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year 2 core concepts > ENT > Flashcards

ENT Flashcards

1
Q

What is the cause of acute otitis media?

A
  • Streptococcus pneumoniae and haemophilus influenzae
  • Upper respiratory tract infection transmitted by eustachian tube to nasopharyngeal disrupts
  • nasopharyngeal microbiome which leads to a secondary bacterial infection
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2
Q

What is the clinical presentation of acute otitis media?

A
  • Child with Otalgia (ear pain) or pulling/ rubbing their ear
  • Recent URTI, fever, vomiting
  • Purulent ear discharge/ otorrhoea if tympanic membrane perforation
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3
Q

What are the investigations for acute otitis media?

A
  • Swab for pus in tympanic membrane perforation
  • Otoscopy
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4
Q

What is the otoscopy results for acute otitis media

A
  • loss of light reflex indicating bulging drum from fluid buildup
  • erythema and perforation may also be seen
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5
Q

What is the management for acute otitis media?

A
  • Self limiting in most cases
  • Amoxicillin
  • Erythromycin
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6
Q

What are the criterias for prescribing antibiotics in acute otitis media?

A
  1. Symptoms for 4 days +
  2. Systemically unwell but not requiring admission
  3. Immunocompromised or high risk of complications due to other conditions
  4. Younger than 2 years of age w/ bilateral otitis media
  5. Otitis media with perforation and/ or discharge
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7
Q

What are the complications of otitis media?

A
  • Mastoiditis (infection spreads to mastoid)
  • Labyrinthitis
  • facial palsy, meningitis, brain/ intracranial abscess
  • Glue ear (also known as otitis media with effusion, chronic, hearing loss)
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8
Q

What is otitis media with effusion? List the cause and symptoms

A
  • Middle ear canal filled with fluid due to unknown cause but most follow acute otitis media
  • Hearing loss
  • Secondary speech and language delay
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9
Q

What is the treatment for glue ear/ otitis media with effusion?

A
  • Initial review and check up again in 3 months
  • Grommet insertion: allow air to pass through middle ear (mimic eustachian tube function)
  • Adenoidectomy
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10
Q

What conditions are considered chronic otitis media/ discharging ear? Define each

A
  • Otitis media with effusion
  • Perforation of tympanic membrane with otorrhea for 6 weeks +
  • Cholesteratoma: squamous metaplasia in the middle ear erodes surrounding bones
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11
Q

What are the clinical presentations of chronic otitis media?

A
  • Chronic discharge
  • Little pain, Reduced hearing
  • Conductive hearing loss w/ flat tympanogram and infected ear will hear better
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12
Q

What is cholesteatoma? Give typical patient profile

A
  • Abnormal collection of squamous epithelial cells in middle ear (non-cancerous)
  • invade local tissue and nerves, can erode bones, predispose to infection
  • 10-20 year old, increased risk in congenital cleft palate patients
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13
Q

What is the pathophysiology of cholesteatoma?

A
  • Eustachian tube dysfunction (closes) leads to negative air pressure in middle air
  • Portion of tympanic membrane gets sucked in (squamous epithelial from the outer tympanic membrane) and proliferates inside the middle ear
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14
Q

What are the symptoms of cholesteatoma? Why do these symptoms occur

A
  • Unilateral recurrent/ non-resolving discharge
  • Unilateral hearing loss
  • Local invasion: vertigo, facial nerve palsy
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15
Q

How does cholesteatoma cause hearing loss? What type is it?

A
  • Hearing loss due to auditory ossicles damage
  • ossicles conduct sound from tympanic membrane to inner ear thus, conductive hearing loss
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16
Q

What is the investigation and result for cholesteatoma?

A
  • Otoscopy: Whitish debris/ Attic crust in the uppermost part of ear drum
  • CT scan to confirm diagnosis and MRI scan to assess invasion
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17
Q

What is the management for cholesteatoma?

A

Refer to ENT for surgical removal
Mastoidectomy + tympanoplasty

18
Q

What is Meniere’s disease? What are the causes

A
  • Long term inner ear disorder causing recurrent vertigo + hearing loss+ tinnitus
  • Excessive buildup of endolymph in labyrinth of inner ear which causes increased pressure in labyrinth and disrupt sensory signals
19
Q

What are the symptoms of meniere’s disease?

A
  1. vertigo, tinnitus, Hearing loss (dizzy spell)-> Unilateral, minutes to hours/ episode, sensorineural
  2. feeling of fullness of ear, nystagmus
  3. 40-50 year old
20
Q

How is meniere’s disease diagnosed? What are the results

A
  • Clinical by ENT specialist
  • Audiology: unilateral sensorineural pattern affecting lower frequencies first
21
Q

How is meniere’s disease diagnosed?

A
  • Prochlorperazine (antiemetic) buccal or intramuscular for acute attacks
  • Betahistine (anti-vertigo) as prophylaxis to reduce frequency of attacks
  • Inform DVLA (truck drivers)
  • Majority self dissolved in 5-10 years but will leave a degree of hearing loss
22
Q

What is the cause and location of vestibular schwannoma/ acoustic neuroma?

A
  • benign tumors of schwann cells surrounding auditory/ vestibulocochlear nerve (innervate inner ear)
  • Location: cerebellopontine angles of the brain
    (Schwann cells: provide myelin sheath that surround neurons in the peripheral nervous system)
23
Q

What are the types of vestibular schwannoma/ acoustic neuroma?

A

Unilateral
bilateral (associated w/ neurofibroma type 2)

24
Q

What are the various presentations of vestibular schwannoma/ acoustic neuroma? (depends on the nerve)

A
  • CN VIII (vestibulocochlear): vertigo, unilateral sensorineural hearing loss and tinnitus (ringing)
  • CN V (facial): absent corneal reflex (blink reflex)
  • CN VII (trigeminal): facial palsy
25
Q

What is the investigation for vestibular schwannoma/ acoustic neuroma?

A
  • MRI of cerebellopontine angle
  • Audiometry: sensorineural hearing loss (downward curve) where air conduction will be louder than bone conduction
26
Q

What is the treatment and risks for vestibular vestibular schwannoma/ acoustic neuroma?

A
  • Surgery, radiotherapy or observation
  • Injury of vestibulocochlear nerve (hearing loss and dizziness)
  • Injury of facial nerve (facial weakness)
27
Q

Which organisms are likely to cause bacterial acute tonsillitis?

A
  • Group A strep/ strep. Pyogenes
  • Haem influenzae, staph aureus, strep pneumoniae
28
Q

What are the likely causes of viral infection?

A
  • EBV, rhinovirus, influenza, parainfluenza
  • Accounts for majority of acute tonsillitis
29
Q

What are the symptoms in both viral and bacterial tonsillitis?

A

Sore throat, dysphagia
Fever
swollen tonsils

30
Q

What are the symptoms more unique to bacterial tonsillitis?

A
  • Lymphadenopathy
  • Rapid onset of symptoms (within 3 days)
  • Last around one week and need antibiotic to settle
  • More severe pain and fever
31
Q

What are the symptoms more unique to viral tonsillitis?

A
  • Gradual onset of symptoms
  • Resolve on its own within a week, paracetamol helps with pain
  • Less tonsil exudate
  • Coryzal symptoms: runny nose, cough, body aches
32
Q

What are the investigations for acute tonsillitis

A
  • Clinical exam and history taking
  • feverPAIN or Centor to determine whether its bacterial and if antibiotic
33
Q

What is the feverPAIN scoring system?

A
34
Q

What is the treatment for acute bacterial tonsillitis?

A
  • Bacterial: penicillin/ clarithromycin if fever pain is 2-3
  • Difficulty breathing: admit for hospital for IV fluids, antibiotic and steroids
  • Severe and recurrent: Tonsillectomy
35
Q

What is the treatment for acute viral tonsillitis?

A

Self care and analgesics

36
Q

What are the early complications of acute tonsillitis?

A

Otitis media
Peritonsillar abscess

37
Q

What are the late complications of acute tonsillitis (both are related to bacterial)

A
  • Rheumatic fever (fever + arthritis + pericarditis 3 weeks post strep A)
  • Glomerulonephritis (haematuria, albuminuria, edema, 1-3 weeks post strep A )
38
Q

What is EBV? What group does it generally target?

A

Ebstein barr virus- apart of herpes causing persistent infection in epithelial cells
Targets young adults

39
Q

What is the classic triad of EBV?

A

Fever + pharyngitis + lymphadenopathy
Sore throat, tonsillitis, coryzal symptoms
splenohepatomegaly
Maculopapulo rash (when given amoxicillin by accident)

40
Q

What is the diagnosis for EBV?

A

Heterophil antibody test/ monospot test
FBC: atypical lymphocytes in peripheral blood

41
Q

What is the treatment for EBV?

A

self limiting: bed rest and paracetamol
Avoid physical activity for 4 weeks due to risk of splenic rupture

year 2 core concepts (9 decks)

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