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General Practice > ENT > Flashcards

ENT Flashcards

1
Q

Ear Pain

DDx

A

Acute otitis media
Acute otitis externa
Referred pain - dental, TMJ, herpes zoster

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2
Q

Ear Discharge

DDx

A

Acute otitis media with perforation

Otitis externa with discharge

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3
Q

Acute otitis media

A

Pain, fever, occasionally vomiting
Eustachian tube dysfunction leads to stasis of fluid in the middle ear with a secondary
Complications are rare
Normally viral - treat with paracetamol and ibuprofen, watchful waiting
Bacterial causes - Strep. pneumonia, H. influenzae, Moraxella catarrhalis (amoxycillin)

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4
Q

Acute otitis media

Who should have antibiotics

A 
Children ≤2 years
Severe pain
Perforation
Fever >48hrs
Toxic
Aboriginal and torres strait islanders
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5
Q

Otitis externa
(Swimmer’s ear)
Causes

A

Bacterial (staph, pseudomonas)
Fungal (candida, aspergillus)
Dermatological (eczema, psoriasis)
Cotton bud abuser

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6
Q

Otitis externa

Treatment

A

Pain relief
Keep dry
Aural toilet
Ear drops (antibiotic and steroid combination) for 2 weeks
Oral antibiotics if associated cellulitis

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7
Q

Otitis media

Complications

A 
Spontaneous resolution (most)
TM perforation
Chronic otitis media with effusion (COME) leading to glue ear
Chronic suppurative otitis media
Mastoiditis
Very rarely intracranial complications
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8
Q

Cholesteatoma

A

Accumulation of keratinising squamous epithelium in the middle ear
Unknown cause
Resorbs underlying bone

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9
Q

Cholesteatoma

Complications

A

Damage to the ossicles resulting in conductive hearing loss
Chronic infection with discharge
Mastoid bone erosion with damage to the facial nerve

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10
Q

Blocked ear

DDx

A

Ear wax

Mild otic barotrauma/Eustachian tube dysfunction

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11
Q

Conductive deafness

Causes

A 
Ear wax
Middle ear fluid
Otitis media ± perforation
Otosclerosis 
Glue ear
Barotrauma
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12
Q

Sensorineural deafness

Causes

A 
Noise induced
Age related (prebyacusis)
Acoustic neuroma (unilateral)
Meniere's disease
Drugs (gentamycin)
Congenital - TORCH infections (toxoplasmosis, other aka syphilis/parovirus/hiv, rubella, cmv, hsv)
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13
Q

Acoustic Neuroma

A

Benign tumour of schwann cells of the vestibular nerve
Unilateral hearing loss and tinnitus
Mild imbalance
Rarely VII palsy

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14
Q

Vertigo (illusion of movement)

DDx

A 
BPPV (seconds)
Meniere's disease (hours)
Vestibular neuronitis (days)
CVA
Acoustic neuroma
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15
Q

BPPV

A

Brief recurrent attacks
Provoked by changes in head position (top shelf vertigo)
Idiopathic but dislodged free floating particles
High spontaneous cure rate within weeks or months
Tx - Epley manoeuver

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16
Q

Meniere’s disease

A

Unknown cause - excess of fluid in the endolymphatic compartment in the inner ear
Incidence in 30s-40s
Usually unilateral but may become bilateral
Disabling veritgo with nausea and vomiting
Hearing loss (revers to normal between episodes)
Roaring tinnitus

17
Q

Meniere’s disease

Treatment

A

Stemetil acutely
Maintenance - lifestyle changes, salt reduction, betahistine hydrochloride regularly, vestibular rehabilitation
Surgery (rarely)

18
Q

Vestibular neuronitis

A 
Acute inflammation of the vestibular nerve
Unknown cause
Young-middle aged
Incapacitating sustained vertigo
Sudden onset
Very unwell and lie still in bed
Nausea and vomiting
No tinnitus or deafness
19
Q

Vestibular neuronitis

Treatment

A

Reassurance and explanation
Stemetil in first few days
Resolution after 2-5 days over period of 6-12 weeks

20
Q

Tinnitus

DDx

A

Conductive hearing loss - ear wax, middle ear fluid, tympanic membrane perforation, otosclerosis
Sensorineural hearing loss - presbyacusis, meniere’s disease, noise induced hearing loss
Acoustic neuroma
Vascular malformations

21
Q

Tinnitus

Management

A 
Reassurance
Hearing test and aids if required
No drugs 
Audiologist/ENT referral
Sound therapy for distraction
CBT and relaxation techniques
Self-help
22
Q

Bell’s palsy

Management

A

Protect the eye
Prednisolone 10 days - start in the first 72 hours
Antivirals?
Resolution in 85% of patients within 4-6 weeks
Psychological counselling and physiotherapy

23
Q

Ramsey Hunt syndrome

A

Herpes zoster oticus
Vesicles on areas of skin or mucous innervated by facial nerve
Very painful with pain preceding the facial palsy
Unilateral hearing loss
Steroids and antivirals within 72hrs - 60% resolve

24
Q

Blocked nose

DDx

A 
Acute viral rhinitis (common cold)
Rhinosinusitis
Allergic rhinitis
Nasal polyps
Rhinitis medicamentosa
Septal deviation following nasal trauma
Nasal tumours (rare)
25
Q

Nasal polyps

A

Often bilateral - if unilateral neoplastic until confirmed otherwise
Tx - medical (topical steroid drops for 6 weeks), surgical (polpectomy or ethmoidectomy)

26
Q

Rhinitis medicamentosa

A

Inappropriate use of vasoconstrictor nasal drops to relieve nasal congestion
Rebound secondary vasodilatation

27
Q

Sore throat

DDx

A 
Pharyngitis (viral usually)
Tonsillitis (viral or bacterial)
Glandular fever
Quinsy
Aphthous ulcer
28
Q

Centor criteria for strep

A 
(need 3 or 4):
Temp >38
Tonsillar exudate
Tender anterior cervical lymph nodes
Absence of cough
29
Q

Glandular fever (infectious mononucleosis)

A

“Kissing disease”
30-50 day incubation period
Lymphocytosis
Monospot test

30
Q

Quinsy (peri-tonsillar abscess)

A

Deviation of the ubula
Trismus (reduced opening of the jaws due to irritation of the pterygoid muscles)
Lateralising pain
Fullness of the soft palate on the affected side
Often due to group A strep
Drain

31
Q

Tonsillectomy

Indications

A

Recurrent tonsillitis (5 attacks in one year with significant time off school/work)
Quinsy (one or more)
OSA
Suspected malignancy

32
Q

Cricopharyngeal spasm

A

Feeling of lump in the throat
Painless
Symptoms improved by swallowing food
Rule out serious pathology with nasendoscopy

33
Q

Laryngeal carcinoma

A

Hoarseness persisting for more than 4 weeks is a laryngeal carcinoma until proven otherwise

34
Q

Conductive loss

Audiogram

A

Air < bone

35
Q

Age related hearing loss

Audiogram

A

Loss at high frequencies

Conductive and sensorineural are the same

36
Q

Otitis media with bulging eardrum

Tympanogram

A

Decrease in compliance with increase in pressure

37
Q

Eustachian tube dysfunction

Tympanogram

A

Normal compliance but a shift in pressure

Ear drum still moves but the baseline pressure is less

38
Q

Solids sticking to bottom of gullet

A

Oesophageal stricture

39
Q

Lump in throat resolved by swallowing

A

Cricopharyngeal spasm

General Practice (9 decks)

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