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4MB Medicine > ENT > Flashcards

ENT Flashcards

1
Q

What is meant by conductive hearing loss?

A

Failure of sound to be conveyed from the external ear to the inner ear

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2
Q

List common aetiology for conductive hearing loss

A 
Wax
Foreign body
Otitis externa
Eardrum perforation
Ossicular damage (otosclerosis)
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3
Q

What is meant by sensorineural hearing loss?

A

Failure of sound to be transduced from inner ear

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4
Q

List common aetiology for sensorineural hearing loss

A

Congenital
Ageing (presbycusis)
Meniere’s disease
Vestibular schwannoma

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5
Q

A positive Rinne’s test is a normal finding. True/False?

A

True

Sound/vibration should be louder over the auditory canal compared to bone conduction

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6
Q

If sound localises to the affected ear in a Weber’s test, what type of hearing loss is this?

A

Conductive

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7
Q

If sound localises to the unaffected ear in a Weber’s test, what type of hearing loss is this?

A

Sensorineural

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8
Q

A patient with a +ve Rinne test in both ears and sound localising to the left ear on Weber’s test indicates what type of hearing loss?

A

Right sensorineural hearing loss

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9
Q

A patient with a +ve Rinne test in the right ear and sound localising to the left ear on Weber’s test indicates what type of hearing loss?

A

Left conductive hearing loss

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10
Q

Other than Rinne and Weber hearing tests, what other investigations could you do for hearing loss?

A

Pure tone audiometry
(child normal = 0-15dB, adult normal = 0-20dB)
Tympanogram measures middle ear pressure
(normal = bell-shaped curve)

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11
Q

What is otitis externa?

A

Inflammation of the skin of the ear canal/external ear

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12
Q

List aetiology/risk factors for otitis externa

A 
Moisture, humidity
Swimming
Trauma (scratching, cleaning)
Absence of wax
Narrow ear canal
Hearing aids
Pseudomonas, Staph aureus
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13
Q

List clinical features of otitis externa

A 
Severe pain, tender pinna and tragus
Auricular lymphadenopathy
Minimal discharge/debris
Swollen ear canal
Conductive hearing loss
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14
Q

Outline management of otitis externa

A

Aural toilet
Topical gentamicin + steroid drops
Strip of ribbon soaked in glycerine-ichthammol/aluminium acetate

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15
Q

What is barotrauma/aerotitis?

A

Occluded Eustachian tube does not allow middle ear pressure to equalise, particularly during aircraft descent or diving

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16
Q

List clinical features of aerotitis

A 
Severe pain as drum indraws
Bleeding
Vertigo
Tinnitus
Deafness
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17
Q

Outline management of aerotitis

A

Avoid flying with URTI
Nasal decongestants (xylometazoline)
Repeated yawns/swallows/jaw movements
Valsalva maneuvre

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18
Q

List clinical features of TMJ dysfunction

A

Earache
Facial pain
Joint clicking/popping
Stress, psychological impact

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19
Q

Outline management of TMJ dysfunction

A 
NSAID (diclofenac)
Orthodontic prostheses
Cognitive behavioural therapy
Physiotherapy
Acupuncture
Surgery
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20
Q

What is otitis media?

A

Inflammation of the middle ear cavity

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21
Q

List aetiology/risk factors for otitis media

A 
Children
Viral
Bacterial: H. influenzae, Pneumococcus, Moraxella
Blocking of Eustachian tube
Preceding URTI
Bottle feeding
Smoking/passive smoking
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22
Q

List clinical features of otitis media

A

Acute: rapid onset earache, fever, irritability, vomiting
Chronic: fluid discharge lasting several months
Purulent discharge
Crescendo-decrescendo otalgia
Tender mastoid
Conductive hearing loss

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23
Q

Describe the appearance of the tympanic membrane in otitis media

A

Bulging, opaque eardrum

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24
Q

Outline management of otitis media

A

NSAID

Amoxicillin for up to 10 days if unresolving

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25
What is cholesteatoma?
Presence of keratinising stratified squamous epithelium in the middle ear
26
List aetiology/risk factors for cholesteatoma
Congenital Eardrum perforation, retracted eardrum Down's syndrome Turner's syndrome
27
List clinical features of cholesteatoma
``` Foul-smelling discharge Deafness Headache Cheesy discharge Itch Tinnitus Vertigo Facial paralysis, meningitis (indicates cerebral infiltration) ```
28
Outline management of cholesteatoma
Surgical excision | Good ear hygiene
29
What is otitis media with effusion/glue ear?
Fluid in the middle ear cavity due to Eustachian tube dysfunction or maldevelopment
30
List aetiology/risk factors for glue ear
``` URTI Oversized adenoids Narrow nasopharynx Boys Atopy Down's syndrome Cleft palate Passive smoking ```
31
List clinical features of glue ear
``` Conductive hearing loss Impact on learning and development Exudate Tinnitus Irritability ```
32
What would the eardrum look like in glue ear?
May be retracted or bulging Bubbles/fluid level seen Reduced drum mobility
33
Outline management of glue ear
Monitor for up to 3 months Oral/topical steroid Grommet insertion +/- adenoidectomy
34
What is tinnitus?
Sensation of ringing/buzzing in the ear due to altered central processing and/or nerve damage
35
List aetiology/risk factors for tinnitus
``` Any ear disease Presbycusis Noise-induced Trauma Otosclerosis Meniere's disease CVS disease Psych disturbance Alcoholism Drugs (aspirin, loop diuretics, metformin, quinine) ```
36
If someone presents with unilateral tinnitus, what scan must you do?
MRI to exclude schwannoma
37
Outline management of tinnitus
``` Mainly supportive Hearing aids Cognitive behavioural therapy Tinnitus training/counselling Hypnotics, melatonin Baclofen ```
38
List aetiology/risk factors for vertigo
``` Meniere's disease BPPV Vestibular failure/insufficiency/neuritis Labyrinthitis Acoustic neuroma Multiple sclerosis Head injury Trauma Drugs (gentamicin, diuretics, co-trimoxazole, metronidazole) ```
39
What is benign paroxysmal positional vertigo (BPPV)?
Displacement of otoconia in (posterior) semicircular canal causes transient dizziness
40
List aetiology/risk factors for BPPV
``` Idiopathic Middle ear disease Head injury Otosclerosis Viral disease ```
41
List clinical features of BPPV
Dizziness upon sudden rotational movement Lasts up to 30 seconds May feel nauseous Nystagmus on Hallpike test
42
Outline management of BPPV
Epley manoeuvre Self-limiting Physiotherapy, Brandt-Dorff exercise Reduce alcohol intake
43
What is Meniere's disease?
Dilation of endolymphatic spaces of the membranous labyrinth causes attacks of dizziness
44
List clinical features of Meniere's disease
``` Unpredictable vertigo Attacks in clusters May last up to 12 hours Nausea, vomiting Feeling of fullness in the ear Bilateral tinnitus Sensorineural hearing loss ```
45
Outline management of Meniere's disease
``` Acute: cyclizine, Betahistine, cinnarizine Gentamicin grommet Reduce salt and caffeine Operative decompression, labyrinthectomy ```
46
Which type of infection in particular does vestibular neuritis usually follow from?
Herpes simplex type 1
47
List clinical features of vestibular neuritis
Sudden vertigo Vomiting May last days Deafness if labyrinthitis
48
Outline management of vestibular neuritis
Cyclizine Usually improves within days/weeks Methylprednisolone may help
49
What is acoustic neuroma/vestibular schwannoma?
Slow-growing benign tumour of CN VIII vestibular branch, usually found at the cerebellopontine angle
50
List clinical features of acoustic neuroma
Progressive ipsilateral tinnitus Sensorineural hearing loss Facial numbness, pain
51
What condition should be suspected in a child presenting with bilateral sensorineural hearing loss?
Neurofibromatosis type 2
52
List common aetiology/risk factors for chronic nasal obstruction in children
``` Large adenoids Rhinitis Choanal atresia Postnasal space tumour Foreign body ```
53
List common aetiology/risk factors for chronic nasal obstruction in adults
``` Deflected nasal septum Rhinitis Polyps Sinusitis Granuloma (TB, vasculitis, syphilis) Tricyclic use ```
54
When should you refer someone urgently for suspected nasal obstruction?
Unilateral Foul smelling/bloody discharge Numbness Tooth loss
55
Outline management of non-allergic rhinitis
Ipratropium nasal spray Cautery Surgical reduction of inferior turbinates
56
What is the pathophysiology of allergic rhinitis?
IgE mediated inflammation triggered by allergen in nasal mucosa, resulting in mast cell degranulation and release of histamine and inflammatory mediators
57
List clinical features of allergic rhinitis
``` Nasal irritation Rhinhorrhoea Sneezing Itch Soft-palate irritation Swollen turbinates Pale mucosa Nasal polyps ```
58
What investigations would you do for allergic rhinitis?
Skin tests | RAST test for specific IgE
59
Outline management of allergic rhinitis
Antihistamines Topical steroid (fluticasone propionate) CysLT antagonist (montelukast) Mast cell stabiliser (cromoglicate)
60
The maxillary sinus drains into which nasal meatus?
Middle meatus
61
The anterior ethmoidal sinus drains into which nasal meatus?
Middle meatus
62
The middle ethmoidal sinus drains into which nasal meatus?
Middle meatus
63
The posterior ethmoidal sinus drains into which nasal meatus?
Superior meatus
64
The sphenoidal sinus drains where?
Sphenoethmoidal recess
65
The frontal sinus drains into which nasal meatus?
Middle meatus
66
List aetiology/risk factors for sinusitis
``` Viral leading to bacterial infection Pseudomonas, H. influenzae Drainage problems Dental root infection Swimming in infected water Anatomic susceptibility (septal deviation, prominent uncinate) Polyps Kartagener's syndrome Immunodeficiency ```
67
List clinical features of sinusitis
``` Pain over sinuses, worse on bending Tender face Purulent rhinorrhoea Nasal congestion Fever Anosmia Sensation of a bad smell ```
68
What investigation would you do for sinusitis?
Rigid endoscopy + CT
69
Outline management of sinusitis
Acute: self-limiting, bed rest, nasal decongestant Co-amoxiclav, topical steroid if beyond 5 days Chronc: FESS drainage if failed medical management
70
What are nasal polyps?
Sinus inflammation and oedema causes mucosal prolapse, consisting of ciliated columnar epithelium with a thickened basement membrane
71
List aetiology/risk factors for nasal polyps
``` Rhinitis Chronic sinusitis Cystic fibrosis Aspirin therapy Asthma ```
72
List clinical features of nasal polyps
``` Watery rhinorrhoea Glistening swelling Non-tender Anosmia Snoring Gentle palpation shows insensitive and mobile mass ```
73
Outline management of nasal polyps
Intranasal steroid Short course oral prednisolone Endoscopic polypectomy
74
List clinical features of a fractured nose
``` Epistaxis Rhinorrhoea Pain Loss of consciousness Diplopia if orbital floor involvement "steps" felt on palpation Exclude haematoma (boggy swelling) ```
75
Outline management of fractured nose
Evacuate under GA and pack if haematoma Co-amoxiclav Fracture reduction and splintage within 2 weeks Nose counselling
76
How does CSF rhinorrhoea arise?
Fracture through the roof of the ethymoid labyrinth disrupts meninges, causing CSF leak
77
What investigation would you do for CSF rhinorrhoea?
Nasal discharge tests +ve for glucose B-transferrin in CSF immunoelectrophoresis
78
List aetiology/risk factors for epistaxis
``` Trauma Local infection Blood dyscrasias (reduced haemostasis) Haemophilia Alcoholism Septal perforation Neoplasm Cold weather NSAIDs, anticoagulants ```
79
Which area on the nose is a frequent site of haemorrhage?
Little's area, formed by anastomosis of anterior ethmoidal, sphenopalatine and facial arteries
80
Outline first aid measures for epistaxis
``` Sit up Keep head straight/tilted DOWN Firm pressure on cartilaginous septum for 15 mins ABCDE approach Suction may be required ```
81
Outline definitive management for epistaxis
Remove clot with suction/blow nose Ice pack Gauze soaked in xylometazoline and lidocaine Silver nitrate cautery for obvious anterior bleed Nasal tampons/rhino packs if persistent
82
List post-epistaxis advice for patients
``` Don't pick nose Sit upright, keep out of sun Avoid bending/lifting/straining Sneeze through mouth No hot food or drink No alcohol or tobacco ```
83
List aetiology/risk factors for tonsillitis
Viral (EBV, influenza, rhinovirus, adenovirus) | Bacterial (Group A Strep, Staph, Moraxella, Chlamydia, Mycoplasma)
84
List clinical features of tonsillitis
``` Sore throat Lymphadenopathy Malaise Systemic upset Odynophagia ```
85
What is the Centor criteria for tonsillitis/bacterial sore throat?
``` Cough absent (1) Exudate (1) Nodes enlarged (1) Temperature (1) OR (young (1) OR old (-1)) -1 to 1: no antibiotic or culture 2-3: culture and treat if +ve 4+: rapid test and treat ```
86
Outline management of tonsillitis
Bed rest Analgesia (paracetamol) Difflam gargle Fluids Penicillin/clarithromycin (NOT amoxicillin) Tonsillectomy if recurrent over years + well-documented, usually if 5+ episodes a year or disabling or chronic over 3 months
87
What is quinsy?
Potentially life-threatening complication of tonsillitis where infection moves outside the tonsillar capsule
88
List clinical features of quinsy
``` Odynophagia Unilateral throat pain Trismus Reduced concavity of palate Displacement of uvula to contralateral side Hot potato voide Unable to swallow saliva ```
89
Outline management of quinsy
Incise and aspirate under LA Penicillin Tonsillectomy
90
Which virus is the typical cause of glandular fever/infectious mononucleosis?
EBV
91
List clinical features of glandular fever
``` Tonsillitis Feel washed out Malaise Tonsillar enlargement Membranous exudate, "cheese on toast" appearance Lymphadenopathy ```
92
What investigations would you do for glandular fever?
+ve Monospot test +ve Paul-Bunnell test (Heterophile) antibody EBV IgM CRP less than 100
93
Outline management of glandular fever
Supportive care and symptom relief (pain relief) Penicillin may be used Systemic steroid if severe
94
What organism causes diphtheria?
Coynebacterium diphtheria
95
List clinical features of diphtheria
``` Tonsillitis Pharyngitis Grey-white pseudomembrane over the fauces Swollen bull neck Polyneuritis and shock may occur later Nasal discharge Excoriated upper lip Tachycardia (may indicate myocarditis) ```
96
What investigations would you do for diphtheria
Swab culture of pseudomembrane | PCR
97
Outline management of diphtheria
Antitoxin within 48h Benzylpenicillin/erythromycin Supportive treatment
98
What is stridor?
Noisy inspiration due to partial obstruction at larynx or distal large airways
99
List aetiology/risk factors for stridor
``` Congenital (laryngomalacia, laryngeal web/stenosis) Tumours Trauma Intubation Foreign body Cord paralysis Infection ```
100
Which organisms are the main cause of croup?
Mainly viral (parainfluenca) Klebsiella Diphtheria
101
List clinical features of croup
``` Stridor Barking cough Pulsus paradoxus Cyanosis Reduced cognition ```
102
Outline management of croup
Self-limiting Humidification, steam +/- antibiotics Admit if severe in children (antibiotics, humidified O2, nebulised adrenaline, dexamethasone)
103
Which organisms are the main causes of acute epiglottitis?
H. influenzae | Strep pyogenes
104
List clinical features of acute epiglottitis
``` Sore throat Fever Dyspnoea Neck tenderness Hoarseness Drooling Head tilted forward, tongue out May develop respiratory arrest ```
105
Outline management of acute epiglottitis
``` Manage in ITU, blood culture Ibuprofen Oxygen, nebulised adrenaline IV dexamethasone IV penicillin G + ceftriaxone Cricothyrotomy kit may be needed ```
106
List aetiology/risk factors for hoarseness
``` GORD Dysphagia Smoking Stress Excessive singing, voice overuse Vasculitis TB, syphilis Goitre Tumour (pancoast, larynx, thymus) Infection Myasthenia Acromegaly Laryngeal nerve palsy ```
107
List aetiology/risk factors for laryngeal nerve palsy
Cancer (laryngeal, thyroid, oesophageal, bronchial) Iatrogenic (intubation, thyroid/parathyroid surgery, oesophageal surgery) Polio Syringomyelia Tuberculosis Aortic aneurysm
108
Outline management of laryngeal nerve palsy
Contralateral cord may compensate in unilateral cases Bioplastique injections Thyroplasty Tracheostomy
109
Histologically, what are the typical types of nasopharyngeal cancer?
``` Squamous carcinoma Non squamous (angiofibromas, lymphoepitheliomas, lymphosarcoma) ```
110
List aetiology/risk factors for nasopharyngeal cancer
``` Abnormal HLA profiles EBV Tobacco Formaldehyde exposure Salted fish weaning early on 25% of all malignancies in China ```
111
List clinical features of nasopharyngeal cancer
``` Epistaxis Diplopia Conductive deafness Referred pain Nasal obstruction Neck lump ```
112
List clinical features of Bell's palsy
``` Mouth sag Dribbling Taste impairment Watering or dry eye Reduced facial expressions and movements ```
113
Outline management of Bell's palsy
``` Protect the eye Artificial tears for dryness Prednisolone Hooks/cheek plumpers Facial reanimation procedures ```
114
What is Ramsay Hunt syndrome?
Herpes zoster oticus affecting CN VII in the ear
115
List clinical features of Ramsay Hunt syndrome
``` Severe otalgia Zoster vesicles CN VII palsy Vertigo Sensorineural hearing loss ```
116
Outline management of Ramsay Hunt syndrome
Valaciclovir | Prednisolone
117
List the main neck lumps in the midline
Dermoid cyst Thyroglossal cyst Thyroid mass
118
List the main neck lumps in the anterior triangle
Lymphadenopathy Lymphoma Branchial cysts Cystic hygromas
119
List the main neck lumps in the posterior triangle
Lymphadenopathy Lymphoma Metastases Cervical rib
120
What investigations would you do for general neck lumps?
``` USS for consistency CT for defining anatomically CXR Virology, Mantoux Consider FNA Refer to ENT within 2 weeks if suspected malignancy ```
121
List the main pathologies to affect salivary glands
``` Infection Obstructing calculus Mumps Inflammation (parotitis) Tumours ```
122
80% of salivary gland tumours affect the parotids. True/False?
True
123
What investigations would you do for suspected salivary gland tumour?
FNA cytology Sialograms Biopsy
124
List aetiology/risk factors for xerostomia
``` Drugs (tricyclics, antipsychotics, hypnotics, B-blockers, diuretics) Mouth breathing Dehydration ENT radiotherapy SLE, Sjogren's, scleroderma Sarcoidosis HIV, AIDS ```
125
List clinical features of xerostomia
``` Dry, atrophic mucosa Fissuring Difficulty eating/speaking Struggle to wear dentures Reduced saliva Salivary gland swelling Dental caries Candida ```

4MB Medicine (19 decks)

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