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ENT Flashcards

1
Q

Describe the external auditory canal:

A

About 2.5cm
Outer 1/3rd is cartilage with hairs and ceruminous (wax)
glands
Inner 2/3rd is bony and lined with sensitive skin

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2
Q

What is chondrodermatitis nodularis helicis?

A

Tender cartilaginous inflammed nodule on helix due to pressure

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3
Q

What is pinna haematoma?

A

Blunt trauma can cause bleeding in the subperichondrial plane elevating perichondrium to form a haematoma

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4
Q

How should pinna haematoma be treated?

A

Incision of haematoma and primary closure

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5
Q

What is the consequence of poor treatment of pinna haematoma?

A

Ischemic necrosis then fibrosis (cauliflower ear)

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6
Q

What are auditory exostoses?

A

Smooth, multiple, bilateral swelling of bony canals that represent local bone hypertrophy from cold exposure

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7
Q

What are the management options for excess ear wax?

A

Olive oil drops
Suction under direct vision using microscope
Syringing after softening with olive oil

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8
Q

Describe the main features seen when examining the tympanic membrane:

A 
Cone of light pointing to side of ear being examined
Malleus and incus often seen 
Pars tensa (inferior drum) and pars flaccida (superior drum)
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9
Q

What are some presenting features of otitis externa?

A

Discharge, itch, pain and tragal tenderness

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10
Q

What are the main causative organisms of otitis externa?

A

Pseudomonas or S. aureus

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11
Q

What are some predisposing factors to otitis externa?

A

Excess canal moisture, trauma, high humidity, absence of wax, narrow ear canal, hearing aids

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12
Q

What is the treatment for mild-moderate otitis externa?

A

Clean EAC, topical Abx ± steroid drops

Keep ears water free

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13
Q

What is the treatment for severe otitis externa?

A

Thin ear wick can be inserted with aluminium acetate
Once meatus opens up - microsuction or careful
cleansing

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14
Q

How can the external auditory canal be cleaned?

A

Gentle syringing to remove debris, dry mopping with cotton wool under direct vision, microsuction

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15
Q

What is furunculosis and what condition is it associated with?

A

Painful staph abscess arising in hair follicle within canal

Associated with diabetes

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16
Q

How can malignant/necrotising otitis externa present?

A

Chronic ear discharge, deep severe otalgia, temporal headaches and sometimes CN palsies

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17
Q

What are the consequences of malignant/necrotising otitis externa?

A

Temporal bone destruction and base of skull osteomyelitis

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18
Q

What is the main causative organism of malignant/necrotising otitis externa and what condition is this disease associated with?

A

Pseudomonas

Diabetes

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19
Q

What is the treatment for malignant/necrotising otitis externa?

A

Surgical debridement, systemic Abx, specific Ig

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20
Q

What conditions can cause referred otalgia?

A

TMJ dysfunction
Ramsay-Hunt syndrome
Cervical spondylosis
Tonsillitis, quinsy

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21
Q

What are the presenting features of acute otitis media?

A

Rapid onset of pain, fever, anorexia, vomiting

Bulging of TM causes pain and eases if drum perforates ± discharge

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22
Q

What are some common organisms causing otitis media?

A

Pneumococcus, haemophilus, moraxella, streps + staph

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23
Q

What is the management for otitis media, when would you give Abx?

A

Analgesia

Amoxicillin if: systemically unwell, immunocompromised, symptoms >4d, <3m, perforation

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24
Q

What is chronic otitis media and what are some symptoms?

A

TM perforation in setting of recurrent or chronic infections

Hearing loss, otorrhoea, fullness, otalgia

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25
Q

What is the management for chronic otitis media?

A

Topical/systemic Abx, aural cleaning, water precautions

May need myringoplasty/mastoidectomy

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26
Q

What is a complication of chronic otitis media?

A

Prolonged low middle ear pressure allows for retraction pocket of pars tensa/flaccida which can enlarge resulting in cholesteatoma

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27
Q

What is cholesteatoma and what are some symptoms?

A

Growth of squamous epithelium

Foul discharge, hearing loss, headache, pain

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28
Q

What can be the complications of cholesteatoma?

A

Meningitis, cerebral abscess, hearing loss, mastoiditis

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29
Q

What is the treatment for cholesteatoma?

A

Mastoid surgery

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30
Q

What is mastoiditis?

A

Middle ear inflamm leads to destruction of air cells in mastoid bone ± abscess formation, can spread intracranially

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31
Q

What are some symptoms of mastoiditis?

A

Fever, tenderness, mastoid swelling and redness, protruding auricle

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32
Q

What is the management for mastoiditis?

A

CT imaging and admit for IV Abx, myringotomy ± mastoidectomy

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33
Q

What is myringoplasty?

A

Perforation in TM is patched using a graft (perichondrium/fascia) and applied underneath TM
Acts as scaffold for TM to grow across

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34
Q

What is mastoidectomy?

A

Mastoid surgery and tympanoplasty used to eradicate source of chronic infection/excise cholesteatoma
Removal of mastoid air cells

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35
Q

What are some presenting features of glue ear?

A

Poor speech, language delay, balance problems, poor progress at school

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36
Q

What are the management options for glue ear?

A

Actively observe for 3m
Autoinflation of Eustachian tube
Insertion of grommets

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37
Q

What does pure tone audiometry aim to measure?

A

Quantifies hearing loss and determines its nature

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38
Q

What does tympanometry aim to measure?

A

Measuring pressure in middle ear and establishing cause of conductive deafness

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39
Q

What hearing tests may be used in newborns?

A

Otoacoustic emissions

Audiological brainstem responses

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40
Q

Describe the tympanogram seen if there is disruption of ossicles or if part of drum is flaccid:

A

Large peak (high compliance) when canal pressure = middle ear pressure

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41
Q

Describe the tympanogram if there is fluid in the middle ear:

A

Low flat result (low compliance) due to stiff ear drum

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42
Q

Describe the tympanogram seen in developing or resolving OM:

A

Shift in peak of curve to left found in negative middle ear pressure

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43
Q

How would you perform a Rinne’s test?

A

Vibrating fork on mastoid to test BC

When sound is no longer audible move in front of ear to test AC

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44
Q

What are the positive and negative results of Rinne’s test?

A

Rinne’s +ve if AC > BC (normal or SNHL)

Rinne’s -ve if BC > AC (CHL)

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45
Q

What are the possible results of Weber’s test?

A

Equal = normal
Localised to side of HL if CHL
Localised away from side of HL if SNHL.

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46
Q

Define normal hearing, mild, moderate and severe hearing loss based on dBHL:

A

Normal hearing = -10-25dBHL with 0 as average
Mild HL = 26-40dBHL
Moderate = 41-70dBHL
Severe = 71-90dBHL

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47
Q

Describe the audiogram in presbycusis:

A

Bilateral, symmetrical, high freq SNHL

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48
Q

Describe the audiogram in noise-induced hearing loss:

A

Cahart’s notch at 4kHz with recovery at 8kHz

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49
Q

Describe the audiogram in conductive hearing loss:

A

Air-bone gap

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50
Q

Describe the audiogram in Meniere’s disease:

A

Poor hearing a low frequencies in one ear, recovering at higher frequencies

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51
Q

What are some genetic causes of childhood deafness?

A

Congenital anomalies of pinna, EAC, drum or
ossicle
Treacher-Collins, Pierre-Robin
Alport’s, Turner’s

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52
Q

What are some non-genetic causes of childhood deafness?

A

Intrauterine TORCH infection (CMV, rubella, toxo, HSV, syphilis)
Prematurity, IVH, hypoxia
Meningitis, measles, mumps

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53
Q

What are the management options for childhood deafness?

A

Support + advice advice
Hearing aids or cochlear implants
Provide support to develop spoken or signed communication

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54
Q

Who are cochlear implants for?

A

Children and adults with profound SNHL who do not

benefit from a conventional hearing aid

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55
Q

How do cochlear implants work?

A

Multichannel electrode inserted surgically into cochlea that directly stimulates the auditory nerve when electrical signals are applied

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56
Q

When are bone-anchored hearing aids used?

A

Intolerance to conventional hearing aid, congenital malformations, single sided deafness

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57
Q

How do bone-anchored hearing aids work?

A

Sound is transmitted to cochlea via bone conduction,

titanium screw implanted into bone and attached to hearing aid

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58
Q

What are some causes of conductive hearing loss in adults?

A

External canal obstruction: wax, pus, debris, FB
Drum perforation: trauma, barotrauma, infection
Otosclerosis

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59
Q

What are some causes of sensorineural hearing loss in adults?

A

Acoustic neuroma, cholesteatoma
Ototoxic drugs
Post-infective: meningitis, measles, herpes, syphilis
Meniere’s, trauma, presbycusis

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60
Q

What are some drugs that can cause of sensorineural hearing loss?

A

Vancomycin, gentamicin, chloroquine, vinca alkaloids

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61
Q

What are some causes of sudden hearing loss?

A

Conductive infection, occlusion, trauma, fracture

If SN: noise exposure, gent toxicity, acoustic neuroma, MS

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62
Q

How should sudden hearing loss be investigated?

A

EAC and TM examination, tuning forks
FBC, CRP, U+E, LFT, TSH, clotting, glucose
Audiometry, MRI

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63
Q

What is otosclerosis?

A

New bone is formed around stapes footplate, leads to fixation and CHL

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64
Q

What is the inheritance pattern of otosclerosis?

A

Autosomal dominant

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65
Q

What are the features of otosclerosis?

A

Early adult life, accelerated by pregnancy, conductive deafness, tinnitus, transient vertigo, pink tinge to drum (Schwartze’s)

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66
Q

What is the treatment for otosclerosis?

A

Hearing aid, surgery (stapedectomy/stapedotomy)

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67
Q

What is presbycusis?

A

Age-related, bilateral, high freq SNHL

Deafness (loss of hair cells) is gradual

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68
Q

Describe how the cochlea is involved in the perception of sound:

A

Stapes articulates with oval window causing movement of perilymph and pressure change
Vibrations transmitted through endolymph to tectorial membrane and movement of this causes movement of hair cells resulting in depolarisation and perception of sound

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69
Q

What is tinnitus?

A

Perception of sound, typically in absence of auditory stimulation

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70
Q

What can cause objective tinnitus?

A

AV malformations, Paget’s, hyperthyroidism, anaemia

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71
Q

What can cause subjective tinnitus?

A

Presbycusis, noise induced HL, Meniere’s, wax, ototoxic drugs, OM, AN, trauma, mental health issues

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72
Q

What drugs can cause tinnitus?

A

Cisplatin + aminoglycosides

Aspirin, NSAIDs, quinine, macrolides, loop diuretics

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73
Q

How should tinnitus be investigated?

A

Audiometry, tympanogram, unilateral may need MRI to exclude AN

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74
Q

What are some management options for tinnitus?

A

Treat cause
Explain tinnitus often improves with time
Hearing aids, sound therapy, CBT, pt support groups, hypnotics

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75
Q

What is an acoustic neuroma?

A

Vestibular schwannomas, usually arising on superior vestibular nerve Schwann cell layer

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76
Q

What are some presenting features of acoustic neuroma?

A

Progressive ipsilateral tinnitus ± SNHL

If large, ipsilateral cerebellar signs, RICP, numb face

77
Q

How might acoustic neuroma be investigated and managed?

A

MRI

Watch and wait, surgery, radiosurgery

78
Q

What are some symptoms of noise induced hearing loss?

A

Bilateral symmetrical SNHL, tinnitus, hearing improves away from source of exposure

79
Q

What is the management for noise induced hearing loss?

A

Reduce risk of occupational exposure – ear defenders, screening of at risk
Hearing aids

80
Q

What is vertigo?

A

Sensation that you, or the world around you, is moving or spinning

81
Q

What are some causes of peripheral vertigo?

A

Meniere’s, BPPV, vestibular failure, labyrinthitis

82
Q

How should vertigo be investigated?

A

CNs and ear examination, cerebellar function, reflexes,

Romberg’s, head thrust test, Hallpike test

83
Q

What are some causes of central vertigo?

A

AN, MS, head injury, migraine associated dizziness, vertebrobasilar insufficiency, stroke

84
Q

Describe benign paroxysmal positional vertigo:

A

Attacks of sudden rotational vertigo lasting >30sec, provoked by head-turning

85
Q

What is the cause of benign paroxysmal positional vertigo?

A

Displacement of otoconia stimulating semi-circular canals

86
Q

How is BPPV diagnosed?

A

Dix-Hallpike +ve

No persistent vertigo; no tinnitus, headache, ataxia,

87
Q

How is BPPV treated?

A

Often self-limiting

If persistent: Epley manoeuvre, home repositioning manoeuvres

88
Q

Describe the Dix-Hallpike test:

A

Ask pt to keep eyes open and look straight ahead
With pt sitting on coach, turn head 45° towards test ear Continue to hold head between hands and ask them to lie backwards then quickly lower head 30° below level of couch
Ask if they feel dizzy and look for nystagmus
If +ve, there is vertigo and rotary nystagmus towards undermost ear, lasting 30sec

89
Q

Describe the Epley manoeuvre:

A

Move pt head through 4 sequential positions, resting for 30sec between movements
Aim is to reposition otoconia away from sensitive posterior canals

90
Q

Describe the features of Meniere’s disease:

A

Sudden attacks of vertigo lasting 2-4h with nystagmus May be increasing fullness in ears ± tinnitus followed by vertigo
Symptoms often become bilateral and fluctuating SNHL common

91
Q

What is the management for Meniere’s? (include acute, prophylactic + persistent)

A

Low-salt diet
Acute: prochlorperazine
Prophylaxis: betahistine, thiazides.
If persistent, instillation of gentamicin via grommets, labyrinthectomy, vestibular neurectomy, vestibular destruction with gent injection

92
Q

What are the features of vestibular neuronitis/labyrinthitis?

A

Sudden attacks of unilateral vertigo and vomiting in previously well person, often following recent URTI
Lasts 1-2d
Hearing loss in labyrinthitis

93
Q

What is the treatment for vestibular neuronitis/labyrinthitis?

A

Vestibular suppressants - prochlorperazine, cyclizine

94
Q

What is vestibular migraine?

A

Migraine variant, characterised by a combination of vertigo, dizziness, or balance disturbance with migrainous features

95
Q

What is acute rhinosinusitis and how is it managed?

A

Common cold and most episodes are self-limiting

If symptoms persist >5d, consider intranasal corticosteroids

96
Q

What is chronic rhinosinusitis and how is it managed?

A

> 12w

Intranasal corticosteroids and nasal saline irrigation

97
Q

If a single unilateral nasal polyp is found, what investigation should be carried out?

A

Biopsy

98
Q

What conditions are nasal polyps associated with?

A

Allergic + non-allergic rhinitis, CF, asthma,

septal deviation, immunosuppression, aspirin hypersensitivity, pregnancy

99
Q

What are some symptoms of nasal polyps?

A

Watery anterior rhinorrhoea, sneezing, purulent postnasal drip, nasal obstruction, sinusitis, mouth-breathing, snoring, headaches

100
Q

How can nasal polyps be investigated?

A

Anterior rhinoscopy or nasal endoscopy, CT

101
Q

How can nasal polyps be differentiated from turbinates?

A

Polyps pale, mobile and insensitive to gentle palpation

Turbinates pink, mobile and sensate

102
Q

What are the management options for nasal polyps?

A

Topical steroid drops shrink polyps
Long term Abx (doxycycline)
Endoscopic sinus surgery, polypectomy

103
Q

How should allergic rhinosinusitis be investigated?

A

Skin prick testing/RAST

104
Q

What are some symptoms of allergic rhinosinusitis?

A

Sneezing, pruritus, nasal discharge, bilateral itchy red eyes, swollen turbinates, pale mucosa, may be nasal polyps

105
Q

How can allergic rhinosinusitis be managed?

A

Allergen avoidance, nasal saline irrigation, antihistamines, intranasal corticosteroids sprays

106
Q

What are some features associated with acute bacterial sinusitis?

A

Discoloured discharge, purulent secretions,

severe local pain (unilateral), fever, elevated CRP

107
Q

What are some common causative organisms of acute bacterial sinusitis?

A

S. pneumoniae, H. influenzae, S. aureus, Moraxella, fungi

108
Q

How should acute bacterial sinusitis be managed?

A

Amoxicillin

Analgesia, nasal saline irrigation, intranasal decongestants

109
Q

How should recurrent sinusitis be investigated?

A

CT paranasal sinuses and nasal endoscopy

110
Q

Which sinuses drain into the middle meatus?

A

Maxillary
Anterior + middle ethmoidal
Frontal

111
Q

Which sinus drains into superior meatus?

A

Posterior ethmoidal

112
Q

Where does the sphenoid sinus drain into?

A

Spheno-ethmoidal recess

113
Q

Where does the naso-lacrimal duct drain into?

A

Inferior meatus

114
Q

What are some complications of sinusitis?

A

Orbital cellulitis/abscess, meningitis, encephalitis, cerebral abscess, cavernous sinus thrombosis

115
Q

How can nasal fractures present?

A

New nasal deformity, facial swelling, black eyes, may have septal haematoma

116
Q

How should nasal fractures be managed?

A

Treat epistaxis, analgesia, ice, close injuries

Reassess 5-7d after and MUA can be performed 10-14d after

117
Q

What can cause septal perforation?

A

Septal surgery, trauma, inhalants (sprays, cocaine), TB, SCC

118
Q

How should septal perforation be managed?

A

Saline nasal irrigation, petroleum jelly, surgical repair

119
Q

How can nasopharyngeal cancer present?

A

Cervical lymphadenopathy, unilateral hearing loss, nasal bleeding/obstruction/discharge, CN palsies

120
Q

What is a septoplasty?

A

Corrects deviated nasal septum

121
Q

What is a septorhinoplasty?

A

Aims to straighten and/or refashion shape of nose

122
Q

What is nasal saline irrigation?

A

Pts sniff saline solution into nostril, removes debris and prevents crusts from forming after surgery or epistaxis, clears irritant allergens

123
Q

What are some causes of epistaxis?

A

Idiopathic, local trauma (nose picking), facial trauma, dry/cold weather, haemophilia, vasculopathies, septal perforation

124
Q

Describe the management steps for epistaxis:

A

Pinch lower part of nose for 20min, sit forward
Silver nitrate cautery of bleeding points
If bleeding continues: anterior nasal pack
If still bleeding, postnasal pack – Foley catheter to occlude posterior choana
Arterial ligation/embolisation

125
Q

What is Little’s area (Kiesselbach’s plexus)?

A

Where anterior ethmoidal, sphenopalatine and facial arteries anastomose

126
Q

What is the name of the site where pharyngeal pouches can form?

A

Killian’s dehiscence

Between inferior constrictor and cricopharyngeus is area deficient of muscle

127
Q

What are the common organisms that cause tonsillitis? (virus + bacteria)

A

Rhinovirus, parainfluenza virus, influenza, adenovirus, EBV

Group A beta-haemolytic strep (S. pyogenes), staph, S. pneumoniae

128
Q

How should tonsillitis be managed?

A

Reassurance, regular ibuprofen ± paracetamol

If Centor criteria 3 or 4, consider pen V for 10d

129
Q

Describe the Centor criteria:

A

Presence of tonsillar exudate, presence of tender anterior cervical lymphadenopathy, fever, absence of cough
Presence of 3/4 suggest Strep infection

130
Q

What are some complications of tonsillits?

A

Otitis media, sinusitis
Peritonsillar abscess (quinsy)
Parapharyngeal abscess
Lemierre syndrome

131
Q

What are some symptoms of quinsy?

A

Sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus, muffled voice

132
Q

How should quinsy be managed?

A

IV Abx and aspiration needed

133
Q

What is Lemierre syndrome?

A

Acute sepsis and jugular vein thrombosis secondary to infection with Fusobacterium + septic emboli

134
Q

What are the indications for tonsillectomy?

A

Recurrent tonsillitis where episodes of sore throat are disabling
≥7 sore throats in preceding year, ≥5 in each of last 2y, ≥3 in each of last 3y

135
Q

What are the complications of tonsillectomy?

A

Primary haemorrhage (<24h) – return to theatre Secondary haemorrhage (typically after 5-10d) due to infection of tonsillar fossae

136
Q

What is the cause of scarlet fever?

A

Exotoxins released by S. pyogenes

137
Q

What are some symptoms of scarlet fever?

A

Red ‘pin-prick’ blanching rash develops on chest, axilla and behind ears after initial sore throat + fever
Strawberry tongue and facial flushing

138
Q

What is the treatment for scarlet fever?

A

Pen V for 10d

139
Q

What is stridor?

A

High-pitched noise heard in inspiration from partial obstruction at larynx or large airways

140
Q

What are some causes of stridor?

A

Laryngomalacia, laryngitis, epiglottitis, croup, anaphylaxis

141
Q

What can cause dysphonia?

A

Laryngeal cancer
Vocal cord palsy and nodules
Laryngitis + reflux laryngitis
Reinke’s oedema

142
Q

What are the features of recurrent laryngeal nerve palsy?

A

Weak, breathy voice, weak cough, repeated coughing, aspiration, exertional dyspnoea

143
Q

What are the causes of recurrent laryngeal nerve palsy?

A

Cancer, iatrogenic (parathyroidectomy, oesophageal/pharyngeal pouch surgery), syringomyelia, TB, aortic aneurysm, idiopathic

144
Q

What investigations should be performed if recurrent laryngeal nerve palsy is suspected?

A

CXR, CT, US thyroid, laryngoscopy

145
Q

What are some malignant causes of dysphagia?

A

Oesophageal, pharyngeal, gastric, extrinsic pressure e.g. lung Ca, node enlargement

146
Q

What are some neurological causes of dysphagia?

A

Bulbar palsy, lateral medullary syndrome, MG, syringomyelia

147
Q

What are some other causes of dysphagia (not malignant/neuro)?

A

Benign strictures, pharyngeal pouch, achalasia, oesophagitis

148
Q

How should dysphagia be investigated?

A

FBC, CRP, CXR, barium swallow, endoscopy + biopsy

149
Q

What are some features of pharyngeal pouch?

A

Dysphagia with gurgling, regurgitation of undigested food, halitosis, lump in neck, aspiration

150
Q

How should pharyngeal pouch be treated?

A

Endoscopic sampling of wall that divides pouch from oesophagus

151
Q

What is globus pharyngeus/hystericus?

A

Sensation of lump in throat most noticed when

swallowing saliva, can be due to stress/anxiety

152
Q

What are some symptoms associated with H+N SCC?

A

Neck pain, lump, hoarse voice (>6w), sore throat (>6w), painless ulcers

153
Q

How should H+N SCC be investigated?

A

Panendoscopy, FNA/biopsy of masses, CT/MRI

neck

154
Q

Describe the course of the facial nerve?

A

Arises in medulla and emerges between pons and medulla, travels through posterior fossa and runs through middle ear before emerging from
stylomastoid foramen to pass into parotid

155
Q

What are some intracranial causes of facial nerve palsy?

A

Brainstem tumour, stroke, MS, acoustic neuroma, meningitis

156
Q

What are some intratemporal causes of facial nerve palsy?

A

OM, RH syndrome, cholesteatoma

157
Q

What are some infratemporal causes of facial nerve palsy?

A

Parotid tumour, trauma

158
Q

How should neck lumps be investigated?

A

Neck examination, endoscopy, US, FNA cytology, biopsy, CT, virology

159
Q

What can be the cause of midline neck lumps?

A

Dermoid cysts, thyroglossal cysts, thyroid mass (goitre)

160
Q

What are the borders of the submandibular triangle?

A

Bordered above by mandible and below by digastric

161
Q

What can be the cause of lumps within the submandibular triangle?

A

Reactive or malignant lymphadenopathy, salivary stone

162
Q

What are the borders of the anterior triangle?

A

Between midline, anterior border of SCM and mandible

163
Q

What can be the cause of lumps within the anterior triangle?

A

Lymphadenopathy, branchial cysts, parotid tumour, laryngoceles, carotid artery aneurysm

164
Q

What are the borders of the posterior triangle?

A

Posterior border of SCM, anterior edge of trapezius, clavicle

165
Q

What can be the cause of lumps within the posterior triangle?

A

Cervical ribs, pharyngeal pouches, cystic hygromas,

lymphadenopathy

166
Q

Where do retropharyngeal abscesses form?

A

Anterior to prevertebral fascia and behind pharynx

Extends from base of skull to mediastinum

167
Q

What are some symptoms of retropharyngeal abscesses?

A

Rigid neck, reluctance to move, systemically unwell, dysphagia, odynophagia

168
Q

How should retropharyngeal abcesses be managed?

A

Secure airway, IV Abx, incision and drainage

169
Q

What is Ludwig’s angina?

A

Infection of space between floor of mouth and mylohyoid

170
Q

What are some symptoms of Ludwig’s angina?

A

Swelling of floor of mouth, painful mouth, protruding tongue, airway compromise, drooling

171
Q

How should Ludwig’s angina be managed?

A

Secure airway, IV Abx, surgery to drain collection

172
Q

What are the commonest causes of obstructive sleep apnoea in adults and children?

A

In children, adenotonsillar hypertrophy

In adults, obesity

173
Q

How should obstructive sleep apnoea be investigated?

A

BMI, TFT, CXR, ECG, sleep study, Epworth score

174
Q

What is the management for obstructive sleep apnoea?

A

Weight loss, CPAP, surgery in children (adenotonsillectomy)

175
Q

What are the main types of thyroid neoplasms?

A 
Benign adenoma – mainly follicular
Papillary adenocarcinoma – 70%
Follicular adenocarcinoma – 20%
Medullary carcinoma – 5%
Anaplastic carcinoma – 5%
176
Q

How should thyroid neoplasms be managed?

A

Adenomas require no further treatment after diagnostic hemithyroidectomy
Carcinoma: total thyroidectomy + adjuvant radio-iodine if papillary and follicular

177
Q

What are the complications of thyroidectomy?

A

Post-op haemorrhage
Airway obstruction
Vocal cord palsy
Hypocalcemia

178
Q

What is sialadenitis?

A

Acute infection of submandibular or parotid glands

179
Q

How should sialadenitis be managed?

A

Abx, good oral hygiene, sialogogues, may need surgical drainage

180
Q

How can sialolithiasis present and which gland is usually affected?

A

Pain and tense swelling of gland during/after meals

Submandibular gland

181
Q

What is Sjogren’s syndrome?

A

Autoimmune, lymphocytic infiltration into ductal tissue of secretory glands

182
Q

How can Sjogren’s present?

A

Dry eyes, dry mouth, enlarged salivary glands

183
Q

What can cause xerostomia?

A

Hypnotics, tricyclics, antipsychotics, beta blockers, diuretics
Dehydration, ENT RT, Sjogren’s, SLE, sarcoid, HIV, parotid stones

184
Q

How should xerostomia be managed?

A

Increase oral fluids, good dental hygiene, saliva substitutes

185
Q

In which gland are the majority of salivary gland tumours found?

A

80% in parotid

186
Q

What are some symptoms of salivary gland tumours?

A

Hard fixed mass, pain, overlying skin ulceration, lymphadenopathy

187
Q

What investigations can be performed if suspected salivary gland tumour?

A

US, MRI, FNA cytology/CT guided biopsy, X-ray, sialography

188
Q

How should salivary gland tumours be managed?

A

Surgery, RT

Neuro and SS (5 decks)

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