Term
| what is above and below the larynx? |
|
Definition
above is the pharynx
below is the trachea |
|
|
Term
| fx of larynx? 3 fold fx what are they? |
|
Definition
when open: breathing
when partially closed: phonation/talking
when totally closed: protects respiratory system |
|
|
Term
| which muscle of the larynx is involved in widening the aperture to help in breathing? |
|
Definition
|
|
Term
which muscle of the laryn is involved when we exhale and whisper?
what happens to the aperture when we do this? |
|
Definition
lateral cricoaretinoid
this narrows the aperture |
|
|
Term
how is phonation created?
what must happen to the vocal cords
which muscles are involved? |
|
Definition
muscles involved are transverse and oblique aretynoids.
the cords must come together |
|
|
Term
| any person with unexplained horseness persisting for how many weeks needs investigation to exclude malignancy? |
|
Definition
|
|
Term
| risk factors for voice problems |
|
Definition
smoking: also risk factors for laryngeal carcinoma
excess alcohol consumption
diabetes: neuropathy and poor glyceamic control
occupation: teachers, actors, singers
GORD
environment: low humidity, atmospheric irritants |
|
|
Term
| what innervates the larynx? |
|
Definition
| the vagus nerve. its branches are the superior laryngeal and the recurrent laryngeal nerve. |
|
|
Term
| infectious cause of hoarseness? |
|
Definition
|
|
Term
| benign laryngeal conditions causing hoarseness? |
|
Definition
singers nodes: polyps and papillomas
voice over use |
|
|
Term
| malignancy related to hoarseness can be due to laryngeal cancer. what is a risk factor for this? |
|
Definition
|
|
Term
| list neurological causes of hoarseness |
|
Definition
stroke
PD, MG, MND
essential tremor
laryngeal nerve palsy from compression, thoracic aortic aneurysm, lung cancer and other tumours |
|
|
Term
| list some contributing factors to hoarseness |
|
Definition
voice over use
smoking
GORD
age related; as we get old the vocal cords are less pliable
URTI
drying of laryngeal mucosa fem low humidity
scarring after prolonged intubation |
|
|
Term
how can voice quality be assessed? using which tool?
GRBAS what does this stand for? |
|
Definition
the GRBAS system. this stands for
grade: severity
roughness
breathy voice:
asthenia (weakness)
strain assessment |
|
|
Term
| what do NICE guidelines say for unexplained horsiness for > 3 weeks especially in smokers over 50 years and those who drink excessively? |
|
Definition
arrange urgent CXR
refer those with positive findings to a team that specialise in management of lung cancer
refer those with negative findings to a team specialising in head and neck cancer. |
|
|
Term
| endocrine disorder that causes hoarseness of voice? |
|
Definition
|
|
Term
| when investigating hoarseness why should you do a chest X-ray? |
|
Definition
| to exclude apical tumours |
|
|
Term
| causes of hoarseness include? |
|
Definition
voice over use
smoking
gord
hypothyroid
lung ca
laryngeal cancer
viral illness |
|
|
Term
| voice assesment is carried put using the GRBAS scale and MPT . what do these stand for? |
|
Definition
GRBAS = grade, roughness, breathiness, asthenia, strain
MPT = maximum phonation time. |
|
|
Term
| what does tracheostomy do to secretions? what is needed to overcome this? |
|
Definition
| it dries secretions so humidified air is usually required. |
|
|
Term
| how does having a tracheostomy reduce work of breathing? |
|
Definition
|
|
Term
| SE of having a tracheostomy tube |
|
Definition
| scarring, infection or bleeding from site, may be long term complications such as swallowing difficulties. |
|
|
Term
| whats the difference between a plastic and a silver tracheostomy tube? |
|
Definition
silver tube doesnt have an inner tube and needs changing every 5-7 days
the plastic ones can be changed every 30 days. |
|
|
Term
| early complications from having a tracheostomy |
|
Definition
tube obstruction or displacement
false passage formation
pooling of secretions leading to LRTI
aspiration
bleeding from tracheostomy site
infection |
|
|
Term
| intermediate complications from tracheostomy tube |
|
Definition
infection
pneumothorax
damage to oesophagus
trauma to recurrent laryngeal nerve
haemorrhage from thyroid isthmus |
|
|
Term
| late complications of tracheostomy |
|
Definition
airway obstruction with aspiration
damage to larynx e.g. stenosis
tracheal stenosis
tracheomalacia
fistula formation |
|
|
Term
| tracheostomy tube care for cuffed tubes |
|
Definition
| pressure should be measure twice daily and maintained between 15-30cmH2O |
|
|
Term
| in double cannulae trachostomy tubes which tube needs to be removed and cleaned? |
|
Definition
| the inner tube. this is done with warm water and left to air dry |
|
|
Term
| how would you clean the skin around the tracheostomy ? |
|
Definition
| clean with saline and apply barrier cream. avoid cotton wool. |
|
|
Term
| in audiograms, anything above how many decibels is classed as normal? |
|
Definition
|
|
Term
| how would you spot sensorineural deafness on an audiogram? |
|
Definition
| both air and bone conduction are impaired |
|
|
Term
| how would you spot conductive hearing loss on an audiogram? |
|
Definition
| only air conduction is impaired |
|
|
Term
| in audiograms, anything above how many decibels is classed as normal? |
|
Definition
|
|
Term
| how would you spot sensorineural deafness on an audiogram? |
|
Definition
| both air and bone conduction are impaired |
|
|
Term
| how would you spot conductive hearing loss on an audiogram? |
|
Definition
| only air conduction is impaired |
|
|
Term
| how would you spot mixed hearing loss on a audiogram? |
|
Definition
| both air and bone conduction are impaired with AIR conduction often being worse than bone conduction. |
|
|
Term
|
Definition
staph aureus, psuedomonas, fungal
sebhorrheic dermatitis
contact dermatitis (allergic and irritant) |
|
|
Term
|
Definition
topical Abx or combined topical Abx with steroid
if canal is extremely swollen then an ear wick is sometimes inserted |
|
|
Term
| USS is done in a pt with renal colic. they reckon its a renal stone. according to guidelines what is the next ix you should do to diagnose renal stones? |
|
Definition
|
|
Term
| mild otitis externa: mild discomfromt, itching but no discharge or deafness. what do NICE recommend prescribing? |
|
Definition
|
|
Term
| risk factors for otitis externa? |
|
Definition
hot humid climate
swimming
older age
diabetes mellitus
immunocompromised
derm conditions such as eczema |
|
|
Term
|
Definition
| lipid/acid balance of outer ear canal |
|
|
Term
|
Definition
pain and itching.
findings on otoscopy; red and swollen ear canal.
there may be pain with movement of tragus or auricle and pre auricular lymphadenopathy |
|
|
Term
what is malignant OE?
who does it effect? |
|
Definition
it is OE that spreads into mastoid or temporal bones
usually effects elderly with diabetes or those who are immunocompromised
usually due to P aeringosa or S aureus
there is pain and headache of greater intensity than clinical signs would suggest
urgently admit if malignant OE suspected |
|
|
Term
| in OE when are PO ABx indicated? |
|
Definition
| if there is cellulitis or cervical lymphadenopathy |
|
|
Term
|
Definition
|
|
Term
| when to suspect malignant OE |
|
Definition
pain and headache more severe than clinical signs would suggest
granulation tissue present at bone cartilage junction
facial nerve is paralysed (dropping of the face on the side of the infection)
admit urgently if you suspect malignant OE |
|
|
Term
|
Definition
|
|
Term
| external ear causes of otalgia |
|
Definition
OE
foreign body including live insects
trauma
impacted wax
furuncle
herpes zoster
neoplasm
Bullous myringitis
perichondritis of pinna |
|
|
Term
| middle ear causes of otalgia |
|
Definition
OM with or without effusion
mastoiditis
acute obstruction of eustachian tube
barotrauma
neoplasm
trauma |
|
|
Term
| referred pain causes of otalgia |
|
Definition
from nasopharynx: adenoidectomy or neoplasm
cranial nerves: V (trigeminal neuralgia), VII (Ramsey-Hunt syndrome and IX (tonsilitis)
salivary glands (calculi or infection)
teeth and jaw, TMJ disfunction
base of skull, elongated styloid process |
|
|
Term
|
Definition
facial nerve palsy
weight loss
dysphagia
voice change
lymphadenopathy |
|
|
Term
|
Definition
viral labrynthitis
vestibular neuritis
BPPV
menerieres
vertrebrobasilar ischemia
acoustic neuroma |
|
|
Term
| episodes of vertigo, tinnitus and hearing loss. what are you thinking? |
|
Definition
|
|
Term
| 30 year old lady recent URTI presents with vertigo and vomiting, her hearing is also affected. symptoms came on suddenly this morning |
|
Definition
|
|
Term
| 30 year old recovering from an URTI presents with vertigo and nausea and vomiting. there is no hearing loss or tinnitus |
|
Definition
|
|
Term
| a 40 year old man has ongoing vertigo tinnitus and hearing loss. he also has an absent corneal reflex |
|
Definition
|
|
Term
| what are acoustic neuromas also known as? |
|
Definition
|
|
Term
features of acoustic neuroma can be predicted by affected cranial nerves.
CN V, VII and VIII can be affected. what are the main features that would arise if they were? |
|
Definition
CN V - loss of corneal reflex.
CN VII - facial palsy
CN VIII - hearing loss, vertigo, tinnitus |
|
|
Term
| in what condition are bilateral acoustic neuromas seen in? |
|
Definition
|
|
Term
| what is the investigation of choice in acoustic neuroma? |
|
Definition
| MRI of cerebellopontine angle? |
|
|
Term
| how can a cholesteatoma cause hearing loss? |
|
Definition
if it is large then it can invade the inner ear resulting in sensorineural hearing loss and vertigo\
other invasion features can cause facial nerve palsy and cerebellopontine angle syndrome |
|
|
Term
| what surgery is performed if a perforated tympanic membrane doesnt heal itself? |
|
Definition
|
|
Term
| 3 year old. dx: OM with perf. what would you do? |
|
Definition
| amoxicillin and 2 week review |
|
|
Term
what is inflamed in viral labrynthitis
what is inflamed in vestibular neuritis? |
|
Definition
viral labrynthitis: vestibular and cochlear inflammation
vestibular neuritis: vestibular nerve inflammation with sparing of the cochlear nerve |
|
|
Term
drug treatment for vertigo.
what should you do about drug rx before seeing ENT? |
|
Definition
prochloperazine
cinnarizine
cyclizine or promethazine.
it is important that the person stop treatment 48hours before seeing a specialist |
|
|
Term
| what is the effect of anxiety on vertigo? |
|
Definition
| it makes it worse so pts need to be reassured in order to reduce their anxiety levels |
|
|
Term
| define chronic suppurative OM? (CSOM) |
|
Definition
| chronic inflammation of middle ear and mastoid cavity |
|
|
Term
| what has happened to the tympanic membrane in CSOM? |
|
Definition
| it is perforated with conductive hearing loss |
|
|
Term
| what is safe CSOM and what is unsafe CSOM? |
|
Definition
safe is CSOM without cholesteatoma
unsafe CSOM is with cholesteatoma |
|
|
Term
| what is cholesteatoma made of? |
|
Definition
| keratinising squamous epithelium |
|
|
Term
| pt presents with chronically draining ear for > 2 weeks. they have a history of recurrent acute OM. they have no fever and no otalgia. their tympanic membrane s perfd. what you thinking? |
|
Definition
|
|
Term
which 2 Abx are used in chronic suppurative otitis media?
in CSOM there is granuloma formation in middle ear. which medication is used for reducing this? |
|
Definition
aminoglycosides and fluoroquinilones
steroids are given to prevent granuloma formation. this can usually be combined with the topical antibiotic. |
|
|
Term
| surgical rx for cholesteatoma? |
|
Definition
|
|
Term
| prophylaxis drug rx for menerieres disease? |
|
Definition
betahistine 16mg tds.
diuretics may be helpful too |
|
|
Term
| a man has his ear wax irrigated. what should he use 3-5 days before this procedure? |
|
Definition
| olive oil or almond oil drops. |
|
|
Term
| after having ears irrigated what signs should make you urgently seek help from ENT |
|
Definition
seek immediate advice from an ENT specialist if
severe pain,
deafness,
or vertigo occurs
during or after irrigation, or if a perforation is seen following the procedure. |
|
|
Term
| why should you not put water into ear canal if their is a foreign body of vegetable matter? |
|
Definition
| it may cause it to swell. you should refer to ENT |
|
|
Term
| facial nerve palsy. in which one is there forehead sparing? |
|
Definition
UMN,
in LMN lesions there is no forehead sparing |
|
|
Term
| if facial palsy is bilateral what conditions would spring to mind? |
|
Definition
immunosupression e.g. HIV
lymme disease
Guillan Barre Syndrome |
|
|
Term
| causes of facially nerve palsy |
|
Definition
bell's palsy: 3 x more common in pregnancy and diabetes
EBV, CMV
ramsay hunt syndrome
HIV, lymme disease
OM, cholesteatoma, |
|
|
Term
| where are vesicles seen in ramsey hunt syndrome. it is UMN or LMN lesions? |
|
Definition
vesicles seen in ipsilateral ear
hard palate and/or anterior 2/3 of tongue |
|
|
Term
|
Definition
steroids e.g. prednisolone
should be given to those ver 16 years who present within 72 hours |
|
|
Term
| what is the commonest synkinesis seen in facial nerve palsy? |
|
Definition
| where blinking causes the angle of the mouth to contract |
|
|
Term
|
Definition
| usually bilateral sensorineural hearing diminishment. it happens in older people |
|
|
Term
what frequency hearing loss predominates in presbyacusis?
what affect does this have on pts |
|
Definition
high frequency hearing loss predominates.
this means the ability to understand speech is the earliest symptom |
|
|
Term
| which drugs can cause tinnitus? |
|
Definition
aspin
quinine
aminoglycosides
loop diuretics |
|
|
Term
features of otosclerosis
it is a cause for deafness. |
|
Definition
AD condition where normal bone is replaced by vascular spongy bone
features:
tinnitus
positive FHx
tympanic membrane: 10% may have a flamingo tinge due to hyperaemia |
|
|
Term
| which frequency is particularly affected in people who have worked in noisy industries and have hearing loss? |
|
Definition
|
|
Term
|
Definition
normal AC is better than BC.
in rinnes you place the fork on the mastoid process. when the noise stops you bring it to the pts external auditory canal and they should be able to hear buzzing again.
there is conductive hearing loss if BC is better than air conduction |
|
|
Term
|
Definition
place fork on head equidistant from both ears.
if unilateral sensorineural loss then the noise will be heard better on the unaffected side
if unilateral conductive loss then noise will be heard better on the affected side |
|
|
Term
| you do webers on a person. they hear it louder on the right side. what can this mean? |
|
Definition
they either have left sided sensorineural deafness
or right sided conductive deafness. |
|
|
Term
| in webers if there is a positive finding, the pt is asked to occlude their ear with a finger. which ear should sound be heard loudest in? |
|
Definition
|
|
Term
| pathophysiology of otosclerosis? |
|
Definition
there is fixation of the stapes in the oval window.
rx: stapedectomy and insertion of a prosthesis. |
|
|
Term
|
Definition
100ml/kg for first 10kg
50ml/kg for second 10kg
20ml/kg for remaining
fluid of choice is 0.9% saline with 5% dextrose |
|
|
Term
| 3 basic parts to a hearing aid are? |
|
Definition
microphone
amplifier
speaker |
|
|
Term
| how long does a hearing aid battery last? |
|
Definition
|
|
Term
| how does a hearing aid work? |
|
Definition
receives sound through microphone
converts sound waves to electrical signals and sends them to an amplifier
amplifier increases power of the signal and send them to the ear through a speaker. |
|
|
Term
| what conditions are associated with nasal polyps? |
|
Definition
asthma
CF
infective sinusitis
kartegeners syndrome
churg strauss syndrome |
|
|
Term
|
Definition
| the association of asthma, aspirin sensitivity and nasal polyps. |
|
|
Term
|
Definition
refer to ENT for examination
steroids reduce size of polyps in 80%
reoccurance is common
sx: polypectomy |
|
|
Term
| where do polyps usually start (anatomically?) |
|
Definition
| near the osteomeatal complex |
|
|
Term
| what must you rule out in unilateral polyps? |
|
Definition
tumour in adults
encephalocele in children |
|
|
Term
how should nasal drops be administered?
which steroid drops are commonly used? |
|
Definition
in the head down position.
fluticasone, mometasone. (negligible systemic absorption)
betamethasone affects childs growth |
|
|
Term
| gold standard rx of polyps? |
|
Definition
| functional endoscopic sinus surgery |
|
|
Term
|
Definition
| inflammation of the nasal mucosa |
|
|
Term
| what are the 3 categories of allergic rhinitis? |
|
Definition
seasonal:occurs same time every year
perennial: all year
occupational: symptoms follow exposure to particular things at work place |
|
|
Term
|
Definition
allergy avoidance
oral intranasal antihistamines
intranasal corticosteroids |
|
|
Term
|
Definition
analgesia
decongestants
Abx: amoxicillin |
|
|
Term
| mx for chronic sinusitis? |
|
Definition
intranasal corticosteroids
refer to ENT |
|
|
Term
| main causes of sinusitis? |
|
Definition
strep pneumonia
haemophilus
rhinovirus |
|
|
Term
| predisposing risk factors for sinusitis? |
|
Definition
nasal obstruction e.g. polyps or deviated septum
recent local infection: rhinitis or dental extraction
swimming
diving
smoking |
|
|
Term
| kartegeners syndrome. what is the triad? |
|
Definition
situs inversus
abnormal frontal sinuses causing sinusitis and bronchiectasis
primary ciliary dyskinesia. |
|
|
Term
| symptoms of a deviated septum? |
|
Definition
infections of sinus
anosmia
sleep apnoea
snoring
repetitive sneezing
facial pain |
|
|
Term
| causes of deviated nasal septum |
|
Definition
congenital
cocaine abuse
genetic conditions Marfans, EDS, homocysteinuria |
|
|
Term
| medical and sx mx of deviated septum |
|
Definition
decongestants, antihistamine, nasala spray
sx: septoplasty |
|
|
Term
| nasopharyngeal carcinoma is associated with which virus? |
|
Definition
|
|
Term
| common cancer of nasopharynx? |
|
Definition
|
|
Term
| where is nasopharyngeal cancer common in the world? |
|
Definition
|
|
Term
features for nasopharyngeal cancer.
systemic features include cervical lymphadenopathy. |
|
Definition
| local features : otalgia, unilateral serous otitis media, nasal obstruction/discharge or epitaxis, CN palsies III-VI |
|
|
Term
| ix and mx for nasopharyngeal cancer? |
|
Definition
combination MRI and CT
mx: radiotherapy first line. |
|
|
Term
|
Definition
| intranasal antihistamine and intranasal corticosteroid |
|
|
Term
|
Definition
trauma e,g nose picking
disorders of platelet fx
drugs: aspirin and anticoagulants
malignancy: juvenile angiofibroma
cocaine
granulomatosis with polyangitis |
|
|
Term
if blood is coming out of one nostril it is usually an ...... bleed
what if it is coming out of both? |
|
Definition
anterior.
more likely to be posterior bleed if coming out of both and mouth |
|
|
Term
| if someone comes with nosebleeds you should ask about facial pain or otalgia, why? |
|
Definition
| may be a sign of nasopharyngeal cancer. |
|
|
Term
mx of nosebleed
modes of cautery |
|
Definition
abc
ask pt to sit upright, lean forward and pinch fleshy part of nose for 10-20mins
breath through mouth. monitor their pulse and BP
cautery: silver nitrate or electrocautery
if bleeding continues nasal tampon.
if still cx you may need to endoscopically ligate some arteries e.g. sphenopalatine artery |
|
|
Term
|
Definition
candidiasis
oesophagitis
tonsilitis
malignancy
peritonsilar abscess |
|
|
Term
centor criteria what is it?
what does it mean |
|
Definition
presence of tonsilar exudate
anterior cervical lymphadenopathy
absence of cough
hx of fever
if 3 or more are present 40-60% chance that sore throat due to group A strep. |
|
|
Term
| most common organism to cause tonsillitis? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| complication of tonsillitis? |
|
Definition
quinsy
otitis media
rheumatic fever or glomerulonephritis |
|
|
Term
| what symptom may small children with tonsillitis complain of? |
|
Definition
|
|
Term
| tonsillitis with small blisters on tonsils and roof of mouth. after a few days they burst and are followed by a painful scab. most likely causative organism? |
|
Definition
|
|
Term
|
Definition
phenoxypeniccilin 10 days
avoid amoxicillin |
|
|
Term
| when can you refer for tonsillectomy? |
|
Definition
7 or more episodes of sore throat documented by GP or parents
5 or more in the past 2 years
symptoms occurring for at least a year
symptoms severe enough to affect childs day to day functioning and normal behaviour |
|
|
Term
| other additional reason you can refer for tonsilectomy |
|
Definition
if child has gut tae psoriasis that is made worse by recurrent tonsillitis
if child has sleep apnoea, day time drowsiness and FTT |
|
|
Term
| how can adults get referred for tonsillitis? |
|
Definition
| 7 or more episodes of sore throat due to tonsillitis. the episodes need to be disabling and prevent normal function |
|
|
Term
| SIGN criteria for referring for tonsilectomy |
|
Definition
7 or more well documented sore throats due to tonsillitis in 1 year
5 or more in preceding 2 years
3 or more in preceding 3 years |
|
|
Term
|
Definition
|
|
Term
thyroid cancer types
please
find
me
a
lover |
|
Definition
papillary
follicular
medullary
anaplastic
lymphoma |
|
|
Term
| mx of papillary and follicular cancer? |
|
Definition
total thyroidectomy
iodine-131 to kill residual cells
annually throglobulin test to detect reoccurrence. |
|
|
Term
| head and neck cancer is the 6th worldwide. what is it associated with? |
|
Definition
|
|
Term
| major it of head and neck cancers are? |
|
Definition
|
|
Term
| risk factors for head and neck cancers? |
|
Definition
tobacco and alcohol (synergistic relationship)
poor dentition
HPV type 16 |
|
|
Term
aged 45
persistent unexplained horsiness
unexplained neck lump
what should you do? |
|
Definition
|
|
Term
| in oral cancer what signs and symptoms would make you refer under 2 week wait? |
|
Definition
mouth ulcer lasting > 3weeks
persistent unexplained neck lump
erythloplakia or erythroleukoplakia
lump on lip or oral mucosa consistent with oral cancer |
|
|
Term
| how to manage choking/ airway obstruction |
|
Definition
ask are you choking?
if mild encourage them to cough
if severe give 5 back blows, 5 abdo thrusts then continue this cycle
if unconscious call ambulance and start CPR |
|
|
Term
|
Definition
menerieres
viral labrynthitis
vestibular neuritis
acoustic neuroma
vestibular ischemia
BPPV
trauma
MS |
|
|
Term
| which neuritis is cause by reactivation of HSV type 1? |
|
Definition
vestibular neuritis
upper respiratory infection precedes |
|
|
Term
| why should you encourage pts with vertigo to be as active as they can during the episode even if it worsens the symptoms? |
|
Definition
| it speeds up vestibular compensation. |
|
|
Term
| in OM when should Abx be prescribed? |
|
Definition
if bilateral OM in a child < 2 years
OM with perf or d/c in canal
if symptoms last > 4 days and are not improving
if the child is systematically unwell but does not require admission
if the child is immunocompromised or high risk of complications secondary to heart, liver, kidney, neuromuscular disease.
give amoxicillin for 5 days
if allergic give erythromycin and clarithromycin |
|
|
Term
| what are the NICE indications for ABx in a sore throat? |
|
Definition
marked systemic upset secondary to sore throat
unilateral peritonsilitis
hx of rheumatic fever
immunodeficiency or DM
3 or more on cent or criteria |
|
|
Term
| which syndrome is caused by reactivation of herpes zoster virus in the geniculate ganglion of the 7th CN? |
|
Definition
Ramsey Hunt syndrome
there can be vesicles in the ear, pinna and anterior 2/3 of tongue |
|
|
Term
|
Definition
| oral aciclovir and corticosteroids |
|
|
Term
| in nasal polyps which unusual symptoms require further investigations? |
|
Definition
| unilateral polyps or bleeding polyps |
|
|
Term
| asthma aspirin and nasal polyps. what is this AKA? |
|
Definition
|
|
