ENT Flashcards
1
Q
What is conductive hearing loss
A
Problem with sound travelling from environment to inner ear
2
Q
What is sensorineural hearing loss
A
Problem with sensory system or vestibulocochlear nerve in inner ear
3
Q
What might hearing loss be accompanied by
A
Tinnitus
Vertigo
Pain
Discharge
Neurological symptoms
4
Q
What is found on Weber’s test in sensorineural hearing loss
A
Louder in normal ear
Quieter in affected ear
5
Q
What is found on Weber’s test in conductive hearing loss
A
Louder in affected ear
Quieter in normal ear
6
Q
What is a normal result on Rinne’s test (Rinne’s positive)
A
Still hear noise when fork moved from mastoid process to front of ear
Air conduction better than bone conduction
7
Q
What is an abnormal result on Rinne’s test (Rinne’s negative)
A
Bone conduction better than air conduction
8
Q
What are the causes of sensorineural hearing loss
A
Sudden sensorineural hearing loss
Presbycusis
Noise exposure
Meniere’s disease
Labyrinthitis
Acoustic neuroma
Neurological condition (stroke, multiple sclerosis, brain tumour)
Infection
Medications (furosemide, gentamicin, cisplatin)
9
Q
What are the causes of conductive hearing loss
A
Ear wax
Infection
Effusion in middle ear
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumour
10
Q
What are audiograms
A
Charts that show the volume at which different tones can be heard
Show the quietest volume at which different frequencies can be heard
11
Q
What is presbycusis
A
Age-related hearing loss
A type of sensorineural hearing loss
Affects high-pitched sounds first
Gradual and symmetrical
12
Q
What are the mechanisms of presbycusis
A
Loss of hair cells in cochlea
Loss of neurones in cochlea
Atrophy of stria vascularis
Reduced endolymphatic potential
13
Q
What are the risk factors for presbycusis
A
Age
Male
Family history
Loud noise exposure over time
Diabetes
Hypertension
Ototoxic medications
Smoking
14
Q
How might presbycusis present
A
Gradual or insidious onset
Speech difficult to understand
May come in with concerns about dementia
Associated tinnitus
15
Q
What would audiometry show in presbycusis
A
Sensorineural hearing loss
16
Q
What is the management for presbycusis
A
Effects can not be reversed
Support to maintain function: optimise environment, hearing aids, cochlear implants
17
Q
What is sudden sensorineural hearing loss
A
Hearing loss over < 72 hours
Not explained by other causes
Often unilateral
Some persistent, some resolve
18
Q
What are the causes of sudden sensorineural hearing loss
A
Idiopathic (90%)
Infection
Meniere’s disease
Ototoxic medications
Multiple sclerosis
Migraines
Stroke
Acoustic neuromas
Cogan’s syndrome (autoimmune inflammation of eye and inner ear)
19
Q
What are the investigations for sudden sensorineural hearing loss
A
Audiometry: loss of > 30 decibels in 3 consecutive frequencies
Consider CT/MRI head
20
Q
What is the management for sudden sensorineural hearing loss
A
Immediate referral for ENT assessment
If cause found: treat
If idiopathic: steroids (oral/intra-tympanic)
21
Q
What is eustachian tube dysfunction linked to
A
Viral upper respiratory tract infections
Allergies
Smoking
22
Q
How might eustachian tube dysfunction present
A
Reduced/altered hearing
Popping noises/sensations
Fullness in ear
Pain
Tinnitus
Worse when external air pressure changes (flying, climbing, diving)
23
Q
What are the investigations for eustachian tube dysfunction
A
Otoscopy (often normal)
Tympanometry
Audiometry
Nasopharyngoscopy
CT
24
Q
What is the management for eustachian tube dysfunction
A
Often resolve spontaneously
Valsalva manoeuvre (hold nose and blow into it)
Decongestant nasal spray
Antihistamines
Steroid nasal spray
Surgery (adenoidectomy, grommets, balloon dilation of tube)
25
What is otosclerosis
Remodelling of small bones in middle ear, leading to conductive hearing loss
Genetic (autosomal dominant) or environmental
Sounds not transmitted effectively from tympanic membrane to cochlea
Usually in under 40s
26
How might otosclerosis present
Unilateral or bilateral
Hearing loss (low pitch first)
Tinnitus
Talk quietly (hear own voice louder)
27
What are the investigations for otosclerosis
Otoscopy
Rinne's
Weber's
Audiometry (conductive pattern)
Tympanometry (generally reduced admittance)
HRCT (detect bony changes)
28
What is the management for otosclerosis
Conservative: hearing aids
Surgical: stapedectomy (remove stapes, replace with prosthetic), stapedotomy (small part of stapes removed, base still attached to oval window)
29
What is otitis media
Infection in middle ear
Middle ear: space between tympanic membrane and inner ear (cochlea, vestibular apparatus, nerves)
Often after viral upper respiratory tract infection
30
What are the bacterial causes of otitis media
Strep pneumoniae (most common)
Haemophilus influenzae
Moraxella catarrhalis
Staph aureus
31
How might otitis media present
Ear pain
Reduced hearing
Fever
Symptoms of upper respiratory tract infection
Balance issues, vertigo (if vestibular system affected)
Discharge (if tympanic membrane ruptured)
32
What are the investigations for otitis media
Otoscopy (bulging, red, inflamed tympanic membrane)
33
How is otitis media managed
Often resolves without antibiotics in 3 days
Simple analgesia
Consider antibiotics: delayed prescriptions
34
Which antibiotics may be given for otitis media
Amoxicillin (first line)
Clarithromycin (penicillin allergy)
Erythromycin (pregnant and penicillin allergy)
35
What are the complications of otitis media
Otitis media with effusion
Hearing loss (usually temporary)
Perforation of membrane
Labyrinthitis
Mastoiditis
Abscess
Facial nerve palsy
Meningitis
36
What is otitis externa
Inflammation of skin in external ear canal
Can be localised or diffuse
Can be acute (< 3 weeks) or chronic
37
What are the causes of otitis externa
Swimming
Trauma to canal
Bacterial infection (pseudomonas aeruginosa, staph aureus)
Fungal infection
Eczema
Seborrhoeic dermatitis
Contact dermatitis
38
How might otitis externa present
Ear pain
Discharge
Itchiness
Conductive hearing loss
39
What might be found on examination in otitis externa
Erythema
Swelling
Tenderness
Discharge
Lymphadenopathy
40
What are the investigations for otitis externa
Otoscopy
Ear swab
41
What is the management for otitis externa
Mild: over the counter meds
Moderate: topical antibiotics, steroids
Severe: oral antibiotics (flucloxacillin, clarithromycin), possibly admit
Ear wicks: sponges of topical treatment, leave in canal for 48 hours
Fungal infection: clotrimazole
42
Give an overview of malignant otitis externa
Severe, potentially life-threatening
Can spread to surrounding bones/skull (osteomyelitis)
Severe symptoms: fever, pain, headaches
Key findings: granulation tissue at junction between bone and cartilage of ear canal
Need emergency management: admission, IV antibiotics, CT/MRI head
Complications: facial nerve palsy, meningitis, intracranial thrombosis, death
43
What is the medical name for ear wax
Cerumen
44
How might a patient present with impacted ear wax
Conductive hearing loss
Discomfort
Feeling of fullness
Pain
Tinnitus
45
What is the management for impacted ear wax
Ear drops
Ear irrigation
Microsuction
46
What is tinnitus
Persistent additional sound heard, but not present in environment
Ringing in ears
Due to background sensory signals produced by cochlea
47
What is primary tinnitus
No identifiable cause
Often found in sensorineural hearing loss
48
What is secondary tinnitus
Identifiable cause
Impacted ear wax, ear infection, Meniere's disease, noise exposure, ototoxic medications, acoustic neuromas, multiple sclerosis, trauma, depression
49
What systemic conditions are associated with tinnitus
Anaemia
Diabetes
Thyroid disorders
Hyperlipidaemia
50
What is objective tinnitus
Actual sound heard in head
Carotid artery stenosis, aortic stenosis, arteriovenous malformations, eustachian tube dysfunction
51
What investigations are needed for tinnitus
Otoscopy
Bloods for underlying cause (FBC, glucose, TSH, lipids)
Audiology
CT/MRI
52
What are the red flags in tinnitus
Unilateral
Pulsatile
Hyperacusis (hypersensitivity to sound)
Associated unilateral hearing loss
Associated vertigo/dizziness
Headache
Visual symptoms
Associated neurological signs/symptoms
Suicidal ideation due to tinnitus
53
What is the management for tinnitus
Often improves over time
Treat underlying cause
Manage symptoms: hearing aids, sound therapy (background noise to mask tinnitus), CBT
54
What is vertigo
Sensation of movement between patient and environment (room spinning, they are moving)
55
What are the associated symptoms of vertigo
Nausea
Vomiting
Sweating
Feeling generally unwell
56
What are the 2 groups of causes of vertigo
Central (involving brainstem/cerebellum, get sustained, non-positional symptoms)
Peripheral (affecting vestibular system)
57
Which sensory inputs are needed for maintenance of balance
Vision
Proprioception
Signals from vestibular system
58
What are the causes of peripheral vertigo
Benign paroxysmal positional vertigo
Meniere's disease
Vestibular neuronitis
Labyrinthitis
Trauma to nerve, acoustic neuromas, otosclerosis, hyperviscosity syndrome, herpes infection
59
What are the causes of central vertigo
Posterior stroke
Tumours
Multiple sclerosis
Vestibular migraines
60
What are the special tests for vertigo
Romberg's test (proprioception/vestibular dysfunction)
Dix-Hallpike manoeuvre (diagnostic)
HINTS examination (peripheral/central causes)
61
What are the components of a HINTS examination for vertigo
Head Impulse (normal in central causes, abnormal in peripheral causes, look for rapid eye movements on certain head movements)
Nystagmus (unilateral in in peripheral causes, bilateral in central causes)
Test of Skew (deviation of eyes)
62
What are the components of a cerebellar examination
Dysdiadochokinesia
Ataxic gait
Nystagmus
Intention tremor
Slurred speech
Heel-shin test
63
What is the management for vertigo
Central cause: refer for imaging
Peripheral cause: prochlorperazine, antihistamines
Meniere's disease: betahistine
Vestibular migraines: avoid triggers, triptans (acute symptoms), propranolol/amitriptyline/topiramate (prophylaxis)
64
What is benign paroxysmal positional vertigo
Common cause of recurrent vertigo
Triggered by head movement
Peripheral cause of vertigo (problem with inner ear)
More common in older adults
65
How might benign paroxysmal positional vertigo present
Triggered by head movement (often when turning in bed)
Symptoms last 20-60 seconds
Asymptomatic between attacks
Often over a few weeks, then go away for a few months
No changes to hearing
No tinnitus
66
What is the pathophysiology of benign paroxysmal positional vertigo
Calcium carbonate crystals become displaced into semicircular canals
Disruption to flow of endolymph through canals
67
How is benign paroxysmal positional vertigo diagnosed
Dix-Hallpike manoeuvre
Move head in a way that causes endolymph to move through the semicircular canals
Get rotational nystagmus and vertigo symptoms
68
What is the management for benign paroxysmal positional vertigo
Epley manoeuvre
Move crystals into a position where they do not disrupt the flow of endolymph
69
What is vestibular neuronitis
Inflammation of vestibular nerve (get vertigo)
Usually due to viral infection
Can lead to BPPV
70
How might vestibular neuronitis present
Acute onset of vertigo
Recent viral upper respiratory tract infection
Most severe on first few days
Associated symptoms (nausea, vomiting, balance problems)
No hearing loss
No tinnitus
71
What are the investigations for vestibular neuronitis
Head impulse test
For diagnosis of peripheral causes of vertigo
Nystagmus on certain eye movements
72
How is vestibular neuronitis managed
Admit if dehydrated
Short term symptom control: prochlorperazine, antihistamine
Refer if symptoms do not: improve in 1 week, resolve in 6 weeks
73
What is labyrinthitis
Inflammation of bone labyrinth of inner ear (semicircular canals, vestibule, cochlea)
Usually due to viral upper respiratory tract infection
74
How might labyrinthitis present
Acute onset vertigo
Hearing loss
Tinnitus
Symptoms of viral infection
75
How is labyrinthitis diagnosed
Head impulse test (for peripheral causes of vertigo)
76
What is the management for labyrinthitis
Acute attacks: prochlorperazine, antihistamine
If bacterial, antibiotics
77
What is Meniere's disease
Long term inner ear disorder
Excessive buildup of endolymph in labyrinth of inner ear (high pressure disrupts sensory signals)
78
What are the triad of symptoms of Meniere's disease
Hearing loss
Vertigo
Tinnitus
79
How might Meniere's disease present
40 - 50
Vertigo (20 mins - several hours, clusters, not triggered by movement)
Hearing loss (fluctuating (then permanent), unilateral, sensorineural, low frequencies affected first)
Tinnitus (unilateral)
Fullness in ear
Unexplained falls without loss of consciousness
Spontaneous nystagmus during attacks
80
What is the management for Meniere's disease
Acute attacks: prochlorperazine, antihistamine
Prophylaxis: betahistine
81
What are acoustic neuromas
Benign tumour of Schwann cells surrounding auditory nerve
Occur at cerebellopontine angle
Usually unilateral
82
How might acoustic neuroma present
40 - 60
Gradual onset
Unilateral
Sensorineural hearing loss
Unilateral tinnitus
Dizziness/imbalance
Fullness in ear
May have facial nerve palsy
83
What are the investigations for acoustic neuromas
Audiometry
CT/MRI brain
84
What is the management for acoustic neuromas
Monitoring (if not causing major issues)
Surgery
Radiotherapy
Complications of treatment: vestibulocochlear/facial nerve injury
85
What is cholesteatoma
Abnormal collection of squamous epithelial cells in the middle ear
Not cancerous
Can invade local tissues and nerves
Can erode bones of middle ear
86
How might a cholesteatoma present
Foul discharge from ear
Unilateral conductive hearing loss
Symptoms of expansion (infection, pain, vertigo, facial nerve palsy)
87
What are the investigations for cholesteatoma
Otoscopy (buildup of white debris on upper tympanic membrane)
CT head (definitive)
88
What is the management for cholesteatoma
Surgical removal
89
What are nosebleeds
Bleeding usually from Kiesselbach's plexus (Little's area)
Common in young children and older adults
Usually unilateral
If bilateral, more likely to be posterior (higher chance of aspiration)
90
What are the triggers for nosebleeds
Nose picking
Colds
Sinusitis
Vigorous nose blowing
Trauma
Changes in weather
Coagulation disorders
Anticoagulant medication
Snorting cocaine
Tumours
91
What is the management for nosebleeds
Usually resolve without intervention
Investigate if: recurrent, significant loss
Admit if: not stopped after 15 mins of compression, severe, bilateral, haemodynamically unstable
Nasal packing
Nasal cautery
Naseptin (topical cream to reduce infection
92
What is sinusitis
Inflammation of paranasal sinuses in face
Acute: < 12 weeks
Chronic: > 12 weeks
Due to blockage of drainage from sinuses
93
What are the 4 sets of paranasal sinuses
Frontal (above eyebrows)
Maxillary (either side of nose, below eyes)
Ethmoidal (in ethmoid bone, middle of nasal cavity)
Sphenoid (in sphenoid bone, at back of nasal cavity)
94
What are the causes of sinusitis
Infection (often viral upper respiratory tract infections)
Allergies
Obstruction of drainage (foreign body, trauma, polyps)
Smoking
95
How might acute sinusitis present
Recent viral upper respiratory tract infection
Nasal congestion/discharge
Facial pain/pressure
Headaches
Facial swelling on affected side
Loss of sense of smell
96
How does chronic sinusitis compare to acute sinusitis
Longer duration
May have polyps
97
What might be found on examination in sinusitis
Tenderness on palpation
Inflammation and oedema of nasal mucosa
Discharge
Fever
Signs of systemic infection
98
What are the investigations for sinusitis
Only if persistent symptoms despite treatment
Nasal endoscopy
CT
99
What is the management for acute sinusitis
Admit if septic
Most resolve in 2-3 weeks
If not improving after 10 days: high dose steroid nasal spray, delayed antibiotic prescription
100
What is the management for chronic sinusitis
Saline nasal irrigation
Steroid nasal spray/drops
Functional endoscopic sinus surgery (remove/correct obstruction, balloon dilation)
101
What are nasal polyps
Growths of nasal mucosa in nasal cavity/sinus
Associated with inflammation (chronic rhinitis, sinusitis, asthma, cystic fibrosis)
Slow growing (but eventually obstruct nasal passage)
Bilateral (red flag if unilateral)
102
How might nasal polyps present
Chronic rhinosinusitis
Difficulty breathing through nose
Snoring
Nasal discharge
Loss of sense of smell
103
What are the investigations for nasal polyps
Nasal speculum
Nasal endoscopy
Round pale yellow/grey growths on mucosal wall
104
What is the management for nasal polyps
Unilateral: refer for exclusion of malignancy
Medical: intranasal topical steroids
Surgical: intranasal polypectomy, endoscopic nasal polypectomy
105
What is obstructive sleep apnoea
Collapse of pharyngeal airway during sleep
Episodes of apnoea (stop breathing for a few minutes)
Assess using Epworth Sleepiness Scale
106
What are the risk factors for obstructive sleep apnoea
Middle age
Male
Obesity
Alcohol
Smoking
107
How might obstructive sleep apnoea present
Apnoea during sleep (reported by partner)
Snoring
Morning headaches
Waking unrefreshed from sleep
Daytime sleepiness
Concentration issues
Reduced O2 sats during sleep
If severe: hypertension, heart failure, increased risk of MI/stroke
108
What is the management for obstructive sleep apnoea
Refer to sleep clinic
Correct reversible risk factors
CPAP
Surgery (reconstruction of soft palate and jaw - uvulopalatopharyngoplasty (UPPP))
109
What is tonsillitis
Inflammation of tonsils
Usually due to viral infection
110
What are the common bacterial causes of tonsillitis
Group A strep (strep pyogenes)
Strep pneumoniae
Haemophilus influenzae
Staph aureus
111
What is Waldeyer's ring
Ring of lymphoid tissue at back of throat
Adenoids, tubal tonsils, palatine tonsils, lingual tonsils
112
How might tonsillitis present
Acute: sore throat, fever > 38, pain on swallowing
Red, inflamed, enlarged tonsils
May have exudate
May have anterior cervical lymphadenopathy
113
What is the centor criteria for tonsillitis
Estimates probability that tonsillitis is bacterial (will benefit from antibiotics)
Give antibiotics if score > 3
Criteria:
- Fever > 38
- Tonsillar exudate
- Absence of cough
- Tender anterior cervical lymph nodes
114
What is the FeverPAIN score for tonsillitis
Gives probability of bacterial tonsillitis and need for antibiotics
2-3: consider delayed prescription
4-5: immediate or delayed prescription
Criteria:
- Fever in last 24 hours
- Pus
- Attend within 3 days of onset
- Inflamed tonsils (severely)
- No cough or coryza
115
What is the management for tonsillitis
Viral: patient education
Bacterial: penicillin V (10 days), clarithromycin (true penicillin allergy)
116
What are the complications of tonsillitis
Peritonsillar abscess
Otitis media
Scarlet fever
Rheumatic fever
Post-strep glomerulonephritis
Post-strep reactive arthritis
117
What is quinsy
Aka peritonsillar abscess
Bacterial infection causing trapping of pus in region of tonsils
A complication of untreated/partially treated tonsillitis
Can arise without tonsillitis
118
What are the bacterial causes of quinsy
Strep pyogenes
Staph aureus
Haemophilus influenzae
119
How might quinsy present
Sore throat
Painful swallowing
Fever
Neck pain
Referred ear pain
Swollen tender lymph nodes
Trismus (unable to open mouth)
Changes in voice (hot potato voice)
Swelling and erythema near tonsils
120
What is the management for quinsy
Incision and drainage
Antibiotics (before and after surgery)
Consider steroids
121
What are the indications for tonsillectomy
Episodes of tonsillitis:
- 7+ in 1 year
- 5 per year for 2 years
- 3 per year for 3 years
Recurrent tonsillar abscess (2 episodes)
Enlarged tonsils causing difficulty breathing/swallowing
122
What are the complications of tonsillectomy
Sore throat (for 2 weeks)
Damage to teeth
Infection
Post-tonsillectomy bleeding
123
What is post-tonsillectomy bleeding
Up to 2 weeks after surgery
Can be severe/life threatening (aspiration)
Management: involve ENT early, analgesia, cross match and group and save, encourage to spit blood out, make NBM, hydrogen peroxide gargles, adrenaline soaked swabs
124
What are the borders of the anterior triangle
Superior - mandible
Medial - midline of neck
Lateral - SCM
125
What are the borders of the posterior triangle
Inferior - clavicle
Posterior - trapezius
Lateral - SCM
126
What are the differentials for neck lumps
Normal structure
Skin abscess
Lymphadenopathy
Tumour
Lipoma
Goitre
Salivary gland stone/infection
Carotid body tumour
Haematoma
Thyroglossal cyst
Branchial cyst
Specific to children cystic hygroma, dermoid cyst, haemangioma, venous malformation
127
What should you look for on examination of neck lumps
Location
Size
Shape
Consistency
Mobile/tethered
Skin changes
Warm (infection)
Pulsatile (carotid body tumour)
Movement on swallowing
Movement on sticking tongue out
Transillumination (cystic hygroma)
128
Explain the 2 week wait criteria for neck lumps
Unexplained neck lump in > 45
Persistent unexplained neck lump at any age
Urgent ultrasound criteria for growing lumps:
- Within 2 weeks for > 25s
- Within 48 hours for < 25s
129
What investigations are needed for neck lumps
Bloods
Imaging
Biopsy
130
Give an overview of infection mononucleosis
Infection with Epstein Barr virus
Causes lymphadenopathy
Spread through saliva
On presentation: fever, sore throat, fatigue, lymphadenopathy
Investigations: monospot test, IgM/IgG for EBV
Management: supportive
131
What are the causes of thyroid goitres
Grave's disease
Toxic multinodular goitre
Hashimoto's thyroiditis
Iodine deficiency
Lithium
132
What are the causes of individual thyroid lumps
Benign hyperplastic nodules
Thyroid cysts
Thyroid adenomas
Thyroid cancer
Parathyroid tumours
133
What are the different salivary glands
Parotid
Submandibular
Sublingual
134
Give an overview of carotid body tumours
Due to excessive growth of glomus cells (chemoreceptors)
May be benign
On presentation: slow growing, in upper anterior triangle, painless, pulsatile, associated with bruit, mobile
Can involve CN 9 - 12
Splaying of internal and external carotids on imaging
Management: surgical removal
135
Give an overview of lipomas
Benign tumour of adipose tissue
On examination: soft, painless, mobile, no associated skin changes
Management: reassurance, surgical removal
136
Give an overview of branchial cysts
Congenital abnormality
2nd branchial cleft doesn't form properly
On presentation: round, soft, cystic swelling, in anterior triangle, mostly in young adulthood
Management: conservative (if not causing issues), surgical (recurrent, causing problems)
137
Head and neck cancers are usually what type of cancers
Squamous cell carcinomas
138
What are the risk factors for head and neck cancers
Smoking
Chewing tobacco
Chewing betel quid
Alcohol
HPV (16)
EBV
139
What are the red flags for head and neck cancers
Lump in mouth/on lip
Unexplained ulceration for > 3 weeks
Erythroplakia, erythroleukoplakia
Persistent neck lump
Unexplained hoarseness of voice
Unexplained thyroid lump
140
What is the management for head and neck cancers
Staging CT
Chemotherapy
Radiotherapy
Surgery
Targeted drug therapy
Palliative care
141
Give an overview of glossitis
Inflamed tongue (red, sore, swollen)
Smooth appearance of tongue (papillae atrophy)
Causes: iron deficiency anaemia, B12 deficiency, folate deficiency, coeliac disease, injury, irritant exposure
Management: correct underlying cause
142
Give an overview of angioedema
Fluid accumulation in tongue, face, lips, limbs
Causes: allergic reaction, ACE inhibitors, hereditary angioedemas
143
Give an overview of oral candidiasis
Oral thrush
White spots/patches on tongue and palate
Risk factors: inhaled corticosteroids, antibiotics, diabetes, immunodeficiency, smoking
Management: antifungal gel/tablets
144
Give an overview of geographic tongue
Patches on tongue surface lose epithelium and papillae
Irregular shapes on tongue
Remitting and relapsing course
Related to: stress, mental illness, psoriasis, atopy, diabetes
Management: usually does not need treatment, topical steroids, antihistamines
145
What is strawberry tongue
Tongue red and swollen
Enlarged, white, prominent papillae
Key causes: scarlet fever, Kawasaki disease
146
Give an overview of black hairy tongue
Due to decreased shedding of keratin from tongue surface
Papillae elongate, look like hair
Dark pigmentation due to food and bacteria
Associated features: sticky saliva, metallic taste in mouth
Management: good hydration, gentle brushing of tongue, stop smoking
147
Give an overview of leukoplakia
White patches in mouth
Precancerous condition
Patches: asymptomatic, irregular, raised, fixed in place
Investigations: biopsy
Management: stop smoking, reduce alcohol intake, close monitoring, laser removal, surgical excision
148
Give an overview of erythroplakia
Red lesions in mouth
High risk of squamous cell carcinoma
Refer urgently to exclude cancer
149
Give an overview of lichen plexus
Autoimmune condition
Chronic localised inflammation of skin
Shiny, purple, flat top, raised area
Wickham's striae (white lines across surface)
> 45s
F>M
Specific patterns: reticular (net-like), erosive (surface layer), plaque (large continuous area)
Management: good oral hygiene, stop smoking, topical steroids
150
Give an overview of gingivitis
Inflammation of gums
On presentation: swollen gums, bleeding after brushing, painful gums, bad breath
Risk factors: plaque on teeth, smoking, diabetes, malnutrition, stress
Management: good oral hygiene, stop smoking, chlorhexidine mouth wash, consider dental surgery
Can get acute necrotising ulcerative gingivitis
151
How might airway emergencies present
Noisy breathing (stridor, stertor)
Increased respiratory rate
Use of accessory muscles
Hoarseness of voice
Dysphagia
Drooling
Pain
