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ENT Flashcards

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1
Q

which 5 medications can cause ototoxicity? (hearing and/or balance can be affected)

A 
quinine
gentamicin
furosemide
aspirin
some chemotherapy
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2
Q

what is presbycusis?

examinations + investigations?

A

age-related sensorineural hearing loss, usually of high-frequency sound

r+ w - weber’s (bone conduction) may lateralise to one side if sensorineural loss isn’t bilateral
otoscopy - rule out otosclerosis, cholesteatoma + conductive hearing loss
tympanometry - normal middle ear function with hearing loss (type A)
audiometry - bilateral sensorineural loss
bloods incl inflam markers + antibodies - normal

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3
Q

otosclerosis - what is it + who does it affect?

A

autosomal dominant (+ve FH)
replacement of normal bone by vascular spongy bone
2° to fixation of stapes in oval window
onset at 20-40 years

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4
Q

otosclerosis - features? management?

A

tinnitus
progressive conductive deafness
flamingo tinge to tympanic membrane in 10% - hyperaemia

hearing aid
stapedectomy + insertion of prosthesis

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5
Q

otitis media with effusion (glue ear) - what age does it affect + what problems can result? management?

A

peaks age 2

conductive hearing loss
balance problems
behavioural problems
SAL delay

TM dull + injected
no retraction/infection/perf

none if not problematic
problematic - grommets (temp hearing aids)

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6
Q

meniere’s - what is it? who does it affect? prognosis?

A

inner ear disorder of unknown cause, characterised by excess pressure + progressive dilatation of endolymphatic (fluid) system
middle-aged adults mainly but can be any age
resolves after 5-10 years but may leave hearing loss

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7
Q

what is an acoustic neuroma (vestibular schwannoma)? association?

A

benign tumour on trigeminal / facial / vestibulocochlear nerve

neurofibromatosis II

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8
Q

meniere’s - presentation? exam findings?

A

every few days, for mins-hours, pt will have vertigo, tinnitus + sensorineural hearing loss

aural fullness / roaring sound, nausea
usually unilateral

nystagmus
romberg’s sign
sensorineural loss

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9
Q

menieres - management (general + acute)

A

ENT assessment
inform DVLA - stop driving until symptoms controlled
prophylaxis: betahistine + vestibular rehab
acute: prochlorperazine (buccal / IM) ± admission

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10
Q

quinsy - management

A 
bleep ENT reg on call
analgesia
IV abx
needle aspiration or incision + drainage
difflam rinse
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11
Q

enlarged tonsils that meet in the midline, white film over them - what is it?

A

acute bacterial tonsillitis

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12
Q

main organism that causes acute tonsillitis?

A

streptococcus pyogenes (group A strep)

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13
Q

management of tonsillitis

A

analgesia
7-10d phenoxymethylpenicillin (erythro if allergic)
admit if can’t eat drink
screen infectious mononucleosis (mimics)

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14
Q

what pathogen is infectious mononucleosis caused by?

A

EBV

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15
Q

splenomegaly, pyrexia and throat symptoms - what is it?

A

infectious mononucleosis

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16
Q

what does monospot test for?

A

infectious mononucleosis

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17
Q

recurrent unilateral pain + swelling on eating - what is it? investigation + management?

A

salivary gland stone - usually submandibular

xray + sialography → surgical removal

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18
Q

sore throat - investigations?

A

CENTOR (3 of Cough absent, Exudate, Nodes, Temp)

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19
Q

rubbery, painless lymphadenopathy - what is it?

A

lymphoma

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20
Q

neck lump that moves up on swallowing

A

thyroid swelling

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21
Q

neck lump that moves up on tongue protrusion - what is it? what about if it hurts?

A

thyroglossal cyst

may hurt if infected

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22
Q

RHS - features

A 
ear pain
vertigo, tinnitus, deafness
vesicular rash around ear
facial nerve palsy
taste loss in anterior ⅔
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23
Q

RHS - management

A

oral acliclovir + high dose corticosteroids

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24
Q

otitis media - mgmt

A

if necessary, amoxicillin 5 days (macrolide if allergic)

eg systemically unwell, comorbidities, immunocompromise, perforation or discharge in canal

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25
nasal polyp - presentation
nasal obstruction sneezing + rhinorrhoea poor taste + smell
26
postnasal drip - presentation
excess mucus from nasal mucosa accumulates → chronic cough + bad breath
27
sensorineural loss on audiogram
air + bone impaired
28
conductive loss on audiogram
air impaired only
29
mixed hearing loss on audiogram
air + bone impaired but air oft worse than bone
30
acoustic neuroma - symptoms? investigation?
CN 8 - hearing loss, vertigo, tinnitus CN 5 - absent corneal reflex CN 7 - facial palsy MRI cerebellopontine angle
31
quinsy - what is it? features?
peritonsillar abscess - complication of tonsillitis unilateral tonsil swelling + pain, uvula deviated away trismus (diff opening mouth) reduced neck mobility fever
32
what is RHS?
reactivation of the varicella zoster virus in the geniculate ganglion of the facial nerve. LMN palsy.
33
BPPV - presentation? diagnosis + management? outlook?
sudden onset dizziness, vertigo ± nausea on moving head/eyes, lasts 10-20s dix-hallpike (head bent back 30° off bed → symptoms + nystagmus) usually resolves spontaneously in weeks-months epley helps 80% teach vestibular rehab exercises (eg brandt-daroff) betahistine is prescribed but little effect
34
cholesteatoma - what is it? RFs?
growth of squamous epithelium behind the TM. trapped within skull base + causes local destruction. may be congenital but usually caused by repeated middle ear infections. most common age 10-20. cleft palate = 100x RF
35
cholesteatoma - features? management?
intermittent, foul-smelling discharge not usually painful hearing ± balance loss, vertigo, FN palsy, CPA angle syndrome (depending on local invasion) otoscopy - 'attic crust' in uppermost part of TM perforated pars flaccida microsuction then inspection audiometry ENT referral - ?surgical removal eg mastoidectomy infected - topical abx + steroids
36
acute otitis externa - what is it? features?
inflammation of ear canal - boil causing: pain on moving pinna ± conductive deafness if ruptures - pus from ear otoscope - swollen, tender canal with debris
37
acute otitis externa - management
keep dry analgesia topical abx + steroid
38
chronic otitis externa - what is it? features?
chronic combined infection in external auditory meatus - usually staph + fungal chronic discharge
39
chronic otitis externa - management
cleansing of external ear | antifungal + antibacterial ear drops
40
acute suppurative otitis media - what is it? features?
viral middle ear effusions 2° to eustachian tube dysfunction usually in kids (rare in adults) may present as symptoms elsewhere eg vomiting severe pain ± fever ± discharge if TM rupture ear canal not inflamed
41
acute suppurative otitis media - management
not always needed | 5d amoxicillin
42
chronic suppurative otitis media - types?
with vs without cholestetoma, active vs inactive without: active mucosal perforation of pars tensa (below handle of malleus) allows infection to develop in ear with: active squamous results from cholesteatoma formation ± perforation of pars flaccida (above handle)?? inactive mucosal - dry perf of PT, no inflam inactive squamous - shallow self-cleansing, retracted TM
43
chronic suppurative otitis media without cholesteatoma - features?
infection comes and goes intermittent, non-offensive discharge perforated pars tensa white plaque in anterior TM
44
chronic suppurative otitis media without cholesteatoma - management?
microsuction then inspection infected - abx + steroid drops 7-10d keep dry myringoplasty (TM repair if) troublesome
45
acute otitis externa - complications
perichondritis (spread to cartilage) cellulitis (spread to skin) malignant otitis externa
46
perichondritis - what is it? management?
inflamed cartilage eg pinna (but not lobe) systemic illness external canal swollen painful IV abx microsuction ear topical abx + steroid drops via aural wick
47
malignant otitis externa - what is it? RFs?
pseudomonas infection progresses to bony ear canal + temporal bone osteomyelitis RF - immunocompromise / DM
48
cellulitis or perichondritis?
cellulitis - inflamed pinna + lobe | perichondritis - inflamed pinna only
49
acute otitis media - complications
mastoiditis
50
anterior epistaxis - what is it?
visible bleeding source | insult to capillary network that form Kiesselbach's Plexus
51
posterior epistaxis - what is it?
more profuse originate from deeper structures more common in older pts risk aspiration + airway compromise
52
epistaxis - management if pt is haem stable
avoid lying down unless faint sit forward + mouth open - decreases blood flow to nasopharynx, allows pt to spit any blood in mouth + reduces aspiration risk pinch soft area of nose for 15m+ + breathe through mouth ± naseptin (topical chlorhexidine + neomycin - antiseptic) - reduce crusting + vestibulitis risk - ask allergies ?admission if comorbidities, ?pathology or <2y (?leukaemia / haemophilia)
53
epistaxis - still bleeding after 15 min of pressure
cautery - if source visible + it's tolerated (not great in young kids) packing - if not admit + refer ENT
54
when should epistaxis be admitted?
post cautery/packing haem unstable unknown or posterior source
55
epistaxis - discharge counselling - what should pt avoid?
blowing + picking heavy lifting + exercise lying flat alcohol + hot drinks
56
sinusitis - presentation
facial fullness + tenderness | nasal discharge, pyrexia or post-nasal drip → cough
57
malignant otitis externa - features
``` reduced hearing ear canal full of debris + TM not visible severe pain temporal headaches purulent otorrhoea ± dysphagia, hoarseness, FN dysfunction ```
58
malignant otitis externa - investigations + management
swab + topical abx 6wk IV abx monitor CRP CT or MR skull base
59
mastoiditis - features
``` fever + unwell severe otalgia, oft behind ear hx recurrent otitis media mastoid tenderness + inflammation forward protrusion of external ear discharge if perf ```
60
nasal polyps - RFs
asthma CF churg-strauss (eGPA)
61
nasal polyps - red flags
unilateral symptoms | bleeding
62
nasal polyps - management
ENT assessment | topical corticosteroids - shrink 80%
63
bleeding post-tonsillectomy - management
primary - <24h: immediate return to theatre secondary haemorrhage - >24h: likely due to infection admit + abx
64
sinusitis - RFs
nasal obstruction - septal deviation, polyps recent local infection swimming smoking
65
sinusitis - features
facial pain/pressure - oft worse bending forward nasal discharge - thick + purulent nasal obstruction post-nasal drip > cough
66
acute sinusitis - management
analgesia intranasal decongestants or nasal saline - but evidence poor >10d - intranasal steroids severe - abx eg phenoxy
67
chronic sinusitis - management
treat acute elements intranasal corticosteroids ± refer ENT
68
thyroid surgery - complications
anatomical eg recurrent laryngeal damage bleeding ± resp compromise damage to PT glands > hypocalcaemia
69
2 physical causes of tinnitus (other than the main conditions)
impacted ear wax | chronic suppurative otitis media
70
3 causes of vertigo other than the main conditions
trauma MS ototoxicity
71
vestibular neuronitis - what is it?
vertigo following viral infection
72
vestibular neuronitis - features
NO hearing loss/tinnitus recurrent vertigo attacks lasting hours or days horizontal nystagmus ± N+V
73
vestibular neuronitis - management
vestibular rehab if chronic betahistine - but poor evidence prochlorperazine for acute phase only

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