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Clinical Flashcards

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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
What are the causes of sensorineural hearing loss?
Presbyacius, noise exposure, head injury, ototoxic meds, acoustic neuroma, viral infection
26
What is the management for sensorineural hearing loss?
Hearing aid
27
What is the normal result from pure tone audiometry?
Better than 20dB
28
What are type A, B and C results in audiometry.
``` A = normal B = low middle ear compliance C = low middle ear pressure ```
29
What is a complication of a auricular haematoma?
Cauliflower ear
30
What is the management of otitis externa?
Antibiotic/steroid ear drops
31
What is "glue ear"?
Sterile fluid in middle ear
32
How does otitis media with effusion present?
Hearing loss and speech delay
33
What is the management of otitis media?
Observe for 3 months Otovent (balloon) Grommet
34
What is acute suppurative otitis media?
Pus in middle ear
35
How does acute suppurative otitis media present?
Otalgia +/- otorrhea
36
What is the management of acute suppurative otitis media?
Observation =/- amoxicillin
37
What is chronic suppurative otitis media?
Long term discharge from ear with perforated tympanic membrane or cholesteatoma
38
Name complications from chronic suppurative otitis media.
"dead ear" (spread into cochlea or semi-circular canals) Facial palsy Meningitis Brain abscess
39
What is tympanosclerosis?
Calcification of tympanic membrane
40
What is otosclerosis?
Fixation of stapes by extra bone. Conductive hearing loss
41
What are the differential diagnoses for vertigo?
Bening positional vertigo Vestibular Neuritis/labrynthitis Meniere's Disease Migraine
42
What causes benign positional vertigo?
Otoconia in semi-circular canals
43
What are the symptoms of benign positional vertigo?
Vertigo from specific changes in head movement Lasts seconds Positional and rotatory nystagmus
44
What test is used for benign positional vertigo?
Dix-hallpike test
45
What is the management of benign positional vertigo?
Epley manoevre
46
What causes vestibular neuritis?
Reactivation of latent HSV of vestibular ganglion
47
What are the symptoms of vestibular neuritis?
Spontaneous vertigo Associated unilateral hearing loss Duration = days Horizontal nystagmus towards affected ear then aways as slows
48
What is the management of vestibular neuritis?
``` Acute = vestibular sedatives Chronic = vestibular rehab ```
49
What is the cause of Meniere's Disease?
Endolymphatic hydropolyps
50
What are the symptoms of Meniere's Disease?
Spontaneous vertigo Associated unilateral hearing loss/tinnitus Aural fullness Duration = hours
51
What is the management of Meniere's Disease?
Bendroflumethazide Intratympanic dexamethasone Intratympanic gentamicin
52
Describe Bell's palsy.
Low motor neuron palsy (forehead involved)
53
What is the treatment for Bell's palsy?
Treat underlying cause Prednisolone Eye care
54
What is the common PMH in rhinology patients?
Medical treatment, nasal surgery, nasal trauma, asthma/aspirin sensitivity
55
What are the examination techniques in rhinology?
Anterior rhinoscopy | Nasal endoscopy
56
What investigations are carried out in rhinoscopy?
Bloods - FBC, ANCA, ESR, ACE, RAST CT/MRI Skin tests Rhinomanometry
57
What organisms are responsible for acute rhinosinusitis?
Strep pneumoniae | H influenzae
58
What are the antimicrobial choices for rhinosinusitis?
B-lactams (penicillins, cephalosporins) | Macrolides (erythromycin, clarithromycin)
59
What are the causes of nasal polyps?
Allergy Chronic inflammation AND dysfunction Genetic predisposition
60
What investigations are carried out for nasal polyps?
``` Sweat test RAST Nasal smear Coronal CT Flexible nasendoscopy ```
61
What is the treatment for nasal polyps?
Oral and nasal steroids Immunotherapy Diet Surgery - traditional polypectomy, microdebrider
62
What is the name for frontal sinusitis?
Pott's puffy tumour
63
Where is the most common site for injury of mandible?
Condyle
64
What scan is carried out for a mandible fracture?
OPG and PA mandible (need imaging in 2 planes)
65
What grading system is used for maxilla fractures?
Le fort (1,2,3)
66
How is facial deformity described?
Class 1 = normal Class 2 = lower jaw forward Class 3 = small jaw
67
What are the main causes of oral cavity cancer?
Whiskey and smoking, HPV (17 and 18)
68
What is the main histological type of oral cavity cancer?
Squamous cell carcinoma
69
What are the features of oral cavity cancer?
Painless lesion, induration, red and white patches, ulcerations
70
What is otorrhea?
Ear discharge
71
What techniques are used for hearing tests for 6-18 months?
Distraction testing
72
What techniques are used for hearing tests for 12 months -3 years?
Visual reinforced audiometry
73
What techniques are used for hearing tests for 3-5 years?
Play audiometry
74
What techniques are used for hearing tests for 4+ years?
Pure tone audiometry
75
What is the most common cause of hearing loss in children?
Otitis media with effusion
76
What are the signs of otitis media in children?
Dull TM, fluid level, bubbles
77
What is the treatment for otitis media with effusion in children?
Otovent (balloon) or grommet
78
What causes otitis media with effusion in children?
Eustachian tube dysfunction, adenoidal hypertrophy, resolving AOM
79
What are the common causes of otorrhea in children?
Otitis externa, acute otitis media, chronic otitis media (cholesteatoma)
80
What is the treatment for acute otitis media in children (commonly aged 3-18m)?
Co-amoxiclav, grommets + adenoidectomy if recurrent
81
What complication can arise from acute otitis media in children?
Mastoiditis
82
What are the common causes of blocked, runny nose in children?
Rhinitus, large adenoids (check for sleep apnoea), sinusitis, polyps, choanal atresia (bilateral/unable to breathe)
83
What is the most common cause of epistaxis in children?
Digital trauma
84
What are the treatment options for epistaxis in children?
Pinch little's area and lean forward Abx ointments - naseptin, bactroban Cautery - silver nitrate under LA or diathermy under GA Nasal packing
85
What are the main pathogens that can cause tonsillitis?
Bacterial (b haem strep B) | Viral (EBV)
86
Name a complication of tonsillitis.
Peritonsilar abscess
87
What is an allergy?
Hypersensitivity disorder of the immune system
88
Why is allergy on the rise?
``` More processed food Obesity Climate change Sedentary lifestyle Cleaner environments ```
89
What are the risk factors for allergy?
Host factors - FH, Race, Age Environmental Occupational
90
What is an allergen?
An antigen that causes an allergic reaction
91
What are the signs of an allergy?
Skin: urticaria/angioedema URT: rhinitus LRT: Asthma Systemic: anaphylaxis
92
What antibodies are responsible for the immediate reaction in allergic rhinitis?
IgE (then mast cells, then degranulation and histamine release)
93
What classification system is used for allergies?
ARIA
94
Describe the ARIA classification system.
``` 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
What tests are used to diagnose allergies?
``` Skin test (high NPV) RAST (IgE levels) ```
96
What is the treatment for allergy?
Allergy avoidance | Topical intranasal steroids, systemic steroids, antihistamines, sodium cromoglycate, allergen immunotherapy, anti-IgE
97
What are the main avoidable factors that can affect global visual impairment?
Clean water access Vit deficiency UV exposure Poor sanitation
98
What is the leading cause of blindness in the world?
Cataract (39%)
99
What is the leading cause of visual impairment in the world?
Uncorrected refractive error
100
What is the second leading cause of blindness/VI in the world?
Glaucoma
101
What is the treatment for corneal opacity/scarring?
Surgery Antibiotics Facewashing Environmental
102
What causes river blindness (onchocerciasis)?
Transmitted via blackly larvae
103
What hearing measurement is classed as disabling hearing loss?
>40dB in adults
104
What maternal infections can cause congenital hearing loss?
Rubella, syphillis, birth asphyxia
105
What are DALYs?
Disability Adjusted Life Years
106
What is the most common cause of death world wide?
Neurological and cerebrovascular

Head and Neck (2 decks)

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