Head and Neck/ ENT Flashcards
1
Q
Risk factors for head and neck cancer
A
- >90%= SCC upper aeodigestive tract eg mouth, larynx, pharynx
- Heavy smoking
- Alcohol
- Poor dentition
- HPV-16
- EBV
- Asian (nasopharyngeal)
2
Q
Key features of laryngeal cancer
A
- 2ww: >45y with peristent unexplained hoarseness or unexplained neck lump
- Presentation: ENT and LN examination!
- Hoarse voice >3w
- Cough
- Dysphagia, ‘lump in throat’
- Earache
- Halitosis
- Pain
- Weight loss
- SOB
- Ix- nasendoscopy/ endoscopy, CXR, PET/CT, biopsy
- Tx- chemo/radio/surgery.
3
Q
Key features of mouth and oropharyngeal cancer
A
- 2ww for: ulcer >3w, persistent neck lump. R/v dentist for lump on lip/oral cavity, erythroleukoplakia
- Presentation:
- Dysphagia
- Speech change
- Neck lump
- Nasal obstruction
- Weight loss
- Halitosis
- Reduced jaw movement
- Leukoplaki/ erythroplaki- pre-cancer
- Pain
- Tooth loss
- Persistent ulcer
- Ix;
- Bedside- pic
- Bloods- LFTs, U+Es, FBC, CRP
- Imaging- x-ray, CT, MRI, PET, barium swallow
- Special- LN biopsy
- Tx- chemo, radio, surgery
4
Q
Definition, diagnosis of sinusitis and common organismes
A
- = Rhinosinusitis +/- inflammation of nasal mucosa
- Commonly maxillary sinus
- Organisms- S. pneumoniae, H. Influenza, moraxella catarrhalis. Usually viral.
- Dx:
- Facial pain/ congestion
- Nasal obstruction
- Loss of smell
- +/- headache, fatigue, dental pain, cough, pressure/ fullness in ears, poor response to nasal decongestants
5
Q
Ix and Tx of sinusitis
A
- Ix- usally clinical.
- Bloods- CRP/ESR
- Imaging- X-ray, nasendoscopy, CT, MRI
- Tx:
- Supportive- paracetamol, NSAIDs, nasal decongestants, nasal irrigation, warm pack, fluids, rest
- ABx >5d (amox)
- Surg
6
Q
Presentation, Dx and Tx of tonsillitis
A
- Presentation:
- Voice change
- Sore throat
- Large/red tonsils with exudate
- Headache
- Lymphadenopathy
- Vomiting
- Fever
- Ix- throat swab, monospot
- Centor criteria- Abx if 3/4 of:
- Fever
- Tonsillar exudate
- No cough
- Tender ant. cervical lymphadenopathy
- Tx:
- Cons- analgesia, fluids
- Med- 10d phenoxymethylpenicillin
- Surg- tonsillectomy (>6 this year, >4 prev year)
7
Q
RF and presentation of otitis media
A
- RF: 6-12m (short eustachian tube), male, smoker/ smoker in house, cranio-facial abnormality, cleft lip
- Presentation:
- ++ Fever
- Pain / pulling at ears/ irritable. Pain relieved with perf –> discharge
- Prev. URTI
- Lethargy, malaise
- Rduced balance
- Otoscopy- red/cloudy TM
- Poor feeding
8
Q
Ix, Tx and complications of otitis media
A
- Ix- usually none. ?Swabs, audiometry
- Tx:
- Cons- watchful waiting. Analgesia, fluids
- Med- ABx (amox/clarith) if >3 days, systemically unwell, bilateral
- Complication= mastoidistis- Erythema, swelling, tenderness behind ear –> pushes ear forward. Tx= ENT, IV ABx
9
Q
Key features of otitis media
A
- Inflammation of middle ear with accumulation of fluid. No acute inflamm
- Presentation: Esp 2-7y
- Earache
- Conductive hearing loss –> poor performance at school
- Poor balance
- Recurrent URTIs
- Dull retracted TM with fluid level
- Ix- tympanometry, audiometry
- Tx:
- Cons- self resolving. >3m= val salva
- Surg- Grommets
10
Q
RF and presentation of otitis externa
A
- = Inflammation of external canal
- Types- localised, diffuse, malignant
- RF: immunocompromise, DM, head and neck radio, swimming, elderly
- Precipitating factors- Ear trauma, moisture, chemicals
- Presentation:
- Otalgia
- Discharge
- Conductive hearing loss
- Lyphadenopathy
- Inflammation of canal/ ear drug
- ?? spreding cellulitis, mastoiditis
11
Q
Ix and Tx of otitis externa
A
- Ix- usually none. ?Swab if recurrent/ chronic
- Tx:
- Cons- stop aggravating factor, analgesia, clean ear if affect penetration of topical treatment?
- Med- Topical acetic acid 2% spray –> topical ABx +/- steroids 7-14d
12
Q
Sensorineural hearing loss- causes, Tx
A
- Sensorineural= usually from birth/ infancy. Profound (>95dB). Cochlear/ auditory nerve.
- Genetic
- Antenatal/perinatal- congenital infection, prem, HIE, hyperbilirubinaemia
- Post-natal- meningitis, head injury, drugs (furosemide, aminoglycosides), neurodegeneration, loud noise, vasculitis, stroke, menieres
- More in adults: Ototoxic drugs (vanc, gent, hydroxychloraquin), post- infective (meningitis, measles, mumps, flu, herpes, syphilis), menieres, trauma, acoustic neuroma, B12 def, MS, brain mets, prebycusis
- Tx- teaching support. Early amplification/ cochlear implant
13
Q
Conductive hearing loss- causes, Tx
A
- Abnormalities of ear canal. Max 60dB. Intermittent/ resolves
- Otitis media +/- effusion
- Eustachian tube dyfunction- Down’s, cleft palate, facial hypoplasia
- Wax, foreign body
- Drum perforation
- Neoplasia
- Tx- conservative –> grommets
14
Q
Interpretation of Rinnie’s and Weber’s
A
- Conductive hearing loss:
- Rinnie’s: Bone > Air. Rinnie’s -ve
- Weber’s: Heard in bad ear
- Sensorineural hearing loss:
- Rinnie’s: Air > Bone. Rinnie’s false +ve.
- Weber’s: Heard in good ear
15
Q
Key features of presbycusis
A
- = Most common sensorineural hearing loss in adults
- Age, related, bilar, high frequency SNHL
- Loss of high pitched sounds in 30s –> degeneration
- Hearing loss worse with background noise- can’t hear voices
- Tx- hearing aid
16
Q
Borders of the neck triangles
A
