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3B Specialties > ENT > Flashcards

ENT Flashcards

1
Q

Signs and symptoms of otitis externa

A

discharge
itch
pain
tragal tenderness

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2
Q

Causes of otitis externa

A

due to acute inflammation of the skin of the meatus
usually caused by excess canal moisture
trauma (fingernails - eczema/psoriasis)
absence of wax
narrow ear canal
hearing aids
commonly pseudomonas or staphylococcus aureus

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3
Q

TMJ dysfunction

A

earache, facial pain, joint clicking/ popping
related to teeth grinding, joint derangement and stress
joint tenderness exacerbated by lateral movement of open jaw or trigger points in the pterygoids
Rx- dental occulsion therapy, physio, CBT, surgery

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4
Q

Acute otitis media

A

middle ear inflammation
rapid onset of pain, fever ± irritability, anorexia or vomiting
commonly pneumococcus, haemophilus or moraxella
pain relief
amoxicillin if not resolved within 24hrs
grommets if recurrent

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5
Q

mastoiditis

A

middle ear inflammation leads to destruction of air cells in the mastoid bone ± abscess formation
beware intracranial extension
prevented by Abx for OM
Signs- fever, tenderness, swelling, redness behind the pinna, protruding auricle
IV abx, myringotomy ± definitive mastoidectomy

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6
Q

Genetic hearing loss

Conductive hearing loss

A

congenital anomalies of the pinna, external ear canal, drum or ossicles
Treacher-Collins, Pierre-Robi, Goldenhar syndrome

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7
Q

Non-genetic hearing loss

A

Intrauterine TORCH infections - CMV, rubella, toxicoplasmosis, HSV, syphillis
Perinatal - prematurity, hypoxia, IVH, kernictus, infection
Infections - meningitis, encephalitis, measles, mumps
Ototoxic drugs, acoustic or cranial trauma

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8
Q

Conductive hearing loss in adults

A

external canal obstruction - wax, pus, debris, FB, developmental abnormalities
drum perforation - trauma, barotrauma, infection
inadequate eustachian tube ventilation

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9
Q

Sensorineural hearing loss in adults

A

defects central to the oval window, cochlea nerve or central pathways
Ototoxic drugs- gentamicin, streptomycin, vancomycin, chloroquine and hydroxychlorquine, vinca alkaloids)

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10
Q

Otosclerosis

A

new bone formed around the stapes footplate
Autosomal dominant with incomplete penetration
usually appears in early adult life, accelerated by pregnancy
conductive deafness, tinnitus, mild transient vertigo
Rx- hearing aids, stapedectomy/otomy, cochlear implants

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11
Q

Tinnitus character

A

unilateral, bilateral, pulsatile or non-pulsatile
ringing, hissing, buzzing –> inner ear or central cause
popping or clicking suggests problems in the external or middle ear of the palate
pulsatile tinnitus is often objective

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12
Q

Objective tinnitus

A

Audible to examiner
rare and occurs due to:
- vascular dioders e.g. AVM, carotid pathology, glous tumours
- high -output cardiac states- paget’s hypoerthyroidism, anaemia,
-myoclonus of palatal or stedius/tensor tympani muscles –> audible click
- patulous Eustachian tube - prolonged opening causes abnormal sound transmission

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13
Q

Subjective tinnitus

A

associated with SNHL
noise induced hearing loss, Meniere’s
- conductive deafness
- ototoxic drugs

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14
Q

Acoustic neuroma

A

typically indolent, histologically benign, subarachnoid tumours
causes problems by local pressure then behave as space occupying lesions
arise from superior vestibular nerve Schwann cell laters
progressive ipsilateral tinnitus ± sensorineural deafness
giddiness common, vertigo rare

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15
Q

Benign paroxysmal positional vertigo

A

commonest cause of peripheral vertigo
attacks of sudden onset rotational vertigo lasting >30 seconds, provoked by head turning
displacement of otoconia stimulate semicircular canals
- no persistent vertigo
- no speech, visual, motor or sensory problems
- no tinnitus, headache, ataxia, facial numbness or dysphagia
- no vertical nystagmus
Hallpike +ve

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16
Q

Meniere’s disease

A

dilatation of endolymphatic spaces of membranous labyrinth causes sudden attacks of vertigo lasting ~2-4hrs
nystagmus is always present
increasing fullness in ears ± tinnitus
Rx- prochlorperazine, betahistine as prophylaxis

17
Q

Causes of nosebleeds

A 
local trauma - picking 
facial trauma 
dry/cold weather
dyscrasia/ haemophilia
septal perforation
18
Q

Peritonsillar abscess

Quinsy

A

presents with sore throat dysphagia, peritonsillar bulge
uvular deviation, trismus (lock jaw) and muffled voice
Abx and aspiration are needed

19
Q

Parapharyngeal abscess

A

serious but rare
diffuse swelling in the neck
Rx- US to identify site, incise and drain under GA

20
Q

Lemierre syndrome

A

acute septicaemia and jugular vein thrombosis secondary to infection with fusobacterium species + septic emboli
rare

21
Q

Scarlet fever

A

caused by endotoxins released from strep pyogenese
- rash on chest, axillae or behind ears 12-48hrs after initial sore throat and fever
red pinprick blanching rash
facial flushing with circumoral pallor
Rx - penicillin v for 10/7

22
Q

CENTOR criteria

A
  • presence of tonsillar exudate
  • presence of tender anterior cervical lymphadenopathy
  • history of fever
  • absence of cough
23
Q

Stridor

A

high pitched noise on inspiration

partial obstruction of the larynx or large airways

24
Q

Stertor

A

inspiratory snoring noise

obstruction of the pharynx

25
Q

Causes of stridor

A

Congenital - laryngomalacia, web/stenosis, vascular rings
Inflammation - laryngitis, epiglottitis, croup, anaphylaxis
Tumours- haemangiomas or papillomas (usually disappear without treatment
Trauma- thermal/chemical or from intubation

26
Q

Laryngotracheobronchitis

CROUP

A

leading cause of stridor
barking cough ± respiratory distress due to upper airway upper airway obstruction
Rx 0/15mg/kg dexamethasone

27
Q

Acute epiglottitis

A

rapidly progressive inflammation of the epiglottis and adjacent tissues
respiratory arrest can occur
presents with fever, irritability, sore throat, pooling and drooling of saliva, muffled voice or cry
lean forward and breath tentatively

28
Q

Laryngomalacia

A

main congenital abnormality of the larynx
noticeable within hours of birth
excessive collapse and in-drawing of the supraglottic airways during inspiration –> stridor

self resolving or may need surgery if not resolved by 2.

29
Q

Differential diagnoses for hoarse voice (dysphonia)

A

laryngeal cancer - progressive and persistent gruff voice
vocal cord palsy - weak breathy voice
laryngitis/reflux laryngitis
reinke’s oedema - chronic cord irritation from smoking ± chronic voice abuse
vocal cord nodules

30
Q

Disorders of speech articulation causing a hoarse voice

A

spasmodic dysphonia
muscle tension dysphonia
children with functional speech disorders

31
Q

Laryngeal nerve palsy

A

recurrent laryngeal nerve supplies intrinsic muscles of the larynx
abduction and adduction of the vocal vold
arrises from the vagus
weak breathy voice
repeated coughing/ aspiration
exertional dyspnoea

  • causes - cancer, iatrogenic, CNS disease, TB, aortic aneurysm, idiopathic
32
Q

Causes of dysphagia

A

oesophageal carcinoma
benign oesophageal stricture, Barrett’s oesophagus, Achalasia
pharyngeal pouch
globus pharyngeus (globus hystericus)- sensation of lump in the throat

33
Q

Bell’s Palsy

A

unilateral LMN facial palsy

diagnosis of exclusion

34
Q

Features of Bell’s palsy

A

inflammatory oedema from entrapment of the facial nerve in the facial canal
abrupt onset- over night/ after a nap
complete weakness at 24-72hrs
mouth sags
dribbling and watering/ dry eyes + impaired brow-wrinkling, blowing, whistling, lid- closure, cheek-pouting taste and speech ± hyperacusis from stapedius palsy

35
Q

Treatment of Bell’s Palsy

A

Prednisolone within 72hrs of onset

eye drops to maintain eye lubrication

36
Q

Ramsay Hunt herpes zoster oticus

A 
herpes zoster of the facial nerve 
often in the elderly 
severe otalgia precedes VII nerve palsy
zoster vesicles around the ear, in the deep meatus ± soft palate and tongue 
may be vertigo, tinnitus or deafness

Rx- prednisolone and aciclovir

37
Q

Vestibular neuronitis/ labyrinthitis, acute vestibular failure

A

sudden attacks of unilateral vertigo and vomiting in a previously well person
often following a recent URTI
lasts 1-2 days and improves over a week
Nystagmus away from the affected side

Rx- prochlorperazine or cyclizine

3B Specialties (7 decks)

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