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FINALS REVISION > ENT > Flashcards

ENT Flashcards

1
Q

Where do most nosebleeds occur?

A

Anterior nosebleeds, little’s area, contains kiesselbach’s plexus

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2
Q

What are some common causes of nosebleeds?

A
  1. Nose picking, nose blowing
  2. Trauma
  3. Colds
  4. Sinusitis
  5. Weather changes
  6. Coagulation disorders (thrombocytopaenia, vWillebrand disease)
  7. Anticoagulants (aspirin, warfarin, DOACs)
  8. Snorting cocaine
  9. Tumours
  10. Granulomatosis with Polyangiitis
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3
Q

What does a bilateral nosebleed indicated?

A

Posterior bleed, higher risk of aspiration

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4
Q

What are some basic measures to stop nosebleeds?

A

Sit forward with mouth open and pinch soft cartilaginous part of nose for at least 20 minutes.

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5
Q

How can epistaxis be managed after 15 minutes of bleeding?

A

Nasal packing using nasal tampons or inflatable packs

Nasal cautery using silver nitrate sticks

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6
Q

How do you manage epistaxis after bleeding has stopped

A

Naseptin cream to reduce crusting, inflammation, and infection.

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7
Q

What is naseptin cream made of and to which group of patients must you not prescribe it?

A

Neomycin and chlorhexidine, avoid in peanut allergy

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8
Q

What is meniere’s disease

A
  • Disease of inner ear of unknown origin

- Progressive pressure and dilatation of endolymphatic system

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9
Q

Which age group is meniere’s disease most common in?

A

40-50, but can be seen at any age

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10
Q

What is the typical triad of symptoms in meniere’s disease

A
  • Hearing loss
  • Vertigo
  • Tinnitus
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11
Q

Aside from the typical triad of meniere’s symptoms, what other symptoms are there?

A
  • Fullness in the ear
  • Nystagmus
  • Positive romberg’s test
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12
Q

How long do meniere’s episodes last?

A

minutes to hours

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13
Q

is meniere’s unilateral or bilateral

A

usually unilateral symptoms, but as it develops, becomes bilateral

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14
Q

what type of hearing loss is menieres. which frequencies affected first

A

sensorineural, low frequencies affected first

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15
Q

what is treatment of acute menieres attack

A

prochlorperazine buccal or IM

antihistamines - cyclizine

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16
Q

what is prophylaxis of meniere’s

A

betahistine, vestibular rehabilitation exercises

17
Q

what are the two most common causes of bacterial otitis externa

A 
pseudomonas aeruginosa (gram -ve rod aerobic)
s. aureus
18
Q

what is significant about pseudomonas aeruginosa infection

A

can colonise lungs in cystic fibrosis, treat with aminoglycosides (gentamicin) or quinolones (ciprofloxacin)

19
Q

what are two common causes of fungal otitis externa?

A

aspergillus

candida

20
Q

what conditions predispose to otitis externa

A

eczema
seborrheic dermatitis
contact dermatitis (both irritant and allergic)

21
Q

what symptoms of otitis externa

A 
ear pain
discharge
fullness
itchiness
hearing loss (conductive)
lymphadenopathy
22
Q

what would you see on otoscopy of otitis externa

A

Swollen, erythematous canal. May be eczematous

23
Q

what is the significance of perforated tympanic membrane?

A

otitis media NOT externa

24
Q

how is otitis externa diagnosed?

A

otoscopy, swab may be done, but not usually required

25
Q

how is mild otitis externa treated?

A

2% acetic acid (earcalm)

26
Q

how is moderate otitis externa treated?

A

combined Abx and steroid, e.g. neomycin, dexamethasone and acetic acid (otomise spray)

27
Q

what class of Abx are ototoxic and should be used with caution in patients with perforated eardrums?

A

aminoglycosides (gentamicin and neomycin)

28
Q

how should severe otitis media be treated

A

if severe or systemic symptoms - oral Abx

29
Q

how can Abx treatment be delivered topically if the ear canal is swollen in otitis externa

A

ear wick

30
Q

how can fungal otitis externa be treated

A

clotrimazole ear drops

31
Q

what is a potentially life-threatening complication of otitis externa

A

malignant otitis externa - osteomyelitis of the temporal bone

32
Q

what risk factors for malignant otitis externa

A
  • Diabetes
  • HIV
  • Immunosuppression (e.g. chemo)
33
Q

What does granulation tissue at the junction between bone and cartilage in the ear canal indicate

A

malignant otitis externa

34
Q

how is malignant otitis externa managed?

A

Admit to hospital
IV Abx
CT/MRI head to assess extent of infection

35
Q

what are the complications of malignant otitis externa?

A
  1. Facial nerve damage, palsy
  2. Other cranial nerve involvement (glossopharyngeal, accessory, vagus)
  3. Meningitis
  4. Intracranial thrombosis
  5. Death
36
Q

what are the symptoms of malignant otitis externa

A

persistent temporal headache
severe ear pain
purulent otorrhea
possibly dysphagia, hoarseness or facial nerve involvement

37
Q

what is the most common causative organism of malignant otitis externa

A

pseudomonas aeruginosa

FINALS REVISION (17 decks)

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