ENT Flashcards
1
Q
What are the 3 names of the ossicles?
A
Malleus
Incus
Stapes
2
Q
Over what time frame can hearing loss be defined as sudden?
A
Over less than 72 hours
3
Q
What is the result of webbers test in sensioneural hearing loss?
A
Louder in normal ear, quieter in the affected ear
4
Q
What is the result of webbers test in conductive hearing loss?
A
Louder in the affected ear
5
Q
What is the result of Rinne’s test in conductive hearing loss?
A
Is louder on the mastoid process than by the ear on the affected side.
6
Q
Which drugs can cause sensioneural hearing loss?
A
Loop diruretics (furosemide) Gentamicin Chemotherapy drugs (cisplatin)
7
Q
Which pitch of sounds does presbycusis affect?
A
High pitched sounds
8
Q
What is the diagnostic criteria for sudden sensorineural hearing loss?
A
loss of at least 30 decibels in 3 consecutive frequencies
9
Q
How can idiopathic SSNHL be managed?
A
Steroids
10
Q
How may eustachian tube dysfunction present?
A
Reduced or altered hearing
Popping noises or sensations in the ear
Pain or discomfort
Tinnitus
11
Q
What are the investigations for Eustachian tube dysfunction?
A
Tympanometry
Audiometry
nasopharyngoscopy
CT scan
12
Q
Which procedure can be done to widen the eustachian tube?
A
Balloon dilatation eustachian tuboplasty
13
Q
What is the inheritance pattern of otosclerosis?
A
Autosomal dominant
14
Q
What is the typical presentation of otosclerosis?
A
Conductive hearing loss
Tinnitus
Woman in her 40s
Hearing loss is generally of lower-pitched sounds
15
Q
Which investigations should be done for otosclerosis?
A
Audiometry
Typanometry
High resolution CT
16
Q
What are the management options for otosclerosis?
A
Stapedotomy
Hearing aids
17
Q
Which bacteria most commonly causes otitis media?
A
Streptococcus pneumoniae
18
Q
what are the symptoms of otitis media?
A
ear pain
Reduced hearing
Fever
Cough, coryza and sore throat
19
Q
What can be seen on otoscopy in otitis media?
A
Red, inflamed looking membrane
20
Q
What is the first line antibiotic for otitis media and for how long?
A
Amoxicillin for 5-7 days
21
Q
What are the 2 most common bacterial causes of otitis externa?
A
Pseudomonas aeruginosa
Staphylococcus aureus
22
Q
What are the 2 conditions which psuedomonas aeruginosa can cause?
A
Otitis externa and can colonise the lungs in patients with cystic fibrosis
23
Q
What can pseudomonas aeruginosa be treated with?
A
Gentamycin and ciprofloxacin
24
Q
What is the management of otitis externa?
A
Mild= acetic acid 2% Moderate= topical antibiotics and steriod (eg neomycin and dexamethosone) aka otomize ear spray
25
What is the potentially life threatening complication of otitis externa and which populations does it occur in?
malinant otitis externa (osteomyelitis of the temporal bone)
Occurs in people with diabetes, people who are immunosuppressed or have HIV
26
What is objective tinnitus? How can you assess this?
The patient can objectively hear an extra sound within their head.
The sound can also be observable on examination by auscultating with a stethoscope around the ear
27
What does pulsatile tinnitus suggest?
May indicate a cardiovascular cause such as carotid artery stenosis
28
What are the suggested investigations for tinnitus?
Bloods to assess for underlying causes:
FBC (anaemia), glucose (diabetes), TSH (thyroid), lipids (hyperlipidaemia)
Audiology
Imaging (CT/MRI)
29
What is the fluid which fills the semicircular canals called?
Endolymph
30
What are the 4 most common causes of vertigo?
BPPV
Menieres disease
Vestibular neuronitis
Labrynthitis
31
What causes BPPV?
Crystals of calcium carbonate called otoconia becoming displaced in the semicircular canals
32
What manoeuvre can be used to diagnose BPPV?
Dix-hallpike
33
What are the symptoms pf menieres disease?
Unilateral hearing loss, tinnitus, vertigo and a sense of fullness in the ear
34
What causes acute vestibular neuronitis?
inflammation of the vestibular nerve, usually secondary to a viral infection
35
What causes labrynthitis?
Inflammation of the inner ear. Usually due to viral infection
36
Name 4 central causes of vertigo
Posterior circulation infarction
Tumour
MS
Vestibular migraine
37
Which test can be used to diagnose a peripheral cause of vertigo?
Head impulse test
38
Which test can be used to diagnose a central cause of vertigo?
Test of skew
39
Which medications can be used to manage symptoms of peripheral vertigo?
Prochlorperazine
| Antihistamines
40
Which medication can be used to reduce attacks in menieres disease?
Betahistine
41
Which manoeuvre can treat BPPV?
Epley manoeuvre
42
Where do otoconia most often occur?
Posterior semi circular canal
43
What are the symptoms of vestibular neuritis?
Constant vertigo, nausea and vomiting and balance problems
44
Which symptoms differentiate neuronitis and labrynthitis?
Labrynthitis- loss of hearing and tinnitus
| neuronitis- no loss of hearing or tinnitus
45
Which 2 conditions is labyrinthitis usually secondary to?
Otitis media or meningitis
46
Which disease are patients always offered an audiology assessment after recovering from?
Meningitis
47
What is the triad of symptoms in menieres disease?
Hearing loss
vertigo
tinnitus
48
What is the increased pressure in the inner ear called in menieres disease?
Endolymphatic hydrops
49
What is the pattern of vertigo in menieres disease?
20 minute episodes
50
What is the management for acute attacks of menieres?
Prochlorperazine
| Antihistamines
51
What is the prophylaxis for menieres?
Betahistine
52
Which cells are acoustic neuromas a tumour of?
Schwann cells
53
Where do acoustic neuromas occur?
Cerebellopontine angle
54
Which disease are acoustic neuromas associated with?
Neurofibromatosis type II
May be bilateral in this case
55
What is the presentation of an acoustic neuroma?
Unilateral sensorineural hearing loss
Unilateral tinnitus
Dizziness or imbalance
Sensation of fullness in the ear
56
What are the investigations for ?acoustic neuroma?
```
Audiometry
Brain injury (CT or MRI)
```
57
What is the management of acoustic neuroma?
Conservative
Surgery
Radiotherapy (+/- surgery)
58
What is a cholesteatoma made up of?
Squamous epithelial cells
59
What is the presentation of cholesteoma?
Foul discharge from the ear
Unilateral conductive hearing loss
60
What is the management of cholesteatoma?
CT head to assess the severity
Surgical removal
61
What is the pathway of the facial nerve?
exists the brainstem at the cerebellopontine angle
| Passes through the temporal bone and the parotid gland
62
What are the 5 branches of the facial nerve?
```
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
```
63
what are the motor functions of the facial nerve?
Supplies the muscles of facial expression, the stapedius, posterior digastric, stylohyoid platysma muscles of the neck
64
What are the sensory functions of the facial nerve?
Carries taste from the anterior 2/3 of the tongue
65
What are the parasympathetic functions of the facial nerve?
Submandibular and sublingual salivary glands
lacrimal gland
66
In which type of motor neurone lesion is the forehead spared? Why is this and what is the differential?
Upper motor neurone lesion
Each side of the forehead has upper motor neurone innervation by both sides of the brain. However, each side of the forehead only has lower motor neurone innervation from one side of the brain.
Suspect stroke (yikes!)
67
What is bells palsy?
Unilateral lower motor neurone facial nerve palsy
68
What is the management of bell's palsy?
Prednisolone if presented within 72 hours of symptom onset
| Lubricating eye drops to protect against exposure keratopathy
69
which virus causes Ramsay-Hunt syndrome?
Herpes zoster
70
What is the presentation of ramsay-hunt syndrome?
Unilateral motor neurone facial nerve palsy, tender and painful vesicular rash in the ear canal, pinna and around the ear
71
What is the management of ramsay hunt?
Prednisolone
| Aciclovir
72
Where does the bleeding in epistaxis usually originate?
Kiesselbach's plexus in little's area
73
If nose bleeding in bilateral, where is the likely location of bleeding?
Posterior in the nose
74
What is the management of acute epistaxis?
Sit up and tilt head forwards. Squeeze the soft part of the nostrils together for 10-15 mins
If this doesn't stop, nasal packing or nasal cautery using silver nitrate sticks
75
What can be prescribed after an acute nosebleed is resolved and why?
Naseptin (chlorhexidine and neomycin) QDS to reduce crusting, inflammation and infection
76
When is naseptin contraindicated?
Peanut or soya allergy
77
What are the time periods which define acute and chronic sinusitis?
```
Acute= <12 weeks
Chronic= >12 weeks
```
78
What are the holes called in the sinuses which allow the mucous to drain?
Ostia
79
Name the 4 sets of paranasal sinuses
Frontal
Maxillary
Ethmoid
Sphenoid
80
Name 4 possible causes for inflammation of the sinuses
Infection
Allergies
Obstruction (foreign bodies, polyps, trauma)
Smoking
81
How does sinusitis present?
```
Nasal congestion
Nasal discharge
Facial pain or headache
Facial pressure
Facial swelling
Loss of smell
Fever
```
82
What are the investigations which can be done for sinusitis?
Nasal endoscopy
| CT scan
83
What is the management of acute sinusitis?
Do not offer antibiotics for the first 10 days, most causes are viral
High dose steroid spray for 14 days (mometasone)
Delayed abx prescription if not improved after 7 days (phenoxymethylpenicillin)
84
What are the options for managing chronic sinusitis?
Saline nasal irrigation
Steroid nasal sprays or drops
Functional endoscopic sinus surgery
85
What is the proper technique for using steroid nasal sprays?
Ask, “do you taste the spray at the back of your throat after using it?” Tasting the spray means it has gone past the nasal mucosa= not be as effective.
1. Tilt head forward
2. Left hand to spray into right and vice versa (away from septum)
3. Don't sniff hard during the spray
4. Very gently inhale through the nose after the spray
86
Which is a red flag- unilateral or bilateral nasal polyps?
Unilateral - think tumour
87
Which conditions are nasal polyps associated with?
Chronic rhinitis or sinusitis
Asthma
Samter's triad (nasal polyps, asthma and aspirin intolerance)
Cystic fibrosis
Eosinophilic granulomatosis with polyangiitis
88
What is the presentation of nasal polyps?
```
Chronic rhinosinusitis
Difficultly breathing through the nose
Snoring
Nasal discharge
Anosmia
```
89
How can nasal polyps be assessed?
Nasal speculum
Otoscope with big attachment
Nasal endoscopy
90
What is the management of nasal polyps?
Intranasal topical steroid drops or spray
Surgery- intranasal/ endoscopic nasal polypectomy
91
What are the risk factors for OSA?
```
Middle age
Male
Obesity
Alcohol
Smoking
```
92
What are some features of OSA?
```
Episodes of apnoea during sleep (often reported by partner)
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
Concentration problems
Reduced oxygen sats during sleep
```
93
Which tool is used to assess symptoms of sleepiness associated with sleep apnoea?
The epworth sleepiness scale
94
What is the management of OSA?
1. Correct reversible risk factors
2. CPAP
3. Surgery- uvulopalatopharyngoplasty
95
What is the most common bacterial cause of tonsilitis?
Group A strep (Strep pyogenes)
96
What is the ring of lymphoid tissue in the pharynx (which contains the adenoids, tubal tonsils, palatine tonsils and lingual tonsil) called?
Waldeyer's tonsillar ring
97
What is the typical presentation of tonsilitis?
Sore throat
Fever (above 38)
Pain on swallowing
Enlarged tonsils with or without exudate
98
What are the criteria of the FeverPAIN score?
```
Fever in 24 hours
P- purulence
A- attended within 3 days of onset
I- inflammed tonsils
N- no cough or coryza
```
99
What score is needed in FeverPAIN for a antibiotic prescription?
>/= 4
100
Which abx should be prescribed in tonsilitis? (and if pen allergic)
Penicillin V (phenoxymethylpenicillin)
Clarithromycin if allergic (loser)
101
Name some complications of tonsilitis
```
Peritonsillar abscess
Otitis media
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis
```
102
What are the borders of the anterior triangle?
Mandible (superior)
Midline of the neck (medial)
Sternocleidomastoid (lateral)
103
What are the borders of the posterior triangle?
Clavicle (inferior)
Trapezius (posterior)
Sternocleidomastoid (medial)
104
What are the 2 week wait criteria for neck lumps?
1. unexplained neck lump in someone >45 years old
| 2. Persistent neck lump at any age
105
Which blood tests should be done for neck lumps?
```
FBC and blood film
HIV test
Monospot test or EBV antibodies
TFT
ANA
LDH (tumour marker for hodgkins)
```
106
Which investigations should be done for a neck lump?
1. Bloods
2. Imaging (ultrasound, CT/MRI and nuclear medicine scan)
3. Biopsy
107
What are the 4 groups of lymphadenopathy?
1. reactive
2. infected
3. inflammatory
4. malignancy
108
what is the presentation of infectious mononucleosis?
Fever
Sore throat
Fatigue
Lymphadenopathy
109
What can occur if you give someone with mononucleosis amoxicillin?
They can develop an intensely itchy maculopapular rash
110
What is the first line investigation for mononucleosis?
The mono-spot test
111
What advise should be given to people with mononucleosis?
```
Avoid alcohol (increased risk of liver impairment)
Avoid contact sport (increased risk of splenic rupture)
```
112
What are the three reasons for salivary glands to enlarge?
Stones blocking drainage (sialolithiasis)
Infection
Tumours
113
Where is the carotid body located?
Just above the carotid bifurcation
114
What are the chemoreceptors in the carotid body called? What is a group of these cells called?
Glomus cells
Paraganglia
115
What is the other name for a carotid body tumour?
Paragangliomas
116
Which nerves can carotid body tumours press on?
Glossopharyngeal (IX)
Accessory (XI)
Hypoglossal (XII)
Vagus (X)
117
What can be caused by a carotid body tumour pressing on the vagus nerve?
Horner's syndrome:
Ptosis
Anhydrosis
Miosis
118
What is the characteristic finding on imaging for carotid body tumour?
Splaying of the internal and external carotid arteries (lyre sign)
119
What is a key differential when considering a thyroglossal cysts?
Ectopic thyroid tissue
120
What are the red flags for head and neck cancer?
```
Lump in mouth or on lip
Unexplained mouth ulceration which lasts more than 3 weeks
Erythoplakia or erythroleucoplakia
Persistent neck lump
Unexplained horseness of voice
Unexplained thyroid lump
```
121
Which monoclonal antibody is commonly used to target squamous cell carcinomas of the head and neck?
Cetuximab
122
What are some causes of glossitis?
```
Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure
```
123
What are the 3 top causes of angioedema (which can lead to tongue swelling)?
Allergic reactions
ACE-i
C1 esterase inhibitor deficiency (hereditary angioedema)
124
Which factors can cause oral candidiasis?
```
Inhaled corticosteroids
Antibiotics
Diabetes
Immunodeficiency (HIV)
Smoking
```
125
What are the treatment options for oral candidiasis?
Miconazole gel
Nystatin suspension
Fluconazole tablets
126
What are the 2 key causes of strawberry tongue?
Scarlet fever
| Kawasaki disease
127
What is leukoplakia?
white patches in the mouth (tongue and inside of cheeks). It is a precancerous condition and increases the risk of squamous cell carcinoma of the mouth
128
What are the 3 patterns that lichen planus can form in the mouth?
reticular
Erosive
Plaque
129
What is wickham's striae?
A reticular pattern of lichen planus in the mouth. It involves a net-like web of white lines
