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PMMH > ENT > Flashcards

ENT Flashcards

1
Q

HX of ear pain

A
  • Use Socrates
  • Ask about quality of pain
  • Any preceding trauma- may indicate CSF leak
  • Any itching?
  • Any discharge?- mucus or blood stain will tell us there’s an infection.
  • hearing loss?
  • Experiencing tinnitus?- subjective sensation of sound
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2
Q

What are the 2 distinct causes of hearing loss?

A
  1. Conductive
  2. Sensorineural
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3
Q

What causes conductive hearing loss?

A
  • When sound gets blocked in the external or middle ear.
  • Any process which disrupts the conduction of sound from outside of the ear to the tympanic membrane and vesicular chain to the inner ear.
    Causes:
  • Wax
  • Foreign body
  • Scar tissue or adhesions
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4
Q

What is sensironeural hearing loss?

A
  • An impairment that develops with damage to the organ for hearing/ 8th cranial nerve.
  • Hearing is impaired

Causes:
- infection- Rubella, influenza, herpes
- Head trauma
- Ototoxic drugs
- Loud noises
- Age related
- Congenital

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5
Q

What’s vertigo?

A
  • The sensation of whirling and loss of balance especially from looking down at great height.
  • Duration and frequency is important to know
  • Is it associated with fullness- think minnieres disease
  • Was there a recent neurological event?
  • Headaches?
  • Head injury
  • Red flag with vertigo is when pt has drowsiness, LOC, inability to stand or walk, new onset of headache, hearing loss.
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6
Q

What’s nystagmus?

A
  • A condition where the eyes move rapidly and uncontrollably.
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7
Q

Physical examination of the ear:

A

INSPECTION:
- Pinna
- Skin around the ear, the size, shape, position, any scars, any hearing aids.
PALPATION:
- Gently pull on the pinna and push the tragus
- palpate over mastoid bone for pain and swelling

  • Perform hearing tests & otoscopy
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8
Q

What is a tuning fork?

A
  • An acoustic resonator that vibrates at a set frequency after being struck on the heel of the hand.
  • It assesses vibratory sensation and hearing- air conduction & bone conduction.
  • 512 hz
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9
Q

What are 3 ways to test hearing?

A
  1. Whispered voice test- whisper a number close to pts ear and again slightly away.
  2. Webers test- Bang tuning fork then place against pts forehead and ask if they can hear it in both ears.
    * This detects unilateral conductive hearing loss/middle ear hearing loss and unilateral sensorineural hearing loss/ inner ear hearing loss.
  3. Rinne’s test: Differentiates sound transmitted through air conduction from those transmitted through bone conduction. Air conduction is better than bone conduction so in a normal ear, the tuning fork is louder in the front of the ear.
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10
Q

Otoscopy

A
  • Inspect the ear for signs of swelling, infection, wax & foreign body.
  • The tympanic membrane should be pearly white and translucent.
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11
Q

Auricular haematoma

A
  • Collection of blood underneath the perichondrium of the ear.
  • Occurs often due to a sporting incident.
  • Referral to minor injuries unit as they require drainage in 7-10 days.
  • There’s a tender fluctuating mass
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12
Q

Mastoiditis

A
  • Infection & inflammation of the mastoid air cells.
  • Behind the ear
  • May cause bone necrosis
  • Pus formation
    Common s&s:
  • Redness, tenderness and pain behind the ear, swelling, discharge behind ear, pyrexia, headache, hearing loss on the affected side.
  • Treatment: antibiotics, may require surgery to drain the ear and remove part of the mastoid bone.
  • Complications: Meningitis, facial paralysis, abscess formation.
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13
Q

Cerumen

A
  • External auditory canal
  • Related to pts attempt to remove ear wax with a cotton bud or finger
  • Conductive hearing loss as an impact on the ear wax can lead to a reduction in the sound travelling to the external ear canal.
  • Treatment is wax softener
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14
Q

Otitis external

A
  • Inflammation of the pinna and external auditory canal
  • Caused by swimming & infections or hypersensitivity to shampoos
  • S&S: Pain, itching & discharge
  • Treatment: if no pus in the early canal, it can be treated with ear drops, if there’s pus it needs to be swabbed, drained.
  • Complications: meningitis, Bell’s palsy
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15
Q

Tympanic membrane rupture:

A
  • Caused by trauma, blast injuries, blows to side of the head
  • Often self healing
  • Advice: avoid entry of water or foreign body.
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16
Q

What are anatomical differences of the ear in a child & adult?

A
  • In paeds, the eustachian tube is at a more of a horizontal angle, making them more susceptible to middle ear infections.
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17
Q

Otitis media

A
  • Inflammation of the middle ear associated with an effusion.
  • More common in kids
  • Caused by viruses or bacteria
    S&S: Pain, pyrexia, malaise, headache, n&v, tinnitus, reduction in hearing
  • Treatment: Antibiotics, Pain relief, antipyretics
  • If left untreated or if they experience it numerous times, it can cause literacy problems and educational development issues.
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18
Q

Labrynthitis

A
  • infection of the inner ear
  • May be secondary to a virus/illness
    S&S: dizziness, n&v, loss of hearing, vertigo, loss of balance, tinnitus
  • Treatment: Anti emetics (stemetil), ENT referral if symptoms not resolving within 4-6wks!
19
Q

Temporal bone fracture

A
  • Trauma can cause hearing loss
  • significant intercranial injury is likely with this
  • Battle sign, bloody discharge from ears, dizziness, altered eye movement, facial muscle paralysis
  • Treatment: initial treatment for head injury, managing s&s
20
Q

Acoustic neuroma

A
  • Slow growing tumour pressing on hearing & balance nerves.
  • Beingn
    S&S: Persistent headaches, blurred vision, ataxia, voice changes
21
Q

BELLS PALSY

A
  • Inability to raise eyebrows!
  • Drooping eyelid, inability to close eyes, inability to puff cheeks, asymmetrical smile, drooping corner of mouth
  • Acute unilateral facial nerve caused by swelling of the facial nerve
  • Often a sudden onset and will resolve after weeks/months
    S&S: Sharp pain in inner ear, impaired/altered sense of taste, sensitivity to loud noise, inability to close eye on affected side, dysphasia.
  • Managment: Referral, eye care, potentially steroids.
22
Q

Function of the nose

A
  • To warm , moisten and filter inhaled air
  • To detect olfactory stimuli CNI
23
Q

HX for nose complaints

A
  • SOCRATES
    Common nose pc: nasal obstruction- ask if bi/unilateral, nasal discharge- colour?, epistaxis (nosebleed)- trauma related?, sneezing- associated factor?. Disturbance of smell?, nasal & facial pain- any deformity?
  • PMHX, DHX, SHX, FHX
24
Q

Physical examination of the nose

A

Inspection:
- Any deviation of septum?, look externally, periorbital swelling/bruising?, any nasal swelling?

PALPATION:
- Feel nasal bones facial swelling, block each nostril

25
Q

Fractures nose

A
  • Need early ENT referral
  • Complications: Septal haematoma- can become an abscess and spread to sinuses & the brain.
26
Q

Foreign body nose

A
  • Common in paeds
  • Can be resolved with the mothers kiss- instruct pts mother to cover unaffected nose and blow into their mouth and the object should come out!
27
Q

Epistaxis

A
  • Nose bleed
  • Is it unilateral or bilateral?
  • Are they on anticoagulants?
  • Hypertensive pts are likely to get it!
  • What caused it- is it trauma related?
  • What have they done since, any blood clots?
  • Put pressure on the tip of their nose and squeeze, get them to lean forward as they do this
28
Q

Sinsitis

A
  • Often get infected after UPRTI
  • Inflammation of the lining of the sinuses often after a common cold.
  • Mainly viral in origin
  • Bacterial in less than 10%
    RED FLAGS:
  • High fever, double/ loss of vision, neck stiffness, confusion/drowsiness, swelling/puffiness around one or both eyes- orbital cellulitis
  • THINK SEPSIS
29
Q

Mouth

A
  • oropharyx contains the tonsils
  • The role of the tonsils is to participate in the fight against inhaled or ingested foreign substances.
30
Q

HX of mouth issues

A
  • SOCRATES
  • Ask if they have got a sore throat/mouth
  • Any stridor?
  • What does their voice sound like- any changes?
  • Are they able to eat as normal?
  • Any enlarged lymph nodes?
31
Q

Physical examination of the mouth

A

Inspection:
- Look at the face first, any drooling, obvious discomfort?
- Are the lips dry?
- Inspect the mouth
- Can they swallow?
- Any dryness
- Ask pt to say aaaa, assessing CNXII

PALPATION: Lymph nodes

32
Q

Red flags for foreign body

A
  • Any compromise to the airway
  • Stridor, drooling, change of voice
  • Signs of oesophageal perforation- chest pain, features of sepsis or surgical emphysema
  • HX of button battery ingestion
33
Q

Glandular fever (MONO)

A
  • Infectious disease caused by Epistein virus
  • AKA as the kissing disease as the virus is spread through saliva and commonly affects young adults.
  • Symptoms typically appear 4-8wks after being infected
    -S&S: sore throat, enlarged lymph nodes, fever, tiredness, swollen tonsils, headache, muscle aches
    *COMPLICATIONS: Anemia, heart problems, meningitis, encephalitis, ruptured spleen- avoid contact sport from 3 months
34
Q

Pharyngitis:

A
  • Inflammation of the mucous membranes of the oropharynx
  • Acute onset of sore throat, no cough, nasal congestion or discharge
  • Consider group A streptococcus pharyngitis
  • Usually self limiting, resolves in 2-12 weeks.
35
Q

Strep A

A
  • Can be carried in the throat & skin.
  • Most serious infection linked to GAS
  • Treated with antibiotics if +ve
36
Q

Rheumatic fever

A
  • Step A left untreated can result in rheumatic fever
  • Rare complication, not contagious
  • Occurs 1-5weeks after infection
  • S&S: Malaise (generally unwell), rash, pyrexia, skin lesions, prolonged PR interval in ECG
  • Jane’s criteria can diagnose rheumatic fever.
37
Q

Tonsilitis

A
  • More common in children
  • Viral infections more common
  • S&S: sore throat, dysphagia, earache, temperature
  • severe tonsillitis need admittance
38
Q

Quinsy

A
  • May folllow recent sore throat
  • Colection of pus that develops between tonsillar capsule and superior constrictor muscle
  • Drooling, foul smelling breath, dehydrated, severe sore throat, pyrexia, trismus, uvula deviation
  • Red flag- severe sore throat, aphasia of rapid onset due to impeding airway disaster
  • require admittance to recieve antibiotics
39
Q

Post tonsillectomy bleed

A
  • Risk of bleed, occurs in 2-5%
  • usually self limiting but may need surgery to resolve heamorrhage
  • paeds can compensate well, so be cautious
  • consider airway management
  • get them to spit the blood out, fluid &TXA
40
Q

Epiglottits

A
  • Inflammation of the epiglottis
  • S&S: High resp rate, DIB, inspiratory stridor, inability to swallow secretions, sore throat, pyrexia
    *RED FLAG: severe sore throat with aphagia, severe dysphagia, hoarse or no voice
41
Q

Ludwigs angina

A
  • Life threatening cellulitis of soft tissue involving the floor of the mouth and neck
  • Often caused by tounge piercings or dental infection
  • As the condition progresses so does airway compromise
  • RED FLAG- hot potato voice, restricted tounge mobility, fever, mouth opening restriction, swallowing difficulty.
42
Q

Angioedema

A
  1. IGE
  2. Bradykinin angioedema

Hereditary angioedema- very rare. Low level of C1 inhibitor or it doesn’t function.
- Bradykinin is a peptide that promotes inflammation.
* Pts who do not have C1 inhibitor, when they have a stressor, bradykinin is produced and the inflammatory process is disregulated leading to angioedema.
- Angioedema is seen in the face and throat, they present as though the are having an allergic reaction.
* Adrenaline does not really do much, do not respond to antihistamines or steroids.
* TXA works

43
Q

Carotid blowout

A
  • Rupture of the caraotid artery
  • Rare
  • Causes: radiotherapy, pts who have sustained trauma, direct trauma invasion
  • Occurs when a damaged arterial wall cannot sustain its integrity against the pts blood pressure.

PMMH (12 decks)

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