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)
2
Q
Where is the most common site for acoustic neuromas?
A
Cerebellopontine angle
3
Q
What condition is bilateral acoustic neuromas associated with?
A
Neurofibramatosis 2
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)
5
Q
What is the GS Ix for acoustic neuromas?
A
MRI of cerebellopontine angle
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
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
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
9
Q
What is the mx of acute mastoiditis?
A
Emergency admission
IV ABX
10
Q
What is the imaging of choice for acute mastoiditis?
A
CT head
11
Q
List the complications of acute mastoiditis?
A
Facial nerve palsy
HL
Meningitis
12
Q
What type of sensitivity reaction is allergic rhinitis?
A
IgE mediated thus Type 1 hypersensitivity reaction
13
Q
List the sx of allergic rhinitis?
A
Nasal pruritus
sneezing
Rhinorrhoea
Nasal congestion
Eye redness
Eye puffiness
Watery eye discharge
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
15
Q
What is Bell’s palsy?
A
An acute, unilateral lower motor neurone facial nerve palsy resulting in facial weakness/paralysis.
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
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
18
Q
What is the 1st line mx for bell’s palsy?
A
Prednisolone 50-60mg OD for 10 days
Eye care
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
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.
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
22
Q
What is the mx of Ramsay bunt syndrome?
A
Antivirals (aciclovir, valaciclovir, famciclovir) AND steroids (prednisolone 60 mg OD 5/7)
23
Q
What is BPPV?
A
condition characterised by sudden, episodic attacks of vertigo induced by changes in head position
24
Q
What is the pathophysiology behind BPPV?
A
Movement of debris/crystals within the semicircular canals of the inner ear.
25
List the sx of BPPV?
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
26
What is the Ix of choice to diagnose BPPV?
Dix-Hallpike manoeuvre
27
What is the mx for BPPV?
Epley manoeuvre
28
Accumulated cerumen in ear canal can cause what type of HL?
Conductive HL
29
What is a cholesteatoma?
An abnormal collection of keratinocytes, and squamous epithelium in the middle ear
30
List the sx of a cholesteatoma?
Recurrent foul-smelling, purulent discharge (which doesn’t respond to treatment with ABx)
Hearing loss
Tinnitus
Dizziness, loss of balance if left untreated
31
What will be seen on otoscope in a pt with cholesteatoma?
Discharge within canal, crust in upper TM, perforation.
32
What is the mx of cholesteatoma?
Refer all cases of suspected cholesteatoma to ENT - require CT imaging and audiology assessment
Management - surgical removal
32
List the clincial features of Chondrodermatitis Nodularis Helicis?
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.
33
What is Chondrodermatitis Nodularis Helicis (CNH)?
common inflammatory condition affecting the cartilage and skin of the helix or antihelix of the ear, sometimes referred to as Winkler's disease.
34
What is the pathophysiology behind Chondrodermatitis Nodularis Helicis (CNH)?
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.
35
What are the common causes of epiglotitis?
HiB
Most commonly streptococcus (S. Pneumonia or pyogenes)
35
List the sx of epiglotitis?
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
35
What is the mx of CNH?
Cx- Relieve pressure
Rx- Topical potemt steroids, Intralesional steroid injections, Topical nitroglycerin
Sx- excision, curettage
36
What sign is seen on CXR in acute epiglottitis?
a lateral view in acute epiglottis will show swelling of the epiglottis - the 'thumb sign
37
What is the mx of epiglotitis?
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
Where does the majority of epistaxis originate from?
90% of cases of epistaxis originate from the Kiesselbach plexus within Little’s area on the anterior nasal septum.
39
Which artery does posterior nose bleeds form?
Branches of the sphenopalatine artery.
40
List 5 causes of epsitaxis?
Nose picking/Nose blowing
Trauma to the nose
Insertion of foreign bodies
Bleeding disorders
Juvenile angiofibroma
Cocaine use
Wagners granulamatosis
41
What is the mx of epistaxis?
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
What is the causes of Infectious mononucleosis?
Ebstein-Barr virus (EBV) 90% CMV/HIV/toxoplasmosis)
43
What is the triad of infectious mononucleosis?
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
What is the Ix of choice to diagnose infectious mono?
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
What is the mx of supportive and includes?
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
What is meniere's disease?
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
List the sx of menieres?
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
What is the mx of menieres?
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
What is presbycusis, and list its fetures?
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
What is otosclerosis?
Abnormal bone remodelling within the middle ear, which results in the resorption and subsequent sclerosis of the stapes bone.
51
List the most common bacterial causes of acute otitis externa?
Pseudomonas aerginos or Staph aureus
52
List the fetures of otitis externa?
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
What is the 1st line mx of otitis externa?
Topical antibiotics +/- topical corticosteroid for 1-2 weeks
54
What is chronic otitis externa?
suggested by persistent pruritus of the ear canal for > 3 months
55
What is malignant otitis externa and list the RFs?
A severe complication of OE, where infection spreads into the temporal bone causing acute osteomyelitis.
Rfs- Immunocompromised, poorly controlled diabetes
56
What is the mx of malignant otitis externa?
Arrange emergency hospital admission, usually IV antibiotics (ciprofloxacin), for 6 weeks.
57
What is acute otitis media?
Inflammation/infection of middle ear
58
List the common bacterial and viral causes of otitis media?
Bacterial - haemophilus, strep. pneumoniae, moraxella
Viral - RSV, adenovirus
59
What is the mx of otitis media?
Acute otitis media is generally a self-limiting condition that does not require an antibiotic prescription however there are some exceptions
60
In which scenarios should abx be prescribed in acute otitis media?
*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
What is the 1st line choice of Abx in acute otitis media if required?
5-7 day course of amoxicillin is first-line.
Penicillin allergy, erythromycin or clarithromycin
62
List 3 complications of AOM?
mastoiditis
meningitis
brain abscess
facial nerve paralysis
63
What are the RF associated with OME?q
Association with cleft palate, Down's syndrome, allergic rhinitis
64
What would be seen on otoscopy in OME?
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
What is the mx of OME?
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
What is the mx of viral rhinosinusitis?
Symptoms < 10 days-Conservative Mx for most patients
Symptoms > 10 days without improvement
Consider a high-dose nasal corticosteroid (mometasone)
67
List the sx of rhinosinusitis?
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
What is the assessment criteria of tonsillitis?
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
What is the mx of acute tonsillitis
Antibiotics:
FeverPAIN score of 4+ or Centor score of 3+ antibiotics
1st line: Phenoxymethylpenicillin
Penicillin allergic: Clarithromycin (erythromycin if pregnant)
70
What is quinsy?
Peritonsilar abscess- complication of streptococcal tonsillitis-
71
What are the features of quinsy?
Systemic upset - fever, SIRS
Sore throat, neck pain
Trismus, muffed ‘hot potato voice’
Uvular deviation away from the quinsy
Hallitosis
72
What is the mx of quinsy?
Admit - IV antibiotics
Needle aspiration/incision & drainage
73
What is the mx of OME in an adult?
UL glue ear- 2WW referral to ENT for evaluation of posterior nasal space tumour
74
What is Samats triad?
Asthma
Nasal polyposis
Aspirin sensitivity
75
What is the mx of nasal polyps?
Refer to ENT
Topical corticosteroids
76
List the associated conditions of SHL?
Prebycusis
Acoustic neuroma
Ototoxic drugs
Infection
Autoimmune
77
List the associated conditions of CHL?
Otitis externa
Otitis media
Wax
Foreign body
Cholestoma
Tympanic membrane perforation
78
What would the results be on webers and rinnes in CHL?
Rinnes -ve (Bone > Air)
Webers localised to affected ear
79
What would the results be on webers and rinnes in SHL?
Rinnes +ve (Air > Bone)
Webers lateralises to unaffected ear
80
List the drugs which are responsible for gingival hyperplasia?
Phenytoin
CCBs (esp. nifedipine)
Ciclosporin
81
What are the common complications for thyroid surgery?
Anatomical- recurrent laryngeal nerve damage
Bleeding- Confined haematoma- can cause resp distress
Damage to parathyroid gland- Hypocalcaemia
82
What is vestibular neuronitis?
Inflammation of the vestibular nerve, most commonly occurs following a viral infection.
83
List the sx of vestibular neuronitis?
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
What is the mx of vestibular neuronitis?
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
What are the sx of labyrinthitis?
Vertigo
Hearing loss
Tinnitus
But NOT aural fullness (suggests Meniere’s)
86
What are the differentials for congenital for neck lumps in children?
branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation
87
What is a branchial cyst?
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
Where are branchial cysts typically located
Located anterior to the sternocleidomastoid muscle
89
Where are cystic hygromas typically located?
Posterior triangle of the neck
90
