ENT Flashcards
(357 cards)
1
Q
What are pharyngeal arches?
A
embryonic structures that contribute to much of the face and neck
2
Q
At what day does arch 1 develop?
A
22
3
Q
At what day do arches 2+3 develop?
A
24
4
Q
At what day do arches 4+6 develop?
A
29
5
Q
What does each arch consist of?
A
Core of mesenchyme
Neural crest cells
Cranial nerve component
Artery (aortic arches)
6
Q
What externally separates the arches?
A
Deep pharyngeal clefts with an ectodermal lining
7
Q
What internally separates the arches?
A
Pharyngeal pouches with an endodermal lining
8
Q
What nerve supplies arch I?
A
Trigeminal (maxillary and mandibular divisions)
9
Q
What nerve supplies arch II?
A
Facial
10
Q
What nerve supplies arch III?
A
Glossopharyngeal
11
Q
What nerve supplies arch IV?
A
Vagus - superior laryngeal branch
12
Q
What nerve supplies arch VI?
A
Vagus - recurrent laryngeal branch
13
Q
What skeletal components arise from the 1st arch?
A
Maxilla zygomatic process part of the temporal bone Incus Malleus Mandible
14
Q
What muscles and nerves arise from the 1st arch?
A
Muscles of mastication anterior belly of digastric mylohyoid tensor tympani tensor palatini Sensory supply to skin on face - trigeminal nerve
15
Q
What skeletal components arise from the 2nd arch?
A
Stapes
Styloid process
Stylohyoid ligament
Lesser horn and upper part of hyoid
16
Q
What muscles and nerves arise from the 2nd arch?
A
Muscles of facial expression stapedius stylohyoid posterior belly of digastric auricular muscles All supplied by the facial nerve
17
Q
What structures arise from the 3rd arch?
A
Greater horn and lower part of hyoid
stylopharyngeus muscle
glossopharyngeal nerve
18
Q
What structures arise from the 4th arch
A
cricothyroid
levator palatini
pharyngeal constrictors
19
Q
What structures arise from the 6th arch?
A
intrinsic laryngeal muscle
20
Q
What structures arise from the 1st pouch?
A
middle ear
eustachian tube
tympanic membrane
21
Q
What structures arise from the 2nd pouch?
A
palatine tonsil
22
Q
What structures arise from the 3rd pouch?
A
inferior parathyroid gland
thymus
23
Q
What structures arise from the 4th pouch?
A
superior parathyroid gland ultimobranchial body (C cells of thyroid gland)
24
Q
What structures arise from the 1st cleft?
A
external auditory meatus
25
What are otic placodes?
thickening of the ectoderm on the outer surface, from which the ear develops
26
otic placodes turn into otic vesicles - what process does this closely resemble
endocytosis
27
Where do the semicircular canals originate?
flattened outpocketings of the otic vesicles
28
What are the 3 semicircular canals?
Superior
Posterior
Lateral
29
What is the dilated end of the semicircular canals called?
Crus Ampullare
30
What is the non-dilated end of teh semicircular canals called?
Crus Nonampullare
31
what is the function of the crista ampullaris within the semicircular canals?
They have sensory cells which aid with balance
| Also contain the vestibular fibres of CN VIII
32
Where does the cochlea arise from?
Saccular portion of the otic vesicles
| Cochlear duct grows in spirals between weeks 6-8 and the surrounding mesenchyme becomes cartilaginous
33
What surrounds the cochlear duct?
Scala vestibuli and the scala tympani (both air spaces)
Spiral ganglion
Spiral ligament
34
Where does the organ of Corti arise from?
Cochlear duct on the basillar membrane
35
What is the organ of corti made up of?
Mechanosensory cells known as hair cells
36
What is the function of the tympanic cavity?
Amplification of sound
37
During development what happens in the EAM?
Month 3 - epithelial cells proliferate to form a meatal plug
| Month 7 - this has dissolved and cells have become some of the tympanic membrane
38
What does the auricle of the ear originate from?
6 mesenchymal proliferactions (hillocks) surrounding the 1st pharyngeal cleft - 3 from arch 1 and 3 from arch 2
The hillock fuse to become the completed auricle
39
Where does the external ear travel from to get to its birth position?
Lower neck - must move due to development of mandible
40
What is anotia?
No development of ear buds
41
What is micronotia?
Small ears
42
What are preauricular appendages?
Extra tissue anterior to the ear proper
43
What is a preauricular pit?
Dent/dimple located anywhere adjacent to the ear proper
44
What is the range of sound in human hearing?
20-20,000Hz
45
What is the basic role of the external ear?
A reciever
46
What is the basic role of the middle ear?
An amplifier
47
How many times is sound amplified by in the tympanic cavity?
x22
48
What is the basic role of the eustachian tube?
ventilation for the middle ear
49
What muscles open the cartilaginous eustachian tube?
tensor veli palatini
| levator palatine
50
What is the basic role of the inner ear?
receiver/transducer
51
What is the basic composition of the inner ear?
curved spiral lamina
| 2.5 turns around a central mediolus
52
What is contained in the scala media?
Endolymph
53
What is contained in the scala tympani and the scala vestibuli?
Perilymph
54
Where is high frequency sound transmitted on the cochlea?
Lower end
55
Where is low frequency sound transmitted on the cochlea?
Upper end
56
What is the organ of corti made up of?
inner and outer hair cells and a highly varied strip of epithelial cells
57
What is the purpose of the organ of corti?
transduction of auditory signals through vibrations of the inner ear structures, which causes displacement of the cochlear fluid and movement of the hair cells to produce APs
58
How do hair cells of the ear produce an electrical impulse?
Conversion of a mechanical bending force into an electrical signal
59
How are the hair cells arranged?
Stereocilia are arranged in height order, with tip links connecting them
60
What causes depolarisation of hair cells?
Cells deflected towards the longest one
61
What causes hyperpolarisation of the hair cells?
Cells deflected away from the longest one
62
Where in the brain is the primary auditory cortex located?
Superior temporal gyrus
63
What does 60% of our balance come from?
Eyes
64
How much of our balance comes from our ears?
15%
65
How much of our balance is mediated by the CNS?
10%
66
How much of our balance comes from proprioception?
15%
67
As well as all the factors and systems that contribute to our ability to balance, what other system plays a part? What role does it have?
Cardiac functions keep everythign runnign smoothly
68
What pathology of the eyes can affect our ability to balance?
Cataracts
| DM eye disease
69
What pathology of the ears can affect our ability to balance?
AVN
Meniere's disease
Migraine
BPPV - benign paroxysmal positional vertigo
70
What pathology affecting the CNS can affect our ability to balance?
Stress
Migraines
MS
Space-occupying lesion in the cranial vault
71
What pathology of proprioception can affect our ability to balance?
DM
Arthritis
Neuropathy
72
What cardiac pathology can affect our balance, and why?
Arrhythmias and postural hypotension can cause lightheadedness, being off-balance and feeling dissociated
73
What is the complex structure of the ear also referred to?
The labyrinth
74
What are the 5 key vestibular organs of the inner ear?
3 semicircular canals
| 2 otolith organs (utricle and saccule)
75
What lies within the maculae of the otolith organs?
Stereocilia projecting up into a gelatinous mix with otoconia (calcium carbonate crystals)
76
What is the purpose of the calcium carbonate crystals in the maculae of the otolith organs?
They lend weight and because of gravity, when we tilt our heads or travel in an elevator the brain perceives a movement known as linear motion
77
Stereocilia are orientated in all directions, so all movements are perceived; but what movements specifically do the saccule and occule detect?
```
Saccule = Vertical movement
Utricle = horizontal movement
```
78
Where does the cupula sit in the semicircular canals?
In the ampulla
79
What causes deflection on the semicircular canals?
Movement of perolymph
80
What is the vestibulo-occular reflex?
Stabilises images on the retina during head movements, by producting eye movement in the opposite direction
81
What is spontaneous nystagmus?
Rhythmic, oscillating movements of the eyes - can be physiological or pathological
82
What do taste buds consist of?
Sensory receptor cells and support cells - arranged like orange slices
83
What is the lifespan of a taste receptor cell?
10 days
84
What type of nerve fibre do taste receptor cells synapse with?
afferent
85
What are the 4 types of papillae on the human tongue?
Filliform
Fungiform
Vallate
Foliate
86
What type of papillae does not contain taste buds?
Filliform
87
What happens when a taste provoking chemical (tastant) binds to a receptor cell on the tongue?
Produces a depolarising AP in afferent nerve fibres
88
Which cranial nerves are responsible for transferring taste from receptor cells to the brainstem?
VII -chorda tympani branch - anterior 2/3 of the tongue
IX - posterior 1/3 of tongue
X - epiglottis and pharynx etc.
89
What area of the brain are these signals conveyed to?
Cortical gustatory area
90
What are the 5 primary tastes?
```
Salty
Sour
Sweet
Bitter
Umami (meaty or savoury)
```
91
What are the salty taste receptors stimulated by?
chemical salts esp. NaCl
92
What are the Sour taste receptors stimulated by?
acids containing free hydrogen ions
93
What are the sweet taste receptors stimulated by?
configuration of glucose
94
What are the bitter taste receptors stimulated by?
alkaloids, poisonous substances, toxic plant derivatives etc.
95
What are the umami taste receptors stimulated by?
amino acids - esp. glutamate
96
What is a complete loss of taste function known as?
Ageusia
97
What can cause aguesia?
Nerve damage, local inflammation, some endocrine disorders
98
What is hypogeusia?
Reduced taste function
99
What causes a reduced taste function?
Chemo, medications etc.
100
What is dysgeusia?
Distorted taste function
101
What can cause a distorted taste function?
```
Glossitis
Gum infection
Tooth decay
Reflux
URTIs
Medications
Neoplasms
Chemo
Zinc deficiency
```
102
Where does the olfactory mucosa lie?
Ceiling of the nasal cavity (bilaterally)
103
What 3 cell types are contained within the olfactory mucosa?
olfactory receptor cells
supporting cells
basal cells (mucous secreting)
104
What are olfactory receptors?
specialised endings of renewable afferent neurons
105
What do neurons involved with the olfactory mucosa contain?
A thick, short dendrite
| An expanded end (olfactory rod)
106
What projects from the olfactory rods into the olfactory mucosa?
Cilia
107
What is the function of the cilia of the nose?
Odorants bind to them
108
What is the life span of an olfactory receptor?
~2 months
109
Where to new olfactory receptor cells arise from?
Basal cells are the precursors
110
The axons of olfactory receptors collectively form afferent fibres of the olfactory nerve; where do these then go?
Pierce the cribriform plate of the ethmpid bone to enter the olfactory bulbs on the inferior brain surface. These then transmit information to the brain
111
In quiet breathing how do odorants reach smell receptors?
Diffusion only - olfactory mucosa is higher than normal path of airflow
112
What must a substance be to be smelled?
Sufficiently volatile and sufficiently water soluble
113
What is the complete inability to smell known as?
Anosmia
114
What can cause anosmia?
viral infections
allergies
nasal polyps
head injury
115
What is hyposmia?
Reduced ability to smell
116
Hyposmia has similar causes to anosmia, but what can hyposmia be an early sign of?
Parkinson's disease
117
What is dysosmia?
Altered sense of smell
118
What cell type outlines the auditory meatus and external ear canal?
Epidermis (skin) cells with sebaceous and ceruminous glands
119
What cell types line the middle ear?
columnar-lined mucosa
120
What cell type lines the nasal vestibule?
Squamous
121
The nose and sinuses are lined by a Scheiderian epithelium - what does this contain?
a modified mucous membrane forming the epithelium part of the olfactory organ - identical to resp. mucosa (pseudostratified ciliated columnar)
122
What cell types line the throat?
respiratory and squamous epithelium
123
Are the salivary glands endocrine or exocrine?
Exocrine
124
What type of cells are in the salivary glands?
Peripheral myoepithelial cells - flat or cuboidal with a clear cytoplasm
125
What is otitis media?
inflammation of the middle ear
126
What bacteria can cause otitis media?
Strep pneumoniae
H. influenzae
Moxarella cattarhalis
(if chronic) pseudomaonas aueroginosa
127
What is a cholesteatoma?
abnormally situated squamous epithelium in the middle ear with associated kertain production and inflammation
128
What is a vestibular Schwannoma?
tumour of the schwann cells of CNVIII
| occurs within the temporal bone
129
If a young patient presents with bilateral vestibular schwannoma, what alternative diagnosis should you consider?
NF type 2
130
What can cause nasal polyps?
```
allergies
infection
asthma
aspirin sensitivity
nickel exposure
```
131
Are nasal polyps sore to the touch?
Not usually no
132
Nasal polyps in young children are not common, what could these be a sign of?
Cystic fibrosis
133
What can cause rhinitis and sinusitis?
Infection - cold
| allergies - hayfever, IgE type 1 hypersensitivity
134
What is wegener's granulomatosis?
An autoimmune condition which presents as a small cell vasculitis limited to the repiratory tract and the kidneys
135
What antibody is associated with Wegener's granulomatosis?
ANCA
136
Histologically what can be seen in Wegener's granulomatosis?
blood vessel walls surrounded by inflammatory cells
137
How common are tumours of the nose?
relatively rare
138
What are some benign lesions of the nose?
squamous papillomas
"Schneiderian" papillomas
angiofibromas
139
What is the most common malignant lesion of the nose?
SCC
140
Where does nasophargyngeal carcinoma have a high incidence?
Far East
141
What is nasophargyngeal carcinoma associated with?
EBV
| Volatile nitroamines in food
142
What carcinomas is EBV associated with?
Burkitt's lymphoma
B-cell lymphomas
Hodgkin's lymphoma
143
How does EBV cause carcinogenisis?
It hi-jacks and mimics helper T-cell responses leading to proliferation and survival of B cells
144
What can cause laryngeal polyps?
reactive change in the laryngeal mucosa secondary to vocal abuse, infection or smoking
145
What can cause contact ulcers?
Benign response to injury caused by a chronic sore throat, voice abuse or GORD
146
What are the 2 incidence peaks of squamous papilloma?
under 5 years
| 20-40 years
147
What is squamous papilloma associated with?
HPV types 6 + 11
148
What is a paraganglioma?
Tumours arising in clusters of neuroendocrine cells dispersed throughout the body.
149
What can differentiate between the 2 types of paraganglioma?
Whether they are chromaffin +ve or chromaffin -ve
150
What are the distinguising features of a chromafin +ve paraganglioma?
occurs within the sympathetic NS
can secrete catecholamines
usually found in the adrenal medulla or paravertebral organ of Zuckerkandl
151
What are the distinguising features of a chromafin -ve paraganglioma?
Affects carotid bodies, aortic bodies, jugulotympanic ganglia and the ganglia nodosum of the vagus nerve.
Clusters arise around the oral cavoty, nose, nasopharynx, larynx and orbit.
152
How does HPV type 16 affect the syntheisis of a SCC?
HPV type 16 produces proteins E6 and E7 which disrupts p53 and RB pathways respectively, leading to cellular immortality.
153
SCCs of the head and neck affect which parts especially?
Tonsils
| tongue-base
154
SCCs of the head and neck are sensitive to whih type of treatment?
Chemo
155
What structures would a T1a SSC laryngeal carcinoma affect?
1 vocal cord
156
What structures would a T1b SSC laryngeal carcinoma affect?
2 vocal cords
157
What structures would a T2 SSC laryngeal carcinoma affect?
extension into the supra/subglottis
158
What structures would a T3 SSC laryngeal carcinoma affect?
Vocal cord fixation or extension into the paraglottic space
| Minor thyroid cartilage involvement
159
What structures would a T4a SSC laryngeal carcinoma affect?
```
Thyroid cartilage
Trachea
Muscles of the tongue
Strap muscles
Thyroid
Oesophagus
```
160
What structures would a T4b SSC laryngeal carcinoma affect?
Prevertebral space
mediastinal structures
carotid artery
161
What are sialolithiasis?
Stones in the salivary glands
162
What can paramyoxovirus cause?
mumps (bilateral parotitis); risk of secondary meningitis
163
Which salivary gland to tumours most commonly affect?
Parotids
164
What is the most common type of parotid tumour?
pleomorphic ademona (benign)
165
What is the 2nd most common tumour of the parotids?
Warthin's tumour - strongly associated with smoking
166
What is the most common malignant salivary gland tumour?
Adenoid cystic tumour
167
Are the majority of sore throats bacterial or viral?
2/3 are viral
168
What is the most common bacterial cause of a sore throat?
Strep. pyogenes
169
What antibiotic is used to treat a strep pyogenes throat infection?
Penicillin
170
What are the acute complications of a bacterial sore throat (tonsillitis)?
Peritonsillar abscess (quincy)
sinusitis/otitis media
scarlet fever
171
What are the late complications of a bacterial sore throat (tonsillitis)?
Rheumatic fever - 3 weeks after sore throat - fever, arthritis, pancarditis
Glomerulonephritis - 1-3 weeks after sore throat - haematuria, albuminaemia and oedema
172
What bacterium causes diptheria?
Corynebacterium diphtheriae
173
What are the symptoms of diptheria?
A severe sore throat
| Grey/white membrane across the pharynx - may become large enough to obstruct airway
174
How does Corynebacterium diphtheriae affect its patients?
Produces a potent exotoxin which is cardiotoxic and neurotoxic
175
What is in the diptheria vaccine?
A cell-free, purified toxin, extracted from a strain of Corynebacterium diphtheriae
176
What is the treatment or diptheria?
Antitoxin and supportive penicillin/erythromycin
177
What is the cause of oral thrush?
Candida albicans
178
How does oral thrush present clinically?
white patches on a red, raw mucous membrane
179
What is the treatment for oral thrush?
Nystatin
180
How does acute otitis media occur?
Extension of infection up the eustachian tube
181
How does acute otitis media present?
Earache
182
Although AOM is often viral, secondary bacterial infections do occur. What are the most likely causative organisms?
H. influenzae
Strep. pneumoniae
Strep pyogenes
183
How do you diagnose AOM?
If the eardrum perforates then pus swabs can be obtained
184
How is AOM treated?
80% of cases resolve in 4 days without antibiotics
| If antibiotics are needed then use amoxicillin
185
How does acute sinusitis present?
Mild discomfort over the frontal or maxillary sinuses due to congestion often seen in patients with viral URTIs
Severe pain and tenderness with a purulent nasal discharge (if secondary bacterial infection)
186
What are the most likely causative organisms of acute sinusitis?
Strep. pneumoniae
| Strep pyogenes
187
What drug(s) is used to treat acute sinusitis (if it is indicated)?
Penicillin V
2nd line = doxycycline (not in children)
188
When should antibiotics be used in acute sinusitis?
If the case is severe or deteriorating, and lasting >10days
189
What are the signs and symptoms of otitis externa?
```
Redness and swelling or ear canal
Itch
Sore and painful
Discharge or increased amounts of earwax
Hearing can be affected if canal is blocked
```
190
What bacteria can cause otitis externa?
Staph. aureus
Proteus spp.
Pseudomonas aeruginosa
191
What fungi can cause otitis externa?
Aspergillus niger
| Candida albicans
192
How is otitis externa managed?
Topical aural toilet
Swabs for unresponsive cases
Further treatment depends on causative organisms
193
What is the common presentation of glandular fever?
```
Fever (in 90% of patients)
lymphadenopathy
pharyngitis
sore throat
malaise
lethargy
tonsillitis
```
194
What are the less common signs and symptoms of glandular fever?
```
jaundice
rash
splenomegaly
palatal petechiae
leucocytosis
```
195
What is the prognosis of glandular fever, and what complications can occur?
It is a protracted but self-limiting illness
May cause anaemia, thrombocytopenia, splenic rupture or obstruction of the upper airways
Also increases the risk of developing lymphoma
196
What organism is glandular fever caused by?
EBV - a virus of the herpes family (persistent infection in the epithelial cells
197
What are the 2 phases of incidence of glandular fever?
Early childhood - rarely results in infectious mononucleosis
| >10y/o - often causes infectious mononucleosis
198
What is the management for glandular fever?
```
Bed rest and paracetamol
Avoid sport (splenic rupture risk)
Corticosteroids may have some use in more complicated cases
```
199
How is a diagnosis of glandular fever confirmed in the lab?
Heterophile antibody - Paul Bunnell test or Monospot test
EBV IgM
Blood count and film
200
What would the differential diagnosis for glandular fever be?
Cytomegalovirus
Toxoplasmosis
Early HIV infection - seroconversion
201
Which type of HSV causes oral ulceration?
HSV1
202
Primary gingivostomatitis is caused by HSV1 infection in preschool children. What symptoms does this cause?
1-2mm vesicles and ulcers on the lips, buccal mucosa and hard palate.
203
How is primary gingivostomatitis treated?
Aciclovir
204
If an HSV1 virus is reactivated after a period of latency, what condition does this cause?
Cold sores
205
With relation to HSV, what occupational hazard does this pose for dentists?
HSV on finger - Herpetic Whitlow
206
How is an HSV infection confirmed?
swabs of the lesion are taken in a viral transport medium and are run through PCR for detection of viral DNA
207
What is a serious complication of HSV relating to ENT?
HSV encephalitis - may lead to necrosis of brain tissue
208
What is herpangina?
Vesicles/ulcers on the soft palate caused by the coxsackie viruses (enteroviruses)
209
What is hand, foot and mouth disease?
Small fluid filled vesciles on the hands, feet and mouth caused by the coxsackie viruses.
210
What 5 swellings are present on the "face" by week 4 of embryo development?
```
Frontonasal prominance (with nasal placodes)
Maxillary prominance (x2)
Mandibular prominance (x2)
```
211
What 4 nasal swellings develop on the frontonasal prominence in week 5 of development?
Medial nasal swellings (x2)
| Lateral nasal swellings (x2)
212
What facial swellings form the upper lip?
The 2 medial nasal prominences and the 2 maxillary prominences
213
What facial swellings form the lower lip?
the 2 mandibular promonences
214
What facial swellings form the nose?
The frontonasal pominenece (bridge and nasal septum)
The 2 medial nasal prominences (crest and tip)
The 2 lateral nasal prominences (alae - sides)
215
How is the intermaxillary segment formed?
via fusion of the medial nasal prominences
216
The intermaxillary segment has 3 portions or parts, what are they and what does each contribute to in the neonatal facial development?
Labial portion - forms the filtrum of the upper lip
Upper jaw component - caries 4 incisers
Palatal component forms the primary palate
217
How is the secondary palate formed?
Palatine shelves grow down from the maxillary prominences and ascend into a horizontal position to fuse with each other and the primary palate.
218
What is happening at the site of the nasal cavities at week 6 of development?
Nasal pits deepen and penetrate the underlying mesenchyme.
219
What is happening at the site of the nasal cavities at week 7 of development?
Nasal cavities connect with the oral cavity via primitive choanae behind the primary palate
220
What is happening at the site of the nasal cavities at week 8 of development?
Definitive choanae open at the nasopharyngeal junction due to formation of the secondary palate
221
What are the 7 D's that should be remembered when taking a history of ear disease from a patient?
```
Deafness
Discomfort
Din Din (tinnitus)
Discharge
Dizziness
Defective facial movements
Destruction by disease
```
222
When are x-rays used in ENT?
Suspected inhalation or ingestion of radio-opaque foreign bodies
223
What investigation is used to investigate dysphagia?
Barium swallow
224
When is ultrasound used in ENT?
Neck lumps
Imaging and FNA of thyroid lumps
Salivary gland disease
Inflammatory masses esp. in children to look for abscesses
225
When is CT/MRI used on the ear?
temporal bone for cholesteotoma
trauma
planning for hearing implants
226
When is CT/MRI used on the nose?
paranasal sinueses prior surgery
| tumours
227
When is CT/MRI used on the throat?
infections
trauma
masses
causes of vocal cord palsy
228
What are the 6 named segments of the facial nerve?
```
Intracranial
Meatal
Labyrnthine
Tympanic
Mastoid
Extratemporal
```
229
What are the anatomical boundaries of the pharynx?
From the base of the skull to C6 - level of the cricopharygeus
230
What muscles are involved with the pharynx?
3 constrictor muscles (superior, middle, inferior)
Cricopharyngeus
Palatopharyngeus
Stylopharyngeus
231
What are the anatomical boundaries of the oropharynx?
From the soft palate superiorly to the epiglottis inferiorly
232
Which muscles help form the oropharynx?
The superior and middle pharyngeal constrictors form the posterior and lateral walls of the oropharynx
233
What are the anatomical boundaries of the hypopharynx?
From the level of the glossoepiglotic and pharyngoepiglottic folds to the inferior cricoid cartilage
234
What lies below the hypopharynx?
Cervical oesophagus
235
Where is the larynx situated?
Anterior to the hypopharynx
236
What lies below the larynx?
Trachea
237
What lies in the pharyngeal mucosal space?
Mucosa
Lymphoid tissue
Constrictor muscles
238
What does the masticator space contain?
Mandible
Muscles
CNV
239
What pathology can arise in the masticator space?
Dental abcess/cyst - invasion from oral cavity
240
What is the retropharyngeal space?
A POTENTIAL space deep to the pharyngeal mucosa, anterior to longus coli and capitus muscles
241
Why is the retropharyngeal space known as the danger space?
It splits 2 deep layers which can track down into the mediastinum
242
Where would a retropharyngeal mass lie?
Anterior to longus coli
243
Where would a perivertebral mass lie?
Would displace longus coli anteriorly.
244
What does the carotid space contain?
Carotid artery
Jugular vein
Cranial and sympathetic nerves
Lymph nodes
245
What potential pathology can arise in the carotid space?
Schwannoma
Paraganglioma
Lymphadenopathy
246
What are the 4 main functions of the tonsils?
Trap bacteria and viruses
Expose pathogens to immune system
Produce antibodies
Prevent subsequent infection
247
Significant adenotonsillar enlargement is uncommon in what age group of children?
under 2y/o
248
When do the adenoids and tonsils decrease in bulk?
In early teenage years (some may disappear altogether - remember you have no adenoids)
249
What is Waldeyer's Ring?
a ring of lymphoid aggregation in the subepithelial layer of the oropharynx and nasopharynx
250
What structures make up Waldeyer's ring?
Palatine tonsils
Adenoid tonsils
Lingual tonsil
251
What histological features do the (palatine) tonsils have?
Made up of specialised squamous epithelium
Have deep crypts and lymphoid follicles
A posterior capsule separates the tonsil from underlying muscle
252
What histological features do the adenoids have?
A ciliated psuedostratified columnar epithelium with a stratified squamous layer deep to this
Deep to both lies a transitional layer
Deep folds and a few crypts
253
In general rules of ENT what type of epithelium do upper aerodigestive structures have?
Ciliated columnar respiratory type mucosa and a squamous epithelium
254
In general rules of ENT what type of epithelium do food-going/high-use/traumatized structures have?
Squamous
| oral cavity/pharynx/vocal cords/oesophagus
255
In general of ENT what type of epithelium do air-going structures have?
Columnar
| Nose/PNS/Larynx/Trachea
256
What viruses can cause tonsillitis?
```
EBV
rhinovirus
influenza
parainfluenza
enterovirus
adenovirus
```
257
What bacteria can cause tonsillitis?
Group A beta haemolytic strep
H.influenza
S.aureus
Strep.pneumonia
258
What percentage of bacteria causing tonsillitis are beta-lactimase producing?
39%
259
What are the main symptoms of viral tonsillitis?
```
Malaise
Sore throat
Temperature
Able to undertake near-normal activity
possible lymphadenopathy
lasts 3-4days
```
260
What are the main symptoms of bacterial tonsillitis?
```
Systemic upset
fever
odynophagia
halitosis
unable to work/ go to school
lymphadenopathy
lasts around 1 week - requires antibiotics to settle
```
261
What are the Centor Criteria for deciding if a tonsillitis patient requires antibiotics?
```
History of fever (+1)
Tonsillar exudates (+1)
Tender anterior cervical lymphadenopathy (+1)
Absence of cough (+1)
44y/o (-1)
```
262
If a patient has a centor criteria of 0-1 what management is required?
No antibiotic given
263
If a patient has a centor criteria of 2-3 what management is required?
Should receive antibiotics if symptoms progress
264
If a patient has a centor criteria of 4-5 what management is required?
Treat empirically with antibiotics
265
What supportive treatment should be given to a patient with tonsillitis?
Eat and drink
Rest
Paracetamol +/- NSAIDs
266
What antibiotic treatment is used in tonsillitis?
Penicillin 500mg 4x/day for 10 days
| Clarithromycin if allergic
267
If a patient is hospitalized with tonsillitis (e.g. in the event or airway constriction), what treatment should be given?
IV fluids
IV antibiotics
Steroids
268
What is the risk of hemorrhage if a patient is eligible for tonsillectomy?
5%
269
A peritonsillar abcess (quincy) can form as a complication of acute tonsillitis when bacteria between the muscle and tonsil produces pus, but what are the typical symptoms of this?
Unilateral throat pain and odynophagia
Trismus (lockjaw)
3-7 days of preceding acute tonsillitis
270
What is the treatment for a peritonsillar abscess?
aspiration and antibiotics
271
What are the signs and symptoms of glandular fever?
```
gross tonsillar enlargement with membranous exudate
marked cervical lymphadenopathy
palatal petechial haemorrhages
generalised lymphadenopathy
hepatosplenomegaly
```
272
how is glandular fever diagnosed?
Atypical lymphocytes in peripheral blood
+ve monospot or Bunnell test
Low CRP ( less than 100)
273
How is glandular fever managed?
Symptomatic treatment
Antibiotics - prevents secondary bacterial infections
Steroids - may help in complex cases
274
What drugs should never be given to a patient with suspected glandular fever? Why?
Ampicillin or Amoxicillin
| A generalised macular rash will 100% result
275
What are the general signs and symptoms of Chronic Tonsillitis?
Malodorous breath
Presence of tonsiliths
Peritonsillar erythema
Persistent tender cervical lymphadenopathy
276
What are the signs of the adenoids causing an obstructive hyperplasia?
obligate mouth breathing
hyponasal voice
snoring and sleep disturbances
AOM/OME
277
What are the signs of the tonsils causing an obstructive hyperplasia?
snoring and sleep disturbance
muffled voice
potential dysphagia
278
What is glue ear?
OME + serous otitis media
| Inflammation of he middle ear accompanied by accumulation of fluid but with no acute inflammation symptoms
279
Who can get glue ear?
Any child (although decreasing incidence with age) and males more than females
280
What can predispose a child to glue ear?
```
Recurrent URTIs and AOM
Prematurity
Craniofacial/genetic abnormalities
Immunodeficiency
Smoking household, bottle fed, allergies
```
281
What are the main symptoms of glue ear?
```
deafness
poor school performance
behavioural problems
speech delay
NOT otalgia
```
282
How is glue ear diagnosed?
Through the history
Otoscopy
Tuning fork tests, audiometry and tympanometry
283
What are teh main signs of glue ear/OME?
TM retraction and decreased mobility
TM colour altered with visible fluid/bubbles
Cognitive HL on tuning fork tests
284
What is the treatment for OME?
Watchful waiting (90% resolved at 3/12)
Review at 3/12 - if persistant refer!
Surgical insertion of grommets is the most common way to treat OME. (If >3y/o consider adenoidectomy)
285
What are the complications that can arise with the insertion of Grommets?
Infection
Retention
Perforation
Swimming/bathign issues
286
Define Dizziness.
A non-specific term which may cover vertigo, pre-syncope, disequilibruim etc.
287
Define Vertigo.
An abnormal sensation of movement, usually spinning
288
What is the prevalence of dizziness?
Most common presentaion to GPs in >74y/os
Current self report of dizziness in the community = 17%
In 50-64y/o this is >25%
5/1000 see GP with vertigo
By 80: 2/3 women and 1/3 men will have expirienced episodes of vertigo
289
What can precipitate dizziness?
```
CVS deisorders
haematological and metabolic disorders
trauma
neurological conditions
migraine
otologial conditions
```
290
What should an examination of a patient with dizziness include?
```
Otoscopy
BP lying/standing
Neuro exam
Balance exam
Audiometry
```
291
What are the common causes of dizziness?
Postural dizziness
Side effect of medications
Psychogenic and interaction with imbalance
292
What are the common causes of vertigo?
```
Menieres disease
BPPV
Vestibular neurotitis
Labyrinthitis
Migrainous vertigo
```
293
What kind of patient history would be suggestive of Menieres disease?
Recurrent, spontaneous vertigo with at least 2 episodes >20mins (but usually hours)
294
Other than vertigo, what other symptoms are suggestive of Menieres disease?
Worsening tinnitus on the affected side
Aural fullness on affected side
Documented SNHL on at least 1 occasion
295
What is involved in the management of Menieres disease?
```
Supportive treatment during episodes
Tinnitus therapy
hearing aids
Avoidance of salt, betahistine, caffeine, alcohol and stress
Grommet insertion
Intratympanic gentamicin/steroids
Surgery
```
296
What does BPPV stand for?
Benign Positional Paroxysmal Vertigo
297
When would someone with BPPV experience vertigo?
```
On looking up
Turning in bed
First thing lying down at night
bending forward
rising from bending
moving head quickly
```
298
What are important negative finding in BPPV?
There is NO associated tinnitus, hearing loss or aural fullness
299
What is the aetiological mechanism behind BPPV?
Otolithiasis - crystalised otoliths which become loose from the semicircular canal fillaments
300
What investigations can be done to prove BPPV as a diagnosis?
Hallpike's test
Epley manoeuvre
Semont manoeuvre
Brandt-Daroff exercises
301
What are the steps performed in Hallpike's test?
Sit on couch so that the patients head will be off the end when they lie back
Turn head 45 degrees to one side
Warn patient to not close eyes if dizzy (test fatigues after first time)
Lie back as quickly as possible and hold them in that position and observe
After a 30second delay nystagmus occurs
302
What are the Epley manoeuvre and the Brandt-Daroff manoeuvre designed to do?
Move the otolith pieces out of the semicircular canals
303
How is Vertebrobasilar insuffieciency different from BPPV?
Has visual disturbances, weakness and numbness associated with the vertigo
304
What is the classical history of vestibular neuronitis?
Prolonged vertigo (days) with no associated tinnitus or HL
305
What is the cause of vestibular neuronitis?
Probably viral infection
306
How does labyrinthitis differ from vestibular neuronitis symptoms-wise?
There may be associated tinnitus or HL
307
How is neuronitis or labyrinthitis treated?
Supportive management with vestibular sedatives but is generally a self-limiting condition.
Further investigation if prolonged or atypical history
308
What is the prevalence of Migraines, and what % of those with migraines suffer vertigo?
15-20% population experience migraines and 25% of those get spontaneous attacks of vertigo and ataxia (balance problem)
309
What is the most common auditory symptom of migraines?
Phonophobia (fear of sound)
310
What questions should be asked when taking a history of a nasal trauma?
```
Mechanism of injury
Timing
LOC
Epistaxis
Breathing affected
```
311
What should be examined in somebody with a nasal trauma?
Looking for bruising, swelling, tenderness, septal deviation and evidence of epistaxis
Infraorbital sensation and all potential CNs affected
312
What must be excluded in a patient with nasal trauma, and if found, what should be done?
Septal haematoma should be excluded and if found drained ASAP
313
How is Nasal trauma managed?
Based on deviation/cosmesis and whether breathing is affected
Reviewed in clinic 5-7 days after injury (swelling reduction)
Nose can be manipulated with LA 3-5 weeks post-injury and 80% of patients who receive this go on to have no further issues
314
What complications can arise following a nasal injury?
Epistaxis esp. with anteroir ethmoid involvement
CSF leak (give 7-10 days before investigation)
Meningitis
Anosmia - cribriform plate fracture
315
What % of the population experience epistaxis every year, what % got to the GP, and what % need specialist help?
5-10% population
10% of those see a GP
1% of those need to see a specialist
316
What are the main arteries supplying the nasal cavity?
Sphenopalatine
Ethmoid
Greater palatine
317
What management can be performed in epistaxis?
```
Resuscitate if needed
Stop/blood flow
Remove blood clots
Anteroir rhinoscopy/ nasendoscopy
Cauterise vessel
Pack nose
Consider arterial ligation
```
318
What should you NEVER do in a patient with epistaxis esp. one whose nose has packing?
Sedate the patient
319
What is a pinna haematoma?
A collection of blood in the pinna
320
What is the treatment for a pinna haematoma?
Aspirate the blood
| Incise and drain and apply a pressure dressing to prevent refilling
321
How should an ear laceration be managed?
Debride dead tissue
closure of wound (usually under LA)
Give prophylactic antibiotics
322
What history would a patient with a temporal bone fracture present with?
HL, history of injury, facial palsy, vertigo, CSF leak
323
What should be looked for on examination of a patient with a potential temporal bone fracture?
Battlesign bruising behind the ear
The condition of the TM and EAM
Check the function of CNVII
Hearing tests
324
How are temporal bone fractures classified?
Longitudinal (along temporal bone axis)
Transverse
Otic capsule imvolvement or sparing
325
What type of temporal bone fracture occurs in ~80% of cases?
Longitudinal fracture
326
Is a longitudinal or transverse temporal bone fracture more likely to involve the otic capsule?
Transverse
327
Is a longitudinal or transverse temporal bone fracture more likely to cause facial palsy?
Transverse
328
Is a longitudinal or transverse temporal bone fracture more likely to have arisen from a lateral blow?
Longitudinal
329
Is a longitudinal or transverse temporal bone fracture more likely to cause CHL?
Longitudinal
330
Is a longitudinal or transverse temporal bone fracture more likely to cause vertigo?
Transverse
331
Is a longitudinal or transverse temporal bone fracture more likely to cause CSF leak?
Longitudinal
332
What are some of the main causes of conductive hearing loss (CHL)?
Fluid effusion, blood, CSF
TM perforation
Ossicular problem
Otosclerosis - fixation of stapes to footplate
333
What 2 structures may be damaged in order to cause SensoryNeural hearing loss (SNHL)?
Cochlea
| 8th cranial nerve
334
What are the 2 classifications of neck injuries?
Penetrating
| Blunt
335
The neck is divided into 3 zones, what structures lie in zone 1?
Trachea and oesophagus
Thoracic duct and thyroid
brachiocephalic, subclavian, common carotid, thyrocervical trunk
Spinal cord
336
The neck is divided into 3 zones, what structures lie in zone 2?
Larynx and hypopharnx
CN 10, 11, 12
Carotids and internal jugular
Spinal cord
337
The neck is divided into 3 zones, what structures lie in zone 3?
Pharynx
many cranial nerves
Carotids, IJV, vertebral vessels
Spinal cord
338
In a patient presenting with neck trauma, what questions would you ask in the history?
Mechanism of injury
SOCRATES
Dyspnoea, hoarseness, dysphonia, dysphagia, haemoptysis
Paraethesias and weakness
339
What examinations would you want to do in a patient with a neck injury?
```
ABCDE
Secondary survery
Through platysma? - if not then unlikely to be as serious
Neck zone
bleeding
aerodigestive injuries
Neuro-power and sensation of upper arm
```
340
What investigations should be done with a petient presenting with neck trauma?
```
FBC, G+S (group and save)
AP/lateral x-ray
CXR
CTAngiogram
MRAngiogram
```
341
How would you manage a patient presenting with neck trauma?
Urgent exploration for haematoma, shock, airway obstruction, blood in Aerodigestive tract
Laryngoscopy, bronchoscopy, pharyngoscopy, oesophagoscpoy
Angiography for emboli and occulsions
342
A bridge lies between the cranial base and the dental occlusion plane, why is this significant to know?
It is a functionally and cosmetically important structure and fracture of these bones is potentially life-threatening as well as disfiguring.
343
How common are orbital floor fractures?
2nd most common mid-facial fractures
344
What is the weak point of the globe of the eye?
The infraoribital rim
345
What information should be obtained in history and examination with someone suffering from facial trauma to the orbital area?
Any pain, decreased visual acuity or diplopia
any hypoaesthesia in the infraorbital region
Any periorbital ecchymosis - subcutanous purpura that may fill with blood
Oedema?
Enopthalmos - posterior displacement of the eye?
Any restriction of occular movement
Feel the body step of the orbital rim
Full ophthalmic examination
346
What investigations should be done for orbital injuries?
CT sinuses to look for an orbital blow-out fracture
347
How should orbital trauma be managed?
Conservatively unless complications of entrapment, large defect or significant enopthalmos occur where surgery is the best option
Surgical buttresses are reccomended in Le Fort fractures
348
What are the important negatives found in Mild rhinitis?
No abnormal sleep
No impairment of daily activities
No problems in work or school
No troublesome symptoms
349
What classifies rhinitis as intermittent?
symptoms for less than 4weeks
350
What classifies rhinitis as persistent?
symptoms for more than 4days/week
AND
more than 4weeks duration
351
What signs and symptoms does moderate to severe rhinitis present with?
Abnormal sleep
Impairment of daily activities
Missing work/school
Troublesome symptoms
352
How is rhinitis managed?
Allergen avoidance
Antihistamines
Topical Steroid +/- antihistamines
Immunotherapy for those with IgE mediated disease
Surgery if indicated for relief of obstruction
353
Nasal polyps can be associated with non-allergic rhinitis. How are they treated?
Oral, then topical steroids
| If steroids to not improve condition then refer for surgery
354
What are the symptoms of acute infective rhinosinusitis?
Facial pain
Discharge
Nasal Blockage
355
What causes infective rhinosinusitis?
98% are viral
356
How is infective rhinosinusitis treated?
Analgesia and decongestants
| If persistant then add an antibiotic
357
What complication can arise with infective rhinosinusitis?
Orbital cellulitis
