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year 5 > ENT > Flashcards

ENT Flashcards

1
Q

3 regions of the nasal cavity

A

vestibule
resp
olfactory

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2
Q

turbinates and meatus

A

turbinates are bony

meatus are the air spaces

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3
Q

3 structures of nasal septum

A

vomer
perpendicualr plate of ethmoid
septal cartilage

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4
Q

choana

A

link between nasal cavity and naso-pharynx

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5
Q

vascular supply to nasala cavity

A
  • anterior/ posterior ethmoidal arteries (ophthalmic arteries)= superior
  • sphenopalatine (maxillary artery)- external carotid artery
  • greater palatine (maxillary artery)
  • superior labial (facial artery)
  • converge in anterior septum= little’s area/ kesselbachs plexus
    o prone to nose bleeds as anastomosis
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6
Q

drainage of 4 sinuses

A

maxillary= into middle meatus into floor of semi lunar hiatus

sphenoid into spheno-ethmoidal recess

frontal also into semi lunar hiatus through frontonasal duct

ethmoid
Anterior – Hiatus semilunaris middle meatus
Middle – Ethmoid bulla
Posterior – Superior meatus

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7
Q

oral cavity boundaries

A
  • anterior oral fissure
  • posterior oropharyngeal isthmus
  • lateral wall buccinator
  • roof hard and soft palates
  • floor tongue and muscular diaphragm
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8
Q

salivary glands

A

parotid
submandibular
sublingual

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9
Q

pharynx

A

nasopharynx
oropharynx
laryngopharynx

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10
Q

what is waldever’s ring

A 
tonsil formation
protects things from entering the pharynx
-pharyngeal tonsil
-palatine tonsil 
-lingual tonsil
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11
Q

weber test
normal
conductive
sensorineural results

A

place in centre of patient forehead

  • normal is to hear it central
  • noise is louder in the ear with conductive deafness
  • in symmetrical hearing loss it is still heard in the middle
  • in unilateral sensorineural deafness the sound is heard better in the better hearing ear

lateralises to conductive hearing loss
lateralises away from sensorineural hearing loss

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12
Q

types of hearing loss

A

sensorineural

conductive

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13
Q

Rinne test how to do

A

vibrate and place the tuning fork at the base behind the ear

  • ask if they can hear it and then to indicate when they can no longer hear the sound
  • when they say they cant hear it place the still vibrating prongs 2cm away from the external auditory meatus and ask if they can still hear it now
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14
Q

rinne test meaning

A
  • air conduction is better than bone conduction normally

- if bone conduction is louder than air conduction this is BC>AC and rinne negative- suggesting conductive deafness

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15
Q

dix hallpike positional testing

A
  • sit patient upright
  • turn head to 45 degrees
  • rapidly lower them so head is 30 degrees below horizontal
  • need to keep eyes open to look for nystagmus
  • repeat with head facing the other way
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16
Q

abnormal hallpike

-bppv vs central pathology

A
  • in BPPV there is a delay of up to 20 seconds before the patient experiences vertigo and rotational jerk nystagmus towards the lower ear
  • in central pathology there is an immediate nystagmus and not necessarily vertigo and does not adapt (ie doesn’t lessen with fatigue)
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17
Q

examination for Ears nose and throat-

A

-otoscope- ears and nose
-nasendoscopy-nose
-rhinometry= peak nasal flow
rhinomanometry
-ciliary function

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18
Q

ENT blood tests

A 
autoimmune
allergens RAST
immunology- SPT, RAST
skin prick test
UPSIT scratch and sniff test
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19
Q

symptoms for ears 8

A 
otalgia
otorrhoea
hearing loss
tinnitus
vertigo 
unsteadiness
nystagmus 
itching
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20
Q

causes of otalgia 7

A 
acute otitis media or externa
referred from pharyngitis, trauma, cancer
perichonditis
herpes zoster- ramsay hunnt
tonsillitis
dental disease
cervical spine disease
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21
Q

causes of itchy ear

A

otitis externa

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22
Q

otorrhoea purulent cause 2

A

eardrum perforation with infection

otitis externa

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23
Q

otorrhoea mucoid 2

A

eardrum perforation

severe trauma causing CSF leak

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24
Q

otorrhoea blood 2 causes

A

granulation tissue from infection

trauma

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25
Q

hearing loss conductive causes 7

A 
wax
otitis externa
middle ear effusion
trauma to tympanic membrane
oteosclerosis
chronic middle ear infection
tumours
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26
Q

hearing loss sensorineural causes 6

A 
genetic 
prenatal infection
degenerative- presbyacusis
occupation or noise induced
acoustic neuroma
idiopathic
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27
Q

tinnitus 2 causes

A

presbyacusis

noise damage

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28
Q

vertigo causes 5 peripherally

A 
BPPV
vestibular neuronitis
drugs eg gentamicin and anticonvulsant
meniere
trauma
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29
Q

vertigo 3 central causes

A
  • brainstem ischaemia or infarction
  • migraine
  • MS
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30
Q

mouth and throat symptoms 8

A 
sore mouth
sore throat
stridor
dysphonia
dysphagia
hallitosis
trismus
xerostomia-dry mouth
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31
Q

sore mouth causes 4

A

gingivitis- gum inflammation
apthous ulcers
unilateral painful vesicles on palate- herpes zoster
diffuse oral infection- candida

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32
Q

sore throat causes 7

A 
viral pharyngitis
acute tonsillitis
infectious mononucleosis
palatal petechiae
peritonsillar abscess
mass or ulcer 
globus pharyngeus
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33
Q

globus pharyngeus causes

A

anxiety
acid reflux
habitual throat clearing

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34
Q

types of stridor and indication

A
  • inspiriatory- indicates narrowing at vocal cords
  • biphasic indicates tracheal obstruction
  • expiration suggests tracheobronchial obstruction
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35
Q

stertor

A

muffled hot potato speech

quinsy

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36
Q

dysphonia

A

disturbance of vocal cord function

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37
Q

dysphonia warning signs

A

> 3 weeks

with bovine cough and breathy dysphosia suggest lung cancer causing recurrent laryngeal palsy

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38
Q

causes of dysphonia

A 
croup
congenital
URTI
laryngitis
trauma
lung cancer
vocal cord nodules
neurological
functional
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39
Q

dysphagia causes

A

pharyngitis

oseophageal disease

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40
Q

lumps causes

A

lymphadenopathy

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41
Q

halitosis causes

A

poor dental hygiene

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42
Q

trismus- cause and meaning

A

trismus is inability to open mouth fully

-quinsy and tetanus

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43
Q

odynophagia

A

pain on swallowing

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44
Q

xerostomia

A

dry mouth

anticholinergic syndrome / sjorgen

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45
Q

rhinology symptoms 6

A 
-obstruction
discharge
sneeze and itch
pain and pressure
nasal deformity
sense of smell disturbance
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46
Q

bilateral water rhinorrhoea suggests

A

-allergic or vasomotor rhinitis

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47
Q

purulent rhinorrhoea suggests

A

bacterial infection eg cold or localised sinus infection or foreign body

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48
Q

new onset unilateral crystal clear rhinorrhoea suggests

A

Head injury CSF leak

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49
Q

anosmia causes

A

complete loss of smell

  • head injury with damage to the olfactory epithelium/ nerve
  • can occur after viral URTI
  • polyps
  • swelling in allergic rhinitis
  • severe mucosal oedema
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50
Q

cacosmia and cause

A

unpleasant smell

-chronic sepsis in nose or sinuses

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51
Q

parosmia

A

distorted sense of smell

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52
Q

nasal deformity causes 5

A 
-trauma
acne rosacea can cause rhinophyma 
-granulomatosis with polyangitis
-congenital syphilis
-cocaine
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53
Q

rhinophyma is

A

destruction of the nasal septum producing flattening of bridge and a saddle deformity
-large red bumpy nose

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54
Q

nasal pain causes

A

rare

trauma

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55
Q

facial pain causes

A
  • temporomandibular joint dysfunction
  • migraine
  • dental
  • sinusitits
  • trigeminal neuralgia
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56
Q

trigeminal neuralgia

A

Trigeminal neuralgia is sudden, severe facial pain. It’s often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums. It usually happens in short, unpredictable attacks that can last from a few seconds to about 2 minutes. The attacks stop as suddenly as they start.

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57
Q

external ear pathologies 15

A
  • pinna haematoma
  • other trauma
  • pinna-microtia
  • pre-auricular sinus
  • pinna cellulitis
  • skin neoplasis
  • external auditory meatus block
  • acute otitis externa
  • malignant otitis externa/ osteomyelitis
  • chronic otitis externa
  • exostois
  • furunculosis
  • foreign body
  • tympanosclerosis
  • granular myringitis
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58
Q

pinna haematoma pathology

A
  • perichondrium stripped off cartilage
  • cartilage devascularised
  • blood accumulates between perichondrium and cartilage
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59
Q

pinn haematoma cause

A

contact sport- rugby

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60
Q

pinna haematoma presentation

A

cauliflower ear

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61
Q

risk of pinna haematoma

A
  • risk of necrosis
  • risk of infection
  • risk of deformity
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62
Q

management pinna haematoma

A

needs aspiration drainage and pressure for 24 hours

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63
Q

possible trauma to the ear

A
  • blunt trauma
  • head injuries risk of temporal # and hearing loss
  • surgical trauma
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64
Q

passage of sound in ear

A 
concha
external auditory canal
tympanic membrane
ossicles- malleus, incus, stapes 
oval window
cochlea 
cochlea nerve
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65
Q

A 62-year-old man presents with a sore throat and 6 kg unintentional weight loss. He has smoked 1 pack of cigarettes daily for the past 45 years and drank 1 bottle of whiskey daily for the past 5 years. On examination, there is a large left tonsillar mass extending to the soft palate, with no cervical adenopathy

A

OROPHAYNGEAL carcinoma

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66
Q

A 74-year-old man presents with an 8-week history of right sided otalgia. This is associated with a sore throat and odynophagia. He smokes 20 cigarettes every day and is known to be a heavy drinker. On examination of the ear, there are no abnormalities noted.

A

nasopharyngeal cancer

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67
Q

children difference in anatomy

A 
obligate nasal breathers
large T and A
large occiput
tall tight supraglottis
short trachea
diaphragmatic breathers
sensitive to small changes in airway 
epiglottis more concave and folded
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68
Q

foreign body ear canal classifications

A

witnessed
unwitnessed- dont see but child tells you
missed- never tells you and dont see till later

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69
Q

type of things used to remove things from ears

A

jobson horne
synringing
crococile forceps
theatre if not successful

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70
Q

when would synringing be used

A

something dehydrated

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71
Q

when would crocidile forceps be used

A

paper but not circular

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72
Q

AOM children management

A

-can delay abx 48-72 hrs
give abx
-bilateral <2
-otorrhoea

admit and IV abx if
unwell child
neuro symptoms
masoiditis suspected

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73
Q

glue ear

A

otitis media with effusion

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74
Q

why do children get glue ear

A

eustachian tube immature

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75
Q

commonest cause of conductive hearing loss children

A

glue ear

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76
Q

presentation glue ear

A 
can be asymptomatic
recurrent otalgia
poor listening skills
indistinct speech or delayed language
behaviour problems
fluctuating hearing
reucurrent ear infection
balance problems
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77
Q

chronic OM dx

A

fluid present behind ear drum for 12 or more weks

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78
Q

tympanometry finding for middle ear effusion

A

flat trace

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79
Q

management of Glue ear - indication for surgical intervention

A

children with persistent bilateral OME over a period of 3 months with a hearing level in the better ear of 25-30 should be considered for surgical intervention

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80
Q

management options for glue ear

A

-surgical =grommet or ventilation tube- always wait 3 months

-abx
-antihistamines
decongestants
steroids
diet
hearing aids if contraindicated surgery

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81
Q

acute mastoiditis cause

A

-often preceded by AOM

as pus builds up in the mastoid bone it starts corroding out

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82
Q

presentation of acute mastoiditis

A 
swollen behind ear
can turn the ear inwards and forwards
severe pain over mastoid process
perforation can relieve the initial discomfort
tachycardic and pyrexia
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83
Q

management of acute mastoiditis

A 
admit
IV abs and analgesia 
swabs if discharging
CT scan if 
-neuro
-systemic
-baby and cant assess

surgical intervention-mastoidectomy
drainage

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84
Q

complications of acute mastoiditis

A

neurological
intra-cranial
temporal bones
systemic eg sepsis, thrombosis

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85
Q

unilateral smelly nasal discarge in a child

A

foreign body until proven otherwise

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86
Q

assessment of foreign body in child

A

rhinoscopy

parental kiss

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87
Q

types of nasal foreign bodies

A

witnessed, unwitnessed and missed
organic FB- need to remove in a week
inorganic FB- remove electively no risk
button batteries- remove immediately risk of erosion

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88
Q

management nasal foreign bodies

A

remove with jobson horne, wax hook, crocodile

theatre list

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89
Q

neonatal hearing assessment

A

OAE otoacoustic emission

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90
Q

epistaxis management in children

A

nasceptin first line 2 weeks 3xa a day

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91
Q

peri-orbital cellulitis presentation

A

swollen eye
proptosis
need to dermine if swelling just eyelid or in the globe

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92
Q

cause of peri-orbital cellulitis

A

from ethmoid sinus- pus travels to the orbit

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93
Q

complications peri-orbital cellulitis

A

visual problems
colour vision goes first

intracranial infections

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94
Q

management peri-orbital cellulitis

A

IV abx and nasal decongestants
CT scan- vision signs, >24hrs no improvement ,difficult to assess child

surgical drainage

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95
Q

pharyngeal abscess in a child presentation

A

unwell
torticollis
trisumus

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96
Q

management of pharyngeal abscess

A

hot tonsillectomy

drain abscess

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97
Q

retropharyngeal abscess presentation

A

drooling
dysphagia
theatre

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98
Q

presentation of atypical mycobacterial infections in a child

and RX

A

-cold abscesses with well child

need clarithromycin
if not settling surgical
tends to resolve by itself though

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99
Q

foreign body oesophagus management

A

admit
CXR

above lower oesophageal sphincter= rigid oesophagocsopcy and remove

below diaphragm= usrgeons

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100
Q

foreign body airway

A

theatre immediatly
bronchoscopy

short live xh of recurrent croup and chest infections

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101
Q

laryngomalacia

A 
prominent few of birth
often related to reflux
inspiratory stridor
tracheal tug 
costal recession
pectus cavum
thriving issues- surgical
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102
Q

paediatric acute rhinosinusitis presentation

A

nasal obstruction, discharge
and one of
frontal pain
cough

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103
Q

pinna haematoma pathology

A

perichondrium stripped off cartilage and devascularised get necorsis and deformity

-aspiration drainage same day ENT

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104
Q

pinna-microtia is

A

-due to an embryological defect
failure formation of ear
develops from 6 hillocks of his

spectrum of malformation- normal to abscence of EAM and pinna

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105
Q

management of microtia

A

speech and language development
surgical
prosthesis
hearing aids

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106
Q

pre-auricular sinus presentation and rx

A

-pit at root of helix- embryologicla remanant
no intervention require unless becomes infected
pus coming out

treat acute infection
surgical excision if recurrent infection

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107
Q

pinna cellulitis

A

needs IV antibiotics
complications of other infections
perichondritis spares lobe
can end up with necrosis

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108
Q

external auditory meatus blockage

A

-wax/ cerumen

conductive hearing loss

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109
Q

wax production

A

by ceruminous glands

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110
Q

management of wax blockage

A
  • soften using almond/ olive oil, sodium bicarb

- syringe/ microsuction

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111
Q

when should syringing for wax not be done

A

if perforation risk of infection

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112
Q

assoc. conditions to acute OE

A

psoriasis
seb k
eczema
bacteria eg strep, staph, pseudomonous, fungi

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113
Q

presentation of acute OE

A 
itch and pain
minimal hearing loss
red, eczematous
swollen external auditory canal
discharge
pain on palpation of tragus
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114
Q

causes of acute OE

A
  • post-trauma eg cotton buds
  • frequent swimmers
  • patients with eczema
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115
Q

treatment of acute OE

A
  • cleaning- syringe suction
  • topical steroids / antibiotics
  • oral antibiotics if not settling and refer to ENT if not responding to topical

aural hydiene and keep dry
-ear wick if extensively swollen

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116
Q

choice of abx for acute OE

A
  • pseudonomas ciprofloxacin for DM

- not aminoglycosides if perforated tympanic membrane

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117
Q

complication of acute OE

A

malignant OE

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118
Q

what is malignant OE

A

-diabetic patient with excessive pain and OE
-osteomyelitis of temporal bone due to pseudomonas infection
aggressive form
immunocompromised also affected

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119
Q

symptoms of malignant OE

A

DM or immunocompromised
severe otalgia
temporal headaches
purulent discharge

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120
Q

treatment of Malignant OE

A

aural toileting
insertion of wicks
high dose ciprofloxacin
surgery for debridement

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121
Q

chronic otitis externa presentation

A 
usuall bilateral
painless
relapse 
thickened skin of canal
chronic discharge 
rare hearing loss
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122
Q

management of chronic otitis externa

A

-cleansing ear

antibacterial ear drops

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123
Q

exostosis is

A

a bony growth - bony protuberance

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124
Q

cause of exostosis

A

-triggered by cold water-surgers

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125
Q

management exostosis

A

-surgery only if obstructive and problems with wax

otherwise leave alone

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126
Q

presentation exostosis

A

conductive hearing loss

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127
Q

what is furunculosis

A

infection in the hair follicles
lateral 1/3 of EAM is hairy
follicle infection
s.aureus main cause

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128
Q

presentation of furunuculosis and rx

A

-severe throbbing pain with pyrexia usually precedes the rupture of the abscess

rx

  • abx
  • drain
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129
Q

round foreign object use

A

blunt hook

syringe as long as not dehydrated

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130
Q

tympanosclerosis is

A

calcification of the fibrous layer
previous ear disease
not clinically relevant

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131
Q

granular myringitis is

A

inflammation of the lateral surfaces of the ear drum
granulation on ear surface of TM
causes discharge
slow to settle

rx-topical

132
Q

acute otitis media pathology

A
  • often follows an URTI which ascends via the eustachian tube-viral
  • eardrum becomes retracted as the tube is blocked an an inflammatory middle ear develops
133
Q

presentation AOM

A 
red bulging ear drum
fever
severe otalgia
discharge
n and v in children
134
Q

treatment of AOM

A

-pain relief
antipyreitcs
analgesia and nasal congestants
delayed abs for 48 to 72 hrs?

135
Q

antibiotics indication for AOM

A
  1. <2 bilateral
  2. immunocompromised
  3. unwell
  4. discharge or perforation
  5. already present >4 days
136
Q

abx for AOM

A

amox first line

137
Q

complications of AOM

A 
perforations
hearing loss
vertigo
intra-cranial infection
CN7 palsy
acute mastoiditis
138
Q

acute perforation causes

A

AOM

traumatic

139
Q

AOM perforation presentation and rx

A

-relief of pain
discharge
topical antibiotics and waterproofing
normally heals -refer at 6 weeks if not

140
Q

perforation signs

A

ear obscured by thin transluencent layer of wax

hearing loss- conductive

141
Q

traumatic perforation management

A

pain at time
visible hole
normally heals in a few weeks
waterproofing

142
Q

surgical option for perforation

A

myringoplasty

143
Q

unilateral OME should consider

A

nasopharyngeal mass

144
Q

chronic squamous otitis media- cholesteatoma pathology

A
  • squamous debris retained in the middle ear/ cleft
  • long standing eustachian tube dysfunction can cause retractions and perforations of the tympanic membrane

can occur with a choelsteatoma which is a non cancerous growth of squamous epithelium - perforated pars flaccida

145
Q

presentation of chronic squamous otitis media

A

non resolving unilateral discharge which is offensive
hearing loss
poor antibiotics response

146
Q

management of chronic squamous otitis media

A

surgery - mastoidectomy, excision of disease

regular microsuction if not fit for surgery

147
Q

complications of cholesteatoma

A 
-hearing
taste 
tinnitus
vertigo
facial nerve palsy
intracranial infection
148
Q

otoscopy cholesteatoma

A

shows attic crust in uppermost part

149
Q

chronic mucosal otitis media symptoms

A

otorrhoea-mucoid- blood stained

-hearing loss

150
Q

two types of chronic mucosal otitis media

A

active or inactive

151
Q

management of chronic mucosal OM

A

aural toilet

steroid eardrops

152
Q

inactive chronic mycosal OM

A

-perforation in Tympanic membrane
longstanding
not healing
may be mild hearing loss

153
Q

management of inactive chronic mucosal OM

A

-no action mandatory

waterproof

154
Q

management of active chronic mucosal OM

A

-perforation with discharge

persistent or intermittent

155
Q

presentation of active chronic mucosal OM

A

-pain
hearing loss
balance
otorrhoea-discharge

156
Q

active chronic mucosal management

A

-waterproof
topical steroid drops
-myringoplasty-surgery

157
Q

indications for myringoplasty for chronic mucosal OM management

A

-recurring discharge
regular swimmer
improve hearing

158
Q

complications of middle ear infections

A

extracranial
-acute mastoiditis
facial paralysis
labyrinthitis

intracranial
meningitis
abscess
lateral sinus thrombosis

159
Q

tympanic membrane retraction cause

A

negtive pressure in the middle ear
previous perforations in TM
weak TM medialised
progression unpredictable

160
Q

complications of tympanic membrane retraction

A

erosion

cholesteatoma

161
Q

Glomus tumours what sort of tumours

A

neuroendocrine - can secrete catecholamines

162
Q

presentation of a GLomus tumour

A

pulsatile tinnitus
conductive hearing loss
facial weakness

163
Q

types of glomus tumours

A

tympanicum
jugulare
vagale

164
Q

treatment of glomus tumours

A

surgery
radiotherapy
or none

165
Q

unilateral ear effusion in adults

A

need to consider nasopharyngeal carcinoma

2 week ENT referral

166
Q

features of middle ear effusion

A

muffled hearing
click or pop on swallowing
usually predisposing cold
mostly children

167
Q

Facial nerve palsy causes

A

-LMN CNVII palsy
-idiopathic= Bell’s palsy
- ramsay hunt
-middle ear pathology
parotid tumour
trauma
CPA tumours

168
Q

Bell’s palsy presentation

A 
dropping mouth
ptosis 
drooping  face- facial paralysis 
most recover 2-12 weeks 
idiopathic
169
Q

bell’s palsy management

A

prednisolone

protect eye with lubricants

170
Q

severity of Bell’s palsy

A

house brackmann definition

171
Q

hearing loss types

A

sensorineural
conductive
mixed

172
Q

cause of sensorineural hearing loss

A 
iatrogenic- surgery, drugs, 
congenital eg genetic, infective, 
autoimmune, malignant
excessive noise exposure
meniere
cochlear failure 
presbyacusis
173
Q

drugs causing SNHL

A

-gentamicin
platinum chemo
anti TB meds

174
Q

cause of presbuacysis

A

bilateral age related SNHL due to degeneration of hair cells cochlea

175
Q

presentation of presbyacusis

A

affects high frequency first

176
Q

conductive hearing loss causes

A

-EAM-wax occlusion
-middle ear disease
OME with effusion
cholesteatoma
perforation
otosclerosis

trauma ossicular discontinuity

177
Q

SNHL management

A

hearing aids

178
Q

types of hearing aids

A

conventional
implantable
cochlear implant

179
Q

treatment of conductive hearing loss

A

-wax softening

surgery

180
Q

vestibular schwannoma

A

slow growing benign tumours

also called acoustic neuroma

181
Q

CN VII vesticular schwanoma

A

facial palsy

182
Q

CV V vestibular schwanoma

A

absent corneal reflex

183
Q

CN VIII vestibular schwanoma

A

-vertigo
unilateral SNHL
unilateral tinnitus

184
Q

inx vestibular schwanoma

A

MRI
urgent ENT
audiogram

185
Q

management acoustic neuroma

186
Q

what is otosclerossi

A

replacement of normal bone by vascular spongy bone

causes progressive conductive deafness due to fixation of the stapes at the oval windown

187
Q

inheritance of otosclerosis

A

autosomal dominant

188
Q

presentation of otosclerosis

A 
usually 20-40
conductive bilateral deafness
tinnitus
normal tympanic membrame- occasionally flamingo tip
positive fhx
can be precipitated in pregnancy
189
Q

inx for otosclerosis fundings

A

normal rine and weber
norm otoscopy
audiometry shows conductive pattern with hearing loss at low frequency

190
Q

causes of tinnitus

A 
otosclerosis
meniere
acoustic neuroma
drugs 
presbyacusis
damage
191
Q

what drugs can cause tinnitus

A

ASPIRIN NSAID
aminoglycosides
loop diuretics
quinine

192
Q

2 red flag features of tinnitus and cause

A
  • pulsatile- suggest vascular

- asymmetric or unilateral look for CPA tumour

193
Q

2 types of tinnitus

A

subjective -only by patient

objextive- heard also by observer

194
Q

causes of objective tinnitus

A

AV malformation

carotid body tumour

195
Q

management of tinnitus

A

reassurance
hearing aid
therapy

196
Q

acoustic trauma

A

loud noises
tinnitus unilateral HL
resolves over hrs to days
permanent damage to hair cells

197
Q

BPPV presentation

A 
sudden onset on head change
transient ot seconds
vertigo on movement
following other inner disease/ trauma
self-limiting
last 10-20 seconds
nausea
198
Q

assessment BPPV

A

hallpike positive

199
Q

pathology BPPV

A

calcium carbonate crystals loose in semi-circular canal

200
Q

management of BPPV

A 
Epley manoeuvre 
-roll around to get crystals out 
habituation
vestibular rehab
betahistine only short term
201
Q

labyrinthitis presentation

A 
vertigo- not triggered but is exacerbated on moving
nausea and vomiting
hearing loss
tinnitus
preceding symptoms of URTI 
episodes last days 
lie in bed with unaffected ear upwards
202
Q

signs of viral labyrinthitis

A
  • spontaneous unidirectional horizontal nystagmus to unaffected side
  • SNHL
  • abnormal head impulse
  • gait disturbance
  • normal skew test
  • abnormality on inspection of ear
203
Q

management viral labyrinthitis

A

support and wait

promethazine, meclizine only if severe

204
Q

meniere presentation

A

lasts minutes to hours
fluctuating hearing loss
-mostly unilateral but over yrs becomes bilateral
low frequency SNHL

episodes usually resolve 5-10 days
degree of overall hearing loss 
nystagmus
fluctuating tinnitus
aural pressure and fullness
205
Q

A 65-year-old woman presents with a chief complaint of dizziness. She describes it as a sudden and severe spinning sensation precipitated by rolling over in bed onto her right side. Symptoms typically last <30 seconds. They have occurred nightly over the last month and occasionally during the day when she tilts her head back to look upwards. She describes no precipitating event prior to onset and no associated hearing loss, tinnitus, or other neurological symptoms

206
Q

A 56-year-old woman presents with a 3-week history of imbalance, right-sided hearing loss, and tinnitus. She reports having an upper respiratory infection 1 week before the onset of her symptoms. Her symptoms began with a severe episode of room-spinning vertigo with associated nausea and vomiting that lasted all day. The next day she noticed right, high-pitched tinnitus and was unable to use the telephone in her right ear. She now reports constant imbalance and slight vertigo with quick head turns to the right.

A

labyrinthitis

207
Q

A 40-year-old woman presents with a 1-year history of recurrent episodes of vertigo. The vertigo spells are described as a sensation of the room spinning that lasts from 20 minutes to a few hours and may be associated with nausea and vomiting. The spells are incapacitating and are accompanied by dizziness, vertigo, and disequilibrium, which may last for days. No loss of consciousness is reported. The patient also reports aural fullness, tinnitus, and hearing loss in the right ear that is more pronounced around the time of her vertigo spells. Physical examination of the head and neck is normal. A horizontal nystagmus is noted. She is unable to maintain her position during Romberg’s testing or the Fukuda stepping test. She turns towards the right side and she is unable to walk tandem. Her cerebellar function tests are normal.

208
Q

management of meniere

A

refer to ENT
DVLA
low cafffeine and salt diet
betahistine- prophylactic- reduce blood flow
diuretics can also help
intratympanic injection steroid or gentamicin
prochlorperazine in acute attacks
surgery decompress inner ear/ labyrinthectomy

209
Q

vestibular migraine presentation

A 
mimics meniere
otheer symptoms eg headache, visual, tibling
phx of fhx of migraine
no flucutation in hearing or tinnitus 
episodic mins to hours
210
Q

vestibular neuronitis presentation

A 
following URTI
Sudden onset often unilateral
severe initially and subsides over severall days
positional vertigo can be present for several weeks
n and v
pain in ear
hrs to days 
horizontal nystagmus
no hearing loss or tinnitus
211
Q

vestibular neuronitis management

A

-rehab exercises

prochlorperazine only short courses for relief

212
Q

SNHL on audiogram

A

both AC and BC reduced

213
Q

conductive on audiogram

A

AC reduced

so BC >AC

214
Q

mixed on audiogram

A

both air and bone decreased

but air is worst

215
Q

tympanometry for fluid in ear, perforation

216
Q

retracted tympanic membrane tympanometry

A

shift curve left

217
Q

causes of presbyacusis

A 
multifactorial
arteriosclerosis
diabetes
noise
drugs eg salicylates, chemo
stress
genetics
218
Q

acute rhinosinusitis definition

A 
<12 weeks
of 
nasal discarhge or obstruction
change of smell
pain
219
Q

avr

A

<10 days common cold

220
Q

acute post viral shinusitis

A

symptoms increase after 5 days or persist >10days but <12 weeks

221
Q

acute bacterial rhinosinusitis

A 
at least 3 of
discolored discharge
severe local pain
temp >38
raised ESR
double sickenings
222
Q

chronic rhinosinusitis

A

> 12 weeks
nasal obstruction or discharge
pain
reduction or loss of sense of smell

223
Q

unilateral polyps management

A

red flags

refer

224
Q

main causes acute sinutisi

A

usually s.pneumoniae, h.influenzae and rhinovirus

225
Q

mangement acute sinusitis

A

<5 DAYS common cold only supportive

symptoms persisting >10days or worsening after 5 days then topical steroids and if no effect after 14 days then refer

symptoms persisting >10 days or worsening after 5 and severe bacterial suggesting then only trial intralnasal steroids for 48hrs and refer if no effect
also can consider phenoxymethylpenicillin

226
Q

acute frontal sinusitis

A

potentially serious condition as a risk of intracranial complications
severe frontal headache and tenderness
CT if suspect intracranial infection

227
Q

complications of acute coryza

A 
otitis media
nasopharyngitis
acute sinusitis
cervical lymphadenitis
laryngitis
pneumonia
228
Q

acute sinusitis predisposing factors

A

nasal obstruction
recent local infection
swimming
smoking

229
Q

chronic sinusitis

A

> 12 weeks

retained secretions allow a spectrum of bacteria to colonise the sinuses further inhibiting clearance

230
Q

management of chronic rhinosinusitis without polyps

A

mild 0-3
topical steroids, irrigation

moderate/ severe
topical steroids
nasal saline irrigation
culture
consider long term abx (if not allergic) 
CT scan
surgery
231
Q

management of chronic rhinosinusitis with polyps

A

mild disease- topical steroid spay and reviwe at 3months

moderate- topical steroid spray and consider democycline

severe- topical or short course oral steroids- review at 1 month if improved continue if not improved CT and surgery

232
Q

polyps are

A

bag of oedematous mucosa
arise from ethmoid cells and prolapse via the middle meatus
bilateral

233
Q

rhinitis is

A

inflamamtion of lining of the nose

inflammed turbinates swell

234
Q

symptoms rhinitis

A

loss of smell
congested
loss of taste

235
Q

types of rhinitis

A

allergic
non-allergic- eosinophilia
infective- viral

236
Q

allergic rhinitis

A 
IgE
seasonal 
watery discharge, sneezing
clinical dx 
trial of allergy avoidance
allergy skin prick testing
237
Q

allergic rhinitis classification

A

mild
normal sleep, daily activities, school and work

moderate to severe
abnormal sleep, impaired activities, problems school or work troublesome activities

intermittent <4 days a week

persistent >4 days a week

238
Q

management rhinitis

A

mild= oral/ topical ah1

severe and mod= topical nasal steroid
check use compliance, increase dose

watery rhinorrhoea- add ipratopium
itch/sneeze= add ah1
catarrh= addd LTRA if asthma
blockage = add decongestant, oc

consider immunotherapy if due to allergy

infection or anatomical- surgery eg turbinoplasty, septoplasty

239
Q

vasomotor rhinitis

A

imbalance sympathetic and parasympathetic supply
increased vascularity during

change in temp
preganncy
puberty
menopause
COCP

decongestants
diathermy

240
Q

rhinitis medicamentosa

A

overuse of decongestants causes reactive vasodilatation of the nasal mucosa

241
Q

atrophic rhinitis

A 
severe crusting of the nasal cavities and atrophy of mucosa
klebsiella 
foul stench
crust
epistaxis

nose hygiene

242
Q

epistaxis causes

A 
idiopathic
infection
trauma
neoplasia- juvenile angiofriboma
FB
HTN
drugs
blood disease
HHT
243
Q

management epistaxis

A

1st aid
cautery silver nitrate-diathermy
anterior packing
surgical arterial ligation of sphenopalatine artery

nasceptin

244
Q

when to admit for epistaxis

A

if packed
haemidrynamic unstable
co-morbidities
<2 yrs old

245
Q

nasal #

A

5-7 days post injury trial MUA

needs to be done in 2 weeks

246
Q

septal devitation

A

cant move cartilage

would need to wait 6 months for septoplasty if severe breathing problems

247
Q

septall haematoma

A

need to exclude on all nasal #
can get saddle nose -infection corrodes through septum
needs to be drained

248
Q

pott’s puffy tumour is

A

complication of infection sinusitis
causes osteomyelitis of frontal bone and formation of abscess
boggy frontal swelling

CT surgical drain and IV abx

249
Q

risk of facial abscess

A

cavernous sinus thrombosis

250
Q

facial palsy causes

A 
bell's diagnosis of exclusion
acoustic neuroma
CVA
brainstem tumour
ramsay hunt
middle ear infection
trauma 
parotid tumour
251
Q

causes of a bilateral facial nerve palsy

A 
sarcoidosis
guillain barre
lyme
bilateral acoustic neuroma
bell's palsy but rare
252
Q

bells’ palsy cf

A 
often get otalgia before onset of facial weakness
loss of hearing
taste
hyperacusis
dropping eyelid and mouth 
3 weeks and improves
idiopathic cause
most common cause
dx of exclusion 
inflammation of facial nerve
253
Q

ramsay hunt syndrome cf

A 
shingles outbreak in facial nerve
painful red rash 
vesicular rash on ear or tongue
facial weakness or paralysis
ear pain often 1st feature 
hearing loss
vesicles on tympanic membrane 
tinnitus
vertigo
254
Q

complications of ramsay hunt

A

permanent hearing loss and facial weakness
eye damage
postherpetic neuralgia

255
Q

rx of ramsay hunt

A

aciclovir and steroids

256
Q

acoustic neuroma cnviii

A

tinnitus
vertigo
hearing loss

257
Q

acoustic neuroma cnv

A

absent corneal reflex

258
Q

acoustic neuroma cnvii

A

facial palsy

259
Q

who gets bilateral acoustic neuroma

A

neurofibromatosis 2

260
Q

management of acoustic neuroma

A

urgent referral ENT
MRI
audiometry
surgical, radiotherapy, observed

slow growing benign

261
Q

types of parotid tumours benign

A

benign pleomorphic adenoma
warthin tumour- papillary
monomorphic adenoma
haemangioma

262
Q

benign pleomorphic adenoma

A 
most common
proliferation of epithelial 
slow growing
recurrence possible
surgical
malignant degeneration 2-10%
263
Q

warthin tumour- papillary cystadenoma

A 
second mot common 
bilateral benign neoplasm of parotid
male
6th and 7th decade
lymphocytic and cystic infiltrates
malignant transformation v..rare
264
Q

monomorphic adenoma

A

slow growing

265
Q

haemagioma parotid

A

consider in child
90% of <1yr old partotid
hypervascular
can spontaneous regress

266
Q

malignant parotid tumours

A 
mucoepidermoid carcinoma
adenoid cystic carcinoma
mixed
acinic cell
adenocarcinoma
lymphoma
267
Q

quinsy cf

A 
unilateral
trismus
temp
referred otalgia
ulvar deviation
reduced neck mobility 
hot potato
268
Q

management quinsy

A

urgent referral ENT
lance
iv abx
theatre if not improving

269
Q

sore throat diff dx

A

pharyngitis
tonsillitis
laryngitis
infectious mononucleosis

270
Q

indications for antibiotics for sore throat

A 
3/4 centor
marked systemic upset
unilateral peritonsillitis
hx rheumatic fever
immunodeficiency
271
Q

tonsillitis cf

A 
sore throat
difficulty swallow
pain
temperature
drooling
vpoice change 
oedematous tonsils
white film that bleeds when attempt to remove
272
Q

main causes of tonsillitis

A

s.pyogenes

EBV

273
Q

management tonsillitis

A

if meets centor 3/4 give phenoxymethylpencillin

274
Q

tonsillectomy indications

A 
7 in 1
5 in 2
3 in 3
sleep apnoea
enlarged adenoids
2 quinsy
malignancy 
disabling tonsillitis
275
Q

post tonsillectomy bleeds

A

all assess by ENT

6-8hrs primary= immediate return to theatre

5-10 days= secondary often assoc. to wound infection so admit and abx

276
Q

glandular fever cf

A

lymphadenopathy
hepatosplenomegaly
can look like tonsillitis
EBV

277
Q

acute laryngitis

A

refer >3 weeks

278
Q

pharyngeal abscess cf

A 
hx of URTI
throat pain
odoynophagia
fever
neck swelling/ tenderness/ lymphadenopathy
neck stiffness
compromised airway
279
Q

management of pharyngeal abscess

A

IV fluids
IV abx
airway protection
needle open surgical drainage

280
Q

retropharyngeal abscess

A

mostly children
inflammation and swelling in retropharyngeal space
child assists hyperextension of the neck which is held rigid

281
Q

vocal cord nodules

A 
dysphonia 
low pitch quality 
husky
most resolve 
rest voice
282
Q

vocal cord palsy

A

recurrent laryngeal nerve injury from iatrogenic, lung, malignancy

CT scan to check

283
Q

sialolithiasis

A

stones
colicky pain and post prandial swelling
on eating pain

284
Q

sialadenitis

A

staph aureus infection of salivary glands
pus erythema
abscess

285
Q

submandibular tumour is ususally

A

adenoid cystic carcinoma

286
Q

red flags for neck lumps

A 
not tender neck lump
hoarseness
dysphagia
otalgia
throat pain
ulceration
stridor
287
Q

midline massess

A

thyroid
thyroglossal cysts
midline dermoids

288
Q

lateral nedk lumps

A 
tumour
lymphoma
metastatic
infective
sjorgen
sarcoidosis 
sebaceous cysts 
lymph nodes
289
Q

brachial cyst

A

embryological remanant
young adult
anterior triangle
assess to exclude cystic degeneration

290
Q

thyroglossal cyst

A

embruological remanant of thyroid duct
moves on swallowing and tongue protrusion
midline

291
Q

submandibular mass

A

sialolithiasis

siladenitis

292
Q

juvenile nasal angiofriboma

A 
more common in teenage boys 
benign vascular tumour
appears in nasal cavity 
expands quickly and extensively including into the brain
intercurrent epistaxis
need to remove tumour
293
Q

reactive lymphadenopathy

A

most common cause of neck swelling
tender
hx of URTI

294
Q

lymphoma

A

rubbery, painless lymphadenopathy
assoc. night sweats and splenomegaly
phenomenon pain on drinking uncommon

295
Q

pharyngeal pouch

A

older men
midline lump gurgles on palpation but not usually visible
dysphagia ,reflux hallotosis

296
Q

cystic hygroma

A

congenital <2 yrs
translluminates
soft and mobile
painless

297
Q

branchial cyst

A 
oval mobile
cystic mass - scm and pharynx 
dont translluminate 
early adulthood
failure to close 2nd branchial cleft
298
Q

carotid aneurysm

A

pulsatile lateral neck mass

not mobile

299
Q

red flags head and neck cancer

A 
hoarseness >2 weeks
neck lump >2 weeks
throat pain >2 weeks 
swallowing problems
smoking hx
weight loss
cough 
unexplained oral cavity ulceration >3 weeks
-unilateral epistaxis
300
Q

lip cancer

A

often squamous cell carcinoma

rf
UV light
tobacco

rx
lip shave ulcer
excision

301
Q

oral cavity cancer

A

mostly malignant squamous cell on tongue

rf

  • betel nut chewing
  • smoking
  • alcohol
  • chronic dental infection
302
Q

tongue cancer

A 
-lateral border
indian
painless ulcers
difficulty chewing
dx on biopsy
L1 under chin lymph node spread
tongue fixation and invasion of mandible
diffculty swalloing and speech 
management- surgery
303
Q

floor of mouth cancer

A 
presents late with invasion of the mandible
dysphagia and pain
odynophagia
CT
biopsy 
surgical resection
304
Q

alveolar ridge

A 
presents late
direct invasion of mandible
inferior alveolar nerve
ill fitting dentures can be presenting symptom
treatment surgery
305
Q

buccal mucosa cancer

A

indian
tobacco
betel nut chewing

306
Q

tonsil cancer

A

unilateral tonsil with L2 spread risk of lymphoma

307
Q

larynx cancer

A

most squamous cell

based on location

308
Q

supraglottis

A

neck lumbs

dysphagia

309
Q

glottis

A

hoarsness
dysphonia
prevents early

310
Q

subglottis

A

respiratory

311
Q

inx for larynx cancer

A

CXR
laryngoscopy
FNA lump

312
Q

glottic carcinoma vocal cords

A

early symptoms
hoarseness

management

  • radiotherapy
  • endoscopic laser resection
  • laryngectomy parital or total
313
Q

supraglottic carcinoma

A

early symptoms are often subtle and ignored
often bilateral
dysphagia

early
-laser excision, radiotherapy, laryngectomy

late
chemoradiotherapy
total or partial laryngectomy with pharyngectomy

314
Q

subglottic cancer

A

rarest laryngeal subsite
prevents late
invasion of surrounding structures
total laryngectomy

315
Q

oropharyngeal

A

tonsil common site
related to HPV

signs
unilateral enlarged tonsil
L2 node enlargement
throat discomfort
dysphagia
otalgia
neck lump 
inx
MRI
CT
FNA
CXR

rx

  • early= primary resection and radiotherapy
  • advanced= primary surgery and chemoradiotherapy
316
Q

nasopharyngeal carcinoma causes

A

malignant squamous cell
chorodoma

angiofibroma benign

317
Q

rf nasopharyngeal

A
  • asian
  • salted fish
  • EBV
  • smoking
  • herbal medicine
318
Q

CF of nasopharyngeal

A 
cervical painless lymphadenopathy
otalgia
nasal obstruction- unilateral epistaxis, discharge,
 palsy 3-6
posterior triangle lump 
facial pain 
speech
319
Q

A 62-year-old man presents with a sore throat and 6 kg unintentional weight loss. He has smoked 1 pack of cigarettes daily for the past 45 years and drank 1 bottle of whiskey daily for the past 5 years. On examination, there is a large left tonsillar mass extending to the soft palate, with no cervical adenopathy.

A

oropharyngeal

320
Q

57-year-old man presents with a 6-month history of hoarseness. He has a reactive airway disease diagnosis and is treated for asthma. Over the past week he has noted progressive difficulty breathing. He also has otalgia, dysphagia, odynophagia (painful swallowing), and a 9-kg weight loss

321
Q

laryngopharynx cancer

A

causes
-tobacco
alcohol
-plummer vinson or paterson brown syndrome

322
Q

laryngopharynx cancer presentation

A 
odynophagia
dysphagia
referred otalgia
hoarsenesss
neck nodes
323
Q

inx laryngopharynx

A

barium swallow
CXR
CT

324
Q

management laryngopharynx

A

surgery
chemoradiotherapy
radical surgery

325
Q

nasal neoplasia

A

benign-osteoma, papilloma

malignant, scc, adenocarcinoma melanoma

326
Q

risk factors nasal malignancy

A 
smoking
hardwood dust-adenocarcinoma ethmoid 
nickel dust to SCC
radiation of nose
transitional cell papillomatoma assoc. snuff
327
Q

cf nasal neoplasia

A 
frontal sinus cancer- orbital, proptossis
nasal cavity- obstruction, epistaxis
mouth-ill fitting dentures, loose teeth
face swelling
antral tumours usually present late
ephiphoria
trigemenial nerve
trismus

year 5 (9 decks)

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