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Conditions Flashcards

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1
Q

Which intracerebral haemorrhage has a lucid interval?

A

Extradural haemorrhage

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2
Q

What intracerebral haemorrhage typically has a midline shift of the falx cerebri?

What vessel is haemorrhaged?

A

Subdural

Bridging veins

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3
Q

What is dangerous about getting an infection in the danger triangle of the face?

A

Infection in the venous system in this triangle (as it is valveless), it will drain back into the dural venous sinus and cause an infection there

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4
Q

If there is a bleed in the loose connective tissue of the scalp, what sign will you see?

A

Periorbital ecchymosis

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5
Q

If there is a bleed in the petrous bone what signs would you see?

A

Mastoid ecchymosis and haemotympanum (blood behind the eardrum)

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6
Q

How does CSF rhinorrhea come about?

A

Crista galli fractured, so falx cerebri pulled from crista galli so CSF in subarachnoid space leaks through the cribriform plate to the nasal cavity

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7
Q

How does a branchial cyst come about?

A

When the 2nd pharyngeal arch grows down to obliterate the other pharyngeal clefts, a cervical sinus (made from ectoderm) is made. This should eventually close but if it persists, a branchial cyst will form

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8
Q

Describe how alcohol effects in the embryological development, thus leading to foetal alcohol syndrome

A

Neural tube doesn’t develop and neural crest cells don’t migrate to populate the pharyngeal arches

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9
Q

What signs would you see in a patient with foetal alcohol syndrome?

5

A 
Smooth philtrum
Flat mid face
Small eyes
Thin upper lip
Small head
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10
Q

How does

A) cleft lip and
B) cleft palate

come about?

A

Cleft lip: Failure of fusion of maxillary and medial nasal prominences

Cleft palate: **, along with failure of fusion of palatal shelves in the MIDLINE

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11
Q

If you get uncal herniation (as a result of raised intracranial kpa), which part of which cranial nerve is most likely to be effected?

What motor effects will this have

A

Parasympathetic fibres (on the periphery) of the oculomotor nerve will first be compressed

So sphincter pupillae will lose its innervation so pupils will remain dilated. Ciliary body will also be affected.

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12
Q

Which cranial nerve lesion leads to diplopia when reading/walking down the stairs?

What muscle is defected?

A

Trochlear nerve CN IV

Superior oblique

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13
Q

How do you correct diplopia caused by a trochlear nerve lesion?

A

Tilt head back

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14
Q

What is an acoustic neuroma?

Give 4 signs/symptoms.

A

Benign tumour of the Schwann cells surrounding CN VIII.

Unlilateral hearing loss - cochlear nerve
Tinnitus
Vertigo - vestibular nerve
Pain, numbness down one half of face

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15
Q

What leads to partial ptosis in Horner’s Syndrome?

A

Levator palpebrae superioris and Superior tarsal muscle both raise the eyelid.

LPS is innervated by oculomotor nerve (NOT the peripheral parasympathetic fibres on CN III) so this muscle and nerve is unaffected.

Superior tarsal muscle is innervated by sympathetic nerve and this muscle is paralysed due to the sympathetic trunk being compressed.

Thus have PARTIAL ptosis.

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16
Q

How do you do an intubation?

A

Put tip of object in vallecula to keep tongue forwards and lift epiglottis. Now tub can go through rima glottidis to enter the infraglottis

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17
Q

Give a reason for why you may not be able to intubate a patient, and what would you do in this situation - given that they cannot breath.

And how would you do this procedure?

Why would you do this procedure?

A

Inflammed (true) vocal cord

Do a cricothyroidotomy.

Make an incision in the cricothyroid ligament (below the true VC) so air can move via the infraglottis as the vocal cords are blocking the movement of air

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18
Q

How would you differentiate between a recurrent laryngeal nerve lesion or an external superior laryngeal nerve lesion?

A

With a recurrent laryngeal nerve lesion you have a defective cough reflex and a hoarse voice, whereas with an external superior laryngeal nerve lesion, you only get a hoarse voice

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19
Q

Give 4 signs of a patient with an upper airway obstruction

A

Distress
Cyanois +/- hypoxia
Hyperventilation
Stridor (on inspiration)

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20
Q

Croup is a self-limiting illness, becoming worse within 48 hours and then gradually improving.

What is croup?

A

Laryngotracheobronchitis (another name for Croup) is a viral infection (of typically Type 1 Parainfluenza virus) leading to inflammation of the larynx, trachea, and bronchus, including the vocal cords - thus leading to exudate formation

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21
Q

What triad do you typically see with croup?

A

Harsh barking cough (due to stiff glottis), inspiratory stridor and hoarse voice

(Pt may also have a fever; reduced oral liquid intake; SOB)

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22
Q

As croup is typically caused by a viral infection, how is it treated?

A: typical case - self limiting

B: severe case - hospitalisation

Include doses

A

Pain and fever - Paracetamol or Ibuprofen

Corticosteroids: Single Oral dose of Dexamathasone (0.15mg/kg)

Severe case: 
- Nebulised Budesonide (ICS) (2mg nebulised as a single dose) or IM Dexamethasone (0.6mg/kg)
If needed:
- Oxygen
- Dehydration: Iv fluids
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23
Q

If you have pain in the middle ear, why can this pain be referred to the oropharynx?

A

Oropharynx and middle ear are both innervated by the glossopharyngeal nerve (general sensation function)

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24
Q

If you have pain in the external ear, why can this pain be referred to the jaw?

A

Auriculotemporal nerve innervates the temporomandibular joint and external ear (general sensation function)

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25
How do you straighten the ear canal so you can view the lateral tympanic membrane with an otoscope?
Hold auricle back, up then out
26
Name 4 pathologies in the external/middle ear that would lead to conductive hearing loss
WOOA Wax Otitis media with effusion Otosclerosis Acute Otitis media
27
Name 5 pathologies in the internal ear that would lead to sensorineural hearing loss
``` Presbycusis Noise-related hearing loss Meniere’s disease Ototoxic medication Acoustic neuroma ```
28
What bacteria cause otitis externa (infection)? Which one is more common?
Pseudomonas aeruginosa>Staphylococcus aureus
29
Although acute otitis media (infection) is commonly caused by a virus, what bacteria can also cause it? Which one is more common?
Haemophilus influenzae>Streptococcus pneumoniae
30
What untreated infection can lead to mastoiditis?
Acute otitis media
31
With what ear pathology do you have a retracted tympanic membrane?
Otitis media with effusion (glue ear)
32
What can an untreated otitis media with effusion cause? And describe what this pathology is
Cholesteatoma (cyst) 1. Negative pressure in middle ear causes ET blockage 2. Ear drum and the pars flaccida/attic is retracted into the middle ear 3. Get a collection of stratified squamous epithelia in pars flaccida and due to this dead skin not being able to be removed out of the ear (via the normal desquamation and skin migration process) it grows in the oars flaccida and forms a cholesteatoma (which first erodes into the ME -> IE -> skull)
33
What causes presbycusis?
The loss of stereocilia at the basilar membrane of the choclear duct so AP cannot me generated
34
What causes Benign Paroxysmal Positional Vertigo?
Small crystals in the semi circular canals moving (as a result of minor movements), causing the fluid to vibrate so the stereocilia moves, thus an AP is generated and is sent to the vestibular nerve but other senses (e.g. sight) is not sending signals to the brain indicating movement. This miscommunication leads to you feeling dizzy.
35
Meniere’s disease: A) Triad B) S+S
Triad: sensorineural hearing loss, tinnitus and vertigo | S + S: aural fullness, nausea and emesis
36
Acute Labrynthitis
A history of URTI Sensorineural hearing loss, vertigo, emesis and tinnitus
37
Acute Vestibular Neuronitis
Emesis and vertigo that lasts days
38
Why does your nose run when you cry?
Due to the nasolacrimal duct connecting your lacrimal ducts to your inferior meatuses in your nasal cavity
39
If you have a nasal cavity infection, why is it easy to get sinusitis - typically in the maxillary sinus?
Due to ostia connecting your paransal sinuses to the meatuses in your nasal cavity, typically your middle meatus so microbes can travel between sites
40
What causes a saddle-nose deformity?
Untreated saddle haemotoma leading to avascular necrosis of the cartilaginous nasal septum
41
A post nasal drip is common in rhinitis and nasal polyps. How does it cause a ticklish cough?
Watery rhinorrhoea drips into the nasopharynx-> larynx
42
What sign would you see in severe ethmoidal sinusitis?
Orbital cellulitis
43
Tonsillitis is typically caused by virus’ but when it is caused by bacteria, what pathogen is it most likely going to be?
Streptococcus pyogenes
44
What structure is found between the 2 submandibular ducts?
Lingual frenulum
45
What is the medical term for salivary gland stones?
Sialolithiasis
46
What is Quinsy? When do you get it? What effect does it have on the uvula?
A peritonsillar abscess of 1 tonsil Untreated tonsillitis, unilateral tonsil infection by bacteria It leads to the deviation of the uvula by pushing it as it grows
47
Discuss where a pharyngeal pouch typically forms and why What is its medical name?
Zenker’s diverticulum typically forms in the Killian’s dehiscence due to the UOS not opening quick enough so the high pressure in the laryngopharynx leads to the bolus being forced into the Killian’s dehiscence. (Killian’s dehiscence is a weakness between the 2 muscles that make up the inferior constrictor muscle (1 of the 3 constrictor pharyngeal muscles) - thyropharyngeus muscle and cricopharyngeus muscle)
48
What is an orbital blow out fracture?
A sudden increase in the intra orbital pressure leading to a fracture of the medial wall/floor of the orbit (typically maxilla bone)
49
In an orbital blow out fracture, what can happen to the contents of the orbit and how will their gaze be effected?
Contents can get prolapsed into the maxillary sinus, leading to the the inferior oblique getting trapped, so you are unable to look upwards and medially
50
What is the function of Meibomian glands and how do you get a Meibomian cyst?
Meibomian glands secrete a oily substance to the edge of eyelids preventing tear spillages and tear film evaporation. If the glands get blocked (by oil), you form a cyst
51
How do styes form?
When an eyelash follicle or its associated sebaceous gland gets blocked as a result of inflammation due to a staphylococcus infection
52
What is blepharitis?
When the eyelid swells: hair, skin and Meibomian gland | A crust forms around the eyelid
53
What is the difference regarding the site of peri-orbital and orbital cellulitis?
Peri-orbital cellulitis is in the pre-septal area | Orbital cellulitis is in the post-septal area
54
What is the medical terms for short and long sightedness?
Short: Myopia Long: Hypermetropia
55
Describe what chronic glaucoma is
Open angle glaucoma caused by a breakdown of the trabecular meshwork so aqueous humour in the anterior drainage is impaired, leading to increased intra-ocular pressure, which leading to optic nerve damage so you get optic cupping at the optic disc
56
What is the difference between papilloedema and glaucoma? How can you identify the difference with an ophthalmoscope?
Papilloedema is caused by a raise in intracranial pressure, whereas glaucoma is caused by a raise in intraocular pressure. In papilloedema you get optic disc swelling, whereas in glaucoma, you get optic cupping
57
Name 2 microvascular diseases that can damage CN III, IV and VI.
Diabetes and hypertension
58
What is a pyramidal lobe?
A lobe extending from the isthmus of the thyroid gland due to the persistence of the thyroglossal duct
59
Describe the pathophysiology of Treacher Collins Syndrome
Deficiency of Treacle (a nuclear phosphoprotein), leads to ribosome insufficiency so neural crest cells are unable to transport to the 1st pharyngeal arch so the bone and cartilage in the face is underdeveloped leading to hypoplasia of the mandible and facial bones
60
Describe the pathophysiology of Di-George Syndrome
Chromosome 22 deletion leads to the underdevelopment of the neural crest cells in the 3rd and 4th pharyngeal POUCHES. Leads to the underdevelopment of the thymus (from 4th PP) and inferior parathyroid (from 3rd PP)
61
What is the most common type of HNC?
SCC
62
What signs and symptoms are specific to pharyngeal cancer? 4
Dysphagia Painful swallowing (Odynophagia) Enlarged deep cervical lymph node (metastases) Otalgia (due to referred pain via vagus nerve)
63
What signs and symptoms are specific to laryngeal cancer)? 6
Enlarged deep cervical lymph nodes (metastases) Otalgia (referred pain - vagus nerve) Hoarse voice Dysphagia Odynophagia Persistent cough (reflex is stimulated so irritant cannot be removed)
64
What virus is a risk factor for nasopharyngeal cancer?
Epstein-Barr Virus
65
List risk factors for HNC 7
``` Heavy alcohol use Smoking Betal nut chewing Male Leukoplakia Erythroplakia Human Papilloma Virus ```
66
How do local anaesthetics work?
Bind and block Na+ channels so AP cannot be generated
67
Give 4 sings/symptoms to indicate sinusitis
Temperature Pain/tenderness over sinus Headache Discoloured nasal discharge
68
With a transient ischaemic attack, patients can have unilateral eye sight loss for 30 minutes. Describe why
Thromboembolus in the central retinal artery blocking perfusion to optic nerve
69
What signs would you see in LOCS? What is LOCS
``` In a lacunar syndrome (stroke) you see: -pure sensory deficit -pure motor deficit -pure sensori-motor deficit -ataxic hemiparesis of >2/3 of FAL (face, arm, leg) ```
70
What signs would you see in TACS? What is TACS?
``` In a total anterior circulation stroke you see: ALL 3: 1. >2/3 motor/sensory loss in FAL 2. Homonymous hemianopia 3. Dysarthria and visuosptaial neglect ```
71
What signs would you see in PACS? What is PACS?
2 out of 3 of TACS bullet points Partial anterior circulation stroke
72
What signs would you see in POCS? What is POCS?
In posterior circulation syndrome you see 1 of: 1. Cranial nerve palsy with contralateral motor/sensory deficit 2. Conjugate eye movements 3. Cerebellum (DANISH) or brainstem syndrome 4. Homonymous hemianopia with macula sparing 5. Bilateral motor/sensory deficit 6. Loss of consciousness
73
How to detect whether the lump is a thyroid pathology or a thyroglossal cyst? Thyroglossal cysts are a fibrous cyst that forms from a persistent thyroglossal duct.
Thyroglossal cyst the lump will move on swallowing AND tongue protrusion, whereas with a thyroid lump, the lump will only move on swallowing and NOT tongue protusion
74
Why does a thyroid lump move on swallowing? 2 reasons.
Thyroid gland and the lump is found in the prevertebral deep fascial layer, with this sheath being connected to the hyoid bone so when the hyoid bone rises during swallowing (so larynx can elevate and close epiglottis) the thyroid gland will rise with it. Also, the thyroid gland is attached to the cricoid cartilage (anteriorly) via the Berry ligament so during swallowing as the larynx is pulled up, the cricoid cartilage is pulled up so the thyroid gland is also pulled up
75
A patient has had signs and symptoms of Bell’s palsy. Onset within the past 72 hours. What would you treat them with?
Prednisolone
76
What 3 questions would you ask a patient to diagnose conjunctivitis?
1. Are the whites of your eye (the conjunctiva) red? 2. When you move your eyeball around, does it feel ‘gritty’? 3. Is your eye tearing?
77
What would be your management plan for Conjunctivitis (3)?
It is highly contagious so ensure that you washing your hands regularly, wash your hands before and after touching each eye, don’t share a towel. Prescribe topical Chloramphenicol eye drops (it reduces the chance of a secondary bacterial infection)
78
What is the most likely causative organism for neonatal conjunctivitis? Describe the mechanism of infection. (Need i.v. antibiotics)
Chlamydia from the mothers vaginal mucus entering the child’s system during vaginal child birth
79
Describe how uveitis (inflammation of the choroid layer) will present (4). What is the management plan for this patient (2).
Acute, painful red eye. Pain is exacerbated when trying to focus onto an object and when looking at bright lights. Urgent referral to ophthalmologist and put on corticosteroid treatment
80
What symptoms will allow you to diagnose sinusitis (3)?
Nasal blockage/discharge Facial pain/pressure (or headache) Reduction in sense of smell
81
In a Rinne’s negative test (which is abnormal), which one is louder/heard longer AC or BC?
BC>AC
82
What is the treatment plan for tonsolitis
Penicillin V (500mg QDS for 10 days) | Erythromycin/Clarithromycin can be given if they have Penicillin allergies
83
What are the 4 characteristics of Heerfort’s Syndrome?
1. Bells palsy (facial nerve palsy) 2. Anterior uveitis 3. Fever 4. Parotid gland enlargement
84
Cranial nerve palsies are one red flag signs of a neck lump. Give 12 other red flags for a neck lump
- hard and fixed lump - fever, weight loss, night sweats, rigors - hoarse voice, stridor - dysphagia (difficultly swallowing), otalgia (ear pain) - epistaxis, unilateral nasal congestion
85
80% of parotid tumours are benign. Of that 80%, 80% of the benign tumours are what type of tumours?
Pleomorphic adenomas (benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both)
86
Warthin’s tumours are benign tumours of the parotid gland. Describe the demographic that typically get this tumour.
(Painless swellings) in Men in their 70’s, that were/are smokers. (10% are bilateral) (Typically treated conservatively)
87
What is the management plan for suspected Epiglottitis?
Give: - High flow oxygen - Nebulised Adrenaline - iv Dexamethasone (steroid) - broad spectrum iv antibiotics - iv fluids * Do ABG, Bloods and Culture (Once stabilised, pt needs Examination Under Anaesthesia (EUA) and intubation in theatre) Continue pt on iv Dexamethasone and antibiotics until stabilised Give prophylactic antibiotics to any family member not immunised for Hib
88
What is the gold standard for imaging suspected vestibular schwannomas
MRI Head with contrast
89
What type of thyroid malignancies comprise approximately 75-80% of cases?
Papillary carcinomas
90
What is the second most common primary thyroid malignancy, comprising 15-20% of cases?
Follicular carcinomas
91
Name a drug that can be given to pt’s as a prophylactic to treat Meniere’s disease
Betahistine (an antihistamine anti-vertigo medication). | Pt should also avoid coffee, alt and chocolate
92
During a Meniere’s episode, what drug should the patient take?
They should be put on a short course of Prochlorperazine. (Meniere attacks last less than 24 hours. The triad - vertigo, hearing loss, tinnitus; +/- nausea. After the attack you can have lasting effects of sensorineural gearing loss).
93
If a patient has had vertigo for the past few days and has had a recent URTI, what condition may they have?
Vestibular neuronitis (inflammation of the vestibular nerve)
94
If a 60 yo man comes to ED with no PMH, complaining of otalgia and facial pain and currently has epistaxis, what is your main differential diagnosis
Nasopahryngeal tumour
95
What is the most common causative organism of deep neck space infections? Name 3 other organisms that can also cause DNSIs.
Most common: Streptococcus viridans Others: Staphylococcus Anaerobes Gram negative bacilli
96
Describe the 2 common types of deep neck space infections
Parapharyngeal abscess - most common type. Infection forms when it spreads to the potential space posterolateral to the nasopharynx. Retropharyngeal abscess - occurs in the retropharyngeal space. Infection can travel down to the mediastinum - leading to an infection in this area (heart, thymus, oesophagus, trachea). Common in children with necrotising lymph nodes
97
Give 5 symptoms of deep neck space infections
- Severe throat pain - Pyrexia (+ systemically unwell) - Dysphagia - Odynophagia - Neck stiffness
98
Give 5 signs of deep neck space infections
- Trismus - Cervical lymphadenopathy - Change in phonation: loss of voice; hoarseness - Stridor - Pharyngeal swelling
99
Briefly describe the treatment of Deep neck space infections
- Broad spectrum antibiotics (cover aerobes and anaerobes) (- Iv fluids if needed) - Humidified oxygen with saline nebuliser - Surgical drainage of abscess via mouth or throat Keep pt at a 45° angle
100
Name 2 possible causes of obstructive sleep apnoea in children. How do they cause obstructive sleep apnoea?
Tonsillar and Adenoid swellings can cause partial upper airway blockage thus leading to obstructive sleep apnoea.
101
Head and Neck Cancers (HNCs) - another name it’s called is Head and Neck Squamous Cell Carcinomas (HNSCCs) due to 90% of HNCs being scc. HPV 16 is linked to what type of HNC? Betel quid is linked to what type of HNC? Occupational wood dust exposure is linked to what type of HNC? EBV infection is linked to what type of HNC?
HPV 16 - Oropharyngeal cancer Betel quid chewing - Oral cancer Occupational wood dust - Sinonasal cancer EBV - Nasopharyngeal cancer
102
Trotters Syndrome is a triad of clinical features suggestive of nasopharyngeal malignancy. Give the triad + a simple reason for 2 out of 3 of the clinical feature
1 - Unilateral conductive deafness due to previous acute otitis media 2 - Trigeminal neuralgia due to perineural invasion 3 - Reduced soft palate mobility
103
What is a perineural invasion? Give 3 cancers that PNIs are common in.
Invasion of the cancer cells in the space that a nerve resides. HNCs Prostate cancers Colorectal cancers
104
Medication can be a risk factor for Sialolithiasis. Give 2 drug types that can cause this. Give 5 other risk factors for Sialolithiasis.
- Medication: Diuretics; Anti-cholinergics - Dehydration - Gout - Smoking - Chronic periodontal disease - Hyperparathyroidism
105
What is the first line treatment for Otitis externa?
Ciprofloxacin ear drops (due to the causative agent most likely being Pseudomonas aeruginosa)
106
After the anti-pyrexial and analgesic conservative treatment for the first 24-48 hours of the onset of acute otitis media symptoms, if symptoms do not subside, what would be your first line anti-microbal treatment.
Oral Amoxicillin
107
A linear fracture of the skull may be harmless but a CT Head should still be done to exclude a haemotoma and intracranial damage. If there is CSF- Otorrhoea or Rhinorrhea what should your treatment be?
Benzylpenicillin

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