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2nd Year Medicine > ENT > Flashcards

ENT Flashcards

1
Q

What is used to test hearing range?

A

Audiogram (the higher up the better the hearing)

  • 20-40 = moderate hearing loss
  • 70-90 = severe hearing loss
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2
Q

Function of external ear?

A

Receives sound

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3
Q

Function of middle ear?

Tympanic memrane : oval window ratio?

A

Acts as an amplifier

* 18:1 (impedance matching air to liquid)

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4
Q

Closure and opening of eustachian tube?

Function of tube?

A

Resting state of cartilaginous tube is closed but opened by tensor veli palatini & levator palatine muscles
*pressure equalisation in ears (dysfunction leads to middle ear negative pressure)

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5
Q

Oval and round windows?

Function?

A

2 openings of cochlea into middle ear

* transmission of pressure wave + vibration of basilar membrane

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6
Q

What causes fluid vibration?

Explain how vibration is picked up by basilar membrane?

A

Movement of stapes via stapedius (smallest skeletal muscle in the entire body)

  • High frequency sound at beginning of membrane
  • Low frequency sound towards apex (end of the spiral)
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7
Q

Function of inner ear?
Structure?
What is found in centre?

A

Receiver/transducer (fluid -> AP)

  • Spiral lamina wrapped around central modiolus
  • cochlear nerve found inside central modiolus
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8
Q

Explain structure of cochlea

What do these open up into?

A

Scala media (endolymph) suspended in between scala tympani & scala vestibuli (perilymph)

  • Scala vestibuli = oval window
  • scala tympani = round window
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9
Q

Ionic composition of periplymph and endolymph?

A

Perilymph
* Na+

Endolymph
* K+

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10
Q

Explain central pathway of sound perception? (5)

A

Organ of Corti depolarises and fires
Stimulates VIIIth nerve and then central pathways

E COLI

  • Ear ->
  • Cochlear nucleus ->
  • superior Olivary complex ->
  • Lateral lemniscus ->
  • Inferior colliculus
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11
Q

Where is primary auditory cortex?

A

Posterior superior temporal gyrus

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12
Q

When can foetus hear?

A

18 weeks - foetus can hear

26 weeks - foetus will respond to sound/voice

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13
Q

Universal neonatal screening for hearing loss?

A

OAEs can be identified in normal cochlea - if absent, suggest a problem

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14
Q

Explain how cochlear implant works

A
  • Inserted into scala tympani

* Will coil around cochlear nerve

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15
Q

Normal development of hearing/vocals? (5)

A
  • 3 months - cooing, recognises mother’s voice
  • 6 months - babbling, makes happy and sad sounds, eyes towards sounds
  • 12 months - mama/dada, follows instructions
  • 12-18 months - syllable deletion/substitution
  • 24 months - two word phrases, 50+ words, understands questions and follows commands
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16
Q

Explain balance input/output to central pathway?

A

Input (4)

  • visual
  • cardiovascular
  • vestibular
  • proprioceptive

Output (2)

  • vestibulospinal tract
  • vestibulo-ocular reflex
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17
Q

Explain the input/output involved in Rombergs test? (standing on foam)

A 
Input = vestibular 
Output = vestibulospinal

(if fall over = positive rombergs)

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18
Q

vestibular nerve supply to inner ear?

A
  • Superior vestibular nerve = lateral, anterior semi-circular canal, and utricle
  • inferior vestibular nerve = poserior semi-circular canal and saccule
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19
Q

Hair cells of inner ear? (2)

Mechanism?

A
  • Kinocilium = longest hair
  • stereocilia = the rest

Movement of hair cells towards longest = depolarises (increases firing rate)
If movement away from longest = hyperpolarised (decreases firing rate)

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20
Q

Otolith organs?

Explain structure

A

Utricle and saccule
* maculae of these organs have stereocilia projecting upwards into gel membrane + otoconia (the gel membrane pulls the hairs in different directions)

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21
Q

What allows the head to perceive position and movement when tilting head or making horizontal movements?

A

Otolith organs

Also in a lift, it is your otolith organ that allows you to sense whether you’e going up or down even tho you can’t see

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22
Q

how many semi-circular canals are there?

Orientation?

A

3 on each side of the head

  • lateral
  • anterior
  • posterior

They are paired
* orientated at 90* from each other

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23
Q

What is the ampullary capula?

Function?

A

Sits in ampulla of semi-circular canal

  • it is pushed by perilymph in opposite direction response to movement
  • “bending” cause cilia to deflect
  • sends signals to vestibular nerve
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24
Q

Vestibulo-occular reflex input and output?

A
  • input: vestibular
  • output: vestibulo-ocular reflex

(hold thumb, look at it, turn head)

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25
Q

S/s of dysfunctional vestibulo-ocular reflex as a result of damaged ear?

A

Nystagmus

* if lose left ear, eyes move left then flick back to right quickly

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26
Q

Oscillopsia?

Ax?

A

Shaky eye movement

* gentamicin toxcicity (no vestibular input)

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27
Q

What is vestibulospinal tract?

A

motor output to the neck, back and leg muscles

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28
Q

What comprises the vestibulo-ocular tract?

A

fasciculus + ocular muscles - motor output to eyes

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29
Q

What are receptors for taste and smell?

A

Chemoreceptors - stimulated by binding of particular chemicals

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30
Q

Gustation?

A

Taste

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31
Q

Taste buds made up of?

A
  • sensory receptor cells
  • support cells

(arranged like slices of orange)

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32
Q

How are taste receptor cells replaced?

A

From basal cells

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33
Q

What do taste receptor cells synapse with?

A

afferent nerve fibres

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34
Q

Where are taste buds found?

A
  • tongue
  • palate
  • epiglottis
  • pharynx
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35
Q

Where do most taste buds sit?

Types? (4)

A

majority of taste buds sits in papillae in the tongue

  • filliform
  • fungiform
  • vallate
  • foliate
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36
Q

Nerve supply to tongue?

A
  • Posterior 1/3rd = glossopharyngeal nerve

* anterior 2/3rds = chorda tympani (CN VII)

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37
Q

Physiology of taste (gustation)?

Nerves involved?

A
  • Binding of tastant to receptor cells causes depolarisation
  • APs conveyed by cranial nerves to cortical gustatory areas

Afferent taste fibres reach the brainstem via:

  • VIIth cranial nerve (chorda tympani branch of facial nerve) - anterior two-thirds of the tongue
  • IXth cranial (glossopharyngeal) nerve - posterior third of the tongue
  • Xth caranial (vagus) nerve - areas other than tongue, including e.g. epiglottis and pharynx
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38
Q

What are 5 primary tastes?

A
  • Salty - stimulated by NaCl
  • Sour - stimulated by acids with free H+ ions
  • Sweet - glucose
  • Bitter - alkaloids + poisonous substances
  • Umami - triggered by amino acids (esp. glutamate)
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39
Q

Abnormalities of taste? (3)

A
  • Ageusia (loss of taste) = nerve damage, inflammation, endocrine disorders
  • Hypogeusia (reduced taste) = chemo, medications
  • Dysgeusia (distortion of taste) = gum infection, tooth decay, reflex, URTI, chemo, meds
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40
Q

What does olfactory mucosa contain? (3)

A

3 cell types

  • olfactory receptor cells
  • supporting cells
  • basal cells (secrete mucus)
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41
Q

Explain structure of olfactory receptor

A

Each neuron has thick short dendrite and expanded end called olfactory rod (rods attach to cilia)

  • odorants (molecules that can be smelled) attach to cilia
  • axons of olfactory receptors form olfactory nerve
  • pierce cribiform plate and enter olfactory bulbs in brain
  • olfactory bulbs send signals to olfactory areas of temporal lobe
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42
Q

What properties must a substance have in order to be smelled? (2)

A
  • volatile

* water soluble

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43
Q

Abnormalities of smell? (3)

A
  • Anosmia (inability to smell) = infections, allergy, nasal polyps
  • Hyposmia (reduced ability to smell) = may be early sign of parkinsons
  • dysosmia (altered sense of smell) = hallucinations etc
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44
Q

Viral causes of oral ulceration? (2)

A
  • herpes simplex

* Coxsackie

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45
Q

Which type of herpes simplex causes oral lesions?

How is it transmitted?

A 
Type 1 (acquired in childhood)
* thru saliva contact
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46
Q

What is primary gingivostomatitis caused by?
Which group of people are affected?
S/s? (3)

A

HSV1
Pre-school children

s/s

  • fever
  • lymphadenopathy
  • ulcers on lips, buccal mucosa, hard palate
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47
Q

Tx for primary gingivostomatitis?

A

Aciclovir

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48
Q

Is herpes simplex “curable”?

A

No

Latent form remains in trigeminal nerve and can reactivate

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49
Q

Tx cold sore?

A

Aciclovir (DOES NOT PREVENT LATENCY)

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50
Q

Are recurrent intra-oral lesions likely to be HSV?

A

No, usually only on lips (cold sore)

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51
Q

Herpetic whitlow?

A

lesion (whitlow) on a finger or thumb caused by the herpes simplex virus (HSV1 or 2)

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52
Q

Dx HSV?

A

Swab of vesicle, then detection of viral DNA by PCR

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53
Q

Significant complication of HSV?

A

herpes simplex encephalitis (high mortality!)

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54
Q

Herpangina?
Ax?
Dx?

A

Ulcers on the soft palate

  • Ax = coxsackie viruses e.g. enterovirus (not HSV)
  • Dx = viral PCR
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55
Q

Hand, foot and mouth disease?
Ax?
Dx?

A

Blisters on hands, feet and mouth

  • Ax = coxsackie virus (enterovirus)
  • Dx = PCR for viral DNA
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56
Q

What is ulcer caused by syphillis called?
Is it a virus?
S/s?
Tx?

A

Chancre
* no, it is caused by bacterium called treponema pallidum

s/s
* painless oral lesions (unlike herpes)

Tx = penicillin :)

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57
Q

apthous ulcers?
Ax?
Tx?

A

recurring painful ulcers of the mouth that are round and have inflammatory halos

  • non-viral (not infectious but INCREDIBLY common)
  • Tx = self-limiting
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58
Q

Differentials for recurrent painful ulcers?

A
  • Apthous ulcers

* Herpes simplex

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59
Q

Recurrent ulcers associated with systemic disease?

A
  • Bechet’s disease (oral ulcers, genital ulcers, uveitis - common in Asia)
  • Coeliacs or IBD (diarrhoea, weight loss)
  • Reiter’s disease (arthritis)
  • Skin diseases (lichen planus, pemphigus, pemphigoid)
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60
Q

When should EBV be suspected as a cause of sore throat?

Other possible differentials? (3)

A

If sore throat and lethargy persist into the second week, especially if the person is 15-25years of age, infectious mononucleosis (EBV) should be suspected

Less common causes

  • HIV
  • gonococcal pharyngitis
  • diptheria
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61
Q

When should you not examine a sore throat?

A

Sore throat with stridor or respiratory difficulty is an absolute indication for
admission to hospital, and attempts to examine the throat should be avoided

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62
Q

What are most sore throats caused by?

Tx?

A

Virus

self-limiting

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63
Q

Most common bacterial cause of sore throat?
What condition does it cause?
Tx?

A

Strep pyogenes (GAS)

  • acute follicular tonsilitis
  • Tx = phenoxymethylpenicillin
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64
Q

Strep pyogenes complications? (2)

A
  • Rheumatic fever - fever, arthritis, pancreatitis

* Glomerulonephritis - haematuria, albuminuria, oedema

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65
Q

What can cause neutropenia?

A

Drugs like carbimazole, chemo

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66
Q

Tx group A strep?
What about if severe?
What is classed as severe?

A

Penicillin

  • phenoxymethylpenicillin
  • severe = Fever PAIN 4 or 5, CENTOR 3 or 4
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67
Q

What is diptheria caused by?
S/s? (3)
Tx?

A 
Corneobacterium diptherae
S/s
* pseudomembrane
* severe sore throat
* produces exotoxin which is cardiotoxic and neurotixic

Tx = antitoxin + supportive (if doesn’t work, penicillin/erythromycin)

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68
Q

S/s infectious mononucleosis? (6)

A
  • Enlarged lymph nodes
  • Sore throat
  • Pharyngitis
  • Tonsilitis
  • Malsaise
  • lethargy
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69
Q

Complications of EBV? (4)

A
  • anaemia, thrombocytopenia
  • splenic rupture
  • upper airway obstruction
  • increased risk of lymphoma
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70
Q

Tx EBV? (4)

A
  • Bed rest
  • paracetamol
  • antivirals NOT effective
  • steroids MAKE WORSE
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71
Q

Dx EBV? (4)

A
  • EBV IgM
  • Heterophile antibody (paul-bunnell test, monospot test)
  • blood count
  • LFT (EBV can result in jaundice)
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72
Q

Differential diagnosis of EBV?

A
  • cytomegalovirus
  • toxoplasmosis
  • primary HIV

common s/s: malaise, sore throay, leucocytosis

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73
Q

Tx candida?

A

nystatin or fluconazole

74
Q

What is acute otitis media?
Group of people?
S/s?

A

URTI infection involving the middle ear by extension of infection up the Eustachian tube

  • infants and children
  • presents with ear ache
75
Q

Infections of middle ear (otitis media) Ax?
Common bacteria?
Dx?

A

Often viral with secondary bacterial infection
* Haemophilus influenzae, strep pneumoniae, strep pyogenes

Dx = swab of pus if eardrum perforates (otherwise samples can’t be obtained)

76
Q

Tx of middle ear infections?

A

normally resolve on their own within 4 days

  • First line = amoxicillin
  • second line = erythromycin
77
Q

Malignant otitis?

S/s? (4)

A

Fatal condition without Tx (can lead to osteomyelitis of skull and meninges)

  • Severe headache
  • SEVERE +++ ear pain (even tho ear just appears a bit red)
  • granulation tissue in ear canal
  • facial nerve palsy (drooping face on side of lesion)
78
Q

Risk factors for malignant otitis?

A
  • diabetes

* radiotherapy to head and neck

79
Q

Dx malignant otitis?
Ax?
Tx?

A

Dx = PV/CRP, imaging, biopsy, culture

  • cause is usually pseudomonas aerguinosa
  • Tx = ciprofloxacin
80
Q

Tx malignant otitis?

A

Ciprofloxacin

81
Q

Otitis externa?

S/s? (5)

A

Inflammation of outer ear canal

  • redness
  • itchy
  • pain
  • discharge or increased amounts of earwax
  • hearing loss can occur if canal becomes blocked by earwax or discharge
82
Q

Ax otitis externa? (3)

A

Bacterial causes

  • staph aureus
  • proteus
  • pseudomonas aeruginosa (swimmers)

Fungal

  • aspergillus niger (appears black)
  • candida albicans
83
Q

Tx otitis externa?

A

Depends on cause

  • Aspergillus niger = topical clotrimazole
  • bacterial = gentamicin
84
Q

Ax acute sinusitis?

What indicates secondary bacterial infection?

A

Preceded URTI

* severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection

85
Q

Organisms in acute sinusitis?

A

Mostly viral

* bacteria similar to otitis media (H. influenzae, strep pneumoniae, strep pyogenes)

86
Q

Tx acute sinusitis? (2)

A

Antibiotics

  • 1st line = phenoxymethylpenicillin
  • 2nd line = doxycycline (NOT IN CHILDREN - tooth staining)
87
Q

types of hearing loss?(3)

A
  • conductive
  • sensorineural
  • mixed
88
Q

Otalgia?

A

ear ache (not necessary indicative of ear pathology as can be referred)

89
Q

Otitis externa?
Ax?
S/s?

A

Inflammation of the skin of the ear canal

  • Ax = bacterial or fungal (cotton buds, water)
  • Sore + itchy
90
Q

Features of acute otitis media?

A
  • More common in children
  • Associated with glue ear
  • Commonly associated with URTIs
91
Q

Types of chronic otitis media? (3)

A
  • Otitis media with effusion (glue ear)
  • Cholesteatoma
  • Perforation
92
Q

Glue ear in children?

Adults?

A 
In children associated with eustachian tube dysfunction or obstruction
IN adults
* rhinosinusitis
* nasopharyngeal carcinoma
* nasopharyngeal lymphoma
93
Q

Symptoms of chronic otitis media with effusion?

A

Conductive hearing loss with flat tympanogram

94
Q

Tx chronic otitis media with effusion?

A

myringotomy + gromet to stop hole closing

95
Q

Tx acute otitis media?

A

Eardrum normally perforates then heals on its own

96
Q

Cholesteatoma?

A

Prescence of keratin within middle ear - can erode ossicles!!

97
Q

S/s cholesteatoma?

Tx?

A

Hearing loss, discharge

* Surgery

98
Q

Complications of acute otitis media and cholesteatoma?

A
  • Medially = tinnitus, vertigo, sensorineural hearing loss, facial palsy
  • Superiorly = brain abscess, meningitis
  • posteriorly = venous sinus thrombosis
99
Q

Otosclerosis?

Tx?

A

Fixation of stapes footplate resulting in gradual conductive hearing loss!
Tx = stapedectomy

100
Q

Otosclerosis affects?

A

Women mostly

progresses faster during pregnancy

101
Q

Presbycusis?

A

Sensorineural hearing loss

usually high frequency

102
Q

Noise-induced hearing loss classical dip?

A

4 kHz

103
Q

Drug-induced hearing loss? (3)

A
  • Gentamicin
  • Chemo - cisplatin, vincristine
  • Aspirin + NSAIDs (overdose)
104
Q

Vestibular schwannoma?

A

Benign tumour arising in internal acoustic meatus (vestibular nerve)

105
Q

Vestibular schwannoma s/s? (3)

Dx?

A
  • hearing loss
  • tinnitus
  • imbalance

Dx = MRI

106
Q

Difference between dizziness and vertigo?

A 
Dizziness = non-speciic term
Vertigo = spinning
107
Q

diseases affecting balance pathways?

A
  • Visual = cataracts, DM
  • Cardio = arrhythmias, postural hypotension
  • Vestibular = BPPV, Menieres, Vestibular neuronitis
  • Proprioceptive = DM, arthritis, neurology
  • Vestibulospinal tract + VOR = stress, migraine, space-occupying lesion, MS
108
Q

Duration of vertigo episodes?

A
  • Seconds = BPPV
  • Hours = Menieres
  • Days = Vestibular neuritis
  • Variable = migraine
109
Q

Top questions for quick dizziness diagnosis? (4)

A
  • Do you get dizzy rolling over in bed? = BPPV
  • First attack severe, lasting hours with nausea and vomiting? = vestibular neuritis
  • Light-sensitive during dizzy spells? = migraine
  • Ear feel full or hearing loss during dizzy spell? = meniere’s
110
Q

Benign positional paroxysmal vertigo?

A

VERY COMMON - commonest cause of vertigo on looking up

111
Q

Ax BPPV?

A

Idiopathic, head trauma, ear surgery

112
Q

Pathophysiology BPPV?

Tx? (3)

A

Otolith material from utricle displaced into semicircular canals (usually posterior SCC)

  • Epley manoeuvre
  • Semont manouevre
  • Brand-Daroff exercises
113
Q

Dx BPPV?

A

Hallpike test

114
Q

Vestibular neuronitis s/s?

A
  • Prolonged vertigo (days)

* NO tinnitus or hearing loss!!

115
Q

Labyrinthitis s/s? (3)

A
  • prolonged vertigo (days)
  • tinnitus
  • hearing loss
116
Q

Vestibular neuronitis + labyrinthitis tx?

A
  • Vestibular sedatives e.g. diazepam

* Self-limiting (viral aetiology)

117
Q

Menieres disease Ax?

Pathophysiology?

A

Unknown

* endolymphatic hydrops

118
Q

Menieres disease s/s? (5)

A
  • recurrent, spontaneous, rotational vertigo with at last 2 episodes lasting >20 mins
  • Tinnitus on affected side
  • aural fullness on affected side
  • SNHL
119
Q

Meniere’s disease tx?

A
  • supportive
  • avoid things like caffeine, alcohol, stress

If severe

  • gentamicin
  • grommet
  • surgery (e.g. vestibular nerve section)
120
Q

Epithelium of middle ear?

A

Non-ciliated cuboidal

121
Q

Otic capsule surrounds?

A

Vestibule, cochlea + semi-circular canals

122
Q

Types of rhinitis?

A
  • Infective = viral URTI

* Non-infective = allergic and non-allergic

123
Q

Tx allergic rhinitis?

A

Stepwise

  • allergen avoidance
  • then antihistamines
  • topical steroids
  • topical steroids + antihistamine combo
124
Q

Nasal polyps associated with?

Tx?

A

Often associated with non-allergic asthma
Tx
* oral then topical steroids
* if not better, then surgery

125
Q

How to tell the difference between a nasal polyp and a large inferior turbinate?

A

If touch a polyp, won’t have any sensation

126
Q

Acute infective rhinitis s/s? (3)

Tx?

A
  • Facial pain
  • discharge
  • nasal blockage

Tx

  • analgesics and decongestants
  • if persistent, add antibiotic
127
Q

Rhinosinusitis complications? (2)

A
  • Cavernous sinus thrombosis

* Orbital cellulitis

128
Q

Infective rhinitis called?

A

Rhinosinusitis

129
Q

Types of non-allergic rhinitis? (2)

A
  • Polyps

* vasomotor rhinitis

130
Q

Investigations rhinitis?

A
  • RAST
131
Q

Unilateral discharge from nose differentials?

A

Adult

  • nasal or paranasal tumour
  • REFER URGENTLY

Child
* foreign body

132
Q

What is orbital cellulitis a complication of?

A

Acute sinusitis

* EMERGENCY REFERRAL (can cause blindness)

133
Q

Benign salivary gland tumours? (4)

A
  • pleomorphic adenoma
  • warthins
  • oncocytoma
  • monomorphic
134
Q

Malignant salivary gland tumours? (5)

A
  • mucoepidermoid
  • adenoid cystic
  • acinic cell Ca
  • SCC
  • adenocarcinoma
135
Q

Non-epithelial salivary gland tumour?

A

Lymphoma

136
Q

What is important to exclude in nasal trauma?

A

Septal haematoma

137
Q

Tx nasal fracture?

A

Digital manipulation <3 weeks

138
Q

Complications of nasal trauma? (3)

A
  • Epistaxis - anterior ethmoid artery
  • CSF leak, meningitis
  • Anosmia - cribiform plate fracture
139
Q

Blood supply in epistaxis? (3)

A
  • Sphenopalatine artery
  • Ethmoid artery
  • Greater palatine artery

from ICA and ETA??

140
Q

Management epistaxis? (3)

A
  • external pressure to nose
  • cautery
  • nasal packing
141
Q

What should you never do to patient with nasal trauma?

A

Sedate

142
Q

CSF leak management?

A

Often settle spontaneously
* need repair if >10 days

(site of fracture may be cribiform plate)

143
Q

Ear emergencies? (4)

A
  • Pinna haematoma
  • Ear lacerations
  • Temporal bone fractures
  • sudden sensorineural hearing loss
144
Q

Tx pinna haematoma? (3)

A
  • Aspirate
  • Incision and drainage
  • Pressure dressing

(no evidence on which technique is best?)

145
Q

Tx ear lacerations? (3)

A
  • Debridement
  • Closure
  • Antibiotics - cartilage
146
Q

Classification temporal lobe fracture? (3)

A
  • Longitudinal vs transverse
  • otic capsule involved
  • otic capsule spared
147
Q

Longitudinal temporal bone fracture caused by?

Complications? (4)

A

Lateral blows

  • haematympanum (conductive deafness)
  • ossicular chain disruption (conductive deafness)
  • Facial palsy
  • CSF otorrhea
148
Q

Transverse temporal bone fracture caused by?

Complications? (3)

A 
Frontal blows
Complications = can cross IAM causing damage to auditory and facial nerves
* sensorineural hearing loss
* Facial nerve palsy
* Vertigo
149
Q

Causes of conductive hearing loss? (3)

A
  • Fluid
  • TM perforation
  • Ossicular problem
150
Q

Mx foreign bodies in ear?

A

Can usually wait until urgent clinic for removal

  • EXCEPT watch batteries - remove immediately
  • Live animals - drown with oil then can be removed next day
151
Q

Classification neck trauma? (3)

A
  • Zone 1 = trachea, oesophagus, throacic duct, thryoid, vessels (brachiocephalic, subclavian, common carotid), spinal cord
  • Zone 2 - larynx, hypopharynx, CN 10, 11, 12, vessels (carotids, internal jugular), spinal cord
  • Zone 3 - pharynx, cranial nerves, vessels (carotids, IJV, vertebral), spinal cord
152
Q

Ix neck trauma? (4)

A
  • FBC
  • Neck X-ray
  • CXR (haemo-pneumothorax)
  • CT angiogram
153
Q

Deep neck space infection?

A
  • extension of infection from tonsil or oropharynx into deeper tissues
154
Q

Deep space neck infection tx? (3)

A
  • Fluid resus
  • IV antibiotics
  • Incision and drainage of neck space
155
Q

Orbital blowout fracture?

A

Medial wall + floor

156
Q

Management orbital blowout fracture?

A 
Conservative
Surgical repair of bony walls if:
* entrapment
* large defect
* significant enopthalmos
157
Q

Ix head and neck cancer? (3)

A
  • radiology
  • fine needle aspiration
  • endoscopy/biopsy
158
Q

Waldeyer’s ring found?

What is it made up of? (3)

A

Found in subepithelial layer of oropharynx and nasopharynx

  • tonsils (palatine tonsil)
  • adenoids (pharyngeal tonsil)
  • Lingual tonsil
159
Q 
Histology tonsils (palatine)?
Adenoids?
A
  • Palatine = Specialised squamous

* Adenoids = ciliated pseudostratified columnar + stratified squamous

160
Q

Histology of throat?

A

Upper aerodigestive

  • ciliated columnar respiratory mucosa
  • squamous epithelium

Where food goes
* squamous (oral, pharyngeal, vocal cords, oesophagus)

Where air goes
* pseudostratified columnar (nose, nasopharynx, larynx, trachea)

161
Q

Common diseases of the tonsils and adenoids? (6)

A
  • acute tonsillitis
  • recurrent/chronic tonsilitis
  • onstructive hyperplasia
  • malignancy
  • tonsiliths (tonsil crypt debris)
  • (otitis media with effusion)
162
Q

Ax acute tonsilitis?

A

Viral = EBV, rhinovirus, influenza

(sometimes bacterial) - GAS very important due to complications!!

163
Q

Most common pathogens involved in chronic tonsilitis? (4)

A
  • GAS
  • H.infleunza
  • Staph aureus
  • strep. pneumoniae
164
Q

Differentials acute tonsilitis? (6)

A
  • Infectious mononucleosis
  • peritonsilar abscess
  • candida infection
  • malignancy
  • diptheria
  • scarlet fever
165
Q

S/s tonsilitis?

A

Viral

  • malaise
  • sore throat
  • lasts 3-4 days

Bacterial

  • systemic upset
  • fever
  • odynophagia
  • hallitosis
  • unable to work/school
  • lymphadenopathy
  • lasts >1 week (reqs antibiotics)
166
Q

Centor criteria?

A

Differentiate bacterial from viral tonsilitis

  • Fever
  • tonsillar exudates
  • tender anterior cervical adenopathy
  • absence of cough

0 or 1 point = no antibiotics
2 - 3 = antibiotics

167
Q

Tx bacterial tonsilitis?

A

Antibiotics

  • penicillin 500mg for 10 days
  • clarithromycin if allergic
168
Q

Peritonsilar abscess?

A

Bacteria between muscle and tonsil produce pus - complication of acute tonsilitis

169
Q

S/s peritonsilar abscess? (5)

Tx?

A
  • history of acute tonsilitis
  • unilateral throat pain and odynophagia
  • medial displacement of tonsil and uvula
  • concavity of palate lost

Tx

  • aspiration
  • antibiotics
170
Q

Glandular fever?

S/s? (4)

A

Infectious mononucleosis - EBV

  • Tonsillar enlargement with membranous exudate
  • cervical lymphadenopathy
  • petechial haemorrhages on palate
  • hepatoplenomegaly
171
Q

Dx glandular fever?

A
  • atypical lymphocytes in blood
  • Monospot or Paul-Bunnel test
  • Low CRP (<100)
172
Q

Tx glandular fever?

A
  • Antibiotics - DO NOT PRESCRIBE AMPICILLIN (macular rash will result!!)
  • Steroids
173
Q

Why should never give amoxicillin to tonsilitis?

A

In case it is infectious mononucleosis

* can cause macular rash

174
Q

Chronic tonsilitis s/s?

A
  • chronic sore throat
  • malodorous breath
  • tonsiliths
  • peritonsillar erythema
  • persistent tender cervical lymphadenopathy
175
Q

Obstructive hyperplasia s/s? (2)

A
  • snoring

* AOM/OME (if affects adenoids)

176
Q

Glue ear?

A
  • otitis media with effusion
  • serous otitis media
  • acute otitis media

Inflammation of middle ear with accumulation of fluid

177
Q

Difference between OME and AOM?

A

OME

  • fluid
  • hearing loss

AOM

  • no fluid
  • no hearing loss
178
Q

OME incidence?

A
  • Children
  • M > F

Increased incidence with daycare, smoking household, recurrent URTI

179
Q

S/s eustachian tube dysfunction? (5)

A
  • TM retraction
  • reduced TM mobility
  • altered TM colour
  • visible fluid/bubbles
  • tuning fork tests
180
Q

Tx AOM?

A

Supportive

refer if persistent, CHL, speech/language problems

181
Q

Surgical management of SEVERE acute otitis media?

A
  • grommets

* if failure, grommets + adenoidectomy

2nd Year Medicine (24 decks)

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