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Head and Neck > Clinical > Flashcards

Clinical Flashcards

1
Q

What are common presenting symptoms?

A

Odynophagia, dysphonia, dysphagia, mouth/throat ulcer, neck lump

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2
Q

What are import factors to consider during history taking?

A

Smoking
Alcohol
Family History

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3
Q

What is a thyroid bruit a sign of?

A

Grave’s disease

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4
Q

What is a carotid bruit a sign of?

A

Carotid stenosis

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5
Q

What is the first line radiological examination in head and neck

A

FNAC

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6
Q

What are the 7 S’s for examining neck lumps?

A 
Site 
Size
Shape
Sore
Skin
Stuck
Soft
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7
Q

What are the signs of a reactive lymph node?

A

oval, soft, smooth, mobile, tender

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8
Q

What are the causes of hoarseness?

A

Nodules, cysts, vocal abuse, laryngitis, laryngeal cancer, smoking, reflux

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9
Q

If dysphagia with liquids. What does this suggest?

A

Neurological problem

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10
Q

If dysphagia with solids. What does this suggest?

A

Narrowing

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11
Q

In 90% of H&N cancers, what is the histology?

A

Squamous carcinoma

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12
Q

What are the features of a malignant neck node?

A

Round, firm, irregular, fixed, non-tender

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13
Q

What are the causes of stridor?

A

infection
tumour
foreign body

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14
Q

What is the treatment for stridor?

A 
ABC
Intubate or FONA
Humidified 02
Adrenaline nebuliser
Steroids
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15
Q

What are the symptoms and signs of tonsillitis?

A

Pus covering nodes, fever, no cough
6-7 attacks/year
Disrupting daily activities
More than 1 quinsy (peritonsilar abscess)

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16
Q

What are common imaging modalities used in ENT?

A 
Plain radiograph
OPG
Saliogram
Barium swallow
Videofluoroscopy
Ultrasound
FNAC
CT
MRI
Sestamibi parathyroid scintigraphy
PET
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17
Q

What are the 6 common symptoms on otology?

A 
Hearing loss
Otalgia
Tinnitis
Vertigo
Otorrhoea
Facial weakness
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18
Q

What are the standard ear examinations?

A

Otoscopy
Microscopy
Tuning fork tests

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19
Q

What are the advantages of microscopy?

A

Magnification, 3D, Suction

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20
Q

What are the tuning fork tests?

A

Rinne’s and Weber’s

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21
Q

What are the signs of a conductive hearing loss in right ear?

A 
Rinne's = bone > ear (-ve)
Weber's = right > left
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22
Q

If bone conduction is greater than ear conduction what does this suggest?

A

Problem with outer or middle ear

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23
Q

If air conduction is greater than bone conduction what does this suggest?

A

Normal or inner ear problem

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24
Q

If sensorineural hearing loss in left ear, what will be the findings with Weber’s test?

A

Right louder than left

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25
Q

What are the causes of sensorineural hearing loss?

A

Presbyacius, noise exposure, head injury, ototoxic meds, acoustic neuroma, viral infection

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26
Q

What is the management for sensorineural hearing loss?

A

Hearing aid

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27
Q

What is the normal result from pure tone audiometry?

A

Better than 20dB

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28
Q

What are type A, B and C results in audiometry.

A 
A = normal
B = low middle ear compliance
C = low middle ear pressure
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29
Q

What is a complication of a auricular haematoma?

A

Cauliflower ear

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30
Q

What is the management of otitis externa?

A

Antibiotic/steroid ear drops

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31
Q

What is “glue ear”?

A

Sterile fluid in middle ear

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32
Q

How does otitis media with effusion present?

A

Hearing loss and speech delay

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33
Q

What is the management of otitis media?

A

Observe for 3 months
Otovent (balloon)
Grommet

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34
Q

What is acute suppurative otitis media?

A

Pus in middle ear

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35
Q

How does acute suppurative otitis media present?

A

Otalgia +/- otorrhea

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36
Q

What is the management of acute suppurative otitis media?

A

Observation =/- amoxicillin

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37
Q

What is chronic suppurative otitis media?

A

Long term discharge from ear with perforated tympanic membrane or cholesteatoma

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38
Q

Name complications from chronic suppurative otitis media.

A

“dead ear” (spread into cochlea or semi-circular canals)
Facial palsy
Meningitis
Brain abscess

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39
Q

What is tympanosclerosis?

A

Calcification of tympanic membrane

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40
Q

What is otosclerosis?

A

Fixation of stapes by extra bone. Conductive hearing loss

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41
Q

What are the differential diagnoses for vertigo?

A

Bening positional vertigo
Vestibular Neuritis/labrynthitis
Meniere’s Disease
Migraine

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42
Q

What causes benign positional vertigo?

A

Otoconia in semi-circular canals

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43
Q

What are the symptoms of benign positional vertigo?

A

Vertigo from specific changes in head movement
Lasts seconds
Positional and rotatory nystagmus

44
Q

What test is used for benign positional vertigo?

A

Dix-hallpike test

45
Q

What is the management of benign positional vertigo?

A

Epley manoevre

46
Q

What causes vestibular neuritis?

A

Reactivation of latent HSV of vestibular ganglion

47
Q

What are the symptoms of vestibular neuritis?

A

Spontaneous vertigo
Associated unilateral hearing loss
Duration = days
Horizontal nystagmus towards affected ear then aways as slows

48
Q

What is the management of vestibular neuritis?

A 
Acute = vestibular sedatives
Chronic = vestibular rehab
49
Q

What is the cause of Meniere’s Disease?

A

Endolymphatic hydropolyps

50
Q

What are the symptoms of Meniere’s Disease?

A

Spontaneous vertigo
Associated unilateral hearing loss/tinnitus
Aural fullness
Duration = hours

51
Q

What is the management of Meniere’s Disease?

A

Bendroflumethazide
Intratympanic dexamethasone
Intratympanic gentamicin

52
Q

Describe Bell’s palsy.

A

Low motor neuron palsy (forehead involved)

53
Q

What is the treatment for Bell’s palsy?

A

Treat underlying cause
Prednisolone
Eye care

54
Q

What is the common PMH in rhinology patients?

A

Medical treatment, nasal surgery, nasal trauma, asthma/aspirin sensitivity

55
Q

What are the examination techniques in rhinology?

A

Anterior rhinoscopy

Nasal endoscopy

56
Q

What investigations are carried out in rhinoscopy?

A

Bloods - FBC, ANCA, ESR, ACE, RAST
CT/MRI
Skin tests
Rhinomanometry

57
Q

What organisms are responsible for acute rhinosinusitis?

A

Strep pneumoniae

H influenzae

58
Q

What are the antimicrobial choices for rhinosinusitis?

A

B-lactams (penicillins, cephalosporins)

Macrolides (erythromycin, clarithromycin)

59
Q

What are the causes of nasal polyps?

A

Allergy
Chronic inflammation
AND dysfunction
Genetic predisposition

60
Q

What investigations are carried out for nasal polyps?

A 
Sweat test 
RAST
Nasal smear
Coronal CT
Flexible nasendoscopy
61
Q

What is the treatment for nasal polyps?

A

Oral and nasal steroids
Immunotherapy
Diet
Surgery - traditional polypectomy, microdebrider

62
Q

What is the name for frontal sinusitis?

A

Pott’s puffy tumour

63
Q

Where is the most common site for injury of mandible?

A

Condyle

64
Q

What scan is carried out for a mandible fracture?

A

OPG and PA mandible (need imaging in 2 planes)

65
Q

What grading system is used for maxilla fractures?

A

Le fort (1,2,3)

66
Q

How is facial deformity described?

A

Class 1 = normal
Class 2 = lower jaw forward
Class 3 = small jaw

67
Q

What are the main causes of oral cavity cancer?

A

Whiskey and smoking, HPV (17 and 18)

68
Q

What is the main histological type of oral cavity cancer?

A

Squamous cell carcinoma

69
Q

What are the features of oral cavity cancer?

A

Painless lesion, induration, red and white patches, ulcerations

70
Q

What is otorrhea?

A

Ear discharge

71
Q

What techniques are used for hearing tests for 6-18 months?

A

Distraction testing

72
Q

What techniques are used for hearing tests for 12 months -3 years?

A

Visual reinforced audiometry

73
Q

What techniques are used for hearing tests for 3-5 years?

A

Play audiometry

74
Q

What techniques are used for hearing tests for 4+ years?

A

Pure tone audiometry

75
Q

What is the most common cause of hearing loss in children?

A

Otitis media with effusion

76
Q

What are the signs of otitis media in children?

A

Dull TM, fluid level, bubbles

77
Q

What is the treatment for otitis media with effusion in children?

A

Otovent (balloon) or grommet

78
Q

What causes otitis media with effusion in children?

A

Eustachian tube dysfunction, adenoidal hypertrophy, resolving AOM

79
Q

What are the common causes of otorrhea in children?

A

Otitis externa, acute otitis media, chronic otitis media (cholesteatoma)

80
Q

What is the treatment for acute otitis media in children (commonly aged 3-18m)?

A

Co-amoxiclav, grommets + adenoidectomy if recurrent

81
Q

What complication can arise from acute otitis media in children?

A

Mastoiditis

82
Q

What are the common causes of blocked, runny nose in children?

A

Rhinitus, large adenoids (check for sleep apnoea), sinusitis, polyps, choanal atresia (bilateral/unable to breathe)

83
Q

What is the most common cause of epistaxis in children?

A

Digital trauma

84
Q

What are the treatment options for epistaxis in children?

A

Pinch little’s area and lean forward
Abx ointments - naseptin, bactroban
Cautery - silver nitrate under LA or diathermy under GA
Nasal packing

85
Q

What are the main pathogens that can cause tonsillitis?

A

Bacterial (b haem strep B)

Viral (EBV)

86
Q

Name a complication of tonsillitis.

A

Peritonsilar abscess

87
Q

What is an allergy?

A

Hypersensitivity disorder of the immune system

88
Q

Why is allergy on the rise?

A 
More processed food
Obesity 
Climate change
Sedentary lifestyle
Cleaner environments
89
Q

What are the risk factors for allergy?

A

Host factors - FH, Race, Age
Environmental
Occupational

90
Q

What is an allergen?

A

An antigen that causes an allergic reaction

91
Q

What are the signs of an allergy?

A

Skin: urticaria/angioedema
URT: rhinitus
LRT: Asthma
Systemic: anaphylaxis

92
Q

What antibodies are responsible for the immediate reaction in allergic rhinitis?

A

IgE (then mast cells, then degranulation and histamine release)

93
Q

What classification system is used for allergies?

A

ARIA

94
Q

Describe the ARIA classification system.

A 
Intermittent = symptoms <4 days/week
Persistent = > 4 days/week and ?4 consecutive weeks
Mild = normal sleep, no impairment of ADLs
Moderate-severe = one or more of: sleep disturbance, impaired ADLs, sport, leisure, school, work, troublesome symptoms
95
Q

What tests are used to diagnose allergies?

A 
Skin test (high NPV)
RAST (IgE levels)
96
Q

What is the treatment for allergy?

A

Allergy avoidance

Topical intranasal steroids, systemic steroids, antihistamines, sodium cromoglycate, allergen immunotherapy, anti-IgE

97
Q

What are the main avoidable factors that can affect global visual impairment?

A

Clean water access
Vit deficiency
UV exposure
Poor sanitation

98
Q

What is the leading cause of blindness in the world?

A

Cataract (39%)

99
Q

What is the leading cause of visual impairment in the world?

A

Uncorrected refractive error

100
Q

What is the second leading cause of blindness/VI in the world?

A

Glaucoma

101
Q

What is the treatment for corneal opacity/scarring?

A

Surgery
Antibiotics
Facewashing
Environmental

102
Q

What causes river blindness (onchocerciasis)?

A

Transmitted via blackly larvae

103
Q

What hearing measurement is classed as disabling hearing loss?

A

> 40dB in adults

104
Q

What maternal infections can cause congenital hearing loss?

A

Rubella, syphillis, birth asphyxia

105
Q

What are DALYs?

A

Disability Adjusted Life Years

106
Q

What is the most common cause of death world wide?

A

Neurological and cerebrovascular

Head and Neck (2 decks)

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