ENT Flashcards
1
Q
function of semicircular canals
A
sense head movements
2
Q
function cochlear
A
converts sound vibration -> nervous signal
3
Q
webers test results
A
sensorineural loss = louder in normal ear
conductive loss = louder in affected ear
4
Q
webers test
A
tuning fork in middle of forehead
5
Q
rinnes test
A
air vs bone
6
Q
rinnes test results
A
positive=normal=air conduction better
negative=bone conduction better=conductive cause
7
Q
causes sensorineural hearin gloss
A
presbyacusis
noise exposure
menieres
labyrinthitis
acoustic neuroma
stroke
MS
tumour
meningiits
meds: loop diuretics, aminoglycoside abx, chemo
8
Q
causes conductive hearing loss
A
wax
otitis media/externa
tumours
effusion
perforated tympanic membrane
otosclerosis
cholesteatoma
exostosis
9
Q
audiometry symbols: X
A
L sided air conduction
10
Q
audiometry symbols: O
A
R sided air conduction
11
Q
audiometry symbols: ]
A
L sided bone conduction
12
Q
audiometry symbols: [
A
R sided bone conduction
13
Q
normal audiometry
A
all readings 0-20dB (top of chart)
14
Q
sensorineural hearing loss audiometry
A
readings >20dB
15
Q
conduction hearin gloss audiometry
A
air conduction (X, O) >20dB
16
Q
mixed hearing loss audiometry
A
all readings >20dB and >15dB difference between bone and air (bone>air)
17
Q
what is presbycusis
A
age-related hearin gloss
sensorineural
18
Q
features presbycusis
A
gradual
high pitched sounds first
+/- tinnitus
19
Q
cause presbycusis
A
due to hair loss cells in chochlear
loss neurons
atrophy stria vascularis
reduced endolymphatic potential
20
Q
RF presbycusis
A
age
M
fhx
noise exposure
DM
HTN
smoking
21
Q
mx presbycusis
A
hearing aids
22
Q
causes sudden (<72hr) sensorineural hearin gloss
A
idiopathic
infection
menieres
meds
MS
migraine
stroke
acoustic neuroma
cogan’s syndrome (AI)
23
Q
diagnosis sudden sensorineural heaing loss
A
loss >30dB in 3 consecutive frequencies
24
Q
mx sensorineural hearing loss
A
emergency referral
steroids
25
role of eustachian tube
equalises pressure and drains fluid from middle ear
26
features eustachian tube dysfunction
reduced hearing
popping
full sensation
pain
tinnitus
27
ix eustachian tube dysfunction
tympanogram: peak admittance with negative ear canal pressures
28
mx eustachian tube dysfunction
none
valsalva
decongestants
antihistamines/steroid spray
surgery: grommets, balloon dilatation, eustachian tuboplasty
29
otosclerosis
remodelling malleus/incus/stapes
more common F <40y
30
features otosclerosis
conductive hearing loss
lower pitched sounds
tinnitus
31
mx otosclerosis
hearing aids
surgery: stapedectomy/stapedotomy
32
what is otitis media
infection middle ear
33
causes otitis media
strep pneumoniae
h.influenzae
moraxella catarrhalis
s.aureus
34
features otitis media
pain
reduced hearing
fever
bulging red tympanic membrane
35
mx otitis media
immediate abx if systemic sx
delayed abx or none if not
5-7d amoxicillin or clarithromycin
36
complications otitis media
otitis media with effusion
hearing loss
perforated tympanic membrane
labrinthitis
mastoiditis
abscess
facial nerve palsy
meningitis
37
causes otitis externa
bacterial: pseudomonas aeruginosa, staph aureus
fungal
eczema
38
features otitis externa
pain
discharge
itching
conductive hearing loss
39
mx otitis externa
mild=acetic acid
moderate=topical abx and steroid (neomycin, dex, acetic acid)
40
what abx is ototoxic
aminoglycoside
must exclude perforated tympanic membrane before topical use
41
malignant otitis externa
spreads to bones
42
RF malignant otitis externa
DM
immunocompromised
HIV
43
features malignant otitis externa
severe pain
headache
fever
granulation tissue in ear canal
44
mx malignant otitis externa
CT/MRI
IV abx
45
complications malignant otitis externa
facial nerve palsy
meningitis
intracranial thrombosis
46
features excess ear wax
conductive hearing loss
fullness
tinnitus
47
mx excess ear wax
drops (olive oil)
irrigation
microsuction
48
tinnitus
ringing or buzing in ears
49
cause tinnitus
background sensory signal produced by cochlear
50
causes tinnitus
primary=none
secondary=wax, infection, menieres, noise, meds, acoustic neuroma, MS, trauma, depression
51
what conditions is tinnitus associated with
anaemia
DM
thyroid
high lipids
52
what is objective tinnitus
the sound is caused by carotid artery or aortic stenosis, arteriovenous malformations, eustachian tube dysfunction
53
ix tinnitus
FBC
glucose
TSH
lipids audiology
54
tinnitus red flags
unilateral
pulsatile
hyperacusis
unilateral hearing loss
sudden hearing loss
vertigo
headaches
visual changes
neuro sx
suicidal ideation
55
mx tinnitus
hearing aids
sound therapy CBT
56
what is vertigo
patient feels like they or the room is moving
57
peripheral causes vertigo
vestibular system: BPPV, menieres, vestibular neuronitis, labyrinthitis
58
central causes vertigo
brainstem/cerebellum: posterior circulation infarct, tumour, MS, vestibular migraine
59
peripheral vs central vertigo
perioheral: sudden onset, short, tinnitus nausea
central: gradual onset, persistant, coordination impaired
60
O/E in vertigo
HINTS
head impulse (jerk head and eyes soccade) positive in peripheral
nystagmus: positive in central
test of skew (cover eye and verticle correction): positive in central
61
ix vertigo
if central cause suspected need CT/MRI
62
mx vertigo
tx cause
short term for peripheral: prochlorperazine, antihistamines
63
benign paroxysmal positional vertigo cause
displaced otoconia (calcium carbonate) into semicircular canals which disrupts flow endolymphs
64
features BPPV
vertigo due to head movements
no tinnitus
65
diagnosis BPPV
dix hallpike manoevre (triggers sx)
66
mx BPPV
epley manoevre
brandt-daroff exercises
67
vestibular neuronitis
inflammation vestibular nerve due to viral infection
68
features vestibular neuronitis
URTI
vertigo
N+V
balance problems
NO HEARING LOSS
69
mx vestibular neuronitis
prochlorperazine
cyclizine
vestibular rehab
70
inner ear
bony labyrinth
semicircular canals
vestibule
cochlea
71
labyrinthitis
inflammation inner ear
72
cause labyrinthitis
viral URTI
73
features labyrinthitis
acute onset vertigo
hearing loss
tinnitus
74
mx labyrinthitis
up to 3d prochlorperazine or cyclizine
abx if bacterial
75
menieres
build up of endolymph in labyrinth
76
features menieres
unilateral sensorineural hearing loss
vertigo (in clusters)
tinnitus
drop attacks
imbalance
77
mx menieres
acute attacks=prochlorperazine, cyclizine
prophylaxis=betahistine
78
acoustic neuroma
=vestibular schwannoma
benign tumour schwann cells surrounding the auditory nerve
occur at cerebellopontine angle
79
bilater acoustic neuroma
neurofibromatosis type II
80
features acoustic neuroma
40-60y
unilateral sensorineural hearing loss and tinnitus
dizziness/imbalance
fulless in ear
+/- facial nerve palsy
81
mx acoustic neuroma
conservative
surgery
radiotherapy
82
cholesteatoma
abnormal squamous epithelial cells in middle ear
non cancerous but locally invasive
83
features cholesteatoma
foul discharge
unilateral conductive hearing loss
infection
pain
vertigo
facial nerve palsy
84
ix cholesteatoma
otoscopy=white debris/crust in tympanic membrane
CT
85
mx cholesteatoma
surgery
86
divisions facial nerve
temporal
zygomatic
buccal
marginal manddibular
cervical
87
facial nerve function
motor: facial expressio, stapedius, posterior digastric, stylohyoid, platysma
sensory: taste to anterior 2/3 tongue
parasymp: submandibular and sublingual salivary glands, lacrimal gland
88
features UMN facial nerve lesion
forehead spared
89
cause UMN facial nerve lesion
stroke
tumour
90
features LMN facial nerve lesion
forehead not spared
91
cause LMN facial nerve lesion
bells palsy
ramsay hunt
infection: otitis media, HIV, lyme disease
systemic: DM, sarcoid, leukaemia, MS, guillain barre
tumour: acoustic neuroma, parotid, cholesteatoma
traum
92
mx bells palsy
pred within 72h
lubricating eye drops
recovery can take 12m, 1/3 have residual weakness
93
cause ramsay hunt syndrome
VZV
94
features ramsay hunt syndrome
unilateral LMN VII palsy
vesicualr and painful rash around ear
95
mx ramsay hunt syndrome
pred/aciclovir
lubricating eye drops
96
where does epistaxis commonly come from
kiesselbacks plexus in litttles area
97
mx epistaxis
squeeze nostrils and head forward
not stopped after 15m=nasal tampon or cautery with silver nitrate stick
naseptin (chlorhex and neomycin) for 10d to reduce inflammation and infeection
98
paranasal sinuses
frontal
maxillary
ethmoid
sphenoid
99
causes sinusitis
infection: viral URTI
allergy
obstruction
smoking
100
features sinusitis
nasal congestion and discharge
facial pain/pressure/swelling
headache
101
mx acute sinusitis
nothing for first 10d, then steroid nasal spray (mometasone) 14d or abx if bacterial (phenoxymethylpenicillin)
102
mx chronic sinusitis
saline nasal irrigation
steroid nasal spray
functional endoscopic sinus surgery
103
unilateral nasal polyps
RED FLAG
104
bilateral nasal polyps associations
chroni rhinitis/sinusiits
asthma
CF
churg strauss
snoring
105
mx nasal polyps
steroid drops/spray
surgery
106
samters triad
nasal polyps
asthma
aspirin intolerance/allergy
107
what happens in obstructive sleep apnoea
collapse pharyngeal airway
108
RF obstructive sleep apnoea
age
M
obese
alcohol
smoking
109
features obstrutive sleep apnoea
apnoea
snoring
daytime sleepiness
reduced oxygen sats in sleep
110
what can obstrutive sleep apnoea lead to
HTN
HF
risk MI, stroke
111
ix obstructive sleep apnoea
epworth sleepiness scale=daytime sleepines
sleep studies
112
mx obstrutive sleep apnoea
ENT/sleep clinic
CPAP
uvulopalatopharyngiplasty
113
causes tonsilitis
group A strep - pyogenes
strep pneumoniae
h.influenzae
morazella catarhallis
staph aureus
114
waldeyers tonsillar ring
adenoids
tubal tonsils
palatine tonsils
lingual tonsils
115
what is usually affected in tonsilitis
palatine tonsils
116
features tonsilitis
sore throat
fever
swallowing pain
anterior cervical lymphadenopathy
117
centor criteria
likelihood tonsilits is bacterial
fever >/= 38, tonsillar exudates, no cough, anterior lymphadenopathy
118
interpreting centor criteria
>/= 3 likely bacterial tonsilitis
119
fever PAIN score
likelihood bacterial
fever within 24h
purulence
attended within 3d sx
inflammed tonsils
no cough or coryza
120
interpreting fever pain score
likely bacterial if >/= 4
121
mx tonsilitis
pnehoxymethylpenicillin (or clarithromycin) if centor >/= 3 or fever pain >/= 4
122
complications tonsilitis
quinsy
otitis media
scarlet fever
rheumatic fever
post strep glomerulonephritis
post strep reactive arthritis
123
quinsy
peritonsillar abscess
124
causes quinsy
strep pyogenes
staph aureus
h influenzae
125
features quinsy
tonsillitis ->
trismus (cant open mouth), hot potato voice, swelling and erythema around tonsils
126
mx quinsy
ENT refer
needle aspiration +/- dex and abx (co-amox
127
indications for tonsillectomy
episodes sore throat:
>/= 7 / yr for 1yr
>/= 5 /yr for 2yr
>/= 3 / yr for 3yr
2 tonsillar abscesses
tonsils cause difficulty breathing
128
complications tonsillectomy
sore throat
damage to teeth
infection
post tonsillectomy bleeding
129
mx post tonsillectomy bleeding
emergency
IV access
hydrogen peroxide gargle
adrenaline swab
theatre
130
anterior triangle
mandible=superior
midline neck=medial
sternocleidomastoid=lateral
131
posterior triangle
clavicle=inferior
trapezius=posteriir
sternocleidomastoid=lateral
132
neck lump differencital
abscess
lymphadenopathy
tumour
lipoma
goitre
salivary gland stones/infeection
carotid body tumour
haematoma
thyroglossal cyst
branchial cyst
children: cystic hygroma, dermoid cyst, haemangioma, venous malformation
133
2ww for neck lump
unexplained >45y
persistant lump at any age
for USS
134
carotid tumour
excessive growth glomus cells above carotid bifurcation
135
features carotid tumour
painless
pulsatile
bruit
may compress CN IX/X/XI/XII or sympathetic NS ->horners
136
ix carotid tumour
imaging=splaying-lyre sign
137
features thyroglossal cyst
move up and down with tongue
midline
mobile soft
138
branchial cyst formation
from 2nd branchial cleft
139
features branchial cyst
>10y
round and soft between angle of jaw and sternocleidomastoif (ant triangle)
140
mx branchial cyst
none
surgery
141
head and neck cancer
usually SCC
142
where does head and neck cancer spread
lymph nodes
143
RF head and neck cancer
smoking
chewing tobacco/betel quid
alcohol
HPV
EBV
144
features head and neck cancer
lump
ulcer
hoarse voice
erythoplakia
145
mx head and neck cancer
surgery
chemo
radio
cetuximab
146
glositis
inflamed red tongue
147
causes glositis
iron/B12/folat defiency
coeliac
injury
148
causes angiodema
allergic rxn
ACE i
hereditary: CI esterase inhibitor deficiency
149
RF oral candidiasis
inhaled corticosteroids
abx
DM
HIV
smoking
150
mx oral candidiasis
miconazole gel
nystatin suspension
fluconazole tablet
151
geographic tongue
patches of epithelium and papillae lost
152
causes geographic tongue
none
stress
psoriasis
atopy
DM
153
features strawberry tongue
red
swollen
enlarged white palpillae
154
causes strawberry tongue
scarlet fever
kawasaki
155
black hairy tongue
reduced shedding of keratin leading to elongated papillae which bacteria and food cause dark pigmentayion
156
features black hairy tongue
dark pigmentation
sticky saliva
metallic taste
157
cause black hairy tongue
dehydration
poor hygiene
smoking
158
mx black hairy tongue
hydrate
hygiene
159
leukoplakia
raised white hairy patches in mouth
increased risk SCC
160
mx leukoplakia
biopsy and excision
161
erythroplakia
red lesions in mouth
162
erythroleukoplakia
red and white lesions in mouth
163
mx erythroplakia and erythroleukplakia
need to exclude SCC - biopsy
164
cause lichen planus
AI
inflammation
165
features reticular lichen planus
wickhams striae
erosive
plaques
166
mx lichen planus
hygiene
topical steroid
167
gingivitis
gum inflammation
168
features gingivitis
swelling
bleeding
halitosis
can lead to periodontitis ->teeth loss
169
RF gingivitis
poor hygiene
smoking
DM
malnutrition
stress
170
features acute necrotising ulcerative gingivitis
rapid onset
pain
171
causes acute necrotising ulcerative gingivitis
anaerobic bacteria
172
gingival hyperplasia
abnormal growth of gums
173
causes gingival hyperplasia
gingivitis
pregnancy
Vit C deficeincy
AML
meds: CCB, phenytoin, ciclosporin
174
aphthous ulcers features
small
painful
white
well punched out
175
cause aphthous ulcers
none
IBD
coeliac
behcets
iron/B12/folate/vit d deficiency
HIV
176
mx aphthous ulcers
none
topical: bonjela (choline salicylate), lidocaine, steroids
2ww if unexplained and been there for 3w
177
head and neck red flags
dysphagia, odynophagia, dysphonia, wt loss, spitting blood, unilateral nasal obstruction, neck mass
178
RF head and neck malignancy
SMOKING
alcohol, beta nut, HPV
179
when to urgently refer mouth ulcers (red flag0
ulcer present for over 3w
persistent lump on lip
persistent red white lesions consistent with cancer
180
when to urgently refer for dysphonia
persistent >/= 3w as potential SCC
181
mx dysphonia
voice rest
steam inhalation
hydration
lifestyle
PPI
182
unilateral tonsil enlargement
RED FLAG
adult=SCC
children=lymphoma (v rare)
183
where may unilateral otalgia be referred from?
throat
184
when to refer sore throat
routine ENT referral if persists for 6w and no improvement/new sx
185
globus pharyngeus
sensation of lump in throat
186
most common parotid masses
warthins: M>60y, bilateral, benign
pleomorphic adenoma: F, middle aged, removed as may turn malignant
187
sialadenitis
infection salivary gland
old, dehydrated
mx: hydrate +/- abx
188
shape of nodes in lymphoma
round
189
shape of nodes reactive lymphadenopathy
oval
190
neck lump clinic
hx
examination
USS
fine needle aspiration
191
unilateral nasal obstruction
child: foreign body
teenage boy: juvenile angiofibroma (unilateral nosebleed)
adult: sinusoidal malignancy (blood dicharge)
192
chinese and malaysian q stem stereotype
sinonasal malignancy due to ebv
(higher incidence in chinese)
193
nasal polyposis
associated with allergic rhinitis
painless, reduced smell and taste
tx with intranasal steroids -> ENT for oral steroids
194
predisposing factors to otitis externa
water
cotton buds
eczema
195
fungal otitis externa
usually after systemic abx tx
black hyphae
canestan drops and clean
196
malignant otitis externa
spread to bone
nerve palsys: VII first
need IV abx
197
when to refer otitis externa
no response to tx
canal oedematous
needs aural toilet
suspicion invasive OE
198
subperichondrial haematoma
trauma
needs aspiration or leads to cauliflower ear (fibrosis)
199
foreign body in ear/nose
only 1 attemt at removal before urgent referral
dont use forceps for round things
can syringle with warm water
200
nasal # mx
exclude other injuries
analegesia
routine referral (5-7d) if obvious deformity as need time for swelling to decrease, however hard to manipulate after 2-3 w(rhinoplasty needed)
urgernt referral if septal haematoma
201
acute sinusitis complications
extracranial: orbital celluliits, potts puffy tumour (frontal sinusitis bursts forward)
intracranail: meningitis, brain abscess, cavernous sinus thrombosis
202
preseptal celluliits progression
->orbital cellulitis->subperiosteal abscess->intraorbital abscess-> cavernous sinus thrombosis
203
cause parotitis
elderly
paramyxovirus
204
mx parotitis
metronidazole, fluclox, hydrate, pineapple
205
deep neck space infection
increasing incidence
mixed organisms
206
mx deep neck space infection
neck and chest CT
broad spectrum ab
surgical drainage
maintain away
