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
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
3
Q
In a patient with chronic oral pain, what condition should always be considered?
A
Malignancy
4
Q
On a lateral neck xray, what condition would be indicated by a ‘thumb sign’?
A
Epiglottitis
5
Q
Give 4 causes of a central vertigo
A
TIA Stroke Migraine Acoustic neuroma MS
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
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
8
Q
What is the ultimate treatment of a peritonsillar abscess?
A
Inscision and drainage
9
Q
Give 4 differentials for a sore throat
A
Tonsillitis
Peritonsillar abscess (PTA)
Supraglottitis (or epiglottitis)
Deep neck-space infection (DSNI)
10
Q
How long do attacks of Meniere disease typically last?
A
About 4 hours
11
Q
What is a good imaging technique in patients with a moderate-severe sore throat?
A
Lateral neck x-ray
12
Q
Give three tonsillitis ‘red-flags’
A
Neck pain Trismus Voice change Dehydration Drooling
13
Q
What treatments are used in cases of peritonsillar abscess
A
Supportive therapy
Penicillin
Inscision and drainage
14
Q
What type of organism typically causes rhinosinusitis?
A
A virus
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
16
Q
Give three significant risk factors for the development of head and neck cancers
A
Smoking
Alchohol
HPV infection
17
Q
In South Auckland, what percentage of Maori or PI children suffer from OME?
A
About 25%
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
19
Q
In a patient with symptoms of vestibular neuronitis + SNHL, what is the most likely diagnosis?
A
Labyrinthitis
20
Q
What are the four symptoms that characterise Meniere disease?
A
- Unilateral fluctuating SNHL 2. Vertigo lasting minutes to hours
- Constant, worsening or intermittent tinnitus
- Aural fullness
21
Q
In a high risk patient with OME, what is the preferred management strategy?
A
Grommets +/- adenoidectomy
22
Q
What type of bacteria are most likely to cause tonsillitis?
A
Group A beta-haemolytic streptococcus progenies (GAS)
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)
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)
25
What is a thyroglossal duct cyst?
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)
26
Using the 'surgical sieve', give 5 causes of a neck lump
```
Vascular: AV malformation, aneurysm
Inflammatory:
Traumatic: Haematoma
Autoimmune: Thyroiditis
Metabolic: Goitre
Infective: Reactive lymphadenopathy
Neoplastic: SCC, Thyroid cancer, lymphoma
Congenital: Thyroglossal cyst, dermoid cyst
```
27
What is HPV?
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.
28
What are the three most likely bacterial causes of sinusitis?
Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
29
Give 3 common viral organisms that cause tonsillitis
Adenovirus
Rhinovirus
RSV
EBV
30
What are the 2 most common pathogenic causes of OE?
Pseudomonas aeruginosa
| S. aureus
31
In a low risk patient with OME, what is the preferred management strategy?
"watchful waiting" + Audiometry
32
What antibiotic is typically used in cases of acute rhinosinusitis?
Amoxicillin (or doxycycline if there is a penicillin allergy)
33
What test is used to confirm the presence of EBV/mononucleosis?
The heterophiles antibody test (or 'monospot' test)
34
Give 3 complications of a cholesteatoma
```
Bone erosion (including the ossicles)
Sensorineural hearing loss
Dizziness
Facial nerve dysfunction
Infection (e.g., mastoiditis, intracranial abscess, meningitis)
```
35
What is the most likely diagnosis of a patient with purulent nasal discharge, nasal obstruction, facial pain and fullness?
Rhinosinusitis
36
Give two sequellae of DSNI
Internal jugular vein thrombophlebitis
| Mediastinitis
37
In patients with moderate to severe tonsillitis, what drug (other than penicillin) can be used?
Dexamethasone
38
In a patient with a bacterial sinusitis, how long would the infection be likely to persist?
10 or more days
There is also often a worsening after an initial improvement within these 10 days
39
How could mediastinitis occur (basic) in a patient with a deep neck space infection?
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
40
What is the most common indication for the use of grommets?
Persistent bilateral OME
41
In a patient with a moderate to severe case of AOM, what is the 1st line antibiotic treatment?
Augmentin
*Not necessarily amoxicillin, due to the increasing prevalence of S. pneumoniae
42
How long does the sense of vertigo typically last when a patient with BPPV moves their head?
About 30s
43
Other than antibiotic drops, what other treatments are available for patients with OE?
Earwicks
Aural suctioning
Analgesia
44
Give 5 circumstances that could predispose a patient to suffering an episode of epistaxis
- 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
What is the most likely cause of vestibular neuritis?
Reactivation of HSV in the vestibular ganglion and nerve
*Note that other viruses e.g. adenovirus are also potential pathogens (e.g., adenovirus)
46
What is the preferred antibiotic used in cases of tonsillitis?
Penicillin
47
What are the three most common causative pathogens of AOM?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
48
In a patient with a viral sinusitis, how long would the infection be likely to persist?
Less than 10 days
49
What is the most useful treatment in patients with BPPV?
The Epley manoeuvre
50
On swallowing, would the thyroid gland or a thyroglossal cyst move?
Both would move on swallowing
51
When considering the presence of Meniere disease, what are two other differentials that must be excluded?
Syphilis
| Acoustic neuroma
52
What is a branchial cleft cyst?
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
What is (supposedly) the 2nd line treatment for OE?
Ciproxin
| *ciprofloxacin + steroid
54
In a patient with a DSNI, what imaging and blood tests should be performed?
```
Lateral neck x-rays
+/- CT
FBC
U&E
Blood cultures
```
55
What is the 1st line antibiotic treatment for epiglottis?
Ceftriaxone
56
What was previously the most common cause of epiglottis?
Hib
*Now most cases are due to bacteria
57
Give three possible (but unlikely) complications of sinusitis
Orbital cellulitis (or abscess)
Cavernous sinus thrombosis
Meningitis
58
On tongue protrusion, will the thyroid gland move superiorly?
No
59
Give two common causes of DSNI
Pharyngitis
Dental infection/abscess
Tonsillitis
60
What is the other name for OME?
Glue ear
61
What investigations are recommended in a patient with a cholesteatoma?
```
CT scan (or MRI if facial nerve dysfunction)
Audiometry
```
62
What drug can be used preventatively for patients with refractory BPPV (in association with the Epley manoeuvre)?
Betahistine (16mg/Q8h)
63
Give 4 causes of sensorineural hearing loss
- 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
What is the proposed pathology in Meniere disease?
Impaired reabsorption of the endolymphatic fluid possibly with a precipitating infectious, immunological or allergic precipitant
65
On tongue protrusion, will a thyroglossal cyst move superiorly?
Yes
66
How does a URTI typically lead to AOM?
The URTI causes pharyngotympanic tube (Eustachian tube) inflammation & therefore a lack of mucociliary clearance and poor pressure equilibration
67
Where (specifically) will a peri-tonsillar abscess form?
In the peritonsillar space. This is a potential space between the tonsil and the capsule of the tonsil
68
In a minor case of AOM, what is the typical approach to treatment?
Watchful waiting
*Most cases spontaneously resolve within 2-14 days
69
What is the hallmark symptom of a cholesteatoma?
Painless, foul smelling otorrhoea with hearing loss
70
What are the two 'deep neck spaces'?
Retropharyngeal space
| Danger space
71
Give one indication that may indicate that a bleed initiated posteriorly
Bilateral nose bleed
| *most anterior nose bleeds start unilaterally and can occasionally progresss to seeming bilateral
72
What criteria are needed for a diagnosis of chronic rhinosinusitis
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
Give four ways in which a nose bleed can be treated?
- 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
What is a cholesteatoma?
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
What drug can be used during an acute attack of Meniere disease?
Prochlorperazine
76
Give 3 causes of conductive hearing loss
- Cerumen impaction
- Middle ear effusion (including OME)
- Tympanic membrane perforation
- Chronic suppurative otitis media
- Cholesteatoma
- Otosclerosis
77
In a patient with a moderate to severe case of AOM, what is the 2nd line antibiotic treatment?
If Augmentin is ineffective, it is reasonable to use ceftriaxone
78
Of the common causes of tonsillitis, which is most likely to take a long(er) time to resolve?
EBV tonsillitis
79
What two 'head and neck' conditions are most comomluy caused by Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis?
Acute bacterial sinusitis
| Otitis media
80
Give 4 special tests that should be included in the exam of a patient with vertigo
- Dix Hallpike test
- Romberg's test
- Tandem gait
- Head thrust
81
What is the treatment for a cholesteatoma?
Mastoidectomy
82
What treatments are available for patients with an episode of Vestibular neuronitis?
1. Prochlorperazine
| 2. Corticosteroids (e.g., prednisone)
83
What antibiotics are used for (bacterial) chronic rhinosinusitis?
Usually culture-directed, but commonly amoxicillin
84
Give 5 important ear-related questions that should be asked about in a history
```
Tinnitus
Vertigo
Imbalance
Otorrhoea
Headache
Facial nerve dysfunction
Head trauma
Ototoxic exposure, Occupational or recreational noise exposure
Family history of hearing impairment
```
85
In a patient with chronic oral pain, what condition should always be considered?
Malignancy
86
Give 4 causes of a peripheral vertigo
```
BPPV
Meniere disease
Vestibular neuronitis
Labyrinthitis
AOM
Sinusitis
```
87
What is (supposedly) the 1st line treatment for OE?
Sofradex
| *framycetin sulphate/gramicidin/dexamethasone
88
What is the hallmark sign of BPPV?
Vertigo that is elicted by certain head positions
89
What drug can be used prophylactically to prevent an attack of Meniere disease?
Betahistine
90
Other than a drug, what can be used to minimise the symptoms of meniere's disease?
Low salt diet
91
Will a branchial cleft cyst transilluminate?
Not very well
92
Will a lipoma transilluminate?
Not very well
93
From what injury is the organism 'Bartonella' likely to arise from?
A cat scratch
94
What is Ramsay-Hunt syndrome?
This is essentially shingles affecting the facial nerve
95
How is Ramsay-Hunt syndrome likely to present?
- Ear pain
- Vertigo
- Deafness
- Facial nerve palsy
96
How is Ramsay-Hunt syndrome treated?
Oral aciclovir and corticosteroids
97
In what condition might bilateral acoustic neuromas be seen?
Neurofibromatosis (Type 2)
98
What is the most common type of parotid tumour?
Pleomorphic adenoma (benign)
99
What is the likely diagnosis of a patient with bilateral parotid gland swelling and a facial palsy?
Sarcoidosis
100
What condition should be suspected in a young adult with parotid swelling and pancreatitis, orchitis and/or reduced hearing?
Mumps (viral parotitis)
101
A few hours after a tonsillectomy, a patient has a small amount of bleeding from the wound, what should be done?
Immediately return the patient to theatre due to the risk of further, more extensive bleeding
102
If a patient presents with acute necrotizing ulcerative gingivitis, what antibiotic should be used?
Oral metronidazole
