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ENT Flashcards

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
Q

nasal polyp - presentation

A

nasal obstruction
sneezing + rhinorrhoea
poor taste + smell

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26
Q

postnasal drip - presentation

A

excess mucus from nasal mucosa accumulates → chronic cough + bad breath

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27
Q

sensorineural loss on audiogram

A

air + bone impaired

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28
Q

conductive loss on audiogram

A

air impaired only

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29
Q

mixed hearing loss on audiogram

A

air + bone impaired but air oft worse than bone

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30
Q

acoustic neuroma - symptoms? investigation?

A

CN 8 - hearing loss, vertigo, tinnitus
CN 5 - absent corneal reflex
CN 7 - facial palsy

MRI cerebellopontine angle

31
Q

quinsy - what is it? features?

A

peritonsillar abscess - complication of tonsillitis
unilateral tonsil swelling + pain, uvula deviated away
trismus (diff opening mouth)
reduced neck mobility
fever

32
Q

what is RHS?

A

reactivation of the varicella zoster virus in the geniculate ganglion of the facial nerve. LMN palsy.

33
Q

BPPV - presentation? diagnosis + management? outlook?

A

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
Q

cholesteatoma - what is it? RFs?

A

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
Q

cholesteatoma - features? management?

A

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
Q

acute otitis externa - what is it? features?

A

inflammation of ear canal - boil causing:
pain on moving pinna
± conductive deafness
if ruptures - pus from ear

otoscope - swollen, tender canal with debris

37
Q

acute otitis externa - management

A

keep dry
analgesia
topical abx + steroid

38
Q

chronic otitis externa - what is it? features?

A

chronic combined infection in external auditory meatus - usually staph + fungal

chronic discharge

39
Q

chronic otitis externa - management

A

cleansing of external ear

antifungal + antibacterial ear drops

40
Q

acute suppurative otitis media - what is it? features?

A

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
Q

acute suppurative otitis media - management

A

not always needed

5d amoxicillin

42
Q

chronic suppurative otitis media - types?

A

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
Q

chronic suppurative otitis media without cholesteatoma - features?

A

infection comes and goes
intermittent, non-offensive discharge
perforated pars tensa
white plaque in anterior TM

44
Q

chronic suppurative otitis media without cholesteatoma - management?

A

microsuction then inspection
infected - abx + steroid drops 7-10d
keep dry
myringoplasty (TM repair if) troublesome

45
Q

acute otitis externa - complications

A

perichondritis (spread to cartilage)
cellulitis (spread to skin)
malignant otitis externa

46
Q

perichondritis - what is it? management?

A

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
Q

malignant otitis externa - what is it? RFs?

A

pseudomonas
infection progresses to bony ear canal + temporal bone osteomyelitis
RF - immunocompromise / DM

48
Q

cellulitis or perichondritis?

A

cellulitis - inflamed pinna + lobe

perichondritis - inflamed pinna only

49
Q

acute otitis media - complications

A

mastoiditis

50
Q

anterior epistaxis - what is it?

A

visible bleeding source

insult to capillary network that form Kiesselbach’s Plexus

51
Q

posterior epistaxis - what is it?

A

more profuse
originate from deeper structures
more common in older pts
risk aspiration + airway compromise

52
Q

epistaxis - management if pt is haem stable

A

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
Q

epistaxis - still bleeding after 15 min of pressure

A

cautery - if source visible + it’s tolerated (not great in young kids)
packing - if not

admit + refer ENT

54
Q

when should epistaxis be admitted?

A

post cautery/packing
haem unstable
unknown or posterior source

55
Q

epistaxis - discharge counselling - what should pt avoid?

A

blowing + picking
heavy lifting + exercise
lying flat
alcohol + hot drinks

56
Q

sinusitis - presentation

A

facial fullness + tenderness

nasal discharge, pyrexia or post-nasal drip → cough

57
Q

malignant otitis externa - features

A 
reduced hearing
ear canal full of debris + TM not visible
severe pain
temporal headaches
purulent otorrhoea
± dysphagia, hoarseness, FN dysfunction
58
Q

malignant otitis externa - investigations + management

A

swab + topical abx
6wk IV abx
monitor CRP
CT or MR skull base

59
Q

mastoiditis - features

A 
fever + unwell
severe otalgia, oft behind ear
hx recurrent otitis media
mastoid tenderness + inflammation
forward protrusion of external ear
discharge if perf
60
Q

nasal polyps - RFs

A

asthma
CF
churg-strauss (eGPA)

61
Q

nasal polyps - red flags

A

unilateral symptoms

bleeding

62
Q

nasal polyps - management

A

ENT assessment

topical corticosteroids - shrink 80%

63
Q

bleeding post-tonsillectomy - management

A

primary - <24h:
immediate return to theatre

secondary haemorrhage - >24h:
likely due to infection
admit + abx

64
Q

sinusitis - RFs

A

nasal obstruction - septal deviation, polyps
recent local infection
swimming
smoking

65
Q

sinusitis - features

A

facial pain/pressure - oft worse bending forward
nasal discharge - thick + purulent
nasal obstruction
post-nasal drip > cough

66
Q

acute sinusitis - management

A

analgesia
intranasal decongestants or nasal saline - but evidence poor
>10d - intranasal steroids
severe - abx eg phenoxy

67
Q

chronic sinusitis - management

A

treat acute elements
intranasal corticosteroids
± refer ENT

68
Q

thyroid surgery - complications

A

anatomical eg recurrent laryngeal damage
bleeding ± resp compromise
damage to PT glands > hypocalcaemia

69
Q

2 physical causes of tinnitus (other than the main conditions)

A

impacted ear wax

chronic suppurative otitis media

70
Q

3 causes of vertigo other than the main conditions

A

trauma
MS
ototoxicity

71
Q

vestibular neuronitis - what is it?

A

vertigo following viral infection

72
Q

vestibular neuronitis - features

A

NO hearing loss/tinnitus
recurrent vertigo attacks lasting hours or days
horizontal nystagmus
± N+V

73
Q

vestibular neuronitis - management

A

vestibular rehab if chronic
betahistine - but poor evidence
prochlorperazine for acute phase only

Progress (20 decks)

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