous mix with otoconia (calcium carbonate crystals)

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76
Q

What is the purpose of the calcium carbonate crystals in the maculae of the otolith organs?

A

They lend weight and because of gravity, when we tilt our heads or travel in an elevator the brain perceives a movement known as linear motion

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77
Q

Stereocilia are orientated in all directions, so all movements are perceived; but what movements specifically do the saccule and occule detect?

A 
Saccule = Vertical movement
Utricle = horizontal movement
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78
Q

Where does the cupula sit in the semicircular canals?

A

In the ampulla

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79
Q

What causes deflection on the semicircular canals?

A

Movement of perolymph

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80
Q

What is the vestibulo-occular reflex?

A

Stabilises images on the retina during head movements, by producting eye movement in the opposite direction

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81
Q

What is spontaneous nystagmus?

A

Rhythmic, oscillating movements of the eyes - can be physiological or pathological

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82
Q

What do taste buds consist of?

A

Sensory receptor cells and support cells - arranged like orange slices

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83
Q

What is the lifespan of a taste receptor cell?

A

10 days

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84
Q

What type of nerve fibre do taste receptor cells synapse with?

A

afferent

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85
Q

What are the 4 types of papillae on the human tongue?

A

Filliform
Fungiform
Vallate
Foliate

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86
Q

What type of papillae does not contain taste buds?

A

Filliform

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87
Q

What happens when a taste provoking chemical (tastant) binds to a receptor cell on the tongue?

A

Produces a depolarising AP in afferent nerve fibres

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88
Q

Which cranial nerves are responsible for transferring taste from receptor cells to the brainstem?

A

VII -chorda tympani branch - anterior 2/3 of the tongue
IX - posterior 1/3 of tongue
X - epiglottis and pharynx etc.

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89
Q

What area of the brain are these signals conveyed to?

A

Cortical gustatory area

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90
Q

What are the 5 primary tastes?

A 
Salty
Sour
Sweet
Bitter
Umami (meaty or savoury)
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91
Q

What are the salty taste receptors stimulated by?

A

chemical salts esp. NaCl

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92
Q

What are the Sour taste receptors stimulated by?

A

acids containing free hydrogen ions

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93
Q

What are the sweet taste receptors stimulated by?

A

configuration of glucose

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94
Q

What are the bitter taste receptors stimulated by?

A

alkaloids, poisonous substances, toxic plant derivatives etc.

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95
Q

What are the umami taste receptors stimulated by?

A

amino acids - esp. glutamate

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96
Q

What is a complete loss of taste function known as?

A

Ageusia

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97
Q

What can cause aguesia?

A

Nerve damage, local inflammation, some endocrine disorders

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98
Q

What is hypogeusia?

A

Reduced taste function

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99
Q

What causes a reduced taste function?

A

Chemo, medications etc.

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100
Q

What is dysgeusia?

A

Distorted taste function

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101
Q

What can cause a distorted taste function?

A 
Glossitis
Gum infection
Tooth decay
Reflux
URTIs
Medications
Neoplasms
Chemo
Zinc deficiency
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102
Q

Where does the olfactory mucosa lie?

A

Ceiling of the nasal cavity (bilaterally)

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103
Q

What 3 cell types are contained within the olfactory mucosa?

A

olfactory receptor cells
supporting cells
basal cells (mucous secreting)

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104
Q

What are olfactory receptors?

A

specialised endings of renewable afferent neurons

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105
Q

What do neurons involved with the olfactory mucosa contain?

A

A thick, short dendrite

An expanded end (olfactory rod)

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106
Q

What projects from the olfactory rods into the olfactory mucosa?

A

Cilia

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107
Q

What is the function of the cilia of the nose?

A

Odorants bind to them

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108
Q

What is the life span of an olfactory receptor?

A

~2 months

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109
Q

Where to new olfactory receptor cells arise from?

A

Basal cells are the precursors

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110
Q

The axons of olfactory receptors collectively form afferent fibres of the olfactory nerve; where do these then go?

A

Pierce the cribriform plate of the ethmpid bone to enter the olfactory bulbs on the inferior brain surface. These then transmit information to the brain

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111
Q

In quiet breathing how do odorants reach smell receptors?

A

Diffusion only - olfactory mucosa is higher than normal path of airflow

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112
Q

What must a substance be to be smelled?

A

Sufficiently volatile and sufficiently water soluble

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113
Q

What is the complete inability to smell known as?

A

Anosmia

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114
Q

What can cause anosmia?

A

viral infections
allergies
nasal polyps
head injury

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115
Q

What is hyposmia?

A

Reduced ability to smell

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116
Q

Hyposmia has similar causes to anosmia, but what can hyposmia be an early sign of?

A

Parkinson’s disease

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117
Q

What is dysosmia?

A

Altered sense of smell

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118
Q

What cell type outlines the auditory meatus and external ear canal?

A

Epidermis (skin) cells with sebaceous and ceruminous glands

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119
Q

What cell types line the middle ear?

A

columnar-lined mucosa

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120
Q

What cell type lines the nasal vestibule?

A

Squamous

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121
Q

The nose and sinuses are lined by a Scheiderian epithelium - what does this contain?

A

a modified mucous membrane forming the epithelium part of the olfactory organ - identical to resp. mucosa (pseudostratified ciliated columnar)

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122
Q

What cell types line the throat?

A

respiratory and squamous epithelium

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123
Q

Are the salivary glands endocrine or exocrine?

A

Exocrine

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124
Q

What type of cells are in the salivary glands?

A

Peripheral myoepithelial cells - flat or cuboidal with a clear cytoplasm

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125
Q

What is otitis media?

A

inflammation of the middle ear

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126
Q

What bacteria can cause otitis media?

A

Strep pneumoniae
H. influenzae
Moxarella cattarhalis
(if chronic) pseudomaonas aueroginosa

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127
Q

What is a cholesteatoma?

A

abnormally situated squamous epithelium in the middle ear with associated kertain production and inflammation

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128
Q

What is a vestibular Schwannoma?

A

tumour of the schwann cells of CNVIII

occurs within the temporal bone

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129
Q

If a young patient presents with bilateral vestibular schwannoma, what alternative diagnosis should you consider?

A

NF type 2

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130
Q

What can cause nasal polyps?

A 
allergies
infection
asthma
aspirin sensitivity
nickel exposure
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131
Q

Are nasal polyps sore to the touch?

A

Not usually no

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132
Q

Nasal polyps in young children are not common, what could these be a sign of?

A

Cystic fibrosis

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133
Q

What can cause rhinitis and sinusitis?

A

Infection - cold

allergies - hayfever, IgE type 1 hypersensitivity

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134
Q

What is wegener’s granulomatosis?

A

An autoimmune condition which presents as a small cell vasculitis limited to the repiratory tract and the kidneys

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135
Q

What antibody is associated with Wegener’s granulomatosis?

A

ANCA

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136
Q

Histologically what can be seen in Wegener’s granulomatosis?

A

blood vessel walls surrounded by inflammatory cells

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137
Q

How common are tumours of the nose?

A

relatively rare

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138
Q

What are some benign lesions of the nose?

A

squamous papillomas
“Schneiderian” papillomas
angiofibromas

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139
Q

What is the most common malignant lesion of the nose?

A

SCC

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140
Q

Where does nasophargyngeal carcinoma have a high incidence?

A

Far East

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141
Q

What is nasophargyngeal carcinoma associated with?

A

EBV

Volatile nitroamines in food

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142
Q

What carcinomas is EBV associated with?

A

Burkitt’s lymphoma
B-cell lymphomas
Hodgkin’s lymphoma

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143
Q

How does EBV cause carcinogenisis?

A

It hi-jacks and mimics helper T-cell responses leading to proliferation and survival of B cells

144
Q

What can cause laryngeal polyps?

A

reactive change in the laryngeal mucosa secondary to vocal abuse, infection or smoking

145
Q

What can cause contact ulcers?

A

Benign response to injury caused by a chronic sore throat, voice abuse or GORD

146
Q

What are the 2 incidence peaks of squamous papilloma?

A

under 5 years

20-40 years

147
Q

What is squamous papilloma associated with?

A

HPV types 6 + 11

148
Q

What is a paraganglioma?

A

Tumours arising in clusters of neuroendocrine cells dispersed throughout the body.

149
Q

What can differentiate between the 2 types of paraganglioma?

A

Whether they are chromaffin +ve or chromaffin -ve

150
Q

What are the distinguising features of a chromafin +ve paraganglioma?

A

occurs within the sympathetic NS
can secrete catecholamines
usually found in the adrenal medulla or paravertebral organ of Zuckerkandl

151
Q

What are the distinguising features of a chromafin -ve paraganglioma?

A

Affects carotid bodies, aortic bodies, jugulotympanic ganglia and the ganglia nodosum of the vagus nerve.
Clusters arise around the oral cavoty, nose, nasopharynx, larynx and orbit.

152
Q

How does HPV type 16 affect the syntheisis of a SCC?

A

HPV type 16 produces proteins E6 and E7 which disrupts p53 and RB pathways respectively, leading to cellular immortality.

153
Q

SCCs of the head and neck affect which parts especially?

A

Tonsils

tongue-base

154
Q

SCCs of the head and neck are sensitive to whih type of treatment?

A

Chemo

155
Q

What structures would a T1a SSC laryngeal carcinoma affect?

A

1 vocal cord

156
Q

What structures would a T1b SSC laryngeal carcinoma affect?

A

2 vocal cords

157
Q

What structures would a T2 SSC laryngeal carcinoma affect?

A

extension into the supra/subglottis

158
Q

What structures would a T3 SSC laryngeal carcinoma affect?

A

Vocal cord fixation or extension into the paraglottic space

Minor thyroid cartilage involvement

159
Q

What structures would a T4a SSC laryngeal carcinoma affect?

A 
Thyroid cartilage
Trachea
Muscles of the tongue
Strap muscles
Thyroid
Oesophagus
160
Q

What structures would a T4b SSC laryngeal carcinoma affect?

A

Prevertebral space
mediastinal structures
carotid artery

161
Q

What are sialolithiasis?

A

Stones in the salivary glands

162
Q

What can paramyoxovirus cause?

A

mumps (bilateral parotitis); risk of secondary meningitis

163
Q

Which salivary gland to tumours most commonly affect?

A

Parotids

164
Q

What is the most common type of parotid tumour?

A

pleomorphic ademona (benign)

165
Q

What is the 2nd most common tumour of the parotids?

A

Warthin’s tumour - strongly associated with smoking

166
Q

What is the most common malignant salivary gland tumour?

A

Adenoid cystic tumour

167
Q

Are the majority of sore throats bacterial or viral?

A

2/3 are viral

168
Q

What is the most common bacterial cause of a sore throat?

A

Strep. pyogenes

169
Q

What antibiotic is used to treat a strep pyogenes throat infection?

A

Penicillin

170
Q

What are the acute complications of a bacterial sore throat (tonsillitis)?

A

Peritonsillar abscess (quincy)
sinusitis/otitis media
scarlet fever

171
Q

What are the late complications of a bacterial sore throat (tonsillitis)?

A

Rheumatic fever - 3 weeks after sore throat - fever, arthritis, pancarditis
Glomerulonephritis - 1-3 weeks after sore throat - haematuria, albuminaemia and oedema

172
Q

What bacterium causes diptheria?

A

Corynebacterium diphtheriae

173
Q

What are the symptoms of diptheria?

A

A severe sore throat

Grey/white membrane across the pharynx - may become large enough to obstruct airway

174
Q

How does Corynebacterium diphtheriae affect its patients?

A

Produces a potent exotoxin which is cardiotoxic and neurotoxic

175
Q

What is in the diptheria vaccine?

A

A cell-free, purified toxin, extracted from a strain of Corynebacterium diphtheriae

176
Q

What is the treatment or diptheria?

A

Antitoxin and supportive penicillin/erythromycin

177
Q

What is the cause of oral thrush?

A

Candida albicans

178
Q

How does oral thrush present clinically?

A

white patches on a red, raw mucous membrane

179
Q

What is the treatment for oral thrush?

A

Nystatin

180
Q

How does acute otitis media occur?

A

Extension of infection up the eustachian tube

181
Q

How does acute otitis media present?

A

Earache

182
Q

Although AOM is often viral, secondary bacterial infections do occur. What are the most likely causative organisms?

A

H. influenzae
Strep. pneumoniae
Strep pyogenes

183
Q

How do you diagnose AOM?

A

If the eardrum perforates then pus swabs can be obtained

184
Q

How is AOM treated?

A

80% of cases resolve in 4 days without antibiotics

If antibiotics are needed then use amoxicillin

185
Q

How does acute sinusitis present?

A

Mild discomfort over the frontal or maxillary sinuses due to congestion often seen in patients with viral URTIs
Severe pain and tenderness with a purulent nasal discharge (if secondary bacterial infection)

186
Q

What are the most likely causative organisms of acute sinusitis?

A

Strep. pneumoniae

Strep pyogenes

187
Q

What drug(s) is used to treat acute sinusitis (if it is indicated)?

A

Penicillin V

2nd line = doxycycline (not in children)

188
Q

When should antibiotics be used in acute sinusitis?

A

If the case is severe or deteriorating, and lasting >10days

189
Q

What are the signs and symptoms of otitis externa?

A 
Redness and swelling or ear canal
Itch
Sore and painful
Discharge or increased amounts of earwax
Hearing can be affected if canal is blocked
190
Q

What bacteria can cause otitis externa?

A

Staph. aureus
Proteus spp.
Pseudomonas aeruginosa

191
Q

What fungi can cause otitis externa?

A

Aspergillus niger

Candida albicans

192
Q

How is otitis externa managed?

A

Topical aural toilet
Swabs for unresponsive cases
Further treatment depends on causative organisms

193
Q

What is the common presentation of glandular fever?

A 
Fever (in 90% of patients)
lymphadenopathy
pharyngitis
sore throat
malaise
lethargy
tonsillitis
194
Q

What are the less common signs and symptoms of glandular fever?

A 
jaundice
rash
splenomegaly
palatal petechiae
leucocytosis
195
Q

What is the prognosis of glandular fever, and what complications can occur?

A

It is a protracted but self-limiting illness
May cause anaemia, thrombocytopenia, splenic rupture or obstruction of the upper airways
Also increases the risk of developing lymphoma

196
Q

What organism is glandular fever caused by?

A

EBV - a virus of the herpes family (persistent infection in the epithelial cells

197
Q

What are the 2 phases of incidence of glandular fever?

A

Early childhood - rarely results in infectious mononucleosis

>10y/o - often causes infectious mononucleosis

198
Q

What is the management for glandular fever?

A 
Bed rest and paracetamol
Avoid sport (splenic rupture risk)
Corticosteroids may have some use in more complicated cases
199
Q

How is a diagnosis of glandular fever confirmed in the lab?

A

Heterophile antibody - Paul Bunnell test or Monospot test
EBV IgM
Blood count and film

200
Q

What would the differential diagnosis for glandular fever be?

A

Cytomegalovirus
Toxoplasmosis
Early HIV infection - seroconversion

201
Q

Which type of HSV causes oral ulceration?

A

HSV1

202
Q

Primary gingivostomatitis is caused by HSV1 infection in preschool children. What symptoms does this cause?

A

1-2mm vesicles and ulcers on the lips, buccal mucosa and hard palate.

203
Q

How is primary gingivostomatitis treated?

A

Aciclovir

204
Q

If an HSV1 virus is reactivated after a period of latency, what condition does this cause?

A

Cold sores

205
Q

With relation to HSV, what occupational hazard does this pose for dentists?

A

HSV on finger - Herpetic Whitlow

206
Q

How is an HSV infection confirmed?

A

swabs of the lesion are taken in a viral transport medium and are run through PCR for detection of viral DNA

207
Q

What is a serious complication of HSV relating to ENT?

A

HSV encephalitis - may lead to necrosis of brain tissue

208
Q

What is herpangina?

A

Vesicles/ulcers on the soft palate caused by the coxsackie viruses (enteroviruses)

209
Q

What is hand, foot and mouth disease?

A

Small fluid filled vesciles on the hands, feet and mouth caused by the coxsackie viruses.

210
Q

What 5 swellings are present on the “face” by week 4 of embryo development?

A 
Frontonasal prominance (with nasal placodes)
Maxillary prominance (x2)
Mandibular prominance (x2)
211
Q

What 4 nasal swellings develop on the frontonasal prominence in week 5 of development?

A

Medial nasal swellings (x2)

Lateral nasal swellings (x2)

212
Q

What facial swellings form the upper lip?

A

The 2 medial nasal prominences and the 2 maxillary prominences

213
Q

What facial swellings form the lower lip?

A

the 2 mandibular promonences

214
Q

What facial swellings form the nose?

A

The frontonasal pominenece (bridge and nasal septum)
The 2 medial nasal prominences (crest and tip)
The 2 lateral nasal prominences (alae - sides)

215
Q

How is the intermaxillary segment formed?

A

via fusion of the medial nasal prominences

216
Q

The intermaxillary segment has 3 portions or parts, what are they and what does each contribute to in the neonatal facial development?

A

Labial portion - forms the filtrum of the upper lip
Upper jaw component - caries 4 incisers
Palatal component forms the primary palate

217
Q

How is the secondary palate formed?

A

Palatine shelves grow down from the maxillary prominences and ascend into a horizontal position to fuse with each other and the primary palate.

218
Q

What is happening at the site of the nasal cavities at week 6 of development?

A

Nasal pits deepen and penetrate the underlying mesenchyme.

219
Q

What is happening at the site of the nasal cavities at week 7 of development?

A

Nasal cavities connect with the oral cavity via primitive choanae behind the primary palate

220
Q

What is happening at the site of the nasal cavities at week 8 of development?

A

Definitive choanae open at the nasopharyngeal junction due to formation of the secondary palate

221
Q

What are the 7 D’s that should be remembered when taking a history of ear disease from a patient?

A 
Deafness
Discomfort
Din Din (tinnitus)
Discharge
Dizziness
Defective facial movements
Destruction by disease
222
Q

When are x-rays used in ENT?

A

Suspected inhalation or ingestion of radio-opaque foreign bodies

223
Q

What investigation is used to investigate dysphagia?

A

Barium swallow

224
Q

When is ultrasound used in ENT?

A

Neck lumps
Imaging and FNA of thyroid lumps
Salivary gland disease
Inflammatory masses esp. in children to look for abscesses

225
Q

When is CT/MRI used on the ear?

A

temporal bone for cholesteotoma
trauma
planning for hearing implants

226
Q

When is CT/MRI used on the nose?

A

paranasal sinueses prior surgery

tumours

227
Q

When is CT/MRI used on the throat?

A

infections
trauma
masses
causes of vocal cord palsy

228
Q

What are the 6 named segments of the facial nerve?

A 
Intracranial
Meatal
Labyrnthine
Tympanic
Mastoid
Extratemporal
229
Q

What are the anatomical boundaries of the pharynx?

A

From the base of the skull to C6 - level of the cricopharygeus

230
Q

What muscles are involved with the pharynx?

A

3 constrictor muscles (superior, middle, inferior)
Cricopharyngeus
Palatopharyngeus
Stylopharyngeus

231
Q

What are the anatomical boundaries of the oropharynx?

A

From the soft palate superiorly to the epiglottis inferiorly

232
Q

Which muscles help form the oropharynx?

A

The superior and middle pharyngeal constrictors form the posterior and lateral walls of the oropharynx

233
Q

What are the anatomical boundaries of the hypopharynx?

A

From the level of the glossoepiglotic and pharyngoepiglottic folds to the inferior cricoid cartilage

234
Q

What lies below the hypopharynx?

A

Cervical oesophagus

235
Q

Where is the larynx situated?

A

Anterior to the hypopharynx

236
Q

What lies below the larynx?

A

Trachea

237
Q

What lies in the pharyngeal mucosal space?

A

Mucosa
Lymphoid tissue
Constrictor muscles

238
Q

What does the masticator space contain?

A

Mandible
Muscles
CNV

239
Q

What pathology can arise in the masticator space?

A

Dental abcess/cyst - invasion from oral cavity

240
Q

What is the retropharyngeal space?

A

A POTENTIAL space deep to the pharyngeal mucosa, anterior to longus coli and capitus muscles

241
Q

Why is the retropharyngeal space known as the danger space?

A

It splits 2 deep layers which can track down into the mediastinum

242
Q

Where would a retropharyngeal mass lie?

A

Anterior to longus coli

243
Q

Where would a perivertebral mass lie?

A

Would displace longus coli anteriorly.

244
Q

What does the carotid space contain?

A

Carotid artery
Jugular vein
Cranial and sympathetic nerves
Lymph nodes

245
Q

What potential pathology can arise in the carotid space?

A

Schwannoma
Paraganglioma
Lymphadenopathy

246
Q

What are the 4 main functions of the tonsils?

A

Trap bacteria and viruses
Expose pathogens to immune system
Produce antibodies
Prevent subsequent infection

247
Q

Significant adenotonsillar enlargement is uncommon in what age group of children?

A

under 2y/o

248
Q

When do the adenoids and tonsils decrease in bulk?

A

In early teenage years (some may disappear altogether - remember you have no adenoids)

249
Q

What is Waldeyer’s Ring?

A

a ring of lymphoid aggregation in the subepithelial layer of the oropharynx and nasopharynx

250
Q

What structures make up Waldeyer’s ring?

A

Palatine tonsils
Adenoid tonsils
Lingual tonsil

251
Q

What histological features do the (palatine) tonsils have?

A

Made up of specialised squamous epithelium
Have deep crypts and lymphoid follicles
A posterior capsule separates the tonsil from underlying muscle

252
Q

What histological features do the adenoids have?

A

A ciliated psuedostratified columnar epithelium with a stratified squamous layer deep to this
Deep to both lies a transitional layer
Deep folds and a few crypts

253
Q

In general rules of ENT what type of epithelium do upper aerodigestive structures have?

A

Ciliated columnar respiratory type mucosa and a squamous epithelium

254
Q

In general rules of ENT what type of epithelium do food-going/high-use/traumatized structures have?

A

Squamous

oral cavity/pharynx/vocal cords/oesophagus

255
Q

In general of ENT what type of epithelium do air-going structures have?

A

Columnar

Nose/PNS/Larynx/Trachea

256
Q

What viruses can cause tonsillitis?

A 
EBV
rhinovirus
influenza
parainfluenza
enterovirus
adenovirus
257
Q

What bacteria can cause tonsillitis?

A

Group A beta haemolytic strep
H.influenza
S.aureus
Strep.pneumonia

258
Q

What percentage of bacteria causing tonsillitis are beta-lactimase producing?

A

39%

259
Q

What are the main symptoms of viral tonsillitis?

A 
Malaise
Sore throat
Temperature
Able to undertake near-normal activity
possible lymphadenopathy
lasts 3-4days
260
Q

What are the main symptoms of bacterial tonsillitis?

A 
Systemic upset
fever
odynophagia
halitosis
unable to work/ go to school
lymphadenopathy
lasts around 1 week - requires antibiotics to settle
261
Q

What are the Centor Criteria for deciding if a tonsillitis patient requires antibiotics?

A 
History of fever (+1)
Tonsillar exudates (+1)
Tender anterior cervical lymphadenopathy (+1)
Absence of cough (+1)
44y/o (-1)
262
Q

If a patient has a centor criteria of 0-1 what management is required?

A

No antibiotic given

263
Q

If a patient has a centor criteria of 2-3 what management is required?

A

Should receive antibiotics if symptoms progress

264
Q

If a patient has a centor criteria of 4-5 what management is required?

A

Treat empirically with antibiotics

265
Q

What supportive treatment should be given to a patient with tonsillitis?

A

Eat and drink
Rest
Paracetamol +/- NSAIDs

266
Q

What antibiotic treatment is used in tonsillitis?

A

Penicillin 500mg 4x/day for 10 days

Clarithromycin if allergic

267
Q

If a patient is hospitalized with tonsillitis (e.g. in the event or airway constriction), what treatment should be given?

A

IV fluids
IV antibiotics
Steroids

268
Q

What is the risk of hemorrhage if a patient is eligible for tonsillectomy?

A

5%

269
Q

A peritonsillar abcess (quincy) can form as a complication of acute tonsillitis when bacteria between the muscle and tonsil produces pus, but what are the typical symptoms of this?

A

Unilateral throat pain and odynophagia
Trismus (lockjaw)
3-7 days of preceding acute tonsillitis

270
Q

What is the treatment for a peritonsillar abscess?

A

aspiration and antibiotics

271
Q

What are the signs and symptoms of glandular fever?

A 
gross tonsillar enlargement with membranous exudate
marked cervical lymphadenopathy
palatal petechial haemorrhages
generalised lymphadenopathy
hepatosplenomegaly
272
Q

how is glandular fever diagnosed?

A

Atypical lymphocytes in peripheral blood
+ve monospot or Bunnell test
Low CRP ( less than 100)

273
Q

How is glandular fever managed?

A

Symptomatic treatment
Antibiotics - prevents secondary bacterial infections
Steroids - may help in complex cases

274
Q

What drugs should never be given to a patient with suspected glandular fever? Why?

A

Ampicillin or Amoxicillin

A generalised macular rash will 100% result

275
Q

What are the general signs and symptoms of Chronic Tonsillitis?

A

Malodorous breath
Presence of tonsiliths
Peritonsillar erythema
Persistent tender cervical lymphadenopathy

276
Q

What are the signs of the adenoids causing an obstructive hyperplasia?

A

obligate mouth breathing
hyponasal voice
snoring and sleep disturbances
AOM/OME

277
Q

What are the signs of the tonsils causing an obstructive hyperplasia?

A

snoring and sleep disturbance
muffled voice
potential dysphagia

278
Q

What is glue ear?

A

OME + serous otitis media

Inflammation of he middle ear accompanied by accumulation of fluid but with no acute inflammation symptoms

279
Q

Who can get glue ear?

A

Any child (although decreasing incidence with age) and males more than females

280
Q

What can predispose a child to glue ear?

A 
Recurrent URTIs and AOM
Prematurity
Craniofacial/genetic abnormalities
Immunodeficiency
Smoking household, bottle fed, allergies
281
Q

What are the main symptoms of glue ear?

A 
deafness
poor school performance
behavioural problems
speech delay
NOT otalgia
282
Q

How is glue ear diagnosed?

A

Through the history
Otoscopy
Tuning fork tests, audiometry and tympanometry

283
Q

What are teh main signs of glue ear/OME?

A

TM retraction and decreased mobility
TM colour altered with visible fluid/bubbles
Cognitive HL on tuning fork tests

284
Q

What is the treatment for OME?

A

Watchful waiting (90% resolved at 3/12)
Review at 3/12 - if persistant refer!
Surgical insertion of grommets is the most common way to treat OME. (If >3y/o consider adenoidectomy)

285
Q

What are the complications that can arise with the insertion of Grommets?

A

Infection
Retention
Perforation
Swimming/bathign issues

286
Q

Define Dizziness.

A

A non-specific term which may cover vertigo, pre-syncope, disequilibruim etc.

287
Q

Define Vertigo.

A

An abnormal sensation of movement, usually spinning

288
Q

What is the prevalence of dizziness?

A

Most common presentaion to GPs in >74y/os
Current self report of dizziness in the community = 17%
In 50-64y/o this is >25%
5/1000 see GP with vertigo
By 80: 2/3 women and 1/3 men will have expirienced episodes of vertigo

289
Q

What can precipitate dizziness?

A 
CVS deisorders
haematological and metabolic disorders
trauma
neurological conditions
migraine
otologial conditions
290
Q

What should an examination of a patient with dizziness include?

A 
Otoscopy
BP lying/standing
Neuro exam
Balance exam
Audiometry
291
Q

What are the common causes of dizziness?

A

Postural dizziness
Side effect of medications
Psychogenic and interaction with imbalance

292
Q

What are the common causes of vertigo?

A 
Menieres disease
BPPV
Vestibular neurotitis
Labyrinthitis
Migrainous vertigo
293
Q

What kind of patient history would be suggestive of Menieres disease?

A

Recurrent, spontaneous vertigo with at least 2 episodes >20mins (but usually hours)

294
Q

Other than vertigo, what other symptoms are suggestive of Menieres disease?

A

Worsening tinnitus on the affected side
Aural fullness on affected side
Documented SNHL on at least 1 occasion

295
Q

What is involved in the management of Menieres disease?

A 
Supportive treatment during episodes
Tinnitus therapy
hearing aids
Avoidance of salt, betahistine, caffeine, alcohol and stress
Grommet insertion
Intratympanic gentamicin/steroids
Surgery
296
Q

What does BPPV stand for?

A

Benign Positional Paroxysmal Vertigo

297
Q

When would someone with BPPV experience vertigo?

A 
On looking up
Turning in bed
First thing lying down at night
bending forward
rising from bending
moving head quickly
298
Q

What are important negative finding in BPPV?

A

There is NO associated tinnitus, hearing loss or aural fullness

299
Q

What is the aetiological mechanism behind BPPV?

A

Otolithiasis - crystalised otoliths which become loose from the semicircular canal fillaments

300
Q

What investigations can be done to prove BPPV as a diagnosis?

A

Hallpike’s test
Epley manoeuvre
Semont manoeuvre
Brandt-Daroff exercises

301
Q

What are the steps performed in Hallpike’s test?

A

Sit on couch so that the patients head will be off the end when they lie back
Turn head 45 degrees to one side
Warn patient to not close eyes if dizzy (test fatigues after first time)
Lie back as quickly as possible and hold them in that position and observe
After a 30second delay nystagmus occurs

302
Q

What are the Epley manoeuvre and the Brandt-Daroff manoeuvre designed to do?

A

Move the otolith pieces out of the semicircular canals

303
Q

How is Vertebrobasilar insuffieciency different from BPPV?

A

Has visual disturbances, weakness and numbness associated with the vertigo

304
Q

What is the classical history of vestibular neuronitis?

A

Prolonged vertigo (days) with no associated tinnitus or HL

305
Q

What is the cause of vestibular neuronitis?

A

Probably viral infection

306
Q

How does labyrinthitis differ from vestibular neuronitis symptoms-wise?

A

There may be associated tinnitus or HL

307
Q

How is neuronitis or labyrinthitis treated?

A

Supportive management with vestibular sedatives but is generally a self-limiting condition.
Further investigation if prolonged or atypical history

308
Q

What is the prevalence of Migraines, and what % of those with migraines suffer vertigo?

A

15-20% population experience migraines and 25% of those get spontaneous attacks of vertigo and ataxia (balance problem)

309
Q

What is the most common auditory symptom of migraines?

A

Phonophobia (fear of sound)

310
Q

What questions should be asked when taking a history of a nasal trauma?

A 
Mechanism of injury
Timing
LOC
Epistaxis
Breathing affected
311
Q

What should be examined in somebody with a nasal trauma?

A

Looking for bruising, swelling, tenderness, septal deviation and evidence of epistaxis
Infraorbital sensation and all potential CNs affected

312
Q

What must be excluded in a patient with nasal trauma, and if found, what should be done?

A

Septal haematoma should be excluded and if found drained ASAP

313
Q

How is Nasal trauma managed?

A

Based on deviation/cosmesis and whether breathing is affected
Reviewed in clinic 5-7 days after injury (swelling reduction)
Nose can be manipulated with LA 3-5 weeks post-injury and 80% of patients who receive this go on to have no further issues

314
Q

What complications can arise following a nasal injury?

A

Epistaxis esp. with anteroir ethmoid involvement
CSF leak (give 7-10 days before investigation)
Meningitis
Anosmia - cribriform plate fracture

315
Q

What % of the population experience epistaxis every year, what % got to the GP, and what % need specialist help?

A

5-10% population
10% of those see a GP
1% of those need to see a specialist

316
Q

What are the main arteries supplying the nasal cavity?

A

Sphenopalatine
Ethmoid
Greater palatine

317
Q

What management can be performed in epistaxis?

A 
Resuscitate if needed
Stop/blood flow
Remove blood clots
Anteroir rhinoscopy/ nasendoscopy
Cauterise vessel
Pack nose
Consider arterial ligation
318
Q

What should you NEVER do in a patient with epistaxis esp. one whose nose has packing?

A

Sedate the patient

319
Q

What is a pinna haematoma?

A

A collection of blood in the pinna

320
Q

What is the treatment for a pinna haematoma?

A

Aspirate the blood

Incise and drain and apply a pressure dressing to prevent refilling

321
Q

How should an ear laceration be managed?

A

Debride dead tissue
closure of wound (usually under LA)
Give prophylactic antibiotics

322
Q

What history would a patient with a temporal bone fracture present with?

A

HL, history of injury, facial palsy, vertigo, CSF leak

323
Q

What should be looked for on examination of a patient with a potential temporal bone fracture?

A

Battlesign bruising behind the ear
The condition of the TM and EAM
Check the function of CNVII
Hearing tests

324
Q

How are temporal bone fractures classified?

A

Longitudinal (along temporal bone axis)
Transverse
Otic capsule imvolvement or sparing

325
Q

What type of temporal bone fracture occurs in ~80% of cases?

A

Longitudinal fracture

326
Q

Is a longitudinal or transverse temporal bone fracture more likely to involve the otic capsule?

A

Transverse

327
Q

Is a longitudinal or transverse temporal bone fracture more likely to cause facial palsy?

A

Transverse

328
Q

Is a longitudinal or transverse temporal bone fracture more likely to have arisen from a lateral blow?

A

Longitudinal

329
Q

Is a longitudinal or transverse temporal bone fracture more likely to cause CHL?

A

Longitudinal

330
Q

Is a longitudinal or transverse temporal bone fracture more likely to cause vertigo?

A

Transverse

331
Q

Is a longitudinal or transverse temporal bone fracture more likely to cause CSF leak?

A

Longitudinal

332
Q

What are some of the main causes of conductive hearing loss (CHL)?

A

Fluid effusion, blood, CSF
TM perforation
Ossicular problem
Otosclerosis - fixation of stapes to footplate

333
Q

What 2 structures may be damaged in order to cause SensoryNeural hearing loss (SNHL)?

A

Cochlea

8th cranial nerve

334
Q

What are the 2 classifications of neck injuries?

A

Penetrating

Blunt

335
Q

The neck is divided into 3 zones, what structures lie in zone 1?

A

Trachea and oesophagus
Thoracic duct and thyroid
brachiocephalic, subclavian, common carotid, thyrocervical trunk
Spinal cord

336
Q

The neck is divided into 3 zones, what structures lie in zone 2?

A

Larynx and hypopharnx
CN 10, 11, 12
Carotids and internal jugular
Spinal cord

337
Q

The neck is divided into 3 zones, what structures lie in zone 3?

A

Pharynx
many cranial nerves
Carotids, IJV, vertebral vessels
Spinal cord

338
Q

In a patient presenting with neck trauma, what questions would you ask in the history?

A

Mechanism of injury
SOCRATES
Dyspnoea, hoarseness, dysphonia, dysphagia, haemoptysis
Paraethesias and weakness

339
Q

What examinations would you want to do in a patient with a neck injury?

A 
ABCDE
Secondary survery
Through platysma? - if not then unlikely to be as serious
Neck zone
bleeding
aerodigestive injuries
Neuro-power and sensation of upper arm
340
Q

What investigations should be done with a petient presenting with neck trauma?

A 
FBC, G+S (group and save)
AP/lateral x-ray
CXR
CTAngiogram
MRAngiogram
341
Q

How would you manage a patient presenting with neck trauma?

A

Urgent exploration for haematoma, shock, airway obstruction, blood in Aerodigestive tract
Laryngoscopy, bronchoscopy, pharyngoscopy, oesophagoscpoy
Angiography for emboli and occulsions

342
Q

A bridge lies between the cranial base and the dental occlusion plane, why is this significant to know?

A

It is a functionally and cosmetically important structure and fracture of these bones is potentially life-threatening as well as disfiguring.

343
Q

How common are orbital floor fractures?

A

2nd most common mid-facial fractures

344
Q

What is the weak point of the globe of the eye?

A

The infraoribital rim

345
Q

What information should be obtained in history and examination with someone suffering from facial trauma to the orbital area?

A

Any pain, decreased visual acuity or diplopia
any hypoaesthesia in the infraorbital region
Any periorbital ecchymosis - subcutanous purpura that may fill with blood
Oedema?
Enopthalmos - posterior displacement of the eye?
Any restriction of occular movement
Feel the body step of the orbital rim
Full ophthalmic examination

346
Q

What investigations should be done for orbital injuries?

A

CT sinuses to look for an orbital blow-out fracture

347
Q

How should orbital trauma be managed?

A

Conservatively unless complications of entrapment, large defect or significant enopthalmos occur where surgery is the best option
Surgical buttresses are reccomended in Le Fort fractures

348
Q

What are the important negatives found in Mild rhinitis?

A

No abnormal sleep
No impairment of daily activities
No problems in work or school
No troublesome symptoms

349
Q

What classifies rhinitis as intermittent?

A

symptoms for less than 4weeks

350
Q

What classifies rhinitis as persistent?

A

symptoms for more than 4days/week
AND
more than 4weeks duration

351
Q

What signs and symptoms does moderate to severe rhinitis present with?

A

Abnormal sleep
Impairment of daily activities
Missing work/school
Troublesome symptoms

352
Q

How is rhinitis managed?

A

Allergen avoidance
Antihistamines
Topical Steroid +/- antihistamines
Immunotherapy for those with IgE mediated disease
Surgery if indicated for relief of obstruction

353
Q

Nasal polyps can be associated with non-allergic rhinitis. How are they treated?

A

Oral, then topical steroids

If steroids to not improve condition then refer for surgery

354
Q

What are the symptoms of acute infective rhinosinusitis?

A

Facial pain
Discharge
Nasal Blockage

355
Q

What causes infective rhinosinusitis?

A

98% are viral

356
Q

How is infective rhinosinusitis treated?

A

Analgesia and decongestants

If persistant then add an antibiotic

357
Q

What complication can arise with infective rhinosinusitis?

A

Orbital cellulitis

x 2nd Year Medicine (10 decks)

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