ENT Pathology Flashcards
road traffic accident - Blood stained serous discharge, and blood behind the tympanic membrane
“halo sign”
what is it?
Basal skull fracture - CSF leaks into the auditory canal causes bruising of the mastoid
Mid line limp in the neck, voice hoarseness and difficulty swallowing
ascends on swallowing BUT NOT on protusion of the tongue
what is it?
Thyroid lump
A lump in the neck that ascends on swallowing AND protusion of the tongue
Thyroglossal lump
what are the clinical features of a head and neck cancer
- hoarseness
- throat pain
- tongue ulcers
- painless neck pain
prebycusis
age related hearing loss
what treatment is given for noise related hearing loss
hearing aids are given first
then cochlear implants
sensorineural deafness and tinnitus that is worse when falling asleep
what treatment is given?
hearing aids
what is sound therapy
treatment for tinnitus
what is sialdeninis
inflammation of the salivary glands
sore throat and difficulty swallowing, bulge of one tonsil and deviation of uvula
what is it? and management
Quinsy
antibiotics and aspiration
what may be a cause of regular of epistaxis
liver disease
dizziness and left sided hearing loss, vertigo, nausea, tinnitus and hearing loss and PROGRESSIVE
what is it?
acoustic neuroma/vestibular schwannoma
dizziness and left sided hearing loss, vertigo, nausea, tinnitus and hearing loss
INTERMETTIENT
what is it
Meniere’s disease
thyroid surgery complications
- hypocalcaemia
- hypothyroidism
- recurrent laryngeal nerve damage - causes voice hoarseness
swelling in right parotid gland and facial nerve palsy
right sided facial nerve palsy
discharge and hearing loss after having chronic Otitis media
what is it?
cholesteatoma - complication of otitis media
due to accumulation of skin in the mastoid air cells
hearing loss without discharge, common in children aged 2-5
otitis media with effusion
hoarseness, ear pain and weight loss
laryngeal tumour
commonly caused by HPV 16
reinkes oedema
vocal cords get surrounded by fluid
they become swollen and distended
can be due to longstanding smoking or thyroid disease
what is reinkes oedema is linked with what
hypothyroidism
nasal trauma and swelling in nasal septum and bruising and deviation to the left - when do you do emergency incision and drainage
if there is bilateral cherry red swelling in the nasal septum in anterior rhinoscopy
what drug causes sensorineural hearing loss due to damage to the cochlea
furosemide
if there is hearing loss in left ear and Webbers test goes more to the right
sensorineural hearing loss
which hearing loss is this?
air conduction is louder
sensorineural hearing loss
what hearing loss is this? if bone conduction is louder
conductive hearing loss
allergic rhinitis happens in hay fever due to?
type 1 hypersensitivity
examples of different type 1 hypersensitivity reactions
- anaphylaxis
- asthma
- hay fever
- eczema
- food allergies
fullness in nostril - single nasal polyp unilaterally
nasopharyngeal cancer - cancer of the tissues in the nasopharynx
the symptoms of this can be:
polyps in the nasal cavity
nose bleeds
lump in neck that doesn’t go after 3 weeks
Vestibular schwannomas - what is it
Benign, slow growing tumour of the Schwann cells
these cells normally wrap around the nerve fibres and insulate them to help with signals passing faster
when the tumour grows it affects hearing and balance and can cause:
tinnitus
dizziness
loss of balance
it can go onto interfering trigeminal nerve: sensation of the face
facial nerve: weakness of the facial muscles
if the tumour gets too big it can press on other structures like the cerebellum - this can present as other symptoms and be life-threatening
When is a vestibular schwannoma life threatening
When it is 40mm or more
Torrential epistaxis
Nose bleed
Telangiectasis
Widened blood vessels on the skin
Hereditary hemorrhagic telangiectasia
and symptoms
inherited condition that causes abnormal genetic vascular formations between arteries and veins
mostly these affects the nose, lungs, brain and liver
they can rupture and cause frequent nose bleeds
tiny red spots on the lips, mouth and tongue
Hoarseness
For over 3 weeks
Best management
Urgent ENT referral
Risk of laryngeal cancer
What is given in severe hayfever
Prednisone
How should nasal steroid spray for hay fever be taken
Head upside down
Consequences of vestibular schwannoma
Build up of pressure can cause hearing loss and tinnitus
Palsy of the CNVIII
One sided occipital pain
What is p16 a marker for
HPV and oropharyngeal squamous cell carcinoma
How to manage blunt trauma to pinna
Incision with primary closure
What is a benign neoplasm
Also known as Warthins tumour - tumour in the salivary gland
Progressive facial swelling without pain and weakness
Thyroglossal cyst
Non tender and mobile cyst that moves in swallowing and tongue profusion
what is quinsy
rare complication of acute tonsilitis
it is an abscess
presentation of quinsy
sore throat
difficulty swallowing
uvula deviation
swelling inside mouth
earache
difficulty speaking
conductive hearing loss - what is it
obstruction of sound waves in the outer ear
can be due to ear infection
inability of the sound waves to reach the inner ear
patient has bilateral ear pain and lower facial pain
painful clicking when she opens her jaw
what is the best management
explanation and reassurance
what is temporomandibular dysfunction
caused by stress
pain in the joint
TMJ joint pain
what is ramsay hunt syndrome
happens with the varicella zoster/shingles virus is reactivated
affects the facial Nerve and can cause palsy
painful shingles rash
facial paralysis
hearing loss in affected ear
‘wonky smile’
unable to raise eyebrow
what is flat tymopanogram indicative of?
fluid behind the tympanic membrane
- suggest middle ear congestion
patient had recurrent episodes of the ‘world spinning’
what is it
BPPV
what is done to diagnose BBPV
hallpike manoeuvre
treatment of BPPV
epley manoeuvre
what is Meniere’s disease
defined by 4 symptoms:
vertigo
hearing loss
tinnitus
feeling fullness in the ear
due to abnormal amount of fluid in the inner ear
symptoms of reinke’s oedema
rough voice
hoarseness
low voice
what is Quinsy
complication of acute tonsillitis
abscess forms in the tonsil and can spread to the walls of the throat
symptoms of quinsy
severe and quickly worsening sore throat
swelling inside mouth
pain when swallowing
headache
earache
bad breath
otitis media - quick overview
- affects the eustachian tube
- anything that is due to an infection is otitis media
- painful middle ear infection
- tympanic membrane looks red
- there is pressure on the tympanic membrane due to fluid buildup which can burst and release pus
- this leaves a hole in the tympanic membrane
otitis externa - quick overview
- anything that is outsider the tympanic membrane
- common after swimming
- congestion in the external ear
- no pain
what is the most common cause of tonsilitis
strep a
tongue cancer characteristics
lump in the mouth or lip
unexplained ulcer that lasts longer than 3 weeks
persistent neck lumps
hoarseness of the voice
thyroid lump
difficulty swallowing
what is leukoplakia
white patches on tongue - precancerous
leukoplakia vs oral candiasis
leukoplakia CANNOT BE SCRAPED
oral candiasis - white spots on the tongue that CAN be scraped
squamous cell carcinoma of the tongue - characteristics
will be raised and ulcerated
fast growing
basal cell carcinoma of the tongue characteristics
slow growing
melanoma of the tongue
dark and pigmented
management is dependent on Breslow Thickness
tonsilitis - what are the 2 causes
group A strep - which is treated with penicillin
but the most common cause is viral
how to score wether or not antibiotics are needed in tonsillitis
CENTOR score
no cough
fever > 38 degrees
exudates from the tonsils
inflammed
test for EBV
IgM and IgG antibody test
treatment for sinusitis
beclamethasone drops
throat cancer risk factors
unilateral nasal polyps
smoker
difficulty swallowing
hoarseness of the voice
and PMH of glandular fever
what is Ramsay hunt syndrome
when the shingles virus - varicella zoster - affects the ganglion in the facial nerve in the facial canal and causes facial drooping
what is reinke’s oedema?
it is the gradual swelling and thickening of the vocal cords
it is linked with hypothyroidism
it can cause voice to get deeper
bacterial rhinosinusitis
happens post cold
yellow discharge from nose
fever
local tenderness
give amoxilin
what is the management for nose bleed if person is on warfarin
if INR is in the 5-8 range then stop warfarin and give Vit K
warfarin works by inhibiting vitamin K
what is the most common cancer of the parotid gland?
muchpidermoid carcinoma
it can spread and cause facial nerve palsy
sudden sensihoneural hearing loss - what is the next step
urgent referral to ENT as this is an emergency
symptoms of Menieres disease
the inner ear has sudden attacks of vertigo and tinnitus
happen without a cause or warning
dizziness and nausea is often what’s seen
vestibular schwannoma
it is a brain tumour of the shwan cells
causes unilateral hearing loss
tinnitus
balance issues
brachial cyst
cyst that slowly gets larger
it moves easily
but does not move with swallowing
happens post infection
what is otosclerosis
it is the thickening of the trabecular part of the bone
it causes generalised hearing loss
the stapes bone becomes fused with the surrounding bone - so it cannot move with the vibrations
patients present with talking quieter as their voice sounds louder in their head
they feel like they hear better when their is background noise
what is CSF rhinnorhea
happens due to trauma to the face
the fronto-basal skull breaks and causes the leak of clear fluid - csf
from the nose
what is tympanoslceoris
it is the chronic inflammation and scarring of the tympanic membrane
due to frequent ear infections
it presents with a chalky white patch on the tympanic membrane due to the collagen deposit
present with hearing loss
what is adenoid cystic carcinoma
it is a salivary tumour of the parotid gland
it can invade the facial nerve
causing facial nerve palsy and facial pain
and swelling of the parotid gland
what is the most common parotid malignant cancer
Mucoepidermoid carcinoma
- a hard mass
- facial nerve palsy and drooping
-
what are the risk factors for nasopharyngeal cancer
EBV that presents as ‘bad tonsillitis’
frequent nose bleeds
unilateral glue ear
do a flexible nasoendoscopy
what is a risk factor for paranasal cancer
rhinorrhea for more than 12 weeks
swelling
and blood stained nasal discharge
management for bells palsy
oral prednisolone and eye drops
because the prednisolone will reduce the inflammation of the facial nerve and the eye drops stop the eye from drying out
what infection increases the risk of oropharyngeal cancer
HPV 16/18
HPV is associated with:
- Cervical cancer (HPV 16/18 most common)
- Anal cancer
- Penile cancer
- Vulval cancer
- Oropharyngeal cancer
Which cranial nerves does acoustic neuroma affect
cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
Vestibular mononeuritis - what is it
inflammation of the vestibular nerve, following an infection
which causes loss of balance - only affects the vestibular nerve
