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ENT Flashcards

1
Q

What is tonsillitis?

A

Inflammation due to infection of the tonsils

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2
Q

What are the most common causative organisms of tonsillitis?

A

Mostly viral- HSV, adenovirus, rhinovirus, influenza, coronavirus, RSV, EBV
Bacterial- staph aureus, strep pneumoniae, mycoplasma pneumoniae
GpA B-haemolytic strep (Strep pyogenes)

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3
Q

What criteria can be used to assess the need for antibiotics in tonsillitis?

A

FeverPAIN or CENTOR

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4
Q

What are the FeverPAIN criteria?

A 
Fever > 38
Purulence- exudate
Attends rapidly- 3 days or less
severely Inflamed tonsils
No cough or coryza
2 or more- consider antibiotics
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5
Q

What are the CENTOR criteria?

A 
Likelihood of a bacterial infection in patients with sore throat
1. Hx of fever
2. Tonsillar exudate
3. Tender anterior cervical adenopathy
4. Absence of cough
Age < 15 (+1) or > 44 (-1)
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6
Q

Management of tonsillitis

A

Fluids, analgesia

Abx- Phenoxymethylpenicillin V for 10 days

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7
Q

What is the most common causative organism for Glandular fever/Infectious mononucleosis?

A

EBV

10% CMV

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8
Q

Presentation of Glandular fever/Infectious mononucleosis

A

Fever, malaise, headache, sore throat, photophobia, red/swollen tonsils with white patches, lymphadenopathy, cough, splenomegaly, abdo pain, nausea

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9
Q

Investigations for Glandular fever/Infectious mononucleosis

A

Monospot/EBV serology

Throat swab

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10
Q

Management of Glandular fever/Infectious mononucleosis

A

Usually self-limiting

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11
Q

Causes of 8th nerve lesions

A

Paget’s disease of bone, Meniere’s disease, Herpes zoster, neurofibroma, acoustic neuroma, CVA, lead, aspirin, furosemide

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12
Q

Presentation of 8th nerve lesions

A

Unilateral sensorineural deafness and tinnitus

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13
Q

Aetiology of conductive deadfness

A

Impediment to passage of sound waves between external ear and footplate of stapes

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14
Q

Aetiology of sensorineural deafness

A

Fault in cochlea or cochlear nerve

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15
Q

What is presbyacusis?

A

Age-related hearing loss

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16
Q

What is the most common cause of acquired deafness??

A

Otitis media with effusion

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17
Q

Is air or bone conduction better in conductive and sensorineural deafness?

A

Conductive: air > bone
Sensorineural: air + bone conduction bad

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18
Q

Causes of conductive hearing loss

A

Obstruction of external ear canal: wax, inflammatory oedema, debris, atresia, FB
Perforated TM
Fixation/Discontinuity of ossicular chain- infection/trauma
Middle ear effusion

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19
Q

Causes of sensorineural deafness

A

Bilateral progressive loss- presbyacusis, drug ototoxicity, noise damage
Unilateral progressive loss- Meniere’s disease, acoustic neuroma
Sudden loss- trauma, viral, CVA, acoustic neuroma, barotrauma

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20
Q

What is Acoustic neuroma/Vestibular Schwannoma?

A

Tumour of vestibulocochlear nerve arising from Schwann cells of the nerve sheath
Slow-growing but mass effect

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21
Q

Risk factors for Acoustic neuroma/Vestibular Schwannoma

A

Neurofibromatosis type 2

Radiation

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22
Q

Presentation of Acoustic neuroma/Vestibular Schwannoma

A

Unilateral sensorineural hearing loss, tinnitus, impaired facial sensation, balance problems
Later- facial pain, earache, ataxia

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23
Q

Investigation of suspected Acoustic neuroma/Vestibular Schwannoma

A

MRI

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24
Q

Management of Acoustic neuroma/Vestibular Schwannoma

A

Microsurgery

Stereotactic radiotherapy

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25
Q

What is Otitis Externa?

A

Inflammation of the outer ear

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26
Q

Most common causative organism of Otitis Externa

A

Pseudomonas aeruginosa

Also fungal- Aspergillus/Candida

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27
Q

Risk factors for Otitis Externa

A

Hot humid climates, swimming, immunocompromise, DM, over-cleaning, eczema, obstruction of meatus

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28
Q

Presentation of Otitis Externa

A

Pain + itching, hearing loss, ear canal erythema, oedema, exudate, mobile tympanic membrane, pain with movement of tragus, pre-auricular lymphadenopathy

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29
Q

Management of Otitis Externa

A

Acute: topical drops, oral/IV Abx- Flucloxacillin or Ciprofloxacin in diabetes
Chronic: Acetic acid + corticosteroid drops; Fungal: Clotrimazole drops

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30
Q

What is Malignant Otitis Externa?

A

Osteomyelitis of EAM + bony tympanic plate (necrotising)

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31
Q

Presentation of malignant Otitis Externa

A

Severe unremitting otalgia, purulent aural discharge, granulaitons

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32
Q

Management of malignant Otitis Externa

A

Quinolones 6-8wks

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33
Q

Complications of Otitis Externa

A

Meningitis, Cerebral abscess, dural sinus thrombosis

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34
Q

What is Mastoiditis?

A

Suppurative infection in the middle ear which spreads to the mastoid air cells
–> inflammation –> bony destruction

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35
Q

Risk factors for Mastoiditis

A

Immunocompromised
Cholesteatoma
Age 6-13

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36
Q

What is the most common causative organism for Mastoiditis?

A

Strep pneumoniae

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37
Q

Presentation of Mastoiditis

A

Intense otalgia, pain behind ear, fever, tender boggy swelling behind ear, external ear protrudes forwards, bulging TM
Conductive deafness

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38
Q

Which type of deafness does Mastoiditis cause?

A

Conductive

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39
Q

Investigation of Mastoiditis

A

CT/MRI

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40
Q

Management of Mastoiditis

A

Broad-spectrum IV antibiotics for 1-2 days then oral
- Cefotaxime/Ceftriaxone
Myringotomy +/- tympanostomy tube

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41
Q

Complications of Mastoiditis

A

Hearing loss
CN palsies- VI/VII or trigeminal opthalmic
Osteomyelitis

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42
Q

What is a Thyroglossal duct cyst?

A

Occurs from a persistent epithelial tract from descent of the thyroid from the foramen caecum

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43
Q

Types of Thyroglossal duct cyst

A 
Infrahyoid
Suprahyoid
Juxtahyoid
Intralingual
Suprasternal
Intralaryngeal
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44
Q

Presentation of Thyroglossal duct cyst

A

Midline lump in neck, moves on swallowing and tongue protrusion, non-tender

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45
Q

What is the typical age for presentation of Thyroglossal duct cyst?

A

Age 10 ish

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46
Q

Management of Thyroglossal duct cyst

A

Surgically removed to diagnose and prevent infection

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47
Q

Causes of Acute Pharyngitis

A

Influenza, mononucleosis, adenovirus, measles, chicken pox, croup, whooping cough, GpA Strep

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48
Q

What is Acute Pharyngitis?

A

Inflammation of the oropharynx but not the tonsils

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49
Q

Presentation of Acute Pharyngitis

A

Pharyngeal exudate, cervical lymphadenopathy, difficulty swallowing, fever, chills, headache

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50
Q

Investigations for Acute Pharyngitis

A

Throat culture for Strep throat

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51
Q

Which tools can be used to assess the need for antibiotics in Acute Pharyngitis

A

FeverPAIN/CENTOR

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52
Q

Management of Acute Pharyngitis

A

Phenoxymethylpenicillin if bacterial

Fluids, paracetamol

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53
Q

What is the typical age of presentation with Epiglottitis?

A

Age 2-5

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54
Q

Causes of Epiglottitis

A

Used to be Hib but now vaccine
Strep, Staph aureus, Moraxella catarrhalis, HSV
Reactive epiglottitis to radiotherapy

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55
Q

Presentation of Epiglottitis

A

Sore throat, odynophagia, drooling, muffled ‘hot potato’ voice, fever
Stridor, respiratory distress

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56
Q

Investigation of Epiglottitis

A

DO NOT examine airway

Fibre optic laryngoscopy- gold standard

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57
Q

Management of Epiglottitis

A

DO NOT examine airway
Medical emergency
IV/Oral antibiotics
Intubation/surgical tracheostomy?

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58
Q

Causes of chronic laryngitis

A

Allergy, asthma, trauma, smoking, sarcoidosis, ACE inhibitors

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59
Q

How long is classified as chronic laryngitis?

A

> 3 weeks

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60
Q

Presentation of laryngitis

A

Hoarse/breathy voice, pain/discomfort in neck, URTI symptoms, dysphagia, globus pharyngeus, throat clearing, fever

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61
Q

Management of laryngitis

A

Acute: mostly self-limiting, voice rest, hydration, antibiotics if fever > 48hrs, purulent sputum, immunocompromised
Chronic: voice therapy, treat underlying condition

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62
Q

What is Quinsy?

A

Peri-tonsillar abscess, complication of acute tonsillitis, pus between tonsillar capsule and lateral pharyngeal wall

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63
Q

Causative organisms of Peri-tonsillar abscess (Quinsy)

A

Strep pyogenes, Staph aureus, HiB

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64
Q

Presentation of Peri-tonsillar abscess (Quinsy)

A

Severe unilateral throat pain, fever, drooling, foul breath, painful swallowing, trismus (lockjaw), earache, unilateral bulging superior and lateral to tonsil
Medial/anterior shift of tonsil + uvula

65
Q

Management of Peri-tonsillar abscess (Quinsy)

A

IV Fluids, analgesia
IV antibiotics- eg Ceftriaxone
Surgical aspiraton

66
Q

What is Ménière’s disease?

A

Increase in fluid (endolymph) in membranous labyrinth –> endolymphatic hydrops

67
Q

What is the peak age for Ménière’s disease?

68
Q

Risk factors for Ménière’s disease

A

Allergy, autoimmune conditions, migraine, viral infections

69
Q

Presentation of Ménière’s disease

A
  • Vertigo
  • Tinnitus
  • Fluctuating hearing loss
  • Sense of aural pressure
70
Q

Management of Ménière’s disease

A
  • Vertigo- Prochlorperazine
  • Prophylaxis- betahistine
  • Endolymphatic sac surgery
  • DVLA
71
Q

Patient presents with vertigo, tinnitus, fluctuating hearing loss and a sense of aural pressure, what is the most likely diagnosis?

A

Ménière’s disease

72
Q

What is the most common cause of vertigo?

A

Benign Paroxysmal Positional Vertigo

73
Q

What is Benign Paroxysmal Positional Vertigo?

A

Otoliths become detached from macula into semicircular canals
–> hair cells are stimulated
Mostly posterior

74
Q

Causes of Benign Paroxysmal Positional Vertigo

A

Idiopathic

Head injury, post-viral infection, complication of surgery

75
Q

Presentation of Benign Paroxysmal Positional Vertigo

A

Episodes of vertigo provoked by head movements, attacks sudden onset with rapid resolution once head is kept still
Worse in morning
No hearing loss or tinnitus

76
Q

Patient presents with episodes of vertigo provoked by head movements and which resolve once head kept still, what is the most likely diagnosis?

A

Benign Paroxysmal Positional Vertigo

77
Q

How is Benign Paroxysmal Positional Vertigo diagnosed?

A

Dix-Hallpike maneouvre

78
Q

Management of Benign Paroxysmal Positional Vertigo

A

Usually self-limiting over weeks
Epley maneouvre
DVLA- can drive once symptoms resolved
Surgery last resort

79
Q

What is the aetiology of Vestibular Neuronitis?

A

Likely a neuropathy caused by reactivation of latent HSV1 in vestibular ganglion

80
Q

Presentation of Vestibular Neuronitis

A

Sudden, spontaneous, severe and incapacitating vertigo, spontaneous nystagmus
NEVER hearing loss or tinnitus

81
Q

How can you differentiate central from peripheral vertigo?

A

HINTS examination:
Head impulse
Nystagmus type
Skew
Peripheral: head impulse abnormal, nystagmus unidirectional or absent, no vertical skew
Central: head impulse normal, nystagmus bidirectional, vertical skew

82
Q

Management of Vestibular Neuronitis

A

Prochlorperazine/antihistamines for vertigo

Reassurance

83
Q

Management of Ramsay-Hunt syndrome

A

Aciclovir + Prednisolone

84
Q

What is the cause of Ramsay-Hunt syndrome?

A

Herpes zoster virus

85
Q

Presentation of Ramsay-Hunt syndrome

A

Unilateral lower motor neuron facial nerve palsy
Painful and tender vesicular rash in ear canal, pinna and around ear, can extend to anterior 2/3 of tongue and hard palate

86
Q

Causes of Acute Otitis Media

A

Viral: RSV, Rhinovirus, Parainfluenza, Influenza
Bacterial: Strep pneumoniae, H influenzae, Moraxella catarrhalis, Strep pyogenes

87
Q

Which age group is most at risk of Acute Otitis Media

A

Children as short and more horizontal eustachian tube

88
Q

Risk factors for Acute Otitis Media

A

Young, male, smoking (+ passive), contact with other children, GORD, prematurity, immunodeficiency

89
Q

Presentation of Acute Otitis Media

A

Inflammation of middle ear

Earache, tugging at ear, fever, irritability, cough, rhinorrhoea

90
Q

What is found on otoscopy in Acute Otitis Media?

A

Red/yellow/cloudy TM, bulging TM, perforated TM

91
Q

Management of Acute Otitis Media

A

Pain relief
Antibiotics if < 6mths or unwell or no improvement by 72hrs- 5-7 days Amoxicillin
Admission if < 3mths with temp > 38 or systemically unwell

92
Q

Management of recurrent Acute Otitis Media

A

Grommets

Prophylactic antibiotics

93
Q

Complications of Acute Otitis Media

A

Post-auricular abscess, mastoiditis, meningitis etc

94
Q

What is the most common cause of hearing impairment in children?

A

Otitis media with effusion

95
Q

What is the most common age of presentation with Otitis media with effusion?

96
Q

Risk factors for Otitis media with effusion

A

Cleft palate, Down’s syndrome, Primary Ciliary Dyskinesia, Allergic rhinitis, AOM, Household smoking, Bottle feeding

97
Q

Presentation of Otitis media with effusion

A

Hearing loss, foul-smelling aural discharge, recurrent ear infections, mild ear pain, popping sensation

98
Q

What is seen on otoscopy in Otitis media with effusion?

A

Abnormal colour of drum, loss of light reflex, air bubbles/air-fluid level, retracted/concaved drum

99
Q

Management of Otitis media with effusion

A

Active observation 6-12wks
Hearing aids
Autoinflation
Myringotomy + grommets

100
Q

What is Cholesteatoma?

A

3D collection of connective and epidermal tissue in middle ear
–> Bone erosion

101
Q

Types of Cholesteatoma

A
  1. Congenital
  2. Primary acquired
  3. Secondary acquired- from trauma to TM
102
Q

What is the aetiology of Congenital Cholesteatoma?

A

Squamous epithelium trapped in temporal bone in embryogenesis

103
Q

Risk factors for Cholesteatoma

A

Ear trauma, cleft palate, grommets

104
Q

Presentation of Cholesteatoma

A

Progressive conductive hearing loss
Erode into structures –> vertigo, headache, facial nerve palsy
Infection –> sigmoid sinus thrombosis, meningitis etc
Grows into auditory canal –> deafness, impaired facial movement
Acquired –> frequent painless foul-smelling otorrhoea

105
Q

What type of hearing loss does Cholesteatoma cause?

A

Progressive conductive hearing loss

106
Q

What is seen on otoscopy in Cholesteatoma?

A

Pearly white mass behind tympanic membrane

107
Q

At what age does congenital Cholesteatoma typically present?

A

6 months - 5 years

108
Q

What is the gold standard investigation in Cholesteatoma?

109
Q

Management of Cholesteatoma

A

Surgery- tympanomastoidectomy/tympanoplasty

Treat infections

110
Q

Differentials of facial pain

A 
Rhinosinusitis
Tension headache
Migraine
Cluster headache
Trigeminal neuralgia
TMJ dysfunction
Atypical facial pain
111
Q

How is atypical facial pain managed?

A

Amitriptylline, Gabapentin, Pregabalin

112
Q

What is Sinusitis?

A

Inflammation of the membranous lining of 1 or more sinuses

113
Q

Name the Paranasal sinuses

A
  1. Maxillary
  2. Sphenoidal
  3. Frontal
  4. Ethmoidal
114
Q

Risk factors for Sinusitis

A

URTI, asthma, allergy, smoking, DM, immunocompromise

115
Q

How is acute vs chronic Sinusitis classified?

A

Acute < 4 weeks

Chronic > 90 days

116
Q

Most common causative organisms of Acute Sinusitis

A

Strep pneumoniae, H influenzae, M catarrhalis

117
Q

Presentation of Acute Sinusitis

A

Non-resolving cold, pain over sinuses, purulent nasal discharge, reduced sense of smell, headache

118
Q

Management of Acute Sinusitis

A

Symptom relief: paracetamol, intranasal decongestant, fluids, nasal saline irrigation
Antibiotics if > 10 days or immunocompromised
- Phenoxymethylpenicillin

119
Q

Causes of Chronic Sinusitis

A

Allergic rhinitis, nasal polyps, ciliary dysfunction, immunodeficiency

120
Q

Presentation of Chronic Sinusitis

A

Non-resolving cold, pain over sinuses, purulent nasal discharge, reduced sense of smell, headache
Ache on palpation of sinuses

121
Q

Management of Chronic Sinusitis

A

Modulate triggers, stop smoking
Nasal steroids
Antibiotics for 3 weeks

122
Q

What are the criteria for diagnosis of Sinusitis?

A
  1. Facial discomfort/pain
  2. Nasal obstruction/discharge/post-nasal drip
  3. Decreased or absent sense of smell
123
Q

What is Trigeminal Neuralgia?

A

Compression of the trigeminal nerve

124
Q

Causes of Trigeminal Neuralgia

A

Compression of trigeminal nerve by…

  • Loop of artery or vein
  • MS
  • Tumours
  • AV malformation
125
Q

Presentation of Trigeminal Neuralgia

A

Sudden unilateral brief stabbing pain in distribution of 1 or more branches of the trigeminal nerve, electric shocks

126
Q

What are the common triggers for Trigeminal Neuralgia?

A

Vibration, skin contact, brushing teeth, oral intake, exposure to wind

127
Q

Management of Trigeminal Neuralgia

A

Reassurance
Carbamazepine
Surgery to relieve pressure

128
Q

Investigationsfor diagnosis of Trigeminal Neuralgia

A

None- clinical diagnosis

129
Q

What is the most common site of bleeding in epistaxis?

A

Anterior- Little’s area- Kiesselbach’s plexus

130
Q

Causes of epistaxis

A

Idiopathic

Coagulopathy, rhinitis, trauma, aspirin, warfarin

131
Q

Investigations in epistaxis

A

Anterior + posterior rhinoscopy to identify bleeding point

132
Q

Management of epistaxis

A 
Acute: ABCDE
Nasal cautery- silver nitrate
Nasal packing- anterior packing
Ligation of vessels under GA
Angiography + embolisation
133
Q

What is the temporomandibular joint?

A

TMJ formed by mandibular condyle inserting into mandibular fossa of the temporal bone

134
Q

Risk factors for Temporomandibular Joint Disorders

A

Disc displacement, TMJ hypo/permobility, trauma, bruxism (grinding teeth), stress, anxiety, gout

135
Q

Presentation of Temporomandibular Joint Disorders

A

3 cardinal features:

  1. Facial pain
  2. Restricted jaw function
  3. Joint noise
136
Q

Management of Temporomandibular Joint Disorders

A 
Rest + self care
Bite guards
Analgesics, NSAIDs, Muscle relaxants
IA steroids
Surgery
137
Q

What is the most common type of Pharyngeal cancer?

A

Squamous cell crcinoma

138
Q

Risk factors for Pharyngeal cancer

A

SCC: tobacco, HPV

Nasopharyngeal carcinoma: EBV, heavy alcohol intake

139
Q

Presentation of Pharyngeal cancer in oropharynx

A

Persistent sore throat, lump in throat or mouth, ear pain

140
Q

Presentation of Pharyngeal cancer in hypopharynx

A

Problems with swallowing, ear pain, hoarseness

141
Q

Presentation of Pharyngeal cancer in nasopharynx

A

Lump in neck, nasal obstruction, deafness, post-nasal discharge

142
Q

2 week wait criteria for Pharyngeal cancer

A

Unexplained ulceration > 3 weeks
Oral red/white patched
Persistent and unexplained lump in neck

143
Q

Management of Pharyngeal cancer

A

External beam radiotherapy main treatment

Surgery, chemo

144
Q

What is the most common type of Laryngeal cancer?

A

Almost all Squamous cell carcinoma

145
Q

Cancer in which areas is classified as Pharyngeal cancer?

A

Oropharynx/Nasopharynx/Hypopharynx

146
Q

Cancer in which areas is classified as Laryngeal cancer?

A

Supraglottis, Glottis, Subglottis

147
Q

Risk factors for Laryngeal cancer

A

Smoking, alcohol, asbestos, formaldehyde, nickel, sulphuric acid, HPV16

148
Q

Which strain of HPV is associated with Laryngeal cancer?

149
Q

Presentation of Laryngeal cancer

A

Chronic hoarseness, pain, dysphagia, lump in neck, sore throat, earache, persistent cough, breathlessness, haemoptysis

150
Q

2 week wait criteria for Laryngeal cancer

A

Persistent unexplained hoarseness

Unexplained lump in neck

151
Q

Management of Laryngeal cancer

A

Total/partial laryngectomy, chemo + radiotherapy

152
Q

What investigation should be done in all people with chronic hoarseness?

A

Chest x-ray

153
Q

Which side does Weber’s test localise to in:

i) conductive deafness;
ii) sensorineural deafness?

A

Conductive deafness- affected side

Sensorineural- unaffected side

154
Q

In Rinne’s test, if Bone conduction > Air conduction, what type of deafness is present?

A

Conductive deafness

155
Q

Aetiology of Branchial cysts

A

Benign developmental defect in branchial arches

Filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium

156
Q

Lump in neck filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium, what is the most likely diagnosis?

A

Branchial cyst

157
Q

When do branchial cysts usually present?

A

Late childhood/early adulthood

158
Q

How do branchial cysts present?

A

Painless lateral neck lump, anterior to sternocleidomastoid

Smooth, soft, fluctuant, non-tender, no transillumination

159
Q

Management of Branchial cyst

A

Refer to ENT, USS, Fine needle aspiration

Finals Revision (13 decks)

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