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Phase 4 Derm, Sexual Health, Breast, Renal, Urology, ENT > ENT > Flashcards

ENT Flashcards

1
Q

What are acoustic neuromas?

A

Benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear

Vestibular schwannoma

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2
Q

Where do acoustic neuromas occur in the brain?

A

Cerebellopontine angle

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3
Q

What do bilateral acoustic neuromas indicate?

A

Neurofibromatosis type II

Acoustic neuromas are usually unilateral

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4
Q

What are the features of acoustic neuromas?

A

cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus

cranial nerve V: absent corneal reflex

cranial nerve VII: facial palsy

sense of fullness in the ear

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5
Q

What are the investigations for acoustic neuromas?

A

Audiometry: Sensorineural pattern of hearing loss

MRI or CT for tumour

MRI is the investigation of choice

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6
Q

What is the management of acoustic neuromas?

A

Urgent ENT referral

Conservative management with monitoring may be used if there are no symptoms or treatment is inappropriate

Surgery to remove the tumour (partial or total removal)

Radiotherapy to reduce the growth

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7
Q

What are the features of Benign Paroxysmal Positional Vertigo?

A

vertigo triggered by a change in head position (e.g. rolling over in bed or gazing upwards)

can be associated with nausea

each episode typically lasts 10-20 seconds

Positive Dix-Hallpike manoeuvre (rotary nystagmus)

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8
Q

What manoeuvre is used to diagnose BPPV? What manoeuvre is used to treat BPPV?

A

Diagnosis: Dix-Hallpike manoeuvre (elicits rotary nystagmus)

Treat: Epley Manoeuvre

Patient home manouveres: Brandt-Daroff Exercises

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9
Q

What are the features of Menieres disease?

A

Recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural)

Vertigo is usually the prominent symptom

full ear

Nystagmus and a positive Romberg test

typically symptoms are unilateral but bilateral symptoms may develop after several years

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10
Q

What is the management of Menieres disease?

A

ENT assessment

Inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved

Acute attacks: buccal or intramuscular prochlorperazine.

Prevention: betahistine and vestibular rehabilitation exercises may be of benefit

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11
Q

What are the features of epiglottitis?

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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12
Q

What causes acute epiglottitis?

A

Haemophilus influenzae type B

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13
Q

What is the investigation for acute epiglottitis?

A

Diagnosis is made by direct visualisation (ENT specialist)

  • lateral view in the acute epiglottis will show swelling of the epiglottis - the ‘thumb sign’
  • posterior-anterior view in croup will show subglottic narrowing, commonly called the ‘steeple sign’
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14
Q

What is the management for acute epiglottitis?

A

immediate senior involvement, including those able to provide emergency airway support (e.g. anaesthetics, ENT)
endotracheal intubation may be necessary to protect the airway

DO NOT examine the throat due to the risk of acute airway obstruction

oxygen

intravenous antibiotics

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15
Q

What are some causes of epistaxis?

A
  • nose picking, nose blowing
  • trauma to the nose
  • insertion of foreign bodies
  • bleeding disorders
  • immune thrombocytopenia
  • Waldenstrom’s macroglobulinaemia
  • juvenile angiofibroma
  • benign tumour (highly vascularised)
  • cocaine use
  • hereditary haemorrhagic telangiectasia
  • granulomatosis with polyangiitis
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16
Q

What is the management for epistaxis?

A

First-aid measures:
- Sit with torso forward and their mouth open
- Pinch the cartilaginous (soft) area of the nose firmly
- At least 20 minutes

If first aid measures are successful:
- Topical antiseptic such as Naseptin (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis
-Mupirocin is a viable alternative

If bleeding does not stop after 10-15 minutes:
- consider cautery or packing

Patients who are haemodynamically unstable or compromised:
- admit to A&E
- Epistaxis that has failed all emergency management may require sphenopalatine ligation in theatre

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17
Q

What are the features of Infectious Mononucleosis?

A

The classic triad of sore throat, pyrexia and lymphadenopathy is seen in around 98% of patients:

Other features include:
malaise, anorexia, headache
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis: the presence of 50% lymphocytes with at least 10% atypical lymphocytes
haemolytic anaemia secondary to cold agglutins (IgM)
a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

18
Q

What is the diagnosis of Infectious Mononucleosis?

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.

19
Q

What is the management of Infectious Mononucleosis?

A

Supportive:

Rest during the early stages, drink plenty of fluid, avoid alcohol

simple analgesia for any aches or pains

Avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

20
Q

What are the features of otitis media?

A

otalgia
some children may tug or rub their ear
fever occurs in around 50% of cases
hearing loss
recent viral URTI symptoms are common (e.g. coryza)
ear discharge may occur if the tympanic membrane perforates

21
Q

What findings are on otoscopy for otitis media?

A

Possible otoscopy findings:
bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea
decreased mobility if using a pneumatic otoscope

22
Q

What are the diagnosis criteria for otitis media?

A

Acute onset of symptoms
- otalgia or ear tugging
Presence of a middle ear effusion
- bulging of the tympanic membrane, or
otorrhoea
- decreased mobility on pneumatic
- otoscopy
Inflammation of the tympanic membrane
i.e. erythema

23
Q

What is the management for otitis media?

A

Acute otitis media is generally a self-limiting condition that does not require an antibiotic prescription.

Analgesia should be given to relieve otalgia. Parents should be advised to seek medical help if the symptoms worsen or do not improve after 3 days.

Antibiotics should be prescribed immediately if:
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

If an antibiotic is given, a 5-7 day course of amoxicillin is the first line. In patients with penicillin allergy, erythromycin or clarithromycin should be provided.

24
Q

What are some complications of otitis media?

A

mastoiditis
meningitis
brain abscess
facial nerve paralysis

25
Q

What are the features of otitis externa?

A

Ear pain, itch, discharge

26
Q

What findings are on otoscopy for otitis externa?

A

Red, swollen, or eczematous canal

27
Q

What is the management for otitis externa?

A

topical antibiotic with/without steroids
Avoid aminoglycosides (gentamicin) for perforated tympanic membrane
Remove debris from ear canal

Second-line options include
Flucloxacillin if the infection is spreading
swab inside the ear canal
empirical use of an antifungal agent

If a patient fails to respond to topical antibiotics then the patient should be referred to ENT.

28
Q

What are the features of rhinosinusistis?

A

Facial pain: typically frontal pressure pain which is worse on bending forward

Nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection

Nasal obstruction: e.g. ‘mouth breathing’

Post-nasal drip: may produce chronic cough

29
Q

What is the management of recurrent or chronic sinusitis

A

Avoid allergen

Intranasal corticosteroids

Nasal irrigation with saline solution

30
Q

What are the red flags symptoms of rhinosinusitis?

A

Unilateral symptoms

Persistent symptoms despite compliance with 3 months of treatment

Epistaxis

31
Q

What are the main causes of vertigo?

A

Viral labyrinthitis
Vestibular neuronitis
Benign paroxysmal positional vertigo
Meniere’s disease
Vertebrobasilar ischaemia
Posterior circulation stroke
Trauma
Multiple sclerosis
Ototoxicity e.g. gentamicin

32
Q

What are the criteria for tonsillectomy?

A

7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years,

the episodes of sore throat are disabling and prevent normal functioning

33
Q

What are some complications of tonsillectomy?

A

primary (< 24 hours): haemorrhage in 2-3% (most commonly due to inadequate haemostasis), pain

secondary (24 hours to 10 days): haemorrhage (most commonly due to infection), pain

34
Q

What is the FeverPAIN criteria

A

Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza

35
Q

What are the CENTOR criteria?

A
  • presence of tonsillar exudate
  • tender anterior cervical lymphadenopathy or lymphadenitis
  • history of fever
  • the absence of cough
36
Q

What antibiotics should be given if indicated for tonsilitis?

A

phenoxymethylpenicillin
clarithromycin (penicillin-allergic)

37
Q

What are the features of obstructive sleep apnoea?

A

Excessive snoring and may report periods of apnoea.

daytime somnolence
compensated respiratory acidosis
hypertension

38
Q

What are the assessments and diagnostic tests for obstructive sleep apnoea?

A

Assessment of sleepiness
- Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
- Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)

Diagnostic tests
- sleep studies (polysomnography) -
- ranging from monitoring of pulse oximetry at night to full polysomnography

39
Q

What is the management for obstructive sleep apnoea?

A

weight loss

CPAP is first line

intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated

the DVLA should be informed if OSAHS is causing excessive daytime sleepiness

40
Q

What are the features of glue ear?

A

peaks at 2 years of age

conductive hearing loss

secondary problems such as speech and language delay, behavioural or balance problems may also be seen

41
Q

What is glue ear?

A

Otitis media with an effusion

42
Q

What is the management of glue ear?

A

Active observation for 3 months - no intervention is required

Refer to ENT if persisting significant hearing loss on two separate occasions (usually 6-12 weeks apart)

Grommet insertion

Adenoidectomy

Phase 4 Derm, Sexual Health, Breast, Renal, Urology, ENT (5 decks)

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