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Finals Revision > ENT > Flashcards

ENT Flashcards

1
Q

How should a pinna haematoma be managed?

A

Urgent drainage <24 hrs : aspiration or incision
Secure a dental roll in place + tight headband to prevent re-accumulation
PO Abx if infected
ENT clinic followup to ensure no deformity

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2
Q

What is the difference between pinna perichondritis and pinna cellulitis?

A

Perichondritis spares the earlobe, cellulitis affects whole ear
Perichondritis most commonly pseudomonas
Cellulitis most commonly staph aureus

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3
Q

What are the risk factors for otitis externa?

A 
Swimming
Cotton bud use
Canal obstruction
Humidity 
Allergy and skin disease
Immunocompromise
Prolonged topical antibiotics
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4
Q

What are the key bacteria involved in otitis external?

A

Staph aureus and pseudomonas

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5
Q

What are the symptoms of otitis external?

A 
Ear pain (pulling in children)
Tragal tenderness
Erythema and swelling
Otorrhoea
Sensation of fullness
Itching
Reduced hearing
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6
Q

What are differentials for otitis externa?

A 
Foreign body
Cellulitis
Otitis media
Dermatitis
Mastoiditis
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7
Q

How is otitis external managed?

A

KEEP EAR DRY
Mild cases may be treated with acetic acid 2%
7-10 days topical antibiotics with steroids e.g. sofradex
Oral abx if resistant
Analgesia
Microsuction

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8
Q

What are symptoms of malignant otitis externa?

A 
Severe deep otalgia
Foul smelling discharge
Headache
Vertigo
Hearing loss
Not responding to topical antibiotics

May have granulation tissue / exposed bone in the ear canal
Facial nerve palsy

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9
Q

How is malignant otitis externa managed?

A

High resolution CT of temporal bones

6 weeks IV and topical abx
May need surgical management of collections and abscesses

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10
Q

What are symptoms of mastoiditis?

A

Usually present days-weeks after otitis media
Fever, persistent throbbing otalgia
Redness
Swelling
Tenderness
Fluctuance and swelling of mastoid process
Lateral and inferior displacement of the pinna

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11
Q

How is mastoiditis managed?

A

IV ceftriaxone and steroids

May need surgical mastoidectomy to manage abscesses

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12
Q

What are the common causative organisms in otitis media?

A

Strep pneumoniae, Haemoglobin influenzae

RSV, rhinovirus

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13
Q

What are the symptoms of otitis media?

A

Often preceding URTI
Otalgia = primary presenting feature in adults
Fever
Spontaneous perforation of tympanic membrane
Purulent Otorrhoea

Ear pulling and poor feeding in small children
Bulging tympanic membrane
May have a fluid membrane

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14
Q

What is the management for otitis media?

A

Oral analgesia
Viral infections are self-limiting usually within 3 days

5-7d oral amoxicillin first line in suspicion of bacterial infection
Clarithromycin if penicillin allergic

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15
Q

What are the two types of chronic otitis media?

A

Mucosal- perforation of the tympanic membrane, chronic middle ear infection

Squamous- tympanic membrane retraction, accumulation of keratin, cholesteatoma

Characterised by ear discharge >2w without pain, fever or tinnitus

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16
Q

What are the symptoms of cholesteatoma?

A 
Conductive hearing loss
Ear discharge resistant to antibiotics
Crusting of retraction pocket 
Tinnitus 
Otalgia

With progression: vertigo, sensorineural hearing loss, facial nerve palsy, meningitis, abscess

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17
Q

How would you manage cholesteatoma?

A

Canal wall-up mastoidectomy

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18
Q

What are the causes of sudden sensorineural deafness?

A 
90% idiopathic
Meningitis/mumps/HIV
Extreme noise
Barotrauma
Acoustic neuroma
Ototoxic medication
Stroke/vasculitis
Labyrinthitis
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19
Q

What are the causes of chronic sensorineural deafness?

A

Presbyacusis
Environmental noise toxicity
Inherited disorders
Diabetic neuropathy

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20
Q

What are the causes of conductive deafness?

A 
Obstruction: foreign body, earwax
Cholesteatoma
Otosclerosis
Otitis media/glue ear
Otitis externa
Trauma- ossicle fracture
Facial nerve palsy (stapedius paralysis)
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21
Q

What is the most common cause of rhinosinusitis?

A

Viral URTI

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22
Q

What are the symptoms of rhinosinusitis?

A

Nasal congestion
Facial pain- worse on leaning forward
Sensation of fullness
Decreased sense of smell

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23
Q

How is rhinosinusitis managed?

A

Saline irrigation
Antihistamines + trigger avoidance in allergic causes
Topical nasal steroids

Only abx if symptoms suggestive of bacterial sinusitis complication/ symptoms >14 days

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24
Q

Which is a red flag: unilateral or bilateral nasal obstruction?

A

Unilateral

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25
Q

How are nasal polyps managed?

A

Oral prednisolone
Topical steroid e.g. fluticasone, beclometasone
Nasal saline irrigation

Surgical removal if refractory and bothersome

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26
Q

What is the recommended management algorithm for epistaxis?

A 
Compression 10-15 min, lean forward
\+ ice to try vasoconstrict
If source visible: silver nitrate cautery (topical lidocaine first)
If not: try anterior packing
If no help: posterior pack
Sphenopalatine artery ligation

Naseptin antiseptic ointment 1-2w to prevent crusting and keep clean
Prevent blowing nose, hot showers + baths, exercise, spicy food

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27
Q

What are important investigations in epistaxis?

A

FBC + Clotting
BP
Rule out bleeding disorders
Examination incl. rhinoscopy

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28
Q

What is the most common bacterium causing quinsy?

A

Streptococcus pyogenes

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29
Q

How does quinsy commonly present?

A

Following recent episode of bacterial tonsilitis
Unilateral peritonsillar swelling, displacement of the uvula
Sore throat, Fever, Malaise
Muffled voice, dysphagia, drooling, difficulty breathing
Trismus
Neck swelling

30
Q

How is quinsy managed?

A 
Incision and drainage
IV antibiotics- clindamycin
IV steroids- dex
IV fluids 
Analgesia
31
Q

What is the management of epiglottitis?

A 
Airway management + A-E
IV cephalosporin antibiotics
IV dexamethasone
IV fluids
Humidified oxygen
32
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma

33
Q

Which thyroid cancer is part of MEN-2?

A

Medullary carcinomas

34
Q

How are papillary and follicular thyroid cancers managed?

A

total thyroidectomy
followed by radioiodine (I-131) to kill residual cells
yearly thyroglobulin levels to detect early recurrent disease

35
Q

What are the differential causes of hoarse voice?

A 
Laryngitis
Pancoast tumours
Largyngeal fold carcinoma
Vocal cord palsy 
Vocal fold polyps
36
Q

How does presbyacusis present?

A

Gradual and insidious hearing loss
Loss of high frequency sounds first
May have associated tinnitus

Diagnosed by audiometry

37
Q

What is the inheritance pattern of otosclerosis?

A

Autosomal dominant

38
Q

What type of hearing loss occurs in otosclerosis?

A

Conductive

39
Q

Which frequencies are most affected by otosclerosis?

A

Lower pitched sounds

40
Q

What are treatment options for otosclerosis?

A

Conservative with use of hearing aids

Stapedectomy

41
Q

What are the peripheral causes of vertigo?

A 
BPPV
Meniere's disease
Vestibular neuronitis
Labyrinthitis 
Acoustic neuroma
HZV infection
42
Q

What are the central causes of vertigo?

A

Posterior circulation stroke
Tumour
MS
Vestibular migraine

43
Q

How would you investigate vertigo?

A 
Ear examination
Neurological examination
CV examination
Cerebellar examination
Romberg's/Dix-Hallpike/HINTS
44
Q

What are the components of cerebellar examination?

A

DANISH

Dysdiadochokinesia
Ataxic gait
Nystagmus
Intention tremor
Speech
Heel-shin test
45
Q

What makes up a HINTS exam?

A

Exam to differentiate between central and peripheral causes of vertigo.

Head Impulse
Nystagmus
Test of Skew

46
Q

What symptomatic treatments can be given in vertigo?

A

Prochlorperazine

Antihistamines

47
Q

What are the symptoms of BPPV?

A

Triggered by head movement

20-60second episodes of vertigo and asymptomatic in between

48
Q

How is BPPV diagnosed and managed?

A

Diagnosed using Dix Hallpike manoeuvre

Managed using Epley manoeuvre

49
Q

What are the symptoms of vestibular neuronitis?

A

Usually a recent viral URTI

Vertigo
Nausea and vomiting
Balance problems
NO LOSS OF HEARING

50
Q

How is vestibular neuronitis managed?

A

Symptomatic treatment < 3 days- any longer may slow down recovery
Symptoms should resolve on their own- intense for a few days then gradually improve over following weeks

51
Q

What are the features of labyrinthitis?

A 
Recent viral URTI
Acute onset vertigo
Hearing loss
Tinnitus
Nausea, vomiting
Balance problems
52
Q

What are the features of meniere’s disease?

A

Usually presents between ages of 40 and 50
Unilateral symptoms
Episodes of vertigo, hearing loss and tinnitus
Vertigo lasting 20m-few hours not triggered by movement/posture
Fluctuating episodes of unilateral SN hearing loss, gradually becomes more permanent, affects low frequencies first

May have sensations of fullness in the ear, unexplained falls without LOC and imbalance
Spontaneous unilateral nystagmus

53
Q

What can be used for prophylaxis of meniere’s disease attacks?

A

Betahistine

54
Q

How do acoustic neuromas usually present?

A 
Unilateral sensorineural hearing loss
Unilateral tinnitus
Dizziness or imbalance
A sensation of fullness in the ear
May have associated facial nerve palsy (LMN, forehead not spared)
55
Q

In bacterial sinusitis, what is the first line antibiotic?

A

Phenoxymethylpenicillin

56
Q

What is the most common cause of bacterial tonsillitis?

A

Group A strep (strep pyogenes)

Strep pneumoniae second

57
Q

Which antibiotic is indicated for bacterial tonsilitis?

A

Phenoxymethylpenicillin (penicillin V)

Clarithromycin in pen allergy

58
Q

What is the Centor criteria?

A

Fever >38 degrees
Tonsillar exudate
Absence of cough
Tender lymphadenopathy

3+ increases likely of bacterial and appropriate to give abx.

59
Q

What is an alternative to the centor criteria?

A 
Fever PAIN
Fever
Purulence
Attended within 3 days of symptoms
Inflamed tonsils
No cough or coryza

Score 4+ likely bacterial

60
Q

What are potential complications of tonsilitis?

A 
Peritonsillar abscess
Otitis media
Scarlet fever
Rheumatic fever
Post-strep GN
Post-strep reactive arthritis
61
Q

What are the indications for tonsillectomy?

A

Episodes of tonsillitis:
7 or more in 1 year
5 per year for 2 years
3 per year for 3 years

Recurrent quinsy (2 episodes)
Enlarged tonsils causing difficulty breathing, swallowing or snoring
62
Q

How is post-tonsillectomy bleeding managed?

A

LIFE THREATENING due to aspiration of blood.

Call the ENT registrar
Get IV access
Bloods including FBC, clotting screen, group & save, crossmatch
Keep the patient calm and give adequate analgesia
Sit them up and encourage them to spit out the blood
Make NBM in case an anaesthetic and operation is required
IV fluids for maintenance and resuscitation, if required

In less severe: Hydrogen peroxide gargle or adrenalin soaked swab can be tried before returning to surgery

63
Q

What are the borders of the anterior triangle?

A

Mandible forms the superior border
Midline of the neck forms the medial border
Sternocleidomastoid forms the lateral border

64
Q

What are the borders of the posterior triangle of the neck?

A

Clavicle forms the inferior border
Trapezius forms the posterior border
Sternocleidomastoid forms the lateral border

65
Q

What are the features of carotid body tumours?

A

Slow-growing lump: in anterior triangle, painless, pulsatile, bruit, mobile horizontally

May cause Horner’s syndrome
Splaying of int and ext carotid arteries

66
Q

What is a branchial cyst?

A

Congenital abnormality
Soft, cystic swelling between angle of jaw and SCM in anterior triangle
Will transilluminate
Usually present after age of 10

Conservative or surgical management

67
Q

What are red flags for head and neck cancers?

A 
Lump in the mouth or on the lip
Unexplained ulceration in the mouth lasting more than 3 weeks
Erythroplakia or erythroleukoplakia
Persistent neck lump
Unexplained hoarseness of voice
Unexplained thyroid lump
68
Q

What is leukoplakia of the mouth?

A

Precancerous condition- SCC
White patches - usually on side of tongue or cheeks
Asymptomatic, irregular and raised patches which can’t be scraped off

69
Q

What is Erythroplakia of the mouth?

A

Similar to leukoplakia but red

Also pre-cancerous

70
Q

What is lichen Planus?

A

autoimmune condition that causes localised chronic inflammation of the skin
shiny, purplish, flat-topped raised areas with white lines across the surface

Finals Revision (23 decks)

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