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FINALS > Ear, Nose, Throat > Flashcards

Ear, Nose, Throat Flashcards

1
Q

Complications of thyroid surgery

A

Recurrent laryngeal nerve damage
Bleeding —> confined space haematomas may rapidly lead to respiratory compromise / laryngeal oedema
Damage to parathyroid gland causing hypocalcemia

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2
Q

ECG changes associated with hypocalcemia

A

Isolated OTc elongation

N.B.
- Hypercalaemia: calaemia is hyper so runs fast and has a short QT interval
- Hypocalaemia: calaemia is hypo so runs slow and has a long QT interval

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3
Q

Life-threatening complication post-thyroid surgery

A

Postoperative stridor due to bleeding –> confined space haematoma –> airway compromise

Tx: Immediate removal of sutures and call for senior help - to relieve pressure and reduce compression on the trachea

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4
Q

Causes of Horizontal Nystagmus

A

Acute viral labrynthitis

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5
Q

Causes of vertical nystagmus

A
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6
Q

Clinical features of Viral Labyrinthitis

A

> VERTIGO
N&V
HEARING LOSS (sensorineural)
TINNITUS
Preceding or concurrent symptoms of URTI
unidirectional horizontal NYSTAGMUS towards the unaffected side
abnormal head impulse test: signifies an impaired vestibulo-ocular reflex

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7
Q

Management of sudden-onset sensorineural hearing loss

A

Urgent referral to ENT
High dose corticosteroids

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8
Q

Issues associated with Otitis media with effusion

A

Upper respiratory tract infections
Oversized adenoids
Narrow nasopharyngeal dimensions
Presence of bacterial biofilms on adenoids
Down Syndrome
Atopy
Primary ciliary dyskinesia / Kartagener syndrome

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9
Q

Common Ototoxic medications

A

Loop diuretics (e.g. furosemide)
Aminoglycoside Abx (e.g. gentamicin)
Chemo drugs

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10
Q

Cranial nerves that may be affected by acoustic neuroma

A

CN V (trigeminal, ophthalamic division) –> absent corneal reflex
CN VII (facial nerve) –> facial palsy
CN VIII (vestibulocochlear n.) –> hearing loss, vertigo, tinnitus

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11
Q

What is otosclerosis

A

Remodeling of small bones in the ear (–> spongy bone forms around the oval window)

Familial condition
Onset is usually at 20-40 years

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12
Q

What type of hearing loss does otosclerosis present with

A

Progessive, bilateral conductive hearing loss
+/- tinitus

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13
Q

Explain Webers test

A

tuning fork is placed in the middle of the forehead equidistant from the patient’s ears
the patient is then asked which side is loudest

in unilateral sensorineural deafness, sound is localised to the unaffected side

in unilateral conductive deafness, sound is localised to the affected side

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14
Q

Explain Rinne’s test

A

tuning fork is placed over the mastoid process until the sound is no longer heard, followed by repositioning just over external acoustic meatus

‘positive test’: air conduction (AC) is normally better than bone conduction (BC)

‘negative test’: if BC > AC then conductive deafness

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15
Q

What is a normal Rinne and webers

A

Air > bone bilaterally
Webers - midline localisation

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16
Q

Rinne and webers results for conductive hearing loss

A

Affected ear:
Bone > air
Webers lateralises to affected ear

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17
Q

Rinne and webers results for sensorineural hearing loss

A

Air > bone BILATERALLY
Webers lateralises to unaffected ear

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18
Q

Common ototoxic medications

A

Loop diuretics (e.g. furosomide)
Aminoglycoside Abx (e.g. gentamicin)
Chemo drugs
Quinine
Aspirin

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19
Q

Fever pain criteria

A

Scoring system used to predict likelihood of strop throat

Fever > 38
Purulence (pharyngeal/tonsillar exudate)
Acute (< 3 days)
Inflamed tonsils
No Cough No Coryza

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20
Q

Antibiotics for tonsilitis

A

Phenoxymethylpenicillin or clarithromycin
7-10 days

21
Q

Complications of mastoiditis

A

facial nerve palsy
hearing loss
meningitis

22
Q

Management of mastoiditis

A

Same day hospital admission
Broad spectrum IV antibiotics

23
Q

Diagnostic and treatment maneuvers for BPPV

A

Dix-hallpike manoeuvre = diagnostic
Epley manoeuvre = therapeutic

Brandt-Daroff manoeuvre
= done after epley at home by patients. As a form of vestibular rehabilitation to promote central compensation and resolution of BPPV symptoms.

24
Q

Duration of each episode of vertigo:
1. BPPV
2. Menieres
3. Vestibular migraine
4. Vestibular neuronitis

A
  1. BPPV - lasts 10-20 seconds, triggered by head movements
  2. Meniere’s - lasts minutes to hours
  3. Vestibular migraine - minutes to hours
  4. Vestibular neuronitis - lasts hours to days/1 week (not triggered by movement, but exacerbated by it)
25
Central causes of vertigo
Vestibular migraine Posterior stroke Acoustic Neuroma Multiple sclerosis
26
Peripheral (vestibular) causes of vertigo
BPPV Menieres Vestibular neuronitis Labyrinthitis
27
Two most common causes of vertigo
1. BPPV 2. Vestibular migraine
28
Distinguishing Labyrinthitis from vestibular neuronitis
Vestibular neuronitis - just the vestibular nerve is affected. Patient has vertigo and N&V but no auditory symptoms (tinnitus) or hearing loss. Labyrinthitis affects: semicircular canals, cochlea and vestibular nerve
29
Clinical features of Quinsy (peritonsillar abscess)
Severe throat pain - lateralising to one side Deviation of the uvula to the unaffected side Trismus (difficulty opening mouth) Reduced neck mobility
30
Treatment of peritonsillar abscess
Needle aspiration or incision & drainage + IV Abx Tonsillectomy should be considered to prevent reoccurrence
31
Key features in Hx suggesting malignant otitis external
Diabetes/immunosuppression Severe, unrelenting otalgia Temporal headaches Purulent otorrhea +/- facial nerve dysfunction, dysphagia, hoarseness
32
Management of acute sinusitis
Analgesia If > 10 days - consider intranasal corticosteroids Antibiotics are not normally given unless systemically very unwell
33
Management of post-tonsilectomy bleeding
All post-tonsillectomy haemorrhages should be assessed by ENT Primary (6-8 hours post-op) --> immediate return to surgery Secondary (5-10 days post-op) --> often associated with wound infection. Tx: admission, antibiotics and hydrogen peroxide mouth wash. Severe bleeding may require surgery.
34
Post-operative complications of tonsillectomy
1. Pain - may increase for up to 6 days 2. Primary / reactionary haemorrhage (6-8 hours) 3. Secondary haemorrhage (5-10 days) - often associated with wound infection
35
Indications for tonsillectomy
≥7 episodes in the preceding year or ≥5 episodes in each of preceding 2 years or ≥3 episodes in each of preceding 3 years Suspected malignancy Presence of sleep apnoea Two previous peritonsillar abscesses
36
Consequence of starting amoxicillin in tonsillitis caused by EBV
maculopapular rash
37
Causes of tonsilitis
VIRAL (50-80% of cases), - adenovirus, - rhinovirus, - influenza, - parainfluenza BACTERIAL (strep throat) - Strep. Pyogenes - S. Aureus
38
Management of tonsilitis
Analgesia (difflam spray + paracetamol) Hydration If bacterial cause suspected - prescribe AbX (phenoxymethylpenicillin or clarithromycin)
39
Imaging for suspected deep neck space infection
CT neck scan with intravenous contrast
40
Two main types of deep neck space infections
Parapharyngeal abscess Retropharyngeal abscess
41
Red flags for deep neck space infections
1. Sore throat with normal oropharyngeal examination 2. Severe neck pain or stiffness 3. Any signs of airway compromise, such as stridor, dyspnoea, drooling, dysphonia
41
Red flags for deep neck space infections
1. Sore throat with normal oropharyngeal examination 2. Severe neck pain or stiffness 3. Any signs of airway compromise, such as stridor, dyspnoea, drooling, dysphonia
42
What is the “danger space” with regard to deep neck space infections
immediately posterior to the retropharyngeal space and immediately anterior to the prevertebral space extends from the skull base to the posterior mediastinum and diaphragm potential path for spread of infections (e.g. retropharyngeal abscess) from the pharynx to the mediastinum
43
Clinical features of deep neck space infections
Severe sore throat New onset dysphagia Voice changes Neck stiffness stridor, trismus, pharyngeal swelling (these can often be discrete), and cervical lymphadenopathy.
44
Management of deep neck space infections
Broad spectrum Abx - with sufficient aerobic and anaerobic cover based on the polymicrobial nature of DNSIs. Fluid resusitation humidified oxygen with saline nebulisers Surgical drainage and washout
45
What causes "Saddle nose" deformity?
untreated irreversible septal necrosis due to pressure-related ischaemia of the cartilage as a result of a septal haematoma
46
Management of a perforated tympanic membrane
No treatment in majority of cases - will usually heal in 6-8 weeks Avoid water in ear If perf following otitis media - prescribe antibiotics Myringoplasty may be performed if TM doesn't heal
47
What is 'double sickening' associated with bacterial sinusitis
an initial period of recovery followed by a sudden worsening of symptoms. It is thought to be caused by a secondary bacterial infection following a viral rhinosinusitis
48
Treatment of chronic sinusitis
Intranasal corticosteroids considered if the symptoms have been present for more than 10 days

FINALS (19 decks)

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