1
Q
What are the 3 parts of the ear?
A
- Outer ear: until tympanic membrane
- Middle ear: tympanic membrane to oval window
- Inner ear: oval window to CN8
2
Q
What are the 2 parts of the vestibule (inner ear) and what does each part do?
A
- Utricle: detects horizontal movements
- Saccule: detects vertical movements
3
Q
What are the 3 ossicles (middle ear)?
A
- Malleus
- Incus
- Stapes
4
Q
What are the 3 semi-circular canals (inner ear) and what do they do?
A
- Anterior, posterior, and lateral
- Contain endolymph and detect rotational (angular) head movements
5
Q
State 2 types of hearing loss and state which part of the ear causes each type:
A
- Conductive: outer, middle ear problems
- Sensorineural: inner ear problems (cochlear or CN8 pathology)
6
Q
State 4 potential causes of conductive hearing loss:
A
- Wax accumulation
- Cholesteatoma
- Otitis media
- Otosclerosis
7
Q
State 4 potential causes of sensorineural hearing loss:
A
- Presbycusis
- Labyrinthitis
- Meniere’s
- Acoustic neuroma
8
Q
Sudden sensorineural hearing loss is usually idiopathic. State 2 actions that should be taken for a patient with sudden SN hearing loss:
A
- High dose PO prednisolone
- Urgent ENT referral (for audiometry and imaging)
9
Q
What are the axis on an NHS audiogram?
A
- X-axis: frequency in Hertz (pitch)
- Y-axis: hearing levels in decibels (loudness)
10
Q
What is an NHS audiogram?
A
- A hearing test conducted under ideal listening conditions that helps distinguish conductive loss from sensorineural loss
11
Q
What dB range is classified as normal hearing?
A
- Less than 20dB
12
Q
What is the air bone gap (ABG)?
A
- The difference between air-conduction and bone-conduction audiometric thresholds
13
Q
What might a normal audiogram look like?
A
- Above 20dB in all frequencies
14
Q
What might an audiogram of a patient with sensorineural hearing loss look like?
A
- No air-bone gap present
15
Q
What might an audiogram of a patient with conductive hearing loss look like?
A
- Air-bone gap present
16
Q
What might an audiogram of a patient with sensorineural hearing loss (presbycusis) look like?
A
- Bilateral hearing loss above 2000Hz
17
Q
What might an audiogram of a patient with sensorineural hearing loss (Meniere’s) look like?
A
- Low-frequency sensorineural hearing loss
18
Q
What might an audiogram of a patient with conductive hearing loss (otosclerosis) look like?
A
- Conductive hearing loss with loss in bone conduction at 2000 Hz (referred to as Carhart’s notch)
19
Q
What would be the results of a normal (positive) Rinne’s test?
A
- AC>BC
- Patient can hear the tuning fork held over the external auditory meatus for longer than the tuning fork held on the mastoid
20
Q
What would be the results of an abnormal (conductive hearing loss) Rinne’s test?
A
- AC<BC
- Patient can hear the tuning fork for longer when held on the mastoid than when held over the external auditory meatus
21
Q
Why might a patient with significant sensorineural hearing loss have a ‘false negative’ Rinne’s test?
A
- As they are unable to hear anything in the affected ear but bone vibrations may be transmitted to the unaffected ear
22
Q
Outline the expected results of Weber’s test with: normal hearing, sensorineural hearing loss and conductive hearing loss:
A
- Normal: sound heard equally in both ears
- Sensorineural hearing loss: sound is heard louder on the side of the intact ear
- Conductive hearing loss: sound is heard louder on the side of the affected ear
23
Q
What is a cholesteatoma?
A
- An abnormal collection of keratinising squamous epithelium in the middle ear or mastoid
24
Q
State and explain 2 ways by which cholesteatomas can erode bone:
A
- Pressure effect: exert chronic pressure on adjacent ossicles and bony walls
- Enzymatic destruction: release osteolytic enzymes
25
What do cholesteatomas arise from?
- A retraction pocket: a sunken area of the tympanic membrane caused by negative middle ear pressure
26
State 3 risk factors for cholesteatoma:
- Down syndrome (dysfunctional Eustachian tube)
- Cleft palate
- Trauma/surgery
27
State 2 symptoms of cholesteatoma:
- Painless, watery, brown, offensive otorrhea
- Progressive, conductive hearing loss
28
State and explain 2 investigations for cholesteatoma:
- Otoscopy: white attic crust, retraction pocket
- CT temporal bone
29
State 1 treatment for cholesteatoma:
- Mastoidectomy
30
What is otosclerosis?
- Abnormal bone remodelling around the stapes footplate, causing it to become fixed to the oval window, which impairs sound transmission
31
Otosclerosis is typically inherited in what pattern?
- Autosomal dominant
32
In otosclerosis, normal bone is replaced by which sort of bone?
- In otosclerosis, spongy (sclerotic) bone replaces normal dense bone around the stapes footplate
33
State the single biggest risk factor for otosclerosis:
- Family history of otosclerosis
34
State 2 symptoms of otosclerosis:
- Progressive, bilateral conductive hearing loss
- Tinnitus
35
State and explain 3 investigations for otosclerosis:
- Otoscopy: Schwartz sign
- Audiometry: Carhart notch
- High resolution CT scan (gold standard)
36
What is Schwartz sign?
- A reddish blush seen through the eardrum in some patients with otosclerosis, caused by increased vascularity of the bony cochlear promontory
37
State 2 treatments for otosclerosis:
- Hearing aids (initially)
- Stapedectomy
38
What is Meniere's disease?
- A disorder of the inner ear labyrinths characterized by endolymphatic hydrops
- Causing membranous labyrinth distension
39
State 1 risk factor for Meniere's disease:
- Autoimmune disease (e.g. RA, SLE)
40
State 5 symptoms of Meniere's disease:
- (Recurrent, episodic:)
- Unilateral aural fullness
- Vertigo
- Sensorineural hearing loss
- Tinnitus
- Horizontal-torsional nystagmus
41
What are drop attacks (Tumarkin’s otolithic crises)?
- Sudden loss of postural control and collapse without loss of consciousness, in patients with Meniere's disease
42
Romberg test can be positive in Ménière’s disease, especially between attacks. What is Romberg test?
- A neurological test to assess balance by measuring a person's ability to stand still with their feet together, first with eyes open and then with eyes closed
43
What are the 3 criteria for a diagnosis of Meniere's disease?
- Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours
- Fluctuating aural symptoms, including hearing loss, tinnitus, or aural fullness
- Audiometry: low frequency, sensorineural hearing loss
44
According to the DVLA, when can a patient with Meniere's disease resume driving?
- When they have good symptom control
45
State 3 treatments for Meniere's disease:
- Betahistine (histamine analog, prophylactic)
- PO antihistamines (cyclizine, for moderate attacks)
- IM/buccal prochlorperazine (for severe attacks)
46
What is benign paroxysmal positional vertigo (BPPV)?
- A peripheral vestibular disorder caused by displaced otoconia (calcium crystals) in the semi-circular canals, leading to brief (15s to 20s), recurrent vertigo triggered by head movements
47
State 2 risk factors for BPPV:
- Head trauma
- Infection
48
Describe the primary symptom associated with BPPV:
- Vertigo episodes (less than 1 minute) on sudden head movement
49
State and explain 1 investigation for BPPV:
- Dix Hallpike test
- Positive result: rotary nystagmus and vertigo
50
State 1 treatment for BPPV:
- Vestibular rehabilitation (e.g. Epley manoeuvre and Brandt Daroff exercises)
51
State and explain 2 types of infections of the inner ear:
- Vestibular neuronitis: inflammation of the vestibular portion of the 8th cranial nerve
- Labyrinthitis: inflammation of the labyrinth (cochlear and vestibular apparatus)
52
What is the most common cause of vestibular neuronitis and labyrinthitis?
- HSV-1
53
Outline the differences in symptoms between vestibular neuronitis and labyrinthitis:
- Both: vertigo, nystagmus, nausea, vomiting (hours to days)
- Just labyrinthitis: SN hearing loss
54
What is the Head Impulse, Nystagmus, Test of Skew (HINTS) examination?
- A 3 part clinical test used to differentiate between the causes of vertigo, specifically central (brain-related) and peripheral (inner ear) causes
55
What is vertigo?
- The sensation of illusory movement
56
State 1 central cause of vertigo:
- Stroke affecting the posterior circulation-supplied vestibular structures (cerebellum, brainstem, or vestibular nuclei)
57
State 1 peripheral cause of vertigo:
- Meniere's disease
58
State 4 investigations for inner ear infections:
- Audiometry
- CT head
- MRI head
- HINTS examination
59
In terms of the head impulse test, nystagmus and test of skew, state the differences between the HINTS exam results of central and peripheral vertigo:
- Central: normal head impulse test, bidirectional or vertical nystagmus, vertical skew
- Peripheral: abnormal head impulse test, no or unidirectional nystagmus, no vertical skew
60
State 2 treatments for inner ear infections:
- Vestibular rehabilitation
- Antiemetics (IM, buccal prochlorperazine)
61
What is an acoustic neuroma (vestibular schwannoma)?
- A benign, slow-growing tumour of Schwann cells on the vestibulocochlear nerve
62
Acoustic neuromas affect which 3 cranial nerves? What symptoms might this cause?
- CN5: facial numbness, absent corneal reflex
- CN7: facial weakness (Bell's palsy)
- CN8: hearing loss, tinnitus, imbalance
63
Acoustic neuromas originate from CN8. How can they grow to affect CN5 and CN7?
- By tumour expansion in the cerebellopontine angle
64
Acoustic neuromas are typically unilateral (unilateral hearing loss). What might bilateral acoustic neuromas suggest?
- Diagnostic of neurofibromatosis type 2 (NF2)
65
State 2 investigations for acoustic neuromas:
- CT head (1st line)
- MRI head (gold standard)
66
State 1 treatment for an acoustic neuroma:
- Surgical removal
67
What is Ramsay Hunt syndrome?
- A neurological disorder caused by the reactivation of varicella-zoster virus (VZV) in the geniculate ganglion of the facial nerve (CN VII)
68
Other than Ramsay Hunt syndrome, state 3 causes of CN7 palsy:
- Idiopathic (Bell's palsy)
- Sarcoidosis
- Parotid tumour
69
State 5 symptoms of Ramsay Hunt syndrome:
- Painful and tender vesicular ear rash (may also be mouth rash)
- Facial paralysis
- Dry eyes
- Vertigo
- Tinnitus
70
State 3 treatments for Ramsay Hunt syndrome:
- PO prednisolone
- PO aciclovir
- Lubricating eye drops
71
What is an auricular haematoma?
- A collection of blood between the cartilage and the perichondrium of the outer ear, most often caused by blunt trauma, especially in contact sports
72
State 1 treatment for auricular haematoma:
- Same day ENT referral for incision and drainage
73
State 1 potential complication of an auricular haematoma:
- Cauliflower ear
74
What is otitis media?
- An infection of the middle ear, causing inflammation and fluid build-up behind the eardrum
75
State 3 common causative organisms of otitis media:
- Strep pneumoniae (most common)
- Haemophilus influenzae
- RSV
76
State 2 risk factors for otitis media:
- Children (6 months to 2 years old)
- Down syndrome
77
State 3 symptoms of otitis media:
- Acute, unilateral ear pain
- Fever
- Conductive hearing loss
78
State and explain 1 investigation for otitis media:
- Otoscopy: erythematous, bulging tympanic membrane, loss of light reflection, air fluid level
79
State 3 complications of otitis media:
- Mastoiditis
- Meningitis
- CN7 nerve palsy
80
Most patients with otitis media do not need antibiotics. State 4 indications for admitting a patient with otitis media:
- Sepsis
- Mastoiditis
- Under 3 years old and a temperature of at least 38 degrees
- Under 2 years old with bilateral symptoms
81
State 2 treatments for otitis media:
- PO amoxicillin 125mg to 250mg TDS for 7 days
- Co-amoxiclav
82
What is otitis media with effusion (glue ear)?
- The build-up of fluid in the middle ear behind the eardrum without signs of acute infection
83
What is the most common cause of conductive hearing loss in children?
- OME (glue ear)
84
State and explain 2 investigations for OME:
- Otoscopy: yellow tympanic membrane, air fluid level, retracted tympanic membrane
- Audiogram: conductive hearing loss
85
OME does not typically present with pain or infective symptoms. State 1 symptom of OME:
- Chronic, conductive hearing loss
86
State 1 potential result of prolonged conductive hearing loss in children:
- Delayed speech/language development
87
Initially, the treatment for OME is to watch and wait for 3 months. State 2 subsequent treatments for OME:
- Grommets
- Myringotomy
88
What are grommets?
- Tubes surgically implanted in the eardrum to drain fluid from the middle ear
89
What is a myringotomy?
- A surgical procedure where a small incision is made in the eardrum to drain fluid from the middle ear/relieve pressure
90
What is otitis externa?
- An inflammation of the outer ear canal, often called "swimmer's ear"
91
State the 2 most common causative organisms for otitis externa:
- Pseudomonas aeruginosa (most common)
- Staph aureus
92
State 3 common symptoms of otitis externa:
- Pruritic, painful ear canal
- Otorrhea
- Conductive hearing loss
93
State 1 investigation for otitis externa:
- Otoscopy
94
State 3 treatments for otitis externa:
- Aural toilet
- Topical steroid
- Topical flucloxacillin/amoxicillin
95
What is malignant otitis externa?
- A severe infection of the outer ear canal that can spread to the tempero-mastoid bones at the base of the skull
96
State 1 otoscopy finding of malignant otitis externa:
- Exposed bone
97
State 2 risk factors for malignant otitis externa:
- HIV
- T2DM
98
State 4 symptoms of malignant OE:
- Severe ear pain
- Conductive hearing loss
- CN7 palsy
- Offensive discharge
99
State 1 investigation for malignant OE:
- CT head
100
State 1 treatment for malignant OE:
- IV antibiotics (for 6 to 12 weeks)
101
What is mastoiditis?
- Inflammation of the mastoid antrum and the lining of the mastoid air cells
102
What is the most common causative organism of mastoiditis?
- Strep pneumoniae
103
State 2 diseases that increase the risk of developing mastoiditis:
- Otitis media
- Cholesteatoma
104
Describe the typical appearance of mastoiditis:
- Postauricular swelling
- Anterolaterally rotated ear pinna
105
State 4 symptoms of mastoiditis:
- Ear pain
- Fever
- Conductive hearing loss
- Otorrhea
106
State 2 investigations for mastoiditis:
- Otoscopy (typically otitis media)
- CT head
107
State 2 treatments for mastoiditis:
- (Urgent ENT referral)
- IV antibiotics
- Cortical mastoidectomy (if abcess)
108
State 1 complication of mastoiditis:
- Meningitis
109
State 2 risk factors for cerumen:
- Cotton bud use
- Earplug use
110
State 1 investigation for cerumen:
- Otoscopy: tympanic membrane not visible due to wax accumulation
111
State 4 symptoms of cerumen:
- Ear pain
- Conductive hearing loss
- Fullness in the ear
- Tinnitus
112
State 3 treatments for cerumen:
- Olive oil ear drops
- Sodium carbonate ear drops
- Suctioning (if recurrent)
113
What is chondrodermatitis nodularis helicis?
- A painful, benign condition causing a tender, firm nodule on the ear's cartilage, caused by chronic pressure on the ear (e.g. sleeping on the side)
114
Describe the typical appearance of chondrodermatitis nodularis helicis:
- Painful, firm, oval-shaped nodule on the ear helix or antihelix with central crusting and surrounding erythema
115
State 1 differential diagnosis for chondrodermatitis nodularis helicis:
- SCC (consider dermatology referral)
116
State 2 treatments for chondrodermatitis nodularis helicis:
- Topical steroids
- Dissection and curettage
117
What is sinusitis?
- Inflammation of the paranasal sinuses in the face (this is usually accompanied by inflammation of the nasal cavity and can be referred to as rhinosinusitis)
118
What are the 2 types of sinusitis?
- Acute (less than 12 weeks)
- Chronic (more than 12 weeks)
119
State 5 causes of sinusitis:
- Viral URTI (most common) e.g. rhinovirus
- Bacterial (often following viral URTI) e.g. strep pneumoniae
- Allergens (e.g. hay fever)
- Obstruction (e.g. foreign body, polyps)
- Smoking
120
Describe a typical presentation of acute sinusitis:
- Someone with a recent viral upper respiratory tract infection presenting with:
- Nasal congestion
- Frontal face headache, worse on leaning forward
- Anosmia
121
Sinusitis usually resolves spontaneously. State 2 treatments for sinusitis:
- Nasal decongestants (short course) e.g. phenylephrine
- Potent nasal steroid (if symptomatic for at least 10 days) e.g. mometasone
122
Why must nasal decongestants not be used on a long-term basis?
- Prolonged use causes rebound congestion (rhinitis medicamentosa) due to rebound vasodilation from receptor desensitization
123
What are nasal polyps?
- Soft, benign growths that form in the mucosal lining of the nose and sinuses
124
State 2 risk factors for nasal polyps:
- Cystic fibrosis (due to chronic sinus inflammation)
- Kartagener’s syndrome
125
What are the components of Samter's triad?
- Asthma
- Nasal polyps
- NSAID sensitivity
126
State 1 condition that is associated with nasal polyps:
- Chronic rhinosinusitis
127
Nasal polyps can cause nasal obstruction. State 2 symptoms of nasal polyps:
- Rhinorrhoea
- Anosmia
128
Why must unilateral nasal polyps be urgently referred to ENT after history and examination?
- Unilateral nasal polyps are more suspicious for nasopharyngeal carcinoma (or other neoplasms)
- Bilateral polyps are more often due to benign inflammatory causes like allergy or chronic sinusitis
129
State 4 typical features of a patient with nasopharyngeal cancer:
- Neck mass
- Unilateral nasal obstruction
- Unilateral, effusive, non-infective otitis media
- Epistaxis
130
Unilateral nasal polyps must be referred urgently to ENT. State 2 treatments for bilateral nasal polyps:
- Intranasal steroid
- Endoscopic polypectomy (if refractory)
131
Describe the typical presentation of a patient with a broken nose:
- Hypermobile, deformed nose
- Bruising
- Pain
- Epistaxis
132
State 1 treatment for nasal fracture:
- Rhinoplasty
133
State and explain 1 complication of a nasal fracture:
- Septal haematoma: bilateral blood pooling between the the perichondrium and septal cartilage
134
Describe the appearance of a septal haematoma:
- Painful, boggy nose swelling
135
State 2 treatments for septal haematoma:
- Surgical incision and drainage
- IV antibiotics
136
State 1 potential complication of untreated septal haematoma:
- Irreversible septal necrosis (within 3 to 4 days later)
137
Where do the majority of nosebleeds originate from?
- Kiesselbach’s plexus (Little’s area): a vascular network on the anterior part of the nasal septum
138
State 4 risk factors for epistaxis:
- Trauma
- Nose picking
- Bleeding disorders
- Snorting drugs
139
Outline how epistaxis should be treated:
- Pinch nose for 10 to 15 minutes, lean forward and breathe through the mouth
- Anterior septal bleed: silver nitrate cautery then anterior nasal packing
- Posterior septal bleed: posterior nasal packing
- Ongoing bleed: arterial embolization
140
State 4 pieces of advice to give to a patient who has just had a major nosebleed:
- Avoid lying flat
- Avoid picking nose
- Avoid heavy lifting
- Avoid alcohol
141
What is the most common type of head and neck cancer?
- Usually squamous cell carcinomas arising from the squamous cells of the mucosa
142
State 5 risk factors for head and neck cancers:
- HPV infection (particularly HPV16)
- Smoking
- Alcoholism
- EBV infection
- GORD
143
State 4 common features of nasopharyngeal cancer:
- Unilateral, effusive otitis media
- Unilateral nasal obstruction
- Nasal/neck mass
- Epistaxis (and crusting)
144
State 4 common features of oropharyngeal cancer:
- Non-healing mouth ulcer
- Neck mass
- Erythroplakia
- Leukoplakia
145
State 5 common features of laryngeal cancer:
- Dysphagia
- Odynophagia
- Hoarseness
- Neck lump
- Stridor
146
Suspected head and neck cancers should be referred via a 2 week wait pathway. State 2 suspicious symptoms that may be caused by head and neck cancer:
- Indeterminate neck mass
- Unexplained hoarseness
147
State the 1st line and gold standard investigations for head and neck cancers:
- 1st line: flexible laryngoscopy with FNA biopsy
- Gold standard: rigid laryngoscopy with core biopsy (under general anaesthetic)
- (And TNM staging with CT/MRI/PET)
148
State 5 treatments for head and neck cancers:
- Chemotherapy
- Radiotherapy
- Surgery
- Monoclonal antibodies (e.g. Cetuximab)
- Palliative care
149
State 4 side effects of radiotherapy for head and neck cancer:
- Mucositis
- Mucosal atrophy
- Radiation induced osteonecrosis of the jaw
- Skin reactions
150
Cetuximab is a monoclonal antibody used to treat head and neck cancer. What receptor does it target?
- It targets epidermal growth factor receptor, blocking the activation of this receptor and inhibiting the growth and metastasis of the tumour
151
State 3 risk factors for thyroid cancer:
- Family history (MEN2A MEN2B genes)
- Neck radiation exposure
- Female sex
152
State 5 types of thyroid cancer. Which type is the most common?
- Papillary (most common)
- Follicular
- Medullary
- Anaplastic
- Lymphoma
153
Which type of thyroid cancer has the best prognosis?
- Papillary carcinoma
154
Which types of cancers are most commonly caused by the MEN1, MEN2A and MEN2B genes respectively?
- MEN1: pancreatic, pituitary, parathyroid
- MEN2A: medullary thyroid, phaeochromocytoma, parathyroid hyperplasia
- MEN2B: medullary thyroid carcinoma, phaeochromocytoma, mucosal neuromas (and marfanoid habitus)
155
TFT's are not usually deranged in thyroid cancer. Calcitonin is elevated in which type of thyroid cancer?
- Medullary carcinoma
156
Papillary carcinomas are common in which demographic?
- Young females
157
Describe the typical histological appearance of papillary carcinomas:
- Tumour has papillary projections and pale empty (orphan Annie eye) nuclei
158
How do papillary carcinomas usually spread in the body?
- Lymphatic spread
159
How can histology distinguish between follicular adenoma and follicular carcinoma?
- Follicular carcinoma: microscopically capsular invasion is seen
- Follicular adenoma: no microscopically capsular invasion is seen
160
What is the Hürthle cell variant?
- A subtype of follicular thyroid carcinoma (and sometimes adenoma)
- Composed of Hürthle cells (also called oncocytic cells): large epithelial cells with eosinophilic, granular cytoplasm packed with mitochondria
161
How do follicular thyroid cancers spread in the body?
- Haematogenous
162
Medullary thyroid carcinoma is a cancer of which cells?
- Parafollicular C cells of the thyroid
163
State 2 symptoms of medullary carcinoma:
- Diarrhoea and flushing (from elevated calcitonin levels)
164
How does medullary carcinoma spread in the body?
- Both haematogenous and lymphatic spread
165
Which type of thyroid cancer has the worst prognosis?
- Anaplastic carcinoma
166
Anaplastic carcinomas are common in which demographic?
- Elderly females
167
Which type of thyroid cancer most commonly causes compression symptoms (e.g. hoarseness) and does not respond to chemotherapy treatment?
- Anaplastic carcinoma
168
Describe the typical histological appearance of anaplastic thyroid carcinoma:
- Highly pleomorphic cells, including spindle cells, giant cells, and squamoid cells
169
State 4 general symptoms of thyroid cancer:
- Neck lump
- Dysphagia
- Lymphadenopathy
- Hoarseness
170
State the 1st line and gold standard investigations for thyroid cancer:
- 1st line: neck USS
- Gold standard: biopsy (FNA or core)
171
State 2 treatments for thyroid cancer:
- Total thyroidectomy (with lifelong T4) with lifelong ablation
- Palliation (for anaplastic)
172
What is Ludwig's angina?
- A rare but life-threatening bacterial infection that causes rapidly progressing swelling in the floor of the mouth, neck, and under the tongue
173
State 4 symptoms of Ludwig's angina:
- Fever
- Neck swelling
- Dysphagia
- Stridor (airway compromise)
174
State 1 treatment for Ludwig's angina:
- (A-E assessment if airway compromise)
- IV antibiotics
175
What is a pleomorphic adenoma?
- A benign, slow-growing tumor that commonly develops in the salivary glands, most often in the parotid gland
176
State 3 symptoms of pleomorphic adenoma:
- Firm, painless lump
- Sialorrhea
- CN7 palsy (runs through parotid gland)
177
State 1 treatment for pleomorphic adenoma:
- Surgical excision (risk of malignant transformation)
178
What is the most common cause of neck swellings?
- Reactive lymphadenopathy
179
What is a branchial cyst?
- A soft, oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
- Develops due to failure of obliteration of the second branchial cleft in embryonic development
180
At what age do branchial cysts tend to present?
- Usually present in early adulthood
181
What is a carotid aneurysm?
- A pulsatile lateral neck mass which doesn't move on swallowing
182
What is a thyroglossal cyst?
- A soft, usually midline mass between the isthmus of the thyroid and the hyoid bone
that moves upwards with protrusion of the tongue
183
What is a cervical rib?
- An extra rib that forms from the seventh cervical vertebra (C7) at the base of the neck
184
Most people with a cervical rib never know that they have it but around 10% go on to develop thoracic outlet syndrome. What is thoracic outlet syndrome?
- A condition where nerves or blood vessels (e.g. brachial, subclavian) in the space between the collarbone and first rib become compressed
185
What is the key symptom of thoracic outlet syndrome?
- Pain, numbness, and tingling in the arm and hand
186
What is Pemberton sign?
- A medical test where raising both arms overhead causes facial congestion and cyanosis, which indicates a potential obstruction in the thoracic inlet
187
State 4 treatments for thoracic outlet syndrome:
- Physiotherapy
- Analgesia
- Steroids
- Surgery
188
What is a cystic hygroma?
- A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side (more evident at birth) that transilluminates
189
Cystic hygromas are often picked up on prenatal scans. State 1 treatment for cystic hygroma:
- Surgical removal
190
What is zenker's diverticulum (pharyngeal pouch)?
- A pouch or sac that forms in the upper part of the throat, a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
191
State 4 symptoms of pharyngeal pouch:
- Dysphagia
- Regurgitation
- Chronic cough
- Halitosis
192
Describe the typical appearance of a pharyngeal pouch:
- Usually not seen but if large then a midline lump in the neck that gurgles on palpation
193
State 1 investigation for pharyngeal pouch:
- Barium swallow
194
State 1 treatment for pharyngeal pouch:
- Endoscopic stapling
Medicine: Phase 4
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