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Finals > ENT > Flashcards

ENT Flashcards

1
Q

What is otitis media?

A

Infection in the middle ear

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2
Q

What are the most common causes of otitis media?

A
  • streptococcus pneumoniae
  • haemophilus influenzae
  • moraxella catarrhalis
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3
Q

Presentation of otitis media

A
  • otalgia ear pain
  • fever
  • hearing loss
  • recent viral URTI symtpoms
  • ear discharge may occur if the eardrum has perforated
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4
Q

Otitis media on otoscopy

A
  • Bulging tympanic membrane leading to loss of the light reflex
  • opacification or erythema of the tympanic membrane
  • otorrhoea
  • inflammation of the tympanic membrane
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5
Q

What is the management of otitis media?

A
  • normally self limiting within 3 days to a week
  • analgesia
  • advised to seek help if not resloved within 3 days
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6
Q

When should you prescribe antibiotics immediately for otitis media?

A
  • symptoms lasting 4 days or not improving
  • systemically unwell
  • immunocompromised
  • younger than 2 with bilateral otitis media
  • otits media with perforation and/or discharge in the canal
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7
Q

Which antibiotic for otitis media?

A

Amoxicillin for 5-7 days, clarithromycin if penicillin allergy

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8
Q

Complications of otitis media

A
  • perforation of the tympanic membrane
  • hearing loss
  • labyrinthitis (causing dizziness/vertigo)
  • mastoiditis
  • meningitis
  • brain abscess
  • facial nerve paralysis
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9
Q

What is chronic suppurative otits media?

A

Perforation of the tympanic membrane with otorrhoea for > 6 weeks

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10
Q

Where do nosebleeds normally originate?

A

Kisselbach’s plexus in littles area (at the front of the nasal cavity)

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11
Q

How can you categorise nosebleeds?

A

Anterior (normally kisselbach’s plexus) and posterior bleeds

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12
Q

What are the causes of epistaxis?

A
  • nose picking or nose blowing
  • trauma
  • foreign body
  • bleeding disorders e.g. thrombocytopenia or von willebrand
  • snorting cocaine
  • granulomatosis with polyangiitis
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13
Q

What is bleeding from both nostrils a sign of?

A

Posterior nose bleed

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14
Q

Management of mild epistaxis

A
  • Sit patient up with head tilting forwards and mouth open
  • squeeze the soft cartilaginous area of the nose firmly for 20 minutes (breath through mouth)
  • if successful then consider naseptin (topical antiseptic) to reduce crusting
  • follow up if comorbid cause suspected, or under 2
  • avoid blowing or picking nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks
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15
Q

What should you do if epistaxis continues despite 10-15 minutes of continuous pressure on the nose

A
  • cautery if source of bleed is visible, use topical anaestheic spray then silver nitrate stick for 3-10 seconds (only cauterise one side of the septum), dab area with naseptin
  • Packing if cautery not viable usign nasal tampons or inflatable pack
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16
Q

When is naseptin contraindicated?

A

Peanut or soya allergy

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17
Q

Management of epistaxis which has failed all emergency management

A

sphenopalatine ligation in theatre

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18
Q

What is nasal septum haematoma?

A

Complication of nasal trauma, development of haematoma between the septal cartilage and overlying perichondrium

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19
Q

Features of nasal septum haematoma

A
  • may be caused by relatively minor trauma
  • sentation of nasal obstruction
  • pain
  • rhinorrhoea
  • bilateral red swelling arising from the nasal septum
  • feel boggy (a deviated septum will feel firm)
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20
Q

What is the management of septal haematoma?

A
  • surgical drianage
  • intravenous antibiotics
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21
Q

Complication of septal haematoma

A
  • septal necrosis may develop after 3-4 days
  • saddle nose deformity
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22
Q

Differential diagnoses of facial pain

A
  • trigeminal neuralgia: sever pain along distribution of trigeminal nerve
  • sinusitis: nasal discharge or congestion
  • dental problems
  • tension type headache: band like
  • migraine: unilateral throb
  • giant cell arteritis
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23
Q

Explain Weber’s test

A
  • tuning fork in centre of forehead
  • normal = both ears equal
  • senorineural: louder in normal ear
  • conductive: louder in affected ear (ear becomes more sensitive to try to hear and when transmitted directly to the cochlea it is heard as louder)
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24
Q

Explain Rinne’s test

A
  • mastoid process then 1cm from ear
  • air conduction better than bone = normal
  • in conductive, the sound is not heard when moved from the mastoid process to the ear canal
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25
Q

Causes of sensorineural hearing loss

A
  • presbycusis
  • noise exposure
  • menieres disease
  • labyrinthitis
  • acoustic neuroma
  • neurological conditions
  • infection
  • loop diuretics, aminoglycosides, chemotherapy
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26
Q

What medications cause sensorineural hearing loss?

A
  • aminoglycosides
  • loop diuretics
  • chemotherapy
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27
Q

What are the causes of conductive hearing loss?

A
  • ear wax
  • infection
  • fluid in the ears
  • eustachian tube
  • perforated tympanic membrane
  • otosclerosis
  • cholesteatoma
  • tumor
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28
Q

What is presbycusis?

A

Age related sensori-neural hearing loss

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29
Q

What is otosclerosis?

A
  • autosomal dominant
  • replacement of the normal bone by vascular spongy bone
  • onset usually age 20-40
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30
Q

Features of otosclerosis

A
  • conductive deafness
  • tinnitus
  • positive family history
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31
Q

What is glue ear

A

Otitis media with effusion

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32
Q

What is vertigo?

A

Movement between the patient and their environment

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33
Q

What are the two categories of causes of vertigo?

A
  • peripheral problems affecting the vestibular system
  • central problem involving the brainstem or the cerebellum
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34
Q

What are the causes of peripheral vertigo?

A
  • benign paroxysmal positional vertigo
  • menieres disease
  • vestibular neuronitis
  • labyrinthitis
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35
Q

What are the causes of central vertigo?

A
  • posterior circulation infarction: sudden
  • tumour: gradual
  • multiple sclerosis
  • vestibular migraine
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36
Q

Features of benign paroxysmal positional vertigo

A
  • vertigo triggered by change in the head position
  • associated with nausea
  • each episode lasts 10-20 seconds
  • positive dix hallpike manoeuvre
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37
Q

Management of BBPV

A
  • usually resolves spontaneously
  • epley manoeuvre
  • teaching the patient Brandt-Daroff exercise
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38
Q

Dix hallpike manoeuvre

A
  • rapidly lower the patient to the supine position with their head at 45 degrees to the right or left, until extended at 30 degrees
  • rotatory nystagmus and patient reports vertigo
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39
Q

What is rhinosinusitis?

A

Inflammation of the paranasal sinuses. Can either be acute or chronic (12 weeks+)

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40
Q

What are the sinuses?

A
  • frontal
  • maxillary
  • ehtmoid
  • sphenoid
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41
Q

Presentation of sinustitis

A
  • nasal congestion
  • nasal discharge
  • facial pain or headache
  • facial pressure
  • facual swelling over the affected areas
  • loss of smell
  • tenderness on palpation of affected areas
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42
Q

Association of sinusitis

A

nasal polyps

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43
Q

Management of sinusitis

A
  • most cases are viral and resolve in 2-3 weeks
  • if symptoms persist over 10 days then high dose nasal spray for 14 days, delayed antibiotic prescription
44
Q

Management of chronic sinusitis

A
  • saline nasal irrigation
  • steroid nasal spray or drops
  • functional endoscopic sinus surgery
45
Q

Causes of otitis externa

A
  • infection: staph aureus, pseudomonas aeruginosa, fungal
  • seborrhoeic dermatitis
  • contact dermatitis
  • recent swimming
46
Q

Features of otitis externa

A
  • ear pain
  • itch
  • discharge
  • otoscopy: red, swollen, eczematous canal
47
Q

Management of otitis externa

A
  • topical antibiotics or combined antibiotic and steroid
  • if the canal is perforated then no aminoglycosides
  • if canal debris you can consider removal
  • if continuing infection can condider: oral antibiotics if spreading, swab, antifungal agent
48
Q

Malignant otitis externa

A

More common in elderly diabetic, extension of infection into the bony ear canal and soft tissues deep to the bony canal. IV antibiotics

49
Q

Treatment of glue ear

A
  • active observation: 3 months
  • grommet insertion
  • adenoidectomy
50
Q

Management of perforated tympanic membrane

A
  • usually heals after 6-8 weeks, avoid getting water in the ear during this time
  • Antibiotics if perforation occurs after an episode of acute otitis media
  • myringoplasty if doesnt heal by itself
51
Q

What is cholesteatoma?

A

Non cancerous growth of squamous epithelium in the middle ear

52
Q

Features of cholesteatoma

A
  • foul smelling, non-resolving discharge
  • hearing loss
  • As it expands: vertigo, facial nerve palsy, infection, pain
53
Q

Otoscopy of cholesteatoma

A

Attic crust (build up of debris in the upper tympanic membrane)

54
Q

Management of cholesteatoma

A

ENT for surgical removal

55
Q

What are the branches of the facial nerve?

A
  • temporal
  • zygomatic
  • buccal
  • marginal mandibular
  • cervical
56
Q

What is the function of the facial nerve?

A
  • Motor: facial expression
  • sensory: taste from the anterior 2/3 of the tongue
  • Parasympathetic supply to the submandibular and sublingual salivary glans aand lacrimal gland
57
Q

How to distinguish between UMN and LMN lesion of the facial nerve

A

if they can wrinkle their forehead then its upper

58
Q

Unilateral UMN lesion of the facial nerve causes

A
  • stroke
  • tumour
59
Q

Bilateral UMN lesion of the facial nerve

A
  • pseudobulbar palsies
  • motor neurone disease
60
Q

Management of bells palsy

A
  • if presents within 72 hours then prednisolone 50mg for 10 days then 60 for 5 then 10 for 5
  • lubricating eye drops
61
Q

Ramsay hunt syndrome

A
  • varicella zoster virus
  • unilateral lower motor neurone facial nerve palsy
  • painful and tender vesicular rash in the ear canal, pinna and around the ear on the affected side
62
Q

Management of ramsay hunt syndrome

A

-Initiate treatment within 72 hours
- prednisolone
- aciclovir
- lubricating eye drops

63
Q

What is vestibular neuronitis?

A

Inflammation of the vestibular nerve. Often following a viral infection

64
Q

Features of vestibular neuronitis

A
  • recurrent vertigo attacks lasting days or hours
  • may have nausea/vomiting
  • horizontal nystagmus
  • no hearing loss or tinnitus
65
Q

How can you distinguish between vestibular neuronitis and posterior circulation stroke

A

HiNTs

66
Q

Management of vestibular neuronitis

A
  • procholrperazine (buccal or IM for severe, oral for less severe)
  • Antihistamines

Treatment should last for 3 days

  • Vestibular rehabilitation exercises if chronic symptoms
67
Q

Features of menieres

A
  • triad of vertigo, tinnitus and hearing loss
  • sensation of aural fullness
  • other features e.g. nystagmus or positive romberg
  • vertigo episodes lasting 20 minutes to hours
68
Q

Causes of neck swelling

A
  • reactive lymphadenopathy
  • lymphoma
  • thyroid swelling
  • thyroglossal cyst
  • pharyngeal pouch
  • cystic hygroma
  • branchial cyst
  • cervical rib
  • carotid aneurysm
69
Q

Lymphoma - neck palpation

A

rubbery, painless lymphadenopathy

70
Q

thyroid swelling exam

A

Moves up on swallowing

71
Q

Thyroglossal cyst exam

A

midline, moves upwards with protrusion of the tongue

72
Q

Symptoms of pharyngeal pouch

A
  • dysphagia
  • regurgitation
  • aspiration
  • chronic cough
73
Q

Cystic hygroma

A
  • congenital lymphatic lesion, classically on the left
74
Q

Branchial cyst

A

Oval, mobile cyst that develops between the sternocleidomastoid and pharynx

75
Q

Carotid aneurysm exam

A

pulsatile lateral neck mass which doesnt move on swallowing

76
Q

Complications of tonsillitis

A
  • otitis media
  • quinsy
  • rheumatic fever and glomerulonephritis
77
Q

Indication for tonsillectomy

A
  • sore throats are due to tonsillitis
  • 7 or more episodes of sore throat per year, 5 or more for 2 years, 3 per year for 3 years
  • symptoms occurring for more than one year
  • episodes are disabling and prevent normal function
78
Q

Features of quinsy

A
  • severe throat pain, lateralises to one side
  • deviation of the uvula to one side
  • trismus (difficulty opening the mouth)
  • reduced neck motility
79
Q

Management of quinsy

A
  • needle aspiration or incision and drainage
  • intravenous antibiotics
  • consider tonsillectomy (2 episodes)
80
Q

What types of cancers do head and neck cancers tend to be?

A

squamous cell carcinoma

81
Q

Where do head and neck cancers spread first?

A

Lymph nodes

82
Q

Risk factors head and neck cancer

A
  • smoking, chewing tobacco
  • alcohol
  • HPV
  • EBV
83
Q

Red flags head and neck cancer

A
  • lump in the mouth or the lip
  • unexplained ulceration in the mouth lasting more than 3 weeks
  • erythroplakia or erythroleukoplakia
  • unexplained hoarseness of voice
  • unexplained thyroid lump
84
Q

monoclonal antibody used to treat squamous cell head and neck cancers

A

Cetuximab (epidermal growth factor receptor)

85
Q

2 week wait laryngeal cancer

A
  • aged 45+
  • persistent unexplained hoarseness or unexplained neck lump
86
Q

Oral cancer 2 week wait

A
  • ulcer 3+ weeks or unexplained lump in neck
  • lump in the lip or oral cavity, red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia
87
Q

What are the types of allergic rhintis?

A
  • seasonal
  • perennial: symptoms throughout the year
  • occupational
88
Q

Features of allergic rhinitis

A
  • sneezing
  • bilateral nasal obstruction
  • clear nasal discharge
  • post nasal drip
  • nasal pruritis
89
Q

Management of allergic rhinitis

A
  • allergen avoidance
  • if mild to moderate then oral or intranasal antihistamine
  • if moderate to severe or antihistamine ineffective then intranasal corticosteroids
90
Q

Nasal deocngestants

A
  • dont use for long periods
  • rebound hypertrophy of the nasal mucosa may occur upon withdrawal
91
Q

Auricular haematoma

A
  • treatment promt to avodid cauliflower ear
  • same day assessment by ENT
  • incision and drainage
92
Q

What is a branchial cyst?

A
  • developmental defect of the branchial arches
  • cyst is filled with acellular fluid with cholesterol crystals, encapsulated by stratified squamous epithelium
93
Q

Management of branchial cyst

A
  • consdier and exclude malignancy
  • USS
  • refer to ENT
  • fine needle aspiration
94
Q

Red flags of rhinosinusitis

A
  • unilateral pain
  • persistent symptoms despite 3 months of treatment
  • epistaxis
95
Q

What are the contraindications to a cochlear implant?

A
  • lesion of cranial nerve VIII or brain stem causing deafness
  • chronic infective otitis media , mastoid cavity or tympanic membrane perforation
  • cochlear aplasia
96
Q

How long do adults have to try hearing aids for before consideration of a cochlear implant?

A

3 months

97
Q

Management simple gingivitis

A

Routine regular review by dentist

98
Q

What is ludwigs angina

A

Cellulitis that invades the floor of the mouth and soft tissues of the neck

99
Q

bacteria malignant otitis externa

A

Pseudomaonas aeruginosa

100
Q

Samter’s triad

A
  • asthma
  • aspirin sensitivity
  • nasal polyposis
101
Q

Management of nasal polyps

A
  • ENT for exam
  • topical corticosteroids
102
Q

Features of nasal polyps

A
  • nasal obstruction
  • rhinorrhoea, sneezing
  • poor sense of taste and smell
103
Q

association of secondary haemorrhage post tonsillectomy

A

wound infection

104
Q

Management of primary haemorrhage after tonsillectomy

A

Immediate return to theatre

105
Q

What can be given to prevent episodes in menieres?

A

Betahistine

106
Q

Labyrinthitis presentation

A
  • vertigo
  • nausea and vomiting
  • hearing loss
  • after viral infection
107
Q
A

Finals (37 decks)

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