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Phase 4 > ENT > Flashcards

ENT Flashcards

1
Q

What are the causes of sinusitis?

A

Infection (usually viral)
Allergic
Air pollution
Structural problems

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2
Q

Treatment of sinusitis?

A

1) Watchful waiting
2) © Acute = Intranasal decongestants, nasal douching + warm face packs
3) © Chronic = Intranasal steroids (beclametasone) if symptoms >10 days + prevention
4) No improvement in 7-10 days + systemically unwell – amoxicillin/co-amoxiclav
5) Symptomatic relief – painkillers e.g. naproxen, nasal steroids

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3
Q

What is BPPV?

A

See notes

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4
Q

What are the 4 cardinal symptoms of Meniere’s?

A
  • Vertigo (lasts mins-hours, the patient is normal between attacks)
  • Hearing loss (uni/bilateral, but level fluctuates)
  • Tinnitus (usually precedes an attack of vertigo)
  • Aural fullness (described as a pressure, fullness or warm feeling in the ear)
  • Can also get nystagmus
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5
Q

What are the average number of Menieres attacks/yr?

A

6-11

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6
Q

Mx of Menieres?

A
  • Tx: medical management – beta-histamine, gentamicin injections (saw the lady in GP), low salt diet and diuretics (to prevent fluid build-up)
  • Surgical management – decompressing the inner ear (draining the endolymphatic sac), disconnecting the labyrinth (vestibular neurectomy) or labyrinthectomy (destruction of the labyrinth)
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7
Q

Difference between labyrinthitis and vestibular neuritis?

A

Lab - semi-circular canals AND vestibular nerve, hearing IS affected, get NYSTAGMUS

VN - ONLY vestibular nerve, UNaffected hearing, Tx with prochlorperazine (antiemetic) in acute phase

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8
Q

What are the S+S of acoustic neuroma?

A
  • Unilateral sensorineural hearing loss (must exclude in all presenting patients)
  • Unilateral tinnitus
  • Impaired facial sensation (CN5)
  • Balance problems
  • Otalgia
  • Ataxia
  • Signs of increased ICP
  • Absent corneal reflex
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9
Q

How to Tx acoustic neuroma?

A

1) Watchful waiting – weigh up the risks of surgery vs rapid tumour growth
2) Surgery
3) Stereotactic radiosurgery

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10
Q

What are the RFs for oral Ca?

A

RFs: men, increasing age, smoking, heavy drinking

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11
Q

What is the treatment for oral Ca?

A

Photodynamic therapy

Excision

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12
Q

What are the S+S of oral Ca?

A
  • An ulcer that won’t heal
  • Red/white plaques on the inside of the mouth
  • A painful lump that won’t resolve
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13
Q

S+S of cholesteatoma?

A

Foul-smelling, unresolving watery discharge, unilateral conductive hearing loss
Other – vertigo, facial nerve palsy

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14
Q

What do you see on otoscope for cholesteatoma?

A

Attic crust

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15
Q

What are nasopharyngeal tumours and how to Ix?

A

See notes

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16
Q

What is otosclerosis?

A

See notes

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17
Q

Cause of sudden onset sensorineural hearing loss?

A

Causes – infection, trauma, immunological, toxins, ototoxic drugs, MS

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18
Q

Mx of sudden onset sensorineural hearing loss?

A

many spontaneously recover c/in 3 days, oral corticosteroid therapy immediately
+ refer to ENT, hyperbaric oxygen, antivirals, vasodilators etc

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19
Q

What are you concerned about with a unilateral serous effusion?

A

Nasopharyngeal tumour

20
Q

How to Tx acute OM?

A

See notes

21
Q

What can you see in OME?

A

Intact, retracted tympanic membrane

Loss of light reflex

22
Q

What can cause OME?

A

Obstruction or damage to the eustachian tube

23
Q

How to Tx OME?

A

o 95% resolve spontaneously within 1 year
o Only consider treatment for persistent bilateral OME and hearing loss after 3 months – Tx with decongestants and antibiotics
o Grommets in some cases

24
Q

What pathogens © cause OM?

A

H. influenza, S. pneumonia, Moraxella catarrhalis

25
Q

What are the causes and RF for OE?

A 
Narrow, tortuous ear canal
Moisture
Foreign body
Trauma
Chronic skin condition
26
Q

Ix for OE?

A

Test urine for sugar if >50

Swabs

27
Q

Tx for OE?

A

abx + steroids = Gentisone-HC
Flucloxacillin
Clotrimazole
Aural toileting

28
Q

What is malignant OE?

A

OE that has spread to cause osteomyelitis of the skull base, due to pseudomonas aeruginosa + anaerobes causing a mound of tissue in the external canal

29
Q

Tx of malignant OE?

A

emergency

IV ciprofloxacin

30
Q

What are the S+S of mastoiditis?

A

Earache + discharge
Pyrexia, ill-looking
Tenderness over mastoid antrum
Pinna may be pushed down and forward due to a swelling in the post-auricular region
Tympanic membrane = red, bulging or perforated
Signs of conductive deafness

31
Q

How to Mx mastoiditis?

A

IV 3rd gen cephalosporin

May req drainage

32
Q

What is masked mastoiditis?

A

abx fail to resolve acute presentation so low-grade granular osteitis develops in the mastoid bone

33
Q

What is a pre-auricular sinus and how to Tx?

A

Form by incomplete fusion of the pinna
Can be foul-smelling pus if infected
Need surgical removal

34
Q

What are the worrying signs for nasal polyps?

A

Unilateral
Bleeding
Triggers thoughts of nasal Ca

35
Q

What is Samter’s triad?

A

Aspirin sensitivity, asthma and nasal polyposis

36
Q

Management of nasal polyps?

A
  • Test for allergy
  • Check for CF in children
  • Biopsy for neoplasia if unilateral
    Medical Mx – topical steroids
    Surgical Mx – nasal polypectomy
37
Q

What is the presentation of nasal septal haematoma?

A
  • © the sensation of nasal obstruction
  • Pain + rhinorrhoea
  • Classically pt has a bilateral, ‘boggy’, red swelling arising from the septum
38
Q

Why do you need to treat nasal septal haematomas as an emergency and how to Tx?

A

Because the septum could become necrotic within 3-4 days and cause a saddle-nose deformity
Tx with drainage and IV abx

39
Q

What is the management for allergic rhinitis?

A

Mild-mod: oral/intranasal antihistamines
Mod-sev: intranasal corticosteroids
For topical decongestants role, see notes

40
Q

S+S of ramsay hunt syndrome?

A

PAIN, hearing loss + earache, FN palsy, vesicular rash around the ear or on tongue, vertigo, tinnitus

41
Q

What is the pathophysiology of ramsay hunt syndrome?

A

Shingles that is affecting the facial nerve

42
Q

What is the management of Ramsay-hunt syndrome?

A

PO acyclovir and corticosteroids

43
Q

Mx of Bell’s palsy?

A

prednisolone PO 10 days within 72 hours + artificial tears

44
Q

Causes of Bell’s?

A

Herpes predominently

45
Q

Which drugs are ototoxic?

A

Gentamicin, quinine, furosemide, aspirin + some chemo

46
Q

What is the presentation of quinsy?

A
  • Severe throat pain, lateralises to one side
  • Deviation of the uvula to the unaffected side
  • Reduced neck mobility
  • ‘lockjaw’ may occur d/t trismus (motor disturbance of the trigeminal nerve)
47
Q

Tx of quinsy?

A

Need urgent ENT review
Tx with needle aspiration under local anaesthasesia
Systemic penicillin
Consider tonsillectomy in 6wks time

Phase 4 (13 decks)

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