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Y3 GP > ENT > Flashcards

ENT Flashcards

1
Q

Why is sudden, severe otalgia a red flag and what would you do about it?

A
  • Acute severe otitis externa
  • Acute otitis media
  • Perforation of the eardrum

Urgent referral to ENT

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2
Q

Why is facial nerve palsy a red flag and what would you do about it?

A
  • Malignant otitis externa
  • Ramsay Hunt syndrome

Further imaging (MRI/CT)
Neurology assessment
Serologic test for lyme disease
Nerve conduction studies and electromyography (EMG) in the case of neuromuscular differentials.

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3
Q

Why is hearing loss and vertigo a red flag and what is done about it?

A
  • Vestibular schwannoma
  • Labyrinthitis

ENT assessment and surgery to remove a vestibular schwannoma

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4
Q

Why is prolonged otalgia a red flag and what is done about it?

A
  • Cellulitis
  • Osteomyelitis

Intravenous antibiotics, hospital referral

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5
Q

What is the difference between conductive and sensorineural hearing loss?

A

Sensorineural hearing loss results from damage to the hair cells within the inner ear, the vestibulocochlear nerve, or the brain’s central processing centers. This differs from a conductive hearing loss, which results from the inability of sound waves to reach the inner ear.

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6
Q

What is the antibiotic treatment for otitis externa (ear drops)

A

Gentamicin

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7
Q

What is Meniere’s disease

A

Excessive buildup of endolymph in the labyrinth of the inner ear, causing a higher pressure than normal disrupting the sensory signals.

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8
Q

How long do Meniere’s disease episodes last?

A

20 minutes to an hour

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9
Q

What is the treatment for managing acute attacks of Meniere’s disease?

A

Prochlorperazine
- Antiemetic and antipsychotic. Blocking dopamine receptors in the brain.
Antihistamines (cyclizine, cinnarizine and promethazine)

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10
Q

What is prophylactic medication for Meniere’s disease

A

Betahistine

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11
Q

What is the triad of meniere’s disease?

A

Vertigo, tinnitus and hearing loss

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12
Q

With noise related hearing loss (sensorineural), what frequencies can people not hear first?

A

High pitched sounds like birds singing

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13
Q

What is a perforated eardrum?

A

Hole/tear in the tympanic membrane

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14
Q

Can someone fly with a ruptured eardrum?

A

Yes as long as they haven’t had tympanoplasty (surgery using a microscope to fix holes in the eardrum that do not heal on their own.

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15
Q

What are the symptoms of acute otitis media?

A

Otorrhoea with otalgia for 2 weeks, maybe hearing loss.

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16
Q

What might you find on fine-cut CT for otitis media?

A

Bone erosion from cholesteatoma

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17
Q

What would you see on otoscopy of mastoditis?

A

Bulging tympanic membrane

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18
Q

Most common bacteria to cause acute otitis media?

A

Strep pneumoniae
Haeophlius influenzae
Morazella catarrhails
staph aureus

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19
Q

What are some complications of acute otitis media?

A
  • hearing loss
    -facial nerve involvement
  • abscess
  • mastoditis
  • perforated hearng loss
  • perforated ear drum
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20
Q

First line medication for acute otitis media

A

Amoxicillin
Erythromycin or Clarithromycin for 5 days

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21
Q

What is the treatment for recurrent otitis media in children?

A

Grommet to help drain the fluid

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22
Q

What is the pathophysiology of Cholesteatoma?

A

Eustachian tube dysfunction- negative pressure in the middle ear- pars flaccida get retracted- squamous epithelial cells proliferate into surrounding area- can damage ossicles leading to permanent hearing loss

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23
Q

What investigations do you do in a cholesteatoma?

A

Otoscopy
Audiogram
CT/MRI

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24
Q

What is the most common cause for referred ear pain?

A

TMJ dysfunction

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25
Q

Which nerve from TMJ dysfunction will cause referred ear pain?

A

Auriculotemporal branch of the trigeminal nerve

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26
Q

What nerve from disease of the oropharynx causes referred ear pain?

A

Glossopharyngeal nerve

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27
Q

What nerve from disease of the larynx and pharynx causes referred ear pain?

A

Vagus nerve

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28
Q

What are some conditions that cause congenital deafness?

A

German measles
Influenza
Mumps

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29
Q

What infections during birth are extremely common causes of congenital hearing loss?

A

CMV or Rubella

30
Q

For urinary incontinence, what should you prescribe as a first line if conservative management fails for men with BPH?

A

Alpha blockers like Tamsulosin or Doxazosin

31
Q

What are some investigations for acute sinusitis?

A
  • Nasal endoscopy (to assess any polyps)
  • Nasal and sinus cultures- in cases of chronic sinusitis
  • CT if indicated- would show you the extent of the disease and any complications
  • Skin prick testing- if there are any allergies
32
Q

What are red flag symptoms of acute sinusitis?

A
  • Eye signs, including periorbital swelling or erythema, displaced globe, visual changes, opthalmoplegia
  • Severe unilateral headache, bilateral frontal headache, or frontal swelling
  • Neurological signs or reduced conscious level
33
Q

When should you make a referral to ENT with acute sinusitis?

A

If there is no improvement after 7-14 days or the presence of red flag symptoms.

34
Q

What is a first line medication for acute sinusitis if your patient is systemically unwell?

A

Co-amoxiclav

35
Q

What is the first line recommendation for acute sinusitis?

A

Phenoxymethylpenicillin

36
Q

What is chronic sinusitis defined as?

A

Inflammation of the paranasal sinuses in the face causing symptoms for more than 12 weeks.

37
Q

What are some risk factors for chronic sinusitis?

A

Allergic rhinitis
Asthma
Cystic fibrosis
Immunocompromised
Cigarette smoking
Sinus surgery
Nasal polyps

38
Q

What are some signs and symptoms of chronic sinusitis?

A

Nasal blockage, nasal discharge with facial pain or pressure +/- reduction of the sense of smell, cough (in children)

39
Q

What course of intranasal corticosteroids would you suggest for chronic sinusitis?

A

Mometasone/fluticasone for up to 3 months

40
Q

What direction does the thyroid gland move on on swallowing?

A

Upwards

41
Q

What are some causes of benign thyroid nodules?

A

Thyroid adenoma, multinodular goitre, hashimotos thyroiditis, cysts

42
Q

What is characteristic of BPPV?

A
  • Settle around 20-60 secons
  • Occur over several weeks
  • Does not cause heearing loss or tinnitus
43
Q

What procedures are used to diagnose and manage BPPV?

A

Diagnose= Dix-Hallpike
Manage= Epley

44
Q

What are some symptoms of nasal polyps?

A

Snoring
Nasal discharge
Chronic rhinosinusitis
Difficulty breathing through the nose
Postnasal drip

45
Q

What surgical management is used when polpys are further in the nose?

A

Endoscopic nasal polpectomy

46
Q

What are some signs of a malignant cervical lymphadenopathy?

A
  • Irregular
  • Hard
  • Tethered to surrounding tissues
  • Painless
  • Lymph node >2cm
47
Q

What serology would you do for infective lymphadenopathy?

A

Epstein Barr or cytomegalovirus

48
Q

What is the surgical treatment of a deviated nasal septum?

A

Septoplasty- surgical removal of part of the septum that is off centre, putting it back in the midline

49
Q

What are the complications of a nasal fracture?

A

CSF leak, anosmia and septal haematoma

50
Q

Features of a vestibular migraines?

A
  • Vertigo
  • Imbalance
  • Visual disturbances
51
Q

What investigations would you do for a vestibular migraines?

A
  • Audiometry
  • EEG
  • Imaging studies (MRI)
  • Neurological examination
52
Q

What is the management of vestibular migraines?

A

NSAIDs and triptans
Tricyclic antidepressants
Vestibular rehabilitation therapy
Cognitive behavioural therapy

53
Q

How long do episodes of BPPV last?

A

20-60 seconds

54
Q

How do you diagnose BPPV?

A

Dix hall pike

55
Q

How do you manage BPPV?

A

Epley

56
Q

What are malignant symptoms/signs of cervical lymphadenopathy?

A

Rapidly growing
Haemoptysis
Dysphagia
Hoarseness
Weight loss, night sweats

Irregular
Hard
Tethered to surrounding tissues
Painless
Lymph nodes >2cm

57
Q

What serology would you do for cervical lymphadenopathy?

A

Epstein Barr virus
Cytomegalovirus
HIV

58
Q

If an infective cause of cervical lymphadenopathy does not resolve in 2-4 weeks, what should you consider?

A

Urgent referral to ENT

59
Q

How long does it take a perforated ear drum to resolve?

A

2 months- hearing will return to normal

60
Q

How should you manage a perforated ear drum?

A

Keep the ear very dry, do not place anything in ear whilst healing
Analgesia and warm compress
Don’t blow nose too hard

61
Q

What is the surgery to repair a perforated ear drum?

A

Myringoplasty

62
Q

What are some red flag symptoms of chronic suppurative otitis media?

A

Mastoditis/intracranial infection:
Headache
Nystagmus
Vertigo
Fever
Labrynthitis
Facial paralysis
Swelling/tenderness behind the ear

63
Q

How to remember the bacterial causes for otitis media and externa?

A

Otitis media
- Hemophilus influenzae
- Hemophilus
- Hemo
- Home- you are at home, inside

Otitis externa
- Pseudomonas auerginosa
- Aeur
- Air
- Outside

64
Q

What should you always consider when someone has bilateral vestibular neuromas?

A

Neurofibromatosis II

65
Q

What is the cause of benign paroxysmal positional vertigo?

A

Benign paroxysmal positional vertigo, as in this condition the vertigo typically lasts seconds and is associated with a precipitating head movement. There is usually no aural symptoms. This is due to dislodged otoconia within the posterior semicircular canal.

66
Q

What diuretics are helpful in meniere’s disease?

A

Acetazolomide
Carbonic anhydrase inhibitors
Reduce the amount of lymph in the ear

67
Q

When do you do grommet insertion for otitis media with effusion?

A

When the infections are recurrent

68
Q

When should you prescribe antibiotics for acute otitis media?

A

Only when the child is systemically unwell or they have had an infection for more than 4 days

69
Q

What are the two medications used in acute angle closure glaucoma?

A

Acetazolamide- carbonic anhydrase inhibitor (stops the production of aqueous humor)

Pilocarpine- muscarinic agonsit, activates parasympathetic system- release of acetylcholine, contracts the ciliary muscles

70
Q

Why do you use oxygen with cluster headaches?

A

Vasoconstriction: Inhalation of high-flow 100% oxygen (at a rate of 7-12 litres per minute) through a non-rebreather mask causes vasoconstriction of cerebral blood vessels, which can help alleviate the headache.

Increased Oxygenation: Oxygen therapy may also reduce the hypoxia and metabolic stress that could contribute to the headache.

Y3 GP (13 decks)

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