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Otolaryngology > Physiology > Flashcards

Physiology Flashcards

1
Q

Histology: External Ear - Lined by what?

A

Stratified squamous epithelium

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2
Q

Histology: External Ear - Dermis contains what? (3)

A

Hair follicles
Sebaceous glands
Ceruminous glands

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3
Q

Histology: Middle Ear - Cellular structure

A

Columnar epithelium lined mucosa with a dense fibrous layer

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4
Q

Histology: Inner Ear - Contains what two structures? (2)

A

Cochlea
Vestibular apparatus

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5
Q

Histology: Nose - Nasal Vestibule cells

A

Squamous epithelium

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6
Q

Histology: Nose - Nose and Sinuses

A

Respiratory epithelium (Pseudostratified Ciliated Columnar epithelium) with sero-mucinous glands

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7
Q

Histology: Salivary Gland - Two main components

A

Acinar component
Ductal component

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8
Q

Histology: Salivary Gland - Serous cells appearance

A

Dark staining with digestive enzymes inside

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9
Q

Histology: Salivary Gland - Mucinous component appearance

A

Clear grey staining containing glycoprotein

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10
Q

Histology: Salivary Gland - Ducts are lined by what?

A

Columnar or cuboidal epithelium

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11
Q

Histology: Salivary Gland - Myoepithelial cell appearance

A

Flat or cuboidal cells with clear cytoplasm

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12
Q

Pathology of the Ear: Bacterial causes of Otitis Media (3)

A

Streptococcus pneumonia
Haemophilus influenzae
Moxarella catarrhalis

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13
Q

Pathology of the Ear: Chronic Otitis Media bacterial causes (2)

A

Pseudomonas aeruginosa
Staphylococcus aureus

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14
Q

Pathology of the Ear: Otitis media has a risk of spreading to what?

A

Mastoid

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15
Q

Pathology of the Ear: Cholesteatoma

A

Abnormal collection of skin cells within the ear

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16
Q

Pathology of the Ear: Cholesteatoma - Pathogenesis for acquired causes

A

Chronic otitis media and perforated tympanic membrane

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17
Q

Pathology of the Ear: Cholesteatoma - Pathogenesis for congenital causes

A

Proliferation of the embryonic crest

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18
Q

Pathology of the Ear: Cholesteatoma - Macro appearance

A

Pearly white mass in the middle ear

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19
Q

Pathology of the Ear: Cholesteatoma - Micro appearance

A

Squamous epithelium with abundant keratin production and inflammation

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20
Q

Pathology of the Ear: Cholesteatoma - Locations (3)

A

Superior posterior middle ear
Petrous apex
Anterior superior ear

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21
Q

Pathology of the Ear: Cholesteatoma - More common in what sex?

A

Males

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22
Q

Pathology of the Ear: Vestibular Schwannoma - Pathophysiology

A

Pathology of the vestibular portion of CN VIII

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23
Q

Pathology of the Ear: Vestibular Schwannoma - Occurs where?

A

Within the temporal bone

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24
Q

Pathology of the Ear: Vestibular Schwannoma - May be associated with what?

A

Extensive exposure to excessive loud noise

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25
Q

Pathology of the Ear: Vestibular Schwannoma - If the case is bilateral and present in the young what must be considered?

A

Neurofibromatosis 2

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26
Q

Pathology of the Ear: Vestibular Schwannoma - Gross appearance

A

Circumscribed tan/white/yellow mass

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27
Q

Pathology of the Nose: Nasal Polyps - If present in young patients what should be considered?

A

Cystic Fibrosis

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28
Q

Pathology of the Nose: Nasal Polyps - Pathophysiology

A

Micro-allergic associations with eosinophils

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29
Q

Pathology of the Nose: Nasal Polyps - Aetiologies (5)

A

Allergy
Infection
Asthma
Aspirin sensitivity
Nickel exposure

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30
Q

Pathology of the Nose: GPA abbreviation

A

Granulomatosis with Polyangiitis

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31
Q

Pathology of the Nose: GPA - Pathophysiology

A

Autoimmune disorder characterised by small vessel vasculitis and necrosis limited to the Respiratory Tract and Kidneys

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32
Q

Pathology of the Nose: GPA - Age of presentation

A

> 40 years old

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33
Q

Pathology of the Nose: GPA - Presentation (3)

A

Respiratory Symptoms
Renal Disease
Nasal symptoms of congestion or septal perforation

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34
Q

Pathology of the Nose: GPA - Antibodies (3)

A

ANCA
PR30-ANCA
MPO-ANCA

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35
Q

Pathology of the Nose: GPA - MPO-ANCA denotes what?

A

Microscopic polyangiitis and Churg Straus

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36
Q

Pathology of the Nose: Sinonasal Papilloma - 3 types

A

Inverted
Exophytic
Oncocytic

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37
Q

Pathology of the Nose: Sinonasal Papilloma - Age of onset

A

> 50 years old

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38
Q

Pathology of the Nose: Sinonasal Papilloma - More common in what sex?

A

Males

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39
Q

Pathology of the Nose: Sinonasal Papilloma - Aetiologies (2)

A

HPV
Organic solvents

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40
Q

Pathology of the Nose: Sinonasal Papilloma - Clinical Presentation

A

Blocked nose

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41
Q

Pathology of the Nose: Sinonasal Papilloma - Exophytic presents where?

A

Nasal Septum

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42
Q

Pathology of the Nose: Sinonasal Papilloma - Inverted type presents where?

A

Lateral walls and paranasal sinuses

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43
Q

Pathology of the Nose: Sinonasal Papilloma - Oncocytic type presents where?

A

Lateral walls and paranasal sinuses

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44
Q

Pathology of the Nose: Nasopharyngeal Carcinoma - Highest incidence where?

A

Far East
African Countries

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45
Q

Pathology of the Nose: Nasopharyngeal Carcinoma - More common in what sex?

A

Males

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46
Q

Pathology of the Nose: Nasopharyngeal Carcinoma - Strong association with what risk factors?

A

EBV
Volatile nitrosamines in food

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47
Q

Pathology of the Nose: Nasopharyngeal Carcinoma - Three types

A

Keratinising
Non-keratinising
Baseloid

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48
Q

Pathology of the Nose: Nasopharyngeal Carcinoma - Prognosis

A

Extensive local spread with early nodal metastasis

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49
Q

EBV is associated with what cancers? (3)

A

Burkitt’s Lymphoma
B Cell Lymphoma
Hodgkins Lymphoma

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50
Q

EBV: LMP-1 acts as what?

A

Oncogene

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51
Q

EBV: EBNA-2 promotes what?

A

Transition from G0 to G1

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52
Q

Pathology of the Throat: Laryngeal Polyps - Pathophysiology

A

Reactive changes in the laryngeal mucosa secondary to vocal abuse, infection or smoking

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53
Q

Pathology of the Throat: Laryngeal Polyps - Nodule location

A

Bilateral on the middle to posterior third of the vocal cord

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54
Q

Pathology of the Throat: Laryngeal Polyps - Most common patient group

A

Young women

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55
Q

Pathology of the Throat: Laryngeal Polyps - Common pathology of polyps

A

Unilateral pedunculated polyps

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56
Q

Pathology of the Throat: Contact Ulcer - Benign response to what?

A

Injury at the posterior vocal cord

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57
Q

Pathology of the Throat: Contact Ulcer - Clinical Presentation (3)

A

Chronic throat clearing
Voice abuse
GORD

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58
Q

Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Recurrent respiratory papilloma two peaks

A

<5 years old
20-40 years old

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59
Q

Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Risk factors

A

HPV-6 and -11

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60
Q

Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Three types of Macro type

A

Exophytic
Sessile
Pedunculated

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61
Q

Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Presentation of micro type

A

Finger-like projections with fibrovascular core covered by stratified squamous epithelium

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62
Q

Pathology of the Throat: Paraganglioma - Pathophysiology

A

Tumours in clusters of neuroendocrine cells throughout the body

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63
Q

Pathology of the Throat: Paraganglioma - May secrete what?

A

Catecholeamines

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64
Q

Pathology of the Throat: Paraganglioma - Relates to what structures? (5)

A

Great vessels of the head and neck around the oral cavity
Nose
Nasopharynx
Larynx
Orbit

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65
Q

Pathology of the Throat: Paraganglioma - Most common age

A

> 50 years old

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66
Q

Pathology of the Throat: Paraganglioma - Associated with what disease?

A

MEN 2

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67
Q

Pathology of the Throat: Squamous Cell Carcinoma - Mainly located where?

A

Oropharynx

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68
Q

Pathology of the Throat: Squamous Cell Carcinoma - Risk factors (3)

A

Smoking
Alcohol
HPV

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69
Q

Pathology of the Throat: Squamous Cell Carcinoma - Micro appearance for well-differentiated cases

A

Epithelial cells with keratinisation and prickle cells

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70
Q

Pathology of the Throat: Squamous Cell Carcinoma - Micro appearance for poor differentiated cases

A

Lack of keratinisation and prickle cells

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71
Q

Pathology of the Throat: Squamous Cell Carcinoma - Linked to what type of HPV?

A

HPV-16

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72
Q

Pathology of the Throat: Squamous Cell Carcinoma - Cellular immortality due to what?

A

Increased expression of E6 and E7 disrupt the p53 and Rb pathways

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73
Q

Pathology of the Salivary Glands: Sialothiasis

A

Stones

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74
Q

Pathology of the Salivary Glands: Pleomorphic Adenoma - Risk of what?

A

Malignant transformation to a carcinoma

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75
Q

Pathology of the Salivary Glands: Pleomorphic Adenoma - More common in what sex?

A

Females

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76
Q

Pathology of the Salivary Glands: Pleomorphic Adenoma - More common in what age?

A

30-60 years old

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77
Q

Pathology of the Salivary Glands: Pleomorphic Adenoma - Macro histological appearance

A

Well-circumscribed light tan to grey mass

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78
Q

Pathology of the Salivary Glands: Pleomorphic Adenoma - Micro histological appearance

A

Variable epithelial and myoepithelial cells in the chondromyxoid stroma

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79
Q

Pathology of the Salivary Glands: Warthin’s Tumour - More common in what sex?

A

Males

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80
Q

Pathology of the Salivary Glands: Warthin’s Tumour - Most common age

A

> 50 years old

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81
Q

Pathology of the Salivary Glands: Warthin’s Tumour - Macro histological appearance

A

Well-circumscribed light grey cystic mass

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82
Q

Pathology of the Salivary Glands: Warthin’s Tumour - Micro histological appearance

A

Bilayered oncocytic epithelium with lymphoid stroma

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83
Q

Pathology of the Salivary Glands: Most common malignant tumour in the world

A

Mucoepidermoid Carcinoma

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84
Q

Pathology of the Salivary Glands: Most common malignant tumour in the UK

A

Adenoid Cystic Carcinoma

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85
Q

Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Location

A

Mainly the parotid gland

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86
Q

Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Genetic associations

A

MECT1-MAML2 Fusion

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87
Q

Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Macro histological appearance

A

Well-circumscribed or infiltrative mass

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88
Q

Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Micro histological appearance

A

Mix of squamous, mucous and intermediate cells with solid and cystic components

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89
Q

Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Common age

A

> 40 years old

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90
Q

Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Location in salivary gland and most common location

A

Parotid
Most common - Palate

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91
Q

Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Complications

A

Perineural invasion causing pain and loss of function

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92
Q

Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Macro Histological Appearance

A

Grey or white infiltrative mass

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93
Q

Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Micro Histological Appearance

A

Small uniform cells with little cytoplasm in solid, tubular or cribiform patterns

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94
Q

Facial Plastic Surgery: Otoplasty

A

Pinning back of the ears

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95
Q

Facial Plastic Surgery: Otoplasty - Assessment Protocol (3)

A

1cm from the most superior point of the pinna to the mastoid
2cm from the top of the trague (Frankfort) posterior part of the pinna to the mastoid
30 degrees to the mastoid and helix

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96
Q

Facial Plastic Surgery: Otoplasty - 3 common problems of the ears

A

Under-developed anti-helical fold
Prominent concha
Protruding lobe

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97
Q

Facial Plastic Surgery: Otoplasty - Mustarde Suturing or Anterior Scoring Method

A

Open the back of the ear uo and mattress sutures to reform the anti-helical fold

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98
Q

Facial Plastic Surgery: Ageing - What happens to the skin melanocytes with age?

A

Melanocytes decrease

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99
Q

Facial Plastic Surgery: Ageing - Impact on the dermo-epidermal junction

A

Flattens by 1/3

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100
Q

Facial Plastic Surgery: Ageing - Impact on collagen

A

Decreased

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101
Q

Facial Plastic Surgery: Ageing - Impact on elastin

A

Decreased turnover

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102
Q

Facial Plastic Surgery: Ageing - Impact on subcutaneous fat

A

Decreased

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103
Q

Facial Plastic Surgery: Ageing - Changes in fat distribution with age

A

Decreased - Face, Hands, Feet
Increased - Thighs, Waist and Abdomen

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104
Q

Facial Plastic Surgery: Belphroplasty

A

Removal of excess skin from the eyelids

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105
Q

Facial Plastic Surgery: Ageing Eyelids - Why do people develop deepening creases in the lower lids?

A

Accumulation of loose skin

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106
Q

Facial Plastic Surgery: Ageing Eyelids - Why does bagginess appear?

A

Slackening of the muscle beneath the skin allows the fat to cushion the eyes in their sockets to protrude forward

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107
Q

Facial Plastic Surgery: Blephroplasty - Process

A

Incision into the creases of the upper lids and just below the lashes to remove extra fat, excess skin and sagging muscles

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108
Q

Facial Plastic Surgery: Reconstruction - Primary closure healing

A

Wound edges are approximated by sutures, staples or glue

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109
Q

Facial Plastic Surgery: Reconstruction - Skin Grafts

A

Transplantation of the skin covers a large surface area

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110
Q

Facial Plastic Surgery: Reconstruction - Skin Grafts Two Types

A

Donor section - thin layer of skin from a healthy part of the body
Full thickness skin graft - pinching and cutting skin away from the donor section

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111
Q

Facial Plastic Surgery: Reconstruction - Skin Flaps

A

Healthy skin and tissue that is partly detached and move to a nearby wound

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112
Q

Airway Obstruction: Neonatal Respiratory System - Obligate … breather

A

Nasal

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113
Q

Airway Obstruction: Neonatal Respiratory System - Nares are …

A

Small

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114
Q

Airway Obstruction: Neonatal Respiratory System - Difference with larynx

A

Small and soft

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115
Q

Airway Obstruction: Neonatal Respiratory System - Difference in tongue

A

Large tongue

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116
Q

Airway Obstruction: Neonatal Respiratory System - Sub-glottis

A

Narrow - 3.5mm at the cricoid

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117
Q

Bernoulli Principel OR Venturi Effect

A

Pressure on the internal wall of the airways occurs due to flow of air

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118
Q

Stridor

A

High pitched harsh noise due to turbulent airflow resulting from airway obstructions

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119
Q

Stertor

A

Low pitched sonourous sound arising from the nasopharyngeal airway

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120
Q

Adenotonsillar Hypertrophy: Clinical sign

A

Breathes with mouth open due to nose blockage

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121
Q

Acute Epiglottitis: Mainly due to what?

A

Haemophilus Influenza Type B

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122
Q

Acute Epiglottitis: Management

A

Intubated with resuscitation to secure the airway (24-48 hours) until the inflammation is reduced

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123
Q

Respiratory Papillomatosis: Associated with what?

A

HPV

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124
Q

Subglottic Stenosis: Management

A

Division of the stenosis with laser and balloon OR laryngotracheal resection and reconstruction

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125
Q

Subglottic Stenosis: Associated with what condition?

A

Vasculitis

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126
Q

Subglottic Stenosis: Clinical Presentation

A

Progressive SOB that is exacerbated by exertion

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127
Q

Burns: How to secure the airway?

A

Endotracheal intubation or tracheostomy

128
Q

Airway Endoscopy: General Anaesthetic

A

Anaesthetic Sevoflurane Gas OR IV Propofol or Remifentanyl

129
Q

Airway Endoscopy: Pharmacotherapy Anaesthesia (4)

A

Heliox - 79% Helium + 21% Oxygen
Nebulised Budesonide - 2mg
Dexamethasone - 0.15-0.6 mg/kg
Nebulised Adrenaline

130
Q

Hearing: Sound Definition

A

Pressure wave caused by oscillating molecules that are set in motion by vibration

131
Q

Hearing: Humans can perceive what frequencies?

A

20-20,000 Hz

132
Q

The Ear: Tympanic Membrane:Oval Window Ratio

A

18:1

133
Q

What is the functional unit of the ear?

A

Hair cells

134
Q

The Organ of Corti: Depolarisation of the Organ of Corti has what following pathway?

A

Stimulates the CN VIII to the Superior Temporal Gyrus Pathways

135
Q

Oval and Round Windows: High frequency hair cells located where?

A

At the base

136
Q

Oval and Round Windows: Low frequency hair cells located where?

A

At the apex of the curve

137
Q

Eustachian Tube: Cartilaginous tube opened when?

A

By the tensor veli palatini and levator palatine muscles to allow air into the middle ear to return to atmospheric pressure

138
Q

Eustachian Tube: Dysfunction leads to what?

A

Negative middle ear pressure - progresses to fluid or effusion within the ear

139
Q

Hearing: Neural Pathway (4 pathways)

A
  1. CN VIII
  2. Cochlear nucleus
  3. Up the brainstem
  4. Into the cerebrum - primary auditory complex in the Posterior Superior Temporal Gyrus and Brodman Areas
140
Q

Hearing: When can the foetus hear?

A

18 weeks

141
Q

Hearing: When will the foetus respond to sound or voice?

A

26 weeks

142
Q

Balance: Central Pathways - Inputs (4)

A

Visual
Proprioceptive
Cardiovascular System
Vestibular System

143
Q

Balance: Central Pathways - Output (2)

A

Vestibulospinal Tract
Vestibulo-ocular Reflex

144
Q

Balance: The Inner Ear - Locations of the Superior Vestibulocochlear Nerve (3)

A

Lateral Semicircular Canal
Anterior Superior Semicircular Canal
Utricle

145
Q

Balance: The Inner Ear - Locations of the Inferior Vestibulocochlear Nerve (2)

A

Posterior Semicircular Canal
Saccule

146
Q

Balance: The Inner Ear - Longest hair cell

A

Kinocilium

147
Q

Balance: The Inner Ear - The name for hair cells that are not the Kinocilium

A

Sterocilia

148
Q

Balance: The Inner Ear - Deflection towards the hair cells has what impact on action potential?

A

Increased potential firing rate

149
Q

Balance: The Inner Ear - Deflection away from the hair cells has what impact on action potential?

A

Decreased potential firing rate

150
Q

Balance: The Inner Ear - Two Otolith Organs

A

Utricle
Saccule

151
Q

Balance: The Inner Ear - What overlies the hair cells?

A

Calcium carbonate crystals within a gel membrane

152
Q

Balance: Semi-Circular Canals - What are the three pairs?

A

Left and Right Horizontals
Left Posterior and Right Anterior
Left Anterior and Right Posterior

153
Q

Balance: Vestibulo-Ocular Reflex - Stereocilia Deflection is due to what?

A

Movement of perilymph

154
Q

Balance: Vestibulo-Ocular Reflex - Balance is due to the relative process of what?

A

Relative pushing of the christa caused by the immobility of the perilymph

155
Q

Balance: Vestibulo-Ocular Reflex - Input

A

Vestibular input

156
Q

Balance: Vestibulo-Ocular Reflex - Output

A

Vestibulo-ocular output

157
Q

Balance: Vestibulo-Ocular Reflex - Inhibits which side?

A

Opposite side to movement

158
Q

Balance: Central Pathways - Vestibulospinal Tract Function

A

Motor output to the neck, back and leg muscles to ensure posture is maintained

159
Q

Balance: Central Pathways - Medial Longitudinal Fasciculus and Ocular Muscles Function

A

Motor output to the eyes gaze stabilisation

160
Q

Balance: Central Pathways - Medial Lemniscus and Thalamus function

A

Cerebrum awareness

161
Q

Taste: Taste Bud - Components

A

Sensory receptor cells
Support cells

162
Q

Taste: Taste Bud - Cell life span

A

10 days

163
Q

Taste: Taste Bud - Replenished by what?

A

Basal cells within the Taste Buds

164
Q

Taste: Taste Bud - Taste receptor cells synapse with what?

A

Afferent nerve fibres

165
Q

Taste: Taste Bud - Present mainly where? (4)

A

Tongue
Palate
Epiglottis
Pharynx

166
Q

Where do most taste buds sit in the tongue?

A

Papillae

167
Q

Taste: Papillae - 4 types

A

Filliform
Fungiform
Vallate
Folliate

168
Q

Taste: Papillae - Which type of papillae does not contain taste buds?

A

Filliform

169
Q

Taste: Pathway - Binding of tastants to receptor cells has what impact?

A

Induces a depolarising receptor potential that initiates action potentials in afferent nerve fibres to synapse with receptor cells

170
Q

Taste: Pathway - Signals from receptor cells are conveyed to where?

A

Brainstem and Thalamus to eventually reach the Cortical Gustatory Areas

171
Q

Taste: Pathway - Afferent Taste Fibres reach the brainstem via what three Cranial Nerves?

A

CN VII - Chorda Tympani Branch of the Facial Nerve
CN IX - Glossopharyngeal Nerve
CN X - Vagus Nerve

172
Q

Ageusia

A

Loss of taste function

173
Q

Hypogeusia

A

Reduced taste function

174
Q

Dysgeusia

A

Distorted taste function

175
Q

Olfaction: Neural Systems - 4 systems

A

CN I
CN V
Vomernasal
CN 0

176
Q

Olfaction: Neural Systems - Main Olfactory System nerve and function

A

CN I - mediates common odours

177
Q

Olfaction: Neural Systems - Trigeminal Somatosensory System nerve and function

A

CN V - chemical and non-chemical sensor with a protective effect of sniffing something harmful

178
Q

Olfaction: Neural Systems - Accessory Olfactory System Nerve

A

Vomernasal

179
Q

Olfaction: Neural Systems - CN 0

A

Nervus Terminalis

180
Q

Olfaction: Smell - Olfactory neuroepithelium is located where?

A

Small region of the nasal mucosa

181
Q

Olfaction: Smell - Olfactory Cleft consists of what?

A

Cribiform plate and small parts of the superior and middle turbinate of the septum

182
Q

Olfaction: Smell - Olfactory Cleft located where?

A

7cm into the nasal cavity from the nostril

183
Q

Olfaction: Smell - How is flavour produced from swallowed food?

A

Retrograde airflow from the nasopharynx during swallowing

184
Q

Olfaction: Pathway - Physiology during quiet breathing

A

Odorants reach smell receptors via diffusion as the olfactory neuroepithelium is located above the normal path of airflow

185
Q

Olfaction: Pathway - Sniffing Process

A

Drawing air currents upwards within the nasal cavity with force

186
Q

Olfaction: Pathway - Before neural conduction can occur from the olfactory cleft the brain odourant must do what? (3)

A

Enter the nose during active or passive processes
Passes to the olfactory cleft
Odourant must move from the air phase to the aqueous phase

187
Q

Olfaction: Pathway - Role of mucous

A

Aids the dispersion of odourants to the olfactory receptors and from the mucous to receptors via diffusion or specialised proteins

188
Q

Olfaction: Pathway - Olfactory neuroepithelium histology

A

Pseudostratified Columnar Epithelium

189
Q

Olfaction: Pathway - Function of Bi-polar Sensory Neurones

A

Extends odourant receptor-containing cilia into the mucous

190
Q

Olfaction: Pathway - Supporting Cell function

A

Insulates and protects olfactory neuroepithelium

191
Q

Olfaction: Pathway - Duct Cell of Bowmans Glands function

A

Secretes mucous

192
Q

Olfaction: Olfactory Receptors - Life span

A

2 months

193
Q

Olfaction: Olfactory Receptors - Axons of the olfactory receptors go where?

A

Afferent fibres of the olfactory nerve

194
Q

Olfaction: Olfactory Receptors - Chemical signals converted to what?

A

Neural Signals - Glutamate and Dopamine

195
Q

Anosmia

A

Inability to smell

196
Q

Hyposmia

A

Reduced ability to smell

197
Q

Dysosmia

A

Altered sense of smell

198
Q

Phantosmia

A

Olfactory hallucination - smell perceived in the absence of stimulation

199
Q

Olfaction: Conductive Smell Abnormalities Aetiologies (3)

A

Nasal polyps
Rhinitis
Nasal masses

200
Q

Olfaction: Sensorineural Smell Abnormalities Aetiologies (5)

A

Viral
Head Trauma
Neurological Conditions - Parkinsons or Alzheimers
Brain tumours
Medication

201
Q

Signs of Ear Disease: How to know if it is upper motor damage inducing facial weakness?

A

Forehead will still move

202
Q

Signs of Ear Disease: How to know if it is lower motor damage inducing facial weakness?

A

Whole face moves

203
Q

Dizziness

A

Non-specific term covering vertigo, pre-syncope and disequilbrium

204
Q

Vertigo

A

Sensation of movement - normally movement

205
Q

Dizziness: Aetiologies within the Visual System? (2)

A

Cataracts
Diabetes Mellitus

206
Q

Dizziness: Aetiologies within Proprioceptive System (3)

A

Diabetes Mellitus
Arthritis
Neurology

207
Q

Dizziness: Aetiologies within Central Pathways (3)

A

Stress
Migraine
Multiple Sclerosis

208
Q

Dizziness: Aetiologies within Cardiovascular Pathways (2)

A

Arrhythrmias
Postural Hypotension

209
Q

Dizziness: Aetiologies within Vestibular System (3)

A

BPPV
Menieres
Vestibular Neuronitis

210
Q

Benign Positional Paroxysmal Vertigo: Most common cause of what?

A

Vertigo on looking upwards

211
Q

Benign Positional Paroxysmal Vertigo: Aetiologies (2)

A

Head trauma
Ear Surgery

212
Q

Benign Positional Paroxysmal Vertigo: Pathophysiology

A

Otoconia from the utricle is displaced within the semicircular canals

213
Q

Benign Positional Paroxysmal Vertigo: Most commonly in what canal

A

Posterior Semicircular Canal

214
Q

Benign Positional Paroxysmal Vertigo: Clinical Presentation

A

Vertigo on:
- Looking up
- Turning in bed
- First lying down
- First getting out of bed
- Bending forward
- Rising from bending
- Moving the head quickly

215
Q

Benign Positional Paroxysmal Vertigo: Diagnostic Test

A

Dix Hallpike Test - patient is sat on the bed and moves into lying down with the head turned 45 degrees to the impacted side

216
Q

Benign Positional Paroxysmal Vertigo: Dix Hallpike Test Positive Result

A

Torsional and Upbeating Nystagmus

217
Q

Benign Positional Paroxysmal Vertigo: Management - Options (3)

A

Epley Manoeuvre
Semont Manoeuvre
Brandt-Daroff Exercise

218
Q

Benign Positional Paroxysmal Vertigo: Management - Epley Manoeuvre

A

Sat on the bed with the head turned to 45 degrees to the affected side and quickly lie back
Wait 30 seconds
Turn your head 90 degrees to the other side
Wait 30 seconds
Turn your head another 90 degrees to the normal side
Wait 30 seconds
Sit up on opposite side to impacted side

219
Q

Benign Positional Paroxysmal Vertigo: Management - Brandt Daroff Exercise Mechanism

A

Repositions the otoconia

220
Q

Vestibular Neuronitis

A

Inflammation of the vestibular nerve

221
Q

Labyrinthitis

A

Inflammation of the labyrinth

222
Q

Vestibular Neuronitis or Labyrinthitis: Viral causes

A

Viral is most likely

223
Q

Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - First severe attack

A

Lasts hours with nausea and vomiting

224
Q

Vestibular Neuronitis or Labyrinthitis: Clinical Presentation (4)

A

Prolonged vertigo - for days
Malaise
Headache
Nausea and Vomiting

225
Q

Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - Labyrinthitis is associated with what? (2)

A

Tinnitus
Hearing loss

226
Q

Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - Management

A

Supportive management with vestibular sedatives

227
Q

Menieres Disease

A

Idiopathic disorder causing vertigo

228
Q

Menieres Disease: Pathophysiology

A

Excess endolymph within the membranous labyrinth

229
Q

Menieres Disease: Symptoms present why?

A

Increase endolymphatic pressure due to dysfunctional sodium channels

230
Q

Menieres Disease: Clinical Presentation - Triad

A

Severe Paroxysmal Vertigo
Sensorineural hearing loss
Tinnitus

231
Q

Menieres Disease: Clinical Presentation - Vertigo

A

Recurrent spontaneous rotational vertigo with at least 2 episodes lasting >20 minutes

232
Q

Menieres Disease: Clinical Presentation - Ear symptoms (2)

A

Change in hearing or tinnitus around the time of dizzy spell
Sensation of ear being full

233
Q

Menieres Disease: Lifestyle Advice

A

Reduce salt
Avoid chocolate and caffeine
Avoid stress

234
Q

Dizziness: Timing - Most likely if Seconds

A

BPPV

235
Q

Dizziness: Timing - Most likely if Hours

A

Menieres

236
Q

Dizziness: Timing - Most likely if Days

A

Vestibular Neuronitis

237
Q

Dizziness: Timing - Most likely if variable timing

A

Migraine-associated Vertigo

238
Q

Dizziness: Most likely if associated with rolling over in bed

A

BPPV

239
Q

Dizziness: Most likely if associated with Nausea and Vomiting

A

Vestibular Neuritis

240
Q

Dizziness: Most likely if associated with light sensitivity during dizzy spells

A

Vestibular migraine

241
Q

Dizziness: Most likely if ear feels full or changes in hearing present

A

Menieres Disease

242
Q

Hearing Aid

A

Sound amplifier

243
Q

Hearing Aids: Mechanism of action

A

Passes from the microphone through an electronic processer to amplify the sound and pass them to the receiver

244
Q

Hearing Aids: Types of fitting (3)

A

Behind the ear
In the ear
In the canal

245
Q

Hearing Aids: 4 parts of the hearing aid

A

Body
Elbow
Tubing
Ear mould

246
Q

Hearing Aids: Open Fitting Hearing Aid - Benefit

A

Do not occlude the ear canal completely to allow natural sound

247
Q

Hearing Aids: Indication

A

Patients with any auditory difficulty with demonstrable hearing loss

248
Q

Hearing Aids: Open Fitting Hearing Aid - Concern with cochlear or retro-cochlear hearing loss

A

Sound can become distorted

249
Q

Hearing Aids: Telecoil - Function

A

Telecoil induction loop systems have telephone receivers that are fitted in public locations

250
Q

Hearing Aids: Telecoil - Mechanism of Action

A

Sound causes distortion in a magnetic field that is picked up by the hearing aid and converted back into sound

251
Q

Hearing Aids: Telecoil - Problem

A

Hearing aid microphone is switched off so cannot hear anything else

252
Q

Hearing Aids: Problems (3)

A

No or Insufficient Sound
Excessive amplification of sound
Pain or discomfort

253
Q

Hearing Aids: Causes of pain or discomfort (3)

A

Ear mould poorly inserted or fitted
Allergy to the ear mould material
Otitis externa secondary to occlusion of the ear canal

254
Q

Hearing Aids: Problems - Feedback definition

A

Whistling noise caused by amplified sound being picked up by the microphone

255
Q

Hearing Aids: Problems - Feedback may be caused by what? (4)

A

Wax in the external acoustic meatus
Earmould not inserted correctly
Misfitting earmould
Leakage of sound through a hole in the tubing or elbow

256
Q

Hearing Aids: Problems - Why may patients be unable to wear conventional hearing aids?

A

Recurrent discharge
Absence of stenosis of the ear canal

257
Q

Hearing Aids: Problems - What can be used for patients that cannot use conventional hearing aids?

A

Bone anchored hearing aids

258
Q

Hearing Aids: Bone Anchored Hearing Aids - How are they fitted?

A

Pure titanium screw is placed in the skull and a metal abutment screws into this and passes through the skin - the hearing aid is attached to the abutment to give amplification without occluding the ear canal or requiring air conduction to the cochlea

259
Q

Hearing Aids: Vibrant Soundbridge - Mechanism

A

Works by direct stimulation of the ossicles and round window - converts sound into electrical signals which are transmitted around the skin to the implant via induction

260
Q

Hearing Aids: Vibrant Soundbridge - Indications (2)

A

Unable to wear conventional hearing airs
Do not wish to wear a device in their ear

261
Q

Hearing Aids: Vibrant Soundbridge - Disadvantages (2)

A

Risk of middle ear and mastoid surgery
Risks of anaesthesia

262
Q

Hearing Aids: Cochlear Implants - Mechanism of action

A

Electrical stimulation of neural structures in the cochlea and is transmitted to the brain where it is perceived as sound

263
Q

Hearing Aids: Cochlear Implants - Indicated when?

A

Severe to profound sensorineural hearing loss when conventional hearing aids do not benefit the patient

264
Q

Ear Drops: Applications

A

Anti-inflammatory
Antibiotics
Wax solvents

265
Q

Bacterial Infection: Most common pathogenic bacteria in Otitis externa (3)

A

Pseudomonas aeruginosa
Proteus species
Staphylococcus aureus

266
Q

Ear Drops: Options for bacterial infections (4)

A

Neomycin
Gentamicin
Polymyxin B
Framycetin - used in Otitis Externa with a steroid

267
Q

Common fungal causes of Otitis Media (2)

A

Aspergillus niger
Candida albicans

268
Q

Ear Drops: Options for fungal Otitis Externa (2)

A

Clotrimazole
Nystatin

269
Q

Ear Drops: Wax Solvents - Options (3)

A

Sodium Bicarbonate
Olive Oil
Almond Oil

270
Q

Ear Drops: Application method

A

Turn the recipients ear upwards
Straighten the ear canal by pulling the pinna upwards and backwards in an adult or directly upwards in a child
Instil the drops
Press the tragus repeatedly over the introitus of. theear canal to encourage passage down the canal

271
Q

Ear Drops: Disadvantage of Gentamicin

A

Ototoxic

272
Q

Ear Drops: Side Effects (2)

A

Dizziness
Ototoxic

273
Q

Ear Drops: Side Effects - When may dizziness occur?

A

When the temperature of the drops is not close to the ear - Lateral Semi-circular canal is stimulated by temperature difference in the Caloric Effect

274
Q

Ear Drops: Side Effects - What increases the risk of Ototoxicity?

A

Use of aminoglycoside

275
Q

Pure Tone Audiometry

A

Painless non-invasive hearing test that measures a persons ability to process different sounds, pitches or frequencies

276
Q

Pure Tone Audiometry: Aim

A

Find the hearing threshold - the quietest sound that an individual can hear across a range of different frequencies

277
Q

Pure Tone Audiometry: Pure Tone

A

Single specific frequency determined by frequency, amplitude, phase and duration

278
Q

Pure Tone Audiometry: When are Warble Tones used?

A

In patients with Tinnitus or children <5 years old

279
Q

Pure Tone Audiometry: Audiometers - Calibrated to what?

A

Measure air conduction thresholds between 125-8000 Hz and bone conduction thresholds between 250-6000 Hz
Measure air conduction thresholds of 120dB and bone conduction of 70dB maximum

280
Q

Pure Tone Audiometry: Audiometers - What happens if set to 70dB for conduction?

A

Produce distortions

281
Q

Pure Tone Audiometry: Audiometers - 3 main transducers that are used to present tones (3)

A

Headphones
Insert headphones
Bone conductor

282
Q

Pure Tone Audiometry: Audiometers - Air conduction thresholds assessed by what? (2)

A

Headphones or Insert Earphones
Assess the entire auditory pathway

283
Q

Pure Tone Audiometry: Audiometers - Bone conduction thresholds assessed by what?

A

Bone conductor

284
Q

Pure Tone Audiometry: Masking - Function

A

Ensures a true threshold of the worse ear is gained by preventing the working ear from picking up any tone

285
Q

Pure Tone Audiometry: Masking - 3 rules

A

1 - Masking is required at any frequency where the difference between the left and right not masked AC thresholds is >40 dB when using headphones or 55 dB when using insert earphones

2 - Masking is required at any frequency where the not masked BC threshold is better than the AC threshold of either ear by >10 dB - the worse ear would be the test ear and better ear would be the non-test ear and BC cannot be below the AC threshold

3 - Masking will be required where rule 1 hasn’t been applied but where BC threshold of one ear is more acute by 40 dB or 55 dB than not masked AC threshold attributed to the other ear

286
Q

Pure Tone Audiometry: Masking - Consequences of not masking (5)

A

Inaccurate measure of threshold
Incorrect diagnosis
May lead to inappropriate treatment options
Difficulty in later interpretation of test results

287
Q

Pure Tone Audiometry: Audiogram - Symbol for right ear

A

Circle

288
Q

Pure Tone Audiometry: Audiogram - Symbol for left ear

A

Cross

289
Q

Pure Tone Audiometry: Audiogram - Symbol for Masked air conduction in the right ear

A

Triangle

290
Q

Pure Tone Audiometry: Audiogram - Symbol for Masked air conduction in the left ear

A

Square

291
Q

Pure Tone Audiometry: Audiogram - Symbol for unmasked bone conduction in the right ear

A

<

292
Q

Pure Tone Audiometry: Audiogram - Symbol for unmasked bone conduction in the left ear

A

>

293
Q

Pure Tone Audiometry: Audiogram - Symbol for Masked bone conduction in the right ear

A

[

294
Q

Pure Tone Audiometry: Audiogram - Symbol for Masked bone conduction in the left ear

A

]

295
Q

Pure Tone Audiometry: Audiogram - Symbol for no response

A

Arrow down

296
Q

Pure Tone Audiometry: Audiogram - Normal hearing in dB

A

20 to -10 dB

297
Q

Pure Tone Audiometry: Audiogram - Pitch relationship with Frequency

A

Low pitch has a lower Hz frequency
High pitch has a higher Hz frequency

298
Q

Pure Tone Audiometry: Audiogram - Loudness relationship with dB

A

Loud has higher dB

299
Q

Pure Tone Audiometry: Audiogram - Mild Hearing Loss Threshold

A

20-40 dB

300
Q

Pure Tone Audiometry: Audiogram - Moderate Hearing Loss Threshold

A

41-70 dB

301
Q

Pure Tone Audiometry: Audiogram - Severe Hearing Loss Threshold

A

71-95 dB

302
Q

Pure Tone Audiometry: Audiogram - Profound hearing loss Threshold

A

> 95 dB

303
Q

Pure Tone Audiometry: Audiogram - For sensorineural hearing loss

A

No significant air-bone gap on audiogram - trend decreases with increased frequency

304
Q

Pure Tone Audiometry: Audiogram - For conductive hearing loss

A

Significant air-bone gap - the bone conduction is within normal limits

305
Q

Pure Tone Audiometry: Audiogram - For Mixed Hearing Loss

A

Parts of significant air-bone gap and others that bone conduction suggest a sensorineural hearing loss

306
Q

Sensorineural Hearing Loss: Pathophysiology

A

Damage to the hair cells within the cochlear or hearing nerve, or both

307
Q

Presbycusis

A

Age-related hearing loss

308
Q

Sensorineural Hearing Loss: Aetiologies (5)

A

Regular and prolonged exposure to loud sounds
Ototoxic drugs
Rubella - and other infections
Complications at birth
Benign tumours on the auditory nerve

309
Q

Conductive Hearing Loss: Pathophysiology

A

Sound not being able to pass freely into the inner ear usually due to an abnormality in the outer and middle ear

310
Q

Conductive Hearing Loss: Aetiologies (3)

A

Ear infections
Middle ear fluid - Glue ear
Perforated ear drums

311
Q

Mixed Hearing Loss: Pathophysiology

A

Combination due. todamage in both the outer or middle ear and the inner ear

312
Q

Mixed Hearing Loss: What disease may cause mixed hearing loss?

A

Otosclerosis

313
Q

Mixed Hearing Loss: Characteristic feature of Otosclerosis

A

Carharts Notch at 2 kHz

314
Q

Tympanometry: Objective test of what?

A

Middle ear function - tests the condition of the middle ear, mobility of the ear drum and conduction of the ossicular chain

315
Q

Tympanometry: Enables a distinction between what?

A

Sensorineural and conductive hearing loss

316
Q

Tympanometry: Important in the diagnosis of what?

A

Otitis media

Otolaryngology (4 decks)

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