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MSPA4023 - Clinical medical & public heath > ENT > Flashcards

ENT Flashcards

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USMLE® Step 1 flashcards
1
Q

What is acute otitis media?

A

infection of the middle ear section, typically from the eustachian tube dysfunction

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2
Q

What is the eustachian tube?

A

Opening that connects the middle ear with the nasal-sinus cavity

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3
Q

What is the function of the eustachian tube?

A
  • equilibration of the middle ear with atmospheric pressure
  • Protect middle ear from reflux of nasopharyngeal content
  • Drain secretion from the middle ear into the nasopharyngeal
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4
Q

Causes of Eustachian tube dysfunction

A

Infection
- oedema of the eustachian tube
- adenoid hypertrophy
Failing of the
- tensor veli palatini
- levator veli palatini

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5
Q

Common infection species that occur in acute otitis media are_____

A

Streptococcus pneumoniae
Haemophilus influenzae
morexilla catarrhalls

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6
Q

What is the pathophysiology of acute otitis media?

A

–> Viral infection happens in the nasal cavity and causes congestion oedema
–> The oedema causes the eustachian tube occlusion and create negative pressure in the middle ear
–> Which can cause accumulation of the fluid in the middle ear
–> Leading to secondary viral and bacterial infection in the middle ear

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7
Q

What is suppurative otitis media?

A
  • It is where build-up pressure in the middle ear,
  • causing perforation of the tympanic membrane
  • and discharge (otorrhea)coming out of the ear
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8
Q

What terminology describes the discharge that comes out from the ear?

A

otorrhea

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9
Q

What is otitis media with effusion?

A

residual fluid in the middle ear cavity after acute otitis media

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10
Q

How can we resolve otitis media with effusion?

A

Nothing…it’ll resolve by itself after 3 months

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11
Q

recurrent acute otitis media definition

A

reinfection of the middle ear
/
The middle ear got infected again

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12
Q

Clinical presentation of otitis media

A

otalgia (ear pain)
pyrexia (fever)
hearing loss
otorrhea
—————————-
Upper respiratory tract infection
irritability
reduced appetite
fatigue

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13
Q

Otitis media is a sensory hearing loss/conductive hearing loss

A

conductive hearing loss

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14
Q

How can you diagnose otitis media?

A

direct visualization of the tympanic membrane with an otoscope / pneumatic otoscope
- culture of the middle ear

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15
Q

What is the first-line treatment for AOM?

A

oral analgesia & observe
*If no improvement after 24/48hrs
vv
Consider antibiotic therapy
(amoxicillin) –>5-7days

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16
Q

What is acute otitis externa?

A

Inflammation of the external auditory canal

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17
Q

how to know whether otitis externa is acute or chronic?

A

acute - less then 3 weeks
chronic - more than 3 months

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18
Q

How common is acute otitis externa?

A

most common in children and adolescents
ages around 7-12

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19
Q

Risk factors of otitis externa

A

Swimming
Humid air
Young age
Diabetes
Trauma
Narrow external auditory meatus
Obstructed external auditory meatus
Eczema, psoriasis
Radiotherapy

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20
Q

What is the most common cause of acute otitis externa?

A

Bacterial
Pseudomonas aeruginosa or Staphylococcus aureus

Fungal
Candida albicans or Aspergillus species.

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21
Q

Clinical features of otitis externa

A

Symptoms
- Itch
- Tenderness
- Hearing loss
- Discharge
Signs
- Inflamed external auditory canal
- Erythema
- Scaly skin
- Pre-auricular lymphadenopathy

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22
Q

investigation to diagnosis otitis externa

A

Ear swab (MC&S)

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23
Q

What is the treatment & management for otitis external?

A
  • cleaning the external canal
  • avoid swimming for at least 7-10 days
  • analgesia —> paracetamol and ibuprofen
  • topical antibiotic / topical steroid
    (ciprofloxacin w fluocinolone)
    -otomycin
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24
Q

what is mastoiditis?

A

a rare life-threatening complication of acute otitis media
Where infection of the mastoid air cells

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25
Q

what is the typical clinical feature of mastoiditis?

A

pain swelling and erythema behind the ear
systemic upset

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26
Q

What are the management to treat mastoiditis?

A
  • early antibiotics
  • myringotomy (drain the middle ear with a hole in the tympanic membrane)
  • mastoidectomy (removal of infected tissue/bone)
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27
Q

What is Otosclerosis

A

Otosclerosis is a condition where there is remodelling of the small bones in the middle ear, leading to conductive hearing loss.

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28
Q

features about otosclerosis

A
  • conducting hearing loss
  • more common in women
  • before 40years
  • development can be environmental/genetic but not fully understood
  • mostly autosomal dominant
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29
Q

what are the 3 auditory ossicles in the ears?

A

Malleus
incus
stapes

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30
Q

What does cochlea do in the ears?

A

coverts vibration into sensory signals

31
Q

What is the site that binds between stapes and the cochlea?

A

Oval window

32
Q

Explain the pathophysiology of otosclerosis

A

abnormal bone remodelling and formation of the oval window
causing stiffening and fixation of the base of the stapes and leading to conductive hearing loss

33
Q

Clinical presentation of otosclerosis

A
  • can be unilateral/bilateral
  • affects hearing of lower-pitched sounds
  • can hear female speech easier
  • hearing loss
  • tinnitus
  • talks more quietly
    ^ (can hear their voice very loudly)
34
Q

what examination can it be done to find otosclerosis?

A

otoscopy
weber’s test
rinne’s test

35
Q

What result will it show in the examination of an otosclerosis patient?

A

otoscopy –> normal
Weber’s test
bilateral –> normal result
unilateral –> affected side will be louder
Rinn’s test
–> Bone conduction - able to hear
–> Air conduction - can’t hear

36
Q

What investigations can it be done to find otosclerosis?

A

Audiometry - conduction hearing loss
tympanometry
High-resolution CT scan

37
Q

What is the management for otosclerosis?

A

Conservative - hearing aids
surgical
- stapedectomy
- stapedotomy

38
Q

What is the difference between stapedectomy and stapedotomy?

A

stapedectomy
Replace the whole stapes, put a prosthesis in it and hook it around the oval window

stapedotomy
drill a whole of the base of the stapes and put a prosthesis between the incus and the base of the stapes

39
Q

What is Presbucusis?

A

Age-related hearing loss. It is a type of sensorineural hearing loss that occurs as people get older.
It tends to affect high-pitched sounds first and more notably than lower-pitched sounds.
The hearing loss occurs gradually and symmetrically.

40
Q

Causes of presbycusis

A

loss of hair cells
loss of neurones
atrophy of the stria vascularis
reduce of the endolymphatic potential

41
Q

Risk factors of presbycusis

A

increase age
male
family history
*** Loud noise exposure
diabetes
hypertension
ototoxic medication
smoking

42
Q

Clinical presentation of presbycusis

A

gradual and insidious hearing loss
loss of high-pitched sounds
-male voices are easier to hear
not paying attention
missing details of conversations
concern about dementia
tinnitus

43
Q

Diagnosis of Presbycusis

A

Audiometry

Normal at lower frequencies
Worsening hearing loss at higher frequencies

44
Q

Management of presbycusis

A

CAN’T REVERSED
supporting normal function
- optimising the environment
- hearing aids
- cochlear implants

45
Q

What is acoustic neuroma?

A

Acoustic neuromas are benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear.

46
Q

Where does the acoustic neuroma occur?

A

at the cerebellopontine angle

47
Q

What do bilateral acoustic neuroma associate with?

A

neurofibromatosis type II

48
Q

Clinical presentation of Acoustic neuroma

A

40-60s
* unilateral sensorineural hearing loss
* unilateral tinnitus
- dizziness or imbalance
sensation of fullness in the ear
*leading to Facial nerve palsy
^ If the tumour grows large enough to compress the facial nerve

49
Q

investigation for acoustic neuroma

A

Audiometry
MRI / CT

50
Q

Management & treatment for acoustic neuroma

A

Conservative
- monitoring
surgery
- partial/total removal of tumour
Radiotherapy
- reduce the growth of the tumour

51
Q

What are the risk factors for treatment in acoustic neuroma?

A

Injury to:
- vestibulocochlear nerve
–>hearing loss
–> dizziness
- facial nerve
–> facial weakness

52
Q

What is sinusitis

A

Sinusitis refers to inflammation of the paranasal sinuses in the face. This is usually accompanied by nasal cavity inflammation and can be referred to as rhinosinusitis.

53
Q

How do we differentiate acute and chronic sinusitis?

A

Acute sinusitis - less then 12weeks

chronic sinusitis - more than 12 weeks

54
Q

What are the 4 sinuses in the nose?

A

Frontal
Ethmoid sinuses
Maxillary sinus
Sphenoid

55
Q

Causes of sinusitis

A

Infection - viral upper respiratory tract infection
allergies - hayfever
obstruction of drainage - foreign body, trauma, polyp
smoking

56
Q

Clinical presentation of sinusitis

A
  • nasal congestion
  • nasal discharge
  • facial pain/headache
  • Facial pressure
  • facial swelling
  • loss of smell
    cough and sore throat
57
Q

What is the likely cause of acute sinusitis?

A

viral upper respiratory tract infection

58
Q

What will the examination show for a sinusitis patient?

A

tenderness
inflammation and oedema
discharge
fever
signs of systemic infection (tachycardic)

59
Q

investigation of sinusitis

A

Nasal endoscopy
sinus culture
CT head

60
Q

How to treat acute sinusitis?

A

Systemic infection/sepsis –> admission to hospital

symptoms < 10days–>
no antibiotics
resolve within 2-3weeks

symptoms >10days
- steroid nasal spray 14 days
(mometasone 200mcg twice a day)
- delay antibiotic prescription
(phenoxymethylpenicillin)

61
Q

How to treat chronic sinusitis

A

saline nasal irrigation
steroid nasal spray/drops
functional endoscopic sinus surgery

62
Q

What to do if a patient experiences recurrent episodes of sinusitis?

A

Refer to ENT specialist

63
Q

another term for ear wax

A

cerumen

64
Q

What is acute rhinosinusitis?

A

acute inflammation of the nose and paranasal sinuses

65
Q

what’s the difference between acute and chronic rhinosinusitis?

A

acute - less than 4 weeks
chronic - more than 12 wwk

66
Q

How does acute recurrent rhinosinusitis occur?

A

develop more than 4 episodes of acute rhinosinusitis within a year with resolution of symptoms between episodes

67
Q

causes of sinuses

A

smoking
obstruction o drainage
allergies
swimming and asthma
Viral - Rhinovirus
bacterial
- Streptococcus pneumoniae
- Haemophilus influenzae

68
Q

Clinical Presentation for sinusitis

A

symptoms:
- nasal congestion
- nasal discharge
- facial pain / headache
- facial pressure
- facial swelling over the affected areas
- loss of smell
- ear pain
- fever

Signs
- tenderness to palpation fo the zygomatic arch / maxillary sinus
- Erythema or swelling around the maxillofacial area

69
Q

feature that support a bacterial over a viral infection in rhinosinusitis?

A
  • persistent clinical features with no improvement more than 10 days
  • double worsening
  • persistent severe symptoms
    (fever, severe facial pain for 3-4 days)
70
Q

Red flags on rhinosinusitis

A

Severe, persistent headache
Periorbital oedema
Visual changes (e.g. reduce acuity, double vision)
Abnormal extra-ocular eye movements
Cranial nerve palsies
Proptosis
Pain on eye movement
Altered mental status
Meningism: headache, neck stiffness, photophobia

71
Q

What investigation would you do for rhinosinusitis?

A

Cultures: nasal, sputum, sinus, blood
Bloods: FBC, U&E, LFT, Bone, CRP
Facial and head imaging (e.g. CT, MRI)

72
Q

When should you give antibiotics to patients with rhinosinusitis?

A

Not give antibiotics for up to 10 days

73
Q

What treatment would you give to a patient with rhinosinusitis?

A

first-line - phenoxymethylpenicillin
steroid nasal spray for 14days - mometasone 200mcg twice daily

74
Q
A

MSPA4023 - Clinical medical & public heath (16 decks)

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