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Y6 Senior Surgery COPY LaLz > ENT > Flashcards

ENT Flashcards

1
Q

sx of acute diffuse otitis externs

A

fever
lymphadenopathy
diffuse swelling
variable pain, pruritus
pain on moving ear and jaw
impaired hearing

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2
Q

how do you manage acute otitis externaal

A

topical antibiotics SOFRADEX + topical steroid

Oral Fluclox or Gent if severe

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3
Q

why are children more likely to have otitis media

A

short horizontal and poorly functioning eustachian tubes

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4
Q

who is otitis media most common in

A

youong children,
male
cleft palate
downs

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5
Q

how does otitis media present

A

pain in the ear and fever
may have reduction in hearing

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6
Q

hat causes otitis media

A

a VIRAL infection whhich swells the eustachian tube
this blocks the middle ear fluid drainage

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7
Q

how do you manage otitis media

A

Oral amox 5 days if:
- more than 4 days of sx
- less than 2 yo and bilateral
- 1 perforation / discharge in canal

otherwise consider delayed / no prescription

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8
Q

what is a choleasteatoma

A

abnormal skin growth / cyst of epithelium in the middle ear

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9
Q

what causes choleasteatoma

A

congenital
due to perforation in chronic suppurative OM

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10
Q

sx choleasteatoma

A

EAR DISCHARGE (foul smelling white discharge)

OR

conductive hearing loss

may also have headache, pain, verttigo, facial paralysis

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11
Q

Who should you suspect choleasteatoma in

A

anyone with unexplained unilateral ear discharge not repsonsive to abx

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12
Q

how do you ix cholesteatoma

A

Otoscopy
or CT

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13
Q

how do you manage choleasteatoma

A

refer to ENT for surgery

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14
Q

what is tintinnus

A

sensation of sound WITHOUT external sound

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15
Q

causes of tintinnus

A

Vestibular system:
- menieres
- otosclerosis

Brain:
- acoustic neuromoaa
- head injury

General:
- noise induced
- presbycusis

drugs
- aspirin
- aminoglycosides
- loop diuretics

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16
Q

differentials for vertigvo

A

vestibular:
- menieres
- BPPV
- labirinthitis

Central:
- acoustic neuroma
- MS
- stroke
- head injury
- inner ear syphilis

Drugs:
- gentamicin
- loop diuretics
- metronidazole
- co-trimoxazole

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17
Q

what does Romberg +ve indicate?

A

vestibular or proprioceptive disorder

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18
Q

what is menieres diseasee

A

dilatation of endolymph spaces due to increaaed lymph fluid

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19
Q

how does menieres prsent

A

CLUSTERED ATTACKS
last <12h
aurala fullness / pressure
vertigo, NV, nystagmus
tintinnus

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20
Q

what ix for meenieres

A

audiometry,

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21
Q

mx menieres

A

cyclizine (to treat emesis)
betahistine (to treat vertfgo)

surgical : use grommets to give gentamicin; saccus decompression

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22
Q

vestibular neuronitis history

A

following a febrl history (URTI)
sudden vertigo and vomiting
exacerbated by eye movements
NO HEARING LOSS

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23
Q

what s the difference between vestibular neuronitis and labirinthitis

A

vestibular neuronitis : NO HEARING LOSS
labirinthitis: hearing loss

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24
Q

how do you manage vestibular neuronitis and labiritinthis

A

prochlorperazine

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25
which maneuvre confirms BPPV?
Dix-Hallpike
26
which maneuvre treats BPPV
Epley maneuvre
27
causes of hearing loss in adults
Conductive (between auricle and round window) - external ear obstruction (wax) - TM perforation (trauma, infection) - Ossicle defect (otosclerosis) sensorineural (defect in cochlea, cochlear nerve or brain) - Drugs (aminoglycosides, vancomycin) - Infective (meningitis, measles, mumps, herpes) - menieres, trauma, MS; CPA lesion, low B12
28
what is an acoustic neuroma
benign slow growing tumour of superior vestibular nerve
29
what condition is acoustic neuroma associated with
NF2
30
sx acoustic neuroma
slow onset unilateral SNHL tintinnus vertigo headache CN palsy (5,7,8) cerebellar signs
31
ix acoustic neutroma
MRI
32
otosclerosis aetiology
AUTOSOMAL DOMINANT fixation of tapes at the oval window
33
S/S otosclerosis
begins in early adult lifwe bilateral conductive deafness tintinnus hearing loss improves with noise hearing loss worsens with pregnancy menstruation menopause
34
mx otosclerosis
hearing ads stapes implant
35
mx allergic rhinosinusitis
mild sx: oral antihistamine (cetirizine) or intranasal antihistamine (azelastine) PRN moderate-severe: Intranasal coorticosteroid
36
what is sinusitis
infection of the maxillary sinuses from viral URTI > may lead to secondary bacterial infection may occur with pain, swelling and tenderness on front of face
37
how do you manage sinusitis
if sx <10 days, no antibiotics sx > 10 days give high dose nasal corticossteroid for 14 days abx if sx dont get better after 7 days
38
how do you manage nasal polyp
routiine referral to ENT medical therapy (topical betamethasone drops 4-6 weeks, followed by short course of oral steroids)
39
common pathogens causing otitis externa
Staph aureus Pseudomonas aeroginosa
40
RF otitis externa
swimming in dirrty water diabetes old age wax buildup
41
what is necrotising otitis externa
progression of otitis externa through ear canal > bon > across skull base ESSENTIALLY CAUSES OSTEOMYELITIS into mastoid and temporal bones
42
sx necrotising otitiis external
severe pain in ear exhudate granulation tissue in ear may cause CN palsy
43
how do you manage necrotising otitis externa
urgent ENT referral ADMIT CT head, IV ABx
44
what does TM look like in otitis media
red and bulging TM loss of normal light reflex perforation and pus
45
what is another name for glue ear?
Otitis media with effusion
46
SSx glue ear
reduced hearing (conductive) NO other problems
47
how do you ix glue ear, and what are findings
otoscopy (eardrum dull and retracted, fluid level visible() audiometry (hearing test)
48
how do you manage glue ear
observe for 3 months if persistent, refer to ENT
49
what is a dangerous complication of otitis media in children?
MASTOIDITIS
50
Explain mastoiditis pèresentation
inflamed mastoids> mastoid pain discharge swelling behinid ear, ear pushed forward
51
How do you manage mastoiditis
ADMIT IV Abx CT scan may require incision and drainage
52
causes of epistaxis
LOCAL - trauma (nose picking) - URTI, allergy - nasal polup SYSTEMIC: - GPA (wegener's) - coagulopathy - hereditary haemorrhagic telangectasi
53
acute mx of epistaxis
sit up, lean forward, mouth open Pinch soft area of nose (compress nasal cartilage) Place ice on nose
54
mx if epistaxis takes longer than 15 minutes to respove
1. remove clots, gauze, rhinoscopy 2. visualise bleeding> CAUTERISE 3. bleeing cannot be visualised > PACKING (anterior / posterior with foley) 4. refer to ENT
55
2 key causes of tonsillitis
- group A beta haemolytic strep - EBV (MONO)
56
what must you never give in suspected MONO
never give AMOXICILLIN as it causes a widespread maculopapular rash
57
what score can you usee for tonsillitis, and what does it detect
CENTOR score Each point scores 1: - Tonsillar exhudate - Tender anterior cervical lymphadenopathy - Fever >38 - no cough if score 3/4, there is up to 50% chance that it is due to bacteria > prescribe antibiotics + rapid strep test
58
sx tonsillitis
sore throat fever dysphagia, odynophagia hoarness, rhinitis, fatigue, lethargy
59
what shows on ENT exam for tonsillitia
enlarged tonsils, white exhudates, cervical lymphadenopathy
60
when do you admit patient with tonsillitis
- pain not tolerated withh analgesia - complete dysphagia - difficulty breating - clinically dehydrated - QUINSY
61
what is QUINSY
PERI-TONSILLAR ABSCESS
62
how does quinsy present
unilateral tonsil swelling with deviated ubvula needs drainage + admission + IV Abx
63
Mx of tonsillitis
Phenoxymethylpen 10 days (if indicated) Clarythromycin if allergy
64
what is a complication of GAS tonsillitis (i.e. what can onsillitis progress to in children)
Group A strep can progress to SCARLET FEVER
65
how does Scarlet fever present
Sandpaper erythematous rash on neck and chest > sppreads to trunk and legs Strawberry tongue may later progress to rheumatic feber
66
mx of scarlet fever
phenooxymethylpenicillin
67
epiglottitis rf
UNVACCINATE child (as caused by H influenza)
68
presentation of epiglottitis
sitting forward drooling sore throat dysphagia STRIDOR
69
what is ludwigs angina
infction of submandibular space
70
how does ludwig angina present
neck swelling - WOODY AND HARD TO TOUCH dysphagia fever drooling
71
what s age related heariing loss also called
presbycusis
72
describe presbycusis presentation
over 65 yo bilateral slow onset may have tinnitusss
73
mx presbycusis
hearinig aiid
74
what does a unilateral polyp require
URGENT ENT REFERRAL as it is a red flag sx
75
what must yoou do if TM rupture does not repair in 6-8 weeks
refer to ENT for MYRINGOPLASTY (repair of perforation)
76
describe the hearing loss type in presbycusis
BILAT HIGH FREQUENCY HEARING LOSS
77
where does most nosebleeding come from
the ANTERIOR nasal septum
78
how do you manage quincy
Admit IV antibioticss + drainage consider tonsillectomy in 6 weeks

Y6 Senior Surgery COPY LaLz (10 decks)

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