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Year 2 - ENT > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is a septal haematoma? How are they treated?

A

Blood clot forming between the nasal cartilage and the perichondrium e.g. as a result of trauma - disrupts blood supply to cartilage and so an abscess could potentially form

Need to be drained

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2
Q

In the event of a nasal fracture, how is a manipulation performed and when does this need to happen?

A

Manipulation is done under either a local or general anaesthetic

This needs to happen within 2 weeks of the injury, as after 3 weeks the bones will have set into place

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3
Q

What are some of the possible complications associated with a nasal fracture?

A

Epistaxis - particularly the anterior ethmoid artery

CSF leak, possibly resulting in meningitis

Anosmia as a result of a fracture of the cribriform plate

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4
Q

What arteries supply the nasal cavity?

A

Anterior Ethmoidal artery (branch of Opthalmic artery)

Sphenopalatine artery (branch of Maxillary artery)

Greater palatine artery (branch of Maxillary artery)

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5
Q

What is Battle’s sign?

What nerve function needs to be assessed?

A

Sign of possible fracture of the middle cranial fossa e.g. temporal bone and as a result, possible brain trauma

The function of CN VII needs to be assessed as if the fracture is transverse (as opposed to longitudinal) the nerve could be damaged

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6
Q

What has a worse prognosis - longitudinal or transverse fracture of the temporal bone? Which is more common?

What are some of the key features of each?

A

Transverse has a much worse prognosis, but is only 20% of temporal bone fractures

Features of longitudinal fracture

  • 80% of temporal fractures
  • typically caused by lateral blow
  • haemotympanum (causing conductive deafness)
  • ossicular chain disruption (also causing conductive deafness)
  • facial palsy in 20% of patients

Features of transverse fracture

  • 20% of temporal fractures
  • typically caused by frontal blows
  • can cross the internal acoustic meatus causing damage to auditory and facial nerves
  • damage to CN VIII (sensorineural deafness)
  • facial palsy in 50% of patients
  • Vertigo
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7
Q

What type of temporal bone fracture is this?

What kind of hearing loss might it present with, and what is the likelihood of facial palsy?

A

Longitudinal

Might present with conductive hearing loss

Chance of facial palsy - 20%

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8
Q

What type of temporal bone fracture is this?

What kind of hearing loss might it present with, and what is the likelihood of facial palsy?

A

Transverse fracture

Might present with sensorineural hearing loss due to damage of CN VIII

Chance of facial palsy - 50%

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9
Q

What are some causes of conductive hearing loss? Which are the most common causes?

A

Fluid - haemotympanum, glue ear, CSF - most common

Perforation of the tympanic membrane

Ossicular problem

Stapes fixation - otosclerosis - second most common

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10
Q

What are some causes of sensorineural hearing loss?

A

Sensory issue with the cochlea

Neural problem with CN VIII

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11
Q

What are the different zones of the neck? Name some of the structures contained in each zone

In what zone do most traumas occur?

A

Zone I

  • Trachea
  • Oesophagus
  • Thoracic duct
  • Thyroid
  • Spinal cord
  • Vessels - brachiocephalic vein, subclavian, common carotid…

Zone II - most traumas occur here

  • Larynx
  • Hypopharynx
  • CN X, XI and XII
  • Carotids and internal jugular
  • Spinal cord

Zone III

  • Pharynx
  • Cranial nerves
  • Vessels - carotids, internal jugular vein, vertebral artery
  • spinal cord
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12
Q

What feature determines if a neck trauma wound goes straight to A&E or not?

A

If the wound has penetrated through the platysma

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13
Q

Name a couple of conditions associated with adult subglottic stenosis

A

GPA

Oesophageal reflux

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14
Q

Should you intubate someone with severe burns on their face/neck?

A

Yes, do so ASAP! This is because everything will swell up

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15
Q

What is Heliox? Why is it useful?

A

combination of helium (79%) and oxygen (21%) - given in an acute setting for patients with breathing difficulty, easier to take in

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16
Q

What might cause discharge from the ear?

A

Acute otitis media

Chronic otitis media

CSF leak - if the fluid is clear, suspect this. Can be investigated by checking the fluid for presence of glucose

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17
Q

What’s the big question to ask if a patient says they are experiencing dizziness?

A

Do you also have any hearing loss?

If not, likely BPPV, vestibular neuronitis etc.

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18
Q

What is the difference between acute otitis media and otitis media with effusion?

A

Acute OM - pus forms in the eustachian tube, passes through the middle ear and pushes against the TM, causing it to bulge. Most commonly due to viral infection

OME - a.k.a. “Glue Ear”, fluid behind the intact ear drum without the presence of infection. Treatment is watchful waiting for 3 months, and if no improvement after this then insertion of grommets

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19
Q

What is the difference between dizziness and vertigo?

A

Dizziness is a very general, non-specific descriptor

Vertigo is specifically a feeling of movement, usually spinning

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20
Q

How common is dizziness and vertigo?

A

Dizziness is the most common presentation to GPs in patients aged 74 and above

>25% of 50-64 year olds state that they currently suffer from dizziness

By the age of 80, 2/3rds of women and 1/3rd of men will have experienced episodes of vertigo

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21
Q

Based on the duration of vertigo, we can get clues as to the cause. How do the following typically present in terms of duration of vertigo?

  • BPPV
  • Vestibular Neuronitis
  • Meniere’s disease
  • Labyrinthitis
A

BPPV - seconds

Vestibular neuronitis - days-weeks, gradually gets better

Labyrinthitis - days-weeks

Meniere’s disease - >20 mins, often lasting hours

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22
Q

BPPV - duration, associated hearing loss/tinnitus, sensation of aural fullness, clear positional trigger?

A

Duration - seconds

Associated hearing loss or tinnitus - no

Aural fullness - no

Clear positional trigger - yes

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23
Q

Meniere’s - duration, associated hearing loss/tinnitus, sensation of aural fullness, clear positional trigger?

A

Duration - minutes-hours

Associated hearing loss or tinnitus - yes

Sensation of aural fullness - yes

Clear positional trigger - no

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24
Q

Labyrinthitis - duration, associated hearing loss/tinnitus, sensation of aural fullness, clear positional trigger?

A

Duration - days-weeks

Associated hearing loss or tinnitus - yes

Sensation of aural fullness - no

Clear positional trigger - no

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25
Q

Vestibular neuronitis - duration, associated hearing loss/tinnitus, sensation of aural fullness, clear positional trigger?

A

Duration - days-weeks

Associated with hearing loss or tinnitus - no

Sensation of aural fullness - no

Clear positional trigger - no

26
Q

BPPV - causes and pathophysiology

A

Causes - head trauma, ear surgery or idiopathic

Pathophysiology - otilith material from the utricle is displaced into the semicircular canals, most commonly the posterior semicircular canal as this is the lowest point

27
Q

In BPPV, when does vertigo typically occur?

A

On positional changes e.g. looking up, turning in bed, bending forward, rising too quickly etc.

28
Q

What tests and manoeuvres can be performed in the event of BPPV?

A

DIX-Hallpike test to look for classical nystagmus

Epley manoeuvre - attempting to relocate the otilith crystals

Semont manoeuvre

Brandt-Daroff exercises

29
Q

What is the key differentiating feature that separates vestibular neuronitis and labyrinthitis?

A

Vestibular neuronitis typically does not present with hearing loss or tinnitus, however this may present in labyrinthitis

30
Q

How are vestibular neuronitis and labyrinthitis managed?

A

Supportive management, possibly with vestibular sedatives (proclorpenzine, cyclazine)

Typically resolves itself

31
Q

Meniere’s presents with aural fullness and tinnitus, but how does this differ to other causes of vertigo that also present with these?

A

In Meniere’s, the aural fullness and tinnitus is typically unilateral and only presents on the affected side

Tinnitus also gets gradually worse

32
Q

Name some risk factors associated with developing head and neck cancer

A

Tobacco

Alcohol

Viruses e.g. EBV

Betel nut - chewed in India, causes oral cancers

Hardwood

33
Q

When inspecting inside the mouth, why is it important to check the sides of the mouth thoroughly?

A

Because most cancers occur on the buccal mucosa

34
Q

What routine investigations are performed if a cancer of the head or neck is suspected?

A

Fine Needle Aspiration

Endoscopy/biopsy

Radiology e.g. CT, be sure to scan head, neck and the chest to look for secondary metastases

(bloods) - of little value, no reliable markers

35
Q

19 year old student comes in with a sore throat that she has had for the last 3 days. O/E - throat is red and inflamed with a small amount of exudate over the tonsils. Patient also complains of feeling tired all the time and has cervical lymphadenopathy. Blood film shows large, atypical lymphocytes.

  • diagnosis?
  • causative organism?
  • tests to confirm?
  • why would you not prescribe amoxicillin?
A

Diagnosis - infectious mononucleosis

Organism - Epstein-Barr Virus

Tests - IgM is best, but also Paul-Bunnell test (slow) and monospot (lots of false +ves)

Amoxicillin not prescribed because condition is caused by a virus, and there is also some suggestion that Amox. + EBV can result in a rash developing

36
Q

What organisms can cause otitis externa? (fungal and bacterial)

What’s the treatment?

What complication could potentially occur?

A

Fungal causes - Candida albicans, Aspergillus niger

Bacterial causes - Staph aureus, Pseudomonas aeruginosa

Treatment - Clean ears, keep dry, possibly co-trimoxazole ear drops

Complication - malignant otitis externa

37
Q

14 year old girl presents with a very painful sore throat and difficulty swallowing. O/E - throat is very red and inflamed with pus on the tonsils. She has cervical lymphadenopathy and appears flushed. Temp is 38.5.

  • What condition does she likely have?
  • What scoring criteria is used?
  • What’s the treatment?
A

Condition - Tonsillitis caused by Strep throat

Scoring criteria - CENTOR

Treatment - penicillin

38
Q

If a patient with tonsillits develops a peritonsilar abscess (quinsy), how does their management change?

What other potential complications could occur as a result of Strep throat?

A

Abscess needs to be drained

Although much rarer, complications include Rheumatic fever and Glomerulonephritis (IgA nephropathy)

39
Q

2 year old presents to GP with difficulty eating for the past 24 hours. He had developed sudden fever the night before without any other systemic flu-like symptoms. Mother noticed some papules - appearing on his hand and on his foot. Patient then developed severe ache in legs, itching over the papules and difficulty eating.

O/E - febrile with a body temp of 39 degrees. Oral exam showed multiple reddish macules on the roof of the hard palate.

Diagnosis?

What other condition is part of this family of pathogens?

A

Hand, Foot and Mouth disease caused by Coxsackie virus

This is an enterovirus, as is Polio virus

40
Q

What classification system is used to grade allergic rhinitis?

A

ARIA classification - based on duration and severity

Severity

  • Mild - normal sleep, no impairment of daily activity, sport or leisure
  • Moderate/severe - change in more than one of the above

Duration

  • Intermittent - <4 days a week OR <4 weeks duration
  • Persistent - >4 days a week OR >4 weeks duration
41
Q

Describe the stepwise approach to treating allergic rhinitis

A
  1. Initially treat with antihistamines (cetirizine, ranitidine, loratidine) or with intra-nasal decongestant spray/oral decongestant
  2. Then progress to using topical (intra-nasal) steroids
  3. Then progress to using both antihistamines and topical steroids

(Immunotherapy can also be used for selected patients with IgE-mediated disease)

At all stages, allergen avoidance is also done

(Leukotriene-receptor antagonists may also be used if the patient also suffers from asthma)

42
Q

How would you treat someone with mild intermittent allergic rhinitis?

A

Oral/Local non-sedative H1-Blocker (certirizine, loratidine)

Intra-nasal decongestant spray/oral decongestant

(maybe use LTRAs)

Avoidance of allergy/irritant

43
Q

How would you treat someone with moderate/severe intermittent allergic rhinitis?

A

Topical intranasal steroids

Can add on antihistamines if need be

44
Q

How would you treat someone with mild, or moderate/severe persistent allergic rhinitis?

A

As with someone with mild/moderate/severe intermittent - antihistamines, decongestants, topical steroids

Would also consider the use of immunotherapy

NB - leukotriene receptor antagonists are useful if the patient also has concomitant asthma

45
Q

What side-effect of decongestants is worth bearing in mind when using them?

A

Use for less than 10 days - prolonged use can precipitate congestion

46
Q

What condition are nasal polyps commonly associated with? How are they managed?

A

Commonly associated with non-allergic rhinitis

Managed with oral, then topical steroids.

May require surgery

47
Q

What complication may develop in someone with acute infective rhinosinusitis? Which group of patients is this more common in?

A

May develop into orbital cellulitis

More commonly seen in children

48
Q

How can rhinitis broadly be broken down?

A

Infective vs Non-infective

Non-infective

  • Allergic
    • Intermittent
    • Persistent
  • Non-allergic
    • Vasomotor rhinitis
    • Nasal polyps

Infective

  • Rhinosinusitis (98% are viral so likely no use for antibiotics)
49
Q

How is allergic rhinitis diagnosed, if suspected based on clinical presentation?

A

Skin-prick test (might prompt anaphylaxis and can’t be done if the patient is on certain medications)

Radioallergosorbent test (RAST) to determine specific antigen

50
Q

Sore throat - viral causes?

A

Rhinovirus

Adenovirus

Coronavirus

Herpes Simplex Virus

EBV

51
Q

Sore throat - bacterial causes?

A

Strep pyogenes/pneumoniae (GAS)

Chlamydia pneumoniae

Haemophilus influenzae

Neisseria meningitides and gonorrhoae

Mycoplasma pneumoniae

52
Q

What is the difference between a live-attenuated and an inactivated vaccine?

A

Live-attenuated - strains of a pathogen are repeatedly grown until a less virulent strain is produced

Inactivated (killed) - toxin produced by the organism is used to make the vaccine after inactivation

53
Q

Give some examples of live-attenuated vaccines

A

BCG

MMR

Oral polio vaccine

Chicken pox

Influenze

Rotavirus

54
Q

Give some examples of inactivated vaccines

A

Polio

Influenza

Hepatitis A and B

Tetanus

Diptheria

Pertussis

HPV

55
Q

Which nerves supply the following muscles

  • Tensor tympani
  • Stapedius
A

Tensor tympani - CN V3

Stapedius - CN VII

56
Q

Name the arteries indicated

A

Going clockwise…

Supraorbital

Maxillary

Facial

External carotid

Internal carotid

57
Q

Answer the following with regards to dizziness and vertigo…

  1. Most likely diagnosis for vertigo lasting just seconds to minutes
  2. Most likely diagnosis for vertigo lasting 20 minutes to several hours
  3. Condition(s) associated with hearing loss and/or Tinnitus
  4. Most likely diagnosis for vertigo lasting days-weeks
  5. BPPV is usually triggered by…?
A
  1. BPPV
  2. Meniere’s
  3. Labyrinthitis and Meniere’s
  4. Labyrinthitis and Vestibular neuronitis
  5. Postional changes
58
Q

Answer the following with regards to neck lumps…

  1. Usually a lump located between isthmus of thyroid and hyoid bone
  2. The most common cause of neck swellings
  3. Moves upwards on swallowing
  4. Most commonly seen in older men
  5. Rarely, patient may report pain when drinking alcohol.
  6. Usually present within the first 2 years of life
  7. Neck lump that is associated with dysphagia, aspiration and chronic cough
  8. Pulsatile lateral neck lump
A
  1. Thyroglossal cyst
  2. Reactive lymphadenopathy
  3. Goitre
  4. Pharyngeal pouch (see pic)
  5. Hodgkin’s disease
  6. Cystic hygroma
  7. Pharyngeal pouch
  8. Carotid aneurysm
59
Q

Answer the following with regards to ENT infections…

  1. Produces a potent exotoxin
  2. Common bacterial cause of Otitis media
  3. The pathogen that causes glandular fever
  4. Most common cause of Otitis externa
A
  1. Corynebacterium diptheriae
  2. Haemophilus influenzae
  3. EBV
  4. Staph aureus
60
Q

In a patient presenting with a very sore throat, feelings of lethargy and malaise, and the following appearance of their throat, what is the most likely diagnosis?

A

Glandular fever

Year 2 - ENT (3 decks)

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