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ENT Flashcards

1
Q

what is atypical facial pain

A
  • Diagnosis of exclusion
  • UL Burning, aching, cramping sensation
  • often in region of CNV
  • can extend further to neck, back of scalp
  • often linked with mood disorders
  • may be worse w fatigue/stress
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2
Q

What conditions may cause or predispose to atypical facial pain?

A
  • Trigeminal neuralgia
  • ***- Temporomandibular joint problems and tendonitis
  • Migraines, cluster headaches
  • teeth/sinus infections
  • neuralgia eg cavitational oseteonecrosis
  • ***- C-spine issues
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3
Q

ix for ?atypical facial pain

A 
exclude other causes:
- XR of skull
MRI/CT
detaile dental and otolaryngologic evaluation
- neuro exmination
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4
Q

tx for atypical facial pain

A

1st line- TCA (amytriptyline, fluoxetine, venlafaxine)

  • gabapentin, pregablin
  • capsaicin- topical
  • acupuncture
  • CBT
  • peripheral subcute field stimulation
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5
Q

How do you read an audiogram?

A
  • one symbol is air, another symbol is bone
    X axis is frequency (pitch), Y axis is volume (db)
  • anything lower than (ie higher on the graph) 20db is normal!
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6
Q

Describe how different ear pathologies would appear on an audiogram

A

Conductive hearing loss
- bone-air gap (with bone performing better)

Sensorineural hearing loss
- bone and air are equal but under 20bd on the graph

Meniere’s
- UL sensorineural hearing loss involving **low frequencies only

Cholesteatoma

  • UL **mixed hearing loss
  • ***- bone and air under 20bd on the graph AND bone air gap

Acoustic neuroma/vestibular schwannomas
- UL sensorineural hearing loss at ***higher frequencies

Presbycusis
- BL sensorineural hearing loss at higher frequencies

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7
Q

what is a cholesteatoma

A

collection/sac of keratinizing sq epithelium in the middle ear, behind the eardrum

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8
Q

causes of cholesteatoma

A

congenital

repeated middle ear infections

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9
Q

Why can a cholesteatoma cause damage?

A
  • local expansion causes erosion

- it releases cytokines which upregulate osteoclasts– bone resorption

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10
Q

What are the red flags in ear hx

A
  • CN VII palsy/bell’s
  • UL sensorineural hearing loss
  • tinnitus UL
  • sudden deafness with no wax/SN
  • conductive hearing loss of unknown cause
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11
Q

sx of cholesteatoma

A
  • repeated UL infections
  • very offensive discharge
  • conductive hearing loss
  • tinnitus/vertigo (if facial nerve is involved- late stage)
  • SensoriN hearing loss if large
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12
Q

signs of cholesteatoma

A
  • otorrhoea (offensive)
  • UL mixed hearing loss (hearing under 20bd on graph and a bone air gap)
  • may be able to see keratin (white material) on otoscope at attic of the TM, may be a TM perf
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13
Q

ix for ?cholesteatoma

A

otoscope
audiometry
CT of temporal bone to determine involvement

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14
Q

tx of cholesteatoma

A

dry, safe ear
repair of perf
remove cholsteatoma, mastoidectomy

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15
Q

What sx are there in CN VIII palsy

A
  • hearing loss
  • vertigo, motion sickness
  • loss of equilibrium in dark places
  • *- nystagmus
  • *- gaze-evoked tinnitus
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16
Q

what are two Examination tests for hearing using a tuning fork

A

Rinne’s- air/mastoid

Weber’s- tuning fork on forehead (fork makes W shape with person’s ears lol)

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17
Q

what size tuning fork do you use for rinne’s/webers

A

512 hz

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18
Q

causes of congenital deafness

A
  • genetic
  • intrauterine infection (rubella)
  • drugs in regnancy (streptomycin- abx)
  • meningitis
  • neonatal jaundice
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19
Q

causes of childhood onset deafness

A

no earache:

  • BL glue ear
  • impacted ear wax
  • hereditary
  • following meningitis, head injury or birth complications

Earache:
- acute otitis media

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20
Q

what are some Qs to ask during hearing loss hx

A
  • do people seem like they’e mumbling, saying pardon alot, conversations hard to follow, missed phone calls or someone ringing the doorbell
  • high or low sounds
  • tinnitus, vertigo
  • *- headaches, visual changes
  • pain- ear, facial
  • weakness
  • nasal congestion
  • dysphagia
  • changes in voice
  • infection- fever, ottorhoea
  • wt loss, fatigue, appetite, night sweats
  • occupation, noise exposure
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21
Q

What does a positive rinne test mean

A

the fork in the air sounds louder than on bone

this means normal or sensorineural hearing loss

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22
Q

what does a negativee rinne’s test mean

A

fork is louder when on the bone

conductive hearing loss

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23
Q

What may it mean when the tuning fork is hear louder in the L ear compared to the R on Weber’s testing

A

Conductive hearing loss in L ear

or R sensorineural hearing loss

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24
Q

Causes of conductive hearing loss

A
  • impacted ear wax
  • debri/foreign body
  • eardrum perforation
  • middle ear effusion.glue ear
  • otosclerosis
  • cholesteatoma
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25
Q

Causes of senorineural hearing loss

A
  • presbycusis
  • infection
  • meniere’s disease
  • drugs
  • acoustic neuroma
  • noise induced
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26
Q

How do you tx impacted ear waxx

A

olive oil drops for ~2w

wash out/suction

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27
Q

What would be present with eardrum perforation

A

purulent discharge

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28
Q

Describe pattern of hearing loss in presbycusis

A
  • gradual onset
  • high frequencies more severely affected
  • examination normal as both ears normally affected to same degree
  • audiometry- SN (bone and air), BL usually
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29
Q

ix for ?presbycusis

A

audiology

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30
Q

tx presbycusis

A

hearing aids

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31
Q

sx of acoustic neuroma, what is it

A

neurofibroma from acoustic nerve

UL sensorineural hearing loss
tinnitus
facial/bell’s palsy

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32
Q

pathophysiology of meniere’s

A
  • idiopathic dilatation of endolymphatic spaces

- poor fluid drainage of endolymph

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33
Q

sx of meniere’s

A

attacks of:

  • vertigo
  • tinnitus
  • ***- feeling of pressure deep inside the ear
  • N+V
  • sudden drop in hearing- sensorineural
  • cumulative sensorineural hearing loss after repeated attacks
  • each attack lasts mins to hours
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34
Q

management of meniere’s attack

A

refer to ENT

acute attack- labyrinthine sedatives:

  • Prochloperazine (1st gen antipsychotic)
  • antihistammines- cyclizine, promethazine
  • Ecourage mobilisaiotn after
  • try to ID and avoid trigger
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35
Q

LT management of meniere’s (ie not of acute attack)

A

LT tx

  • hearing aids
  • tinnitus markers
  • surgery to control vertigo
  • thiazide like diuretics (hydrochlorothiazide)/betahistine to reduce freq
  • avoid alcohol, caffeine, smoking, salt

must inform DVLA

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36
Q

RF for meniere’s

A
  • allergies
  • immune disorder
  • viral infections eg meningitis
  • head injury
  • migraines
  • fam hx
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37
Q

What is otosclerosis, sx

A
  • BL Conductive hearing loss
  • positive family history of early onset deafness
  • young (<40s)
  • tinnitus/vertigo sometimes
  • focus/foci of spongy bone affecting ossicles
  • adheres od stapes footplate to bone
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38
Q

tx of otosclerosis

A

surgery

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39
Q

What is glue ear, who is it common in

A

middle ear effusion
non infective fluid causing
- eustachian tube dysfunction

  • most common cause of hearing loss in children- can have grommets inserted
  • rarer in adults, may follow a URTI but self-resolves
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40
Q

A 32 year old has had a middle ear effusion for 2 months, which has not resolved depsite your previous advice to watch and wait- what could this be?

A

posterior nasal space tumour- refer to ENT as needs excluding

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41
Q

When are cochlear implants used

A
  • profound, BL sensorineural hearing loss
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42
Q

What are some causes of vertigo

A

Central

  • MS
  • Posterior Stroke
  • **- Head Trauma/concussion
  • **- Migraine
  • Space occupying lesion

Otological

  • Benign positional paroxysmal vertigo
  • Meniere’s Disease
  • Vestibular Neuronitis/labrynthitis
  • Persistent postural perceptual dizziness- sudden unsteadiness/vertigo
  • Acoustic Neuroma
  • **- Ramsay Hunt Syndrome- Herpes Zoster Oticus
  • Motion Sickness
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43
Q

Causes of fainteness/lightheadedness

A
  • haemodynamic orthostatic hypotension (postural hypotension)
  • Cardiovascular disease- arrhythmias, narrowed/blocked blood vessel, hypertrophic cardiomyopathy, decrease in blood volume
  • hypoglycaemia
  • vasovagal- emotional triggers, prolonged standing
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44
Q

Name some causes of loss of balance

A
  • nerve damage (peripheral neuropathy
  • joint issues
  • Muscle issues- weakness
  • Vision issues
  • Medications
  • Parkinson’s
  • psychiatric disorders- depression, anxiety
  • hyperventilation
  • vertigo
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45
Q

What is benign paroxysmal positional vertigo

A
  • presence of canaliths in the semicircular canals instead of in the utricle
  • these crystals cause abnormal movement of the endolymph when the pts head is moved
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46
Q

RF for benign paroxysmal positional vertigo

A

trauma- head injury or whiplash
Vestibular neuronitis
Meniere’s
elderly

often idiopathic though

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47
Q

what are the symptoms of an episode of benign paroxysmal positional vertigo

A 
very sudden onset vertigo
settles after a few seconds
starts when pt looks up.sideways/when turning in bed
N+V
pt feels normal between attacks
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48
Q

How do you diagnose benign paroxysmal positional vertigo?

A

Hx

Dix-Hallpike Manoeuvre/supine lateral head turn
- positive if nystagmus and vertigo are evoked
- pt sat up, then lie pt down with head hanging of end of bed, whilst turning their head to the side
- repeat maneouvre twice, turning head on side each time
- posterior canal- rotatory nystagmus on diagnostic procedure
Lateral canal- horizontal nystagmus on diagnostic procedure

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49
Q

Management of benign paroxysmal positional vertigo

A

meds- none

Epley’s manoeuvre/particle repositioning manoeuvre

  • removes crystals from the canal and resolves
  • pts advised not to drive and to keep/sleep upright/not to bend over in 48hours
  • Brandt-Doroff exercises given to pts to do at home to reduce intensity of sx
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50
Q

What are the theories on the pathophysiology of Meniere’s

A
  • endolymphatic pressure, caused by dysfunctioning Na channels
  • osmotic gradient created which draws fluid into endolymph
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51
Q

sx of Meniere’s

A
  • attacks of tinnitus (UL), vertigo, SN hearing loss
  • feeling of pressure deep inside the ear (UL)
    N+V

hearing recovers after the attacked but cumulative attacks cause progressive SN hearing loss

lasts 2-3 hours, usually resolves fully within 24hours

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52
Q

age range of Meniere’s

A

20-40

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53
Q

ix for Meniere’s

A
  • audiometry (UL SN hearing loss in lower frequencies)
  • tympanometry
  • otoscopy- normal looking eardrum
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54
Q

Management of Meniere’s

A

Refer to ENT

acute attack tx:
- cyclizine/prochloperazine (vestibular sedatives)- N+V and vertigo
- Antihistamines- promethazine- helps with N+V and vertigo
- encourge to mobilize after
- try to ID trigger
LT tx and prophylaxis
- betahistine reduced attack frequency , or thizide like diuretics
- avoid alcohol, caffeine, smoking , slat
- hearing aids, tinnitus markers
- surgery to control vertigo
- must inform DVLA!!

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55
Q

RFs/causes of meniere’s

A
  • immune disorder
  • *- allergies
  • viral infection eg meningitis
  • fam hx
  • head injury
  • migraines
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56
Q

What is labrynthitis/vestibular neuritis

A

inflammation of the vestibular never (and cochlear if labrynthitis)

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57
Q

causes of labrynthitis/vestibular neuritis

A
  • viral mostly
  • can be bacterial

preceded by URTI in about 50% of cases

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58
Q

sx of labrythnitis/vestibular neuritis

A
  • vertigo lasts for days or up to 3w
  • sudden onset
  • severely incapacitating
  • N+V
  • hearing drop (SN) and tinnitus if labrynthitis
  • imbalance
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59
Q

ix for ?labrynthitis

A
  • otoscopy- eardrum normal
  • horizontal nystagmus
  • Neuro exmaination- normal
  • hearing normal or reuced
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60
Q

complication of labrynthitis/vestibular neuritis

A
  • lasting unsteadiness
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61
Q

tx of labrynthitis/vestibular neuritis

A

vestibular sedative
- prochlorperzine/cyclizine
- promethazine
should be stopped after worst of acute episode as brain needs to get used to new unsteadiness

  • consider IV fluids if pt is dehydrated from N+V
  • LT vestibular rehab if vestibular hypofucntion persists- Cawthorne-Cooksey exercises
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62
Q

What cell type represents most head/neck cancers

A

sq cell carcinoma

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63
Q

Where are most head and neck cancers

A

oral cavity- buccal mucosa, retromolar triangle, alveolus, anterior 2/3 of tongue, hard palate, floor of mouth, mucosal surface of the lip

Pharynx
Oropharynx- base of tongue, tonsil, soft palate
Hypopahrynx- postcricoid surface, posterior pharyngeal wall
Nasopharynx- behind the nose

Larynx

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64
Q

Presentation of tongue cancer

A

usually dont present util large (>2cm)
speech difficult
sqallowing difficulty
***pain when tumour involved nerve- referred to ear

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65
Q

Presentation of tonsillar cancers

A
  • trismus (lockjaw)
  • *- neck mass
  • foreign body/mass sensation
  • *- ear pain
  • *- bleeding
  • sore throat

O/e- may be under the surface, so may only see a slight increase in size and firmness in the area

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66
Q

presentation of buccal mucosa cancer

A
  • warty/ulcerative invasive lesion
  • painless in early stages
  • bleeding
  • difficulty chewing
  • leukoplakia, eryhtroplakia
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67
Q

When to refer ?oral cavity malignancy on 2ww

A
  • unexplained ulceration in oral cavity lasting >3w
  • persistent and unexplained lump in the neck
  • lump on the lip or in the oral cavity
  • red or red/white patch in the oral cavity (leukoplakia- white, doesn’t come off when scraped;, erythroplakia- red, bleeds easily when scraped)
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68
Q

Management of oral cavity malignancy

A

RT
CT
Surgical resection with reconstruction

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69
Q

Sx or oropharyngeal malignancy

A
  • persistent sore throat
  • lump in mouth.throat
  • pain in the ear
  • dysphagia
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70
Q

sx of hypopharynx cancer

A
  • dysphagia
  • ear pain
  • hoarseness
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71
Q

sx of nasopharynx cancer

A 
lump in neck
nasal obstruction
***deafness
recurrent ear effusions- posterior nasal space tumour
postnasal discharge
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72
Q

what virus are pharyngeal cancers associated with

A

HPV

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73
Q

O/E what may you see in pharyngeal cancers

A

unexplained red/white pacthed (erythroplakia, leucoplakia), which are painful and bleed easily

mass

nodes (BL mets are common)

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74
Q

Ix for ?pharyngeal cancer

A

biopsy
CT and MRI
CXR and LFTs for mets

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75
Q

criteria for 2ww for ?pharyngeal cancer

A
  • neck mass whihc is persistent and unexplained

- unepxlained ulceration in oral cavity/back of throat >3w

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76
Q

Management of pharyngeal cancer

A

Surgery
RT
CT
mixture of above

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77
Q

sx of laryngeal cancer

A
  • chronic hoarseness
  • pain- throat, ear
  • dysphagia, aspiration
  • lump in neck
  • haemoptysis, persistent cough , SOB
  • Fatigues, weakness, wt loss
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78
Q

Referral for ?laryngeal cancer

A
  • Hoarseness >3w

- unexplained lump in the neck

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79
Q

Ix for ?laryngeal cancer

A
  • Laryngoscopy with biopsy - under GA
  • fine needle aspiration of a neck mass
  • CT/ MRI
  • CXR if hoarseness >3w
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80
Q

Management of Laryngeal cancer

A

surgery
CT
RT

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81
Q

What cell type are ear malignancies

A

Sq cell
basal cell
melanoma

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82
Q

Sx of ear malignancies

A

Ear canal:

  • Pain
  • Otorrhoea
  • Loss of hearing
  • Lump in ear canal
  • Weakness of the face

Middle Ear

  • hearing loss
  • Earache
  • Cannot move face on ipsilateral side

Inner ear

  • pain, headache
  • hearing loss
  • tinnitus
  • vertigo
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83
Q

Ix of ?ear malignancy

A

Biopsy
MRI
CT

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84
Q

tx of ear malignancy

A

surgery
RT
CT

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85
Q

Name the salivary glands and where they are

A

sublingual gland (under tongue)

Submadibular- deep to sublingual gland, connected with sublingual

Parotid- slightly inferior and anterior to the ear

Many minor salivary glands widely distributed throughout oral mucosa, palate, uvula, floor of mouth, post tongue, retromolar and peritonsillar regions, pharynx, larynx and paranasal sinuses

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86
Q

Where to most of the salivary gland cancers arise from

A

Parotid gland

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87
Q

What cell type are salivary gland tumours

A

Adenoid cystic carcinomas are most common

Can also be mucoepidermoid, acinic

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88
Q

Presentation of salivary gland cancers

A
  • facial nerve weakness/palsy
  • Paraesthesia and anaesthesia of neighbouring sensory nerves
  • salivary gland mass
  • usually painless,or with increasing painfulness, which becomes relentless
  • ulceration or induration (or both) of the mucosa or skin overlying
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89
Q

RF for salivary gland malignancy

A
  • hx of previous skin ca
  • Sjogrens
  • previous radiation to head/neck
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90
Q

clincial features of salivary gland malignancies

A
  • hardness on palpation of parotid/submandibular/sublingual regions
  • fixed lump
  • tenderness
  • infiltration of surrounding structures- Facial nerve palsy, local lymph node enlargement
  • overlying skin ulceration
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91
Q

When to refer for ?salivary gland malignancy

A
  • any unexplained neck lump in >45y/o

- peristent and unexplained neck lump in any pt

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92
Q

ix for salivary gland malignancy

A
  • USS- if superficial
  • USS guided fine needle aspiration
  • MRI/CT
  • all tumour in lublinguinal gland should be imaged with MRI as the risk of malignancy is high
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93
Q

management of salivary gland malignancy

A
  • ablation
  • radiotherapy
  • chemotherapy
  • removal of the affected gland
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94
Q

Eye and optic nerve tumour- presentation

A

Generally, in over 50s

  • pupil distortion
  • cataract
  • visual decline/disturbances
  • pain due to elevated intraocular pressure
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95
Q

Management of eye/optic nerve tumours

A

observe
surgery
radiotherapy
removal of the eyeball

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96
Q

Sx /signsof reintoblastoma

A

sx

  • pain
  • Apparent change in the colour of the iris
  • inflammation, redness or increased pressure in/around the eye without infection
  • detioration of vision in one or both eyes
  • buphthalmos (enlarged eye)
  • leukocoria- after flash is taken (white pupillar reflex)

Signs

  • Strabismus
  • glaucoma
  • nystagmus
  • parental hx
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97
Q

Ix of ?retinoblastoma

A
  • Examination under anaesthesia with maximally dilated pupil

- MRI

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98
Q

tx of retinoblastoma

A

radiation
chemo
surgery

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99
Q

Where do nosebleeds bleed from most commonly

A

Little’s area/kiesselbach’s plexus- most accessible part of the nose anteriorly and very well vascularised

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100
Q

Where do posterior epistaxis arise from?

A
  • Sphenopalatine artery
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101
Q

causes of epistaxis

A
  • nose picking
  • inflammation (URTI, sinusitis)
  • foreign body
  • trauma- blowing nose with force, insertion of object, injury to nose/face
  • bleeding disorder/anticoag/antiplatelets
  • HTN
  • ## Dry air
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102
Q

management of epistaxis

A
  • ABCDE- vast majority are self-limiting
  • group and save
    IV access
  • 15min pressure leanign forward
  • silver nitrate cautery if you can see offending BV
  • pack the nose
  • Epistaxis that has failed all emergency management may require sphenopalatine ligation in theatre
  • if recurrent- topical naseptin for 10d then consider cautery

surgical
-electrocautery

103
Q

A 14 year old boy presents with his 5th nosebleed in 3 months

He feels he cant breath through his nose anymore

what should you suspect- Ix, and tx

A
  • Juvenile nasopahryngeal angiofibroma

MRI head

Tx- resect

104
Q

What is mononucleosis caused by ?

A

Epstein Barr Virus

sometimes caused by toxoplasmosis, human herpes virus 6, cytomegalovirus, HIV, adenovirus

105
Q

presentation of mononucleosis

A
  • low grade fever
  • fatigue, malaise– may persist for several months after acute infection
  • sore throat, tonsillar enlargement- classically exudative
  • petechiae on oropharynx
  • uvular oedema, palatal oedema
  • fine macular non-pruritic rash- disappears fast
  • lymphadenopathy, especial cervical
  • nausea, anorexia
  • arthralgia, myalgia
  • cough
  • chest pain
  • photophobia
  • transient upper eyelid oedema

Later signs

  • mild hepatomegaly
  • splenomegaly with abdo pain
  • may be jaundice
106
Q

ix for ?mononucleosis

A
  • if <12 or immunosupressed– check EBC serology after person has been ill for at least 7d
  • if >12 and immunocompetent- FBC, WCC, monospot test in the 2nd week of illness
  • FBC- >20% atypical or reactive lymphcytes
    LFTs
  • ESR
    Abdo USS for splenomegaly assessment in those who do contact sports
  • if monospot is negative- repeat in 5-7 days
  • If monospot is negative but you have hgih clinical suspicion- can order EBV serology,
  • CMV/toxoplasmosis, esp. if pregnant or immunocomprimised
  • HIV testing in at risk people
107
Q

Advice and management of mononucleosis

A
  • avoid contacr sports for ~3w (risk of splenic rupture due to splenomegaly)- duraiton should be guided by USS
  • avoid alcohol
  • advise paracetemol
  • no evidence for antivirals or steroids
108
Q

A 19 year old female comes to you complaining of itchy skin. You saw her 1 week ago for a sore throat, which you gave her amoxicillin for. O/E- she has a maculopapular rash. what is the reason for this?

A

She has mononucleosis

ampicillin and amoxicillin will cause and itchy maculopapular rash during infectious mononucleosis

109
Q

casues of head/neck lumps

A
  • infective- reactiev lymphandenopathy

Neoplastic

  • lymphoma
  • head/neck cancer
  • salivary gland tumour
  • mets
  • lipoma

Vascular
- carotid body tumour

Inflammatory

  • sarcoidosis
  • thyroid cyst

Congential

  • cystic hygroma
  • thyroglossal cyst
  • dermoid cyst
110
Q

ddx of neck lumps

A

Midline:

  • lymph node
  • lipoma
  • thyroglossal cyst

Anterior triangle

  • lymph node
  • lipoma
  • carotid body aneurysm/tumour

Posterior Triangle

  • Lymph node
  • Lipoma
  • subclavian artery aneurysm
111
Q

ddx of head lumps

A
  • Lymph nodes (inflammatory, mets, viral, bacteria)
  • Cystic- dermoid , epidermoid, sebaceous, lipoma
  • encephalocele- a sac-like protrusion or projection of the brain and the membranes that cover it through an opening in the skull
  • tumour secondaries
  • SCC, lymphoma
  • bone diseases- Paget’s, cherubism, malignant, benign (ossifying fibroma)
  • salivary glands- stones, cancer, infections
  • trauma
112
Q

red flags of neck/head lump

A
  • inflamed >2/52
  • enlarging rapdily
  • hard, fixed
  • assoc with ***otalgia, dysphagia, stridor, hoarse voice
  • epistaxis, UL nasal congestion
  • unexplained wt loss, night sweats, fever, rigors
  • CN palsies

children:

  • ***- supraclavicular mass
  • > 2cm
113
Q

reassuring signs of a neck lump

A
  • <2cm
  • small
  • persistent
114
Q

ix of head/neck lump

A

1st line if sus- USS with or without fine needle aspiration

  • if suspicious USS- FNA needs to be done
  • if ?lymphoma- core excision biopsy should be done instead
  • further CTs and MRIs
115
Q

what is a cystic hygroma/lymphangioma

A
  • benign fluid filled sac caused by malformation of lymphatic system
  • most commonly noticed in <2 year olds
  • can grow large enough to obstruct airways or cause dysphagia
  • not all require tx

Ix- USS

tx- surgery, lymphatic sclerotherapy

116
Q

where is a thyroglassal cyst found

A

midline neck

117
Q

features of thyroglossal cyst

A
  • painless if nto infected
  • increase in size
  • moves up with protrusion of tongue
  • get infected
  • sometimes discharge
118
Q

what is a thyroglossal cyst

A
  • embryological part of thyroid gland which descends from base of tongue past hyoid and cricoid cartilage
  • thyroglossal cyst is when this persists and remains patent somehwere along the dscent pathway
  • they cause a collection of fluid, are prone to infection, and occassionally discharge
119
Q

tx of thyroglossal cyst

A

surgery and removal of part of hyoid bone to avoid recurrence

120
Q

What is a branchial fistula

A

branchial arch remnants that have persisted

  • if fistula- connect back of mouth into pharynx towards the skins
  • they discharge
  • they may just become cysts that become inflammed and dont discharge

Appearance

  • small lump (red dot)
  • may discharge (white)
121
Q

tx of branchial fistula

A
  • surgical resection
122
Q

what is a carotid body tumour

A
  • benign neuroendocrine tumour that arises from paraganglion cells of the carotid body
appearance:
- pulsatile , painless neck lump
- bruit
in anterior triangle of neck
slow growing
-
123
Q

what is a branchial cyst , ix tx

A

congential mass arising from lateral aspect of neck
- if large will cause dysphagia, dysphonia, difficulty breathing

ix- USS FNA

tx- surgery, sclerotherapy

124
Q

what is an external angular dermoid cyst , tx

A

swelling that are superior and lateral to the eyebrow

  • embryological remnant
  • pocket of skin with epithelium trapped inside- skin cell secrete sebum and proliferate- cyst expands
  • risk of infection

tx- removal at 1y of age

125
Q

Ddx of lymphadenopathy

A

MIAMI

Malignancy, infection, autoimmune, misc/unusual, Iatrogenic (meds)

126
Q

What common medications can cause lymphaneopathy

A 
Allopurinol
Atenolol
Carbamazepine
Hydralazine
Penicillins
Phenytoin
Quinidine
Trimethoprim
127
Q

What questions do you want to ask in a hx for lymphadenopathy

A

assoc sx

  • fever, SOB, cough, sore throat, painful testicles/discharge (infection)
  • malaise, fatigue , abdo pain (mononucleosis)
  • wt loss (malignancy)
  • night sweats, fever, wt loss >10%- Lymphomas
  • ***- arthrlagia, muscle weakness, unusual rash (autoimmune)
  • Pain at lymph nodes after alcohol- Hodgkin’s
  • breast sx
  • skin changes
  • characteristics of lump- fixed, irregular, hard

Exposure

  • infectious contacts
  • insect/animal bites or scratches
  • hx of recurrent infections
  • tobacco
  • alcohol
  • UV radiation
  • Occupational exposure
  • Sexual hx- HIV
  • travel hx
  • ***- immunisation hx

PMHX

Medications
Allopurinol
***Atenolol
Carbamazepine, phenytoin
Penicillins, trimethoprim

fam hx
- carcinomas of breast, melanoma

128
Q

What must you also palpate in an exmaination of lymph nodes

A
  • the spleen for lymphoma, mononucleosis, lymphocytic leukaemia, sarcoidosis
129
Q

ix for lymphadenopathy

A

biopsy
blood test for infective causes/leukaemia
USS of the node if ?salivary gland

130
Q

What would make you suspect a malignancy with a pt with lymphadenopathy

A
  • older age
  • firm, fixed, nodal
  • UL
  • painless!
  • duration >2w
  • ## supraclavicular location- always investigate these!!!!
131
Q

How would a lymph node feel o/e if caused by infection

A

BL
Mobile
Nontender

132
Q

Causes of superior vena cava obstruction

A
  • SCC and non-small cell lung cancer
  • Non-hodgkins lymphoma
  • mediastinal lymph node mets
  • scarring eg TB
  • Aortic anuerysm
  • Blood clots
  • Constrictive pericarditis
  • Goitre
133
Q

sx of SVCO

A
  • **- supraclavicular mass (hard, painless, immobile- lymph node)
  • facial oedema
  • **- engorged conjunctiva
  • anorexia
  • Distended veins in upper L chest/trunk
  • *- Dyspnoea
  • Headache
  • Severe- cerebral oedema, laryngeal oedema, airway compromise
134
Q

ix for ?SVCO

A 
CXR
CT
MRI
Doppler
Contrast venography
135
Q

tx for SVCO

A
  • endovascular stenting, bypass, resection with reconstruction
  • Radiotherpay with chemo if cancer
  • Corticosteroids if laryngeal oedema present, diuretics
  • **- Anticoagulation or thrombolysis if thrombosis related
136
Q

What age is mastoiditis seen in

A

6-13m

rare in adults as their cortical bone is much thicker

137
Q

What is mastoiditis, how does it occur

A

Abscess behind the year

  • middle ear infections make its way through middle ear and through antrum (mastoid cells and middle ear connection)- will push through the ting cortical tmep bone in temporal bone.
138
Q

What are some examples of autoimmune causes of lymphadenopathy

A

RA, SLE, dermomyositis

139
Q

what are some misc/unusual causes of lymphadenopathy?

A
  • Sarcoidosis
  • Silicosis
  • Hyperthyroidism
  • Histiocytosis
  • Kawasaki
  • SVC obstruction
140
Q

tx of mastoiditis

A

IV abx eg ceftriaxone, vancomycin

Myringotomy/mastoidectomy if severe

141
Q

sx of nasal polyps

A

rhinorrhea
BL obstruction, pressure sensation
paroxysmal nocturnal dyspnoea

assoc with chronic rhinosinusitis (facial pain/fullness, mucopurulent discharge, change in sense of smell for >12w)

142
Q

UL nasal polyps- what should you investigate for?

A

malignancy

143
Q

difference between turbinates and nasal polyps on anterior rhinoscopy with nasal endoscopy

A
  • turbinates- pink, arise laterally, VERY sensitive

- Polyps- white/pearlish, arise medially, insensate

144
Q

Ix for ?nasal polyps

A
  • anterior rhinoscopy with nasal endoscopy
  • CT if considering surgery
  • MRI if concerned about malignancy
145
Q

tx for nasal polyps

A

benign- need ENT referrl for full ENT examination
UL- red flag sx- urgent referral
causing breathing issues- refer

  • Topical steroid (memetasone)
  • intranasal douche
  • If no improvement- polypectomy
146
Q

RF for otitis externa

A
  • swimming
  • *- cotton bud use
  • hot/humid climates
  • *- Narrow ear canals (down’s)
  • older age
  • derm issues (eczema, Seborrhoeic dermatitis)
  • *- Prev ear surgery
  • Immunosupression
  • hx of otitis media/externa
  • prev. RT to head/neck
147
Q

causative organisms of otitis externa

A 
Psuedomons aeruginosa (esp if diabetic)
Staph aureus
  • viral
  • aspergillus
  • candida (otomycosis)
148
Q

sx of otitis externa

A
  • rapid onset
  • otlagia
  • otorrhoea
  • **- itch
  • **- tragal tenderness
149
Q

signs O/E of otitis externa

A

erythematous and oedematous ear canal

150
Q

tx otitis externa

A
  • topical dexamethasone with abx (CIPRO)
  • clean ear canal if blocked
  • keep ear dry (put insert in when swimming if necessary)
  • analgesia
  • if no response- refer to ENT !!!! as you should be thinking nec otitis externa
  • if ear canal is swollen shut- refer to oncall ENT as will need microsuction and insertion of a pope wick
151
Q

What is malignant/necrotising otits externa

A
  • invasion to the tympanic bone and beyond

- can affect CN

152
Q

What is a major RF for malignant/necrotising otits externa

A

Diabetes (90%), immunosupression

153
Q

causative agent of nec otitis externa

A

Pseudomonas aeruginosa

154
Q

sx of nec otitis externa

A
  • severe otalgia disproportionate to clinical findings
  • aural fullness (sensation of blockage or fullness of the ear)
  • discharge
155
Q

what would you see on otoscopy for nec otitis externa

A
  • granulation of ear canal
156
Q

ix for ?nec otitis externa

A
  • CT temporal bone

- MRI internal auditory cana and brain

157
Q

tx nec otitis externa

A

oral and topical abx (cipro)

debridement

158
Q

what is the middle ear made up of

A

behind tympanic membrane

contains Malleus, Incus, Stapes

159
Q

what is the outer ear made up of

A

pinna, ear canal, tympanic membrance

160
Q

what is the outer ear made up of

A

pinna, ear canal, tympanic membrane

161
Q

causative organisms of acute otitis media

A

Strep pneumoniae, H. influenzae

viral

  • respiratory syntactical virus
  • rhinovirus
162
Q

causative organisms of acute otitis media

A

Often precedes or is concurrent with URTI

Strep pneumoniae, H. influenzae

viral

  • respiratory syntactical virus
  • rhinovirus
163
Q

What may occur in acute otitis media infections

A

eardrum perf (5%)

164
Q

what are the RFs for recurrent otitis media infections

A
  • early 1st episode
  • GORD
  • dummy use
  • winter season
  • supine feeding
165
Q

sx of acute otitis media

A
  • pain- younger children will pull at ear
  • reduced hearing
    nice n vague infective paeds sx– malaise, irritable, fever, vomiting, poor feeding
  • coryza/rhinorrhea - usually accompanied with URTI
166
Q

signs of acute otitis media O/E

A 
febrile
Otoscope
- red/yellow/cloudy TM
- bulging TM
- loss of light reflex
- air-fluid level behind TM
- discharge in canal secondary to perf
- erythema of pinna
167
Q

sx of eardrum perf following an acute otitis media infection

A
  • rapid resolution of acute otitis media sx

- then ear discharges pus

168
Q

management of acute otitis media

A
  • majority will resolve spotaneously- sx should improve within 24 hours and resolve in 3d in 80% of children
  • fever- NSAIDs, paracetemol
  • advise come back if sx no better in 4 or any worsening (could do delayed px)- offer review of sx in 4d from onset
  • abx
    1st line- amoxicillin 5d course/erythromycin or clarithro if allergy
    2nd line coamox
  • give abx straight away if <2yo
  • give abx if perforated (discharge) which occur following an episode of acute otitis media, then myringoplasty may be performed if the tympanic membrane does not heal by itself (6w)
169
Q

who do you give immediate abx to for acute otitis media

A
  • children who are systemically very unwell/serious illness
  • eardrum has perfed (purulent discharge)
  • higher risk of complications eg heart/lung/kidney/liver/neruomusc disease, immunocomp)
  • those inwhich sx have lased >4d
170
Q

when to admit a child with acute otitis media

A
  • signs of systemic infection
  • acute complication incl. mastoiditis, meningitis, intracranial abscess, sinus thrombosis, CN VII paralysis
  • <3m old
    _ children 3-6months with temp of 39
171
Q

when should you seek specialist advise for acute otitis media

A
  • 2 courses of abx not worked
  • ?perf
  • > 3 episodes in 6m/>4 in 1 year
  • impaired hearign after infection
172
Q

what is glue ear

A

otitis media with effusion

- collection of fluid within the middle ear without signs of acute infection

173
Q

sx and signs of glue ear

A

developmental delay

conductive hearing loss

174
Q

ix for ?glue ear

A
  • otoscopy
    exclude acute otitis media, foreign body, impacted ear wax, imbalance disorder
  • tympanometry
  • audiometry/audiogram
175
Q

Management of glue ear

A
  1. observe
    - consider developmental effects
    - resolution occurs commonly in 6-12w
  2. eustachian tube autoinflation with otovent tube
    - not very effective
    - blowing up balloon via the nostril 2-3 times a day
    - stop if causes pain
    - consider doing in observation phase
    - in older children can do valsalva manouvre ie without the balloon- pinch nose and forcibly exhale
  3. ventilation tubes- myringotomy and grommet insertion
    - can be done with or wihtout adenoidectomy if frequent UTRI sx
  4. hearing aids for BL otitis media and surgery not wanted/accepted
176
Q

what is chronic suppurative otitis media , tx

A
  • persistent purulent discharge with hearing loss
  • usually due to otitis media or blockage of a eustachian tube

tx- microsuction and topical eardrops

177
Q

sx and signs of pharyngitis

A 
sore throat, esp when swallowing 
hoarseness
mild cough
fever
headache
nausea
tiredness

swollen lymph nodes
may be pus on tonsils

178
Q

when does pharyngitis usually subside by?

A

a week

179
Q

tx of pharyngitis

A

fluids
NSAIDS, paracetemol, lozenges

most are caused by viruses so dont use abx routinely- use feverPAIN score (and then use phenoxymethylpenicillin - erythro/clarithro if allergic)

180
Q

causative organsims of laryngitis

A

viral

  • rhino
  • adeno
  • influenza

bacterial

  • H.influenzae B
  • Strep pneumoniae
  • staph areus
181
Q

other causes (not infective) of laryngitis

A
  • voice misuse

screaming, yelling, loud singing, coughing, habitual throat clearing

182
Q

causes of chronic laryngitis

A
  • GORD
  • Smoking
  • Trauma
  • Autimmune disease
  • Sarcoidosis
  • allergies
  • meds
183
Q

sx of laryngitis

A 
hoarseness
pain/discomfort in the neck
URTI- cough, rhinitis
dysphagia
lump in throat feeling
continual throat clearing
mayalgia, fever, malaise
184
Q

qs to ask if laryngitis lasts >3w

A 
other conditions:
sx of lung cancer
sx of thyroid disease
**hx of asthma, allergies (pets, mould)
sx of GORD- heartburn, chest pain, wheezing
**hx of intubation/neck trauma
**ingestion of caustic substance
travel hx
voice abuse
immunocoprimise (candida) 
meds
**fam hx- autoimmune diseases, cancer, contagious diseases eg TB
social hx- smoking, rec drug, alcohol
sexual hx- syphillis
diet (GORD)
185
Q

what medications may cause laryngitis

A

GORD inducers- bisphos, NSAIDs, abx, iron, quinidine, K
- immunosupressants
- ACEI, CCBs, nitrates, BB
- inhaled steroids
antihistammines, anticholinergic, diuretics- drying of mucosa
- danazol and testosterone, progesterone

186
Q

redflags for hoarseness of voice ?laryngitis

A
  • assess airway
  • recent surgery to neck (consider recurrent laryngeal nerve injury)
  • recent RT to neck
  • recent endotracheal intubation
  • hx of smoking, wt loss, mass in neck
  • professional voice use
  • otalgia, dysphagia, pain when swallowing (odynophagia)
  • signs of serious systemic illness
187
Q

tx of laryngtitis

A

should be mild and self limiting

vocal hygiene:

  • rest voice
  • avoid smoking and alcohol
  • humidification
  • hydration
  • reduce caffeine

abx have limited effect

if chronic
- above plus
- voice therapy
tx underlying coniditon eg GORD

188
Q

what is quinsy

A

peritonsillar abscess

most commonly follows bacterial tonsillitis , can also be a complicaton of mononucleosis

189
Q

causative agents of quinsy

A

strep pyogenes
staph areus
h. influenze
anaerobes

190
Q

sx of quinsy

A
  • severe UL sore throat
  • dysphagia
  • drooling of saliva
  • trismus (difficulty opening mouth)
  • hot potato voice- due to pharyngeal oedema and trsmus
  • neck stiffness/pain
    headache/malaise
191
Q

signs of quinsy

A
  • **- difficult to open mouth (trismus)
  • **- +- torticollis severe neck muscle spasms- head fixed in place
  • breath is fetid
  • drooling/salivation
  • UL bulging, usually above or lateral to the tnosil
  • uvulae displacement
  • Medial/anterior shift of tonsil
  • erythema, enlarged
  • exudate
  • lymphadenopathy
192
Q

ix for quinsy

A
  • none- clinical diagnosis
193
Q

Management of quinsy

A
  • urgent ENT referral
  • analgesia
  • inscision, drainage
  • IV abx
    – phenoxymethylpenicillin for 5-10 days
    clarithro or erythro if allergic– 5d
    – 2nd line- cephalosporins, coamox, clindamycin all ok
  • consider tonsillectomy at 6w
  • IV fluids
  • IV immunoglobulins if atypical (eg S.pyogens)
  • some studies show steroids IV with abx can help recovery
194
Q

what advise would you give to someone recovering from quinsy

A
  • keep fluid intake up
  • avoid hot drinks- can make pain worse
  • children may return to school or daycare after fever has resolved and no longer feeling unwell- and after abx for at least 24hours
195
Q

primary causes of otalgia

A

otitis externa and otitis media

196
Q

secondary causes of otlagia

A

– otalgia accompanied with normal ear exam

  • temporomandibular joint syndrome
  • pharyngitis
  • dental disease
  • c spine arthritis
  • tonsillar /tongue/pharygeal/laryngeal/ear cancer
197
Q

sx of tonsillar ca

A

nekc mass
sore throat
bleeding
lockjaw

198
Q

sx of tongue cancer

A

speech changed

dysphagia

199
Q

sx of pharyngeal ca

A

dysphagia
lump in throat
hoarseness
sore throat

200
Q

sx of laryngeal ca

A 
hoarseness
sore throat 
dysphagia
cough, SOB
lump in throat
201
Q

sx of ear malignancy

A

otorrhoea

loss of hearing

202
Q

what are the four types of hypersensitvity reactions

A

I- IgE mast cell

  • immediate allergy
  • eg anaphylaxis , asthma

II- cytotoxic IgG, IgM

  • bind to antigen on target cell leading to cellular destruction – transfusion reactions, autoimmunity
  • testing- direct and indirect coombs

III- immune complexes-

  • IgG binds to soluble antigen.
  • Deposited in and damage tissues eg vessel walls of joint, kidneys
  • autoimmunity eg RA, SLE

IV- delayed -

  • memory t-cell respond to antigen and activate macrophages
  • eg contact dermatitis
V
- autoimmune
igM or igG
- used as a dstinction from type 2
- Graves, MG
203
Q

sx of allegric rhinitis

A
  • itch
  • puffy eyes
  • nasal obstruction, rhinorrhoea
  • sneezing

pmhx- eczema, asthma

204
Q

ix for allegric rhinitis

A

clinical dx

if poor repsonse to tx- skin prick test and RAST

205
Q

tx of allergic rhinitis

A

mild/intermittent moderate
- intranasal antihistamine- azelastine, cetrizine

mod/severe/no reposnse to above
- intranasal corticosteroid

206
Q

what type of hypersensitivity is allergic rhintiis

A

type I- IgE/mast cell mediated

207
Q

sx of acute rhinosinusitis

A
  • usually follows URTI
  • obstruction
  • loss of smell
  • rhinorrhoea
  • facial pain/pressure- worse when beindign over
  • headache, toothache
  • viral : <10d- peak then improves, clear discharge
  • bacterial- >10d- improvement followed by further worsening of sx, purulent dishcarge
208
Q

tx of rhinosinusitis

A
  • supportive
    adjuncts:
    **- intranasal steroid
    **decongestant- nasal ipratropium, steam

bacterial

  • watch and wait for 10d or
  • oral amoxicillin
  • if immunocomp- just start abx
209
Q

chronic sinusitis- what does this suggest

A

nasal polyps

atopy

210
Q

sx of chronic rhinosinusitis

A

sx of acute rhinosinusitis for >12w:

  • change in smell
  • obstruction
  • mucopurulent discharge
  • fail pain/fullness
  • post nasal drip leading to (chronic) cough
211
Q

ix for chronic rhinosinusitis

A
  • anterior rhinoscopy with nasal endoscopy- to see if nasal polyps present
  • CT is diagnostic and indictaed if medical tx has failed
212
Q

tx of chronic rhinosinusitis

A
  • saline irrigation
  • corticosteroids- esp if polyps present
  • abx
213
Q

ddx for salivary gland swelling, managament for all in primary care

A

infection

  • viral- mumps, coxsackie, parainfluenza A, parvovirus, herpes
  • bacterial- staph aureus
  • HIV related lymphcytic infiltration
inflammation
obstruction
- stone 
- sjorgrens
- sarcoidosis
- granulomatosis with polyangitis

tumours

  • benign
  • malignant

All need urgent referral

214
Q

sx of salivary galnd swelling and their meaning (ie ddx)

A
  • loclised lump- tumour
  • generalised swelling- inflammation, obstruction
  • weakness in facial nerve- malignancy
  • pressure on gland with mouth open can expel pus/stone from duct opening
  • swelling on the floor of the mouth (sublinguinal gland)
  • dry eyes- Sjogrens
  • tooth enamel wasting- bulimia
  • pain/swelling gets worse on eating- stone obstruction
215
Q

how do you know if swelling is from salivary gland or lymph node

A

lymph node- possible to feel infront

impossible t get infront of the parotid

216
Q

ix for salivary gland swelling

A 
FBC, CRP, UE, Blood culture, viral serology, HIV test
pus swab for MCS if present
sialography
USS
CT/MRI to exclude neoplasms
FNA or incisional biopsy
217
Q

Management of salivary gland swelling

A

mumps- notifiable, self limiting

bacterial- abx with incisions for drainage if abscess

warm compress, sialogoes (lemon drops, gum, vit C lozenge), hydration, slaovary gland massage, oral hygeine

remove stones

218
Q

what is a complication of nasal trauma?

A

septal haematoma

219
Q

what is a risk/complication of septal haematoma

A

necrosis

220
Q

sx of septal haematoma

A

obstructed nasal canal- difficulty breathing through nose, often following trauma

221
Q

signs of septal haematoma

A
  • boggy septum on palpation

BL septal swelling

222
Q

tx of septal haematoma

A

drainage

abx if not caught early and has become infected

223
Q

Causes of temporomandibular joint dysfunction

A

Muscle issues

  • tension (clenching)
  • overuse- gum chewing, biting nails
  • movement disorders- orofacial dystonias
  • increased sensitivity to pain

Joint issues

  • OA
  • RA
  • Gout
  • injury/trauma to TMJ
224
Q

sx of temporomandibular joint dysfunction

A
  • pain infront of the ear, may spread to the cheek, the ear and the temple
  • reduced movement of the jaw- tightness, locking
  • clicking/grating o fthe jaw
  • ear sx
  • noise in the ear
  • sensitivity to sounds
  • dizziness/vertigo
225
Q

ix of temporomandibular joint dysfunction

A
  • clinical dx

if sx dont settle

  • bloods- inflam/gout
  • XR- teeth for #, dislocations, severe OA
  • MRI/CT
  • arthroscopy
226
Q

tx of temporomandibular joint dysfunction

A
  • massage the muscles, hot compress
  • improving posture can help
  • splints, bite guards
  • rest the joint
  • physio
  • tx underlying condition
  • NSAIDs, paracetemol, codeine, TCA (small dose)
  • muscle relaxants
  • steroid injections
  • surgery
  • acupuncture
227
Q

what advice can you give to someone with temporomadibular joint dysfunction concerign resting their TMJ

A

stop chewing gum/biting nails
try and keep teeth slightly apart with tongue resting in the bottom of your mouth
eat soft food
avoiding opening too widely- yawn smaller!

228
Q

what physio exercise can be done for someone with TMJ dysfunction

A
  • put finger on chin
  • try to move jaw forward against resistance
  • hold this for 12s
  • repeat 3x
  • do same laterally
  • do several times a day
229
Q

sx of tonsilltitis

A

obstructive sleep apnoea

  • snoring with shirt pauses
  • often restless, kick quilt off and end up on other side of bed
  • behaviour goes off at about 2pm due to fatigue
  • stridor- noisy breathing
  • restless
  • sweaty
  • poor eater- drink milk copiously
  • FFT
  • behaviourla issues- hyperactivtiy, stress
230
Q

O/E appearance of child with tonsillitis

A
  • mouth breather
  • adenoid faces- bags under eyes, mouth open, tnogue out a little bit
  • large tnosils, may be exudative
  • pes excavatum
231
Q

tx of tonsillitis

A

Abx if indicated (feverpain)
- phenoxymethylpenicillin (penicillin V) for 5-10d

  • clarithro or erythro if pregnant of allergic for 5d
  • fluid intake
  • avoid hot drinks- exacerbates pain
  • return to school when fever has gone and no longer feeling unwell and wehn abx have started at leats for 24hours

adenotonsillectomy- GUIDELINES:

  • 7 episodes in 1 year
  • 5 episodes in 2 years
  • 3 episodes in 3 years
  • remember- 3 for 3 then two more for each preceding year

monitor O2 sats overnight post op

232
Q

describe the scoring used to decide whether someone with sore throat/tonsillitits should be given abx

A

feverPAIN

  • fever in past 24 hours (1)
  • purulent tonsils (1)
  • attend rapidly <3d (1)
    ***- inflammation of the tonsils (1)
  • no cough or coryza (1)
    calculates chance of strep being isolated

1- no abx
2-3- consider delayed script
4-5- consider abx

233
Q

What is an acoustic neuroma/vestibular schwannoma

A

tumour of schwann cells of the myelin sheath in the vestibulocochler nerves

234
Q

sx of acoustic neuroma

A 
UL SN hearing loss
vertigo
tinnitus
facial numbness
facial N palsy
235
Q

ix for ?acoustic neuroma

A
  • audiometry- UL SN hearing loss, worsening in higher frequencies
  • MRI gold standard
236
Q

tx of acoustic neuroma

A
  • refer to ENT
  • conservative
  • RT
  • surgery
237
Q

red flag sign concerning nasal polyps

A

UL

238
Q

tx of perforated tympanic membrane that does not heal spotaneously within 6-8w /keeps getting infected/discharging

A

myringoplasty

239
Q

what op can improve conductive hearing loss

A

stapedectomy

240
Q

sx of Ramsay Hunt Syndrome

A

Herpes Zoster Oticus

  • auricular pain
  • CN VII palsy
  • vesicular rash around the ear
  • vertigo and tinnitus
241
Q

tx Ramsay Hunt

A

PO acyclovir and pred

242
Q

tx CMV

A

Ganciclovir

243
Q

tx of sudden onset UL Sensorineural hearing loss

A

high-dose oral corticosteroids

urgent referral to ENT

244
Q

sx and tx of pharyngeal pouch

A

dysphagia
halitosis (bad breath)
regurgitation of undigested food

tx- surgical correction - diverticulectomy.

245
Q

sx and signs of oesophageal candida

A

difficulty swallowing
history of steroid use
white plaques seen in the pharynx

246
Q

what is Globus hystericus

A

sensation of lump in throat but no physical findings found on laryngoscopy

247
Q

what are the sx of viral parotitis, incl complications

A

most commonly caused by mumps (orthorubulavirus)

  • young adult
  • parotid swelling
  • pancreatitis
  • orchitis
  • reduced hearing
  • meningoencephalitis
248
Q

sx occurring in face with sarcoidosis

A
  • bilateral (in most cases) parotid gland swelling
  • dry mouth
  • facial nerve palsies
  • improves with steroids
249
Q

Associations with nasal polyps

A 
asthma (particularly late-onset asthma)
aspirin sensitivity
infective sinusitis
cystic fibrosis
Kartagener's syndrome
Churg-Strauss syndrome
250
Q

side effect of LT use of nasal decongestants

A

tachyphylaxis (becoming tolerant/need more for same effect)

rebound nasal congestion

251
Q

management of traumatic haematoma of the ear cartilage

A

Untreated they can lead to a classic ‘cauliflower ear’ deformity.
- early incision and drainage (not needle aspiration) so same day ENT referral is needed.

252
Q

what antiemetics do you use when

A
  • Ondansetron from your Oncologist- CT induced nausea (5ht3)
  • Haloperidol for causes in your Head (intracranial issues)
  • Prochlorperazine for when you feel Peculiar (i.e. vestibular vertigo)
  • Metoclopramide for things attached to the Mesentry- GI issues
253
Q

complciations of sinusitis

A
  • cerebral abscess (UL weakness, seizure)

- cavernous sinus thrombosis- UL facial oedema, photophobia, proptosis, III, IV, VI palsies, V1 and V2 sensory palsies

Finals (15 decks)

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