Conditions/Diseases

Question 1

Acute Otitis Media

Answer 1

Common; 3-18months

Pain, fever, discharge

Microbiology - H. Influenza, Strep. Pneumonia, Moraxella Catarrhalis

Treatment - ABs i.e. co-amoxiclav, grommets, adenoidectomy if recurrent

Question 2

Acute Suppurative Otitis Media

Answer 2

Pus in middle ear

Otalgia, otorrhea

Observation, amoxicillin

Question 3

Allergic rhinitis

Answer 3

inflammation nose due to allergen

Antihistamines, corticosteroid possible if chronic

Question 4

Auricular Haematoma

Answer 4

blood collection in ear due to bursting of perichondrial vessels

blunt trauma to external ear structures, leads to “cauliflower ear”

Bleeding

Incision and drainage, pressure dressing, ABs

Question 5

Benign positional vertigo

Answer 5

Otoconia in semicircular canals

vertigo precipitated bu specific changes in head position, lasts seconds, no associated symptoms

Dix-Hallpike test

epley manoeuvre

Question 6

Branchial Cyst

Answer 6

birth defect, remnant of embyrological development

Question 7

Carotid Stenosis

Answer 7

narrowing of carotid arteries due to atherosclerosis in artery wall

sudden numbness or weakness of face/limbs, trouble speaking, trouble seeing, dizziness, severe headache

Duplex US, CTA/MRA head, neck and chest

Antiplatelet therapy, cardiovascular risk deduction, symptomatic = carotid endarcterectomy/stenting

Question 8

Cervical Lymphadenopathy

Answer 8

enlargement of cervical lymph nodes

infection, thyroid problems, cancer

Question 9

Choanal Atresia

Answer 9

congenital disorder where back of nasal passage is blocked

chest retraction unless mouth breathing or crying, inability to nurse and breath simultaneously, inability to pass catheter, cyanosis

Imaging possible

Bilateral is EMERGENCY so insertion of oral airway to break seal prior to surgery

Question 10

Cholesteatoma

Answer 10

abnormal benign collection of squamous epithelial cells in middle ear

possibly repeated middle ear infections

discharge, hearing loss, vertigo, tinnitus

Pure tone audiogram, CT scan of petrous temporal bones

Surgery, preoperative ABs and aural care

Question 11

Chronic Suppurative Otitis Media

Answer 11

perforated tympanic membrane/cholesteatoma

complications = dead ear, facial palsy, meningitis, brain abscesses

Question 12

Perforated tympanic membrane

Answer 12

Infection, trauma, grommet

recurrent infection, hearing loss

water precautions, myringoplasty

Question 13

Cleft palate

Answer 13

roof of mouth contain opening into nose

feeding problems, speech problems, hearing problems, frequent ear infections

surgery, speech therapy

Question 14

Colloid goitre

Answer 14

Due to gland hyperplasia, iodine deficiency, puberty, pregnancy, lactation

RARELY; breathing difficulty, dysphagia, neck vein distension and dizziness when arms raised above head (large goitre)

hormone test, US neck, biopsy

medication, hormone therapy, surgery

Question 15

Cystic hygroma

Answer 15

fluid filled sac in neck resulting from blockage in lymphatics system

soft spongy lump

can normally be seen on scan during pregnancy

Surgical removal, sclerotherapy

Question 16

Epistaxis

Answer 16

Common, M>F

digital trauma, consider coagulapathy, haematological abnormality

Appropriate first aid, AB ointments i.e. naseptin, bactroban, cautery i..e silver nitrate under LA, nasal packing

Question 17

Facial Nerve Palsy

Answer 17

lower motor neuron facial palsy

Differentials;
intratemp - cholesteatoma
extratemp - parotid tumour
idiopathic - Bell’s palsy

treat underlying cause, steroids, eye care

Question 18

Foreign body in the ear

Answer 18

EMERGENCY

removal; urgency would be

Button battery > organic > inorganic

Question 19

Grave’s Disease

Answer 19

aka Toxic Diffuse Goitre, autoimmune disease affecting thyroid causig overproduction of thyroid hormone

F>M

anxiety, irritability, weight loss but no appetite loss, thyroid goitre, bulging eyes, fatigue, tachycardia, irregular heart beat

fine tremor, thyroid eye disease, clubbing, pre-tibial myxoedema

TSH; suppressed, serum T3 and T4

radioiodine therapy, anti-thyroids, beta blockers, thyroid surgery

Question 20

Laryngeal Carcinoma

Answer 20

mostly squamous cell carcinomas

hoarseness of voice, odynophagia

nasendoscopy, laryngoscopy, biopsy, CT, PET-CT, MRI, US

radiotherapy, surgery, chemotherapy

Question 21

laryngomalacia

Answer 21

congenital softening of tissues of the larynx

stridor/wheeze, high pitched sound, difficulty feeding, poor weight gain, choking while feeding, apnoea

flexible laryngoscopy

observation, GORD therapy including smaller meals/thickened feed, surgical therapy

Question 22

Lipoma

Answer 22

benign tumour made of fat tissue

soft lump, moves with light finger pressure, generally small, may be painful

surgical removal

Question 23

Malignant Otitis Externa

Answer 23

osteomyelitis of temporal bone

severe pain in elderly diabetic, granulations in external auditory meatus, possible cranial nerve palsies

ABs for weeks or months

Question 24

Meniere’s disease

Answer 24

condition of the inner ear, endolymphatic hydrops

dizziness, spinning sensations, unsteadiness, nausea, vomiting, noise inside ear, sudden drop in hearing

bendroflumethazide, untratympanic, dexamethasone, intratympanic gentamicin

Question 25

Migraine

Answer 25

?vascular ?renal spontaneous vertigo, variable duration, headache, sensory sensitivity, precipitated by triggers avoid migraine triggers, prophylactic medication

Question 26

Nasal Polyps

Answer 26

soft, painless, non-cancerous growths chronic inflammation due to asthma, recurrent infection, allergies, drug sensitivity or certain immune conditions runny nose, persistent stuffiness, postnasal drip, decreased/absent sense of smell, facial pain/headache anterior rhinoscopy, nasendoscopy intranasal corticosteroid, leukotriene receptor antagonist, surgical polypectomy

Question 27

Otitis Media with Effusion (glue ear)

Answer 27

80% before 10yo, 2 peaks at 2yo and 5yo risks; day care, smoking, cleft palate, down syndrome eustachian tube dysfunction, adenoidal hypertrophy hearing loss, speech delay, behavioural problems, academic decline (imbalance) dull tympanic membrane, fluid level, bubbles most improve within 3 months, autoinflation, grommet, hearing aids

Question 28

Otosclerosis

Answer 28

fixation of stapes by extra bone conductive hearing loss, normal tympanic membrane hearing aid or stapendectomy

Question 29

Parotitis

Answer 29

systemic infection localises to salivary gland resulting in swelling and inflammation of the gland stone formation or stenosis of parotid duct, HIV, mumps swollen gland in side of face, pain whilst chewing or swallowing treat infection causing it

Question 30

Pharyngeal pouch

Answer 30

herniation of pharyngeal mucosa between thyropharyngeus and cricopharyngeus muscles of inf. constrictor voice hoarseness, dysphagia, aspiration pneumonia, regurgitation, weight loss barium swallow excision, dilate

Question 31

Pleomorphic adenoma

Answer 31

benign salivary gland neoplasm; neoplastic proliferation of parenchymatous glandular cells, myoepithelial components

Question 32

Quinsy

Answer 32

aka peritonsillar abscess - collection of pus forms between one of tonsils and wall of throat - a complication of tonsillitis severe sore throat (usually one-sided), swelling, dysphagia, odynophagia, earache on affected side ABs; penicillin V, clarithromycin, amoxicillin etc. corticosteroids, painkillers, surgery i.e. tonsillectomy

Question 33

Sensorineural Hearing Loss

Answer 33

hearing loss in which root cause is in the inner ear viral infections, trauma, presbyacusis, noise exposure, ototoxic medications, acoustic neuroma hearing aids

Question 34

Septal haematoma

Answer 34

blood collection in the septum, no blood supply to septum post trauma, almost always bilateral, can lead to perforation If perforation occurs then whistling noise, bleeding Drainage ASAP

Question 35

Thyroid cancer (general)

Answer 35

4 main types - papillary - follicular - medullary - anaplastic lump, changes in speech i.e. hoarseness, dysphagia, pain in neck and throat, tenderness, redness are all possible cervical lymphadenopathy TSH, fine needle biopsy, US neck, laryngoscopy, blood tests for thyroid function

Question 36

Papillary thyroid cancer

Answer 36

Most common Usually asymptomatic; may have some symptoms Usually high cure rate w/10yr survival ~90% Treatment - surgery to remove tumour +/- radioactive iodine

Question 37

Follicular thyroid cancer

Answer 37

Follicular cells Haematogenous thyroid metastasis, women over 50 High cure rate w/10yr survival ~90% Treatment - surgery to remove tumour +/- radioactive iodine

Question 38

Medullary thyroid cancer

Answer 38

Familial association 10%, commonly asociated with multiple endocrine neoplasia (MEN) Arises from parafollicular C cells; secrete calcitonin Lymph node spread common 10 yr survival ~75% Treatment - total thyroidectomy - removal nearby lymph nodes *radioactive iodine won't work as it won't be taken up by this type of cancer

Question 39

Anaplastic thyroid cancer

Answer 39

Aggressive, local spread, very old, poor prognosis Spread to lymph nodes and organs more likely than papillary Median life expectancy ~4months Radiotherapy, chemo, chemoradiation, surgery, supportive care

Question 40

Thyroglossal cyst

Answer 40

Benign; dilatation of thyroglossal duct remnant, may become infected, midline grows with age tenderness, redness and swelling of neck mass, dysphagia, difficulty breathing moves upward on tongue protrusion Blood tests for thyroid function, FNA cytology, US Scan prior to removal to ensure functioning thyroid tissue elsewhere excision but chance of recurrence

Question 41

Tympanosclerosis

Answer 41

Calcification in tympanic membrane +/- middle ear usually asymptomatic usually no treatment

Question 42

Tinnitus

Answer 42

any perception of sound not caused by an external source unilateral, pulsatile treat underlying cause, sound enrichment, stress management

Question 43

Vertigo

Answer 43

problem with the way balance works in inner ear DIFFERENTIALS; benign positional vertigo, meniere's, vesitbular neuritis, migraine

Question 44

Vestibular neuritis

Answer 44

reactivation of latent HSV infection of vestibular ganglion spontaneous vertigo, associated unilateral hearing loss, duration; days, nystagmus Acute treatment; vestibular sedatives Chronic treatment; vestibular rehab

Question 45

Huntington's disease

Answer 45

Inherited disease, death of brain cells Difficulty concentrating, memory lapses, depression, stumbling and clumsiness, involuntary jerky/fidgety movements, mood swings, personality changes, difficulty moving Medication for depression, mood swings, involuntary movements OT, SLT, Physio

Question 46

Spondylosis

Answer 46

Degeneration intervertebral discs Painful Cervical causes neck pain; exercises can help

Question 47

Horner syndrome

Answer 47

Interruption sympathetic system Miosis, ptosis, absence facial sweating, sinking of eyeball into bony cavity