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ENT Flashcards

1
Q

most common otitis external organisms

A

pseudomonas - bc swimmers
stap aureus

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2
Q

otitis externa presentation

A

itchy painful ear
watery discharge
tragus tenderness
conductive hearing loss if pretty inflamed
may have fever and cervical lymphadenopathy

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3
Q

rx of acute otitis external
- lifestyle, medical

A

avoid swimming for 7 days, wear ear plugs or tight fitting swim cap
Keep shampoo and soap out of ears when showering
Dont use earphones/earplugs

aural toilet eg with irrigation so topical treatments work
paracetamol
if >12 give topical acetic acid for 7 days
Can give topical abx based on clinical judgement

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4
Q

Presentation of malignant otitis external

A

unremitting pain,
purulent ear discharge,
systemic illness,
hearing loss,
granulation tissue in the ear canal,
- possible facial nerve palsy
- can lead to meningitis

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5
Q

Rx of malignant otitis externa

A

ENT referral! for admission for IV abx

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6
Q

Who is at risk of malignant otitis externa

A

diabetics
immunocompromised eg on chemo
elderly
HIV

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7
Q

Acute otitis media common organisms

A

viral - after viral URTI
strep pneumoniae
haemophillus influenzae
mortadella caterrhalis

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8
Q

Acute OM presentation

A

in kids - tugging at ear, irritability, fever, recent hx of URTI

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9
Q

Acute OM O/E

A

red bulging TM, may be perforated
fever

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10
Q

When do you give abx for acute OM

A

Symptoms lasting more than 4 days or not improving
Immunocompromised
<2 with bilateral otitis media
Otitis media with TM perforation.

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11
Q

Complications of acute OM

A

mastoiditis
TM perf
facial nerve palsy
meningitis
sepsis

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12
Q

OME presentation

A

SAL delay
inattention at school

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13
Q

OME O/E

A

Retracted TM
Yellow
Fluid level/air bubbles

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14
Q

Rx of OME

A

most resolve spontaneously.
If not, grommets

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15
Q

Presentation of mastoiditis
Investigation
Rx

A

pain behind ear, sticky out ear, feels ‘boggy’ behind the ear

CT temporal bones

Admit for IV abx, myringotomy +/- mastoidectomy

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16
Q

What is cholesteatoma and its presentation

A

Locally destructive expansion of stratified squamous epithelium within the middle ear.

Smelly ottorhoea, ear pain, hearing loss, facial paralysis

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17
Q

complications of cholesteatoma

A

ossicle erosion - deafness
meningitis
cerebral abscess

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18
Q

Rx of ramsey hunt

A

Oral acyclovir and oral prednisolone
Need lubricating eye drops

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19
Q

What is ramsey hunt and presentation

A

shingles affecting the facial nerve
facial nerve palsy
vesicular rash in ear that may extend to 2/3 anterior tongue and palate

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20
Q

Fever PAIN score use and break down

What does centor have in addition

A

used to predict whether tonsillitis has been cause by strep or not

Fever in last 24hrs
Purulent tonsils
Attend in <3 days
Inflammation severe
No cough or coryza

Centor adds age - 1+ if 3-14, 0 if 15 - 44, -1 if >44

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21
Q

Rinnes and weber results in sens and cond

A

sens - lateralises to other ear. AC>BC
Cond - lateralisises to ear. BC>AC

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22
Q

peripheral and central causes of vertigo

A

Peripheral - Menderes, bppv, labrynthitis,

Central - stroke (POCS), meningitis, MS, vestibular migraine, SOL

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23
Q

differentiating between peripheral and central causes of vertigo

A

Central has vertical nystagmus (RED FLAG)
Rarely associated with tinnitus or hearing loss

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24
Q

what is inflamed in labrynthitis

presentation

Rx

A

semi circular canals, vestibule and cochlear

Acute onset vertigo, tinnitus and hearing loss most commonly preceded by a viral URTI. N+V

prochlorperazine and antihistamine for max 3 days

25
Q

presentation of vestibular neuritis and course

rx

what ay they go on to develop

A

acute onset of vertigo and n+v. Often incapacitating for few days then gets better over 2-6 weeks

Rx - prochlorperazine and antihistamine for 3 days

BPPV

26
Q

BPPV pathophys

which way will nystagmus move in dix hallpike

rx including name of exercises to do at home

A

otoconia (crystals of calcium carbonate) dislodge into semicircular canals causing disruption to endolymph flow

towards affected ear

employ manoeuvre. Cawthorne cooksey exercises

27
Q

How is epley manoeuvre performed

A

head at 45 degrees with neck extended.
Then turn 90 degrees to other side. then another 90 degrees by getting pt to roll on to side. Then pt sits up

28
Q

first line abx treatment for AOM if meets criteria for abx

A

penicillin
or clarithro if pen allergic

29
Q

acute vs prophylactic rx of menieres

A

acute - prochlorperazine and antihistamine
prophylaxis - betahistine

30
Q

rx of cholesteatoma

A

ent referral for surgery

31
Q

which window is the stapes connected to

A

oval window

32
Q

what condition can cause low pitch hearing loss (opposite to presbycusis)

A

otosclerosis

33
Q

ix results for otosclerosis - audiometry, tympanometry, high res CT

A

conductive hearing loss
stiff, non compliant tm
bony changes

34
Q

rx of otosclerosis

A

hearing aids
or surgery for stapes prosthesis

35
Q

who is affected by otosclerosis

A

under 40s

36
Q

risk factors for presbycusis

A

increased age
male
fix
loud noise exposure
diabetes
htn
ototoxic meds

37
Q

rx of presbycusis

A

Optimising the environment, for example, reducing the ambient noise during conversations, lights instead of doorbells
Hearing aids
Cochlear implants (in patients where hearing aids are not sufficient)

38
Q

what is acoustic neuroma a tumour of
where in the brain do they occur

A

schwann cells around vestibularcochlear nerve

cerebellopontine angle

39
Q

what do b/l acoustic neuromas almost always indicate

A

neurofibromatosis type 2

40
Q

presentation of acoustic neuroma

A

The typical patient is aged 40-60 years presenting with a gradual onset of:

Unilateral sensorineural hearing loss (often the first symptom)
Unilateral tinnitus
Dizziness or imbalance
A sensation of fullness in the ear

41
Q

abx choice for bacterial tonsillitis and course length

A

penicillin V for 10 days

42
Q

rx of post tonsillectomy bleeding as an fy1

A

call on call ent surgeon
encourage to spit blood not swallow
give fluids
take bloods - fbc, clotting, cross matt, g+s
NBM incase theatre needed

43
Q

symptoms of quinsy

A

‘hot potato’ voice
inability to open mouth
swelling and erythema
sore throat
painful swallowing
fever
tender lymphadenopathy

44
Q

rx of quinsy

A

refer to hospital for ent
needle aspiration or surgical incision and drainage
broad spec abx

45
Q

first aid rx for active nose bleed

other advice after

A

sit forward
squeeze soft part of nose
spit don’t swallow

don’t pick nose
med review if needed
stay out of sun

46
Q

rx of epistaxis if:
- after 15 mins first aid is successful
- after 15 mins first aid is unsuccessful and the bleed site is visible
- after 15 mins first aid is unsuccessfuland the bleed site is not visible
- if doesn’t stop at all

A
  • topical naseptin antiseptic
  • cautery
  • packing
  • sphenopalatine ligation
47
Q

who can’t have naseptin antiseptic after a nose bleed
what is an alternative

A

if peanut allergy
can use muciprocin

48
Q

examination and presentation of thyroglossal cyst inc location of neck

A

moves up on swallowing and tongue protrusion
asymptomatic

49
Q

branchial cyst presentation inc age group and inc location of neck

A

typically presents in young adults when an URTI causes it to increase in size
usually painless
anterior or posterior triangle

50
Q

cystic hygroma presentation and location in neck

A

diagnosed at birth or prenatally. Typically presents in left posterior triangle. Benign but often require surgery

51
Q

red flag of nasal polyp

A

unilateral polyp

52
Q

what other conditions are nasal polyps commonly associated with

A

chronic rhinits/sinusitis
asthma
cystic fibrosis

53
Q

who are nasal polyps rare in

A

<10s
consider neoplasms or cystic fibrosis

54
Q

rx of sudden snesironeural hearing loss (<72 hrs with no obvious cause)

A

urgent referral to ENT <24hrs
Classed as an otological emergency
high dose oral corticosteroids used

55
Q

hypocalacaemia on an ecg (complication of thyroid surgery - parathyroid damage)

A

long QTc

56
Q

rx of uncomplicated sinusitis

rx of complicated inc what makes it complicated

A

uncomplicated - analgesia, keep hydrated
complicated
- if >10 days - intranasal corticosteroids
- abx not usually used unless severely unwell or ‘double sickening’ ie had a viral and now got worse again

57
Q

rx of recurrent or chronic sinusitis

A

nasal irrigation with saline
avoid any allergens

58
Q

what can secondary haemorrhage after tonsillectomy indicate

rx

A

infection
admit and give abx

59
Q
A

To Revise (29 decks)

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