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CSIM 1: Microbiology Strand > CSIM 1.56: ENT Infections > Flashcards

CSIM 1.56: ENT Infections Flashcards

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1
Q

Problems with which structures cause issues with balance?

A
  • Eyes
    • Proprioception
    • Vestibular system
    • Cerebellum/brain
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2
Q

Why do you look behind the ear when doing an ear exam?

A

To look for a post-auricular incision scar, indicative of previous ear surgery

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3
Q

Which incisions are possible in ear surgery?

A
  • Post-auricular incision
    • Endaural incision

IMG 126

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4
Q

How do you hold an otoscope (OSCE)?

What do you do with the other hand?

A

Like a pen IMG 127

Pull the ear upwards, outwards and backwards

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5
Q

What conditions or abnormal features of the outer ear canal can be visible with otoscopic examination?

A
  • Otitis externa
    • Mastoid cavity (removed mastoid air cells causing a completely different appearance inside, NB: this is not pathological)
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6
Q

What condition or abnormal features of the tympanic membrane can be seen?

A

• Perforations (central or marginal)

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7
Q

What are the tuning fork tests?

Which frequency of tuning fork is used

A

Rinne’s test:
• Positive Rinne is good. This means that the sound is heard better in front of the ear than on the mastoid process

Weber’s test:
• Place fork in midline of head and see if the patient can hear it in the middle

512Hz

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8
Q

How do you activate a tuning fork?

A

Hit it onto a bony prominence (not a hard surface)

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9
Q

Describe interpretation of abnormal Weber’s tests

A

Normal/central
• Normal hearing
• OR: equal hearing loss on both sides

To one side:
• Conductive loss - tone is louder on the affected side because sensorineural hearing is more sensitive
• Sensorineural loss - tone louder on the contralateral side

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10
Q

How is otitis externa treated?

A
  • Reassurance
    • Microsuction
    • Analgesia
    • Ear drops
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11
Q

When do you refer someone with otitis externa?

A

When the canal is completely closed with discharge/debris/swelling

If malignant:
• Emergency referral for surgery
• Antibiotics

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12
Q

What is malignant/necrotic otitis externa?

A

An aggressive infection with extreme pain (not related to cancer) seen in immunocompromised patients which causes cranial nerve palsies

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13
Q

What are the types of otitis media?

A
  • Acute otitis media
    • Acute suppurative otitis media
    • Chronic suppurative otitis media
    • Otitis media with effusion
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14
Q

Describe acute/chronic suppurative otitis media.

A

Drainage of the middle ear is compromised due to some kind of blockage in the eustachian tube. This causes a negative middle ear pressure, causing effusion of fluid into middle ear

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15
Q

What is otitis media with effusion more commonly referred to as?

A

Glue ear

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16
Q

What is the treatment for acute otitis media?

A
  • Analgesia of paracetamol + NSAID

* NOT antibiotics, as AOM is usually viral

17
Q

What is the treatment for acute suppurative otitis media?

A
  • Analgesics

* Antibiotics - as in this case, ASOM usually is bacterial

18
Q

What are the potential complications of acute suppurative otitis media?

A

Intracranial
• Meningitis
• Intracranial abscess
• Sinus thromboses

Extracranial
  •  Mastoiditis (mastoid air cells, expands, erodes the bone)
  •  Facial nerve palsy
  •  Labyrinthitis 
  •  Sensorineural hearing loss
19
Q

Describe the features of mastoiditis

How is this dealt with?

A
  • Protruding ear due to red swelling behind ear (IMG 128)
    • Fever
    • Associated with Acute suppurative otitis media and deafness

Immediately referred to ENT (life-threatening)

20
Q

Is glue ear an emergency? Is it infective? Does it need antibiotics

A

No, no and no.

21
Q

What is cholesteatoma

A

Congenital trapped keratinising squamous epithelium which is found in the MIDDLE EAR:
• Usually skin migrates from the umbo outwards as it grows, creating a ‘conveyer belt’ which carries out dead cells
• This doesnt happen, so they accumulate

22
Q

How is glue ear treated?

A
  • Hearing aids

* Ventilation tubes (grommets)

23
Q

What is chronic suppurative otitis media? What is seen on examination

A

Condition which follows ASOM which is slow-to-heal
• Perforated eardrum
• Discharge in ear

24
Q

Describe the clinical features of rhinosinusitis

A
  • Nasal discharge
    • Tender over cheeks
    • No nasal airflow
25
Q

How is acute sinusitis treated?

A
  • Decongestants
    • Analgesia
    • Sometimes antibiotics
26
Q

What is a potential complication of severe ethmoidal sinusitis?

A 
Orbital cellulitis/abscess:
  •  Upper eyelid red and swollen
  •  Eye closed
  •  Sclera red
  •  Colour vision affected
27
Q

How is orbital cellulitis/abscess treated?

A
  • Urgent ENT referral
    • IV antibiotics
    • Nasal decongestants
28
Q

What is a serious complication that can result from frontal sinusitis?

A

Pott’s puffy tumour (not cancerous):
• Tender, puffy/doughy swelling over frontal bone
• Due to sub-periosteal abscess

29
Q

What are nasal polyps and how are they treated?

A

Prolapsed lining of sinuses into the nasal cavity often due to over-inflammation, treated with nasal steroids to reduce swelling

30
Q

What is septal haematoma and why is it important to treat quickly

A

Blood-filled swelling of mucosa (IMG 129) which strips the cartilage in the middle of its blood supply

31
Q

What is seen upon examination of someone with tonsillitis?

A
  • Pyrexia
    • Enlarged, inflamed tonsils
    • White surface exudate
    • Palpable neck lymph nodes
32
Q

How is tonsillitis treated?

A
  • Oral penicillin if not viral or if persistent

* Analgesia

33
Q

What is the possible complication of tonsillitis

A

Peritonsillar abscess:
• All signs of tonsillitis present but patient is unable to open mouth or swallow saliva
• There is a space above the tonsil where exudate collects and forms an abscess

34
Q

What causes inability to open mouth in peritonsillar abscess?

A

Trismus:

• Spasm of pterygoid muscles

35
Q

What happens if peritonsillar abscesses resulting from tonsillitis are untreated?

A

Pus tracks to the neck spaces, causing parapharyngeal abscess and therefore difficulty breathing

36
Q

Describe glandular fever

A

Epstein-Barr virus caused fever which causes membranous exudate, lethargy and bilateral neck lymph nodes swelling

CSIM 1: Microbiology Strand (18 decks)

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