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ENT > Conditions > Flashcards

Conditions Flashcards

1
Q

Peripheral vertigo causes

A

BPPV
Meniere’s
Ramsay Hunt syndrome
Labyrinthitis
Vestibular neuritis
Acoustic neuroma
Superior semicircular canal dehiscence
Cholesteatoma

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2
Q

Central vertigo causes

A

Cerebrellar infarction/haemorrhage
Vertebrobasilar insufficiency
Vestibular migraine
Multiple sclerosis

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3
Q

Conductive hearing loss causes

A

Cerumen
OE
Exostosis
Psoriasis
OM
Cholesteatoma
Otosclerosis
TM perforation

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4
Q

SNHL causes

A

Hereditary
Presbycusis
Meningitis
Thyrotoxicosis
Ototoxic drugs
Meniere’s disease
Noise exposure
Acoustic neuroma
Barotrauma
CVA

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5
Q

Severity of hearing loss

A

Mild; 20-40db
Moderate; 41-60db
Severe; 61-90db

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6
Q

Barotrauma

A

Pressure/pain/SNHL/tinnitus/vertigo
Tx; conservative, analgesia
Prevention; nasal decongestants/antihistamines, valsalva, chewing

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7
Q

Eustachian tube dysfunction

A

Hearing loss, aural fullness, otalgia, tinnitus, popping noise
retracted pars flaccida, shortened handle of malleus
Tx; conservative, autoinsufflation

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8
Q

Cholesteatoma

A

Invading cyst into TM/middle ear/mastoid
Conductive HL, foul discharge, otalgia, vertigo, facial weakness
Unsafe perforation; superior or posterior edge of TM, assoc granulation tissue
Tx mastoid surgery

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9
Q

Otalgia causes

A

Infection
Trauma
FB
Cerumen
Osteomyelitis
Temporal arteritis
Ramsay Hunt syndrome
Odontogenic
TMJ
Trigeminal neurlagia

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10
Q

Otitis externa

A

Swimming, Eczema, psoriasis
P aeruginosa, S aureus, candida/aspergillus
Tx
- Dry aural toilet 6hrly until dry
- Bacterial; otodex (dex/framycetin/gramcidin) 3 drops TDS 7/7
- Fungal; debride/aural ++, otocomb (triamcinolone/neomycin/gramcidin/nystat)
- Systemic; fluclox 500mg QID 7-10/7
Prevention; acetic acid + isopropyl alcohol after swimming, ear plugs

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11
Q

Types of otitis media

A

Acute OM; middle ear inflamm + effusion PLUS one of; red TM, discharge, fever, pain, irritability
OME: fluid behind TM without acute sx (glue ear)
Episodic OME: <3/12
Chronic OME: >3/12
Recurrent AOM: >=3 episodes in 6/12 or >=4 in 12/12
Chronic suppurative OM: persistent discharge with perforation >2/52

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12
Q

AOM Abx indication

A

<6mo
<2yo and bilateral
Systemic features
Otorrhoea in children
Immunocompromised
High risk ATSI

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13
Q

AOM SDM Abx

A

Self limiting
Consider Abx if nil improvement after 48hrs
Sx last 2-3 days regardless of Abx
Abx only shortens duration by 12hrs
Discuss harms of ABx

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14
Q

AOM Abx tx

A

Amoxicillin 15mg/kg TDS 5/7
If no response - switch to amox/clav 22.5+3.2mg/kg BD 5/7
->if allergic - cefuroxime 15mg/kg BD 5/7 or bactrim 4+20mg/kg BD 5/7

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15
Q

Indications for Abx in ATSI for AOM

A

Remote/rural
<2yo or first episdoe <6/12 age
Persistent OME
Bilateral AOMwoP
AOMwiP
Hx recurrent AOMwiP
Hx of CSOM
Down syndrome/cleft palate/immunodeficiency
<2yo with T>38.5 or bilateral AOM = high risk episode

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16
Q

AOM Abx ATSI

A

AOMwoP; amoxicillin 50mg/kg/day in 2-3 doses 7/7
-> nil improvement -> 90mg/kg/day
-> nil improvement -> augmentin 90mg/kg 7/7
-> poor compliance - single dose azithromycin 30mg/kg and repeat at day 7 if not improved
AOMwiP; amoxicillin 50-90mg/kg/day 14/7 of stat dose azithromycin 30mg/kg

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17
Q

Recurrent AOM ATSI

A

Amoxicillin 50mg/kg/day 3-6/12 if <2yo - refer ENT if nil improvement

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18
Q

Chronic OME ATSI

A

Amoxicillin 50mg/kg/day 2-4/52
ENT if >3/12 or hearing loss >20dB in better ear
Refer for language support/ speech pathology

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19
Q

Tympanostomy tube otorrhoea ATSI mx

A

Dry mopping
Cipro 0.3% 5 drops BD 7/7
Review weekly for 4/52

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20
Q

Chronic suppurative OM ATSI

A

Dry mopping/suction
Ciprofloxacin ear drops 5 drops BD -> add amoxicillin 50-90mg/kg/day for 3/7 after ear dry- review weekly until discharge resolve - then 4 weeks after resolution of sx

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21
Q

OME

A

<3/12
- normal hearing - observe
- speech delay/learning issues/TM retraction/cholesteatoma - ENT
>3/12; audiometry and ENT
Consider prolonged Abx if prolonged hearing impairment

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22
Q

Causes of tinnitus

A

Cerumen
OE
Otosclerosis
OM
Cholesteatoma
Vestibular schwannoma
Meniere’s
Neuritis
Ototoxic meds (frusemide, aspirin, aminoglycosides)
Vascular anomalies
Nasopharyngeal carcinoma

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23
Q

Tinnitus history

A

Pulsatile vs nonpulsatile
Unilateral; e.g. schwannoma
Otalgia/otorrhoea/vertigo - indicates secondary cause
Sudden onset SNHL - require prompt steroids and ENT
Noise exposure
Medication
Bothersome vs nonbothersome
Assoc anxiety/depression

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24
Q

Tinnitus examination

A

Weber
Rinne
Carotid/periauricular auscultation - if pulsatile

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25
Q

Tinnitus mx

A

Hearing aids for SNHL - can amplify and mask tinnitus
Sound therapy via audiologist - device to emit sounds that pt focuses on
CBT

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26
Q

Tinnitus Ix

A

Audiology
Head/neck imaging if; unilateral, pulsatile (CT angiography), asymmetric hearing loss >10db (MRI cerebellopontine angle and internal acoustic meatus for schwannoma), focal neuro deficit, otosclerosis (CT temporal bone)

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27
Q

External auditory exostosis

A

Blocked feeling, recurrent OE, otalgia, conductive hearing loss
Mx; ear plugs, surgical removal for severe/sx or Grade 3/recurrent infection/hearing loss

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28
Q

Voice hoarseness causes

A

Thyroid disease - deep
Reflux - raspy
Functional - intermittent
Vocal cord mass - gravelly
Soft; VC paralysis/Parkinson’s
Fatigueable; mysaesthenia, Parkinsons

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29
Q

Red flags of voice hoarseness

A

Smoking hx
Otalgia
Dysphagia/odynophagia
Stridor
Haemoptysis
Fevers/weight loss
Neck mass
REFER TO ENT

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30
Q

TMJ dysfunction

A

Causes; bruxism, stress, OA/RA/ankylosing spondylitis
Sx; TMJ pain, small mouth opening, crepitus, headache, otalgia/tinnitus/vertigo/fullness, crepitus when palpating ear canal whilst opening mouth, auscultation of TMJ whilst opening (crepitus = articular disc displacement)
Ix; orthopantomogram (OPG)
Tx; jaw rest (soft foods), avoid chewing, warm compress/massage, CBT, sleep hygiene, stress reduction, NSAID, intra-articular celestone injection, botox, jaw physio

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31
Q

Neck mass hx

A

Red flags; >2 weeks, voice change, dysphagia, odynophagia, ipsilateral otalgia, nasal obstruction, weight loss

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32
Q

Risk factors for head/neck Ca

A

smoker
alcohol
>40yo
hx malignancy
hx of cutaneous lesions

33
Q

Neck mass exam

A

Size >1.5cm more likely malignant
FIxed masses more likely malignant
Firmness
skin ulceration
Otoscopy; effusion may indicate nasopharyngeal carcinoma
Rhinosocopy
Oral cavity exam
Flexible nasopharyngolaryngoscopy

34
Q

Neck mass Ix

A

1st line; CT with contrast + FNA

35
Q

Acute cervical lymphadenitis

A

Staph, group A strep, site of entry (mouth, scalp)
Tx
- Most cases self limiting
- IF bacterial signs (unilateral tender fluctuant) - cefalexin 12.5mg/kg QID 7/7

36
Q

Epistaxis mx

A

Pinch nostrils - lean forward
Pressure 10-20min
Merocel (nasal tampon) for anterior packing
Rapid rhino; anterior/posterior packing
if posterior epistaxis - consider foley catheter
All pt with packing -> PO amoxicillin to prevent toxic shock - leave for 3-5 days
Septal haematoma - urgent ED referral for IVAbx and drainage

37
Q

Uncomplicated nasal fracture mx

A

Closed reduction under LA 10-14/7 post injury
Paediatric; 3-5 days post injury

38
Q

Allergic rhinitis classification

A

Frequency
- Intermittent sx <4 days/week or <4 consec weeks
- Persistent; sx >4 days/week ADN >4 consec weeks
Severity
- Mild; sx present but not troublesome, nil impairment
- Mod-severe; troublesome sx, sleep disturbance, impaired ADL/school/work

39
Q

Causes of allergic rhinitis

A

Non-allergic rhinitis
Sinusitis
Recurrent URTRI
Nasal septal deviation
Nasal polyps
Foreign bodies
Rhinitis medicamentosa
Occupational; animal, woods, industrial, food processing

40
Q

Allergic rhinitis Ix

A

Nasal polyps in children - test for CF
Nasal polyps adults - test asthma/aspirin sensitivity
If sx not responding after 1/12 - assess for IgE triggers via RAST

41
Q

Allergic rhinitis tx options

A

Avoidance of triggers
Intranasal steroids 4/52 minimum (1st line if mild)
- fluticasone 55mcg daily 4/52 -> 27.5mcg
Intranasal antihistamine
- Azelastine 1mg/ml 1 spray BD OR levocabastine 0.5mg/ml 2 sprays BD
Combination steroid/antihistamine
- Azelastine + fluticasone propionate 125+50mcg 1 spray BD (dymista)
Oral anthistamine; loratadine 10mg daily
Montelukast; use with antihistamine + intranasal steroid
- 10mg daily
Intranasal ipratropium; marked rhinorrhoea - use with steroid/antihistamine
- Ipratropium 44mcg 2 sprays TDS
Immunologist for sublingual immunotherapy
ENT for inferior turbinate reduction

42
Q

Allergic rhinitis tx persistent mod-severe

A

Intranasal steroids
PLUS oral/intranasal antihistamine
AND/OR montelukast
If rhinorrhoea present - add intranasal ipratropium

43
Q

Causes of chronic rhinitis

A

OCP
Sildenafil
Aspirin/NSAID
Antidepressants
Benzos
Rhinitis medicamentosa

44
Q

Symptomatic therapy for sore throat

A

Panadol
NSAID
Lozenges
Severe sx; prednisolone 60mg 1-2/7

45
Q

Indications for Abx for tonsillitis/strep pharyngitis

A

2-25yo ATSI rural/remote, Maori, Pacific Islander
Pt with existing RHD
Pt with Scarlet Fever
Severe sx of pharyngitis

46
Q

Tx tonsillitis

A

Phenoxymethylpenicillin 500mg BD (child 15mg/kg) 10/7
OR IM benzathine benzylpenicillin stat 1.2million UNIT

47
Q

Complications of GAS tonsillitis/pharyngitis

A

ARF
Poststrep reactive arthritis
Scarlet fever
Acute glomerulonephritis
Cellulitis/abscess
Sepsis
Meningitis

48
Q

Peritonsillar abscess (quinsy)

A

Prednisolone 1mg/kg stat dose
Hydration
Analgesia
Surgical drainage
IV benzylpenicillin 1.2g (child 50mg/kg) IV QID for 2/7 post surgical drainage then switch PO phenoxymethylpenicillin to complete 10/7 total ABx

49
Q

Oral manifestation of IBD

A

Lip swelling
Cobblestoning of buccal mucosa
Mucogingivitis
Aphthous-like ulcers
Angular cheilitis

Tx; immunosuppressants, topical steroids, avoid NSAIDs

50
Q

Causes of oral burning

A

Medication
Trauma
Autoimmune; Sjogren’s, lichen planus
Neoplastic; CNS pathology
Burning mouth syndrome
Candidiasis
B12/folic acid/iron deficiency
Diabetes/hypothyroidism

51
Q

Causes of salivary gland swelling

A

Lymphoma
Mumps
EBV
Cocksackie infection
Staph - acute suppurative sialdenitis
Alcohol
Bulimia
Diabetes
Sialolith
Sjogren’s syndrome

52
Q

Ix of salivary gland swelling

A

If suspect inflammatory cause -> USS then consider sialography or MR sialography
If suspect solid mass/neoplasm -> MRI/CT then FNAC

53
Q

Causes of salivary gland hypofunction

A

Drugs; anticholinergic, antihistamine, antiHTN
Sjogren’s, sarcoidosis, amyloidosis
T2DM
HIV/Hep C
Anxiety
Dehydration
Age
Mouth breathing

54
Q

Mx dry mouth

A

Brush/floss, avoid sugar/acidic food
Salivary substitution; rinse (biotene)
Salivary flow stimulation; sugar free gum, pilocarpine

55
Q

Mx sialolithiasis

A

Hydration
Moist heat to area
Massage gland
Milk the duct
Suck on lollies to promote salivary flow
Secondary infection; dicloxacillin 500mg QID
ENT referral if failed conservative mx

56
Q

Mx aphthous ulcer

A

Hydrocortisone 1% TDS
Benzydamine 1% gel 2-3hrly for pain relief
If persisting >2 week - consider malignancy

57
Q

Atrophic glossitis causes

A

B12/folic acid/iron deficiency
Dry mouth
Sjogren syndrome
Oral candida
Coeliac disease

58
Q

Oral candidiasis mx

A

Amphotericin B 10mg lozenge sucked then swallow QID post meal 14-7 until 2-3 after sx resolve
Nystatin oral 100,000 u/mL 1ml topical then swallow QID post meals 14/7 and continue 2-3/7 after sx resolve
Miconazole 2% oral gel 2.5ml topical then swallow QID post meals 14/7 then for 7/7 after sx resolve
if HIV; fluconazole 50-100mg 7-14/7

59
Q

Mx angular cheilitis

A

Topical clotrimazole 1% cream BD 14/7 then continue 14/7 after sx
consider add on hydrocortisone 1% cream BD for inflammation

60
Q

Oral lichen planus clinical features

A

Reticular; interlacing white lines - Wickham’s striae pattern
Erosive; ulceration, atrophy, erythema - needs MAXFACS referral to rule out malignancy
DDx; Can be lichenoid reaction from drug; NSAID, antiHTN, oral hypoglycaemics

61
Q

Oral lichen planus mx

A

Betamethasone dipropionate 0.05% cream BD post meals
Immunosuppressants; cyclosporine, tacrolimus ointments
DMARDs; MTX
Abx; dapsone
Retinoids; isotretinoin

62
Q

Leukoplakia

A

White patch/plaque that cannot be characterised by any other disease
Potentially premalignant/malignant
DDx; carcinoma in situ (IEC), nicotine stomatitis, candidiasis, oral lichen planus, frictional keratosis, cheek biting, lupus
Risk; smoking, alcohol, betel quid chewing
Must have biopsy

63
Q

Oral hairy leukoplakia

A

EBV infection of tongue
Common in immunocompromised
Not malignant
Asymp white plaques on lateral tongue that don’t wipe off
Dx biopsy
Nil tx needed- may resolve

64
Q

Peripheral vertigo signs

A

Nystagmus; unidirectional, fast toward normal ear, horizontal with torsional component (never purely torsional or vertical)
Visual fixation suppressed
Unidirectional instability with walking
Deafness/tinnitus may be present
Positive Head impulse test

65
Q

Central vertigo signs

A

Nystagmus; sometimes reverse direction, any direction, if purely vertical or torsional this is central
Visual fixation not suppressed
Deafness/tinnitus absent usually
Neuro signs; diplopia, ataxia, dysathria, dysphagia, weakness

66
Q

Mx vertigo

A

Betahistine
Nausea; prochlorperazine 5-10mg QID 2/7
Vomiting; Prochlorperazine 12.5mg IM
Salt restriction
Avoid alcohol/coffee
Vestibular rehab with physio

67
Q

BPPV

A

Brief episodes vertigo, nausea, nystagmus (rotational)
Dx; Dix-Hallpike
Mx
- Epley
- Home Brandt-Daroff exercises
- Referral vestibular physio

68
Q

Labyrinthitis

A

Preceding viral infection
Vertigo, hearing loss (distinguishes from BPPV)
Nil tx required
if suppurative - refer ED for drainage of otitis media

69
Q

Meniere’s disease clinical features

A

Vertigo min-hrs- attacks in clusters
Nausea/vomiting
Fluctuating hearing loss - SNHL
Tinnitus - unilateral
Aural fullness; ipsilateral worse during or before attack
Drop attacks; elderly, late stages
Risk factors; fhx, autoimmune, recent viral illness

70
Q

Meniere’s disease Ix

A

MRI with gadolinium to exclude retrocochlear pathology (acoustic neuroma, demyelinating disease)

71
Q

Meniere’s disease Tx

A

Nil cure
betahistine
Low salt <2g dailiy
Diuretic; hydrochlorothiazide 25mg daily - once asymp 6/12 taper off
Audiologist for amplification
Intratympanic injection steroid/gentamicin
Surgical drainage of endolymph

72
Q

Vestibular neuronitis

A

Inflammation of vestibular nerve - preceding viral URTI, herpes zoster
Rapid onset severe vertigo, n/v, gait instability - NIL hearing issues
Tx
- bed rest
- antiemetics
- Prednisolone 1mg/kg 5/7 then taper over 15/7 for severe cases

73
Q

Acute rhinosinusitis sx

A

<4/52 duration
Nasal blockage/congestion/discharge
Facial pain/pressure
Reduction/loss of smell
Acute bacterial; THREE of
- purulent discharge
- severe pain
- T>38
- Raised CRP/ESR
- Double sickening
Orbital involvement; ophthalmoplegia, diplopia, reduced VA

74
Q

Acute rhinosinusitis tx

A

first 3-4/7 illness- tx as viral
Consider tx for bacterial if sx >7-10/7 without improvement or if double sickening
Intranasal saline
Intranasal decongestants <5 days duration
Intranasal ipratropium if rhinorrhoea prominent
Intranasal steroids
Acute bacterial
- conservative for 5/7
- Abx; amoxicillin 500mg TDS 5/7 OR if allergic doxycycline 100mg BD 5/7
-> if nil improvement > augmentin BD 5/7

75
Q

Red flag clinical features of acute rhinosinusitis

A

Bleeding
Meningitis
Altered neurology
Orbital involvement; diplopia, reduced VA, painful ophthalmoplegia, peri-orbital oedema

76
Q

Complications of acute rhinosinusitis

A

Pre-septal cellulitis
Orbital cellulitis
Orbital abscess
Cavernous sinus thrombosis
Meningitis
Intracranial abscess

77
Q

Chronic rhinosinusitis sx

A

> 12/52
Samter’s triad; NSAID sensitivity, asthma, polyps
if child <12yo - refer to paed ENT

78
Q

Chronic rhinosinusitis tx

A

Allergy avoidance
Mild; oral/intranasal antihistamine
Mod-severe; oral/intranasal antihistamine PLUS steroid
If nasal polyps - burst prednisolone 25mg 5-10/7 prior to specialist review
Refer specialist if polyps or not responding after 1/12
FESS procedure by ENT

79
Q

Tympanostomy tube otorrhoea ATSI mx

A

Dry mopping
Cipro 5 drops BD 7/7
Review weekly for 4/52

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