ENT Flashcards
which disorder is associated with the following description:
- Hearing loss, vertigo, tinnitus
- Absent corneal reflex is important sign
- Associated with neurofibromatosis type 2
acoustic neuroma
which disorder is associated with the following characteristics:
- Elderly patient
- Dizziness on extension of neck
vertebrobasilar ischaemia
which disorder is associated with the following:
- associated with hearing loss, tinnitus and sensation of fullness or pressure in one or both ears
meniere’s disease
which disorder is characterised by the following:
- gradual onset
- triggered by change in head position
- each episode lasts 10-20 seconds
benign paroxysmal positional vertigo
which disorder is characterised by the following:
- recent viral infection
- recurrent vertigo attacks lasting hours or days
- no hearing loss
vestibular neuronitis
brainstorm some causes of vertigo:
- posterior circulation stroke
- trauma
- multiple sclerosis
- ototoxicity e.g. gentamicin
describe webers test
- vibrating tuning fork
- in centre of head
- sound travels to both ears
- if sound louder is one ear (say left)
- will indicate conductive hearing loss in the opposite (right) ear
describe Rinne’s test
- tuning fork next to each ear in turn
- placed on mastoid process
- if its louder on bone - indicates conductive hearing loss
what are acoustic neuromas ?
tumours of the vestibulocochlear nerve
form of sensorineural hearing loss
describe positive Rinne’s test
‘positive test’: air conduction (AC) is normally better than bone conduction (BC)
‘negative test’: if BC > AC then conductive deafness
exostosis caused by:
- repeated exposure to cold water and wind
- causes benign bony growth
- in external auditory canal
- form of conductive hearing loss
30 y/o female
pc: recurrent LHS nose bleeds, lasting 9 mins, starts again on cough
what part of the history prompts urgent investigation:
- unilateral epistaxis is a red flag symptom
which disorder is characterised by the following:
- recent viral infection
- sudden onset
- nausea and vomiting
- hearing may be affected
viral labyrinthitis
what distinguishes vestibular neuronitis from labyrinthitis
unaffected hearing in vestibular neuronitis
finger spasms when blood pressure was taken
trousseau’s sign
firstline management for patient with otitis media with no improvement of symptoms after 2-3 days
start amoxicillin
what is the common anatomical origin of a nose bleed?
- anterior nasal septum
- ‘little’s area’ confluence of 4 arteries
nasal decongestants should not be used for prolonged periods of time as…
- increasing doses will be required to achieve the same effect
- known as tachyphylaxis
following perforation of tympanic membrane - healing should occur within
6 to 8 weeks
if not… then mringoplasty can be performed to repair the perforation
The cyst is filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium
This cyst is a benign, developmental defect of the branchial arches.
typical examination features
- unilateral
- anterior to sternocleidomastoid
- non-tender
branchial cyst
non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction.
- foul smelling discharge
- hearing loss
cholesteatoma
quinsy should be treated with:
- IV antibiotics
- surgical drainage
past medical history of chronic ear infections and offensive discharge are suggestive of
cholesteatoma
2 y/o lil baby
- lump in neck
- swelling in subcut tissue of posterior triangle
- transilluminates
classic description of:
cystic hygroma
- collection of dilated lymphatic sacs
- which are fluctuant and brilliantly trans illuminable
40 y/o female
- painless neck lymo
- mass beneath sternocleidomastoid
- history of regurg of undigested food
- coughing at night
- halitosis
- throat infections
classic history of:
pharyngeal pouch
32 y/p female
- recurrent infections and abscesses in neck
- midline defect with overlying scab
- moves upwards on tongue protrusion
what is it:
thyroglossal cyst
- connection with foramen caecum means it will move on tongue protrusion
shingles affecting the facial nerve.
This results in ear pain, vesicles in the external ear canal associated with vertigo and deafness.
indicative of:
Ramsay-hunt syndrome
- herpes zoster oticus
- caused by reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve
management of ramsay-hunt syndrome
oral aciclovir
and corticosteroids
usually given
A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatment.
sarcoidosis
Sarcoid occurs bilaterally in 70% of cases and facial nerve involvement is recognised. Treatment is conservative in most cases although individuals with facial nerve palsy will usually receive steroids with good effect.
An 18-year-old boy presents with pancreatitis. He has bilateral painful parotid enlargement.
likely to be:
viral parotitis
A 50-year-old lady presents with symptoms of a dry mouth that has been present for the past few months. She also has a sensation of grittiness in her eyes.
On examination she has a diffuse swelling of her parotid gland. There is no evidence of facial nerve palsy.
likely diagnosis:
sjogren’s syndrome
high-frequency loss associated with ageing
presbyacusi
what describes the replacement of normal bone by vascular spongy bone.
It causes a progressive conductive deafness due to fixation of the stapes at the oval window.
otosclerosis
management of otosclerosis
hearing aid
stapedectomy
A 64-year-old woman with a one week history of pain above and lateral to her left eye. On examination she is tender over that area.
indicative of:
temporal arteritis
A 62-year-old woman presents with a two week history of shooting pains across her left cheek. The pain is sometimes triggered by touching her face. She has no past medical history note
indicative of:
trigeminal neuralgia
common cause of bacterial otitis media
Haemophilus influenzae is a common cause of bacterial otitis media
The combination of asthma, aspirin sensitivity and nasal polyps is known as
Samter’s triad
In patients with asthma, aspirin and other NSAIDs should be avoided as these may precipitate an asthma exacerbation.
Features
- ear pain, itch, discharge
-otoscopy: red, swollen, or eczematous canal
indicative of:
otitis externa
causes of otitis externa include
- infection: bacterial (staph. aureus, pseudo. aeruginosa) of fungal
- seborrheic dermatitis
- contact dermatitis
An 8-year-old child presents with enlarged tonsils that meet in the midline and are covered with a white film that bleeds when you attempt to remove it. He is pyrexial but otherwise well.
indicative of:
acute bacterial tonsillitis
A 10-year-old child presents with enlarged tonsils that meet in the midline. Oropharyngeal examination confirms this finding and you also notice peticheal haemorrhages affecting the oropharynx. On systemic examination he is noted to have splenomegaly.
indicative of:
infectious mononucleosis
James, 40, has presented to his GP with weakness of the right side of his face, which examination confirms. James also reveals that he has experienced pain in his ear and otoscopy reveals the presence of vesicles on his tympanic membrane. Which of the following is the likely diagnosis?
ramsay hunt syndrome
A 33-year-old with coryzal symptoms presents with a one day history of vertigo and nausea. There is no hearing loss on examination
vestiubular neuronitis
A 62-year-old man with a 3 month history of dizziness when he rolls over in bed. Episodes last for about 20 seconds
benign paroxysmal positional vertigo
A 51-year-old female with a 3 week history of recurrent attacks of vertigo, right ear tinnitus and the sensation of fullness in her right ear. On testing, there is noted to be right-sided hearing loss affecting low frequencies.
meniere’s disease
pain on palpation of the tragus, itching, discharge and hearing loss
Otitis externa
A 4-year-old is brought to the general practitioner by her mother. She has been distressed with ear pain for the past 14 hours. She is constantly touching and pulling at her ear. Whilst she is sat in the waiting room her mother notices a discharge of foul smelling fluid from the ear, following which the pain resolves.
Acute suppurative otitis media
