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Phase 3 > ENT > Flashcards

ENT Flashcards

1
Q

A 32 year old man presents with a 1 month Hx of offensive ear discharge from the left ear. Examination reveals a facial nerve palsy and there is an attic perforation of the tympanic membrane. What is the likely diagnosis?

A

Cholesteatoma

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2
Q

An 82 year old woman presents with a one day Hx of a severely painful right ear, a right facial palsy and a vesicular rash around the right ear. What is the diagnosis?

A

Herpes zoster otitis - Ramsay Hunt syndrome

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3
Q

What is an acoustic neuroma and what are the symptoms?

A

Slow growing neurofibroma arising from the acoustic nerve’s vestibular division
Ipsilateral tinnitus, sensorineural deafness, giddiness

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4
Q

What are the most common variety of submandibular tumours?

A

Adenoid cystic

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5
Q

What should be done to manage a patient with a suspected submandibular tumour?

A

Fine needle aspiration
CT
Surgery with node dissection
Radiotherapy

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6
Q

What are symptoms of carotid body tumours?

A 
Asymptomatic 
Dysphagia
Hoarseness
Stridor
Weakness of the tongue 
Compression of vagus or hypoglossal nerves
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7
Q

In which group of people are carotid body tumours more likely?

A

Those living at altitude

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8
Q

What is the most common site for glandular calculi? Why?

A

Submandibular

High calcium content in saliva

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9
Q

What is the treatment for submandibular duct calculi?

A

Opening warthins duct and milking stone along

Excision of gland

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10
Q

What is the second most common parotid rumour?

A

Adenolymphoma/warthins tumour

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11
Q

A 53 year old woman is seen in clinic reporting pain in left hand on exertion such as when she brushes her hair. At rest her pulses are palpable but they disappear after repeatedly elevating her arm. An X-ray is performed that confirms the diagnosis. What is it?

A

Thoracic outlet syndrome

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12
Q

What is the definitive test for thoracic outlet syndrome?

A

Adsons test - palpate radial pulse on affected side with elbow fully extended
Patient rotate head to side being tested and extend neck
Abduct extend and laterally rotate the shoulder
Patient take deep breath and hold
Positive test - decrease in pulse vigor

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13
Q

What is Roos test?

A

Patient raises arm to 90 degrees of abduction with arms fully externally rotated and elbows at 90 degrees flexion
Open and close hands for 3 mins
If unable to hold arms up or if pain /paraesthesia
Test for thoracic outlet syndrome

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14
Q

A child puts a pea in his ear while having dinner and is taken to paeds ED by his father. Otoscopy shows a green object in the external auditory canal. What is the appropriate action to remove this?

A

Suction

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15
Q

What are contraindications to syringing an ear?

A 
Tympanic membrane perforation
Vegetable matter 
Otitis media
Otitis externa
History of ear surgery
Unilateral deafness
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16
Q

Why is the hyoid bone resected with a thyroglossal cyst?

A

Prevent recurrence

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17
Q

When is hemithyroidectomy performed for thyroid nodules?

A

Cytology of nodule is equivocal or when follicular cells are seen as follicular adenomas cannot be differentiated from follicular carcinomas by cytological assessment

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18
Q

What operation is performed for thyroid cancer if there is spread to local lymph nodes?

A

Total thyroidectomy with central compartment node clearance

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19
Q

What is the function of calcitonin?

A

Inhibits osteoclast function

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20
Q

What can cause hair cell damage and therefore lead to sensorineural hearing loss?

A 
Gentamicin toxicity
Bacterial meningitis
Skull fracture
Noise exposure
Presbycusis
Genetic syndromes
Hereditary deafness
Acoustic neuroma
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21
Q

What is otosclerosis and what type of hearing loss does it lead to?

A

Overgrowth of bone in the middle ear fixing the foot plate of the stapes at the oval window, leading to a conductive hearing loss
If present untreated for many years, the cochlear can become affected and a mixed loss results

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22
Q

What are causes of a thyroid nodule? What should be done to investigate it?

A

Colloid cyst
Adenoma
Carcinoma
Fine needle aspiration

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23
Q

What causes benign positional vertigo?

A

Degenerative inner ear changes that result in debris impacting on the hair cells giving rise to the sensation of movement

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24
Q

What technique can be used to demonstrate the symptoms of benign positional vertigo?

A

Hallpike manoeuvre

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25
Q

How is benign positional vertigo best treated?

A

Inner ear physiotherapy

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26
Q

A 20 year old woman is referred to an ENT surgeon with recurrent epistaxis. No cause is found on nasal speculum examination and she is discharged. Four days later she is admitted to ED after massive haematemesis. What is the likely diagnosis? Why does this happen?

A

Hereditary haemorrhagic telangiectasia
Osler-weber-render syndrome
Fragile punctiform lesions on mucous membranes

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27
Q

A 29 year old singer is referred to ENT in a worried state as she has noticed her voice has become hoarse. Indirect laryngoscopy reveals small nodules on both vocal cords. What is the problem and how do you manage it?

A

Vocal cord nodules - keratin
Smaller nodules will disappear with voice rest
Larger ones need to be removed surgically

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28
Q

What is hysterical aphonia?

A

Hysterical reaction to some deep rooted psychological problem
Sudden onset
Failure to adduct the vocal cords

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29
Q

Levels of what hormone can be used to monitor for subclinical recurrence of medullary thyroid cancer after thyroidectomy?

A

Calcitonin

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30
Q

What are the 2 most common forms of thyroid cancer?

A

Papillary carcinoma 60%

Follicular carcinoma 20%

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31
Q

What is medullary carcinoma of the thyroid?

A

Tumour of parafollicular cells (C cells) which are derived from neural crest

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32
Q

Which infectious agent is associated with the development of nasopharyngeal carcinoma?

A

Epstein Barr virus

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33
Q

What are presenting features of nasopharyngeal carcinoma?

A 
Otalgia
Unilateral serous otitis media
Nasal obstruction/discharge/epistaxis
Cranial nerve palsies - III to VI
Cervical lymphadenopathy
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34
Q

What is the first line treatment for nasopharyngeal carcinoma?

A

Radiotherapy

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35
Q

What are possible complications of thyroid surgery?

A

Anatomical such as recurrent laryngeal nerve damage
Bleeding: Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema
Damage to the parathyroid glands resulting in hypocalcaemia

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36
Q

What are treatment options for Graves’ disease?

A

Antithyroid drugs - carbimazole
Radio iodine
Surgery

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37
Q

A cachectic 77 year old woman is rushed into ED with acute dyspnoea. On examination she is exhibiting stridor and has an irregular form goitre. What pathological thyroid problem is likely present? What is the treatment?

A

Anaplastic carcinoma - rapidly growing hard thyroid
Emergency radiotherapy
Excision of thyroid isthmus with tracheostomy

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38
Q

What is pendred syndrome?

A

Genetic disorder leading to congenital bilaterally sensorineural hearing loss and goitre with euthyroid or mild hypothyroidism

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39
Q

A 60 year old woman from Derbyshire is seen with progressively enlarging mass on right side of neck. It has been present for 10 years and is now causing dyspnoea on exertion. What is the underlying pathology?

A

Multinodular goitre - iodine deficiency

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40
Q

What are the most common thyroid neoplasms?

A

Papillary tumours

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41
Q

Who gets papillary thyroid carcinoma?

A

Young and middle aged women

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42
Q

How is papillary carcinoma of the thyroid treated?

A

Resection followed by thyroxine suppression

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43
Q

How does papillary carcinoma of the thyroid spread?

A

Lymph nodes

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44
Q

How is follicular carcinoma of the thyroid treated?

A

Total thyroidectomy

Radioiodine for mets

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45
Q

What are branchial cysts?

A

Congenital defects related to incomplete obliteration of the two or three branchial clefts which if left, get infected and form an abscess

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46
Q

What is done to manage branchial cysts?

A

Excised in continuity with its track, taking care of to damage adjacent structures such as facial nerve

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47
Q

Where can thyroglossal cysts form?

A

Anywhere from foramen caecum to thyroid isthmus, mostly infrahyoid

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48
Q

What is done to manage thyroglossal cyst?

A

Cyst excised in continuity with tract and body of hyoid to prevent recurrence

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49
Q

What is a cystic hygroma?

A

Hamartomas of jugular lymphatics

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50
Q

Why might a cystic hygroma enlarge quickly? Why is this a problem?

A

Haemorrhage
Develop secondary infection
Compress local structures

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51
Q

Which type of thyroid cancer may be familial?

A

Medullary thyroid carcinoma - c cells

Can be associated with MEN or ret proto oncogene mutations

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52
Q

A 35 year old woman presents with a hard mass in her neck which is progressively enlarging. Her PMH includes sclerosing cholangitis. On examination there is a hard mass affecting both right and left lobes. What is the likely diagnosis?

A

Riedels thyroiditis - dense fibrous infiltrate associated with sclerosing cholangitis and mediastinal and retroperitoneal fibrosis

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53
Q

What type of lymphoma is thyroid lymphoma usually?

A

Non hodgkins B cell lymphoma

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54
Q

On the background of what disease can thyroid lymphoma occur?

A

Hashimoto’s thyroiditis

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55
Q

A 65 year old lady presents to GP with recurrent bouts of deafness. A typical attack starts with a full feeling in the ear with tinnitus, which gradually increases in volume, followed by nausea, vomiting and rotational vertigo. What is the diagnosis?

A

Menieres disease - gradual increase in fluid in endolymphatic compartment of inner ear

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56
Q

How is otosclerosis treated?

A

Stapedectomy

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57
Q

A 35 year old man presents to GP with progressive bilateral hearing loss over 1 year. Rinne’s test is negative and on examination the tympanic membrane is normal. His father had a similar problem at his age and required a hearing aid. What is the diagnosis?

A

Otosclerosis - progressive conductive deafness due to fixation of stapes in the oval window

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58
Q

What typically are swellings in the posterior triangle?

A

Lymph nodes

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59
Q

What are characteristics of thyroid swellings which allow them to be differentiated from other causes?

A

Move with degluition but not protrusion of the tongue

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60
Q

Give some differentials for a swelling in the neck which moves on degluition

A

Thyroid swellings
Thyroglossal cyst
Hyoid bursa
Median/pyramidal lobe of thyroid

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61
Q

What are your differentials for swellings in the neck with a cough impulse?

A

Pharyngeal pouch
Laryngeal pouch
Diverticula
Cystic hygroma

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62
Q

How do you treat sinusitis?

A

Amoxicillin, decongestants, steroid drops/spray, mucolytics, antihistamines, lavage

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63
Q

What is the most common cause of community acquired sinusitis?

A

Streptococcus pneumoniae and Haemophilus influenzae

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64
Q

When is a tonsillectomy considered for children?

A

History of recurrent tonsillitis causing them to miss significant time at school
5 episodes per year requiring time off and have seen a doctor to be classed as “recurrent tonsillitis”

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65
Q

What does petechiae on the palate suggest in the context of a sore throat?

A

Infectious mononucleosis or group A streptococcal pharyngitis

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66
Q

When is de Quervains thyroiditis commonly seen?

A

Young women following a flu like illness

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67
Q

How is de Quervains thyroiditis treated?

A

Self limiting

NSAIDs

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68
Q

Who tends to get follicular carcinoma of the thyroid?

A

Females, mean age 50

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69
Q

How does follicular carcinoma of the thyroid differ from papillary?

A

Spreads haematogenously to the lungs

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70
Q

What is the most common cause of primary hypothyroidism?

A

Hashimotos disease

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71
Q

How is a diagnosis of hashimotos disease confirmed?

A

Biopsy

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72
Q

A 48 year old woman is seen in clinic. A referral letter from GP notes elevated TSH, low T4 and presence of antithyroid antibodies. She reports lethargy, dry skin, hair loss and weight gain. On examination she has a diffusely enlarged thyroid. What is the diagnosis?

A

Hashimotos disease

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73
Q

What is Reinkes oedema?

A

Recent strain on vocal cords - singers

Strain causes subepithelial infiltration of interstitial fluid into vocal cords causing oedema

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74
Q

What does the tympanic membrane look like in acute otitis media?

A

Retracted initially, handle and short process of malleus more prominent
Pressure builds up, ear drum may become distended and bulge outwards

75
Q

What is treatment for acute otitis media?

A

Broad spec abx to cover haemophilus and streptococci
Bed rest
Analgesia

76
Q

When should grommet insertion be considered?

A

Persistent middle ear effusion or recurrent attacks of acute otitis media

77
Q

What are some complications of thyroidectomy?

A

Bleeding
Recurrent and superior laryngeal nerve injury
Infection
Hypoparathyroidism - hypocalcaemia

78
Q

How should you treat symptomatic hypocalcaemia secondary to total thyroidectomy?

A

IV calcium gluconate

79
Q

How do you distinguish thyroid neoplasms from benign conditions?

A

History
Examination
USS
Fine needle aspiration cytology

80
Q

What clinical and investigation features suggest subacute (de Quervains) thyroiditis?

A

Tender goitre
Hyperthyroidism
Raised ESR
Globally reduced uptake on technetium scan

81
Q

What are the 4 phases of subacute (de Quervains) thyroiditis?

A

Phase 1: hyperthyroidism, painful goitre, raised ESR
Phase 2: euthyroid
Phase 3: hypothyroidism
Phase 4: thyroid structure and function returns to normal

82
Q

What are causes of Thyrotoxicosis?

A 
Graves' disease
Toxic nodular goitre
Acute phase of de Quervains thyroiditis
Acute phase of post partum thyroiditis 
Acute phase of Hashimoto's thyroiditis 
Amiodarone therapy
83
Q

Which patients with sub clinical hypothyroidism need treating?

A

TSH >10
Thyroid autoantibodies positive
Other autoimmune disorder
Previous treatment of Graves’ disease

84
Q

What is an antithyroid drug titration regime for graves?

A

Carbimazole 40mg then reduced gradually to maintain euthyroidism
Continued for 12-18 months

85
Q

What is a major complication of carbimazole therapy for Graves’ disease?

A

Agranulocytosis

86
Q

What is a block and replace regime for Graves’ disease?

A

Carbimazole started at 40mg
Thyroxine added when patient is euthyroid
Treatment for 6-9 months

87
Q

What are contraindications to radioiodine therapy for Graves’ disease?

A 
Pregnancy 
Breast feeding
Age <16
Severe uncontrolled thyrotoxicosis 
Thyroid eye disease (relative)
88
Q

What is the most likely adverse effect of radioiodine therapy for Graves’ disease?

A

Hypothyroidism

89
Q

A 9 month old boy is referred to ENT as he has been noted to have stridor. He sometimes chokes when drinking or feeding. His head circumference has risen from the 50% at birth to the 98% centile and he has short limbs. What is the likely problem?

A

Achondroplasia associated with hydrocephalus (Arnold Chiari malformation) which in turn can be associated with vocal cord palsy

90
Q

A 3 year old boy is brought to ED with stridor onset in last few hours and a barking cough. Over past 3 days he has been unwell with coryzal symptoms and ear temperature of 38.2. What is the diagnosis? What is the causative organism?

A

Croup

Parainfluenza

91
Q

What are local causes of chronic nasal discharge?

A 
Nasal polyps
Chronic sinusitis
Chronic infected adenoids
Deviated septum 
Foreign body
Nasal diphtheria
92
Q

What are systemic causes of chronic nasal discharge?

A 
Cystic fibrosis 
Dismotile cilia syndrome 
Allergy
Syphilis
Wegeners granulomatosis 
Immune deficiency 
Hypothyroidism
93
Q

What are features of infectious mononucleosis?

A 
Sore throat
Lymphadenopathy
Pyrexia
Malaise, anorexia, headache
Palatal petechiae
Splenomegaly
Splenic rupture
Hepatitis
Haemolytic anaemia cold agglutinins
Maculopapular rash if given amoxicillin
94
Q

How is a diagnosis of infectious mononucleosis made?

A

Monospot test in second week of illness

95
Q

What features of otitis externa make it more severe?

A 
Red oedematous ear canal which is narrow and obscured by debris
Conductive hearing loss
Discharge
Regional lymphadenopathy 
Cellulitis spreading beyond the ear
Fever
96
Q

How is otitis externa managed?

A

Mild: topical acetic acid 2% spray

More severe: 7 days of topical antibiotic with or without topical steroid

97
Q

What are indications for abx in a sore throat?

A 
Marked systemic upset
Unilateral peritonsillitis 
History of rheumatic fever
Increased risk from infection: diabetes, immunodeficiency 
3 or more centor criteria present
98
Q

In which circumstances are antibiotics required for otitis media?

A

Symptoms lasting more than 4 days or not improving
Systemically unwell
Immunocompromise or high risk of complications due to comorbidity
Younger than 2 with bilateral symptoms
Otitis media with perforation and or discharge in canal

99
Q

What antibiotics are prescribed for otitis media?

A

5 day course of amoxicillin

100
Q

What is the management for otitis externa?

A

Topical antibiotic and steroid
If canal debris consider removal
If swollen, ear wick

101
Q

What is Samters triad?

A

Asthma
Aspirin sensitivity
Nasal polyposis

102
Q

What are features of nasal polyps?

A 
Nasal obstruction
Rhinorrhoea
Sneezing
Snoring
Poor sense of taste and smell
103
Q

What is the management of nasal polyps?

A

Refer to ENT for full examination, particularly if unilateral, bleeding
Topical corticosteroids

104
Q

Which drugs can cause corneal opacities?

A

Amiodarone

Indomethacin

105
Q

Which drugs can cause optic neuritis?

A

Ethambutol
Amiodarone
Metronidazole

106
Q

What can be used as a tumour marker for medullary thyroid cancer?

A

Calcitonin

Originates from parafollicular cells

107
Q

What is Ludwigs angina?

A

Cellulitic like infection of floor of mouth with gram positive strep pyogenes

108
Q

What are the triad of symptoms in Ménière’s disease?

A

Spontaneous vertigo
Sensorineural hearing loss
Tinnitus

109
Q

What are complications of tonsillitis?

A

Otitis media
Quinsy
Rheumatic fever
Glomerulonephritis

110
Q

What are the criteria for tonsillectomy?

A

Sore throats due to tonsillitis
Person has five or more episodes per year
Symptoms occurring for at least a year
Episodes are disabling and prevent normal functioning

111
Q

What is Ménière’s disease?

A

Idiopathic swelling of the membranous labyrinth
Endolymphatic hydrops
Usually unilateral, is progressive

112
Q

What can be used as a tumour marker for papillary thyroid cancer?

A

Thyroglobulin

113
Q

What is hutchinsons sign?

A

Presence of vesicular rash on the tip of the nose which is strongly predictive for ocular involvement in herpes zoster

114
Q

What are neurological complications of Hashimoto’s thyroiditis?

A 
Cerebellar dysfunction/ataxia
Entrapment neuropathies - carpal tunnel syndrome 
Dementia/myxoedema madness
Coma
Hashimoto's encephalopathy
115
Q

What are associations of nasal polyps?

A 
Asthma 
Aspirin sensitivity
Infective sinusitis
Cystic fibrosis 
Kartageners syndrome
Churg Strauss
116
Q

What are features of nasal polyps?

A

Nasal obstruction
Rhinorrhoea
Sneezing
Poor sense of taste and smell

117
Q

What are unusual features of nasal polyps which require further investigation?

A

Unilateral symptoms

Bleeding

118
Q

What is Samters triad?

A

Asthma
Aspirin sensitivity
Nasal polyposis

119
Q

Which bugs most commonly cause sinusitis?

A

Strep pneumoniae
Haemophilus influenzae
Rhinovirus

120
Q

What are predisposing factors for sinusitis?

A

Nasal obstruction: septal deviation or nasal polyps
Recent local infection: rhinitis or dental extraction
Swimming/diving
Smoking

121
Q

What are features of sinusitis?

A

Facial pain: frontal pressure, worse on bending forward
Nasal discharge: thick and purulent
Nasal obstruction: mouth breathing
Post nasal drip: chronic cough

122
Q

What is the management of acute sinusitis?

A

Analgesia
Intranasal decongestants
Oral abx for severe presentations: amoxicillin

123
Q

Above what line on an audiogram is normal hearing?

A

20dB line

124
Q

Why does a thyroglossal cyst move on tongue protrusion?

A

Connected with the foramen caecum at back of tongue

125
Q

What is Mikulicz syndrome?

A

Chronic condition characterised by abnormal enlargement of glands in head and neck
Occurs in association with other disorders: TB, leukaemia, syphilis, hodgkins, sjogrens, SLE

126
Q

Which procedure is used to excise a thyroglossal cyst?

A

Sistrunks procedure

Small segment of hyoid bone is removed to gain access to cystic tract

127
Q

What are features of cholesteatoma?

A 
Foul smelling discharge
Hearing loss 
Vertigo
Facial nerve palsy
Cerebellopontine angle syndrome 
Attic crust seen on otoscopy
128
Q

What is cerebellopontine angle syndrome?

A 
Space occupying lesion causing:
Ipsilateral deafness
Nystagmus
Reduced corneal reflex
Vth and VIIth nerve palsies
Ipsilateral cerebellar signs
129
Q

Which bug causes cat scratch disease?

A

Bartonella henselae

130
Q

What are signs and symptoms of cat scratch disease?

A 
Tender swollen lymph nodes near site of scratch 
Malaise
Anorexia
Abdominal pain
Muscle and joint pains 
Sweats
131
Q

What is the management for a perforated ear drum?

A

Watch and wait- ent referral if persists beyond 6 weeks
Advise skin like structure will heal self like skin
Avoid getting water in ear to reduce chance of infection

132
Q

Why should topical nasal decongestants not be used for prolonged periods of time?

A

Tachyphylaxis: increasing doses required to achieve same effect
Rebound hypertrophy of nasal mucosa may occur on withdrawal

133
Q

What is the first line medication for treating otitis media if no improvement of symptoms after 2-3 days?

A

Amoxicillin 500mg TDS for 7 days

134
Q

What are the most common causes of hearing loss?

A

Ear wax
Otitis media
Otitis externa

135
Q

What are some complications of thyroid surgery?

A

Recurrent laryngeal nerve damage
Bleeding which can lead to laryngeal oedema and respiratory compromise
Hypocalcaemia due to parathyroid damage

136
Q

What are causes of otitis externa?

A

Infection: staph aureus, pseudomonas, fungal
Seborrhoeic dermatitis
Contact dermatitis: allergic and irritant

137
Q

What is the management of otitis externa?

A 
Topical antibiotic or combined with topical steroid
If canal debris: removal
If canal is swollen: ear wick
Oral antibiotics if infection spreading 
Swab
138
Q

How long do grommets usually last?

A

6-12 months

139
Q

What is the management of otitis media?

A 
80% resolve within 3 days
Antibiotics not usually recommended: NNT = 3-7 (depending on measure of success), NNH = 3-10 (rash, diarrhoea – mainly children)
Analgesia:
Paracetamol NNT = 6
Ibuprofen NNT = 5
140
Q

What are causes of earache?

A 
Otitis media
Otitis externa
Boils and furuncles of canal and pinna
Trauma / foreign body
Referred pain: throat, teeth, neck
TMJ dysfunction
Less common: Mastoiditis, Cholesteatoma, Malignancy
141
Q

What is the management of otitis externa?

A

Consider sending ear swab, ideally before starting antibacterial
Rarely may have fungal OE
Acetic acid spray / drops
Combined steroid and antimicrobial spray / drops: Consider ease-of-use
Appropriate analgesia

142
Q

What are complications of otitis externa?

A 
Malignant otitis externa: Elderly, diabetic patients most at risk, Often Pseudomonas spp. resistant to regular antibiotics, 50% mortality
Mastoiditis
Facial nerve (CN VII) palsy
143
Q

What investigation should be done for a patient presenting with unilateral hearing loss, tinnitus and vertigo?

A

Urgent MRI via 2 week wait head and neck protocol

Rule out acoustic neuroma

144
Q

What are common ent causes of vertigo?

A

Labyrinthitis (usually viral)
Benign Paroxysmal Positional Vertigo
Ménière’s disease

145
Q

What is the management of labyrinthitis?

A

Self-limiting, Duration up to 3 weeks
May need vestibular sedative / antiemetic
Consider impact on work / caring: Fit to drive? Sick note?
Persistent or worsening symptoms demand ENT review
Vestibular rehabilitation therapy (VRT) in extreme cases

146
Q

What causes BPPV?

A

Probable otolith in semicircular canal

147
Q

How is a diagnosis of BPPV confirmed?

A

Dix-Hallpike provocation test, Check they didn’t drive here

148
Q

How is BPPV managed?

A

Symptomatic treatment with betahistine, cinnarizine, prochlorperazine
Self-treatment with Brandt-Daroff exercises
Epley Manoeuvre

149
Q

What is the management of nasal polyps?

A

Steroid nasal sprays
Adjust underlying asthma treatment
Surgical treatment

150
Q

What is the management of allergic rhinosinusitis?

A

Allergen avoidance
Steroid nasal sprays
Antihistamine nasal spray: fexofenadine

151
Q

What is the management for post nasal drip?

A

Avoid antigens
Antihistamine
Oral decongestant
Nasal steroids

152
Q

What are causes of sore throat?

A 
Pharyngitis / viral URTI
Tonsillitis
Glandular fever
Quinsy (peritonsillar abscess)
Thrush (oropharyngeal candidiasis)
Less common: Reflux, Rare infections – Herpes simplex, diphtheria, Thyroiditis, Oropharyngeal carcinoma
153
Q

What is the management of quinsy?

A

Needs incision, drainage and IV abx

154
Q

What investigations might you do for a sore throat?

A 
Throat swab
FBC
Infectious mononucleosis test: monospot 
Upper GI endoscopy; in absence of oropharyngeal pathology a trial of PPI often resolves problem
Biopsy
155
Q

What is the centor criteria?

A

Adults and children >3y
1 point for each of the following:
Tonsillar exudate
Tender cervical lymph nodes
Fever
Absence of cough
Score 1: 2-23% chance of bacterial cause (GrpA Strep)
Score 4: 25-86% chance of bacterial cause
NICE: Antibiotics only if scoring 3 or more

156
Q

What larynx presentations warrant a 2 week wait referral?

A

Aged 45 years and over with:
Persistent, unexplained hoarseness > 3 weeks
Unexplained, persistent sore throat > 3 weeks
Need nasendoscopy

157
Q

What oral and oropharyngeal presentations warrant a 2 week wait referral?

A

Unexplained ulceration in oral cavity lasting more than 3 weeks
Assessed by a dentist/doctor as having a lump or erythroplakia on the lip/oral cavity consistent with oral cancer
Persistent, unexplained lump in neck > 3 weeks

158
Q

What thyroid presentations warrant 2 week wait referral?

A

Unexplained thyroid lump
Will need TFTs, TPO, UE, Ca2+
May already have USS but this should not delay referral

159
Q

What salivary gland presentations warrant a 2 week wait referral?

A

Persistent swelling in parotid / submandibular gland > 3 weeks
Examine for tenderness, congestion and history suggestive of sialolithiasis

160
Q

What are causative organisms of otitis media?

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

161
Q

When are antibiotics indicated for otitis media?

A

If persists beyond 4 days, Amoxicillin is the first line choice

162
Q

What are common causes of pharyngitis?

A 
Rhinovirus 
Corona virus 
Adenovirus 
HSV 
Streptococcus pyogenes (Group A Streptococci) 
Group C and Group G Streptococci
163
Q

How can the organism causing pharyngitis be detected?

A

Throat swab for culture

Rapid Antigen Detection Test (RADT)

164
Q

What are common causes of lumps in the neck?

A 
Skin and Subcutaneous lumps 
Lymph Nodes
Salivary Gland
Thyroid
Branchial Cysts
Laryngeal Cysts
Pharyngeal Pouches
165
Q

What are the different lymph node levels of the neck?

A

Level 1: a submental, b submandibular
Level 2-4: deep cervical/internal jugular chain
Level 5: posterior triangle/spinal accessory nodes
Level 6: prelaryngeal/pre tracheal
Level 7: superior mediastinal nodes

166
Q

What are the causes of lymphadenopathy?

A

Follicular (B cell): Bacterial Infection, RA, EBV (infectious mononucleosis), Toxoplasmosis
Paracortical (T cell): Viruses, Drugs, Dermatopathic
Sinus histiocytosis: Tumour Drainage, Other lesions e.g bruises
Granulomas: TB, fungi, Cat Scratch, Toxoplasmosis, Sarcoidosis, Crohn’s, Tumour Reaction e.g. SCC
Neoplastic: Primary (lymphomas), Secondary (metastases)

167
Q

What is a granuloma?

A

Focus of chronic inflammation consisting of a microscopic aggregation of macrophages surrounded by a collar of lymphocytes

168
Q

What are examples of benign salivary gland tumours?

A

Pleomorphic Adenoma

Warthin Tumour

169
Q

What is a pleomorphic adenoma?

A

Most common salivary gland tumour in major and minor salivary glands
Natural history: slow growing, usually asymptomatic
Histology: Innumerable patterns. Tumour that shows epithelial and myoepithelial elements mixed with a myxoid and chondroid
material

170
Q

What is a warthin tumour?

A

2nd most common salivary gland tumour in parotid
Natural history: slow growing, link to cigarette smoking
Histology: Cystic structures lined by oncocytic epithelium within a lymphoid stroma

171
Q

What are examples of malignant salivary gland tumours?

A

Adenocarcinomas: Mucoepidermoid, Adenoid Cystic
Lymphoma: MALToma (salivary gland), Other types (Within lymph nodes)
Secondaries (Parotid): Squamous cell carcinoma, Malignant melanoma

172
Q

What is a mucoepidermoid carcinoma?

A

Most common malignant salivary gland tumour
Natural history: Firm, fixed and painless swellings
Histology: Contains epidermoid cells, intermediate cells andmucocytes. It can be cystic.

173
Q

What is an adenoid cystic carcinoma?

A

<10% of salivary gland tumour
Natural history: Slow growing swelling. Numbness paresthesia or pain. It can cause facial or tongue weakness
Histology: Tubular cribiformand solid patterns of epithelial and
myoepithelial cells

174
Q

Where are salivary gland stones the most common?

A

Submandibular Gland due to stickier/more mucinous secretions - Sialolithiasis

175
Q

What cancer are Sjögren’s syndrome sufferers at risk of?

A

MALT lymphoma in salivary glands

176
Q

What is Sjögren’s syndrome?

A

Autoimmune disease that involves lacrimal and salivary glands
Dry eyes, dry mouth, enlargement of parotid glands. Positive
Schirmer test. Auto antibodies to Ro or La in serum
Histology: Lymphocytic infiltration of the gland with epithelial
differentiation in the parotid

177
Q

What are differential diagnosis for a single thyroid nodule?

A

Cyst
Multinodular Goitre +/- dominant hyperplastic nodule
Benign: Follicular Adenoma, NIFTP (non invasive follicular thyroid neoplasm with papillary like features)
Malignant: Papillary thyroid carcinoma (>70% of thyroid malignancies), Follicular thyroid carcinoma, Poorly Differentiated, Anaplastic, Medullary, Lymphoma, Metastases

178
Q

What results are given from a thyroid fine needle aspiration?

A

Thy1: Non diagnostic
Thy2: Benign features
Thy3a: Atypical cytology (5– 15% could be malignant)
Thy3f: Follicular lesion, (20 – 30% could be malignant)
Thy4: Suspicious for malignancy (60 – 75% could be malignant)
Thy5: Malignant (>97% are malignant)

179
Q

What is the difference in prognosis between different thyroid cancers?

A

Papillary: Good
Follicular: Minimally invasive – good, Widely invasive – worse
Poorly differentiated – about same as WI FC
Anaplastic – appalling, but presents differently

180
Q

Who is involved in the MDT for thyroid cancers?

A 
Pathology
Oncology
Radiology
CNS
SALT/Dietetics
Surgery
181
Q

39 year old male. Non smoker, non drinker. Presents with 2 months of enlarging left neck mass and increasing difficulty in swallowing. What investigations would you like?

A 
Flexible nasendoscopy
FNA
Contrast CT neck and chest
Contrast MRI
(PET CT if no obvious primary lesion)
Panendoscopy/biopsy
182
Q

What is the link between HPV and oropharyngeal squamous cell carcinoma?

A

Base of tongue and tonsils
Incidence of OPSCC has risen over the past 3 decades
Male to female ratio of 4:1
HPV16 >90% of cases
Oral sex is an established risk factor
Significantly better survival outcomes than HPV negative OPSCC

183
Q

59 year Old Female. Smokes 15 cigarettes per day. Presenting with 8 months of increasing dysphonia. What investigations would you like to order?

A

Nasendoscopy
Microlaryngoscopy
Biopsy
Imaging

Phase 3 (23 decks)

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