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DPD Stuff > ENT > Flashcards

ENT Flashcards

1
Q

Who do ENT work with?

A 
ITU
Oncology
Respiratory and allergy
SALT
Anaesthetics
Neuro
Opthalmology
Thoracic surgery
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2
Q

What do you need to clinically diagnose chronic rhinosinusitis?

A
  • Nasal obstruction or congestion bilaterally for at least 3 months

PLUS either:

  • Rhinorrhoea
  • Post nasal drip

AND either:

  • Loss of sense of smell (or cough if child)
  • Facial pain

oedema/ polyps/ CT findings

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3
Q

What do you look for in the Hx of Chronic rhinosinusitis?

A
  • Nosebleeds
  • Allergies
  • Surgeries
  • Nasal steroids (not as bad as orals)
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4
Q

What is the treatment for CRS?

A
  • Many polyps = surgery
  • Intranasal steroids
  • Sea salt
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5
Q

What are the serious complications of nasal surgery?

A
  • Brain damage

- Eye damage

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6
Q

What is a septal haematoma?

A

Blood supply damage causes revascularisation of the septal cartilage and causes it to seperate
Causes perforation and atrophy of septal cartilage and saddle nose

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7
Q

What is allergic rhinitis?

A
  • Positive allergy test

- Symptoms

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8
Q

What are the symptoms of allergic rhinitis?

A
  • Blocked congested nose
  • Watery/ red/ itchy eyes
  • Sneezing/ cough
  • Sore throat
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9
Q

How do you treat allergic rhinitis?

A
  • Nasal antihistamines
  • Intranasal corticosteroids (but not in glaucoma)
  • Avoid allergen
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10
Q

What is rhinoplasty?

A

Operation of the nose ‘nosejob’

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11
Q

What is otology?

A

The study of hearing of balance

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12
Q

What is the part of the outer ear?

A

Pinna/ auricle

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13
Q

What is the in the middle ear?

A

Contains the ossicles (malleus, incus, stapes) attached to the tympanic membrane

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14
Q

What is in the inner ear?

A

Semicircular canals and cochlea

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15
Q

What is the pars tensa?

A

Taut part of the eardrum under the ossicles

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16
Q

What is the pars flaccida?

A

Floppy part of the eardrum above the ossicles

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17
Q

What is the central part of the tympanic membrane called?

A

Umbo

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18
Q

Where are vulnerable points in the ear?

A

Pars flaccida
Facial nerve over the stapes
Eustachian tube

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19
Q

What can cause otitis externa?

A

Staphylococcus
Klebsiella
E. Coli
Pseudomonas

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20
Q

Who is more likely to get otitis externa?

A

People who have:

  • Eczema
  • Psoriasis
  • Sebhorrhoeic Dermatitis

use of:

  • Shampoo
  • Detergent
  • aerosols
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21
Q

What does otitis media look like?

A
  • Bulging
  • Dilated blood vessels
  • Pus
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22
Q

What can otitis media cause?

A
  • Mastoiditis with abscess which requires surgery 9can result in mastoid fistula if not treated
  • Brain abscess which causes death
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23
Q

What does a tympanic membrane perforation look like?

A
  • Blood

- Hole

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24
Q

What causes tympanic membrane perforation?

A
  • Pressure changes

- Cottone buds

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25
Q

What happens if a tympanic perforation heals badly?

A
  • Can be fine if kept clean and dry
  • May cause pouching and dead cell aggregation resulting in a tumour like appearance and can grow into bone, sinuses, brain (cholesteatoma) needs surgery
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26
Q

What are the routes of ear surgery?

A
  • Through the ear canal
  • Through the Mastoid bone
  • Both
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27
Q

How do you treat otitis media with effusion (glue ear)?

A
  • Put in a grommet (to air out the middle ear when the eustachian tube can’t)
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28
Q

What does unilateral glue ear suggest?

A

Compression of eustachian tube not from a cold (cancer more likely)

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29
Q

Why is an active middle ear implant better?

A

Drives stapes directly not through ear canal and membrane

30
Q

What is a BAHA?

A

Bone Anchored Hearing Aid

Vibrate the cochlea throug the skull bone to hear

31
Q

How do you treat a damaged cochlea?

A

Cochlea implant

Stimulates 8th nerve directly via electical impulse

32
Q

What happens if you don’t have an 8th nerve?

A

Brainstem implant

electrodes onto auditory nucleus on brainstem

33
Q

What are the parts of the vestibular system?

A
  • Vestibular apparatus (semicircular canals, utricle and saccule)
  • 8th nerve (vestibular branch)
  • Vestibular nuclei (medulla)
  • Cerebellum, RETICULAR FORMATION, somatic motor neurone controlling eyes
  • Thalamus
  • Cerebral cortex
34
Q

What are the semicircular canals oriented like?

A

Superior
Posterior
Lateral

35
Q

Why are the SCC oriented like that?

A

To allow detection of movement of your head in any rotational direction

Allows focus on a fixed point (vestibular ocular reflex)

36
Q

Which canals detect which movements?

A

Superior- Forward/ Back
Posterior- Sidewards (ear to shoulder)
Lateral- Sidewards (Look around)

37
Q

How do SCC work?

A

Endolymph (filled with cations) moves around the SCC in movement which opens ion channels on hair cells causing nerve firing as cations rush in

38
Q

How do the utricle and saccule work?

A

(Linear movements and gravity)
Have their own stereocilia
Endolymph moves up and down causing ion channel opening in hair cells
Gravity causes constant downward pushing so we know which way is down

Utricle = lying down 
Saccule = gravity
39
Q

What can the word dizzy mean?

A

Light headed (presyncope)
Unsteadiness (Dysequilibrium)
Spaced out (Dissociation)
Vertigo (Abnormal sensation of motion)

40
Q

What is associated with vertigo?

A

Room spinning
on a boat
N/V
Nystagmus

41
Q

What are peripheral causes of vertigo?

A

BPPV
Menieres
Vestibular neuritis/ labrynthitis

42
Q

What is BPPV?

A

Otolith organ has dislodged otoconia causing abnormal sensation on movement

Seconds
Horizontal nystagmus

43
Q

What tests are used to diagnose and cure BPPV?

A 
Diagnose: Dix-Hallpike
Lie them down very quickly- causes horizontal nystagmus
Cure: Epley manouvre
Sit up
Lie down
Turn head
Sit up
(30 s between each)
44
Q

What is menieres?

A

Abnormal sensation of motion (minutes)
Too much endolymph
Vertigo, hearing loss, tinnitus, ear fullness

45
Q

What is the treatment of Menieres?

A

Betahistine

Intr tympanic steroid injection

46
Q

What is vestibular neuritis/ labrynthitis?

A

Vestibular neuritis- Inflamed nerve

Labrynthitis- inflamed labrynth

47
Q

What are central causes of Vertigo ?

A

Vestibular migraine

Brainstem, cerebellar, thalamic or cortical pathology

48
Q

What is a vestibular migraine?

A

Dizziness and migraine

Treat like a migraine

49
Q

What may indicate a central cause of vertigo?

A

Non horizontal nystagmus

50
Q

What are the common conditions in paediatric ENT?

A 
Tonsils
Adenoids
Glue Ear and grommets
Paediatric airways
Foreign bodies
51
Q

What is tonsilitis?

A

Glandular rings at the back of the throat which become inflamed due to infection

52
Q

Where is the adenoid?

A

Behind uvula

53
Q

What are the tonsil diseases?

A

Acute tonsilitis
Recurrent tonsilitis
Obstructive hyperplasia
Malignancy

54
Q

What are the symptoms of tonsilitis?

A 
Prodrome (1-2 days) - fever and malaise
Sore throat, odynophagia, dysphagia
Otalgia
Cervical LN (>2cm) or tender LN
Off school/ work
55
Q

What are the common tonsil infections?

A
  • Virus (Adenovirus, EBV, RSV, CMV)

- Bacteria (Strep pyogenes, Haemophilus influenza, Staph aureus, Strep pneumoniae)

56
Q

What is the treatment of tonsilits?

A
  • Analgesia

- Antibioitic (penicillin, erythromycin)

57
Q

What are the differentials for tonsilitis?

A 
Infectious mononucleosis
Malignancy (lymphoma, leukaemia, carcinoma)
Diptheria
Scarlet fever
Agranulocytosis
58
Q

What is obstructive hyperplasia?

A 
Sleep disordered breathing
- snoring
- upper airway resistance
- obstructive sleep apnoea 
(mild/ moderate/ severe)
59
Q

What can obstructive hyperplasia cause?

A

Snoring
Restless sleep
Daytime symptoms (chronic mouth breathing, poor mentation, decreased attention, poor scholastic performance, dysphagia)

60
Q

What conditions predispose to obstructive hyperplasia?

A

Downs
Craniofacial abnormalities (Pierre Robin, Treacher Colins)
NM disorders

61
Q

What are the tonsil grades?

A 
0- in fossae
1- <25% obstruction
2- 25-50%
3- 50-75%
4- >75%
62
Q

What investigations might you do for obstructive hyperplasia?

A

Sleep study polysonography
+ Interpretation
perioperative issues (HDU post- op)

63
Q

What are the complications of obstructive sleep apnoea?

A
  • Pulmonary HTN
  • Cor pulmonale
  • Dysrhythmias
  • Failure
  • Intracranial HTN
64
Q

What are the causes of unilateral tonsillar enlargement?

A

Apparent vs true
- Displacement by parapharyngeal mass

Non-neoplastic

  • Hypertrophy
  • Acute/ chronic infection
  • Congenital

Neoplastic

  • Benign papillomas
  • Lymphoma
  • SCC
65
Q

What are some adenoid diseases?

A

Obstructive hyperplasia
Acute adenoiditis
Recurrent adenoiditis
Malignancy

66
Q

What are some Adenoidal symptoms?

A

Obstruction

  • Smoring
  • Mouth breathing
  • Hyponasality

Discharge

  • Rhinorrhoea
  • Post nasal drip
  • Nocturnal cough

Adenoide facies

  • Overbite
  • long face
  • crowded incisors
67
Q

What are the investigations for adenoids?

A

Nasendoscopy
Posterior rhinoscopy
Lateral Neck soft tissue X ray

68
Q

When is a lateral neck X ray useful?

A

When Hx/ Ex not in agreement

Accuracy dependent on proper positioning and patient co-operation

69
Q

What are the indications for a tonsilectomy?

A 
- Recurrent or chronic tonsilitis
> Children: 7 episodes for 1 yr, 5/y or more for 2 years , 3/y or more in 3 years
- Peritonsilar abscess
- Hypertrophy causing SDB
- Unilateral tonsillar enlargement
- Halitosis, tonsiloliths
70
Q

What are the indications for an adenoidectomy?

A

Obstruction

  • chronic or obligate mouth breathing
  • SDB/ OSA
  • Speech problems

Infection

  • Recurrent/ chronic adenoiditis
  • Recurrent/ chronic glue ear
71
Q

What are the contraindications for an adenoidectomy?

A
  • Overt or submucous cleft palate
  • Neuromuscular abnormalities with impaired palatal function
  • anaemia or disorders of haemostasis
72
Q

You need to evaluate a palate before an adenoidectomy- how?

A
  • Cleft palate
  • Bifide uvula
  • midline muscle diastasis
  • Velopharyngeal insufficiency
  • Neuromuscular disease
  • evaluate speech

DPD Stuff (23 decks)

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