Everything Flashcards
In a patient with polyps, what feature of the polyps might suggest malignancy?
Most patients have bilateral polyps, however unilateral polyps may suggest malignancy
A patient presents with a sudden attack of vertigo with associated nausea and vomiting in the absence of hearing loss presents. They have a history of a URTI 2 weeks ago. What is the most likely diagnosis?
Vestibular neuronitis
In a patient with chronic oral pain, what condition should always be considered?
Malignancy
On a lateral neck xray, what condition would be indicated by a ‘thumb sign’?
Epiglottitis
Give 4 causes of a central vertigo
TIA Stroke Migraine Acoustic neuroma MS
Within the neck, what are the three fascia that create the two deep neck ‘spaces’
Anterior: Deep cervical fascia
Middle: Alar fascia
Posterior: Prevertebral fascia
What is exostosis?
It is essentially a bony spur, which is commonly referred to as ‘surfers ear’
*It generally requires surgical intervention to prevent recurrence
What is the ultimate treatment of a peritonsillar abscess?
Inscision and drainage
Give 4 differentials for a sore throat
Tonsillitis
Peritonsillar abscess (PTA)
Supraglottitis (or epiglottitis)
Deep neck-space infection (DSNI)
How long do attacks of Meniere disease typically last?
About 4 hours
What is a good imaging technique in patients with a moderate-severe sore throat?
Lateral neck x-ray
Give three tonsillitis ‘red-flags’
Neck pain Trismus Voice change Dehydration Drooling
What treatments are used in cases of peritonsillar abscess
Supportive therapy
Penicillin
Inscision and drainage
What type of organism typically causes rhinosinusitis?
A virus
Give three possible complications of tonsillitis
Rheumatic fever Peritonsillar abscess (Quinsy) Scarlet fever Post-strep glomerulonephritis Cervical lymphadenitis Deep neck-space infections
Give three significant risk factors for the development of head and neck cancers
Smoking
Alchohol
HPV infection
In South Auckland, what percentage of Maori or PI children suffer from OME?
About 25%
In a patient who presents with tonsillitis with accompanying lymphadenopathy, splenomegaly, lethargy and EBV-infected tonsils, what condition should also be suspected?
Infectious mononucleosis
In a patient with symptoms of vestibular neuronitis + SNHL, what is the most likely diagnosis?
Labyrinthitis
What are the four symptoms that characterise Meniere disease?
- Unilateral fluctuating SNHL 2. Vertigo lasting minutes to hours
- Constant, worsening or intermittent tinnitus
- Aural fullness
In a high risk patient with OME, what is the preferred management strategy?
Grommets +/- adenoidectomy
What type of bacteria are most likely to cause tonsillitis?
Group A beta-haemolytic streptococcus progenies (GAS)
What treatments are usually used for a patient with chronic rhinosinusitis?
Normal antibiotics for an acute flare (i.e., amoxicillin)
Saline nasal rinses
Prednisone
Decongestant sprays (e.g., fluticasone)
What is the most common presenting complaint of a patient (or their parents) with OME?
Hearing loss (80%) (i.e., it is often asymptomatic)
What is a thyroglossal duct cyst?
This is a mass located in the midline of the neck due to improper fetal development of this area.
*They typically remain asymptomatic until they become infected (often during an URTI)
Using the ‘surgical sieve’, give 5 causes of a neck lump
Vascular: AV malformation, aneurysm Inflammatory: Traumatic: Haematoma Autoimmune: Thyroiditis Metabolic: Goitre Infective: Reactive lymphadenopathy Neoplastic: SCC, Thyroid cancer, lymphoma Congenital: Thyroglossal cyst, dermoid cyst
What is HPV?
This is a very common virus that infects about 80% of people at some point. There are many different strains, with most being transmitted sexually.
In some people it can cause genital warts and it may also cause the development of precancerous and cancerous lesions.
What are the three most likely bacterial causes of sinusitis?
Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis
Give 3 common viral organisms that cause tonsillitis
Adenovirus
Rhinovirus
RSV
EBV
What are the 2 most common pathogenic causes of OE?
Pseudomonas aeruginosa
S. aureus
In a low risk patient with OME, what is the preferred management strategy?
“watchful waiting” + Audiometry
What antibiotic is typically used in cases of acute rhinosinusitis?
Amoxicillin (or doxycycline if there is a penicillin allergy)
What test is used to confirm the presence of EBV/mononucleosis?
The heterophiles antibody test (or ‘monospot’ test)
Give 3 complications of a cholesteatoma
Bone erosion (including the ossicles) Sensorineural hearing loss Dizziness Facial nerve dysfunction Infection (e.g., mastoiditis, intracranial abscess, meningitis)
What is the most likely diagnosis of a patient with purulent nasal discharge, nasal obstruction, facial pain and fullness?
Rhinosinusitis
Give two sequellae of DSNI
Internal jugular vein thrombophlebitis
Mediastinitis
In patients with moderate to severe tonsillitis, what drug (other than penicillin) can be used?
Dexamethasone
In a patient with a bacterial sinusitis, how long would the infection be likely to persist?
10 or more days
There is also often a worsening after an initial improvement within these 10 days
How could mediastinitis occur (basic) in a patient with a deep neck space infection?
If the infection was in the ‘danger space’, the infection may spread through this space into the mediastinum because the danger space extends from the skull base to the diaphragm
What is the most common indication for the use of grommets?
Persistent bilateral OME