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Finals (HV) > ENT > Flashcards

ENT Flashcards

1
Q

What is an acoustic neuroma?

A

Benign tumours arising from the Schwann cells which form the myelin sheath surrounding the vestibulocochlear nerve (CN8)

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2
Q

Where is the most common site for acoustic neuromas?

A

Cerebellopontine angle

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3
Q

What condition is bilateral acoustic neuromas associated with?

A

Neurofibramatosis 2

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4
Q

List the triad of sx present with an acoustic neuroma?

A

Progressive unilateral HL
Unilateral tinnitus
Vertigo
+
Absent corneal reflex (CN5)
Facial palsy (CN7)

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5
Q

What is the GS Ix for acoustic neuromas?

A

MRI of cerebellopontine angle

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6
Q

What is the mx for acoustic neuromas?

A

Most cases are managed conservatively with observation/interval MRI monitoring (due to slow growth)

Surgical excision

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7
Q

What is acute mastoiditis?

A

A complication of acute otitis media in which there is an extension of infection into the mastoid air cells of temporal bone

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8
Q

What bare the sx and sign of acute mastoiditis?

A

Sx:
*Ear pain
*Otorrhoea
*Worsening HL

Signs:
Postauricular erythema-tenderness to palpation, boggy/fluctuant
Pinna can be displaced forwards and downwards
Systemic upset
Otoscopy- erythematous, bulging tympanic membrane

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9
Q

What is the mx of acute mastoiditis?

A

Emergency admission
IV ABX

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10
Q

What is the imaging of choice for acute mastoiditis?

A

CT head

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11
Q

List the complications of acute mastoiditis?

A

Facial nerve palsy
HL
Meningitis

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12
Q

What type of sensitivity reaction is allergic rhinitis?

A

IgE mediated thus Type 1 hypersensitivity reaction

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13
Q

List the sx of allergic rhinitis?

A

Nasal pruritus
sneezing
Rhinorrhoea
Nasal congestion
Eye redness
Eye puffiness
Watery eye discharge

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14
Q

What is the mx of allergic rhinitis?

A

Avoiding triggers
Nasal irrigation with saline
Intra-nasal or oral anti-histamines
Regular intranasal steroids if initial measures are ineffective
Oral steroids for severe cases affecting quality of life

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15
Q

What is Bell’s palsy?

A

An acute, unilateral lower motor neurone facial nerve palsy resulting in facial weakness/paralysis.

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16
Q

What is the role of the facial nerve?

A

Motor-
innervate the muscles of facial expression
Innervates Stapedius muscle

Sensory-
Taste sensation to anterior 2/3 of tongue
Some sensory input from external ear

Parasympathetic-
Tear, saliva, mucous gland secretions

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17
Q

List the features of bells’s palsy?

A
  • lower motor neuron facial nerve palsy → forehead affected
  • Post auricular pain
  • Altered taste
  • Dry eyes
  • Hyperacusis
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18
Q

What is the 1st line mx for bell’s palsy?

A

Prednisolone 50-60mg OD for 10 days
Eye care

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19
Q

When should a referral to ENT be made in regard to bell’s palsy?

A

Paralysis still ongoing/not improved after 3 weeks

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20
Q

What is Ramsay Hunt syndrome?

A

caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

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21
Q

List the sx of Ramsay Hunt Syndrome?

A

Facial droop- acute LMN CN7 palsy
Ear pain
Painful, erythematous vesicular rash- within ear canal and mucus membrane of oropharynx
SNHL
Tinnitus
vertigo

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22
Q

What is the mx of Ramsay bunt syndrome?

A

Antivirals (aciclovir, valaciclovir, famciclovir) AND steroids (prednisolone 60 mg OD 5/7)

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23
Q

What is BPPV?

A

condition characterised by sudden, episodic attacks of vertigo induced by changes in head position

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24
Q

What is the pathophysiology behind BPPV?

A

Movement of debris/crystals within the semicircular canals of the inner ear.

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25
Q

List the sx of BPPV?

A

Vertigo is triggered by head movements/changes in position - classically when the person rolls over in bed or bends over.
Episodes of vertigo are usually short, lasting < 1-2 minutes
Hearing and tinnitus are NOT features of BPPV

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26
Q

What is the Ix of choice to diagnose Bell’s palsy?

A

Dix-Hallpike manoeuvre

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27
Q

What is the mx for BPPV?

A

Epley manoeuvre

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28
Q

Accumulated cerumen in ear canal can cause what type of HL?

A

Conductive HL

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29
Q

What is a cholesteatoma?

A

An abnormal collection of keratinocytes, and squamous epithelium in the middle ear

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30
Q

List the sx of a cholesteatoma?

A

Recurrent foul-smelling, purulent discharge (which doesn’t respond to treatment with ABx)
Hearing loss
Tinnitus
Dizziness, loss of balance if left untreated

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31
Q

What will be seen on otoscope in a pt with cholesteatoma?

A

Discharge within canal, crust in upper TM, perforation.

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32
Q

What is the mx of cholesteatoma?

A

Refer all cases of suspected cholesteatoma to ENT - require CT imaging and audiology assessment
Management - surgical removal

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32
Q

List the clincial features of Chondrodermatitis Nodularis Helicis?

A

Painful, firm nodule on the helix (in men) or antihelix (in women), often measuring 4–6 mm.
lesion is typically painful, aggravated by pressure
oval-shaped with a central crust and surrounding erythema.

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33
Q

What is Chondrodermatitis Nodularis Helicis (CNH)?

A

common inflammatory condition affecting the cartilage and skin of the helix or antihelix of the ear, sometimes referred to as Winkler’s disease.

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34
Q

What is the pathophysiology behind Chondrodermatitis Nodularis Helicis (CNH)?

A

Chronic pressure - e.g. sleeping on one side, trauma, underlying connective tissue disease.
Poor blood supply to the thin cartilage of the ear leads to ischaemia, inflammation, and eventual nodule formation.

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35
Q

What are the common causes of epiglotitis?

A

HiB
Most commonly streptococcus (S. Pneumonia or pyogenes)

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35
Q

List the sx of epiglotitis?

A

rapid onset
high temperature, generally unwell
stridor
drooling of saliva
‘tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position

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35
Q

What is the mx of CNH?

A

Cx- Relieve pressure

Rx- Topical potemt steroids, Intralesional steroid injections, Topical nitroglycerin

Sx- excision, curettage

36
Q

What sign is seen on CXR in acute epiglottitis?

A

a lateral view in acute epiglottis will show swelling of the epiglottis - the ‘thumb sign

37
Q

What is the mx of epiglotitis?

A

medical emergency

Do not examine or upset the child without senior support
Securing the airway, possibly through endotracheal intubation, as a first priority
Culturing and examination of the throat once the airway is secure
Administration of IV antibiotics, typically cefuroxime

38
Q

Where does the majority of epistaxis originate from?

A

90% of cases of epistaxis originate from the Kiesselbach plexus within Little’s area on the anterior nasal septum.

39
Q

Which artery does posterior nose bleeds form?

A

Branches of the sphenopalatine artery.

40
Q

List 5 causes of epsitaxis?

A

Nose picking/Nose blowing
Trauma to the nose
Insertion of foreign bodies
Bleeding disorders
Juvenile angiofibroma
Cocaine use
Wagners granulamatosis

41
Q

What is the mx of epistaxis?

A

Admit if profuse/posterior bleed/hemodynamically unstable etc.

First aid measures
-If ongoing bleeding after 10 minutes, options include:
– Nasal cautery with silver nitrate stick to bleeding point for 5-10 seconds
– Nasal packing with nasal tampons (merocel), inflatable packs (rapid-rhino), ribbon gauze (only in secondary care)

If ongoing bleeding/unstable, secondary care measures may include:
-Electrocautery
-Formal packing
-Arterial embolization

42
Q

What is the causes of Infectious mononucleosis?

A

Ebstein-Barr virus (EBV) 90% CMV/HIV/toxoplasmosis)

43
Q

What is the triad of infectious mononucleosis?

A

Sore throat
Lymphadenopathy
Pyrexia

other sx:
Malasise, Headache, Splenomegaly,

*a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

44
Q

What is the Ix of choice to diagnose infectious mono?

A

heterophil antibody test (Monospot test)

NICE guidelines suggest FBC and Monospot in the 2nd week of the illness to confirm a diagnosis of glandular fever.

45
Q

What is the mx of supportive and includes?

A

Rest during the early stages, drink plenty of fluid, avoid alcohol
simple analgesia for any aches or pains
consensus guidance in the UK is to avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

46
Q

What is meniere’s disease?

A

Meniere’s disease is an inner ear disorder of uncertain aetiology. t is characterised by excessive pressure and progressive dilation of the endolymphatic system.

47
Q

List the sx of menieres?

A

Episodic vertigo
-Spontaneous +/- N&V
-Episodes last at least 20 minutes (and no longer than 24hs)
Fluctuating sensorineural hearing loss
Roaring tinnitus
A sensation of aural fullness - the feeling of ‘pressure’ within the affected ear - often precedes a vertigo attack
Symptoms are most commonly unilateral

48
Q

What is the mx of menieres?

A

ENT assessment is required to confirm the diagnosis
patients should inform the DVLA

acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required

prevention: betahistine and vestibular rehabilitation exercises may be of benefit

49
Q

What is presbycusis, and list its fetures?

A

Age-related hearing loss which results from the degeneration of the cochlea and associated inner ear structures.

CF:
A progressive, irreversible, bilateral SNHL
HL is most marked with high frequency sounds

50
Q

What is otosclerosis?

A

Abnormal bone remodelling within the middle ear, which results in the resorption and subsequent sclerosis of the stapes bone.

51
Q

List the most common bacterial causes of acute otitis externa?

A

Pseudomonas aerginos or Staph aureus

52
Q

List the fetures of otitis externa?

A

Acute onset of ear pain and pruritus
Ear discharge
Pain on palpating tragus/Tragal tug
Erythema of the external auditory canal +/- oedema, discharge or debris

53
Q

What is the 1st line mx of otitis externa?

A

Topical antibiotics +/- topical corticosteroid for 1-2 weeks

54
Q

What is chronic otitis externa?

A

suggested by persistent pruritus of the ear canal for > 3 months

55
Q

What is malignant otitis externa and list the RFs?

A

A severe complication of OE, where infection spreads into the temporal bone causing acute osteomyelitis.

Rfs- Immunocompromised, poorly controlled diabetes

56
Q

What is the mx of malignant otitis externa?

A

Arrange emergency hospital admission, usually IV antibiotics (ciprofloxacin), for 6 weeks.

57
Q

What is acute otitis media?

A

Inflammation/infection of middle ear

58
Q

List the common bacterial and viral causes of otitis media?

A

Bacterial - haemophilus, strep. pneumoniae, moraxella
Viral - RSV, adenovirus

59
Q

What is the mx of otitis media?

A

Acute otitis media is generally a self-limiting condition that does not require an antibiotic prescription however there are some exceptions

60
Q

In which scenarios should abx be prescribed in acute otitis media?

A

*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
*Younger than 2 years with bilateral otitis media
*Otitis media with perforation and/or discharge in the canal

61
Q

What is the 1st line choice of Abx in acute otitis media if required?

A

5-7 day course of amoxicillin is first-line.

Penicillin allergy, erythromycin or clarithromycin

62
Q

List 3 complications of AOM?

A

mastoiditis
meningitis
brain abscess
facial nerve paralysis

63
Q

What are the RF associated with OME?q

A

Association with cleft palate, Down’s syndrome, allergic rhinitis

64
Q

What would be seen on otoscopy in OME?

A

Tympanic membrane discolouration - e.g. yellowing
Air/fluid level, or bubbles behind the TM
Retracted TM (indrawn due to pressure)
Blunting of light reflex

65
Q

What is the mx of OME?

A

1st Line: Watchful waiting for 3 months
- Monitoring involves 2 x hearing tests (audiometry), 3 months apart

Exceptions: Patients with Down’s syndrome or cleft palate should be referred to ENT

66
Q

What is the mx of viral rhinosinusitis?

A

Symptoms < 10 days-Conservative Mx for most patients

Symptoms > 10 days without improvement
Consider a high-dose nasal corticosteroid (mometasone)

67
Q

List the sx of rhinosinusitis?

A

History of viral/coryzal illness
Nasal congestion or nasal drip, speech may sound nasal
Frontal headache/facial pain, worse on leaning forward
Anosmia
Bacterial sinusitis is suggested by purulent nasal discharge, fever, elevated CRP

68
Q

What is the assessment criteria of tonsillitis?

A

The FeverPAIN or Centor criteria

Fever
P - Purulence (exudate on tonsils/pharynx)
A - Attend within 3/7 of symptom onset
I - Inflamed tonsils
N - No cough/coryzal symptoms

C - cervical LN
E - exudate on tonsils
N - no cough
T - temperature >38

69
Q

What is the mx of

A

Antibiotics:
FeverPAIN score of 4+ or Centor score of 3+ antibiotics
1st line: Phenoxymethylpenicillin
Penicillin allergic: Clarithromycin (erythromycin if pregnant)

70
Q

What is quinsy?

A

Peritonsilar abscess- complication of streptococcal tonsillitis-

71
Q

What are the features of quinsy?

A

Systemic upset - fever, SIRS
Sore throat, neck pain
Trismus, muffed ‘hot potato voice’
Uvular deviation away from the quinsy
Hallitosis

72
Q

What is the mx of quinsy?

A

Admit - IV antibiotics
Needle aspiration/incision & drainage

73
Q

What is the mx of OME in an adult?

A

UL glue ear- 2WW referral to ENT for evaluation of posterior nasal space tumour

74
Q

What is Samats triad?

A

Asthma
Nasal polyposis
Aspirin sensitivity

75
Q

What is the mx of nasal polyps?

A

Refer to ENT
Topical corticosteroids

76
Q

List the associated conditions of SHL?

A

Prebycusis
Acoustic neuroma
Ototoxic drugs
Infection
Autoimmune

77
Q

List the associated conditions of CHL?

A

Otitis externa
Otitis media
Wax
Foreign body
Cholestoma
Tympanic membrane perforation

78
Q

What would the results be on webers and rinnes in CHL?

A

Rinnes -ve (Bone > Air)
Webers localised to affected ear

79
Q

What would the results be on webers and rinnes in SHL?

A

Rinnes +ve (Air > Bone)
Webers lateralises to unaffected ear

80
Q

List the drugs which are responsible for gingival hyperplasia?

A

Phenytoin
CCBs (esp. nifedipine)
Ciclosporin

81
Q

What are the common complications for thyroid surgery?

A

Anatomical- recurrent laryngeal nerve damage
Bleeding- Confined haematoma- can cause resp distress
Damage to parathyroid gland- Hypocalcaemia

82
Q

What is vestibular neuronitis?

A

Inflammation of the vestibular nerve, most commonly occurs following a viral infection.

83
Q

List the sx of vestibular neuronitis?

A

Vertigo is often severe and constant, and begins suddenly
Imbalance, falls
Does NOT feature hearing loss ( labyrinthitis does - this is a key differentiating factor)
Does NOT cause tinnitus ( Meniere’s disease does)
There is often a history of a recent viral illness,

84
Q

What is the mx of vestibular neuronitis?

A

For rapid relief of severe vertigo/N&V - buccal/IM prochlorperazine (or cyclizine)
If symptoms less severe - short course (up to 3/7) of PO prochlorperazine/AH (cyclizine)

85
Q

What are the sx of labyrinthitis?

A

Vertigo
Hearing loss
Tinnitus
But NOT aural fullness (suggests Meniere’s)

86
Q

What are the differentials for congenital for neck lumps in children?

A

branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation

87
Q

What is a branchial cyst?

A

A benign, developmental defect of the branchial arches. The cyst is filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium.

88
Q

Where are branchial cysts typically located

A

Located anterior to the sternocleidomastoid muscle

89
Q

Where are cystic hygromas typically located?

A

Posterior triangle of the neck

90
Q
A

Finals (HV) (19 decks)

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