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Fifth Year Medicine > ENT > Flashcards

ENT Flashcards

1
Q

What is the management of acute otitis media without complications?

A

With perforation - review drum in 6-8 weeks.

If no hearing loss, dry perforation, does not need to be repaired.

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2
Q

What is the management of a traumatic perforation of the ear drum?

A

Review drum in 6-8 weeks. If not hearing loss, dry perforation, does not need to be repaired.

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3
Q

What are the symptoms of otitis externa?

A

Inflammation of skin
Itch (cardinal feature)
Minimal hearing loss
Pain

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4
Q

What is otitis externa most commonly caused by?

A

Pseudomonas

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5
Q

What are the predisposing factors for otitis externa?

A

Skin conditions (eczema, psoriasis)
Systemic conditions (diabetes)
Cotton bud use
Cosmetics

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6
Q

What is the treatment for otitis externa?

A

Clean the ear
Topical steroids
Topical antibiotics
Topical antifungals if fungal

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7
Q

What is a sign of necrotising otitis externa?

A

Granulation tissue

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8
Q

What are the features of necrotising otitis externa?

A

Pain +++
Discharge
Granulation tissue on floor of ear canal
+/- facial palsy or abducens palsy

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9
Q

What is the management of necrotising otitis externa?

A

Refer to ENT on call for admission
IV antibiotics with bone penetration for at least 6 weeks
CT temporal bones
Medical management of immunocompromise

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10
Q

Who is most at risk of developing necrotising otitis externa?

A

Diabetics

People who are immunocompromised.

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11
Q

What is cholesteatoma?

A

Squamous epithelium in middle ear or mastoid

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12
Q

What are the features of cholesteatoma?

A

Discharging ear that does not resolve with antibiotics treatment.

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13
Q

What is the management of cholesteatoma?

A 
Surgery:
Mastoidectomy
Atticotomy
Atticoantrostomy
Endoscopic approaches
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14
Q

What are the possible methods of pathogenesis for cholesteatoma?

A

Retraction pocket - pars flaccida, pars tensa
Non-retraction pocket - perforation, traumatic/iatrogenic
Congenital - epithelial rest, intact TM.

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15
Q

What is a discharging perforation?

A

Perforation with inflammation of middle ear mucosa.

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16
Q

What are the symptoms of a discharging perforation?

A

Pain initially
Discharging ear
Hearing loss

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17
Q

What is the treatment for a discharging perforation (active chronic otitis media)?

A

Medical:
Aural toilet (microsuction)
Antibiotics/steroid drops/sprays

Surgical:
Myringoplasty or tympanoplasty

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18
Q

What are the causes of otorrhoea (ear discharge)?

A

Otitis externa
Acute otitis media with perforation
Active chronic otitis media (COM) - mucosa/squamous
Trauma

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19
Q

What is otalgia?

A

Ear pain

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20
Q

What can cause otalgia?

A 
Acute otitis media
Otitis externa
Necrotising otitis externa
Furuncle in ear canal
Otitis media with effusion
Temporomandibular joint
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21
Q

What are the symptoms of acute otitis media?

A

Otalgia
Pyrexia
Hearing loss
Discharge if drum perforates

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22
Q

What is the management of acute otitis media?

A

Analgesia

Antibiotics if no improvement

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23
Q

What are the red flags for otitis media with effusion?

A

Young south-east asian male

Middle aged adults with neck nodes

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24
Q

What are you worried about if you see red flags for otitis media with effusion?

A

Nasopharyngeal carcinoma

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25
Q

What are the features of tympanic scleorsis?

A

White flecks on ear drum
Retracted tympanic membrane
Can see head of stapes

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26
Q

What is the function of the eustachian tube?

A

It equalises pressure across the tympanic membrane.

Allows air into the middle ear.

Opens on swallowing and yawning.

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27
Q

What is the management of otitis meda with effusion?

A 
Decongestant nose drops to nasopharynx.
Valsalva maoeuvre/otovent
Ventilation tubes
Hearing aid
Chest postnasal space if unilateral
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28
Q

What are the symptoms of tonisiltis?

A

Odynophagia
Dysphagia
Systemic upset

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29
Q

What is the management of tonisiltis?

A

Symptomatic treatment

Penicillin V + analgesia

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30
Q

Which drug should you avoid giving in glandular fever?

A

Ampicillin - it can cause a rash that lasts for up to 6 months

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31
Q

What are the sign guidelines for tonsillectomy?

A

Sore throats are due to acute tonsilitis.
Episodes are disabling and prevent normal functioning.
7 or more well documented, clinically significant, adequately treated sore throats in preceding year.
5 or more episodes in each of the preceding two years.
3 or more episodes in each of the preceding three years.

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32
Q

What are the symptoms of allergic rhinitis?

A 
Nasal congestion
Runny nose
Itchy nose
Sneezing 
\+/- red and watery eyes
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33
Q

What is the appearance of the nose in allergic rhinitis?

A

Pale, oedematous turbinates
Nasal congestion
Clear discharge

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34
Q

What is the treatment for non-allergic rhinitis?

A

Saline douching/spray
Trigger avoidance/reduction
+/- nasal steroid

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35
Q

What is rhinitis medicamentosa?

A

Rhinitis or nasal blockage caused by medication.

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36
Q

Which medications tend to cause rhinitis medicamentosa?

A

Xylometazoline HCl
Oxylometazoline HCl/phenylephrine sprays
Sudafed
Can occur after 7 days of use

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37
Q

What do nasal polyps looks like?

A

Pale

Insensate

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38
Q

What are the symptoms of nasal polyps?

A

Rhinorrhoea
Blockage
Smell disturbance
(Subset of chronic rhinosinusitis)

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39
Q

What are the two main symptoms of sinusitis?

A

Nasal blockage
Nasal discharge

\+/-:
facial pain
poor sense of smell 
endoscopic features
CT changes
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40
Q

How long does acute rhinosinusitis last?

A

Less than 12 weeks

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41
Q

How long does chronic rhinosinusitis last?

A

> 12 weeks

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42
Q

How do you make a diagnosis of acute bacterial rhinosinusitis?

A 
At least 3 of:
Discoloured discharge
Severe, localised facial pain
Pyrexia
Raised ESR/CRP
Deterioration after initial milder symptoms
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43
Q

What is the management for acute bacterial rhinosinusitis?

A

Consider topical steroids

Consider oral antibiotics

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44
Q

What is the treatment of a deviated septum?

A

Exclude or treat concurrent pathology i.e. allergic rhinitis
Trial of medical therapy
Septoplasty if symptoms match the deformity

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45
Q

What are the red flags for sinonasal malignancy?

A

Unilateral anything.
Blood stained discharge.
Dental/orbital signs: loose teeth, proptosed eye, unilateral decreased eye movements.

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46
Q

What is a symptom of septal perforation?

A

Nasal obstruction

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47
Q

What can septal perforation be a symptom of?

A

Underlying systemic condition

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48
Q

What are the causes of septal perforation?

A 
Idiopathic
Rhinotillexomania
Cocaine use
Iatrogenic
Autoimmune conditions
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49
Q

What is the treatment for septal perforation?

A

Saline douching
Vaseline
Stop causative agents

Surgery:
Septal button, flaps

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50
Q

What can GPs prescribe for epistaxis?

A

Naseptin (but not if the patient has a peanut or soy allergy)

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51
Q

What causes globus sensation?

A

Increased tension in the muscles of the neck/pharynx.
Stress and anxiety; particularly when trying to hold back strong emotions
Acid reflux

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52
Q

Which types of HPV are most carcinogenic?

A

16 and 18

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53
Q

What are the red flags of head and neck cancer?

A

Hoarseness for >6 weeks
Ulceration or swellings of the oral mucosa >3 weeks
Red and white patches of the oral mucosa
Dysphagia
Persistent unilateral nasal obstruction, especially if accompanied with purulent discharge.
Neck masses >3 weeks duration.
Cranial nerve involvement
Persistent unilateral otalgia with normal otoscopy.

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54
Q

What are the causes of a hoarse voice?

A 
Laryngitis
Laryngeal cancer
Vocal cord palsy
Vocal cord polyp
Vocal cord granuloma
Respiratory papillomatosis
Reinke's oedema
Vocal nodules
Muscle tension dysphonia
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55
Q

What does dysphagia mean?

A

Difficulty swallowing

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56
Q

What does odynophagia mean?

A

Painful swallowing

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57
Q

What is the management for sudden onset hearing loss?

A

Steroids (1ml/kg, max 60mg) within 72 hours of symptom onset if normal ear canal, tympanic membrane, no infection and reduced hearing with clinical testing.

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58
Q

What are the features of a malignant neck lump?

A

Firm to touch, but can be cystic.

Overlying skin changes

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59
Q

What are the investigations of a lateral neck mass?

A

Full examination
Ultrasound and fine needle aspirate/core biopsy
CT/PET-CT

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60
Q

What could a malignant lateral mass on the neck arise from?

A

Squamous cell carcinoma - likely to arise from head and neck
Adenocarcinoma - pathology more likely to lie below clavicles
Lymphoma

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61
Q

What are the types of benign parotid lump?

A 
Pleomorphic adenoma (malignant potential)
Warthin's (can be bilateral)
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62
Q

What are the features of a parotid lump that would suggest malignancy?

A

Pain
Facial nerve palsy
Skin changes
Associated lymphadenopathy

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63
Q

What are the investigations of a parotid lump?

A

Full examination including inside mouth
Ultrasound and fine needle aspirate
Parotidectomy if malignant/PSA

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64
Q

What is a second cleft branchial cyst?

A

Lateral mass
Squamous-lined cyst - hypothesised to be epithelial inclusions with lymph nodes that occur during development of neck from pharyngeal arches

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65
Q

Who is most likely to to present with a 2nd cleft branchial cyst?

A

Young adults

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66
Q

What are the investigations of 2nd cleft branchial cysts?

A

Ultrasound and fine needle aspirate

Extreme care in over 35s - can be similar to cystic metastases

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67
Q

What is the management of 2nd cleft branchial cysts?

A

Can be treated by surgical excision

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68
Q

What causes a thyroglossal duct cyst?

A

Failure of thyroglossal duct to obliterate during development

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69
Q

Who is most likely to present with a thyroglossal duct cyst?

A

Usually present in children, but can be young adults.

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70
Q

What is the key feature of a thyroglossal duct cyst?

A

Midline neck lump that moves on swallowing and tongue protrusion

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71
Q

What is the risk of a thyroglossal duct cyst becoming infected?

A

Can form fistula

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72
Q

What is the treatment of a thyroglossal duct cyst?

A

Surgical excision along with central portion of body of hyoid bone (sistrunk’s procedure)

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73
Q

What are the features of thyroid nodules?

A

Midline neck lump that only moves on swallowing (not tongue protrusion)

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74
Q

What are the red flags for thyroid nodules?

A 
Family history of thyroid cancer
Radiation history
Child
Hoarseness/stridor
Rapid enlargement
Cervical lymphadenopathy
Associated pain
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75
Q

What are the causes of a thyroid goitre?

A

Iodine deficiency
Hashimoto’s thyroiditis
Grave’s disease

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76
Q

How would a thyroid goitre be investigated?

A

TFTs
TPO antibodies
TSH receptor antibodies

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77
Q

What is stertor?

A

A kind of snoring

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78
Q

What causes stertor?

A

Partial obstruction above larynx

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79
Q

What causes stridor?

A

Partial obstruction at level/below larynx

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80
Q

What forms the borders of the anterior triangle of the neck?

A

Sternocleidomastoid muscle
Midline
Border of mandible

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81
Q

What forms the borders of the posterior triangle of the neck?

A

Trapezius
Clavicle
Midline

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82
Q

What are the causes of vocal cord pathology?

A

Mucosal lesion
Paralysis
Age related

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83
Q

What are the risk factors for vocal cord pathology?

A

Smoking

Alcohol excess

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84
Q

What happens to the vocal cords in age-related voice change (presbyphonia)?

A

Bowing of vocal cords due to atrophy

Incomplete glottic closure

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85
Q

What is laryngitis?

A

Common, short lasting acute inflammation affecting the laryngeal mucosa.

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86
Q

What are the aetiologies of laryngitis?

A

Upper respiratory tract infection
Chemical injury
Physical injury

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87
Q

What can cause chronic or recurrent laryngitis?

A 
Laryngeal reflux
Smoking
Alcohol
Snoring
Systemic disease (rare) e.g. RA, sarcoidosis
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88
Q

What are the symptoms of a vocal cord palsy?

A

Breathy voice

Cough/choking after swallowing

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89
Q

What is the aetiology of a vocal cord palsy?

A

Iatrogenic - neck surgery (particularly thyroid)/cardiothoracic surgery
Tumours - head and neck - direct invasion of larynx or recurrent laryngeal nerve
Lung cancer
Stroke
Neck or chest injury
Neurological
Viral infections

90
Q

What is the treatment for vocal cord palsy?

A

Usually conservative - especially if lung tumour, poor prognosis
Speech and language therapy
Cord medialisation procedures to improve voice
Cordotomy procedures to improve airway

91
Q

What are the types of vocal cord polyps?

A

Pedunculated or sessile

92
Q

What is the aetiology of vocal cord polyps?

A 
Voice abuse
Chronic cough
Chemical - laryngeal pharyngela reflux, smoking, alcohol
Infection
Allergy/inflammation
93
Q

What can cause a vocal cord granuloma?

A

Continous damage and the subsequent healing process.

e.g. intubation trauma, arytenoid granuloma

94
Q

What can infection with HPV types 6 and 11 cause?

A

Recurrent respiratory papillomatosis

95
Q

What is the treatment for recurrent respiratory papillomatosis?

A

Endoscopic removal with microdebrider
LASER
Mitomycin/interferon
Preventative - HPV vaccination

96
Q

What is Reinke’s oedema?

A

Bilateral oedema of the vocal cords caused by smoking (and sometimes severe laryngeal reflux)

97
Q

What are the consequences of reinke’s oedema?

A

Deepening of the voice

98
Q

What is the treatment for reinke’s oedema?

A 
Stop smoking
Lateral cordotomy (remove fluid) if required
99
Q

What is the main cause of vocal cord nodules?

A

Voice misuse: singers, teachers, sports coaches, children

100
Q

What is the treatment for vocal cord nodules?

A

Speech and language therapy

101
Q

What is the progression of vocal cord nodules?

A

Early: soft inflammatory swelling over microhaemorrhage
Later: fibroblasts and collagen fibres

102
Q

What causes muscle tension dysphonia?

A

Increased and sustains tension in laryngeal muscles resulting in abnormal movement of cords.

103
Q

What is the most common type of laryngeal cancer?

A

Squamous cell carcinoma

104
Q

What are the risk factors for laryngeal cancer?

A

Smoking
Alcohol
Lower socio-economic group
HPV related

105
Q

What is the cardinal symptom of laryngeal cancer?

A

Hoarseness

106
Q

What are the other symptoms of laryngeal cancer?

A 
Dysphagia
Weight loss
Haemoptysis
Neck lump
Pain
Aspiration
Airway compromise
107
Q

What are the investigations for laryngeal cancer?

A

Cytology (fine needle aspirate of cervical lymphadenopathy or biopsy of vocal cords)
Imaging - CT/USS/PET

108
Q

What is the management of laryngeal cancer?

A

Depends on staging - MDT decision.
Surgery - laser resection for early stage.
Laryngectomy
Radio/chemotherapy

109
Q

What are the possible causes of airway compromise?

A

Facial trauma: maxiall/mandibular fracture, base of skull fracture
Oral cavity: foreign body, tongue enlargement, angioedema, floor of mouth swelling
Bleeding: tonsil bleed, trauma
Neck: masses, goitre, scars
Larynx: mass, infection

110
Q

What is the presentation of supraglottitis?

A

Septic with sore throat

111
Q

Why is swallowing button batteries bad?

A

It causes local erosion

112
Q

What are the signs of glandular fever?

A

White exudate
Lymphadenopathy
Hepatosplenomegaly

113
Q

What causes glandular fever?

A

EBV infection

114
Q

What is the management of glandular fever?

A

Avoid alcohol
Avoid anything that could lead to abdominal trauma e.g. contact sports, gigs, sex
Avoid sharing of saliva (to prevent passing it on)

115
Q

What is the management for quinsy?

A 
Drain abscess
Aspirate or incise and drain
Admit
IV antibiotics +/- dexamethasone
Consider tonsillectomy if more than 1 episode
116
Q

How do you manage a patient with post tonsillectomy bleed?

A

Treat as any haemorrhaging patient

117
Q

What is ludwig’s angina?

A

Severe cellulitis involving the floor of the mouth

118
Q

What are the symptoms of a parapharyngeal abscess?

A

Neck mass
Unwell
Febrile
Decreased rotational neck movements

119
Q

What are the features of a retropharyngeal abscess?

A 
Swinging pyrexia (picket fence)
Decreased neck movements
Maybe relatively well
Usually children
May cause airway compromise
120
Q

What is the possible emergency management for retropharyngeal abscess?

A

May need tracheostomy
Likely difficult intubation
May rupture abscess on intubation

121
Q

In what age group do you immediately give antibiotics for otitis media?

A

<2 years

122
Q

What are the possible complications of acute otitis media?

A

Intracranial abscess
Facial palsy
Mastoiditis
Meningitis

123
Q

What is the management of mastoiditis?

A

24 hours of IV antibiotics
Nil by mouth until ENT review
May need CT head/temporal bones and drainage if unwell

124
Q

What does peri-orbital cellulitis often follow?

A

URTI

125
Q

What are the features of peri-orbital cellulitis?

A

Eye proptosis
Reduced visual acuity
Unwell
Red vision reduced

126
Q

What is the management of peri-orbital cellulitis?

A

ENT/ophthalmology/paeds assessment
NBM
Stat IV antibiotics

127
Q

What does a Pott’s puffy tumour often follow?

A

URTI

128
Q

What is the management of a suspected Pott’s puffy tumour?

A

CT with contrast
NBM
IV antibiotics

129
Q

What is the treatment ladder for epistaxis?

A

Adequate 1st aid:

  • head forward over bowl/sink
  • pinch soft part of nose
  • ice over bridge/back of neck/in mouth

Secondary care intervention:

  • protection (gloves, goggles, apron, mask)
  • headlight and thudichums
  • suction clot from nose/nasopharynx/oropharynx
  • spray LA
  • Identify bleeding points

Monitor for shock.

Silver nitrate cautery of bleeding vessels
Nasal packing - nasal packs, foley catheter and BIPP

130
Q

What are the causes of epistaxis?

A 
Trauma
Nasal septal deviation/spur/perforation
Iatrogenic
Inflammation
Foreign body
Environmental
Malignancy
Systemic disorders
131
Q

Which area of the nose is most commonly involved in a nose bleed?

A

Kiesselbach’s plexus in Little’s area

132
Q

What is a fractured nose assessed for?

A

Other injuries/fractures
Compound fracture
Septal haematoma

133
Q

What are the causes of a septal haematoma?

A

Nasal trauma

Post operative complication

134
Q

What is the management of a septal haematoma?

A

Incision and drainage
Antibiotics
Take to theatre same day.

135
Q

What are the risks associated with septal haematoma?

A

Septal perforation
Abscess
Cavernous sinus thrombosis

136
Q

What are the features of a septal haematoma?

A

Boggy cherry red swelling

137
Q

When should a fractured nose be treated?

A

Assessment 5-7 days after injury to allow swelling to settle.
Manipulation before 14 days.

138
Q

How should a fractured nose be treated?

A

Septoplasty +/- rhinoplasty later

139
Q

What is bell’s palsy?

A

Facial palsy with no identified underlying cause.

140
Q

What is the treatment for facial nerve palsy?

A

Treat underlying cause
Steroids within 72 hours.
Eye protection

141
Q

What is the name of the scale given to document a facial palsy?

A

House Brackmann scale

I-VI

142
Q

Where on a House Brackmann scale can a patient still close their eye?

A

I-III

143
Q

What is the aetiology of facial palsy?

A

Idiopathic (68%)
Trauma
Tumour
Infection

144
Q

What is Ramsay Hunt syndrome?

A

Bells palsy + vesicles

Herpes zoster infection

145
Q

What are the symptoms of Ramsay Hunt syndrome?

A 
Bells palsy
Vesicles in mouth and around ear
Hearing loss
Vertigo
Pain
146
Q

What is the management of Ramsay Hunt syndrome?

A

Analgesia
Steroids
Acyclovir

147
Q

What happens if you don’t drain a pinna haematoma?

A

You get a cauliflower ear

148
Q

How do you remove a foreign body from an ear?

A

Syringing
Suctioning
Fine hook

If it’s an insect drown it first.

149
Q

What are the symptoms of a traumatic tympanic membrane perforation?

A

Hearing loss
Bleeding ear
Discharge

150
Q

What are the signs of a base of skull fracture?

A 
Panda eyes
Battle's sign
Facial palsy
Haemotympanim (blood behind eardrum)
Halo sign
151
Q

How do you know if a facial palsy if lower motor neurone or upper motor neurone?

A

If it involves the forehead it is lower motor neurone.

152
Q

How do you test visual stimulus in a patient with vertigo?

A

Halmaygi head thrust test

153
Q

How do you test proprioception in a patient with vertigo?

A

Romberg’s test

154
Q

How do you test vestibular function in a patient with vertigo?

A

Unterberger’s test

155
Q

What is the most likely cause if a patient get dizzy on head movements or looking up/

A

BPPV

156
Q

What is the most likely cause if the patient gets vertigo with a feeling of a blocked ear or tinnitus?

A

Meniere’s

157
Q

What is the most likely cause if the patient gets sudden onset vertigo and feels dreadful for weeks with no hearing loss?

A

Vestibular neuronitis

158
Q

What is the diagnosis if a patient gets sudden onset vertigo and feels dreadful for weeks with hearing loss?

A

Labyrinthitis

159
Q

What is a positive finding in the halmaygi head thrust test?

A

Eyes do not stay fixed on target, deviate to the side of the lesion.
Indicates pathology in vestibular system.

160
Q

What is a positive finding in a test of skew?

A

Quick vertical gaze corrections suggests a central cause

161
Q

Where is the location of pathology if the patient has dysdiadokinesis or past pointing?

A

Cerebellum

162
Q

What happens in a Romberg’s test?

A

If patient closes eyes they can’t stay upright

163
Q

What happens in unterberger’s test?

A

If patient closes eyes they rotate

164
Q

What happens in a positive Dix-Hallpike test?

A

Rotatoinal nystagmus related to head movement. Fatiguable. Latency period.

165
Q

What are the phases of nystagmus?

A

Slow and fast phase

166
Q

Which phase of nystagmus defines the direction?

A

Fast phase`

167
Q

What are the causes of nystagmus?

A 
Physiological
Spontaneous nystagmus (pathological vestibular)
Gaze evoked nystagmus
Positional nystagmus
Central positional nystagmus
168
Q

What happens in spontaneous pathological nystagmus?

A

Constant drift of eyes to side of lesion, interrupted by fast component in contralateral direction.

169
Q

How is spontaneous nystagmus graded?

A

Alexander’s law
1st degree: only present if eye deviated towards fast phase.
2nd degree: present when eye in primary position.
3rd degree: present when eye deviated towards slow phase.

170
Q

What happens in gaze evoked nystagmus?

A

Cannot sustain gaze away from primary position i.e. cannot sustain lateral gaze.

171
Q

What causes gaze evoked nystagmus?

A 
Central dysfunction (i.e. areas controlling reflexes)
Maybe iatrogenic (anticonvulsants, psychotrpic) or due to alcohol.
172
Q

What are the common causes of vertigo?

A

Benign paroxysmal positional vertigo
Vestibular neuronitis
Migraine

173
Q

What are causes of imbalance?

A 
Common:
Postural hypotension
Hypertension
Vestibular migraine
BPPV

Uncommon:
Meniere’s disease
Cerebellopontine angle tumour

174
Q

What is the patholphysiology of benign paroxysmal positional vertigo?

A

Otolith dislodgement in posterior semicircular canal causing irritation of the cupula.
Or
Cupulolithiasis - otoliths adherent to cupula

175
Q

What is the treatment for vestibular neuronitis?

A

Prochlorperazine (short course)

176
Q

What is the treatment for Meniere’s disease?

A

Conservative:
lifestyle - low salt, reduce caffeine
Medical:
Preventitive medication - betahistine (limited evidence)
Symptomatic medication - buccal prochlorperazine.
Surgical - vestibular destructive:
Disabling vertigo and patient not coping
Intratympanic gentamicin.
Effective in 90%. Hearing loss in 15-20%.

177
Q

What are the indications for a tracheostomy?

A 
Mechanical obstruction
Protection of trachebronchial tree
Respiratory failure
Retention of bronchial secretions
Elective (part of major surgery)
178
Q

What are the advantages of a tracheostomy?

A

Bypasses obstruction when ET tube cannot be passed.
Decreases dead space by 150ml (50%)
Better tolerated than ET tube.
Eventual swallowing and speaking.

179
Q

What are the disadvantages of a tracheostomy?

A

Lost of humidifcation and warming - increased mucous, increased mucous plugging.
Neck wound/scar
Tracheocutaneous fistula
Possible discharge from hospital delay

180
Q

Where is the tracheal window?

A

2nd/3rd ring

181
Q

What are the elements of tracheostomy care?

A

Humidification
Suctioning
Cleaning
Changing

182
Q

Which virus causes epiglottitis?

A

Haemophilis influenza B

183
Q

What is the decibel threshold for normal hearing?

A

up to 20 decibels

184
Q

Which patients get a pharyngeal pouch?

A

Patients over 70

185
Q

What are the symptoms of a pharyngeal pouch?

A 
Dysphagia
Regurgitation of unaltered food (food enters pouch preferentially)
Chronic cough
Recurrent chest infections
Weight loss
186
Q

What is the management of a pharyngeal pouch?

A

Conservative:
Alter diet
Manage risk factors

Medical:
Reflux control

Surgery:
Endoscopic division/stapling (most common)
Open resection

187
Q

What is globus sensation?

A

Feeling of something stuck in the throat/tightness in the throat.

188
Q

What are the symptoms of silent reflux?

A 
Sore throat - mild, daily, in the morning.
Lump in throat sensation
Post nasal drip sensation
Nocturnal cough
Hoarse voice
Excessive throat clearing
Throat closing over (laryngospasm)
Water brash (liquid suddenly appearing in the throat)
189
Q

What are the risk factors for GORD?

A 
Adult:
Smoking
Alcohol/coffee
High BMI
Pregnancy
Hiatus hernia
Trigger foods (typically salted or fatty)
Late night eating
Some connective tissue disorders.
Infant:
Neuromuscular disorders
Cow's milk intolerance
13q14 mutation
Neuro-developmental conditions
190
Q

What is the treatment for GORD?

A

Weight loss
Alginate
PPI
H2-receptor antagonist

191
Q

What are the complications of GORD?

A

Oesophagitis including erosion and ulcers.
Barrett’s oesophagus
Adenocarcinoma of oesophagus
Laryngeal granulomas
Laryngospasm
Stenosis
Association with laryngeal carcinoma in non-smokers

192
Q

What is sialolithiasis?

A

Salivary gland stones.

193
Q

What is the most common location of a salivary gland stone?

A

Submandibular gland

194
Q

What is the presentation of sialolithiasis?

A

Intermittent pain and swelling associated with meals +/- palpable hard lump in duct.

195
Q

Who is most commonly affected by sialolithiasis?

A

Men aged between 30-60 years.

196
Q

What are the complications of salivary gland stones?

A

Infection - associated erythema, pus discharging from duct.

197
Q

What is the management for sialolithiasis?

A

Hydration
Sialogogues
Analgesia +/- antibiotics

Surgery: incision over duct to remove stone. Gland removal (associated risks)

198
Q

What is sialadenitis?

A

Infection/inflammation of salivary glands.

Viral or bacterial.

199
Q

What is the presentation of sialadenitis?

A

Swelling of gland
Pain
Systemic upset

200
Q

What is the management of sialadenitis?

A

Supportive: rehydration, sialogogues, antibiotics.

201
Q

Name two hearing tests.

A

Pure tone audiogram.

Tympanogram.

202
Q

On a hearing test which ear does red represent?

A

Right.

203
Q

What does a tympanogram test?

A

Middle ear function

204
Q

What are the causes of conductive hearing loss?

A

Pinna - microtia/atresia
External auditory canal - wax, foreign body etc.
Tympanic membrane - large perforations, large tympanosclerotic plaques.
Middle ear - otitis media with effusion, haemotympanum, cholesteatoma, ossicular disruption, otosclerosis.

205
Q

What are the causes of sensorineural hearing loss?

A 
Inner ear - cochlear aplasia/hypoplasia
Perilymph fistula
Otoxic medication
Meningitis
Menieres
cochlear otosclerosis
Labyrinthitis
Noise induced hearing loss
Presbyacusis

Retrocochlear - cochlear nerve damage
IAM/CPA lesions
Intracranial lesions/disease
Processing dysfunction

206
Q

What happens in age related hearing loss (presbycusis)?

A

Peripheral degeneration
Reduction in number of inner and outer hair cells.
Leads to secondary neural (central degeneration)
Central component (arteriosclerosis)
Hearing impaired in background noise

207
Q

What is otosclerosis?

A

Abnormal bone growth around stapes, leading to stapes fixation.

208
Q

What is the age of onset of otosclerosis?

A

Young adult/adult

Can become worse in pregnancy

209
Q

What is the inheritance pattern of otosclerosis?

A

Autosomal dominant inheritance.

Often sporadic mutation

210
Q

What is the management of otosclerosis?

A

Hearing aid

Stapedectomy if does not tolerate hearing aid and sensorineural component negligible.

211
Q

What is the management of otitis media with effusion?

A

Decongestant nasal drops to nasopharynx
Valsalva manoeuvre/otovent
Ventilation tubes (grommets)
Hearing aid

212
Q

What are the causes of tinnitus?

A 
Drugs:
Salicylate
Quinine
Ototoxic
Noise induced
Menieres
Otosclerosis
Vestibular schwannoma
213
Q

What is the management of tinnitus?

A 
Habituation
 - explanation and information
 - reasurrance
 - masking - white noise, hearing aids, tinnitus maskers
Formal tinnitus counselling (severe cases)
Medication (rarely):
TCA, benzos, high dose lignocaine.
Surgery (rarely):
anatomical causes (glomus tumour)
214
Q

When do we investigate tinnitus?

A

Pulsatile
Unilateral
Associated vestibular symptoms or signs

215
Q

How is an acoustic neuroma investigated?

A

MRI

216
Q

How is acoustic neuroma managed?

A 
Watchful waiting (serial MRI)
Stereotactic radiotherapy (small but rapidly growing)
Surgery
217
Q

Which rheumatological conditions can have nasal symptoms?

A 
Granulomatosis with polyangitis
Sarcoidosis
Eosinophillic granulomatosis with polyangiitis
Relapsing polychondritis
Systemic lupus erythematosis
218
Q

What is the management of chronic rhinosinusitis?

A

Nasal steroids
Increase potency and/or frequency of nasal steroids
Saline douching 2-3x per day
Oral steroids
Antibiotics
CT scan if no improvement despite compliance.
Function endoscopic sinus surgery

219
Q

Which arteries make up Kiesselbach’s plexus?

A

Anterior ethmoidal
Superior labial
Sphenopalatine
Greater palatine

220
Q

Give some causes of hoarse voice.

A 
Laryngitis
Vocal cord palsy
Laryngeal cancer
Vocal cord polyp
VC granuloma
Papillomas
Reinke's oedema
Vocal nodules
Muscle tension dysphonia

Fifth Year Medicine (9 decks)

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