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3b > ENT > Flashcards

ENT Flashcards

1
Q

Causes of Stridor

A

Congenital: Laryngomalacia, vascular rings
Inflammation: Laryngitis, epiglottis, croup, anaphylaxis
Tumours
Trauma: Thermal/chemical burns, intubation

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2
Q

Signs of impending obstruction

A

Swallowing difficulty, drooling, pallor/cyonosis, use of accessory breathing muscles, downward plunging of trachea

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3
Q

Croup
Symptoms
Treatment

A

Barking cough & increased respiratory effort. Worse at night.

Dexamethasone IM

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4
Q

Acute epiglottis
Cause
Symptoms
Management

A

H influenzae

Fever, irritability, sore throat, drooling, leaning forward.

Do not examine throat, keep upright, IV antibiotics & Dexamethasone IM

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5
Q

Acute airway obstruction management

A
  1. O2
  2. Nebulised adrenaline
  3. Note 02 saturation, RR, HR, BP
  4. Call ENT/Anaesthetics
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6
Q

Sore throat causes

A
  1. Viral: Coronovirus, rhinovirus, adenovirus, epstien barr

2. Bacterial: Group A B-haem strep (Pyogenes)

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7
Q

Sore throat treatment

A
  1. Paracetamol & Ibuprofen
  2. Pen V/Clarithromycin if 3 Centor criteria

Nb avoid amoxicillin as causes rash in EBV

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8
Q

Centor criteria (4)

A
  1. Absence of cough
  2. Lymphadenopathy
  3. Exudates
  4. History of fever
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9
Q

Tonsillitis complications (5)

A
  1. Otitis media
  2. Sinusitis
  3. Quincy
  4. Parapharngeal abcess
  5. Lemierre syndrome - Acute septicemia, and jugular vein thrombosis
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10
Q

Quincy
What?
Symptoms/Signs?

A

Peritonsillar abcess

Sore throat
Peritonsilar bulge 
Uvular deviation
Trismus
Muffled voice.
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11
Q

Scarlet fever
Cause
Signs/symptoms
Management

A

Caused by exotoxins of S.Pyogenes.

Sandpaper red rash 12 hours after sore throat & fever. Strawberry tongue.

Pen V/Clarithromycin

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12
Q

Hoarseness causes

A

Reflux laryngitis
Laryngeal carcinoma (>3 weeks & smoking indicators), Vocal cord palsy.
Reinke’s oedema (Chronic cord irritation causing oedematous cords)

Smoking, stress, singing, shouting, voice overuse.

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13
Q

Recurrent laryngeal nerve palsy
Symptoms?
Causes?

A

Weak breathy voice
Repeated coughing
Exertional dyspnoea.

Cancer
Iatrogentic (oesophageal/pharangeal pouch surgery), Post viral.
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14
Q

Dysphagia

Causes?

A

Malignant (Oesophageal/Pharyngeal/Gastric/Lung)
Neurological (Bulbar palsy, Myasthenia gravis)
Other (Benign stritcures, pharyngeal pouch, achalasia, systemic sclerosis)

Nb. If fluid can be drank = Stricture (with pain = malignant)
Difficulty swalling = Bulbar palsy

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15
Q

Oesophageal cancer associated with.

A

Achalasia, smoking, alcohol, Barrets oesophagus.

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16
Q

Benign oesophageal stricture caused by:

A

GORD

Swallowing corrosives/foreign body

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17
Q

Pharyngeal pouch
What?
Symptoms?
Investigation?

A

Pharyngeal mucosa herniates through an area of weakness.

Dysphagia, gurgling, halitosis, lump in the neck, aspiration pneumonia.

Barium swallow

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18
Q

Head and neck SSC

Associations

A 
Smoking
Alcohol 
HPV
GORD
Vitamin A & C deficiency
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19
Q

Facial palsy

Causes

A

Intracranial - Brain stem tumours, stroke, MS, Acoustic neuroma, meningitis

Intratemporal - Otitis media, Ramsay hunt, cholesteatoma

Infratemporal - Parotid tumour

Bells palsy

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20
Q

Ramsay Hunt syndrome
What?
Symptoms?

A

Facial nerve shingles (VZV)

Painful rash or blisters in or around the ear, scalp or hair line, facial droop and weakness, altered taste, difficulty closing eye.

21
Q

Bells palsy
What?
Symptoms?
Treatment

A

Idiopathic LMN unilateral facial palsy

Abrupt onset of drooling, facial droop, poor facial expressions, reduced taste and speech.

Prednisolone & eye drops. 80% better in 3 months.

Nb Refer in recurrent & bilateral facial palsy (Lyme/Guillian barre, leukaemia, sarcoidosis)

22
Q

Forehead sparing facial paralysis

A

UMN lesion as has bilateral innervation.

23
Q

Sialadenitis
What?
Symptoms?
Treatment?

A

Acute infection of the submandibular or parotid gland. Common in elderly, dehydrated and poor oral hygiene.

Painful swelling, fever, pus leakage.

Abx and good oral hygine

24
Q 
Sialolithiasis
What?
Which gland?
Symptoms?
Investigations?
Management?
A

Salivary gland stone

Submandibular most common.

Painful swelling after/during meals.

X-ray or salinograph

Warm compress or surgery if big.

25
Q

Causes of salivary gland swelling

A

Malignancy
Stones
Mumps
Sjogrens syndrome

26
Q

Dry mouth causes

A 
Antipsychotics
B blockers
Diuretics
Dehydrations
Sjogrens syndrome
Parotid stones
SLE & Scleroderma
27
Q

Salivary gland tumour
Where?
Suggestive symptoms?

A

Parotid most common

Hard fixed mass, overlying ulceration, lymph node enlargement, facial palsy.

28
Q

Otitis externa causes

A

Trauma
Eczmea/psoriasis
Pseudomonas
Staph aureus

29
Q

Otitis externa mild/moderate/severe
Symptoms
Management

A

Mild
Scaly skin with some erythema. Normal canal diameter
Cleaning EAC - Gentle syringing, dry moping, microsuction

Moderate
Painful narrowed EAC with malodorous creamy discharge
Acetic acid + steroid drops (Aminoglycosides contraindicated)

Severe
Occluded EAC
Aluminium acetate wick to open canal.

30
Q

Necrotizing otitis externa

A

Persitant OE that is life threatening through osteomyelitis. Common in immunosuppresed, diabetics and elderly.
Pseudomonas

31
Q

Temporomandibular joint dysfunction

A

Earache, facial pain and joint clicking/popping related to teeth grinding or joint degeneration.
Stress can play a key role.
Pain in exaggerated on lateral jaw movement

32
Q 
Acute otitis media
What
Organisms
Presentation
Treatment
A

Middle ear infection presenting with rapid onset fever pain, irritability, vomiting after a URTI.

Caused by Pseudomonas/Haemophilus

Pain associated with bulging TM which eases when rupture occurs.

Treatment - Optimize ear spray + Amoxcillin (in systemically unwell or delayed perscription)

33
Q

CFS discharge from ear/nose diagnosis

A

Transferrin B or glucose

34
Q 
Otits media with effusion
What?
Signs?
Associations in children?
Treatment?
A

Occurs when effusion present after symptoms of OM have subsided.

Retracted or bulging TM with bubbles/fluid level
URTI, oversized adenoids, congenital malformations e.g cleft palate, down syndrome, kartangers syndrome.

Active observation for 3 months then grommets (can cause tympanosclerosis)/auto inflation of eustation tube.

35
Q

Childhood deafness
Genetic
Acquired

A

Conductive - Pierre Robin & congential anatomy abnormalities.
SN - Waardrenburg syndrome, Turners

TORCH infections
Perinatal causes - Hypoxia, premature
Infections - Meningitis, measles, mumps 
Ototoxic drugs
Trauma
36
Q

Hearing tests in babies/children

A

Otoacoustic emissions testing
Audiological brainstem response
Distraction testing (>18months)
Visually reinforced audiometry.

37
Q

Conductive hearing loss
Causes
Weber & Rinne

A

Impaired sound transmission due to obstruction, TM rupture, and ossicular problems (otosclerosis & infection)

Weber = Sound best in abnormal ear
Rinne = Bone conduction better.
38
Q

Sensorineural hearing loss
Causes
Weber & Rinne

A

Results from defects in the cochlea or nerves caused by ototoxic drugs, infection (meningitis, measles, mumps), vascular disease, menieres and trauma.

Weber = Sound heard best in normal ear
Rinne = Air conduction better.
39
Q

Presbyacusis

A

Age related SN hearing loss due to loss of hair cells

40
Q

Tinnitus causes

A

Objective
Vascular disorders (AV malformation, carotid pathology)
High ouput cardiac states (Pagets, hyperthyroid)

Subjective
Meniere's
Ototoxic drugs
Aspirin, NSAIDS, quinine.
MS
Trauma 
Acoustic neuroma
41
Q

Acoustic neuroma

A

Benign tumour of swann cell of the superior vesitbular nerve.
Progressive ipsilateral tinnitus +/- SN hearing loss.
Can cause increased ICP signs and trigeminal nerve compression (numb face)

42
Q

Vestibular vs Central vertigo

A

Vestibular is often severe associated with loss of balance, nausea, vomiting, hearing loss and tinnitus and horizontal nystagmus.
E.g. Menieres, BBPV, Labyrinthitis

Central is often less severe not associated with hearing loss and tinnitus and nystagmus can be horizontal or vertical.
E.g. Acoustic neuroma, MS, Head injury

43
Q

BBPV

A

Attacks of sudden rotational vertigo lasting 30s provoked by head turning.
Dix hallpike test to diagnose.
Epley manoeuvres as treatment. Drugs dont work

44
Q

Menieres disease
Cause
Presentation
Treatment - Acute/prophylaxis

A

Dialitiation of endolymph spaces causing sudden attacks lasting 2-4hrs.
With fluctuating SN hearing loss, tinnitus and nystagmus.

Acute treatment: Prochlorperazine.
Prophylaxis: Betahistine.

45
Q

Acute vestibular failure

A

Sudden attacks of unilateral vertigo and vomiting often following a URTI.
Lasts for 1-2 days improving over a week.
Nystagmus away from the affected side

46
Q

Rhinosinusitis

A 
Inflamation of the nose and paranasal sinuses with 2 or more of:
Nasal blockage/congestion
Discharge
Facial pain/pressure
Reduced smell
47
Q

Nasal polyps

A

Causing water nasal discharge, sneezing, purulent postnasal drip, mouth breathing and snoring.
Betamethasone steroid drops can shrink.
Surgery is definitive.

48
Q

Causes of bacterial sinusitis (4)

A

Direct spread - Swimming/diving
Odd anatomy - Septal deviation
Mechanical ventilation
Kartageners

49
Q

Common causative organisms & treatment for sinusitis

A

S.pneumoniae, H.influenzae, S.aureus

Amoxicillin. Most are viral though

3b (15 decks)

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