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Year 6 > ENT > Flashcards

ENT Flashcards

1
Q

Otitis externa presentation

A

Watery discharge
Itch
Pain and tragal tenderness
otoscopy: red, swollen or eczematous canal

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2
Q

Causes of otitis externa

A

Moisture, eg swimming
Trauma, eg fingernails
absence of wax
hearing aid
organisms: mostly pseudomonas, or some staph aureus

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3
Q

Mx otitis externa

A

Clean external auditory canal
Drops: topical antibiotic or combined topical antibiotic with steroid
If tympanic membrane is perforated then traditionally don’t use aminoglycosides
2nd line options: oral fluclox if infection spreading, swab ear canal, empirical antifungal
fail to respond to topical? refer to ENT

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4
Q

Malignant otitis externa

A

extension of infection into bony ear canal and soft tissues deepp to bony canal. May require IV abx.
90% of pts are diabetic
copious otorrhoea and granulation tissue in the canal

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5
Q

Organisms causing otitis media

A

Viral
Pneumococcus
Haemophilus
Moraxella

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6
Q

Presentation acute otitis media

A

Usually children post viral URTI
Rapid onset ear pain, tugging at ear
Irritability, anorexia, vomiting
Purulent discharge (otorrhoea) if drum perforates
O/E bulging red tympanic membrane, fever

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7
Q

Mx acute otitis media

A

Generally self limiting and doesn’t require abx. analgesia to relieve otalgia. Parents seek help if worsened or not improved after 3 days
abx immediately if:
symp >4 days
Systemically unwell (buut not needing admission)
Immunocompromise or high risk of complications as other disease
Under 2 years and bilateral OM
OM with perforation and/or discharge in canal
Antibiotic choice: 5-7d amoxicillin 1st line. if allergic, erythromycin or clarithro

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8
Q

Complications of acute OM

A

Mastoiditis
Meningitis
Brain abscess
Facial nerve paralysis

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9
Q

Glue ear (Otitis media with effusion) risk factors

A

male sex
siblings with glue ear
higher incidence winter and spring
bottle feeding
day care attendance
parental smoking

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10
Q

Features of glue ear

A

Peak at 2 yrs
Hearing loss usually presenting feature
-> inattention at school, poor speech development
O/E: retracted dull TM, poss fluid level
audiometry: flat tympanogramM

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11
Q

Mx glue ear

A

Usually resolves spontaneously
Consider grommets if persistent hearing loss (they normally work for approx 10 months and then fall out)
Adenoidectomy

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12
Q

Chronic suppurative OM

A

Painless discharge and hearing loss after TM perforates
Need aural cleansing
Antibiotics + steroid ear drops
Complic: cholesteatoma

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13
Q

Cholesteatoma what is

A

Locally destructive expansion of stratified squamous epithelium within the middle ear
Either congenital, 2ndary to attic perforaiton in chronic suppurative otitis media

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14
Q

Presentation of cholesteatoma

A

Foul smelling, white discharge
Headache, pain
CN involvement -» vertigo, deafness, facial paralysis
O/E: pearly white w surroundign inflammation

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15
Q

Complications of cholesteatoma

A

Deafness (ossicle destruction)
meningitis
cerebral abscess

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16
Q

Management of cholesteatoma

A

Surgery

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17
Q

History and examination w tinnitus

A

Character: cosntant, pulsatile
Unilateral: acoustic neuromal
FH: otosclerosis
Allerviating/exac ffactors
Associations:
- vertigo and deafness –> Meniere’s, acoustic neuroma
cause: head injury, noise, drugs, FH
Otoscopy
Weber and Rinne’s
Pulse and BP
Audiometry and tympanogram

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18
Q

Ototoxic drugs

A

Gentamicin
Loop diuretics
Metronidazole
Cotrimoxazole

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19
Q

Peripheral/vestibular causes of vertigo

A

Meniere’s
BPPV
Labyrinthitis

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20
Q

Central causes of vertigo

A

Acoustic neuroma
MS
Vertebrobasilar insufficiency/stroke
Head injury
Inner ear syphilis

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21
Q

Meniere’s disease what is

A

Dilation of endolymph spaces of membranous labyrinth
Unknown cause

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22
Q

Featuers of Meniere;s disease

A

Attacks occur in clusters and last up to 12h
Progressive sensori-neural hearing loss
Vertigo and N&V
tinnitus
Nystagmus and positive Romberg test
Aural fullness
Middle aged adults, M=F
Audiometry: fluctuating low freq SNHL

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23
Q

Management of Meniere’s disease

A

Conserve: symptoms resolve in majority after 5-10 yrs, but leaving degree of hearing loss, psych distress
Inform DVLA and no driving until symptom control
Acute attacks: buccal or IM procholrperazine
prevent: betahistine and vestibular rehab exercises
Surg: gentamicin instillation via grommets, saccus decompression?

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24
Q

Vestibular neuronitis/viral labyrinthitis presentation

A

Following febrile illness eg URTI
Severe vertigo exacerbated by head movement
Sudden vomiting
Attacks last hours to days
No hearing loss or tinnkitus if neuronitus but YES if labyrinthitis

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25
Q

Mx vestibular neuronitis/viral labyrinthitis

A

Cyclizine
Improves in days

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26
Q

BPPV cause and path

A

Displacement of otoliths in semicircular canals, common after head injury
Or idiopathic
Otosclerosis
Post-viral

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27
Q

presentation BPPV

A

Sudden rotational vetigo for <30 seconds provoked by head turning (eg rolling over in bed)
Nystagmus

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28
Q

management BPPV

A

Dix-hallpike manouevre -> upbeat torsional nystagmus is diagnostic
Epley manoeuvre and teach to self-Epley
Betahistine but tends to be of limited value
Spontaneously resolvse after a few weeks-months
But 50% recur 3-5 years later

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29
Q

Differentials for conductive hearing loss

A

External canal obstruction: wax, pus, foreign body
TM perforation: trauma, infection
Ossicle defects: otosclerosis, infection, trauma

30
Q

Differentials for sensorineural hearing loss

A

Drugs: aminoglycosides, vancomycin
Post-infective: meningitis, measles, mumps, herpes
Misc; Meniere’s, trauma. MS, cerebellopontine angle lesion (eg acoustic neuroma), reduced B12

31
Q

Acoustic neuroma

A

Path: benign slow growing tumour of superior vestibular nerve, acts as space occupting lesion. Associated with neurofibromatosis 2
Present; slow onset, unilateral sensorineural hearing loss, tinnitus +/- vertigo
Headache (incr ICP)
CN palsies: 5,7,8
Cerebellar signs
IX: MRI cerebellopontine angle
Differential: meningioma, cerebellar astrocytoma, mets
Mx: gamma knife, surgery

32
Q

Otosclerosis

A

Autosomal dominant condition, fixation of stapes at oval window, F>M, 2:1
begins early adult life, bilatereal conductive deafness and tinnitus
Hearing loss IMPROVED in noisy places
Worsened by pregnancy, menstruation, menopaus
PTA shows dip at 2kHz
Mx: hearing aid/stapes implant

33
Q

Presbyacusis

A

Age related hearing loss
>65s, bilateral, slow onset +/- tinnitus
PTA
Mx: hearing aid

34
Q

Nasal polyps who where what

A

Male >40yrs, middle turbinates, middle meatus, ethmoid
Sympt
watery, anterior rhinorrhoea
purulent post-nasa drip
Nasal obstruction
sinusitis
headaches
Snoring
SIgns: mobile pale, insensitive

35
Q

single unilateral nasal polyp

A

Is a sinister sign eg of
Nasopharyngeal cancer
Glioma
Lymphoma
Neuroblastoma
Sarcoma
-> do CT and get histology

36
Q

Management nasal polyps

A

Betamethasone drops for 2 days, short coue oral steroids
Endoscopic polypectomy, but apparently limited use

37
Q

Fractured nose where ad history

A

Upper 3rd of nose = bony support, lower 2/3 and septum are cartilaginous
Find out
- time of injury
- LOC
- CSF rhinorrhoea
- epistaxis
- prev nose injury
- obstruction
- consider facial fracture

38
Q

Management fractured nose

A

Very little use doing radiographs as cartilaginous injury won’t show, and won;t change Mx
Exclude septal haematoma
Re-examine after 1 week check swelling reducing
Reduction under GA with post op splinting best within 2 weeks

39
Q

Septal haematoma

A

Septal necrosis + nasal collapse if untreated - as cartilage blood supply comes from mucosa
Boggy swelling and nasal obstruction
Needs evacuation under GA w packing +/- suturing

40
Q

Causes of epistaxis

A

80% unknown
Trauma eg nose picking, fractures
Local infection
Pyogenic granulosa (overgrowth of tissue Little’s area due to irritation or hormonal factors
Coagulopathy: warfarin, NSAIDs, haemophilia, reduced platelets, vWD, incr alcohol
Neoplasm

41
Q

Initial management epistaxis

A

Wear PPE
Assess for shock and manage accordingly
If not shocked, sit up, head tilt down, compress nasal cartliage for 15 mins
If bleeding not controlled, remove clots by suction/blowing and try to visualise bleed w rhinoscopy

42
Q

Anterior epistaxis

A

Usually septal haemorrhage: Little’s area = anterior ethmoidal artery, sphenopalatine A, facial A
1. insert gauze soaked in vasoconstrictor and local anaesthetic (xylometazoline +2% lidocaine) for 5 mins
2. cauterise w silver nitrate sticks
3. pack with Mericel pack
Refer to ENT if this fails or you can’t visualise bleeding point, they may insert posterior pack or take to theatre

43
Q
A
44
Q

Posterior/major epistaxis management

A

Posterior pack (+anterior pack)
-> pass 18/18G Foley atheter through nose into nasopharynx, inflate w 10ml water and pull forward until it lodges
-> admit patient and leave pack for ~48h
GOld standard: endoscopic visualisation and direct control, eg by cautery or ligation

45
Q

Management post-epistaxis

A

Don’t pick nose
sit upright, out of the sun
Avid bending, lifting or straining
Sneeze through mouth
No hot food or drink
Avoid alcohol and tobacco`

46
Q

Causes of tonsillitis

A

Viruses are most common (consider EBV)
Group A strep (pyogenes)
Staphs
Moraxella

47
Q

Centor criteria

A

1 point for each of:
history of fever
tonsillar exudates
tender anterior cervical lymphadenopathy
no cough
0-1: no abx
2: consider rapid Ag test and mx if +ve
3+: abx (pen V 250mg PO QDS for 5-7days, or erythyromyvin if pen allergic)

48
Q

Tonsillectomy indications

A

7 episodes in one year
5+ episoder per 2 year
episodes are disabling and prevent normal functioning
also if recent febrile convulsions secondary to episodes of tonsillitis
OSA, stridor or dysphagia 2ndary to enlarged tonsils
Quinsy if unresponsive to standard treatment

49
Q

Complications of tonsillectomy

A

primary: haemorrhage in 2-3% (RETURN TO THEATRE), pain
Secondary: harmorrhage (commonly due to infection), pain
Tonsillar gag may damage teeth, TMJ or posterior pharyngeal wall

50
Q

Quinsy (peritonsillar abscess)

A

complication of bacterial tonsilitis
Severe throat pain, lateralising to one side
deviation of uvula to the UNAFFECTED side
trismus (difficulty opening the mouth)
reduced neck mobilitiy

-> urgent ENT review
Mx: needle aspiration or incision+ drainage, + IV abx
tonsillectomy consideration to prevent recurrence

51
Q

Retropharyngeal abscess

A

Rare complication of tonsillitis
Unwell child w stiff, extended neck who refuses to eat/drink, fails to improve w IV abx
unilateral swelling of tonsil and neck
Lat neck XR show soft tissue swelling
CT from skull base to diaphtagm
Need IV abx and I&D

52
Q

Scarlet fever

A

strep throat complication
Sandpaper like rash on chest, axillae or behind ears
12-48h after pharyngotonsillitis
circumoral pallor
strawberry tongue
start Pen V/G and notify HPA

53
Q

Rheumatic fever

A

Strep throat complication
Carditis
Arthritis
subcutaneous nodules
Erythema marginatum
Sydenham’s chorea

54
Q

Post-streptococcal glomerulonephritis

A

Malaise and smoky urine 1-2 weeks after a pharyngitis

55
Q

Functions of the larynx

A

Phonation
Positive thoracic pressure, incl auto PEEP
Respiration
Prevention of aspiration

56
Q

Recurrent laryngeal nerve palsy sympt

A

Supplies all intrinsic laryngeal muscles except for cricothyroideus = responsible for ab and adduction of the vocal folds
Sympt:
hoarseness
“breathy” voice w bovine cough
repeated coughing from aspiration
exertional dyspnoea (narrow glottis)

57
Q

Causes of recurrent laryngeal nerve palsy

A

30% are cancers: larynx, thyroid, oesophagus, hypopharynx, bronchus
25% are iatrogenic: para/thyroidectomy, carotid endarterectomy
Other: aortic aneurysm, bulbar/pseudobulbar palsy

58
Q

Laryngomalacia

A

Immature and floppy aryepiglottic fikds and glottis -> laryngeal collapse on inspiration
Present: stridor (most common cause in first weeks of life)
Partic noticeable when lying on back, feeding, excited/upset
Problems can occu w concurrent laryngeal infections or w feeding
Usually no manamgent required, but severe cases may need surgery

59
Q

Bell’s palsy cause

A

Inflammatory oedema from entrapment of CN7 in narrow facial canal
Probably of viral origin (HSV1)
75% of facial palsy

60
Q

Features of bell’s palsy

A

Sudden onset, eg overnight
Complete, unilateral facial weakness in 24-72h
-> failure of eye closure -> dryness and conjunctivitis
-> drooling, speech difficulty
Numbness or pain around ear
Reduced taste
Hyperacusis (stapedius palsy)

61
Q

Ix for Bell’s Palsy

A

Serology: Borrelia or VZV abs
MRI: SOL, stroke or MS
LP

62
Q

Mx Bell’s palsy

A

Protect eye: dark glasses, artificial tears, tape closed at night
Give pred within 72h, 60mg PO for 5 days then taper
Valaciclovir if zoster suspected
Plastics if no recovery
Incomplete paralysis normally recovvers within weeks
If complete, 80% have full recovery, but remainder delayed or permanent abnormalities

63
Q

Ramsay Hunt syndrome

A

Reactivation of VZV in geniculate ganglion of CN7
Preceding ear pain/stiff neck -> vesicular rash in auditory canal +/- tympanic membrane, pinna, tongue, hard palate
Ipsilateral facial weakness, ageusia, hyperacusis. May have CN8 involvement -> vertigo, tinnitus, deafness
Give valaciclovir and pred within 72h -> 75% recovery

64
Q

Allergic rhinosinusitis pathol

A

Seasonal hayfever = 2% prevalence, or perennial
T1 cells IGE mediated inflammation from allergen exposure.
Allergens: pollen, house dust mites (perennial)

65
Q

Sympt and sngs of allergic rhinosinusitis

A

Sneezing, pruritus, rhinorrhoea
Swollen, pale and boggy turbinates
Nasal polyps

66
Q

Ix for allergic rhinosinusitis

A

Skin prick testing to find allergens (but don’t if prone to eczema)
RAST tests

67
Q

Manaement of allergic rhinosinusitis

A

Allergen avoidance. Regular washing on high heat, stay indoors when pollen count high
1st: anti histamines, or beclometasone nasal spray
2nd: inrtanasal steroids + antihistamines
3rd: zafirlukast
4th: immunotherapy aim to induce desensitisation to allergen

68
Q

Sinusitis pathol and caus

A

Viruses -> muvosal oedema and reduce ciliary actions -> mucus retention and 2ndary bacterial infection
Acute: pneumococcus, haemophilus, moraxella
Chronic: staph, anaerobes
5% are 2ndary to dental root infections
Diving/swimming in infected water
Anatomical susceptibility, PCD and immunodefic incr risk

69
Q

Symptoms of sinusitis

A

Pain: maxillary (cheek/teeth) or ethmoidal (between eyes), incr on bending/straining
discharge: from nose -> post nasal drip w foul taste
Nasal obstruction/congestion
Anosmia or cacosmia (bad smell)
Fever

70
Q

Mx sinusitis

A

Acute/single episode
- bed rest, decongestants, analgesia
- nasal douching and topical steroids
- abx eg clarithro uncertain benefit

Chronic/recurrent
- usually structural/drainage problem
- stop smoking +fluticasone nasal spray
- if failed medical therapy= functional endoscopic sinus surgery

Year 6 (9 decks)

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