ENT Flashcards
(248 cards)
1
Q
What kind of receptor are taste/smell receptors?
A
Chemoreceptors
2
Q
Where are taste receptors located?
A
Tongue, palate, epiglottis and pharynx
3
Q
What is the lifespan of a receptor cell?
A
approx. 10 days
4
Q
What are the four types of papilla on the tongue?
A
Filiform, fungiform, vallate and foliate
5
Q
Which type of papilla does not contain tastebuds?
A
Filiform
6
Q
What are “tastants”?
A
Taste provoking chemicals
7
Q
What happens when tastants bind to taste buds?
A
Ionic channels change to produce a depolarising receptor potential which initiates APs in afferent nerves
Signals conveyed to brainstem and thalamus then to cortical gustatory areas in the frontal lobe
8
Q
What nerve gives supply to the epiglottis and pharynx?
A
CNX, vagus
9
Q
What are the five primary tastes?
A
Salty, sour, sweet, bitter, umami
10
Q
What stimulates salty taste receptors?
A
Chemical salts, especially NaCl
11
Q
What stimulates sour taste receptors?
A
Acids with free H+ ions
12
Q
What stimulates sweet taste receptors?
A
Glucose
13
Q
What stimulates bitter taste buds?
A
Alkaloids, poison and toxic plant derivatives
14
Q
What stimulates umami taste buds?
A
Amino acids, especially glutamate
15
Q
What is ageusia?
A
Loss of taste
16
Q
What is hypoguesia?
A
Reduced taste function
17
Q
What is dysguesia?
A
Distortion of taste
18
Q
What can cause aguesia?
A
Nerve damage, inflammation, endocrine disorders
19
Q
What can cause hypogeusia?
A
Medication or chemo
20
Q
What can cause dysguesia? (9)
A
Glossitis, gum infection, tooth decay, reflux, URTIs, medication, cancer, zinc, chemo
21
Q
Which cell types does olfactory mucosa contain?
A
Olfactory mucosa, supporting cells and basal cells
22
Q
Describe the structure of an olfactory receptor.
A
Thick short dendrite with a wide end called an olfactory bulb from which there is cilia projections
23
Q
What is the lifespan of an olfactory receptor?
A
2 months
24
Q
Describe the path of a signal from the olfactory nerve to the brain.
A
Olfactory receptors which then form afferent fibres of the olfactory nerve which pierces the cribiform plate to enter olfactory bulbs in the inferior surface of the brain then along the olfactory tract to reach the temporal lobe and olfactory areas.
25
How do odorants reach receptors in quiet breathing?
Diffusion
26
What must a substance be in order to be smelled?
Volatile to be inspired with air
| Soluble in water to dissolve in the mucous
27
What is anosmia?
Inability to smell
28
What can cause anosmia?
Viral infection, allergy, nasal polyps, head injury
29
What is hyposmia?
Reduced ability to smell
30
What is dysosmia?
Altered sense of smell
31
At which frequencies do humans perceive sound?
20-20,000Hz
32
Summarise the main role of the outer ear
Sound collector
33
Summarise the main role of the middle ear
Mechanical force amplifier
34
Summarise the main role of the inner ear
Sound transducer
35
What is the TM to OW ratio?
18:1
36
Where are sound waves transmitted to after the OW?
Cochlea, organ of Corti on basilar membrane
37
Which nerve is stimulated on depolarisation of the Organ of Corti?
CN VII, vestibulocochlear (then to central pathways)
38
In the rest state is the Eustachian tube opened or closed?
Closed
39
Which muscles can open the Eustachian tube?
Tensor veli palatine and levator palatine
40
Why does the Eustachian tube open?
To equalise pressure in the ear
41
What is the scala media?
Cavity inside cochlea, between the tympanic duct and the vestibular duct, separated by the basilar membrane and Reissner's membrane
42
What does the scala media contain?
Endolymph and Organ of Corti
43
What do the scala tympani and the scala vestibule contain?
Perilymph
44
When do the hair cells on the cochlea depolarise?
When hairs are deflected towards the longest hair
45
What are the five vestibular end organs?
Ampullae of lateral, posterior and superior semi-circular canals
Maculae of utricle and saccule
46
What process does the brain perceive as movement?
Weight of the gelatinous matrix changing
| This is where the stereocilia/hairs of the utricle and sacuule project
47
What are otoconia?
Calcium carbonate crystals
48
Where at otoconia found?
Utricle and saccule
49
What do otoconia do?
Sense linear movement and gravitational movement
50
What happens to otoconia on movement?
They exert a shearing force on the hair they are coupled to
51
How are signals transmitted from the utricle and saccule?
Utricle - superior division of vestibular nerve
| Saccule - inferior division of the vestibular nerve
52
Why are throat swabs not routinely carried out?
Due to commensals which are not the causative organism
53
When would you considering referring sore throat?
If neck mass present or if lasts longer than 3-4 weeks
54
When would you considering referring dysphagia or odynophagia?
If progressive or lasting >3 weeks
55
What supportive advice would you give a sore throat?
Avoid hot drinks, good fluid intake, warm salty water washes
56
What are the points on the Centor criteria?
Tonsillar exudate; cervical lymphadenopathy; fever; no cough
57
Who can't the Centor criteria be used for?
Children under 3
58
What is the most common bacterial cause of sore throat?
Strep pyogenes
59
What is strep pyogenes?
Gram positive cocci, beta haemolytic
60
Which conditions may occur following a sore throat?
Rhuematic fever 3 weeks post sore throat
| Glomerulonephritis 1-3 weeks post sore throat
61
How does diphtheria present?
Severe sore throat with a white membrane across the pharynx
62
Which bacteria causes diphtheria?
Corynebacterium diptheriae
63
When is the toxoid vaccine for diphtheria given?
2, 3 and 4 months
64
How is diphtheria treated?
Anti-toxin, penicillin/erythromycin and supportive treatment
65
What causes oral thrush?
Candida albicans
66
How does oral thrush present?
Patches of red raw mucous membranes in the throat and mouth
67
How is oral thrush treated?
Nystatin
68
Which group most commonly gets acute otitis media?
Children and infants
69
How does acute otitis media present?
Discharge, hearing loss, fever, lethargy
70
Which bacteria commonly cause acute otitis media?
H influenzae
| Strep pyogenes
71
When do you take a swab in acute otitis media?
If the TM perforates, but not unless that happens
72
How should acute otitis media be treated?
Most resolve within 4 days without abx
If not, give amoxicillin or erythromycin
If immunocompromised, systemic illness or bilateral AND under two, give abx immediately
73
How does acute sinusitis present if there is secondary bacterial infection?
Severe pain and tenderness with purulent nasal discharge
74
What usually predisposes acute sinusitis?
URTI
75
How is acute sinusitis treated?
If severe/deteriorating for >10 days, penicillin or doxycycline
Most are self limiting over 2.5 weeks
76
What is otitis externa?
Infection of the outer ear canal
77
How does otitis externa present?
Swelling and redness of the ear canal, itch, pain, discharge
78
What are bacterial causes of otitis externa?
Staph aureus, pseudomonas aeruginosa
79
What are fungal causes of otitis externa?
Aspergillus niger, candida albicans
80
How is bacterial otitis externa treated?
Topical aural toilet
81
How is fungal otitis externa treated?
Topical clotrimazole (canesten) or gentamicin 0.3% drops
82
What is malignant otitis externa?
Extension of otitis externa into the surrounding ear canal
83
Which bones does malignant otitis externa commonly affect?
Mastoid and temporal
84
How does malignant otitis externa present?
Disproportionately severe pain and headache; exposed bone in ear canal and facial nerve palsy
85
How is malignant otitis externa investigated?
PV, CRP, imaging, biopsy and culture
86
What is a culture in malignant otitis externa most likely to show?
Pseudomonas aerginuosa
87
Which patients are at risk of malignant otitis externa?
Immunocompromised and radiation to head and neck
88
Which virus causes infectious mononucelosis?
EBV
89
How does infectious mononucleosis present?
Fever, lymphadenopathy, sore throat, pharyngitis, tonsillitis, malaise, lethargy, jaundice, rash, atypical lymphocytes
90
How is infectious mononucleosis treated?
Usually self-limiting over 4 weeks, paracetamol
| Corticosteroids if it is a complicated case
91
What advice should be given to infectious mononucleosis patients?
Avoid sport for 6 weeks (to avoid splenic rupture); get bed rest; avoid alcohol
92
How is infectious mononucleosis investigated?
EBV IgM; Paul Bunnell test; FBC; LFT; monospot film
93
When is HSV Type 1 most likely to be acquired?
In childhood, through saliva contact
94
What are the symptoms of HSV type 1?
May be asymptomatic OR systemic upset, fever, inflammation, vesicles on lips, buccal mucosa and hard palate
95
How is HSV type 1 treated?
Acyclovir 3 weeks
96
Which type of HSV tends to reactivate more?
HSV Type 2
97
Which virus causes genital herpes?
HSV Type 1 or 2
98
What is a herpetic whitlow?
Paiful lesion on finger or thumb caused by HSV
99
How is HSV confirmed?
Swab of whitlow lesion and PCR
100
What causes herpangina?
Coxsackie virus (enterovirus)
101
How does herpangina present?
Vesicles or ulcers on soft palate
102
How is herpangina diagnosed?
PCR test of swab in medium
103
What are apthous ulcers?
Recurring painful oval ulcers around the mouth which have inflammatory halos
104
How are apthous ulcers treated?
Self-limiting over 3 weeks
105
Which bacterium can cause syphilis?
Bacterium treponema pallidum
106
How is syphilis investigated?
IgG and IgM antibodies
107
How is syphilis treated?
IM Penicillin
108
What are important facts to find out on nasal trauma?
Blood/discharge, airway restriction, LOC
109
What is a septal haematoma?
"boggy" swelling in the nasal apertures
110
How is septal haematoma treated?
Incised and drained under LA
111
What is a complication of stagnant blood in the nose?
Infection, leading to abscess
112
From what does the cartilage of the nasal septum receive its blood supply?
Perichondrium
113
How are nasal fractures managed?
Diagnosed clinically, reviewed in 5-7 days when swelling goes down, can be straightened under LA within 2 weeks
114
Which arteries supply the nose?
Sphenopalatine, ethmoid and greater palatine
115
What can be given in epistaxis if bleeding does not cease within 10 mins?
Lignocaine and adrenaline, cauterisation with silver nitrate
116
What may fracture to cause a CSF leak?
Cribiform plate of the ethmoid bone
117
What is otherwise known as cauliflower ear?
Pinna haematoma
118
How is a pinna haematoma treated?
Drained and sutured together, pressure dressing applied
119
How is a laceration on the outer ear treated?
Sutured in the anatomical position (may need to remove some cartilage)
120
What shouldn't be used in the ear for risk of necrosis?
Adrenaline
121
What are "racoon eyes" or bruising posterior to the ear indicative of?
Temporal bone fracture
122
What should be done in a temporal bone fracture?
Test hearing for TM function, CNVII testing
123
What is haemotympanum?
Blood behind the TM
124
What can cause haemotympanum or ossicular chain disruption?
Temporal fractures
125
What can haemotympanum or ossiculr chain disruption cause?
Conductive deafness
126
In how many patients does facial palsy accompany temporal fractures?
Longitudinal - 20% of cases
| Transverse - 80% of cases
127
How do temporal fractures come about?
Transverse - frontal blows
| Longitudinal - lateral blows
128
Which kind of temporal fracture is more common?
Longitudinal
129
Where are transverse temporal fractures seen?
Perpendicular to the long axis of the petrous pyramid
130
What is conductive hearing loss?
When sound isn't properly conducted through the ear canal
131
What can cause conductive hearing loss?
Fluid in the ear canal, TM perforation, ossicular disruption, stapes fixation (osteosclerosis?)
132
What can cause sensorineural hearing loss?
CNVIII palsy, cochlea pathology
133
What is sensorineural hearing loss?
Problems which changing sound waves into electrical impulses (transduction)
134
How is facial paralysis managed?
Never decompression and EMG studies
135
In which group(s) is neck trauma more common?
Men (fight), adolescents (dumb)
136
What does Zone 1 of the neck include?
Trachea, oesophagus, thoracic duct, thyroid, vessels and spinal cord
137
What are the borders of zone 1 of the neck?
Clavicles to cricoid cartilage
138
What are the borders of zone 2 of the neck?
Cricoid cartilage to angle of mandible
139
What does Zone 2 of the neck include?
larynx, hypopharynx, CNX, XI, XII, carotids, internal jugular, spinal cord
140
What does Zone 3 of the neck include?
Pharynx, caortids, IJV, spinal cord
141
What are the borders of Zone 3 of the neck?
Angle of mandible to base of skull
142
What is a complete penetrating neck injury?
One which completely goes through the platysma
143
How should a neck injury be investigated?
Endoscopy, FBC, CXR, CT angiogram
144
When should urgent exploration be done in the neck?
If suspicion of expanding haematoma, hypovolaemic shock, airway obstruction of blood in aerodigestive tract.
145
What urgent investigation should be done?
Bronchoscopy, phayngoscopy, oesophagoscopy
146
What is the weakest point of the orbital rim?
Infraorbital groove
147
Where do most fractures of the bony oribt occur?
Posterior medial section (as is the thinnest)
148
What is a "tear drop sign" on CT?
Shows infraorbital contents coming into the sinus (due to a blow out fracture)
149
How are bony orbit fractures managed?
Conservatively
| Surgical repair if there is entrapment, large defects or significant exophthalmos
150
Where is a Le Fort I fracture?
Across the apices of the theeth
151
Where is a Le Fort II fracture?
Through frontal maxilla, through lacrimal bone and inferior orbital floor
152
Which cartilage determines the diameter of the larynx?
Cricoid
153
What is the karina?
When the trachea splits into the left and right bronchus
154
What does Poiseuille's equation show?
Larger radius of trachea = less resistance (therefore less work of breathing)
155
What are sternal or subcostal recession signs og?
Airway obstruction
156
How is epiglottitis treated?
Give antibiotics and fluids, get ENT consultant
157
How are foreign bodies investigated?
Bronchoscopy
158
What causes recurrent respiratory papillomatosis?
HPV 6, 11, 16, 18
159
How is a sub-glottis stenosis treated?
Cut in 4 places and inflate balloon to set size, then inject steroids
160
What can causes subglottic stenosis?
Vasculitis
161
What should be assessed in suspected airway obstruction?
Work of breathing, skin circulaions
162
When should tracheostomy be performed?
As a last resort
163
What simple test can be done first to check hearing?
Tuning fork test
164
What does a tympanogram show?
How the TM moves/how mobile it is
165
What may reduce a tympanogram?
Fluid or something else behind the TM
166
What are the 4 types of deafness?
Conductive, sensorineural, mixed, central
167
Where may referred pain in the ear be coming from?
Back of the throat (CN IX), always look in throat
168
How can a CSF leak present?
Clear discharge from the ear
169
What does dizziness suggest?
That the inner ear is damaged
170
If dizziness but no hearing loss, what could this be?
BPPV or vestibular neuronitis
171
What is tinnitus?
Constant extra sounds
172
Which age group typically gets AOM?
Children
173
How does AOM present?
Red, swollen, angry ear, tender
| Bacterial infections will cause yellow/smelly discarhge
174
What is "glue ear"?
Otitis media with effusion.
| Presence of fluid blocks Eustachian tube
175
How is "glue ear" treated?
Nothing for three months if unilateral
| If >3 months or bilateral then offer heaing aid or grommet insertion
176
What is a cholesteatoma?
Skin in the wrong place (middle of ear) causing flaky discharge
177
What is vertigo?
The sensation of the room spinning
178
What do the lateral semi-circular canals do?
Sense rotational movement
179
What do the superior semi-circular canals do?
Sense vertical movement
180
What does the utricle sense?
The downward force of gravity
181
What is the vestibulo-ocular reflex?
When the head is turned to one side, there is increase firing in the semi-circ canals on that side, and reducedon the other
182
How do you determine if the cause is vestibular or not?
Videonystagmogrpahy
183
What can failure of the vestibule-ocular reflex cause?
Nystagmus
184
How should "dizziness" be investigated?
Otoscopy, neurologically, BP, balance, audiometry
185
How does BPPV present?
Vertigo on leaning forward or back or turning over in bed for 30s to 1min.
186
What causes BPPV?
Calcium carbonate on hair cells break free, float up in fluid and sit in the posterior semi-circular canal
187
What test should be done for BPPV? Describe it.
Hallpike's test.
Position the patient sitting but so when the lie back their head will be over extended. Turn the head to one side and lie back in one quick motion. Nystagmus present on BPPV.
188
Which manoeuvre is done to attempt to move the otoliths back to the utricle in BPPV?
Epley manoeuvre
| Sit, head to left, head to right, recovery position, sit.
189
How often should the Epley manoeuvre or Brandt-Daroff exercises be performed?
5 times in a set
3 sets per day
2 weeks
190
What is vestibular neuronitis?
Vertigo for up to 3 days
191
What may precede vestibular neuronitis?
Viral symptoms
192
How does labrynthitis present?
Sudden onset vertigo which improves over a few days with hearing loss or tinnitus
193
How is labyrinthitis treated?
Vestibular sedatives or prochloperazine/buccastem (dopamine receptor antagonist), but normally self-limiting
194
How is Meniere's diagnosed?
Diagnosis of exclusion
195
What happens during an attack in Meniere's?
Vertigo so violent it makes people sick and they are too dizzy to do anything during the attack
196
What may precede an attack in Meniere's?
Worsening tinnitus and hearing loss
197
What dietary factors may help Meniere's?
Salt restriction
198
What happens to the endolymphatic space in a Meniere's attack?
There is a break which allows the two fluids to mix and damage organs
199
What should be done if hearing is completely lost?
Give gentamicin to destroy the balance function in the ear
| can't get an attack on ur balance if u don't have balance
200
Which kinds of tissue does MRI visualise best?
Soft tissue
201
What is the common separate primary tumour for a head and neck cancer?
Lung
202
What is the most common type of tumour in the head and neck?
SCC
203
Which side of the vocal cords is more likely to be paralysed?
The left, due to its longer course
204
What may a high resp rate indicate with regards to a head and neck cancer?
Upper airway mass/narrowing
205
What is the 5 year survival rate of head and neck cancer?
25%
206
Why might plastic surgery be under taken?
Aesthetics, reconstruction, functional
207
What is the botulinum toxin and how does it work?
Botox
| Paralyses small parts of the muscle for 3-6 months
208
What two naturally occurring options can be used as a filler?
Fat or hyaluronic acid
209
What must be done before wound closers?
Clean, debridement, checked for foreign bodies
210
What is primary wound closure?
When the wound edges are pulled together
211
What is rhinitis?
An infection or non-infective inflammation of the mucosal membrane of the nose
212
What can infective rhinitis progress to?
Rhinosinusitis
213
What can cause non-infective rhinosinusitis?
Allergy, vasomotor issues or polyps
214
What is intermittent allergic rhinitis set off by pollen better known as?
Hayfever
215
What may cause persistent rhinitis?
House dust mite allergy, pet saliva allergy
216
What can medication can be given for rhinitis?
Anti-histamines for immediate relief
Min dose topical steroids for background defence
Immunotherapy for IgE mediated reactions
217
How can polyps in the nose be treated?
Steroids, but more commonly surgically excisesd
218
How is infective rhinosinusitis treated?
Not treated unless worsening over 5 days or leads to orbital cellulitis
219
How does rhinosinusitis present?
Pain, discharge and blockage
220
Why does orbital cellulitis need treated in rhinosinusitis?
Risk of blindness and potential spread to brain
221
What tests should be performed in non-infective allergic rhinitis?
Skin prick testing, RAST for specific IgE
222
What might a painful, boggy swollen nose be indicative of?
Septal haematoma
223
What complication may occur in septal haematoma?
Cartilage necrosis and collapse
224
What to the palatine tonsils develop from?
Dorsal wing of the 1st pharyngeal pouch, ventral wing of second pouch
225
When do adenoid tonsils developed?
16 weeks gestation
226
What is the tonsillar fossa formed by?
Muscular tonsillar pillars - palatoglossus and palatopharyngeus
227
What are "crypts" on the tonsils?
Stratified squamous epithelium deeply invaginates the tonsil to form crypts
228
What is the epithelium in the adenoid tissue made of?
Ciliated pseudostratified columnar
229
What causes acute viral tonsillitis?
EBV, rhinovirus, parainfluenza, enterovirus and adenovirus
230
What causes acute bacterial tonsillitis?
GABHS - Strep pyogenes/pneumo, SA, H influenzae
231
How does viral acute tonsillitis present?
Malaise sore throat, fever, lymphadenopathy
232
How does bacterial acute tonsillitis present?
Odynophagia, halitosis, unable to do normal activity
233
What treatment is given with a Centor criteria score of 0-1?
No antibiotics
234
What treatment is given with a Centor criteria score of 2-3?
Delayed abx, chance of infection
235
What treatment is given with a Centor criteria score of >4?
Treated empirically with abx, probably bacterial infection
236
Which antibiotic is given in tonsillitis?
Penicillin 500mg QDS for 10 days
| Clarithromycin if allergic
237
When is a tonsillectomy considered?
If >5 cases per year for 2 years
or
>7 prescriptions for one year
>3 per year for 3 years
238
How does a peritonsillar abscess form?
When bacterial escapes the capsule of the tonsil and produces pus
239
How does a peritonsillar abscess present?
Odynophagia and sore throat following tonsillitis, displacement of the uvula
240
How is a peritonsillar abscess treated?
Aspirin and abx, drain if they don't "pop" themselves
241
What virus commonly causes glandular fever?
EBV
242
How does glandular fever present?
Membranous exudate, lymphadenopathy, petechial haemorrhages, hepatosplenomegaly
243
How is glandular fever investigated?
EBV IgM, monospot and Paul Bunnell tests
244
How is glandular fever treated?
Antibiotics and steroids for 6 weeks
245
How is obstructive hyperplasia in kids treated?
Usually isn't as there is a good chance they will regress as child grows
246
What are risk factors for "glue ear"?
Kids, daycare, smokers in household, recurrent UTRI, immunodeficiency, bottle feeding, preterm
247
What will tuning fork tests show in glue ear?
Conductive hearing loss
248
What are complications of grommets?
Infection risk, early extrusion, perforation
