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Med Student Finals > ENT > Flashcards

ENT Flashcards

1
Q

Otitis Externa

Definition (1)

A

Discharge, itch, pain and tragal tenderness due to acute inflammation of the skin of the meatus, usually caused by excess canal moisture

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2
Q

Otitis Externa

Aetiology (5)

A 
Mostly excess canal moisture 
Trauma eg. fingernails, itching especially in eczema and psoriasis 
Absence of wax (from self-cleaning) 
Narrow ear canal 
Hearing aids 
Pseudomonas and Staph. aureus
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3
Q

Otitis Externa

Mild (3)

A

Scaly skin with some erythema
Normal diameter of external auditory canal
Treatment: clearing with irrigation/syringing, hydrocortisone cream, antibacterial spray

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4
Q

Otitis Externa

Moderate (4)

A

Painful ear
Narrowed external auditory canal
Malodorous creamy discharge
Prescribe topical antibiotic +/- steroid drops

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5
Q

Otitis Externa

Severe (2)

A

External auditory canal is occluded

Treatment: thin ear wick inserted with aluminium acetate allowing canal to open up enough for microsuction/cleaning

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6
Q

Acute Otitis Media

Aetiology (3)

A

Commonly follows a viral URTI
Pneumococcus
Haemophilus

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7
Q 
Acute Otitis Media
Risk factors (4)
A

URTI
Passive smoking
Asthma
GORD

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8
Q

Acute Otitis Media

Signs + symptoms (5)

A 
Rapid onset of pain due to bulging of the tympanic membrane, which eases if the drum perforates
Fever
Irritability 
Vomiting 
Purulent discharge
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9
Q

Acute Otitis Media

Treatment (4)

A

Analgesia
Many resolve spontaneously
Antibiotics if systemically unwell or no improvement over 4 days, amoxicillin
Clean external auditory canal

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10
Q

Acute Otitis Media

Complications (4)

A

Mastoiditis
Labyrinthitis
Facial palsy
Meningitis

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11
Q

Chronic Otitis Media

Definition (1)

A

Ear with a tympanic membrane perforation in the setting of recurrent/chronic infections

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12
Q

Chronic Otitis Media

Signs + symptoms (4)

A

Hearing loss
Otorrhoea
Fullness
Otalgia (painful ear)

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13
Q

Chronic Otitis Media

Classification (3)

A

Benign chronic otitis media: dry tympanic membrane perforation without active infection
Chronic serous otitis media: continuous serous drainage (straw coloured)
Chronic suppurative otitis media: persistent purulent drainage through a perforated tympanic membrane

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14
Q

Chronic Otitis Media

Treatment (3)

A

Topical/systemic antibiotics
Aural cleaning
Surgery: myringoplasty (repair of the tympanic membrane alone) or mastoidectomy

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15
Q

Chronic Otitis Media

Complications (1)

A

Cholesteatoma

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16
Q

Cholesteatoma

Definition (1)

A

A cyst/sac of keratinising squamous epithelium that most often occurs in the attic part of the middle ear

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17
Q

Cholesteatoma

Pathology (5)

A

Negative pressure in middle ear causes pars flaccida to balloon backwards, forming pocket
Epithelium falls into pocket
Ball of debris enlarges and is infected with Pseudomonas
Grows upwards into attic and backwards into mastoid
Cholesteatoma erodes bone: ossicles- conductive deafness, facial nerve- palsy, labyrinth- vertigo, roof of middle ear- intracranial sepsis

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18
Q

Cholesteatoma

Signs + symptoms (5)

A

Foul-smelling discharge
Conductive hearing loss
Attic retraction filled with squamous debris
Discharging attic perforation
Complications: facial palsy, vertigo, intracranial sepsis

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19
Q

Cholesteatoma

Treatment (2)

A

Surgical removal

More advanced disease that extends into the mastoid may require mastoidectomy

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20
Q

Otitis Media with Effusion (Glue Ear)

Aetiology (3)

A

Dysfunction of Eustachian tubes
URTIs
Oversized adenoids

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21
Q

Otitis Media with Effusion (Glue Ear)

Signs + symptoms (5)

A

Chief cause of hearing loss in young children (conductive)
May cause no pain
Variable appearance of tympanic membrane, eg. retracted/bulging drum
May have bubbles or a fluid level
Flat tympanogram (distinguishes from otosclerosis)

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22
Q

Otitis Media with Effusion (Glue Ear)

Treatment (3)

A

Usually resolves spontaneously
Surgery: if persistent and bilateral, insert ventilation tubes (grommets or tympanostomy tube)
Hearing aids

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23
Q

Mastoiditis

Definition (1)

A

Middle ear inflammation leads to destruction of air cells in the mastoid bone +/- abscess formation

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24
Q

Mastoiditis

Signs + symptoms (3)

A

Erosion of the bone can lead to swelling behind ear and thickening of the postauricular tissues, leading to the pinna becoming pushed out
Fever
Tenderness, swelling and redness behind pinna (mastoid)

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25
Q

Mastoiditis

Investigations (1)

A

CT

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26
Q

Mastoiditis

Treatment (2)

A

IV antibiotics

Myringotomy (incision into eardrum to relieve pressure or drain fluid) +/- mastoidectomy

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27
Q

Conductive Hearing Loss

Definition (1)

A

Impaired sound transmission via the external canal and middle ear ossicles to the foot of the stapes

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28
Q 
Conductive Hearing Loss 
Hearing tests (3)
A

Pure tone audiometry: air-bone gap
Rinne’s test: negative (bone conduction > hearing loss)
Weber’s test: sound localises to the affected ear

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29
Q

Conductive Hearing Loss

Aetiology (4)

A

External canal obstruction (wax, debris, foreign body)
Drum perforation (trauma, infection)
Problems with the ossicular chain (otosclerosis, infection, trauma)
Inadequate Eustachian tube ventilation of the middle ear (eg. with effusion)

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30
Q

Conductive Hearing Loss

Sudden hearing loss (4)

A

Infection
Occlusion
Trauma
Fracture

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31
Q

Sensorineural Hearing Loss

Definition (1)

A

Defects central to the oval window in the cochlea or cochlear nerve leading to hearing loss

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32
Q 
Sensorineural Hearing Loss
Hearing tests (2)
A

Rinne’s: positive, AC>BC

Weber’s: localises to unaffected ear

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33
Q

Sensorineural Hearing Loss

Aetiology (7)

A

Ototoxic drugs (eg. streptomycin, vancomycin, gentamicin)
Post-infective (meningitis, measles, mumps, syphilis)
Meniere’s disease
Trauma
Presbyacusis
Acoustic neuroma (consider if unilateral)
Cholesteatoma (consider if unilateral)

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34
Q

Sensorineural Hearing Loss

Sudden Hearing Loss (6)

A 
Noise exposure 
Gentamicin toxicity 
Mumps 
Acoustic neuroma 
MS 
May require steroids as treatment
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35
Q

Otosclerosis

Pathology (1)

A

New bone is formed around the stapes footplate, leading to its fixation and consequent conductive hearing loss

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36
Q

Otosclerosis

Signs + symptoms (4)

A

Usually appear in early adult life and can be accelerated in pregnancy
Conductive deafness: hearing often better with background noise
Tinnitus
Mild vertigo

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37
Q

Otosclerosis

Investigations (1)

A

Audiometry with masked bone conduction shows a dip at 2kHz (Cahart’s notch)

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38
Q

Otosclerosis

Treatment (3)

A

Hearing aid
Surgery: stapedectomy or stapedotomy to replace the adherent stapes
Cochlear implant if severe

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39
Q

Presbyacusis

Definition (1)

A

Age-related, bilateral, high-frequency sensorineural hearing loss

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40
Q

Presbyacusis

Signs + symptoms (2)

A 
Gradual deafness (unnoticed until hearing of speech is affected with loss of high frequency sounds) 
Hearing most affected when there is background noise
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41
Q

Presbyacusis

Treatment (1)

A

Hearing aids

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42
Q

Childhood Deafness

Epidemiology (2)

A

1 in 500 newborns

50% genetic, 25% non-genetic, 25% idiopathic

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43
Q

Childhood Deafness

Genetic (2)

A

Conductive: congenital anomalies of pinna, external ear canal, drum or ossicles
Sensorineural: non-syndromic most common, Alport’s syndrome, Alport’s syndrome, Turner’s syndrome

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44
Q

Childhood Deafness

Non-genetic (4)

A

Intrauterine infection: CMV, HSV, syphilis
Perinatal: prematurity, hypoxia
Infections: meningitis, encephalitis, measles, mumps
Acoustic/cranial tumour

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45
Q

Childhood Deafness

Universal newborn hearing screening (3)

A

Within weeks of birth
Otoacoustic emissions: microphone placed in external meatus detects tiny cochlear sounds produced by movement of the outer hair cells
Audiological brainstem responses: earphones emit a series of soft clicks, electrodes on the infant’s forehead and neck measure brain wave activity in response to the clicks

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46
Q 
Childhood Deafness
Cochlear implants (1)
A

Directly stimulates auditory nerve when electrical signals are applied

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47
Q

Tinnitus

Definition (1)

A

Perception of sound typically in the absence of auditory stimulation

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48
Q

Tinnitus

Prevalence (1)

A

15%

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49
Q

Tinnitus

Signs + symptoms (4)

A

Unilateral or bilateral
Pulsatile or non-pulsatile
Ringing, hissing or buzzing suggests an inner ear or central cause
Popping or clicking suggests problems in the external or middle ear

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50
Q

Tinnitus

Classification (2)

A

Objective: audible to examiner, rare and due to vascular disorders (pulsatile vibratory sounds from AV malformation/carotid pathology) or high-output cardiac states (anaemia or hyperthyroidism)
Subjective: audible only to patient, most commonly associated with disorders causing SNHL (presbyacusis, Meniere’s, noise-induced), ototoxic drugs

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51
Q

Tinnitus

Investigations (3)

A

Audiometry
Tympanogram
Must do MRI if unilateral to rule out acoustic neuroma

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52
Q

Tinnitus

Treatment (5)

A 
Treat any underlying cause 
Often improves over time 
Hearing aids 
Psychological support 
CBT
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53
Q

Noise-Induced Hearing Loss

Aetiology (3)

A

One-time exposure to intense sound eg. explosion
Most commonly occupational, continuous exposure to loud sounds that causes hearing loss overtime
Rupture of drum and ossicular fracture may occur

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54
Q

Noise-Induced Hearing Loss

Symptoms (2)

A

Bilateral symmetrical, sensorineural hearing loss +/- tinnitus
Audiometry typically shows a ‘notch’ at 3, 4 or 6kHz with recovery at 8kHz

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55
Q

Noise-Induced Hearing Loss

Treatment (4)

A

Reduce risk of occupational exposure
Provide ear defenders
Screen occupations at risk
In established hearing loss use hearing aids

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56
Q

Vertigo

Classification (2)

A

Vestibular (peripheral) vertigo: often severe and may be accompanied by loss of balance, nausea, vomiting, reduced hearing, tinnitus, nystagmus
Central vertigo: usually less severe, no hearing loss/tinnitus

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57
Q

Vertigo

Causes of peripheral vertigo (4)

A

Meniere’s disease
Benign paroxysmal positional vertigo
Vestibular failure
Labyrinthitis

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58
Q

Vertigo

Causes of central vertigo (4)

A

Acoustic neuroma
MS
Head injury
Migraine associated dizziness

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59
Q

Vertigo

Investigations (4)

A

Assess cranial nerves and ears
Test cerebellar function and reflexes
Romberg’s test (+ve if balance worse when eyes are shut)
Dix-Hallpike test

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60
Q

Benign Paroxysmal Positional Vertigo

Pathology (1)

A

Displacement of otoconia (otoliths) stimulate the semicircular canals

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61
Q

Benign Paroxysmal Positional Vertigo

Signs + symptoms (4)

A

Attacks of sudden rotational vertigo
Last >30 seconds
Provoked by head turning
+ve Dix-Hallpike

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62
Q

Benign Paroxysmal Positional Vertigo

Treatment (2)

A

Usually self-limiting

Epley manoeuvre

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63
Q

Meniere’s Disease

Pathology (1)

A

Dilatation of the endolymphatic spaces of the membranous labyrinth

64
Q

Meniere’s Disease

Signs + symptoms (6)

A

Sudden attacks of vertigo
Last 2-4h
Nystagmus always present
Increasing fullness of ears +/- tinnitus followed by vertigo
Symptoms often become bilateral
Fluctuating SNHL is common and may become permanent

65
Q

Meniere’s Disease

Treatment (3)

A

Acute: prochloperazine bucally as short-term vestibular sedative
Prophylaxis: betahistine
Surgery if persistent

66
Q

Acute Vestibular Failure (Labyrinthitis)

Signs + symptoms (4)

A

Sudden attacks of unilateral vertigo and vomiting in a previously well person, often following URTI
Lasts 1-2 days, improving over a week
Nystagmus away from affected side
May have haring loss

67
Q

Acute Vestibular Failure (Labyrinthitis)

Treatment (1)

A

Vestibular suppressants eg. Buccastem or cyclizine

68
Q

Furunculosis

Definition (1)

A

Very painful staphylococcal abscess arising in a hair follicle within the ear canal

69
Q 
Furunculosis
Risk factors (1)
A

Diabetes

70
Q

Furunculosis

Treatment (2)

A

Lancing

If there is a pinna cellulitis start oral antibiotics (eg. flucloxacillin)

71
Q

Rhinosinusitis

Definition (1)

A

Inflammation in the nose and paranasal sinuses with >2 symptoms, one of which must be nasal blockage/obstruction/discharge/congestion +/- facial pain/pressure, reduction/loss of smell, and either endoscopic or CT signs

72
Q

Rhinosinusitis

Classification (5)

A

Acute rhinosinusitis (common cold): self limiting but if persist >5 days give intranasal steroids, only use antibiotics if very severe, should easily resolve in 14 days
Chronic rhinosinusitis with nasal polyps
Chronic rhinosinusitis without nasal polyps
Allergic rhinosinusitis
Acute bacterial rhinosinusitis

73
Q

Allergic Rhinosinusitis

Aetiology (1)

A

IgE-mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells

74
Q

Allergic Rhinosinusitis

Signs + symptoms (7)

A 
Sneezing 
Pruritus 
Nasal discharge (bilateral and variable) 
Bilateral itchy red eyes 
Turbinates may be swollen 
Mucosae may be pale or mauve 
Nasal polyps
75
Q

Allergic Rhinosinusitis

Treatment (6)

A

Allergen/irritant avoidance
Nasal saline irrigation
Antihistamines
Intranasal corticosteroid sprays
Oral prednisolone can resolve severe symptoms
Immunotherapy can induce long-term tolerance to allergens

76
Q

Chronic Rhinosinusitis

With nasal polyps (6)

A

Typical patient is a male >40
Sites: usually bilateral, most often in middle meatus
Symptoms: watery anterior rhinorrhoea, sneezing, purulent postnasal drip, nasal obstruction, sinusitis, mouth breathing, snoring
Associations: allergic rhinoscopy/nasal endoscopy (polyps are pale, mobile and insensitive to gentle palpation)
Treatment: topical steroid, endoscopic sinus surgery

77
Q

Chronic Rhinosinusitis

Without nasal polyps (1)

A

Treatment: intranasal corticosteroids and nasal saline irrigation, consider microbiological cultures and long-term antibiotics, surgery

78
Q

Acute Bacterial Rhinosinusitis

Signs + symptoms (4)

A

Discoloured discharge (unilateral predominance) and purulent secretion in the nasal cavity
Severe local pain
Fever
High ESR/CRP

79
Q

Acute Bacterial Rhinosinusitis

Differentials of sinusitis (4)

A

Migraine
TMJ dysfunction
Dental pain
Temporal arteritis

80
Q

Acute Bacterial Rhinosinusitis

Causes (3)

A

Direct spread
Odd anatomy: septal deviation, polyps
Mechanical ventilation

81
Q

Acute Bacterial Rhinosinusitis

Investigations (3)

A 
Clinical diagnosis (examine nose and look for mucosal inflammation, oedema, discharge) 
CT paranasal sinuses 
Nasal endoscopy
82
Q

Acute Bacterial Rhinosinusitis

Treatment (4)

A

98% of sinusitis cases are viral and self-limiting
Simple analgesia, nasal saline irrigation, intranasal decongestants
Antibiotics
Endoscopic sinus surgery

83
Q

Acute Bacterial Rhinosinusitis

Complications (3)

A

Orbital cellulitis/abscess
Intracranial involvement: meningitis, encephalitis
Osteomyelitis

84
Q

Nasal Fractures

Signs + symptoms (4)

A

Often brief but short-lived epistaxis
New nasal deformity
Associated facial swelling and black eyes
Look for septal haematoma (a boggy swelling of the septum causing near-total nasal obstruction)- if present do urgent incision and drainage

85
Q

Nasal Fractures

Treatment (4)

A

Treat epistaxis
Analgesia/ice
Close any skin injury
Reassess 5-7 days post-injury once swelling has resolved, can perform manipulation 10-14 days after injury (before nasal bones set)

86
Q

CSF Rhinorrhoea

Pathology (2)

A

Ethmoid fractures disrupting dura and arachnoid can result in CSF leaks
If not associated with trauma it may be a tumour

87
Q

CSF Rhinorrhoea

Investigations (2)

A

Nasal CSF discharge tests +ve for glucose

CSF contains B2 (tau) transferrin

88
Q

CSF Rhinorrhoea

Treatment (1)

A

If traumatic, conservative management has high spontaneous resolution: bed rest, head elevation +/- lumbar drain

89
Q

Septal Perforation

Aetiology (4)

A

Septal surgery most common
Trauma (nose picking, foreign body, septal haematoma)
Inhalants (nasal steroid/decongestant spray, cocaine)
Infection (TB, syphilis, HIV)

90
Q

Septal Perforation

Signs + symptoms (3)

A

Irritation
Whistle breathing
Bleeding

91
Q

Septal Perforation

Treatment (2)

A

Saline nasal irrigation

Surgical closure with septal prosthesis

92
Q

Epistaxis

Aetiology (5)

A 
Local trauma (eg. nosepicking) 
Facial trauma 
Dry/cold weather 
Dyscrasia/haemophilia 
Septal perforation
93
Q

Epistaxis

Blood supply to nasal septum (7)

A 
Anterior ethmoidal artery 
Posterior ethmoidal artery 
Sphenopalatine artery 
Little's area (anterior ethmoidal, sphenopalatine and facial arteries anastomose to form) 
Septal branch 
Greater palatine artery 
Superior labial artery
94
Q 
Epistaxis
Anterior epistaxis (2)
A

Almost always septal

Little’s area

95
Q 
Epistaxis
Posterior epistaxis (3)
A

Difficult to see on rhinoscopy so may require invasive procedures
Examination under anaesthesia: if discrete bleeding point it can be treated directly eg. with diathermy
Arterial ligation: of sphenopalatine artery is cornerstone of serious epistaxis

96
Q

Epistaxis

Management (7)

A

Apply pressure by pinching lower part of nose for 20 mins
Ice pack to dorsum of nose
Cauterise with silver nitrate and remove clots with gentle suction
Apply cotton ball soaked in adrenaline for 2 mins to cause vasoconstriction or use local lidocaine spray
If can’t see bleeding point, refer to ENT
Anterior nasal pack, remove after 24h
If bleeding continues, try postnasal pack

97
Q

Tonsillitis

Aetiology (2)

A

Viral: common cold
Bacterial: group A B-haemolytic strep

98
Q

Tonsillitis

Investigations (2)

A

Don’t routinely take throat swabs for all sore throats (which are either due to tonsillitis or acute pharyngitis)
Antistreptococcal antibody tests have no role but can confirm for group A B-haemolytic Strep.

99
Q 
Tonsillitis
Centor Criteria (5)
A

Presence of tonsillar exudate
Presence of tender anterior cervical lymphadenopathy
History of fever
Absence of cough
Presence of 3+ of these criteria suggest infection due to Strep and patient may benefit form antibiotics (penicillin V 10 days)

100
Q

Tonsillitis

Complications (4)

A

Otitis media
Sinusitis
Peritonsillar abscess (quinsy): sore throat, dysphagia, peritonsillar bulge, uvular deviation, muffled voice
Parapharyngeal abscess

101
Q 
Tonsillitis
Tonsillectomy criteria (3)
A

> 7 well documented, clinically significant adequately treated sore throats in the preceding year
5 episodes in each of the last 2 years
3 in the last year

102
Q 
Stridor
Definitions (2)
A

Stridor: high-pitched noise heard in inspiration from partial obstruction at the larynx/large airways
Stertor: inspiratory snoring noise, coming from obstruction of the pharynx

103
Q 
Stridor
Aetiology (4)
A

Congenital: laryngomalacia, stenosis, vascular rings
Inflammation: laryngitis, epiglottitis, croup, anaphylaxis
Tumours: haemangiomas or papillomas (usually disappear without treatment)
Trauma: thermal, chemical, intubation

104
Q 
Stridor
Red flags (4)
A

Swallowing difficulty/drooling
Pallor cyanosis
Use of accessory muscles of respiration
Downward plunging of the trachea with respiration (tracheal tug)

105
Q

Croup

Aetiology (1)

A

95% viral (parainfluenza)

106
Q

Croup

Signs + symptoms (4)

A

Leading cause of stridor, predominantly inspiratory
Barking cough
May have respiratory distress due to upper airway obstruction
Often worse at night

107
Q 
Croup 
Severity grading (3)
A

Mild: occasional cough, no stridor at rest
Moderate: frequent cough, stridor at rest
Severe: same as moderate + respiratory distress

108
Q

Croup

Treatment (2)

A

Give all children with croup of any severity a single dose of dexamethasone
Advise it is usually self-limiting and resolves in 48h

109
Q

Acute Epiglottitis

Definition (2)

A

Rapidly progressive inflammation of the epiglottis and adjacent tissues
An emergency because respiratory arrest can occur abruptly due to airway obstruction

110
Q

Acute Epiglottitis

Signs + symptoms in adults (3)

A

Severe sore throat
Painful swallowing
Stridor

111
Q

Acute Epiglottitis

Signs + symptoms in children (5)

A 
Short history of fever 
Irritability 
Sore throat 
Drooling 
Muffled voice/cry
112
Q

Acute Epiglottitis

Treatment (5)

A

Don’t examine throat and get senior help
Diagnosis made by laryngoscopy
Intubate
Dexamethasone
Antibiotics (usually caused by H. influenzae type B)- cefotaxime

113
Q 
Vocal Cord Palsy 
Unilateral presentation (3)
A

May manifest in first few weeks of life
Hoarse, breathy cry that is aggravated by agitation
Feeding difficulties +/- aspiration

114
Q 
Vocal Cord Palsy 
Bilateral presentation (2)
A

Inspiratory stridor at rest

Worsens upon agitation +/- significant respiratory distress

115
Q

Vocal Cord Palsy

Treatment (2)

A

Unilateral: supportive, most recover by 2-3 years
Bilateral: urgent airway intervention may be needed (tracheostomy, intubation)

116
Q 
Hoarseness
Differential diagnoses (6)
A

Laryngitis: usually viral and self-limiting or may be secondary to GORD, present with pain, hoarseness and fever
Vocal cord palsy: weak ‘breathy’ voice, cancer
Laryngeal cancer: progressive, persistent gruff voice
Reflux laryngitis: chronic laryngeal symptoms associated with GORD
Vocal cord nodules: due to vocal abuse, variable husky voice
Reinke’s oedema: chronic cord irritation from smoking +/- chronic voice abuse causes cord enlargement- hypothyroid old lady smokers

117
Q

Hoarseness

Investigations (2)

A

Always investigate hoarseness (especially in smokers) lasting > 3 weeks as it is the chief presentation of laryngeal carcinoma
Laryngoscopy to assess cord mobility, inspect mucosa and exclude local causes

118
Q

Laryngeal Nerve Palsy

Anatomy of recurrent laryngeal nerve (3)

A

Supplies the intrinsic muscles of the larynx
Responsible for abduction and adduction of the vocal fold
Originates from vagus nerve and has a complex course making it susceptible to damage

119
Q

Laryngeal Nerve Palsy

Aetiology (3)

A

30% due to cancers (larynx, thyroid, oesophagus, hypopharynx, bronchus)
25% iatrogenic (after parathyroidectomy, oesophageal or pharyngeal pouch surgery)
15% idiopathic

120
Q

Laryngeal Nerve Palsy

Signs + symptoms (3)

A

A weak ‘breathy’ voice with a weak cough
Repeated coughing/aspiration
Exertional dyspnoea (narrow glottis reduces air flow)

121
Q

Laryngeal Nerve Palsy

Investigations (2)

A

CXR

CT +/- US thyroid if CXR normal

122
Q

Laryngeal Nerve Palsy

Treating non-malignant causes (2)

A

Unilateral palsies can be compensated for by movement of the contralateral cord
Reinnervation nerve surgery

123
Q

Dysphagia

Differentials (9)

A 
Oesophageal cancer 
Pharyngeal cancer 
Gastric cancer 
Extrinsic pressure, eg. from lung cancer or node enlargement 
Bulbar palsy 
Myasthenia gravis 
Benign strictures 
Pharyngeal pouch 
Achalasia
124
Q

Dysphagia

Investigations (5)

A 
Endoscopy with biopsy
Oesophageal motility studies 
FBC, ESR 
CXR 
Barium swallow
125
Q

Head and Neck Cancer

Pathology (2)

A

90% squamous cell carcinoma

Invades adjacent structures and spreads via lymphatics

126
Q

Head and Neck Cancer

Associations (5)

A 
Smoking increases risk by 10x 
Alcohol consumption 
Vitamin A + K deficiency 
HPV 
GORD
127
Q

Head and Neck Cancer

Signs + symptoms (10)

A 
Neck pain/lump 
Hoarse voice >6 weeks 
Sore throat >6 weeks 
Mouth bleeding.numbness 
Sore tongue 
Painless ulcers 
Patches in the mouth 
Earache/effusion 
Speech change 
Dysphagia
128
Q

Head and Neck Cancer

Investigations (3)

A

Fibre-optic endoscopy
Fine needle aspiration or biopsy of any masses
CT/MRI primary tumour

129
Q

Head and Neck Cancer

Staging (3)

A

T: extent of primary tumour, T1= <2cm, T4= extension to bone, muscle, skin, neck
N: involvement of regional lymph nodes, N3= any node >6cm
M

130
Q 
Oropharyngeal Carcinoma
Risk factors (5)
A 
Age
Smoking (especially pipes) 
Chewing tobacco 
HPV 
Male
131
Q

Oropharyngeal Carcinoma

Signs + symptoms (4)

A

Often advances at presentation
Sore throat
Sensation of lump
Referred otalgia

132
Q

Oropharyngeal Carcinoma

Investigations (1)

A

MRI

133
Q

Oropharyngeal Carcinoma

Treatment (2)

A

Surgery

Radiotherapy

134
Q

Oropharyngeal Carcinoma

Prognosis (1)

A

5-year survival 50% for stage 1 (better for tonsillar cancer)

135
Q

Hypopharyngeal Tumours

Signs + symptoms (5)

A 
Lump in throat 
Dysphagia 
Odynophagia (painful to swallow) 
Pain referred to ear 
Hoarse voice
136
Q

Hypopharyngeal Tumours

Prognosis (1)

A

Poor (it is rare cancer or may be premalignant)- 60% at 1 year

137
Q 
Laryngeal Cancer 
Risk factors (4)
A

Age
Male
Smoking
HPV

138
Q

Laryngeal Cancer

Signs + symptoms (2)

A

Progressive hoarseness leading to stridor

Difficulty or pain on swallowing +/- haemoptysis +/- ear pain

139
Q

Laryngeal Cancer

Investigations (3)

A

Laryngoscopy + biopsy
HPV status
MRI staging

140
Q

Laryngeal Cancer

Treatment (2)

A

Radical radiotherapy for small tumours

Larger tumours treated with partial/total laryngectomy

141
Q 
Neck Lumps
Differentiating signs (2)
A

If lump present <3 weeks, reactive lymphadenopathy from a self-limiting infection
If intradermal, may be sebaceous cyst (with central punctum) or lipoma

142
Q

Neck Lumps

Investigations (5)

A

US to show lump architecture and vascularity and allows FNAC
CT to define masses
Virology + Mantoux test
CXR may show malignancy or lymphadenopathy
FNAC

143
Q 
Neck Lumps
Midline lumps (4)
A

If <20 likely to be dermoid cyst
If it moves up on protruding tongue and is below the hyoid, it is likely a thyroglossal cyst
If >20 could be thyroid mass
If bony hard may be a chondroma

144
Q 
Neck Lumps
Submandibular triangle (3)
A

If <20, self-limiting reactive lymphadenopathy is likely
If >20 exclude malignant lymphadenopathy
If not a node think of submandibular salivary stone/tumour

145
Q 
Neck Lumps
Anterior triangle (6)
A 
Lymphadenopathy common 
Branchial cysts: emerge under sternomastoid 
Parotid tumour 
Laryngocele 
Carotid aneurysm 
Carotid body tumour
146
Q 
Neck Lumps
Posterior triangle (4)
A

May be due to intruding cervical ribs
Pharyngeal pouches
Cystic hygromas (transilluminate)
Lymphadenopathy

147
Q

Salivary Gland Infection (Sialadenitis)

Definition (1)

A

Acute infection of the submandibular or parotid glands

148
Q

Salivary Gland Infection (Sialadenitis)

Signs + symptoms (2)

A

Painful diffuse swelling of gland + fever

Pressure applied over gland may lead to pus leaking out of the duct

149
Q

Salivary Gland Infection (Sialadenitis)

Treatment (2)

A

Antibiotics + good oral hygiene

Surgical drainage

150
Q 
Salivary Stones (Sialothiasis)
Pathology (1)
A

Usually effect submandibular gland where secretions are richer in calcium and thicker

151
Q 
Salivary Stones (Sialothiasis)
Signs + symptoms (3)
A

Pain
Tense swelling of the gland during/after meals
Stone may be palpable in the floor of the mouth

152
Q 
Salivary Stones (Sialothiasis)
Investigations (1)
A

Plain X-ray or sialogram if diagnostic doubt

153
Q 
Salivary Stones (Sialothiasis)
Treatment (2)
A

Small stones may pass spontaneously (sialogogues may help- they stimulate salivation)
Large stones may need surgical removal

154
Q

Salivary Gland Tumours

Pathology (2)

A

Parotid gland mostly (superficial lobe)

Most are benign pleomorphic adenomas

155
Q 
Salivary Gland Tumours
Risk factors (2)
A

Radiation to neck

Smoking

156
Q

Salivary Gland Tumours

Signs + symptoms suggestive of malignancy (5)

A 
Hard, fixed mass +/- pain 
Overlying skin ulceration 
Local lymph node enlargement 
Tumours don't vary in size at all as seen in inflammation or salivary stones 
Facial nerve palsy
157
Q

Salivary Gland Tumours

Investigations (2)

A

US/MRI

FNAC/CT-guided biopsy

Med Student Finals (23 decks)

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