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ALS > ENT > Flashcards

ENT Flashcards

1
Q

Otitis Media

A

Infection in the middle ear

Causes - bacterial infection 2nd to viral URTI (strep pneum, Hib, Moraxella cattarrhalis)

= acute onset, ear pain, fever, hearing loss, URTI, effusion (bulging, discharge), inflam

Inv - otoscopy (bulging, red, loss of light reflex)

-> 5-7d amox (or erythromycin) if not improving >3 days, <2yrs and bilateral, systemically unwell, IC, perf

Comp - perf can cause chronic suppurative OM, labyrinthitis, hearing loss, mastoiditis, meningitis, FN paralysis

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2
Q

Glue Ear

A

Otitis media with effusion, common in childhood

RF - male, FHx, bottle fed, smoking

= peaks at 2yrs, conductive hearing loss, speech and language delay

-> observe 3m, grommets (allow air to pass through middle ear), adenoidectomy

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3
Q

Otitis Externa

A

Causes - bacterial (staph), fungal (candida), recent swimming, seborrhoic and contact dermatitis

= itchy painful ear, discharge, red swollen flakey canal

-> topical Ab +/- steroid, refer to ENT if not responding, oral Abx if spreading, empirical antifungal

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4
Q

Malignant Otitis Externa

A

RF - IC (elderly diabetics), pseudomonas

= worsening pain, osteomyelitis, severe headaches, otorrhea, FN nerve issues

Inv - CT

-> IV Abx (ciproflox)

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5
Q

Acoustic Neuroma

A

Benign tumour of Schwann cells of auditory nerve

RF - NF2 (bilateral)

= vertigo, tinnitus, SN hearing loss (CN VIII), absent corneal reflex (CN V), facial palsy (CNVII)

Inv - urgent referral to ENT, MRI cerebellopontine angle

-> observe, surgery or radiotherapy

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6
Q

Submandibular Gland Disease

A

Sialolithiasis
Salivary gland stones, calcium based (radio-opaque)
= colicky pain, post-prandial swelling

Sialadenitis
Staph aureus infection
= pus leaking from duct, redness

Salivary gland tumours
50% malignant
Inv - fine needle aspiration, CT, MRI

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7
Q

Conductive Hearing Loss

A

Causes - ear wax, infection, effusion, Eustachian tube issues, perf, otosclerosis, tumours and cholesteatoma

Inv - Webers (louder in affected ear), Rinnes -ve (bone better than air)

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8
Q

Sensorineural Hearing Loss

A

Causes - sudden onset (urgent referral, PO steroids), presbycusis, Meniere’s, noise, labyrinthitis, neuro issues, loop, aminoglycoside, cisplatin

Inv - Webers (louder in normal ear), Rinnes +ve (air better than bone)

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9
Q

Ramsay Hunt Syndrome

A

Herpes zoster oticus - reactivation of Varicella in geniculate ganglion of CN7

= auricular pain, facial nerve palsy, vesicular rash, vertigo, tinnitus

-> PO aciclovir and steroids

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10
Q

Eustachian Tube dysfucntion

A

= may be preceded by URTI, reduced / altered hearing, popping, fullness, tinnitus and pain

If no clear cause may need tympanomotry audiometry and CT

-> conservative, valsalva, decongestants, Otevnet OTC (blow into balloon using one nostril), surgery

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11
Q

Meniere’s Disease

A

Disorder of inner ear, excessive endolymph, higher pressure disrupts signals

= unilateral episodes of SN hearing loss (may become constant), tinnitus and vertigo, last 20min-1hr, in clusters, aural fullness, unidirectional nystagmus, +ve Rhomberg

Inv - ENT assessment

-> buccal/IM prochlorperazine (acute), betahistine / vestibular rehab (prevention), inform DVLA

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12
Q

Labrynthitis

A

Inflammation of the middle ear normally due to Viral URTI

= 40-70yrs, acute onset vertigo, worse with movement, n+v, SN hearing loss, tinnitus, unidirectional nystagmus to unaffected side, abnormal head impulse test, gait (fall to affected side)

-> self limit, prochlorperazine or antihistamines

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13
Q

Tonsillitis

A

Causes - viral most common, group A strep pyogenes, strep pneum

= sore throat, painful swallowing, fever, nodes, red swollen tonsils +/- exudate

Centor: prob of bacterial (>38, exudates, absence of cough, tender cervical nodes)
FeverPAIN: fever, pus, <3d of onset, inflamed, no cough

-> penicillin V for 7-10 days

Comp - chronic, quinsy, otitis media, scarlet fever, rheumatic fever, GN, reactive arthritis

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14
Q

Acute Sinusitis

A

Inflammation of the mucous membranes of the paranasal sinuses

Causes - strep pnuemoniae, Hib, rhinoviruses

RF - nasal obstruction (deviated septum, polyps), recent local infection, swimming, smoking

= facial pain, worse bending forward, discharge, obstruction, double sickening (viral to bacterial)

-> analgesia, IN decongestants, IN steroids if >10 days, Abx if systemically unwell/ high risk of comp (phenoxymethyl)

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15
Q

Allergic rhinitis

A

Inflammatory disorder, sensitised to allergens

= sneezing, obstruction, discharge, drip, itchy

-> avoid allergen, oral/ IN antihistamines, IN steroids, short course of PO steroids for events

Topical decongestants should not be used for a long time due to tachyphylaxis and rebound hypertrophy of nasal mucosa

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16
Q

Chronic Rhinosinusitis

A

Inflammation of paranasal sinuses >12wks

-> IN steroids and saline irrigation

Red flags incl. unilateral, >3m treatment, bleeding

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17
Q

Auricular Haematoma

A

Prompt treatment to avoid cauliflower ear

-> same day assessment by ENT, incise and drain

18
Q

Black Hairy tongue

A

Defective desquamation of filiform papillae, can be variety of colours

RF - poor dental hygiene, Abx, radiation, HIV, IVDU

Swab to exclude candida

-> tongue scraping

19
Q

Branchial Cyst

A

Benign developmental defect of the branchial arches, filled with acellular fluid and cholesterol crystals

= late childhood, male, asymp lateral neck lump. ant to SCM, smooth, non tender, fluctuant, no movement on swallow (doesn’t transilluminate)

Inv - refer to ENT, US

-> can be surgically removed

20
Q

Cholesteatoma

A

Non-cancerous growth of squamous epithelium, trapped in skull base = local destruction

RF - cleft palate

= 10-20yrs, foul smelling discharge, hearing loss, local invasion can cause vertigo/ FN palsy

Inv - otoscopy (attic crust)

-> ENT referral, surgery

21
Q

Nosebleeds

A

Anterior - visible source, Kiesselbachs plexus
Posterior - profuse and deeper, more dangerous

-> sit forward with mouth open, pinch nose for 20 min
If successful consider top antiseptic (Naseptin chlorhexidine/neomycin)
If unsuccessful at 10mins try cautery (packing if can’t see source)

If everything fails use sphenopalatine ligation

22
Q

Gum disease

A

Gingival Hyperplasia
Causes - phenytoin, CCB (n), ciclosporin, AML

Gingivitis
Simple (painless bleeding and swelling) or acute necrotizing (painful and punched out lesions)
-> nec refer to dentist, oral metro + chlorhexidine mouth wash + pain relief

23
Q

Head and Neck 2WW

A

Laryngeal:
45+ with persistent hoarseness or unexplained neck lump

Oral:
Unexplained ulceration >3wks or unexplained neck lump
Refer to dentist if lump in lip/oral cavity or patch consistent with erythro/leukoplakia

Thyroid:
Unexplained thyroid lump

24
Q

Layngopharyngeal reflux

A

GORD causes inflammatory changes to the larynx

= 70% have sensation of globus (midline), hoarse, chronic cough, dysphagia, heartburn, sore throat, redness of posterior pharynx

Clinical diagnosis if no red flags

-> lifestyle, PPI, gaviscon

25
Q

Ludwigs angina

A

Progressive cellulitis that invades the floor of the mouth and soft tissue of neck

Causes - odontogenic infections (infected stones) which spread to submandibular area

= neck swelling, dysphagia, fever

-> Life-threatening, airway management, IV Abx

26
Q

Mastoiditis

A

Infection spreads from the middle ear to mastoid air spaces of the temporal bone

= severe pain behind ear, fever, very unwell, swelling, redness, ear may protrude forwards

Inv - clinical, CT

-> IV Abx

Comp - hearing loss, meningitis and FN palsy

27
Q

Nasal Polyps

A

RF - M, adults

Link - asthma, aspirin sensitivity (samters triad), sinusitis, CF, Kartagener’s, Churg Strauss

= nasal obstruction, rhinorrhoea, sneezing, poor sense of taste and smell

-> refer to ENT for full exam (esp. unilateral/ bleeding), top steroids to shrink

28
Q

Nasal Septal Haematoma

A

Complication of nasal trauma, bleed between septal cartilage and overlying perichondrium

= sensation of nasal obstruction, pain, rhinorrhea, bilateral red swelling and boggy

-> surgical drainage and IV Abx

Comp - irreversible septal necrosis in 3-4days

29
Q

Nasopharyngeal cancer

A

Squamous cell, link to EBV and southern china

= otalgia, unilateral serous otitis media, nasal obstruction, epistaxis, CN 3-6 palsies, cervical nodes

Inv - combined CT and MRI

-> radiotherapy

30
Q

Thyroglossal Cyst

A

Patent thyroglossal duct

= <20yrs, midline (between thyroid and hyoid), moves upwards on tongue protrusion

31
Q

Cystic Hygroma

A

Congenital lymphatic lesion found on left side of neck

= neonate - 2yrs

32
Q

Parotid gland disease

A

Malignant
Mucoepidermoid - 30% of all parotid cancers
Adenoid cystic - 35% survival, perineural spread

-> radical parotidectomy

Benign
Pleomorphic adenoma - most common tumour, some malignant degeneration
= gradual onset of painless unilateral swelling, movable

Warthin (papillary cystadenoma) - link to smoking, bilateral, male

-> superficial parotidectomy

33
Q

Perforated tympanic membrane

A

Causes - infection, trauma

-> no treatment needed (heals in 6-8 weeks), avoid getting wet, myringoplasty if this does not work

34
Q

Bleeding following tonsillectomy

A

All need to be assessed by ENT

Primary (<24hrs) - most 6-8hr after, return to theatre.

Secondary (>24hrs) - most 5-10 days after, usually a wound infection, admit and Abx

35
Q

Presbycusis

A

SN hearing loss that comes with age

Causes - arteriosclerosis, DM, salicylates, noise exposure

= elderly, lose high pitch first, worse in noisy environments

Inv - normal otoscopy, audiometry (BL SN pattern)

36
Q

Complications of thyroid surgery

A

Recurrent laryngeal nerve damage
Bleeding - can cause laryngeal oedema
Parathyroid gland damage = low calcium

37
Q

Indications for tonsillectomy

A

Sore throats due to tonsillitis +
5 or more episodes a year +
Occuring for at least a year +
Disabling and prevent normal function

Other:
Recurrent febrile convulsions due to tonsillitis
OSA, stridor or dysphagia
Quinsy not responding

38
Q

Audiogram Interpretation

A

Conductive - only air bad
Sensorineural - both bad
Mixed - both bad but air worse

39
Q

Benign paroxysmal positional vertigo (BPPV)

A

= 55yrs, sudden onset dizziness/ vertigo, worse with head movement, nausea, 10-20secs, Dix-Hallpike manoeuvre, rotatory nystagmus

-> spont resolve in weeks-mths, Epley manoeuvre, vestibular rehab for home

Prog - 50% recur in 3-5yrs

40
Q

Otosclerosis

A

AD, replacement of normal bone by vascular spongy bone, causes fixation of stapes at oval window

= 20-40yrs, progressive conductive deafness, tinnitus, 10% flamingo tinged eardrum (hyperaemia)

-> hearing aid, stapedectomy

41
Q

Quincy

A

Peritonsillar abscess 2nd to bacterial tonsillitis

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

-> urgent review by ENT, needle asp or incise and drain, + IV Abx, tonsillectomy

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