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Flashcards in ENT Deck (162):
1

what body system mediates balance?

vestibular

2

what system regulates gravity, linear and angular acceleration and regulates muscle tone?

vestibular

3

what are the 2 otolith organs?

utricle
saccule

4

how many semicircular canals are there?

3

5

what is smooth pursuit used for?

tracking moving objects

6

what is optokinetic nystagmus?

reflex when tracking objects that lie outside the fovea

7

what is the vestibular-ocular reflex?

stabilised the eye on an object when the head moves

8

where are the main gravity receptors located?

major blood vessels
abdominal viscera

9

what balance disease is characterised by the illusion of movement when there is none?

vertigo

10

what is the onset of being paroxysmal positional vertigo?

sudden, last only seconds

11

does hearing loss accompany BPPV?

no

12

what manoeuvre/test might you perform to diagnose BPPV?

dix-hallpike

13

what manoeuvre night you perform to treat BPPV?

epley's manœuvre

14

what eye problem is characterised by involuntary rhythmic oscillation of the eyes?

nystagmus

15

what is the onset of meniere's disease?

lasts hours
episodi

16

what hearing problem accompanies meniere's?

tinnitus

17

what is vestibular neuronitis?

vertigo that lasts hours after a URTI

18

is there any hearing loss or neurological signs with vestibular neuronitis?

no

19

what is treatment for vestibular neuronitis?

supportive

20

what is presbystasis and what causes it?

balance disorder
related to ageing

21

what is saccades?

normal eye jerk between current and new stimuli

22

what is head shaking nystagmus?

nystagmus following head shaking

23

why might you test calorics when testing vestibular function?

vestibular-ocular reflex is based on calorics (hot/cold sense)

24

who is most commonly affected by epistaxis?

children

25

what causes 85% of all cases of epistaxis?

idiopathic

26

give 3 simple local causes of epistaxis

trauma e.g. nose picking
mucosal irritation
anatomical abnormalities

27

give a tumour cause of epistaxis

nasopharyngeal angiofibroma (benign tumour that bleeds)

28

give 3 associated symptoms of nasopharyngeal angiofibroma - who does it affect?

headache
rhinorrhoea
anosmia
affects young males

29

give 4 pathological systemic causes of epistaxis

bleeding disorders
neoplasms
inflammatory disorders
hypertension

30

give 3 medications that may increase the risk of epistaxis

aspirin
clopidogrel
warfarin

31

the blood supply of the nose is
a) very rich
b) poor
c) absent in some

a) very rich

32

how do you distinguish between an anterior and a posterior nosebleed?

pooling in front of nose or running down back of throat

33

what type of facial pain is characterised by throbbing?

vascular

34

what type of facial pain is characterised by severe stabbing, nasal obstruction and nausea?

trigeminal neuralgia

35

name 2 other types of facial pain

sinogenic
migraine

36

is there pain in chronic sinus obstruction?

no

37

what does acute sinus obstruction often precede?

URTI

38

describe how sinusitis affects one's sense of smell

hyposmia

39

what might you expect on a painful tooth when you percuss it?

more pain

40

is dental pain well or poorly localised?

poorly

41

what type of migraine make up 25% of cases?

classical

42

name 2 accompanying features of migraine

aura
visual disturbances

43

which gender is paroxysmal hemicrania more common in?

women

44

is pain unilateral or bilateral with paroxysmal hemicranial?

unilateral

45

how long does the pain last for paroxysmal hemicrania?
a) seconds
b) less than an hour
c) over 12 hours
d) days

b) less than an hour

46

give 2 associated symptoms of paroxysmal hemicrania

lacrimation
nasal congestion
rhinorrhoea

47

describe the onset of cluster headaches

sudden

48

which gender is more commonly affected by cluster headaches?

men (middle aged)

49

how can cluster headaches impinge on the trigeminal nerve?

dilate blood vessels

50

give a neurological symptom of cluster headaches

horner's

51

what is horner's characterised by?

myosis
anhydrous
ptosis

52

what type of pain is mid facial segment pain and where does it occur?

tightness/pressure over nasal bridge or orbit

53

is mid facial segment pain symmetrical or not?

symmetrical

54

describe the changes to sensation that occur with mid facial segment pain

hyperaesthesia

55

what might a patient with mid facial segment pain complain of in regards to their nose? (although it would appear normal upon examination)

nasal congestion

56

give an example of a specific trigger for trigeminal neuralgia

washing face
brushing teeth

57

what is firstline treatment for trigeminal neuralgia

carbamazepine

58

name 3 other drugs that may be used to treat trigeminal neuralgia

gabapentin
pregabalin
lidocaine
amitryptilline

59

what type of patient is more likely to get atypical facial pain that has no dermasomal associations?

pessimistic or with negative life events/stressed

60

which branches of the trigeminal nerve are affected in 1/3 of trigeminal neuralgia cases?

V2 and V3

61

name the 4 sinuses from top to bottom

frontal
ethmoidal
sphenoidal
maxilliary

62

what is the definition for rhinosinusitis?

inflammation of the nose and paranasal sinuses

63

give 2 examples of endoscopic signs you might see in rhinosinusitis

polyps
mucopurulent discharge

64

what is the difference between acute and chronic rhinosinusitis?

acute 12 weeks

65

how are nasal polyps normally managed?

topical steroid drops e.g. luticason or beclomethasone

66

what is FESS?

functional endoscopic sinus surgery

67

give 3 examples of viruses that can cause rhinosinusitis

rhinovirus
influenza
respiratory syncytial virus

68

give 3 examples of bacteria that can cause rhinosinusitis

pneumococcus
streptococcus
h influenzae

69

give 3 abnormalities of the osteomeatal complex that can cause rhinosinusitis

too small
increase secretion
impaired ciliary function

70

what are kartagener's syndrome and primary ciliary dyskinesia both examples of?

mucociliary disorders

71

what is Samter's triad?

aspirin hypersensitivity
nasal polyps
asthma

72

what complication of rhino sinusitis is characterised by diplopia, proptosis and visual abnormalities?

peri-orbital celluliitis

73

give a vascular complication of rhinosinusitis

cavernous sinus thrombosis

74

give an infective complication of rhinosinusitis

meningitis
abscess

75

what are the 3 major salivary glands?

parotid
submandibular
sublingual

76

what nerve supplies the parotid gland?

glossopharyngeal

77

what is the name of the duct which flows from parotid and where does it open?

stepson's duct
opens next to 2nd molar

78

what type of fluid does the parotid gland produce?

watery, serous

79

what 2 senses does the parotid help to stimulate?

gustatory
olfactory

80

what nerve does it lie very close to?

facial

81

what type of secretion does the submandibular gland produce?

thick mucoid

82

what type of tumours constitute 80% of salivary gland tumours?

pleomorphic adenomas

83

are 80% of salivary gland tumours benign or malignant?

benign

84

where do 80% of salivary gland tumours lie?

parotid

85

give 5 functions of saliva

moisten mucosa
taste
transport
buffer
digestion
antibacterial
mineralisation
pellicle (layer of proteins)

86

describe the swelling characteristic of acute viral parotitis

bilateral with mild pain

87

give a systemic symptom of acute viral parotitis

pyrexia

88

what causes acute viral parotitis?

paramyxovirus

89

what 2 supportive management options are used to treat acute viral parotitis?

rehydration
analgesia

90

give 3 complications of acute viral parotitis

meningitis
encephalitis
pancreatitis
orchiditis
deafness

91

give 5 causes of hypo function of the salivary glands

candidiasis
lichen planes
pathos ulcers
xerostomia
poor dentition
burnt mouth

92

what are the symptoms of acute bacterial parotitis similar to?

acute viral parotitis

93

why is acute bacterial parotitis more serious that acute viral parotitis?

mortality 80% if not treated

94

what is the most common causative organism for acute bacterial parotitis?

staph aureus

95

what are the 4 parts of treatment for acute bacterial parotitis?

antibiotics
rehydration
analgesia
drainage

96

describe the swelling characteristic of HIV parotitis

firm, non-tender

97

is HIV parotitis often bilateral or unilateral?

bilateral

98

benign lymphopithemial cysts are types of what parotitis? what causes them?

HIV parotitis
hyperplasia of follicles in lymph nodes

99

what immune cells infiltrate lymph glands in HIV parotitis/benign lymphopithemial cysts?

CD8 t cells (cytotoxic)

100

what is sjoren's syndrome?

autoimmune connective tissue disorder

101

give 2 symptoms of sjoren's syndrome and their implications

keratoconjuctivitis sicca (dry eyes)
xerostomia (dry mouth)

102

what occurs to the lymph glands in sjoren's syndrome?

infiltration and atrophy of acini

103

how is sjoren's treated?

antinuclear antibodies

104

give a complication of sjoren's syndrome

non-hodgkin's lymphoma

105

what is a ranula?

painless salivary gland mass of constant size

106

what is a ranula made of?

mucocoele

107

what type of agent is used to treat a ranula?

sclerosing agent

108

what is sialolithiasis?

deposition of crystals in gland

109

when is the pain of sialolithiasis worst?

around eating

110

what does sialodentesis have that sialolithiasis doesn't?

erythema and pus

111

what is the word for ear discharge?

ottorhoea

112

what is an inflamed ear canal called?

otitis externa

113

give 3 symptoms of mastoiditis

swelling over mastoid process
non-draining
ear pushed forwards and downwards

114

give 2 bacterial causative organisms of otitis externa

pseudomonas
s aureus
proteus

115

if a patient with otitis external was complaining of deep pain and had cranial nerve palsies, what would you be concerned about?

malignancy

116

give 2 fungal causative organisms of otitis externa. what predisposes to fungal ear infections?

aspergillus
candida
fumigatis
predisposed by prolonged antibiotic use

117

give the 3 most common causative organisms for acute otitis media

s pneumonia
h influenza
moraxella

118

what abnormal growth can cause chronic suppurative otitis media?

cholesteatoma

119

give 2 causes of chronic suppurative otitis media

perforated tympanic membrane
trauma/grommets
bacteria
abnormality of tympanic membrane

120

what systemic complication can occur with acute mastoiditis?

septicaemia

121

give 4 causes of non infective ear discharge

atopic dermatitis
eczema
psoriasis
trauma
CSF
blood

122

what is the difference between antibiotic treatment of bacterial otitis externa, malignant otitis externa and fungal otitis externa?

bacterial = topical abx
malignant = IV abx
fungal = topical antifungals + stop abx

123

what type of otitis externa has the highest mortality?

malignant

124

what is the difference between treatment in AOM and CSOM?

AOM only give abx if it fails to improve
CSOM topic abx

125

what surgical treatment would you recommend for
a) mucosal CSOM
b) squamous CSOM

a) tympanoplasty
b) mastoidectomy

126

give 3 viral causes of acute sore throat

rhinovirus
coronavirus
syncytial virus
parainfluenza
aden, EBV, HSV, paramyxo

127

give 3 bacterial causes of acute sore throat

group a strep (pyogenes)
scarlet fever (s pyogenes)
c diphtheriae

128

what causes glandular fever?

EBV infectious mononucleosis

129

give 3 symptoms of glandular fever

sore throat
pyrexia
malaise
anorexia
rash

130

give 2 signs of glandular fever

lymphadenopathy
splenomegaly

131

how is glandular fever treated?

suppurative w steroids

132

what is laymen's terms for pharyngitis?

sore throat

133

what would the throat look like upon inspection of a patient with pharyngitis?

erythematous
maybe tonsil swelling

134

give 4 signs/symptoms of pharyngitis

temperature
lymphadenopathy
cough
rhinorrhoea

135

how can you distinguish a peritonsilar abscess from peritonsillar cellulitis?

uvula is central in peritonsilar cellulitis

136

place unilateral and bilateral into this sentence:
peritonsilar abscess is characterised by severe ___ pain and _____ earache, with pyrexia

severe unilateral pain
bilateral earache

137

how is the voice of someone with a peritonsilar abscess described?

hot potato

138

describe these two symptoms of peritonsilar abscesses
a) odynophagia
b) trismus

a) pain when swallowing
b) inability to open jaw fully

139

name a breath symptom of peritonsilar abscesses

oris halitosis

140

give the 2 main causative organisms of peritonsilar abscesses

strep progenies
staph aureus

141

how are peritonsilar abscesses managed?

broad spectrum abx and drainage

142

when is the pain worse in pharyngotonsillitis?

swallowing

143

name 3 bacterial causative organisms for pharyngotonsillitis

strep progenies
staph aureus
haem influenza

144

give 2 symptoms for laryngitis

fever
dysphonia

145

give 3 causes for laryngitis

chemical trauma
physical trauma
viral infection

146

how is laryngitis treated?

voice rest + humidity
steroids

147

give 4 symptoms of epiglottis, supraglottitis

sore throat
dysphagia
dysarthria
tachycardia
difficulty breathing

148

which of epiglottitis and supraglottitis is more common in children?

supraglottitis more common in children

149

what are 2 bacterial causative organisms for epiglottis and supraglottitis?

s pneumoniae
h parainfluenzae

150

what is immediate emergency treatment for epiglottitis and supraglottitis?

secure airway

151

what drugs might you give to treat epiglottitis and supraglottitis?

broad spectrum abx
steroids

152

complete this pneumonic for the branches of the facial nerve
Two zebras bit Miley Cyrus

temporal
zygomatic
buccal
mandibular
cervical

153

if a facial nerve is damaged above the spinal cord, which parts of the face will be affected?

lower contralateral quadrant (as upper quadrants are supplied doubly by nerves from both sides)

154

if a facial nerve is damaged below the spinal cord, which parts of the face will be affected?

ipsilateral half of face

155

what is neuropraxia?

reversible blockage of transmission of nerve impulses

156

what causes neuropraxia?

pressure on nerve fibres

157

what is axonotmesis?

blockage of axon flow causing neuronal degeneration

158

what is neurotmesis?

total nerve transection

159

bell's palsy is dysfunction of which cranial nerve?

7

160

which of these is not a symptom of Melkersson-Rosenthal syndrome?
a) facial paralysis
b) face and lip swelling
c) widespread erythema
d) furrows/folds in tongue

c) widespread erythema

161

what is the pathophysiology of lambert eaton disease?

autoantibodies block presynaptic calcium channels

162

what causes lambert eaton disease?

underlying malignancy