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F year medicine facts > ENT > Flashcards

ENT Flashcards

1
Q

ACUTE otitis media = is preceeded by what?

A

Viral URTI

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2
Q

most common bacterial cause of otitis media

A
  • strep pneumonia
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3
Q

when do you admit a child for otitis media

A
  • <3 months old with 38 degrees + temp

- 3-6monthhs with 39 degrees

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4
Q

rx otitis media

A
  • no abx as most resolve in 3 days
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5
Q

most common complication of otitis media

A

mastoiditis

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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
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7
Q

what abx would you give if you had to for otitis media

A
  • amoxicillin 5/7

- erythromycin/ clairthro if pen allergy

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8
Q

protective factors for otitis media

A
  • pneumococcal and influenzae vaccine
  • breastfeeding for 6/12
  • avoidign smoke
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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
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10
Q

what is rx for recurrent AOM

A
  • Grommets
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11
Q

glue ear rx

A
  • wait and watch
    3/12
  • autoinfalte eustachian tube by otovent
  • grommet if persists or recurs
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12
Q

complications of grommet insertion

A
  • tympanosclerosis

- infection

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13
Q

grommet insertion criteria

A
  • > 4 AOM /year

- >3 AOM in 6/12

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14
Q

what happens to grommets once inserted

A
  • natuurally falls out after 6-12/12
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15
Q

what pars perforates in chronic supparative otitis media without choleostatoma

A
  • pars tensa
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16
Q

what pars perforates in chronic supparative otitis media with choleostatoma

A
  • pars flaccida
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17
Q

rc chronic supparative otis media

A
  • pars tensa - conservative or myringoplaty if severe

- pars flaccida; mastoidectomy

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18
Q

what is pericondirits

A
  • inflammation of the pinna - inflammed cartilage layer
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19
Q

what causes pericondirits

A
  • piercing
  • otitis externa
  • haematoma
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20
Q

periconditis infective organism

A
  • pseudomonas

- sometimes staph aureus

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21
Q

rx pericondirits

A
  • IV abx - ciprofloxacin/tazocin
  • IV steroids
  • I and D if need be
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22
Q

name abx used for otitis externa

A
  • sofradex
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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
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24
Q

acute labrynthitis triad

A
  • vertigo
  • n and v
  • tinnitus/ hearing involved

note - recent viral infection usual
- sudden onset sx

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25
Q

what is gradenigo syndrome/ apical petrositis

A
  • trigeminal pain distribution
  • acute otitis media
  • abducens palsy
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26
Q

rx for apical petrositis

A
  • IV abx
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27
Q

subjective vs objective tinnitus

A
  • subjective - not a an actual sound but a defect in auditroy pathway
  • objective - sound made in inner ear.
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28
Q

most common causes of objective tinnitus

A
  • Vascular; AV malformations, eustachian abnormalities, myoclonus of osccicualr msucles, high output CCF
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29
Q

causes of subjective tinnitus

A
  • Presbyacusis
  • NIHL
  • menieres
  • otoxicity
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30
Q

which drugs cause reversible tinnitus

A
  • macrolides and loops
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31
Q

Acoustic neuromas are associated with which type of neurofibromatosis

A
  • NF2
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32
Q

what happens to corneal reflex in acoustic neuromas

A
  • absent
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33
Q

triad of acoustic neuroma

A
  • hearing loss, vertigo, tinntitus
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34
Q

vestibular neuronitis sx

A
  • no hearing loss

- recurrent vertigo attacks lasting hrs to days

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35
Q

what does and elderly patient with dizziness on extension of th neck have

A
    • vertbrobasilar ischaemia
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36
Q

in acute vestibular failure (neuronitis/labrynthitis) where does nystagmus go

A
  • away from affected side
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37
Q

which 6 nerves give rise to referred pain in the ear

A
  • auriculotemporal branch of trigeminal
  • aurivular branch of vagus
  • greater auiicular nerve
  • lesser occipital - facial
  • glossopharyngeal
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38
Q

auriculotemporal nerve arises from which CN and gives pain from what issues

A
  • V

- TMJ dysfunction and dental disease

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39
Q

which nerve causes pain in ramsey hunt syndrome

A
  • CN VII
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40
Q

what cause ear pain via glossopharyngeal nerve

A
  • primary glossopharyngwal neuralgia induced by talking ro swallowing
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41
Q

what conditions cause ear pain due to tympanic breach of glossopharyngeal nerve and auricular branch of vagus

A
  • refer pain from cancer of posterior 1/3 of tongue, pyriform fossa, or larynx
  • quinsy
  • post tensillectomy
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42
Q

what conditions do you get ear pain due to the great auricular nerve at c2 and c3

A
  • soft tissue injury in cervival spondylosis/arthritis
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43
Q

what drug is used to prevent barotraum

A

xylometazoline

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44
Q

what drug users have a obliterated septum

A

cocaine

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45
Q

rx epistaxis

A
  • lean forward mouth open, spit out blood

- naseptin to reduce crusting and risk of vestibulitis

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46
Q

who should you not give naseptin to

A

those with peanut allergy or soy or neomycin allergy

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47
Q

what should you give those with a nosebleed that cannot have naseptin

A
  • mupirocin
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48
Q

who with epistaxis, do you admit

A
  • comorbidity such as HTN thats severe or coronary artery disease
  • aged under 2 - as more likely underlying cause
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49
Q

what do you do if a nosebleed does not stop with initial measures and lasts more than 15mins

A
  • packing. and cautery if visible source
  • packing if cautery not viable or no visual of bleeding point
  • go to hospital if packed
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50
Q

why should you never cauterise both sides of a septum

A

risks perforation

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51
Q

what if bleeding does nto stop after 24hrs of packing

A
  • foley catheter
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52
Q

what does serious posterior epistaxis need

A
  • EUA, Endoscopic arterial ligation or embolisation
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53
Q

if after nasal facture, Examinationn under anaesthesia is required when shoudl you do this

A
  • not till 10-14 days after injury before nasal bones set
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54
Q

diagnostic criteria for rhinosinusitis

A
  • 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
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55
Q

how many weeks is chronic rhinosinusitis diagnosis

A

> 12

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56
Q

rx chronic rhinosinusitis

A
  • intranasal steroids and saline irrigation

- if no improved after 4/52 = mod/severe endoscopic findings - culture and prophylactoc abx if ige normal

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57
Q

if nasal polyps are identified in a person <10yrs , what are the ddx

A
  • tumours
  • CF
  • Meningeocoele
  • Encephalocoele
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58
Q

ix for single unilateral polyp

A
  • biopsy for NPC or lymphoma
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59
Q

ix for polyps

A

rhinoscopy

60
Q

rx for polyps

A
  • steroids ; topical.

- endoscopic sinus surgery

61
Q

rhinitis urgent referral criteria

A
  • numbness
  • tooth loss
  • bleeding - -unilateral
62
Q

acute bacterial rhinosinusitis diagnostic criteria

A
  • 3 of:
  • discoloured discharge with unilateral prominence and purulent secretion
  • severe local pain; unilateral
  • fever > 38
  • inflam markers
  • deteriorates after mild illness
63
Q

acute bacterial rhinosinusitis rx

A
  • simple analgesia
  • nasal saline irrigation, intranasal decongenstants
  • stop smoking
64
Q

define acute post viral sinusitis

A
  • worsening in sx 5/7 after or perisstent sx >10/7
65
Q

rx acute sinusitis

A 
<10/7 = support
10+ = high dose IN corticosteroids
66
Q

what type of ca are head and neck ca in genral

A
  • SCC
67
Q

RF laryngeal ca

A
  • age, male. hc RDT, Hx Family, smoking, alcohol
68
Q

at how many weeks of hoarse voice do you refer to ENT and what ix do you do

A
  • 3 weeks

- CXR

69
Q

Types of laryngeal ca

A

supraglottis
glottis
subglottis

70
Q

which organ does laryngeal ca spread to commonly

A

lungs

71
Q

rx laryngeal ca

A
  • total laryngectomy if sybglottis with perm trache and valve for speaking
  • RDT +/- chemo
  • partial laryngectomy
  • palliative
72
Q

sx of tonsillar ca

A
  • otalgia

- asymettrical tonsil = tonsillectomy

73
Q

do pharyngeal ca present late or early

A

late

74
Q

Nasopharyngeal ca sx

A
  • middle ear effusion
75
Q

nasopharyngeal ca is most common in which ethnicity

A

southern china

76
Q

how do maxillary antral tumours present

A
  • epiphora (tears spill on face), loose teeth, glue ear, face swelling, nasal obstruction
77
Q

if there is a neck lump in <20yrs old in midline - what is likely dx

A
  • thyroglossal cyst

- dermoid cyst

78
Q

neck lump in >20yrs in midleine?

A
  • thyroid mass

- chondroma

79
Q

submandibular neck mass <20

A
  • self limiting LNA
80
Q

Submandibular lump >20yrs dx

A
  • salivary stone/tumour

- ca

81
Q

anterior triangle tumours

A
  • LN
  • Branchial cyst; at junction of upper and middle 1/3rd
  • cystic hygroma; transilluminates
  • carotid bdy paragangliomas - move laterally and firm
  • parotid tumours
82
Q

wegeners granulomatosis sx

A
  • epistaxis, ulcers, obstruction nasal
  • haemoptysis, pleuritis
  • glomerulonephritis, proteinuria, haematuria
  • purpura, neuropathy, arthritis, uveitis
83
Q

wegeners granulomatosis ix

A
  • cANCA
  • urinalysis
  • CXR and CT lung
84
Q

wegeners granulomatosis rx

A

induce remission

  • corticosteroids
  • cyclophosphamide

maintain

  • azothioprine
  • methotrexate

prophylaxis for infection
- pneumocystis jirovecii

85
Q

laryngitis rx

A
  • supportive

- if severe = phenoxymethylpen 1/52

86
Q

what is reinkes oedema

A
  • fusiform gelatinous enlarged cords due to chronic cord irritation
87
Q

reinkes oedema occurs in which patients

A
  • female smokers
  • hypoTH
  • Elderly
  • chronic voice use
88
Q

sx reinkes oedema

A
  • deep gruff voice
89
Q

rx reinkes oedema

A
  • support if early

- laser if late

90
Q

vocal cord nodules symptoms

A
  • husky voice + laryngitis sx
91
Q

cause of vocal cord nodules

A
  • chronic voice abuse
92
Q

rx vocal cord nodules

A
  • speech therapy/surgical excision
93
Q

laryngitis causes

A
  • viral
  • bacterial
  • reflux- fungal
  • chemicals
    -foreign body
    -
94
Q

what are the common bacterial and viruses that cause laryngitis and what are the prognosis

A
  • viral; rhino in spring and autumn, influenza in winter. are self limiting
  • bacterial most common HIb = life threatening
95
Q

predisposing factors to laryngitis

A
  • pollution
  • croup
  • epiglottitis
  • smoking
  • mouth breathing
  • climate
  • immunodeficient
  • DM
  • HypoTH
  • IDA
  • Voice use
96
Q

diptheria laryngitis rx

A
  • abx and antitoxin

- only negative after 3 clear swabs and a culture

97
Q

define acute laryngitis

A

<7/7

98
Q

define chronic laryngitis

A

> 3/52

99
Q

epiglottitis definition

A
  • cellulitis of supraglottis
100
Q

epiglottitis neck XR findings and rx

A
  • thumb sign; enlarged epiglottitis

- ceftriaxone = empirical

101
Q

what is the most worrying cause of pharyngitis

A
  • GAS
102
Q

What is the centor criteria

A
  • 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
Q

complications of tonsillitis

A
  • 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
Q

scarlet fever organism

A
  • GABHS

- Strep pyogenes

105
Q

where does rash spread to in scarlet fever and how quickly

A
  • chest
  • axillae
  • behind ears
    12-28hrs after rash

+ facial flush and strawberry tongue

106
Q

rx scarlet fever

A
  • pen v 10/7
107
Q

complications scarlet fever

A
  • sydenhams choreo

- demyleiantign disorders

108
Q

tonsillectomy criteria

A

> 7 /12, >4 in 2 years, >3 in 3 years

109
Q

tonsillectomy complications

A
  • 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
Q

what type of cancers are most head and neck cancers

A
  • SCC
111
Q

RF for head and neck cancers

A
  • smoking
  • alcohol
  • Vit A and C deficiency
  • HPV 16
  • Nitrosamines
  • GORD
112
Q

sx for head and neck cancer

A
  • 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
Q

which head and neck cancers is HPV linked to

A
  • lingual, tonsillar and pharyngeal and laryngeal
114
Q

anterior triangle lump ddx

A
  • lymphoma
  • branchial cyst ( squamous lined cholesterol)
  • parotid ca esp if >40yrs
115
Q

posterior triangle lump ddx

A
  • pharyngeal pouch
  • cystic hygroma (transilluminates)
  • cervical rib
  • EBV LNA
  • lymphoma
116
Q

options for voice restoration after laryngectomy

A
  • artificial larynx

- trans-oesophageal puncture

117
Q

what does a radical neck dissection involve

A
  • all neck LN + spinal accessory nerve and internal jugular vein and SCM
118
Q

where do head and neck cancers spread to

A
  • cervical LN first

- lungs after

119
Q

suspected head and neck cancer ix

A
  • flexible nasolaryngoscopy
  • CT neck and chest
  • FNA LN +/- USS - core/excision biopsy
  • primary tumour = GA; BIOPSY through panendoscopy
120
Q

dx criteria for OSA

A
  • 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
Q

rx OSA

A
  • CPAP

- CNS stimulant = modafinil

122
Q

what does the recurrent laryngeal nerve supply

A
  • most of the isntrinsic muscles of the larynx except cricothyroid
123
Q

what are the only muscles to open vocal fold

A
  • posterior cricoarytenoid
124
Q

sx vocal cord paralysis

A
  • hoarsness = breathy
  • SOBOE
  • Repeat coughing and aspiration
  • weak cough
125
Q

causes of vocal cord paralysis

A
  • tumours
  • iatrogenic
  • CNS
  • TB
  • Iatrogenic
126
Q

ix vocal cord paralysis

A
  • MRI, Endoscopy, CXR, Barium swallow
127
Q

rx vocal cord paralysis

A
  • medialisation - medialisation thyroplasty

- treat tumour

128
Q

what metabolic abnormalities cause bilateral vocal cord paralysis

A
  • hypokalaemia and hypocalcaemia

- DM

129
Q

what is the one cause that causes bilateral not unilateral palsy

A
  • neurological disease
130
Q

the parotid gland is innervated by which cranial nerve

A
  • CN XI - accessory nerve
131
Q

parotid gland produces what

A
  • serous saliva
132
Q

submandibular gland produces what

A

mucous and serous saliva

133
Q

submandibular gland is innervated by what

A
  • CNVII
134
Q

unilateral salivary gland enlargement causes

A
  • tumour
  • bacterial infection
  • stone
135
Q

bilateral hypofunctioning salivary gland enlargement causes

A
  • infections often viral, HIV or mumps
  • autoimmune - sjogrens
  • granulomatous disease; sarcoid, TB
136
Q

bilateral asymptomatic Salivary gland enlargement causes

A
  • eating disorder - anorexia, BN
  • Cirrhosis
  • chronic pancreatitis
  • endocrine - acromegaly/DM
137
Q

pain and sweling when eating indicates what

A

= duct

138
Q

what does a dry mouth indicate about salivary issues

A

they are diffuse

139
Q

ix for salivary stones

A
  • plain XR

- if not seen = sialogram or USS

140
Q

what is heerfordts syndrome

A
  • sarcoidosis with bilateral parotid enlargmeent, fever, anterior uveitis and facial nerve palsy
141
Q

parotid duct pathway

A
  • 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
Q

parotid enlargement with facial nerve palsy = ?

A
  • malignancy
143
Q

benign tumour s of parotid

A
  • benign pleomoprhic adenoma; slow growth - remove with parotidectomy
  • adneolymphoma - soft, old men
  • haemangioma
  • lympangioma = kids
144
Q

intermediate ca parotid tumours

A
  • mucoepidermoid
  • acinic cell cancer
  • oncocytoma
145
Q

malignant parotid tumours

A
  • adenoid cystic ca - slow growing, distant mets, exocrine mucous glands
  • adenocarcinoma; rapid growth, hard mass, pain and 7th CN palsy
  • SCC
146
Q

when should you not do a sialogram in patients with parotid tumours-

A

iodine/ contrast allergy

  • acute infections
  • CT instead
147
Q

complications of parotid surgery and RDT

A
  • 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

F year medicine facts (19 decks)

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