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Phase 4 Medicine > Ear, Nose and Throat > Flashcards

Ear, Nose and Throat Flashcards

1
Q

Define otitis media

A

Describes infection of the middle ear (Space between tympanic membrane and inner ear)

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2
Q

What often precedes otitis media?

A

Viral Upper Respiratory tract infections

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3
Q

What is the most common bacterial cause of otitis media? Give 2 other causes

A

Streptococcus pneumoniae (most common)

Other;
Haemophilus influenzae
Moraxella catarrhalis

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4
Q

Give 4 clinical features of otitis media

A

Otalgia (ear pain) (children may tug/rub ear)

Fever (50% of cases)

Hearing loss

Symptoms of upper airway infection (cough, coryza, sore throat)

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5
Q

Give 1 complication of otitis media

A

Tympanic membrane perforation (discharge from ear)

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6
Q

What investigation is used to diagnose otitis media? Give 3 possible findings

A

Otoscopy

Possible findings;

Bulging red tympanic membrane > Loss of light reflex

Opacification or erythema of tympanic membrane

Perforation with purulent otorrhoea

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7
Q

Give 3 features required for diagnosis of otitis media

A

Acute onset of symptoms (ear pain)

Presence of middle ear effusion (bulging, otorrhoea)

Inflammation of tympanic membrane (erythema)

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8
Q

When should antibiotics be prescribed in a case of otitis media?

A

If;

Symptoms last >4 days and are not improving

Systemically unwell (but not requiring admission)

Immunocompromise or high risk for complications

Younger than 2 with bilateral otitis media

Otitis media with perforation and/or discharge in canal

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9
Q

What antibiotic is given to treat otitis media? (plus penicillin allergy)

A

Amoxicillin (for 5-7 days)

Erythromycin/clarythromycin (if pen allergy or pregnant)

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10
Q

Give 4 possible complications of otitis media

A

Mastoiditis

Meningitis

Brain abscess

Facial nerve paralysis

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11
Q
A
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12
Q

Give 4 causes of otitis externa

A

Swimming (aka swimmers ear)

Infection - Staph aureus, pseudomonas aeuroginosa)

Seborrheic dermatitis

Contact dermatitis

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13
Q

Give 2 common bacterial causes of otitis externa

A

Staphylococcus aureus

Pseudomonas aeruginosa

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14
Q

Give 4 clinical features of otitis externa

A

Ear pain

Discharge

Itchiness

Conductive hearing loss (if ear becomes blocked)

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15
Q

Give 4 examination findings (otoscopy) for otitis externa

A

Erythema and swelling in the ear canal

Tenderness in ear canal

Pus or discharge in ear canal

Lymphadenopathy around neck/ear

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16
Q

Give 2 investigations useful to conduct in a patient with otitis externa

A

Otoscopy (direct examination)

Ear swab (identify causative organism)

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17
Q

How is mild otitis media treated?

A

Acetic acid 2% (EarCalm)

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18
Q

How is moderate otitis media managed?

A

Topical antibiotic + Steroid (Otomize spray)

Spray includes; Neomycin + Dexamethasone + Acetic acid

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19
Q

What is it essential to exclude before prescribing aminoglycosides (gentamycin and neomycin) when treating otitis externa? and why?

A

Exclude perforated tympanic membrane.

As aminoglycosides are ototoxic

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20
Q

How is otitis externa managed in patients with severe or systemic symptoms?

A

Oral flucloxacillin or clarithromycin

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21
Q

Define malignant otitis externa

A

A severe and life-threatening form of otitis media.

Infection spreads to bones of ear canal and skull, progressing to osteomyelitis of the temporal bone.

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22
Q

Give 3 risk factors for malignant otitis externa

A

Diabetes

Immunosuppressant medications (chemo)

HIV

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23
Q

What key feature indicates malignant otitis externa?

A

Granulation tissue at junction between bone and cartilage in the ear canal

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24
Q

How is malignant otitis externa managed? (3)

A

Admission under ENT team

IV antibiotics

CT/MRI head to assess extent of infection

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25
Q

Define vertigo

A

A false sensation that the body or environment is moving

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26
Q

Give 5 possible causes of vertigo

A

Viral labyrinthitis

Vestibular neuronitis

Benign paroxysmal positional vertigo

Meniere’s disease

Acoustic neuroma

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27
Q

How is benign paroxysmal positional vertigo characterised?

A

Sudden onset of dizziness and vertigo triggered by changes in head position.

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28
Q

What is the average age of onset for BPPV?

A

55

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29
Q

Give 2 presenting features of BPPV

A

Vertigo triggered by change in head position (turning over in bed)

Episodes lasting 10-20 seconds

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30
Q

Describe the pathophysiology of BPPV

A

Caused by calcium carbonate crystals being displaced into the semi-circular canals (most commonly the posterior semi-circular canal)

Crystals disrupt the normal flow of endolymph through these canals, causing vertigo.

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31
Q

What test is used to diagnose BPPV?

A

Dix-Hallpike manoeuvre

Involves moving pt’s head to trigger vertigo.

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32
Q

What can be used to treat BPPV?

A

Epley manoeuvre

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33
Q

What is vestibular neuronitis?

A

Describes inflammation of the vestibular nerve, usually due to viral infection

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34
Q

Name the 3 parts of the inner ear

A

Semi circular canals

Vestibule (middle section)

Cochlea

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35
Q

Give 4 clinical features of vestibular neuronitis

A

Recent history of viral upper resp infection

Recurrent vertigo attacks lasting hours/days

Nausea and vomiting

Horizontal nystagmus

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36
Q

What can be used to distinguish vestibular neuronitis from a posterior circulation stroke?

A

HiNTs exam

(Head Impulse, Nystagmus, Test of Skew exam)

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37
Q

How is vestibular neuronitis managed? (3)

A

Oral Prochlorperazine or Antihistamine (cyclazine or promethazine) (for mild cases)

Buccal or IM prochlorperazine (for rapid relief in severe cases)

Vestibular rehabilitation exercises (for chronic symptoms - sx dont improve after 1 week or resolve after 6 weeks)

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38
Q

Describe Meniere’s disease

A

Describes a disorder of the inner ear, characterised by excessive pressure and progressive dilation of the endolymphatic system (endolymphatic hydrops).

Causes recurrent attacks of vertigo, hearing loss, tinnitus and a feeling of fullness in the ear

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39
Q

What triad of symptoms is seen in Meniere’s disease?

A

Hearing loss (sensorineural)

Vertigo

Tinnitus

(Unilateral episodes)

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40
Q

What is the typical age of onset for Meniere’s disease?

A

40-50 years old

41
Q

What type of hearing loss is seen in Meniere’s disease?

A

Sensorineural hearing loss (unilateral)

42
Q

Give 4 clinical features of Meniere’s disease (inc triad)

A

Triad; Hearing loss, Vertigo, Tinnitus

Aural fullness

Nystagmus + Positive Romberg test

Episodes last minutes to hours

43
Q

Give 3 history features of meniere’s disease

A

Symptoms resolve after 5-10 years

Majority of patients are left with a degree of hearing loss

Psychological distress is common

44
Q

How is Meniere’s disease managed? (4)

A

ENT assessment required to confirm diagnosis

Patient should inform DVLA and cease driving until symptoms are controlled.

Acute attacks - Buccal/IM prochlorperazine

Prevention - Betahistine or vestibular rehabilitation exercises

45
Q

Describe acoustic neuroma

A

Benign tumour of the Schwann cells surrounding the auditory nerve (vestibulocochlear) that innervates the inner ear

46
Q

What nervous system are schwann cells found in? What is their function?

A

Peripheral Nervous System

Function; provide the myelin sheath around neurones

47
Q

Where do acoustic neuroma’s commonly occur?

A

Cerebellopontine angle

48
Q

Acoustic neuromas are usually unilateral. Bilateral acoustic neuromas indicate what?

A

Neurofibromatosis type II

49
Q

Give 4 clinical features of acoustic neuroma

A

Unilateral sensorineural hearing loss

Unilateral tinnitus

Absent corneal reflex (CN V)

Dizziness or imbalance

50
Q

If an acoustic neuroma is affecting CN VIII (vestibulocochlear), what symptoms will the patient likely have? (3)

A

Vertigo

Unilateral Sensorineural Hearing Loss

Unilateral Tinnitus

51
Q

If an acoustic neuroma is affecting CN V (Trigeminal), what symptoms will the patient likely have?

A

Absent corneal reflex

52
Q

If an acoustic neuroma is affecting CN VII (Facial), what symptoms will the patient likely have?

A

Facial palsy

53
Q

What is the investigation(s) of choice used to diagnose acoustic neuroma? (2)

A

MRI of cerebellopontine angle

Audiometry (to assess hearing loss)

54
Q

Describe Presbycusis

A

Age related hearing loss.

Describes a type of sensorineural hearing loss. Tends to affect high-pitched sounds first.

Hearing loss occurs gradually and symmetrically

55
Q

Give 4 risk factors for Presbycusis

A

Increasing age

Family history

Loud noise exposure

Smoking

56
Q

Define Quinsy

A

Peritonsillar abscess that develops as a complication of bacterial tonsillitis

57
Q

Give 4 features of a Quinsy

A

Severe throat pain, which lateralises to one side

Deviation of uvula to the unaffected side

Trismus (difficulty opening mouth)

Reduced neck mobility

58
Q

What bacteria most commonly causes Quinsy?

A

Streptococcus pyogenes (group A strep)

59
Q

Why does Quinsy cause trismus? (Pain on opening mouth)

A

Due to inflammation of the pterygoid muscles

60
Q

How is Quinsy managed? (3)

A

Urgent review by ENT specialist

Needle aspiration/incision and drainage

IV antibiotics (co-amoxiclav)

61
Q

What lymph node is commonly affected in quinsy

A

Jugulodigastric lymoh nodes

62
Q

What is considered to prevent recurrence of Quinsy?

A

Tonsillectomy

63
Q

How many episodes of acute sore throat qualify a patient for tonsillectomy? (3)

A

7 or more in 1 year

5 per year for 2 years

3 per year for 3 years

64
Q

Give 2 other indications for tonsillectomy (other than number of acute episodes)

A

Recurrent tonsillar abscesses (2 episodes)

Enlarged tonsils causing difficulty breathing, swallowing or snoring

65
Q

Give 4 complications of tonsillectomy

A

Sore throat (where tonsillar tissue is removed, can last 2 weeks)

Damage to teeth

Post-tonsillectomy bleeding

Infection

66
Q

Define labyrinthitis

A

Describes inflammation of the bony labyrinth of the inner ear, including the semi-circular canals, vestibule (middle section) and cochlear.

Inflammation is usually due to a viral upper resp infection.

67
Q

Give 3 clinical features of Labyrinthitis

A

Acute onset vertigo

Hearing loss

Tinnitus

68
Q

Give 1 feature seen in both labyrinthitis and vestibular neuronitis

A

Acute onset vertigo

69
Q

Give 2 features seen in labyrinthitis but not in vestibular neuronitis

A

Hearing loss

Vertigo

70
Q

Give 4 complications of tonsillitis

A

Otitis media

Quinsy (peritonsillar abscess)

Scarlet fever

Post streptococcal glomerulonephritis

71
Q

What is the most common cause of tonsillitis?

A

Viral infection

72
Q

What is the most common bacterial cause of tonsillitis?

A

Group A Streptococcus Pyogenes

73
Q

Which tonsils are typically affected in tonsillitis?

A

Palatine tonsils

74
Q

What is it important to examine in children presenting with tonsillitis? (2)

A

Ears - Otoscopy (tympanic membranes)

Cervical lymphadenopathy

75
Q

Describe the Fever PAIN score for used to estimate whether tonsillitis is due to a bacterial cause

A

Fever - During last 24 hours

P - Pus on tonsils
A - Attended within 3 days of onset of symptoms
I - Inflamed tonsils
N - No cough/coryza

76
Q

What Fever PAIN score warrants prescription with antibiotics?

A

Score >=4

77
Q

What are the 1st and 2nd line antibiotics for bacterial tonsillitis?

A

1st - Penicillin V for 10 days (may be syrup in child)

2nd - Clarithromycin (if pen allergy)

78
Q

What causes Ramsay Hunt Syndrome? How does it present?

A

Varicella Zoster Virus.

Presents as unilateral Lower Motor Neurone facial nerve palsy with a painful/tender vesicular rash in the ear canal, pinna and round the ear.

79
Q

How is Ramsay Hunt Syndrome managed?

A

Acyclovir + Prednisolone + Lubricating eye drops

80
Q

What is the most likely location of bleeding for a patient presenting with nosebleeds?

A

Little’s area (Kiesselbach’s plexus)

81
Q

Give 5 common causes of nosebleeds

A

Nose picking

Colds/Sinusitis

Vigorous nose-blowing

Coagulation disorders (thrombocytopenia/Von willebrand disease)

Anticoagulant medications (Aspirin, DOAC, warfarin)

82
Q

Name 3 medications that could increase the risk of nosebleeds

A

DOAC

Aspirin

Warfarin

83
Q

Describe the acute non-pharmacological/surgical management of nosebleeds (3)

A

Sit up and tilt head forwards (avoids blood flowing towards airway)

Squeeze the soft part of the nostrils together for 10-15 mins

Spit out any blood in the mouth, rather than swallowing

84
Q

If a nosebleed does not stop after 10-15 minutes, the nosebleed is severe, is bleeding from both nostrils or they are harmodynamically unstable, what are the treatment options? (2)

A

Hospital admission;

Nasal packing with nasal tampons or inflatable packs

Nasal cautery using silver nitrate sticks

85
Q

What is it useful to prescribe after treating an acute nosebleed? and why?

A

Naseptin nasal cream (Chlorhexidine and neomycin) 4x per day for 10 days.

Reduces crusting, inflammation and infection

86
Q

In whom is Naseptin nasal cream (chorohexidine and neomycin) contraindicated?

A

Patients with a peanut or soya allergy

87
Q

What causes infectious mononucleosis (glandular fever)?

A

Epstein-Barr virus

88
Q

What triad of symptoms is seen in infectious mononucleosis?

A

Sore throat

Lymphadenopathy (anterior and posterior triangles of neck)

Pyrexia

89
Q

Give 4 clinical features of infectious mononucleosis (inc triad as 1)

A

Triad; Sore throat, Lymphadenopathy, Pyrexia

Splenomegaly

Malaise, anorexia, headacke

Hepatitis

90
Q

Taking what can cause patients with infectious mononucleosis to present with a maculopapular, pruritic rash?

A

Taking amoxicillin/ampicillin

91
Q

What test is used to diagnose infectious mononucleosis?

A

Monospot test (Heterophil antibody test)

NICE - Suggest FBC and Monospot test in 2nd week of illness to confirm diagnosis

92
Q

Describe the management of infectious mononucleosis (3)

A

Rest during early stages, fluids and avoid alcohol

Simple analgesia for aches or pains

Avoid contact sports for 4 weeks after having glandular fever, to reduce risk of splenic rupture.

93
Q

Define obstructive sleep apnea

A

Describes episodes of apnoea during sleep caused by collapse of the pharyngeal airway.

94
Q

Give 4 risk factors of obstructive sleep apnoea

A

Male

Obesity

Alcohol

Smoking

95
Q

Give 5 clinical features of obstructive sleep apnoea

A

Episodes of apnoea during sleep (reported by their partner)

Snoring

Morning headache

Daytime sleepiness/waking unrefreshed from sleep

Concentration problems

96
Q

Severe cases of obstructive sleep apnoea can cause what? (2)

A

Hypertension

Heart failure

97
Q

What scale is used to assess symptoms of sleepiness associated with obstructive sleep apnoea?

A

Epworth Sleepiness Scale

98
Q

How is obstructive sleep apnoea managed? (4)

A

ENT referral/Specialist sleep clinic (sleep studies)

Lifestyle advice (stop alcohol/smoking, lose weight)

CPAP

Surgery - Uvulopalatopharyngoplasty (UPPP)

Phase 4 Medicine (15 decks)

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