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Its the final countdown > ENT > Flashcards

ENT Flashcards

1
Q

define acoustic neuroma

A

benign tumours of Schwann cells surrounding vestibulocochlear nerve,

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2
Q

acoustic neuroma, aka (x2)

A

vestibular schwannoma
*cerebellopontine angle tumours

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3
Q

acoustic neuroma presentation
- bi or unilateral?
- age group
- may be associated with what palsy?
- 4main symptoms

A

Typically unilateral. (Bilateral =ass. w/ neurofibromatosis type II).

Aged 40-60 years

facial nerve (CNVII) palsy

  • Gradual onset of:
    o Unilateral sensorineural hearing loss (often the first symptom)
    o Unilateral tinnitus
    o Dizziness or imbalance
    o A sensation of fullness in the ear
    *
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4
Q

BPPV
Dx manouvre
Mx manaouvre

A

Dx- Dix-hallpike
Mx - Epsley

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5
Q

BPPV
give 2
- Sx associated with the vertigo
- Sx NOT associated with the vertigo

A
  • Triggered by head movement
  • symptoms last 20-60s

not ass/ w/
- hearing loss
- tinnitus

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6
Q

comonly associated cause of epiglottitis

A

Haemophilus influenzae b (Hib) - reduced since vaccines

Other causes are: Infectious (Streptococcus spp, Staph aureus, Pseudomonas, Herpes simplex) or Non-infectious (Thermal, foreign bodies, radiotherapy)

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7
Q

key differential Sx of epiglotitis (x4)

A

high temperature, inspiratory stridor, difficulty breathing, drooling, and irritability.

differentials :
croup: barking cough & coryzal w/inspiratory stridor in moderate/severe cases. Sx worse at night.

Bacterial Tracheitis: Sx intermediary between croup and epiglottitis, (difficulty breathing, SOB, High temp)

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8
Q

2 steps in managing epiglottitis

A

1 Nebulised adrenaline and IV dexamethasone ) reduce mucosal oedema)
2 If medical mx unsuccessful – intubate to get definitive airway

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9
Q

acute unilateral vertigo lasting 15 hours. With ipsilateral dulling of hearing.
It began suddenly, no obvious trigger, while sat on the sofa.
Can hear a faint buzzing in the ear and feels nauseous.
Hx: mild viral illness one week earlier.
Exam: CN intact. Otoscopy:translucent tympanic membrane with normal ossicles and no effusion. What is the most likely diagnosis?

A

Acute labrynthitis

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10
Q

In BPPV, what type of nystagmus is seen in Dix-hallpike manouevre

A

rotatory nystagmus

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11
Q

what is the most likely location of bleeding in epistaxis>

A

Littles area ( comtains Kiesselbachs plexus, where belled comes form

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12
Q

Give 10 causes of epistaxis

A
  • Nose picking
  • Colds
  • Sinusitis
  • Vigorous nose-blowing
  • Trauma
  • Changes in the weather
  • Coagulation disorders (e.g., thrombocytopenia or Von Willebrand disease)
  • Anticoagulant medication (e.g., aspirin, DOACs or warfarin)
  • Snorting cocaine
  • Tumours (e.g., squamous cell carcinoma)
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13
Q

4 reasions to admit patient with epstaxis

A

o bleeding >10 – 15 minutes,
o sesvere bleed
o bilateral bleed
o haemodynamically unstable

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14
Q

Mx eistaxis ( acute x 2, post-event )

A

acute:
nasal packing
nasal cautery

Naseptin nasal cream QDS 10/7 (reduces crusting, inflammation and infection)

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15
Q

Give 3 other names for glandular fever

A

kissing disease
infectious monocnucleosis
mono

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16
Q

typical infectious monocnucleosis Sx in :
- childhood
- teen/adulthood

A

childhood - minimal Sx
teen/adult: fever, sore throat, fatigue

other: * Lymphadenopathy (swollen lymph nodes)
* Tonsillar enlargement
* Splenomegaly & splenic rupture (rare)

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17
Q

name 2 tests used in EBV Dx

A

Heterophile Ab teat ( Monospot test / Paul-Bunnell test

Viral capsid antigen test ( specific EBV Ab)

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18
Q

EBV Mx

A

condition is self-imiting, lasts 2-3 weeks

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19
Q

what shoud patiets with EBV avoid ( x3)

A

Alcohol
Contact sports
Ammoxicillin/cephalosporin

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20
Q

x6 complications of EBV

A
  • Splenic rupture
  • Glomerulonephritis
  • Haemolytic anaemia
  • Thrombocytopenia
  • Chronic fatigue
  • Increased cancer risk e.g., Burkitt’s lymphoma.
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21
Q

menieres triad

A
  • Hearing loss
  • Vertigo
  • Tinnitus
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22
Q

typical menieres presentation

A

40-50 years old,
unilateral UNILATERAl vertigo (20mins-hrs, not triggered by mvtm), hearing loss (fluctuating, ass.w/ vertigo, then permanent), and tinnitus (gradually becomes permmanent

also
* A sensation of fullness in the ear
* Unexplained falls (“drop attacks”) without loss of consciousness.
* Imbalance (can persist after episodes of vertigo resolve

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23
Q

Dx Ix for menieres

A

audiooogy assessment

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24
Q

menieres Mx
acute x2
prophylaxis x 1

A

For acute attacks
short-term:
* Prochlorperazine
* Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

Prophylaxis:
* Betahistine

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25
Q

OSA
define
5x risk factors

A

def: collapse of the pharyngeal airway characterised by episodes of apnoea during sleep

RF: * Middle age
* Male
* Obesity
* Alcohol
* Smoking

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26
Q

OSA Mx
1 who to refer 2
1st-3rd line Mx

A

Management
* ENT specialist / specialist sleep clinic
* 1st step: correct reversible risk factors: weightloss, stop alcohol, stop smoking
* 2nd: CPAP
* 3rd Surgery: reconstruction of the soft palate and jaw.

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27
Q

give 5 causes of otitis externa

A

Bacteria ( pseudomonas aeruginosa, staph. aureus)
fungal ( aspergillus, candida)
eczema
sebhorrhoeic dermatitis
contact dermatitis

28
Q

the stages of otitis externa and the management

A

mild - acetic acid
mod - topical abx & steroid *(e.g. otomize spray - neomycine+dex+acetic acid)
sev: oral abx, ear wick before ear drops/soray , clotrrimozole
malignant: Adx, IV Abx & MRI/CT for assessing extent of infeciton

29
Q

4 causes of otitis media

A

most common - strep. pneumonia
also: H. influenzae, M. catarrhalis, Staph. aureus

(bacterial inflection often preceded by viral URTI)

30
Q

the 1st line meds for otitis media

A

Amoxicillin 5-7 days
if allergic: clarithromycin
if allergic & pregnant: erythromycin

31
Q

sinusitis vs rhinosinusitis

A

rhinosinusitis = sinusitis (imnflammed paranasal siniuses) combined with infammation of nasal cavity

32
Q

how does sinusitois occur

A

normally: sinuses is where mucous is produced and this drains into the ostia

blocked ostia –> no drainage –> sinusitis

33
Q

name the paranasal sinuses

A

frontal sinuses (above eyebrows)
maxillary sinuses )either soide of nose, the largest)
ethmoid sinuses (in ethmoid bone, mid nasal cav ity)
sphenoid sinuses (sphenoid bone, back of nasal cavity

34
Q

acute sinusitis Mx

  • Sx for <10 days
  • Sx for >10 days (x2)
A

no Rx - resolves in 2-3wks if viral

Mometasone 200mcg BD 14days (high dose steroid nasal spray
Delayed Rx ABx (phenoxymethylpenicillin 1st line)

35
Q

Mx Chronic sinusitis
x3

A

nasal irrigation
nasal spray/drop (mometasone/fluticasone
FESS (Functional endoscopic suinus surgery)

36
Q

most common cause of tonsillitis

A

viral

37
Q

most common bacterial cause of tonsillitis

A

GAS (strep pyogenes)

or strep pneumoniae

other common bact. causes are same as in otitis media (h.influenza, M.catharrhalis, Staph. aureus

38
Q

what name describes the tonsil ring

how many areas of tonsil tissue are there? Name them

which of them is typically enlarged in tonsillitis

A

Waldeyer’s tonsillar ring = 6 areas of limphoid tissue

adenoid, x2 tubal, x2 palatine, lingual

palatine

39
Q

when would you Rx Abx in tonsillitis? (x3)

A
  1. Centor score >/= 3
  2. FeverPAIN >/=4
  3. high risk for infection
40
Q

1st line Tx in tonsillitis

A

Penecillin V )(phenoxymethylpenecillin/ clarithromycin (if allergic)

41
Q

give 7 complications of tonisllitis

A

chronic tonsillitis
Wuinsy
Otitis media
scarlet fever
rhematic fever
post-strep glomerulonephritis
post-strep ReA

42
Q

give 4 main causes of peripheral vertigo

A

BPPV
Menieres
labrynthitis
vestiibular nueronitis

43
Q

give 4 central causes of vertigo

A

Posterior circulation infarction
tumour
MS
vestibular migraine

(central vertigo = sustained, non-positional vertigo)

44
Q

name the 4 types of exams to conduct in vertigo

A

ear (?infection)
neuro (inc cerebellar exam - danish)
CV exam
Special tests - rombergs, dix-hall-pike, HINTS

45
Q

Mx peripheralvertigo
- 2 groups meds
- menieres prophylaxis
- DVLA instructions

A

Short term Mx in peripheral : Prochlorperazine/ antihistmisn (cyclizine, cinnarizine, promethazine)

Menieres prophylaxis - betahistine

DVLA - do not drive, inform DVLAA if liable to “ sudden, unprovoked episodes of disablign dizziness”

46
Q

does vestibular neuronitis affect

tinnitus

hearing

A

no, as cochlea/cochlear nerve are not affected

47
Q

3 Sx of vestibular neuronitis

A

vertigo ( most sivere for 1st ew days
nausea & vom , and balance problems

48
Q

Examination ofr vestibular neuronitis

A

head impulse test

49
Q

Mx in vestibular neuronitis

  • when to afmit
  • the short term Mx options
A

Adx ( in dehydration from N&V)

short term ( 3days)
prochlorperazine/ antihistamines (cyclizine, cinnariziene, promethazine)

50
Q

prognosis of vestibular neuronitis (x2)

A

most severe st few days, slowly resolves over 2-6 weeks

may develop into BPPV

51
Q

Short term Sx (vertigo) options in labyrinthitis/vestibular neuronitis/ menieres )

How long can these be prescribed for in vertigo?

A

Prochlorperazine
antihistamines ( cyclizine, cinnarizine, promethazine)

max 3 days

52
Q

what differentiates labrythithisis fro vestuiiular neuronitis

A

similarities - acute onset vertigo ( esp followign viral URTI)

difference
Labryinthitis - Loss of hearing, and tinnitus

53
Q

what differentiates labrythithisis fro vestuiiular neuronitis

A

similarities - acute onset vertigo ( esp followign viral URTI)

difference
Labryinthitis - Loss of hearing, and tinnitus

54
Q

primary tinnitus
- what causes it?
- what Sx is it associated with (not tinnitus)

A

cause: no identifiable cause
Sx: sensorineural hearing loss

55
Q

name 3 drugs associated with secondary tinnitus

A

secondary tinnitus - tinitus w/ associated cause
meds: loop diuretics, gentamicin, chemo drugs (cisplatin)

56
Q

give 4 ENT & 4 systemic conditions associated with tinnitus

A

ENT - Ear infection acoustic neuroma, menieres, (MS)

Systemic - anaemia, diabetes, Hypo/hyperthyroid, hyperlipidaeimaia

57
Q

additional sounds causing objective tinnitus

pulsatile carotid bruit

A

carotid artery stenosis

58
Q

additional sounds causing objective tinnitus

radiating pulsatile murmur sounds

A

aortic stenosis

59
Q

additional sounds causing objective tinnitus

pulsatile

A

arteriovenous malformations

60
Q

additional sounds causing objective tinnitus

popping/clicking noises

A

eustachian tube dysfunction

61
Q

5 mx options for tinnitus

A
  • improves/ resolves over time w/o interventions.
  • Tx Underlying causes (e.g., ear wax/infection).
  • Hearing aids
  • Sound therapy (adding background noise to mask the tinnitus)
  • CBT
62
Q

What are indications for hospital admission in Tonsillitis

A

Systemically unwell child
Dehydration
Suggestion of airway compromise

63
Q

Cholesteatoma

  • what is it

-What is the cause

A

Cause: recurrent otitis Media

64
Q

Mx in acute labyrinthitis

A
  • self-limiting
  • Med: prochlorperazine or antihistamines (e.g. promethazine) for dizziness - can only be given for 3 days
65
Q
A

Its the final countdown (23 decks)

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