Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
65 Cards in this Set
- Front
- Back
|
concha =
|
turbinate
|
|
|
concha bullosa =
|
air-filled cavity within a turbinate
|
|
|
Is having concha bullosa pathological?
|
normal anatomic variant in <50%
- NOT more prone to have sinus disease - but a large concha bullosa can obstruct sinus openings leading to recurrent sinusitis -often associated with deviation of the nasal septum toward the opposite side |
|
Haller cell =
|
pneumatized infraorbital ethmoid cell
(below the orbit in the roof of the maxillary sinus) |
|
|
How can a Haller cell be pathological?
|
occurs in 10% of people
enlarged Haller cells → narrowing of the ethmoidal infundibulum → recurrent sinus disease |
|
|
Paradise Criteria for Tonsillectomy in children
|
7 or more episodes in the preceding year, OR
5 or more episodes in each of the preceding 2 yrs 3 or more episodes in each of the preceding 3 yrs |
|
|
most common tumour of the nose
|
benign polyposis
OR SCC adenoma |
|
|
Treatment for nasal polyps causing obstructive symptoms
|
CT ± MRI
prednisone (reducing regimen) saline nasal douche ± biopsy |
|
|
symptoms of vasomotor rhinitis
|
persistent daytime rhinorrhea
|
|
|
laryngopharyngeal reflux only responds to
|
Gaviscon vs. Nexium
(ie. antacid vs. PPI) |
|
|
polyp =
|
benign growth
|
|
|
innervation of nasal glands
|
Vidian n.
(nerve of the pterygoid canal) |
|
|
steroids are effective in rhinitis/rhinosinusitis?
|
rhinosinusitis (sinusitis) only
|
|
|
rhinitis =
|
inflammation of mucous membranes of the nose
|
|
|
rhinosinusitis (sinusitis) =
|
inflammation of the sinuses
|
|
|
Nasal Obstruction Hx
|
Is it a runny or blocked nose? Postnasal drip?
How often? How long? Has it affected your sense of smell or taste? Infections? Epistaxis? Sore throat? Any pain? Headache? Earache, hearing? Tonsillitis? Snoring? Have you had any previous surgery? |
|
|
nasopharyngeal carcinoma can be visualised by laryngoscopy of the
|
postnasal space
|
|
|
Tonsilitis Hx
|
Have you ever had glandular fever / quinsy before?
|
|
|
What is the risk of bleeding post-tonsillectomy?
|
10% within 2 weeks
|
|
|
Epistaxis Protocol
|
Lean forward, pinch nostrils tightly & hold for 15 min. Don't blow the nose.
3 treatments tds for 3 days = 3x3x3 1. wash nose using nasal saline douche 2. topical decongestant (3 sprays each nostril) 3. moisturise & protect with Nasalate cream |
|
|
venous drainage of tonsils
|
peritonsillar plexus
lingual veins and pharyngeal veins internal jugular vein |
|
|
nerve supply of tonsils
|
glossopharyngeal (CN 9)
|
|
|
blood supply to tonsils
|
branches of external carotid a. :
Lingual artery Facial artery Ascending pharyngeal artery Maxillary artery |
|
|
the tonsil bed is formed by 2 muscles
|
Superior constrictor
Styloglossus |
|
|
palatine tonsil arises from which embryological origins
|
2nd pharyngeal pouch (endoderm)
|
|
|
tonsils =
|
mucous lymphoid tissue
1st line of defence, forms Waldeyer's ring |
|
|
components of Waldeyer's ring
|
palatine tonsils
lingual tonsils adenoids openings of eustachian tube |
|
|
Describe the anatomical location of the palatine tonsils
|
lateral oropharynx
Deep - Superior constrictor muscle Anterior - Palatoglossus Posterior - Palatopharyngeus Superior - Soft palate Inferior - Lingual tonsil |
|
|
contraindications to tonsillectomy
|
Acute infection
Bleeding predisposition Anemia Poor anesthetic risk or uncontrolled medical illness |
|
|
Conditions that predispose to sinusitis
|
Allergic/Nonallergic rhinitis
Anatomic (Septal deviation, Paradoxical middle turbinate, Ethmoid bulla hypertrophy, Choanal atresia, Adenoid hypertrophy) GORD hormonal factors (eg. pregnancy, hypothyroid) immune deficiency |
|
|
microorganisms in acute sinusitis
|
Streptococcus pneumoniae
Haemophilus influenzae Moraxella catarrhalis |
|
|
microorganisms in chronic sinusitis
|
Streptococcus pneumoniae
Haemophilus influenzae Moraxella catarrhalis Staphylococcus spp. |
|
|
concha bullosa
|
|
|
septal spur
|
|
|
Sx of chronic sinusitis
|
Facial pain or pressure
Facial congestion or fullness Nasal obstruction or blockage Nasal discharge, purulence, or postnasal drip Hyposmia or anosmia Headache Fever Halitosis Fatigue Dental pain Cough Ear pain, pressure, fullness |
|
|
posterior ethmoid & sphenoid sinus drainage to
|
sphenoethmoidal recess and superior meatus
|
|
|
anterior ethmoid & frontal/maxillary sinus drainage to
|
middle meatus
|
|
|
Zenker's diverticulum (pharyngeal pouch) classical hx finding
|
coughing up /spitting undigested food
halitosis |
|
|
Function of anterior 2/3 vocal cord
|
phonation
|
|
|
Function of posterior 1/3 vocal cord
|
respiration
|
|
|
what is the management of vocal cord nodules (benign) ?
|
conservative mx with voice therapy/rest & PPI
|
|
|
classical hx finding in Laryngospasm
|
panic attacks
inspiratory stridor cyanosis |
|
|
classical exam finding in Laryngospasm
|
paradoxical vocal cord movement
|
|
|
prognosis of fungal sinusitis
|
high mortality
|
|
|
Cholesteatoma
|
a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear / mastoid process
|
|
|
acute otitis media common age group
|
1-6 years old
|
|
|
microoganisms causing acute otitis media
|
Strep pneumoniae
H. influenzae Moraxella catarrhalis S. aureus / pyogenes viral |
|
|
Pathophysiology of acute otitis media
|
eustachian tube obstruction → air absorbed in middle ear (becomes irritant) → oedema of mucosa → infection of exudate from nasopharyngeal secretions
|
|
|
Causes of acute otitis media
|
URTI
allergies / chronic sinusitis adenoid hypertrophy tumour (eg. NPC) cleft palate Down's syndrome immunosuppression |
|
|
Risk Factors for acute otitis media
|
bottle feeding
2nd hand smoke crowded living male +ve FH |
|
|
Sx of acute otitis media
|
TRIAD:
fever + otalgia + conductive hearing loss Rarely: tinnitus, vertigo, CN7 paralysis, otorrhea if TM perforated |
|
|
Tx of acute otitis media
|
amoxycillin / cephalosporin for 10-14 days
± paracetamol ± decongestants |
|
|
Prevention of acute otitis media
|
vaccination (Hib, pneumococcal)
antibiotic prophylaxis surgery |
|
|
Complications of acute otitis media
|
TM perforation
chronic suppurative otitis media effusion brain abscess, meningitis mastoiditis labyrinthitis CN 7 paralysis |
|
|
most common benign tumour of parotid gland
|
pleomorphic adenoma (rarely transformation to SCC)
adenolymphoma |
|
|
most common malignant tumour of parotid gland
|
SCC
adenocarcinoma |
|
|
Symptomatically what is the distinguishing feature between acute sinusitis & chronic sinusitis?
|
acute = FEVER (unwell), pain
|
|
|
How does the middle turbinate separate the blood supply of the nose?
|
ABOVE middle turbinate = internal carotid a.
BELOW middle turbinate = external carotid a. |
|
|
blood supply of the superior nasal septum
|
internal carotid a. → ethmoidal aa.
|
|
|
blood supply of the lower nasal septum
|
external carotid a. → sphenopalatine + greater palatine + nasopalatine a.
→ anastomose to form Kiesselbach's plexus anteriorly |
|
|
Investigations for epistaxis
|
CT
FBC & coags |
|
|
Tx of epistaxis
|
ABC
hemostasis |
|
|
Causes of epistaxis
|
LOCAL:
trauma - fracture, foreign body dryness septal perforation inflammation - rhinitis, infection tumors - benign (polyps, inverting papilloma, angiofibroma) & malignant (SCC) iatrogenic / cocaine SYSTEMIC: coagulopathies (liver failure, vWB, hemophilia, haematological malignancy, anticoagulants) |
|
|
Treatment of benign tumours of the vocal cord
|
voice rest
speech therapy |
|
|
Which patients with hoarseness should you refer to an ENT?
|
voice change > 3 weeks
red flags (neck trauma, hx of malignancy) px who rely on their voice as professionals |
