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* year 3 special senses > ENT > Flashcards

Flashcards in ENT Deck (16):
1

hearing loss:
- causes of conductive? 5

- excessive wax build up

- otosclerosis

- otitis media

- glue ear

- paget's bone disease

2

hearing loss:
- causes of chronic sensorineural? 3
- causes of acute sensorineural? 7

chronic:
- accumulated environmental noise toxicity
- presbycusis (ie aging, loose high pitched sounds first)
- FH/genetics

acute:
- noise exposure
- gentamicin/other toxin
- mumps
- acoustic neuroma
- MS
- stroke
- vasculitis

3

tinnitus:
- what is it?
- causes of unilateral tinnitus w sensorineural hearing loss? 2
- causes of bilateral tinnitus w sensorineural hearing loss? 2
- causes of tinnitus w conductive hearing loss? 3

when you can hear sounds inside your head that are created by your inner ear, not your environment (often ringing)

unilateral + sensorineural
- acoustic neuroma
- meniere's disease

bilateral + sensorineural
- over-exposure to loud noises
- age-related hearing loss

tinnitus + conductive
- wax build up
- otitis media
- otosclerosis

nb other rare causes

4

discharging ear:
- technical name?
- common causes? 3
- other causes? 4

otorrhoea

- otitis media (w perforated ear drum)
- otitis externa
- perforated ear drum dt trauma

- CSF leak dt head trauma
- epidural abscess
- ear foreign body
- neoplasm

5

vertigo:
- what is it?
- what makes it worse? 1
- associated symptoms? 5

illusion of movement, often rotatory

worsened by movement (better if stay still)

- difficulty walking (or even standing)
- nausea/vomitting
- pallor
- sweating
- (hearing loss or tinnitus)

6

vertigo:
- labyrinth & 8th nerve causes?
- brainstem or cerebellum causes?
- other cause?

labyrinth & 8th nerve

- benign positional vertigo
- Meniere's disease
- acute labyrinthitis (aka vestibular neuronitis)

- motion sickness
- trauma

- ototoxic drugs
- herpes zoster virus


brainstem or cerebellum causes

- MS
- acoustic neuroma

- stroke/TIA
- migraine


other = ALCOHOL INTOXICATION

7

facial palsy:
- how to differentiate between upper + lower motor neurone lesion?
- symptoms/signs?
- LMN causes?
- UMN causes?
- treatment?

UMN: frontal sparing (they CAN wrinkle their forehead)

on affected side:
- inability to fully close eye
- paralysis of muscles of facial expression
- hyperacusis
- change in taste

- idiopathic (bells) (nb more common in pregnancy + diabetes) -MOST COMMON
- CV disease (e.g. brainstem stroke)
- iatrogenic (e.g. for dental treatment)
- infective (often viral, if bilateral likely to be Lyme disease)
- trauma (fractures of skull base, forceps delivery, etc)
- neurological (Gillian barre, mononeuropathy dt DM, sarcoidosis etc)
- neoplastic
- HTN in pregnancy + eclampsia

- CV disease
- intracranial tumours
- MS
- syphillis
- HIV
- vasculitis

treat underlying cause!
- if bells, steroids and eye protection

8

facial pain:
- sinus causes? 3
- nose causes? 3
- ear causes? 2
- mastoid causes? 1
- teeth causes? 1
- soft tissue infection causes? 2
- neuro causes?
- parotid gland causes? 6
- eye causes? 2
- headache causes? 3
- vasculitis cause? 1
- tumour causes? 4
- bone causes? 2
- psychological cause? 1

sinus:
- sinusitis
- trauma
- carcinoma

nose:
- URTI
- nasal injury
- foreign bodies

ear:
- otitis media
- otitis externa

mastoid:
- mastoiditis

teeth:
- dental abscess

local soft tissue infection
- cellulitis
- erysipelas

neuro
- trigeminal neuralgia
- herpes zoster
- post-herpetic neuralgia

parotid gland:
- mumps
- other causes of parotiditis
- abscess
- duct obstruction
- calculi
- tumour

eye
- orbital cellulitis
- glaucoma

headaches
- cluster
- migraine
- medication-overuse

vasculitis
- temporal arteritis

tumours:
- nasopharyngeal
- oral
- posterior fossa
- brain stem gliomas
(nb also upper lobe lung cancer)

bone
- maxillary or mandibular osteitis
- cyst

idiopathic/atypicalpain , may be worse with fatigue or stress, often linked with depression or mood disturbances

9

facial pain:
- how to diagnose?
- other symptoms to ask about?
- management of atypical facial pain?

SOCRATES

- otorrhoea
- hearing loss
- nasal obstruction +/- watery eyes
- proximal muscle weakness (polymyalgia rheumatic)
- any lumps on face

- tricyclic antidepressant

10

rhinosinusitis
- cause of acute?
- cause of chronic?
- symptoms? 7
- treatment? 3

- cold virus or URTI

- allergies (or sometimes fungus)

- runny nose (+/- post-nasal drip)
- nasal congestion

- decreased sense of smell
- halitosis

- pain/pressure/fullness in nose, eyes or ears
- toothache
- headache

nb children often have a cough as well whereas adults often don't

depends on cause, often symptomatic:
- OTC analgesia
- nasal decongestanats
- antihistamines (if allergy)

11

epistaxis:
- causes of anterior bleeds? 3
- causes of posterior bleeds? 4
- which ages most at risk?

- picking your nose
- blowing nose too hard
- inside of nose being too dry (change in air)

- trauma
- HTN
- underlying haemophilia
- iatrogenic (e.g. anticoagulants)

- young kids
- elderly
- pregnant women

12

epistaxis:
- how to treat minor? 4
- how to treat major/recurrent? 3
- which groups to worry about recurrent in? 4

- sit forward
- pinch nose hard for 15mins (just above nostrils)
- breath through mouth

- can use naseptin cream applied to nostrils following attack (for both minor + major)

- nasal cautery
- nasal packing
- find underlying cause

- children < 2 years old
- people >50 (higher chance of cancer)
- Chinese origin (higher chance of cancer)
- people with other signs (nasal obstruction, facial pain, hearing loss, eye symptoms etc)

13

pharyngitis:
- symptoms? 6
- signs that it is caused by bacteria? 4 (incl name of criteria)
- red flags for more active treatment? 5

- painful throat (esp when swallowing)
- dry, scratchy throat
- red throat
- bad breath/funny taste
- mild cough
- neck lymphadenopathy

Centaur criteria (if 3 or 4 signs present, likelihood of bacteria is >60%)
- tonsillar exudate
- tender anterior cervical lymph nodes
- absence of cough
- history of fever

- stridor (or difficulty breathing)
- recurrent sore throats
- immunosuppressed (incl on chemo)
- quinsy
- signs of sepsis or severe dehydration

14

pharyngitis:
- advice for self-care? 6

- gargle with warm salty water (not kids)
- drink plenty of water (not hot drinks)

- eat cool or soft foods
- suck ice cubes, ice lollies or hard sweets (not kids)

- avoid smoking/smoky places
- rest

15

salivary gland conditions, what are they and how do they present:
- sialolithiasis?
- sialoadenitis?
- sjogren's syndrome?
- commonest tumour?
- viral infections? 5

sialolithiasis
= calcium stones block exist of saliva
- painful lump under the tongue
- pain that increases when eating (as more saliva being produced)

sialoadenitis
= infection, often secondary to stones
- lump in cheek or under chin
- pus in mouth
- strong/foul-smelling pus
- fever

sjogren's syndrome
= autoimmune attack of saliva producing cells (most common in SLE)
- dry mouth
- dry eyes
- tooth decay
- sores in mouth
- joint pain/swellng
- dry cough
- unexplained fatigue
- swollen salivary glands
- frequent salivary gland infection

pleomorphic adenoma

- influenza
- mumps
- coxsackie virus
- echovirus
- cytomegalovirus

16

main symptoms of:
- nose + sinus cancer
- nasopharyngeal cancer?
- mouth cancer?
- parotid cancer?
- oro or hypopharyngeal cancer?
- laryngeal cancer?

nose + sinus cancer
- persistent unilateral blocked nose
- nosebleeds
- decreased sense of smell
- increased mucus +/- postnasal drip

nasopharyngeal cancer
- lump in neck (dt lymph node spread)
- blocked/stuffy nose
- nosebleeds
- unilateral hearing loss

mouth cancer (commonest head + neck)
- persistent mouth ulcers
- lump in mouth (may be painful)

parotid cancer
- lump around jaw
- numbness on part of face
- drooping of face

oro or hypopharyngeal cancer
- lump in neck
- persistent sore throat
- difficulty swallowing

laryngeal cancer
- persistent hoarseness
- difficulty/pain on swallowing
- SOB
- persistent cough
- lump in throat