ENT Flashcards
1
Q
Criteria for antibiotics in otitis media
A
symptoms longer than 4 days, or not improving
systemically unwell
immunocompromised, or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
younger than 2 years old with bilateral otitis media
otitis media with perforation and/or discharge in the canal
2
Q
symptoms longer than 4 days, or not improving
systemically unwell
immunocompromised, or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
younger than 2 years old with bilateral otitis media
otitis media with perforation and/or discharge in the canal are conditions for
A
giving antibiotics in otitis media
3
Q
if antibiotics required to treat otitis media what is given?
A
amoxicillin, erythromycin/clarithromycin if penicillin allergic
4
Q
amoxicillin, erythromycin/clarithromycin if penicillin allergic are given for
A
otitis media
5
Q
common organisms causung otitis media
A
rhinovirus, staphylococcus, haemophilus, moroxella
6
Q
rhinovirus, staphylococcus, haemophilus, moroxella are common organisms causing
A
otitis media
7
Q
vertigo is defined as
A
the false sensation that the body or environemnt
8
Q
the false sensation that the body or environemnt is moving defines
A
vertigo
9
Q
causes of vertigo
A
viral labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease, vertebrobasilar ischaemia, acoustic neuroma, trauma, multiple sclerosis, ototoxicity e.g gentamicin
10
Q
viral labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease, vertebrobasilar ischaemia, acoustic neuroma, trauma, multiple sclerosis, ototoxicity e.g gentamicin are causes of
A
vertigo
11
Q
viral labyrinthitis
A
vertigo, recent viral infecion, sudden onset, nausea, vomiting, hearing may be affected
12
Q
vertigo, recent viral infecion, sudden onset, nausea, vomiting, hearing may be affected in
A
viral labyrinthitis
13
Q
vestibular neuronitis
A
recent viral infection, recurrent vertigo attacks lasting hours/days, no hearing loss
14
Q
recent viral infection, recurrent vertigo attacks lasting hours/days, no hearing loss in
A
vestibular neuronitis
15
Q
benign paroxysmal positional vertigo
A
gradual onset vertigo, triggered by change in head position, each episode lasts 10-20 seconds
16
Q
gradual onset vertigo, triggered by change in head position, each episode lasts 10-20 seconds in
A
benign paroxysmal positional vertigo
17
Q
Meniere’s disease
A
middle ages adults, recurent episodes of vertigo associated with hearing loss (sensorineural), tinnitus, sensation of fullness/pressure in one or both ears, nystagmus, positive Romberg’s test, episodes last minutes to hours, typically unilateral
18
Q
middle ages adults, recurent episodes of vertigo associated with hearing loss (sensorineural), tinnitus, sensation of fullness/pressure in one or both ears, nystagmus, positive Romberg’s test, episodes last minutes to hours, typically unilateral in
A
Meniere’s disease
19
Q
vertebrobasilar ischaemia
A
elderly patient, vertigo, dizziness on neck extension
20
Q
elderly patient, vertigo, dizziness on neck extension in
A
vertebrobasilar ischaemia
21
Q
acoustic neuroma
A
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex (important sign)
cranial nerve VII: facial palsy
bilateral associated with neurofibromatosis type 2
22
Q
hearing loss, vertigo, tinnitus, absent corneal reflex, facial palsy, associated with neurofibromatosis type 2 is
A
acoustic neuroma
23
Q
three most common causes of hearing loss
A
ear wax, otitis media, otitis externa
24
Q
ear wax, otitis media, otitis externa are the three most common causes of
A
deafness
25
presbycusis
age related sensorineural hearing loss, difficulty following conversations, audiometry shows bilateral high frequency hearing loss
26
age related sensorineural hearing loss, difficulty following conversations, audiometry shows bilateral high frequency hearing loss describes
presbycusis
27
otosclerosis
autosomal dominant, replacement of bone by vascular spongy bone, onset at 20-40 years, conductive deafness, tinnitus, 'flamingo tinge' to tympanic membrane, positive family history
28
autosomal dominant, replacement of bone by vascular spongy bone, onset at 20-40 years, conductive deafness, tinnitus, 'flamingo tinge' to tympanic membrane, positive family history describes
otosclerosis
29
glue ear/otitis media with effusion
peaks at 2 years old, conductive hearing loss, secondary problems e.g. speech, language, behavioural, balance problems
30
peaks at 2 years old, conductive hearing loss, secondary problems e.g. speech, language, behavioural, balance problems describes
glue ear/otitis media with effusion
31
drugs causing ototoxicity
aminoglycosides (gentamicin), furosemide, aspirin, cytotoxic agents
32
aminoglycosides (gentamicin), furosemide, aspirin, cytotoxic agents are drugs which cause
ototoxicity
33
noise damage
workers in heavy industries, bilateral, 4000Hz notch on audiogram, sensorineural hearing loss
34
workers in heavy industries, notch on audiogram at 4000Hz, sensorineural hearing loss
noise damage
35
acoustic neuroma is more correctly called
vestibular schwannoma
36
vestibular schwannoma
is the correct name for acoustic neuroma
37
reactive lymphadenopathy
most common cause of neck swelling, history of local infection, generalised viral illness
38
most common cause of neck swelling, history of local infection, generalised viral illness describes
reactive lymphadenopathy
39
lymphoma
rubbery, painless, lymphadenopathy, night sweats, splenomegaly
40
rubbery, painless, lymphadenopathy, night sweats, splenomegaly describes
lymphoma
41
thyroid swelling
moves upwards on swallowing, symptoms of hyper/eu/hypothyroidism
42
moves upwards on swallowing, symptoms of hyper/eu/hypothyroidism
thyroid swelling
43
thyroglossal cyst
more common in patients <20 years old, midline, between isthmus of the thyroid and the hyoid bone, moves upwards with tongue protrusion, painful if infected
44
more common in patients <20 years old, midline, between isthmus of the thyroid and the hyoid bone, moves upwards with tongue protrusion, painful if infected describes
thyroglossal cyst
45
isthmus of the thyroid
the bit of the thyroid gland that crosses the midline of the throat, about at the level of the shoulders
46
hyoid bone
top bone under the chin, above the Adam's apple
47
the bit of the thyroid gland that crosses the midline of the throat, about at the level of the shoulders
isthmus
48
top bone under the chin, above the Adam's apple
hyoid bone
49
pharyngeal pouch
more common in older men, posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles, usually not seen, if large midline lump, gurgles on palpation, dysphagia, regurgitation, aspiration, chronic cough
50
more common in older men, posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles, usually not seen, if large midline lump, gurgles on palpation, dysphagia, regurgitation, aspiration, chronic cough describe
pharyngeal pouch
51
cystic hernia/lymphangioma
congenital lymphatic lesion, left side, present before 2 years
52
congenital lymphatic lesion, left side, present before 2 years describes
cystic hernia/lymphangioma
53
branchial cyst
oval, mobile, cystic mass, between sternocleidomastoid muscle and pharynx, due to failure of obliteration of the second branchial cleft in embryonic development, early adulthood
54
oval, mobile, cystic mass, between sternocleidomastoid muscle and pharynx, due to failure of obliteration of the second branchial cleft in embryonic development, early adulthood describes
branchial cyst
55
cervical rib
adult females, can lead to thoracic outlet syndrome
56
adult females, can lead to thoracic outlet syndrome
cervical rib
57
thoracic outlet syndrome
when the blood vessels between clavicle and first rib get compressed
58
when the blood vessels between clavicle and first rib get compressed describes
thoracic outlet syndrome
59
carotid aneurysm
pulsatile, lateral, doesn't move on swallowing
60
pulsatile, lateral, doesn't move on swallowing describes
carotid aneurysm
61
mnemonic to remember how to describe a lump
5 Students and 3 Teachers went to build a CAMPFIRE
62
5 Students and 3 Teachers went to build a CAMPFIRE to remember
how to describe a lump
63
5 students to comment on when you find a lump
```
site - from a specific landmark
size
shape
skin
scar
```
64
3 teachers to comment on when you find a lump
tenderness - pain on touching
temperature - feel with back of hand
transillumination - especially for testicular masses
65
campfire to comment on when you find a lump
consistency - soft, spongy, firm
attachment - identify between which layers it is by moving the skin, then muscle etc over it
mobility - try to move lump horizontally and vertically
pulsatile - assess with two fingers, transmitted vs expansile
fluctuance - tap lump with fingers either side, fluctuant will displace fingers
irr/
reducible
enlarged lymph nodes
66
cause of Meniere's disease
unknown
67
site of Meniere's disease
inner ear
68
inner ear is the site of what disease
Meniere's
69
Meniere's disease is characterised by
the progressive dilation of the endolymphatic system
70
the progressive dilation of the endolymphatic system characterises
Meniere's disease
71
the natural history of Meniere's disease
symptoms resolve after 5-10 years, degree of residual hearing loss (sensorineural), psychological distress
72
symptoms resolve after 5-10 years, degree of residual hearing loss, psychological distress describes the natural history of
Meniere's disease
73
management of Meniere's disease
ENT assessment, inform DVLA, cease driving until satisfactory control of symptoms, buccal/intramuscular prochlorperazine for acute attacks, betahistine and vestibular rehabilitation exercises may be of benifit in prevention
74
ENT assessment, inform DVLA, cease driving until satisfactory control of symptoms, buccal/intramuscular prochlorperazine for acute attacks, betahistine and vestibular rehabilitation exercises may be of benifit in prevention describes the management of
Meniere's disease
75
prochlorperazine
dopamine receptor antagonist, antipsychotic class, buccal or intramuscular for acute Meniere's disease attacks, extrapyramidal side effects
76
dopamine receptor antagonist, antipsychotic class, buccal or intramuscular for acute Meniere's disease attacks, extrapyramidal side effects
prochlorperazine
77
betahistine
used in the prevention of the symptoms of Meniere's disease
78
used in the prevention of the symptoms of Meniere's disease
betahistine
79
the effusion in glue ear is a transudate or an exudate?
transudate (systemic, low protein)
80
glue ear is caused by a
dysfunction eustatian tube
81
a dysfunctional eustation tube in children causes
glue ear/otitis media with effusion
82
otitis externa orgnaisms
staphylococcus, streptococcus, pseudomonas
83
staphylococcus, streptococcus, pseudomonas are common causative orgnaisms of
otitis externa
84
middle ear bones in order
malleus, incus, stapes
85
adult with glue ear think
nasopharyngeal cancer
86
think of nasopharyngeal cancer in
adults with glue ear/otitis media with effusion
87
sodium bicarbonate ear drops
softens ear wax
88
ear drops used to softens ear wax
sodium bicarbonate
89
obstructive sleep apnoea in young children may be caused by enlarged
tonsils and adenoids
90
enlarged tonsils and adenoids in young children may cause
obstructive sleep apnoea
91
cholesteatoma
squamous cells in the middle ear causing local destruction
92
squamous cells in the middle ear causing local destruction describes
cholesteatoma
93
features of cholesteatoma
foul smelling discharge, hearing loss, vertigo, facial nerve palsy, cerebellopontine angle syndrome, otoscopy = 'attick crust' seen in uppermost part of eardrum
94
foul smelling discharge, hearing loss, vertigo, facial nerve palsy, cerebellopontine angle syndrome, otoscopy = 'attick crust' seen in uppermost part of eardrumare features of
cholesteatoma
95
management of cholesteatoma
ENT referral for surgical removal
96
ENT referral for surgical removal is the management for
cholesteatoma
97
cerebellopontine angle syndrome
caused by a space occupying lesion at junction fo cerebellar and pons: ipsilateral deafness, nystagmus, reduced corneal reflex, V and VII nerve palsys, ipsilateral cerebellar signs
98
caused by a space occupying lesion at junction fo cerebellar and pons: ipsilateral deafness, nystagmus, reduced corneal reflex, V and VII nerve palsys, ipsilateral cerebellar signs
cerebellopontine angle syndrome
99
normal on an audiogram
above 20dB
100
above 20dB on an audiogram
normal
101
audiogram of sensorineural hearing loss
both bone (arrowheads) and air (circles or crosses) are >20dB
102
both bone (arrowheads) and air (circles or crosses) are >20dB on audiogram indicates
sensorineural hearing loss
103
audiogram of conductive hearing loss
only air (circles or crosses) are >20dB
104
only circles or crosses are >20dB
conductive hearing loss
105
audiogram of mixed hearing loss
both bone (arrowheads) and air (circles or crosses) are >20dB, with air significantly worse than bone
106
both bone (arrowheads) and air (circles or crosses) are >20dB, with air significantly worse than bone
mixed hearing loss
107
chronology of symptoms in otitis media acute
pain, pop, discharge
108
pain, pop, discharge is the chronology of
otitis media acute
109
what route to give antibiotics for otitis media acute
orally/systemically
110
what route to give antibiotice for otitis externa
topical/drops
111
chronology of events for otitis externa
pus, pain
112
pus, pain is the chronology of events for
otitis externa
113
stapes connects with
oval window
114
the cochlea is filled with
perilymph
115
perilymph lines the
cochlea
116
metaplasia
when one fully differentiated cell type changes into a different fully differentiated cell type in respose to a stimuli (occurs in otitis media with effusion)
117
when one fully differentiated cell type changes into a different fully differentiated cell type in respose to a stimuli describes
metaplasia
118
window of opportunity to develop speech
<6 years old
119
<6 years old is the window of opportunity
to develop speech, after that a cochlear implant will only enable the perception of sounds as Wernike's + Broca's areas haven't developed
120
transient evoked otoacoustic emissions
used in newborn screening hearing test
121
used in newborn screening hearing test
transient evoked otoacoustic emissions
122
automated brainstem responce
secondary testing if neonates scores low on the transient evoked otoacoustic emission, hearing version of an EEG
123
secondary testing if neonates scores low on the transient evoked otoacoustic emission
automated brainstem response
124
management of glue ear/otitis media with effusion
grommets or hearing aids
125
grommets or hearing aids id the management of
glue ear/otitis media with effusion
126
caution with grommets
don't get water in the ear - no swimming, wear plugs when showering, will fall out in 7-9/12
"water precautions"
127
water precautions must be adhered to when
domeone has grommets in their ears, or when a perforation is healing
128
mild hearing loss
20-40dB
129
20-40dB
mild hearing loss
130
moderate hearing loss
40-70dB
131
40-70dB
moderate hearing loss
132
severe hearing loss
70-90dB
133
70-90dB
severe hearing loss
134
profound hearing loss
>90dB
135
>90dB
profound hearing loss, required cochlear implant
136
range of frequencies of human ear
20-20000Hz
137
20-20000Hz
range of frequencies of the human ear
138
range of frequencies of speech
250-8000Hz
139
250-8000Hz
range of frequencies of speech
140
5-10dB differnce between ears/air and bone conduction
insignificant, can say symetrical
141
insignificant, can say symetrical audiometry difference
5-10dB
142
carhart notch
at 2000Hz, indicated otosclerosis
143
at 2000Hz, indicated otosclerosis
cahart notch
144
management of otosclerosis
stapedectomy and prosthesis
145
stapedectomy and prosthesis is the management for
otosclerosis
146
Meniere's hearing loss is worse at which frequencies
lower
147
hearing loss worse at lower frequencies indicates
Meniere's disease
148
tympanometry
test of middle ear relative pressure
149
test of middle ear relative pressure
tympanometry
150
microtia
congenital malformation of pinna
151
congenital malformation of pinna
microtia
152
types of hearing aids
post auricular, bone conduction, cochlear implant, bone anchored hearing aid
153
post auricular, bone conduction, cochlear implant, bone anchored are
types of hearing aid
154
tachyphylaxis definition
increasing dose required to achieve same effect
155
increasing dose required to achieve same effect
tachyphylaxis
156
prolonged periods of using topical nasal decongestants can lead to
tachyphylexis
157
tachyphylexis can develop when
using topical nasal decongestants e.g. oxymetazoline
158
types of allergic rhinitis
seasonal e.g. hayfever, perennial (all year round) e.g. house mites, occupational
159
seasonal, perennial, occupational are types of
allergic rhinitis
160
first line management of allergic rhinitis
oral/intranasal antihistamines
161
oral/intranasal antihistamines are first line management for
allergic rhinitis
162
otalgia
ear pain
163
ear pain
otalgia
164
small bilateral nasal polyps
can be treated in primary care with saline nasal douche and intranasal steroids
165
can be treated in primary care with saline nasal douche and intranasal steroids
small bilateral nasal polyps
166
polyps due to rhinosinusitis are usually unilateral or bilateral?
bilateral
167
complications of tonsillitis
otitis media, quinsy, rheumatic fever, glomerulonephritis
168
otitis media, quinsy, rheumatic fever, glomerulonephritis are complications of
tonsillitis
169
quinsy
peritonsillar abscess
170
peritonsillar abscess is called
quinsy
171
indications for tonsillectomy - NICE recommends meeting all of these
disabling sore throats due to tonsillitis, 5+ episodes of tonsillitis per year, symptoms for at least 1 year
172
disabling sore throats due to tonsillitis, 5+ episodes of tonsillitis per year, symptoms for at least 1 year are
what NICE recommends need to be met (all) in order to justify a tonsillectomy
173
other established indications for tonsillectomy
recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, quinsy if unresponsive to standard treatment
174
recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, quinsy if unresponsive to standard treatment are
other established indications for a tonsillectomy
175
tonsillectomy complications
primary (within 24h) = haemorrhage, secondary = haemorrhage, pain, infection
176
Ramsey Hunt syndrome also known as
herpes zoster oticus
177
herpes zoster oticus also known as
Ramsey Hunt syndrome
178
features of Ramsey Hunt syndrome/herpes zoster oticus
auricular pain, facial nerve palsy, vesicular rash around ear, vertigo, tinnitus
179
auricular pain, facial nerve palsy, vesicular rash around ear, vertigo, tinnitus are features of
Ramsey Hunt syndrome/herpes zoster oticus
180
management of Ramsey Hunt syndrome/herpes zoster oticus
oral aciclovir + corticosteroids
181
oral aciclovir + corticosteroids given in
Ramsey Hunt syndrome/herpes zoster oticus
182
sialadenitis
inflammation of the salivary gland
183
inflammation of the salivary gland
sialadenitis
184
sialadenitis is often secondary to a
stone impacted in the duct
185
a stone impacted in the salivary duct can lead to
sialadenitis
186
three main salivary glands
parotid, submandibular, sublingual
187
parotid, submandibular, sublingual describe
the three main salivary glands
188
otoscopy L vs R ear
half with cone of light + maleolus process (i.e. L/R) is same half as the ear (i.e. L/R ear)
189
ear wax impaction
excessive build up of ear wax in canal, conductive hearing loss, sometimes pain
190
excessive build up of ear wax in canal, conductive hearing loss, sometimes pain
ear wax impaction
191
myringosclerosis
thickening + calcification of the tympanic membrane 2' to inflammation, usually asymptomatic
192
thickening + calcification of the tympanic membrane 2' to inflammation, usually asymptomatic
myringosclerosis
193
nosebleed management
1. local compression over Little's area
2. nasal cautery (chemical or electrical)
3. nasal packing - uncomfortable for PT, risks of P necrosis, post migration into the airway + aspiration of blood clots
4. ligation of sphenopalatine a (life threatening haemorrhage)
194
salivary duct calculus
Ca, submandibular gland > affected due to longer duct, antigravity drainage + > vicous secretions, pain + swelling when eating
195
salivary duck calculus management
siologram > XR, conservative = increasing saliva produciton (sucking sweets), drinking H2O, massaging the area, silandoscopy, lithotripsy
196
siologram > XR, conservative = increasing saliva produciton (sucking sweets), drinking H2O, massaging the area, silandoscopy, lithotripsy describes the managementof
salivary duck calculus
197
tuning fork for hearing test
512Hz
198
parts of the eardrum
pars tensa (lower part), pars flaccida (upper part)
199
inspection of the ear
examine face for palsy/m weakness, , scars inflammation, trauma, pits/sinuses around pinna
200
palpation of the ear
mastoid tip, mastoid bone, pinna, parotid, temperomandibular joint area
201
otoscopy
inspect the meatus, tympanic menbrane
202
doccument fondings from otoscopy
draw a picture of the tympanic menbrane
203
Rinne's test
512Hz tunig fork - air vs bone conduction, 1. can you hear both 2. which is louder
204
+ve Rinne's test
air > bone conduction, indicated N hearing or SNHL
205
-ve Rinne's test
bone > air, conductive HL
206
false -ve Rinne's test
v severe unilateral SNHL so much so that when tuning fork is placed on the mastoid it conducts round + is detected by the other cochlear
207
Weber's test
512Hz tuning fork - placed in centre of forehead, equal or localises to one ear
208
equal hearing in Weber's indicates
N hearing or equal SNHL/CHL
209
Weber's localises to
good ear in SNHL, bad ear in CHL
210
512Hz tunig fork - air vs bone conduction, 1. can you hear both 2. which is louder
Rinne's
211
air conduction > bone condutcion
+ve Rinne's test
212
bone conduciton > air conduciton
-ve Rinne's test
213
512Hz tuning fork - placed in centre of forehead, equal or localises to one ear
Webber's
214
inspecting the nose
inspect from all angles, size of nostrils, size of septum
215
test of airway patency (nose)
cold Lack's depressor under nostrils + ask PT to exhale through nose
216
otoscopy
comment on nasal septum, nose floor, lateral turbinate
217
mouth inspection
lip border, (head torch/good light source) stick out tongue, Lack's tongue depressors, inspect contents, hard, soft palate, tonsils, upper teeth, lateral mouth, tongue, floor of mouth, lower teeth, lower lateral buccal area
218
number of adult teeth
32
219
mouth palpation
bimanual, submanibuilar gland, mucosa, check for thickening, abnormalities, stones, cysts, ulcers
220
neck inspection
fully exposed, swellings, skin lesions, skin discolouration, scars, lumps: size, site, shape, overlying skin (scar/colour), surface,margin, pulsatile, cross fluctiation
221
neck palpation
from behind, start with abnormality (single/multiple, discrete/diffuse, surface, edge, T'c, consistency, fluctuation, compressibility, reducibility, pulsatility, fixation), stick out tongue
222
nasendoscopy is used to examine the
nose, pharynx, larynx
223
epistaxis
nosebleed
224
types of epistaxis
1' (majority of epistaxis, no obvious causal factor), 2' (due to an identifiable cause), childhood, adult, acute, recurrent
225
2' causes of epistaxis
EtOH, aspirin, NSAIDs, antiplatelets (clopidogrel), anticoagulants (warfarin), herbal remidies (St John's wort, fish oil), blood dyscrasias (thrombocytopaenia), coagulopathy (haemophillia, vWD), trauma (nasal #), tumour, Sx, septal perforation
226
childhood epistaxis
common, tends to be 1', ant inf bleeding of nasal septum (Little's area)
227
susceptibility to childhood epistaxis
nose picking, infection
228
management of childhood epistaxis
pinch Little's area (Hippocratic manoeuvre), examine nose (good light) once bleeding stopped, spray bleeds with LA + vasoconstrictor (lignocaine + phenylephrine), chemical cautery, diathermy
229
prescribed to prevent recurrence of childhood epistaxis
course of chlorhexidine-neomycin cream
230
adult 1' epistaxis
> posteriorly than in children, > bleeding
231
management of adult 1' epistaxis
Hippocratic manoeuvre, IV access, contact ENT, examination, cautery of bleed, diathermy
232
failure to control bleeding in 1' adult epistaxis within
24h warrents referral to specialist rhinologist (endoscopy under GA, diathermy, ligation)
233
2' epistaxis management
identificaion/treatment of cause, Hippocratic manoeuvre
234
pharmacological causes of 2' epistaxis
NSAIDs, clopidogrel, aspirin, warfarin, herbal remidies, EtOH - loss of control, OD
235
2' epistaxis by trauma
craniofacial trauma required ENT referral, risk = ethmoidal #
236
ethmoidal # presentation
black eyes, nasal #, dislocation with broadened nasal dorsum, episodes of epistaxis
237
ethmoidal # management
ENT referral, assessment, Sx ligation, angiography
238
ux, bloodstained discharge indication for
urgent ENT referral, ?malignancy
239
ux nasal obstruction + epistaxis in pubertal/adolescent male think
juvenile nasopharyngeal angiofibroma (rare)
240
hereditary haemorrhagic telangectasia
rare, AD, variable penetrance, severe recurent epistaxis, telangectasias on mucosal surface/oral cavity/lips, anaemia, spider naevi, AVM
241
course of chlorhexidine-neomycin cream is used to
prevent recurrence of childhood epistaxis
242
black eyes, nasal #, dislocation with broadened nasal dorsum, episodes of epistaxis
ethmoidal #
243
juvenile nasopharyngeal angiofibroma (rare) presentation
ux nasal obstruction + epistaxis in pubertal/adolescent male
244
rare, AD, variable penetrance, severe recurent epistaxis, telangectasias on mucosal surface/oral cavity/lips, anaemia, spider naevi, AVM
hereditary haemorrhagic telangectasia
245
examples of congenital SNHL
syndromic, non-syndromic, gestational infection
246
what types of gestational infection could cause congenital SNHL
TORCH infections (toxo, rubella, CMV, herpes)
247
examples of acquired SNHL
perinatal jaundice, perinatal hypoxia, meningitis, measles, mumps, Sx, head injury, noise exposure, baro-trauma, aminoglycosides, cytotoxics, vestibular schwannoma, sudden SNHL, Meniere's, presbycusis
248
what's baro-trauma
injuries caused by increasing air/water P e.g. scuba diving, flights
249
examples of congenital CHL
ossicular abnormality, microtia, anotia, external auditory canal atresia
250
anotia is
absence of external ear
251
examples of acquired CHL
wax, OE, foreign body, middle ear effusion, chronic suppurative OM, ossicular disruption
252
suddent SNHL is defined as
SNHL over 3/7, >30dD, in 3 contiguous frequencies
253
suddent SNHL presentation
50-60 y.o., ux > bx
254
sudden SNHL management
steroids, may resolve spontaneously
255
syndromic, non-syndromic, gestational infection are examples of
congenital SNHL
256
perinatal jaundice, perinatal hypoxia, meningitis, measles, mumps, Sx, head injury, noise exposure, baro-trauma, aminoglycosides, cytotoxics, vestibular schwannoma, sudden SNHL, Meniere's, presbycusis are examples of
acquired SNHL
257
ossicular abnormality, microtia, anotia, external auditory canal atresia are examples of
congenital CHL
258
absence of external ear is called
anotia
259
wax, OE, foreign body, middle ear effusion, chronic suppurative OM, ossicular disruption are examples of
acquired CHL
260
SNHL over 3/7, >30dD, in 3 contiguous frequencies describes
sudden SNHL
261
the most common complication of meningitis is
SNHL
262
facial palsy UMN vs LMN
forehead is spared in UMN lesion as it has supply from both hemispheres
263
facial n palsy presentation
ux m weakness, unable to close eye, dribbling from one side of mouth, unable to clear food from one cheek
264
idiopathic facial n palsy aka
Bell's palsy
265
causes of facial n palsy
stroke (UMN), cholesteatoma, ear malignancy, parotid lesions, head injury (basal skull #), HSV, acute OM, malignant/necrotising OE, sarcoid, idiopathic (Bell's palsy, LMN)
266
management of Bell's palsy
eye care+ protection = taping eye shut at night, artificial tears, high dose steroids (ASAP post-symptoms), antivirals
267
ux m weakness, unable to close eye, dribbling from one side of mouth, unable to clear food from one cheek describes the presentation of
facial palsy
268
Bell's palsy aka
idiopathic facial n palsy
269
stroke, cholesteatoma, ear malignancy, parotid lesions, head injury, HSV, acute OM, malignant/necrotising OE, sarcoid, idiopathic are causes of
facial n palsy
270
eye care+ protection = taping eye shut at night, artificial tears, high dose steroids (ASAP post-symptoms), antivirals is the mangement of
Bell's palsy
271
causes of hoarseness/dysphonia
chronic sinusitis, pharyngitis, skull base lesion (trauma, ca), laryngeal ca, thyroid/parathyroid ca, vocal cord nodules, Reinke's oedema, GORD, foreign body, bronchogenic ca, aortic arch aneurysm
272
when to refer to ENT for hoarseness
3/52 w/o resolution
273
acute laryngitis is a common feature of
URTI
274
management of acute laryngitis
fluids, analgesia, anti-inflammatory drugs, voice rest (avoidance of whispering, shouting)
275
duration of acute laryngitis
2/52
276
causes of chronic laryngitis
smoking, EtOH, excessive/misuse of voice
277
management of chronic laryngitis
voice rest, smoking cessation, SALT
278
vocal cord palsy can lead to
hoarseness, aspiration
279
vocal cords are supplied by
recurrent laryngeal n, branches of the vagus n
280
causes of vocal cord paralysis
post thyroid/parathyroid Sx (direct n damange), mediastinal mass (bronchogenic ca), thyroid ca
281
vocal cord nodules are caused by
repeated trauma to the edge of the cords, excessive untutored voice projection, leading to fibrosis
282
management of vocal cord nodules
voice rest, SALT
283
m tendon dysphonia describes
uncoordinated laryngeal m leading to voice problems
284
management of m tendon dysphonia
SALT
285
chronic sinusitis, pharyngitis, skull base lesion (trauma, ca), laryngeal ca, thyroid/parathyroid ca, vocal cord nodules, Reinke's oedema, GORD, foreign body, bronchogenic ca, aortic arch aneurysm are potential causes of
hoarseness/dysphonia
286
fluids, analgesia, anti-inflammatory drugs, voice rest describes the management of
acute laryngitis
287
smoking, EtOH, excessive/misuse of voice can cause
chronic laryngitis
288
voice rest, smoking cessation, SALT describes the management of
chronic laryngitis
289
recurrent laryngeal n + branches of the vagus n supply
vocal cords
290
post thyroid/parathyroid Sx (direct n damange), mediastinal mass (bronchogenic ca), thyroid ca can cause
vocal cord paralysis
291
repeated trauma to the edge of the cords, excessive untutored voice projection, leading to fibrosis which are called
vocal cord nodules
292
uncoordinated laryngeal m leading to voice problems is called
m tendon dysphonia
293
CVS causes of imbalance
hypotension, TIA, stroke, arrhythmia, vertebrobasillar insufficiency, atherosclerosis
294
iatrogenic causes of imbalance
vestibular sedatives, antihypertensives, aminoglycosides, EtOH
295
trauma causes of imbalance
brain injury, temporal bone #, Sx
296
ear causes of imbalance
BPPV, labrynthitis, Meniere's DZ, middle ear DZ, perilymph fistula, impacted wax
297
CNS causes of imbalance
migraine, brainstem ischaemia, MS, ca, epilepsy
298
general medical causes of imbalance
ageing, degeneration, DM, anaemia, peripheral neuropathy, cervical spondylosis, psychiatric illness
299
lightheadedness describes
feeling faint
300
unsteadiness describes
gait abnormality
301
feeling faint describes
lightheadedness
302
gait abnormality describes
unsteadiness
303
blunt trauma to the pinna can cause a
hamatoma
304
management of a pinna haematoma
drainage, P dressing
305
if a pinna haematoma is not managed quickly it can lead to
necrosis becuase of P, causing unsightly deformity aka cauliflower ear
306
furunculosis is
infection of a hair folicle in the external ear
307
furunculous presentation
local swelling, tender, painful
308
malignant/necrotising OE presentation
severe, unremitting pain, not responding to simple analgesia
309
malignant/necrotising OE is
progressive osteomyelitis of the temporal bone, resulting from OE
310
PTs at risk of malignant/necrotising OE are
immunocompromised, DM
311
OM occurs > commonly in children becuase
shorter, wider, more horizontal Eustachian tube, more immature immune defences
312
OM presentation
otalgia (worse at night), fever, HL, otorrhoea
313
OM management
most cases will resolve on their own, criteria for ABx
314
infection of a hair folicle in the external ear describes
furunculosis
315
severe, unremitting pain, not responding to simple analgesia describes
malignant/necrotising OE
316
perforated tympanic membrane causes
infeciton, barotrauma, direct trauma
317
Mx of perforated tympanic membrane
6-8/52 to heal by itself (water precautions), myringoplasty if fails to resolve
318
most common tumour of parotid gland
pleomorphic adenoma (benign)
319
second most common parotid gland tumour
Warthian tumour (benign)
320
type of cancerous parotid tumour
adenocarcinoma
321
features of benign pleomorphic adenoma
most comon parotid neoplasm, slow growing, lobular, 2-10% malignant degeneration
322
most comon parotid neoplasm, slow growing, lobular, 2-10% malignant degeneration
benigm pleomorphic adenoma
323
complications of thyroid Sx
anatomical: recurrent laryngeal n damage
bleeding: haematomas can lead to resp compromise
parathyroid gland damage: hypocalcaemia
324
ABx in sinusitis
systemically unwell, signs of a > serious illness, at high risk of complications
325
sinusitis and any of: periorbital oedema, displaced eyeball, diplopia, reduced VA
refer to hospital
326
common causative agents for sinusitis
Strep pneumo, H. influenzae, rhinoviruses
