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ENT Flashcards

1
Q

Name 3 predisposing factors for perichondritis of the pinna

A

Acute otitis externa, piercing, haematoma

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2
Q

What bacterium is usually associated with perichonidritis of the pinna?

A

Staph aureus, pseudomonas aeruginosa

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3
Q

How do you treat otitis externa?

A

Topical ear drops (antibiotic + steroid) plus analgesia

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4
Q

What type of hearing loss is associated with chronic wax build up?

A

Conductive

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5
Q

Name 3 functions of ear wax

A

Waterproofing, assists cleaning, some pretections against insects/bacteria/fungi

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6
Q

Name the ossicles (lateral-> medial)

A

Malleus, incus, stapes

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7
Q

Who is usually affected by acute otitis media with effusion? How common?

A

Aged 2 and 5 yrs

15-40% point prevalence from infancy 5

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8
Q

What does acute otitis media with effusion look like otoscopically? Treatment?

A

Tympanic membrane dull/opaque, fluid bubbles may be seen behind it
Usually settles without intervention
Otherwise: antibiotics, steroids, decongestants, autoinflation, gromits

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9
Q

What is a cholesteatoma?

A

Squamous epithelium trapped in skull base, that can erode or destroy important structures within the temporal bone
Usually affects attic area

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10
Q

How does a cholesteatoma present?

A

Intermittent painless offensive othorhea, conductive hearing loss, dizziness

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11
Q

Treatment of cholesteatoma + risks

A

Surgery

Labyrinthine fistula, brain herniation, bleeding

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12
Q

Severe complications of chronic cholesteatoma

A

Sigmoid sinus thrombosis, epidural abscess, meningitis, long term vertigo

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13
Q

Give 2 ways perforation of the tympanic membrane presents

A

Audible whistling sounds during sneezing, otorrhea. If painful: cholestaetoma or infection

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14
Q

What surgery is used to treat a perforated tympanic membrane?

A

Fat plug tympanoplasty

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15
Q

What is tinnitus?

A

Perception of sound without stimulus

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16
Q

What is vertigo?

A

Sensation that the world is spinning.whirling

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17
Q

Give three ways in which an acoustic neuroma may present to an ENT surgeon

A

Facial nerve palsy, hearing loss, tinnitus, balance disturbance

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18
Q

What is the gold standard investigation for an acoustic neuroma?

A

Gadolinium enhanced MRI

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19
Q

What is Meniere’s?

A

Triad of symptoms

Vertigo, hearing loss, tinnitus

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20
Q

What is BPPV? Treatment?

A

Benign paroxysmal positional vertigo
Caused by a grain of calcium dislodged in the semicircular canal
Vertigo when they turn to a specific side in bed
Epley manoeuvre

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21
Q

What is an exostosis?

A

Bony outgrowths into the ear canal (eg surfer’s ear)

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22
Q

What should you worry about with excessive ear pain ?

A

Malignant otitis externa

Necrotic bony infection, seen in the immunocompromised

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23
Q

Treatment of labrinthitis

A

Exercise helps

Antiemetics only acute treatment

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24
Q

Why do the elderly present with dizziness?

A

Visual loss, poor muscle tone, vestibular degeneration, brain ischaemic changes, benzodiazepines. Give them exercise!

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25
What is Ramsay Hunt syndrome?
Herpes zoster infection Rash in ear canal or back of mouth Dizzy/deaf Early acyclovir
26
Between what frequencies is a pure tone audiogram commonly measured?
0-25db
27
What do circles and triangles mean on an audiogram?
Circles: air conduction Triangles: bone conduction
28
Masked bone conduction is represented how on an audiogram?
Filled in shapes
29
Name 3 investigative hearing tests
Pure tone audiogram Speech audiometry Acoustic reflex testing
30
What is the major cause of hearing loss in adults? What type of loss?
Age related hearing loss | Sloping loss of upper frequencies
31
5 categories of hearing ability
Normal, mild, moderate, severe, profound
32
Which side should an unmasked bone conduction test be on?
Doesn't matter | Skull is a fused bone so sound travels to both ears
33
What 3 things does a tympanogram measure?
Compliance of ear drum Volume of ear canal Middle ear pressure
34
4 causes of tinnitus?
Meniere's Damage to the inner canal Otosclerosis Salicylate poisoning
35
How do you test the hearing of an newborn and 18 months old?
Otoacoustic emissions at birth | Auditory brainstem response
36
4 roles of the nose
Humidify, warm and filter air Primary immune response (lysozyme/adenoid tonsils) Taste and smell To breathe
37
Name the 4 paranasal sinuses
Frontal Ethmoid Maxillary Sphenoid
38
Name the type of mucosa found in the paranasal sinuses
Ciliated pseudostratified columnar epithelium
39
How can you determine nasal air flow?
Metal tongue depressor under nose, breathe normally, comment on misting
40
Where do nose bleeds usually come from?
Little's area
41
Name 3 techniques for the management of epistaxis
Cauterisation (silver nitrate/diathermy/laser) Pressure on tip of nose Packing (nasal tampon/gauze) Endoscopic SPA ligation
42
Name the arteries that meet in Little's area
Sphenopalatine artery Posterior and anterior ethmoidal arteries Greater palatine Superior labial artery
43
What is loss of sense of small called?
Anosmia
44
4 common causes of anosmia
Polyps Trauma Cocaine abuse Old age
45
Unilateral foul nasal discharge in a child..
Is a foreign body until proved otherwise
46
Unilateral nasal discharge in an adult..
Foreign body, rhinolith, tumour
47
4 common aero-allergens associated with allergic rhinitis
Pollen, fungal spores, dog and cat fur, house dust mites
48
Treatment of allergic rhinitis
Avoidance of allergen Antihistamines Nasal douches
49
What is SMR?
Submucous resection of the septum
50
SMR vs septoplasty
SMR: older technique. Preserves bilateral mucoperichondrial flaps and cartilaginous supports. Septoplasty: correction of the deflected nasal septum, minimal removal of septal cartilage and/or bone
51
SMD?
Submucous diathermy of turbinates
52
What is a nasal polyp? Treatment?
Swelling of the lining of the nose, due to allergic inflammation. They contain inflammatory fluid and are non sensate. Nasal steroid spray
53
Unilateral nasal polyps are significant because..
Could be a tumour or foreign body
54
What is the triad that includes nasal polyps?
Rhinosinusitis, bronchial asthma and nasal polyps
55
What is the most common cause of obstructive sleep apnoea syndrome (OSAS) in children vs adults?
Children: Enlarged adenoids and tonsils Adults: Obesity
56
How do you investigate obstructive sleep apnoea? Treatment?
Polysomnography | Nasal CPAP at night for children. Lose weight and don't sleep on front in adults
57
Most common infective agent for epiglottitis?
Haemophilus influenza B (HiB) | Rare now due to HiB vaccine
58
Croup/laryngotracheal bronchitis infective agents
Parainfluenza 1/2/3 Adenovirus Respiratory syncytial virus
59
Treatment of epiglottitis?
Humidified oxygen, being ready to intubate or perform cricothyroidotomy if needed
60
Treatment of larynotracheal bronchitis
Corticosteroids and nebulised adrenaline, oxygenation and monitoring
61
Most common infective agent for tonsilitis
Group B haemolytic streptococcus pyogenes
62
How many episodes of tonsilitis is needed to warrant tonsilectomy?
7/1 year 5/2 consecutive years 3/ 3 consecutive years
63
What is quinsy? Treatment?
Peritonsillar abscess Aspiration, incision and drainage Antibiotics
64
Cause of glandular fever? Presentation?
EBV (epstein barr virus) | Lymphadenopathy, sore throat, pharyngitis, palatal petechiae, fungal looking tonsilitis
65
Where are the adenoids?
Above soft palate | Posterior wall of nasopharynx
66
What is stertor?
Noisy inspiration due to obstruction above the larynx
67
What is stridor?
Noise from obstruction at level of larynx | Can be inspiratory, expiratory & biphasic
68
3 signs associated with acute mastoiditis
Mastoid area erythema, proptosis of auricle, fever
69
4 aetiological agents in head and neck cancer
Sun damage Smoking Alcohol Betul chewing
70
What type of carcinoma is most common in head and neck malignancy?
SCC
71
Earliest sign of a laryngeal malignancy
Hoarse voice
72
Worrying clinical signs/symptoms in head and neck malignancy
Difficulty swallowing Hoarse voice Chronic mouth ulcer
73
3 indications for a tracheostomy
Emergency airway management ITU longterm ventilation Mass in larynx
74
Common types of tracheostomy tubes
Non fenestrated single cannula tube with cuff: acute. Dual cannula tube with cuff for chronic. Made of polyurethane/PVC
75
Where does the parotid gland open?
Inner surface of cheek, opposite second molar
76
Most common type of tumour affects the parotid gland
Pleomorphic adenoma
77
Complications of a parotidectomy
Facial nerve palsy | Salivary fistula
78
What nerves are at risk in a submandibulectomy
Hypoglossal, lingual, ansa cervicalis
79
8 differentials of a neck lump
Enlarged lymph node, cyst, tumour, lymphoma, lipoma, thyroid swelling, aneurysm, abscess
80
Gold standard for investigation of a neck lump
Ultrasound guided fine needle aspiration with cytology
81
Describe the external auditory canal
2.5cm long Outer 1/3 hairy, cartilage, secreted wax, non migratory Inner 2/3 migratory skin, bone, thin sensitive skin
82
How do you know which ear you are looking at?
The umbo is the foot, the lateral malleolar process is the knee of a man on a horse
83
2 parts of tympanic membrane
Pars tensa, pars flaccida
84
Name the 3 parts of the cochlear
Vestibular canal Cochlear duct Tympanic canal
85
What senses sound?
Hair cell displacement-> cochlear neurones/ganglia = organ of corti Tonotropic arrangement in cochlear
86
How do you differentiate between conductive/sensorineural hearing loss with tuning forks
Rinne test: mastoid and outside. Conductive hearing loss, bone conduction will be heard better. Weber test: Sensorineural, sounds is perceived in good ear. In conductive hearing loss sound will be perceived in the affected ear. (primed for sensation)
87
Whats the vestibule?
Saccule and utricle | Balance organs
88
Function of semicircular canal
Detects angular acceleration in 3 different planes
89
Function of labyrinth
Sense of position in space and change in position | Helps maintain gaze (gyroscopic stabilisation of vision)
90
What is oscilopsia?
The world moves as I walk | Like video camera footage
91
What forms the nasal septum?
``` Ethmoid Nasal bone Septal cartilage Maxilla Palatine bone Vomer ```
92
What can nasal sinusitis lead to in children
Periorbital cellulitis-> vision affected/ brain abscess
93
What is found in the sphenoid sinus?
Internal carotid artery Optic nerve Cavernous sinus CN II, IV, VI
94
Sinus functions
Vocal resonance Decreased skull weight Crumple zone to protect other structures
95
Name 2 ways of examining nose
Nasendoscope | Thudicum speculum
96
Name palpable neck anatomy
Hyoid bone Thyroid cartilage Cricoid cartilage Trachea
97
Where do you palpate lymph nodes
``` Cervical chain Occipital Posterior auricular Parotid Submandibular Posterior triangle Supraclavicular ```
98
Time frame for neck lump/voice change/dysphagia
4-6 weeks-> 2 week wait referral
99
Describe the ladder of reconstruction
* Secondary healing (secondary intention, esp scalp and floor of mouth) * Direct closure (crescent shape and suture) * Skin graft (using planer, from thigh) * Obturation and implants (eg for hard palate, must occlude hole) * Local flaps * Pedicled flaps (artery, vein and tissue supplied) * Free flaps (esp bone from fibula)
100
Biggest risk factor for oral cancer
HPV
101
Branches of facial nerve
``` Temporal Zygomatic Buccal Mandibular Cervical (posterior auricular) ```
102
What is the problem with a total thyroidectomy
``` Gets rid of parathyroid glands too Hypocalcaemia Spasms, twitching Cardiac arrest Bone weakness later ```
103
How do you tell that hearing loss of sensorineural on audiometry?
Same hearing loss with bone conduction as with air conduction
104
Name the branches of the external carotid
``` Some anatomists like freaking out poor medical students Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal ```
105
Give 3 causes of saddle nose deformity
Cauterisation of both sides of septum Cocaine abuse Granulomatous disease (wagner's) Trauma

Year 4 (9 decks)

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