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Med school finals > Ear, nose and throat > Flashcards

Ear, nose and throat Flashcards

1
Q

What is a normal result in pure tone audiometry?

A

All results above 20dB line

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2
Q

What is the difference between SNHL, conductive HL and mixed HL?

A

SNHL = both air and bone conduction are impaired (AC is better than BC)
Conductive HL: only air conduction is impaired
Mixed HL: air and bone condution both impaired, but BC is better than AC

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3
Q

How can middle ear function be evaluated?

A

Tympanometry - measures stiffness of ear drum

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4
Q

What is automated auditory brainstem response audiometry?

A

Auditory stimulus with measurement of elicited brain response by surface electrode

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5
Q

What are the components of the child hearing exams?

A

All babies get evoked otoacoustic emission testing
If not normal –>
Automated auditory brainstem response audiometry

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6
Q

What are the signs and symptoms of TMJ dysfunction?

A 
Otalgia (referred pain from auriculotemporal nerve) 
Facial pain 
TMJ joint clicking/popping 
Bruxism (teeth grinding) 
Stress
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7
Q

What condition does ‘swimmer’s ear’ refer to?

A

Acute diffuse otitits externa

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8
Q

How should necrotising otitis externa be managed?

A

Urgent ENT referral
CT head
IV ciprofloxacin

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9
Q

How should acute otitis externa be managed?

A

Topical abx +/- topical steroid –> oral flucloxacillin

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10
Q

What is the most common pathogen implicated in otitis media?

A

S. pneumoniae (as secondary to URTI)

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11
Q

How should acute otitis media without perforation be managed?

A

Delayed/no script unless:

  • symptoms >4 days and not improving
  • systemically unwell but not requiring admission
  • Immunocompromised
  • <2y with BL OM
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12
Q

How should acute otitis media with perforation be managed?

A

Oral amoxicillin 5 days

Review in 6w

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13
Q

What condition is known as ‘glue ear’?

A

Otitis media with effusion

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14
Q

How should glue ear be managed?

A

If no comorbidities: active observation for 6-12w, if no improvement –> ENT referral
If co-existent cleft palate/ Down’s –> refer to ENT

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15
Q

How long do grommets last?

A

Up to 12 months

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16
Q

What are the signs and symptoms of cholesteatoma?

A

Headache, pain
Foul smelling discharge from ear
Hearing loss

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17
Q

How should cholesteatoma be managed?

A

Refer for surgery

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18
Q

Recall 4 drugs that can cause tinnitus

A

Aspirin
Aminoglycosides
Loop diuretics
Ethanol

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19
Q

What is the most concerning cause of unilateral tinnitus?

A

Acoustic neuroma

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20
Q

Recall 3 vestibular causes of vertigo

A

Meniere’s
BPPV
Labyrinthitis

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21
Q

Recall 5 central causes of vertigo

A 
Vestibular schwannoma
MS
Stroke
Head injury 
Inner ear syphillis
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22
Q

What is Meniere’s?

A

Dilatation of endolymph spaces of membranous labyrinth

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23
Q

What are the symptoms of Meniere’s?

A 
Clustered attacks lasting <12 hours
Aural fullness
Progressive SNHL 
Vertigo + N&V + nystagmus 
Tinnitus
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24
Q

How is Meniere’s managed?

A

Medically:
Betahistine for vertigo
Cyclizine for emesis

Surgically:
Gentamicin installation via grommets

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25
What are the symptoms of viral labyrinthitis/vestibular neuronitis?
Severe vertigo, nystagmus and vomiting following an URTI
26
How can you differentiate between vestibular neuronitis and viral labyrinthitis clinically?
Hearing may be affected in viral labyrinthitis but isn't in vestibular neuronitis
27
How should viral labyrinthitis/ vestibular neuronitis be managed?
If severe: IV prochlorperazine | If less severe: PO cyclizine and prochlorperazine
28
What is BPPV?
Displacement of otoliths in semi-circular canals
29
What are the symptoms of BPPV?
Suden rotational vertigo for <30s provoked by head turning +/- nystagmus; chronic history
30
How can BPPV be investigated?
Dix-Hallpike manoevre --> up-beat torsional nystagmus
31
How can BPPV be managed?
Epley manoevre and betahistine
32
What is acoustic neuroma also known as?
Vestibular schwannoma
33
What are the symptoms of acoustic neuroma?
Slow-onset, unilateral SNHL, tinnitus +/- vertigo
34
How should possible acoustic neuroma be investigated?
Pure tone audiometry | MRI
35
What are the symptoms of otosclerosis?
Begins early adult life BL conductive deafness and tinnitus Hearing loss improves with noise but worsens with pregnancy, menstruation, menopause
36
How should otosclerosis be managed?
Hearing aid, stapes implant
37
What is the fancy name for age-related hearing loss?
Presbycusis
38
How should sudden SNHL be managed?
Refer to ENT in <24 hours, high dose PO prednisolone
39
How should allergic rhinosinusitis be managed?
- Avoid causative allergen - For mild symptoms: PRN oral antihistamine (eg cetirizine) and PRN intranasal antihistamine (eg azelastine) - For severe symptoms: Intranasal CS (eg beclomethasone) and nasal irrigation
40
What are the red flags in sinusitis that would prompt an urgent ENT referral?
Unilateral symptoms Persistent >3m despite treatment Epistaxis
41
What are the indications for admission to hospital with sinusitis?
``` Severe systemic infection Signs of dangerous complications of sinusitis eg: Periorbital/orbital cellulitis Meningitis Brain abscess ```
42
How should sinusitis be managed?
If symptoms <10 days --> advice and safetynetting If symptoms >10 days --> 14 day course of high-dose nasal corticosteroid Can give back-up prescription of abx
43
What are the symptoms of nasal polyps?
``` Watery anterior rhinorrhoea Sinusitis Snoring Headaches Nasal obstruction ```
44
What is Samter's triad?
Triad of nasal polyps, asthma and aspirin hypersensitivity Therefore if person has nasal polyps and asthma, advise to avoid NSAIDs and aspirin as could cause a life-threatening reaction
45
What would make nasal polyps seem concerning?
If it is single and unilateral - as this may be a sign of a rare but sinister pathology
46
How should nasal polyps be managed?
- Routine referral to ENT for exam - Medical: 4-6w course of topical steroids - Surgically: can be removed endoscopically
47
What is a septal haematoma?
Untreated nasal fracture --> septal necrosis and nasal collapse as cartillage blood supply comes from the mucosa --> boggy swelling with nasal obstruction
48
How should all nosebleeds be initially managed?
Sit up Lean forwards Mouth open Compress nasal cartilage for 15 mins
49
What are the 2 most common causes of tonsilitis?
EBV | GAS
50
Recall the score used to determine whether tonsilitis is likely bacterial/viral
``` CENTOR (only used if <3 days of pharyngitis) Cough absent Exudate Nodes (cervical anterior) Temp >38 at any point ```
51
How high a centor score do you need to give abx and do a rapid strep test in tonsilitis?
3 or 4
52
What are the symptoms of infectious mononucleosis?
``` Sore throat Fever Malaise LNopathy pharyngitis petechiae on soft palate splenomegaly ```
53
What antibiotic is used in bacterial tonsilitis?
Phenoxymethylpenicillin
54
How does diptheria classically appear?
Pseudomembranous 'web' at back of throat
55
When would you admit for tonsilitis?
- Difficulty breathing - Clinical dehydration - Peri-tonsillar abscess (quinsy) or cellulitis - Marked systemic illness or sepsis - Suspected rare cause (e.g. Kawasaki disease, diphtheria)
56
How frequent does tonsilitis have to be to indicate tonsillectomy?
7 bouts in 1 year 5 bouts/ year for 2 years 3 bouts/year for 3 years
57
What are the signs that GAS infection has progressed to scarlet fever?
Rash ('sandpaper') | Strawberry tongue
58
What is the risk of scarlet fever?
May progress to rheumatic fever with a week latency period
59
How should scarlet fever be managed?
Notify PHE | Phenoxymethylpenicillin
60
What is the main RF for tonsilar SCC?
HPV infection
61
What are the symptoms of Bell's palsy?
UL facial weakness Otalgia Ageusia (loss of taste) Hyperacusis (due to stapedius palsy)
62
What is Bell's sign?
Failure of eye closure --> dryness and conjunctivitis | Seen in Bell's palsy
63
How should Bell's palsy be investigated?
Serology, possible LP
64
How should Bell's palsy be managed?
Eye care | Prednisolone (50mg PO OD for 10 days)
65
What is the aetiology of RamsayHunt syndrome?
Reactivation of the varicella zoster virus in the genticulate ganglion of CNVII
66
What are the symptoms of Ramsay Hunt syndrome?
Otalgia Facial nerve palsy Vesicular rash around ear Vertigo + tinnitus
67
How should Ramsay Hunt syndrome be managed?
Valaciclovir PO Steroids PO If treated within 72 hours, 75% recover, otherwise only 1/3 fully recover
68
If a small parotid lump enlargens very quickly, what is the likely cause?
Stone that has blocked parotid duct
69
How long after a TM perforation should a referral to ENT be made if it hasn't healed?
6-8w
70
Recall some differentials for the cause of salivary gland swelling
``` Infective (TB/mumps) Neoplastic Calculi blockage Autoimmune (Sjogren's/IgG4) Sarcoidosis ```
71
How is a pharyngeal pouch managed?
Surgical repair with minimally-invasive stapling (Dohlman's procedure)
72
What are the symptoms of pharyngeal pouch?
Hallitosis | Food getting stuck
73
What are the FeverPAIN criteria?
Fever (during previous 24 hours) Purulence (pus on tonsils) Attend rapidly (within 3 days after onset of symptoms) severely Inflamed tonsils No cough or coryza

Med school finals (27 decks)

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