ENT Flashcards by jenn martin

Infection is a common cause of otitis externa, name 2 more.

Seborrhoeic dermatitis
Contact dermatitis

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Ear pain is a common symptom of otitis externa, name 2 more.

Itching
Discharge
Hearing loss (potential)

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What is seen on otoscopy in otitis externa?

Red
Swollen
Eczematous
= canal

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What is the management of otitis externa?

Firstline:
Topical antibiotic or combined topical antibiotic (ciprofloxacin) + steroid
Removal of debris if present

Secondline: Referral to ENT
Oral antibiotics - flucloxacillin
Swab the ear canal
Empirical use of antifungal

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What is the most common causative organism of malignant otitis externa?

Pseudomonas aeruginosa

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How does otitis externa become malignant?

Infection commences in the soft tissues of the external auditory meatus, then progresses to invovle the soft tissues an dinto the bony ear canal -> temporal bone osteomyelitis.

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What are the key features in the hx of otitis externa?

Diabetes or immunosuppression
Severe, unrelenting, deep-seated otalgia.
Temporal headaches
Purulent ottorheoa
Possible: dysphagia, hoarseness and/or facial nerve dysfunction.

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What investigations are done for MOE?

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What are some of the complications of otitis externa?

Malignant otitis externa
Periauricular cellulitis
Perforation

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Streptococcus pneumoniae is a common cause of acute otitis media, name 2 more common causes.

Haemophilus influenzae
Moraxella catarrhalis

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Otalgia is a common symptom of otitis media, state 4 more.

Fever (in around 50%)
Hearing loss
Recent URTI sx
Ear discharge - if TM peforates.

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A buldging tympanic membrane may be seen on examination of the ear canal of a patient with otitis media, state 2 more findings of OM on otoscopy.

Opacification or erythema (injected TM) of the TM
Peforation with purulent discharge

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Which antibiotic is firstline for otitis media?

Amoxicillin for 10 days
Erythromycin or Clarithromycin if penicillin allergic.

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Mastoiditis is a potential complication of otitis media, state 3 more complications.

Brain abscess
Meningitis
Facial nerve paralysis

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Vertigo is a feature of vestibular neuronitis, state 3 more features.

Nausea and vomiting
Horizontal nystagmus
No hearing loss or tinnitus

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What are the differentials for vestibular neuronitis?

Viral labyrinthitis
Posterior circulation stroke (HiNTs exam)

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What is the management of vestibular neuronitis?

Short-term: prochlorperazine IM or buccal in severe, oral in mild.
Long-term: Vestibular rehabilitation exercises for chronic sx.

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What is the average age of onset for BPPV?

55 years.

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What are the key features of BPPV?

Vertigo triggered by head movements.
Associated nausea.
10-20 second episodes.

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What are the results of a positive Dix-Hallpilke test?

Recreation of the sx.
Rotatory nystagmus

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What are the management options for BPPV?

Epley maneouvre
Vestibular rehabilitation

What are the 3 key features of Meniere’s Disease?

Recurrent episodes of vertigo
Tinnitus
Hearing Loss (Sensorineural)

Other than hearing loss, vertigo and tinnitus, name 2 more symptoms of Meniere’s disease.

Aural fullness
Nystagmus

What is the short-term treatment for Meniere’s?

Prochlorperazine (IM or buccal)
Low salt diet

A 10-year-old child presents with enlarged tonsils that meet in the midline. Oropharyngeal examination confirms this finding and you also notice peticheal haemorrhages affecting the oropharynx. On systemic examination he is noted to have splenomegaly. What is the diagnosis?

Infectious Mononucleosis

If a child is younger than 2 years with bilateral otitis media this is an indication for antibiotics with acute otitis media, name 4 other indications.

Symptoms lasting more than 4 days or not improving Systemically unwell but not requiring admission Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease Otitis media with perforation and/or discharge in the canal

For a patient presenting with otitis media with effusion and is an adult, what is the most appropriate initial mx and why?

Urgent 2WW referral to ENT cancer Otitis media with an effusion in adults can be a sign of nasopharyngeal cancer.

What are the cranial nerves that are affected in acoustic neuroma?

V - absent corneal reflex VII - facial palsy VIII - tinnitus, unilateral sensorineural hearing loss, vertigo.

What are the management options for acoustic neuroma?

Surgery Radiotherapy

What are the 2ww criteria for throat problems?

over 45 persistent hoarse voice or unexplained lump unexplained thyroid lump oral ulcer lasting longer than 3 weeks.

How to assess the disease impact and disease severity for psoriasis?

DLQI Daily Life Quality Index PASI

How to assess the disease disease severity for eczema?

EASI

What are the management options for ear wax build-up?

Warm olive oil Sodium bicarbonate Suctioning

What are the two types of chronic otitis media?

Squamous - cholesteatoma Mucosal - perforation with infection

Smelly discharge is one of the sx of cholesteatoma, name 4 more.

Pain Facial nerve palsy Conductive hearing loss Vertigo

What are the features of cholesteatoma on otoscopy?

Attic crust on TM

What is the management of cholesteatoma?

Surgical removal of debris. Mastoid cavity drilling.

What is the pathophysiology of cholesteatoma?

Non-cancerous growth of squamous epithelium that is 'trapped' within the skull base causing local destruction.

What congential problem increases the risk of cholesteatoma?

Cleft palate

How would you investigate pulsatile tinnitus?

BP Listen Duplex doppler of carotids CT angiogram

What are some of the mx options for tinnitus?

Noise generator (white noise) Hearing aids

What can be done to prevent relapse of meniere's?

Betahistine Vestibular rehabilitation

What is the treatment for otosclerosis?

Stapedectomy Stapedotomy

What is the antibiotic treatment for rhinosinusitis? When would you do this?

7 days of Amoxicillin Discoloured discharge High fever Severe localised pain Double sickening = gets better and then gets worse

If rhinosinusitis persists for longer than 10 days or gets worse after 5 days what can be given?

Corticosteroids

What is the FeverPAIN score?

Fever Purulent tonsils Attend in under 3 days Inflamed tonsils No cough or coryza = 4 or more antibitoics (3 consider delayed antibiotics)

What is the most common type of thyroid cancer?

Papillary

What are the tumour markers for calcitonin?

Calcitonin TSH CEA Thyroglobulin

What is the cancer with the worst prognosis?

Anaplastic

What is the most likely vessel to bleed in epistaxis?

Sphenopalatine atery

What is the treatment for acute otitis media with a perforation?

Oral amoxicillin (clarithro or erythro)

What medication is used to prevent attacks of Ménière’s disease?

Betahistine