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Year 5 > ENT > Flashcards

ENT Flashcards

1
Q

name some causes of acute otitis media

A

viral (common)- rhinovirus/ enterovirus/ RSV

bacterial- haem influenzae/ strep pneumoniae

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2
Q

what would you see on examination of AOM?

A

bulging tympanic membrane +/- pus +/- perforated ear drum

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3
Q

name some red flags in AOM that would warrant referral

A

Cellulitis of the outer ear or surrounding skin
Mastoiditis (tender mastoid, often with cellulitis looking ear and ear appears to be pressed forwards)
Headache
Facial palsy
Fever in child under 3 months old

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4
Q

antibiotics for AOM

A

amoxicillin 5 days may improve symptoms earlier but often not used for risk of resistance/ GI upset ?delayed script

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5
Q

in AOM if TM rupture, when should you follow up?

A

2 weeks

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6
Q

when should you refer AOM to ENT non-urgently

A

> = 6 episodes in 12 months

Persisting OME for >3 months (bilateral) or >6 months unilateral

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7
Q

what does hearing loss in AOM suggest?

A

otitis media with effusion

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8
Q

how does OME appear on examination?

A

opaque ear drum
Loss of light reflex
Indrawn or retracted TM – rarely can be bulging
Bubbles in fluid behind TM / fluid level visible behind TM

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9
Q

how long for OME to resolve?

A

up to 1 year 90% resolved

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10
Q

indications for surgery in OME

A

Persistent bilateral OME lasting >3 months, OR
Hearing loss >25dB in the best ear, OR
Language, education or social developmental delay

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11
Q

what are indications for surgical treatment of OME

A

grommets

adenoidectomy

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12
Q

what level of hearing loss is significant in OME

A

> 25dB

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13
Q

name 3 RFs for developing OME

A

cleft palate
chronic sinusitis in adults
parents who smoke

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14
Q

name 3 RFs for otitis externa

A

swimming
humidity
hearing aids

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15
Q

OE with out of proportion pain, in immunocompromised patient

A

necrotising (malignant) OE, infection has spread to mastoid/ temporal bones

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16
Q

OE with severe pain, vesicles + crusting, facial palsy

A

ramsay hunt syndrome, caused by herpes zoster infection

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17
Q

first line for OE

A

topical ABx- aminoglycosides/ ciprofloxacin if TM ruptured +/- steroids. May need wick. aural toileting e.g. micro-suction

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18
Q

what are some causes of SNHL in adults?

A 
idiopathic hearing loss
presbyacusis
noise exposure
inflammatory disease
ototoxic drugs
tumours
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19
Q

what is presbyacusis?

A

Loss of hair cells on cochlear as increase in age, High frequencies lost first, low frequencies stay in normal range, no increased air-bone gap
noticed after 60, no tx- aural hearing aids

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20
Q

which infections can cause HL

A

measles
mumps
meningitis

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21
Q

which drugs can cause HL

A

systemic aminoglycosides
cytotoxic agents- cisplatin
salicylate/ quinine (reversible)

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22
Q

what are some causes of conductive hearing loss in adults?

A

external- wax/ exostoses
eardrum- TM rupture
middle ear- otosclerosis

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23
Q

what is otosclerosis?

A

AD inherited condition. New bone growth in middle ear causes fusion of stapes footplate to oval window causing conductive HL

24
Q

Abnormal result on Weber’s test

A

SNHL- louder in normal ear

CHL- louder in abnormal ear

25
Q

abnormal result in Rinne’s

A

normal/ SNHL- AC>BC

CHL BC>AC

26
Q

name some causes of dizziness

A

CVD- AF/ arrhythmias, postural hypotension
neuro- head inj, MS, tumours
otological- meniere’s BPPV, vestibular neuritis,
others- migraines

27
Q

what is a positive Dix- Hallpike test?

A

nystagmus, diagnostic of BPPV

28
Q

which manoeuvre can be used to treat BPPV?

A

Epley’s

29
Q

A 50 year old woman with type 2 neurofibromatosis visits her GP with a 2 month history of headaches and dizziness. On examination, she has reduced hearing in one ear.

A

aoustic neuroma (benign tumour of schwann cells of vestibulocochlear nerve)- ipsilateral CN V, VI, IX and X may be affected ?signs of raised ICP

30
Q

What is meniere’s disease?

A

long term, progressive condition affecting the balance and hearing parts of the inner ear. Symptoms are acute attacks of vertigo, fluctuating tinnitus, increasing deafness, and a feeling of pressure in the ear. ?due to excess fluid in inner ear (endolymphatic hydrops)

31
Q

what is vertigo?

A

the hallucination of rotation due to the abnormal stimulation of the hair cells of the vestibular system.

32
Q

what can be used in acute attacks of meniere’s

A

Antihistamine

33
Q

what can be used to relieve symptoms in vestibular neuronitis?

A

vestibular sedatives such as Prochlorperazine

34
Q

what is a cholesteatoma?

A

non-cancerous skin growth in middle ear, usually as a result of multiple infections

35
Q

which area is most likely to be the cause of epistaxis?

A

Little’s area

36
Q

name some RFs for epistaxis

A

local- nose picking, dry mucosa (nasal O2/ nasal sprays)

systemic- clotting disorders, HTN, Hereditary Haemorrhagic Telangiectasia (AD, also causes oral telangectasia)

37
Q

management of epistaxis

A

ABCDE
pressure 20 mins, head forward.
anterior bleed-> cautery/ merocel nasal pack
posterior-> balloon catheter

38
Q

how would a septal haematoma present and why is it important?

A

bilateral intra-nostril cherry red swelling following trauma. stops blood supply to septum therefore needs emergency incision and drainage

39
Q

name some causes other than allergic of rhinitis?

A 
occupational
drug induced- aspirin, ACEIs
pregnancy
idiopathic
rhinitis medicamentosa (lots of OTC vasoconstrictor sprays)
40
Q

first line management for rhinitis

A

antihistamine spray +/- steroid (if main symptom blockage)

41
Q

where would you palpate frontal sinuses?

A

press upwards beneath medial side of supraorbital ridge

42
Q

where would you palpate maxillary sinuses?

A

below inferior orbital margin

43
Q

where would you palpate ethmoidal sinuses?

A

medial against medial wall of orbit

44
Q

what is typical of sinusitis pain?

A

pain/ pressure increased on bending forward

45
Q

most common cause of tonsillitis

A

viral (70%)

46
Q

most common bacterial cause of tonsillitis

A

Group A strep

47
Q

4 points on Centor criteria

A 
tonsilar exudate
temp >38
no cough
tender cerviacal lymphadenopathy
If all 4 = 50% chance of bacterial cause, give ABx
48
Q

what ABx for tonsillitis

A

Pen V, not amoxicillin as can cause rash in glandular fever

49
Q

what is Quinsy?

A

this is a peritonsillar abscess

50
Q

what causes glandular fever

A

EBV

51
Q

When should you consider tonsilectomy?

A

> 5 episode tonsillitis in one calendar year
Symptoms ongoing for >1 year
Episodes are disabling and prevent normal function
Tonsillitis is known to be the cause of the sore throats!

52
Q

which organism causes epiglottitis?

A

HiB

53
Q

which organism causes croup?

A

parainfluenza virus

54
Q

what level indicates impaired hearing on audiogram?

A

above 20dB

55
Q

what on audiogram indicates SNHL?

A

both air and bone conduction impaired

56
Q

what on audiogram indicates CHL?

A

only air conduction impaired

57
Q

what on audiogram indicates mixed HL?

A

both air and bone impaired but air worse than bone

Year 5 (12 decks)

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