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FCM Matrix > ENT > Flashcards

ENT Flashcards

1
Q

What typically preceeds acute otitis media

A

Viral URTI

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2
Q

causes of acute otitis media

A

viral or bacterial

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3
Q

S/s acute otitis media

A
  • otalgia
  • ear tugging
  • fever
  • URTI sx
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4
Q

Otoscopy findings in acute otitis media

A
  • loss of light reflex due to bulging tympanic membrane
  • middle ear effusion
  • inflammation (erythema)
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5
Q

How is acute otitis media diagnosed

A

Clinical

Otoscopy

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6
Q

Management of acute otitis media

A
  • generally self-limiting
  • analgesia
  • if abx indicated amoxicillin
    • pen. allergy : clarithromycin/erythromycin
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7
Q

When are abx indicated in acute otitis media

A
  • sx persist >4 days
  • systemically unwell (not requiring admission)
  • immunocompromised
  • <2yo and bilateral otitis media
  • perforation and/or discharge
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8
Q

sx of cerumen impaction

A
  • Hearing loss
  • Blocked ears
  • Ear discomfort
  • Feeling of fullness in ear
  • Earache
  • Tinnitus
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9
Q

cerumen impaction management

A
  • removal not routinely needed
  • ear drops if sx of hearing loss
  • ear irrigation if sx persist
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10
Q

When should ear drops NOT BE USED

A

perforated tympanic membrane, active dermatitis, or active infection of the ear canal.

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11
Q

Causes of labyrinthitis

A

viral, bacterial or associated with systemic diseases

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12
Q

labyrinthitis

A

inner ear infection

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13
Q

labyrinthitis vs vestibular neuritis

A

vestibular neuritis : only the vestibular nerve is involved, hence there is no hearing impairment

labyrinthitis : both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment

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14
Q

sx of labyrinthitis

A
  • vertigo
  • n&v
  • hearing loss
  • tinnitus
  • preceding or conceding URTI sx
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15
Q

signs of labyrinthitis

A
  • sensorineural loss
  • gait disturbance
  • nystagmus
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16
Q

how is labyrinthitis diagnosed

A

clinical

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17
Q

management of labyrinthitis

A
  • usually self-limiting

- prochlorperazine or antihistamines may help reduce the sensation of dizziness

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18
Q

otitis externa

A

inflammation (redness and swelling) of the external ear canal

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19
Q

sx of otitis externa

A
  • ear pain
  • itch
  • discharge
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20
Q

common trigger of otitis externa

A

swimming

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21
Q

management of otitis externa

A

topical antibiotic or a combined topical antibiotic with a steroid

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22
Q

What should be done if otitis externa is not responding to initial treatment

A

ENT referral

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23
Q

Vertigo

A

false sensation that the body or environment is moving.

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24
Q

Which neurological finding may be found with vertigo

A

nystagmus

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25
Q

Main causes of vertigo

A

central : brain pathology - uncommon

peripheral : inner ear pathology

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26
Q

management of vertigo

A
  • secondary care referral

- symptomatic drug tx: antihistamines e.g. prochlorperazine

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27
Q

chronic suppurative otitis media (CSOM)

A

Ear discharge persisting for more than 2 weeks, without ear pain or fever

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28
Q

chronic suppurative otitis media sx

A

persistent ear discharge
hearing loss
tinnitus

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29
Q

chronic suppurative otitis media management

A

ENT referral

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30
Q

What is mastoiditis

A

when an infection spreads from the middle to the mastoid air spaces of the temporal bone

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31
Q

s/s of mastoidits

A
  • otalgia: severe, classically behind the ear
  • fever
  • swelling, erythema and tenderness over the mastoid process
  • external ear may protrude forwards
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32
Q

how is mastoiditis diagnosed

A

clinical

CT if complications supected

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33
Q

complication of mastoiditis

A
  • meningitis
  • facial nerve palsy
  • hearing loss
34
Q

management of mastoiditis

A

IV abx

35
Q

s/s menieres disease

A
  • recurrent episodes of vertigo, tinnitus and hearing loss
  • fullness / pressure in ear
  • positive Romberg
36
Q

management of menieres disease

A
  • ENT specialist referral
  • acute attacks: buccal or intramuscular prochlorperazine
  • stop driving until sx controlled
37
Q

how long do attacks last in menieres disease

A

present for at least 20 minutes, but typically last a few hours

38
Q

What does barotrauma lead to

A

perforated tympanic membrane

39
Q

sx of barotrauma

A
  • hearing loss
  • ear pain
  • fullness in ear
40
Q

What does positive and negative Rinnes test indicate

A

Positive : air conduction > bone conduction (normal)

Negative : bone conduction > air conduction (conductive hearing loss)

41
Q

What is the webers test result in conductive and sensorineural hearing loss

A

conductive : lateralises to affected ear

sensorineural : lateralises to unaffected ear

42
Q

How to manage hearing loss in primary care if all other causes have been treated/excluded

A
  • ENT referral for audiological assessment

- hearing aids

43
Q

When to urgently refer a patient with hearing loss

A
  • Sudden onset (over 3 days or less) unilateral or bilateral hearing loss which has occurred within the past 30 days and all other causes excluded
  • Unilateral hearing loss associated with focal neurology
  • Hearing loss associated with head or neck injury
  • Hearing loss associated with severe infection or Ramsay Hunt syndrome
  • Rapidly progressive hearing loss
44
Q

Causes of tympanic membrane perforation

A
  • infection (most common)
  • barotrauma
  • direct trauma
45
Q

management of tympanic membrane perforation

A
  • self resolving in 6-8 weeks
  • abx if following acute otitis media
  • myringoplasty if not healing
46
Q

most common infectious agents of acute sinusitis

A

Haemophilus influenzae
rhinovirus
Streptococcus pneumoniae

47
Q

sx of acute sinusitis

A
  • facial pain (worse on leaning forward)

- thick nasal discharge

48
Q

management of acute sinusitis

A
  • analgesia
  • intranasal corticosteroids if sx > 10 days
  • phenoxymethylpenicillin if severe presentations
49
Q

How can allergic rhinitis be classified

A
  • seasonal
  • occupational
  • perennial: symptoms occur throughout the year
50
Q

sx of allergic rhinitis

A
  • sneezing
  • bilateral nasal obstruction
  • clear nasal discharge
  • post-nasal drip
  • nasal pruritus
51
Q

management of allergic rhinitis

A
  • allergen avoidance
  • mild-to-moderate : oral or intranasal antihistamines
  • moderate-to-severe : regular intranasal corticosteroid
  • tx failure : short-term intranasal decongestant
52
Q

management of epistaxis

A
  • haemodynamically stable pt : ask pt to sit with torso forward with mouth open & pinch the soft area of the nose firmly
  • topical antiseptic preparation if above not effective

nasal cautery or nasal packing if above not effective

53
Q

sx of nasal polyps

A
  • nasal obstruction
  • rhinorrhoea
  • sneezing
  • poor sense of taste and smell
54
Q

which feature of nasal polyps is unusual and requires further investigation

A

unilateral nasal polyps or bleeding

55
Q

management of nasal polyps

A
  • ENT referral

- topical corticosteroids

56
Q

how long do sx have to persist to be chronic sinusitis

A

12 weeks

57
Q

management of chronic sinusitis

A
  • nasal irrigation with saline solution
  • course of intranasal corticosteroids
  • specialist referral
58
Q

Sx of tonsillitis

A

pharyngitis, fever, malaise and lymphadenopathy.

59
Q

Most common pathogen causing tonsillitis

A

Streptococcus pyogenes

60
Q

Appearance of tonsils in tonsillitis

A

Typically oedematous and yellow or white pustules

61
Q

When is abx indicated in tonsillitis?

A

bacterial tonsillitis

62
Q

Complication of bacterial tonsillitis

A

quinsy (peritonsilar abscess)

63
Q

Tx for bacterial tonsillitis

A

phenoxymethylpenicillin

64
Q

What is aphthous ulcer?

A

ulcer of oral mucosa

- avoid trigger

65
Q

1st line for aphthous ulcer

A

Topical corticosteroid

66
Q

What is oral herpes simplex?

A

cold sores

67
Q

Management of cold sores

A

topical aciclovir

68
Q

What is parotitis?

A

swelling of salivary glands

69
Q

Features of quinsy

A
  1. severe throat pain, which lateralises to one side
  2. deviation of the uvula to the unaffected side
  3. trismus (difficulty opening the mouth)
  4. reduced neck mobility
70
Q

Management of quinsy

A

Patients need urgent review by an ENT specialist.

Tx:

  1. needle aspiration or incision & drainage + intravenous antibiotics
  2. tonsillectomy should be considered to prevent recurrence
71
Q

What is oral leukoplakia?

A

malignant disorder affecting the oral mucosa.

  • white patch or plaque that develops in the oral cavity
72
Q

Diagnosis of oral leukoplakia

A

diagnosis of exclusion

Biopsy

73
Q

What is sialadenitis?

A

salivary gland infection

74
Q

What is acoustic neuroma also known as?

A

Vestibular schwannoma

75
Q

Features of acoustic neuroma

A
  1. vertigo
  2. sensorineual hearing loss
  3. unilateral tinnitus
  4. an absent corneal reflex.
76
Q

Management of acoustic neuroma

A

referred urgently to ENT

  • Surgery, radiotherapy or observation
77
Q

Ix for acoustic neuroma

A

MRI of the cerebellopontine angle is the investigation of choice

78
Q

2WWW Referral for oral cancer

A

Either:
unexplained ulceration in the oral cavity lasting for more than 3 weeks

or

a persistent and unexplained lump in the neck.

79
Q

Features of Nasopharyngeal carcinoma

A

Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI

80
Q

Imaging for Nasopharyngeal carcinoma

A

Combined CT and MRI.

81
Q

Tx for Nasopharyngeal carcinoma

A

Radiotherapy is first line therapy.

FCM Matrix (17 decks)

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