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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
Q

Central causes of vertigo

A

Vestibular migraine
Posterior stroke
Acoustic Neuroma
Multiple sclerosis

26
Q

Peripheral (vestibular) causes of vertigo

A

BPPV
Menieres
Vestibular neuronitis
Labyrinthitis

27
Q

Two most common causes of vertigo

A
  1. BPPV
  2. Vestibular migraine
28
Q

Distinguishing Labyrinthitis from vestibular neuronitis

A

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
Q

Clinical features of Quinsy (peritonsillar abscess)

A

Severe throat pain - lateralising to one side
Deviation of the uvula to the unaffected side
Trismus (difficulty opening mouth)
Reduced neck mobility

30
Q

Treatment of peritonsillar abscess

A

Needle aspiration or incision & drainage
+ IV Abx

Tonsillectomy should be considered to prevent reoccurrence

31
Q

Key features in Hx suggesting malignant otitis external

A

Diabetes/immunosuppression
Severe, unrelenting otalgia
Temporal headaches
Purulent otorrhea
+/- facial nerve dysfunction, dysphagia, hoarseness

32
Q

Management of acute sinusitis

A

Analgesia
If > 10 days - consider intranasal corticosteroids
Antibiotics are not normally given unless systemically very unwell

33
Q

Management of post-tonsilectomy bleeding

A

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
Q

Post-operative complications of tonsillectomy

A
  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
Q

Indications for tonsillectomy

A

≥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
Q

Consequence of starting amoxicillin in tonsillitis caused by EBV

A

maculopapular rash

37
Q

Causes of tonsilitis

A

VIRAL (50-80% of cases),
- adenovirus,
- rhinovirus,
- influenza,
- parainfluenza

BACTERIAL (strep throat)
- Strep. Pyogenes
- S. Aureus

38
Q

Management of tonsilitis

A

Analgesia (difflam spray + paracetamol)
Hydration

If bacterial cause suspected - prescribe AbX (phenoxymethylpenicillin or clarithromycin)

39
Q

Imaging for suspected deep neck space infection

A

CT neck scan with intravenous contrast

40
Q

Two main types of deep neck space infections

A

Parapharyngeal abscess
Retropharyngeal abscess

41
Q

Red flags for deep neck space infections

A
  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
Q

Red flags for deep neck space infections

A
  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
Q

What is the “danger space” with regard to deep neck space infections

A

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
Q

Clinical features of deep neck space infections

A

Severe sore throat
New onset dysphagia
Voice changes
Neck stiffness
stridor, trismus, pharyngeal swelling (these can often be discrete), and cervical lymphadenopathy.

44
Q

Management of deep neck space infections

A

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
Q

What causes “Saddle nose” deformity?

A

untreated irreversible septal necrosis
due to pressure-related ischaemia of the cartilage as a result of a septal haematoma

46
Q

Management of a perforated tympanic membrane

A

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
Q

What is ‘double sickening’ associated with bacterial sinusitis

A

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
Q

Treatment of chronic sinusitis

A

Intranasal corticosteroids

considered if the symptoms have been present for more than 10 days

FINALS (19 decks)

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