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Year 4 > ENT > Flashcards

ENT Flashcards

1
Q

Describe the difference between a laryngectomy and a tracheostomy

A

Laryngectomy - surgical removal of larynx and vocal cords, no functional upper airway, trachea separated from oesophagus and brought out opening at front of neck

Tracheostomy - opening in neck made and trachea brought out, voice box in tact, can be permanent/temporary. Tracheostomy tube then placed below level of vocal cords

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2
Q

Describe types of dizziness

A

Can be

  • light headedness
  • vertigo (rotational)
  • unsteadiness
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3
Q

Describe the types of vertigo

A

Subjective - patient is stationary and environment rotates

Objective - patient is in motion and environment is stationary

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4
Q

List the differential causes of vertigo

A

BPPV
Meniere’s disease
Vestibular neuronitis (acute vertigo with no hearing loss)
Labyrinthitis (acute vertigo and hearing loss)
Vestibular migraine
Acoustic neuroma (vestibular schwannoma)

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5
Q

Describe the hallmark features of BPPV:

A
  • comes on with head movements
  • symptoms last seconds
  • repeated episodes
  • no hearing changes
  • Dix-Hallpike manouevre is diagnostic
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6
Q

Describe the hallmark features of Meniere’s disease:

A
  • PRODROME of aural fullness, SN hearing loss and tinnitus, THEN vertigo occurs
  • episodic lasting days/months

Between episodes of the disease the patient is completely fine

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7
Q

Describe the hallmark features of vestibular neuronitis:

A
  • acute onset vertigo, unwell and bed bound, lasts constantly for weeks before resolving, NO HEARING CHANGES
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8
Q

Describe the hallmark features of acute labyrinthitis:

A
  • acute onset vertigo, unwell and bed bound, lasts constantly for weeks before resolving, WITH HEARING LOSS
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9
Q

What special tests are used to

a) diagnose
b) treat

BPPV

A

a) Dix-Hallpike to diagnose

b) Epley to treat

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10
Q

Define tinnitus (subjective and objective)

A

Tinnitus = perception of sound in the absence of acoustic or electrical stimulation of the cochlea lasting >5 minutes

Sub - only heard by the patient, obj - audible to the patient and the examiner

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11
Q

List 7 causes of tinnitus

A 
Idiopathic
Ototoxic drugs
Hearing loss
Meniere's disease
Otosclerosis
Acoustic neuroma
Somatosounds
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12
Q

What are glomus tumours

A

A type of paraganglioma
Can occur in the middle ear, temporal bone, vagus nerve or carotid body
Present with persistent pulsatile tinnitus
Can also secrete catecholamines and present with hypertension
Often a pulsatile red mass can be seen behind the eardrum

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13
Q

When should tinnitus be investigated?

A

If it is pulsatile, unilateral or associated with neurological of vestibular (balance) symptoms

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14
Q

What Q’s would you ask in a tinnitus Hx?

A

constant or intermittent?
Disturbing sleep?
Pulsatile/with heart beat?
Is it in both ears?

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15
Q

How is tinnitus managed

A

Objective - treat the underlying cause -> surgery

Subjective - reassurance, explanation, hearing aids, white noise, councelling, ?TCA’s

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16
Q

Describe red flag symptoms for head and neck cancers

A 
Hoarseness
Weight loss
Dysphagia
New persistent neck lump
Unilateral nasal obstruction
Unilateral otalgia with normal examination
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17
Q

Describe a thyroglossal duct cyst

A

Forms due to failure of the duct to obliterate during embryological development
Midline, firm, trans-illuminatable lump which elevates with tongue protrusion/swallowing
Can malignant transformation later in life
Tx: surgical removal + portion of hyoid bone (sistrunk procedure)

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18
Q

Describe a branchial cyst, its classical presentation and investigation

A

Usually <30yrs (rare >35 therefore need to exclude a cystic met)
A swelling in the middle 1/3 of SCM in the anterior triangle, a developmental abnormality due to failure of closure of branchial cyst

Investigate with USS and FNA

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19
Q

What 2 H&N malignancies present with hoarseness

A 
Laryngeal cancer
Lung cancer (compressing RLN)
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20
Q

What is the most common type of H&N cancer

A

Squamous cell

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21
Q

Describe the centor clinical prediction score

A

Used to predict the risk that a patient has bacterial tonsillitis caused by GABHS and assists the decision to prescribe antibiotics

If >3 are present, then 50% chance the sore throat is caused by GABHS

  • absent cough
  • history of fever
  • presence of tonsillar exudate
  • tender cervical LN
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22
Q

Describe the emergency management of epiglottitis

A

1) O2
2) Get senior help - anaesthetist/ENT
3) Secure airway with ET tube
4) Nebulised adrenaline 1:1000 1mg in 5ml normal saline
5) IV dexamethasone 6.6mg
6) IV antibiotics (ceftriaxone) 2g
7) Heliox if available
8) NBM

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23
Q

Describe the cardinal features of otitis externa

A

ITCH
Discharge and pain which onset at the same time
Sloughy debris seem in the EAM on examination

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24
Q

What is the most common causative bacterial agent of otitis externa?

A

Pseudomonas aeroguinosa

25
Q

How is otitis externa treated?

A

CLEAN - cut nails, no cotton buds
Topical steroids
Topical Abx drop
(May need Pope Wick insertion by ENT in some cases)

26
Q

Describe necrotising otitis externa

A

A form of skull base osteomyelitis
Seen in immunocompromised/DM
Caused by pseudomonas
Ear pain which KEEPS AWAKE AT NIGHT and discharge

Granulation tissue seen on examination

Needs Tx with IV Abx with bony penetration for 6/52

27
Q

Describe otitis media

A

Infection of middle ear with fluid present
Can be sterile fluid (glue ear) or pussy (acute OM)

Commonly caused by strep pneumoniae

Ear pain, discharge then occurs later if TM perfs

Buldging red TM seen on examination

Tx: paracetamol +/- amoxicillin

28
Q

Differentiate PTA testing from tympanometry

A

PTA = pure tone audiogram, this is subjective and needs soundproof conditions

Tympanometry = objective, tests middle ear compliance, more time consuming

29
Q

List conductive causes of hearing loss

A
  • pinna malformation
  • ear wax
  • otitis externa
  • TM performation
  • otitis media
  • cholesteatoma
  • otosclerosis
30
Q

Describe a cholesteatoma and how it may present

A

= active squamous otitis media
- a sac of keratinising squamous epithelium occurs in the middle ear and presents with a DISCHARGING EAR THAT DOES NOT RESPOND TO ABX

31
Q

What is the most common cause of sensorineural hearing loss?

A

Presbyacusis (age related SNHL)

32
Q

List causes of SNHL

A 
Presbyacusis
Cochlear nerve damage
Menieres disease
Labyrinthitis
Ototoxic medication
Infection e.g. meningitis
CPA lesions e.g. acoustic neuroma
33
Q

Describe otosclerosis

A

Abnormal bone growth around the stapes leading to stapes fixation

34
Q

What is the characteristic feature of otosclerosis on PTA

A

Carhart’s notch

35
Q

How is otosclerosis treated

A

Hearing aid

Stapedectomy

36
Q

When are air conduction and bone conduction hearing aids used?

A

Air conduction hearing aids -> for CHL

Bone conduction hearing aids -> for CHL when ^ does not work, or for some types of SNHL

37
Q

Describe the newborn hearing tests which exist

A

AOAE (automated oto-acoustic emission test): from birth to 3 months, plays noise into ear and looks for rebound response. May need repeated if noisy surroundings or fluid in ear canal

AABR (automated auditory brainstem response): used if failed result from ^, sensors placed on baby’s head and noise played through headphones, looks for brainstem stimulation

38
Q

Wha are the impacts of hearing loss in childhood?

A

Slowed development
Poor speech and language
Peer acceptance/social isolation
Access to work/higher education opportunities reduced

39
Q

Define allergic rhinitis vs non-allergic rhinitis

A

Allergic rhinitis = inflammation of the nasal mucosa caused by an allergen, and non-allergic rhinitis = inflammation of the nasal mucosa not formed caused an allergen but by an irritant e.g. smoke, air pollution (allergy tests are -ve)

40
Q

What are the features of allergic rhinitis

A

nasal congestion, runny nose (discharge), itch, sneezing, red watery eyes, associated with other atopic disease e.g. house dust, pollen

41
Q

What are the findings on examination of allergic rhinitis

A

Oedematous, swollen nasal turbinates, nasal congestion and clear discharge

42
Q

What should you ask in a history for allergic rhinitis?

A

When did symptoms start?
Do they occur every year or always at the same time?
Do they have pets/feather bedding?
When are their symptoms worst - e.g. when visiting a relative with pets?
What treatments are they on/have tried?

43
Q

What are the treatments for allergic rhinitis

A

self care
nasal saline / steroid sprays / antihistamine nasal sprays
barrier creams (vaseline) to catch allergen
Oral antihistamine for seasonal allergic rhinitis only

44
Q

Is itchiness mainly a feature of allergic or non-allergic rhinitis?

A

Allergic

45
Q

Define acute and chronic sinusitis/rhinosinusitis

A 
Sinusitis = inflammation of the paranasal sinuses
Rhinosinusitis = inflammation of the paranasal sinuses + nasal mucosa

Acute <12/52, chronic >12/52

46
Q

Describe the EPOS criteria for diagnosing rhinosinusitis

A

2+ of the following symptoms:

  • nasal obstruction
  • nasal blockage
  • nasal congestion
  • nasal discharge
47
Q

What investigations may be carried out for sinusitis?

A
  • CT paranasal sinuses

- endoscopy

48
Q

What complication can arise from nasal fracture which must be ruled out

A

Septal haematoma -> can lead to ischaemia, necrosis and perforation

49
Q

List 5 causes of voice hoarseness

A 
Laryngeal cancer (SCC)
Functional dysphonia
Vocal cord nodules
Reinke's oedema (smokers)
Presbyphonia
50
Q

What are the branches of the facial nerve?

A 
temporal
zygomatic
buccal
marginal mandibular
cervical
51
Q

Describe the common parotid tumours

A

80% benign (pleomorphic adenomas and warthlin’s tumour)
20% malignant (mucoepidermoid carcinomas, adenocarcinomas and squamous cell carcinomas)

parotid tumours make up 80% of all salivary gland tumours

52
Q

What virus causes ramsay hunt syndrome

A

HZV (herpes zoster virus)

53
Q

What are the red flag symptoms that warrant a 2 week urgent referral for suspicion of H&N cancer?

A

Hoarseness > 6 weeks
Oral mucosa (ulcerations or swellings) > 3 weeks
Red/white patches on oral mucosa
New persistent neck lump >3 weeks
Dysphasia
Persistent unilateral nasal obstruction (esp. accompanied with purulent discharge)
Persistent unilateral otalgia with normal otoscopy
Cranial nerve involvement

54
Q

List 6 differentials of hoarse voice

A 
Laryngeal cancer
Vocal cord palsy (from RLN damage 2o to lung ca)
Presbyphonia
Laryngitis (from reflux)
Reinke's oedema
Vocal cord cyst/polyp
55
Q

What is the most common type of H&N cancer

A

Squamous cell carcinoma

56
Q

Contrast the infective agents which cause OM vs OE

A 
OE = pseudomonas aerginosa
OM = strep pneumoniae, haem influenza
57
Q

What is the visible difference between costochondritis and pinna cellulitis

A

Lobe is spared in costochondritis

58
Q

What 4 blood vessels converge to form Little’s area in the nose?

A

GASS

  • greater palatine
  • anterior ethmoidal
  • sphenopalatine
  • superior labial

(all branches of the internal and external carotid branches)

Year 4 (28 decks)

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