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Surgery > ENT > Flashcards

ENT Flashcards

1
Q

whats conductive hearing loss and casues

A

where sound cant get to the sensory system -> probelm with sound travelling from outer enviroment to the inner ear

ear wax
foreign body
ottitis externa / interna
fluid in middle ear- effusion
eustachian tube dysfunction
perforated tympanic membrane
osteosclerosis
cholesteoma
exostoses
tumours

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2
Q

whats sensironeural hearing loss and casues

A

problem with the snesory system/vestibular nerve

stroke
brain tumour
sudden sensironeural hearing loss
prebsycusis- age related
noise exposure
menieres disease
labrynthitis
acoustic neuroma
neure- stroke, MS , brain tumpour
infecitons- meningitits
meds: loop diuretics, aminoglycosdies (gentamycin) , chemo- cisplatin

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3
Q

drugs that can casue sensironeural hearing loss

A

loop diuretics- furosemide
aminoglycoside abx- gentamicin
chemo- cisplatin

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4
Q

otitis externa

A

inflammation of external ear cancal
infection can be diffuse/ localsied
acute- less 3 weeks
chronic - mpore 3 weeks

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5
Q

risk factors ottits externa

A

swimming
trauma- ear plugs, cotton buds
removal ear wax
lots of course of abx- can casue fungal infection- candia / aspergillus

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6
Q

casues of ottis externa

A

bacterial infection
fungal infection- candida/ aspergillus
eczema
seborrheic dermatitis
cxontact dermatitis

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7
Q

casues of bacterial inection of otitis externa

A

pseudomonas aeuringosa
staphylcoccus aureus

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8
Q

treat psuedomonas aeuginosa infection ottitis externa

A

aminoglcoside-gentamyic/ quinolones- ciprfloxacin

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9
Q

presentation otitis externa

A

pain
discarge
itchy
conducive hearing lsos if blcoked
eyrhtmea
tender
swelling in cancal
pus/discharge in ear canal

typanic memebrane may be obstructed by wax/discharge - if perfroated then discharge may ne from ottis media not externa

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10
Q

investigations otits externa

A

otoscop- clinical
ear swap- not really needed often

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11
Q

managemnt of mild otits externa

A

acetic acid 2% - antifungal and antibacterial
can use for prophylaxiss before and after swimming

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12
Q

managemnt of moderate otitis externa

A

topical abx and steroids
otomize spray- neomycin, dexamethoasone, acetic acid
neomycin and betamethoason
gentamycin and hydrocortisone
ciprofloxacin and dexamethoasone

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13
Q

when giving aminoglycosides to otitis externa what need do

A

check not got perforateed tympanic membrane as aminoglycosed can be ottoixic- gentamyicn and neomycin

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14
Q

severe/ suystemic symtpoms otitis externa

A

oral abx- flucloxacillin/clarithromycin
ent to discuss iv

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15
Q

treat fingal otitis externa

A

clotrimazole ear drops

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16
Q

if ear canal swollen / discharge cant get dropsspray in how treat

A

ear wick - opens it up once swelling gone down can put drops in

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17
Q

whats malignat otits externa

A

severe potentilally lifethreatinging form otitis externa
infection spread to bones surroudning ear canal and skull
progresses to osteomyeltitis of temporal bone

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18
Q

rf for malinangt otitis externa

A

rf for severe infection
diabetes
hiv
immunsupress drugs

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19
Q

s and s malingant otitis externa

A

severe pain
more severe otitis externa
peristatn headache
fever
grnaluation tissue at junction between bone and cartilage of ear canal- bout half way along

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20
Q

granulation tissue at junction of bone and cartilage in ear canal

A

malingant otitis externa

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21
Q

treat malgiant otitis externa

A

hosp
iv abx
ct/mri head

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22
Q

complications malignant otitis externa

A

death
facial nerve dmaange and palsy
other cn damage
menigngitis
intracranial thrombosis

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23
Q

fucntion ear wax

A

cerumen
pritective fucntion againtst infection
made of secretions from xternal ear, dead skin cells and anything entering ear

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24
Q

s and s impacted ear wax

A

build up and stuck in ear
pain
tinnitus
discomfort
feeling fullness in ear
conductive hearing loss

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25
Q

investigations ear waxq

A

ototscope- may not see tympanic membrane if ear wx

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26
Q

managment eat wax

A

non
ear drops- oliver oil/ sodium bicarbonate 5% = frist
ear irrigation- 2nd
contraindications irrigation: infection, perforated tympanic memnrare
if irrigation ci then microscution

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27
Q

tinitus

A

presitant addition sound thats not present in surrounding enviroment
ringing
cxan be buzzing, humming, hissing

background sensory signal produced by cohclea thats not effectively filtered out but the central auditory syste,

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28
Q

casues tinnitus

A

primary= no found cause
often occurs iwth sensironeural hearing loss

secondary- odentifiable causes:
impacted ear wax
infection
meneiers
noise exposure
MS
truama
depression
meds:
loop diuretcis, gentamycin, chemo- cisplatin
acoustic neuroma

can be associatefd with system conditions:
diabtetes
hyperlipidameia
hypo/hyperthryoidism
anemia

objective tinnitus:
an acutalcause can hear if asucultate aorund ear:
carotid artery stensois- pulsatile carotid bruit
aortic stneosis- pulsatile raadiating murmur sound
arterivenous malformation- pulsatile
eustachian tube dysfucntion- popping and clicking

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29
Q

systemi conditions assocaited with tinnitus

A

diabetes
anemia
hyperlipidameia
hypo/hyper thyroidsim

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30
Q

investigations for tinnitus

A

fbc- anemia
tsh=thyroid issues
glucose-diabetes
lipids- hyperlipdamiea
audiology
rarely ct/ mri head for vcascualr malformations/ acoustic neuorm

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31
Q

assesment of hx for tinnitus

A

stress axneirty
pattern: unilaterla/bilateral
hearingloss?
frequency/uration
severity
pulsatile
noise exposure
vertigo, pain, discharge
ototscope
webers and rinnes test to asses hearing loss

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32
Q

red flags for tinnitus

A

pulsatile
unilateral
assicated with unilateral hearing loss
assocaited with sudden onset hearing loss
assocaited with vertigo/dizzy
assoaited with headache/vision symtpoms
assocaited with neuro- stroke signs, facial n pasly
sucicadal ideation
hyperacinus- hypersenstitivty, pain, discomfort to enviromental sounds

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33
Q

management tinnitus

A

ususally resovles by self
underyling cause treat
hearing aids
cbt
sound therpay- add noise to backgrund to masl it

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34
Q

vertigo

A

feel room moving/ they are moving

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35
Q

associated symtpoms vertigo

A

nasuea
vomiting
feeling unwell
sweating

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36
Q

maintaing balacne and posture comes form

A

mantiantng balance and posture of are vision, signals from vestibular system and proprioception

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37
Q

causes peripheral - veestibalr of vertigo

A

menieres disease
labrynthitis
bppv
vestibular neuritis
herpes zoster ewith facial n palsy and vesciles round eae- ramsay hunt

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38
Q

casues of vertigo thats central casues- cerrebelum / brainstem

A

tumour
vestibular migraine
posterior circulation infarction- stroke
ms

= all sustaine dna dnon posittional vertigo

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39
Q

if recent illness and vertigo

A

prob labyrhthintits/ vestibular neuritits

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40
Q

headache with vertigo

A

vestibular migraine, tumour
cerebrovascualr accident

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41
Q

typical triggers and vertigo

A

vestibular migraine

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42
Q

ear symptoms vertigo

A

infection

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43
Q

acute onset neuo symtposm and vertigo

A

stroke

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44
Q

examination of person vertigo

A

ear examination
neuro exam
cv exam- arrythmia, heart valve
danish - cerebellum examn
rombergs test
dix hallpike manouvere- dx BPPV
hints exam = head impulse- nomral then currently no symptoms or central - abnormal then peripheral casue
nyastgmus- unilateral and horizontal- peropherla
bilateral and vertical- central
test of skew

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45
Q

managment f central vertigo

A

ct/mri head

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46
Q

managemnt peripheral vertigo

A

antihistmaines
prochlorperazine

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47
Q

managment menieres disease

A

betahistine- dec number attacks

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48
Q

treat BPPV

A

epley manouvere

49
Q

treat vestibular migraines

A

avoid triggers
same mifraine
acute- triptans
prophylaxis- propanolol, amitrypitaline, topiramate

50
Q

vertigo and dvla

A

cant drive and inform dvla if have sudden unprovocked attacks of vertigo

51
Q

orignation of nosebleeds

A

littles area- where kiesselbacks plexus is locatied

52
Q

triggers of nosebleed

A

weather changes
trauma
nose picking
blowing nose vigourosuly
colds
sinusitits
coagulation disorders- thromocytopenia, von willebrands disease
anti coag meds
snorting coacain
tumours

can swallow blood- look likevomit blood if vomit

53
Q

nose bleed bilateral

A

more likely from posterio and increase risk aspirate

54
Q

mnangment nose bleeds

A

normally resov
lean head forward and sit up
oinch soft nose 10-15 mins

not resovled after this time, sevre, haemodynamically unstable, both nostril:
hosp
nasalpacking with nasal tampons/ inflatable packs
nasal cautery with silver nitrate sticks

after rx consider prescribing naseptin nasal cream- chlorhexadine and neomycin- 4 a day for 10 days- reduces crusting, inflam and infection

ci= peanut or soya allergy

55
Q

ci fro naseptin nasal cream

A

peanut soya allergy

56
Q

sinusitits

A

inflammation of paranasal sonuses
usally accompanied by inflamation of nasal cavity=> rhinosinusitits

57
Q

acute sinusisits and chronic duration

A

acute- less 12 weeks
chronic - more 12 weeks

58
Q

sinsues function

A

produce mucous and drain into nasal cavities via holes- ostia
blockage of these holes prevents drainage and so get sinusiits

59
Q

casues of sinusitis

A

infection- esp get after a VIRAL upper resp tract infection
allergies with alergic rhinitits (hayfever)
obstrucition of drainage- foregin body, trauma, nasal polyp
smoking

60
Q

risk factor for sinusutits

A

asthma

61
Q

presentation sinusitis

A

often after viral upper resp tract infection
facial swelling over affected area
facial pressure
facial pain / headache
nasal congestion
nasal discharge
loss of smell

tenderness on palpation of affected area
inflam and oedema of nasal mucosa
dishcarge
fever
sighns of systemic illness- tachycardia

chronic similar

62
Q

chronic sinutisist associated with what

A

nasal polyps

63
Q

investigfations sinusitis

A

nthing
if persitant despite rx:
nasal endoscopy
ct scan

64
Q

management of acute sinusits

A

nothigng - usally resocles 2-3 weeks and due to viral so not keen for abx

if not improved after 10 days of symtoms then:
high dose nasal steroid spray for 14 days = mometasone 200mcg BD
or
delayed abx prescition- if worsening or not improving whtin 7 days abx= phenoxymethylpenicillin

65
Q

managemnt chronic sinusitis

A

steroid nasal spray/ drops= mometasone/ fluticasone
saline nasal irrigation
functional endocopic sinus surgfery

66
Q

technique of nasal spray

A

tilt head foreward slighlty
left hand for r nostril - not directly to septum
not sniff during spray
inhale gently through nose after spray

ask do you taste it in back of mouth after it - shouldnt as means not in nose

67
Q

tonsilits- which tonstils

A

inflammation of tonsils
palatine tonsils in waldeyers ring

68
Q

cause of tonstitlits

A

most common cause is viral!
bacterial- most common is streptococcus pyogenes
second most common is streptococcus pneumoniae
other bacterial:
moraxella catarrhalis
haemophilus influenzae
staphylcoccus aureus

69
Q

presentationtonsitltis

A

fever- over 38
sore throat
pain on swallowing
inflammed, red, enlarged tonsils
can have exudate
may have anterior cervical lymphadenopathy

70
Q

how to know if bacterail tonsitlits

A

feverPAIN score- 4 or more likely bacteria
Centor criteria - 3 or more liekly bacterial

71
Q

feverPAIN score criteria

A

fever- during previous 24hrs
purulence- pus
attended within 3 days of onset
inflammed
no cough.coryza

if 4 or more then tonsiltits bacterial likely = abx

72
Q

centor score

A

fever
tonsilar exudates
no cough
lymphadenopathy - tender anterior cervical lymph nodes
3 or more ikly bacterial tonsiltis

73
Q

managemnt of tonisittlis- viral and bacterial and what abx givr

A

consider admit if:
immunocompromised
dehydrated
strifor
resp disease
cellulitis
peritonsilar abscess
systemically unwell

viral:
resolve by self- use soimple analgesia for pain and fever - paracetamol and nsaids
if not settled with 3 days/ fever over 38.3 then return and consider abx

score centor 3 or more, painFEVER 4 or more consider abx or if at risk of severe infection - young infant, sign co morbities, hx of rheumatic fever, immunocompromised

consider delayed prescirbtio if not imrpvoe / worse 2-3 days

abx= penicillin v (phenoxymethylpenicillin)- narrow good agasint streptococcus pyogenes

if pen allergy- clarightromycin

74
Q

complciations tonisiltis

A

quinsy
otits media
scarlet fever
rheumatic fever
post streptococccal glomerulonephritis
post streptococcal reactive arthritits

75
Q

whats post streptococcal reactive arthirits

A

usally within 10 days after strep infection
joint pain and swelling- localised

76
Q

sore throat
fever
no cough
neck pain
refered ear pain
swollen and tender lymoh nodes neck

differentials- qu to differentiate

A

tonsiiltis
quinsy- able to open mouth? , change voice?, swellijng and red beside tonsils?

77
Q

sore throat
fever
pain on swallowing
rfered ear pain
voice sounds diff

dx

A

quinsy

78
Q

whats quinsy

A

peritonsilar abscess
bacterial infection with trapped pus foprming an abscess in region of tonsils

79
Q

casues of peritonsilar abscess/ quinsy

A

bacterial infection
untreated/ partially treated tonsiltits
can arise without tonsiltis

streptococcus pyogenes- most common
streptococcus aureus
haemophilus influenzae

80
Q

presentation quinsy/peritonsillar abscess

A

like tonsilits
fever
pain swallowing
sore throat
pain radiate to ear
tender cervical anterior lymoh nodes
neck pain

indicate abscess and not tonsiltis:
change in voice- pharangeal swelling
trismus = cant open mouth
erythma and swelling beside the tonsils too

81
Q

mangment peritonisllar abscess/ quinsy

A

hos- incision and drainage under GA
abx before and after surgey as usually bacterial casue
co - amoxiclav- want broad specturm

some surgeons give steorids- dexamethoason- to reduce inflam and help recovery

82
Q

tonsillectomy procedure

A

GA
day case
can still get sore throat other casues- pharyngitits
to prevent further tonsilitis

83
Q

indications for tonsilectomy

A

number of episodes of acute sore throat:
7 in 1 yr
5 per yr for 2yrs
3 per year for 3 years

recurrent episodes tonsillar abscess- 2
enlarged tonsils casuing diff breathing, swallowing, snoring

84
Q

complications tonsilectomy

A

infection
GA risks
post tonsillectomy bleeding!!
sore throat- can last 2 weeks after op
damage to teeth

85
Q

treatment for post tonsillectomy bleeding

A

severe- can be lifethreatenigng esp if aspiration of blood
5% occur
can occur up to 2 weeks afger op

ent reg
iv acess- bloods= fbc, clotting screen, group and save and crossmatch
keep pt calm and appropriate analgesia
sit pt up and encouage spit out blood and not swallow it
nbm
iv fluids - maintence and resus if needed
if severe bleedig or airway compromised may need anaethesitits for intubatio n

stop the bleeding:
hydrogen peroxide gargle
adrenalin soaked swab topically
if not work theatre

86
Q

differentials for neck lumps

A

normal strucutres
skin abscess
lymphadenopathy
thyroid nodules/ goitre
lipoma
branchial cyst
carotid body tumour
thryoglossal cysts
haematoma
salivary gland stones/ infection
tumour- squamous cell carcinoma/sarcoma

childnre also:
cystic hygromas
dermoid cysts
haemangiomas
venous malformations

87
Q

redflas when to refer 2ww neck lumpps

A

45 and over if unexpalined neck lumo- eg. no infection
persitant neck lump any age

us pt if lump growong in size
witin 2 weeks if 25 and over
within 48hrs if under 25

88
Q

investigations may consider for neck lums

A

bloods- fbc, and blood film if leukaemia / infection
hiv test
monospot test/ EBV antiboides
ANA- SLE
thhyroid levels
LDH- non specific marker for non-hodgkins lymphoma
us- first line often
MRI/CT
nuclear medicine scan - thryoid toxic nodules
pet sscan- mets
biopsy

89
Q

causes of lymphadenopathy in neck

A

reactive lymph nodes- swelling, viral upper resp infection, dental infection, tosiltis
infected lymoh nodes- TB,HIV,EBV
inflammaation- SLE, sarcoidosis
malignacyc- lymphoma, leukaemia, mets

90
Q

lump in neck thats maligant on examination

A

non tender
hard/rubbery
unexpalined
enalrge always
abnomral shape
tehtered
weight lsos
fatigue
night swats
fecers

91
Q

s and s infectios mononucleosis
and rx and investigation frst line

A

casued by EBV
trnamissionvia saliva

fever
lymphadenopathy
sore thorat
fatigue
itchy maculopapular rash rxn to amoxicllin/ceflosporins

investigations: monospot test
IgM= actue
IgG= immunity

rx= support
no contact sport as risk splenic rupture
no alcohol as liver

92
Q

s and s lymphoma

A

lymphodenopathy- inguinal, cervical, axialla
fever
weight loss
fatigue
night sweats

93
Q

finding on biopsy for lymphona

A

ree-sternberg cell on biopsy

94
Q

leaukaemia investiation and s and s

A

fever
night sweats
weight loss
lymphadenopahty
pallor-anaemia
petechiaa and abnormal brusing- thrombocytopenia
abnormal bleeding
hepatosplenomegaly

95
Q

casues of thryoid neck lumos

A

goitre:
graves - hyper
toxic multinodular goitre- hyper
hashimotis thryoididits- hypo
idoine def
lithium

individual lumps:
benign hyperplastic nodules
thryoid cysts
thryoid adenomas- bengin increase in thryoid hormone
thryoid cancer
parathrypid tumours

96
Q

casues of salovary gland casuing neck lumo

A

glands:
parotid
submandibular
sublingual
casues:
stone blocking drainage
infection
tumours

97
Q

carotid body tumours what are they and s and s

A

carotid body made of glomus cells that are cehmo receptors- co2, ph
excesivve growth of glomus cells
most are benign
= paragliomas

s and s
slow growing lump
upper anteiro triganle
painless
pulsitile
bruit on auscultation
mobile side to side bu not up and down

can compress cn 9,12,11,12
compress 10= horners syndrome - triad of miosis, ptosis, anhydrosis

98
Q

imaging shows splaying of internal and external carotid arties
casues this and what name of this sign

A

splaying of internal and external carotid a = lyre sign

due to carotid body tumour

99
Q

lipoma s and s

A

bengin fat lumo- anywhere adipose tissue
soft
painess
mobile
no skin changes

can leaveor can remove

100
Q

branchial cyst
s and s

A

congenital
normally second branchial cleft
anteior to sternocleidomastoid muscle and under jaw angle
round soft
transillumiate

treat- conservative or can remove if recurrent infection

101
Q

lump on midline that moves when stick tongue out/ swallow

A

thyroglossal cysts

102
Q

thyroglossal cyst
and s and s

A

embryo thryoid gland moves down from base of tongue and leaves a thryoglossal duct which then closes

sometimes this persitis and fluid cyst can occur

midline in neck
mobile
soft
non tender
fluctuant
move with tongue up and down wehn stick tongue out and move when swallow- upawards

103
Q

investigations and treamnt and compliation thryoglossal cyst

A

us/ct
remove
infection complication

104
Q

differential for midline lump on neck

A

thryoglossal cysts
ectopic thyroid tissue

105
Q

drugs can casue goitre

A

lithium
amiodarone

106
Q

goitre will they move on tongue protrustion?
swallowing?

A

no
thryoglossal cysts will move on tongue protursion as connected to base of tongue

Thyroid gland masses (e.g. a goitre) and thyroglossal cysts typically move upwards with swallowing.
Lymph nodes will typically move very little with swallowing.
An invasive thyroid malignancy may not move with swallowing if tethered to surrounding tissue

107
Q

nasal polyps

A

growths of nasal mucosa that can occur in nasal cavity/ sinuses

108
Q

important thing to remebr about nasal polyps

A

unilateral consider malignancy and refer to specilaist

109
Q

assocaitions with nasal polyps

A

inflammation- chronic sunisitits/rhinitits (something there grwoing and obstructing so going to get inflammation which can then cause sinusuits/rhinitis depndisng locations)
asthma
samters triad- asthma, nasal polyps, aspiring intolerenace/allergy
cystic fibrosis
eosinophilic granulomatosis with polyangitits= chrug strauss syndrome

110
Q

what presentations may you see nasal polyps

A

may be found in patients presenting with:
chronic rhinosinusitis
diff breathing through nose
snoring
nasal discharge
loss of sense of smell

111
Q

how to view nasal polyps and what look like

A

nasal speculum/otoscope with large speculum
nasal endocsopy

round pale yellow/grey growths on the mucosal wall

112
Q

managment nasal polyps

A

unilateral - refer to specialst to exclude malignancy
intranasal topical steroid spray/drops

if doenst work:
surgical removal:
intranasal polypectomy- if close to nostrils and visisble
endoscopic nasal polypectomy- polyps further insdie the nose/sinuses

113
Q

obstructive sleep apnoea

A

episides of apnoea during sleep
stops breathing periodically for up to a few mins

114
Q

casue of obstructive sleep apnoea

A

collaspe of pharyngeal airway

115
Q

risk factors obstructive sleep apnoea

A

male
middle age
obesity
alcohol
smoking

116
Q

features of obstricitve sleep apnoea

A

episodes of apnoea at noght- wkaing at night - usually reported by partner
daytime sleepiness- ask re job may need amened duties
waking feeling unrefreshed
morning headache
snoring
reduced o2 sats at night
concentration problems

117
Q

important questions to ask in pt with obstrucitve sleep apnoea

A

whats their occupation and if they have day time sleepiness - if so may need amend work dutites

118
Q

severe obstructive sleep apnoea can cause

A

hypertension
heart failure
increase risk for stroke and mi

119
Q

management obstrucitve sleep apnoea

A

refer to ent specialst/ specialsit sleep clinic-> sleep studies

1-correct revrisble risk factors- loose weight, stop drinking, stop smoking

2- cpap at night

3- surgry- uvulopalatopharyngeoplasty= UPPP

Surgery (7 decks)

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