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ENT Flashcards

1
Q

What different categories of problems can cause neck lumps?

A 
cerviacle swellings 
saliva gland swelling 
developmental abnormalities 
thyroid conditions 
sternomastoid tumours in neonates
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2
Q

what can cause cervicle lymphadenopathy?

A

Infections: mononucleosis CMV URTI

malignancy: lymphoma or metastatic

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3
Q

what are the causes of saliva gland swellings?

A

Mumps sialadenitis

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4
Q

what type of developmental abnormalities cause neck lumps?

A

thyroglossal cysts or branchial cysts

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5
Q

up what type of thyroid conditions cause lumps?

A

thyroid swellings such as goitre or benign/malignant nodules and hyper/hypothyroidism

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6
Q

what is benign paroxysmal positional vertigo

A

a peripheral vestibular disorder manifesting as sudden short lived episodes of vertigo elicited by specific head movements

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7
Q

what causes benign paroxysmal positional vertigo

A

the endolymphcalinth particles migrate to the semicircular canals rendering them sensitive to gravity

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8
Q

what are risk factors for benign paroxysmal positional vertigo?

A

Female increased age head trauma labyrinthitis inner ear surgery merniers disease

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9
Q

what are the symptoms of benign paroxysmal positional vertigo?

A

Brief and severe vertigo provoked by specific positions of the head

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10
Q

what would the findings of a neurological and otological examination be in benign paroxysmal positional vertigo?

A

normal

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11
Q

what is diagnostic for benign paroxysmal positional vertigo?

A

Positive Dicks HallPike manoeuvre and supine lateral head turns

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12
Q

what is the management of benign paroxysmal positional vertigo?

A

Reassurance and particle repositioning manoeuvres

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13
Q

what is Merniers disease?

A

aka. Endolymphatic hydrops . It episodic auditory and vestibular disease of unknown cause

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14
Q

what are the symptoms of Merniers disease?

A

sudden onset of vertigo sudden onset of hearing loss Sudden onset of tinnitus sensation of fullness in the ear symptoms lasting from minutes to hours

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15
Q

what is the pathophysiology of Merniers disease?

A

overproduction or impaired absorption of Endo length causing excess pressure which disrupts and ruptures Reisners membrane releasing potassium rich and live into the perilymphatic space causing injury to the inner ear which leads to symptoms

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16
Q

what tests are diagnostic in Merniers disease? And what they show?

A

pure tone audiometry and bone conduction audiometry showing sensorineural hearing loss with positive Rosenberg’s test

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17
Q

what is the management of Merniers disease?

A

low-salt diets Vertigo: vestibular suppressants antiemetics or corticosteroids (more severe cases or in acute hearing loss) or intra-tympanic injections tonight as: benzodiazepines or antidepressants

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18
Q

what is labyrinthitis?

A

The stimulate new writers. An inflammatory condition affecting the inner ear

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19
Q

what causes labyrinthitis?

A

Usually caused by viral infections also bacterial ones it is a complication of otitis media or meningitis

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20
Q

what is the presentation of labyrinthitis and how does it differ between bacterial and viral?

A

bacterial: profound hearing loss and vertigo viral has less severe symptoms and hearing loss usually recovers. There is vertigo and dizziness nausea and vomiting hearing ortorrhoea nystagmus tinnitis

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21
Q

what does ortorrhoea in labyrinthitis?

A

cause of labyrinthitis is acute or chronic at otitis media with tympanic membrane perforation

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22
Q

what tests are diagnostic for labyrinthitis?

A

audiogram showing hearing loss . webbers and rinnies shows neural hearing loss

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23
Q

what is the management of labyrinthitis?

A

Bacterial: antibiotics – ofloxacin vertigo: diazepam antiemetics: promethezine corticosteroids: prednisolone

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24
Q

how can a brainstem TIA present?

A

Dizziness vertigo and imbalance sometimes :double vision slurred speech and decreased consciousness

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25
Q

how do you diagnose a brainstem TIA?

A

Imaging such as CT and angiogram

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26
Q

what is the management of a brainstem TIA?

A

thrombolysis

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27
Q

what is orthostatic hypotension?

A

A fall in systolic blood pressure of at least 20 or 13 patients with hypertension +/or a fall of 10 in diastolic blood pressure within three minutes the standing

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28
Q

what is the presentation of orthostatic hypotension?

A

Dizziness lightheadedness and other symptoms of cerebrally hypoperfusion such as loss of vision and tinnitus

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29
Q

what are the causes of orthostatic hypotension?

A 
Frailty 
volume depletion 
autonomic neuropathy 
Parkinson's or Lewy body dementia multisystem atrophy 
anaemia
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30
Q

what is the management of orthostatic hypotension?

A

treating the cause and if that’s not enough add fludrocortisone –> midrodine a short acting pressor

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31
Q

is newly mediated reflex syncope?

A

group of conditions where there is a symptomatic hypotension. These occur as a neural reflex of the vagal nerve causing vasodilation and/or bradycardia

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32
Q

what is the most common type of neuroly mediated reflex syncope?

A

Vaso vagal a.k.a. faints

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33
Q

what may cause a vaso vagal episode?

A

Emotional or lifestyle factors such as stress dehydration low blood sugar standing still for too long heat

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34
Q

are vasovagal episodes harmful?

A

in itself no however they can cause injury because of the fall

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35
Q

what is the management of vasovagal syncope?

A

physical techniques to improve orthostatic intolerance
drinking electrolyte rich drink
flucoortisone can be used in exceptional cases

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36
Q

what is a vestibular migraine?

A

the most common cause of spontaneous episodic vertigo occurring in 10% of migraine patients

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37
Q

what is the presentation of vestbular migraines?

A

Spontaneous positional vertigo head motion vertigo dizziness and a taxi - photophobia and aura may be present if these are present as it is a diagnostic factor

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38
Q

do vestibular migraines always accompany headaches?

A

No they can occur independently from headaches and are of variable duration

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39
Q

what is the management of vestibular migraine?

A

Same management as normal migraines

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40
Q

walks ENT problem can HSV cause in the ears?

A

Vestibular neuritis a.k.a. labyrinthitis

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41
Q

how does HSV cause labyrinthitis?

A

An acute peripheral vestibular with the caused by the reactivation of HSP in the vestibular ganglia on nerve or labyrinth

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42
Q

what is the management of HSV caused vestibular neuritis?

A

Corticosteroids and acyclovir

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43
Q

what are differences of signs and symptoms in the common causes of vertigo/dizziness?

A

insert picture page 9

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44
Q

what is acute sinusitis?

A

An acute inflammation of the mucosal lining of the nasal cavity and paranasal sinuses. Lasting less than four weeks

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45
Q

what causes sinusitis?

A

Usually a viral cause – rhinovirus and coronavirus bacterial infections can occur – S pneumoniae and H influenza

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46
Q

what is the presentation of sinusitis?

A

Facial pain/pressure purulent nasal discharge causing a blocked nose if symptoms are lasting more than 10 days it can be a bacterial cause. Systemic features and sore throat usually also indicate a viral aetiology

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47
Q

when would you want to do a swab in sinusitis?

A

if sinusitis is lasting more than 10 days do a swab and culture for bacteria

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48
Q

what is the management of sinusitis?

A 
analgesia/antipyretic
 decongestant  
intranasal corticosteroid 
ipratropium 
intranasal saline 
possibly antibiotics
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49
Q

what is the name of a common decongesant?

A

oxymetazoline

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50
Q

What is the name of a common intranasal corticosteroid?

A

mometasone

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51
Q

when would you want to use ipratropium?

A

to manage rhinorrhea

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52
Q

what is a common mucolytic?

A

guafenasine

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53
Q

When would you want to refer sinusitis to ENT?

A

if you know compromised patient or refractory sinusitis after antibiotics

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54
Q

what is chronic sinusitis?

A

Inflammation of the paranasal sinuses lasting more than 12 weeks

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55
Q

what are the causes of chronic sinusitis?

A

This is not refractory acute sinusitis chronic sinusitis has an unknown aetiology but seems to be an endpoint for many pathologies such as smoking cystic fibrosis and structural abnormalities or microbiological imbalances

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56
Q

a patient presents with facial pain/pressure they have recently had new RTI symptoms and symptoms have been present for three weeks what is the diagnosis?

A

acute sinusitis

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57
Q

what are the symptoms of chronic sinusitis?

A

Facial pain/pressure and nasal discharge

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58
Q

what investigations are required in chronic sinusitis?

A

Anterior rhinoscopy checks for structural defects and for presence of purulent if required nasal endoscopy can be used and swabs may be taken

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59
Q

what structural defects can cause chronic sinusitis?

A

Polyps and deviated septum

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60
Q

what is the management of chronic sinusitis?

A

try antibiotics nasal saline nasal corticosteroids decongestanta oral corticosteroids (prednisolone if nasal corticosteroids are working and if there are polyps or oedema) antihistamine or L RTA if concomitant allergic rhinitis is present finally surgery

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61
Q

what is atypical facial pain?

A

Facial pain that doesn’t fit any diagnosis and no abnormalities have been found in facial structures. Also doesn’t have characteristics of facial neuralgias

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62
Q

what is the presentation of atypical facial pain?

A

Facial pain present daily and persisting for most of the day usually confined to one aspect of the face it is deep and poorly localised there is no associated sensory loss or physical signs

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63
Q

how do you diagnose atypical facial pain?

A

it is a diagnosis of exclusion clean swabs normal x-ray CT and MRI

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64
Q

what is oral dyaesthesia?

A

altered sensation in the mouth or gums or a nasty taste

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65
Q

what are some symptoms of oral dyasthesia?

A

nasty taste increased sensation of saliva or decreased sensation of saliva difficulty tolerating dentures or new fittings crowns or bridges

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66
Q

what is phantom bite?

A

the unpleasant awareness that your teeth do not meet comfortably together which does not respond to altering your bite

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67
Q

what is atypical odontalgia?

A

adult or severe discomfort in the teeth or in a tooth sometimes after filling root canal treatments or even extraction

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68
Q

what are the symptoms of atypical odontalgia?

A

burning pain or pins and needles in the tooth area with no dental cause pain can be made further with more treatment touching area makes the pain worse

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69
Q

What is trigeminal neuralgia?

A

A facial pain syndrome in one or more of the trigeminal branches

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70
Q

which cranial nerve is the trigeminal nerve?

A

V

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71
Q

Describe the branches of the trigeminal nerve?

A

healthy ophthalmic branch maxillary branch and mandibular branch

insert picture page 12

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72
Q

what is usually the cause of trigeminal neuralgia?

A

Compression of nerve root usually by a vascular loop of the superior cerebellar artery. However can also be because of MS and other demyelinating diseases or herpetic infection

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73
Q

what is the presentation of trigeminal neuralgia?

A

Facial pain following the distribution of the nerves paroxysmal pain sharp intense and stabbing lasting less than two minutes repeated attacks often triggered by brushing teeth or cold wind can also be a component of constant burning/aching with no neurological deficits

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74
Q

does trigeminal neuralgia cause neurological deficit?

A

No

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75
Q

how would you investigate trigeminal neuralgia?

A

MRI shows structural abnormalities or demyelination trigeminal nerve reflex testing is used in symptomatic trigeminal neuralgia and shows early reflexes

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76
Q

why might someone perform an intraoral x-ray in trigeminal neuralgia?

A

Symptoms of the maxillary or the mandibular nerve can be akin to dental problems

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77
Q

what is the management of trigeminal neuralgia?

A

Anticonvulsants: carbamazepine or baclofen if it is anti-convulsive unresponsive

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78
Q

What is temporal mandibular joint dysfunction?

A

An umbrella term used for various disorders involving the mandibular joint

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79
Q

What is the most common type of temporomandibular joint dysfunction?

A

myofascial pain and dysfunction

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80
Q

What are the three types of temporomandibular joint dysfunction

A

internal derangement ( when the articular disc is dislocated from its place in the glenoid fossa) osteoarthritis and myofascial pain and dysfunction

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81
Q

describe the anatomy of the TMJ?

A

Insert pictures page 13

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82
Q

what are risk factors which predispose someone to developing TMJ dysfunction?

A

trauma orthodontic treatment arthritis in excess use of the joint such as clenching of teeth

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83
Q

what is the presentation of TMJ joint dysfunction?

A

Pain abnormal mandibular movement which may be reduced and have uncorrected deviation tender muscles on palpation clicking and catching of the joints

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84
Q

what symptoms and signs would indicate that TMJ dysfunction is caused by osteoarthritis?

A

Continuous pain and crepitus

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85
Q

how would you diagnose TMJ joint dysfunction?

A

An x-ray would show osteoarthritis or internal derangement but it is usually made on clinical diagnosis

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86
Q

what is the management of TMJ dysfunction?

A

joint rest and physiotherapy CBT splints/bikes cards NSAIDs (osteoarthritis and internal derangement) benzodiazepines (myofascial) and surgery

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87
Q

what is a dental abscess?

A

An orthodontic infection, Usually poly microbial, which invades neurovascular structures

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88
Q

what are the three types of dental abscesses?

A

Peri apical periodontal and precordial

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89
Q

what is the main pathogen which causes dental abscesses?

A

Streptococcus viridans although it is poly microbial

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90
Q

what are risk factors to developing dental abscesses?

A

Gingivitis and tooth decay/improper dental hygiene

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91
Q

what is a presentation of a dental abscess?

A

Dental pain intra-or extra oral oedema erythema discharge thermal hypersensitivity if severe enough can cause airway obstruction

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92
Q

what investigations are required in dental abscesses?

A

panoramic x-ray shows the infection

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93
Q

how would you manage a dental abscess?

A

Drain antibiotics and if high-risk admit to hospital for airway management and supportive care

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94
Q

which part of the ear does conductive hearing loss occur from?

A

Outer/middle ear

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95
Q

which part of the ear does sensorineural hearing loss occur from?

A

the cochlear or cranial nerve eight

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96
Q

what are the five parts of an ear examination?

A

Examine the pinna: scars quality of cartilage active infection and compare symmetry with the other side master: Move the pin forwards and gently assess the tenderness free auricular area: pits sinuses or fistulas Kong conchal bowl and perform internal ear examination

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97
Q

describe the anatomy of the eardrum?

A

insert picture page 16

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98
Q

what might you see in an ear exam on the Pars Tensa?

A

perforations
retraction pockets
ossicles and grommets

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99
Q

what does the image below show?

A

perforation of the eardrum insert picture

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100
Q

what is the picture below show what is a common cause of it?

A

retraction pockets commonly because of chronic otitis media inset picture

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101
Q

what might you see in an ear exam on the Pars Flaccida?

A

attic retraction pockets and cholesteatoma

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102
Q

what does the image below show?

A

Attic retraction pocket insert picture

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103
Q

what two tests are used to determine type of hearing loss?

A

Turning fork tests: Rinnies and Webers

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104
Q

Describe Rinnes test

A

is used to assess for air conduction. Tuning fork is placed against the mastoid bone and then by the ear in normal hearing air conduction is louder than bone conduction this also occurs in sensorineural hearing loss which is why Webber’s test is required AC>BC means +ve test

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105
Q

Describe Webers test

A

in the Webers test normal hearing hears the sound equally in both ears this is also the case for bilateral either conductive or sensorineural hearing loss . If the test is being performed on the right-hand side and the sound lateral licence to the left this indicates sensorineural hearing loss of the right side. if the test is being performed on the right side and sound is louder on the right side then indicates a unilateral conductive hearing loss of the right side

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106
Q

during a tuning fork exam revenues is positive in both years and Webbers lateral rises to the left what does this indicate?

A

Right-sided sensorineural hearing loss

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107
Q

if rinnes was negative on the L ear and webers lateralised L what does this mean?

A

leaft conductive hearing loss

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108
Q

what is conductive deafness?

A

Decreased transmission of sound to the cochlea via air conduction

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109
Q

what are the causes of conductive deafness?

A

obstructive causes

perforation of the tympanic membrane

discontinuation of the ossicular chain

fixation of the ossicular chain

110
Q

what are some causes of obstruction which can lead to conductive deafness?

A

wax inflammatory oedema degree and foreign bodies and atresia

111
Q

what types of things can cause the discontinuation of the ossicular chain?

A

infection or trauma

112
Q

what usually causes the fixation of the ossicular chain?

A

osteo sclerosis

113
Q

what is otitis media?

A

A common complication of viral respiratory illnesses causing infection involving the middle ear space

114
Q

how does a URTI lead to otitis media?

A

Inflammation of the nasal passages of the eustation tube in the middle ear means mucosal flow and ventilation of the eustachian tube is impaired.

Nasopharyngeal flora cannot be cleared and the bacteria colonise the effusion from the respiratory tract infection

115
Q

what bacteria usually is present in otitis media?

A

S pneumoniae

116
Q

a 15 year old presents with ear pain, some hearing loss, on examination they have a fever and when you take the history they had a proceeding upper respiratory tract infection they also have a feeling of fullness and pressure within the ear what is the most likely diagnosis

A

otitis media

117
Q

how would the presentation of otitis media present in young children?

A

irritability and sleep disturbances

118
Q

what does the image below show?

A

bulging tympanic membrane and redness/erythema (myringitis) from acute otitis media

119
Q

how would you manage acute otitis media?

A

simple analgesia and antibiotics such as amoxicillin

120
Q

what are the complications of acute otitis media?

A

Perforation of the tympanic membrane cranial nerve seven palsy or mastoiditis

121
Q

what is a cholesteatoma?

A

the presence of a keratinising squamous epithelium within the middle ear or other areas of the temporal bone. This epithelium shows independent growth and leads to expansion and resorption of the underlying bone

122
Q

how does a cholesteatoma occur?

A

eustachian tube dysfunction causes and negative pressure in the ear which causes the tympanic membrane to be pulled into the middle ear causing retraction pockets these pockets fill with degree and scream cells these cells then proliferate and formulate cholesteatoma although they can also be congenital

123
Q

What are risk factors in the development of eustachian tube dysfunction?

A

Turners and Down’s syndrome

124
Q

what are symptoms of a Cholesteatoma?

A

hearing loss is a discharge resistant to antibiotic therapy and tinnitis

125
Q

what does the picture below show?

A

Attic crust in the retraction pocket - acquired cholesteatoma

126
Q

what does the picture below show?

A

A white mass behind an intact tympanic membrane a congenital cholasteoma

127
Q

what should you always do in the investigations of Cholesteatoma?

A

audiogram as may show conductive hearing loss and a CT of the petro’s temporal bones to assess bone damage

128
Q

how do you manage a cholesteatoma?

A

surgery

129
Q

what is otitis externa?

A

Diffuse inflammation of the external air canal which can involve the pinna or the external ear canal it is a form of cellulitis involving skin and sub- dermis.

130
Q

what pathogen usually causes otitis externa?

A

P Aeruginosa and staphylococcus

131
Q

What can predispose you to developing otitis externa?

A

humidity warmer conditions swimming external auditory canal obstruction diabetes

132
Q

patient presents with you with ear pain fullness ear discharge which is usually clear itching of the ear canal and some symptoms of decreased hearing what is the most likely diagnosis?

A

otitis externa

133
Q

what would an otoscope show in otitis externa?

A

oedematous ear canal and erythematous tympanic membrane

134
Q

what is the management of otitis externa?

A

antibacterial drops – Ciproflaxin/dexamethasone mix

135
Q

what is chronic ototis media?

A

persistentdrainage from themiddle earthrough aperforatedtympanic membranelasting> 6–12 weeks

136
Q

what causes chronic otitis media?

A

bacterial infection following perforation of the tympanic membrane due to
(Recurrent) acute otitis media
Placement of ventilation tube
Trauma

137
Q

what is the presentation of chronic ottis media?

A

Clinical features
Painless, recurrent otorrhea (usually odorless; mucoid or serous )
Conductive hearing loss → Weber test lateralizes to the affected ear
Possibly development of concurrent cholesteatoma
Fever is not typical and indicative of complications if it occurs.

138
Q

what is the management of chronic otitis media?

A

rinsing of the ear; topical antibiotic (e.g., ciprofloxacin) and steroid drops (e.g., dexamethasone)
Surgical treatment: tympanoplasty with insertion of a graft

139
Q

what is eustachian tube dysfunction?

A

The inability of the eustachian tube to properly regulate air pressure inside the middle ear or effectively drain secretions (or both) sometimes there can be reflux of nasopharyngeal secretions into the middle ear

140
Q

what causes eustachian tube dysfunction?

A

Infections or inflammatory conditions such as allergy or chronic rhinosinusitis or less commonly from tumour or malformations

141
Q

what is the pathophysiology of eustachian tube dysfunction?

A

inflammation causes Deem out which compares mucosal ore clearance or because of inflammation there is hypersecretion of mucus causing obstruction

142
Q

what is a fairly common consequence of eustachian tube dysfunction?

A

Otitis media and chronic otitis media

143
Q

what is the presentation of eustachian tube dysfunction?

A

Feeling of fullness and hearing loss (not true hearing loss as it is caused by the inability to clear or pop the ear)

144
Q

what is the management of eustachian tube dysfunction?

A

Monitoring and supportive care or treating the underlying cause such as infection give antibiotics allergies gives antihistamine if it is persistent to give intranasal corticosteroids

145
Q

what is the image below show?

A

perforation of the tympanic membrane

146
Q

what other causes of perforation of the tympanic membrane

A

Here infections such as otitis media trauma for sudden changes in pressure/loud noises

147
Q

what is the presentation of perforation of the eardrum?

A

Sudden hearing loss / muffled hearing earache itching fluid leakage and tinnitus

148
Q

what is the management of perforated eardrum?

A

If it is small usually heals on its own however after a few weeks it does not heal or the whole is large it will require surgery

149
Q

What is osteo sclerosis of the ear bones?

A

Abnormal bone growth inside the ear causing the stapes to begin to fuse with surrounding bone eventually becoming fixed so it cannot move causing conductive hearing loss

150
Q

who does osteo sclerosis of the ears usually affect?

A

young adults aged 20 to 30

151
Q

What is the presentation of osteo sclerosis of the ears?

A

gradual hearing loss getting worse over time usually affecting low-frequency sound and tinnitis

152
Q

what investigations are required for the diagnosis of osteo sclerosis of the ear?

A

Audiometry showing the conductive hearing loss and CT show fusion of bones

153
Q

what does atresia of the ear refer to?

A

Absence of the ear canal and it can be associated with malformations of the external part of the ear

154
Q

Describe the sensorineural deafness?

A

Sound is transmitted normally to the inner air but either at the cochlea or the vestibular cochlear nerve (or both) there is a fault/damage

155
Q

What are the causes of bilateral progressive sensorineural hearing loss?

A

presbycusis, Drug toxicity or noise damage

156
Q

what are the causes of unilateral sensorineural progressive hearing loss?

A

merniers disease or acoustic neuroma

157
Q

what causes of sudden sensorineural hearing loss?

A

Trauma viral infections (measles mumps or via seller) CVA impaired flow acoustic neuroma barotrauma leakage of her lymph fluid from the inner ear

158
Q

what is Presbycusis?

A

age-related hearing loss are progressive and irreversible sensorineural hearing loss

159
Q

What is the pathophysiology of Presbycusis?

A

theirs degeneration of the organ of Corsie (the hair cells) or degeneration of spiral ganglion or loss of capillaries of the street vascular’s causing difficulties in maintaining resting and… Potential

160
Q

what is the presentation of Presbycusis?

A

hearing loss difficulty understanding group conversations loss of high-frequency hearing

161
Q

how do you diagnose Presbycusis?

A

audiology testing and tympanography

162
Q

what is the management of Presbycusis?

A

hearing aid

163
Q

what drugs cause ototoxicity?

A

insert picture page 22

164
Q

how do ototoxic drugs affect hearing?

A

Tonight is loss of high-frequency hearing and can cause the stipulated function

165
Q

how he do loud noises cause hearing loss?

A

loud noises condemning the hair cells in your ears, can also damage the auditory nerve. and can be from either extreme loud noises or prolonged listening to loud noises damage is irreversible

166
Q

what is an acoustic neuroma?

A

A benign tumour which grows from the vestibular component of the tubular cochlear nerve aka vestibular schannoma

167
Q

workers and acoustic neuroma occur?

A

cerebro pontine angle

168
Q

what is the presentation of an acoustic neuroma?

A

Asymmetrical hearing loss which is usually gradual tonight progressive episodes of dizziness and facial numbness - this is a late stage symptom

169
Q

how do you diagnose an acoustic neuroma?

A

and audiogram shows sensorineural hearing loss and MRIs diagnostic

170
Q

what is the management of an acoustic neuroma?

A

observation as it is stable and slow-growing until it is large enough to need radiation or surgery

171
Q

what are late stage symptoms of acoustic neuroma?

A

Headaches coordination difficulties obstructive hydrocephalus facial numbness severe tinnitus and hearing loss

172
Q

how does a a cerebrovascular aneurysm cause hearing loss?

A

causes impaired blood flow to the cochlear

173
Q

what is tinnitis??

A

The perception of sound in the absence of an external auditory stimulus it is a symptom not a diagnosis

174
Q

what are two types of tinnitus and which is more common?

A

Objective and subjective (more common)

175
Q

What other causes of subjective tinnitus

A

Presbycusis sensorineural last wax impaction tympanic membrane perforation otosclerosis ototoxicity merniers disease acoustic neuroma

176
Q

what is objective tinnitus?

A

Due to the perception of sounds caused by neighbouring structures such as vascular noise or muscle contractions

177
Q

what are the causes of objective tinnitus??

A

AV malformations anaemia viral toxicity middle ear infection vascular neoplasms benign intracranial hypertension

178
Q

what can cause referred pain?

A

Insert image page 24

179
Q

what is oropharyngeal cancer?

A

Escuela cell carcinoma arising from the oral pharynx namely the base of the tongue soft palate and palatine tonsils as well as the pharyngeal wall

180
Q

what other risk factors for developing oropharyngeal cancer?

A

also raised of the mucosa causing oral pain persistent sore throat net lamp dysphasia next lymphadenopathy and otalgia as well as systemic Fx

181
Q

what causes ear pain in oropharyngeal cancer?

A

referred pain from cranial nerve nine and 10 although this is usually a late sign

182
Q

how do you diagnose oropharyngeal cancer?

A

Biopsy inc. lymph nodes and CT , barium swallow to assess dysphasia and HPV immune chemistry may be indicated?

183
Q

what other methods of removing a foreign body?

A

forceps irrigation balloon catheter or endoscopy (nasal)

184
Q

what are the common types of oral lesion?

A

apathous ulcers herpes simplex and infectious causes

185
Q

what are apathous ulcers?

A

of common condition of the oral mucosa occurring mainly in healthy patients causing recurrent multiple erythematous ulcers

186
Q

what is the appearance of an apathous ulcers?

A

Eric Emeritus round while circumcised with a blister in the middle

187
Q

what are the types of apathous ulcers?

A

minor the most common less than 10 mm diameter major larger more painful herpetiformis the rarest

188
Q

describe herpetic apathous ulcers?

A

very painful clusters of tiny ulcers often converging into larger patches mimics herpes simplex but doesn’t have proceeding these calls or blisters

189
Q

what investigations should you carry out the diagnosis of apathous ulcers?

A

FBC and iron studies including B12 to roll out apathous like ulcers which occur in deficiencies if any deficiencies occur then finding the cause is important

190
Q

if in the investigations of apathous ulcers there appears to be deficiencies what further investigation could you perform?

A

Zero IgA TTG for coeliac and ESL/CRP for any other inflammatory conditions

191
Q

what should you do if an apathous ulcers isn’t healing?

A

take a biopsy and check for oral cancer

192
Q

what is the management of apathous ulcers?

A

change toothpaste use antibacterial mouthwash avoid triggers and use over-the-counter symptomatic relief if they are more severe use corticosteroids topically then move on to systemic or immune modulation even if vitamin B12 is normal oral Whitsun B12 may help

193
Q

what does the image below show?

A

apathous ulcer

194
Q

what does the image below show?

A

herpes simplex

195
Q

describe the pathophysiology of herpes simplex virus oral ?

A

replicates in the epidermis and effects sensory autonomic nerve endings travels up the nurse to the sensory ganglia where it enters the latent stage when it reactivates the travel down the nerves to the mucosal surfaces for the cutaneous ones

196
Q

what is the management of oral herpes simplex?

A

oral or topical antivirals like acyclovir

197
Q

what does image below show

A

oral candidiasis

198
Q

who does oral candidiasis usually infect?

A

immunosuppressed infants for older adults

199
Q

what is the presentation of oral candidiasis?

A

Creamy white/yellowish plaque fairly adhering to the oral mucosa can have angular colitis can experience burning or pain and can be erythematous

200
Q

what is the management of oral candidiasis?

A

Topical antifungal is such as lozenge if more severe you systemic such as fluconozole

201
Q

How do you diagnose oral candidiasis?

A

superficial smear of lesion and microscopy

202
Q

what is gingivitis?

A

Inflammation of the gingiva usually caused by bacterial induced inflammation from dental plaques form on the teeth

203
Q

what is a serious consequence of gingivitis and wonders that usually occur?

A

can become necrotising and tends to occur in less developed countries where there is no treatment

204
Q

what is glandular fever?

A

also known as infectious mononucleosis is a clinical syndrome caused by EBV in 90% of cases

205
Q

what is a presentation of glandular fever?

A

characterised by pharyngitis fever - lasting from 2-5weeks and lymphadenopathy - generalising can be long lasting usually most prominent by the end of the second week fatigue and splenomegaly present 50% of cases

206
Q

how do you diagnose glandular fever?

A

Diagnosed with EBV antibodies IgM shows acute infection and IgG shows past infection

207
Q

what should you always check and gradually fever and why?

A

Liver function can be + ALT and Ast

208
Q

what is the management of glandular fever?

A

Supportive management unless there is a upper airway obstruction or presence of haemolytic anaemia or thromcocytopenia is in which case give corticosteroids IVIg also can be given in thrombocytopenia

209
Q

what is a Quinsy?

A

Perry tonsillar abscess or a retro foreign jewel abscess it’s an accumulation of pus behind the tonsils

210
Q

what pathogen usually causes Quinsy?

A

S viriridan Saureus S epidermidis or B heamolytic strep

211
Q

what usually triggers the formation of a Quinsy??

A

URTI usually proceeds

212
Q

what is the presentation of a Quinsy?

A

spiking fever that pain severely sore throat with painful swallows resulting in decreased oral intake neck and oropharyngeal swelling and lymphadenopathy irritability and weight loss due to decreased intake

213
Q

how do you diagnose a Quinsy?

A

CT with contrast ultrasound scan is commonly used to differentiate from normal lymphadenopathy and then culture of pus is needed

214
Q

what is the management of a Quinsy?

A

empirical IV antibiotics of clindamycin and ceftriaxone with supportive care and simple analgesia and give more targeted antibiotics if necessary if there is airway obstruction give Ivy corticosteroids followed by surgery

215
Q

what is epistaxis?

A

nosebleeds from nasal cavity and/or nasopharynx

216
Q

what is the most common area which epistaxis occurs from?

A

little the area of the anterior septum where the kiesselbachs plexus is found

217
Q

what are causes of epistaxis?

A

mucosal compromise (trauma or impairment of vasoconstriction and inadequate clotting) or less commonly sinus tumours or juvenile nasal angiofibroma. HTN can be a cause in adults

218
Q

what must you do when a patient presents with epistaxis?

A

patient will not present unless there is active at the stacks and if they are significantly concerned so should take it seriously if possible always try and identify the bleeding started anteriorly or posteriorly - if bleeding does not stop with simple packing then you must visualise it and this can be done directly using nasal speculum headlamp

219
Q

what is the management of epistaxis?

A

anterior septal pressure plus vasoconstrictor spray (oxymrtazoline) topical anaesthetic and vasoconstrictor – Lidocaine helps any discomfort if packing is required anterior nasal packing or balloon catheter however if posterior bleed is detected IV sedation with morphine and antiemetic plus give antibiotics endoscopic Magnet and and cautery surgical ligation

220
Q

What is Sialadenitis?

A

Inflammation of any of the saliva glands which can be caused by bacterial viral or autoimmune causes

221
Q

what bacterial cause usually causes Sialadenitis?

A

Staphylococcus aureus

222
Q

what is the pathophysiology of Sialadenitis?

A

infections arise and there is decreased saliva reflow this can be due to mechanical obstruction ductal abnormalities or sjorgens syndrome causing predisposition to infection

223
Q

how does Sialadenitis present?

A

fever pain and dysphagia facial/neck swelling episodic swelling during eating

224
Q

what is the presentation of severe Sialadenitis?

A

respiratory distress and cranial nerve 7 9 12 - from compression causing palsy

225
Q

what might be seen on examination of the mouth in Sialadenitis?

A

purse exudates at the saliva gland openings

226
Q

what investigations are required in Sialadenitis?

A

cultures and sensitivity of exudates and FBC

227
Q

why might you perform a facial x-ray in a patient with Sialadenitis?

A

if he suspects the library stones sialolithitis

228
Q

What is the management of Sialadenitis?

A

broad-spectrum antibiotics analgesia and hydration and sialogues to increase saliva. If there is lots of swelling corticosteroids and drainage of abscess is detected

229
Q

what is mumps?

A

aka parotitis systemic infectious disease caused by RNA paramyoxy virus

230
Q

what does the image below show?

A

Mumps

231
Q

what is the presentation of mumps?

A

para tightest constitutional symptoms orchitis or oophotritis . Can cause aseptic meningitis

232
Q

how do you diagnose mumps?

A

saliva gland IgM

233
Q

what is the management of mumps?

A

If isolation and supportive care

234
Q

How many episodes of tonsillitis are required in one year to warrant a tonsillectomy according to SIGN?

A

7

235
Q

16 year old female presented sore throat is a febrile has no tender neck no no cough what would be her Centor score? (insert image)

A

2

236
Q

describes the Centor score?

A

insert image

237
Q

what is the most appropriate management of an individual who scores a centor score of 2?

A

reassure and give analgesia do a throat swab and review if symptoms persist

238
Q

what would be the management of an individual with a Centor score of 5?

A

give oral antibiotics - consider the delayed prescription do rapid antigen test (SWAB)

239
Q

you suspect the patient has EBV what is the most management of a patient with EBV?

A

consider hospital admission is struggling to swallow liquids if they have abnormal liver function tests consider steroids if there is any sign of airway obstruction

240
Q

why is koa moxa curve contraindicated in the management of sore throats?

A

Because if so throat is caused by EBV amoxicillin causes a large rash

241
Q

25 old man has had right ear pain for eight weeks the tympanic membrane looks as such (insert image) What is the most likely cause of ear pain?

A

Tympanic membrane is normal most likely is referred pain

242
Q

a 70 year old gentleman says he has suddenly gone deaf in his right ear Webers test is heard loudest in his left ear and Rinnies is positive in both years what is the diagnosis?

A

sensorineural loss in right ear

243
Q

are 45 old woman has recurring a pain discharge when you examine the is the following is seen (insert picture – what is most likely diagnosis

A

fungal otitis externa what you see fungal spores

244
Q

are seven professional rugby player presents with vertigo following a concussion six months ago he finds that episodes are worse when he bends over what is most likely diagnosis?

A

BPPV

245
Q

what is the first line management of BPPV?

A

Epley manoeuvre

246
Q

how would you manage a broken nose?

A

If a broken nose has obvious deformity and swelling they need referral within five days this is because after five days swelling has reduced enough for you to see the full impact of the break bones then be manipulated under local anaesthetic or in general anaesthetic in adults

247
Q

what is glue ear?

A

when the middle ear feel fills with viscous fluid instead of air

248
Q

what causes glue ear?

A

typically caused by eustachian tube dysfunction after a proceeding upper respiratory tract infection also can be caused by recurrent otitis media

249
Q

what is the management of glue ear?

A

Supportive as hearing usually goes back to normal within a few months but if it doesn’t then grommets are inserted

250
Q

what are grommets?

A

A.k.a. tympanostomy tubes allow for air to pass through the eardrum equalising the pressure and the fallout on their own after 6 to 12 months

251
Q

what is a cleft pallet?

A

An abnormal opening secondary to developmental failure en utero

252
Q

what are the types of cleft palates?

A

Cleft lip with or without cleft palate which can be unilateral or bilateral

253
Q

describe the pathophysiology of cleft palates?

A

failure of fusion of the frontonasal and maxillary process as well as failure to fuse the palatine process and nasal septum

254
Q

what are some causes of cleft palates?

A

Foley acid deficiency chromosomal abnormalities maternal anticonvulsants therapy maternal smoking

255
Q

what are some consequences of cleft palates?

A

Difficulty feeding causing poor weight gain airway obstruction and hearing difficulties may present

256
Q

which members of the MDT are required in the management of a cleft pallet?

A

Audiology surgery (early life) nursing dentistry orthodontics speech and language therapy

257
Q

what is a stenocleido mastoid tumour?

A

tumour of infancy which is a rare benign mass in the muscle on the side of the neck

258
Q

when do stenocleido mastoid tumours commonly present?

A

at two – four weeks

259
Q

what investigations are required in a stenocleido mastoid tumour?

A

diagnosis is usually clinical but ultrasound scan and fine-needle aspiration may be used for confirmation

260
Q

what is the management of a stenocleido mastoid tumour?

A

physiotherapy and if it is persistent after one year then surgery is sometimes required

261
Q

what is a branchial cyst?

A

swelling caused by an embryological remenent

262
Q

what is the pathophysiology behind branchial cysts?

A

failure of the obliteration of the second third and fourth branchial cleft

263
Q

what is the presentation of a branchial cyst

A

solitary painless mass on the side of the neck which are usually unnoticed until there is an upper respiratory tract infection which causes them to get infected and enlarge

264
Q

how do you diagnose a branchial cyst?

A

clinical aided by CT imaging

265
Q

what is the management of a branchial cyst?

A

antibiotics and then surgery is required to prevent recurrence

266
Q

what is a thyroglossal cyst?

A

a for breast cyst forming a persistent viral glottal duct caused by remnant cells from the formation of the thyroid gland during development

267
Q

what is the presentation of a thyroglossal cyst?

A

bump in the middle of the neck which is usually painless and moves during swallowing however can become painful if infected which can lead to swelling and dysphagia

268
Q

how do you diagnose a thyroglossal cyst?

A

clinical diagnosis aided by ultrasound scan and thyroid scan if necessary

269
Q

what is the management of a thyroglossal cyst?

A

surgical

270
Q

what is a retinopathy of prematurity?

A

vascular proliferation causing retinal detachment

271
Q

what are the risk factors associated with retinopathy of prematurity?

A

Hi O2 therapy low birthweight premature (under 28 weeks increased risk of bilateral)

272
Q

what is the management of retinopathy of prematurity?

A

weekly funduscopy to monitor progress and laser surgery

FINALS (24 decks)

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