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ENT Flashcards

1
Q

What is allergic rhinitis?

A

Inflammatory condition of the nasal mucosa

Characterised by nasal pruritus, sneezing, rhinorrhoea, nasal congestion

It is associated w/ allergic conjunctivitis with eye redness, puffiness and watery discharge
It is IgE MEDIATED RESPONSE TO ALLERGENS WITHIN THE ENVIRONMENT AND may demonstrate a seasonal variation

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2
Q

What are the causes of sensironeural hearing loss?

A 
Presbycusis 
Noise induced hearing loss 
congenital infections- rubella, CMV 
Neonatal complications 
drug induced deafness (aminoglycosides- gentamicin/neomycin) 7
Vascular pathology- stroke, TIA,
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3
Q

What are the risk factors for H+N neoplasia?

A

Smoking
Alcohol misuse
Viral infections- HPV (TYPE 16) and EBV
Radiation exposure
Immunosuppresion (Organ transplantation)
Occupational exposure (acid mists, asbestos, wood dust)
FHx

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4
Q

What do H+ N cancers present with?

A

Hoarseness, throat pain, tongue ulcers or a painless neck lump and symptoms for longer than 3 weeks duration should prompt utgent referral
they may present with weight loss and lymphadenopathy

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5
Q

What are the features of acute otitis media?

A

Deep seated pain, impaired hearing with systemic illness and fever
The onset is usually rapid with a feeling of aural fullness, followed by discharge when the tympanic membrane perforates with relief of pain
Tympanic membrane shows injection of blood vessels and then diffuse erythema
Bacterial infection is common particularly in young children

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6
Q

What are the complications of otitis media?

A

Extra cranial complications’ facial nerve palsy, mastoiditis, petrositis, labyrinthitis

Intra cranial- Meningitis, sigmoid sinus thrombosis (sepsis, swinging pyrexia, meningitis), brain abscess

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7
Q

What is the treatment of AOM?

A

most the time don’t need to treat but can give Amoxicillin for 5-7 days if systemically unwell, bilateral otitis media and under 2, >4days etc…

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8
Q

What is a cholesteatoma and what does it present like?

A

Overgrowth of stratified squamous epithelium in the middle ear
persistent foul smelling discharge, headache, otalgia

On examination there will be an area of white in the attic behind the tympanic membrane

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9
Q

What is a vestibular schwannoma, what are the clinical features, Ix, Management?

A

Benign subarachnoid tumour that causes local pressure effects on the VIII cranial nerve

clinical features- asymmetric or unilateral hearing loss and progressive ipsilateral tinnitus

MRI should always be performed in a pt with unilateral tinnitus and sensorineural deafness

Management is with surgery

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10
Q

What are the causes of conductive hearing loss?

A 
Wax impaction 
Otitis media w/ effusion 
Eustachian tube dysfunction 
Ear infections 
Perforations of the tympanic membrane 
Chronic suppurative otitis media
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11
Q

What are the clinical features of Menieres?

A

typically affects one ear, in 30 to 60 year old
Characterised by sudden paroxysmal vertigo (lasting 12-24 hours)
associated with deafness and tinnitus
attacks normally occur in clusters with periods of remission
nausea and vomiting, bed bound, fluctuating hearing

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12
Q

How do you manage menieres?

A

Betahistine

Prochlorperazine for acute attack

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13
Q

epistaxis

A

sjdkljwapo

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14
Q

What are the risk factors for head and neck cancers?

A 
Leukoplakia (1/3 become cancerous) 
Erytroplakia (1/2 become cancerous)
Tobacco/alcohol 
HPV 16 and 18 
Occupation- woodwork, textiles, nickel
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15
Q

What are the symptoms of head and neck cancer?

A 
Odynophagia/dysphagia >3 weeks
Hoarseness >3 weeks
Trismus- oropharyngeal malignancy 
Referred otalgia 
Dyspnoea/stridor

If they have had odynophagia/dysphagia/hoarseness for >3 weeks then they need a 2ww referral

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16
Q

What are the signs of H and N cancer?

A 
Erythroplakia
Leukoplakia 
Bleeding in mouth/throat or haemoptysis 
Persistent mouth ulceration (>3 weeks) 
Persistent unexplained neck lump (>3 weeks)
Weight loss, night sweats, fever
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17
Q

How do you diagnose H and N cancer?

A 
History and H and N exam 
Flexible nasal endoscopy 
Fine needle aspiration cytology 
CT/MRI of neck 
CXR/CT chest 
Bloods- FBC, UEs, LFT, TFT, glucose, albumin

Biopsy is diagnostic however avoid because it needs GA

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18
Q

In terms of H and N, what symptoms/signs would warrant 2ww referral?

A 
Odynophagia/dysphagia >3 weeks 
Hoarseness >3 weeks
Persistent unexplained neck lump >3 weeks
Persistent mouth ulceration>3 weeks
Leukoplakia 
Erytroplakia
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19
Q

What are the causes of dysphagia?

A

Structural changes- post op/radiotherapy
Obstructive- malignancy, pharyngeal oouch
Neurological- CVA/stroke
Muscular- age related weakness, cerebral palsy
Resp- COPD
Gastro oesophageal- LP reflux/GORD

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20
Q

What are the causes of neck lumps?

A

Infection
Neoplasm (lymphoma)
Thyroid- cyst, neoplasm, multinodular goitre
Thyroglossal cyst, cystic hygroma, branchial cyst
Salivary gland- neoplasm, infection, syone
Carotid aneurysm
Sebaceous cyst, lipoma

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21
Q

What are the 3 types of salivary glands?

A

Parotid
Submandibular
Sublingual

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22
Q

What are the causes of dry mouth?

A

Depression/anxiety
Drugs- antimuscarinics
Radiotherapy to head/neck
Sjorgens syndrome

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23
Q

What is scialadenitis?

A

Inflammation of gland
Caused by infection, stones, malignancy
Symptoms= swollen, tender gland
+/- Pus, +- fever and systemic symptoms

Treat w/ analgesia and abx

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24
Q

What is scialothiasis?

A

Calculi in glands

After eating swelling and pain

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25
``` What is tonsilitis? What does it present with What scoring system is used for tonsilitis? Management? Complications? ```
Acute bacterial infection (strep pyogenes, staph, m. Catarrhalis) Symptoms= sore throat and odynophagia, pyrexia, malaise, lymphadenopathy +/- Pus on tonsils Centor score= absence of cough, fever >38, tender cervical nodes, tonsillar exudates Management Analgesia, fluids, soft food, PO penicillin V if increased chance of being bacterial Tonsillectomy if recurrent/complications Complications= peritonsillar abscess (quincy), deep neck space infection
26
What is peritonsillar abscess? | What are the symptoms?
Pus between tonsil capsule and lateral pharyngeal wall (strep pyogenes) Sore throat, odynophagia, dysphagia, TRISMUS (restriction of the range of motion of the jaws), hot potato voice, referred otalgia
27
What are the signs of peritonsillar abscess?
Unilateral swelling lateral to tonsil | Deviated tonsil and uvula to the opposite side
28
What is the management of tonsilitis?
ENT referral Needle aspiration/incision and drainage IV ABX +/- steroids for swelling Analgesia, fluids, soft food
29
What are the symptoms, investigations and management of glandular fever (infectious mononucleosis)?
``` Symptoms= prodromal illness= fever/malaise Sore throat/dysphagia Cervical lymphadenopathy Abdo pain Hepatosplenomegaly ``` Investigations: FBC, LFTS, blood film, monospot test Management: supportive (analgesia, fluids), monitor LFTS, advice - avoid intimate contact, no contact sport as it can cause splenic rupture, no alcohol because this can lead to liver damage
30
What are the symptoms of pharyngitis ? What are the causes? What advice would you give?
Acute= sudden onset sore throat Causes are usually viral- rhinovirus, influenza, coronavirus, HSV, VZV May be bacterial= group A strep
31
What is epiglottitis caused by? What are the symptoms of epiglottitis What is the management
Haemophilus influenza B Symptoms= very dore throat and high fever, dysphagia, drooling, stridor Management= immediate admission, airway protection (intubation/tracheostomy), IV abx and steroids
32
What is the safety netting for tonsilitis?
Seek urgent medical help if develop abdo pain (splenic rupture in EBV) , reduced urine output, breathing problems Come back if abx dont work
33
What should you ask about in a patient who has came in with epistaxis?
Whether its bleedings from one side or both sides One side= more likely to be anterior bleed Both side= more likely to be posterior How long Any SOB, lethargy? Previous episodes/surgery/trauma Blood thinning medication
34
What is the stepwise management of epistaxis?
Silver nitrate cauterisation Nasal packing Surgical intervention- ligation of the sphenopalantine artery
35
What do foreign bodies in kids present like?
Offensive grey discharge from one nostril
36
What are the clinical features of otitis externa?
Otalgia Deafness Discharge
37
What pathogens cause otitis externa?
Pseudomonas auerignosa Staph aureus Candida Aspergillus
38
What is the managemeng of otitis externa?
Aural toilet (hoover out debris) Antibiotics and steroid drops Keep ear dry If this doesnt work then referral to ENT for microsuction
39
What do you need to think about in patients with otitis externa who have diabetes?
Necrotizing otitis externa
40
What is necrotizing otitis externa?
Skull based osteomyelitis | Potentially fatal
41
What are the suspicious features of necrotising otitis externa and what are the complications?
Suspicious features- night pain, granulations in ear canal, non resolving otitis externa Complications- sinus thrombosis, cerebral abscess, meningitis, aspiration due to palsies
42
What is the management of necrotising otitis externa?
Admit Get a CT Mdt management IV abx until resolution of pain and inflammatory markers
43
When should you give abx in acute otitis media?
``` Under 2 years old Bilateral Symptoms of local complications- facial weakness, diziness, visual change, neck swelling Severe or recurrent If no resolution after 3 days ```
44
What should you do if pt has mastoiditis?
Admit IV abx +/- CT scan and surgery
45
How do you read a audiogram
If there is a gap between the two lines= conductive hearing loss If both low= sensironeural hearing loss X= left
46
When is hearing los an emergency?
If sensorineural treat as an emergency Give high dose prednisolone for 1 week They should have an audiogram the next working day
47
What would be the rinnes and webers test show in conductive hearing loss?
Bone > air | Webers localises to affected ear
48
What would the rinnes and webers show in sensironeueal hearing loss?
Air > bone in Rinnes | Normal ear localisation in Webers
49
When would you admit someone with tonsilitis?
If they are unable to eat and drink
50
What should your immediate management for quinsy be?
Aspiration Admit IV Abx- benpen and metronidazole Dexamethasone
51
Why is stridor more common in children?
Small diameter of the airways
52
What are the causes of stridor in children?
``` Croup Acute epiglottitis Foreign body Laryngeal papilloma Congenital abnormalities Laryngomalacia ```
53
What are the causes of stridor in Adults?
``` Laryngeal neoplasms Bilateral vocal cord palsy Croup Epiglottitis Trauma FB Stenosis ```
54
Why would you do a tracheostomy?
Real upper airway obstruction- supraglottic, glottic, subglottic Impending upper airway obstruction If they are in ITU for a long period of time
55
What are the causes of otitis externa?
Can be bacterial or fungal Bacterial= staph aureus or pseudomonas Fungi- candida, aspergillus
56
What advice should you give someone with otitis externa?
Dont go swimming Dont use ear buds Professional removal of ear wax
57
What are the causes of middle ear infections?
Influenza, H influenza, staph pneumonia
58
What are the symptoms of otitis media?
``` Otalgia Fever Conductive hearing loss Bulging tympanic membrane May have tympanic membrane perforation and pus/blood ```
59
What is the treatment of acute otitis media?
Most cases resolve within 24 hours May give topical abx/steroids Oral amoxicillin in some cases
60
What is chronic suppurative otitis media? What are the symptoms? What is the management?
This is repeated ASOM (for more than 6 weeks) Non healing TM perforation Symptoms= repeated ottorhoea, conductive hearing loss Regular aural toilet, ENT referral, abx and steroid drops
61
What are the symptoms of mastoiditis?
``` Otalgia Hearing loss Malaise Pyrexia Pinna down and forwards Post auricular swelling ```
62
What is acute otitis media w/ effusion? What are the symptoms? What are the causes? What is the management?
Fluid in the middle ear Glue ear Symptoms - middle ear fluid with no signs of infection (it is painless) - conductive hearing loss 20-30 - speech delay and school problems ``` Causes eustachian tube dysfunction Nasal/ sinus infeftion Allergic response Ciliary dysfuncton ``` Management Most resolve by themselves If more than 3 months without resolution then give grommets and hearing aids
63
What is cholesteatoma?
Accumulation of keratinising squamous epithelium in the middle ear Caused by pseudomonas aeurignosa
64
What is the presentation of cholesteatoma?
Conductive hearing loss Foul smelling otorrhoea Attic retractuin and squamous debris
65
What do you get with tympanic membrane perforation?
Conductive HL | +/- pain, tinnitus, vertigo
66
What are the causes of sensironeural hearing loss?
``` Anything that affects the inner ear Menieres Viral infection Ototoxic drugs Temporal bone fracture Tumour (exclude acoustic neuroma with an MRI or CT) ```
67
What is an acoustic neuroma?
A vestibular schwannoma which compresses the craniak nerve 8
68
What are the symptoms of acoustic neuroma?
Unilateral SNHL, tinnitus, vertigo +/- neuro symptoms
69
How do you investigate acoustuc neuroma? | How do you manage?
Pure tone audiometry CT/MRI Management is with surgical excision (there is a risk to the facial nerve), highly focused radiotherapy
70
What is presbyacusis? | What symptoms do you get?
A cause of sensironeural hearing loss, it is due to aging and loss of outer hair cells of cochlea You get bilateral SNHL +/- tinnitus which is worse with background noise Pure tone audiometry and otoscopy can be used to disgnose
71
What are some causes of ototoxicity?
Diuretics Aminoglycosides (gentamicin) Salicylates Chemo agents
72
What are the causes of vertigo?
``` Menieres Acoustic neuroma Ramsay hunt Otoxicity BPPV Acute labyrinthitis ```
73
What is BPPV What is the diagnostic Ix What is the treatment
The presence of debris in the semicircular canals of the ears causing vertigo upon head movement The hallpike manouevre is diagnostic, where certain movements of the head causes fatiguable nystagmus Epley manoueveres and vestibular sedatives (prochlorperazine)
74
What is the management of labyrinthitis and vestibular neuronitis?
Vestibular sedatives (prochlorperazine) Bed rest Antiemetics
75
What are the features of menieres disease and how do you treat?
Vertigo Sensironeural hearing loss Tinnitus Aural fullness Treatment involves antihistamines and bed rest
76
Give some causes of facial palsy..,
Bells palsy Ramsay hunt Stroke
77
What should you do Ix wise for facial palsy?
``` Hx Ent exam Neuro exam PTA Electroneurogeaphy MRI/CT ```
78
What is bells palsy? | What is the management?
Viral infection of facial nerve (increased risk in diabetes and pregnancy) Ipsilateral facial palsy +/- pain Management= high dose PO steroids, eye care and analgesia
79
What is ramsay hunt syndrome? What are the symptoms What is the management
Herpes zoster virus infection of the facial nerve Symptoms= ipsilateral facial palsy, ear pain/vesicles, vesicular rash +/- SNHL, vertigo, tinnitus Management= acyclovir +/- steroids Eye care and analgesia
80
What are the red flags for FNP?
Neuro symptoms- CVA Progressive palsy/ parotid mass- neoplasm Associated ear infection/ foul otorrhoea- cholesteatoma

Finals (24 decks)

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