Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Special Senses > ENT > Flashcards

ENT Flashcards

1
Q

Otitis Externa definition

A

Inflammation of the eternal ear canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Otitis Externa epidemiology

A

10% experience in lifeetime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Otitis Externa aetiology

A
  • Usually infectious, can be allergic / inflammatory
  • Infection: 90% bacterial = S. aureus ± P. aeruginosa, 10% fungal = aspergillus and candida (usually follows prolonged antibiotic treatment)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Otitis Externa risk factors

A
  • hot humid climates
  • swimming
  • immunocompromised, elderly
  • DM
  • acoustic meatus obstruction
  • insufficient or build up of wax
  • trauma to ear canal e.g. cotton buds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Otitis Externa presentation

A 
Symptoms:
-otalgia
-itching
-hearing loss and otorrhoea if more severe
Signs:
-erythematous ear canal 
-oedema
-exudate
-mobile tympanic membrane
-pain on movement of tragus or auricle
-pre-auricular lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Otitis Externa differentials

A
  • otitis media
  • foreign body
  • impacted wax
  • malignancy (swollen ear canal with regular bleeding)
  • referred pain from sphenoidal sinus / teeth / neck / throat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Otitis Externa investigation

A
  • assess tympanic membrane

- cultures not useful for management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Otitis Externa management

A

Acute:

  • antibiotic ear drops
  • if systemic symptoms, ENT review and may need IV abx

Chronic:
-remove agravating factors e.g. swimming, scratching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Otitis Externa complications:

A

Necrotising otitis externa: life-threatening extension of infection into mastoid / temporal bones

  • especially in elderly / immunocompromised / DM
  • can cause facial nerve palsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Otitis Media definition

A 
Infection of middle ear
-acute
-with effusion 
-chronic suppurative 
(disease continuum)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Otitis Media epidemiology

A
  • More common in children

- Occurs more in Winter, associated with cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Otitis Media aetiology

A
  • Bacterial: H. influenzae, S. pneumoniae
  • VIral: rhinovirus, RSV
  • Suppurative OM means pus is present in middle ear - can lead to TM perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Otitis Media risk factors

A
  • Smoking
  • Eustachian tube dysfunction
  • URTI
  • Allergies
  • Chronic sinusitis
  • Craniofacial abnormalities
  • Immunosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Otitis Media presentation

A
  • Hearing loss, otalgia and fever
  • Followed by otorrhoea if TM perforates
  • Otitis Media with Effusion: effusion of glue-like fluid behind intact TM with absence of SSx of acute inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Otitis Media differentials

A
  • Otitis externa
  • URTI
  • Referred pain from teeth
  • Foreign body
  • Trauma
  • Giant cell arteritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Otitis Media investigation

A
  • acute phase Ix not helpful

- culture of discharge may be helpful if chronic perforation expected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Otitis Media management

A
  • analgesics and antipyretics
  • no antibiotics - make little difference to symptoms
  • steroids if persistent AOM with allergic background
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Otitis Media complications

A
  • TM perforation
  • Mastoiditis = facial nerve palsy
  • Cholesteatoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cholesteatoma definition

A

Collection of epidermal and connective tissues within middle ear. Grows independently and can damage bony ossicles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cholesteatoma aetiology

A
  • Congenital: squamous epithelium trapped within temporal bone during embryogenesis
  • Primary acquired: negative middle-ear pressure due to Eustachian tube dysfunction causes TM to be ‘sucked back’. This erodes lateral wall which causes pocket lined by squamous non-keratinising epithelium to form.
  • Secondary acquired: injury to TM = implantation of squamous epithelium to trigger process of cellular growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Cholesteatoma risk factors

A

Congenital: cleft palate
Acquired: ear trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cholesteatoma presetnation

A

Varies according to size.

  • characteristic is progressive hearing loss and painless otorrhoea
  • progressive conductive hearing loss
  • vertigo
  • headache
  • facial nerve palsy
  • painless otorrhea, may be foul-smelling
  • pus-filled canal with granulation tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Cholesteatoma differentials

A

Myringosclerosis

Myospherulosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cholesteatoma investigation

A
  • CT to assess lesion extent and bony defects

- MRI if soft tissue concern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cholesteatoma management

A

Surgical removal

Topical antibiotics and potentially steroids if granulation tissue present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cholesteatoma complications

A

Will continue to grow if left in situ causing all symptoms to worsen

27
Q

Vertigo definition

A

False sensation that surroundings are spinning, usually accompanied by nausea and loss of balance

28
Q

Vertigo aetiology

A

Central causes: cerebral cortex, cerebellum, brainstem

  • cerebrovascular disease
  • migraine
  • MS
  • acoustic neuroma
  • diplopia
  • alcohol addiction

Peripheral causes: vestibular labyrinth, semi-circular canals, vestibular nerve

  • viral labyrinthitis
  • vestibular neuritis
  • BPPV
  • Meniere’s disease
  • Motion sickness
  • Ototoxicity
  • Herpes zoster (ramsay hunt) n
29
Q

Vertigo presentation

A

Sensation that surroundings are spinning accompanied by nausea and balance loss.
Associated symptoms:
-Ear: hearing loss, otorrhoea, tinnitus
-Neurological: headache, diplopia, paraesthesia, muscle weakness, ataxia
-Autonomic: N+V, sweating palpitations
-Migraine aura

30
Q

Vertigo differentials

A
  • Postural hypotension
  • Disequilibrium
  • Presyncope
  • Panic attacks with hyperventilation
31
Q

Vertigo investigations

A
  • Romberg’s test to identify central or peripheral cause

- Dix-Hallpike: to confirm BPPV

32
Q

Vertigo management

A
  • Treat underlying cause
  • Symptomatic treatment: prochlorperazine, cinnarizine, cyclizine or promethazine - maximum 1 week
  • Rehabilitation: vestibular conditioning for unilateral disorder with at home exercises
33
Q

Vertigo complications

A
  • Increased falls risk

- Confines to home = depression

34
Q

Facial nerve palsy definition

A

Damage to facial nerve - can be LMN or UMN lesion

35
Q

Facial nerve palsy Aetiology

A

LMN

  • Bell’s palsy (idiopathic compression and paralysis of CNVII): pregnancy, DM
  • Cerebrovascular disease
  • Iatrogenic: local anaesthetic
  • Infective: HSV1, Ramsay Hunt (VZV), EBV, CMV, Lyme disease, otitis media / cholesteatoma
  • Trauma
  • Neurological: Guillain-Barre syndrome, mononeuropathy
  • Neoplastic: parotid gland tumours

UMN

  • Cerebrovascular disease
  • Intracranial tumours
  • MS
  • Syphillis
  • HIV
  • Vasculitides
36
Q

Facial nerve palsy presentation

A
  • Weakness of facial expression muscles
  • Face sags, drawn across to opposite side on smiling
  • Voluntary eye closure not possible

LMN

  • Rapid onset unilateral full facial paralysis
  • Aching pain below ear / mastoid ear
  • Hyperacusis
  • Lesions proximal to geniculate ganglion unable to produce teras, loss of taste

UMN:

  • Upper facial muscles spared
  • Muscle weakness in unilateral lower face
  • Usually caused by cerebrovascular event
37
Q

Facial nerve palsy investigation

A

Serology - lyme, herpes and zoster

38
Q

Facial nerve palsy managment

A

MDT approach depending on cause

  • eye care
  • steroids
  • antivirals
  • surgical e.g. facial decompression
39
Q

Facial nerve palsy complications

A
  • lack of regain of function in facial muscles
  • facial asymmetry
  • gustatory lacrimaiton
  • inadequate lid closure, brow ptosis, drooling, hemifacial spasm
40
Q

Acute rhinosinusitis definition

A

Inflammation of membranous lining of one or more of sinuses. Lasts 7-30 days.

41
Q

Acute rhinosinusitis aetiology

A

Viral infection with sinus drainage obstruction followed by secondary bacterial infection.
Bacteria: S. pneumoniae, H. influenzae, M. catarrhalis

42
Q

Acute rhinosinusitis risk factors

A
  • URTI
  • Allergy
  • Smoking
  • Hormonal status e.g. pregnancy
  • Nasal dryness
  • DM
  • Foreign body
  • Iatrogenic
43
Q

Acute rhinosinusitis clinical presentation

A
  • Non-resolving cold with biphasic character
  • Pain over affected sinus
  • Pyrexia
  • Purulent nasal discharge
  • Poor response to decongestants

Sinusitis diagnosed if:

  • facial discomfort
  • nasal obstruction or discharge
  • decreased / absent sense of smell
44
Q

Acute rhinosinusitis management

A
  • Reassure that viral infection will take 3 weeks to resolve
  • Symptomatic relief: pain, nasal decongestant / irrigation, fluids, rest
  • Abx only if severe and prolonged
45
Q

Chronic rhinosinusitis definition

A

Lasts over 90 days.

  • with polyps
  • without polyps
  • with associated fungal infection
46
Q

Chronic rhinosinusitis aetiology

A
  • Anaerobes
  • GNB
  • S. Aureus
  • Coagulase -ve staph

-Usually underlying chronic issue

47
Q

Chronic rhinosinusitis risk factors

A
  • URTI
  • Allergy
  • Smoking
  • Hormonal status e.g. pregnancy
  • Nasal dryness
  • DM
  • Foreign body
  • Iatrogenic
48
Q

Chronic rhinosinusitis presentation

A
  • Non-resolving cold with biphasic character
  • Pain over affected sinus
  • Pyrexia
  • Purulent nasal discharge
  • Poor response to decongestants

Sinusitis diagnosed if:

  • facial discomfort
  • nasal obstruction or discharge
  • decreased / absent sense of smell
49
Q

Chronic rhinosinusitis managment

A
  • Topical nasal steroids / oral steroids
  • Good dental hygiene
  • Smoking cessation
  • No evidence of Abx benefit
50
Q

Chronic rhinosinusitis complications

A
  • Adenoiditis, dacryocystitis and laryngitis
  • Orbital complications - cellulitis, abscesses cavernous sinus thrombosis
  • Intracranial: meningitis, abscess
  • Oteomyelitis
  • Mucocele
51
Q

Epistaxis aetiology

A
  • Trauma to nose: picking, foreign body, blowing
  • Platelet disorders
  • Drugs: aspirin, anti-coagulant, cocaine
  • Vessel abnormality
  • Malignancy, especially juvenile angiofibroma in males
  • Granulomatosis with polyangiitis
52
Q

Epistaxis presentation

A

Anterior haemorrhage:
-source of bleeding visible, usually from nasal septum, especially Little’s area (kiesselbach’s plexus)

Posterior haemorrhage

  • deeper structures of nose
  • more common in elderly
  • more profuse
53
Q

Epistaxis management

A

Treatment ladder:

  1. Stem bleed: ask patient to sit forwards and squeeze cartilage
  2. Cautery: silver nitrate used to chemically burn vessels to stem bleed
  3. Consider packing
54
Q

Acute sore throat definition

A

Inflammation of URT.

  • pharynx
  • larynx
  • tonsils
  • epiglottitis
55
Q

Acute sore throat aetiology

A

Viral infection: rhinovirus, coronavirus, influenza, parainfluenza, adenovirus

Bacterial infection: group A beta-haemolytic strep

56
Q

Acute sore throat presentation

A

Symptoms:

  • headache
  • malaise
  • rhinitis
  • cough
  • hoarse voice

Signs:

  • red pharynx / tonsils
  • tonsillar enlargement
  • exudate, enlarged cervical lymph glands

Epiglottitis:
-drooling, leaning forward, pyrexia

57
Q

Centor criteria for bacterial tonsillitis

A
  • History of fever
  • Tonsillar exudate
  • Absence of cough
  • Tender anterior cervical lymphadenopathy
58
Q

Supraglottitis / Epiglottitis

A
  • Above larynx = supraglottitis
  • Below larynx = epiglottitis
  • Hoarse voice, odynophagia
  • Stridor is late symptom
  • Seen in immunocompromised

Causes:

  • Adults: H. influenzae, S. pneumoniae, group A strep
  • Paeds: H. influnzae, gourp A strep, S. pneumoniae

Management

  • Emergency
  • ABCDE assessment

Treat with IV cefotaxime

59
Q

Head and neck lumps differentials

A

Most common cause is reactive lymph nodes:

  • Bacterial: beta-haemolytic strep, S. aureus, TB, syphilis
  • Viral: URTI viruses, EBV, CMV, HIV, HSV
  • Parasitic
  • Non-infective: sarcoidosis, connective tissue disease
Other causes
-Malignant lymph nodes
-Skin infections
-Lipomas and other benign tumours
-Thyroid swellings
-Thyroglossal cyst, brachial cyst
Carotid body aneurysm or tumour
-Malignant tumour
60
Q

Head and neck lumps diagnosit tools

A
  • Age: inflammatory more likely than malignancy in young. Branchial cyst present in late teens.
  • Onset: inflammatory = sudden, 2-6 weeks resolution, malignant = progressive enlargement over time, transient with eating .= salivary gland.
  • Consistency: hard mass = malignant, thyroid gland swellings move with swallowing, fluctuant mass = cystic.
  • Location: midline = thyroid, posterior triangle = lymph nodes, bilateral across mandibular angle = mumps
61
Q

Head and neck lumps investigations

A
  • Bloods: FBC, ESR, TFTs
  • Viral serology
  • Throat swab
  • CXR if supraclavicular lymph node swelling
  • USS for thyroid swellings
  • CT or MRI
62
Q

Meniere’s disease triad

A

Vertigo, tinnitus and hearing loss

with a feeling of fullness

63
Q

Ramsay Hunt Characteristic features

A

Bell’s palsy, herpetic rash, deafness, tinnitus, vertigo

Year 3 Special Senses (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions