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MED-Y3 > ENT > Flashcards

ENT Flashcards

1
Q

What are the symptoms of BPV ?

A
  • head movements that trigger vertigo (typically rolling over in bed)
  • Nausea and vomiting
  • No hearing loss or tinnitus
  • Often asymptomatic between attacks.
  • Symptoms settle within minutes
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2
Q

What is used to diagnose BPPV ?

A

Dix-hallpike manoeuvre

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3
Q

How is the dix hallpike manoevere carried out ?

A
  • Sit the patient upright on a flat examination couch with their head turned 45 degrees to one side (right to test the right ear ect)
  • Support the patients head to stay in the 45 degree position while rapidly lowering the patient backwards untill their head is hanging off the end of the couch and extend 20-30 degrees.
  • Observe for at least 30 seconds
  • Watch eyes for nystagmus and symptoms of vertigo. Nystagmus towards the affected ear e.g clockwise in the left ear.
  • Rotatory geotropic nystagmus.
  • Repeat on other ear
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4
Q

What will be observed in the DIX hallpike manoeuvre if the patient has BPPV ?

A

Rotatory geotropic nystagmus.

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5
Q

What manoeuvre can be used to treat BPPV ?

A

Epley manoeuvre

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6
Q

How is the Epley manoevre carried out ?

A
  • Follow the steps of the Dix hallpike manoevre, so the patients head is lying off the bed at a 45 degree angle.
  • Rotate the patients head 90 degrees past the central position.
  • Get the patient to rotate 90 degrees in the same position maintain for 30-60 seconds
  • Have the patient sit up sideways with legs off side of the cough.
  • Position the head in the central position with the neck flexed 45 degrees, with the chin towards the chest. Maintain for 30 seconds
  • At each stage, support the patient’s head in place for 30 seconds and wait for any nystagmus or dizziness to settle
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7
Q

What are brandt Daroff excersisies ?

A
  • Can be performed by the patient at home to improve symptoms. This involves sitting in the end of the bed and lying sideways from one side to the other, while rotating the head slightly to face the ceiling.
  • Repeated several times a day until symptoms resolve.
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8
Q

How will a patient with BPPV in the left ear present ?

A
  • Symtpoms when rolling onto the left side
  • Dix hallpike - Rotatory nystagmus towards the left (clockwise)
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9
Q

What is an acoustic neuroma ?

A

benign tumours of the schwann cells that surround the auditory nerve.

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10
Q

Where do acoustic neuromas commonly present ?

A

The cerebellopontine angle.

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11
Q

What are bilateral acoustic neuromas associated with ?

A

neurofibromatosis type 2

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12
Q

How does an acoustic neuroma commonly present ?

A
  • Unilateral sensioneural hearing loss.
  • Tinnitus
  • Absent corneal reflex
  • Fullness in the ear
  • Facial nerve palsy if the nerve compresses the facial nerve
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13
Q

How should a patient with suspected acoustic neuroma be managed ?

A
  • Urgent refferal to ENT
  • Audiometry
  • MRI of cerebelloponteine angle.
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14
Q

How are acoustic neuromas managed ?

A
  • Can be conservative management with monitoring if it is asymptomatic or treatment is inappropriate
  • Surgery (risk of vestibulocochlear nerve injury and facial nerve injury)
  • Radiotherapy
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15
Q

What are the common causes of otitis externa ?

A
  • Infectious - Bacterial (staphylococcus aureus, psudomonas aerginosa) or fungal
  • Seborrhoeic dermatitis (dandruff, similar to eczema)
  • Contact dermatitis (allergic and irritant)
  • Recent swimming is a common trigger.
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16
Q

What are the features of otitis externa ?

A
  • Ear pain
  • Itch
  • Discharge
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17
Q

What will be present on otoscopy in otitis externa ?

A

a red, swollen or eczematous canal.

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18
Q

What is the initial management of otitis externa ?

A
  • Initial management recommended a topical antibiotic or a combined topical antibiotic with a steroid.
  • If there is canal debris, consider removal. If the canal is extensively swollen, an ear wick is then sometimes inserted.
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19
Q

If a patient with otitis externa fails to respond to topical AbX, how should they be managed ?

A

If a patient fails to respond to topical AbX, then they should be referred to ENT.

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20
Q

What is malignant otitis externa ?

A

More common in elderly diabetics. There is an extension of infection into the bony ear canal and the soft tissues deep to the bony canal and IV AbX may be required.

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21
Q

What are the common causes of otitis media ?

A
  • Viral upper resp tract infections typically precede otitis media, most infections have a bacterial cause.
  • Most common bacterial causes are Haemophilus influenzae, streptococcus pneumoniae and Moraxella catarrhalis.
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22
Q

What are the common symptoms of otitis media ?

A
  • Otalgia (young children may tug or rub their ear)
  • fever
  • Hearing loss
  • Recent viral URTI symptoms
  • Ear discharge if there is perforation of the tympanic membrane
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23
Q

What are the possible findings on otoscopy in patients with otitis media ?

A
  • Bulging tympanic membrane (loss of light reflex)
  • Opacification or erythema of the tympanic membrane
  • Perforation with purulent otorrhoea
  • Decreased mobility if using a pneumatic otoscope.
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24
Q

What are the criteria to diagnose otitis media ?

A
  • Acute onset of symptoms - otalgia or ear tugging
  • Presence of middle ear infection (bulging of the tympanic membrane/otorrhoea/decreased mobility on pneumatic otosocopy)
  • Inflammation of the tympanic membrane (erythema)
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25
Q

How is acute otitis media typically managed ?

A
  • Acute otitis media is generally a self limiting condition that does not need an AbX prescription, however there are some exceptions. They should be given analgesia for the pain

Patients should seek medical help if the symptoms worsen or do not improve after three days.

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26
Q

When should patients be given AbX for otitis media ?

A
  • Symptoms more than 4 days or not improving
  • Systemically unwell
  • Immunocompromise or high risk of complication
  • Younger than 2 with bilateral otitis media
  • Otitis media with perforation and/or discharge in the canal
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27
Q

What is the first line of Abx treatmement in acute otitis media ?

A

5-7 day course of amoxicillin is first line. If the Pt has a penicillin allergy (erythromycin/clarithromycin).

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28
Q

What is CSOM in the context of acute otitis media ?

A

CSOM is defined as perforation of the tympanic membrane with otorrhoea for more than 6 weeks.

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29
Q

What are some of the possible complications of acute otitis media ?

A
  • Mastoiditis
  • Meningitis
  • Brain abscess.
  • Facial nerve palsy.
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30
Q

What is meinieres disease ?

A

Infection of the inner ear of an unknown cause and is characterised by excessive pressure and progressive dilation of the endolymphatic system.

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31
Q

What are the features of meinieres disease ?

A
  • Recurrent episodes of vertigo, tinnitus and sensorineural hearing loss.
  • **Vertigo is usually the most prominent symptom.
  • Sensation of pressure
  • Nystagmus and positive romberg test (stand on one leg and the hip will drop).
  • Episodes will last minutes to hours.
  • Typically unilateral but bilateral symptoms may develop after a number of years.
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32
Q

How is meinieres disease managed (non medically) ?

A
  • ENT assessment is required to confirm the diagnosis.
  • Patients should inform the DVLA. Cease driving untill control of symptoms.
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33
Q

What should patients take in an acute attack of meinieres disease ?

A

Buccal/IM prochloperazine

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34
Q

What can be used in prevention of attacks in meinieres disease ?

A

Betahistine or vestibular rehabilitation excersises may be of benefit.

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35
Q

What is the management of acute onset sensioneural hearing loss ?

A

Urgent refferal to ENT and patients are given high dose oral steroids.

36
Q

What is the majority of causes of acute onset sensioneural hearing loss ?

A

Idiopathic

37
Q

What is rhinosinusitis ?

A

Inflammatory disorder of the paranasal sinuses and the linings of the nasal passages

Lasts 12 weeks or longer = chronic

38
Q

What are some of the pre-disposing factors for rhinosinusitis ?

A
  • Atopy
  • Nasal obstruction (septal deviation or nasal polyps)
  • Recent local infection (rhinitis or dental extraction)
  • swimming/diving
  • Smoking
39
Q

What are some of the symptoms of rhinosinusitis ?

A
  • facial pain - frontal pressure pain that is worse on bending forwards
  • Nasal discharge - Clear is allergic/vasomotor cause. Thicker, purulent discharge suggests a secondary infection
  • Nasal obstruction - Mouth breathing
  • Post nasal drip may produce a chronic cough.
40
Q

How is rhinosinusitis managed ?

A
  • Allergen avoidance
  • Intranasal corticosteroids
  • Nasal irrigation with saline solution
41
Q

What are some of the red flag symptoms in rhinosinusitis (that can lead to meningitis, osteomyelitis and abscesses) ?

A
  • Unilateral symptoms
  • Persistent symptoms despite 3 months of treatment
  • Epistaxis.
42
Q

What is the most common cause of infectious mono ?

A

EBV (HHV-4)

43
Q

What is the common triad of symptoms in infectious mono (glandular fever) ?

A
  • Sore throat
  • Lymphandenopathy (anterior and posterior triangles of the neck).
  • Pyrexia.
44
Q

What are some of the other symptoms associated with infectious mono ?

A
  • Mailaise, anorexia and headache
  • Palatal petechiae (bruising on the roof of the mouth)
  • Splenomegaly in 50 percent of patients
  • Hepatitis and hence transient rise in ALT
  • Lymphocytosis (10 percent will have atypical lymphocytes)
  • Haemolytic anaemic secondary to IgM.
45
Q

What will be present on blood tests in patients with infectious mono ?

A

haemolytic anaemia Secondary to IgM
Hepatitis and rise in ALT
Lymphocytosis

46
Q

What will develop in 99 percent of patients that take amoxicillin and have glandular fever ?

A

A maculopapular pruritic rash.

47
Q

What are the NICE guidelines for confirming a diagnosis of infectious mono ?

A

FBC and monospot (heterophil antibody test) in the 2nd week of illness to confirm a diagnosis.

48
Q

How is infectious mono managed ?

A

Management is supportive and includes …

  • Drinking plenty of fluid, avoid alcohol and simple analgesia
49
Q

What advice about sport should be given to all patients with infectious mono ?

A

Avoid playing contact sports for 4 weeks after having EBV due to risk of splenic rupture as patients often have splenomegaly.

50
Q

What symptoms are associated with tonsilitis ?

A

Pharyngitis, fever, malaise and lymphandenopathy.

Tonsils are oedematous and yellow/white pusules may be present.

51
Q

Half of the cases of tonsillitis are bacterial. What is the most common causative organism ?

A

Streptococcus pyrogenes

52
Q

How is bacterial tonsillitis treated ?

A

Penicillin AbX.

53
Q

What is a common complication of bacterial tonsilitis ?

A

Quinsy ( local abscess formation)

54
Q

What are the symptoms of quinsy (bacterial tonslitis) ?

A
  • Severe throat pain which lateralises to one side.
  • Deviation of the ulna to the unaffected side.
  • Difficulty opening the mouth
  • Decreased neck mobility
55
Q

How are patients with qunisy reffered ?

A

Urgent review by ENT specialist.

56
Q

How is quinsy managed ?

A
  • Needle aspiration or incision and drainage + IV (phenoxymethylpenicillin)
  • Tonsillectomy to prevent recurrence.
57
Q

What are the NICE guidelines for tonsillectomy ?

A
  • Sore throats due to tonsilitis and not a URTI
  • Five or more episodes of sore throat a year.
  • Symptoms have been occurring for at least a year
  • Episodes of sore throat are disabling and prevent normal functioning.
58
Q

What are the complications of a tonsillectomy ?

A
  • Less than 24 hours - Haemorrhage in 2-3 percent and pain
  • 24-10 days - Haemorrhage commonly due to infection.
59
Q

What ref-feral should all patients with post tonsillectomy pain have ?

A

Assessment by ENT.

60
Q

How is primary or reactionary haemorrhage managed post tonsillectomy (6-10 hours post surgery) ?

A

Immediate return to theatre

61
Q

How is secondary haemorrhage post tonsillectomy managed (5-10 days post surgery) ?

A

Treatment is admission and AbX.

62
Q

What is the scoring system used in tonsilitis to assess if a patient has a bacterial cause ?

A

Centor

63
Q

What are the divisions of the centor criteria ?

A
  • Temperature over 38
  • Tender anterior cervical lymphandenopathy
  • Absence of cough
  • Exudate on tonsils.

Likely to be a bacterial cause if 3/4 are present.

64
Q

What is the first line treatment of bacterial tonsillitis ?

A

Phenoxymethylpenicillin.

65
Q

What is labyrinthitis ?

A

inflammatory disorder of the membranous labyrinth, affectingboth the vestibular and cochlear end organs. Labyrinthitis can be viral, bacterial or associated with systemic diseases.

66
Q

What is the most common form of labyrinthitis ?

A

Viral.

67
Q

How does labrythitis present ?

A
  • vertigo: not triggered by movement but exacerbated by movement
  • nausea and vomiting
  • hearing loss: may be unilateral or bilateral, with varying severity
  • tinnitus
  • preceding or concurrent symptoms of upper respiratory tract infection
68
Q

How can labrynthitis be distinguished from vestibular neuritis ?

A

In vestibular neuritis, only the vestibular nerve is involved, hence no hearing impairment. Just vertigo.

Labrythitis, the vestibular nerve and the labrynth is involved hence vertigo and hearing loss.

69
Q

What are some of the signs on examination of labrythitis ?

A
  • spontaneous unidirectional horizontal nystagmus towards the unaffected side
  • sensorineural hearing loss: shown by Rinne’s test and Weber test
  • abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
  • gait disturbance: the patient may fall towards the affected side
70
Q

How is labrythitis managed ?

A
  • episodes are usually self-limiting
  • prochlorperazine or antihistamines may help reduce the sensation of dizziness
71
Q

How is epistaxis that has failed all emergency management treated ?

A

sphenopalatine ligation in theatre.

72
Q

How is epistaxis that has not been managed with first aid measured managed ?

A
  • Cautery should be used initially if the source of the bleed is visible and will be tolerated.
  • Packing is cautery is not viable and the bleeding point cannot be visualised. Patients with packing should be admitted for obs and seen by ENT

Anesthetic spray like co-phenylcaine and afterwards anti septic like naseptin.

73
Q

What are initial first aid measures used in controlling epistaxis ?

A

Haemodynamically stable bleeding can be controlled with ….

  • Sit torso forward and mouth open
  • Pinch the cartilaginous area of the nose firmly for at least 20 minutes.

If successful ….

  • Topical antiseptic like Naseptin (Dont give in peanut allergy) - ALT mupirocin.
  • Admission and follow up if patients have severe co-morbidities and an undelying cause is suspected. Also if the patient is under 2.
  • Self care advice to reduce the risk of re bleeding.
74
Q

What is obstructive sleep apnoea ?

A

Obstructive sleep apnoea (OSA) isa relatively common condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing.

75
Q

What are the predisposing factors for obstructive sleep apnoea ?

A
  • Obesity
  • Acromegaly, hypothyroidism, amyloidosis.
  • Large tonsils
  • Marfans
76
Q

How do patients with obstructive sleep apnoea present ?

A
  • Excessive snoring
  • Daytime fatigue
  • Compensated resp acidosis
    -Hypertension
77
Q

What can be used as measurements of sleepiness in patients with obstructive sleep apnoea ?

A
  • epworth sleep scale
  • Multiple sleep latency test
78
Q

What testing is diagnostic in obstructive sleep apnoea ?

A

Sleep studies (polysomnography)

79
Q

How is obstructive sleep apnoea managed ?

A
  • Weight loss
  • CPAP is first line for moderate or severe cases.
  • Intra orbital devices can be used in patients with milder symptoms of if CPAP is not tolerated.
  • DVLA should be informed if it is causing excessive daytime sleepiness.
80
Q

How does a typical patient with Meinieres disease present ?

A

Patient presents with vertigo and associated tinnitus and hearing loss. Attacks last mins to hours

81
Q

What type of hearing loss is associated with age related and music related hearing loss ?

A

Sensioneural.

82
Q

What are the common bacterial causes of otitis media ?

A

Haemophilus influenzae, streptococcus pneumoniae and Moraxella catarrhalis.

83
Q

What is a complication of chronic otitis media ?

A

Cholestetoma

84
Q

What are the clinical features of cholestatoma ?

A

Foul smelling discharge, headache and otalgia.

85
Q

What is the typical presentation of otosclerosis ?

A

Most common cause of progressive deafness in young adults. Autosomal dominant condition where there is conductive and progressive hearing loss in young adults.

MED-Y3 (24 decks)

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