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Module 3 > Ears, Nose & Throat (ENT) > Flashcards

Ears, Nose & Throat (ENT) Flashcards

1
Q

A patient presents with unilateral hearing loss. The PA performs the Weber’s test and the patient hears the buzzing noise coming from their normal, unaffected ear. What type of hearing loss is this?

A

Sensorineural

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2
Q

A patient presents with unilateral hearing loss. The PA performs the Weber’s test and the patient hears the buzzing noise coming from their affected ear. What type of hearing loss is this?

A

Conductive

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3
Q

A patient presents with unilateral hearing loss. The PA performs the Rinne’s test and the patient hears the noise loudest when the tuning fork is held away from the ear (in the air). What type of hearing loss is this?

A

Sensorineural

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4
Q

A patient presents with unilateral hearing loss. The PA performs the Rinne’s test and the patient hears the noise loudest when the tuning fork is held on their mastoid bone of their affected ear. What type of hearing loss is this?

A

Conductive

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5
Q

What is the most common bacterium that causes acute otitis externa?

A

Pseudomonas aeruginosa

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6
Q

Unremitting otalgia, exposed bone, facial nerve palsy and a fever are signs of

A

Malignant/necrotising otitis externa

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7
Q

What are the risk factors for otitis externa?

A

Dermatitis, swimmers, trauma to ear canal, hearing aids/plugs, diabetes, immunosuppression

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8
Q

An inflamed external auditory meatus is a sign of

A

Otitis externa

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9
Q

What chromosomal condition increases the likelihood of earwax/cerumen impaction?

A

Down’s Syndrome

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10
Q

Where does fluid build up in acute otitis media?

A

Behind the tympanic membrane/ear drum

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11
Q

Name 2 common bacteria that cause acute otitis media in children

A

H. influenzae and S. pneumoniae

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12
Q

Name 2 common viruses that cause acute otitis media in children

A

Rhinovirus and RSV

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13
Q

What is a rare (5%) complication of acute otitis media?

A

Tympanic membrane perforation

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14
Q

When can antibiotics be prescribed for a patient with acute otitis media?

A
  1. Patient is systemically unwell
  2. High risk of complications (i.e. eardrum perforation)
  3. Children < 2 years with bilateral infection
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15
Q

What is another term for chronic otitis media?

A

Glue ear/chronic otitis media with effusion

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16
Q

What is the most common cause of acquired hearing loss in children?

A

Chronic otitis media/glu ear

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17
Q

What is are the risk factors for chronic otitis media?

A

Smoking (passive - affects children) and recurrent ear/URTI infections

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18
Q

What is the chronic otitis media recovery rate?

A

90%

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19
Q

A child has recent PMH of acute otitis media presents to A&E with erythema and tenderness behind the ear, fever and hearing loss. What is the diagnosis?

A

Mastoiditis

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20
Q

What is the management for mastoiditis?

A

IV antibiotics, myringotomy/tympanostomy and mastoidectomy

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21
Q

A cholesteatoma is made up of what type of epithelium?

A

Keratinising squamous epithelium - goes on to erode bone through release of osteolytic enzymes and increased pressure.

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22
Q

A patient presents with painless, foul-smelling otorrhoea, progressive unilateral conductive hearing loss and a retracted tympanum. What is the diagnosis?

A

Cholesteatoma

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23
Q

What is the most common type of pathogen that causes labyrinthitis?

A

Virus

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24
Q

A patient presents with acute vertigo, dizziness and otorrhoea. What is the diagnosis?

A

Labyrinthitis

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25
Q

Meniere’s disease is caused by an excess of what type of fluid in the Reisner’s membrane?

A

Endolymph - potassium rich fluid

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26
Q

A patient complains of random attacks of vertigo, tinnitus and sudden loss of balance over the last 3 months. What is the diagnosis?

A

Meniere’s Disease

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27
Q

What type of pathogen commonly caused sinusitis?

A

Virus

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28
Q

A patient complains of a 7-day history of headache, facial pain and a fever that were worse at the start but have gradually began to ease. What type of sinusitis is this?

A

Viral sinusitis as the symptoms peaked initially and have been resolving < 10 days

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29
Q

A patient complains of facial pain, headache, purulent nasal discharge and dental pain for over 10 days. What type of sinusitis is this?

A

Bacterial sinusitis as the symptoms > 10 days and the patient has purulent nasal discharge, nasal obstruction, dental pain and facial pain/headache.

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30
Q

Severe sinusitis in a systemically well patient is treated with what type of antibiotic?

A

Phenoxymethylpenicillin

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31
Q

Where do nosebleeds arise from in the anterior septum?

A

Little’s area at Kiesselbach plexus

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32
Q

Nasal polyps can be caused by

A

Cystic fibrosis, nasal cancer, asthma, chronic rhinosinusitis

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33
Q

Acute pharyngitis is commonly caused by what viruses?

A

EPV, adenovirus, enterovirus, influenza, parainfluenza

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34
Q

What seasons does viral pharyngitis occur in?

A

Summer and autumn

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35
Q

What seasons does bacterial pharyngitis occur in?

A

Winter and early spring

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36
Q

Cough, nasal congestion and rhinorrhoea are all signs of what type of pharyngitis?

A

Viral pharyngitis

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37
Q

A patient complains of a sore throat. They have no other cough, nasal congestion or rhinorrhoea. What type of pharnygitis is this?

A

Bacterial pharyngitis

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38
Q

What bacteria causes pharyngitis?

A

Group A beta haemolytic streptococcus bacteria

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39
Q

What is the most common causative agent of tonsillitis?

A

Rhinovirus

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40
Q

A patient complains of a feeling of malaise. Upon examination, the patient has tonsillar exudate and anterior cervical lymphadenopathy. Is this tonsillitis bacterial or viral?

A

Viral tonsillitis because the patient has no cough or rhinitis.

41
Q

What are the 4 points of Centor Criteria?

A
  1. Fever > 38 degrees
  2. Tonsillar exudate
  3. No cough
  4. Tender anterior cervical lymphadenopathy

Score = 3+ implies bacterial infection (40-60% chance)

42
Q

What bacteria causes bacterial tonsillitis?

A

Group A beta haemolytic streptococcus

43
Q

What inflammatory or autoimmune conditions can cause mouth ulcers?

A

Crohn’s, Coeliac’s, Behcet’s Syndrome

44
Q

What bacteria causes life-threatening laryngitis?

A

H. influenzae

45
Q

What is the most common pathogen that causes laryngitis?

A

Virus

46
Q

A patient presents with a hoarse voice, fever and a sore throat. They complain they had a recent chest infection. What is the diagnosis?

A

Laryngitis - often occurs after a UTRI and presents with a hoarse voice, sore throat and fever.

47
Q

A patient with a PMH of T2DM presents with white plaques adherent to the oral mucosa. When scraped, the cracks bleed slightly. What is the diagnosis?

A

Oral candidiasis

48
Q

What bacteria commonly caused epiglottis?

A

H. influenzae B

49
Q

A mother brings her 2 year old child to the GP surgery. She says her child’s voice is muffled and they’re finding it difficult to swallow food. On examination, they’re breathing with their arms forward (tripod breathing). What is the management?

A

Call 999, child must be intubated by anaesthetist and ENT doctor.

50
Q

A man presents to the GP surgery with fever, a hoarse voice and a sore throat that has been getting worse for over a week. What is the diagnosis?

A

Quinsy/peritonsillar abscess. The patient must be referred urgently/same day.

51
Q

What complications are associated with quinsy?

A

Necrotising fasciitis, pericarditis, pleural effusions.

52
Q

A 21 year old female presents to the GP complaining of anorexia, fatigue and a sore throat. She has noticed petechiae in her mouth. On examination, she has tender cervical lymphadenopathy and a non-pruritic erythematous macular rash. What is the diagnosis?

A

Infectious mononucleosis/glandular fever

53
Q

What is the management of infectious mononucleosis?

A

Avoid contact sports (splenic rupture risk), avoid alcohol, supportive care.

54
Q

What antibiotics should be avoided as they cause an itchy maculopapular rash in glandular fever?

A

Ampicillin and amoxicillin

55
Q

What are the common causes of parotitis?

A

Mumps (RNA paramyoxivirus), parotid duct stone

56
Q

A 50 year-old man presents with progressive unilateral sensorineural hearing loss and dizziness. He has a PMH of neurofibromatosis type II. What is the diagnosis?

A

Acoustic neuromas/vestibular schwannomas.

57
Q

What type of cancer is nasopharyngeal/oropharyngeal cancer?

A

Squamous cell carcinoma

58
Q

What is an ototoxic antibiotic?

A

Gentamicin

59
Q

2 common bacterial causes of otitis externa

A

Pseudomonas aeruginosa and Staph aureus

60
Q

What acid can break down earwax/cerumen?

A

Acetic acid

61
Q

5 RF for otitis media

A
  1. Children
  2. Recent URTI
  3. Smoking/passive smoking
  4. Eustachian tube dysfunction/deformities
  5. Allergies
62
Q

What can be offered to someone with bad AOM but not severe?

A

Prescription of back-up antibiotics

63
Q

Safety netting for someone with AOM (4 points)

A
  1. Take analgesia/drink lots of fluid/rest as AOM takes 3 days to pass
  2. If symptoms persist after 3 days or become worse or you feel systemically unwell - seek help
  3. Back-up prescription of antibiotics can then be taken
  4. If symptoms still persist 2-3 days after antibiotics, or worsen, seek help
64
Q

1st and 2nd line Abx for AOM

A

1st: Amoxicillin or clarithromycin
2nd: Co-amoxiclav

65
Q

Altered taste and facial weakness, alongside tinnitus is a sign of

A

Cholesteatoma

66
Q

5 RF for cholesteatoma

A
  1. Males
  2. Middle ear disease/previous history of AOM
  3. Ear surgery/trauma
  4. Congenital conditions
  5. Bisphosphonates
67
Q

What number is the facial nerve?

A

VII/7

68
Q

Most common cause of bacterial labyrinthitis

A

AOM

69
Q

Acute vertigo and tinnitus can be a sign of

A

Labyrinthitis

70
Q

Spontaneous vertigo with no N&V may be a sign of

A

Meniere’s

71
Q

2 main causes of vertigo

A

Central or peripheral/inner ear

72
Q

What distinguishes BPPV from other conditions? (3 points)

A
  1. Vertigo attacks happen when head position changes
  2. No hearing problems
  3. No tinnitus
73
Q

Acute sinusitis time frame

A

< 12 weeks

74
Q

Most common cause of acute sinusitis and what number of cases are caused by this?

A

Virus - 98 in every 100 people

75
Q

3 criteria to admit someone to hospital with sinusitis

A
  1. Very systemically unwell
  2. Orbital complications
  3. Intracranial complications
76
Q

2 medications for sinusitis lasting more than 10 days

A

Nasal ICS and antibiotics

77
Q

1st line antibiotic for sinusitis

A

Phenoxymethylpenicillin

78
Q

What immune response is allergic rhinitis?

A

IgE mediated

79
Q

Allergic rhinitis is another word for

A

Hayfever

80
Q

When should someone go to hospital with a nosebleed?

A

After 10-15 minutes of leaning forwards/applying firm pressure/packing nose

81
Q

An acoustic neuroma affects what nerve?

A

Vestibulocochlear nerve

82
Q

What type of cancer is nasopharyngeal cancer and what ethnic background does it tend to affect?

A

Squamous and Chinese/North African

83
Q

Leukoplakia that is persistent could be a sign of

A

Oral cancer

84
Q

Adenovirus in pharyngitis causes

A

Pharyngoconjunctival fever

85
Q

A sore throat caused by enterovirus, and small lesions in the mouth and palms/soles of hands/feet is a sign of

A

Hand, foot and mouth disease

86
Q

Group A Strep pharyngitis can cause

A

Scarlet fever

87
Q

Acute tonsillitis affects the

A

Parenchyma of the palatine tonsils

88
Q

The Centor criteria is particularly assessing for what bacteria?

A

Group A beta haemolytic strep.

89
Q

Clarithromycin and erythromycin should be avoided in what 3 conditions/medications

A
  1. Prolonged QT interval drugs: Sotalol
  2. History of QT interval/Torsades de Pointes/v. fibrillation
  3. Hypokalaemia
90
Q

Red flag in a patient with a mouth ulcer

A

Solitary ulcer > 3 weeks = oral malignancy

91
Q

Most common cause of laryngitis

A

Rhinovirus

92
Q

Quinsy commonly occurs after

A

Strep. pharyngitis

93
Q

Trismus and neck pain could suggest

A

Quinsy

94
Q

What 3 should be avoided in suspected EBV?

A

Amoxicillin, contact sport, alcohol

95
Q

In adults > 40, what 2 features may suggest glandular fever?

A

Fever and jaundice

96
Q

Mumps is caused by what virus?

A

Paramyxovirus

97
Q

Parvovirus B19 causes

A

Slapped cheek syndrome

98
Q

Ig found in mumps

A

IgM

99
Q

2 symptoms of leukoplakia

A
  1. White oral lesion

2. Strongly adhered to oral mucosa

Module 3 (6 decks)

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