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ENT Flashcards

1
Q

What anatomical landmark is the boundary between the external and middle ear?

A

Tympanic membrane

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2
Q

Which nerve runs through the middle ear?

A

Facial nerve

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3
Q

What is the anterior and posterior blood supply to the nose?

A

Anterior = Little’s area/Kiesselbach’s plexus (most common site for nose bleeds)
Posterior = Woodruff’s plexus

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4
Q

Which muscle separates the anterior and posterior triangles of the neck?

A

Sternocleidomastoid

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5
Q

What are the common neck lumps found in the anterior triangle?

A

Branchial cysts

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6
Q

What are the common neck lumps found in the posterior triangle?

A

Cystic hygromas

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7
Q

Which salivary gland is the most common site for tumours?

A

Parotid gland

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8
Q

What is the definition of conductive hearing loss?

A

Problem with sound travelling from environment to inner ear, the sensory system may be working but sound is not reaching it

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9
Q

What is the definition of sensorineural hearing loss?

A

Caused by a problem with the sensory system or vestibulocochlear nerve in the inner ear

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10
Q

How to you interpret the results of Weber’s?

A

Equal volume in each ear = normal

In sensorineural hearing loss = will be louder in the normal ear and quieter in bad ear

In conductive hearing loss = sound will be louder in the affected ear

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11
Q

How do you interpret the results of Rinne’s?

A

Normal = air conduction is better than bone conduction so can still hear it after it has been moved (positive)

Abnormal = bone conduction is better than air conduction, suggests conductive cause for hearing loss (negative)

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12
Q

What are the causes of conductive hearing loss?

A

Ear wax, infection, effusion, eustachian tube dysfunction, perforated tympanic membrane, otosclerosis, cholesteatoma, tumours

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13
Q

What are the causes of sensorineural hearing loss?

A

Presbycusis, noise exposure, Meniere’s disease, labyrinthitis, acoustic neuroma, ototoxic medications

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14
Q

What is the pattern of hearing loss in presbycusis?

A

Tends to affect high pitched sound first before lower pitched sounds, hearing loss occurs gradually and symmetrically

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15
Q

What are the risk factors for presbycusis?

A

Age, male, family history, loud noise exposure, diabetes, hypertension, ototoxic medications, smoking

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16
Q

What is the management of presbycusis?

A

Audiometry to diagnose, hearing aids, cochlear implants

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17
Q

What type of hearing loss requires urgent ENT referral?

A

Sudden onset (over <72 hours) sensorineural hearing loss (no conductive cause can be found)

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18
Q

What are the causes of sudden onset sensorineural hearing loss?

A

Idiopathic = most common
Infection, Meniere’s disease, ototoxic medications, migraine, stroke, acoustic neuroma, Cogan’s syndrome

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19
Q

What investigations may be done in someone with sudden onset sensorioneural hearing loss?

A

Audiometry
MRI/CT head

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20
Q

What is the function of the eustachian tube?

A

Equalise the air pressure in the middle ear and drain fluid from the middle ear

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21
Q

What are the causes of eustachian tube dysfunction?

A

Viral URTI, allergies, smoking

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22
Q

What is the presentation of eustachian tube dysfunction?

A

Reduced or altered hearing, popping noises in the ear, feeling of fullness, pain or discomfort, tinnitus, otoscopy will be normal

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23
Q

What investigations are done if eustachian tube dysfunction is persistent or severe?

A

Tympanometry, audiometry, nasopharyngoscopy, CT to assess for structural pathology

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24
Q

What is the management of eustachian tube dysfunction?

A

No treatment, valsalva manoeuvre, decongestant nasal sprays, antihistamines and steroid nasal spray if related to allergies, surgery if severe or persistent

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25
Q

What is otosclerosis?

A

Condition where there is remodelling of the small bones in the middle ear leading to conductive hearing loss

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26
Q

What is the presentation of otosclerosis?

A

Patient under 40 presenting with unilateral/bilateral hearing loss and tinnitus, tends to affect lower pitched sounds more than higher pitched sounds

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27
Q

What investigations are done in otosclerosis?

A

Audiometry, tympanometry, high resolution CT scan

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28
Q

What is the management of otosclerosis?

A

Hearing aids, surgical procedures (stapedectomy)

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29
Q

Why are ear infections more common in children?

A

Their eustachian tubes are shorter and wider and allow easier transmission of bacteria from the throat to the ear

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30
Q

What is the most common cause of otitis media?

A

Strep pneumoniae

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31
Q

What is the presentation of otitis media?

A

Ear pain, reduced hearing in affected ear, generally unwell, may have had preceding URTI

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32
Q

What is found on otoscopy in someone with otitis media?

A

Bulging red inflamed tympanic membrane, may be perforation in which case there will be discharge in ear canal

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33
Q

What is the management of otitis media?

A

Most resolve spontaneously, simple analgesia but need to safety net

Give abx if systemically unwell, immunocompromised

Consider delayed prescription if symptoms have not improved or have worsened

1st line = amoxicillin for 5-7 days

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34
Q

What is mastoiditis?

A

A complication of otitis media

Will have painful mastoid process, tired and appear meningitic, bulge/abscess behind ear

Refer to ENT and treat like sepsis, abx = ceftriaxone

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35
Q

What is otitis media with effusion (glue ear)?

A

A collection of non-infective fluid in the middle ear, seen only in children

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36
Q

What is the otoscopy of someone with glue ear?

A

Viscous bubbles behind tympanic membrane, dull tympanic membrane, absent light reflex

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37
Q

How is glue ear managed?

A

Regular follow up as most will resolve in 3 months, if persistent hearing aids/grommets

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38
Q

What are the causes of perforated ear drum?

A

Recurrent otitis media infections, trauma, grommet insertion

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39
Q

What is the management of a perforated ear drum?

A

Washing out ear canal, topical antibiotics/steroids, allow perforation to heal

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40
Q

What are the risk factors for otitis externa?

A

Swimming, trauma to the ear, excessive use of cotton buds, immunocompromised

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41
Q

What are the causes of inflammation in the otitis externa?

A

Bacterial infection, fungal infection, eczema, seborrhoeic dermatitis, contact dermatitis

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42
Q

What is the most common bacterial cause of otitis externa?

A

Pseudomonas aeruginosa (gram negative rod)

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43
Q

What is the presentation of otitis externa?

A

Ear pain, discharge, itchiness, conductive hearing loss, erythema and swelling/tenderness in ear canal, lymphadenopathy

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44
Q

What is the management of otitis externa?

A

Mild = topical acetic acid 2%
Moderate = topical antibiotic and steroid e.g. neomycin/dexamethasone/acetic acid (need to exclude perforation before giving this

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45
Q

What is the management if the otitis externa has spread to the pinna (i.e. chondritis)?

A

IV antibioitics

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46
Q

What is malignant/necrotising otitis externa?

A

Severe and potentially life-threatening form of otitis externa where the infection has spread to the bones surrounding the ear canal and skull

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47
Q

What are the symptoms of malignant otitis externa?

A

Persistent headache, severe pain and fever

48
Q

What is the management of malignant otitis externa?

A

Admission under ENT, IV abx, imaging to assess extent of infection

49
Q

What should you do when an adult presents with unilateral glue ear?

A

Urgent referral to ENT for assessment to rule out posterior nasal space tumour

50
Q

What are the symptoms of impacted ear wax?

A

Conductive hearing loss, discomfort in ear, pain, tinnitus, feeling of fullness

51
Q

What are the red flags for tinnitus?

A

Unilateral, pulsatile, associated with any neurological deficits

52
Q

What are the causes of tinnitus?

A

Impacted ear wax, ear infection, menieres disease, ototoxic medications, acoustic neuroma, MS, trauma, depression, anaemia, diabetes, thyroid disorders

53
Q

What is associated with unilateral tinnitus?

A

Acoustic neuromas

54
Q

What is associated with pulsatile tinnitus?

A

Glomus tumour

55
Q

What is vertigo?

A

Sensation that either you are moving or that the room is moving - often a horizontal spinning sensation

56
Q

Acute onset of vertigo is … until proven otherwise

A

Posterior circulation stroke (unless they have known meniere’s disease)

57
Q

What are the causes of peripheral vertigo?

A

BPPV, meniere’s disease, vestibular neuronitis, labyrinthitis (more often sudden onset)

58
Q

What are the central causes of vertigo?

A

Posterior circulation stroke (sudden) , tumours, MS, vestibular migraine (rest are gradual onset)

59
Q

What would be the results of the HINTS exam in someone with a peripheral cause of vertigo?

A

Unidirectional nystagmus, no vertical skew, abnormal head impulse test

60
Q

What would be the results of the HINTS exam in someone with a central cause of vertigo?

A

Bidirectional nystagmus, vertical skew, normal head impulse test

61
Q

Once central causes have been ruled out how is vertigo managed?

A

Prochlorperazine is 1st line antiemetic for vertigo

62
Q

What is the presentation of BPPV?

A

Recurrent episodes of vertigo triggered by head movements, symptoms settle after 20-60 seconds and patients are asymptomatic between attacks, NO hearing loss/tinnitus

63
Q

What is done to diagnose BPPV?

A

Dix-Hallpike manoeuvre

64
Q

How is BPPV managed?

A

Epley manoeuvre or Brandt-Daroff exercises done at home

65
Q

What is the difference between vestibular neuronitis and labyrinthitis?

A

Vestibular neuronitis does not cause hearing problems or tinnitus whereas laryrinthitis does

66
Q

What is the presentation of vestibular neuronitis?

A

Acute onset vertigo, may have preceding viral URTI (can be spontaneous), N+V, balance problems

67
Q

What is the management for vestibular neuronitis?

A

Ensure not central cause of vertigo, prochlorperazine and antihistamine antiemetics, if do not improve after 1 week or resolve after 6 weeks refer to ENT

68
Q

What is the presentation of labyrinthitis?

A

Acute onset vertigo, hearing loss, tinnitus, preceding URTI

69
Q

What is the management of labyrinthitis?

A

Prochlorperazine and antihistamines, antibiotics are sued to treat bacterial cause, if hearing loss has not resolved after few weeks refer to ENT

70
Q

What are the symptoms of meniere’s disease?

A

40-50 years old with unilateral episodes of vertigo, hearing loss and tinnitus, can last 20mins-2 hours before settling, patient feels unwell between episodes, tinnitus can become permanent, may have feeling of fullness in air or struggle with balance

71
Q

How is meniere’s disease managed?

A

Clinical diagnosis by ENT, usually self resolves, use prochlorperazine during acute attacks, betahistine (can only be used short term)

72
Q

Where do acoustic neruomas occur?

A

At the cerebellopontine angle

73
Q

What is the presentation of acoustic neuromas?

A

40-60 years
Gradual onset and unilateral symptoms
Sensorineural hearing loss, tinnitus, dizziness, imbalance, fullness in ear, facial nerve palsy

74
Q

What is the management of acoustic neuroma?

A

Audiometry, MRI/CT used to diagnose

Surgery to remove tumour or radiotherapy to shrink it, can leave it alone if not causing any symptoms

75
Q

What is a cholesteatoma?

A

Abnormal collection of squamous epithelial cells in middle ear, not cancerous but can invade local tissues and erode bone etc.

76
Q

What is the presentation of cholesteatoma?

A

Persistent foul-smelling brown discharge from ear, unilateral conductive hearing loss

On otoscopy = pearly white/grey appearance and brown discharge in ear canal

77
Q

What is the management of cholesteatoma?

A

CT head/temporal bone = confirm diagnosis

Surgical removal of cholesteatoma (all of it must be removed or it will recur)

78
Q

What foreign bodies require emergency care if suspected in the ear?

A

Live insects or button batteries

79
Q

What is the presentation of Ramsay-Hunt syndrome?

A

Unilateral LMN facial nerve palsy, painful, tender vesicular rash in ear canal - due to VZV

80
Q

What is the management of Ramsay-Hunt syndrome?

A

Prednisolone and aciclovir

81
Q

What are the causes of epistaxis?

A

Nose picking, colds, sinusitis, vigorous nose blowing, trauma, coagulation disorder/anticoagulants, recreational drug use, tumours

82
Q

What is the step wise approach for managing epistaxis?

A
  1. Sit up and tilt head forwards, squeeze nostrils together for 15-20 minutes
  2. Nasal cautery using silver nitrate sticks
  3. Nasal packing using nasal tampons
  4. Surgical ligation of the arteries
83
Q

What are the causes of sinusitis?

A

Infection particularly viral URTI, allergies, obstruction in nasal passage, smoking, asthma

84
Q

What is the presentation of sinusitis?

A

Nasal congestion, facial pain or headache, facial pressure/swelling, loss of smell, tenderness on palpation, fever

85
Q

What is chronic sinusitis and what is the most common cause?

A

Chronic sinusitis involves symptoms for >12 weeks and is associated with nasal polyps

86
Q

What is the management of sinusitis?

A

Reassurance unless not resolving after 10 days in which case high dose steroid nasal spray (mometasone) and a delayed abx prescription (phenoxymethylpenicillin)

87
Q

What is a nasal polyp?

A

Growth of the nasal mucosa that can occur in the nasal cavity or sinuses

88
Q

Is bilateral and unilateral nasal polyps a red flag and what is it a red flag for?

A

Red flag = unilateral as it raises suspicions of nasopharyngeal tumours

89
Q

What are the symptoms of nasal polyps?

A

Chronic rhinosinusitis, difficulty breathing through nose, snoring, nasal discharge, loss of sense of smell

90
Q

What is the management of nasal polpys?

A

Intranasal topical steroid drops/spray

Surgery is used when medical treatment fails

91
Q

When assessing a nasal fracture what should you look for?

A

Nose deformity and septal haematoma (collection of blood within the septum which cuts off the blood supply to the cartilage and leads to saddle nose deformity

92
Q

What are the most common causes of viral and bacterial tonsilitis?

A

Viral - adenovirus, influenza, rhinovirus
Bacterial - Group A strep

93
Q

What do you score points for on the Centor/FeverPain scores?

A

Fever, exudative tonsils, absence of cough, tender lymph nodes, severely inflamed tonsils

94
Q

When should you give antibiotics to a patient with tonsilitis?

A

Centor score >3 or FeverPAIN >4, immunocompromised, young infants or history of rheumatic fever

95
Q

What is the 1st line antibiotic for tonsilitis?

A

Penicillin V for 10 day course (clarithromycin if penicillin allergy)

96
Q

What are the complications of tonsilitis?

A

Peritonsillar abscess (quinsy), otitis media, scarlet fever, rheumatic fever, post-strep glomerulonephritis

97
Q

What is the presentation of Quinsy?

A

Sore throat, painful swallowing, fever, neck/ear pain, swollen lymph nodes, unable to open mouth, change in voice, unilateral tonsil swelling with uvula deviating away from swelling

98
Q

How is quinsy managed?

A

Needle aspiration or surgical incision and drainage

Abx before and after surgery e.g. IV co-amoxiclav

99
Q

What are the indications for tonsillectomy surgery?

A

7 or more episodes of acute sore throat in a year

5 per year for 2 years

3 per year for 3 years

Recurrent tonsillar abscess

100
Q

How is post-tonsillectomy bleeding managed?

A

Call ENT, gain IV access, analgesia, nil by mouth, IV fluids and encourage them to spit out rather than swallow

Hydrogen peroxide gargle and adrenalin-soaked swab can be applied topically if initial measures are unsuccessful

101
Q

What is obstructive sleep apnoea?

A

Collapse of the pharyngeal airway which causes episodes of apnoea during sleep

102
Q

What are the risk factors for OSA?

A

Middle age, male, obesity, alcohol, smoking

103
Q

What is the presentation of OSA?

A

Episodes of apnoea during sleep, snoring, morning headache, waking up unrefreshed from sleep, daytime sleepiness

104
Q

What scoring system is used to assess for OSA in primary care?

A

Epworth sleepiness scale

105
Q

What is the management of OSA?

A

Sleep studies to diagnose

1st step = correct any reversible risk factors

CPAP

Surgery

106
Q

What is the 2ww referral criteria for neck lumps?

A

Unexplained neck lump in someone aged 45 or above

A persistent unexplained neck lump at any age

USS neck is investigation

107
Q

What are the causes of lymphadenopathy?

A

URTI, HIV, EBV, SLE, sarcoidosis, malignancy

108
Q

What test is done to confirm EBV infection?

A

Monospot test

109
Q

What should patients avoid following EBV infection?

A

Alcohol and contact sports due to risk of liver impairment and splenic rupture

110
Q

What is the presentation of thyroglossal cyst?

A

Mobile, non-tender, midline neck lump which moves up and down with movement of tongue

111
Q

What is a branchial cyst?

A

Round, soft, cystic swelling in anterior triangle of neck which usually presents after age of 10

112
Q

What is a cystic hygroma?

A

Congenital lesion in posterior triangle of neck found in young children

113
Q

What are the risk factors for head and neck cancer?

A

Smoking, chewing tobacco, alcohol, HPV strain 16, EBV infection

114
Q

What are the red flags for head and neck cancer?

A

Lump in mouth or on the lip, unexplained ulceration in the mouth lasting more than 3 weeks, erythroplakia, unexplained hoarseness of voice, unexplained thyroid lump

115
Q

What investigation is done to diagnose head and neck cancer?

A

Fine needle aspiration

116
Q

What is the management of oral candidiasis?

A

Miconazole gel, nystatin suspension, fluconazole tablets

117
Q
A

Finals (21 decks)

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