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Year 5 > ENT > Flashcards

ENT Flashcards

1
Q

Otitis Externa Features

A

Ear pain
Discharge
Red swollen ear canal

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2
Q

Common causes of otitis externa

A

Staphylococcus aureus
Pseudomonas aeruginosa
Fungal infection

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3
Q

Management of otitis externa

A

Ear drop - combined topical abx and steroid drop e.g, gentamicin + prednisolone

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4
Q

When would you avoid using gentamicin in otitis externa and why

A

If there is tympanic membrane perforation

Due to risk of ototoxicity

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5
Q

What is malignant otitis externa?

A

Uncommon type of otitis externa where the infection commences in the soft tissues of the external auditory meatus, then progresses to involve the bony ear canal

It can progress to cause temporal bone osteomyelitis

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6
Q

What group of patients is malignant otitis externa most common?

A

Diabetics and Immunocompromised patients

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7
Q

What organism is the most common cause of malignant otitis externa?

A

Pseudomonas aeruginosa

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8
Q

Features of malignant otitis externa?

A

Severe, deep seated otalgia
Temporal headaches
Purulent otorrhea
Possibly facial nerve dysfunction

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9
Q

Management of malignant otitis externa

A

Urgent referral to ENT

IV abx - ciprofloxacin most common to cover pseudomonas

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10
Q

Features of otitis media

A 
Otalgia 
Fever
Hearing loss 
Recent viral URTI 
Ear discharge
Bulding tympanic membrane
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11
Q

When would you give antibiotics in otitis media

A 
If symptoms >4 days 
If pt unwell 
In Immunocompromised pts 
<2 years old with bilateral otitis media
If there is tympanic membrane perforation 
If there is discharge
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12
Q

What abx are used for otitis media

A

5-7 day course of amoxicillin (erythromycin if penicillin allergy)

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13
Q

What is a cholesteatoma?

A

Complication of otitis media

Non cancerous growth of keratin within pars flaccida (upper tympanic membrane)

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14
Q

Features of cholesteatoma

A

Foul smelling Non resolving discharge

Hearing loss

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15
Q

Management of cholesteatoma

A

Referral to ENT for surgical removal

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16
Q

What is the most common cause of conductive hearing loss

A

Ear wax

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17
Q

Causes of perforated tympanic membrane

A

Infection e.g, otitis media
Barotrauma
Direct trauma

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18
Q

Management of perforated tympanic membrane

A

Most cases will usually heal after 6-8 weeks
Avoid water in ear during this time
Amoxicillin - if caused by otitis media
Myringoplasty - if it does not heal by itself

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19
Q

What is otosclerosis?

A

Replacement of normal bone by vascular spongy bone - this causes fixation of the stapes at the oral window in the ear leading to hearing loss

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20
Q

What type of hearing loss does otosclerosis cause

A

Conductive

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21
Q

Risk factors for otosclerosis

A

Family history - as it is autosomal dominant condition

Pregnancy - may precipitate disease in those who are genetically predisposed

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22
Q

Features of otosclerosis

A 
Typically presents at age 20-40 
Conductive deafness 
Tinnitus 
Normal tympanic membrane 
Positive family history 
Symptoms improve with background noise
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23
Q

Management of otosclerosis

A

Hearing aid

Stapedectomy

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24
Q

Causes of sudden-onset sensorineural hearing loss

A

Idiopathic

Vestibular schwannoma

25
Q

Management of sudden-onset sensorineural hearing loss

A

High dose prednisolone for 7 days

26
Q

Causes of Vertigo and how to distinguish

A

Viral labyrinthitis - recent viral infection, hearing affected
Vestibular neuronitis - recent viral infection, hearing okay
BPPV - gradual onset, triggered by change in position
Ménière’s disease - hearing loss, tinnitus, sense of fullness in ears
Vertebrobasilar ischaemia - elderly pt, occurs on neck extension
Acoustic neuroma - hearing loss, tinnitus, absent corneal reflex

27
Q

What is meinere’s disease

A

Disorder of inner ear of unknown cause

Excessive pressure and progressive dilation of the endolymphatic system

28
Q

Features of meneires disease

A 
Unilateral Episodes lasting minutes to hours of:
Vertigo 
Tinnitus 
Sensorineural hearing loss 
Feeling of fullness in ear

Pts will have:

  • Nystagmus
  • positive romberg’s test
29
Q

Management of Ménière’s disease

A

Prevention of attacks - beta histone
During attacks - buccal or IM prochlorperazine

Must inform DVLA of diagnosis

30
Q

Features of vestibular schwannoma

A 
Unilateral:
Vertigo 
Sensorineural hearing loss
Tinnitus 
Absent corneal reflex 
Possible Facial palsy
31
Q

Diagnosis of acoustic neuroma

A

MRI of the cerebellopontine angle

32
Q

What is Ramsey hunt syndrome?

A

Reactivation of varicella zoster virus in the geniculate ganglion of the facial nerve

33
Q

Features of Ramsey hunt syndrome

A 
Ear pain 
Facial nerve palsy 
Vesicular rash around ear 
Vesicular lesions may be seen on anterior 2/3rds of the tongue and soft palate 
Vertigo 
Tinnitus
34
Q

Management of Ramsey hunt syndrome

A

Oral aciclovir

Corticosteroids

35
Q

Management of allergic rhinitis

A

Allergen avoidance
Mild disease - Oral or intra nasal antihistamines
Moderate disease - intra nasal corticosteroids
Severe disease - oral corticosteroids

36
Q

What are the common causative agents of rhinosinusitis

A

Streptococcus pneumoniae
Haemophilis influenzae
Rhino viruses

37
Q

Definition of chronic Rhinosinusitis

A

Inflammation of paranasal sinuses and linings of nasal passages lasting >12 weeks

38
Q

Risk factors for Rhinosinusitis

A 
Hayfever or rhinitis 
Asthma 
Nasal obstruction e.g, septal deviation, nasal polyps 
Swimming 
Smoking
39
Q

Features of Rhinosinusitis

A

Facial pain - typically a frontal pressure worse on bending forward
Nasal discharge
Nasal obstruction - e.g, mouth breathing
Post nasal drip - may be producing a cough

40
Q

Management of Rhinosinusitis

A

Intra nasal corticosteroids

Oral phenoxymethylpenicillin - for severe presentations

41
Q

What population group are nasal polyps more common in?

A

Males

42
Q

What is samter’s triad

A

Asthma
Aspirin sensitivity
Nasal polyposis

43
Q

Clinical features of nasal polyps

A

Nasal obstruction
Rhinorrhoea (runny nose)
Poor sense of taste/smell
Bilateral symptoms (unilateral nasal polyps is red flag sign for nasal pharyngeal cancer)

44
Q

Management of nasal polyps

A

Bilateral - routine referral to ENT
Unilateral - urgent referral to ENT

Topical steroids are usually given to shrink polyps

45
Q

CENTOR Criteria for tonsillitis

A

Tender cervical lymphadenopathy
Tonsillar exudate
Absence of cough
Fever >38

46
Q

Antibiotics given for tonsillitis

A

Phenoxymethylpenicillin - 7-10 day course

Erythromycin if penicillin allergy

47
Q

Indications for tonsillectomy

A

All of the following:
>5 episodes of sore throat in a year due to tonsillitis
Symptoms present for >1 year
Episodes are disabling and preventing normal functioning

OR one of the following:
Recurrent febrile convulsions due to tonsillitis
Obstructive sleep apnea, stridor or dysphagia secondary to large tonsils
Peritonsillar abscess

48
Q

Complications of tonsillitis

A

Otitis media
Quinsy/peritonsilar abscess
Rheumatic fever and glomerulonephritis

49
Q

Features of peritonsillar abscess

A

Severe unilateral throat pain
Deviation of uvula to unaffected side
Difficulty opening mouth

50
Q

Management of quinsy

A

Urgent ENT referral
Needle aspiration or incision and drainage
IV abx

51
Q

What are sialolithiasis

A

Calculi in the salivary glands or ducts

52
Q

Features of sialolithiasis

A

Unilateral colicky pain and swelling on eating

Swelling of submandibular gland

53
Q

What is sialadenitis

A

Inflammation of salivary gland secondary to obstruction by stone in the duct
Caused by staph aureus infection
Can cause foul taste in mouth as purulent discharge from duct drains into floor of mouth

54
Q

Most common cause of parotid tumour

A

Pleomorphic adenoma

55
Q

Which medications can cause ototoxicity

A 
Gentamicin 
Quinine 
Furosemide 
Aspirin 
Some chemotherapy agents
56
Q

What is glue ear?

A

Otitis media with effusion
Where the Eustachian tube becomes blocked, which causes fluid to build up in the middle ear
When the middle ear becomes full of fluid it can cause loss of hearing in that ear

57
Q

Management of glue ear

A

Referral to audiometer - to help establish diagnosis and extent of hearing loss
Usually resolves without treatment in 3 months
Grommets can be inserted into tympanic membrane by ENT surgeons which allows fluid to drain out through the tympanic membrane into the ear canal (grommet usually fall out within a year)

58
Q

Common site of epistaxis

A

Kiesselabachs plexus (littles area) - area that contains lots of blood vessels in the nose

59
Q

Management of epistaxis

A

Sit up and head tilt forwards squeezing soft part of nose

Nasal packing if it doesn’t stop
Nasal cautery if it doesn’t stop

Year 5 (17 decks)

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