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ENT Flashcards

1
Q

What type of hearing loss is seen in Meniere’s disease?

A

sensorineural, more pronounced at lower frequencies

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2
Q

What examination sign accompanies tinnitus in Meniere’s disease?

A

nystagmus away from affected ear

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3
Q

What are 4 types of investigations that may be used in Meniere’s disease?

A
  1. Routine bloods, consider syphilis testing
  2. MRI to rule out mass lesion
  3. Audiometry
  4. Transtympanic electrocochleography (ECOG) and electronystagmography (ENG) - may be helpful
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4
Q

What advice should be given for an acute attack in Meniere’s disease?

A

lie down on a flat surface and keep still as possible

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5
Q

What medications may be useful in an acute attack of Meniere’s disease?

A

cinnarizine or prochlorperazine (buccal or IM)

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6
Q

What 2 things are used as prophylaxis in Meniere’s disease?

A
  1. betahistine hydrochloride
  2. vestibular rehabilitation exercises
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7
Q

What is an option for Meniere’s disease refractive to medical management?

A

surgery - reserved for this group

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8
Q

What is the difference between conductive vs sensorineural hearing loss on PTA?

A

Air-bone gap in conductive - bone conduction preserved, air reduced. Both reduced in proportion in SN

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9
Q

What is the range for normal hearing on PTA?

A

> 20 dB

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10
Q

What distinguishes vestibular neuronitis from labyrinthitis?

A

No hearing loss in vestibular neuronitis. You get hearing loss in labyrinthitis

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11
Q

How can vestibular neuronitis be distinguished from posterior circulation stroke?

A

HiNTS examination test (head impulse, nystagmus, test of skew) - if negative stroke very unlikely
- Head impulse - positive in peripheral causes of vertigo, negative in stroke
- Nystagmus - peripheral = unilateral horizontal. Central = vertical or rotational, or direction changing horizontal
- Test of skew - patient stands in front of examiner, fixates on nose and eyes alternately covered. In central - may have vertical misalignment of eyes and corrective movement on covering

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12
Q

What is the consensus on management of Bell’s palsy?

A

commence steroids within 72h of symptom onset - if no improvement in paralysis after 3w, refer urgently to ENT

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13
Q

What is the prognosis for Bells palsy?

A

most people make full recovery in 3-4 months, if untreated 15% have moderate to severe weakness

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14
Q

What virus is associated with nasopharyngeal carcinoma?

A

EBV

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15
Q

What is the presentation of Ramsay-Hunt syndrome?

A

auricular pain, facial nerve palsy, vesicular rash around ear; vertigo + tinnitus

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16
Q

What is the management of Ramsay-Hunt syndrome?

A

high dose oral aciclovir, high dose oral corticosteroids, eye protection

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17
Q

What organism may be the cause of recurrent otitis externa despite multiple courses of abx, with white curd-like discharge in the EAC?

A

candida albicans

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18
Q

What is otosclerosis?

A

progressive conductive hearing loss due to fixation of stapes at oval window due to laying down of vascular spongy bone across joint between margin of stapes footplate and oval window (creates ankylosis)

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19
Q

What is the classic patient who presents with otosclerosis?

A

female, third decade of life (40s), positive family history - slowly progressive hearing loss, +-tinnitus

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20
Q

What can accelerate the progression of otosclerosis?

A

pregnancy + oestrogen therapy

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21
Q

In what proportion of patients with otosclerosis is hearing loss bilateral?

A

70%

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22
Q

What may be found in otoscopy in otosclerosis?

A

flamingo-pink tinge ‘Schwartze sign’ (but often normal)

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23
Q

What are 2 treatment options for otosclerosis?

A
  1. hearing aids (usually effective early on)
  2. stapedectomy (definitive tx)
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24
Q

What are the indications for hospital admission in acute otitis media?

A
  1. evidence of severe complication: meningitis, mastoiditis, intracranial abscess, sinus thrombosis, CNVII paralysis
  2. <3 months with T ≥38°C
  3. <6 months with T ≥ 39°C
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25
Q

What are 5 indications for antibiotic treatment in acute otitis media?

A
  1. systemically very unwell
  2. symptoms lasting >4 days or not improving
  3. high risk of serious complications because of pre-existing comorbidity
  4. children < 2y with bilateral AOM
  5. children of any age with perforation and / or otorrhoea
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26
Q

What are the 3 most common bacteria causing AOM?

A
  1. Haemophilus influenzae
  2. Streptococcus pneumoniae
  3. Moraxella catarrhalis
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27
Q

What are 2 most common viruses that cause AOM?

A
  1. RSV
  2. rhinovirus
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28
Q

Is dummy use a risk factor or protective factor or AOM?

A

risk factor

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29
Q

What is bullous myringitis?

A

blisters on the tympanic membrane caused by mycoplasma pneumoniae

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30
Q

What is the first line antibiotic if indicated in AOM? And which for pen-allergy?

A
  • amoxicillin
  • clarithromycin
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31
Q

What pathology characterises Meniere’s disease?

A

excessive pressure and progressive dilatation of the endolymphatic system

32
Q

What is the prognosis for Meniere’s?

A

symptoms resolve in majority of patients after 5-10 years

33
Q

What type of referral should be made in Meniere’s disease?

A

routine ENT referral - ENT assessment required to confirm diagnosis

34
Q

What is the advice regarding driving in Meniere’s disease?

A

patients should inform DVLA; advised to cease driving until satisfactory control of symptoms is achieved

35
Q

What are the 5 components of the FeverPAIN score and what does the score correspond to?

A
  1. fever >38
  2. purulence on tonsils
  3. attend within <3 days
  4. severely inflamed tonsils
  5. no cough

0-1: discharge, safety net
2-3: delayed abx
4-5: immediate abx

36
Q

What are the 4 components of the Centor score for sore throat?

A
  1. No cough
  2. anterior cervical lymphadenopathy
  3. Tonsillar exudate
  4. Fever

3 or more present - antibiotics

37
Q

What are 5 indications for antibiotics in sore throat?

A
  1. features of marked systemic upset
  2. unilateral peritonsillitis
  3. h/o rheumatic fever
  4. increased risk from acute infection (child with diabetes / immunodeficiency)
  5. acute sore throat/pharyngitis/tonsillitis when 3 or more Centor criteria present
38
Q

What abx are indicated for sore throat if there is a pencillin allergy?

A

clarithromycin (phenoxymethylpenicillin if not allergic)

39
Q

What is the hearing test which is done as part of the newborn hearing screening programme?

A

otoacoustic emission test (computer generated click played throuh earpiece, presence of soft echo indicates healthy cochlea)

40
Q

What hearing test may be done if the otoacoustic emission test in a newborn is abnormal?

A

Auditory Brainstem Response test

41
Q

What isthe distraction test (for hearing)?

A

performed at 6-9 months old, by health visitor - requires 2 trained staff

42
Q

Which type of hearing test is performed in school children >3y at school entry in most areas of the UK?

A

pure tone audiometry

43
Q

How can hearing be tested in children >2.5y? 2 options

A
  1. Speech discrimination tests - uses similar sounding objects e.g. Kendall Toy test, McCormick Toy test
  2. performance testing
44
Q

How can recognition of familiar objects be used to test hearing in children 18 months - 2.5 y?

A

uses familiar objects e.g. teddy, cup. ask child simple questions e.g. where is the teddy?

45
Q

What is seen in a positive Dix-Hallpike manoeuvre?

A

recreates symptoms of BPPV, rotatory nystagmus seen

46
Q

What is the rate of recurrence of BPPV?

A

50% have recurrence of symptoms 3-5 years after their diagnosis

47
Q

What type of hearing loss in seen in presbycusis?

A

sensorineural - typically bilateral, high frequency hearing loss

48
Q

What causes presbycusis?

A

sensory hair cells and neurons in the cochlea atrophy over time

49
Q

Which gender is at higher risk of presbycusis?

A

males (M:F 55:45)

50
Q

What are 6 risk causes that are thought to contribute to presbycusis?

A
  1. Arteriosclerosis: diminished perfusion of cochlea, resulting in damage to inner ear structures
  2. Diabetes: Acceleration of arteriosclerosis
  3. Accumulated exposure to noise
  4. Drug exposure (Salicylates, chemotherapy agents etc.)
  5. Stress
  6. Genetic: certain individuals may be programmed for early ageing of the auditory system
51
Q

What is the definition of chronic rhinosinusitis?

A

inflammatory disorder of paranasal sinuses and nasal mucosa lasting 12 weeks or more

52
Q

What are 5 predisposing factors to chronic rhinosinusitis?

A
  1. atopy: hayfever, asthma
  2. nasal obstruction e.g. septal deviation, polyps
  3. recent local infection e.g. rhinitis or dental extraction
  4. swimming / diving
  5. smoking
53
Q

What is the management of chronic rhinosinusitis?

A

allergen avoidance, intranasal steroids, nasal irrigation with saline solution

54
Q

What are 3 red flags in chronic rhinosinusitis?

A
  1. unilateral symptoms
  2. epistaxis
  3. persistent symptoms despite 3 months of treatment
55
Q

How is the diagnosis of necrotising OE (malignant OE) made?

A

CT

56
Q

What is the management of necrotising otitis externa?

A
  • urgent ENT referral
  • IVAB that cover pseudomonas infections - ciprofloxacin
  • ear toilet
57
Q

What is the first line abx to treat sinusitis?

A

phenoxymethylpenicillin

58
Q

What is the first line abx to treat periapical or periodontal abscess?

A

amoxicillin

59
Q

What is first line abx to treat ginigivitis (acute necrotising ulcerative)?

A

metronidazole

60
Q

What is the commonest cause of a perforated tympanic membrane?

A

infection

61
Q

What is the management of a perforated tympanic membrane?

A
  • no treatment needed in most cases - most heal after 6-8 weeks, bring back to GP to review
  • avoid getting water in ear
  • often abx prescribed in infections that occur following episode of acute OM
  • myringoplasty if TM doesn’t heal
62
Q

What are 5 possible symptoms of Bells palsy?

A
  1. Lower motor neuron facial nerve palsy (forehead affected)
  2. post-auricular pain
  3. altered taste
  4. dry eyes
  5. hyperacusis (third)
63
Q

What is cholesteatoma?

A

non-cancerous growht of squamous epithelium trapped within skull base, causing local destruction

64
Q

What condition increases the risk of cholesteatoma 100x?

A

cleft palate at birth

65
Q

What are 4 signs of labyrinthitis?

A
  1. spontaneous unidirectional horizontal nystagmus
  2. sensorineural hearing loss
  3. abnormal head impulse test (impaired VOR)
  4. gait disturbance (fall to affected side)
66
Q

What are 6 indications for 2 week wait referral to oral surgery?

A
  1. Unexplained oral ulceration or mass persisting for greater than 3 weeks
  2. Unexplained red, or red and white patches that are painful, swollen or bleeding
  3. Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy
  4. Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
  5. Unexplained persistent sore or painful throat
  6. Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion
67
Q

What is an important sign of acoustic neuroma?

A

absent corneal reflex

68
Q

What genetic condition is acoustic neuroma associated with?

A

neurofibromatosis type 2

69
Q

What causes a pharyngeal pouch (Zenker’s diverticulum)?

A

posteromedial diverticulum through Killian’s dehiscence (triangular area in wall of pharynx between thyropharyngeus and cricopharyngeus muscles)

70
Q

What are 2 risk factors for pharyngeal pouch?

A
  1. older age
  2. 5x more common in men
71
Q

What are 5 features of pharyngeal pouch?

A
  1. dysphagia
  2. regurgitation
  3. aspiration
  4. neck swelling which gurgles on palpation
  5. halitosis
72
Q

What is the investigation of choice for pharyngeal pouch?

A

barium swallow combined with dynamic video fluoroscopy

73
Q

What is the management of a pharyngeal pouch?

A

surgery

74
Q

What are 6 risk factors for glue ear?

A
  1. male sex
  2. siblings with glue ear
  3. higher incidence Winter and Spring
  4. bottle feeding
  5. day care attendance
  6. parental smoking
75
Q

At what age does glue ear peak?

A

2 years

76
Q

What are 3 treatment options for glue ear?

A
  1. avtive observation (3 months) - if first presentation of OME
  2. grommet insertion
  3. adenoidectomy
77
Q

After how long do most grommets stop functioning?

A

10 months

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