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GP FELLOWSHIP RNZGP > ENT > Flashcards

ENT Flashcards

1
Q

Old age hearing loss name

A

Presbycusis

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2
Q

Hearing loss history questions

A
  • Onset & progression
  • Symptoms: otorrhoea, otalgia
  • Vertigo, tinnitus or disequilibrium
  • Headaches (acoustic neuroma)
  • Exposure to loud noise
  • Head trauma, ear trauma, barotrauma
  • Ear surgery
  • Recurrent ear infections, major infections
  • Family history
  • Ototoxic medications: frusemide, gentamicin
  • Systemic symptoms; eg thyrotoxicosis (late stage)
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3
Q

Examination for hearing loss

A
  • Otoscopy
  • Pneumatic otoscopy
  • Weber & Rinne test
  • Cranial nerve exam
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4
Q

Conductive hearing loss causes

A

OUTER EAR
- Otitis externa
- trauma
- Wax
- Exostotsis
- Osteoma
- Congenital atresia

MIDDLE EAR
- Otitis media
- Cholesteatoma
- Otosclerosis
- TM perforation
- Temporal bone trauma
- Congenital atresia

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5
Q

Sensorineural hearing loss causes

A
  • Presbycusis (age related sensorineural HL)
  • Hereditary hearing loss
  • Accoustic neuroma
  • Menier’s
  • Ototoxic drugs
  • Noise exposure
  • CVA
  • Barotrauma
  • Meningitis
  • Thyrotoxicosis
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6
Q

History questions for Ear ache

A
  • Fever
  • Otorrhoea
  • Hearing loss
  • URTI /coryzal symptoms (most AOM, OME follow on from nasal congestion/infection)
  • Swimming (OE) (barotrauma)
  • ATSI
  • Trauma
  • Speech issues
  • Attention /behaviour /school issues
  • Balance issues
  • Second hand smoke exposure
  • Air travel (barotrauma)
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7
Q

Indications for antibiotics in acute otitis media

A
  • <6m
  • Bilateral <2
  • Systemically unwell
  • ATSI
  • Otorrhoea (perforation)
  • Immunocompromised
  • Cochlear implant
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8
Q

Analgesia in AOM

A

Paracetemol 15mg/kg

Lignociane 2% 1-2 drops to INTACT TM

Ibuprofen 10mg/kg

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9
Q

Acute otitis media NON Aboriginal no red flags

A
  1. Analgesia
  2. Review 48 hours –> can give abx then
  3. Review 3 months to ensure effusion resolved
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10
Q

Persistent otitis media with effusion AKA

A

Glue ear

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11
Q

Features of chronic suppurative OM

A

Infection of middle ear
Perforated TM
Discharge
TIME COURSE: > 6 weeks

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12
Q

Treatment for Chronic suppurative OM

A
  • Dry Aural Toilet 6hourly
  • Ciprofloxacin 0.3% 5 drops BD until no d/c for 3days
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13
Q

OME (otitis media with effusion) Definition

A

Middle ear effusion without:
- Bulging membrane,
- fever

Looks like
- Loss of lucency
- Grey/white fluid
- Immobile TM with dilated vessels

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14
Q

OME referral for grommets (tympanostomy)

A

<3 months of OME
BUT with hearing loss and or learning/speech problems

> 3 months
Bilateral hearing loss

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15
Q

ATSI persistent otitis media with effusion (glue ear) for >3 months

A
  • Refer for hearing assessment
  • Consider 2-4 weeks of abx (amox 50mg/kg/day)
  • Referral to ENT if OME> 3 months OR DB>20 loss in better ear
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16
Q

ATSI Acute Otitis Media with poor compliance antibiotics

A

Azithromycin 30mg/kg stat day 1 and 7

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17
Q

ATSI AOMwiP (with perforation) management
= Small hole (difficult to see) but with discharge

A

Amox 50-90mg/kg/day for 14 days

OR
Single dose azithromycin 30mg/kg

Review at day 7
If no better then 90mg/kg amox or second dose azithro

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18
Q

ATSI Recurrent AOM (rAOM)

A

Prophylactic not routine
but consider
Amox 50/mg on time per day for 3-6 months
??seems like a massive dose. (if child is <2)

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19
Q

ATSI chronic suppurative OM (CSOM)
= visible perf and discharge

A
  • Clean pus
  • Cipro 0.3% ear drops 5 drops BD
  • Add amox 50-90mg/kg/day if perf not readily visible
  • Continue for at least 3 days after ear becomes dry3
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20
Q

Tinnitis - causes

A

External ear:
- wax
- OE

Middle ear:
- OM
- Otosclerosis
- Cholesteatoma

Inner ear
- Schwannoma
- Menniers
- Ototoxicity
- nueritis

Non Auditory cuases
- Vascular anomalies
- Nasopharyngeal carcinoma

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21
Q

Imaging for tinnitis - when is it reasonable?

A

Pulsatile
- Vascular cause- get CT angio

Unilateral
- Focal lesion

Asymmetrical hearing loss
- MRI

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22
Q

Risk factors for head and neck cancers

A
  • Smoking
  • etOH
  • > 40
  • Previous neck malignancy
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23
Q

RED flags for head and neck masses

A
  • Mass <2 weeks
  • Voice change
  • Dysphagia, odynophagia
  • Otaliga, epistaxis, nasal obstruction (ipsilateral)
  • Weight loss, loss of apetite
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24
Q

Investigation of neck mass

A

CT with contrast
FNA

25
Q

Oral /mucosal ulcer: time course for suspicion?

A

> 2 weeks
(as cell turnover <10 days)

26
Q

Leukoplakia & erythroplakia- what to do?

A

Biopsy is mandatory

NOTE: white plaques vs red plaques

27
Q

Jaw swelling first line investigation

A

OPG

28
Q

Otitis media step wise approach (no red flags)

A

1.Analgesia and review 48 hours
2. Amoxicillin 15mg/kg TDS for 5 days
3. If not improving at 48 hours: Augmentin DF (22.5/3.2mg/kg) BD 5 days

29
Q

Intranasal antihistamine example

A

Azelastine 1mg/ml 1 spray each nostril BD

30
Q

Allergic rhinitis intranasal cortisteroid

A

Mometasone 100microg daily 4 weeks then 50microg (2 spray to 1 spray)

= Nasonex

31
Q

Allergic rhinitis combination therapy

A

Azelastine + fluticasone propionate 125+50mcg 1 spray BD

Olopatadine & mometasone 665+25mcg 2 sprays BD

32
Q

Allergic rhinitis severe: intranasal atrovent

A

Ipatropium 44 mcg (2 sprays each nostril up to TDS

33
Q

Caution with intranasal decongestants

A

Rhinitis medicamentosa (rebound congestion)

34
Q

What type of hearing loss (specific)

A

Presbyacusis

35
Q

Type of hearing loss pattern?

A

Sensorineural

36
Q

Type of hearing loss pattern?

A

Conductive

37
Q

Type of hearing loss pattern?

A

Noise induced hearing loss (sensorineural)

38
Q

Otosclerosis features & managment

A
  • Conductive hearing loss
  • Develops 20s-30s
  • Family hx (autosomal dominant)
  • Lower frequencies then progresses

REFERRAL TO ENT (consider stapedectomy)

39
Q

Symptomatic relief of acute rhino-sinusitis

A
  • Simple analgesia
  • Saline nasal preparations
  • Intranasal corticosteroid
  • Intranasal decongestant (short term)
  • Intranasal ipatropium
40
Q

Acute rhino-sinusitis- antibiotic regime & step wise

A

Shared decision making

Amoxicillin 15mg/kg (up to 500mg) TDS 5 days

Review in 5 days

Step up to Augmentin DF (22.5/3.2 mg/kg) BD 5 days

41
Q

Middle ear effusion (OME) time course for referral

A

Persistent >3 months –> ENT REFERRAL

42
Q

Cervical lymphadenitis Abx

A

Cephalexin 12.5mg (up to 500mg) 6hourly for 7 days

43
Q

Persistent Cervical Lymphadenopathy (2-6 weeks) paeds investigations

A
  • FBC, blood film
  • CRP, ESR
  • LDH
  • LFT
  • Serology; EBV/CMV/HIV
  • Toxoplasmosis/Bartonella Henselae
  • TB
  • CXR
  • Neck USS
  • biopsy (excisional is gold standard, FNA less helpful)
44
Q

What is the cause of 90% of unilateral hearing loss?

A

Idiopathic

45
Q

Treatment of idiopathic SNHL

A

Prednisolone 1mg/kg up to 60mg for 7-14 days

46
Q

Menier’s disease management

A
  • Hydrochlorothiazide 25mg daily
  • Betahistine
  • Vestibular rehabilitation
47
Q

AOM with perforation antibiotics

A

Amoxicillin 15mg/kg TDS for 5 days
ADD
Ciprofloxacin drops

48
Q

weber test: Lateralising to one side. 2 options

A

Sensorineural hearing loss in the other ear
Conductive in that ear

49
Q

Menniers non- pharmacological advice

A

Sodium <2g /day
Limit caffeine
Limit etOH
Referral to audiologist for hearing aid
Referral to AEP for vestibular rehab

50
Q

Menniers pharmacological management

A

Hydrochlorothiazide 25mg daily

51
Q

Sore throat: RED flag populations necessitating antibiotics

A
  • ABORIGINAL
  • Maori/ pacific islanders
  • RF or RHD
  • Family history of RHD or RF
  • Immunosuppressed
52
Q

Dose of Phenoxymethylpenicillin for Strep Pharyngitis (and alternative for non compliance)

A

PMP
15mg/kg up to 500mg 12hourly for 10 days

Benzathine benzylpenicillin IM stat dose

53
Q

Tympanostomy Tube Otorrhoea (TTO)

A

Dry mopping
Topical ciprofloxacin 5drops BD 7 days

54
Q

Sudden onset (idiopathic) sensorineural hearing loss treatment

A

Prednisone 60mg 7-14 days

55
Q

Mometasone dose for a child

A

50 microg each nostril daily

56
Q

Mennier’s pharmacotherapy

A

HCT 25mg daily

57
Q

Vestibular Neuritis Pharmacology

A

Prednisolone 1mg/kg (up to 75mg) daily for 5 days

58
Q

Examination for hearing loss (what are your three key exams)

A

Otoscopy
Weber and rinnes
Cranial nerve exam

59
Q

Persistent Cervical Lymphadenopathy (2-6 weeks) paeds investigations

A
  • FBC, blood film
  • CRP, ESR
  • LDH
  • LFT
  • Serology; EBV/CMV/HIV
  • Toxoplasmosis/Bartonella Henselae
  • TB
  • CXR
  • Neck USS
  • biopsy (excisional is gold standard, FNA less helpful)

GP FELLOWSHIP RNZGP (20 decks)

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