ENT Flashcards
1
Q
ACUTE otitis media = is preceeded by what?
A
Viral URTI
2
Q
most common bacterial cause of otitis media
A
- strep pneumonia
3
Q
when do you admit a child for otitis media
A
- <3 months old with 38 degrees + temp
- 3-6monthhs with 39 degrees
4
Q
rx otitis media
A
- no abx as most resolve in 3 days
5
Q
most common complication of otitis media
A
mastoiditis
6
Q
who should you give abx to for otitis media
A
- no improve after 4/7
- immunocompromised
- systemic unwell
- severe co morbidities
- <2yrs with bilateral
- those with discharge
7
Q
what abx would you give if you had to for otitis media
A
- amoxicillin 5/7
- erythromycin/ clairthro if pen allergy
8
Q
protective factors for otitis media
A
- pneumococcal and influenzae vaccine
- breastfeeding for 6/12
- avoidign smoke
9
Q
risk factors or otitis media
A
- first epidose in 6/12, male. day care, smoking exposure, winter, sibling with recurrent AOM, Craniofacial abnormalities, pacifiers use, not breastfed, bilateral disease
10
Q
what is rx for recurrent AOM
A
- Grommets
11
Q
glue ear rx
A
- wait and watch
3/12 - autoinfalte eustachian tube by otovent
- grommet if persists or recurs
12
Q
complications of grommet insertion
A
- tympanosclerosis
- infection
13
Q
grommet insertion criteria
A
- > 4 AOM /year
- >3 AOM in 6/12
14
Q
what happens to grommets once inserted
A
- natuurally falls out after 6-12/12
15
Q
what pars perforates in chronic supparative otitis media without choleostatoma
A
- pars tensa
16
Q
what pars perforates in chronic supparative otitis media with choleostatoma
A
- pars flaccida
17
Q
rc chronic supparative otis media
A
- pars tensa - conservative or myringoplaty if severe
- pars flaccida; mastoidectomy
18
Q
what is pericondirits
A
- inflammation of the pinna - inflammed cartilage layer
19
Q
what causes pericondirits
A
- piercing
- otitis externa
- haematoma
20
Q
periconditis infective organism
A
- pseudomonas
- sometimes staph aureus
21
Q
rx pericondirits
A
- IV abx - ciprofloxacin/tazocin
- IV steroids
- I and D if need be
22
Q
name abx used for otitis externa
A
- sofradex
23
Q
rx refractory otitis externa
A
think fungal
- swab
- canestan and prolonged for 3/52
- if still suspect bacterial; high dose steroid/antifungal/abx = all 3 = triadcortyl
24
Q
acute labrynthitis triad
A
- vertigo
- n and v
- tinnitus/ hearing involved
note - recent viral infection usual
- sudden onset sx
25
what is gradenigo syndrome/ apical petrositis
- trigeminal pain distribution
- acute otitis media
- abducens palsy
26
rx for apical petrositis
- IV abx
27
subjective vs objective tinnitus
- subjective - not a an actual sound but a defect in auditroy pathway
- objective - sound made in inner ear.
28
most common causes of objective tinnitus
- Vascular; AV malformations, eustachian abnormalities, myoclonus of osccicualr msucles, high output CCF
29
causes of subjective tinnitus
- Presbyacusis
- NIHL
- menieres
- otoxicity
30
which drugs cause reversible tinnitus
- macrolides and loops
31
Acoustic neuromas are associated with which type of neurofibromatosis
- NF2
32
what happens to corneal reflex in acoustic neuromas
- absent
33
triad of acoustic neuroma
- hearing loss, vertigo, tinntitus
34
vestibular neuronitis sx
- no hearing loss
| - recurrent vertigo attacks lasting hrs to days
35
what does and elderly patient with dizziness on extension of th neck have
- - vertbrobasilar ischaemia
36
in acute vestibular failure (neuronitis/labrynthitis) where does nystagmus go
- away from affected side
37
which 6 nerves give rise to referred pain in the ear
- auriculotemporal branch of trigeminal
- aurivular branch of vagus
- greater auiicular nerve
- lesser occipital - facial
- glossopharyngeal
38
auriculotemporal nerve arises from which CN and gives pain from what issues
- V
| - TMJ dysfunction and dental disease
39
which nerve causes pain in ramsey hunt syndrome
- CN VII
40
what cause ear pain via glossopharyngeal nerve
- primary glossopharyngwal neuralgia induced by talking ro swallowing
41
what conditions cause ear pain due to tympanic breach of glossopharyngeal nerve and auricular branch of vagus
- refer pain from cancer of posterior 1/3 of tongue, pyriform fossa, or larynx
- quinsy
- post tensillectomy
42
what conditions do you get ear pain due to the great auricular nerve at c2 and c3
- soft tissue injury in cervival spondylosis/arthritis
43
what drug is used to prevent barotraum
xylometazoline
44
what drug users have a obliterated septum
cocaine
45
rx epistaxis
- lean forward mouth open, spit out blood
| - naseptin to reduce crusting and risk of vestibulitis
46
who should you not give naseptin to
those with peanut allergy or soy or neomycin allergy
47
what should you give those with a nosebleed that cannot have naseptin
- mupirocin
48
who with epistaxis, do you admit
- comorbidity such as HTN thats severe or coronary artery disease
- aged under 2 - as more likely underlying cause
49
what do you do if a nosebleed does not stop with initial measures and lasts more than 15mins
- packing. and cautery if visible source
- packing if cautery not viable or no visual of bleeding point
- go to hospital if packed
50
why should you never cauterise both sides of a septum
risks perforation
51
what if bleeding does nto stop after 24hrs of packing
- foley catheter
52
what does serious posterior epistaxis need
- EUA, Endoscopic arterial ligation or embolisation
53
if after nasal facture, Examinationn under anaesthesia is required when shoudl you do this
- not till 10-14 days after injury before nasal bones set
54
diagnostic criteria for rhinosinusitis
- inflammation of nose and paranasal sinuses with at least 2 sx:
- must have; nasal blockage/obstruction/congestion or discharge
- facial pain/pressure
- reduced/loss of smell
- endoscopic or CT imaging changes
55
how many weeks is chronic rhinosinusitis diagnosis
>12
56
rx chronic rhinosinusitis
- intranasal steroids and saline irrigation
| - if no improved after 4/52 = mod/severe endoscopic findings - culture and prophylactoc abx if ige normal
57
if nasal polyps are identified in a person <10yrs , what are the ddx
- tumours
- CF
- Meningeocoele
- Encephalocoele
58
ix for single unilateral polyp
- biopsy for NPC or lymphoma
59
ix for polyps
rhinoscopy
60
rx for polyps
- steroids ; topical.
| - endoscopic sinus surgery
61
rhinitis urgent referral criteria
- numbness
- tooth loss
- bleeding - -unilateral
62
acute bacterial rhinosinusitis diagnostic criteria
- 3 of:
- discoloured discharge with unilateral prominence and purulent secretion
- severe local pain; unilateral
- fever > 38
- inflam markers
- deteriorates after mild illness
63
acute bacterial rhinosinusitis rx
- simple analgesia
- nasal saline irrigation, intranasal decongenstants
- stop smoking
64
define acute post viral sinusitis
- worsening in sx 5/7 after or perisstent sx >10/7
65
rx acute sinusitis
```
<10/7 = support
10+ = high dose IN corticosteroids
```
66
what type of ca are head and neck ca in genral
- SCC
67
RF laryngeal ca
- age, male. hc RDT, Hx Family, smoking, alcohol
68
at how many weeks of hoarse voice do you refer to ENT and what ix do you do
- 3 weeks
| - CXR
69
Types of laryngeal ca
supraglottis
glottis
subglottis
70
which organ does laryngeal ca spread to commonly
lungs
71
rx laryngeal ca
- total laryngectomy if sybglottis with perm trache and valve for speaking
- RDT +/- chemo
- partial laryngectomy
- palliative
72
sx of tonsillar ca
- otalgia
| - asymettrical tonsil = tonsillectomy
73
do pharyngeal ca present late or early
late
74
Nasopharyngeal ca sx
- middle ear effusion
75
nasopharyngeal ca is most common in which ethnicity
southern china
76
how do maxillary antral tumours present
- epiphora (tears spill on face), loose teeth, glue ear, face swelling, nasal obstruction
77
if there is a neck lump in <20yrs old in midline - what is likely dx
- thyroglossal cyst
| - dermoid cyst
78
neck lump in >20yrs in midleine?
- thyroid mass
| - chondroma
79
submandibular neck mass <20
- self limiting LNA
80
Submandibular lump >20yrs dx
- salivary stone/tumour
| - ca
81
anterior triangle tumours
- LN
- Branchial cyst; at junction of upper and middle 1/3rd
- cystic hygroma; transilluminates
- carotid bdy paragangliomas - move laterally and firm
- parotid tumours
82
wegeners granulomatosis sx
- epistaxis, ulcers, obstruction nasal
- haemoptysis, pleuritis
- glomerulonephritis, proteinuria, haematuria
- purpura, neuropathy, arthritis, uveitis
83
wegeners granulomatosis ix
- cANCA
- urinalysis
- CXR and CT lung
84
wegeners granulomatosis rx
induce remission
- corticosteroids
- cyclophosphamide
maintain
- azothioprine
- methotrexate
prophylaxis for infection
- pneumocystis jirovecii
85
laryngitis rx
- supportive
| - if severe = phenoxymethylpen 1/52
86
what is reinkes oedema
- fusiform gelatinous enlarged cords due to chronic cord irritation
87
reinkes oedema occurs in which patients
- female smokers
- hypoTH
- Elderly
- chronic voice use
88
sx reinkes oedema
- deep gruff voice
89
rx reinkes oedema
- support if early
| - laser if late
90
vocal cord nodules symptoms
- husky voice + laryngitis sx
91
cause of vocal cord nodules
- chronic voice abuse
92
rx vocal cord nodules
- speech therapy/surgical excision
93
laryngitis causes
- viral
- bacterial
- reflux- fungal
- chemicals
-foreign body
-
94
what are the common bacterial and viruses that cause laryngitis and what are the prognosis
- viral; rhino in spring and autumn, influenza in winter. are self limiting
- bacterial most common HIb = life threatening
95
predisposing factors to laryngitis
- pollution
- croup
- epiglottitis
- smoking
- mouth breathing
- climate
- immunodeficient
- DM
- HypoTH
- IDA
- Voice use
96
diptheria laryngitis rx
- abx and antitoxin
| - only negative after 3 clear swabs and a culture
97
define acute laryngitis
<7/7
98
define chronic laryngitis
>3/52
99
epiglottitis definition
- cellulitis of supraglottis
100
epiglottitis neck XR findings and rx
- thumb sign; enlarged epiglottitis
| - ceftriaxone = empirical
101
what is the most worrying cause of pharyngitis
- GAS
102
What is the centor criteria
- whether or not to give abx for tonsillitis
score 1 for each of the following:
- exudate
- fever
- cervical LNA
- absence of cough
3/4 = pen v 10 days or erythro
103
complications of tonsillitis
- acute otitis media
- sinusitis
- quinsy; abx nd aspirate
- parapharyngeal abscess - I and D
- lemierres disease; acute septicaemia and jugular vein thrombosis secondary to fusobacterium + septic emboli
104
scarlet fever organism
- GABHS
| - Strep pyogenes
105
where does rash spread to in scarlet fever and how quickly
- chest
- axillae
- behind ears
12-28hrs after rash
+ facial flush and strawberry tongue
106
rx scarlet fever
- pen v 10/7
107
complications scarlet fever
- sydenhams choreo
| - demyleiantign disorders
108
tonsillectomy criteria
>7 /12, >4 in 2 years, >3 in 3 years
109
tonsillectomy complications
- primary = in 24hrs - back to theatre
- secondary; after 24hrs but typical 5-10 days = major haemorrhaoge protocol
if bleedign stops - hydrogen peroxide gargles and IV ABX
110
what type of cancers are most head and neck cancers
- SCC
111
RF for head and neck cancers
- smoking
- alcohol
- Vit A and C deficiency
- HPV 16
- Nitrosamines
- GORD
112
sx for head and neck cancer
- neck pain/lump/ hoarse or soar throat >6/52
- mouth bleeding and numbness
- sore tongue
- painless ulcers
- oral patches
- toaglia effusion
- speech change and effusion
113
which head and neck cancers is HPV linked to
- lingual, tonsillar and pharyngeal and laryngeal
114
anterior triangle lump ddx
- lymphoma
- branchial cyst ( squamous lined cholesterol)
- parotid ca esp if >40yrs
115
posterior triangle lump ddx
- pharyngeal pouch
- cystic hygroma (transilluminates)
- cervical rib
- EBV LNA
- lymphoma
116
options for voice restoration after laryngectomy
- artificial larynx
| - trans-oesophageal puncture
117
what does a radical neck dissection involve
- all neck LN + spinal accessory nerve and internal jugular vein and SCM
118
where do head and neck cancers spread to
- cervical LN first
| - lungs after
119
suspected head and neck cancer ix
- flexible nasolaryngoscopy
- CT neck and chest
- FNA LN +/- USS - core/excision biopsy
- primary tumour = GA; BIOPSY through panendoscopy
120
dx criteria for OSA
- Epworth scale.. 17/21 = narcolepsy
- overnight pulse oxiemtry = cyclical desaturation with sawtooth appearance
- if nto diagnosed by above then inpatient sleep study
- dx if 10-15 hypoapneas or apnoea in 1hr of sleep
121
rx OSA
- CPAP
| - CNS stimulant = modafinil
122
what does the recurrent laryngeal nerve supply
- most of the isntrinsic muscles of the larynx except cricothyroid
123
what are the only muscles to open vocal fold
- posterior cricoarytenoid
124
sx vocal cord paralysis
- hoarsness = breathy
- SOBOE
- Repeat coughing and aspiration
- weak cough
125
causes of vocal cord paralysis
- tumours
- iatrogenic
- CNS
- TB
- Iatrogenic
126
ix vocal cord paralysis
- MRI, Endoscopy, CXR, Barium swallow
127
rx vocal cord paralysis
- medialisation - medialisation thyroplasty
| - treat tumour
128
what metabolic abnormalities cause bilateral vocal cord paralysis
- hypokalaemia and hypocalcaemia
| - DM
129
what is the one cause that causes bilateral not unilateral palsy
- neurological disease
130
the parotid gland is innervated by which cranial nerve
- CN XI - accessory nerve
131
parotid gland produces what
- serous saliva
132
submandibular gland produces what
mucous and serous saliva
133
submandibular gland is innervated by what
- CNVII
134
unilateral salivary gland enlargement causes
- tumour
- bacterial infection
- stone
135
bilateral hypofunctioning salivary gland enlargement causes
- infections often viral, HIV or mumps
- autoimmune - sjogrens
- granulomatous disease; sarcoid, TB
136
bilateral asymptomatic Salivary gland enlargement causes
- eating disorder - anorexia, BN
- Cirrhosis
- chronic pancreatitis
- endocrine - acromegaly/DM
137
pain and sweling when eating indicates what
= duct
138
what does a dry mouth indicate about salivary issues
they are diffuse
139
ix for salivary stones
- plain XR
| - if not seen = sialogram or USS
140
what is heerfordts syndrome
- sarcoidosis with bilateral parotid enlargmeent, fever, anterior uveitis and facial nerve palsy
141
parotid duct pathway
- crosses the masseter and opens via small papilla on the buccal membrane opposite the crown of second upper molar
- facial nerve passes through it
142
parotid enlargement with facial nerve palsy = ?
- malignancy
143
benign tumour s of parotid
- benign pleomoprhic adenoma; slow growth - remove with parotidectomy
- adneolymphoma - soft, old men
- haemangioma
- lympangioma = kids
144
intermediate ca parotid tumours
- mucoepidermoid
- acinic cell cancer
- oncocytoma
145
malignant parotid tumours
- adenoid cystic ca - slow growing, distant mets, exocrine mucous glands
- adenocarcinoma; rapid growth, hard mass, pain and 7th CN palsy
- SCC
146
when should you not do a sialogram in patients with parotid tumours-
iodine/ contrast allergy
- acute infections
- CT instead
147
complications of parotid surgery and RDT
- facial palsy
- salivary fistula
- freys syndrome; auriculotemporal branch of trigeminal resprouts to swiitch symp fibres to parotid and paraymp to facial sweat glands = gustatory sweating
