ENT Flashcards
What is the shared function of the tensor tympani and stapedius?
Which is more effective?
Both increase the stiffness of the ossicular chain in response to loud noises
The stapedius is more effective
What is located at the apical end of hair cells?
A bundle of sensory hairs called stereocilia
What is located adjacent to the tallest of each stereocilial bundle?
A single kinocilium
What is meant by the term morphological polarization?
The orientation of hair cells with respect to the kinocilium
What is the mechanoreceptor for hearing?
The hair cell
When does depolarization occur in the cochlea?
Depolarization occurs when hairs are deflected towards the kinocilium
When does hyperpolarization occur in the cochlea?
Hyperpolarization occurs when hairs are deflected away from the kinocilium
What does depolarization of the hair cells result in?
Increased firing of the fiber
What does hyperpolarization of the hair cells result in?
Cessation of firing
What are the three layers of the cochlea?
Scala vestibuli
Scala media
Scala tympani
What separates perilymphatic space from endolymphatic space?
Reissner’s membrane
How does the bony cochlea and basilar membrane change as the apex of the cochlea is reached?
Bony cochlea becomes narrower
Basilar membrane becomes progressively wider
How do the fibres compare at the base of the cochlea compared to apex?
At the base they are short and stiff - vibrate in accordance to high pitch sound
At the apex they are longer and looser- vibrate in accordance with lower pitch sound
What determines the volume of the sound perceived by the brain?
Hair cells being moved more, which generated more APs
What is the function of the utricle, saccule and semicircular canals?
Utricle and saccule sense linear acceleration of head tilt
Semicircular canals sense angular acceleration
What are the swelling at the ends of semicircular canals called?
What lies within these?
Ampullae
Within these are the sense organs called crista
What are the hair cells embedded in in the crista?
A gelatinous mass called the cupula
What stimulates movement of hair cells in the semicircular canals?
Fluid inertia during angular acceleration results in displacement of the cupula and bending of the sensory hairs
What are the otolith organs and what do they sense?
Utricle and saccule
Linear acceleration
What are the sense organs within the utricle and saccule called?
Maculae
What covers the maculae in the utricle and saccule?
Gelatinous mass called the otolithic membrane - contains secretions of calcium carbonate called otoconia and
What direction are stereocilia orientated in the otolith organs?
All directions
What can BPPV be confused with?
Vertebrobasilar insufficiency - would get more neuro symptoms in this e.g. weakness, numbness
What should you tell a patient with BPPV to do at night?
Have an extra pillow or two
Difference between vestibular neuronitis and labyrinthitis?
Labyrinthitis has associated hearing loss/tinnitus
What causes Meniere’s?
Increased pressure in endolymph - to do with salt balance
Low frequency hearing loss with bone conduction the same as air (i.e. sensorineural) = ?
Meniere’s disease
What is the most common auditory symptom in migraine associated vertigo?
Photophobia
Most common type of head and neck cancer?
Squamous
Which virus is associated with nasopharyngeal cancer?
Epstein-Barr virus
Which virus is associated with oropharyngeal carcinoma in young women?
Human papilloma virus
List the centor criteria
Temperature >38 Absence of cough Swollen anterior lymph nodes Tonsillar swelling or exudates Age <14 add one point Age >44 minus one point
What is malignant otitis?
Main symptom?
Extension of otitis externa into mastoid + temporal bone
Fatal without treatment
Pain + headache more severe than clinical signs would suggest?
Most common cause of malignant otitis?
Pseudomonas aeruginosa
Organism in mono?
Epstein-Barr virus
Vesicles/ulcers on the soft palate = ?
Organism?
Herpangia
Coxsackie virus
Treatment of cold sore?
Aciclovir
Which organism causes stomatitis in children?
Herpes simplex virus type 1
What is herpetic whitlow?
Abscess on end of finger caused by infection with HSV1 or HSV2
Organism in hand, foot and mouth disease?
Coxsackie virus
Recurrent mouth ulceration with inflammatory halo = ?
Aphthous ulcers
Recurrent oral and genital ulcers, uveitis, associated with Asia = ?
Behcets disease
What is Chancre?
Primary syphilis - caused by bacterium Treponema palladium
What should you ask about in the history of otitis externa?
Skin diseases e.g. eczema
What is furunculosis?
Very painful staphylococcal abscess arising from a hair follicle within the canal
Halo sign on filter paper or increased glucose or B2 transferrin = ?
CSF otorrhoea
What usually precedes AOM?
Viral UTI
What is mastoiditis?
Signs?
Treatment?
Middle ear inflammation leads to destruction of air cells in the mastoid bone +/- abscess formation
Swelling and redness behind the pinna, protruding auricle
IV antibiotics, myringotomy +/- definitive mastoidectomy
What does the tympanic membrane look like in OME?
Retracted or bulging drum
Fluid level present
If bilateral OME is confirmed, how long should you wait before checking up on the patient?
3 months
When should you consider grommet insertion in OME?
> 3/12 bilateral OME +
CHL >25dB in good ear +
Speech/language problems or developmental problems
What should you do if grommets don’t work?
Adenoidectomy
What should you suspect in a chinese patient presenting with OME?
Nasopharyngeal carcinoma
What is chronic otitis media?
Treatment?
Perforation of the tympanic membrane which hasn’t healed
Myringoplasty
What is stridor?
High pitched inspiratory harsh noise due to turbulent airflow resulting from narrows laryngeal or tracheal airway
What is sertor?
Low pitched inspiratory snoring sound arising from nasopharyngeal airway i.e. above the larynx
What three things should you look at to assess airway?
Appearance
Work of breathing
Skin circulation
Which airway device should be used first line?
Endotracheal tube
Treatment of croup?
Single dose dexamethasone
What should you not do in epistaxis patients?
Sedate them
Which type of temporal bone # in frontal blow vs lateral blow?
Which type of deafness in each?
Lateral blow - longitudinal # - conduction deafness
Frontal blow - transverse # - sensorineural deafness
Treatment of sudden sensorineural hearing loss?
High dose steroids if presumed inflammatory cause
Histology of the throat?
True vocal cords are squamous, below that is respiratory
Chronic otitis media which smells bad = ?
Pseudomonas
Nasal polyp in a child = ?
CF
Which infection causes papillomatosis?
HPV types 6+11
Koilocytosis = ?
HPV infection
Benign salivary tumour in old man who smokes = ?
Warthin’s tumour
What is the frequency of tonsillitis that would indicate tonsillectomy?
Seven or more episodes in the last year
Five or more episodes in the last two years
Three or more episodes in the last three years
Rash on chest, axillae, behind ears 24-48h after sore throat + fever = ?
Organism?
Scarlet fever
Exotoxins from strep pyogenes (GABHS)
Treatment of acute rhinosinusitis?
Analgesics + decongestants
If persisting, add antibiotics
How does a polyp appear on rhinoscopy?
Pale, mobile, insensitive to gentle palpation
What should you do in unilateral polyp?
Urgent referral for biopsy
Treatment of nasal polyps?
Topical steroid drops to shrink them e.g. betametasone
What is choanal atresia?
Congenital blockage of one or both nasal passages by bone or tissue
Management of unilateral tinnitus?
MRI to exclude acoustic neuroma
Hearing loss in middle age, exacerbated by pregnancy = ?
Otosclerosis
Background noise masks the problem and actually improves hearing
Cahart’s notch on audiology = ?
Otosclerosis
Bilateral cookie bite loss on audiology = ?
Hereditary deafness
Discharge from ear + facial palsy = ?
Cholesteatoma that has eroded the bone overlying the facial nerv
Conductive hearing loss in both ears + normal tympanic membrane = ?
Otosclerosis
How can you test the semicircular canals?
Caloric testing
What do O, T and M stand for on hearing aids?
Off
Telephone
Microphone - general setting
What is the difference in action between warfarin and aspirin?
Warfarin stops the blood from clotting
Aspirin
What disease presents to ENT with nasal crusting?
GPA
Investigation for pleomorphic adenoma?
Fine needle aspiration cytology
Aetiology of Bell’s palsy?
Herpes virus infection
Nasal crusting + strong, foul smell = ?
Atrophic rhinitis
Associated with poor hygiene and malnutrition
