Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General practice > ENT > Flashcards

ENT Flashcards

1
Q

What is otitis media

A

Infection in the middle ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common bacterial cause of otitis media

A

The most common bacterial cause of otitis media is streptococcus pneumoniae. This also commonly causes other ENT infections such as rhino-sinusitis and tonsillitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Presentation of otitis media

A

Ear pain is the primary presenting feature of otitis media in adults.

It may also present with:

Reduced hearing in the affected ear
Feeling generally unwell, for example with fever
Symptoms of an upper airway infection such as cough, coryzal symptoms and sore throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why does otitis media sometimes cause balance issues and vertigo

A

Can infect and affect the vestibular system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Otoscope examination - otitis media

A

Bulging, red, inflamed looking membrane.

When there is a perforation, you may see discharge in the ear canal and a hole in the tympanic membrane.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of otitis media

A

Most resolve without abx within around 3 days

Simple analgesia for pain and fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When should you consider immediate antibiotics for otitis media

A

Consider immediate antibiotics at the initial presentation in patients who have significant co-morbidities, are systemically unwell or are immunocompromised.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When should you consider a delayed prescription for otitis media

A

Consider a delayed prescription that can be collected and used after three days if symptoms have not improved or have worsened at any time. This can be a helpful strategy in patients pressing for antibiotics or where you suspect the symptoms might worsen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Appropriate antibiotics for otitis media

A

Amoxicillin for 5-7 days first-line
Clarithromycin (in pencillin allergy)
Erythromycin (in pregnant women allergic to penicillin)

Always safety-net, offering education and advice to patients on when to seek further medical attention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of otitis media

A 
Otitis media with effusion
Hearing loss (usually temporary)
Perforated tympanic membrane (with pain, reduced hearing and discharge)
Labyrinthitis (causing dizziness or vertigo)
Mastoiditis (rare)
Abscess (rare)
Facial nerve palsy (rare)
Meningitis (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is mastoiditis

A

Mastoiditis is inflammation of the mastoid antrum and the lining of the mastoid air cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common aetiology of mastoiditis

A

Children of school age following an untreated episode of acute otitis media or recurrent episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risk factors for developing mastoiditis

A 
Immunosuppression.
Diabetes mellitus.
Congenital defects of the middle and outer ear.
Recurrent episodes of acute otitis media
Cholesteatoma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical features of mastoiditis

A

Recent or concurrent acute otitis media in around 50% of cases.
Deep otalgia on the affected side in nearly all cases.
Recent loss of hearing (progressive) on affected side.
Generally unwell with young children often not eating or drinking as normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Key findings on examination in mastoiditis

A

Fever.

Usually bulging tympanic membrane with clear fluid level or perforation with purulent discharge from the ear.

Erythema and swelling over mastoid process behind the ear in up to 75% of cases.

Mastoid tenderness.

Cervical lymphadenopathy on affected side.

External ear may protrude forwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Key IX for mastoiditis

A

CT scanning is quick and will demonstrate the extent of mastoid air cell opacification.

A CT scan with contrast can also identify intracranial infection and the extent of this.

MRI imaging is better for identifying intracranial infection and will give better detail of the soft tissues but struggles to see the bone in as much detail.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Antibiotic for mastoiditis

A

Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can mastoiditis cause facial nerve damage

A

If the infection enters the facial canal within the bone it can result in facial nerve damage and ipsilateral facial weakness (without forehead sparing due to the lower motor neurones being affected).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most serious complication of mastoiditis

A

Meningitis.
Formation of a subdural empyema.
Intracerebral abscess formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common bacterial causes of otitis external

A

Pseudomonas aeurginosa

Staphylococcus aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of inflammation in otitis externa

A 
Bacterial infection
Fungal infection (e.g., aspergillus or candida)
Eczema
Seborrhoeic dermatitis
Contact dermatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Symptoms of otitis externa

A

Ear pain
Discharge
Itchiness
Conductive hearing loss if blocked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Examination findings in otitis externa

A

Erythema and swelling in the ear canal
Tenderness of the ear canal
Pus or discharge in the ear canal
Lymphadenopathy (swollen lymph nodes) in the neck or around the ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diagnosis of otitis externa

A

Otoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mx of mild otitis externa

A

Acetic acid 2% OTC (EarCalm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Self-care measures for acute otitis externa

A

Avoid ear buds
Avoid swimming
Keep shampoo, soap, and water out of the ear when bathing and showering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Management of moderate otitis externa

A

Moderate otitis externa is usually treated with a topical antibiotic and steroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Mx of fungal otitis externa

A

Clotrimazole ear drops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is malignant otitis externa

A

Severe and potentially life-threatening form of otitis externa. The infection spreads to the bones surrounding the ear canal and skull.

It progresses to osteomyelitis of the temporal bone of the skull.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Risk factors for malignant otitis externa

A

Diabetes
Immunosuppressant meds(chemo)
HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a key finding in malignant otitis externa

A

Granulation tissue at the junction between the bone and cartilage in the ear canal (about halfway along) is a key finding that indicates malignant otitis externa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Mx of malignant otitis externa

A

Admission to hospital under the ENT team
IV antibiotics
Imaging (e.g., CT or MRI head) to assess the extent of the infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Complications of malignant otitis externa

A 
Facial nerve damage and palsy
Other cranial nerve involvement (e.g., glossopharyngeal, vagus or accessory nerves)
Meningitis
Intracranial thrombosis
Death
34
Q

When should follow up for otitis externa be arranged

A

Symptoms have not fully resolved after 2 weeks of starting initial treatment.

Symptoms are severe and/or there is cellulitis spreading beyond the external ear canal

The person is immunocompromised and at risk of severe infection, depending on clinical judgement.

35
Q

When does hearing impairment require thorough assessment immediately

A

Sudden onset hearing loss (over less than 72 hours) requires a thorough assessment to establish the cause.

36
Q

Weber’s test result that indicates sensorineural hearing loss

A

In sensorineural hearing loss, the sound will be louder in the normal ear (quieter in the affected ear).

The normal ear is better at sensing the sound.

37
Q

Weber’s test result that indicates conductive hearing loss

A

In conductive hearing loss, the sound will be louder in the affected ear.

This is because the affected ear “turns up the volume” and becomes more sensitive, as sound has not been reaching that side as well due to the conduction problem.

When the tuning fork’s vibration is transmitted directly to the cochlea, rather than having to be conducted, the increased sensitivity makes it sound louder in the affected ear.

38
Q

What is a normal rinne test result

A

A normal result is when the patient can hear the sound again when bone conduction ceases and the tuning fork is moved next to the ear rather than on the mastoid process.

It is normal for air conduction to be better (more sensitive) than bone conduction. This is referred to as “Rinne’s positive”.

39
Q

Rinne test result that indicates conductive hearing loss

A

An abnormal result (Rinne’s negative) is when bone conduction is better than air conduction. The sound is not heard after removing the tuning fork from the mastoid process and holding it near the ear canal.

40
Q

Causes of sensorineural hearing loss

A 
Presbycusis (age-related)
Noise exposure
Ménière’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
Infections
41
Q

Medications associated with sensorineural hearing loss

A 
Loop diuretics (e.g., furosemide)
Aminoglycoside antibiotics (e.g., gentamicin)
Chemotherapy drugs (e.g., cisplatin)
42
Q

Causes of conductive hearing loss

A 
Ear wax
Infection
Effusion
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
43
Q

What is presbyacusis

A

It is a type of sensorineural hearing loss that occurs as people get older. It tends to affect high-pitched sounds first and more notably than lower-pitched sounds.

The hearing loss occurs gradually and symmetrically.

44
Q

Risk factors for presbyacusis

A 
Age
Male gender
Family history
Loud noise exposure
Diabetes
Hypertension
Ototoxic medications
Smoking
45
Q

What are patients with hearing loss more likely to develop

A

patients with hearing loss are more likely to develop dementia, and treating the hearing loss (e.g., a hearing aid) may reduce the risk.

46
Q

Mx of presbyacusis

A

Optimising the environment, for example, reducing the ambient noise during conversations
Hearing aids
Cochlear implants (in patients where hearing aids are not sufficient)

47
Q

Conductive causes of rapid-onset hearing loss

A

Ear wax (or something else blocking the canal)
Infection (e.g., otitis media or otitis externa)
Fluid in the middle ear (effusion)
Eustachian tube dysfunction
Perforated tympanic membrane

48
Q

Causes of SSNHL

A 
Idiopathic(90%)
Meniere's disease 
Otoxic meds 
MS
Migraine 
Stroke 
Acoustic neuroma
49
Q

Diagnosis of SSNHL

A

Audiometry is required to establish the diagnosis. A diagnosis of SSNHL requires a loss of at least 30 decibels in three consecutive frequencies on an audiogram.

50
Q

Mx of SSNHL

A

immediate referral to ENT for assessment within 24 hours for patients presenting with sudden sensorineural hearing loss presenting within 30 days of onset.

Idiopathic SSNHL may be treated with steroids

51
Q

Purpose of Eustachian tube

A

The Eustachian tube is present mainly to equalise the air pressure in the middle ear and drain fluid from the middle ear.

52
Q

What might Eustachian tube dysfunction may be related to

A

Eustachian tube dysfunction may be related to a viral upper respiratory tract infection (URTI), allergies (e.g., hayfever) or smoking

53
Q

Presentation of Eustachian tube dysfunction

A 
Reduced or altered hearing
Popping noises or sensations in the ear
A fullness sensation in the ear
Pain or discomfort
Tinnitus

Symptoms tend to get worse when external pressure changes and middle ear pressure cannot equalise to the outside pressure

54
Q

IX for Eustachian tube dysfunction

A

May not be required if URTI/hayfever aetiology

Tympanometry
Audiometry
Nasopharyngoscopy
CT scan

55
Q

Mx of eustachian tube dysfunction

A

No rx if URTI
Valsalva manoeuvre
Decongestant nasal sprays(short term only)
Antihistamines and a steroid nasal spray
Surgery

Otovent

56
Q

Surgical options for mx of Eustachian tube dysfunction

A

Treating any other pathology that might be causing symptoms, for example, adenoidectomy (removal of the adenoids)
Grommets
Balloon dilatation Eustachian tuboplasty

57
Q

What is otosclerosis

A

There is remodelling of the small bones in the middle ear, leading to conductive hearing loss

58
Q

Otosclerosis aetiology

A

Combination of environmental and genetic factors, although the exact mechanism is not understood.

It can be inherited in an autosomal dominant pattern.

59
Q

Presentation of otosclerosis

A

Age < 40 - hearing loss and tinnitus

Affects hearing of lower-pitched sounds more

Patient can experience their voice as being loud compared to the environment (due to bone conduction of their voice)

60
Q

Mx of otosclerosis

A

Conservative, with use of hearing aids

Surgical(stapectomy or stapedotomy)

61
Q

Main methods for removing excessive ear wax

A

Ear drops – usually olive oil or sodium bicarbonate 5%

Ear irrigation – squirting water in the ears to clean away the wax

Microsuction – using a tiny suction device to suck out the wax

62
Q

Systemic conditions associated with tinnitus

A

Anaemia
Diabetes
Hypothyroidism or hyperthyroidism
Hyperlipidaemia

63
Q

What is objective tinnitus

A

Refers to when the patient can objectively hear an extra sound within their head

64
Q

Causes of objective tinnitus

A 
Carotid artery stenosis (pulsatile carotid bruit)
Aortic stenosis (radiating pulsatile murmur sounds)
Arteriovenous malformations (pulsatile)
Eustachian tube dysfunction (popping or clicking noises)
65
Q

Red flags in tinnitus assessment

A 
Unilateral tinnitus
Pulsatile tinnitus
Hyperacusis (hypersensitivity, pain or distress with environmental sounds)
Associated unilateral hearing loss
Associated sudden onset hearing loss
Associated vertigo or dizziness
Headaches or visual symptoms
66
Q

General mx of tinnitus

A

Tends to improve or resolve over time

Treat underlying causes

Hearing aids
Sound therapy (adding background noise to mask the tinnitus)
Cognitive behavioural therapy

67
Q

Most common peripheral causes of vertigo

A

Benign paroxysmal positional vertigo
Ménière’s disease
Vestibular neuronitis
Labyrinthitis

68
Q

BPPV pathophys

A

caused by crystals of calcium carbonate called otoconia that become displaced into the semicircular canals

69
Q

Causes of BPPV

A

They may be displaced by a viral infection, head trauma, ageing or without a clear cause

70
Q

Diagnosis of BPPV

A

Dix-Hallpike manoeuvre

71
Q

Pathophys of meneiere’s disease

A

caused by an excessive buildup of endolymph in the semicircular canals, causing a higher pressure than normal, disrupting the sensory signals

72
Q

Central causes of vertigo

A

Posterior circulation infarction (stroke)
Tumour
Multiple sclerosis
Vestibular migraine

73
Q

Peripheral vs central vertigo presentation

A

Peripheral more sudden, shorter, tinnitus often present, coordination intact and nausea more severe

74
Q

What is HINTS

A

HI – Head Impulse
N – Nystagmus
TS – Test of Skew

To distinguish between central and peripheral vertigo

75
Q

Mx of peripheral vertigo

A

Prochlorperazine
Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

Betahistine may reduce attacks in meneiere’s disease

76
Q

Antibiotics in otitis externa

A

Topical Ciproflox/dexamethasone 0.3%/0.1% ear drops

77
Q

What are renal transplant patients matched based on

A

human leukocyte antigen (HLA) type A, B and C on chromosome 6. They don’t have to fully match. Recipients can receive treatment to desensitise them to the donor HLA when there is a living donor.

78
Q

Incision associated with renal transplant

A

Hockey stick incision

79
Q

Immunosuppressant regime for patients post renal transplant

A

Tacrolimus
Mycophenolate
Prednisolone

80
Q

Complications relating to renal transplant

A

Transplant rejection (hyperacute, acute and chronic)
Transplant failure
Electrolyte imbalances

81
Q

Complications relating to immunosuppression in renal transplantation

A

Ischaemic heart disease
Type 2 diabetes (steroids)
Infections are more likely and more severe
Unusual infections can occur (PCP, CMV, PJP and TB)
Non-Hodgkin lymphoma
Skin cancer (particularly squamous cell carcinoma)

General practice (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions