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Y2 ENT > Vertigo and Tonsils > Flashcards

Vertigo and Tonsils Flashcards

1
Q

What are otoliths

A

Calcium carbonate crystals located in the saccule and utricle of the inner ear

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2
Q

Function of saccule and utricle

A

Detect linear movements of the head hence contribute to balance and equilibrium

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3
Q

What is benign positional paroxysmal vertigo

A

Vertigo caused by the detachment of the otoliths hence loose otoliths move around in semicircular canals

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4
Q

Risk factors of BPPV

A

Elderly

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5
Q

Causes of BPPV

A

Head trauma
Cholelithiasis - deposits of calcium
idiopathic

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6
Q

How does BPPV cause vertigo

A

Once the otolith is in the canal, movement of the head will result in movement of the otoliths hence causing an abnormal movement of endolymph -> abnormal stimulation of hair cells

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7
Q

Triggers of vertigo in BPPV

A

Looking up
Turning in bed
First lying down in bed
Getting out of bed
Bending forward
Moving head quickly in one direction

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8
Q

How long does BPPV last

A

30sec - 1 min
Episodes will disappear but reappear again within a few weeks / months

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9
Q

Does BPPV have any ear symptoms

A

No

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10
Q

Investigations for BPPV

A

Dix-Hallpike manouevre

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11
Q

What would suggest a positive Dix-hallpike manoeuvre

A

Causing vertigo
Torsional nystagmus

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12
Q

What is nystagmus

A

Eyes make repetitive, uncontrolled rotatory movements

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13
Q

Management of BPPV

A

Epley manoeuvre
Selmont manoeuvre
Brandt-Daroff exercises

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14
Q

Describe the epley manoeuvre

A
  1. Patient sitting up with their heads 45 degress turned to the affected side
  2. Keep the head turned and lay the patient down
  3. Turn head 90 degrees to the opposite side
  4. Turn head another 90 degrees by rolling body towards unaffected side
  5. Sit patient up while keeping head turned
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15
Q

What is vestibular neuritis

A

Inflammation of the vestibular nerve

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16
Q

Symptoms of vestibular neuritis

A

First attack is severe - lasts hours
Prolonged vertigo - days or weeks
horizontal nystagmus

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17
Q

Symptoms of labrynthitis

A

Prolonged vertigo - days or weeks
Tinnitus / hearing loss
Horizontal nystagmus

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18
Q

vestibular neuritis is commonly preceded by

A

viral illness

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19
Q

How to differentiate between vestibular neuritis and labrynthitis

A

Vestibular neuritis does not cause tinnitus / hearing loss whereas labrynthitis does

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20
Q

Management of vestibular neuritis / labrynthitis

A

Self-limiting, resolves in a month
May be helped by rehabilitation exercises if prolonged

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21
Q

What is vestibular migraine

A

Episode of vertigo in someone who has a history of migraines

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22
Q

Symptoms of vestibular migraine

A

Light sensitive during dizzy spells
Phonophobia
Fluctuating hearing loss
Motion sensitivity

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23
Q

Management of vestibular migraine

A

Lifestyle modifications, avoid triggers
Propanolol
CCB
Amitriptyline

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24
Q

Pathophysiology of Ménière’s disease

A

Dilatation of endolymph spaces -> excess endolymph in the membranous labryinth

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25
Q

Symptoms of Ménière’s disease

A

Severe paroxysmal vertigo
Sensorineural hearing loss
Tinnitus
Sensation of ear being full

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26
Q

What type of vertigo does Ménière’s disease cause

A

Rotational vertigo

27
Q

Pattern of attacks of Ménière’s disease

A

Recurrent
Spontaneous
Lasts for hours

28
Q

What is the pattern on audiometry for Ménière’s disease

A

Sensorineural hearing loss
Affecting low frequency

29
Q

management of Ménière’s disease

A

Supportive
Tinnitus therapy
Hearing aids
Lifestyle modifications
Prochlorperazine - for acute attacks

30
Q

What are the lifestyle modifications suggested for patients with Ménière’s disease

A

Reduce salt
Avoid chocolate
Avoid caffeine
Avoid stress

31
Q

What is a possible prophylactic therapy for Ménière’s disease

A

Betahistine

32
Q

Which type of vertigo has a positional trigger

A

BPPV

33
Q

Which types of vertigo causes tinnitus

A

Labrynthitis
Meniere’s

34
Q

Most common type of vertigo

A

BPPV

35
Q

Most common cause of obstructive sleep apnea in children

A

Adenotonsillar hypertrophy

36
Q

How does adenotonsillar hypertrophy cause obstructive sleep apnoea

A

Disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in narrowed upper airway

37
Q

At what age do tonsils and adenoids grow the most

A

between 2-8 years old

38
Q

Symptoms of adenoid hypertrophy

A

Hyponasal voice
Snoring
Sleep disturbances
Acute otitis media
Otitis media with effusion

39
Q

How does adenoid hypertrophy cause otitis media / otitis media with effusion

A

Blocks the Eustachian tube opening causing Eustachian tube dysfunction

40
Q

Symptoms of tonsil hypertrophy

A

Muffled voice
Snoring
Sleep disturbances
Visibly enlarged tonsils

41
Q

Management of adenotonsillar hypertrophy

A

Adenoidectomy / tonsillectomy if indicated

42
Q

When is adenoidectomy indicated

A

Recurrent AOM / OME
Upper airway obstruction (snoring, obstructive sleep apnoea)
Dysphagia
Speech difficulty

43
Q

Where is the most common site of head and neck cancer

A

Larynx

44
Q

Types of head and neck cancers

A

Squamous cell carcinoma
Nasopharyngeal carcinoma
Laryngeal carcinoma
Oropharyngeal carcinoma
Oral cavity carcinoma

45
Q

Most common type of head and neck cancer

A

Squamous cell carcinoma

46
Q

Squamous cell carcinoma of the head and neck is associated with

A

Smoking
Alcohol
HPV type 16

47
Q

How may HPV type 16 cause squamous cell carcinoma

A

Produce proteins E6 and E7 which disrupts p53 -> cellular immorality

48
Q

Risk factors of head and neck cancers

A

Male
>55
Smoking
Alcohol
HPV, EBV
Radiation exposure
Immunosuppression
Occupational exposure (acid mists, asbestos, wood dust)
Family history

49
Q

Which type of head and neck cancer is associated with EBV

A

Nasopharyngeal carcinoma

50
Q

Who does HPV related oropharyngeal carcinoma typically affect

A

NON-SMOKER
Higher socio-economic class
Multiple sexual partners

51
Q

What is the route of spread for head and neck cancers

A

Lymphatic spread

52
Q

Which lymph nodes does supraglottic tumours drain into

A

Drains into the superior deep cervical nodes

53
Q

Which lymph nodes does subglottic tumours drain into

A

Drains into paratracheal nodes

54
Q

What is special about glottic tumours

A

Most stay on the vocal cords instead of spreading

55
Q

Symptoms of head and neck cancer

A

Dysphonia
Dysphagia
Unilateral otalgia
Neck lump
Stridor
Hoarseness
Lymphadenopathy

56
Q

Symptoms of nasopharyngeal carcinoma

A

Unilateral symptoms
Symptoms of eustachian tube obstruction
Nasal obstruction
Blood-stained nasal discharge
Persistent epistaxis
May develop a glue ear

57
Q

Investigations for head and neck cancer

A

Urgent referral if symptoms occurred for more than 3 weeks
US + Fine needle aspiration
Panendoscopy + biopsy
Staging

58
Q

What is used to stage head and neck cancer

A

CT neck, chest
MRI
PET

59
Q

Management for early laryngeal cancer T1-T2

A

Transoral laser surgery
Radiotherapy

60
Q

Management for late laryngeal cancer T3-T4

A

Partial / total laryngectomy
Chemo and radiotherapy

61
Q

Management for early oropharyngeal cancer T1-T2

A

Transoral laser surgery
Radiotherapy

62
Q

Management for late oropharyngeal cancer T3-T4

A

Chemo and radiotherapy

63
Q

Management for nasopharyngeal cancer

A

Chemo and radiotherapy

Y2 ENT (7 decks)

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