ENT Flashcards
What is the criteria used to decide whether or not to give antibiotics for a sore throat?
CENTOR: tonsillar exudate lymphadenopathy history of fever absence of cough
What is the treatment of strep throat?
penicillin
What is the most important investigation for BPPV?
Dix-Hallpike manoeuvre
What is the treatment for BPPV?
Epley manoeuvre
What is hearing loss associated with Menieres?
sensorineural
What is the most useful investigation for an acoustic neuroma?
MRI
How long does BPPV tend to last?
10-20 seconds
What kind of hearing loss do you get with otitis externa?
conductive hearing loss
What is the treatment of otitis externa?
mild cases: topical acetic acid 2% spray
severe inflammation: 7 days of topical antibiotic with or without a topical steroid
What are the features of cholesteatoma?
foul smelling discharge and hearing loss
What is the treatment of a cholesteatoma?
patients are referred to ENT for consideration of surgical removal
What type of malignancy may present as painless lymphadenopathy?
Nasopharyngeal carcinoma (due to its tendency for early spread)
What is the management of haemorrhage following a tonsillectomy?
primary haemorrhage is within 6-8 hours and required immediate return to theatre.
Secondary haemorrhage is between 5-10 days after surgery and is associated with wound infection. Treatment is with admission and antibiotics
What is the treatment of a perforated tympanic membrane?
nothing- let it rest and arrange to see in 4 weeks
How long does it take for a perforated eardrum to heal itself?
6-8 weeks
What causative organisms are involved in otitis externa?
Staph aureus and pseudomonas aeruginosa
What is the treatment for otitis externa if the infection spreads?
Flucloxacillin
What is Rinnes test?
tuning fork is placed over the mastoid process until the sound is no longer heard followed by repositioning over the external acoustic meatus
What are the results for Rinnes test in a normal ear?
Air conduction > bone conduction
What is Webers test?
tuning fork is placed in the middle of the forehead equidistant from the patients ears then they are asked where they heard it loudest
What are the results of Webers test?
sound localised to the unaffected side: sensorineural
Sound localised to the affected side: conductive
What is a Thyroglossal cyst?
more common in patients <20 years old. They are usually midline, between the isthmus of the thyroid and hyoid bone. Moves upward with protrusion of the tongue
What is a pharyngeal pouch?
it is more common in older men and represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles.
What is a cystic hygroma?
a congenital lymphatic lesion typically found in the neck classically on the left side which is most evident at birth
What is a Branchial cyst?
an oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx. develops due to failure of obliteration of the second branchial cleft in embryonic development.
What are the symptoms of Menieres?
tinnitus, hearing loss, vertigo and a feeling of fullness
What kind of hearing loss does otosclerosis cause?
bilateral conductive hearing loss
What is Presbycusis?
age-related sensorineural hearing loss
What drugs can cause ototoxicity?
gentamicin, furosemide, aspirin, quinine
At what sound frequences can hearing loss occur?
3000-6000Hz
In what condition can you get bilateral acoustic neuromas?
Neurofibromatosis type 2
What are the features of vestibular neuronitis?
recent viral infection, recurrent vertigo attacks lasting for hours or days with NO hearing loss
What is the treatment for acute otitis media with perforation?
oral antibiotics (amoxicillin)
What kind of hearing loss is associated with a perforated ear drum?
conductive hearing loss
What are the symptoms of a base of the skull fracture?
Battle sign, bleeding from the ear, CSF rhinorrhoea, raccoon eyes
What is trigeminal neuralgia?
unilateral facial pain characterised by brief electric shock like pains, abrupt onset and termination. may be triggered by light touch
What is otosclerosis?
sclerosis of bone and fixation of the stapes to the oval window
What kind of hearing loss does otosclerosis cause?
Conductive
What type of hearing loss is associated with Menieres?
Sensorineural
What is first line treatment in tonsilitis?
Penicillin V as amoxicillin has the potential to cause a rash in glandular fever
What is the treatment for otitis media?
oral amoxicillin. if penicillin allergic then erythromycin
What is the treatment of gingivitis?
Oral metronidazole
How do sensorineural and conductive hearing loss appear on an audiogram?
sensorineural- both bone and air conduction are below 20dB
conductive: only air conduction is below 20dB
What are the most common causative organisms involved in acute sinusitis?
Strep pneumoniae, haemophilus influenzae and rhinoviruses
What would give you unilateral vertigo and doesn’t affect hearing?
Vestibular neuronitis
What is a nasal septal haematoma?
it occurs post nasal trauma and is a haematoma between the septal cartilage and the overlying perichondrium
What is Ludwig’s angina?
Cellulitis at the floor of the mouth
If a monospot test was positive, what is this a marker of?
Infectious mononucelosis
What virus causes mononucleosis?
EBV
What is a pleomorphic adenoma?
benign, mixed parotid tumour. it occurs in the middle aged and is a slow growing painful lump
What is a Warthin’s tumour?
it is a benign cystic tumour of the salivary glands that contains abundant lymphocytes and germinal centers
What symptoms are indicative of a stone in the glands?
recurrent unilateral swelling and pain on eating
Which gland is most commonly affected by stones?
Submandibular
What are the features of Ramsay hunt syndrome
Vesicles on the tympanic membrane, otalgia, facial paralysis, taste loss, dry eyes, tinnitus, vertigo and hearing loss.
Reactivation of what virus causes ramsay hunt syndrome?
Varicella Zoster in CN VII
What is Bell’s palsy?
Facial weakness on one side.
What is the treatment of Ramsay hunt syndrome?
oral aciclovir and corticosteroids
What are the features of viral labyrinthitis?
sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo. the patient has usually had a viral infection
What is the difference between labyrinthitis and vestibular neuritis?
Labyrinthitis: the vestibular nerve and the labyrinth (vertigo and hearing impairment)
Vestibular neuritis: the vestibular nerve only. (vertigo)
What is the treatment for a perforated ear drum if it does not heal itself?
myringoplasty
When would you perform a tonsillectomy?
when the person has had 5 or more episodes of tonsilitis per year
What is the causative organism in otitis externa in diabetics?
Pseudomonas
What are the commonest tumours of the parotid gland?
Pleomorphic adenoma
What is a mucoepidermoid carcinoma?
it is a malignant tumour of the parotid gland. accounts for 30% of cases
What is an adenoid cystic carcinoma?
malignant tumour
What is the management of otitis media with effusion?
Grommets
What is the cause of presbycusis?
loss of outer hair cells, loss of ganglion cells, strial atrophy
What is an acoustic neuroma?
Slow growing benign schwannoma of vestibular nerve
What would you suspect if someone presented with asymmetric sensorineural hearing loss
Vestibular schwannoma
What is Vertigo that lasts seconds to minutes?
BPPV
Vertigo that lasts from minutes to hours?
menieres disease
Vertigo that lasts hours to days?
Labyrinthitis, vestibular neuronitis, migrainous vertigo
What causes BPPV?
loose otoliths from urtile displaced into semicircular canals- most commonly in the posterior semicircular canal
What condition associated with vertigo also have tinnitus?
Menieres disease and labyrinthitis
Where is an area in the nose that is a frequent site of nasal haemorrhage
Little’s area
what are causative organisms associated with sinusitis?
streptococcus pneumoniae and haemophilus influenzae
What does a RAST test measure?
levels of IgE
What would happen to a patients voice if polyps are found on the free edge of vocal cords?
prevents full closure and gives breathy, harsh voice
What is Reinkes oedema?
collection of tissue fluid in subepithelial layer of vocal cord. Due to the poor lymphatic drainage, vocal cords are predisposed to oedema
What is the treatment of Reinke’s oedema?
surgery to incise the vocal cords
What is in the vestibular labyrinth?
urticle and saccule- 2 small communicating sacs in the vestibule of the bony labyrinth and 3 semicircular ducts in the semicircular canals
What is the normal range of hearing?
20dB and quieter
How does conductive hearing loss look on audiogram?
There is a gap between air and bone conduction because there is something in the ear blocking sound transmission
How does sensorineural hearing loss look on audiogram?
Both bone and air conduction are affected (they will both be below 20dB)
What kind of hearing loss can ear wax cause?
Conductive
What kind of hearing loss is accompanied by cholesteatoma?
Conductive
What kind of hearing loss is caused by prolonged exposure to noise in the work place?
Sensorineural
What is the most common cause of sensorineural hearing loss?
Presbyacusis
How would mixed hearing loss look on audiogram?
gap between air and bone conduction however the bone conduction thresholds still show normal hearing range
When can the foetus hear in utero?
18 weeks
How do you test babies hearing?
Otoacoustic emission (hair cells produce sound in response to sound)
What is primary gingivostomatitis?
it is inflammation of the gingiva and oral mucosa and is the most common infection of the mouth
What is the virus responsible for gingivostomatitis?
HSV1
What is the treatment of gingivostomatitis?
Aciclovir
What does HSV 2 cause?
Genital lesions
How do you detect herpes simplex virus?
Swab the lesion and run Viral PCR looking for viral DNA
What is Herpangia?
It is vesicles/ulcers on the soft palate
What causes Herpangia?
Coxsackie virus
What causes Hand Foot and mouth disease?
Coxsackie virus
What are the symptoms of coxsackie virus?
mouth ulcers and spots on the hands and feet. It generally begins with a fever and is then followed a day or 2 later with flat discoloured spots or bumps that may blister
What is Chancre?
painless genital ulcer found in the primary stages of syphillis.
What are Apthous ulcers?
recurrent painful ulcers of the mouth that are round and have inflammatory halos. they are confined to the mouth and begin in childhood
What should you be worried about if someone has a sore throat and lethargy on week 2 and is between 15-25 y/o?
infectious mononucleosis (glandular fever)
What causes Glandular fever?
Epstein barr virus
What is quinsy?
Peri-tonsillar abscess
What is mastoiditis?
The result of an infection that extends to the air cells of the skill behind the ear
What is the most common causative organisms in bacterial sore throats?
Streptococcus pyogenes
What are complications of bacterial sore throats?
Rheumatic fever (fever, arthritis and pancarditis) and glomerulonephritis
What drug can cause neutropenia?
Carbimazole
What is the treatment for strep throat?
Phenoxymethylpenicillin/ penicillin V
What is the treatment for diptheria?
Penicillin or erythromycin if penicillin allergic
What are the features of infectious mononucleosis?
fever, lymphadenopathy, sore throat, pharyngitis, tonsilitis, malaise, lethargy
What is the treatment for glandular fever?
bed rest, paracetamol. avoid sport (splenomegaly), corticosteroids
What tests are done to look for infectious mononucleosis?
EBV IgM and heterophile antibody
What is the treatment for otitis media?
Most resolve in 4 days or amoxicillin
What is the management of otitis externa?
topical aural toilet, swab, topical clotrimazole or gentamicin
