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ENT 2 Flashcards

1
Q

What is a serious infection of the ear that must be considered in someone presenting with severe otalgia and discharge, how is it diagnosed and what is the treatment?

A

Malignant/ necrotizing otitis media:
- severe infection usually pseudomonas

CT Scan to diagnosis - as can cause osteomyelitis of temporal bone

Treatment:

  • IV antibiotics
  • surgical debridement
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2
Q

What are some differentials for otalgia:

A

Primary:

  • Otitis external
  • Otitis media
  • Barotrauma
  • Temporomandibular Joint Dysfunction

Referred:

  • Dental disease via 5th cranial nerve
  • Ramsay Hunt Syndrome via 7th cranial nerve
  • Throat/ mouth cancer via IX and X nerve
  • C1, C2 trauma
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3
Q

What are the common organisms to cause otitis media?

A

H. Influenza
Pneumococcus
Moraxella

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4
Q

What are the clinical signs of mastoiditis and how should it be treated?

A

Swelling behind the ear
Pushing anterior of the pinna
Pain

  • CT scan
  • IV antibiotics
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5
Q

What are the complications of acute media otitis?

A

Intracerebral abcsess

Mastoiditis

Facial nerve palsy

Labyrinthitis

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6
Q

What investigations are done into otitis media with effusion/ glue ear? and why do adults get more tests? and which group are particularly prone to the worrying factor?

A

Pure Tone Audiometry
Tympanogram - Type B will be shown

Flexible nasoendoscopy

ENT examination

*adults are at increased risk of nasopharyngeal carcinoma

**Young south asian males

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7
Q

What is the biggest cause of hearing loss in children?

A

Otitis media with effusion/ Glue ear

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8
Q

What can worsen otosclerosis?

A

Pregnancy

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9
Q

What investigations and treatment should be given to someone presenting with sudden onset hearing loss?

A

Examination:

  • External ear (exclude conductance)
  • Tunning forks

Investigations:

  • FBC, U&Es, Coagulation, Autoimmune panel, ESR, CRP
  • Audiometry + audiological brainstem responses

Management if no underlying cause found:
- Prednisolone 80mg

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10
Q

What investigations and management should be done into tinnitus?

A

Tinnitus:
defined as sound perceived by patient in the absence of stimulus for >minutes. without previous noise exposure.
- primary
- secondary (underlying condition)

Investigations:

  • Audiological assessment
  • Tympanogram
  • Cranial nerve examination
  • TFTs
  • FBC
  • U&Es
  • MRI of head

Management:

  • Habituation training
  • Tinnitus retraining therapy
  • CBT
  • Hearing aids to mask sound
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11
Q

What are the diagnostic features for rhinosinusitis? and what is needed for a diagnosis of acute bacterial rhinosinusitis?

A 
Nasal blockage 
Nasal discharge 
\+/- 
Fascial pain 
Loss of sense of smell

Bacterial, at least 3 of the following:

  • discoloured discharge
  • several localised pain
  • fever
  • high CRP
  • Double sickening
  • swelling is not that common
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12
Q

What are the complications of bacterial rhinosinusitis?

A

Orbital cellulitis

Intracranial involvement

  • meningitis
  • cerebral abscess

Osteomyelitis

Pott’s puffy tumour
- osteomyelitis of frontal bone

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13
Q

What is the criteria used to figure whether someone should receive antibiotics for a sore throat? and what antibiotic is prescribed for strep throat?

A

Centor Criteria

  • fever
  • swelling
  • lymph swelling
  • absence of cough

Penicillin V

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14
Q

What are some differentials for a hoarse voice and how is it investigated?

A 
Laryngeal cancer 
Laryngitis 
Reinke's oedema 
Vocal cord nodules 
Muscle tension dystonia

Investigations:

  • Neck examination
  • Flexible nasal Endoscopy
  • Stroboscopy
  • CT head/ neck and thorax
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15
Q

Name some pre-malignant conditions seen in the mouth:

A

Leukoplakia

Erythroplakia

Erythroleukoplakia

Oral Lichen planus

Actinic Cheilitis

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16
Q

What is the clinical set of symptoms which can be associated with advanced nasopharyngeal cancer?

A

Trotter’s syndrome

  • unilateral conductance deafness (middle ear effusion)
  • Trigeminal neuralgia
  • Defective mobility of the soft palate
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17
Q

What are the symptoms of laryngeal cancer, what are the different types and which has the best prognosis?
and what are the treatment options?

A 
Hoarse voice 
Dysphagia 
Persistent cough 
Stridor 
Referred otalgia

Glottis
Supraglottis
Hypoglottis

Treatment:

  • Transoral laser therapy
  • Laryngectomy
  • Neck resection - radical or modified
  • Adjuvant therapy

Glottis has best prognosis due to relatively low lymphatic drainage.

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18
Q

Give some differentials for facial palsy:

A

Intracranial:

  • tumour
  • stroke
  • MS

Intratemporal:

  • Otitis media
  • Ramsay hunt syndrome
  • Cholesteatoma

Infratemporal:

  • Parotid tumour
  • Trauma

Others:

  • lyme disease
  • Bell’s palsy
  • Diabetes
  • sarcoidosis
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19
Q

What are the features and what is the diagnostic mechanism for sialolithiasis and how are they treated?

A

Intermittent pain
Swelling around meals
Palpation

Clinically diagnosed
Sialogram (x-ray)

Management:

  • Hydration
  • Sialogogues
  • Surgical
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20
Q

Which medication can cause ototoxicity inducing tinnitus and hearing loss?

A 
NSAIDS 
Loop diuretics
Gentamicin
Quinine 
Vancomycin
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21
Q

Which medication are nasal polyps sensitivity associatted with?

A

Aspirin

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22
Q

What is the most common cause of snoring in children and list another symptom often seen with it?
and what is the most important thing to enquire about?

A

Adenoid hypertrophy
- usually reduces in size after 6 years of age.

Green discharge of rhinitis is also seen

Sleep disturbance.

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23
Q

What are the antibiotics used in otitis externa?

A

Ciprofloxacin drops

*this is usually combined with topical dexamethasone

24
Q

What condition is highly associated with cleft palate affecting the ear?

A

Cholesteatoma

- active squamous epithelium of the external canal

25
Q

Which neck lymph nodes drain the external auditory meatus?

A

Pre-auricular (Mastoid)

26
Q

Where are the deep cervical lymph nodes located?

A

Through the carotid sheath with superior and inferior poles.

Drainage of the entire head and neck either directly or indirectly

27
Q

What makes up Waldeyer’s ring?

A

Adenoids x1

Tubal x2

Palatine x 2

Lingual x 2

28
Q

Where do the parathyroid glands lie?

A

Superior at 1st tracheal ring

Inferior at the inferior thyroid artery level

29
Q

Otosclerosis causes conductive hearing loss at higher tones, what is this pattern called on the pure auditory tone?

A

Cathart notch

30
Q

What test can be conducted to assess for a vestibulospinal reflex defect?

A

Romberg’s test

- The person will tend to fall to the side of the vestibular defect

31
Q

What is the initial hearing exam done in neonates?

A

Otoacoustic emissions
- ear probe in the ear makes clicks which stimulates the hair cells on the outer edge to move in response (a motor function). this is picked up by the microphone attached to probe

32
Q

What are the most common bacterial causes of otitis externa and list some risk factors:

A

Staph Aureus
Pseudomonas

  • swimming
  • ear trauma
  • eczema
  • diabetes
33
Q

If a perforation is to occur on the tympanic membrane, where is it most likely to occur?

A

Pars tensa

34
Q

Where is a grommet most likely to be inserted? and when is it used? And what signs of this condition would you see on otoscopy?

A

Anterior inferior portion of tympanic membrane

Used for otitis media with effusion (glue ear)

Signs:

  • retracted membrane
  • no inflammation
  • loss of light reflex
35
Q

Following a large epistaxis, what further measurements may need to be undertaken?

A

Hypertension control

Anti-coagulation monitoring/ control

36
Q

if surgery is needed to remove a nasal polyp what is it called? what other conditions is this surgery used for and name some complications:

A

Functional Endoscopic Sinus Surgery (FESS)

  • rhinosinusitis
  • polyps
  • Epistaxis
  • CSF leaks

Complications:

  • CSF leak
  • intraorbital bleeding
  • Nasolacrimal duct damage
  • optic nerve injury
37
Q

What maneuver can be done for sleep apnea which identifies if the oro and/or hypopharynx collapses?

A

Muller’s Manoeuvre

- inhalation through mouth with nose closed viewing it with flexible nasoscopy

38
Q

What are the criteria and contraindications for tonsillectomy. and name some complications:

A

Indications:

  • > 7 episodes in 1 year
  • > 5 episodes in 2 years

Contraindications:

  • acute infection
  • cleft palate
  • bleeding disorder

Complications:

  • primary haemorrhage (within 24hours)
  • secondary haemorrhage (5-10days)
  • tooth damage
  • temporal mandibular joint dislocation
39
Q

What are the triangles of the neck, and what are theyre borders?

A

Anterior Triangle:

  • Superior: Mandible
  • Middle: Midline
  • Lateral: SCM

Posterior Triangle:

  • Anterior: SCM
  • Inferior: Clavicle mid 1/3rd
  • Posterior: Trapezius
40
Q

What surgeries are carried out for a cholesteatoma?

A

Mastoidectomy
Atticotomy
Endoscopic approaches

41
Q

What are the two major types of cholesteatomas?

A

Acquired

  • retraction
  • non- retracted (perforation)

Congenital

42
Q

What are the treatment options for Active mucosal (discharging) chronic otitis media?

A

Medical:

  • aura toileting
  • Antibiotic/ steroid sprays

Surgical:

  • Myringoplasty
  • Tympanoplasty
43
Q

What are the red flags for otitis media with effusion?

A

Young south east asian males

Adults with neck lymph nodes

44
Q

What is the criteria for bacterial sinusitis? and how many episodes are needed in a year before referral to ENT?

A 
Fever >38 
Double sickening 
Unilateral
Severe pain 
Raised CRP/ ESR

Must have >3 or more
then treat with antibiotics

> 3 or more episodes a year for referral

45
Q

What is the treatment for parotid malignant tumour?

What are some complications of treatment?

A

Formal conservative parotidectomy
- sparing of the facial nerve
or
Total parotidectomy

+/-
Radiotherapy
+/-
Neck dissection

Complications:

  • Haematoma
  • facial nerve damage
  • Frey’s syndrome (sweating, flushing due to nervous dysfunction)
  • Salivary fistula
46
Q

List some non-cancerous causes enlarged parotid glands:

A

Viral:

  • Mumps
  • Coxsackievirus

Granulomatous sialadenitis

  • sarcoidosis
  • TB
  • Syphilis
47
Q

Which foramen does the facial nerve exit the skull at?

A

stylomastoid foramen

48
Q

What is Chronic Squamous Otitis Media? and how is it treated?

A

Cholesteatoma

  • Atticotomy
  • Mastoidectomy +/- reconstruction
49
Q

With facial pain, name what areas you wish to examine and why:

A

External face: swelling, spasms
Oral cavity: dental irregularities
Temporomandibular joint: crepitus/ clicking
Nose: discharge, crusting

secondary care:
- nasoendoscopy

50
Q

Will anosmia improve or worsen once a polyp is removed?

A

It usually worsens

51
Q

What is the term for a cluster headache?

A

Trigeminal Autonomic Cephalgia

52
Q

What is the headache called which causes pain across the face with facial tenderness. associated with stress and usually occurs daily?

A

Mid-facial Segment Pain

- subtype of tension headache

53
Q

What surgery is conducted for sinusitis if indicated?

A

Functional Endoscopic Sinus Surgery

54
Q

Why might previous thyroid or neck tumours increase risk of malignancy in future?

A

radiation exposure

55
Q

How many weeks of hoarseness requires referral?

A

> 6 weeks

- after which a two week referral is needed

56
Q

Which muscle does the recurrent laryngeal nerve not supply?

A

Cricothyroid

57
Q

In a young person what factors must you consider for a potentially malignant neck lump?

A

HPV infection

Inherited conditions such as Fanconis

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