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Zero to finals > ENT > Flashcards

ENT Flashcards

1
Q

sensorineural hearing loss is a problem with

A

the vestibulocochlear nerve or the sensory system in the inner ear

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2
Q

the eustahian tube connects

A

the middle ear to the throat

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3
Q

role of cochlea

A

transmitting sound vibrations to a nervous signal

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4
Q

in webers test, if there is sensorineural hearing loss the sound is heard louder in

A

the normal ear

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5
Q

in webers test, if there is conductive hearing loss the sound is heard louder in

A

the affected ear

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6
Q

rinnes test positive means

A

air conduction is louder than bone

this is normal

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7
Q

rinnes test negative means

A

bone conduction is better than air

this suggests conductive hearing loss

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8
Q

drugs that cause sensorineural hearing loss

A

aminoglycosides
chemotherapy
loop diuretics

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9
Q

above what on an audiogram is normal

A

20 dB

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10
Q

sensorineural hearing loss on an audiogram

A

both air and bone conduction over 20 dB (lower down)

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11
Q

conductive hearing loss on an audiogram

A

air conduction readings will be over 20 dB

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12
Q

mixed hearing loss on an audiogram

A

both air and bone conduction will be over 20 dB

there will be a difference of 15 dB between them

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13
Q

what is age related hearing loss called

A

presbycusis

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14
Q

whats presbycusis

A

age related hearing loss
affects high pitched sounds first

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15
Q

what type of hearing loss is presbycusis

A

sensorineural

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16
Q

sudden onset sensorineural hearing loss mx

A

immediate referral to ENT
steroids

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17
Q

what is the role of the eustachian tube

A

to equalise the pressure between the middle ear and throat

to drain fluid from the middle ear

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18
Q

what is eustachian tube dysfunction associated with

A

viral URTI
allergies
smoking

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19
Q

pressure in middle ear compared to ambient air in eustachian tube dysfunction

A

lower- negative ear canal pressure on tympanogram

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20
Q

where are grommets inserted

A

into the tympanic membrane

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21
Q

role of grommets

A

allows air or fluid to drain from the middle ear through the tympanic membrane

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22
Q

what type of hearing loss occurs in otosclerosis

A

conductive

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23
Q

what is otosclerosis

A

remodelling and hardening of the auditory ossicles, most commonly the base of the stapes

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24
Q

presentation of otosclerosis

A

hearing loss and tinnitus in under 40 yrs old

affects lower pitched sounds

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25
Q

how to patients hear their voice in otosclerosis

A

louder than the environment
this might lead to them speaking more quietly

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26
Q

what will tympanomentry show in otosclerosis

A

reduced admittance

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27
Q

mx of otoslcerosis

A

conservative with the use of hearing aids

stapedectomy or stapedotomy

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28
Q

most common bacteria causing otitis media

A

strep pneumoniae

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29
Q

otitis media is an infection where

A

between the tympanic membrane and inner ear

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30
Q

what does a normal tympanic membrane look like

A

pearly grey and translucent

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31
Q

abx for otitis media

A

usually sx resolve in 3 days so consider waiting till then or giving a delayed prescription

amoxicillin 5-7days
clarithromycin if penicillin allergic
erythromycin if pregnant and penicillin allergic

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32
Q

complications of otitis media

A

temporary hearing loss
perforated tympanic membrane
labyrinthitis
mastoiditis
abscess
meningitis

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33
Q

what should you consider in someone with otitis externa that doesnt respond to multiple abx

A

fungal infection

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34
Q

what is otitis externa associated with

A

swimming

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35
Q

common bacteria causing otitis externa

A

pseudomonas aerunginosa
staph aureus

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36
Q

pseudomonas aerunginosa is what type of bacteria

A

gram negative aerobic rod

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37
Q

pseudomonas aerunginosa mx

A

aminoglycosides
quinolones

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38
Q

mild otitis externa mx

A

topical 2% acetic acid

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39
Q

moderate otitis externa

A

topical abx and steroid

commonly otomize spray

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40
Q

what do you need to rule out before giving aminoglycosides in otitis externa

A

a perforated tympanic membrane

aminoglycosides can cause hearing loss sometimes if they get past the membrane

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41
Q

what is malignant otitis externa

A

when the infection spread to the bones- osteomyelitis of the temporal bone

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42
Q

sign of malignant otitis externa

A

granulation tissue at junction between bone and cartilage

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43
Q

emthods for removing ear wax

A

drops (olive oil or sodium bicarb)
irrigation
microsuction

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44
Q

causes of tinnitus

A

impacted ear wax
ear infection
menieres disease
medications
acoustic neuroma
systemic conditions: diabetes, hypothyroidism, anaemia
aortic stenosis
carotid artery stenosis
eustachian tube dysfunction

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45
Q

where is the vestibular apparatus found

A

the inner ear

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46
Q

what is in the vestibular apparatus

A

semicircular cannals filled with endolymph

47
Q

where is the vestibular nucleus found

A

the brainstem and the cerebellum

48
Q

4 main causes of peripheral vertigo

A

BPPV
menieres disease
vestibular neuronitis
labyrinthitis

49
Q

what type of stroke causes vertigo

A

posterior circulation infarct

50
Q

how does central vertigo differ from peripheral vertigo

A

sustained
non positional
gradual onset (apart from stroke)
usually no hearing loss or tinnitus
impaired coordination
nausea is milder

51
Q

components of the HINTS examination

A

head impulse test
nystagmus
test of skew

52
Q

head impulse test and results

A

patient looks at examiners nose, their head is jerked in one direction multiple times then the other direction

if the patients eyes saccade as trying to fix on the nose this suggests a peripheral cause of vertigo

53
Q

unilateral horizontal nystagmus indicates

A

peripheral vertigo

54
Q

bilateral or vertical nystagmus indicates

A

central vertigo

(vertical like looking up the to brain which is the central nervous system)

55
Q

test of skew and results

A

the examiner covers the eyes with their hands, alternating between each eye and the patient is asked to fix their gaze on the examiners nose

vertical movement to fix indicates central vertigo

56
Q

HiNTS exam results

A

head impulse test- positive= peripheral vertigo

nystagmus- unilateral/horizontal= peripheral vertigo
bilateral/vertical= central vertigo

test of skew- vertical movement to fix= central vertigo

57
Q

central vertigo mx

A

further imaging for causes eg CT/MRI

58
Q

peripheral vertigo mx

A

prochlorperazine
antihistamines

59
Q

what medication is used to reduce attacks in menieres disease

A

betahistine

60
Q

DVLA rules for vertigo

A

patients shouldnt drive if they get sudden attacks of vertigo

61
Q

vestibular migraine mx

A

avoid triggers
triptans for acute sx
propanolol, topiramate, amitriptyline to avoid attacks

62
Q

BPPV pathophysiology

A

calcium carbonate crystals become displaced most commonly in the posterior semicircular canal, disrupting the flow of endolymph

63
Q

what is triggered in the dix hallpike manouevre if someone has BPPV

A

rotational nystagmus

clockwise if left ear
anti clockwise if right ear

64
Q

what exercises can be used to improve sx of BPPV

A

brandt daroff exercises

65
Q

what is vestibular neuronitis

A

inflammation of the vestibular nerve

66
Q

what part of the HiNTs exam will be abnormal in the head impulse test

A

head impulse test
the eyes will saccade

67
Q

what parts of the hints exam are abnormal in peripheral vertigo

A

head impulse test (eyes will saccade)

nystagmus (unilateral horizontal)

68
Q

what parts of the hints exam will be abnormal in central vertigo

A

nystagmus (bilateral and horizontal)

test of skew (vertical movements to fix)

69
Q

vestibular neuronitis mx

A

prochlorperazine or antihistamines for 3 days

vestibular rehabilitation therapy if sx unresolved after 1-6 weeks

70
Q

how to differentiate labyrinthitis from vestibular neuronitits

A

in labyrinthitis you get hearing loss and tinnitus

71
Q

labyrinthitis mx

A

prochlorperazine or antihistamine for 3 days

abx if bacterial

72
Q

menieres disease pathophysiology

A

build up of endolymph in the labyrinth of the inner ear

73
Q

menieres disease sx

A

hearing loss
vertigo
tinnitus
fullness in the ear
drop attacks (falls but no LOC)
imbalance

74
Q

acoustic neuromas are also known as

A

vestibular schwannomas

75
Q

what is an acoustic neuroma

A

a benign tumor of the schwann cells surrounding the vestibulococchlear nerve

76
Q

bilateral acoustic neuromas are associated with

A

MEN II

77
Q

acoustic neuroma sx

A

unilateral hearing loss
sensation of fullness
unilateral tinnitus
dizziness/imbalance
facial palsy

78
Q

what type of facial palsy is seen in acoustic neuroma

A

non forehead sparing as its lower motor neurone

79
Q

acoustic neuroma mx

A

surgical removal
radiotherapy to shrink

if asymptomatic no mx needed

80
Q

what is cholesteatoma

A

an abnormal non cancerous collection of squamous epithelial cells in the middle ear

81
Q

cholesteatoma sx

A

foul smelling discharge
unilateral conductive hearing loss

82
Q

path of the fcial nerve

A

exits brainstem at cerebellopontine angle

travels through temporal bone and parotid gland

83
Q

functions of the facial nerve

A

motor- supples muscles of facial expression, stylohyoid and platyama muscles as well as the stapes

sensory- taste to anterior 2/3 of tongue

parasympathetic- to submandibular and sublingual salivary glands and lacrimal gland

84
Q

how is forehead affected in UMN lesions

A

spared

as there is supply from UMN from both sides of the brain

85
Q

how is forehead affected in LMN lesions

A

not spared

86
Q

how do you check for forehead sparing

A

can they raise their eyebrows

87
Q

what type of facial nerve palsy is bells palsy

A

unilateral lower motor neurone lesion

88
Q

steroid dose in bells palsy

A

50mg prednisolone for 10 days

89
Q

cause of bells palsy

A

idiopathic

90
Q

what type of facial nerve palsy is ramsay hunt syndrome

A

unilateral lower motor neurone lesions

91
Q

most common location of bleed in epistaxis

A

kiesselbachs plexus located in littles area

92
Q

what can be prescribed after acute epistaxis and who cant have it

A

naseptin (for reducing crusting, infection and inflammation)

contraindicated if there is a peanut/soya allergy

93
Q

what type of nasal polyp is concerning

A

unilateral

94
Q

what is used to examine nasal polyps

A

a nasal speculum

95
Q

causes of nasal polyps

A

churg strauss
CF
asthma
chronic rhinitis

96
Q

nasal polyp mx

A

intranasal steroid drops or spray
polypectomy

97
Q

most common cause of tonsillitis

A

viral infection

98
Q

what does fever pain score assess for

A

if tonsillitis is baterial

99
Q

what fever pain score indicates abx

A

4 or above

100
Q

how many episodes of tonsillitis for tonsillectomy

A

7 in 1 yr
5 per year for 2 years
3 per year for 3 years

2 episodes of abscess
SOB, swallowing difficulty or snoring

101
Q

what time frame comprises post tonsillectomy bleeding

A

2 weeks

102
Q

if post tonsillectomy bleed is less severe what can be done

A

hydrogen peroxide gargle
adrenaline soaked swab

103
Q

red flags for neck lump referral

A

over 45 and unexplained neck lump

persistent neck lump any age

104
Q

how are growing lumps imaged

A

ultrasound

within 48 hrs if under 25
within 2 weeks if over 25

105
Q

bloods for neck lumps

A

FBC
monospot test/EBV antibodies
ANA for SLE
TFTs
HIV

106
Q

first line test for infectious mono

A

monospot test

107
Q

hodgkins lymphoma is a proliferation of

A

lymphocytes

108
Q

lymph node biopsy in hodgkins lymphoma

A

reed sternberg cell

109
Q

what does the carotid body contain

A

chemoreceptors that detect blood oxygen, co2 and pH

110
Q

carotid body tumor sx

A

neck lump- painless, pulsatile, mobile side to side but not up and down
can cause nerve palsy including horners

111
Q

how does a thyroglossal cyst form

A

when part of the thyroglossal duct doesnt disappear and fluid fills inside it

112
Q

where are branchial cysts found

A

anterior triangle of the neck

113
Q

where does a branchial cyst originate

A

second branchial cleft

114
Q
A

Zero to finals (11 decks)

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