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General practice > ENT II > Flashcards

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
Q

What do otolith organs detect(utricle and saccule)

A

gravity and linear acceleration

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26
Q

Purpose of vestibular nerve

A

transmits signals from the vestibular system (the semicircular canals and vestibule) to the brain to help with balance

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27
Q

Presentation of vestibular neuronitis

A

History of URTI
Nausea and vomiting
Balance problems

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28
Q

Neuronitis vs labyrinthitis

A

Labyrinthitis – Loss of hearing

Neuronitis – No loss of hearing

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29
Q

Test to diagnose peripheral causes of vertigo

A

Head impulse test

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30
Q

Mx of peripheral vertigo such as neuronitis

A

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

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31
Q

Complication of neuronitis

A

BPPV

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32
Q

What is labyrinthitis

A

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

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33
Q

What can labyrinthitis be secondary to

A

Otitis media or meningitis

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34
Q

Presentation of labyrinthitis

A

Acute onset vertigo

Hearing loss
Tinnitus

35
Q

What are acoustic neuromas

A

benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear

36
Q

Where do acoustic neuromas tend to occur

A

cerebellopontine angle and are sometimes referred to as cerebellopontine angle tumours

37
Q

Presentation of acoustic neuromas

A

Unilateral sensorineural hearing loss (often the first symptom)
Unilateral tinnitus
Dizziness or imbalance
A sensation of fullness in the ear

38
Q

What can acoustic neuromas sometimes be associated with

A

Facial nerve palsy if tumour grows large enough

39
Q

Diagnosis of acoustic neuromas

A

Audiometry(sensorineural hearing loss)

Brain imaging(MRI or CT)

40
Q

Mx of acoustic neuromas

A

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
Q

Risks of surgery for acoustic neuroma removal

A

Vestibulocochlear nerve injury, with permanent hearing loss or dizziness
Facial nerve injury, with facial weakness

42
Q

Pathophys of meniere’s disease

A

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
Q

Presentation of meniere’s disease

A

Hearing loss(sensorineural)
Vertigo
Tinnitus

(unilateral)

44
Q

What can sometimes be seen during an acute attack of meniere’s disease

A

Spontaneous nystagmus may be seen during an acute attack. This is usually in one direction (unidirectional).

45
Q

Mx of acute attacks of meniere’s disease

A

Prochlorperazine

Antihistamines

46
Q

Prophylaxis in meniere’s disease

A

Betahistine

47
Q

What is a cholesteatoma

A

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
Q

Presentation of cholesteatoma

A 
Foul discharge from the ear
Unilateral conductive hearing loss
Infection
Pain
Vertigo
Facial nerve palsy
49
Q

What can be seen on otoscope in cholesteatomas

A

build-up of whitish debris or crust in the upper tympanic membrane

50
Q

Mx of cholesteatoma

A

CT head - diagnosis and plan for surgery

MRI may help assess invasion

Surgical removal

51
Q

Where do nosebleeds usually originate from

A

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
Q

What might bleeding from both nostrils indicate

A

Bleeding posteriorly in the nose –> higher risk of aspiration of blood

53
Q

How should patients manage a nosebleed

A

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
Q

Treatment options for epistaxis

A

Nasal packing using nasal tampons or inflatable packs

Nasal cautery using silver nitrate sticks

55
Q

what can be considered after an acute nosebleed

A

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
Q

What are nasal polyps associated with

A 
Chronic rhinitis or sinusitis
Asthma
Samter’s triad
Cystic fibrosis
Eosinophilic granulomatosis with polyangiitis
57
Q

Presentation of nasal polyps

A 
Chronic rhinosinusitis
Difficulty breathing through the nose
Snoring
Nasal discharge
Loss of sense of smell (anosmia)
58
Q

When should nasal polyps be referred

A

Unilateral polyps should be referred for specialist assessment to exclude malignancy.

59
Q

Medical mx of nasal polyps

A

intranasal topical steroid drops or spray

60
Q

Surgical mx of nasal polyps

A

Intranasal polypectomy

Endoscopic nasal polypectomy

61
Q

What type of cancers are head and neck tumours usually

A

SCC

62
Q

Risk factors for head and neck tumours

A 
Smoking 
Chewing tobacco 
Chewing betel quid 
Alcohol 
HPV(strain 16) 
EBV
63
Q

Red flags - head and neck tumours

A 
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
Q

Mx of head and neck tumours

A

MDT
Staging - TNM
Chemo/radiotherapy
Surgery

65
Q

Indications for tonsillectomy

A

Acute sore throat(7 or more in 1 year)

Recurrent tonsillar abscess(2)

Enlarged tonsils causing difficulty breathing, swallowing or snoring

66
Q

Complications of tonsillectomy

A

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
Q

Mx of post-tonsillectomy bleeding

A

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
Q

Options for stopping bleeding post-tonsillectomy

A

Hydrogen peroxide gargle
Adrenalin soaked swab applied topically

Intubation may be Druid

69
Q

Causes of glossitis

A 
Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure
70
Q

Causes of angioedema

A

Allergic reactions
ACE inhibitors
C1 esterase inhibitor deficiency (hereditary angioedema)

71
Q

Risk factors for oral candidiasis

A 
ICS
Abx 
Diabetes 
Immunodeficiency
Smoking
72
Q

Treatment options for oral candidiasis

A

Miconazole gel
Nystatin suspension
Fluconazole tablets

73
Q

What is leukoplakia and what is it associated with

A

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
Q

Mx of leukoplakia

A

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
Q

What is lichen planus

A

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
Q

Mx of lichen planus

A

good oral hygiene, stopping smoking and topical steroids

77
Q

Risk factors for gingivitis

A 
Plaque build-up on the teeth (inadequate brushing)
Smoking
Diabetes
Malnutrition
Stress
78
Q

Mx of gingivitis

A

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
Q

Causes of gingival hyperplasia

A 
Gingivitis
Pregnancy
Vitamin C deficiency (scurvy)
Acute myeloid leukaemia
Medications, particularly calcium channel blockers, phenytoin and ciclosporin
80
Q

What are apthous ulcers

A

small, painful ulcers of the mucosa in the mouth. They have a well-circumscribed, punched-out, white appearance.

81
Q

Causes of apthous ulcers

A

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
Q

Mx of apthous ulcers

A

Usually no intervention required

Choline salicylate (e.g., Bonjela)
Benzydamine (e.g., Difflam spray)
Lidocaine

topical corticosteroids in more severe ulcers

83
Q

When should patients be referred for mouth ulcers

A

“unexplained ulceration” lasting over 3 weeks.

General practice (26 decks)

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