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Year 3 > ENT > Flashcards

ENT Flashcards

1
Q

Define Benign paroxysmal positional vertigo (BPPV)

A

peripheral vestibular disorder causing sudden short-lived episodes of vertigo elicited by certain head movements

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2
Q

Cause of BPPV

A

movement of otolith (crystals) from utricle + saccule => semi-circular canals causing movement of endolymph even when head has stopped moving.

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3
Q

Presenting symptoms of BPPV

A
  • sudden severe episodic vertigo provoked by specific head movements
  • nausea
  • imbalance
  • lightheadedness
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4
Q

Examination findings of BPPV

A
  • normal neurological exam
  • BUT positive DIX-HALLPIKE manoeuvre -sitting => supine positions => head tilted back and 45 degrees =>see nystagmus (eyes jumping) within 30s.
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5
Q

Investigations for BPPV

A
  • Dix-hallpike maneouvre
  • audiogram- exclude sensorineural hearing loss (meniere’s disease/ labrynthitis)
  • MRI brain- exclude MS, tumours
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6
Q

Management for BPPV

A
  • educate patient about condition and to continue exercise
  • 3- position particle repositioning manoeuvre (PRM)
  • if not- vestibular rehabilitation
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7
Q

define Meneiere’s

A

disorder of the inner ear causing sudden vertigo due to increased pressure and dilation of endolymphatic system

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8
Q

symptoms for Meniere’s

A
  • spontaneous vertigo (20mins-12hours)
  • tinitus
  • ear fullness
  • fluctuating sensorineural hearing loss
  • nausea/vomiting
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9
Q

signs of Meniere’s

A
  • nystagmus
  • positive Romberg’s test (poor proprioception - ataxia is sensory in nature not cerebellar)
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10
Q

Risk factors for Meniere’s

A
  • viral infections
  • head trauma
  • genetics
  • autoimmune
  • metabolic disturbances (changes to Na+/K+ in ear)
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11
Q

Management of Meniere’s disease

A

Severe => refer to hospital for IV labrynthite, fluids and nutrition

Medical:

  • acute attacks => prochlorperazine- anti-emetic
  • prevention => betahistine (anti-histamine)- anti-emetic, treats vertigo

MDT approach

  • refer to ENT for diagnosis
  • refer to audiology for hearing loss

Lifestyle:

  • keep medication nearby, vertigo usually gets better with treatment and symptoms usually resolve within 24hrs
  • caution of operating heavy mahcinery/ driving
  • inform DVLA
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12
Q

define epistaxis

A

nose bleeds due to damage of vessels in nasal mucosa

  • usually self-limiting
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13
Q

causes of epistaxis

A
  • Nose trauma (picking/blowing nose, allergies /surgery)
  • nasal polyps/ tumours (SCC)
  • Hypertension/ atherosclerosis
  • Haematological (leukaemia, haemophillia, thrombocytopenia)
  • Environmental factors (low humidity, high altitude)
  • Drugs (anticoagulants, antiplatelets)
  • XS alcohol
  • vascular causes (hereditary haemorrhagic telangiectasia/ Wegener’s granulomatosis
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14
Q

investigations for epistaxis

A
  • rarely done
  • FBC - Hb (anaemia)
  • coagulation studies (clottting disorders)
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15
Q

Management of epistaxis

A

Acute epistaxis

  • Lean forward, mouth open and hold nose for 10-15 mins
  • if posterior bleed (profuse, bleeding from both nostrils => A&E)
  • apply naseptin (antiseptic) to prevent re-bleeding
  • after bleeding- advise to not heavy lift/pick nose for >24hrs

Recurrent epistaxis:

  1. topical antiseptic (naseptin- chlorohexidine + neomycin)- prevent crusting/vestibulitis
  2. nasal cautery
  3. referral to ENT
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16
Q

complications of epistaxis

A
  • rare
  • anaema
  • hypovolaemia
17
Q

define rhinosinusitis

A
  • inflammation of nasal cavity + paranasal sinuses (frontal,nasal, ethmoid, maxillary sinuses) usually viral infection but can be followed by bacterial infection (uncommon)
  1. acute - symptoms <3 months
  2. chronic - symptoms >3 months
18
Q

causes of rhinosinusitis

A

acute

  • triggered by viral respiratory tract infection (influenza, RSV) =>followed by bacterial infection
  • allergies, asthma, seasonal variation
  • smoking
  • CF
  • anatomical obstruction (deviated nasal septum, nasal polyps, trauma, foreign body)

chronic

  • inflammatory cause
  • triggers: allergies, asthma, smoking, CF,
  • immunocompromised
19
Q

symptoms of rhinosinusitis

A

Adults:

  • nasal blockage/nasal discharge + face pain (around sinuses)
  • headache
  • fever
  • loss of smell
  • cough
  • red,tender, swollen cheeks/periorbital areas

Child:

  • nasal blockage/ discoloured nasal discharge
  • fever
  • face pain / pressure
  • cough

Examination => nasal inflammation, nasal disharge, mucosal oedema

Signs of bacterial infection

  • discoloured discharge
  • high fever
  • followed a mild illness
20
Q

investigations for rhinosinusitis

A
21
Q

Differentials for rhinosinusitis

A

nasal blockage/discharge

  • URTI
  • tonsilitis
  • tumour
  • foreign body

face pain

  • migraine
  • giant cell/temporal arteritis
  • dental pain
  • temperomandibular disorders
  • trigeminal neuralgia
22
Q

management for rhinosinusitis

A

If signs of orbital/bone/neuro complications => hospital

AB use is not encouraged as bacterial infection is rare

Acute

  • if symptoms <10 days - no further action needed, should resolve on own
  • if > 10 days => high dose nasal corticosteroids + (backup antibiotics?)
  • recurrent/ ABs don’t help => refer to ENT (rare)

Chronic

  • avoid triggers, stop smoking
  • nasal irrigation with saline
  • high dose nasal corticosteroids
  • refer to ENT
23
Q

complications of rhinosinusitis

A

acute:

  • Orbital complications — orbital cellulitis, orbital abscess, cavernous sinus thrombosis.
  • Intracranial complications —meningitis, encephalitis, abscess, venous thrombosis.
  • Bony complications — osteomyelitis.
  • Progression to chronic sinusitis.

Chronic

  • poor sleep, fatigue, depression

Year 3 (27 decks)

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