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Otorhinolaryngology Flashcards

Flashcards for the Ear, Nose and Throat Surgery rotation at the University of Stellenbosch for undergraduate MB.ChB (Bachelors of Medicine and Bachelors of Surgery) students. Note that decks are always a work in progress and are liable to factual, grammatical and spelling errors.

1
Q

Parts of the Ear

A
  1. External ear
  2. Middle ear
  3. Inner ear
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2
Q

Parts of External Ear

A
  1. Pinna
  2. External Auditory Meatus
  3. Tympanic Membrane
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3
Q

Tissues of the External Ear

A
  • skin (including hair, wax)
  • cartilege (perichondrium)
  • bone
  • membrane
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4
Q

Functions of the External Ear

A
  1. Seals off middle ear: protection
  2. Desquamation
  3. Migration
  4. Expulsion
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5
Q

Broad Parts of the Middle Ear

A
  1. Middle Ear per se
  2. Eustachian Tubes
  3. Mastoid Air Cell System
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6
Q

Contents of the Middle Ear

A
  • Tympanic membrane
  • Ossicles
  • Oval window
  • Round window
  • Facial nerve
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7
Q

Components that aerate the middle ear

A

a. Eustachian tubes

b. Mastoid air cell reservoir

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8
Q

Components that amplify sound in the middle ear

A

a. Tympanic membrane

b. Ossicles

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9
Q

Parts of the Inner Ear

A
  1. Cochlea
  2. Vestibule
  3. Vestibulocochlear nerve
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10
Q

Compartments of the Cochlea

A
  • scala tympani
  • scala media
  • scala vestibuli
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11
Q

Types of Tuning Fork Tests

A
  1. Rinne
  2. Weber
    [3. Loock - starting off by asking patient to listen on each side]
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12
Q

Subjective Audiometry Tests

A

Pure tone audiograms

Speech audiometry

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13
Q

Objective Audiometry Tests

A

Impedance Audiometry/ Tympanometry
Evoked Response Audiometry
Cochlear Echo Measurement

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14
Q

Normal human hearing range (dB)

A

0-130

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15
Q

Populations where ERA is useful

A
  1. Babies
  2. Handicapped
  3. Malingerers
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16
Q

Frequency at which noise-induced hearing loss starts

A

4000Hz

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17
Q

Parts of the Vestibule

A
  1. Utricle
  2. Saccule
  3. Semicircular canals
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18
Q

Vestibular tests

A
  • positional test
  • fistula test
  • caloric test
  • rotation tests
  • electronystagmography
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19
Q

Layers of the tympanic membrane

A
  1. skin
  2. fibrous tissue
  3. mucosa
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20
Q

Name the nasal turbinates and what they drain

A 
SUPERIOR TURBINATE:
posterior ethmoid sinus
sphenoid sinus
MIDDLE TURBINATE:
anterior and middle ethmoid sinus
frontal sinus
maxillary sinus
INFERIOR TURBINATE:
nasolacrimal duct
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21
Q

Briefly explain the arterial supply of the nose

A

a. trigeminal branches of external and internal carotid arteries
b. anterior and posterior ethmoidal branches supply structures superior to middle turbinate
c. sphenopalatine arteries, palatine arteries and labial arteries supply other structures

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22
Q

Briefly explain the venous drainage of the nose

A

a. facial veins and ophthalmic veins

b. drain through the cavernous sinus

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23
Q

Briefly explain the innervation of the nose

A
  1. sensory: maxillary division of CNV (Trigeminal Nerve)
  2. secretory: Vidian nerve
  3. vessels: sympathetic constrict, parasympathetic dilate
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24
Q

Functions of the Nose

A
  1. Filtration of air and protection
  2. Humidification and warming of air
  3. Olfaction
  4. Vocal resonance
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25
Q

Name the paranasal sinuses

A

frontal sinus
maxillary sinus
ethmoid sinus
sphenoid sinus

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26
Q

Anatomical relations to the maxillary sinus

A

orbit
teeth
cheek
nasal cavity

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27
Q

Important boundaries of the frontal sinus

A

orbit

anterior cranial fossa

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28
Q

Important adjacent structures to sphenoid sinus

A

internal carotid artery
optic nerve
cavernous sinus

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29
Q

Contents of the cavernous sinus

A

oculomotor nerve
trochlear nerve
abducens nerve
1st and 2nd divisions of trigeminal nerve

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30
Q

Possible functions of paranasal sinuses

A
  1. aid vocal resonance
  2. reduce skull weight
  3. protect eye from trauma
  4. protect vital intracranial structures
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31
Q

Parts of the Pharynx

A

Nasopharynx
Oropharynx
Hypopharynx

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32
Q

Functions of the larynx

A

protect tracheobronchial tree

voice production

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33
Q

Innervation of the larynx

A
  1. Recurrent Laryngeal Nerve
    - laryngeal muscles except cricothyroid
    - glottis
    - subglottis
  2. Superior Laryngeal Nerve
    - cricothyroid muscle
    - supraglottis
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34
Q

Predisposing factors for otitis externa

A

a. environmental (heat, humidity, swimming)
b. trauma (cotton buds, fingernails)
c. physical (narrow canals, eczematous skin)

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35
Q

Clinical features of otitis externa

A 
otalgia
pruritis
erythema of skin
oedema of skin/canal
debris in canal
hearing loss can occur due to oedema
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36
Q

Most important aspect of managing otitis externa

A

Aural toilet

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37
Q

Common pathogens for otitis externa

A
  • staph pyogenes
  • pseudomonas pyocyanea
  • diphtheroids
  • proteus vulgaris
  • e. coli
  • aspergillus niger
  • candida albicans
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38
Q

define otitis externa

A

inflammation of the skin of the external auditory meatus

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39
Q

constituents of quadriderm cream

A

Betamethasone
Gentamicin
Clioquinol
Tolnaflate

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40
Q

Good treatment for very mild otitis externa

A
  1. Aural toilet
  2. Topical drops:
    acetic acid
    weak povidone-iodine solution
    ichthammol glycerin
    thiomersal tincture
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41
Q

Appearance of fungal otitis externa

A

“soggy newspaper”

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42
Q

Define localised otitis externa

A

furuncle of a hair-bearing area of the external auditory meatus

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43
Q

Define malignant otitis externa

A

otitis externa that progresses to an osteomyelitis

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44
Q

Common sites of malignant OE spread

A

tympanic plate
skull base
petrous bone

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45
Q

Main pathogen of malignant OE

A

Pseudomonas Aeruginosa

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46
Q

Complications of Malignant OE

A
  1. CN 7-12 palsies
  2. meningitis
  3. sigmoid sinus thrombosis
  4. brain abscess
  5. death
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47
Q

Clinical features of malignant OE

A
  1. constant deep otalgia
  2. granulation tissue deep in the EAM
  3. failure to resolve on conventional treatment
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48
Q

Management of malignant OE

A
  1. hospitalise
  2. IV antibiotics - prolonged
    - aminoglycosides
    - B-lactams
    - fluoroquinolones
  3. surgery is debated and should only take place in the form of debridement if at all
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49
Q

Define Acute Otitis Media

A

infection of the mucous membrane of the entire middle-ear cleft

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50
Q

Risk factors for AOM

A
  • recent URTI
  • Eustachian tube dysfunction
  • 2nd hand smoke inhalation
  • bottle feeding
  • immunosuppression
  • low socioeconomic status
  • allergies
  • craniofacial abnormalities
  • neuromuscular abnormalities
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51
Q

Common pathogens of AOM

A 
BACTERIAL
- Strep Pneumoniae
- H. Influenzae
- Moraxella Catarrhalis
VIRAL
- RSV
- Influenza
- Rhinovirus
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52
Q

Complications of AOM

A

Mastoiditis

CN VII palsy

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53
Q

Complications of Mastoiditis

A 
intracranial abscess
meningitis
labyrinthitis
sigmoid sinus thrombosis
petrositis
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54
Q

Symptoms of AOM

A
  1. otalgia
  2. fever
  3. irritability/ poor feeding
  4. hearing loss
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55
Q

Signs of the TM in AOM

A
  1. loss of lustre/ decreased light reflex
  2. redness/ hypervascularity
  3. bulging/ fullness
  4. reduced mobility
  5. perforation
  6. mucoid discharge (only if perforated)
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56
Q

Treatment: AOM

A
  1. Antibiotics
  2. Analgesia
  3. Nasal decongestants
  4. Follow-up
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57
Q

Antibiotics in AOM

A

co-amoxiclav

cefuroxime

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58
Q

Causes of non-resolving AOM

A
  1. sinusitis
  2. inefficient antibiotic choice
  3. low grade mastoid air cell infection
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59
Q

Causes of recurrent AOM

A

IgA deficiency

hypogammaglobulinaemia

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60
Q

Define acute mastoiditis

A

inflammation of mastoid air cells, usually follows AOM

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61
Q

Symptoms: Acute Mastoiditis

A

otalgia

acutely ill patient

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62
Q

Signs: Acute Mastoiditis

A
  1. pyrexia
  2. auricle protrusion
  3. acute hearing loss
  4. pinna displacement down and out
  5. otorrhoea
  6. leukocytosis
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63
Q

Treatment: Acute Mastoiditis

A
  1. IV antibiotics
  2. Analgesia
  3. Antipyretcis
  4. Mastoidectomy
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64
Q

Classify Chronic Otitis Media

A

A. Chronic Otitis Media with Effusion (OME)
B. Chronic Suppurative Otitis Media (CSOM)
- mucosal type
- bony type (with cholesteatoma)

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65
Q

Define OME

A

fluid collection behind an in tact TM, usually in children

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66
Q

Causes: OME

A
  1. post AOM
  2. Eustachian abnormality/dysfunction
  3. idiopathic
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67
Q

Symptoms: OME

A
  1. may have none
  2. moderate hearing loss picked up by parents
  3. speech/language difficulties
  4. aural fullness
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68
Q

Signs: OME

A
  1. may have none
  2. bulging or retracted TM
  3. discoloured TM
  4. fluid/ air-fluid level visualised
  5. pneumatic otoscopy changes
  6. type B tympanogram
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69
Q

Management: OME

A
  1. Watchful waiting
  2. Steroids (debatable)
  3. Behavioural changes (parents stop smoking etc)
  4. Surgery e.g. grommets if persists >3 months
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70
Q

Causes: CSOM

A
  1. AOM with perforation
  2. TB
  3. Cholesteatoma
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71
Q

Common organisms: CSOM

A

Pseudomonas Aeruginosa
Staph Aureus
Anaerobes
Fungi

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72
Q

Symptoms: CSOM

A
  1. otorrhoea
  2. hearing loss
  3. painless
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73
Q

Signs: CSOM without cholesteatoma

A
  1. central perforation

2. wet purulent discharge

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74
Q

Signs: CSOM with cholesteatoma

A
  1. abnormal keratinising squamous epithelium in middle ear
  2. bony destruction
  3. marked hearing loss
  4. granulations
  5. sentinel polyps
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75
Q

Treatment: CSOM without cholesteatoma

A
  1. keep ear dry
  2. syringe/dry mopping
  3. antibiotic drops
  4. steroid drops
  5. myringoplasty/tympanoplasty
  6. hearing aid if needed after resolution
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76
Q

Treatment: CSOM with cholesteatoma

A
  1. keep ear dry
  2. aural/suction toilet
  3. mastoid surgery
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77
Q

Diagnoses to consider in runny ear

A
  1. TB
  2. foreign body
  3. neoplasia
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78
Q

Features of Atopic Syndrome

A
  1. infantile eczema
  2. allergic asthma
  3. nasal and conjunctival allergy
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79
Q

Signs of Allergic Rhinitis

A
  1. oedematous nasal mucosa
  2. pale/violet nasal mucosa
  3. copious clear mucous in nose
  4. “allergic salute”
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80
Q

History of Allergic Rhinitis

A
  1. seasonal/perennial - association with exposure
  2. family history of atopy
  3. rhinorrhoea
  4. nasal irritation and sneezing
  5. itchy/watery eyes
  6. previous dermatitis/eczema
  7. symptoms of nasal obstruction e.g. hyposmia
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81
Q

Nasal complications of Allergic Rhinitis

A

nasal septal deviation
turbinate hypertrophy
sinus disease

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82
Q

Management of Allergic Rhinitis

A
  1. Avoidance
  2. Oral/intranasal antihistamines
  3. Topical steroid nasal sprays
  4. Depot IM steroids (only when symptoms interfere with special events)
  5. Topical anticholinergics
  6. Sodium chromoglycate
  7. Desensitisation
  8. Surgery for turbinate hypertrophy
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83
Q

Define Sinusitis

A

inflammation of the mucosa of the paranasal sinuses

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84
Q

Aetiology of Sinusitis

A

a. rhinogenic
b. dental
c. traumatic
d. neoplastic

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85
Q

Common pathogens of acute sinusitis

A

strep. pneumoniae
h. influenzae
moraxella catarrhalis
staph pyogenes
anaerobes (in dental origins)

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86
Q

Signs of acute sinusitis

A
  1. pyrexia
  2. tenderness over sinus/es
  3. mucopus in nose/nasopharynx
  4. imaging: opacity or fluid-level in sinus
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87
Q

Treatment of acute sinusitis

A
  1. bed rest
  2. systemic antibiotics e.g. augmentin
  3. nasal decongestants e.g. illiadin drops
  4. analgesia
  5. steam/menthol inhalation
  6. antral wash-outs (only in certain cases)
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88
Q

Associations with chronic sinusitis

A
  • polyposis
  • allergy
  • immune deficits
  • Wegener’s granulomatosis
  • Churg-Strauss
  • sarcoidosis
  • cystic fibrosis
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89
Q

Common pathogens: chronic sinusitis

A

staph aureus

strep viridans

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90
Q

Treatment: chronic sinusitis

A
  1. prevent acute episodes
  2. nasal douche
  3. nasal steroids
  4. systemic steroids (only if obstructive polyps)
  5. antibiotics (short course)
  6. surgery (if medical mx fails)
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91
Q

DDX for sinusitis

A 
viral rhinitis
allergic rhinitis
migraine
TMJ pain
dental pathology
sinus tumour
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92
Q

Diagnosis of sinusitis is clinical. What can you use as adjuncts?

A
  1. endoscopy
  2. bloods
  3. microscopy
  4. imaging
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93
Q

Complications of Sinusitis

A
  • meningitis
  • dental abscess
  • intracranial abscess
  • osteomyelitis of the frontal bone (Pott’s puffy tumour)
  • cavernous sinus thrombosis
  • orbital cellulitis
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94
Q

Indications for sinus surgery

A

failure of medical treatment >6 weeks
obstructed osteomiatal complex
large obstructive polyps

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95
Q

Surgical options for sinus surgery

A

functional endoscopic sinus surgery

open sinus surgery

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96
Q

Management: complicated sinusitis

A
  1. drain complication
  2. address problematic sinus
  3. maxillary sinus washout
  4. drains in sinus/es and irrigate til clear
  5. broad spectrum antibiotics, adjust after MCS
  6. nasal decongestants
  7. long-term intranasal steroids
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97
Q

Principles for safe use of systemic steroid in allergic rhinitis

A
  1. short term (<2weeks)
  2. not more than every fourth month
  3. not instead of, but in addition to other medication
  4. not for: children, pregnant women, insulin dependent DM
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98
Q

Orbital complications of acute sinusitis

A
  1. preseptal oedema
  2. orbital cellulitis
  3. subperiostial abscess
  4. orbital abscess
  5. cavernous sinus thrombosis
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99
Q

Aetiology: Sore throat in children

A 
acute pharyngitis
acute tonsilitis
infectious mononucleosis
blood dyscrasias
diphtheria
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100
Q

Aetiology: Acute sore throat in adults

A

tonsillitis
pharyngitis
quinsy
candidiasis

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101
Q

Aetiology: Chronic sore throat in adults

A

tonsillitis
pharyngitis
GORD
eagle syndrome

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102
Q

Symptoms: tonsillitis

A 
sore throat
dysphagia
otalgia
headache
malaise
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103
Q

Signs: tonsillitis

A
  1. pyrexia
  2. tonsils enlarged and hyperaemic
  3. inflamed pharyngeal mucosa
  4. hallitosis
  5. tender cervical lymphadenopathy
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104
Q

Treatment: Tonsillitis

A
  1. Bed rest
  2. Analgesia, Antipyretics
  3. Hydration
  4. Antibiotics - penicillin
  5. Surgery when earned
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105
Q

Complications: Tonsillitis

A
  1. acute otitis media
  2. peritonsillar abscess
  3. pulmonary infection
  4. IgA nephropathy
  5. Acute rheumatism
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106
Q

Chronic Tonsillitis symptoms and signs

A

malaise
halitosis
sore throat
small tonsils

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107
Q

Chronic tonsillitis treatment

A

surgery

long-term antibiotics

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108
Q

Symptoms: Quinsy

A

severe unilateral sore throat
dysphagia/odynophagia
otalgia

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109
Q

Signs: Quinsy

A
  1. deviating tonsil and uvula
  2. trismus
  3. cervical lymphadenopathy
  4. halitosis
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110
Q

Treatment: Quinsy

A
  1. Aspirate
  2. Penicillin IVI
  3. Fluids
  4. Surgery if earned
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111
Q

Causes: acute pharyngitis

A

viral

candidiasis

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112
Q

Causes: chronic pharyngitis

A
  1. post nasal drip
  2. tobacco smoke
  3. gastro-oesophageal reflux disease (GORD)
  4. mouth breathing
  5. chronic sinusitis
  6. industrial fumes
  7. antiseptic throat lozenges
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113
Q

Important to exclude with sore throat

A
  1. post-nasal drip
  2. reflux disease
  3. tedonitis
  4. sinister causes
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114
Q

What is Eagle Syndrome

A

stylohyoid ligament calcification

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115
Q

Formal name of croup

A

Laryngotracheobronchitis

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116
Q

Causes of croup

A

Parainfluenza virus
Respiratory syncytial virus
Bacterial superinfection

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117
Q

Clinical features: croup

A
  1. pyrexia
  2. cough: painful, barking
  3. gross mucosal oedema of lower resp tract
  4. stridor: inspiratory, later biphasic
  5. later complete airway obstruction
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118
Q

Management: Croup

A
  1. admit
  2. humidifier
  3. oxygen
  4. intubate if indicated
  5. tracheostomy if indicated
  6. regular saline suction
  7. physiotherapy
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119
Q

Difference between croup and epiglottitis

A
  1. croup has no drooling

2. croup does not have constant forward leaning

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120
Q

Stridor Grading Scale

A

I. Inspiratory stridor
II. Expiratory stridor
III. Inspiratory and Expiratory stridor with pulsus paradoxus
IV. Respiratory arrest

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121
Q

Causes: Stridor in adults

A
  1. malignancy
  2. laryngeal trauma
  3. acute laryngitis
  4. supra/epiglottitis
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122
Q

Causes: stridor in children

A
  1. croup
  2. epiglottitis
  3. foreign body
  4. trauma
  5. retropharyngeal abscess
  6. laryngeal papillomata
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123
Q

Benign Laryngeal Tumours

A
  1. Haemangiomata of childhood
  2. Respiratory Papillomatosis
  3. Benign cartilaginous tumours
  4. Granular cell myoblastoma
  5. Paragangliomas
124
Q

Malignant Laryngeal Tumours

A
  1. SCC
  2. Adenocarcinoma
  3. Adenoid cyst carcinoma
  4. Sarcoma
  5. Lymphoma
  6. Verrucous carcinoma
125
Q

Risk factors: laryngeal carcinoma

A

tobacco smoking

heavy alcohol use

126
Q

T-grading of larynx carcinoma

A 
T1S: Carcinoma in Situ
T1: Carcinoma in on region
T2: carcinoma in two regions, but with mobile vocal cords
T3: fixation of vocal cords
T4: carcinoma beyond the larynx
127
Q

Anatomical spread of laryngeal carcinoma

A

thyroid
tongue
hypopharynx

128
Q

Types of Laryngeal Carcinom

A
  1. Carcinoma in Situ
  2. Supraglottic Laryngeal Carcinoma
  3. Glottic Laryngeal Carcinoma
  4. Subglottic Laryngeal Carcinoma
  5. Transglottic Laryngeal Carcinom
129
Q

Treatment option for laryngeal carcinoma and when you would use them

A

A. Excision/Laser of affected surfaces: Carcinoma in Situ
B. Supraglottic Laryngectomy: supraglottic laryngeal carcinoma with no nodal involvement or spread, this conserves the voice
C. Radiotherapy: all laryngeal carcinomas with nodal and/or neck involvement
D. Total laryngectomy: residual or recurrent disease after radiotherapy

130
Q

Why do UMN lesions of CNVII usually spare the forehead, while LMN lesions do not?

A

Upper Motor Neuron innvervation of the forehead is bilateral. The pons is supplied by the contralateral hemisphere, but ipsilateral fibres also supply the portion of the nucleus which innervates the forehead.

131
Q

Components of the Facial Nerve

A
  1. Motor
  2. Sensory (N. Intermedius)
  3. Secretomotor (parasympathetic)
132
Q

Structures found in the internal auditory canal

A
  1. CNVII
  2. Vestibulocochlear nerve
  3. Nervus Intermedius
  4. Internal auditory artery and vein
133
Q

Acquired Causes of Facial Palsy

A

A. Malignancies
B. Infective
C. Trauma
D. Miscellaneous

134
Q

Malignancies causing facial palsy

A

acoustic neuroma
brain stem tumour
parotid tumours
schwannoma

135
Q

Infective causes of facial palsy

A

Herpes Zoster Oticus

Bell’s Palsy (query HSV)

136
Q

Traumatic causes of facial palsy

A

Base of skull fracture
Penetrating injury
Surgery

137
Q

Miscellaneous causes of facial palsy

A

Sarcoidosis
Polyneuritis
CVA

138
Q

Congenital Causes of Facial Palsy

A

A. Traumatic (difficult delivery, forceps, big infant)
B. Inherited (myotonic dystrophy)
C. Developmental (Moebius Syndrom, Charge Syndrome)

139
Q

Potential features of CNVII palsy

A
  1. History of otalgia, otalgia, injury, surgery
  2. Tissue masses in region of parotid
  3. Middle ear mass
  4. Taste alteration
  5. Dry eyes
  6. Facial weakness/assymetry
  7. Hyperacusis
140
Q

Examining CNVII

A
  1. Inspection (forehead spared?)
  2. Schirmer test (lacrimation)
  3. Audiometric evaluation (stapedius reflex)
  4. Taste testing (chorda tympani)
  5. Electrodiagnosis
141
Q

Facial branches of CNVII

A
  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Mandibular
  5. Cervical
142
Q

Signs that CNVII palsy may be due to malignant cause

A
  1. slowly evolving paresis
  2. facial twitching
  3. middle ear mass
  4. conductive deafness (as opposed to sensorineural)
143
Q

Management: Bell’s Palsy

A
  1. Exclude other causes of palsy
  2. Reassure and educate patient
  3. Eye protection if necessary
  4. Systemic steroids
  5. Acyclovir (debated)
  6. Re-evaluate after five days, continue steroids if necessary
  7. ENT/opthalmology referral, depending
144
Q

Systems used to grade palsy

A

A. House-Brackmann Score

B. Sunderland Score

145
Q

Methods of Eye-Protection in Palsies

A
  1. Eyedrops/Ointments
  2. Spectacles with side protector
  3. Insertion of gold weights in upper lid (NOT in South Africa!)
  4. Temporary suturing of eyelids
  5. Canthoplasty
  6. Lower lid augmentation
146
Q

Congenital causes: nasal obstruction

A
  1. choanal atresia
  2. repaired cleft palata
  3. tumours
147
Q

Congenital tumours that may cause nasal obstruction

A

meningo-encephalocoele

nasal glioma

148
Q

Acquired causes: nasal obstruction without discharge

A

A. Trauma
B. Polyps
C. Neoplasia
D. Post Nasal Masses

149
Q

Traumatic conditions that cause nasal obstruction

A

septal deviation

septal haematoma

150
Q

Neoplasia that cause nasal obstruction

A

inverted papilloma
juvenile angiofibroma
malignancies

151
Q

Post nasal space masses that cause nasal obstruction

A

adenoids
carcinoma/lymphoma
angiofibroma

152
Q

Acquired causes: nasal obstruction with discharge

A 
viral
bacterial
chemical 
allergic
foreign body
153
Q

Features of nasal foreign body

A

child usually calm
unilateral nasal discharge
foul smelling discharge
skin excoriation of upper lip, nasal vestibulum

154
Q

Define: rhinolith

A

large foreign body in the nose of an adult, composed of calcium and magnesium, forming around a nidus of gauze or dried blood

155
Q

How to differentiate a nasal turbinate from a polyp

A
  1. a polyp is mobile
  2. a polyp is paler
  3. a polyp has reduced sensation
  4. polyp bleeds less
156
Q

Causes of nasal polyps

A

infection
idiopathic
neoplastic
other disease

157
Q

Diseases with an association for polyps

A

nasal allergy
asthma
cystic fibrosis
bronchiectasis

158
Q

Management of nasal polyps

A
  1. steroids (intranasal or systemic, usually for small polyps)
  2. pernasal removal
  3. ethmoidectomy (severe, recurring)
  4. treat underlying allergies/sinusitis/asthma
  5. post-op steroids to reduce recurrence
159
Q

Clinical features of septal deviation

A
  • nasal obstruction, usually unilateral
  • crusting or discharge
  • epistaxis
  • facial pain
  • compensatory hypertrophy of inferior turbinate
  • external deformity
160
Q

Management: septal deviation

A

A. watchful waiting
B. submucous resection
C. Septoplasty

161
Q

Management: septal haematoma

A
  1. Emergency when acute
  2. Drainage: aspiration, or incision and evacuation
  3. Nasal packing
  4. Antibiotics
162
Q

Types of Hearing Loss

A

Conductive
Sensorineural
Mixed

163
Q

Important History points in hearing loss

A
  1. Onset and progression
  2. Pain/discharge
  3. Tinnitus
  4. Imbalance
  5. Noise exposure
  6. Drug history
  7. Chronic disease
  8. Recent URTIs
  9. Family history
164
Q

Causes: conductive hearing loss in adults

A 
A. External Auditory Canal
- wax
- exostoses
B. Tympanic Membrane
- perforation
- chronic supurative otitis media
C. Middle Ear
- otitis media with effusion
- ostosclerosis
165
Q

Causes: sensorineural hearing loss in adults

A

i. age
ii. noise
iii. ototoxicity
iv. syphilis
v. acoustic neuroma
vi. vascular
vii. labyrinthitis
viii. perilymph fistula
ix. genetic

166
Q

Causes: wax impaction

A

narrow canal
wax consistency
elderly
earbud use

167
Q

What are exostoses?

A

bony projections into the external auditory canal, found commonly in surfers and swimmers

168
Q

Complications: exostoses

A

obstruction
hearing loss
infections

169
Q

Causes: otitis media with effusion in adults

A

U/LRTI
chronic sinusitis
nasopharyngeal carcinoma

170
Q

Management: otosclerosis

A

A. hearing aid

B. stapedectomy

171
Q

Characteristics: Presbyacusis

A
  1. loss of high frequency hearing
  2. decreased speech discrimination
  3. reduced dynamic range
172
Q

Management: noise-induced hearing loss

A
  1. avoid further noise exposure
  2. hearing aids
  3. compensation from employer
173
Q

Causes: sudden-onset sensorineural hearing loss

A
  1. vascular
  2. infective
  3. trauma
  4. neoplastic
  5. ototoxic
  6. immunologic
174
Q

Define sudden hearing loss

A

Loss of 30dB or more in 3 adjacent frequencies over 72 hours or less

175
Q

Treatment of non-traumatic, non-malignant sudden sensorineural hearing loss

A
  1. Vasodilators e.g. Betahistine

2. Prednisone

176
Q

Ototoxic drugs

A 
Aminoglycosides
Streptomycin
Cytotoxic drugs
Salicylates
Quinine
177
Q

Which ototoxic drug damage is reversible

A

Salicylates

Quinine

178
Q

Suspect hearing loss in these children:

A
  1. Birth factors
  2. Failed distraction test
  3. Parental suspicion of HL
  4. Abnormal speech/language development
  5. Parental or sibling hearing loss
179
Q

Birth factors predisposing to HL

A
  1. prematurity
  2. very low birth weight
  3. intraventricular haemorrhage
  4. neonatal jaundice
  5. aminoglycoside administration
180
Q

Types of congenital conductive HL

A

atresia/aplasia of EAM

ossicular abnormalities

181
Q

Types of congenital sensorineural HL

A 
A. Hereditary
B. Intrauterine events
- infections
- ototoxic drugs
- metabolic disease
- perinatal events
182
Q

Symptoms associated with otalgia

A
  1. hearing loss
  2. otorrhoea
  3. systemic symptoms
  4. dermatological changes
  5. odynophagia/dysphagia
183
Q

Causes of referred otalgia

A
  1. TMJ
  2. parotid
  3. teeth/dentures
  4. tongue
  5. oropharynx
  6. nose/ sinuses
  7. larynx/ hypopharynx
  8. oesophagus
  9. C-spine
184
Q

Contraindications to syringing an ear

A
  1. base of skull fracture
  2. organic foreign body
  3. traumatic perforation
  4. dry perforation
185
Q

Causes: Otalgia of the external ear

A
  1. otitis externa
  2. Ramsay-Hunt syndrome
  3. Meatal furunculosis
  4. cellulitis/erysipelas
  5. myringitis bullosa
  6. perichondritis
  7. neoplasia
186
Q

Treatment: Myringitis Bullosa

A
  1. analgesia
  2. topical steroids
  3. antibiotic drops
187
Q

Treatment: EAM furunculosis

A

incision and drainage

antibiotics

188
Q

Treatment: pinna perichondritis

A
  1. local astringents (magnesium sulphate)

2. systemic antibiotics

189
Q

Classify: Neoplasia of the Ear

A 
A. Auricular
- squamous cell carcinoma
- basal cell carcinoma
- malignant melanoma
- keratoacanthoma
B. Ear canal
- squamous cell carcinoma
- ceruminoma
C. Middle Ear
- squamous cell carcinoma
D. Glomus tumours
190
Q

Define ceruminoma

A

term for all benign and malignant tumours of the ceruminous glands of the external auditory meatus, the most common being adenoid cystic carcinoma

191
Q

Treatment: Auricular neoplasm

A

a. wedge excision
b. total auriculectomy
c. nodal and neck dissection

192
Q

Treatment: SCC of the EAM

A
  1. mastoidectomy
  2. removal of parotid gland
  3. removal of TMJ
  4. post-op radiotherapy
193
Q

Treatment: Ceruminoma

A
  1. wide excision

2. post-operative radiotherapy

194
Q

Treatment: SCC of the middle ear

A
  1. radical mastoidectomy
  2. petrosectomy
  3. post-op radiotherapy
195
Q

Complications: petrosectomy

A

CSF leak
meningitis
facial paralysis
damage to lower cranial nerves

196
Q

Define dysphonia

A

Alteration in the quality of the voice as a result of turbulent airflow over the larynx and irregularities of the vocal cord’s vibrations

197
Q

Classification: Dysphonia

A 
A. Congenital
B. Inflammatory
C. Trauma
D. Neoplasia
E. Neurological
F. Systemic
G. Non-organic
198
Q

Congenital causes of dysphonia

A

laryngomalacia
nerve palsies
haemangioma
laryngocoele

199
Q

Inflammatory causes of dysphonia

A

acute laryngitis
chronic laryngitis
reflux disease

200
Q

Systemic causes of dysphonia

A

rheumatic arthritis
hypothyroidism
angioneurotic oedema

201
Q

Neurological causes of dysphonia

A
  1. myasthenia gravis
  2. cancer of the lung/oesophagus/breast
  3. post-thyroidectomy
  4. spasmodic dysphonia
  5. aortic arch aneurysm
  6. cortical/subcortical lesions
  7. glossopharyngeus
  8. vagus
  9. hypoglossal
202
Q

Traumatic causes of dysphonia

A 
iatrogenic (surgery, intubation)
inhalation (chemicals, fumes)
blunt trauma
penetrating trauma
foreign body aspiration
203
Q

Non-organic causes of dysphonia

A 
A. habitual dysphonia
- acute non-infective laryngitis
- chronic non-infective laryngitis
- vocal cord nodules
- vocal cord oedema/polyps
- contact ulcers
B. psychogenic dysphonia
- musculoskeletal tension
- ventricular dysphonia
- conversion disorder
- mutational falsetto
204
Q

Management: Organic dysphonia

A
  1. treat underlying cause
  2. watchful waiting
  3. medialisation procedures
205
Q

Medialisation techniques

A
  1. injection of silicone/collagen/fat

2. placement of tissue

206
Q

Always biopsy these dysphonic features:

A

polyps
unilateral ulcers
non-healing/recurring ulcers
hyperkeratosis

207
Q

Symptoms associated with noisy breathing

A
  1. signs of respiratory distress
  2. cough
  3. dysphonia
  4. poor feeding (especially in babies)
208
Q

define stertor

A

rough, unmusical sound caused by vibration in the tissues of the nasopharynx, oropharynx and soft palate

209
Q

define stridor

A

musical sound of obstruction in the larynx, trachea or bronchi

210
Q

Sites and causes of respiratory obstruction

A 
A. Nose/Nasopharynx
- nasal polyps
- severely deviated septum
- adenoids
B. Oropharynx/Velopharynx
- macroglossia
- soft palate
- tonsils
C. Laryngotrachea
- tumours/ cysts
- inflammation
211
Q

Causes: noisy breathing in adults

A
  1. malignancy
  2. largyngeal trauma
  3. acute laryngitis
  4. supraglottitis/epiglottitis
212
Q

Causes: noisy breathing in children

A
  1. laryngotracheobronchitis
  2. epiglottitis
  3. foreign body
  4. trauma
  5. retropharyngeal abscess
  6. laryngeal papillomata
213
Q

Causes: noisy breathing in neonates

A
  1. laryngomalacia
  2. congenital cysts
  3. webs
  4. subglottic stenosis
  5. vocal cord paralysis
214
Q

define apnoea

A

cessation of airflow at the nostrils for 10 seconds or longer

215
Q

define sleep apnoea syndrome

A

five or more episodes of apnoea in an hour of sleep

216
Q

Sleep apnoea types

A
  1. central
  2. obstructive
  3. mixed
217
Q

Risk factors: Obstructive Sleep Apnoea Syndrome (OSAS)

A 
obesity
older males
anatomical facial abnormalities
family history
sedative/alcohol use
smoking
218
Q

Clinical features: OSAS

A 
sleep fragmentation
daytime fatigue/somnolence
morning headaches
poor job performance
depression and family discord
219
Q

Complications: OSAS

A 
A. Cardiac
- systemic hypertension
- pulmonary hypertension
- cor pulmonale
- polycythemia
- cardiac dysrhythmias
B. CNS
- hypersomnolence
- fatigue
- reduced concentration and memory
C. Other (in children)
- failure to thrive
- Sudden Infant Death Syndrome
220
Q

Special investigations: OSAS

A
  1. polysomnography
  2. lateral X-ray of the neck
  3. CXR
  4. ECG
  5. nasal endoscopy
  6. elective intubation
221
Q

Treatment: OSAS

A 
A. Conservative
- weight loss
B. Medical
- nasopharyngeal airway
- continuous positive airway pressure
C. Surgical
- adenotonsillectomy
- uvulopharyngopalatoplasty
- tracheostomy
222
Q

Signs: Epiglottitis

A
  1. pyrexia
  2. severe sore throat
  3. stridor
  4. dribbling
  5. breathing with raised chin and open mouth
  6. cherry red epiglottis
223
Q

Treatment: Epiglottitis

A
  1. IVI antibiotics

2. intubation

224
Q

Define tinnitus

A

the perception of sound in the absence of external stimuli or hallucinations

225
Q

Causes: objective tinnitus

A
  1. AV malformations
  2. Glomus jugulare
  3. Glomus tympanum
  4. Atherosclerosis
  5. Cardiac murmurs
  6. Persistent stapedial artery
  7. Increased cardiac output
  8. Palatal myoclonus
  9. Patulous Eustachian tube
  10. Carotid body tumour
  11. TMJ pathology
226
Q

Causes: subjective tinnitus

A
  1. Presbyacusis
  2. Noise exposure
  3. Meniere Disease
  4. Otosclerosis
  5. Head trauma
  6. Acoustic neuroma
  7. Drugs
  8. Middle ear effusion
  9. Depression
  10. Meningitis
  11. Syphilis
227
Q

Places to listen for bruits when patient has tinnitus

A 
Orbit
Mastoid process
Skull
Neck
Heart
228
Q

Drugs causing tinnitus

A 
Aminoglycosides
Antidepressants
Aspirin
Quinine
Loop diuretics
Cytotoxics
229
Q

Management of Tinnitus

A
  1. Avoid dietary stimulants
  2. Smoking cessation
  3. Avoid drugs causing tinnitus
  4. Reassurance
  5. White noise machine
  6. Hearing aids
  7. Tinnitus retraining therapy
  8. Cochlear implants
  9. Surgery for vascular causes
230
Q

Classification: Head, Neck and Facial Pain

A 
A. Rhinological
B. Dental
C. Vascular
D. Tension-Type
E. Neurological
F. Tumours
G. Atypical Facial Pain
231
Q

Important points on history of headaches

A
  1. Site and radiation
  2. Duration
  3. Character
  4. What relieves the pain
  5. Effect on quality of life
232
Q

Features: pain due to TMJ dysfunction

A
  1. periauricular or deep otalgia
  2. unilateral pain
  3. pain worsens when chewing
  4. crepitus felt over TMJ
  5. pain ellicited over TMJ in palpation
233
Q

Treatment: pain due to TMJ dysfunction

A
  1. correct bite

2. muscle relaxants

234
Q

Features: Migraine

A
  1. visual disturbance (scotoma, photophobia)
  2. pain: throbbing, unilateral
  3. nausea
  4. triggers are usually identifiable
235
Q

Treatment: Migraine

A
  1. avoid triggers
  2. headache diary
  3. NSAIDs for acute
  4. anti-emetics for acute
  5. triptans for acute
  6. prophylaxis: Beta-blockers
236
Q

Treatment: post-herpetic neuralgia

A
  1. tricyclic antidepressants

2. carbamazepine

237
Q

Features: tension-type headache

A
  1. duration: hours to days
  2. pain: “band around head”
  3. pain present on waking
  4. pain not worse with activity
  5. no or little interference with quality of life
  6. hyperaesthesia of skin of forehead
238
Q

Treatment: Tension-type headaches

A
  1. lifestyle changes

2. amitryptyline 10-20mg nocte for six weeks

239
Q

Features: cluster headaches

A
  1. pain unilateral, forehead and eye
  2. pain very severe and debilitating
  3. lacrimation and redness of eye
  4. rhinorrhoea and nasal obstruction
  5. pain wakes patient
  6. episodes occur in clusters
240
Q

Treatment: cluster headaches

A
  1. avoid alcohol during the cluster period

2. triptans

241
Q

Features: atypical facial pain

A
  1. diagnosis of exclusion
  2. pain: severe and generalised
  3. multiple trigger points
  4. history of depression
242
Q

Treatment: atypical facial pain

A
  1. amitryptyline

2. psychiatry/psychology referral

243
Q

Define otorrhoea

A

aural discharge

244
Q

Causes of Otorrhoea

A 
Acute Otitis Externa
Chronic Otitis Externa
Furunculosis
Eczema of EAM
Acute otitis media
CSOM with cholesteatoma
CSOM without cholesteatoma
Discharging mastoid cavities
Fracture of Temporal Bone
245
Q

Types of Otorrhoea and what causes them

A 
WATERY:
- CSF
- eczema of EAM
BLOODY:
- Trauma
PURULENT:
- acute otitis externa
- furunculosis
MUCOPURULENT:
- acute otitis media
- neoplasia of the ear
FOUL-SMELLING
- CSOM with cholesteatoma
246
Q

Causes: persistently discharging mastoid cavities (after mastoid surgery e.g. for CSOM with cholesteatoma)

A
  1. small external opening
  2. infection
  3. residual cholesteatoma
  4. allergy to topical drops
  5. high posterior canal wall
  6. neoplasia
247
Q

Define vertigo

A

The illusion of rotary movement, which is worsened by closing the eyes or being in the dark

248
Q

Important history question in patient with balance disorder

A
  1. details of first episode
  2. onset and duration
  3. associated hearing loss or tinnitus
  4. relation to activities
  5. effect of darkness
  6. co-morbidities
  7. medication history
  8. alcohol use
  9. anxiety
249
Q

Otological causes of balance disorders

A
  1. middle ear disease
  2. trauma (perilymph fistula)
  3. BPPV
  4. Meniere’s disease
  5. labyrinthitis
  6. otosclerosis
  7. syphilis
  8. ototoxic drugs
250
Q

Non-otological causes of balance disorders

A 
A. CNS disease
B. CVS factors
C. cervical spondylosis
D. ageing
E. psychogenic
251
Q

Features: Benign Paroxysmal Positional Vertigo

A
  1. episodic vertigo
  2. positional association
  3. may have had recent URTI or trauma
  4. lasts seconds to minutes
  5. positive Dix Hallpike manoevre
252
Q

Features: Labyrinthitis

A
  1. history of otitis media or meningitis
  2. acute onset vertigo
  3. nystagmus
  4. hearing loss
253
Q

Features: Meniere’s Disease

A
  1. True vertigo
  2. Hearing loss
  3. Tinnitus
  4. Aural fullness
254
Q

Treatment: Meniere’s Disease

A 
A. CONSERVATIVE
- reassurance
- cease smoking, salt, caffeine
B. MEDICAL
- Betahistine
- Diuretics
C. SURGICAL
- drainage of endolymphatic sac
- disconnection of labyrinth
- labyrinthectomy
255
Q

When should one refer a patient with balance disorder?

A
  1. auditory associations e.g. tinnitus, hearing loss
  2. signs of supurative middle ear disease
  3. symptoms triggered by an increase in pressure
256
Q

Warning signs in a patient with dysphagia

A
  1. loss of weight
  2. neck mass
  3. regurgitation
  4. respiratory symptoms
  5. otalgia
  6. dysphonia
257
Q

Medications that may cause dysphagia

A
  1. anti-histamines
  2. anticholinergics
  3. antidepressants
  4. antihypertensives
258
Q

Causes: Acute dysphagia

A
  1. tonsillitis
  2. aphthous ulceration
  3. foreign body
  4. caustic ingestion
  5. tracheostomy
259
Q

Causes: Chronic dysphagia

A 
A. Neurologic/Neuromuscular disorders
B. Intrinsic features of the GIT
C. Extrinsic features
D. Autoimmune disorders
E. Ageing
F. Psychosomatic (Globus)
260
Q

Extrinsic causes of dysphagia

A
  1. thyroid
  2. aortic aneurysm
  3. aberrant right sublavian artery
261
Q

Neurological causes of dysphagia

A
  1. stroke
  2. amyotropic lateral sclerosis
  3. multiple sclerosis
  4. parkinson’s disease
  5. muscular dystrophy
  6. myasthenia gravis
  7. diffuse oesophageal spasm
262
Q

Intrinsic GIT features causing dysphagia

A
  1. neoplasia
  2. pharyngeal pouch
  3. oesophageal stricture
  4. oesophageal achalasia
263
Q

Treatment: Globus

A
  1. Exclude true dysphagia
  2. 2 week treatment with
    - iron rich diet/supplements
    - reflux medication
    - amitryptyline nocte
  3. stress management
  4. if no improvement, contrast swallow
264
Q

Imaging available for dysphagia

A

CXR
contrast swallow
manometry
endoscopic evaluation of swallowing

265
Q

Autoimmune causes of dysphagia

A
  1. systemic sclerosis
  2. SLE
  3. dermatomyositis
  4. mixed connective tissue disease
  5. Sjogren’s syndrome
  6. Rheumatoid Arthritis
266
Q

How does rheumatoid arthritis cause dysphagia?

A

causes cricoarytenoid joint fixation

267
Q

Surgeries for achalasia

A

a. bougie dilation

b. cardiomyotomy (Heller’s operation)

268
Q

Treatment: Auricular haematoma

A
  1. aspiration OR incision&drainage
  2. irrigation
  3. oral antibiotics
  4. pressure dressings
  5. re-assess in 24h, re-aspirate if necessary
269
Q

Treatment: auricular keloids

A

a. silicone gel clip
b. steroid injections
c. excision and local radiotherapy

270
Q

Which mechanisms protect the tympanic membrane from trauma?

A
  1. narrow isthmus

2. Eustachian tubes

271
Q

Causes: otic barotrauma

A

flying
diving
slap/box to ear

272
Q

Prophylaxis: otic barotrauma

A
  1. repeated valsalva manoevre
  2. nasal decongestants (topical or systemic)
  3. myringotomy and grommets
273
Q

Complications: otic barotrauma

A
  1. Tympanic membrane rupture
  2. Cochlear damage
    - SNHL
    - tinnitus
  3. Vestibular damage
    - balance disorders
274
Q

Management: Tympanic membrane rupture

A
  1. most will resolve spontaneously in six week to three months
  2. Water precautions - do not get fluid in ear
  3. topical antibiotics and steroids if infected
  4. audiogram if hearing loss suspected
  5. myringoplasty if not healed by 3 months
275
Q

Management: Ossicular chain dislocation

A

a. ossiculoplasty

b. hearing aids

276
Q

Signs: Temporal bone fracture

A
  1. hearing loss - conductive in longitudenal, sensorineural in transverse
  2. nausea and vomiting
  3. vertigo
  4. nystagmus
  5. battle sign
  6. racoon eyes
  7. CSF rhinorrhoea/otorrhoea
  8. facial nerve palsy - delayed in longitudenal, immediate in transvers
277
Q

Symptoms and signs: perilymph fistula

A
  1. vertigo: episodic, worse with loud noise
  2. tinnitus
  3. hearing loss - sensorineural, fluctuating
  4. headache
  5. progresses during the day
  6. symptoms worse with valsalva
278
Q

Important assessments after naso-facial trauma

A
  1. nasal airway patency and respiratory status
  2. ocular movement and function
  3. cranial nerve V function/sensation
  4. dental occlusion
  5. circulation status
  6. C-spine integrity
279
Q

Management: nasal soft tissue injury

A
  1. clean wounds
  2. anti-tetanus injection if appropriate
  3. antibiotics if appropriate
  4. abrasions cleaned and left open
  5. small lacerations: steristrips
  6. large lacerations: suture with fine microfilament
280
Q

How to distinguish CSF rhinorrhoea from normal fluid rhinorrhoea

A
  1. CSF has glucose
  2. CSF has positive B-transferrin assay testing
  3. CSF leaves a halo on a white cloth when mixed with blood
  4. CSF will stain with fluorescein after fluroescein lumbar puncture
281
Q

Complications of nasal trauma

A
  1. respiratory obstruction
  2. haemorrhage
  3. inhalation/aspiration
  4. sensory loss
  5. CSF rhinorrhoea
  6. cavernous sinous thrombosis
  7. physical deformity
282
Q

Management: CSF rhinorrhoea

A
  1. conservative: nurse in upright position, many will abate by itself
  2. surgical repair
    - endoscopically
    - craniotomy
283
Q

Classify epistaxis

A 
A. LOCAL
- digital trauma
- direct trauma
- viral nasal infection
- neoplasia
- foreign bodies
B. GENERAL
- hypertension
- clotting defects 
- drugs
- hereditary haemorrhagic telangiectasia
284
Q

Management: Epistaxis

A
  1. initial first-aid measures
  2. assess blood loss
  3. evaluate cause
  4. procedures to stop the bleeding
285
Q

Trotter’s measure for initial epistaxis management

A
  1. pinch nostril (NOT bony pyramid) together
  2. place container under chin
  3. sit upright
  4. lean forward (NOT backward)
286
Q

Options to control bleeding in epistaxis

A

a. vessel cautery (with silver nitrate sticks of electrocautery)
b. anterior or posterior nasal packing
c. examination under anaesthesia
d. endoscopic diathermy
e. arterial ligation (sphenopalatine, maxillary, external carotid)

287
Q

Minimum investigations in a neck mass - before considering FNA!

A
  1. full blood count
  2. erythrocyte sedimentation rate
  3. chest x-ray
288
Q

Causes of midline neck masses in children

A
  1. thyroglossal duct cysts
  2. dermoid cysts
  3. chondromas
  4. thyroid masses
289
Q

Causes of lateral neck masses in children

A

a. infective
b. congenital
c. neoplastic

290
Q

Infective causes of lateral neck masses in children

A
  1. mumps
  2. lymphadenitis
  3. tuberculosis
291
Q

congenital causes of lateral neck masses in children

A
  1. branchial cysts
  2. cystic hygroma
  3. haemangioma
  4. chemodectomas
292
Q

neoplastic causes of lateral neck masses in children

A
  • lymphoma
  • neurblastoma
  • parotid malignancy
  • rhabdomyosarcoma
  • metastases
293
Q

Causes of midline neck masses in adults

A
  1. thyroid masses
  2. thyroid cancers
  3. untreated congenital masses
294
Q

causes of lateral neck masses in adults

A
  • neoplasia
  • glandular fever
  • parotitis
  • TB lymphadenitis
  • Sjogren’s syndrome
  • sarcoidosis
  • HIV
  • normal variants
295
Q

characteristics of Sjogren’s syndrome

A
  1. xerostomia
  2. keratoconjuncitivitis sicca
  3. systemic autoimmune condition e.g. RA
296
Q

Levels of the neck

A 
I. submental and submandibular
II. upper jugular
III. mid jugular
IV. lower jugular
V. posterior triangle
VI. anterior compartment
297
Q

Signs: laryngotracheal injury

A
  1. stridor
  2. haemoptysis
  3. dysphonia
  4. dysphagia
  5. surgical emphysema
  6. laryngeal tenderness/echymoses/oedema
  7. loss of thyroid cartilage prominence
  8. associated injuries - vascular/c-spine/oesophageal
298
Q

Causes: laryngotracheal trauma

A

BLUNT - MVA, sports
PENETRATING - gunshots, knives
MISCELLANEOUS - corrosive ingestion, smoke inhalation, intubation

299
Q

Principles of managing laryngotracheal injury

A
  1. secure airway
  2. control haemorrhage
  3. drain laryngeal haematomas
  4. laryngeal exploration
  5. laryngeal reconstruction
300
Q

Causes of chronic laryngotracheal stenosis

A
  1. subglottic/tracheal stenosis
  2. bilateral vocal cord palsies
  3. glottic webs
301
Q

Causes: subglottic/tracheal stenosis

A
  • traumatic endotracheal intubation
  • too large endotracheal tube/cuff
  • GERD
  • infection
  • delay in changing to tracheostomy
  • incorrectly sited tracheostomy
302
Q

Treatment: subglottic stenosis

A

a. cruciate cuts using knife/laser
b. temporary stenting
c. topical mitomycin c
d. anterior augmentation
e. tracheal resection and end-to-end anastomosis

303
Q

Treatment: bilateral vocal cord palsy

A

a. intubation/tracheostomy
b. lateralisation of cords
c. airway lasering

304
Q

Treatment: glottic webs

A

a. surgical division
b. mitomycin c
c. silasitc sheet in anterior commisure

305
Q

Management: Caustic ingestion

A
  1. identify substance
  2. do not induce emesis
  3. do not dilute
  4. airway control
  5. do not give activated charcoal
  6. do not perform gastric lavage
  7. IV resuscitation and blood products if necessary
  8. Surgical consult for complications
  9. ENT consult for complications especially stenosis
  10. psychiatry consult
306
Q

Complications: Caustic ingestion

A
  1. oesophageal stenosis
  2. laryngotracheal trauma
  3. mediastinitis
  4. oesophageal perforation
  5. peritonitis

Otorhinolaryngology (1 decks)

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