ent Flashcards
Are unilateral nasal polyps a red flag
Yes
What is a serum mono spot test
To test for mononucleosis / glandular fever
Investigation for BPPV
Dix-hallpike
Treatment for BPPV
Epley
T/F bilateral polyps are a red flag
F - a unilateral polyp is red flag
What is Samter’s triad
Asthma
Aspirin sensitivity
Nasal polyposis
Treatment for polyps
Topical corticosteroids usually work
*carhart notch @ 2000hz
Otosclerosis
- stapes
Which organisms are commonly found in acute otitis media
Strept. Pneumoniae
Haemophilus influenza
Moraxella catarrhalis
Via what route does the normal middle ear relieve the air within it
Via the Eustachian tube
What additional treatment to grommet insertion can improve resolution of otitis media with effusion
Adenoidectomy
What is thought to be the underlying pathophysiology behind otitis media with effusion
Poor Eustachian tube function
How do grommets prevent accumulation of middle ear effusion
By allowing equalisation of pressure between the air in the middle ear and atmosphere
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What are chemoreceptors
Taste adn smell receptors
How often are chemoreceptors replaced
Every 10 days
How often are olfactory receptors replaced
Every 2 months
What cells replaces taste and smell receptors ?
Basal cells
What do the olfactory bulb neurons pass through to reach the temporal lobe adn olfactory areas
The olfactory tract
How do the vagus nerve exit the cranial cavity
Via jugular foramen
What is the first nerve to branch off of vagus
Superior laryngeal nerve
How does the vagus nerve descend through the neck ?
Through the carotid sheath
What nerve branches off the vagus at the mediastinum and then ascends ?
Recurrent laryngeal
*vertigo lasting seconds to minutes
BPPV
*vertigo lasting days - weeks
Labyrinthitis AND vestibular neuronitis
What triggers BPPV
Positional changes
*vertigo lasting 20 minutes to several hours
Menieres
Vertigo associated conditions associated with hearing loss and/or tinnitus
Menieres + labyrinthitis
What can be seen on blood film of glandular fever ?
Atypical lymphocytes
Second line treatment of child with persistent otitis media with effusion (persisten glue ear)
Adenoidectomy
Other than antibiotics what other medication can you give in severe tonsillitis
Steroids
First line treatment for child with persistent otitis media with effusion
Grommet insertion
Does otitis media with effusion present with signs and symptoms of acute inflammation
No
What is a cystic hygroma
A benign congenital lymphatic lesion, most commonly located in left posterior triangle of neck
*neck lump that can sometimes present pain when drinking alcohol
Hodgkin’s lymphoma
*neck lump that usually presents within 2 years of life
Cystic hygroma
*neck lump commonly seen in older men
Pharyngeal pouch
*neck lump usually located between isthmus of thyroid and hyoid bone
Thyroglossal cyst
*neck lump = most common cause if neck
Reactive lymphadenopathy
*neck lump that moves upwards on swallowing
Goitre
*neck lump associated with dysphagia , aspiration and chronic cough and commonly seen in older men
Pharyngeal pouch
*pulsatile lateral neck lump
Carotid sheath
What criteria is used to determine whether or not a sore throat is likely to be viral or bacterial ?
CENTOR
One point for each:
Tonsillar exudate
Tender anterior cervical nodes
History of fever
Absence of cough
What is the most common bacteria fro sore throat ?
Streptococcus pyogenes (group a)
What group of pathogens cause the majority of tonsillitis cases ?
Viruses
Are throat swabs routinely taken in primary care
Mo
Gram + cocci chains
Streptococcus pyogenes
Pathogen that causes glandular fever
EBV
Pathogen that produces a potent exotoxin
Corynebacterium diphtheria
Most common causative organism of otitis externa (Swimmers ear)
Staph. Aureus
Most common causative organism of otitis media
Haemophilus influenza
What vertebral level is the thyroid cartilage located
C4/5/6
What vertebral level is the cricoid cartilage located
C6
At what vertebral level is the hyoid cartilage located
C3
What is this likely to be
Otitis external - fungal cause
What is this likely to be
Cholesteatoma
What is this likely to be
Cholesteatoma
What is this likely to be
Glandular fever -
Can be distinguished from bacterial tonsillitis due to gross enlargement of the tonsils with membranous exudate
Investigation for glandular fever
Monospot +
Or
Paul Bunnel test
What is this
Candidiasis
What are the 4 features if labyrinthitis other than vertigo
Vertigo lasting days to weeks
Associated with viral infection
Associated with hearing loss or/and tinnitus
May experience tinnitus on affected side
What is Ramsay hunt syndrome
Caused by reactivation of varicella zoster in the geniculate ganglion
Characterised by unilateral facial nerve palsy (CN VII)
Presents as: unable to raise eyebrows, or bear teeth, loss of nasalabial folds
Lesions are also visible with crusting in to behind the ear
*pink tinge on tympanic membrane
Otosclerosis
This is known as Schwarze sign
How to manage acute otitis media
Delayed oral antibiotic prescription (if symptoms don’t clear within 3 days come for antibiotics)
NICE recommends amoxicillin for acute OM w/o complications
Management of Menieres
Prophylactic use of betahistine to reduce frequency of attacks
Acute use management = prochlorperazine
What cancers is HPV associated with
Increased risk of oral, pharyngeal and laryngeal cancer
What is the most common type of cancer in head and neck
Squamous cell carcinoma
Difference between thyroid lump and thyroglossal lump
Thyroid lump = ascends on swallowing but no on protrusion of the tongue due to mass effect > infiltration of the recurrent laryngeal nerve
Thyroglossal lump = ascends on both swallow and tongue protrusion , voice hoarseness is intermittent > due to laryngeal oedema from hypothyroidism
What should you see on anterior rhinoscopy for a septal haematoma
Bilateral cherry-red swelling
What is a brachial cyst
Formed due to obliteration of the second, third adn fourth brachial cleft
Typically undetectable until the cyst swells in size - commonly due to infection
Do no move on tongue protrusion nor auscultate or trans illuminate
what is the imaging modality of choice for neck lumps
Ultrasound
Sensineural hearing loss unilaterally probably due to an inflammatory cause - what is the treatment
High dose prednisolone oral
What is sudden sensorineural hearing loss
An ent emergency which is often idiopathic and requires urgent assessment by a specialist
High does steroids should be started as they are 85% effective if started within 24-48 hours of onset
What is vestibular Schwanomma
A benign subarachnoid tumour that causes local pressure effects of CN VIII
How does vestibular schwanomma present ?
Asymmetric or unilateral hearing loss
And progressive ipsilateral tinnitus
Larger tumours may cause mass effect leafing to signs of raised intracranial pressure and lead to focal neurology including compression of the 5th cranial nerve, 7th and 8th
What is the management of vestibular schwannoma
Surgery
If over 40mm
If under = requires 6-monthly annual surveillance scans via MRI
Most common mouth cancer
Squamous cell carcinoma
Most common causative organism for AOM
Haemophilus
*attic crust
Cholesteatoma
Which diuretic can cause hearing loss
Furosemide
*affected cranial nerve associated hearing loss
Vestibular schwannoma / acoustic neuroma
Ie hearing loss with an absent corneal reflex / facial palsy
Management of sudden onset sensorineural hearing loss ?
URGENT - prescribe high dose oral prednisolone
What is the main complication patients should be warned of when undergoing a mastoidectomy ?
Permanent unilateral facial weakness
- facial nerve runs in close proximity to the mastoid process
—> affecting ability to smile, or show teeth on affected side
*hypothyroid + progressively deep voice ?
Reinke’s oedema (vocal cord oedema)
Treatment of hypothyroid
Levothyroxine
What is the rare sign seen in otosclerosis ?
Schwarze sign - or - flamingo flush
Describes a pink tinge to the tympanic membrane
Treatment of mild - moderate otitis externa
Topical drops of combined abx and steroid
Keep the ear dry for the next 7-10 days
Treatment of severe otitis externa
Ie when the meatus is is completely occluded and there is significant swelling of the external meatus
Can be treated with strip of ribbon gauze ‘Pope’ wicks - which can then be used for the application of topical antibiotics (usually gentamicin)
Common complication of chronic sinusitis
Nasal polyps - presenting as continuous purulent nasal discharge and snoring / apnea
Treatment of nasal polyps
Nasal steroids
Management of vestibular neuronitis
Prochlroperazine
