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FINALS > ENT > Flashcards

ENT Flashcards

1
Q

How common are acoustic neuromas?

A

5% of intracranial tumours

90% of cerebellar pontine angle tumours

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2
Q

Where are acoustic neuromas found?

A

Cerebellar pontine angle

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3
Q

Name 4 masses that can be found at the cerebellar pontine angle.

A

S - schwannoma
A - aneurysm, arachnoid cyst
M - meningioma
E - ependymoma

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4
Q

What causes a bilateral acoustic neuroma?

A

Neurofibromatosis type II

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5
Q

What is the classic history of acoustic neuroma?

A

Vertigo
Hearing loss
Tinnitus
Absent corneal reflex

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6
Q

Which cranial nerves are affected by an acoustic neuroma?

A

5, 7 and 8

V - trigeminal (absent corneal reflex)
VII - facial (absent corneal reflex)
VIII - vestibulocochlear (vertigo, tinnitus, hearing loss)

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7
Q

What is the gold standard investigation for an acoustic neuroma?

A

MRI of CPA

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8
Q

How should an acoustic neuroma be managed?

A

Referral to ENT –> surgery, radiotherapy, observation

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9
Q

What is a cholesteatoma?

A

A destructive, hyperproliferating growth of keratinizing squamous epithelial cells of the middle ear.

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10
Q

What are the risk factors for developing a cholesteatoma?

A

Recurrent acute otitis media
Eustachian tube dysfunction
Previous ear surgery

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11
Q

How do cholesteatoma’s commonly present?

A

Otorrhoea, often brown (most common)
Conductive hearing loss - damage to the ossicles
Sensorineural hearing loss - invasion of the cochlea
Dizziness - invasion of the semi-circular canals
Facial nerve palsy - invasion of cranial nerve II (runs through the middle ear)

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12
Q

Which investigation is needed to confirm the diagnosis of cholesteatoma?

A

CT temporal bone (also needed for pre-operative planning).

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13
Q

What might be seen on otoscopy in cholesteatoma?

A

Pearly white/grey appearance

Brown discharge

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14
Q

What is the management of cholesteatomas?

A

Complete surgical removal.

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15
Q

Name two complications of cholesteatomas.

A

Intracranial invasion

Infection

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16
Q

Name two causes of true ear pain.

A

Otitis media

Otitis externa

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17
Q

Name 4 causes of referred ear pain.

A

CN V - trigeminal nerve (disease of the teeth)
CN VII - facial nerve (herpes zoster infection, Bell’s palsy)
CN IX - glossopharyngeal (tonsillitis, pharyngitis)
Cervical spinal nerves (cervical arthritis)

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18
Q

What is conductive hearing loss?

A

Sound is not conducted at the ear canal to the inner ear
It is a problem of the external or middle ear
Think about what it sounds like when you have ear plugs or headphones in - this mimics the symptoms of conductive hearing loss

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19
Q

What is sensory hearing loss?

A

Sound is received at the inner ear but issue at the sensory organ (Cochlear) or the vestibulocochlear nerve
It is a problem of the inner ear or cranial nerve VIII
Most commonly caused by age-related changes- think of elderly family and friends who you always have to speak loudly to

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20
Q

What are the different causes of sensorineural hearing loss?

A 
• Sudden sensorineural hearing loss (over less than 72 hours)
• Presbycusis (age-related)
• Noise exposure
• Ménière’s disease
• Labyrinthitis
• Acoustic neuroma
• Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
• Infections (e.g., meningitis)
Medications
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21
Q

Which drugs cause sensorineural hearing loss? Name three.

A

• Loop diuretics (e.g., furosemide)
• Aminoglycoside antibiotics (e.g., gentamicin)
Chemotherapy drugs (e.g., cisplatin)

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22
Q

What are the different causes of conductive 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
• Otosclerosis
• Cholesteatoma
• Exostoses
Tumours
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23
Q

What are the risk factors associated with presbycusis?

A

Age
Exposure to loud noise
Smoking
Male

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24
Q

What is the typical presentation of presbycusis?

A 
Gradual
Symmetrical
High-pitched sound lost first
Concerns about dementia
Tinnitus
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25
Q

What is the management of presbycusis?

A

Supportive

Hearing aid

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26
Q

What are the causes of sudden sensorineural hearing loss?

A 
Idiopathic (80%)
Infection
Ototoxic medications
MS
Migraine
Stroke
Acoustic neuroma
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27
Q

How does sudden sensorineural hearing loss present?

A

<72 hours

Unilateral

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28
Q

What is seen on audiometry in sudden sensorineural hearing loss?

A

loss of 30 decibels in 3 consecutive frequencies

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29
Q

What is the management of sudden sensorineural hearing loss?

A

• Emergency - immediate referral to ENT (within 24 hours)
• Treat underlying cause
High-dose PO prednisolone

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30
Q

What are the risk factors for otosclerosis?

A

Women

Autosomal dominant

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31
Q

How does otosclerosis present?

A

<40 years
Tinnitus
Talk quieter

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32
Q

What is seen on audiometry in otosclerosis?

A

Low-pitched sound loss

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33
Q

What is the management of otosclerosis?

A

Supportive

Surgery: stapedectomy

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34
Q

What are the risk factors for Eustachian tube dysfunction?

A

Upper RTI
Smoking
Allergy

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35
Q

How does Eustachian tube dysfunction usually present?

A 
Popping sensation
Fullness
Pain
Tinnitus
(symptoms worse when air pressure changes)
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36
Q

What is the management of Eustachian tube dysfunction?

A 
• Conservative.
• Valsalva manoeuvre
• Decongestant nasal spray
• Antihistamines/steroids
Surgery (adenoidectomy, grommets, balloon dilation Eustachian tuboplasty)
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37
Q

What is true vertigo?

A

Sensation that the room is spinning.

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38
Q

What are the three most common causes of vertigo?

A
  1. BPPV
  2. Meniere’s disease
  3. Vestibular neuronitis
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39
Q

Name three central causes of vertigo.

A
  1. Stroke
  2. MS
  3. Migraine
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40
Q

How can the causes of vertigo be classified?

A

Otological

Central

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41
Q

What is the gold standard test to confirm BPPV?

A

Dix-Hallpike Manoeuvre

42
Q

Who is at risk of developing necrotising otitis externa?

A

Diabetes

43
Q

When should you use intranasal steroids in acute sinusitis?

A

symptoms >10 days

44
Q

When should you use antibiotics in acute sinusitis? What is first-line?

A

Severe/systemically unwell

Phenoxymethylpenicillin

45
Q

What is included under the umbrella term ‘Head and neck cancer’?

A

oral cavity cancers
cancers of the pharynx
cancers of the larynx

46
Q

Name some features of head and neck cancer

A

neck lump
hoarseness
persistent sore throat
persistent mouth ulcer

47
Q

When should you refer for 2WW in suspected laryngeal cancer?

A

> 45 and:

  1. persistent unexplained hoarseness
  2. an unexplained lump in the neck
48
Q

When should you refer for 2WW in suspected oral cancer?

A

unexplained ulceration in the oral cavity lasting for more than 3 weeks

a persistent and unexplained lump in the neck.

49
Q

When should your refer to a dentist in suspected oral cancer?

A

a lump on the lip or in the oral cavity

a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.

50
Q

When should you refer to 2WW in suspected thyroid cancer?

A

unexplained thyroid lump

51
Q

What is double-sickening?

A

an initial period of recovery followed by a sudden worsening of symptoms - associated with bacterial sinusitis

52
Q

What is tonsilitis?

A

Infection of the palatine tonsils caused by viral or bacterial infection

53
Q

What causes tonsilitis?

A

70% of infections are viral, the rest bacterial

54
Q

Which virus’ most commonly cause tonsilitis?

A

Adenovirus, influenza, rhinovirus and parainfluenza are the common viruses involved

55
Q

Which bacteria most commonly cause tonsilitis?

A

Group A beta-haemolytic streptococci

56
Q

What are the symptoms of tonsilitis?

A

Sore thorat
Odynophagia
Earache

57
Q

What is the management of tonsilitis?

A

Self-resolving in 5-7 days (viral)

Paracetamol

58
Q

Which criteria are used to indicate antibiotic use in tonsilitis?

A

Centor criteria

1-2 unlikely to benefit from abx
3-4 = penicillin V (10 days)

59
Q

What four features make up the Centor criteria?

A

• History of pyrexia
• Exudates on tonsil
• Absence of cough
- Tender cervical lymphadenopathy

60
Q

What is the management of severe tonsilitis?

A 
Admit:
	• IV fluids
	• IV analgesia
	• IV abx
	• IV dexamethasone
	• Throat swab
Send home when can eat/drink normally
61
Q

Name two complications of tonsilitis.

A

Quinsy (peritonsillar abscess)

Parapharyngeal and retropharyngeal abscess

62
Q

What is the treatment of peritonsillar abscess (Quinsy)?

A

Incision & drainage

Send pus for MC&S

63
Q

What is the tonsillectomy criteria?

A

• 7 episodes in the last year OR
• 5 episodes in each of the last two years OR
• 3 episodes in each of the last three years
- Swelling from tonsillitis affecting normal function

64
Q

Which nerves provide sensory innervation to the ear?

A

CN V - trigeminal nerve (disease of the teeth)
CN VII - facial nerve (herpes zoster infection, Bell’s palsy)
CN IX - glossopharyngeal (tonsillitis, pharyngitis)
Cervical spinal nerves (cervical arthritis)

65
Q

What is otitis externa?

A

Infection of the external ear - can cause canal oedema

66
Q

What are the risk factors for otitis externa?

A 
Increased water contact
Humid conditions
Excessive use of cotton buds
Presence of hearing aids
Immunocompromised patients
67
Q

What is the most common bacterial cause of otitis externa?

A

Pseudomonas aeruginosa

68
Q

What is the first-line management of otitis externa?

A

Topical abx and steroids (may need to be inserted by a Pope Wick)

Amoxicillin PO if systemically unwell

69
Q

When should you refer to ENT in otitis media?

A

Poor response to topical abx

70
Q

What is malignant otitis externa?

A

Uncommon type of otitis externa found in immunocompromised individuals - diabetes.

71
Q

How is malignant otitis externa diagnosed?

A

CT

72
Q

How is malignant otitis externa treated?

A

IV ciprofloxacin

73
Q

What causes AOM?

A

Upper respiratory tract infections: viral OR bacterial

Viral: RSV, rhinovirus, enterovirus
Bacterial: s.pneumoniae

74
Q

Who is most likely to be affected by AOM?

A

Children (shorter eustachian tube)

75
Q

What is first-line management of AOM?

A

Supportive, analgesia

76
Q

What is management for severe AOM?

A

Abx: amoxicillin

77
Q

How can you treat recurrent AOM?

A

Gromets

78
Q

Name three complications of AOM.

A
  1. Tympanic membrane rupture
  2. Hearing loss (recurrent infections)
  3. Mastoiditis
  4. Facial nerve palsy
  5. Intracranial infection
79
Q

What are the symptoms of a perforated tympanic membrane?

A

Otorrhoea (discharge from the ear)

Sudden relief of pain

80
Q

What causes chronic OM?

A

Recurrent otitis media infections leading to a perforated tympanic membrane
Trauma
Iatrogenic (gromet insertion)

81
Q

What might be seen on otoscopy in chronic otitis media?

A

Perforated tympanic membrane

82
Q

What is first-line management of chronic OM?

A
  1. Aural toilet - washing out the ear canal

2. Topical abx and steriods

83
Q

What causes OM with effusion?

A

NON-INFECTIVE fluid in the middle ear
Most common cause us eustachian tube dysfunction
Other: cleft plate, allergies are risk factors

84
Q

What might be seen on otoscopy in OM with effusion?

A

Dull tympanic membrane
Light reflex reflected upwards
Absent light reflex

85
Q

What is management of OM with effusion?

A

50% resolve within 3 months

If more than 3 months: hearing aids or gromets

86
Q

What are the complications of OM with effusion in children?

A

Delayed speech development

87
Q

What are the features of quinsy?

A

severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility

88
Q

What is the treatment of post-tonsillectomy haemorrhage?

A

Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.

Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.

89
Q

How long does it take for a perforated ear drum to heal?

A

6-8 weeks

90
Q

When should packing be used before cautery in the management of epistaxis?

A

When the bleed is not visible

91
Q

What is the most common type of parotid tumour?

A

Pleomorphic tumour

92
Q

Which virus is associated with tonsillar SCC?

A

HPV

93
Q

What is Ludwig’s angina?

A

Cellulitis that occurs on the floor of the mouth
Common in immunocomprised patients
can cause airway obstruction

94
Q

Describe the arterial supply to the nose.

A
  • There are two clinically important plexuses to be aware of; anterior and posterior
  • Anterior is known as Little’s area or Kiesselbach’s plexus and has a rich blood supply that is the frequent source of epistaxis (nose bleeds)
  • Posterior is Woodruff’s plexus and is the site of posterior nose bleeds
95
Q

Which type of nosebleed is most common?

A

Anterior 90%

96
Q

Which factors might predispose nose bleeds?

A

Mucosal dryness
Children/elderly
Hypertension/atherosclerotic disease

97
Q

How should epistaxis be managed?

A

Step-wise approach, if the bleeding has not stopped, move on to the next step:

  1. A–>E assessment
  2. Pinch cartilage, sit forward - 20 minutes
  3. Cauterise with silver nitrate
  4. Pack
  5. Surgical ligation
98
Q

How is the nose packed?

A

Pack the nose, anterior or posterior depending on where you suspect the bleed is. This is essentially a tampon that absorbs and tamponades any bleeding. Posterior packing requires a catheter - the same as is used for urinary catheters.

99
Q

What are the key symptoms on epiglottis?

A

3 D’s are the key symptoms:
Drooling
Distressed
Dysphagia

100
Q

What is seen on a lateral C-spine in epiglottis?

A

Thumb-print sign

101
Q

What causes epiglottis?

A

Haemophilus Influenza type B

102
Q

What is the management of acute epiglottis?

A

Intubation

IV antibiotics

FINALS (26 decks)

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