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ENT 3 Flashcards

1
Q

Where else in someone with suspected glandular fever should you examine other than just the throat? and what additional blood tests would you consider?

A

Abdomen for hepatosplenomegaly

LFTs
Monospot test

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2
Q

What is the management for quinsy?

A

Drainage - aspiration/ incision
- under LA

IV antibiotics

  • metronidazole
  • Penicillin V

Dexamethasone

IV fluids

Analgesia

*tonsillectomy if >1 episode

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3
Q

Other a parapharyngeal abscess name two other deep neck spaces which can become infected in complications of tonsillitis:

A

Submental
pre-vertabral

*requires max fax input and may require tracheostomy

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4
Q

Outline your immediate management of someone with epiglottitis or supraglottis:

A
  • High flow oxygen
  • Senior help
  • Nebulised adrenaline 1:1000 1mg in 5ml solution
  • IV dexamethasone 6.6mg
  • IV ceftriaxone 2mg
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5
Q

What is supraglottis?

A

Inflammation of epiglottis and aryepiglottic folds

  • *note the patient may actually look relatively well, and only have abnormal findings on examination
  • there is an impeding airway compromise coming
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6
Q

Name a clinic finding when examining the throat that may suggest epiglottitis:

A

Cherry red swelling

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7
Q

What is the most common pathogen of otitis externa?

A

Pseudomonas aeruginosa

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8
Q

As well as examining the ear on an otoscopy, which other place should you examine and why?

A

Finger nails

- long dirty nails may be used for picking which harbour bacteria

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9
Q

If the patients ear canal is too thin for drops what can be done?

A

ENT referral and a Pope Wick can be inserted

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10
Q

What are the key symptoms of necrotising otitis externa? What may be seen on otoscopy?
What other neurological signs may be seen?

A

Ear pain that keeps patient up at night

Continual discharge despite antibiotic therapy

  • granulation tissue on floor of ear canal

Neuro:

  • facial nerve palsy
  • Abducens nerve palsy
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11
Q

What is treatment for otitis media?

A

paracetamol if stable

If unstable or:
- <2 years old
- co-morbities
Amoxicillin

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12
Q

A complication of otitis media is intracerebral abscess, how is this identified and how is it scanned for?

A

CT with contrast

Ring enhanced lesion

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13
Q

What is the differential for pina cellulitis and how doe sit differ?

A

perichondritis
- infection of cartilage
- the lobe will be spared as no cartilage there.
much more serious and can lead to long term deformity cutting of blood supply to cartilage

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14
Q

What blood vessels make up Kiesselbach’s plexus in Littles area?

A

GASS

  • Greater palatine
  • Anterior ethmoid
  • Sphenopalatine
  • Superior labial
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15
Q

If there is a posterior nose bleed, which artery is it most likely to be?

A

Sphenopalatine

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16
Q

What would you expect to see on a tympanogram with someone with a grommet or perforated ear drum? and what about with a middle ear effusion?

A

High volume
- Type B

Type B
- Low volume

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17
Q

What does a type C tympanogram suggest?

A

Eustachian tube dysfunction

*tympanogram still has a small peak but is pulled more to the left showing it is negative and thus.

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18
Q

What is the underlying pathology of otosclerosis?

A

Abnormal bone formation around stapes leading to its fixation

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19
Q

What is the definition of tinnitus and how is it differentiated from an auditory hallucination?

A

Sound perceived for >5mins in the absence of any external acoustical or electrical stimulus. and does not occur after loud noise.

differentiated from hallucination as it has no organised content. i.e. voice

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20
Q

Define objective and subjective tinnitus:

A

Objective is when both patient and practitioner can hear the tinnitus.

  • usually vascular pathology
  • hyperdynamic states
  • myoclonus of the middle ear muscles

Subjective is when only the patient can hear the tinnitus

  • meiners
  • presbycusis
  • ototoxic drugs
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21
Q

When should tinnitus be referred?

A

Pulsatile tinnitus
- CT angio

Unilateral
- MRI head

Focal neurology

Asymmetric hearing loss
- MRI head

22
Q

What may present with tinnitus, pulsatile mass and hypertension?

A

Glomus tumours

- paragangliomas in middle ear usually of carotid decent which can release catecholamines

23
Q

Name a risk factor for more intrusive tinnitus:

A

Depression

24
Q

List the symptoms of allergic rhinitis and describe what may be seen on nasoscopy:

A

Itchy eyes
Blocked nose
Runny nose
Sneezing

Pale large Turbinates

25
Q

In allergic rhinitis what medication is recommend when there is also asthma and what other circumstances is this medication useful?

A

Leukotriene receptor antagonists

Useful in:

  • exercise induced
  • Aspirin
26
Q

What are the causes of non- allergic rhinitis? and what is the treatment?

A

Air pollutants
Smoke
Odours
Food

Saline douche

27
Q

In nasal trauma what should you inspect for and when is imaging required?

A

Bilateral/ unilateral ecchymosis
Swelling over nasal bridge (develops within 2 hours)
Visible deformity

Anterior Rhinoscopy:

  • Epistaxis
  • septal deviation
  • Septal haematoma (requires immediate ENT)

Imaging:
- maxilla or skull fracture suspected

28
Q

What is the management of a septal haematoma?

A

Incision and drainage

Antibiotics

29
Q

How many days following a nasal fracture should an ENT assessment take place?
When is the window for manipulation if needed?
and what i sthe surgery done if manipulation is unsuccessful and when?

A

5-7 days

7-21days - ideally within 14 days

Septorhinoplasty
- >6 months following initial injury

30
Q

What investigations are wanted into laryngeal carcinoma?

A

Nasoendoscopy

FNA
- including cervical lymph nodes

Imaging - CT

31
Q

Name two universal newborn hearing screening methods that can be conducted:

A

otoacoustic Emissions

  • usually done first. Listening to outer hair cells for click of noise back
  • conducted in the first three months

Audiological Brainstem responses
- Headphones on and monitoring for response

32
Q

What imaging is used for rhinosinusitis and when is it implemented?

A

CT paranasal sinuses
- usually used for planning for surgery

When chronic or recurrent acute sinusitis

33
Q

What differentiates acute and chronic rhinosinusitis?

A

Acute: <12 weeks
- most commonly due to cold

Chronic >4 episodes throughout the year

34
Q

What investigations should be done into a child with hearing loss?

A

Audiometry

Tympanometry
- to assess for glue ear

Otoscopy

35
Q

What is the management of glue ear?

A

Chronic otitis media with effusion in children requires:

  • grommets
  • hearing aid
36
Q

What are the symptoms suggestive of bacterial rhinosinusitis?

A 
Discoloured discharge 
Fever 
Severe pain 
Elevated CRP 
Double sickening
37
Q

What are the complications of bacterial rhinosinusitis?

A

Orbital cellulitis / Abscess

Meningitis

Cerebral abscess

Osteomylitis

Pott’s puffy tumour
- subperiosteal abscess arising from osteomyelitis

38
Q

What are the causes of otitis externa and what is the most common organism?

A

Swimming
Hearing aid
Finger picking
Lack of wax

Pseudomonas is most common, followed by Staph

39
Q

What are the core symptoms of malignant otitis externa?

A

Severe otalgia
- worse at night

Continual discharge/ Copious otorrhea

Granulation tissue within the ear drum

40
Q

What are the signs of TMJ dysfunction?

A

Pain on lateral movement of jaw

Signs of bruxism

Earache
- this is via the auriculotemporal nerve

Facial pain

41
Q

What are the most common causes of Ottis media?

A

Pneumococcus

Haemophilus Influenza

42
Q

How does otitis media with effusion/ glue ear, usually present and what may be seen on examination and what examinations can be conducted:

A

Inattention
Poor speech development
Hearing impairment

Examination:

  • retraction of the ear drum
  • loss of light reflex

Investigations:

  • Audiogram
  • Tympanogram (will be flat due to pressure within the middle ear restricting the amount of response of the tympanic membrane)
43
Q

What are some of the causes of a type B tympanogram?

A

Otitis media with effusion

Perforation/ grommet in situ

Otosclerosis

Cholesteatoma

44
Q

Highlight the common causes of hearing loss in an adult:

A 
Conductive: 
External meatus obstruction: 
- wax 
- pus 
- foreign body

TM dysfunction:

  • Infection
  • trauma

Ossicles defects:

  • otosclerosis
  • infection
  • trauma

Sensorineural:
Drugs:
- gent
- Vancomycin

Post infective:

  • mumps
  • measles
  • meningitis

Neuro:

  • Meniere’s disease
  • acoustic neuroma
  • MS
45
Q

List some congenital causes of SNHL in children:

A

Waardenburg’s syndrome

  • Hetrochromia
  • telecanthus
  • AD

Alport’s syndrome

  • Haematuria
  • AR

Congenital Rubella

46
Q

What are the causes of bacterial sinusitis?

A

Bacterial infection secondary to viral infection

  • most common cause
  • double sick sign

Dental root infections

Direct contact with pathogens
- swimming

Anatomical susceptible
- deviated septum

Systemic disease
- primary ciliary dyskinesia

47
Q

in recurrent sinusitis, what investigations should be done and what is usually the treatment?

A

Further investigations into the cause should be undertaken.
typically it is due to anatomical defects.

Investigations:

  • flexible nasal endoscopy
  • CT head and sinus

Treatment may include:
- functional endoscopic sinus surgery

48
Q

What are the core symptoms of acute bacterial sinusitis?

A 
Discoloured discharge 
Severe localised facial pain 
Pyrexia 
Raised CRP 
Prior viral infection
49
Q

What are the symptoms of nasal polyps and how would you distinguish them from swollen turbinate’s? and what is the investigations that should be undertaken into a single nasal polyp?

A 
Watery Rhinorrhoea 
Sneezing 
Nasal obstuction 
Mouth breathing 
Snoring

Differentiate because they are:

  • pale
  • mobile
  • non tender when gentle palpation

Single:
- referral for endoscopy and biopsy to assess for malignancy

50
Q

List some causes to epistaxis:

A

Local causes:

  • idiopathic
  • Trauma - nose picking
  • Neoplasm
  • bleeding polyp

Systemic:

  • bleeding disorder - Primary haemostatic bleeding disorders (platelets)
  • hypertension
  • leukaemia - pancytopenia
51
Q

What is the secondary haemorrhage of tonsillectomy and what is the management?

A

Bleeding >24 hours. usually in the 5-10day mark.

Medical Emergancy:

  • contact anaesthetist
  • contact ENT
  • IV access
  • Cross match/ bloods

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