ENT revision Flashcards
1
Q
what are the 2 otolith organs?
A
utricle
saccule
2
Q
what is smooth pursuit used for?
A
tracking moving objects
3
Q
what is the vestibular-ocular reflex?
A
stabilised the eye on an object when the head moves
4
Q
where are the main gravity receptors located?
A
major blood vessels
abdominal viscera
5
Q
what is the onset of being paroxysmal positional vertigo?
A
sudden, last only seconds
6
Q
does hearing loss accompany BPPV?
A
no
7
Q
what manoeuvre/test might you perform to diagnose BPPV?
A
dix-hallpike
8
Q
what manoeuvre night you perform to treat BPPV?
A
epley’s manœuvre
9
Q
what is the onset of meniere’s disease?
A
lasts hours
episodi
10
Q
what hearing problem accompanies meniere’s?
A
tinnitus
11
Q
what is vestibular neuronitis?
A
vertigo that lasts hours after a URTI
12
Q
is there any hearing loss or neurological signs with vestibular neuronitis?
A
no
13
Q
what is treatment for vestibular neuronitis?
A
supportive
14
Q
what is presbystasis and what causes it?
A
balance disorder
related to ageing
15
Q
what is saccades?
A
normal eye jerk between current and new stimuli
16
Q
why might you test calorics when testing vestibular function?
A
vestibular-ocular reflex is based on calorics (hot/cold sense)
17
Q
give 3 simple local causes of epistaxis
A
trauma e.g. nose picking
mucosal irritation
anatomical abnormalities
18
Q
give a tumour cause of epistaxis
A
nasopharyngeal angiofibroma (benign tumour that bleeds)
19
Q
give 3 associated symptoms of nasopharyngeal angiofibroma - who does it affect?
A
headache
rhinorrhoea
anosmia
affects young males
20
Q
give 4 pathological systemic causes of epistaxis
A
bleeding disorders
neoplasms
inflammatory disorders
hypertension
21
Q
give 3 medications that may increase the risk of epistaxis
A
aspirin
clopidogrel
warfarin
22
Q
what type of facial pain is characterised by severe stabbing, nasal obstruction and nausea?
A
trigeminal neuralgia
23
Q
name 2 other types of facial pain
A
sinogenic
migraine
24
Q
is there pain in chronic sinus obstruction?
A
no
25
what does acute sinus obstruction often precede?
URTI
26
what type of migraine make up 25% of cases?
classical
27
name 2 accompanying features of migraine
aura
| visual disturbances
28
which gender is paroxysmal hemicrania more common in?
women
29
is pain unilateral or bilateral with paroxysmal hemicranial?
unilateral
30
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
31
give 2 associated symptoms of paroxysmal hemicrania
lacrimation
nasal congestion
rhinorrhoea
32
which gender is more commonly affected by cluster headaches?
men (middle aged)
33
how can cluster headaches impinge on the trigeminal nerve?
dilate blood vessels
34
give a neurological symptom of cluster headaches
horner's
35
what is horner's characterised by?
myosis
anhydrous
ptosis
36
what type of pain is mid facial segment pain and where does it occur?
tightness/pressure over nasal bridge or orbit
37
is mid facial segment pain symmetrical or not?
symmetrical
38
describe the changes to sensation that occur with mid facial segment pain
hyperaesthesia
39
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
40
what is firstline treatment for trigeminal neuralgia
carbamazepine
41
name 3 other drugs that may be used to treat trigeminal neuralgia
gabapentin
pregabalin
lidocaine
amitryptilline
42
what type of patient is more likely to get atypical facial pain that has no dermasomal associations?
pessimistic or with negative life events/stressed
43
which branches of the trigeminal nerve are affected in 1/3 of trigeminal neuralgia cases?
V2 and V3
44
what is the definition for rhinosinusitis?
inflammation of the nose and paranasal sinuses
45
give 2 examples of endoscopic signs you might see in rhinosinusitis
polyps
| mucopurulent discharge
46
what is the difference between acute and chronic rhinosinusitis?
acute 12 weeks
47
how are nasal polyps normally managed?
topical steroid drops e.g. luticason or beclomethasone
48
what is FESS?
functional endoscopic sinus surgery
49
give 3 examples of viruses that can cause rhinosinusitis
rhinovirus
influenza
respiratory syncytial virus
50
give 3 examples of bacteria that can cause rhinosinusitis
pneumococcus
streptococcus
h influenzae
51
give 3 abnormalities of the osteomeatal complex that can cause rhinosinusitis
too small
increase secretion
impaired ciliary function
52
what are kartagener's syndrome and primary ciliary dyskinesia both examples of?
mucociliary disorders
53
what is Samter's triad?
aspirin hypersensitivity
nasal polyps
asthma
54
what complication of rhino sinusitis is characterised by diplopia, proptosis and visual abnormalities?
peri-orbital celluliitis
55
give a vascular complication of rhinosinusitis
cavernous sinus thrombosis
56
give an infective complication of rhinosinusitis
meningitis
| abscess
57
what nerve supplies the parotid gland?
glossopharyngeal
58
what is the name of the duct which flows from parotid and where does it open?
stepson's duct
| opens next to 2nd molar
59
what type of fluid does the parotid gland produce?
watery, serous
60
what 2 senses does the parotid help to stimulate?
gustatory
| olfactory
61
what nerve does it lie very close to?
facial
62
what type of secretion does the submandibular gland produce?
thick mucoid
63
what type of tumours constitute 80% of salivary gland tumours?
pleomorphic adenomas
64
where do 80% of salivary gland tumours lie?
parotid
65
give 5 functions of saliva
```
moisten mucosa
taste
transport
buffer
digestion
antibacterial
mineralisation
pellicle (layer of proteins)
```
66
what causes acute viral parotitis?
paramyxovirus
67
what 2 supportive management options are used to treat acute viral parotitis?
rehydration
| analgesia
68
give 3 complications of acute viral parotitis
```
meningitis
encephalitis
pancreatitis
orchiditis
deafness
```
69
give 5 causes of hypo function of the salivary glands
```
candidiasis
lichen planes
pathos ulcers
xerostomia
poor dentition
burnt mouth
```
70
what are the symptoms of acute bacterial parotitis similar to?
acute viral parotitis
71
why is acute bacterial parotitis more serious that acute viral parotitis?
mortality 80% if not treated
72
what is the most common causative organism for acute bacterial parotitis?
staph aureus
73
what are the 4 parts of treatment for acute bacterial parotitis?
antibiotics
rehydration
analgesia
drainage
74
describe the swelling characteristic of HIV parotitis
firm, non-tender
75
is HIV parotitis often bilateral or unilateral?
bilateral
76
benign lymphopithemial cysts are types of what parotitis? what causes them?
HIV parotitis
| hyperplasia of follicles in lymph nodes
77
what immune cells infiltrate lymph glands in HIV parotitis/benign lymphopithemial cysts?
CD8 t cells (cytotoxic)
78
give 2 symptoms of sjoren's syndrome and their implications
```
keratoconjuctivitis sicca (dry eyes)
xerostomia (dry mouth)
```
79
what occurs to the lymph glands in sjoren's syndrome?
infiltration and atrophy of acini
80
how is sjoren's treated?
antinuclear antibodies
81
give a complication of sjoren's syndrome
non-hodgkin's lymphoma
82
what is a ranula?
painless salivary gland mass of constant size
83
what type of agent is used to treat a ranula?
sclerosing agent
84
what is sialolithiasis?
deposition of crystals in gland
85
when is the pain of sialolithiasis worst?
around eating
86
what does sialodentesis have that sialolithiasis doesn't?
erythema and pus
87
give 3 symptoms of mastoiditis
swelling over mastoid process
non-draining
ear pushed forwards and downwards
88
give 2 bacterial causative organisms of otitis externa
pseudomonas
s aureus
proteus
89
if a patient with otitis external was complaining of deep pain and had cranial nerve palsies, what would you be concerned about?
malignancy
90
give 2 fungal causative organisms of otitis externa. what predisposes to fungal ear infections?
aspergillus
candida
fumigatis
predisposed by prolonged antibiotic use
91
give the 3 most common causative organisms for acute otitis media
s pneumonia
h influenza
moraxella
92
what abnormal growth can cause chronic suppurative otitis media?
cholesteatoma
93
give 2 causes of chronic suppurative otitis media
perforated tympanic membrane
trauma/grommets
bacteria
abnormality of tympanic membrane
94
give 4 causes of non infective ear discharge
```
atopic dermatitis
eczema
psoriasis
trauma
CSF
blood
```
95
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
```
96
what type of otitis externa has the highest mortality?
malignant
97
what is the difference between treatment in AOM and CSOM?
AOM only give abx if it fails to improve
| CSOM topic abx
98
what surgical treatment would you recommend for
a) mucosal CSOM
b) squamous CSOM
a) tympanoplasty
| b) mastoidectomy
99
give 3 viral causes of acute sore throat
```
rhinovirus
coronavirus
syncytial virus
parainfluenza
aden, EBV, HSV, paramyxo
```
100
give 3 bacterial causes of acute sore throat
group a strep (pyogenes)
scarlet fever (s pyogenes)
c diphtheriae
101
give 2 signs of glandular fever
lymphadenopathy
| splenomegaly
102
how is glandular fever treated?
suppurative w steroids
103
what would the throat look like upon inspection of a patient with pharyngitis?
erythematous
| maybe tonsil swelling
104
give 4 signs/symptoms of pharyngitis
temperature
lymphadenopathy
cough
rhinorrhoea
105
how can you distinguish a peritonsilar abscess from peritonsillar cellulitis?
uvula is central in peritonsilar cellulitis
106
place unilateral and bilateral into this sentence:
| peritonsilar abscess is characterised by severe ___ pain and _____ earache, with pyrexia
severe unilateral pain
| bilateral earache
107
how is the voice of someone with a peritonsilar abscess described?
hot potato
108
describe these two symptoms of peritonsilar abscesses
a) odynophagia
b) trismus
a) pain when swallowing
| b) inability to open jaw fully
109
give the 2 main causative organisms of peritonsilar abscesses
strep progenies
| staph aureus
110
how are peritonsilar abscesses managed?
broad spectrum abx and drainage
111
name 3 bacterial causative organisms for pharyngotonsillitis
strep progenies
staph aureus
haem influenza
112
give 2 symptoms for laryngitis
fever
| dysphonia
113
give 3 causes for laryngitis
chemical trauma
physical trauma
viral infection
114
how is laryngitis treated?
voice rest + humidity
| steroids
115
give 4 symptoms of epiglottis, supraglottitis
```
sore throat
dysphagia
dysarthria
tachycardia
difficulty breathing
```
116
which of epiglottitis and supraglottitis is more common in children?
supraglottitis more common in children
117
what are 2 bacterial causative organisms for epiglottis and supraglottitis?
s pneumoniae
| h parainfluenzae
118
what drugs might you give to treat epiglottitis and supraglottitis?
broad spectrum abx
| steroids
119
complete this mnemonic for the branches of the facial nerve
| Two zebras bit Miley Cyrus
```
temporal
zygomatic
buccal
mandibular
cervical
```
120
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)
121
if a facial nerve is damaged below the spinal cord, which parts of the face will be affected?
ipsilateral half of face
122
what is neuropraxia?
reversible blockage of transmission of nerve impulses
123
what causes neuropraxia?
pressure on nerve fibres
124
what is axonotmesis?
blockage of axon flow causing neuronal degeneration
125
what is neurotmesis?
total nerve transection
126
bell's palsy is dysfunction of which cranial nerve?
7
127
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
128
what is the pathophysiology of lambert eaton disease?
autoantibodies block presynaptic calcium channels
129
what causes lambert eaton disease?
underlying malignancy
