ENT Flashcards
1
Q
What two structures is the external ear made up of ?
A
- External auditory canal
2. Pinna
2
Q
What parts of the external auditory canal are cartilage and what is bone?
A
First 1/3rd is cartilage
The next 2/3rd is bone
3
Q
Which part of the external auditory canal contains glands and allows for secretions?
A
The outer 1/3rd cartilage section.
Contains ceruminous glands that secrete wax
4
Q
What 3 nerves supply the pinna ?
A
- Facial nerve
- Lesser Occipital nerve
- Greater auricular nerve
5
Q
What are 3 causes of cauliflower ear ?
A
- Trauma
- Infection
- Inflammation
6
Q
What is the pathophysiology behind cauliflower ear?
A
Cartilage necrosis
7
Q
What is the function of the middle ear? 2 functions:
A
- Amplify sound
2. Transmit sound
8
Q
What are the 3 bones in the middle ear?
A
- Malleus
- Incus
- Stapes
MIS - in order from ear drum to distal
9
Q
What ear structure detects head acceleration?
What ear structure detects linear acceleration?
A
The 3 semicircular canals detect head acceleration
The Utricle and Saccule detect linear acceleration
10
Q
What is vertigo?
A
Spinning/Movement of the surrounding environment
11
Q
What are the two types of vertigo?
A
- Central (problem with the brain)
2. Peripheral (problem with the ears)
12
Q
What are the 4 main causes of Vertigo?
A
- Benign Paroxysmal Positional Vertigo (BPPV)
- Menieres Disease
- Vestibular Neuronitis
- Vestibular Migraine
13
Q
Describe how Benign Paroxysmal Positional Vertigo (BPPV) may present..
A
Normally common in people 40-60s. More common in women.
Dix Hallpike positive (you get nystagmus) plus you get rotational vertigo on moving the head
14
Q
Describe how Menieres Disease presents…
A
Middle aged women.
Hearing loss
Tinnitus
Rotational vertigo
Comes in attacks so above symptoms get worse in a flare
15
Q
How will vestibular neuronitis present?
A
- Sudden onset no hearing issues.
- The patient will have severe N+ V and be confined to bed
16
Q
How would a vestibular migraine present?
A
It would present with rotational vertigo
Headache
Photophobia
Visual changes
Phonophobia
17
Q
What is the management of the following conditions?
BPPV
Menieres
Vestibular neuronitis
Vestibular migraines
A
BPPV: Epley manoeuvre
Menieres: low salt diet, betahistine and diuretics
Vestibular Neuronitis: anti emetics
Vestibular migraine: migraine meds
18
Q
If a patient has suspected vertigo what investigations would you like to do?
A
Dix Hallpike’s Test
Pure Tone Audiometry
Video Head Impulse Testing
19
Q
What is a pharyngeal pouch?
A
An outpouching of the mucosa and the Submucosa of the pharynx
Between two muscles the cricopharyngeus and the thyropharyngeus
20
Q
What is a Zenker’s Diverticulum ?
A
This is a pharyngeal pouch
21
Q
Who are pharyngeal pouches common in?
A
Incidence increases with age
More common in men
22
Q
How do Zenker’s Diverticulum aka pharyngeal pouches present?
A
- Assymptomatic if small
- Progressive dysphagia
- Lump in back of throat
- Regurgitation of undigested food
- Halitosis
- Recurrent chest infections
23
Q
How would you diagnose a pharyngeal pouch?
A
Barium Swallow
Rigid oesphagoscopy
24
Q
How do you manage a pharyngeal pouch ?
A
- Assymptomatic: Conservative treatment
2. Symptomatic: Endoscopic stapling
25
What is globus pharyngeus ?
When you get the sensation of a lump or discomfort in the throat with no obvious cause.
Diagnosis of exclusion, Need to do a flexible nasopharyngoscopy.
26
What is a thyroglossal cyst?
A thyroglossal cyst is an embryological remnant of the thyroglossal tract
Commonly seen in children and associated with an ectopic thyroid! So need to ensure they have one first!
27
How does a thyroglossal cyst present?
Generally assymptomatic=. However can swell up and become tender if the patient is suffering from a URTI.
The mass is palpable and moves up on swallowing or tongue protrusion
28
What investigations do you need to do on someone with a thyroglossal cysts?
You need to do an US scan to determine if they have an ectopic thyroid
Then do a fine needle aspiration to determine the cause
29
What is the management of a thyroglossal cyst?
1. Conservative
| 2. If troublesome: may need to do surgery
30
If a patient had a diffuse multinodular goitre would they be hypothyroid, euthyroid or hyperthyroid?
Euthyroid
31
What investigations would you do on someone with a multinodular goitre?
1. CT scan
2. Bloods
3. Thyroid US with fine needle aspiration
32
Can you watch and wait if you have a multinodular goitre?
YES
33
Who are parotid neoplasms more common in ?
Males or Females ?
Females
34
Are parotid neoplasms more likely to be benign or malignant?
80% are benign
35
What is the most common type of parotid neoplasm?
Pleomorphic Adenoma
36
How do you treat a parotid neoplasm?
Surgery
37
Are submandibular and sublingual neoplasms more likely to be benign or malignant?
Malignant
38
What is the most common form of malignant sub man or sub lingual neoplasm?
Mucoepidermoid
39
How would you manage a mucoepidermoid neoplasm?
Parotidectomy
40
What lymphoma is increased risk if you have Sjögren’s syndrome ?
Non Hodgkin’s Lymphoma
41
How do you investigate salivary gland mass?
US and biopsy
Use a CT to stage
42
How to salivary gland neoplasms present?
Slow growing painless mass
Red flag: ulceration, tenderness and hardness
Facial palsy can suggest malignancy
43
What cell type is cancer of the oral cavity?
Squamous Cell Carcinoma
44
What is cancer of the oral cavity associated with RF wise?
Smoking
Alcohol
45
How does cancer of the oral cavity typically present?
Painless ulcer or white plaques that never heals
Less common: bleeding and numbness
46
How do you investigate a cancer of the oral cavity?
Biopsy under GA
CT to stage
47
Who is carcinoma of the lip common in?
Old Men
Who are fair skinned and had lots of sun exposure
48
Anatomically what are two places where lip cancer typically presents?
Anterior 2/3rd of the tongue
Lateral border of the tongue
49
What are two causes of obstructive sleep apnoea in children?
large adenoids or tonsils
Large tongue (genetic cause)
50
What is the gold standard investigation used to diagnose obstructive sleep apnoea?
Nocturnal Polysomnography (measures EMG, EEG, ECG and O2 stats)
51
What are some investigations you would like to do in a patient with suspected OSA?
Nocturnal Polysomnography
Neck Circumference and BMI index
Flexible nasopharyngolaryngoscopy
Epsworth Sleepiness Score
52
What virus is pharyngeal cancer associated with?
What are 2 other RF?
EBV
Smoking and Alcohol
53
If you have recurrent epistaxis in a young adult male. What disease are you thinking?
How do you treat it?
Especially a male, Think could this be juvenile nasopharyngeal angiofibroma
Surgery
54
What are 3 symptoms of pharyngeal carcinoma?
Ear pain
Recurrent secretory otitis media with no URTI symptoms
Cervical lymphadenopathy
Anosmia and Epistaxis
55
What are three investigations you would want to do in a suspected pharyngeal cancer?
Nasal endoscopy
FNA of nodes
MRI
56
How do you treat pharyngeal cancer?
Radio and Chemo
57
What are oropharyngeal cancers normally secondary to?
HPV virus
58
How does oropharyngeal cancer present?
1. Trismus (painful Jaw locking)
2. painless unilateral tonsil swelling
3. Throat pain
4. Lump in throat and difficulty swallowing.
59
What are some investigations for pharyngeal cancer?
Panendoscopy and Biopsy
FNA of lymph nodes
MRI
60
Management of oropharyngeal cancer?
Surgery
Radio + Chemo
61
Is it common to get mets with hypoglossal cancer?
YES
62
Where does hypo pharyngeal cancer normally arise from?
Pyriform Sinus
63
How does hypopharyngeal cancer normally present?
Cervical lymphadenopathy and pain that radiates from the throat to the ear
You get vocal and swallowing issues
64
What is Paterson Brown Kelly syndrome?
Dysphagia
Hypochromic microcytic anaemia
Oesphageal webs
Hypopharyngeal cancer
65
What investigations would you want to do in someone with suspected hypopharyngeal cancer?
Endoscopy with biopsy
CT scan
Barium Swallow
66
What are the 3 sections of the larynx?
Supraglottis
Glottis
Subglottis
67
What is the most common carcinoma of the larynx?
What cell type does it normally involve?
Glottis
Squamous cell
68
What are 5 symptoms of larynx disease?
Hoarse voice
Strider
Dysphagia
Odynophagia
Cough
Haemoptysis
69
How do you investigate a laryngeal cancer?
Nasal endoscopy + biopsy
70
What is the gold standard investigation for laryngopharyngeal reflux ?
Dual Probe pH manometry
71
How does laryngopharyngeal reflux present?
1. Chronic cough
2. Hoarse voice
3. Dysphagia
4. Globus pharyngeus
72
What is otosclerosis?
This is when you get hardening of the bone. Found on imaging.
causes conductive hearing loss
73
What is presbycusis ?
Is it conductive or sensorineural hearing loss ?
This is when you get gradual hearing loss with age. Generally b/l and gradual. Need to do a Pure Tone Audiogram
74
Is tinnitus and acoustic neuromas... conductive or sensorineural ?
Sensorineural
75
What are 5 causes of Otalgia?
Otitis Externa
Otitis Media
Temporal Mandibular Joint Dysfunction
Nec Otitis Externa
Head and neck malignancy
76
What is acute rhinosinusitis normally caused by?
Viruses i.e. parainfluenza or RSV
77
What are some bacterial causes of acute rhinosinusitis?
H influenzae
Parainfluenzae virus
78
What is the diagnostic criteria for acute rhinosinusitis?
Have nasal congestion/blockage or obstruction
Plus either:
1. Facial pain/pressure
2. Reduction in smell or loss of smell <12 weeks
79
How do you manage acute rhino sinusitis?
Initially and then later?
1. Prescribe analgesia and nasal decongestants. Days <5
| 2. Worse for after 5 days or longer than 10 days. Give intranasal steroids and possibly abx.
80
How long does rhinosinusitis have to be present for to be called chronic?
More than 12 weeks
81
What are the two types of chronic rhinosinusitis?
With polyps or
Without polyps
treatment is different for both.
82
What is the diagnostic criteria for chronic rhinosinusitis?
You need visible inflammation of the nasal mucosa + 2 of
Facial pain/loss of smell
Nasal discharge or post nasal drip
Nasal blockage or congestion
83
How do you investigation chronic rhinosinusitis?
You need to do a CT scan
84
What is the management of generic chronic rhinosinusitis
Then specifically for CRS with polyps
And CRS without polyps?
Management (generic): nasal decongestants , saline nasal irrigation, antihistamine if allergic
CRS with polyps: oral steroids
CRS without polyps: nasal steroids
V bad may need to do functional endoscopic sinus surgery (FESS)
85
What is the last management option for chronic rhino sinusitis?
1. Functional Endoscopic Sinus Surgery (FESS)
86
How does a patient with nasal polyps normally present?
1. Change in smell
| 2. Nasal blockage
87
What are the two types of benign nasal polyp types? What do both of them look like?
Type 1: inflammatory/Allergic: multiple grey/oedematous polyps typically with CRS
Type 2: Astro-choanal polyps: single polyp from the maxillary sinus extending to the nasopharynx
88
What are the two ways to manage a patient with nasal polyps?
Oral steroids once short course is over.
Treat patient on intranasal steroid drops to maintain the issues
89
What is the surgical management of nasal polyps?
1. Functional Endoscopic Sinus Surgery (FESS)
90
What is a pyogenic granuloma?
Who is common in?
Friable lesions that normally arises from trauma on the septum. More common in pregnancy.
91
What does a unilateral nasal polyp suggest?
1. CANCER
92
If you had a young male patient with extreme nose bleeds.
What condition would you be thinking of? How do you manage it?
Juvenile Nasopharyngeal Angiofibroma
Management: embolisation and secondary surgical removal
93
What are some symptoms of malignant nasal lesions?
Unilateral growth
Unilateral glue ear
Nasal bleeds
Pains
Unexplained weight loss
94
What is a branchial cyst?
Upper neck mass in young adults (in their 30s)
Epithelial inclusions into lymph nodes
95
Are branchial cysts normally Assymptomatic?
YES
Unless they get infected
96
How do you investigate a branchial cyst?
US
| Fine needle aspiration
97
What is a cholesteatoma?
Benign Keratinizing Squamous Cells
The squamous cellls proliferate and secrete more enzymes and lead to local destruction.
98
What is the general presentation of a cholesteatoma ?
Persistent ear discharge despite topical abx.
Normally unilateral and hearing loss occurs
99
Where does a cholesteatoma like to be in the ear?
Attic
100
What investigations would you like to do on a suspected cholesteatoma?
Pure tone Audiometry
CT head
101
What CN is affected in acoustic neuroma?
vestibulocochlear nerve (CN VIII)?
102
What is the typical presentation of someone with an acoustic neuroma?
Unilateral tinnitus
Unilateral sensorineural hearing loss
Balance problems
Otalgia
103
What are 5 causes of nasal obstruction?
1. foreign object
2. Benign or malignant polyp
3. Trauma
4. Rhinosinusitis
5. Drugs: decongestants, COCP, Beta Blockers
104
When can you send a patient straight home when they have a nose fracture?
1. No epistaxis
2. No septal haematoma
3. No sensory impairment when touched with a jobson horn
105
AT presentation if a nose fracture has lots of swelling/bruising obscuring your view. What should you do?
Follow up the patient in 5-7 days at an ENT clinic.
To assess whether manipulation under LA is needed.
106
What is the management of a septal haematoma?
Drain immediately to prevent cartilage destruction.
this can lead to saddle deformity and infection.
107
What is a septoplasty?
Remodelling of the midline cartilage or bony septum.
108
What is septorhinoplasty?
May be indicated if the septum and the bony vault is deviated
109
What is the management of otitis Externa?
Micro suction/candle suction
Antibiotic + Steroid Cream
110
What are two viral causes of otitis media?
RSV and Rhinovirus
111
What are some of the bacterial causes of otitis media?
Strep Pneumoniae
H influenzae
112
What anatomical area does epistaxsis normally occur at?
Little’s Area includes LEGS
Labial
Ethmoidal
Greater Palatine
Sphenopalatine
113
What are 5 causes of epistaxis?
Idiopathic
HTN
Drug induced: warfarin or nasal spray
Rhinitis
114
What is the 5 step management of epistaxis?
1. ABCDE + pinch soft part of the nose
2. See the bleeding vessel visible use cautery with silver nitrate
3. Still bleeding? Pack the nose with Mercel nasal packs (anterior)
4. Balloon catheter
5. Surgical ligation artery
115
What are some of the symptoms of rhinitis?
Post nasal drip
Sneezing
Itchy nose
Runny nose
Nasal Congestion
116
What are some associated eye and ear symptoms with rhinitis?
red itchy watery eyes
Blocked or painful ears
117
How can you manage rhinitis?
non sedating AH
Nasal AH and steroid spray
AH eye drops
118
What are some of the causes of non allergic rhinitis?
Cold temperature
Spicy food
Nasal sprays or cocaine use
Irritants: cleaning products or tobacco
119
What can be the management of Non allergic rhinitis?
Avoid triggers
Use a decongestant short term
Intranasal steroids long term
120
What two groups can the facial muscles be separated into?
Muscles of expression
Muscles of mastication
121
What is the surgery called that repairs a perforated tympanic membrane?
What muscle does it use?
Myringoplasty
The temporalis muscle is used in this surgery
122
What are the 8 branches of the external carotid artery?
Some Anatomists like freaking out poor medical students!
```
Superior thyroid artery
Ascending pharyngeal artery
Lingual artery
Facial artery
Occipital artery
Posterior auricular artery
Maxillary artery
Superficial temporal artery
```
123
Where is the carotid sinus located?
At the bifurcation of the carotid arteries
124
Which of the internal or external carotid artery has branches?
The external carotid artery has at least 2 branches
The internal carotid has none
125
Are the following glands serous, mucous or mixed?
Parotid: serous
Submandibular: Mixed
Sublingual: Mucous
126
What CN provides taste to the tongue + sensation to the posterior 1/3rd?
Glossopharyngeal Nerve
127
Which CN provides sensation for the anterior 2/3rd and the muscles of the tongue?
Hypoglossal
128
Which papillae on the tongue surface contains taste buds?
Fungi form
129
What papillae on the tongue separates the anterior tongue from the posterior tongue?
It’s in a V shape and called the circumvallate papillae
130
If you have unilateral hypoglossal nerve palsy. Will the tongue deviate towards or away from the lesion?
Deviates towards the lesion
131
What is Frey’s syndrome?
This occurs post parotidectomy. The nerve gets attached to the sweat gland.
Causing sweating along the cheek with consumption of food
132
What CN is likely to be damaged in a tonsillectomy?
Glossopharyngeal
133
Damage to what two nerves (CN) can cause vocal cord paralysis?
Recurrent Laryngeal
Vagus
134
What are the three stages of swallowing?
1. Voluntary: food bolus and creates a ball that is propelled to the back of the oral cavity.
2. Involuntary: pharyngeal phase: soft palate elevates. Larynx is closed to prevent aspiration
3. Oesphageal phase: via peristalsis
135
What are 3 forms of investigations/imaging you would like to do on a patient with dysphagia?
1. CT/MRI scan
2. Barium Swallow
3. Panendoscopy
136
What investigation would you want to do in someone with dysphonia (hoarseness?)
Nasoendoscope
137
What is the no/1 bacterial cause of tonsillitis? What bacteria closely follows it?
Group A beta haemolytic strep
Other causes include: strep Pneumoniae
138
If you have a patient with tonsillitis and they develop trismus (jaw locking). What condition are you thinking?
Peritonsillar Abscess aka Quinsy
139
What is Hot potato voice associated with?
Quinsy
140
What is the normal dB of a whisper vs a conversation?
Whisper: 30 dB
Normal conversation: 60 dB
141
What dB is defined as normal hearing?
What is a moderate hearing loss?
What is severe hearing loss?
a dB of 20 dB or better
Moderate: 40-70 dB
Severe: 70-90
142
What is seen on a PTA in someone with conductive hearing loss?
What will happen to their bone and air conduction results?
1. Bone conduction will be normally <20
| 2. Air conduction will be significantly reduced. This will present as a bone air gap
143
What will be shown on a PTA with someone who has sensorineural hearing loss? What will happen to the bone and air conduction?
Both bone and air conduction will be reduced!
144
How will presbyacusis present on PTA?
It will present as
Sensorineural hearing loss- gradual worsening at higher frequencies
145
How does a foreign body in the nasal passage typically present?
Unilateral nasal discharge
Nasal obstruction
Irritability in the infant
146
How do you remove a foreign object in the nose?
1. Use Thudichum’s speculum
2. Aligator forceps
3. If it can’t be removed needs to be done under GA
147
Why does a nasal septal haematoma need to be immediately drained?
Can cause cartilage necrosis
Typically occurs secondary to trauma. Can be unilateral or bilateral
148
What is the management of a nasal septum haematoma?
Urgent excision and drainage
149
How do you know if there is a foreign body in the ear?
Hearing loss
Ear discharge
Mx: remove the object
150
What are 3 causes of a perforated tympanic membrane?
1. Infection
2. Trauma
3. Past surgery i.e. grommets
151
How would a perforated tympanic membrane present?
1. Ear pain when the perforation occurs
2. Recurrent discharge
3. Hearing loss
152
How do you treat a perforated tympanic membrane?
1. Conservative: keep the ear free of water
2. Often heals over 6-8 weeks
3. ? Infection you may need to give antibiotic ear drops
153
What two foreign bodies definitely need to be removed from a pharynx or oesphagous?
Bone
Battery
154
How could a foreign body in the pharynx or oesphagous present?
Drooling
Odynophagia
Dysphagia
Off food or lethargic: in kids
155
What is Ludwig’s Angina?
Rare skin infection of the floor of the mouth. Commonly staph infection.
156
How does Ludwig’s Angina present?
1. Difficulty swallowing, drooling or pain on swallowing
2. Difficulty speaking, fever, chills or confusion
3. Examination may show a swollen neck, tongue and deviated tongue
4. Patient will generally be SOB
157
What investigation should you do on someone with suspected ludwug’s angina?
CT scan and throat Swab
158
How do you treat Ludwig’s Angina ?
1. Clear airway
2. Drain excess fluid
3. Treat with antibiotics
159
The neck is split into 3 zones: what key structures are in the following zones?
Zone 1
Zone 2
Zone 3
Zone 1: common carotid, internal jugular vein, oesophagus and trachea
Zone 2: Cranial Nerves, Carotid arteries and pharynx
Zone 3: skull and cranial nerves
160
What muscle if breached in a penetrating neck injury would concern you?
Platysma
