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FINALS revision - @medicbotanist > ENT > Flashcards

ENT Flashcards

1
Q

What two structures is the external ear made up of ?

A
  1. External auditory canal

2. Pinna

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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

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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

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4
Q

What 3 nerves supply the pinna ?

A
  1. Facial nerve
  2. Lesser Occipital nerve
  3. Greater auricular nerve
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5
Q

What are 3 causes of cauliflower ear ?

A
  1. Trauma
  2. Infection
  3. Inflammation
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6
Q

What is the pathophysiology behind cauliflower ear?

A

Cartilage necrosis

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7
Q

What is the function of the middle ear? 2 functions:

A
  1. Amplify sound

2. Transmit sound

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8
Q

What are the 3 bones in the middle ear?

A
  1. Malleus
  2. Incus
  3. Stapes

MIS - in order from ear drum to distal

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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

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10
Q

What is vertigo?

A

Spinning/Movement of the surrounding environment

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11
Q

What are the two types of vertigo?

A
  1. Central (problem with the brain)

2. Peripheral (problem with the ears)

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12
Q

What are the 4 main causes of Vertigo?

A
  1. Benign Paroxysmal Positional Vertigo (BPPV)
  2. Menieres Disease
  3. Vestibular Neuronitis
  4. Vestibular Migraine
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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

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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

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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

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16
Q

How would a vestibular migraine present?

A

It would present with rotational vertigo

Headache
Photophobia
Visual changes
Phonophobia

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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

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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

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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

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20
Q

What is a Zenker’s Diverticulum ?

A

This is a pharyngeal pouch

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21
Q

Who are pharyngeal pouches common in?

A

Incidence increases with age

More common in men

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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
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23
Q

How would you diagnose a pharyngeal pouch?

A

Barium Swallow

Rigid oesphagoscopy

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24
Q

How do you manage a pharyngeal pouch ?

A
  1. Assymptomatic: Conservative treatment

2. Symptomatic: Endoscopic stapling

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25
Q

What is globus pharyngeus ?

A

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.

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26
Q

What is a thyroglossal cyst?

A

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!

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27
Q

How does a thyroglossal cyst present?

A

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

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28
Q

What investigations do you need to do on someone with a thyroglossal cysts?

A

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

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29
Q

What is the management of a thyroglossal cyst?

A
  1. Conservative

2. If troublesome: may need to do surgery

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30
Q

If a patient had a diffuse multinodular goitre would they be hypothyroid, euthyroid or hyperthyroid?

A

Euthyroid

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31
Q

What investigations would you do on someone with a multinodular goitre?

A
  1. CT scan
  2. Bloods
  3. Thyroid US with fine needle aspiration
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32
Q

Can you watch and wait if you have a multinodular goitre?

A

YES

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33
Q

Who are parotid neoplasms more common in ?

Males or Females ?

A

Females

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34
Q

Are parotid neoplasms more likely to be benign or malignant?

A

80% are benign

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35
Q

What is the most common type of parotid neoplasm?

A

Pleomorphic Adenoma

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36
Q

How do you treat a parotid neoplasm?

A

Surgery

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37
Q

Are submandibular and sublingual neoplasms more likely to be benign or malignant?

A

Malignant

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38
Q

What is the most common form of malignant sub man or sub lingual neoplasm?

A

Mucoepidermoid

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39
Q

How would you manage a mucoepidermoid neoplasm?

A

Parotidectomy

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40
Q

What lymphoma is increased risk if you have Sjögren’s syndrome ?

A

Non Hodgkin’s Lymphoma

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41
Q

How do you investigate salivary gland mass?

A

US and biopsy

Use a CT to stage

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42
Q

How to salivary gland neoplasms present?

A

Slow growing painless mass

Red flag: ulceration, tenderness and hardness
Facial palsy can suggest malignancy

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43
Q

What cell type is cancer of the oral cavity?

A

Squamous Cell Carcinoma

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44
Q

What is cancer of the oral cavity associated with RF wise?

A

Smoking

Alcohol

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45
Q

How does cancer of the oral cavity typically present?

A

Painless ulcer or white plaques that never heals

Less common: bleeding and numbness

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46
Q

How do you investigate a cancer of the oral cavity?

A

Biopsy under GA

CT to stage

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47
Q

Who is carcinoma of the lip common in?

A

Old Men

Who are fair skinned and had lots of sun exposure

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48
Q

Anatomically what are two places where lip cancer typically presents?

A

Anterior 2/3rd of the tongue

Lateral border of the tongue

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49
Q

What are two causes of obstructive sleep apnoea in children?

A

large adenoids or tonsils

Large tongue (genetic cause)

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50
Q

What is the gold standard investigation used to diagnose obstructive sleep apnoea?

A

Nocturnal Polysomnography (measures EMG, EEG, ECG and O2 stats)

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51
Q

What are some investigations you would like to do in a patient with suspected OSA?

A

Nocturnal Polysomnography

Neck Circumference and BMI index

Flexible nasopharyngolaryngoscopy

Epsworth Sleepiness Score

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52
Q

What virus is pharyngeal cancer associated with?

What are 2 other RF?

A

EBV

Smoking and Alcohol

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53
Q

If you have recurrent epistaxis in a young adult male. What disease are you thinking?

How do you treat it?

A

Especially a male, Think could this be juvenile nasopharyngeal angiofibroma

Surgery

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54
Q

What are 3 symptoms of pharyngeal carcinoma?

A

Ear pain

Recurrent secretory otitis media with no URTI symptoms

Cervical lymphadenopathy

Anosmia and Epistaxis

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55
Q

What are three investigations you would want to do in a suspected pharyngeal cancer?

A

Nasal endoscopy

FNA of nodes

MRI

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56
Q

How do you treat pharyngeal cancer?

A

Radio and Chemo

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57
Q

What are oropharyngeal cancers normally secondary to?

A

HPV virus

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58
Q

How does oropharyngeal cancer present?

A
  1. Trismus (painful Jaw locking)
  2. painless unilateral tonsil swelling
  3. Throat pain
  4. Lump in throat and difficulty swallowing.
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59
Q

What are some investigations for pharyngeal cancer?

A

Panendoscopy and Biopsy

FNA of lymph nodes

MRI

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60
Q

Management of oropharyngeal cancer?

A

Surgery

Radio + Chemo

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61
Q

Is it common to get mets with hypoglossal cancer?

A

YES

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62
Q

Where does hypo pharyngeal cancer normally arise from?

A

Pyriform Sinus

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63
Q

How does hypopharyngeal cancer normally present?

A

Cervical lymphadenopathy and pain that radiates from the throat to the ear

You get vocal and swallowing issues

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64
Q

What is Paterson Brown Kelly syndrome?

A

Dysphagia

Hypochromic microcytic anaemia

Oesphageal webs

Hypopharyngeal cancer

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65
Q

What investigations would you want to do in someone with suspected hypopharyngeal cancer?

A

Endoscopy with biopsy

CT scan

Barium Swallow

66
Q

What are the 3 sections of the larynx?

A

Supraglottis

Glottis

Subglottis

67
Q

What is the most common carcinoma of the larynx?

What cell type does it normally involve?

A

Glottis

Squamous cell

68
Q

What are 5 symptoms of larynx disease?

A

Hoarse voice
Strider
Dysphagia

Odynophagia
Cough
Haemoptysis

69
Q

How do you investigate a laryngeal cancer?

A

Nasal endoscopy + biopsy

70
Q

What is the gold standard investigation for laryngopharyngeal reflux ?

A

Dual Probe pH manometry

71
Q

How does laryngopharyngeal reflux present?

A
  1. Chronic cough
  2. Hoarse voice
  3. Dysphagia
  4. Globus pharyngeus
72
Q

What is otosclerosis?

A

This is when you get hardening of the bone. Found on imaging.

causes conductive hearing loss

73
Q

What is presbycusis ?

Is it conductive or sensorineural hearing loss ?

A

This is when you get gradual hearing loss with age. Generally b/l and gradual. Need to do a Pure Tone Audiogram

74
Q

Is tinnitus and acoustic neuromas… conductive or sensorineural ?

A

Sensorineural

75
Q

What are 5 causes of Otalgia?

A

Otitis Externa

Otitis Media

Temporal Mandibular Joint Dysfunction

Nec Otitis Externa

Head and neck malignancy

76
Q

What is acute rhinosinusitis normally caused by?

A

Viruses i.e. parainfluenza or RSV

77
Q

What are some bacterial causes of acute rhinosinusitis?

A

H influenzae

Parainfluenzae virus

78
Q

What is the diagnostic criteria for acute rhinosinusitis?

A

Have nasal congestion/blockage or obstruction

Plus either:

  1. Facial pain/pressure
  2. Reduction in smell or loss of smell <12 weeks
79
Q

How do you manage acute rhino sinusitis?

Initially and then later?

A
  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
Q

How long does rhinosinusitis have to be present for to be called chronic?

A

More than 12 weeks

81
Q

What are the two types of chronic rhinosinusitis?

A

With polyps or

Without polyps

treatment is different for both.

82
Q

What is the diagnostic criteria for chronic rhinosinusitis?

A

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
Q

How do you investigation chronic rhinosinusitis?

A

You need to do a CT scan

84
Q

What is the management of generic chronic rhinosinusitis

Then specifically for CRS with polyps

And CRS without polyps?

A

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
Q

What is the last management option for chronic rhino sinusitis?

A
  1. Functional Endoscopic Sinus Surgery (FESS)
86
Q

How does a patient with nasal polyps normally present?

A
  1. Change in smell

2. Nasal blockage

87
Q

What are the two types of benign nasal polyp types? What do both of them look like?

A

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
Q

What are the two ways to manage a patient with nasal polyps?

A

Oral steroids once short course is over.

Treat patient on intranasal steroid drops to maintain the issues

89
Q

What is the surgical management of nasal polyps?

A
  1. Functional Endoscopic Sinus Surgery (FESS)
90
Q

What is a pyogenic granuloma?

Who is common in?

A

Friable lesions that normally arises from trauma on the septum. More common in pregnancy.

91
Q

What does a unilateral nasal polyp suggest?

A
  1. CANCER
92
Q

If you had a young male patient with extreme nose bleeds.

What condition would you be thinking of? How do you manage it?

A

Juvenile Nasopharyngeal Angiofibroma

Management: embolisation and secondary surgical removal

93
Q

What are some symptoms of malignant nasal lesions?

A

Unilateral growth

Unilateral glue ear

Nasal bleeds

Pains

Unexplained weight loss

94
Q

What is a branchial cyst?

A

Upper neck mass in young adults (in their 30s)

Epithelial inclusions into lymph nodes

95
Q

Are branchial cysts normally Assymptomatic?

A

YES

Unless they get infected

96
Q

How do you investigate a branchial cyst?

A

US

Fine needle aspiration

97
Q

What is a cholesteatoma?

A

Benign Keratinizing Squamous Cells

The squamous cellls proliferate and secrete more enzymes and lead to local destruction.

98
Q

What is the general presentation of a cholesteatoma ?

A

Persistent ear discharge despite topical abx.

Normally unilateral and hearing loss occurs

99
Q

Where does a cholesteatoma like to be in the ear?

A

Attic

100
Q

What investigations would you like to do on a suspected cholesteatoma?

A

Pure tone Audiometry

CT head

101
Q

What CN is affected in acoustic neuroma?

A

vestibulocochlear nerve (CN VIII)?

102
Q

What is the typical presentation of someone with an acoustic neuroma?

A

Unilateral tinnitus

Unilateral sensorineural hearing loss

Balance problems

Otalgia

103
Q

What are 5 causes of nasal obstruction?

A
  1. foreign object
  2. Benign or malignant polyp
  3. Trauma
  4. Rhinosinusitis
  5. Drugs: decongestants, COCP, Beta Blockers
104
Q

When can you send a patient straight home when they have a nose fracture?

A
  1. No epistaxis
  2. No septal haematoma
  3. No sensory impairment when touched with a jobson horn
105
Q

AT presentation if a nose fracture has lots of swelling/bruising obscuring your view. What should you do?

A

Follow up the patient in 5-7 days at an ENT clinic.

To assess whether manipulation under LA is needed.

106
Q

What is the management of a septal haematoma?

A

Drain immediately to prevent cartilage destruction.

this can lead to saddle deformity and infection.

107
Q

What is a septoplasty?

A

Remodelling of the midline cartilage or bony septum.

108
Q

What is septorhinoplasty?

A

May be indicated if the septum and the bony vault is deviated

109
Q

What is the management of otitis Externa?

A

Micro suction/candle suction

Antibiotic + Steroid Cream

110
Q

What are two viral causes of otitis media?

A

RSV and Rhinovirus

111
Q

What are some of the bacterial causes of otitis media?

A

Strep Pneumoniae

H influenzae

112
Q

What anatomical area does epistaxsis normally occur at?

A

Little’s Area includes LEGS

Labial
Ethmoidal
Greater Palatine
Sphenopalatine

113
Q

What are 5 causes of epistaxis?

A

Idiopathic

HTN

Drug induced: warfarin or nasal spray

Rhinitis

114
Q

What is the 5 step management of epistaxis?

A
  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
Q

What are some of the symptoms of rhinitis?

A

Post nasal drip

Sneezing

Itchy nose

Runny nose

Nasal Congestion

116
Q

What are some associated eye and ear symptoms with rhinitis?

A

red itchy watery eyes

Blocked or painful ears

117
Q

How can you manage rhinitis?

A

non sedating AH

Nasal AH and steroid spray

AH eye drops

118
Q

What are some of the causes of non allergic rhinitis?

A

Cold temperature

Spicy food

Nasal sprays or cocaine use

Irritants: cleaning products or tobacco

119
Q

What can be the management of Non allergic rhinitis?

A

Avoid triggers

Use a decongestant short term

Intranasal steroids long term

120
Q

What two groups can the facial muscles be separated into?

A

Muscles of expression

Muscles of mastication

121
Q

What is the surgery called that repairs a perforated tympanic membrane?

What muscle does it use?

A

Myringoplasty

The temporalis muscle is used in this surgery

122
Q

What are the 8 branches of the external carotid artery?

Some Anatomists like freaking out poor medical students!

A 
Superior thyroid artery 
Ascending pharyngeal artery 
Lingual artery 
Facial artery 
Occipital artery 
Posterior auricular artery
Maxillary artery 
Superficial temporal artery
123
Q

Where is the carotid sinus located?

A

At the bifurcation of the carotid arteries

124
Q

Which of the internal or external carotid artery has branches?

A

The external carotid artery has at least 2 branches

The internal carotid has none

125
Q

Are the following glands serous, mucous or mixed?

A

Parotid: serous

Submandibular: Mixed

Sublingual: Mucous

126
Q

What CN provides taste to the tongue + sensation to the posterior 1/3rd?

A

Glossopharyngeal Nerve

127
Q

Which CN provides sensation for the anterior 2/3rd and the muscles of the tongue?

A

Hypoglossal

128
Q

Which papillae on the tongue surface contains taste buds?

A

Fungi form

129
Q

What papillae on the tongue separates the anterior tongue from the posterior tongue?

A

It’s in a V shape and called the circumvallate papillae

130
Q

If you have unilateral hypoglossal nerve palsy. Will the tongue deviate towards or away from the lesion?

A

Deviates towards the lesion

131
Q

What is Frey’s syndrome?

A

This occurs post parotidectomy. The nerve gets attached to the sweat gland.

Causing sweating along the cheek with consumption of food

132
Q

What CN is likely to be damaged in a tonsillectomy?

A

Glossopharyngeal

133
Q

Damage to what two nerves (CN) can cause vocal cord paralysis?

A

Recurrent Laryngeal

Vagus

134
Q

What are the three stages of swallowing?

A
  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
Q

What are 3 forms of investigations/imaging you would like to do on a patient with dysphagia?

A
  1. CT/MRI scan
  2. Barium Swallow
  3. Panendoscopy
136
Q

What investigation would you want to do in someone with dysphonia (hoarseness?)

A

Nasoendoscope

137
Q

What is the no/1 bacterial cause of tonsillitis? What bacteria closely follows it?

A

Group A beta haemolytic strep

Other causes include: strep Pneumoniae

138
Q

If you have a patient with tonsillitis and they develop trismus (jaw locking). What condition are you thinking?

A

Peritonsillar Abscess aka Quinsy

139
Q

What is Hot potato voice associated with?

A

Quinsy

140
Q

What is the normal dB of a whisper vs a conversation?

A

Whisper: 30 dB

Normal conversation: 60 dB

141
Q

What dB is defined as normal hearing?

What is a moderate hearing loss?

What is severe hearing loss?

A

a dB of 20 dB or better

Moderate: 40-70 dB

Severe: 70-90

142
Q

What is seen on a PTA in someone with conductive hearing loss?

What will happen to their bone and air conduction results?

A
  1. Bone conduction will be normally <20

2. Air conduction will be significantly reduced. This will present as a bone air gap

143
Q

What will be shown on a PTA with someone who has sensorineural hearing loss? What will happen to the bone and air conduction?

A

Both bone and air conduction will be reduced!

144
Q

How will presbyacusis present on PTA?

A

It will present as

Sensorineural hearing loss- gradual worsening at higher frequencies

145
Q

How does a foreign body in the nasal passage typically present?

A

Unilateral nasal discharge

Nasal obstruction

Irritability in the infant

146
Q

How do you remove a foreign object in the nose?

A
  1. Use Thudichum’s speculum
  2. Aligator forceps
  3. If it can’t be removed needs to be done under GA
147
Q

Why does a nasal septal haematoma need to be immediately drained?

A

Can cause cartilage necrosis

Typically occurs secondary to trauma. Can be unilateral or bilateral

148
Q

What is the management of a nasal septum haematoma?

A

Urgent excision and drainage

149
Q

How do you know if there is a foreign body in the ear?

A

Hearing loss

Ear discharge

Mx: remove the object

150
Q

What are 3 causes of a perforated tympanic membrane?

A
  1. Infection
  2. Trauma
  3. Past surgery i.e. grommets
151
Q

How would a perforated tympanic membrane present?

A
  1. Ear pain when the perforation occurs
  2. Recurrent discharge
  3. Hearing loss
152
Q

How do you treat a perforated tympanic membrane?

A
  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
Q

What two foreign bodies definitely need to be removed from a pharynx or oesphagous?

A

Bone

Battery

154
Q

How could a foreign body in the pharynx or oesphagous present?

A

Drooling

Odynophagia

Dysphagia

Off food or lethargic: in kids

155
Q

What is Ludwig’s Angina?

A

Rare skin infection of the floor of the mouth. Commonly staph infection.

156
Q

How does Ludwig’s Angina present?

A
  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
Q

What investigation should you do on someone with suspected ludwug’s angina?

A

CT scan and throat Swab

158
Q

How do you treat Ludwig’s Angina ?

A
  1. Clear airway
  2. Drain excess fluid
  3. Treat with antibiotics
159
Q

The neck is split into 3 zones: what key structures are in the following zones?

Zone 1
Zone 2
Zone 3

A

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
Q

What muscle if breached in a penetrating neck injury would concern you?

A

Platysma

FINALS revision - @medicbotanist (20 decks)

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