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ENT II Flashcards

1
Q

Presentation of BPPV

A

A variety of head movements can trigger attacks of vertigo.

A common trigger is turning over in bed.

Symptoms settle after around 20 – 60 seconds, and patients are asymptomatic between attacks

BPPV does not cause hearing loss or tinnitus

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2
Q

Treatment for BPPV

A

Epley manoeuvre

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3
Q

Exercises to help improve BPPV symptoms at home

A

Brandt-daroff exercises

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4
Q

Neck lump red-flag referral criteria

A

An unexplained neck lump in someone aged 45 or above

A persistent unexplained neck lump at any age

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5
Q

Ultrasound scan referral criteria for neck lumps

A

Patients with a lump that is growing in size.

This should be within 2 weeks in patients 25 and older and within 48 hours in patients under 25.

They require a two week wait referral if the ultrasound is suggestive of soft tissue sarcoma.

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6
Q

Causes of lymphadenopathy in the neck

A

Reactive lymph nodes (swelling caused by URTI, dental infection or tonsillitis)

Infected lymph nodes(TB, HIV or infectious mononucleosis)

Inflammatory conditions (e.g., systemic lupus erythematosus or sarcoidosis)

Malignancy (e.g., lymphoma, leukaemia or metastasis)

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7
Q

Which type of lymphadenopathy is most concerning in the neck

A

Enlarged supraclavicular nodes are the most concerning for malignancy of the cervical lymph nodes. They may be caused by malignancy in the chest or abdomen and require further investigation.

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8
Q

Features of malignant lymphadenopathy

A

Unexplained
Persistently enlarged (particularly over 3cm in diameter)
Abnormal shape (normally oval shaped)
Hard or “rubbery”
Non-tender
Tethered or fixed to the skin or underlying tissues

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9
Q

Features of lymphadenopathy in lymphomas

A

Characteristically non-tender and feel “rubbery”. Some patients will experience pain in the lymph nodes when they drink alcohol.

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10
Q

Causes of a goitre

A 
Graves disease (hyperthyroidism)
Toxic multinodular goitre (hyperthyroidism)
Hashimoto’s thyroiditis (hypothyroidism)
Iodine deficiency
Lithium
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11
Q

Causes of salivary gland pathology

A

Stones blocking the drainage of the glands through the ducts (sialolithiasis)
Infection
Tumours (benign or malignant)

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12
Q

How do carotid body tumours present

A

They present with a slow-growing lump that is:

In the upper anterior triangle of the neck (near the angle of the mandible)
Painless
Pulsatile
Associated with a bruit on auscultation
Mobile side-to-side but not up and down
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13
Q

Neurological effects of carotid body tumours

A

May compress the glossopharyngeal (IX), vagus (X), accessory (XI) or hypoglossal (XII) nerves.

Pressure on the vagus nerve may result in Horner syndrome

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14
Q

Characteristic sign of carotid body tumours on imaging

A

splaying (separating) of the internal and external carotid arteries (lyre sign)

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15
Q

Features of lipomas

A

Soft
Painless
Mobile
Do not cause skin changes

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16
Q

Features of thyroglossal cysts

A

Mobile
Non-tender
Soft
Fluctuant

Move up and down with movement of tongue

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17
Q

Diagnosis of thyroglossal cysts

A

Ultrasound/CT

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18
Q

Mx of thyroglossal cysts

A

Thyroglossal cysts are usually surgically removed to provide confirmation of the diagnosis on histology and prevent infections.

The cyst can reoccur after surgery unless the entire thyroglossal duct is removed.

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19
Q

Main complication of thyroglossal cysts

A

Infection of the cyst, causing a hot, tender and painful lump.

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20
Q

What is a branchial cyst

A

A branchial cyst is a congenital abnormality that arises when the second branchial cleft fails to form properly - fluid filled lump is called a branchial cyst

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21
Q

Features of branchial cyst

A

Branchial cysts present as a round, soft, cystic swelling between the angle of the jaw and the sternocleidomastoid muscle in the anterior triangle of the neck.

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22
Q

Mx of branchial cysts

A

Conservative, without any active intervention, where it is not causing problems

Surgical excision where recurrent infections are occurring, there is diagnostic doubt, or it is causing other problems

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23
Q

What is vestibular neuronitis and what is it usually associated with

A

Inflammation of vestibular nerve attributed to a viral infection

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24
Q

What do semicircular canals detect

A

Rotation of head

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25
What do otolith organs detect(utricle and saccule)
gravity and linear acceleration
26
Purpose of vestibular nerve
transmits signals from the vestibular system (the semicircular canals and vestibule) to the brain to help with balance
27
Presentation of vestibular neuronitis
History of URTI Nausea and vomiting Balance problems
28
Neuronitis vs labyrinthitis
Labyrinthitis – Loss of hearing | Neuronitis – No loss of hearing
29
Test to diagnose peripheral causes of vertigo
Head impulse test
30
Mx of peripheral vertigo such as neuronitis
Prochlorperazine Antihistamines (can be used up to 3 days) Referral if symptoms do not improve after 1 week or resolve after 6 weeks --> may need vestibular rehabilitation therapy
31
Complication of neuronitis
BPPV
32
What is labyrinthitis
Inflammation of the bony labyrinth of the inner ear, including the semicircular canals, vestibule (middle section) and cochlea. The inflammation is usually attributed to a viral upper respiratory tract infection
33
What can labyrinthitis be secondary to
Otitis media or meningitis
34
Presentation of labyrinthitis
Acute onset vertigo Hearing loss Tinnitus
35
What are acoustic neuromas
benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear
36
Where do acoustic neuromas tend to occur
cerebellopontine angle and are sometimes referred to as cerebellopontine angle tumours
37
Presentation of acoustic neuromas
Unilateral sensorineural hearing loss (often the first symptom) Unilateral tinnitus Dizziness or imbalance A sensation of fullness in the ear
38
What can acoustic neuromas sometimes be associated with
Facial nerve palsy if tumour grows large enough
39
Diagnosis of acoustic neuromas
Audiometry(sensorineural hearing loss) Brain imaging(MRI or CT)
40
Mx of acoustic neuromas
Conservative management with monitoring may be used if there are no symptoms or treatment is inappropriate Surgery to remove the tumour (partial or total removal) Radiotherapy to reduce the growth
41
Risks of surgery for acoustic neuroma removal
Vestibulocochlear nerve injury, with permanent hearing loss or dizziness Facial nerve injury, with facial weakness
42
Pathophys of meniere's disease
Ménière’s disease is associated with the excessive buildup of endolymph in the labyrinth of the inner ear, causing a higher pressure than normal and disrupting the sensory signals. This increased pressure of the endolymph is called endolymphatic hydrops.
43
Presentation of meniere's disease
Hearing loss(sensorineural) Vertigo Tinnitus (unilateral)
44
What can sometimes be seen during an acute attack of meniere's disease
Spontaneous nystagmus may be seen during an acute attack. This is usually in one direction (unidirectional).
45
Mx of acute attacks of meniere's disease
Prochlorperazine | Antihistamines
46
Prophylaxis in meniere's disease
Betahistine
47
What is a cholesteatoma
Abnormal collection of squamous epithelial cells in the middle ear. It is non-cancerous but can invade local tissues and nerves and erode the bones of the middle ear. It can predispose to significant infections.
48
Presentation of cholesteatoma
``` Foul discharge from the ear Unilateral conductive hearing loss Infection Pain Vertigo Facial nerve palsy ```
49
What can be seen on otoscope in cholesteatomas
build-up of whitish debris or crust in the upper tympanic membrane
50
Mx of cholesteatoma
CT head - diagnosis and plan for surgery MRI may help assess invasion Surgical removal
51
Where do nosebleeds usually originate from
Kiesselbach’s plexus, which is located in Little’s area. This is an area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels.
52
What might bleeding from both nostrils indicate
Bleeding posteriorly in the nose --> higher risk of aspiration of blood
53
How should patients manage a nosebleed
Sit up and tilt the head forwards Squeeze the soft part of the nostrils together for 10 – 15 minutes Spit out any blood in the mouth, rather than swallowing
54
Treatment options for epistaxis
Nasal packing using nasal tampons or inflatable packs | Nasal cautery using silver nitrate sticks
55
what can be considered after an acute nosebleed
Naseptin nasal cream (chlorhexidine and neomycin) four times daily for 10 days to reduce any crusting, inflammation and infection. This is contraindicated in peanut or soya allergy.
56
What are nasal polyps associated with
``` Chronic rhinitis or sinusitis Asthma Samter’s triad Cystic fibrosis Eosinophilic granulomatosis with polyangiitis ```
57
Presentation of nasal polyps
``` Chronic rhinosinusitis Difficulty breathing through the nose Snoring Nasal discharge Loss of sense of smell (anosmia) ```
58
When should nasal polyps be referred
Unilateral polyps should be referred for specialist assessment to exclude malignancy.
59
Medical mx of nasal polyps
intranasal topical steroid drops or spray
60
Surgical mx of nasal polyps
Intranasal polypectomy | Endoscopic nasal polypectomy
61
What type of cancers are head and neck tumours usually
SCC
62
Risk factors for head and neck tumours
``` Smoking Chewing tobacco Chewing betel quid Alcohol HPV(strain 16) EBV ```
63
Red flags - head and neck tumours
``` Lump in the mouth or on the lip Unexplained ulceration in the mouth lasting more than 3 weeks Erythroplakia or erythroleukoplakia Persistent neck lump Unexplained hoarseness of voice Unexplained thyroid lump ```
64
Mx of head and neck tumours
MDT Staging - TNM Chemo/radiotherapy Surgery
65
Indications for tonsillectomy
Acute sore throat(7 or more in 1 year) Recurrent tonsillar abscess(2) Enlarged tonsils causing difficulty breathing, swallowing or snoring
66
Complications of tonsillectomy
Sore throat where the tonsillar tissue has been removed (this can last 2 weeks) Damage to teeth Infection Post-tonsillectomy bleeding Risks associated with a general anaesthetic
67
Mx of post-tonsillectomy bleeding
Senior referral IV access + bloods + group and save/crossmatch Analgesia Sit them up and encourage to spit blood rather than swallow NBM IV fluids
68
Options for stopping bleeding post-tonsillectomy
Hydrogen peroxide gargle Adrenalin soaked swab applied topically Intubation may be Druid
69
Causes of glossitis
``` Iron deficiency anaemia B12 deficiency Folate deficiency Coeliac disease Injury or irritant exposure ```
70
Causes of angioedema
Allergic reactions ACE inhibitors C1 esterase inhibitor deficiency (hereditary angioedema)
71
Risk factors for oral candidiasis
``` ICS Abx Diabetes Immunodeficiency Smoking ```
72
Treatment options for oral candidiasis
Miconazole gel Nystatin suspension Fluconazole tablets
73
What is leukoplakia and what is it associated with
White patches in the mouth, often on the tongue or insides of the cheeks (buccal mucosa). It is a precancerous condition, meaning it increases the risk of squamous cell carcinoma of the mouth.
74
Mx of leukoplakia
biopsy to exclude abnormal cells (dysplasia) or cancer. Management involves stopping smoking, reducing alcohol intake, close monitoring and potentially laser removal or surgical excision.
75
What is lichen planus
autoimmune condition that causes localised chronic inflammation of the skin. The skin has shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae.
76
Mx of lichen planus
good oral hygiene, stopping smoking and topical steroids
77
Risk factors for gingivitis
``` Plaque build-up on the teeth (inadequate brushing) Smoking Diabetes Malnutrition Stress ```
78
Mx of gingivitis
Good oral hygiene Stopping smoking Dental hygienist treatment to remove plaque and tartar Chlorhexidine mouth wash Antibiotics for acute necrotising ulcerative gingivitis (e.g., metronidazole) Dental surgery if required
79
Causes of gingival hyperplasia
``` Gingivitis Pregnancy Vitamin C deficiency (scurvy) Acute myeloid leukaemia Medications, particularly calcium channel blockers, phenytoin and ciclosporin ```
80
What are apthous ulcers
small, painful ulcers of the mucosa in the mouth. They have a well-circumscribed, punched-out, white appearance.
81
Causes of apthous ulcers
Inflammatory bowel disease (Crohn’s disease and ulcerative colitis) Coeliac disease Behçet disease Vitamin deficiency (e.g., iron, B12, folate and vitamin D) HIV
82
Mx of apthous ulcers
Usually no intervention required ``` Choline salicylate (e.g., Bonjela) Benzydamine (e.g., Difflam spray) Lidocaine ``` topical corticosteroids in more severe ulcers
83
When should patients be referred for mouth ulcers
“unexplained ulceration” lasting over 3 weeks.

General practice (26 decks)

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