ENT Flashcards
list the causes of sensorineural hearing loss
noise / trauma infection - HIV, CMV, rubella presbycusis drugs - gentamicin, furosemide meniere's acoustic neuroma vascular problem
what do you see in rhinnes and weber’s test in sensorineural hearing loss?
rhinnes +ve (i.e. normal - air conduction better than bone)
weber’s localises to normal ear
what do you see in rhinnes and weber’s test in conductive HL?
rhinnes -ve ( ie. abnormal - bone conduction better than air)
weber’s localises to affected ear
causes of conductive hearing loss
impaction
cholesteatoma
otosclerosis
otitis
how does cholesteatoma present?
conductive HL
headache
vertigo
facial nerve palsy
causes of otitis externa and management
staph aureus / p. aeruginosa (swimmers)
topical neomycin
causes of otitis media and management
h. influenza / s. pneumoniae
5/7 amoxicillin in systemically unwell
complication of spreading otitis media and management
mastoiditis (bone infection) blood cultures and CT tympanocentesis IV ceftriaxone (meningitis and encephalitis)
causes and general presentation of central vertigo
severe instability, cant walk
CVA
migraine
acoustic neuroma
causes and general presentation of peripheral vertigo
horizontal nystagmus
BPPV
meniere’s
vestibular neuritis
presentation and investigation of acoustic neuroma
unilateral sensorineural hearing loss!!!
tinnitus, altered facial sensation, vertigo, ataxia
MRI
how can you tell a stroke from other causes of vertigo?
HINTS test
- Head Impulse +ve
- Nystagmus (unidirectional/ horizontal)
- Skew -ve
presentation of BPPV (and Ix finding)
20-30 second attacks on head movement
dix halle pike maneuver = rotatory nystagmus and vertigo
management of BPPV
inform DVLA
epley’s manoeuvre +/- antiemetic
follow up 4/52
triad in meneires disease
- vertigo - mins-hours
- tinnitus - low roaring
- fluctuation SN hearing loss
+ feeling of aural fullness and +ve romberg’s test
what causes vestibular neuritis / labyrinthitis
neuritis - HSV reactivation
labyrinth - viral , URTI, drugs
causes of objective tinnitus
movement of blood, TM spasm
causes of subjective tinnitus
otosclerosis, impaction, infection, menieres, acoustic neuroma
MS/ head injury
drugs
unilateral nose bleed in a child with visible bleeding point likely to be where?
anterior
little’s area in kiesselbach’s plexus
management of epistaxis if can see bleeding point?
cautery with silver nitrate
bilateral, profuse epistaxis in elderly likely to be where? and management?
posterior
ribbon packing and foley catheter
what are some pathological causes of epistaxis
clotting disorder leukaemia juvenile nasopharyngeal angiofibroma hereditary telangiectasia wegeners / GPA (eroded nasal septum)
causes of enlarged parotid gland
mumps HIV sjogren's sarcoid vomiting - bulimia benign pleomorphic adenoma warthin's tumour in elderly
causes of lymphadenopathy
CHICAGO Cancer (lymphoma, CLL, mets) Hypersensitivity Infection (EBV, TB, HSV, HIV) Collagen disease (sjogren's, SLE, RA, dermatomyositis) Atypical Granulomas - sarcoid Other
csf leak from nose suggest fracture where?
cribriform plate
what are the centor criteria
fever exudate tender cervical lymphadenopathy absence of cough (4-5 points = penicillin)
what does virchow’s node suggest
stomach, lung, breast, bowel cancer
most common type of thyroid cancer
papillary (radioactive iodine treatment)
red flags in neck lump
stridor previous radiation family history of thyroid ca voice change cervical lymphadenopathy
presentation of a thyroglossal cyst
moves on swallowing and tongue protrusion
non tender
mobile
presents in first 10 years
how does a branchial cyst present
painless , fluctuant, lump in anterior triangle - usually behind the sternocleidomastoid muscle
how does a cystic hygroma present
fluid filled sac on left side of neck
investigations in obstructive sleep apnoea
epworth sleepiness scale >10
polysomnography (>5 apnoeas in 1 hour)
