ENT Flashcards
what body system mediates balance?
vestibular
what system regulates gravity, linear and angular acceleration and regulates muscle tone?
vestibular
what are the 2 otolith organs?
utricle
saccule
how many semicircular canals are there?
3
what is smooth pursuit used for?
tracking moving objects
what is optokinetic nystagmus?
reflex when tracking objects that lie outside the fovea
what is the vestibular-ocular reflex?
stabilised the eye on an object when the head moves
where are the main gravity receptors located?
major blood vessels
abdominal viscera
what balance disease is characterised by the illusion of movement when there is none?
vertigo
what is the onset of being paroxysmal positional vertigo?
sudden, last only seconds
does hearing loss accompany BPPV?
no
what manoeuvre/test might you perform to diagnose BPPV?
dix-hallpike
what manoeuvre night you perform to treat BPPV?
epley’s manœuvre
what eye problem is characterised by involuntary rhythmic oscillation of the eyes?
nystagmus
what is the onset of meniere’s disease?
lasts hours
episodi
what hearing problem accompanies meniere’s?
tinnitus
what is vestibular neuronitis?
vertigo that lasts hours after a URTI
is there any hearing loss or neurological signs with vestibular neuronitis?
no
what is treatment for vestibular neuronitis?
supportive
what is presbystasis and what causes it?
balance disorder
related to ageing
what is saccades?
normal eye jerk between current and new stimuli
what is head shaking nystagmus?
nystagmus following head shaking
why might you test calorics when testing vestibular function?
vestibular-ocular reflex is based on calorics (hot/cold sense)
who is most commonly affected by epistaxis?
children
what causes 85% of all cases of epistaxis?
idiopathic
give 3 simple local causes of epistaxis
trauma e.g. nose picking
mucosal irritation
anatomical abnormalities
give a tumour cause of epistaxis
nasopharyngeal angiofibroma (benign tumour that bleeds)
give 3 associated symptoms of nasopharyngeal angiofibroma - who does it affect?
headache
rhinorrhoea
anosmia
affects young males
give 4 pathological systemic causes of epistaxis
bleeding disorders
neoplasms
inflammatory disorders
hypertension
give 3 medications that may increase the risk of epistaxis
aspirin
clopidogrel
warfarin
the blood supply of the nose is
a) very rich
b) poor
c) absent in some
a) very rich
how do you distinguish between an anterior and a posterior nosebleed?
pooling in front of nose or running down back of throat
what type of facial pain is characterised by throbbing?
vascular
what type of facial pain is characterised by severe stabbing, nasal obstruction and nausea?
trigeminal neuralgia
name 2 other types of facial pain
sinogenic
migraine
is there pain in chronic sinus obstruction?
no
what does acute sinus obstruction often precede?
URTI
describe how sinusitis affects one’s sense of smell
hyposmia
what might you expect on a painful tooth when you percuss it?
more pain
is dental pain well or poorly localised?
poorly
what type of migraine make up 25% of cases?
classical
name 2 accompanying features of migraine
aura
visual disturbances
which gender is paroxysmal hemicrania more common in?
women
is pain unilateral or bilateral with paroxysmal hemicranial?
unilateral
how long does the pain last for paroxysmal hemicrania?
a) seconds
b) less than an hour
c) over 12 hours
d) days
b) less than an hour
give 2 associated symptoms of paroxysmal hemicrania
lacrimation
nasal congestion
rhinorrhoea
describe the onset of cluster headaches
sudden
which gender is more commonly affected by cluster headaches?
men (middle aged)
how can cluster headaches impinge on the trigeminal nerve?
dilate blood vessels
give a neurological symptom of cluster headaches
horner’s
what is horner’s characterised by?
myosis
anhydrous
ptosis
what type of pain is mid facial segment pain and where does it occur?
tightness/pressure over nasal bridge or orbit
is mid facial segment pain symmetrical or not?
symmetrical
describe the changes to sensation that occur with mid facial segment pain
hyperaesthesia
what might a patient with mid facial segment pain complain of in regards to their nose? (although it would appear normal upon examination)
nasal congestion
give an example of a specific trigger for trigeminal neuralgia
washing face
brushing teeth
what is firstline treatment for trigeminal neuralgia
carbamazepine
name 3 other drugs that may be used to treat trigeminal neuralgia
gabapentin
pregabalin
lidocaine
amitryptilline
what type of patient is more likely to get atypical facial pain that has no dermasomal associations?
pessimistic or with negative life events/stressed
which branches of the trigeminal nerve are affected in 1/3 of trigeminal neuralgia cases?
V2 and V3
name the 4 sinuses from top to bottom
frontal
ethmoidal
sphenoidal
maxilliary
what is the definition for rhinosinusitis?
inflammation of the nose and paranasal sinuses
give 2 examples of endoscopic signs you might see in rhinosinusitis
polyps
mucopurulent discharge
what is the difference between acute and chronic rhinosinusitis?
acute 12 weeks
how are nasal polyps normally managed?
topical steroid drops e.g. luticason or beclomethasone
what is FESS?
functional endoscopic sinus surgery
give 3 examples of viruses that can cause rhinosinusitis
rhinovirus
influenza
respiratory syncytial virus
give 3 examples of bacteria that can cause rhinosinusitis
pneumococcus
streptococcus
h influenzae
give 3 abnormalities of the osteomeatal complex that can cause rhinosinusitis
too small
increase secretion
impaired ciliary function
what are kartagener’s syndrome and primary ciliary dyskinesia both examples of?
mucociliary disorders
what is Samter’s triad?
aspirin hypersensitivity
nasal polyps
asthma
what complication of rhino sinusitis is characterised by diplopia, proptosis and visual abnormalities?
peri-orbital celluliitis
give a vascular complication of rhinosinusitis
cavernous sinus thrombosis
give an infective complication of rhinosinusitis
meningitis
abscess
what are the 3 major salivary glands?
parotid
submandibular
sublingual
what nerve supplies the parotid gland?
glossopharyngeal
what is the name of the duct which flows from parotid and where does it open?
stepson’s duct
opens next to 2nd molar
what type of fluid does the parotid gland produce?
watery, serous
what 2 senses does the parotid help to stimulate?
gustatory
olfactory
what nerve does it lie very close to?
facial
what type of secretion does the submandibular gland produce?
thick mucoid
what type of tumours constitute 80% of salivary gland tumours?
pleomorphic adenomas
are 80% of salivary gland tumours benign or malignant?
benign
where do 80% of salivary gland tumours lie?
parotid
give 5 functions of saliva
moisten mucosa taste transport buffer digestion antibacterial mineralisation pellicle (layer of proteins)
describe the swelling characteristic of acute viral parotitis
bilateral with mild pain
give a systemic symptom of acute viral parotitis
pyrexia
what causes acute viral parotitis?
paramyxovirus
what 2 supportive management options are used to treat acute viral parotitis?
rehydration
analgesia
give 3 complications of acute viral parotitis
meningitis encephalitis pancreatitis orchiditis deafness
give 5 causes of hypo function of the salivary glands
candidiasis lichen planes pathos ulcers xerostomia poor dentition burnt mouth
what are the symptoms of acute bacterial parotitis similar to?
acute viral parotitis
why is acute bacterial parotitis more serious that acute viral parotitis?
mortality 80% if not treated
what is the most common causative organism for acute bacterial parotitis?
staph aureus
what are the 4 parts of treatment for acute bacterial parotitis?
antibiotics
rehydration
analgesia
drainage
describe the swelling characteristic of HIV parotitis
firm, non-tender
is HIV parotitis often bilateral or unilateral?
bilateral
benign lymphopithemial cysts are types of what parotitis? what causes them?
HIV parotitis
hyperplasia of follicles in lymph nodes
what immune cells infiltrate lymph glands in HIV parotitis/benign lymphopithemial cysts?
CD8 t cells (cytotoxic)
what is sjoren’s syndrome?
autoimmune connective tissue disorder
give 2 symptoms of sjoren’s syndrome and their implications
keratoconjuctivitis sicca (dry eyes) xerostomia (dry mouth)
what occurs to the lymph glands in sjoren’s syndrome?
infiltration and atrophy of acini
how is sjoren’s treated?
antinuclear antibodies
give a complication of sjoren’s syndrome
non-hodgkin’s lymphoma
what is a ranula?
painless salivary gland mass of constant size
what is a ranula made of?
mucocoele
what type of agent is used to treat a ranula?
sclerosing agent
what is sialolithiasis?
deposition of crystals in gland
when is the pain of sialolithiasis worst?
around eating
what does sialodentesis have that sialolithiasis doesn’t?
erythema and pus
what is the word for ear discharge?
ottorhoea
what is an inflamed ear canal called?
otitis externa
give 3 symptoms of mastoiditis
swelling over mastoid process
non-draining
ear pushed forwards and downwards
give 2 bacterial causative organisms of otitis externa
pseudomonas
s aureus
proteus
if a patient with otitis external was complaining of deep pain and had cranial nerve palsies, what would you be concerned about?
malignancy
give 2 fungal causative organisms of otitis externa. what predisposes to fungal ear infections?
aspergillus
candida
fumigatis
predisposed by prolonged antibiotic use
give the 3 most common causative organisms for acute otitis media
s pneumonia
h influenza
moraxella
what abnormal growth can cause chronic suppurative otitis media?
cholesteatoma
give 2 causes of chronic suppurative otitis media
perforated tympanic membrane
trauma/grommets
bacteria
abnormality of tympanic membrane
what systemic complication can occur with acute mastoiditis?
septicaemia
give 4 causes of non infective ear discharge
atopic dermatitis eczema psoriasis trauma CSF blood
what is the difference between antibiotic treatment of bacterial otitis externa, malignant otitis externa and fungal otitis externa?
bacterial = topical abx malignant = IV abx fungal = topical antifungals + stop abx
what type of otitis externa has the highest mortality?
malignant
what is the difference between treatment in AOM and CSOM?
AOM only give abx if it fails to improve
CSOM topic abx
what surgical treatment would you recommend for
a) mucosal CSOM
b) squamous CSOM
a) tympanoplasty
b) mastoidectomy
give 3 viral causes of acute sore throat
rhinovirus coronavirus syncytial virus parainfluenza aden, EBV, HSV, paramyxo
give 3 bacterial causes of acute sore throat
group a strep (pyogenes)
scarlet fever (s pyogenes)
c diphtheriae
what causes glandular fever?
EBV infectious mononucleosis
give 3 symptoms of glandular fever
sore throat pyrexia malaise anorexia rash
give 2 signs of glandular fever
lymphadenopathy
splenomegaly
how is glandular fever treated?
suppurative w steroids
what is laymen’s terms for pharyngitis?
sore throat
what would the throat look like upon inspection of a patient with pharyngitis?
erythematous
maybe tonsil swelling
give 4 signs/symptoms of pharyngitis
temperature
lymphadenopathy
cough
rhinorrhoea
how can you distinguish a peritonsilar abscess from peritonsillar cellulitis?
uvula is central in peritonsilar cellulitis
place unilateral and bilateral into this sentence:
peritonsilar abscess is characterised by severe ___ pain and _____ earache, with pyrexia
severe unilateral pain
bilateral earache
how is the voice of someone with a peritonsilar abscess described?
hot potato
describe these two symptoms of peritonsilar abscesses
a) odynophagia
b) trismus
a) pain when swallowing
b) inability to open jaw fully
name a breath symptom of peritonsilar abscesses
oris halitosis
give the 2 main causative organisms of peritonsilar abscesses
strep progenies
staph aureus
how are peritonsilar abscesses managed?
broad spectrum abx and drainage
when is the pain worse in pharyngotonsillitis?
swallowing
name 3 bacterial causative organisms for pharyngotonsillitis
strep progenies
staph aureus
haem influenza
give 2 symptoms for laryngitis
fever
dysphonia
give 3 causes for laryngitis
chemical trauma
physical trauma
viral infection
how is laryngitis treated?
voice rest + humidity
steroids
give 4 symptoms of epiglottis, supraglottitis
sore throat dysphagia dysarthria tachycardia difficulty breathing
which of epiglottitis and supraglottitis is more common in children?
supraglottitis more common in children
what are 2 bacterial causative organisms for epiglottis and supraglottitis?
s pneumoniae
h parainfluenzae
what is immediate emergency treatment for epiglottitis and supraglottitis?
secure airway
what drugs might you give to treat epiglottitis and supraglottitis?
broad spectrum abx
steroids
complete this pneumonic for the branches of the facial nerve
Two zebras bit Miley Cyrus
temporal zygomatic buccal mandibular cervical
if a facial nerve is damaged above the spinal cord, which parts of the face will be affected?
lower contralateral quadrant (as upper quadrants are supplied doubly by nerves from both sides)
if a facial nerve is damaged below the spinal cord, which parts of the face will be affected?
ipsilateral half of face
what is neuropraxia?
reversible blockage of transmission of nerve impulses
what causes neuropraxia?
pressure on nerve fibres
what is axonotmesis?
blockage of axon flow causing neuronal degeneration
what is neurotmesis?
total nerve transection
bell’s palsy is dysfunction of which cranial nerve?
7
which of these is not a symptom of Melkersson-Rosenthal syndrome?
a) facial paralysis
b) face and lip swelling
c) widespread erythema
d) furrows/folds in tongue
c) widespread erythema
what is the pathophysiology of lambert eaton disease?
autoantibodies block presynaptic calcium channels
what causes lambert eaton disease?
underlying malignancy
