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Maud- Phase 3b > ENT > Flashcards

ENT Flashcards

1
Q

Examining the ear. What do you do to the pinna / post-auricular?

A

Pinna: inspect for Deformities / abnormal cartilaginous fragments
Scars/skin changes e.g CA / inflammation

Palpate: Pre/Post auricular lymph nodes. Tragus

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2
Q

On palpation the Tragus is tender. Potential cause?

A

Otitis Externa

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3
Q

What do you look for when examining the external ear?

A

Wax/ foreign body, skin changes/ erythema / discharge

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4
Q

Name 2 tuning fork tests for measuring hearing?

A

Rhinne test

Webber test

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5
Q

Placing a tuning fork against the mastoid process and when ptx. stops hearing it holding it infront of ear is known as…

A

Rhinne test

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6
Q

Patient is Rhinne Test Positive, what does this mean?

A

Air conduction heard better than bone conduction (Rh+)= normal/sensorineural HL

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7
Q

Patient is Rhinne Test negative, what does this mean?

A

Bone conduction heard better than air conduction (Rh-)= conductive HL

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8
Q

Placing a tuning fork on the forehead midline is known as what test?

A

Weber test

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9
Q

Rhines test indicates that a patient has right-sided conductive hearing loss (bone conduction heard louded than air conducution).
You perform webers test- placing the tuning fork in the middle of their head. Which side does the patient report it is heard loudest?

A

Heard loudest on right (same side as conductive hearing loss) as the left is subject to ambient sound.

(I think of it as if you have conductive hearing loss your brain has to turn up the sound input on the cochlea)

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10
Q

What is conductive hearing loss?

A

When there’s a problem transferring sound at some point on the pathway from the outer ear–> tympanic membrane –>middle ear

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11
Q

What is sensorineural hearing loss?

A

When there’s a problem with the inner ear e.g cochlea or vestiboulocochlear nerve

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12
Q

In Sensorineural loss which side is the sound loudest on in webers test?

A

Contralateral side

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13
Q

What structures make up the external ear?

A

Pinna, external auditory canal (meatus), lateral surface tympanic membrane

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14
Q

What makes up earwax

A

squamous debris, cerumen and sebum

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15
Q

What structures make up the middle ear?

A

medial surface tympanic membrane, tympanic cavity + eustachian tube, ossicles

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16
Q

Name the 3 ossicles

A

malleus, stapes, incus

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17
Q

Describe the normal appearance of tympanic membrane

A

grey, semitransulscent, lower part= pars tensa, upper part= pars flaccida

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18
Q

Which nerve passes through the middle ear? Function?

A

Chorda tympani

Branch of facial nerve provides taste to anterior 2/3 tongue

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19
Q

Describe the function of the cochlea

A

Hair cells convert mechanical energy from sound to electrical impulses passed down cochlea branch of CN8

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20
Q

Describe the function of the semi-circular canals

A

movement of endolymph in semicircular canals converted to electrical impulses carried by vestibular branch of CN8

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21
Q

What allows us to maintain visual fixation on an object despite head movement?

A

Vestibulo-ocular reflex

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22
Q

Differentials for otalgia (otological causes)

A

Perichondritis / acute otitis externa/ acute otitis media
Trauma / Tumour
Ramsay Hunt syndrome

RHS is paralysis of facial nerve and rash effecting the ear or mouth

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23
Q

Give 3 infective causes of otoligical otalgia

A

Perichondritis
Acute otitis externa
Acute otitis media
Herpes Zoster (ramsay hunt syndrome)

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24
Q

Give 3 non-otological causes of otalgia

A

Tonsil / Pharyngeal inflammation / CA
Temporomandibular joint dysfunction
Dental / Cervical Spine disease

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25
Q

Patient presents with a chronic and offensive ear discharge. Likely diagnosis?

A

Cholesteatoma

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26
Q

Patients ottorhoea is mucoid, cause?

A

CSF leak from severe trauma

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27
Q

Itchy ear- likely cause?

A

Otitis externa

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28
Q

Purulent ottorhoea- likely cause?

A

Purulent disharge:

ear-drum perforation + infection / otitis externa

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29
Q

What type of patient is tinnitus more common in?

A

Tinnitis more common in ptx. with hearing loss

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30
Q

What is tinnitus

A

Buzzing/ringing/whooshing/humming in the absense of stimulus

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31
Q 
Give a cause of conductive hearing loss relating to:
External ear
Tympanic membrane 
Middle ear space 
Ossicles
A

External ear: wax / otitis externa
Tympanic membrane: trauma
Middle ear space: effusion, infection, trauma, tumour
Ossicles: trauma, otosclerosis

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32
Q

Differentials of sensorineural hearing loss?

A

Genetic / Idiopathic / Presbyacusis

Infection: meningitis, MM(R) (pre-natal)

Acoustic neuroma, Meniere’s disease

Trauma // Occupational / noise-induced

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33
Q

What are the three salivary glands?

A

Parotid, submandibular, sublingual

34
Q

Causes of parotid swelling

A

mumps, stone in salivary duct, benign/malignant tumour,

Sjogren’s, sarcoidosis, HIV

35
Q

Patient presents with bilateral parotid swelling for 1 week and a low-grade fever, what diagnosis should you work to exclude?

A

Mumps

36
Q

What investigations should you undertake for swollen parotids

A

FBC, ESR/CRP, UE
Blood culture, Viral Seroligy
Salivary antibody testing (mumps IgM)

Imaging: USS / Sialography
CT/MRI ?neoplasm

37
Q

Give a viral and bacterial cause of parotitis?

A 
viral= mumps 
bactereial= staph aureus
38
Q

Symptoms of parotitis

A

painful, swollen,

fever, dry mouth

39
Q

Management of mumps

A

Usually self-limiting

40
Q

Management of suppurative parotitis?

A

abx +/- incision and drainage

41
Q

What structures form the anterior triangle of the neck

A

Superior- inferior border of mandible
Medial- sagittal line of body
Lateral- medial border sternocleidomastoid

42
Q

What are the three paired salivary glands?

A

Parotid, Sublingual, Submandibular

43
Q

What important structure passes through the parotid gland?

A

Facial nerve

44
Q

Most parotid gland tumours are…

A

benign (80%)

45
Q

Risk factors for parotid gland tumour

A

Radiation exposure, EBV, smoking, genetics

46
Q

S&S of parotid gland tumour

A

painless enlarging mass, facial nerve palsy, redness, ulceration

47
Q

Which key symptom of a parotid gland tumour indicates that it is malignant?

A

Facial nerve palsy

48
Q

Investigations of parotid gland tumour

A

Bloods- ?infective cause
FNA cytology- ?malignant
CT neck + thorax- staging

49
Q

What is the management for a parotid gland tumour?

A

Partial/Total parotidectomy +/- adjuvant radiotherapy

50
Q

What is sialadenosis?

A

Chronic, bilateral swelling of parotids
Non-inflammatory, non-neoplastic
Associated with sjogren’s

51
Q

Name a medication given to patients with hyposalivation?

A

Pilocarpine

52
Q

What are the 4 tonsils surrounding the superior pharynx (waldeyer’s ring)?

A

Pharyngeal, Tubal, Palatine, Lingual

53
Q

What is xerostomia?

A

Dry mouth

54
Q

What is sialectasis?

A

Cystic dilation of salivary gland ducts

55
Q

Tonsilitis is most commonly viral or bacterial?

Give examples of each

A

*Viral- Rhino/corono/parainfluenza virus

Bacterial- group A beta haemolytic strep

56
Q

What are the centor criteria for tonsilitis?

A

Tonsilar exudate, fever, tender lymphadenopathy, absence of cough
Score 3/4= likely strep, give Abx

57
Q

Commonest bacterial cause of tonsilitis?

A

Group A B-haemolytic strep

58
Q

Management of viral / bacterial tonsilitis

A

Viral: sx relief (ibruprofen / paracetamol)
Bacterial: sx relief and penicillin 10 days

59
Q

What is quinsy?
3 S&S?
Mx?

A

Asymmetrical peritonsilar abscess which pushes uvula to one side
Dysphagia, hot potato voice, trismus, uvula deviation
Drainage, tonsilitis mx

Trismus= locked jaw

60
Q

Cause of Glandular Fever?

A

EBV

61
Q

Patient presents with sore throat, fever, malaise, lethargy, cervical lymphadenopathy, white film on tonsils and hepatosplenomegaly. Likely diagnosis? Mx?

A

Glandular fever

Analgesia, steroids, no contact sports +/-abx

62
Q

Commonest form of laryngeal CA?

A

Squamous cell carcinoma

63
Q

Risk factors for laryngeal CA?

A

smoking, alcohol, HPV, M>F

64
Q

What are the risk factors for epistaxis

A

trauma, nose pickers, cold/hayfever, pregnancy, chemotherapy, anticoagulants, infection

65
Q

Mx of epistaxis

A

ABCDE
Topical: vasoconstrictors (e.g adrenaline), lidocaine, tranexamic acid, cautery
Nose packing / gauze

66
Q

Anterior nasal blood supply:
Name of area
Name of arteries

A

Kiesselbach’s (little’s) area.

LEGS: labial, ethmoidal (anterior), greater palpatine, sphenopalpatine

67
Q

Differentials for anosmia

A

nasal obstruction, parkinsons, DM, alzheimer’s, COVID-19

68
Q

What is trismus?

A

lock jaw / reduced jaw movement

69
Q

How many episodes of bacterial tonsilitis per year to have tonsilectomy?

A

7

70
Q

Does the presence or absence of cough score a point on centor criteria and why?

A

Absence of cough scores

Cough is more indicative of URTI than tonsilitis

71
Q

What is tympanosclerosis?

A

Calcification of tymapanic membrane and middle ear

72
Q

What is a potential treatment for fungal otitis externa?

A

Canestan

Co trimazole

73
Q

What happens to the light reflex in AOM?

A

Lost because the tympanic membrane bulges towards you

74
Q

O/E of ear you see black dots, what is the likely diagnosis?

A

Fungal infection aspergillis niger

75
Q

What is a furuncle?

A

AKA boil

painful infection which forms around a hair follicle, contains pus

76
Q

OE there is eczematous inflammation with otitis externa. Give 2 examples of drugs which could be used to treat this?

A 
Gentisone (gentamicin + hydrocortisone) 
Otomize soray (neomycin, dexamethasone, acetic acid)
77
Q

Give 3 drugs which are involved in the treatment of balance disorders?

A

Prochlorperazine (stematil)- labrynthitis

Cinnarizine (sturgeron) / Betahistine dihydrochloride (serc)- vertigo, tinnitus and menierre’s

78
Q

Give an example of a drug prescribed for acute otitis media?

A

Augmentin (amoxicillin and clavulanate potassium)

79
Q

Give several differentials for a patient that presents with otorrhoea?

A

Serous- otitis externa
Mucoid/purulent- otitis media
Clear/blood stained- CSF (if head injury)
Foul smelling- cholesteatoma

80
Q

Give several differentials of otalgia:
External?
Middle ear?
Referred?

A

External- trauma, otitis externa, furunculosis
Middle ear- acute otitis media, acute mastoiditis
Referred- teethh, larynx, pharynx, neck

81
Q

Patient on webers test reports the sound is heard equally in both ears. What does this indicate?

A

Normal hearing

82
Q

Rhinnes test reveals
Left ear: air conduction heard louder than bone conduction
Right ear: bone conduction heard louder than air conduction
What does this indicate?

A

Right sided conductive hearing loss

Maud- Phase 3b (14 decks)

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