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Specialties > ENT > Flashcards

ENT Flashcards

1
Q

What is the definition of tonsillitis?

A

Sore throat + lymphadenopathy

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2
Q

What is the main cause of tonsillitis?

A

Group A streps

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3
Q

What criteria should be present to give patients with tonsillitis antibiotics?

A

Centor criteria:

pyrexia, pus on tonsils, no cough, cervical adenopathy

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4
Q

What are the complications of tonsillitis?

A

Retrophayngeal abscess -
rare, in children typically has extended stiff neck, refuses to eat and drink. the lateral xray shows soft tissue swelling.

Peritonsillar abscess (quinsy) - 
sore throat, dysphagia, peri tonsillar bulge, uvular dieviation, trismus (reduced mouth opening), muffled voice. Needs antibiotics and draining

Parapharyngeal and hypopharyngeal abscesses -
only need medical therapy

Lemierre’s syndrome -
Pharyngotonsillitis, internal jugular vein thrombophlebitis + septic emboli (lungs, bone, muscle, kidney, liver etc).
Caused by Fusobacterium necrophorum

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5
Q

What are the criteria for a tonsillectomy?

A

Sore throats that are actually due to tonsillitis
5+ episodes in a year
Symptoms for at lest a year

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6
Q

What are the complications of a tonsillectomy?

A

Bleeding - primary may need to return theatre, secondary due to infection.
Damage to teeth, TMJ, an posterior pharynegeal wall

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7
Q

What are some differentials for tonsillitis?

A 
Peritonsillitis, 
Parhyngitits/ Parapharyngeal abscess
Dental infection 
Infective mononucleosis 
Lymphoma 
Internal carotid artery aneurysm 
Salivary gland mass
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8
Q

How can epistaxis be classified?

A

Anterior or posterior

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9
Q

What is Little’s area?

A

Where a network of blood vessels are found (the Kiesselbach’s plexus) on the anterior portion of the nasal septum - it is the commonest site of bleeding in the anterior nasal cavity.
Feeds vessels from the superior labial, greater palatine and anterior ethmoid arteries.

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10
Q

Which blood vessels bleed in posterior epistaxis?

A

Branches of the sphenopalatine artery

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11
Q

What are the causes of epistaxis?

A 
Local:
idiopathic
local trauma - nose picking, #
iatrogenic - NG tube, 
Infection 
Neoplasia 
septal perforation or deviation 
vascular abnormalities 
foreign body 
irritants

Systemic:
HTN
bleeding disorders - haemophilia, platelet dysfunction,
leukaemia
liver disease
medications - NSAIDs, aspirin, heparin, warfarin

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12
Q

What medications are used to stop epistaxis?

A

Lidocaine
Phenyleprine - vasoconstrictor
Silver nitrate - cauterizes

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13
Q

What is the definition of stridor?

A

The noise heard in INSPIRATION due to partial obstruction at the larynx or large airways

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14
Q

What are the causes of stridor?

A

Congenital:
Laryngmalacia (85% resolve by 2yrs)
Web/ stenosis
Vascular rings

Inflammation:
Laryngitis
Epiglottitis 
Laryngotracheobronchtis (croup)
Anaphylaxis

Tumours:
Haemangiomas or papillomas

Trauma

Other:
Foreign body
Compression (thyroid disease)
Vocal cord palsy

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15
Q

What are the most common organisms responsible for Croup?

A

Parainfulenza virus

Bacteria are rare

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16
Q

What organism is responsible for acute epiglottitis?

A

Haemophilus inluenzae B
Strep pyogenes

MUST NOT EXAMINE THROAT IF SUSPECTING AS IT MAY CLOSE UP COMPLETELY

17
Q

What is the course of the facial nerve?

A

Arises in medulla, emerges between pons and medulla, the then passes through the posterior fossa and runs through the middle ear before emerging from the stylomastoid foramen to pass into the parotid.

18
Q

What are the causes of facial nerve palsy?

A

Intracranial:
Brain stem tumour (UMN), strokes (UMN), polio (UMN), MS (UMN), cerebellopontin angle lesions (acoustic neuroma LMN)

Intratemporal (LMN):
Otitis media, Ramsey Hunt syndrome (herpes of facial n), cholesteatoma

Infratemporal (LMN):
Parotid tumours, trauma

Others (LMN):
Lymes disease, sarcoid, Guillain - Barre, diabetes, Bell’s Palsy.

19
Q

How can you tell the difference between UMN and LMN lesions?

A

LMN lesions will cause paralysis of one side of the face

UMN lesions will cause paralysis of one side of the face but the forehead will be spared.

20
Q

What is the prognosis of Bell’s Palsy?

A

1/3 recover
1/3 incomplete recovery of facial motor function
rest have permanent neurological and cosmetic abnormalities

21
Q

When taking a brief history before examining a neck what questions are important to ask?

A

Pain
Hoarseness
Swallowing problems
Neck swelling

22
Q

When taking a brief history before examining the nose what questions are important to ask?

A 
Obstruction 
Discharge 
Pain 
Bleeding 
Sense of smell
23
Q

When taking a brief history before examining the ears what questions are important to ask?

A 
Pain 
Discharge 
Hearing loss
Tinnitus 
Vertigo
24
Q

What are the two scars to look out for around the ear?

A

Endural and postaural - very difficult to see as they heal really well

25
Q

What tuning forks do you use for the weber or rinnes test?

A

256 or 512 hz

26
Q

Explain webers test…

A

Strike tuning fork on your elbow
Place on a midline bony prominence - forehead
Ask patient which ear they hear it loudest in

It lateralises towards a conductive hearing loss of >15 dB
It lateralises away from a sensorineural hearing loss

27
Q

Explain the Rinne test

A

Test each ear individually
Ask patient to compare loudness of tuning fork placed on mastoid process vs 2cm from external auditory meatus.

Rinne positive test = normal (or sensorineural loss where webers lateralised away from that ear). Air conduction is better than bone conduction

Rinne negative = abnormal. Bone conduction is better than air. Conductive hearing loss >20dB

28
Q

What are the complications of acute otitis media?

A 
Extra cranial 
Perforated tympanic membrane
Labyrinthitis 
Mastoiditis - most common and most important. Give a protruding ear. Needs surgery if abscess (grommet insertion, drainage of abscess and then drill out the infected bone) 
Facial paralysis 
Neck abscess

Intra cranial
Cerebral abscess, subdural abscess, venous sinus thrombosis

29
Q

What are the causes of hearing loss?

A 
Conductive:
Wax impaction (has to be ++ wax so don't assume its just wax) 
Otitis media with effusion 
Perforation 
Cholesteatoma 
Ossicular abnormality 
Sensory neural:
Congential 
Presbyacuis
Drugs 
Tumours 
Autoimmune conditions
30
Q

What is an exostoses?

A

Smooth bilateral swellings of the boney canals. Only a problem if they are encrouchig on the lumen of the ear canal causing a build up of wax and skin etc

31
Q

What is cholesteatoma?

A

A serious condition like chronic otitis media. It is a locally destructive process around the pars flaccida. There is crusting and white debris in the attic of the ear. Can result in hearing loss

32
Q

What do bubbles behind the ear drum signify?

A

Glue ear - otitis media with effusion.

33
Q

How is otoscerlosis inherited?

A

Autosomal dominant with incomplete penetrance.

Vascular spongy bone replaces the normal bone that fixes the stapes footplate.

34
Q

What are the causes of tinnitus?

A

Hearing loss, presbyacusis, noise induced, head injury, otosclerosis, Meniere’s
HTN, anaemia, heart failure
Asprin, loop duiretics, aminoglycosides, quinine, alcohol excess,

35
Q

What are the symptoms associated with acoustic neuroma?

A

Progressive ipsilateral tinnitus, sensorineural deafness

Cerebellar signs, trigeminal compression leading to numb face.

36
Q

What are the causes of vertigo?

A 
Peripheral -
Menieres disease
Benign positional vertigo 
Vestibular failure 
Labyrinthitis 
Cholesteatoma 
Central-
Acoustic neuroma 
MS
Head injury 
Inner ear syphilis 
Vertebrobasilar insuffiencey 
Drugs- 
Gent
Duiretics 
Co trimoxazole 
Metronidazole
37
Q

What is Menieres disease?

A

Dilatiation of the endolymphatic spaces of the membranous labyrinth causing vertigo for >12hrs with prostation, N+V, tinnitus and sensory neural deafness

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