Brainscape's Knowledge GenomeTM

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


See full index

Medicine > ENT > Flashcards

ENT Flashcards

1
Q

Conductive deafness

A

occurs due to abnormalities of the outer or middle ear which impair conduction of sound waves from the external ear (pinna, ear canal or tympanic membrane) through the ossicles (malleus, incus and stapes) in the middle ear to the cochlea in the inner ear.

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

Sensorineural deafness

A

occurs due to abnormalities in the cochlea, auditory nerve or other structures in the neural pathway leading from the inner ear to the auditory cortex

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

Common causes of conductive deafness

A

Impacted Wax
Foreign bodies
Middle ear effusion ( glue ear)
Tympanic membrane perforation
Otosclerosis
infection
Cholesteatoma
Neoplasm
Exostoses

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

Common causes of sensorineural deafness

A

presbycusis
Congenital
Viral
Iatrogenic ( surgery, drugs)
Noise trauma/exposure
Meniere’s disease
Sudden sensorineural hearing loss
Vestibular schwannoma (also known as acoustic neuroma)
neuro eg MS and stroke
Systemic infections
malignancy
Labyrinthitis
Autoimmune conditions

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

Otosclerosis

A

Replacement of normal bone by vascular spongy bone

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

Otosclerosis clinical features

A

gradual-onset, bilateral, painless hearing loss in adults aged 30–50 years.
Causes a progressive conductive deafness
may have tinnitus,10% have flamingo tinge of tympanic membrane caused by hyperaemia. family history-AD

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

Mx otosclerosis

A

hearing aid and stampedectomy- surgical replacement of the stapes bone

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

Glomus tumour clinical presentation

A

pulsatile tinnitus, a feeling of fullness in the ear and hearing loss
A reddish blue mass may be visible behind a normal looking tympanic membrane

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

Sudden sensorineural hearing loss

A

Sudden onset of unilateral or bilateral hearing loss within 72 hours
May be associated with tinnitus, ear fullness or pressure, and vertigo
Examination is usually normal

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

what is Vestibular schwannoma (also known as acoustic neuroma)

A

slow growing, benign tumour (usually arising from Schwann cells in the vestibulocochlear nerve sheath) which causes hearing loss due to compression of the vestibulocochlear nerve
Bilateral acoustic neuromas almost certainly indicate neurofibromatosis type 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Vestibular schwannoma (also known as acoustic neuroma) clinical features

A

gradual onset, unilateral hearing loss which may be associated with tinnitus and/or vertigo
neuro signs
sensorineural hearing loss

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

Mx Vestibular schwannoma (also known as acoustic neuroma)

A

MRI of the cerebellopontine angle is the investigation of choice
Surgery is the definitive management

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

What is Tympanosclerosis

A

chronic inflammation and scarring of the tympanic membrane leading to subsequent calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Associated causes of Tympanosclerosis

A

Long term otitis media and tympanostomy (grommet) insertion.

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

Clinical presentation Tympanosclerosis

A

significant hearing loss and on examination will present with chalky white patches on the tympanic membrane

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

What causes Ramsay hunt syndrome

A

reactivation of varicella zoster

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

Ramsay hunt syndrome clinical presentation

A

unilateral facial nerve (Cranial nerve VII) palsy (e.g. unable to raise eyebrow against resistance or bear teeth, loss of nasolabial fold)
vestibulocochlear nerve (cranial nerve VIII) symptoms (e.g. tinnitus, unilateral hearing impairment) and
lesions visible with crusting in or behind the ear
And pain and vesicular rash in the external auditory meatus, palate or tongue.

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

Tx Ramsay Hunt syndrome

A

treated with acyclovir and prednisolone

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

automated otoacoustic emissions (AOAE)

A

part of NHS Newborn Hearing Screening Programme
A computer-generated click is played through a small earpiece. The presence of a soft echo indicates a healthy cochlea

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

Automated auditory brainstem responses (AABR)

A

used to clarify findings if there is no clear response from AOAE during screening. AABR is similar to an electroencephalogram, whereby electrodes are placed on the scalp and ear lobes and the waveform analysed after a stimulus is presented to the ear.

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

Distraction test

A

6-9 months
Performed by a health visitor, requires two trained staff.Sounds are produced to the right or left of the baby out of their field of view and the loudness required until they react to these is assessed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Recognition of familiar objects

A

18 months - 2.5 years
Uses familiar objects e.g. teddy, cup. Ask child simple questions - e.g. ‘where is the teddy?’

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

Speech discrimination tests

A

> 2.5 years
Uses similar-sounding objects e.g. Kendall Toy test, McCormick Toy Test.. These are done in young children over 2-years-old and assess the child’s ability to understand speech and differentiate it from background noise.

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

Pure tone audiometry

A

> 3 years
Done at school entry in most areas of the UK

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

Cholesteatoma

A

abnormal sac of keratinizing squamous epithelium and accumulation of keratin within the middle ear or mastoid air cell spaces which can become infected and also erode neighbouring structures

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

Cholesteatoma risk factors

A

M
Middle ear disease
Eustachian tube dysfunction
Otological surgery or trauma
Congenital anomalies and genetic syndromes
FHx

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

Cholesteatoma clinical features

A

persistent or recurrent discharge from the ear that is often foul smelling
Hearing loss or tinnitus
Less commonly, otalgia, vertigo, or facial nerve (VII) involvement (altered taste or facial weakness)

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

Cholesteatoma on examination

A

may appear as white mass being tympanic membrane
Crust or keratin in the upper part of the tympanic membrane.
ear discharge

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

Mx cholesteatoma

A

otomicroscope and micro-suctioning for discharge
pure tone audiology assessment to assess the degree of hearing loss. and a CT scan of the temporal bone
clinical judgement should be used to decide whether to treat for presumed infection
canal wall up mastoidectomy, which allows removal of cholesteatoma but leaves the canal wall intact
emergency admission for serious cx eg neuro

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

Causes of earwax obstruction

A

Overproduction
Obstruction
Inadequate epithelial migration

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

Clinical presentation ear wax impaction

A

Hearing loss (most common symptom)
Blocked ears
Ear discomfort
Feeling of fullness in the ear
Earache
Tinnitus (noises in the ear)
Itchiness
Vertigo (not all experts believe that wax is a cause of vertigo)
Cough

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

Risk factors for earwax impaction

A

> 50y and <5y
M
Narrow/deformed ear canal
Down syndrome
Dermatological condtions
use of cotton buds
Repeated insertion of hearing aids or earplugs

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

Common causes tinnitus

A

Presbycusis
meniere’s disease
noise induced hearing loss
Impacted wax
Otosclerosis
ototoxicity
Very rarely unilateral tinnitus can be cause by an acoustic neuroma
associated with Ear infections and temporomandibular joint dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Ototoxic drugs include:

A

Loop, aspirin and NSAID, Antimalarials, tetracyclines, macrolide antibiotics, amino glycoside antibiotics, cytotoxic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Mx of tinnitus

A

Refer immediately if high risk suicide, acute vertigo, neuro problems, pulsatile etc
Treat underlying cause
sound therapy to reduce the impact of tinnitus
Psychological approach
Hearing aid if communication difficulty
Advice ( eg stress, exposure to loud noise can make it worse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Vertigo

A

false sensation of movement (spinning or rotation) of the person or their surroundings in the absence of any actual physical movement

37
Q

Common causes of vertigo

A

Meniere disease
Acute vestibular failure
Vestibular neuronitis and labyrinthitis
Benign positional vertigo
brainstem vascular disease/stroke
Migraine

38
Q

Acute vestibular syndrome

A

acute onset dizziness and/or vertigo; intolerance of head movement; continuous dizziness of 24 hours to several weeks’ duration; spontaneous or gaze-evoked nystagmus; unsteadiness of gait; nausea and/or vomiting.
can be caused by peripheral conditions vestibular neuronitis or labyrinthitis or stroke and MS

39
Q

Drugs that may cause vertigo

A

aminoglycosides, furosemide, antidepressants, antipsychotics

40
Q

Examining a person with vertigo

A

examine ear
neuro exam and cranial nerves
fundoscopy
check peripheral neuropathy
examine gait
CVS exam
Specific clinical tests

41
Q

Dix-Hallpike manoeuvre

A

to help make a diagnosis of benign paroxysmal positional vertigo
Left ear BPPV has a clockwise torsional nystagmus, right ear BPPV nystagmus rotates anti-clockwise.

42
Q

Unterberger’s test

A

to identify dysfunction of one of the labyrinths.Ask the person to march on the spot with their eyes closed and observe them for lateral rotation.If there is labyrinthine damage, the person will rotate to the side of the affected labyrinth.

43
Q

Epidemiology Benign paroxysmal positional vertigo

A

commonly presents between the fifth and seventh decades
F>M

44
Q

Risk factors BPPV

A

can be precipitated by a head injury
a prolonged recumbent position
ear surgery
following an episode of any inner ear pathology
may also be associated with sleep position; people with BPPV are more likely to lie on the side of the affected ear

45
Q

Clinical presentation BPPV

A

Symptoms are brought on by specific movements and positions of the head relative to gravity (for example lying down, turning over in bed, looking upwards, or bending over)
Transient vertigo
N & V
Light headiness/imbalance
hearing is not affected and neither is tinnitus

46
Q

Mx BPPV

A

Most people recover over several weeks
simple repositioning manoeuvre (Employ) can help alleviate their symptoms
get out of bed slowly and to avoid tasks that involve looking upwards
Safety advice on driving, workplace, falls in home
Brandt-Daroff exercises which the person can do at home

47
Q

Epidemiology Meniere’s disease

A

30–60 years
F>M

48
Q

Risk factors Meniere disease

A

Autoimmunity
Gentics
Metabolic disturbances
Vascular factors
Viral infection
head trauma

49
Q

Meniere’s disease clinical features

A

Episodes of vertigo
fluctuating hearing loss
tinnitus
and is associated with a feeling of fullness in the affected ear
attacks last 20 mins- few hours

50
Q

Mx Menieres

A

Admit people with severe symptoms to hospital for intravenous (IV) labyrinthine sedatives and fluids to maintain hydration, and nutrition
if hearing loss symptoms, refer for an audiology assessment
To help alleviate nausea, vomiting, and vertigo consider prescribing prochlorperazine or an antihistamine
long-term condition, but vertigo usually significantly improves with treatment

51
Q

Prevent recurring attacks of meniere disease

A

trial of betahistine to reduce the frequency and severity of attacks of hearing loss, tinnitus, and vertigo.

52
Q

Vestibular neuronitis clinical features

A

Rotational vertigo occurs spontaneously
N & V malaise, pallor, and sweating
spontaneous nystagmus may be present at the start of the episode
Balance affected
Hearing loss and tinnitus are not features of vestibular neuronitis
head impulse test may be positive

53
Q

Mx Vestibular neuronitis

A

buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms

54
Q

Labyrinthitis clinical presentation

A

vertigo
N&V
sensoneural hearing loss
preceding or concurrent symptoms of upper respiratory tract infection
unidirectional horizontal nystagmus towards the unaffected side
abnormal head impulse test
gait disturbance

55
Q

Mx labyrinthitis

A

episodes are usually self-limiting
prochlorperazine or antihistamines may help reduce the sensation of dizziness

56
Q

Otitis externa epidemiology

A

incidence peaks at age 7–12 y

57
Q

most common cause of otitis externa

A

bacterial infection, caused by Pseudomonas aeruginosa or Staphylococcus aureus.

58
Q

otitis externa clinical features

A

Ear pain and tenderness of the tragus and/or pinna (often severe), with possible jaw pain.
Itch of ear cannal
Ear discharge
Hearing loss due to ear canal occlusion (less common)

59
Q

Precipitating factors for otitis externa include

A

ear trauma
excessive moisture
dermatitis
ear canal obstruction
skin conditions
acute otitis media

60
Q

otitis externa on examination

A

Tenderness of the tragus and/or pinna.
ear canal is red and oedematous, there may be debris and ear discharge contributing to swelling and canal occlusion
Tympanic membrane erythema
Cellulitis of the pinna and adjacent skin
Conductive hearing loss (less common)

61
Q

Chronic otitis externa symptoms

A

Constant itch in the ear.
Mild discomfort or pain (rare).

62
Q

Chronic otitis externa signs

A

Lack of ear wax in the external ear canal.
Dry scaly skin in the ear canal
Fluffy, cotton-like debris, hyphae, or dots of black debris may be seen in the ear canal if there is fungal infection.
Conductive hearing loss.

63
Q

Malignant/necrotising otitis externa

A

Unremitting disproportionate ear pain- disturbs sleep, headache, purulent otorrhoea, fever, or malaise.
Vertigo.
Profound conductive hearing loss
may cause facial nerve palsy
may cause additional cranial nerve palsies

64
Q

Mx otitis externa

A

Managing any aggravating or precipitating factors (such as diabetes mellitus, dermatitis, or ear trauma).
Offering paracetamol or ibuprofen for symptomatic relief
tx infection topically
Considering the need for investigations (such as taking an ear swab)
self-care advice
Referring to secondary care if needs
apply local heat using a warm flannel for localised otitis externa
incision and drainage if pus is causing severe pain and swelling

65
Q

Benign positional vertigo clinical features

A

common, self limiting, patients gets sudden veritgo on sudden head movements, lasts a few seconds to a minute,not associated with tinnitus or hearing loss

66
Q

Acute otitis media clinical presentation

A

earache. Younger children may hold or rub their ear, or may have non-specific symptoms such as fever, crying, poor feeding, restlessness, cough, or rhinorrhoea.

67
Q

Causes of bilateral conductive hearing loss

A

bilateral otitis media with effusion (glue ear)
ear wax in both ears,
bilateral perforated tympanic membranes
otosclerosis.

68
Q

Otitis media with effusion/’glue ear

A

characterized by a collection of fluid within the middle ear space without signs of acute inflammation

69
Q

Otitis media with effusion
/glue ear epidemiology

A

most common cause of hearing impairment in childhood
between the ages of 6 months and 4 years
more in winter months

70
Q

Risk factors for Otitis media with effusion

A

cleft palate
Down syndrome
CF, primary ciliary dyskinesia
allergic rhinitis
Several environmental factors (such as low socioeconomic group, parental smoking, and frequent upper-respiratory infections)

71
Q

Clinical presentation otitis media with effusion ( glue ear)

A

Hearing loss
Mild intermittent ear pain with fullness or ‘popping’ may occur
Aural discharge
Recurrent ear infections, upper respiratory tract infections, or frequent nasal obstruction.

72
Q

otitis media with effusion ( glue ear) on examination

A

Abnormal colour of the drum, such as yellow, amber, or blue.
Loss of light reflex or a more diffuse light reflex.
Opacification of the drum (other than that due to scarring).
Air bubbles or an air/fluid level.
A retracted, concave, or indrawn drum or, less frequently, fullness or bulging.

73
Q

Mx middle ear effusion

A

Active observation (or ‘watchful waiting’) for 3 months
Autoinflation
Hearing aids may be offered to children with persistent bilateral otitis media with effusion (OME) and hearing loss as an alternative to surgical intervention
Myringotomy and insertion of grommets (ventilation tubes)
Adjuvant adenoidectomy is recommended for children over 4 y as it improves the efficacy of ventilation tubes

74
Q

Otitis media epidemiology

A

from birth to 4 years

75
Q

acute otitis media on examination

A

tympanic membrane is distinctly red, yellow, or cloudy and may be bulging.

76
Q

Mx acute otitis media

A

resolves 3d-1w
Pain and fever should be managed with paracetamol or ibuprofen.
May benefit from Abx if high risk,5–7 day course of amoxicillin is recommended first-line
Consider eardrops containing an anaesthetic and an analgesic for pain if an immediate oral antibiotic prescription is not given, and there is no eardrum perforation or otorrhoea.

77
Q

Extra-cranial Complications of Otitis Media

A

facial nerve palsy
Mastoiditis
Petrositis
Labrynthtitis

78
Q

Intra-cranial Complications of Otitis Media

A

Meningitis
Sigmoid sinus thrombosis
Brain abscess

79
Q

Mx epistaxis

A

person should sit with their upper body tilted forward and their mouth open; the soft part of the nose should be pinched firmly and held for 10–15 minutes
1. direct compression and if resolves neseptin o reduce crusting
2. nasal cautery
3. nasal packing
4. Aggressive therapies such as nasal balloon catheter and transnasal endoscopy with direct cautery/arterial ligation

If a posterior bleed is suspected (bleeding is profuse, from both nostrils, and the bleeding site cannot be identified on examination), admission to hospital is recommended

80
Q

Cause of glandular fever

A

Epstein Barr virus (EBV (also known as the human herpesvirus 4)).

81
Q

Laryngitis

A

Hoarseness
associated with GORD and or autoimmune disorders
It commonly presents as worse in the morning
can be viral or chronic

81
Q

Glandular fever

A

incubation period of glandular fever is about 4–7 weeks
causes more severe symptoms when adult
Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar enlargement
splenomegaly

82
Q

most common bacterial cause of sore throat

A

Group A beta-haemolytic streptococcus (GABHS), also known as Streptococcus pyogenes

83
Q

The number of episodes of acute sore throat they specify for a tonsillectomy are:

A

7 or more in 1 year
5 per year for 2 years
3 per year for 3 years

Other indications are:
Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficulty breathing, swallowing or snoring

84
Q

Tonsillitis clinical features

A

tonsillar exudate and enlargement and erythema of the tonsils.
Exudates are small white patches of pus on the tonsils.
Pain on swallowing.
anterior cervical lymphadenopathy
fever >38°C,Headache, nausea, vomiting, and abdominal pain

85
Q

Differences between bacterial and viral tonsillitis

A

Bacterial tonsillitis is more associated with cervical lymphadenopathy.
Viral tonsillitis is associated with headache, apathy and abdominal pain.

86
Q

CENTOR criteria

A

give an indication of the likelihood of a sore throat being due to bacterial infection. They are as follows:

Tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever over 38
Absence of cough

A score of 3 or 4 is thought to be associated with a 32 to 56% likelihood of isolating streptococcus.

87
Q

Antibiotic for bacterial tonsillitis

A

Penicillin V (phenoxymethylpenicillin) as the first-choice antibiotic for a 10 day course .It has a relatively narrow spectrum of activity and is effective against Streptococcus pyogenes.

88
Q

Quinsy

A

caused by spread of infection from the tonsils into the peritonsillar space this can pose a risk of airway compromise, aspiration of pus, and death due to vascular involvement
sore throat and difficulty swallowing,uni-tonsillar bulge and uvula deviation

Medicine (72 decks)

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