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Clinical Flashcards

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1
Q

what are the 6 D’s of ear disease?

A
  • deafness
  • discomfort
  • discharge
  • dizziness
  • din din (tinnitus)
  • defective movement of the face
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2
Q

what are the 4 types of deafness?

A

conductive
sensorineural
mixed
central

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3
Q

compare what the tympanic membrane would look like for AOM to OME?

A

AOM- bulging and red

OME- retracted and hypomobile/immobile

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4
Q

what is vertigo?

A

a sensation of movement, usually spinning

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5
Q

What is benign paroxysmal positional vertigo?

A

the feeling of vertigo due to the otoconia moving from the utricle (usual position) to the semicircular canals

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6
Q

what is the most common cause of vertigo on looking up?

A

BPPV

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7
Q

what is the vestibulo-ocular reflex?

A

a reflex which causes the eyes to move in the opposite direction that the head is turned in order to keep an image on the central visual field

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8
Q

in BPPV the otoconia are dislodged from the utricle into the semicircular canals, which one is particularly affected?

A

the posterior semicircular canals

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9
Q

what are the main causes of BPPV?

A

head trauma

ear surgery

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10
Q

what is the Dix Hallpike test?

A

a test to identify benign paroxysmal positional vertigo

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11
Q

what maneouvres can be used to improve BPPV?

A

Epley manoeuvres

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12
Q

what is the purpose of Epley manoeuvres?

A

to get the otoconia out of the semi-circular canals

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13
Q

what is vestibular neuronitis/labyrinthitis?

A

inflammation of the inner ear causing vertigo

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14
Q

what is likely to be the cause of vertibular neuronitis/labyrinthitis?

A

viral aetiology

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15
Q

what is the main difference between vestibular neuronitis and labyrinthitis?

A

no hearing loss or tinnitus with vestibular neuronitis

may have hearing loss or tinnitus with labyrinthitis

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16
Q

what is the duration of BPPV?

A

minutes

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17
Q

what is the duration of menieres?

A

hours

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18
Q

what is the duration of labyrinthitis?

A

days-weeks

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19
Q

what is the duration of vestibular neuronitis?

A

days-weeks

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20
Q

is BPPV associated with hearing loss or tinnitus?

A

no

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21
Q

is menieres associated with hearing loss or tinnitus?

A

yes

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22
Q

is labyrinthitis associated with hearing loss or tinnitus?

A

yes

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23
Q

is vestibular neuronitis associated with hearing loss or tinnitus?

A

no

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24
Q

is BPPV associated with aural fullness?

A

no

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25
is menieres associated with aural fullness?
yes
26
is labyrinthitis associated with aural fullness?
no
27
is vestibular neuronitis associates with aural fullness?
no
28
does BPPV have a clear positional trigger?
yes
29
does menieres disease have a clear positional trigger?
no
30
does labyrinthitis have a clear positional trigger?
no
31
does vestibular neuronitis have a clear positional trigger?
no
32
respiration causes the vocal cords to carry out what movement?
abduction
33
what type of obligate breathers are neonates?
obligate nasal breathers
34
as the radius of a tube decreases, what happens to the work of breathing?
increases | which is why neonates with a small URTI find it very hard to breath
35
what is stertor?
snoring | low pitched noises arising from the nasopharyngeal airway
36
what is a papillomatosis?
HPV infection causing a benign growth
37
what is the most common cause of adult subglottic stenosis?
vasculitis
38
why don't young children tend to break their nose?
because it is still cartilage waiting to ossify
39
what does the cartilage of the nose get it's blood supply from?
perichondrium
40
why after a suspected nasal fracture should there be a 5-7 day wait before review in an ENT clinic?
need the swelling to go down to be able to assess bony contours
41
in a traumatic nose injury, what artery is most likely to bleed causing epistaxis?
anterior ethmoidal artery
42
what type of deafness will haemotympanum cause?
conductive deafness
43
what type of deafness will ossicular chain disruption cause?
conductive deafness
44
what type of deafness does fluid (effusion, blood or CSF) within the middle ear cause?
conductive hearing loss
45
what type of deafness does a TM perforation cause?
conductive hearing loss
46
what is stapes fixation?
otosclerosis of the stapes causing it to become fused to the oval window
47
what type of conductive hearing loss has a normal looking TM?
otosclerosis of stapes (stapes fixation)
48
what is the commonest zone of the neck to be injured?
zone 2
49
what is the zone of neck injury which is least likely to cause catastrophic injury? and why?
zone 2 | because the structures are mobile
50
what is the most common midfacial fracture?
nose
51
what is the second most common midfacial fracture?
orbital floor
52
what does a tear drop sign on CT of the face show?
herniation of orbital contents through the infra-orbital groove
53
what does an air-bone gap on an audiogram suggest?
conductive hearing loss
54
if there is hearing loss, but no air-bone gap on audiogram what does this suggest?
sensorineural hearing loss
55
on an audiogram, a Carhart's notch (at 2000Hz) is seen in what disease?
otosclerosis
56
what is diplopia?
double vision
57
what is Waldeyer's ring?
ring of lymphoid tissue within the oropharynx and nasopharynx
58
what tonsils are involved in Waldeyer's ring?
palatine tonsils pharyngeal tonsils lingual tonsils
59
what is the point of attachment of the palatine tonsils?
plica triangularis
60
what is the name of the space created lateral to the adenoids and posteromedial to the eustachian tube opening?
fossa of rosenmuller
61
where is Gerlach's tonsil?
within the lip of fossa of Rosenmuller
62
what margin does the adenoid extend inferiorly to?
passavants ridge of the superior constrictor
63
compare the mucosa of the pharyngeal tonsils (adenoids) to palatine tonsils?
adenoids- ciliated pseudostratified columnar epithelium with deep folds palatine tonsils- stratified squamous epithelium with deep crypts
64
what is the most common bacterial cause of acute tonsilitis?
GAS
65
why are throat swabs not recommended for acute tonsilitis?
majority is viral in cause | you will end up picking up natural flora
66
how do you empirically treat tonsilitis if it is believed to be bacterial in cause?
10 day course of penicillin 500mg QID | clarithromycin if allergic
67
what is peritonsilar abscess/quinsy?
a complication of acute tonsilitis when the space between the tonsil and muscle becomes infected and produces pus
68
what is the treatment of peritonsilar abscess/quinsy?
aspiration and antibiotics
69
what happens to the uvula in a peritonsilar abscess/quinsy?
displaced away from the midline
70
what is seen of the tonsils of a patient with glandular fever?
gross tonsilar enlargement with 'cheese on toast' appearance- white membranous exudate
71
why must you avoid contact sport for 6 weeks after glandular fever?
to prevent rupturing spleen
72
compare AOM and OME in terms of earache?
AOM- present | OME- absent
73
compare AOM and OME in terms of middle ear effusion?
AOM- may be present | OME- present
74
compare AOM and OME in terms of TM appearance?
AOM- bulging TM | OME- regressed TM
75
compare AOM and OME in terms of TM mobility?
AOM- may have impaired TM mobility | OME- impaired TM mobility
76
compare AOM and OME in terms of hearing loss?
AOM- may have hearing loss | OME- has hearing loss
77
when should you refer a patient with persistent OME with symptoms? (such as deafness, speech impaired, balance issues)
after 3 months
78
what is the surgical management plan for OME greater than 3 months?
3 years old, first intervention: grommets | > 3 years old, second intervention: grommets and adenoidectomy
79
compare the shape of normal lymph nodes to malignant lymph nodes?
normal: oval malignant: round
80
which is the only full ring of cartilage around the trachea?
cricoid cartilage
81
what is the anterior commissure?
where the vocal cords meet
82
for imaging deafness, when is an MRI used compared to CT?
MRI- investigation of sensorineural deafness | CT- investigation of conductive deafness
83
compare the course of the facial nerve to the position of the malleus and incus?
medial to the malleus | lateral to the incus
84
what are the 4 core nasal symptoms?
Stuffy Smell loss Snot Sore
85
what are the 4 other nasal symptoms that are important to ask about on top of the core symptoms?
- sneezing - itch - crusting - epistaxis
86
why might a blocked nose give you a dry mouth and halitosis?
due to obligatory mouth breathing | dry mouth causes bacteria to build up
87
what causes an allergic crease on the nose?
rubbing and itching the nose
88
compare the treatment of allergic rhinitis for symptoms such as itching, sneezing and blocked nose?
itching, sneezing- antihistamines | blocked nose- topical steroid spray
89
what type of asthma are nasal polyps associated with?
non-allergic
90
how do you treat nasal polyps?
oral steroids, then topical steroids if no imporvement: surgery
91
what are the 2 types of non-infective rhinitis?
allergic | non-allergic
92
what are the types of non-infective, non-allergic rhinitis?
vasomotor rhinitis | polyps
93
when someone has been punched, what way is there nasal septum most likely to deviate?
to the right
94
what strains of HPV are high risk for malignant cancer?
16 and 18
95
why do patients with a nasopharyngeal carcinoma often present with conductive hearing loss in one ear?
eustachian tube is blocked by cancer | fluid fills up within middle ear

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