Week 2 Flashcards
What are the pharyngeal tonsils also known as?
Adenoids
How does the basic histological structure of the adenoids differ from the palatine tonsils?
Adenoids- ciliated pseudostratified columnar epithelium
tonsils- specialised squamous
Define the following: Rhinoplasty Otoplasty Mentoplasty blephroplasty
Rhinoplasty- plastic surgery to the nose
Otoplasty- plastic surgery to the ear (pinning back)
Mentoplasty- plastic surgery to the chin
plastic surgery to the eyelids
Define vertigo
A sensation of movement, usually spinning, or falling, being pushed
How might you distinguish between cardiac, neurological and vestibular system as the cause of dizziness?
Cardiac- lightheadedness, syncope, palpitations
Neurological- blackouts, parasthesia, visual disturbance, speech and swallow problems, weakness
Vestibular- Vertigo
What is nystagmus?
Where someone suffers from involuntary uncontrollable eye movements
What are the three types of hearing loss
Conductive
Sensorineural
Mixed
What is presbycusis?
Gradual hearing loss with old age
What scoring system is used to check if tonsillitis is a strep infection. What does it stand for?
FeverPAIN score Fever Purulence on tonsils attend rapidly Very Inflamed tonsils no Cough/Coryza
What are the possible signs of tonsillitis?
Erythematous, inflamed tonsils
Purulence on tonsils
Erythema and oedema of palate
What is Quinsy?
A peritonsillar abscess
What are the two types of obstructive hyperplasia and give some possible symptoms of each
Enlarged tonsils- snoring, sleep apnoea, muffled voice
Enlarged adenoids- snoring, sleep apnoea, obligate mouth breathing
Give two other possible names of glue ear
Otitis media with effusion (OME), serous otitis media (SOM)
How does acute otitis media differ from OME/SOM?
Both present with middle ear inflammation, fluid accumulation. Only AOM has acute signs/symptoms of inflammation
How does presbycusis often present?
Mainly high-frequency hearing loss with low frequencies preserved, often worse in one ear than the other.
Identify 4 possible treatments of tinnitus
CBT
Relaxation therapy
Use of environmental sound
Hearing aids in case of associated hearing loss
What antibiotic should be used to treat bacterial tonsillitis? What is the alternative if not tolerated?
Penicillin
Clarithromycin
How does the tympanic membrane present of a patient with AOM? What about in OME?
Bulging, erythematous tympanic membrane
Opaque/dull tympanic membrane with bubbles
Identify some of the possible symptoms of otitis media
Otalgia Fever Discharge Hearing loss Upset behaviour/school performance
How would you approach the management of Otitis media?
1st watch and wait/ Oral antibiotics if bacterial and acute
2nd Review after 3 months- referral
3rd Grommet insertion
Identify four investigations other than history for Otitis media.
Otoscopy
Tympanometry
audiometry
tuning fork tests
How does the classical presentation of otitis externa differ from otitis media?
OE- discharge followed by otalgia
OM- otalgia followed by discharge
Identify some of the signs and symptoms of herpes simplex infection
Cold sores (perioral lesions) Mucous membrane/skin lesions Genital lesions Ocular infections encephalitis
What causes Primary Gingivostomatitis? How does it present? How is it treated?
Initial infection of Herpes simplex virus.
Swelling and lesions of the gingiva (gums) and perioral lesions. Also fever, lymphadenopathy.
Aciclovir
What is herpetic Whitlow?
Herpes simplex infection of the finger
What is the classic triad of symptoms for Infectious Mononucleosis?
Fever
Pharyngitis
Lymphadenopathy
Give two differentials of tonsillitis
Glandular fever
Quinsy
Apart from Fever, pharyngitis and lymphadenopathy give some other symptoms of Glandular fever
Jaundice Macular rash (from ampicillin for sore throat) Splenomegaly palatal petechiae tonsillar exudate
Give three investigations for glandular fever
EBV IgM test
Heterophile antibody test
Bloods show Atypical lymphocytes (lymphocytosis)
Name three topical treatments you may use to treat otitis externa
Earcalm
Otomize
sofradex
What investigations would you consider for a patient presenting with dizziness/vertigo
Otoscopy Neurological exam Blood Pressure (including lying and standing to rule out orthostatic hypotension) Balance system manoeuvres Audiometry
What is the most common cause of vertigo?
Benign Positional Paroxysmal Vertigo (BPPV)
Identify three causes of BPPV
idiopathic
head trauma
ear surgery
Describe the pathophysiology of BPPV
The aetiology causes the otoconia crystals to be displaced into the Semi-circular canals from the utricle.
What are the distinguishing symptoms of BPPV?
Vertigo upon: Looking up Getting up Bending over Turning in bed Lasts under 30seconds Nystagmus
What is the main test for BPPV?
Dix-Hallpike test
What is the mainstay of treatment for BPPV?
Epley Manoeuvre
Name a cause of prolonged vertigo that is often also causes nausea and vomiting. How is it treated?
Vestibular neuronitis
Vestibular sedatives
What is the known pathophysiology associated with Meniere’s disease? How does it present?
Endolymphatic hydrops
Vertigo, Low frequency sensorineural hearing loss, tinnitus
Name a complication of otitis media
Mastoiditis- if untreated possible meningitis
Define Cholesteatoma.
What is the appropriate treatment of this condition?
Keratinizing squamous epithelium within the middle ear cleft
Mastoidectomy
Name the two tuning fork tests
Rinne’s test
Weber’s test
What is otosclerosis?
Gradual onset conductive hearing loss due to fixation of the stapes bone
What is septal haematoma and why is it a medical emergency?
It is the accumulation of blood in the nasal septum resulting in swelling.
It is an emergency because it can lead to ischaemic necrosis of the septal cartilage
Identify four possible complications of nasal bone fracture
epistaxis
CSF leak
Meningitis
Anosmia- cribriform plate fracture
Describe the typical first aid advice for epistaxis
Digital compression of nostrils
ice packs
leaning forward
Following first aid, if necessary what are the other treatments of epistaxis?
Intranasal cautery- diathermy/silver nitrate
Intranasal packing- Rapid-rhino packs
Sphenopalatine artery ligation last resort
Recurrent ______ __________ results in Cauliflower ears. It is treated by…
Pinna Haematoma
aspiration or incision and drainage
What type of fracture is caused by 1.lateral blows and 2. frontal blows to the head?
- longitudinal
2. transverse
What causes conductive hearing loss in Longitudinal fractures and what causes sensorineural hearing loss in transverse fractures
conductive- haemotympanum, ossicle bone damage
sensorineural- vestibulocochlear disruption
How do you treat facial nerve palsy?
Facial nerve decompression
Enophthalamus and teardrop sign on CT are suggestive of what?
Maxillary bone fracture
blowout fracture
The horizontal, pyramidal and transverse fractures of the midface are called what?
Le Fort I, II, and III
How would one manage airway obstruction
ABC Heliox Nebulised steroid Nebulised adrenaline possible tracheostomy
What effectively are hearing aids?
Sound amplifying devices- like miniature loudspeakers, some can reduce background noise
Define Halitosis
Unpleasant breath
What tool is used to look at the nasal cavity?
Oroscope
Neonates are ______ ________ breathers
Obligate nasal
Give an alternative name for snoring sounds which originate from the oropharynx
Stertor
What pathogen most commonly causes acute epiglottitis?
Haemophilus Influenzae type b (Hib)
How is acute epiglottitis treated?
Endotracheal intubation
IV antibiotics
Identify the three steps on the WHO analgesic ladder
1st Adjuvant analgesics
2nd mild Opioids and adjuvant analgesics
3rd moderate Opioids and adjuvant analgesics
What are adjuvant analgesics?
Painkillers who’s primary indication is for something other than pain
Name two types of adjuvant diuretics and two examples of each
Anti-convulsant: gabapentin, pregabalin
Anti-depressant: Amytriptyline, duloxetine
Name 5 types of Rhinitis
Intermittent Rhinitis Persistent Rhinitis Nasal Polyps Vasomotor Rhinitis Infective rhinitis
What triggers intermittent rhinitis and what triggers persistent rhinitis?
Intermittent- Tree and grass pollens, fungal spores
Persistent- Dust mite faeces, Dogs, cat
What does the treatment of allergic rhinitis entail?
1st Allergen avoidance
2nd Antihistamines
3rd topical steroids
4th Antihistamines and topical steroids
Name a virus that is a significant cause of head and neck cancer in the UK
HPV (Human Papilloma Virus)
What is the main type of cancer effecting the head and neck?
Squamous cell carcinoma
What are the most common three bacterial causes of otitis externa?
Pseudomonas
Proteus
Staph aureus
Name four antibiotics used to treat otitis externa
Neomycin
Gentamicin
Polymyxin B
Framycetin
Name two fungal causes of otitis externa
Aspergillus
candida
Name three possible wax solvents (Cerumenolytics)
Sodium bicarbonate
Almond oil
olive oil
Identify three possible side effects of ear drops
Dizziness
Local sensitivity
Ototoxicity- with aminoglycoside antibiotics when TM is perforated
The Paul-Bunnell test and Monospot test are examples of what?
Heterophile tests for Infectious mononucleosis
What does QALYs and ICER stand for?
ICER- Incremental Cost Effectiveness Ratio- used to determine best drug for cost
QALY- Quality Adjusted Life Years- calculation of how many quality of life years potentially shall be gained by having treatment
All The laryngeal muscles are supplied by the _________ ________ nerve apart from the _________ muscle.
Recurrent laryngeal
Cricothyroid
Name the main cause of reinke’s oedema
Smoking
Name the investigation used to provide information about the vocal chords
Stroboscopy
How does Ramsay-Hunt syndrome present? What virus causes this?
Herpetic rash, Bell’s Palsy, tinnitus, hearing loss, vertigo
Varicella zoster virus
Name the ducts of the submandibular gland and the parotid gland
Submandibular- Whartons duct
Parotid- Stensons duct
