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H&N > ENT Passmedicine > Flashcards

ENT Passmedicine Flashcards

1
Q

What is otosclerosis?

A

Replacement of normal bone by vascular spongy bone

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2
Q

What kind of deafness does otosclerosis cause?

A

Progressive conductive deafness

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3
Q

Why do you get deafness in otosclerosis?

A

The stapes becomes fixed at the oval window

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4
Q

How is otosclerosis inherited?

A

Autosomal dominantly

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5
Q

When is the typical onset of otosclerosis?

A

20-40y

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6
Q

What are the clinical features of otosclerosis?

A

Conductive deafness
Tinnitus
Normal tympanic membrane (10% have flamingo tinge caused by hyperaemia)
+ve FH

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7
Q

How do you manage otosclerosis?

A

Hearing aid

Stapedectomy

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8
Q

What is Meniere’s disease?

A

Disorder of the inner ear of unknown cause

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9
Q

What is Meniere’s characterised by?

A

Excessive pressure and progressive dilation of the endolymphatic system

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10
Q

In which age group is Meniere’s most common?

A

Middle aged

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11
Q

What are the features of Meniere’s?

A

Recurrent episodes of vertigo, tinnitus and sensorineural hearing loss
Sensation of aural fullness/pressure
Nystagmus
Positive Romberg test

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12
Q

How long do the symptoms last in episodes of Meniere’s?

A

minutes to hours

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13
Q

Are symptoms of Meniere’s typically bilateral or unilateral?

A

Unilateral usually

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14
Q

What is the natural history of Meniere’s?

A

Symptoms tend to resolve after 5-10 years

Majority are left with hearing loss

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15
Q

What is involved in the management of Meniere’s?

A

ENT assessment req. for diagnosis
Inform DVLA (cease driving until adequate control of sx)
Rx of acute attacks and prevention

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16
Q

How do you treat acute attacks in Meniere’s?

A

Buccal/IM prochlorperazine

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17
Q

How do you prevent attacks in Meniere’s?

A

Betahistine and vestibular rehabilitation exercises

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18
Q

What drugs can cause gingival hyperplasia?

A

Phenytoin
Ciclosporin
CCB, esp nifedipine

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19
Q

What conditions can cause gingival hyperplasia?

A

AML

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20
Q

What are complications of tonsillitis?

A

Otitis media
Quinsy/peritonsillar abscess
Rheumatic fever + GN very rarely

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21
Q

When do NICE recommend tonsillectomy should be considered?

A

If they meet all of the following:

  1. Sore throats are due to tonsillitis
  2. Person has 5+ episodes pa
  3. Symptoms been occurring for at least 1 year
  4. Episodes of sore throat are disabling + prevent normal functioning
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22
Q

What are some established indications for a tonsillectomy?

A

Recurrent febrile convulsions 2ndary to tonsillitis
Obstructive sleep apnoea/stridor/dysphagia due to enlarged tonsils
Quinsy unresponsive to standard Rx

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23
Q

What are the primary complications of tonsillectomy?

A

Occur within 24h:

  1. Haemorrhage
  2. Pain
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24
Q

What are the secondary complications of tonsillitis?

A

Occur after 24h:

  1. Haemorrhage (mostly due to infection)
  2. Pain
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25
Q

Define vertigo

A

False sensation that the body/environment is moving

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26
Q

List 10 causes of vertigo

A 
Meniere's disease
BPPV
Acoustic neuroma
Viral labyrinthitis
Vestibular neuronitis 
Vertebrobasilar ischaemia 
Posterior circulation stroke
Trauma
Otoxoticity
MS
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27
Q

What are the things that should stand out in a history that point towards a diagnosis of viral labyrinthitis?

A

Recent viral infection
Sudden onset
NV
Hearing affected

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28
Q

What are the things that should stand out in a history that point towards a diagnosis of vestibular neuronitis?

A

Recent viral infection
Recurrent vertigo attacks lasting hours/days
No hearing loss

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29
Q

What are the things that should stand out in a history that point towards a diagnosis of BPPV?

A

Gradual onset
Triggered by change in head position
Episodes last 10-20s

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30
Q

What are the things that should stand out in a history that point towards a diagnosis of Meniere’s?

A

Hearing loss
Tinnitus
Vertigo
Sensation of fullness/pressure in one/both ears

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31
Q

What are the things that should stand out in a history that point towards a diagnosis of vertebrobasilar ischaemia?

A

Elderly patient

Dizziness on extension of neck

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32
Q

What are the things that should stand out in a history that point towards a diagnosis of acoustic neuroma?

A 
Gradual progressive unilateral deafness
Vertigo
Tinnitus
Absent corneal reflex is important sign 
Facial nerve palsy
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33
Q

With which condition is acoustic neuroma associated?

A

NF2

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34
Q

What is Ramsay-Hunt syndrome?

A

Reactivation of the varicella zoster virus in the geniculate ganglion of the 7th cranial nerve

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35
Q

What are the features of Ramsay-Hunt syndrome?

A 
Auricular pain
Facial nerve palsy
Vesicular rash around hear
Vertigo
Tinnitus
May also get vesicular lesions on anterior 2/3rd of tongue and soft palate
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36
Q

How do you manage Ramsay-Hunt syndrome?

A

Oral acyclovir

Corticosteroids

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37
Q

What infection is tonsillar SCC associated with?

A

HPV 16

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38
Q

What are risk factors for tonsillar SCC?

A

Smoking
High alcohol intake
Poor oral hygiene

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39
Q

Head and neck cancer encompasses what cancers?

A

Oral cavity cancers
Cancers of the pharynx (oropharynx, nasopharynx, hypopharynx)
Cancers of larynx

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40
Q

What are possible features of a head and neck cancer?

A

Neck lump
Hoarseness
Persistent sore throat
Persistent mouth ulcer

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41
Q

How quickly do you get an appointment with the suspected cancer pathway referral?

A

Within 2 weeks

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42
Q

What is the suspected laryngeal cancer pathway referral criteria?

A

Age 45y+ with:

Persistent unexplained hoarseness or unexplained lump in neck

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43
Q

What is the suspected oral cancer pathway referral criteria?

A

Unexplained ulceration in the oral cavity >3weeks or persistent or unexplained neck lump

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44
Q

When should you consider urgent referral (2w) for assessment of possible oral cancer by a dentist?

A

Those with either:
Lump on lip/oral cavity
Red/red-white patches in the oral cavity consistent with erythroplakia/erythroleukoplakia

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45
Q

What is the suspected thyroid cancer pathway referral criteria?

A

Unexplained thyroid lump

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46
Q

How do you investigate an acoustic neuroma?

A

MRI

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47
Q

What resources can you use to help you decide whether or not to give antibiotics for a sore throat?

A

FEVERpain
Centor

These predict whether the sore throat is likely to be bacterial and would benefit from antibiotics

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48
Q

What are the centor criteria?

A

Tonsillar exudate
Absence of cough
Hx of fever
Cervical lymphadenopathy/lympadenitis

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49
Q

What centor score should you give antibiotics for?

A

3 or 4

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50
Q

What does a centor 3/4 sore equate to % chance of having a strep throat infection?

A

40-60%

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51
Q

What does a centor 0/1/2 sore equate to % chance of having a strep throat infection?

A

80% chance of not having a bacterial throat infection

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52
Q

How should you manage a sore throat?

A

Paracetamol/ibruprofen

Antibiotics if indicated

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53
Q

When are antibiotics indicated for sore throat?

A 
Centor 3/4
Marked systemic upset
Unilateral peritonsillitis
Hx rheumatic fever
Increased risk from acute infection, e.g. someone with DM/immunodef
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54
Q

What are the FEVERpain criteria?

A 
Fever >38
Pharyngeal/tonsillar exudate
Attends rapidly (3 days or less)
Severely inflamed tonsils
No cough/coryza
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55
Q

What antibiotics should be given for tonsillitis?

A

Phenoxymethylpenicillin or erythromycin if penicillin allergic for 7-10d

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56
Q

What tends to be the first line investigation for those presenting with hearing difficulties?

A

Audiograms

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57
Q

How do you interpret an audiogram?

A

Anything above 20b is normal
Sensorineural deafness - air + bone conduction impaired
Conductive deafness - only air conduction impaired
Mixed hearing loss - air and bone conduction impaired, air worse than bone

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58
Q

What are the causes for otitis externa?

A

Infection (staph, aureus, pseudomonas, fungi)
Seborrheic dermatitis
Contact dermatitis

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59
Q

What are the features of otitis externa?

A 
Ear pain
Itch
Discharge
Pain on palpation of tragus
Conductive hearing loss
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60
Q

What are the otoscopy findings in otitis externa?

A

Red, swollen, eczematous canal

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61
Q

What do you manage otitis externa in the first instance?

A

Topical antibiotic and steroid ear drop
Consider removal of ear canal debris
If ear canal is swollen consider ear wick insertion

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62
Q

What are second line management options for otitis externa?

A

Flucloxacillin (oral) if infection spreading
Swab ear canal
Empirical use of an antifungal

IF PATIENT FAILS TO RESPOND TO TOPICAL ANTIBIOTICS SHOULD BE REFERRED TO ENT

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63
Q

In which groups is malignant otitis externa most common?

A

Elderly

DM

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64
Q

What happens in malignant otitis externa?

A

Infection extends into bony ear canal and soft tissues deep to the bony canal

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65
Q

When should you prescribe antibiotics for otitis media?

A

Symptoms >4 days + not improving
Systemically unwell
Immunocomprised/high risk of complications due to significant heart, lung, kidney, liver or neuromuscular disease
Age <2 with bilateral otitis media
Otitis media w. perforation +/or discharge in the canal

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66
Q

What antibiotic is given for otitis media?

A

Amoxicillin 5 days

Penicillin allergy: erythromycin/clarithromycin

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67
Q

What is the commonest cause of bacterial otitis media?

A

H. influenzae

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68
Q

What other organism can cause otitis media?

A

Strep pneumoniae

Moraxella catarrhalis

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69
Q

What is Ludwig’s angina?

A

Cellulitis on the floor of the mouth
Deadly as it spreads in the fascial spaces of the head and neck
Swelling pushes on floor of mouth upwards and can block airway

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70
Q

What are risk factors for Ludwig’s angina?

A

Immunocompromise
Poor denition
Pericoronitis

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71
Q

What is pericoronitis?

A

Inflammation around a partially erupted wisdowm tooth

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72
Q

What are the three salivary glands called?

A

Parotid
Submandibular
Sublingual

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73
Q

What kind of secretions come from the parotid glands?

A

Serous

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74
Q

What kind of secretions come from the submandibular glands?

A

Mixed

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75
Q

What kind of secretions come from the sublingual glands?

A

Mucous

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76
Q

In which salivary gland do most tumours arise?

A

Parotid

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77
Q

Which salivary glands are most commonly blocked by stones?

A

Submandibular

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78
Q

What are the most common parotid tumours?

A

Pleomorphic adenomas

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79
Q

What is the typical hx of a pleomorphic adenoma?

A

Middle aged

Slow growing, painless lump

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80
Q

How do you manage a pleomorphic adenoma?

A

Superficial parotidectomy

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81
Q

What is the major risk of a superficial parotidectomy?

A

CNVII damage

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82
Q

What is the second most common parotid tumour?

A

Warthin’s tumour

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83
Q

What is the typical hx of a Warthin’s tumour?

A

Male, middle aged

Soft, mobile and fluctuant mass

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84
Q

What is a typical hx of a stone lodging in the salivary gland ducts?

A

Recurrent unilateral pain and swelling on eating

If becomes infected may –> Ludwig’s angina

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85
Q

How do you investigated a suspected stone in the salivary glands ducts?

A

Plain xray

Sialography

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86
Q

How are blocked salivary ducts managed?

A

Surgery

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87
Q

What things apart from tumours and stones can cause salivary gland enlargement?

A

Acute viral infections, e.g. mumps
Acute bacterial infection
Sicca syndrome
Sjogrens

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88
Q

What are the two types of epistaxis?

A

Anterior bleed - visible source of bleeding

Posterior bleed - tends to be more profuse, due to damage of deeper structures

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89
Q

Where do anterior bleeds tend to be from?

A

Kiesselbach’s plexus (little’s area - where 4 arteries come together)

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90
Q

What is the most common cause of epistaxis?

A

Trauma to nose (insertion of FB, nose picking, nose blowing)

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91
Q

What might recurrent epistaxis indicate?

A

Platelet disorders (e.g. thrombocytopenia, splenomegaly, leukaemia, ITP)
Juvenile angiofibroma (benign highly vascularised tumour)
Granulomatosis with polyangiitis
Pyogenic granuloma

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92
Q

In epistaxis, what may an atrophied nasal septum indicate?

A

Cocaine use - cocaine is a powerful vasoconstrictor and may lead to obliteration of the septum

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93
Q

How do you manage epistaxis?

A

Lean forward, mouth open
Pinch cartilaginous area of nose for 15m and breath through mouth
If this is successful use antiseptic e.g. Naseptin to reduce crusting and risk of vestibulitis

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94
Q

If bleeding doesn’t stop within 10-15m of continuous pressure on the nose, what management should be considered?

A

Cautery (source of bleeding isolated)

Packing and admit to secondary care

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95
Q

What is Naseptin a combination of?

A

Chlorhexidine and neomycin

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96
Q

What are CI to naseptin?

A

Peanut, soy or neomycin allergies

Can cause mupirocin as alternative

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97
Q

What patients might you consider follow up care even if bleeding is halted by pressure?

A

Co-morbidity (e.g. severe HTN, CAD)
Underlying cause suspected
<2y (more at risk of haemophilia, leukaemia)

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98
Q

Describe how to carry out cautery

A

Blow nose to remove clots
Use topical anaesthetic spray + wait 3-4m to take effect
Identify bleeding point + apply silver nitrate stick until it becomes grey-white
ONLY cauterise 1 side of septum due to risk of perforation
Dab area with naseptin/muciprocin

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99
Q

Describe the process of packing for epistaxis

A

Use topical LA + wait 3-4m
Pack nose while patient sits forward
Ex nose/mouth for continued bleeding
Admit to hospital for review by ENT

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100
Q

Which patients should be immediately referred into ED with epistaxis?

A

Haemodynamically unstable or compromised

Bleeding from unknown posterior source

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101
Q

What self-care advice should be given re. the risk of another bleed?

A

Avoid blowing/picking nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks

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102
Q

What sore symptoms do you get in infectious mononucleosis?

A

Pharyngitis and tonsillitis

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103
Q

Why should you not give penicillin in glandular fever?

A

Will cause a reash

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104
Q

What may indicate quinsy in a sore throat?

A

Unilateral swelling and fever

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105
Q

What pathogen causes >50% of sore throats?

A

Streptococcus pyogenes

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106
Q

What is the appearance of the tonsils in bacterial tonsillitis?

A

Oedematous, yellow or white pustules

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107
Q

How can you distinguish vestibular neuronitis from viral labyrinthitis?

A

Hearing is unaffected in vestibular neuronitis

108
Q

What are complications of thyroid surgery?

A

Recurrent laryngeal nerve damage
Bleeding - due to confined space haematomas may lead to respiratory compromise
Parathyroid gland damage –> hypocalcaemia

109
Q

What ECG sign do you see with hypocalcaemia?

A

Prolonged QT interval

110
Q

What otoscopy findings do you get with otitis media?

A

Bulging tympanic membrane

111
Q

What is the biggest risk factor for malignant otitis externa?

A

DM

112
Q

What causes most causes of malignant otitis externa?

A

Pseudomonas aeruginosa

113
Q

What can malignant otitis externa progress to?

A

Temporal bone osteomyelitis

114
Q

What are the key features of malignant otitis externa in the history?

A 
DM/immunosuppression
Severe, unrelenting, deep seated otalgia
Temporal headaches
Purulent otorrhoea
Dysphagia/hoarseness/facial nerve dysfunction
115
Q

How do you diagnose malignant otitis externa?

A

CT

116
Q

How do you manage malignant otitis externa?

A

NON-RESOLVING OTITIS EXTERNA WITH WORSENING PAIN SHOULD BE REFERRED URGENTLY TO ENT
IV antibiotics usually req.

117
Q

What causes acute otitis externa?

A

Boil in external auditory meatus

118
Q

What causes chronic otitis externa?

A

Usually combined staph and fungal infection (req. antibacterial and antifungal ear drops)

119
Q

What is acute suppurative otitis media?

A

Viral induced middle ear effusion secondary to eustachian tube dysfunction

120
Q

What are the features of acute suppurative otitis media?

A

Usually in children
Severe pain
Fever
Discharge if tympanic membrane ruptures

121
Q

How do you treat acute suppurative otitis media?

A

Amoxicillin

122
Q

What causes chronic suppurative otitis media?

A

Cholesteatoma with perforation of pars flaccida

No cholesteatoma + perforation of pars tensa

123
Q

What are the symptoms of chronic suppurative otitis media?

A

Without cholesteatoma - intermittent non-offensive discharge

With cholesteatoma - impaired hearing, foul discharge

124
Q

How do you manage chronic suppurative otitis media?

A

Without cholesteatoma - non-operative/myringoplasty

With cholesteatoma - radical mastoidectomy

125
Q

What are pre-auricular sinuses?

A

Common congenital condition in which an epithelial defect forms around the external ear

126
Q

How do you treat pre-auricular sinuses?

A

Small - no Rx

Deeper - may become blocked and infected so can be difficult to excise

127
Q

What is exostosis?

A

Benign bony growth in EAC

128
Q

What causes exostosis?

A

Repeated exposure to cold water and wind

129
Q

What two tests can you use to differentiate between sensorineural and conductive hearing loss?

A

Rinne’s

Weber’s

130
Q

What is Rinne’s test?

A

Tuning fork placed on mastoid process and over acoustic meatus
+ve: AC > BC (normal)
-ve: BC>AC (conductive deafness)

131
Q

What is Weber’s test?

A

Tuning form place on forehead
Asked which sound is loudest
Unilateral sensorineural deafness - localises to unaffected side
Unilateral conductive deafness - localises to affected side

132
Q

What should you do if someone has undergone neck surgery and develops post-operative stridor?

A

Urgent removal of stiches and call for senior help

May be due to post-op bleed –> pressure behind suture line compresses trachea

133
Q

What are the most common causes of hearing loss?

A

Ear wax
Otitis media
Otitis externa

134
Q

What is presbycusis?

A

Age related sensorineural hearing loss

135
Q

What do you see on the audiogram in presbycusis?

A

Bilateral high frequency hearing loss

136
Q

What is glue ear?

A

Otitis media with effusion

137
Q

When is glue ear most common?

A

Age 2

138
Q

How does glue ear present?

A 
Hearing loss (conductive hearing loss) 
Secondary problems, e.g. speech and language delay, behavioural or balance problems
139
Q

What drugs can cause hearing loss through ototoxicity?

A 
Aminoglycosides, e.g. gentamicin
Furosemide
Aspirin
Cytotoxic agents
Quinine
140
Q

What kind of hearing loss is seen with noise damage?

A

Bilateral

Typically worse at frequencies of 3000-6000Hz

141
Q

If the acoustic neuroma is affecting cranial nerve 8 what signs will you see?

A

Hearing loss
Vertigo
Tinnitus

142
Q

If the acoustic neuroma is affecting cranial nerve 5 what signs will you see?

A

Absent corneal reflex

143
Q

If the acoustic neuroma is affecting cranial nerve 7 what signs will you see?

A

Facial palsy

144
Q

What can cause a perforated tympanic membrane?

A

Infection (most common)
Barotrauma
Trauma

145
Q

What are the clinical features of a perforated tympanic membrane?

A

Hearing loss depending on size

Increased risk of otitis media

146
Q

How do you manage a perforated tympanic membrane?

A

Should heal spontaneously within 6-8w
Antibiotics for perforations due to acute otitis media
Myringoplasty if failure to spontaneously heal

147
Q

What advise should you give patients with a perforated ear drum?

A

Keep it dry if possible

148
Q

What % of the population have nasal polyps?

A

1%

149
Q

What things are associated with nasal polyps?

A 
Asthma
Aspirin sensitivity
Infective sinusitis
CF
Kartagener's syndrome
Churg-strauss syndrome
150
Q

What are the clinical features of nasal polyps?

A

Nasal obstruction
Rhinorrhoea, sneezing
Poor sense of taste and smell

151
Q

How do you manage nasal polyps?

A

Referral to ENT

Topical corticosteroids shrink polyps

152
Q

What is samter’s triad?

A

Asthma
Aspirin sensitivity
Nasal polyps

153
Q

What would you expect in the hx of a lymphoma?

A

Rubbery, painless lymphadenopathy
Night sweats
Splenomegaly

154
Q

What would you expect on hx of thyroid swelling?

A

Moves upwards on swallowing

May be hypo/hyper/euthyroid

155
Q

What would you expect in the hx of a thyroglossal cyst?

A

<2oy
Midline, between isthmus of thyroid and hyoid bone
Moves upwards with protrusion of tongue
May be painful if infected

156
Q

What is a typical hx of pharyngeal pouch?

A 
Older men most commonly
Midline lump that gargles on palpation
Dysphagia
Regurgitation
Aspiration
Halitosis
Chronic cough
157
Q

What is a pharyngeal pouch?

A

Posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles

158
Q

What is a cystic hygroma?

A

Congenital lymphatic lesion on neck, classically the left side(transilluminates, and is soft and painless)

159
Q

What is a branchial cyst?

A

Oval, mobile cystic mass that develops between the SCM and pharynx

160
Q

What causes a branchial cyst?

A

Failure of obliteration of the second brachial cleft in embryonic development

161
Q

When do branchial cysts tend to present?

A

Early adulthood

162
Q

Who are cervical ribs most common in?

A

Adult females

163
Q

What do 10% of those with cervical rib develop?

A

Thoracic outlet syndrome

164
Q

What is a typical hx of a carotid aneurysm?

A

Pulsatile lateral neck mass which doesn’t move on swallowing

165
Q

What is a cholesteatoma?

A

Non-cancerous growth of squamous epithelium trapped in the skull base causing local destruction

166
Q

At what age is cholesteatoma most common?

A

10-20y

167
Q

What condition increases the risk of developing cholesteatoma?

A

Cleft palate

168
Q

What are the features of cholesteatoma?

A

Foul smelling, nonresolving discharge
Hearing loss

Symptoms due to local invasion -
Vertigo
Facial nerve palsy
Cerebellopontine angle syndrome

169
Q

What do you see on otoscopy with cholesteatoma?

A

Attic crust seen in uppermost part of ear drum

170
Q

How do you manage cholesteatoma?

A

Referral to ENT for surgical removal

171
Q

What is SCC of the nasopharynx associated with?

A

EBV

172
Q

What are the presenting features of nasopharyngeal carcinoma?

A 
Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge 
Epistaxis
Cranial nerve palsies
173
Q

What imaging should be done for suspected nasopharyngeal carcinoma?

A

CT and MRI

174
Q

What is the first line treatment for nasopharyngeal carcinoma?

A

Radiotherapy

175
Q

Which ethnicity is most affected by SCC of the nasopharynx?

A

Asian

176
Q

List causes of hoarseness

A 
Voice overuse
Smoking
Viral illness
Hypothyroidism
GOR
Laryngeal cancer
Lung cancer
177
Q

What investigation should be done when investigating hoarseness?

A

CXR to exclude apical lung lesions

178
Q

What are features of mastoiditis?

A 
Ear displaced anteriorly 
Swelling, erythema and tenderness over mastoid process
Systemically unwell
Pain behind ear
Fever
Hx of recurrent otitis media
179
Q

What are acute complications of otitis media?

A

Meningitis
Mastoiditis
Facial nerve paralysis

180
Q

What are the criteria for 2 week wait referrals to oral surgery?

A

Unexplained oral ulceration/mass >3w
Unexplained red/red/white patches that are painful, swollen or bleeding
Unexplained one sided pain in head/neck region >w associated with ear ache and no abnormal otoscopy findings
Unexplained recent neck lump/prev. undiagnosed lump that has changed over a period of 3-6w
Unexplained persistent sore throat
Sx/sx in oral cavity >6w that cannot be diagnosed as benign

181
Q

In who should we have an increased level of suspicion for oral cancer?

A

Patients who are >40, smokers, heavy drinkers and chew tobacco/betel nut

182
Q

List 7 causes of tinnitus

A 
Impacted ear wax
Chronic suppurative otitis media
Drugs (aspirin, aminoglycosides, loop diuretics, quinine)
Hearing loss
Acoustic neuroma
Otosclerosis
Meniere's
183
Q

What % of salivary gland tumours are benign?

A

80%

184
Q

What is a pleomorphic adenoma a proliferation of?

A

Epithelial and myoepithelial cells and stromal components

185
Q

What cancer does pleomorphic adenoma most commonly transform into?

A

Carcinoma ex-pleomorphic adenoma

186
Q

How does Warthin’s tumour present?

A

Lymphocytic infiltrate and cystic epithelial proliferation

187
Q

Is malignant transformation common in Warthin’s tumour?

A

Very rare

188
Q

What kind of cells do monomorphic adenomas consist of?

A

Just one morphological cell type (e.g. basal cell, canalicular cell..)

189
Q

What is the most common parotid tumour in <1y?

A

Haemangioma

190
Q

Name the benign parotid tumours

A

Pleomorphic adenoma
Warthins tumour
Monomorphic adenoma
Haemangioma

191
Q

What are the malignant parotid tumours?

A 
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Mixed tumours
Acinic cell carcinoma
Adenocarcinoma
Lymphoma
192
Q

How do you diagnose parotid tumours?

A 
Plain x-ray 
Sialography 
FNAC
Superficial parotidectomy (can be diagnostic or therapeutic)
CT/MRI for staging
193
Q

How do you treat parotid tumours?

A

Surgical resection (if benign superficial parotidectomy, if malignant may need radical parotidectomy and neck dissection if nodal involvement)

194
Q

How might HIV affect the parotids?

A

Lymphoepithelial cysts may occur in parotid

Typically bilateral, multicystic symmetrical swelling

195
Q

What is Sjogren’s syndrome?

A

Autoimmune condition with parotid enlargement, xerostomia, keratoconjunctivitis sicca

196
Q

How are the parotids affected by Sjogren’s?

A

Bilateral, non-tender enlargement of gland usually

197
Q

How might the parotid glands be affected in sarcoidosis?

A

Bilateral usually
Non-tender gland
May also get xerostomia

198
Q

What is allergic rhinitis?

A

Inflammatory disorder of nose where nose becomes sensitised to allergens

199
Q

What are common allergens in allergic rhinitis?

A

Tree, grass and weed pollens

House dust mite

200
Q

How can you classify allergic rhinitis?

A

Seasonal - symptoms at same time every year
Perennial - symptoms throughout the year
Occupational - due to particular allergens in the work place

201
Q

What are the features of allergic rhinitis?

A 
Sneezing
Bilateral nasal obstruction
Clear nasal discharge
Post-nasal drip
Nasal pruritus
202
Q

What is the management of allergic rhinitis?

A

Allergen avoidance
Mild-moderate symptoms: oral/intranasal antihistamines

Mod-severe symptoms: intranasal corticosteroids
occasionally may need short courses of oral corticosteroids/topical decongestants

203
Q

Why should intranasal decongestants not be used for long periods?

A

Increasing doses are req. to give same effect = tachyphylaxis
Rebound hypertrophy of nasal mucous may occur on withdrawal

204
Q

What are the features of vestibular neuronitis?

A

Recurrent vertigo attacks lasting hrs/days
NV
Horizontal nystagmus

205
Q

How do you manage vestibular neuronitis?

A

Vestibular rehab exercises
Buccal/IM prochlorperazine for rapid relief
Antihistamine may be used for less severe cases

206
Q

What is sinusitis?

A

Inflammation of the mucous membranes of the paranasal sinuses

207
Q

What are the most common infective agents seen in sinusitis?

A

Strep pneumoniae
H. influenzae
Rhinoviruses

208
Q

What factors predispose to sinusitis?

A

Nasal obstruction, e.g. septal deviation, nasal polyps
Recent local infection, e.g. rhinitis, dental extraction
Swimming/diving
Smoking

209
Q

What are the features of sinusitis?

A

Facial pain, worse on bending forward
Thick and purulent nasal discharge
Nasal obstruction

210
Q

How do you manage acute sinusitis?

A

Analgesia
Intranasal decongestants/saline
Intranasal corticosteroids if symptoms present 10+ days
Phenoxymethylpenicillin if severe presentation or co-amoxiclav if systemically unwell/at high risk of complications

211
Q

Should a tonsillectomy be considered for quinsy?

A

Yes - but 6w after episode

212
Q

What are the features of quinsy?

A

Severe throat pain, lateralising to one side
Deviation of the ulna to unaffected side
Trismus (difficulty opening mouth)
Reduced neck mobility

213
Q

How do you manage quinsy?

A

Urgent ENT review

Needle aspiration or incision and drainage with IV antibiotics

214
Q

What are branchial cysts filled with?

A

Acellular fluid containing cholesterol crystals, encapsulated by stratified squamous epithelium

215
Q

What are typical Ex features of a branchial cyst?

A 
Unilateral, usually on left
Lateral, ant. to SCM
Slowly enlarging
Smooth, soft, fluctuant 
Non-tender
Fistula may be present
No movement on swallowing
No transillumination
216
Q

How should you investigate a branchial cyst?

A

US
Referral to ENT
FNAC

217
Q

How are branchial cysts managed?

A

Conservatively or surgery

218
Q

For very mild otitis externa what is an alternative treatment option?

A

Topical acetic acid 2% spray

219
Q

List some causes of facial pain

A

Sinusitis
Trigeminal neuralgia
Cluster headache
Temporal arteritis

220
Q

What are the characteristic features of sinusitis?

A

Facial fullness and tenderness

Nasal discharge, pyrexia, post-nasal drip leading to cough

221
Q

What are the characteristic features of trigeminal neuralgia?

A

Unilateral facial pains that are brief and electric shock-like, abrupt in onset and termination
Triggered by light touch and emotion

222
Q

What are the characteristic features of cluster headache?

A

Pain 1/2x per day, lasting 15m-2h
Clusters typically last around 4-12w
Intense pain around 1 eye
Accompanied by redness, lacrimation, lid swelling, nasal stuffiness

223
Q

What are the characteristic features of temporal arteritis?

A

Tender around temples

Raised ESR

224
Q

What is sialadenitis?

A

Inflammation of the salivary gland usually due to obstruction by an impacted stone

225
Q

How do you manage primary haemorrhage after a tonsillectomy?

A

Immediate return to theatre

226
Q

How long may patients experience pain after a tonsillectomy?

A

Pain may increase for up to 6 days post-op

227
Q

How do you treat a secondary haemorrhage post-tonsillectomy?

A

Admission and IV antibiotics

228
Q

If you identify sensorineural hearing loss what drug can you give that may potentially be of some benefit?

A

High dose steroids for 7 days may improve prognosis

Most sensorineural hearing loss is idiopathic

229
Q

What is labyrinthitis?

A

Inflammatory disorder of membranous labyrinth affecting both the vestibular and cochlear end organs

230
Q

What are the types of labyrinthitis?

A

Viral, bacterial or associated with systemic disease

231
Q

What is a typical presentation of viral labyrinthitis?

A 
Acute onset of -
Vertigo: exacerbated by movement 
NV
Hearing loss
Tinnitus
Preceding/concurrent symptoms of a URTI
232
Q

What are the signs of viral labyrinthitis?

A 
Unidirectional horizontal nystagmus 
Sensorineural hearing loss
Abnormal head impulse test 
Gait disturbance:  patient may fall towards affected side
Normal skew test
233
Q

How do you diagnose viral labyrinthitis?

A

Hx, Ex

In most pts Ix aren’t req.

234
Q

What investigations can you do in viral labyrinthitis if diagnosis is uncertain?

A

Pure tone audiometry
FBC, BC
Temporal bone CT scan (if suspecting mastoiditis/cholesteatoma)
MRI
Vestibular function testing: helpful in difficult cases or in determining prognosis

235
Q

What is the most commonly used antibiotic/steroid topical preparation used for otitis externa?

A

Gentamicin and hydrocortisone

236
Q

What kind of nervous activity causes the submandibular glands to produce more serous secretions?

A

Parasympathetic

237
Q

What is sialothiasis?

A

Stone formation in the salivary gland ducts

238
Q

What are the stones formed in sialothiasis usually composed of?

A

Calcium phosphate or calcium carbonate

239
Q

What are the typical symptoms of sialothiasis?

A

Colicky pain
Prandial swelling of the gland
Halitosis
Dry mouth

240
Q

How do you investigate sialothiasis?

A

Sialography

241
Q

How do you manage sialothiasis?

A

If in distal aspect of Whartons duct may be removed orally

Other stones and chronic inflammation usually req. gland excision

242
Q

What most commonly causes sialadenitis?

A

Staph aureus

243
Q

What are the signs of sialadenitis?

A

Pus leaking from duct

Erythema

244
Q

What is a serious complication of sialadenitis?

A

Submandibular abscess (may spread through other deep fascial spaces + occlude airway)

245
Q

How do you diagnose submandibular tumours?

A

FNAC

Imaging with CT/MRI

246
Q

What are the clinical features of BPPV?

A

Vertigo triggered by change in head position
Associated nausea
Lasts 10-20s

247
Q

What age of onset of BPPV is most common?

A

55y

248
Q

What is the prognosis of BPPV?

A

Good - usually resolves spontaneously after a few weeks/mouths
Recurrence in 50%

249
Q

What are the management options for BPPV?

A

Epley manoeuvre (successful in 80%)
Vestibular rehabilitation exercises
Betahistine is of limited vlalue

250
Q

How do you diagnose BPPV?

A

Dix-Hallpike manoeuvre

251
Q

What is gingivitis usually secondary to?

A

Poor dental hygiene

252
Q

What is the spectrum of presentations of gingivitis?

A

Simple gingivitis (painless, red, swelling of gum margin which bleeds on contact) to acute necrotizing ulcerative gingivitis (painful bleeding gums with halitosis and punched out ulcers on the gyms)

253
Q

How do you manage simple gingivitis?

A

Advise to seek regular rv with dentist

254
Q

How do you manage acute necrotizing ulcerative gingivitis?

A

Refer to dentist, in meanwhile, oral metronidazole for 3 days, chlorhexidine/hydrogen peroxide mouthwash
Simple analgesia

255
Q

What is a nasal septal haematoma?

A

Development of a haematoma between the septal cartilage and overlying perichondrium

256
Q

What may cause a nasal septal haematoma?

A

Relatively minor trauma may precipitate it

257
Q

What are the symptoms of a nasal septal haematoma?

A

Nasal obstruction
Pain
Rhinorrhoea

258
Q

What are the signs of a nasal septal haematoma?

A

Bilateral, red swelling arising from the nasal

Gently prod it and it will be boggy if it is a haematoma

259
Q

How do you manage a nasal septal haematoma?

A

Surgical drainage

IV antibiotics

260
Q

What can happen if a nasal septal haematoma is left untreated?

A

Irreversible septal necrosis may develop within 3-4 days

Due to pressure related ischaemia in the cartilage

–> saddle nose deformity

261
Q

What is rhinitis mediacmentosa?

A

Rebound nasal congestion brought on by extended use of topical decongestants

262
Q

How do you manage rhinitis mediacmentosa?

A

Remove offending nasal spray

Saline nasal sprays may help

263
Q

What are risk factors for vertebrobasilar ischaemia?

A

CV disease

264
Q

What causes vertebrobasilar ischaemia?

A

Atherosclerosis in the vertebrobasilar distribution exacerbated by changes in head position –> ischaemia and symptoms

265
Q

Why is mastoiditis a medical emergency?

A

Due to potential risk of meningitis

May also cause cranial nerve palsies, hearing loss, OM, and carotid artery spasm

266
Q

What causes acute mastoiditis?

A

Acute otitis media spreads out from the middle ear

267
Q

Recurrent unilateral epistaxis is a red flag for what condition?

A

Nasal cancer

H&N (4 decks)

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