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ENT Flashcards

1
Q

What is acute otitis media and what are the most common causative organisms?

A

Acute middle ear infection

Most common cause = strep pneumonia or haemophilus influenzae

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2
Q

How does acute otitis media present?

A

Ear pain

Reduced hearing

Fever

Cough/coryza/sore throat

If tympanic membrane has ruptured - discharge

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3
Q

What is seen on otoscopy in acute otitis media?

A

Bulging red tympanic membrane

Dull/absent light reflex (due to middle ear effusion)

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4
Q

What are indications for antibiotics for acute otitis media?

A

Symptoms lasting more than 4 days

Systemically unwell

Immunocompromised

<2 years + bilateral otitis media

Perforation/discharge

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5
Q

What antibiotic is used for acute otitis media?

A

Amoxicillin

Clarithromycin if pen allergic

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6
Q

What are complications of acute otitis media?

A

Perforation of the tympanic membrane

Labyrinthitis

Mastoiditis –> urgent ENT referral needed

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7
Q

What is otitis externa and what are the most common causative organisms?

A

Inflammation of the outer ear

Organisms = Pseudomonas / staph aureus

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8
Q

How does otitis externa present?

A

Ear pain

Itching

Discharge

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9
Q

What is seen on otoscopy in otitis externa?

A

Normal tympanic membrane

However often not able to be visualised

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10
Q

How is otitis externa managed?

A

Topical Neomycin + Dexamethasone

If tympanic membrane is perforated has to be Clarithromycin + Dexamethasone

If no response -> oral flucloxacillin

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11
Q

What is malignant otitis externa?

A

Life-threatening form of otitis externa - spreads to the temporal bone and becomes temporal bone osteomyelitis

found in immuno-compromised people esp. diabetics

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12
Q

How does malignant otitis externa present?

A

Deep-seated severe ear pain

Temporal headaches

Purulent discharge

May be cranial nerve palsies

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13
Q

How is malignant otitis externa managed?

A

ENT referral for IV Abx/debridement

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14
Q

What is acute sinusitis and how does it present?

A

Inflammation of the facial sinuses

Facial pressure which is worse on bending forewards

Thick, purulent nasal discharge

Nasal obstruction

Tenderness of the affected areas

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15
Q

How is acute sinusitis managed?

A

Supportive

If symptoms have not improved after 10 days - intranasal corticosteroids can be tried

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16
Q

What is allergic rhinitis and how does it present?

A

Inflammatory disorder of the nose (sensitised to dust mites/grass/pollen)

Sneezing

Bilateral nasal obstruction

Clear nasal discharge

Nasal pruritus

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17
Q

How is allergic rhinitis managed?

A

Anti-histamines e.g. Cetirizine

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18
Q

What is chronic rhinosinusitis? How does it present?

A

Inflammatory disorder of the paranasal sinuses

Facial pain worse on bending forwards

Nasal obstruction

Symptomsneed to have been present for at least 12 weeks

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19
Q

When do nasal polyps/chronic rhinosinusitis require referral for 2WW?

A

If unilateral

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20
Q

What is the most common bacterial cause of acute tonsillitis?

A

Group A strep (Strep pyogenes)

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21
Q

How does acute tonsillitis present?

A

Red, inflamed, enlarged tonsils

+/- exudae

+/- fever

+/- cough

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22
Q

What is the Centor criteria?

A

Estimates probability of acute tonsillitis being bacterial

Fever

Exudate

Lymphadenopathy

Absence of cough

If 3 or more = abx indicated

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23
Q

What is the antibiotic of choice for acute tonsillitis?

A

Penicillin V

If pen allergic = Clarithromycin

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24
Q

What are the indications for tonsillectomy?

A

7 episodes in a year
5 episodes every year for 2 years
3 episodes every year for 3 years

Enlarged tonsils causing difficulty

Recurrent abscess

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25
When is post-tonsillectomy bleeding a cause for concern?
If bleeding occurs less than 24 hours post surgery -> immediate return to surgery If occurs more than 24 hours post surgery -> antibiotics
26
What is Quinsy and how does it present?
Peritonsillar abscess (complication of untreated bacterial tonsillitis) Symptoms of tonsillitis Trismus - patient unable to open mouth UNILATERAL Swelling + erythema Patient will be extremely unwell - fever, tachycardia
27
How is Quinsy managed?
Admit for incision and drainage + abx
28
How should post-tonsillectomy bleeding be managed as an F1?
Call ENT reg Get IV access - take bloods (FBC, clotting, group and save, cross match) Nil by mouth in case surgery is needed If severe bleeding- anaesthetics should be called
29
What is the causative organism for glandular fever?
Epstein-barr virus
30
How does glandular fever present?
Triad of sore throat, fever and lymphadenopathy Malaise Palatal petechiae Splenomegaly - at risk of splenic rupture Deranged LFTs Lymphocytosis Haemolytic anaemia
31
What blood test results may be seen in glandular fever?
Deranged LFTs Lymphocytosis Haemolytic anaemia
32
Which antibiotics should you not give to someone with glandular fever and why?
Ampicillin/Amoxicillin Causes a maculopapular pruritic rash
33
How is glandular fever diagnosed? When should the test be conducted?
Monospot test Conduct in 2nd week of illness
34
How is glandular fever managed?
Supportive Advise patients to avoid contact sports for 4 weeks due to risk of splenic rupture
35
What is otosclerosis and how does it present?
Otosclerosis = remodelling of the bones in the middle ear Causes conductive hearing loss Presents as hearing loss and tinnitus (usually mainly difficulty which lower pitched sounds)
36
Which hearing problem causes issues with lower pitched sounds?
Otosclerosis
37
What is seen on otoscopy in otosclerosis?
Normal tympanic membrane May be flamingo pink tinge
38
How is otosclerosis managed?
Hearing aid/stapedectomy
39
How does Meniere's disease present?
Triad - hearing loss, tinnitus and vertigo Symptoms come on episodes Most prominent symptom = vertigo Symptoms are usually unilateral Feeling of fullness/pressure
40
What medication is used for acute management of Meniere's, and what is used as prevention?
Acute attacks = Prochlorperazine Prophylaxis = Betahistine
41
What is classed as sudden sensorineural hearing loss? How is investigated? How is it managed?
Hearing loss over less than 72 hours Referral to ENT for investigation with audiometry Oral or intra-tympanic high-dose corticosteroids
42
How does Eustachian tube dysfunction present?
Often a recent URTI reduced/altered hearing Popping noises Sensation of fullness Pain/discomfort Tinnitus
43
What is benign paroxysmal positional vertigo? How is it diagnosed and how is it treated?
Sudden onset of vertigo triggered by movement of head position (e.g. rolling over in bed) Symptoms settle after 20-60 seconds Diagnosis = Dix-Hallpike manoeuvre will show rotary nystagmus Management = Epley manoeuvre
44
What is vestibular neuronitis?
Inflammation of the vestibular nerve which develops following a viral infection
45
How does vestibular neuronitis present?
Recurrent vertigo Nausea/vomiting Horizontal nystagmus NO HEARING LOSS OR TINNITUS
46
How is vestibular neuronitis and labyrinthitis differentiated?
Labyrinthitis = vertigo, hearing loss, tinnitus Vestibular neuronitis = just vertigo
47
How is vestibular neuronitis managed?
Short course of Prochlorperazine (up to 3 days) if no improvement -> vestibular rehabilitation
48
What is labyrinthitis?
Inflammatory disorder of the labyrinth usually secondary to a viral infection e.g. otitis media/meningitis
49
How does labyrinthitis present?
Recent URTI Acute onset vertigo Sensorineural hearing loss Tinnitus Horizontal nystagmus
50
How is labyrinthitis managed?
Self-limiting Prochlorperazine can provide symptomatic relief
51
What is an acoustic neuroma/vestibular schwannoma?
Benign tumour of the Schwann cells of the vestibulocochlear nerve
52
What condition is associated with bilateral acoustic neuromas?
Neurofibromatosis type II
53
How does an acoustic neuroma present?
Gradual onset Unilateral sensorineural hearing gloss Tinnitus Dizziness Imbalance Sensation of fullness
54
What is a characteristic finding of acoustic neuroma?
Absent corneal reflex
55
What is a cholesteatoma?
A benign growth of squamous epithelial cells deep inside ear
56
How does a cholesteatoma present?
Foul-smelling, non-resolving discharge Conductive hearing loss
57
What is seen on otoscopy in cholesteatoma?
Attic crust (brown dried skin in the upper eardrum?
58
How is a cholesteatoma managed?
Any discharge which does not respond to abx should be referred to ENT
59
What is Ramsay Hunt syndrome?
Syndrome caused by herpes zoster virus - when a shingles outbreak occurs in the facial nerve distribution Ear pain Lower motor neurone facial nerve palsy (forehead not spared) Vesicular rash around the ear
60
How is Ramsay Hunt syndrome managed?
Oral aciclovir + oral prednisolone
61
What is the most common site for a nose bleed to originate from?
Little's area (in the Kiesselbech's plexus)
62
What are common triggers for epistaxis?
Nose picking Colds Sinusitis Trauma Changes in weather Coagulation disorders Cocaine use
63
How is a nose bleed managed?
Tilt head forwards Pinch nose for up to 20 mins If bleeding does not stop... If source of bleed is visible -> Cautery If source of bleed is not visible -> packing
64
What does a bilateral nose bleed suggest?
More likely to be a posterior source of bleeding
65
What are features of nasal polyps?
Nasal obstruction Snoring Anosmia Usually bilateral - if unilateral it is suggestive of tumours
66
How are unilateral nasal polyps managed?
Urgent referral to ENT
67
What conditions are associated with nasal polyps?
Samter's triad Asthma Cystic fibrosis Eosinophilic GPA
68
How are nasal polyps managed?
Topical corticosteroids Polypectomy
69
What is presbycusis and how does it present?
Sensorineural hearing loss which affects the elderly Usually affects higher frequency first e.g. female voices Difficulty using telephone
70
How can you tell the difference between a thyroid swelling and a thyroglossal cyst?
Thyroid swelling - moves upward on swallowing Thyroglossal cyst - moves upward on protrusion of tongue
71
Neck lump: dysphagia, regurgitation, halitosis?
Pharyngeal pouch
72
Neck lump: evident at birth, soft, transilluminates?
Cystic hygroma
73
Neck lump: presents in childhood, infront of sternocleidomastoid, does not transilluminate?
Branchial cyst
74
Neck lump: firm swelling with weakness/numbness?
Cervical rib
75
Neck lump which moves upwards on swallowing?
Thyroid swelling
76
Neck lump which moves upwards on protrusion of the tongue?
Thyroglossal cyst
77
What are risk factors for head + neck cancers?
Smoking Alcohol HPV EBV
78
What are red flags for head and neck cancers?
Lump in the mouth or on lip Unexplained mouth ulceration persisting for more than 3 weeks Erythroplakia or Leukoplakia Unexplained hoarse voce Unexplained thyroid lump
79
What type of cancer are head and neck cancers usually?
Squamous cell carcinoma
80
What is a normal Rinne's test result and what does an abnormal test mean?
Normal result = air conduction > bone conduction Conductive hearing loss = bone conduction > air conduction
81
How can you interpret Weber's test?
Sensorineural deafness = louder in non-affected ear Conductive deafness = louder in affected ear
82
What is a cervical rib and how can it present?
An extra rib above first rib Can be felt as a lump in the neck Can lead to thoracic outlet syndrome
83
Whens should otitis externa be referred to ENT?
Non-resolving + worsening pain
84
What is the usual causative organism of malignant otitis externa?
Pseudomonas
85
Management for otitis externa + perforation?
Topical clarithromycin+dexamethasone
86
What is sialdenitis? How is it treated?
Inflammation of the salivary glands due to viral/bacterial infection Treated w/ Abx + oral hygiene advice.
87
How should noise-induced hearing loss be treated?
Hearing aid
88
What is the hereditary pattern of otosclerosis?
Autosomal dominant
89
Which salivary gland swelling can cause facial nerve palsy?
Malignant tumours – e.g. Adenoic cystic carcinoma
90
What is the most common benign salivary tumour?
Pleomorphic adenoma
91
What are symptoms of a thyroid lump?
``` Voice hoarseness Difficulty swallowing – dysphagia, painful swallow Airway compromise Weight loss Low-grade fever May be cervical lymphadenopathy ```
92
Which type of head and neck cancer is most associated with HPV?
Oropharyngeal squamous cell carcinoma
93
What does loss of corneal reflex suggest?
Vestibular schwannoma/acoustic neuroma
94
When should a hoarse voice be investigated?
If it has lasted more than 3 weeks
95
What is the most common cause of hearing impairment post head injury?
Perforated tympanic membrane
96
What can you prescribe for epistaxis to reduce crusting?
Topical antiseptic e.g. Naseptin (chlorhexidine + neomycin)- caution in peanut allergies
97
What is seen during Dix-Hallpike manoevure in BPPV?
Vertigo + Rotary nystagmus
98
How is an auricular haematoma managed?
Require same day ENT assessment for incision ad drainage
99
How can you manage epistaxis which has failed all emergency management?
Ligation of the sphenopalatine artery in theatre
100
How does a nasal septal haematoma present and how should it be managed?
Head/facial trauma- may be relatively minor Bilateral red boggy swelling from nasal septum Surgical drainage + IV Abx
101
What is Ludwig's Angina and how is it managed?
Type of progressive cellulitis which affects the floor of the mouth and the soft tissues of the neck- presents with neck swelling, dysphagia and fever needs emergency airway management = IV Abx Preauricular sinus
102
What is glue ear?
Otitis media with effusion
103
What are risk factors for glue ear?
``` Male Family history Bottle feeding Parental smoking Eustachian tube dysfunction Down syndrome ```
104
How does glue ear present?
Hearing loss Most common cause of conductive hearing loss in children May be secondary problems e.g. speech and language delay
105
How is glue ear treated?
Grommet insertion or Adenoidectomy
106
Which drugs can cause hearing loss?
``` Gentamicin/Vancomycin Furosemide Sildenafil Aspirin Quinines ```
107
How are acoustic neuromas diagnosed?
MRI of the cerebellopontine angle
108
What is the 2WW criteria for laryngeal cancer?
>45 + persistent unexplained hoarse voice | >45 + unexplained lump in neck

Medicine Finals (32 decks)

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