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ENT Flashcards

1
Q

Suggest the complication of otitis media

A

Facial nerve palsy
Mastoiditis
Petrositis - Gradenigo syndrome
Labrynthitis
Meningitis
Sigmoid sinus thrombosis
Brain abcess

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2
Q

What are some causes for otlagia?

A

50% non otological e.g. grinding, TMJ
Trauma
Eczema
Furunculosis
NOE
Barotrauma

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3
Q

Suggest the most common infections in the ear canal

A

Pseudomonas then staphylococcal

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4
Q

How are OE infections managed?

A

Antibiotics + steroid
Aural toilet

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5
Q

What are some otitis media infections?

A

Pneumococcus
Haemophillus
Moraxella

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6
Q

How is otitis media managed?

A

If no systemic symptoms and simply pain, may recover in 24 hours without antibiotics and simple analgesia. However if systemically unwell, fever or <2 years old may benefit from amoxicillin. Consider a delayed prescription

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7
Q

What is benign or inactive COM?

A

A perforated ear drum
Dry
No active infection

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8
Q

What is chronic serous otitis media?

A

Characterised by continous serous drainage

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9
Q

What is chronic suppurative otitis media?

A

Diagnosed when there is persistent purulent draiange

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10
Q

What are the complications of a cholesteosteoma?

A

Facial nerve palsy
Mastoiditis
Hearing loss
Petrositis
Cerebral abcess

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11
Q

What is a cause of middle ear infections in adults?

A

Posterior space tumours

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12
Q

How should children with bilateral OME be managed?

A

3 month period of active observation and re-assess wit repeat hearing tests at 3 months. Consider after 3 months of ventillation tubes i.e. grommets or surgery.

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13
Q

How should children modify activities with grommets?

A

Swimming is permitted
However diving is not or forcing water

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14
Q

What are some causes of hearing loss in children?

A

50% genetic e.g. Jervell Lange, Klippel-Feil syndrome, Waardenburg syndrome, Alport

25% are non-genetic e.g. TORCH infections, meningitis, encephalitis, measles and mumps, ototoxic drugs

25% idiopathhic

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15
Q

What tests may be done in neonates for hearing impairment?

A

Otoacoustic emission testing
Auditory brainstem response (ABR)

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16
Q

What are the causes of tinnitus in patients?

A

Objective:
Vascular disorders: AV malformations, globus tumours,
high cardiac output states.

Subjective:
Menierre’s syndrome
Ototoxic drugs
Otitis media
SNHL
Noise induced damage

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17
Q

How is tinnitis treated?

A

Manage depression, anxiety and insomnia
Hearing aids
Psychological support
CBT

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18
Q

What are the features of acoustic neuroma?

A

Unilateral hearing loss
Unilateral tinnitis
Dizziness

MRI and pure tone audigram

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19
Q

What is the Jastreboff model?

A

It suggests there is a limbic and autonomic link with tinnitus annoyance

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20
Q

What type of nystagmus is seen in peripheral vertigo/ vestibular vs central vertigo?

A

Peripheral = horizontal
Central = vertical

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21
Q

What is Unterberger’s test?

A
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22
Q

What are the two types of vertigo?

A

Central and peripheral

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23
Q

What is BPPV?

A

<30 seconds are provoked by head turning
Dix-Hallpike test +ve
Self limited
Epley manoeuvre
Brandt Daroff exercises

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24
Q

What is Meniere’s?

A

2 or more episodes of vertigo lasting between 20 mins and 12 hours
Abnormality with endolymph
Fluctuating hearing loss, vertigo, tinnitus and fullness
Acute use prochlorperazine
Prophylaxis: beta histine

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25
What is vestibular neuritis and labyrinthitis?
Sudden attacks of unilateral vertigo and vomiting in a previously well person, often following an URTI. Lasts 1-2 days improving over the week Vestibular suppresants Prochlorperazine or buccastem and rehabilitation Labrynthitis has hearing loss
26
What is FESS?
Functional endoscopic sinus surgery (FESS) is a minimally invasive surgery for serious sinus conditions. It is used to clear blockages in the sinuses and make breathing easier
27
What drains to the superior meatus?
Posterior ethmoidal
28
What drains to the inferior meatus?
Nasolacrimal duct
29
What does the maxillary, anterior ethmoidal, middle ethmoidal and front sinus drain to?
Middle meatus
30
What does the sphenoid sinus drain to?
Sphenoethmoidal recess
31
When should manipulation of the nasal bones be performed?
Day 7-14 First check for a boggy swelling a septal haematoma
32
What does CSF contain?
B2 tau transferrin and >0.5ml is gold standard for rhinorrhea
33
How is CSF rhinorrhea managed?
Check for glucose and B2 tau protein Give antibiotics and prophylaxis pneumococcal vaccine
34
How is epistaxis managed?
Nosebleeds can be anterior or posterior Can be life threatening Assess blood loss: ABC, IVI, oyxgen sats Which side? trauma? how much blood lost? on wafarin? Pinch the lower part of the nose for 10 minutes Place an icepack on the dorsum on the nose Prepare to cauterize the nose with silver nitrate Use headlight and Thudicum's speculum Anterior nasal pack
35
Compare and contrast tonsillitis and quinsy?
Quinsy is a peritonsillar abscess
36
What is the fever pain score?
37
What are the complications of tonsilitis?
Peritonsilar abscess - presents with sore throat, dysphagia, peritonsilar bulge, uvular deviation, trismus and a muffled voice Abscess of parapharangeal Lemierre's syndrome
38
What is Lemierre's syndrome?
Infectious thrombophlebitis of the internal jugular vein caused by fusobacterium and emboli
39
What is the Paradise criteria?
40
How is a primary haemorrhage and secondary haenorrhage different following tonsillectomy?
Primary <24 hours back to theatre Secondary >24 hours observe in hospital and antibiotics
41
What are the causes of stridor?
Congenital: Laryngomalacia Inflammation: laryngitis, epiglossitis, group, anaphylaxis Trauma: burns
42
What are the causes of drooling?
Not necessarily with epiglossitis Angiooedema. rabies, muscular problems, ingestion of foreign body
43
List the causes of hoarseness
Vocal cord palsy Spadmodia dysphonia Cranial nerve palsy Laryngitis Vocal cord nodules Laryngeal cancer Reflux Reinke's oedema Muscle tension dysphonia Laryngeal vocal nerve palsy
44
What are the questions you should ask with swallowing difficulties?
1. Solids 2. Liquids - can't swallow liquids well e.g. achalasia, bulbar palsy 3. Initiate swallowing - can't initiate bulbar palsy 4. Painful - malignant swelling 5. Swelling on drinking - retropharnygeal abscess
45
What is the most common cause of head and neck cancers?
HNSCC
46
What are some risk factors for HNSCC?
Cigarette smoking HPV Alcohol Vitamin A and C deficiencies GORD
47
What are some causes of dysphasia?
Achalasia Strictures Malignancy Pharyngeal pouch Globus hystericus/ pharyngeus
48
What are some tests for swallowing defects?
Barium swallow Endoscopy Motility studies
49
How are laryngeal cancers treated?
First line chemoradiotherapy Second line surgery and radiotherapt
50
What are the intracranial nerves of facial nerve palsy?
Chorda tympani = 2/3rds taste Branches to stapedius = hyeracusis
51
What are the causes of a cranial nerve palsy?
Intracranial: brainstem tumours, strokes, polio, MS, acoustic neuroma, meningitis Intratemporal: Ramsay Hunt, cholesteatoma Infratemporal: Parotid tumours Others: Lyme disease and sarcoidosis
52
What are the tests for a facial nerve palsy?
ESR, glucose, Lyme disease, check parotids for lumps and bumps
53
What are some differentials for neck lumps?
Duration: if < 3 weeks likely reactive lympadenopathy If midline: <20 midline lump = dermoid cysts <20 midline + elevates on tongue protrusion = thyroglossal cyst >20 midline + elevates likely a thyroid mass/ goitre If submandibular: <20 self limiting = reactive lymphadenopathy >20 = malignant lymphadenopathy Could it be a submandiubular stone, tumour, or siadelinitis If anterior triangle: Lympadenopathy Branchial cyst Parotid tumours Carotid artery aneurysm Carotid artery tumour If posterior triangle/ i.e. behind sternocleidomastoid Cervical ribs Pharyngeal pouches Cystic hygroma Lympadenopathy (TB, HIV) If >20 lymphoma
54
What is the most common parotid tumour?
Pleomorphic adenoma
55
What is a high grade salivary tumour?
Mucoepidermoid carcinoma
56
Which salivary gland tumour spreads along the nerve?
Adenoid cystic tumours
57
Which salivary tumours tend to be bilateral?
Warthin's tumour (adenolymphoma)
58
How is Vincent's angina treated?
This is ncerotising ulcerative gingivitis Amoxicillin and netroniazole
59
What are causes of gum hyperplasia?
Phenytoin, cyclosporin and nifedipine
60
How can you distinguish between pain in the teeth?
Caused by sugar or heat - pulpitis Worse with percussion = osteitis or abcess Exacerbated by movement - abscess
61
What are the causes of a black hairy tongue
poor oral hygiene antibiotics head and neck radiation HIV intravenous drug use

Finals (24 decks)

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