ENT Flashcards
1
Q
sensory inputs responsible for maintianing balance and posture are
A
- vision
- proprioception
- signals from vestibular system
2
Q
vestibular apparatus is located in
A
the inner ear
3
Q
inner ear patho
A
- 3 loops = semicircular canals, filled with endolymph
- head turns and fluid shifts = detected by stereocilia
- vestibular nerve carries to vestibular nucleus in brainstem and cerebellum
4
Q
peripheral vs central
A
- peripheral = affects vestibular system
- central = brainstem/cerebellar involvement
5
Q
4 most common causes peripheral vertigo
A
- BPPV
- menieres
- vestibular neuronitis
- labyrinthitis
6
Q
4 most common causes central vertigo
A
- posterior circulation infarct
- tumour
- MS
- vestibular migraine
7
Q
features peripheral vertigo
A
- sudden onset
- short duration
- hearing loss can be present
- coordination in tact
- nausea more severe
central = opposite
8
Q
common triggers for BPPV
A
- turning over in bed
9
Q
patho of BPPV
A
- crystals of calcium carbonate = otoconia
- become displaced in semicircular canals
- = disrupt normal flow of endolymph
10
Q
dix hallpike manoevre
A
- diagnoses bppv
- sit up, head 45 to one side
- rapidly lower backwards until hanging off and watch eyes
- triggers rotational nystagmus and vertigo
11
Q
epley manoevre
A
- treat bppv
- same as DH but when head off bed, rotate 90 degrees past central position and roll on side
- sit up sidewats
- flex 45 degrees
12
Q
peripheral vertigo short term mx
A
- prochloperazine
- antihistamines
13
Q
triad in menieres
A
- hearing loss
- vertigo
- tinnitus
unilateral episodes
14
Q
patho menieres
A
- excessive build up of endolymph in labrynth
15
Q
what frequency hearing affected in menieres
A
- low frequency affected first
16
Q
other sx menieres
A
- fullness
- drop attacks
- imbalance
17
Q
prophylaxis menieres
A
betahistine
18
Q
vestibular neuronitis presentation
A
- recent viral illness (URTI)
- nausea and vomiting
- balance problems
- vertigo
- no loss of hearing
19
Q
vestibular neuronitis management
A
- Severe = buccal/IM prochlorperazine
- vestibular rehab preferred if chronic
- Oral prochlorperazine or antihistamine less severe
20
Q
labyrinthitis sx
A
- hearing loss
- tinnitues
- acute onset vertigo
21
Q
2 most common bacterial causes otitis externa
A
- pseudomonas aeruginosa = G-, rod
- staph aureus
22
Q
S+S externa
A
- ear pain
- discharge
- itchiness
- conductive hearing loss
23
Q
exam externa shows
A
- erythema and swelling
- tender canal
- pus
24
Q
Mx externa
A
- mild = acetic acid 2%
- moderate = top abx and steroid = otomize spray
- fungal = clotrimazole drops
25
most common causes media
- strep pneumoniae
- HI
- staph aureus
26
S+S media
- ear pain
- reduced hearing
- fever
- upper airway infection
27
normal tympanic membrane looks
pearly grey, translucent, slightly shiny
28
tympanic membeane in media
bulgin, red, inflamed
- discharge if perforation
29
mx media
- most resolve with no abx
- immediate abx if systemically unwell
- delayed prescription if sx not better in 3 days
- amoxicillin 5-7 days 1st line
30
acoustic neuromas are
benign tumours of schwann cells surrounding vestibulocochlear nerve
- usually unilateral
- also called cerebellopontine angle tumours
31
presentation acoustic neuroma
- unilateral sensorineural hearing loss
- unilateral tinnitus
- dizziness or imbalance
- full ear
32
what sort of hearing loss in acoutic neuroma
sensorineural hearing loss
33
mx AN
- conservative
- surgery
- radiotherapy
34
most likely location of bleeding in epistaxis
- littles area
35
is bleeding in episaxis unilateral or bilateral
- usually unilateral
- bilateral = bleeding posteriorly in nose
36
mx epistaxis
- >10 minutes = nasal packing
- nasal cautery
- naseptin qds for 10 days if tx
37
features of apnoea
- snoring
- mornign ehadach e
- waking up unrefreshed
- daytime sleepiness
- concentration problems
epworth sleepiness scale
38
mx apnoea
- sleep studies
- correct reversible factors
- cpap
39
most common cause of bacterial tonsilitis
group A strep = strep pyogenes
- 2nd = strep pneumoniae
40
tx bacterial tonsilitis
pehenoxymethylpenicillin
41
centor criteria
- fever over 38
- tonsillar exudates
- absence of cough
- tender ln
42
fever pain score
fever in 24 hrs
purulence
attented in 3 days sx
inflamed tonsils
no cough
43
prescribe abx in tonsilitis when
- centor >3
- fever pain >4
44
quinsy is
peritonsillar abscess
45
additional sx in quinsy
- trismus
- change in voice
- swelling and erythema
46
mx quinsy
- needle aspiration
- surgical incision drainage
- dex
- abx pre and post surgery
47
tinnitus
- ringing in ears
- primary = with senorineural eharing loss
- secondary = identifiable cause
48
neck lump red flag referral when
- unexplained neck lump in 45 or more
- persitent lump at any age
- USS scan in lump growing in size
49
head and neck cancers are usually
squamous cell carcinomas
50
red flags for head and neck cancer
- lump in mouth or on lip
- ulceration unexplaines 3w
- erythroplakia
- persistent neck lump
- hoarseness
- unexplained thyroid lump
51
monoclonal antibody in head and neck cancer
cetuximab
52
when are nasal polyps concerning
when they are unilateral = specialist referral
53
cholesteatoma
- non cancerous growth of squamous epithelium trapped in skull base
- foul smelling discharge
- hearing loss, conductive
- attic crust on otoscopy = uppermost eardrum
- ent refer
54
glue ear
- OM with effusion
- Conductive hearing loss
55
Rinne and weber in conductive
- Rinne = negative = bone better than air
- Weber = localises to affected ear
56
Rinne and weber sensioneural
- Rinne = +ve = Air better than bone
- Weber = heard in unaffected ear
57
name of LN enlarged in tonsilitis
jugulodigastric
58
Barrets is
metaplasia from squamous to columnar epithelium in lower oesophagus
- predisposes to adenocarcinoma
59
triad in infectious monomucelosis
- fever
- pharyngitis
- lymphadenopathy
self limiting
60
infectious mono and amoxicillin?
itchy maculopapular rash in response to amoxicillin or cefalosporins
61
