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ORL > Everything > Flashcards

Everything Flashcards

1
Q

In a patient with polyps, what feature of the polyps might suggest malignancy?

A

Most patients have bilateral polyps, however unilateral polyps may suggest malignancy

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2
Q

A patient presents with a sudden attack of vertigo with associated nausea and vomiting in the absence of hearing loss presents. They have a history of a URTI 2 weeks ago. What is the most likely diagnosis?

A

Vestibular neuronitis

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3
Q

In a patient with chronic oral pain, what condition should always be considered?

A

Malignancy

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4
Q

On a lateral neck xray, what condition would be indicated by a ‘thumb sign’?

A

Epiglottitis

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5
Q

Give 4 causes of a central vertigo

A 
TIA
Stroke
Migraine
Acoustic neuroma
MS
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6
Q

Within the neck, what are the three fascia that create the two deep neck ‘spaces’

A

Anterior: Deep cervical fascia
Middle: Alar fascia
Posterior: Prevertebral fascia

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7
Q

What is exostosis?

A

It is essentially a bony spur, which is commonly referred to as ‘surfers ear’

*It generally requires surgical intervention to prevent recurrence

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8
Q

What is the ultimate treatment of a peritonsillar abscess?

A

Inscision and drainage

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9
Q

Give 4 differentials for a sore throat

A

Tonsillitis
Peritonsillar abscess (PTA)
Supraglottitis (or epiglottitis)
Deep neck-space infection (DSNI)

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10
Q

How long do attacks of Meniere disease typically last?

A

About 4 hours

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11
Q

What is a good imaging technique in patients with a moderate-severe sore throat?

A

Lateral neck x-ray

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12
Q

Give three tonsillitis ‘red-flags’

A 
Neck pain
Trismus
Voice change
Dehydration
Drooling
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13
Q

What treatments are used in cases of peritonsillar abscess

A

Supportive therapy
Penicillin
Inscision and drainage

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14
Q

What type of organism typically causes rhinosinusitis?

A

A virus

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15
Q

Give three possible complications of tonsillitis

A 
Rheumatic fever
Peritonsillar abscess (Quinsy)
Scarlet fever
Post-strep glomerulonephritis
Cervical lymphadenitis
Deep neck-space infections
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16
Q

Give three significant risk factors for the development of head and neck cancers

A

Smoking
Alchohol
HPV infection

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17
Q

In South Auckland, what percentage of Maori or PI children suffer from OME?

A

About 25%

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18
Q

In a patient who presents with tonsillitis with accompanying lymphadenopathy, splenomegaly, lethargy and EBV-infected tonsils, what condition should also be suspected?

A

Infectious mononucleosis

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19
Q

In a patient with symptoms of vestibular neuronitis + SNHL, what is the most likely diagnosis?

A

Labyrinthitis

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20
Q

What are the four symptoms that characterise Meniere disease?

A
  1. Unilateral fluctuating SNHL 2. Vertigo lasting minutes to hours
  2. Constant, worsening or intermittent tinnitus
  3. Aural fullness
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21
Q

In a high risk patient with OME, what is the preferred management strategy?

A

Grommets +/- adenoidectomy

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22
Q

What type of bacteria are most likely to cause tonsillitis?

A

Group A beta-haemolytic streptococcus progenies (GAS)

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23
Q

What treatments are usually used for a patient with chronic rhinosinusitis?

A

Normal antibiotics for an acute flare (i.e., amoxicillin)
Saline nasal rinses
Prednisone
Decongestant sprays (e.g., fluticasone)

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24
Q

What is the most common presenting complaint of a patient (or their parents) with OME?

A 
Hearing loss (80%)
(i.e., it is often asymptomatic)
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25
Q

What is a thyroglossal duct cyst?

A

This is a mass located in the midline of the neck due to improper fetal development of this area.

*They typically remain asymptomatic until they become infected (often during an URTI)

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26
Q

Using the ‘surgical sieve’, give 5 causes of a neck lump

A 
Vascular: AV malformation, aneurysm
Inflammatory:
Traumatic: Haematoma
Autoimmune: Thyroiditis
Metabolic: Goitre
Infective: Reactive lymphadenopathy
Neoplastic: SCC, Thyroid cancer, lymphoma
Congenital: Thyroglossal cyst, dermoid cyst
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27
Q

What is HPV?

A

This is a very common virus that infects about 80% of people at some point. There are many different strains, with most being transmitted sexually.

In some people it can cause genital warts and it may also cause the development of precancerous and cancerous lesions.

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28
Q

What are the three most likely bacterial causes of sinusitis?

A

Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis

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29
Q

Give 3 common viral organisms that cause tonsillitis

A

Adenovirus
Rhinovirus
RSV
EBV

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30
Q

What are the 2 most common pathogenic causes of OE?

A

Pseudomonas aeruginosa

S. aureus

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31
Q

In a low risk patient with OME, what is the preferred management strategy?

A

“watchful waiting” + Audiometry

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32
Q

What antibiotic is typically used in cases of acute rhinosinusitis?

A

Amoxicillin (or doxycycline if there is a penicillin allergy)

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33
Q

What test is used to confirm the presence of EBV/mononucleosis?

A

The heterophiles antibody test (or ‘monospot’ test)

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34
Q

Give 3 complications of a cholesteatoma

A 
Bone erosion (including the ossicles)
Sensorineural hearing loss
Dizziness
Facial nerve dysfunction
Infection (e.g., mastoiditis, intracranial abscess, meningitis)
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35
Q

What is the most likely diagnosis of a patient with purulent nasal discharge, nasal obstruction, facial pain and fullness?

A

Rhinosinusitis

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36
Q

Give two sequellae of DSNI

A

Internal jugular vein thrombophlebitis

Mediastinitis

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37
Q

In patients with moderate to severe tonsillitis, what drug (other than penicillin) can be used?

A

Dexamethasone

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38
Q

In a patient with a bacterial sinusitis, how long would the infection be likely to persist?

A

10 or more days

There is also often a worsening after an initial improvement within these 10 days

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39
Q

How could mediastinitis occur (basic) in a patient with a deep neck space infection?

A

If the infection was in the ‘danger space’, the infection may spread through this space into the mediastinum because the danger space extends from the skull base to the diaphragm

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40
Q

What is the most common indication for the use of grommets?

A

Persistent bilateral OME

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41
Q

In a patient with a moderate to severe case of AOM, what is the 1st line antibiotic treatment?

A

Augmentin

*Not necessarily amoxicillin, due to the increasing prevalence of S. pneumoniae

42
Q

How long does the sense of vertigo typically last when a patient with BPPV moves their head?

43
Q

Other than antibiotic drops, what other treatments are available for patients with OE?

A

Earwicks
Aural suctioning
Analgesia

44
Q

Give 5 circumstances that could predispose a patient to suffering an episode of epistaxis

A
  • Infection (i.e., URTI)
  • Trauma (e.g., nose-picking, foreign body, air-conditioning)
  • Medications (e.g., anticoagulants, illicit drugs)
  • Systemic conditions (e.g., coagulopathy, sarcoidosis, Wegener’s granulomatosis)
  • Tumours
45
Q

What is the most likely cause of vestibular neuritis?

A

Reactivation of HSV in the vestibular ganglion and nerve

*Note that other viruses e.g. adenovirus are also potential pathogens (e.g., adenovirus)

46
Q

What is the preferred antibiotic used in cases of tonsillitis?

A

Penicillin

47
Q

What are the three most common causative pathogens of AOM?

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

48
Q

In a patient with a viral sinusitis, how long would the infection be likely to persist?

A

Less than 10 days

49
Q

What is the most useful treatment in patients with BPPV?

A

The Epley manoeuvre

50
Q

On swallowing, would the thyroid gland or a thyroglossal cyst move?

A

Both would move on swallowing

51
Q

When considering the presence of Meniere disease, what are two other differentials that must be excluded?

A

Syphilis

Acoustic neuroma

52
Q

What is a branchial cleft cyst?

A

This is a mass near the anterior border of the SCM, which arises due to failure of branchial cleft obliteration during fetal development.

*Much like thyroglossal duct cysts, they typically remain asymptomatic until they become infected (often during an URTI)

53
Q

What is (supposedly) the 2nd line treatment for OE?

A

Ciproxin

*ciprofloxacin + steroid

54
Q

In a patient with a DSNI, what imaging and blood tests should be performed?

A 
Lateral neck x-rays 
\+/- CT 
FBC
U&E
Blood cultures
55
Q

What is the 1st line antibiotic treatment for epiglottis?

A

Ceftriaxone

56
Q

What was previously the most common cause of epiglottis?

A

Hib

*Now most cases are due to bacteria

57
Q

Give three possible (but unlikely) complications of sinusitis

A

Orbital cellulitis (or abscess)
Cavernous sinus thrombosis
Meningitis

58
Q

On tongue protrusion, will the thyroid gland move superiorly?

59
Q

Give two common causes of DSNI

A

Pharyngitis
Dental infection/abscess
Tonsillitis

60
Q

What is the other name for OME?

61
Q

What investigations are recommended in a patient with a cholesteatoma?

A 
CT scan (or MRI if facial nerve dysfunction)
Audiometry
62
Q

What drug can be used preventatively for patients with refractory BPPV (in association with the Epley manoeuvre)?

A

Betahistine (16mg/Q8h)

63
Q

Give 4 causes of sensorineural hearing loss

A
  • Infections (e.g. OM, mumps, meningitis or HIV)
  • Trauma
  • Ototoxic drugs (e.g. aminoglycosides)
  • Presbycusis
  • Neoplasms (e.g., acoustic neuroma, cerebellopontine angle tumours)
  • Congenital
    • Syndromic (e.g., Usher syndrome)
    • Prenatal (e.g. CMV, rubella, toxoplasmosis, varicella)
64
Q

What is the proposed pathology in Meniere disease?

A

Impaired reabsorption of the endolymphatic fluid possibly with a precipitating infectious, immunological or allergic precipitant

65
Q

On tongue protrusion, will a thyroglossal cyst move superiorly?

66
Q

How does a URTI typically lead to AOM?

A

The URTI causes pharyngotympanic tube (Eustachian tube) inflammation & therefore a lack of mucociliary clearance and poor pressure equilibration

67
Q

Where (specifically) will a peri-tonsillar abscess form?

A

In the peritonsillar space. This is a potential space between the tonsil and the capsule of the tonsil

68
Q

In a minor case of AOM, what is the typical approach to treatment?

A

Watchful waiting

*Most cases spontaneously resolve within 2-14 days

69
Q

What is the hallmark symptom of a cholesteatoma?

A

Painless, foul smelling otorrhoea with hearing loss

70
Q

What are the two ‘deep neck spaces’?

A

Retropharyngeal space

Danger space

71
Q

Give one indication that may indicate that a bleed initiated posteriorly

A

Bilateral nose bleed

*most anterior nose bleeds start unilaterally and can occasionally progresss to seeming bilateral

72
Q

What criteria are needed for a diagnosis of chronic rhinosinusitis

A

12 week (or longer) history of at least 2 of the following:

  • Mucopurulent discharge
  • Nasal obstruction/congestion
  • Facial pains, pressure or fullness
  • Decreased sense of smell

***In addition to CT imaging suggestive of purulent mucus in the sinuses

73
Q

Give four ways in which a nose bleed can be treated?

A
  • Pinching the fleshy part of the nose
  • Cotton balls soaked in mixture of lignocaine and adrenaline
  • Cauterisation (once bleeding ceases)
  • Rapid rhino (can be bilaterally placed)
  • Arterial ligation (very rare)
74
Q

What is a cholesteatoma?

A

It is not a tumour, rather it is essentially trapped squamous epithelium, which forms a sac with keratin debris. It is chronically inflamed and commonly infected. This leads to growth and migration of the squamous epithelium, destruction of bone and causes PT tube dysfunction and oedema

75
Q

What drug can be used during an acute attack of Meniere disease?

A

Prochlorperazine

76
Q

Give 3 causes of conductive hearing loss

A
  • Cerumen impaction
  • Middle ear effusion (including OME)
  • Tympanic membrane perforation
  • Chronic suppurative otitis media
  • Cholesteatoma
  • Otosclerosis
77
Q

In a patient with a moderate to severe case of AOM, what is the 2nd line antibiotic treatment?

A

If Augmentin is ineffective, it is reasonable to use ceftriaxone

78
Q

Of the common causes of tonsillitis, which is most likely to take a long(er) time to resolve?

A

EBV tonsillitis

79
Q

What two ‘head and neck’ conditions are most comomluy caused by Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis?

A

Acute bacterial sinusitis

Otitis media

80
Q

Give 4 special tests that should be included in the exam of a patient with vertigo

A
  • Dix Hallpike test
  • Romberg’s test
  • Tandem gait
  • Head thrust
81
Q

What is the treatment for a cholesteatoma?

A

Mastoidectomy

82
Q

What treatments are available for patients with an episode of Vestibular neuronitis?

A
  1. Prochlorperazine

2. Corticosteroids (e.g., prednisone)

83
Q

What antibiotics are used for (bacterial) chronic rhinosinusitis?

A

Usually culture-directed, but commonly amoxicillin

84
Q

Give 5 important ear-related questions that should be asked about in a history

A 
Tinnitus
Vertigo
Imbalance
Otorrhoea
Headache
Facial nerve dysfunction
Head trauma
Ototoxic exposure, Occupational or recreational noise exposure
Family history of hearing impairment
85
Q

In a patient with chronic oral pain, what condition should always be considered?

A

Malignancy

86
Q

Give 4 causes of a peripheral vertigo

A 
BPPV
Meniere disease
Vestibular neuronitis
Labyrinthitis
AOM
Sinusitis
87
Q

What is (supposedly) the 1st line treatment for OE?

A

Sofradex

*framycetin sulphate/gramicidin/dexamethasone

88
Q

What is the hallmark sign of BPPV?

A

Vertigo that is elicted by certain head positions

89
Q

What drug can be used prophylactically to prevent an attack of Meniere disease?

A

Betahistine

90
Q

Other than a drug, what can be used to minimise the symptoms of meniere’s disease?

A

Low salt diet

91
Q

Will a branchial cleft cyst transilluminate?

A

Not very well

92
Q

Will a lipoma transilluminate?

A

Not very well

93
Q

From what injury is the organism ‘Bartonella’ likely to arise from?

A

A cat scratch

94
Q

What is Ramsay-Hunt syndrome?

A

This is essentially shingles affecting the facial nerve

95
Q

How is Ramsay-Hunt syndrome likely to present?

A
  • Ear pain
  • Vertigo
  • Deafness
  • Facial nerve palsy
96
Q

How is Ramsay-Hunt syndrome treated?

A

Oral aciclovir and corticosteroids

97
Q

In what condition might bilateral acoustic neuromas be seen?

A

Neurofibromatosis (Type 2)

98
Q

What is the most common type of parotid tumour?

A

Pleomorphic adenoma (benign)

99
Q

What is the likely diagnosis of a patient with bilateral parotid gland swelling and a facial palsy?

A

Sarcoidosis

100
Q

What condition should be suspected in a young adult with parotid swelling and pancreatitis, orchitis and/or reduced hearing?

A

Mumps (viral parotitis)

101
Q

A few hours after a tonsillectomy, a patient has a small amount of bleeding from the wound, what should be done?

A

Immediately return the patient to theatre due to the risk of further, more extensive bleeding

102
Q

If a patient presents with acute necrotizing ulcerative gingivitis, what antibiotic should be used?

A

Oral metronidazole

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