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Finals HH > ENT > Flashcards

ENT Flashcards

1
Q

When to refer to ENT within 24h with hearing loss?

A
  • Unexplainable sudden onset unilateral or bilateral (<3 days) hearing loss developed in last 30 days
  • Unilateral hearing loss + focal neurology (facial droop, stroke?)
  • Hearing loss associated with head or neck injury
  • Hearing loss associated with severe infection (Necrotising otitis media or Ramsay hunt)
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2
Q

What is the management for cerumen impaction hearing loss?

A
  1. Removal by ear drops:
    - Sodium bicarbonate 5%
    - Olive oil
    - Sodium chloride 0.9%
  2. Ear irrigation or micro suction
  3. Refer
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3
Q

What is the diagnostic test for a suspected acoustic neuroma?

A

Dx - MRI

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4
Q

How does the tympanic membrane look in acute otitis media?

A

TM:
- Red, yellow or cloudy
- bulging + loss of landmarks
- Perforation +/- discharge

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5
Q

Mx of acute otitis media?

A

No perforation or discharge
-> topical analgesia (ear drops) + back-up antibiotic

Symptoms >3 days, discharge or <2y with bilateral ear infection -> antibiotic

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6
Q

When should you admit a baby <6months with acute otitis media to hospital?

A

Admit if <3mo or 3-6mo with >39°C

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7
Q

Px of otitis media with effusion (glue ear)?

A

Slow hearing loss + no otalgia
Poorly behaved child
Recurrent ear infections / URTI
Balance problems / clumsiness

  • Tympanic membrane altered colour, visible fluid bulging
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8
Q

Mx for otitis media with effusion?

A

Grommets if >3 months

Hearing aids (first line for down’s syndrome)

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9
Q

What is the mx of otitis externa?

A

Acute:
- Keep ear dry
- Avoid swimming during mx

Mild – OTC 2% acetic acid ear drops
Moderate – Topic antibiotic +/- corticosteroid

Severe acute -> oral antibiotics

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10
Q

What antibiotic for acute otitis media if needed?

A

Antibiotics if age is less than 2, systemically unwell, bilateral or exudate
1. Amoxicillin (5-7 day course)
Pen Allergic -> clarithromycin or erythromycin
2. Co-amoxiclav

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11
Q

What is a cholesteatoma?

A

Repeat infection -> ear drum collapse (retraction) -> creates pocket where dead skin cells collect

Keratin in middle ear -> hearing loss
1. Enzymes erode surrounding bone
2. Bacteria grow on keratin -> discharge complications

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12
Q

What is otosclerosis?

A

New bony deposits occur on stapes footplate -> gradual onset hearing loss

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13
Q

Which patient group is more likely to suffer form otosclerosis?

A

More common in women (oestrogen related) [20-30s]
o Progresses more rapidly during pregnancy
o Hormone replacement therapy

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14
Q

Mx of otosclerosis?

A

Stapedectomy (stapes replaced with prosthesis)

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15
Q

What is presbycusis?

A

Degenerative hearing loss due to loss of outer hair cells, ganglion cells and strial atrophy

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16
Q

What is observed on an audiometry in a patient with presbycusis?

A

Characteristic dip at 4kHz

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17
Q

What is the px of acoustic neuroma?

A

Insidious unilateral hearing loss +/- tinnitus or vertigo
Sensation of fullness in ear
LMN facial nerve palsy

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18
Q

What condition makes bilateral acoustic neuroma more likely?

A

Neurofibromatosis type 2

19
Q

What is battle’s sign?

A

Bruising behind the ear due to a fractured temporal bone

20
Q

What are the causes of peripheral vertigo?

A

BPPV
Meniere’s
Vestibular neuronitis
Labrynthitis

21
Q

What is the Ix and Mx for BPPV?

A

Ix – Dix Hallpike manoeuvre
Mx – Epley manoeuvre (re-positioning)

22
Q

What is the mx of Meniere’s?

A

Mx – Refer
- ITS, ITG
N&V -> Prochlorperazine

Prophylaxis – Betahistine

23
Q

What is the difference between vestibular neuronitis and labyrinthitis?

A

Labrynthitis px with hearing loss +/- tinnitus

24
Q

What anti-emetic is given for peripheral vertigo?

A

Prohlorperazine

25
Q

What are some causes of central vertigo?

A

Posterior circulation infarction
Vestibular migraine
Multiple sclerosis
Brain tumour

26
Q

What is the Centor criteria for bacterial tonsillitis?

A

1 point for each:
- Fever (>38 degrees)
- Tonsillar exudates
- Absence of cough
- Tender anterior cervical lymph nodes

27
Q

How many points of Centor criteria to offer antibiotics?

A

> 3 points = 40-60% of bacterial tonsillitis -> offer antibiotics

28
Q

What is the FeverPAIN criteria for tonsillitis?

A

1 point for each:
- Fever during last 24h
- Purulence (pus on tonsilis)
- Attended within 3 days of onset of symptoms
- Inflamed tonsils
- No cough or coryza

29
Q

How many points on FeverPAIN to offer antibiotics?

A

Score of 4-5 = 62-65% chance of bacterial tonsillitis -> offer antibiotics

30
Q

What antibiotic for bacterial tonsillitis?

A

Penicillin V (phenoxymethylpenicillin)
o Clarithromycin if allergic

31
Q

When to admit with tonsillitis?

A

Admission if immunocompromised, systemically unwell, dehydrated, stridor, resp distress, peritonsillar abscess or cellulitis

32
Q

What is the Px of Quinsy’s?

A

Fever, throat pain, painful swallow, trouble opening mouth (trismus)
o Displaces tonsil and uvula

33
Q

Mx of quinsy?

A

Refer to ENT for aspiration + antibiotics
o Dexamethasone to settle inflammation

34
Q

What not to give if a patient has suspected glandular fever?

A

NO AMOXICILLIN – will cause an itchy maculopapular rash

35
Q

Mx of nose bleeds

A
  1. ABCDE
  2. Sit up and tilt head forwards squeezing soft part of the nostrils for 10-15 mins
    o Spit out any blood in mouth instead of swallowing
  3. If bleeding >10-15 minutes or from both nostrils
    o Nasal packing – nasal tampons or inflatable packs
    o Nasal cautery – using silver nitrate sticks
36
Q

What can be given after a patient has a nosebleed?

A

Naseptin (chlorhexidine and neomycin) to reduce crusting, inflammation and infection

37
Q

What are some midline neck lumps?

A

Thyroid swelling
Thyroglossal cyst
Laryngeal swelling
Submental lymph node
Dermoid cyst

38
Q

What are some anterior triangle neck lumps?

A

Thyroid swelling
Pharyngeal pouch
Submandibular swelling
Branchial cyst
Lymph nodes
Parotid swelling

39
Q

What are some posterior triangle neck lumps?

A

Lymph nodes
Carotid artery aneurysm or tumour
Cervical rib
Lipoma

40
Q

When would a patient be given a 2-week wait referral for a neck lump?

A
  • Unexplained neck lump in someone aged >45
  • Persistent unexplained neck lump at any age
41
Q

How long to wait for an ultrasound for a neck lump growing in size?

A
  • <25 years – less than 48h
  • > 25 years – less than 2 weeks
42
Q

What are the Mx options for mild-moderate rhinitis?

A

o PRN intranasal antihistamine - azelastine
o Oral antihistamine – loratadine, cetirizine
o PRN intranasal chromone – sodium cromoglicate

43
Q

What is the Mx for moderate to severe rhinitis?

A

o Intranasal corticosteroid (mometasone, fluticasone)

44
Q

When to refer to ENT with rhinitis?

A

o Red flag features – unilateral px, bloody discharge, recurrent epistaxis, pain
o Structural abnormality making mx difficult, uncertain dx
o For skin prick testing, persistent symptoms despite optimum mx in primary care

Finals HH (21 decks)

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