Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Fifth Year Medicine > ENT > Flashcards

ENT Flashcards

(220 cards)

Start Studying
1
Q

What is the management of acute otitis media without complications?

A

With perforation - review drum in 6-8 weeks.

If no hearing loss, dry perforation, does not need to be repaired.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the management of a traumatic perforation of the ear drum?

A

Review drum in 6-8 weeks. If not hearing loss, dry perforation, does not need to be repaired.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the symptoms of otitis externa?

A

Inflammation of skin
Itch (cardinal feature)
Minimal hearing loss
Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is otitis externa most commonly caused by?

A

Pseudomonas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the predisposing factors for otitis externa?

A

Skin conditions (eczema, psoriasis)
Systemic conditions (diabetes)
Cotton bud use
Cosmetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the treatment for otitis externa?

A

Clean the ear
Topical steroids
Topical antibiotics
Topical antifungals if fungal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a sign of necrotising otitis externa?

A

Granulation tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the features of necrotising otitis externa?

A

Pain +++
Discharge
Granulation tissue on floor of ear canal
+/- facial palsy or abducens palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the management of necrotising otitis externa?

A

Refer to ENT on call for admission
IV antibiotics with bone penetration for at least 6 weeks
CT temporal bones
Medical management of immunocompromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Who is most at risk of developing necrotising otitis externa?

A

Diabetics

People who are immunocompromised.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is cholesteatoma?

A

Squamous epithelium in middle ear or mastoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the features of cholesteatoma?

A

Discharging ear that does not resolve with antibiotics treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of cholesteatoma?

A 
Surgery:
Mastoidectomy
Atticotomy
Atticoantrostomy
Endoscopic approaches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the possible methods of pathogenesis for cholesteatoma?

A

Retraction pocket - pars flaccida, pars tensa
Non-retraction pocket - perforation, traumatic/iatrogenic
Congenital - epithelial rest, intact TM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a discharging perforation?

A

Perforation with inflammation of middle ear mucosa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the symptoms of a discharging perforation?

A

Pain initially
Discharging ear
Hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for a discharging perforation (active chronic otitis media)?

A

Medical:
Aural toilet (microsuction)
Antibiotics/steroid drops/sprays

Surgical:
Myringoplasty or tympanoplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of otorrhoea (ear discharge)?

A

Otitis externa
Acute otitis media with perforation
Active chronic otitis media (COM) - mucosa/squamous
Trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is otalgia?

A

Ear pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can cause otalgia?

A 
Acute otitis media
Otitis externa
Necrotising otitis externa
Furuncle in ear canal
Otitis media with effusion
Temporomandibular joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the symptoms of acute otitis media?

A

Otalgia
Pyrexia
Hearing loss
Discharge if drum perforates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the management of acute otitis media?

A

Analgesia

Antibiotics if no improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the red flags for otitis media with effusion?

A

Young south-east asian male

Middle aged adults with neck nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are you worried about if you see red flags for otitis media with effusion?

A

Nasopharyngeal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the features of tympanic scleorsis?
White flecks on ear drum Retracted tympanic membrane Can see head of stapes
26
What is the function of the eustachian tube?
It equalises pressure across the tympanic membrane. Allows air into the middle ear. Opens on swallowing and yawning.
27
What is the management of otitis meda with effusion?
``` Decongestant nose drops to nasopharynx. Valsalva maoeuvre/otovent Ventilation tubes Hearing aid Chest postnasal space if unilateral ```
28
What are the symptoms of tonisiltis?
Odynophagia Dysphagia Systemic upset
29
What is the management of tonisiltis?
Symptomatic treatment | Penicillin V + analgesia
30
Which drug should you avoid giving in glandular fever?
Ampicillin - it can cause a rash that lasts for up to 6 months
31
What are the sign guidelines for tonsillectomy?
Sore throats are due to acute tonsilitis. Episodes are disabling and prevent normal functioning. 7 or more well documented, clinically significant, adequately treated sore throats in preceding year. 5 or more episodes in each of the preceding two years. 3 or more episodes in each of the preceding three years.
32
What are the symptoms of allergic rhinitis?
``` Nasal congestion Runny nose Itchy nose Sneezing +/- red and watery eyes ```
33
What is the appearance of the nose in allergic rhinitis?
Pale, oedematous turbinates Nasal congestion Clear discharge
34
What is the treatment for non-allergic rhinitis?
Saline douching/spray Trigger avoidance/reduction +/- nasal steroid
35
What is rhinitis medicamentosa?
Rhinitis or nasal blockage caused by medication.
36
Which medications tend to cause rhinitis medicamentosa?
Xylometazoline HCl Oxylometazoline HCl/phenylephrine sprays Sudafed Can occur after 7 days of use
37
What do nasal polyps looks like?
Pale | Insensate
38
What are the symptoms of nasal polyps?
Rhinorrhoea Blockage Smell disturbance (Subset of chronic rhinosinusitis)
39
What are the two main symptoms of sinusitis?
Nasal blockage Nasal discharge ``` +/-: facial pain poor sense of smell endoscopic features CT changes ```
40
How long does acute rhinosinusitis last?
Less than 12 weeks
41
How long does chronic rhinosinusitis last?
>12 weeks
42
How do you make a diagnosis of acute bacterial rhinosinusitis?
``` At least 3 of: Discoloured discharge Severe, localised facial pain Pyrexia Raised ESR/CRP Deterioration after initial milder symptoms ```
43
What is the management for acute bacterial rhinosinusitis?
Consider topical steroids | Consider oral antibiotics
44
What is the treatment of a deviated septum?
Exclude or treat concurrent pathology i.e. allergic rhinitis Trial of medical therapy Septoplasty if symptoms match the deformity
45
What are the red flags for sinonasal malignancy?
Unilateral anything. Blood stained discharge. Dental/orbital signs: loose teeth, proptosed eye, unilateral decreased eye movements.
46
What is a symptom of septal perforation?
Nasal obstruction
47
What can septal perforation be a symptom of?
Underlying systemic condition
48
What are the causes of septal perforation?
``` Idiopathic Rhinotillexomania Cocaine use Iatrogenic Autoimmune conditions ```
49
What is the treatment for septal perforation?
Saline douching Vaseline Stop causative agents Surgery: Septal button, flaps
50
What can GPs prescribe for epistaxis?
Naseptin (but not if the patient has a peanut or soy allergy)
51
What causes globus sensation?
Increased tension in the muscles of the neck/pharynx. Stress and anxiety; particularly when trying to hold back strong emotions Acid reflux
52
Which types of HPV are most carcinogenic?
16 and 18
53
What are the red flags of head and neck cancer?
Hoarseness for >6 weeks Ulceration or swellings of the oral mucosa >3 weeks Red and white patches of the oral mucosa Dysphagia Persistent unilateral nasal obstruction, especially if accompanied with purulent discharge. Neck masses >3 weeks duration. Cranial nerve involvement Persistent unilateral otalgia with normal otoscopy.
54
What are the causes of a hoarse voice?
``` Laryngitis Laryngeal cancer Vocal cord palsy Vocal cord polyp Vocal cord granuloma Respiratory papillomatosis Reinke's oedema Vocal nodules Muscle tension dysphonia ```
55
What does dysphagia mean?
Difficulty swallowing
56
What does odynophagia mean?
Painful swallowing
57
What is the management for sudden onset hearing loss?
Steroids (1ml/kg, max 60mg) within 72 hours of symptom onset if normal ear canal, tympanic membrane, no infection and reduced hearing with clinical testing.
58
What are the features of a malignant neck lump?
Firm to touch, but can be cystic. | Overlying skin changes
59
What are the investigations of a lateral neck mass?
Full examination Ultrasound and fine needle aspirate/core biopsy CT/PET-CT
60
What could a malignant lateral mass on the neck arise from?
Squamous cell carcinoma - likely to arise from head and neck Adenocarcinoma - pathology more likely to lie below clavicles Lymphoma
61
What are the types of benign parotid lump?
``` Pleomorphic adenoma (malignant potential) Warthin's (can be bilateral) ```
62
What are the features of a parotid lump that would suggest malignancy?
Pain Facial nerve palsy Skin changes Associated lymphadenopathy
63
What are the investigations of a parotid lump?
Full examination including inside mouth Ultrasound and fine needle aspirate Parotidectomy if malignant/PSA
64
What is a second cleft branchial cyst?
Lateral mass Squamous-lined cyst - hypothesised to be epithelial inclusions with lymph nodes that occur during development of neck from pharyngeal arches
65
Who is most likely to to present with a 2nd cleft branchial cyst?
Young adults
66
What are the investigations of 2nd cleft branchial cysts?
Ultrasound and fine needle aspirate | Extreme care in over 35s - can be similar to cystic metastases
67
What is the management of 2nd cleft branchial cysts?
Can be treated by surgical excision
68
What causes a thyroglossal duct cyst?
Failure of thyroglossal duct to obliterate during development
69
Who is most likely to present with a thyroglossal duct cyst?
Usually present in children, but can be young adults.
70
What is the key feature of a thyroglossal duct cyst?
Midline neck lump that moves on swallowing and tongue protrusion
71
What is the risk of a thyroglossal duct cyst becoming infected?
Can form fistula
72
What is the treatment of a thyroglossal duct cyst?
Surgical excision along with central portion of body of hyoid bone (sistrunk's procedure)
73
What are the features of thyroid nodules?
Midline neck lump that only moves on swallowing (not tongue protrusion)
74
What are the red flags for thyroid nodules?
``` Family history of thyroid cancer Radiation history Child Hoarseness/stridor Rapid enlargement Cervical lymphadenopathy Associated pain ```
75
What are the causes of a thyroid goitre?
Iodine deficiency Hashimoto's thyroiditis Grave's disease
76
How would a thyroid goitre be investigated?
TFTs TPO antibodies TSH receptor antibodies
77
What is stertor?
A kind of snoring
78
What causes stertor?
Partial obstruction above larynx
79
What causes stridor?
Partial obstruction at level/below larynx
80
What forms the borders of the anterior triangle of the neck?
Sternocleidomastoid muscle Midline Border of mandible
81
What forms the borders of the posterior triangle of the neck?
Trapezius Clavicle Midline
82
What are the causes of vocal cord pathology?
Mucosal lesion Paralysis Age related
83
What are the risk factors for vocal cord pathology?
Smoking | Alcohol excess
84
What happens to the vocal cords in age-related voice change (presbyphonia)?
Bowing of vocal cords due to atrophy | Incomplete glottic closure
85
What is laryngitis?
Common, short lasting acute inflammation affecting the laryngeal mucosa.
86
What are the aetiologies of laryngitis?
Upper respiratory tract infection Chemical injury Physical injury
87
What can cause chronic or recurrent laryngitis?
``` Laryngeal reflux Smoking Alcohol Snoring Systemic disease (rare) e.g. RA, sarcoidosis ```
88
What are the symptoms of a vocal cord palsy?
Breathy voice | Cough/choking after swallowing
89
What is the aetiology of a vocal cord palsy?
Iatrogenic - neck surgery (particularly thyroid)/cardiothoracic surgery Tumours - head and neck - direct invasion of larynx or recurrent laryngeal nerve Lung cancer Stroke Neck or chest injury Neurological Viral infections
90
What is the treatment for vocal cord palsy?
Usually conservative - especially if lung tumour, poor prognosis Speech and language therapy Cord medialisation procedures to improve voice Cordotomy procedures to improve airway
91
What are the types of vocal cord polyps?
Pedunculated or sessile
92
What is the aetiology of vocal cord polyps?
``` Voice abuse Chronic cough Chemical - laryngeal pharyngela reflux, smoking, alcohol Infection Allergy/inflammation ```
93
What can cause a vocal cord granuloma?
Continous damage and the subsequent healing process. | e.g. intubation trauma, arytenoid granuloma
94
What can infection with HPV types 6 and 11 cause?
Recurrent respiratory papillomatosis
95
What is the treatment for recurrent respiratory papillomatosis?
Endoscopic removal with microdebrider LASER Mitomycin/interferon Preventative - HPV vaccination
96
What is Reinke's oedema?
Bilateral oedema of the vocal cords caused by smoking (and sometimes severe laryngeal reflux)
97
What are the consequences of reinke's oedema?
Deepening of the voice
98
What is the treatment for reinke's oedema?
``` Stop smoking Lateral cordotomy (remove fluid) if required ```
99
What is the main cause of vocal cord nodules?
Voice misuse: singers, teachers, sports coaches, children
100
What is the treatment for vocal cord nodules?
Speech and language therapy
101
What is the progression of vocal cord nodules?
Early: soft inflammatory swelling over microhaemorrhage Later: fibroblasts and collagen fibres
102
What causes muscle tension dysphonia?
Increased and sustains tension in laryngeal muscles resulting in abnormal movement of cords.
103
What is the most common type of laryngeal cancer?
Squamous cell carcinoma
104
What are the risk factors for laryngeal cancer?
Smoking Alcohol Lower socio-economic group HPV related
105
What is the cardinal symptom of laryngeal cancer?
Hoarseness
106
What are the other symptoms of laryngeal cancer?
``` Dysphagia Weight loss Haemoptysis Neck lump Pain Aspiration Airway compromise ```
107
What are the investigations for laryngeal cancer?
Cytology (fine needle aspirate of cervical lymphadenopathy or biopsy of vocal cords) Imaging - CT/USS/PET
108
What is the management of laryngeal cancer?
Depends on staging - MDT decision. Surgery - laser resection for early stage. Laryngectomy Radio/chemotherapy
109
What are the possible causes of airway compromise?
Facial trauma: maxiall/mandibular fracture, base of skull fracture Oral cavity: foreign body, tongue enlargement, angioedema, floor of mouth swelling Bleeding: tonsil bleed, trauma Neck: masses, goitre, scars Larynx: mass, infection
110
What is the presentation of supraglottitis?
Septic with sore throat
111
Why is swallowing button batteries bad?
It causes local erosion
112
What are the signs of glandular fever?
White exudate Lymphadenopathy Hepatosplenomegaly
113
What causes glandular fever?
EBV infection
114
What is the management of glandular fever?
Avoid alcohol Avoid anything that could lead to abdominal trauma e.g. contact sports, gigs, sex Avoid sharing of saliva (to prevent passing it on)
115
What is the management for quinsy?
``` Drain abscess Aspirate or incise and drain Admit IV antibiotics +/- dexamethasone Consider tonsillectomy if more than 1 episode ```
116
How do you manage a patient with post tonsillectomy bleed?
Treat as any haemorrhaging patient
117
What is ludwig's angina?
Severe cellulitis involving the floor of the mouth
118
What are the symptoms of a parapharyngeal abscess?
Neck mass Unwell Febrile Decreased rotational neck movements
119
What are the features of a retropharyngeal abscess?
``` Swinging pyrexia (picket fence) Decreased neck movements Maybe relatively well Usually children May cause airway compromise ```
120
What is the possible emergency management for retropharyngeal abscess?
May need tracheostomy Likely difficult intubation May rupture abscess on intubation
121
In what age group do you immediately give antibiotics for otitis media?
<2 years
122
What are the possible complications of acute otitis media?
Intracranial abscess Facial palsy Mastoiditis Meningitis
123
What is the management of mastoiditis?
24 hours of IV antibiotics Nil by mouth until ENT review May need CT head/temporal bones and drainage if unwell
124
What does peri-orbital cellulitis often follow?
URTI
125
What are the features of peri-orbital cellulitis?
Eye proptosis Reduced visual acuity Unwell Red vision reduced
126
What is the management of peri-orbital cellulitis?
ENT/ophthalmology/paeds assessment NBM Stat IV antibiotics
127
What does a Pott's puffy tumour often follow?
URTI
128
What is the management of a suspected Pott's puffy tumour?
CT with contrast NBM IV antibiotics
129
What is the treatment ladder for epistaxis?
Adequate 1st aid: - head forward over bowl/sink - pinch soft part of nose - ice over bridge/back of neck/in mouth Secondary care intervention: - protection (gloves, goggles, apron, mask) - headlight and thudichums - suction clot from nose/nasopharynx/oropharynx - spray LA - Identify bleeding points Monitor for shock. Silver nitrate cautery of bleeding vessels Nasal packing - nasal packs, foley catheter and BIPP
130
What are the causes of epistaxis?
``` Trauma Nasal septal deviation/spur/perforation Iatrogenic Inflammation Foreign body Environmental Malignancy Systemic disorders ```
131
Which area of the nose is most commonly involved in a nose bleed?
Kiesselbach's plexus in Little's area
132
What is a fractured nose assessed for?
Other injuries/fractures Compound fracture Septal haematoma
133
What are the causes of a septal haematoma?
Nasal trauma | Post operative complication
134
What is the management of a septal haematoma?
Incision and drainage Antibiotics Take to theatre same day.
135
What are the risks associated with septal haematoma?
Septal perforation Abscess Cavernous sinus thrombosis
136
What are the features of a septal haematoma?
Boggy cherry red swelling
137
When should a fractured nose be treated?
Assessment 5-7 days after injury to allow swelling to settle. Manipulation before 14 days.
138
How should a fractured nose be treated?
Septoplasty +/- rhinoplasty later
139
What is bell's palsy?
Facial palsy with no identified underlying cause.
140
What is the treatment for facial nerve palsy?
Treat underlying cause Steroids within 72 hours. Eye protection
141
What is the name of the scale given to document a facial palsy?
House Brackmann scale | I-VI
142
Where on a House Brackmann scale can a patient still close their eye?
I-III
143
What is the aetiology of facial palsy?
Idiopathic (68%) Trauma Tumour Infection
144
What is Ramsay Hunt syndrome?
Bells palsy + vesicles | Herpes zoster infection
145
What are the symptoms of Ramsay Hunt syndrome?
``` Bells palsy Vesicles in mouth and around ear Hearing loss Vertigo Pain ```
146
What is the management of Ramsay Hunt syndrome?
Analgesia Steroids Acyclovir
147
What happens if you don't drain a pinna haematoma?
You get a cauliflower ear
148
How do you remove a foreign body from an ear?
Syringing Suctioning Fine hook If it's an insect drown it first.
149
What are the symptoms of a traumatic tympanic membrane perforation?
Hearing loss Bleeding ear Discharge
150
What are the signs of a base of skull fracture?
``` Panda eyes Battle's sign Facial palsy Haemotympanim (blood behind eardrum) Halo sign ```
151
How do you know if a facial palsy if lower motor neurone or upper motor neurone?
If it involves the forehead it is lower motor neurone.
152
How do you test visual stimulus in a patient with vertigo?
Halmaygi head thrust test
153
How do you test proprioception in a patient with vertigo?
Romberg's test
154
How do you test vestibular function in a patient with vertigo?
Unterberger's test
155
What is the most likely cause if a patient get dizzy on head movements or looking up/
BPPV
156
What is the most likely cause if the patient gets vertigo with a feeling of a blocked ear or tinnitus?
Meniere's
157
What is the most likely cause if the patient gets sudden onset vertigo and feels dreadful for weeks with no hearing loss?
Vestibular neuronitis
158
What is the diagnosis if a patient gets sudden onset vertigo and feels dreadful for weeks with hearing loss?
Labyrinthitis
159
What is a positive finding in the halmaygi head thrust test?
Eyes do not stay fixed on target, deviate to the side of the lesion. Indicates pathology in vestibular system.
160
What is a positive finding in a test of skew?
Quick vertical gaze corrections suggests a central cause
161
Where is the location of pathology if the patient has dysdiadokinesis or past pointing?
Cerebellum
162
What happens in a Romberg's test?
If patient closes eyes they can't stay upright
163
What happens in unterberger's test?
If patient closes eyes they rotate
164
What happens in a positive Dix-Hallpike test?
Rotatoinal nystagmus related to head movement. Fatiguable. Latency period.
165
What are the phases of nystagmus?
Slow and fast phase
166
Which phase of nystagmus defines the direction?
Fast phase`
167
What are the causes of nystagmus?
``` Physiological Spontaneous nystagmus (pathological vestibular) Gaze evoked nystagmus Positional nystagmus Central positional nystagmus ```
168
What happens in spontaneous pathological nystagmus?
Constant drift of eyes to side of lesion, interrupted by fast component in contralateral direction.
169
How is spontaneous nystagmus graded?
Alexander's law 1st degree: only present if eye deviated towards fast phase. 2nd degree: present when eye in primary position. 3rd degree: present when eye deviated towards slow phase.
170
What happens in gaze evoked nystagmus?
Cannot sustain gaze away from primary position i.e. cannot sustain lateral gaze.
171
What causes gaze evoked nystagmus?
``` Central dysfunction (i.e. areas controlling reflexes) Maybe iatrogenic (anticonvulsants, psychotrpic) or due to alcohol. ```
172
What are the common causes of vertigo?
Benign paroxysmal positional vertigo Vestibular neuronitis Migraine
173
What are causes of imbalance?
``` Common: Postural hypotension Hypertension Vestibular migraine BPPV ``` Uncommon: Meniere's disease Cerebellopontine angle tumour
174
What is the patholphysiology of benign paroxysmal positional vertigo?
Otolith dislodgement in posterior semicircular canal causing irritation of the cupula. Or Cupulolithiasis - otoliths adherent to cupula
175
What is the treatment for vestibular neuronitis?
Prochlorperazine (short course)
176
What is the treatment for Meniere's disease?
Conservative: lifestyle - low salt, reduce caffeine Medical: Preventitive medication - betahistine (limited evidence) Symptomatic medication - buccal prochlorperazine. Surgical - vestibular destructive: Disabling vertigo and patient not coping Intratympanic gentamicin. Effective in 90%. Hearing loss in 15-20%.
177
What are the indications for a tracheostomy?
``` Mechanical obstruction Protection of trachebronchial tree Respiratory failure Retention of bronchial secretions Elective (part of major surgery) ```
178
What are the advantages of a tracheostomy?
Bypasses obstruction when ET tube cannot be passed. Decreases dead space by 150ml (50%) Better tolerated than ET tube. Eventual swallowing and speaking.
179
What are the disadvantages of a tracheostomy?
Lost of humidifcation and warming - increased mucous, increased mucous plugging. Neck wound/scar Tracheocutaneous fistula Possible discharge from hospital delay
180
Where is the tracheal window?
2nd/3rd ring
181
What are the elements of tracheostomy care?
Humidification Suctioning Cleaning Changing
182
Which virus causes epiglottitis?
Haemophilis influenza B
183
What is the decibel threshold for normal hearing?
up to 20 decibels
184
Which patients get a pharyngeal pouch?
Patients over 70
185
What are the symptoms of a pharyngeal pouch?
``` Dysphagia Regurgitation of unaltered food (food enters pouch preferentially) Chronic cough Recurrent chest infections Weight loss ```
186
What is the management of a pharyngeal pouch?
Conservative: Alter diet Manage risk factors Medical: Reflux control Surgery: Endoscopic division/stapling (most common) Open resection
187
What is globus sensation?
Feeling of something stuck in the throat/tightness in the throat.
188
What are the symptoms of silent reflux?
``` Sore throat - mild, daily, in the morning. Lump in throat sensation Post nasal drip sensation Nocturnal cough Hoarse voice Excessive throat clearing Throat closing over (laryngospasm) Water brash (liquid suddenly appearing in the throat) ```
189
What are the risk factors for GORD?
``` Adult: Smoking Alcohol/coffee High BMI Pregnancy Hiatus hernia Trigger foods (typically salted or fatty) Late night eating Some connective tissue disorders. ``` ``` Infant: Neuromuscular disorders Cow's milk intolerance 13q14 mutation Neuro-developmental conditions ```
190
What is the treatment for GORD?
Weight loss Alginate PPI H2-receptor antagonist
191
What are the complications of GORD?
Oesophagitis including erosion and ulcers. Barrett's oesophagus Adenocarcinoma of oesophagus Laryngeal granulomas Laryngospasm Stenosis Association with laryngeal carcinoma in non-smokers
192
What is sialolithiasis?
Salivary gland stones.
193
What is the most common location of a salivary gland stone?
Submandibular gland
194
What is the presentation of sialolithiasis?
Intermittent pain and swelling associated with meals +/- palpable hard lump in duct.
195
Who is most commonly affected by sialolithiasis?
Men aged between 30-60 years.
196
What are the complications of salivary gland stones?
Infection - associated erythema, pus discharging from duct.
197
What is the management for sialolithiasis?
Hydration Sialogogues Analgesia +/- antibiotics Surgery: incision over duct to remove stone. Gland removal (associated risks)
198
What is sialadenitis?
Infection/inflammation of salivary glands. | Viral or bacterial.
199
What is the presentation of sialadenitis?
Swelling of gland Pain Systemic upset
200
What is the management of sialadenitis?
Supportive: rehydration, sialogogues, antibiotics.
201
Name two hearing tests.
Pure tone audiogram. | Tympanogram.
202
On a hearing test which ear does red represent?
Right.
203
What does a tympanogram test?
Middle ear function
204
What are the causes of conductive hearing loss?
Pinna - microtia/atresia External auditory canal - wax, foreign body etc. Tympanic membrane - large perforations, large tympanosclerotic plaques. Middle ear - otitis media with effusion, haemotympanum, cholesteatoma, ossicular disruption, otosclerosis.
205
What are the causes of sensorineural hearing loss?
``` Inner ear - cochlear aplasia/hypoplasia Perilymph fistula Otoxic medication Meningitis Menieres cochlear otosclerosis Labyrinthitis Noise induced hearing loss Presbyacusis ``` Retrocochlear - cochlear nerve damage IAM/CPA lesions Intracranial lesions/disease Processing dysfunction
206
What happens in age related hearing loss (presbycusis)?
Peripheral degeneration Reduction in number of inner and outer hair cells. Leads to secondary neural (central degeneration) Central component (arteriosclerosis) Hearing impaired in background noise
207
What is otosclerosis?
Abnormal bone growth around stapes, leading to stapes fixation.
208
What is the age of onset of otosclerosis?
Young adult/adult | Can become worse in pregnancy
209
What is the inheritance pattern of otosclerosis?
Autosomal dominant inheritance. | Often sporadic mutation
210
What is the management of otosclerosis?
Hearing aid | Stapedectomy if does not tolerate hearing aid and sensorineural component negligible.
211
What is the management of otitis media with effusion?
Decongestant nasal drops to nasopharynx Valsalva manoeuvre/otovent Ventilation tubes (grommets) Hearing aid
212
What are the causes of tinnitus?
``` Drugs: Salicylate Quinine Ototoxic Noise induced Menieres Otosclerosis Vestibular schwannoma ```
213
What is the management of tinnitus?
``` Habituation - explanation and information - reasurrance - masking - white noise, hearing aids, tinnitus maskers Formal tinnitus counselling (severe cases) Medication (rarely): TCA, benzos, high dose lignocaine. Surgery (rarely): anatomical causes (glomus tumour) ```
214
When do we investigate tinnitus?
Pulsatile Unilateral Associated vestibular symptoms or signs
215
How is an acoustic neuroma investigated?
MRI
216
How is acoustic neuroma managed?
``` Watchful waiting (serial MRI) Stereotactic radiotherapy (small but rapidly growing) Surgery ```
217
Which rheumatological conditions can have nasal symptoms?
``` Granulomatosis with polyangitis Sarcoidosis Eosinophillic granulomatosis with polyangiitis Relapsing polychondritis Systemic lupus erythematosis ```
218
What is the management of chronic rhinosinusitis?
Nasal steroids Increase potency and/or frequency of nasal steroids Saline douching 2-3x per day Oral steroids Antibiotics CT scan if no improvement despite compliance. Function endoscopic sinus surgery
219
Which arteries make up Kiesselbach's plexus?
Anterior ethmoidal Superior labial Sphenopalatine Greater palatine
220
Give some causes of hoarse voice.
``` Laryngitis Vocal cord palsy Laryngeal cancer Vocal cord polyp VC granuloma Papillomas Reinke's oedema Vocal nodules Muscle tension dysphonia ```

Fifth Year Medicine (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions