ENT Flashcards
Analgesic associated with tinnitus
NSAIDs
Hearing loss from base of skull fracture
= sensorineural hearing loss
Audiogram threshold for ‘normal’ hearing
Above 20dB is normal
Hearing better in noisy environments =
Paracusis
Arteries supplying the nose
Anterior ethmoidal Posterior ethmoidal Lateral nasal Septal branch of superior labial Greater palantine Sphenopalantine
Carotid branches supplying nose
Internal - ophthalmic
External - facial, maxillary
Common nosebleed site
Location in nose
Kiesselbach’s Plexus
Found on lateral nasal wall
What type of nosebleed is more common?
Anterior
Posterior - usually bilateral bleeding
Space between true vocal cords
Rima glottidis
Difference (anatomically) between stertor and stridor
Stertor = obstruction above the level of the larynx Stridor = air flow changes within the larynx, trachea or main bronchi
Process of Laryngectomy
Larynx removed
End stoma created, brings trachea to the neck midline
Pharynx closed so that oesophagus ONLY connects with mouth and nose
Problem with cricothyroidotomy
Lets the air in but doesn’t offer the best ventilation
A temporary or emergent procedure
Investigation of OME
Tympanogram
Will be flat
If OME in adults need to look at the nasopharyngeal area = tumour?
Surgical management of OME
Myringotomy
Then insert grommet into hole in ear drum
Complications of acute OM (2)
Acute mastoiditis - ear pinna pushed laterally if abscess forms
Cholesteatoma
Otosclerosis
Association with worsening of hearing loss
Pregnancy
HRT
= driven by oestrogens
Pathophysiology of otosclerosis
Stapes footplate becomes fixated to the tympanic membrane
Autoimmune causes of sensorineural hearing loss
GPA
Sarcoidosis
Pulsatile tinnitus (2)
Idiopathic intracranial hypertension
Giant cell arteritis
Nerve supply of the tympanic membrane
CN V3
CN VII
CN IX
Difference between primary and secondary otalgia
Primary = direct stimulation of the nerve due to otogenic pathology Secondary = referred pain e.g. cervical spine, dental disease/TMJ or oropharynx
Leukoplakia =
= white patches in the mouth, premalignant
Testing for allergies (2)
Skin prick testing
RAST testing
Non-sedating anti-histamines (2)
Cetirizine
Loratadine
Inhaled steroids used in asthma (3)
Beclometasone
Fluticasone
Mometasone
What bone do the olfactory fibres pass through?
Cribriform plate of ethmoid
What part of the brain stem does CN VII come off at?
Pontomedullary junction
CN VII supplies what middle ear structure?
Stapedius muscle
Nerve fibres contained in chorda tympani
Relation to ear drum
CN VII and CN V3
Can be damaged in a superior-posterior perforation of the ear drum
Need assessment of hearing
Scale used to assess facial palsy
House-Brackmann Scale
Facial Palsy
Feature in Stroke
Facial palsy in stroke is FOREHEAD SPARING
The forehead receives bitemporal innervation (if Bell’s palsy = LMN, stroke = UMN)
Management of Bell’s Palsy
Often self-limiting but high dose steroids can help
Symbols in Audiogram
Circle = round right X = left Triangle = bone conduction
Snoring: stertor or stridor?
Stertor = turbulent airflow at level of soft palate, tonsils and tongue base
Mild Obstructive SA =
5-15 episodes/hour
Management of Obstructive SA
CPAP
Mandibular advancement splint
Test for BPPV
Dix Hallpike
Management of BPPV
Epley Manoeuvre
Presentation of Vertebrobasilar Insufficiency
Vertigo + other symptoms
e.g. visual disturbance, weakness, numbness
Management of Migraine
Abortive agents
Prophylaxis
Abortive = triptans Prophylaxis = amitriptyline, propranolol
Association with non-syndromic SNHL
Connexin-26 mutations
Usher’s Sydnrome (3)
Mode of Inheritance
SNHL
Retinitis Pigmentosa
Balance Problems
Autosomal recessive
Newborn Screening Test
Objective Audiometry
Insertion Site of Grommets
Antero-inferior quadrant
Presentation of viral pharyngitis (2)
Coryzal symptoms
NORMAL tonsils
Commonest bacterial cause of tonsillitis
Group A streptococci
Centor Criteria (4)
Absence of cough
Tonsillar exudates
History of fever
Tender anterior cervical lymphadenopathy
FeverPAIN Score (5)
Fever in past 24 hours Purulence Attend rapidly Severely inflamed tonsils No cough or coryza
Indication for Tonsillectomy
> 7 episodes in one year
OR >5/year for 2 years OR >3/year for 3 years
Presentation of Pero-Tonsillar Abscess (4)
Severe unilateral sore throat
Dysphagia
Odynophagia
Otalgia
Trismus =
= lock jaw
Investigation of Infectious Mononucleosis
Serum monospot
Atypical lymphocytes
Abnormal LFTs
Contraindication in Glandular Fever
Don’t prescribe amoxicillin, can get generalised macular rash
Risk in Glandular Fever
Splenic Rupture
Need to avoid contact sports
AB used in Epiglottitis
Ceftriaxone
Contraindication in Epiglottitis (Kids)
Examining the airway - may worsen/close off the airway
Pathophysiology of Pharyngeal Pouch
= laterally above the cricopharyngeus muscle and below the lower constrictor muscle
Normal Ear Rinne’s Result
Rinne’s POSITIVE
Weber’s Conductive Hearing Loss Result
LOUDER in the ear with conductive loss
How does Paget’s cause SNHL?
= bony growth can compress CN VIII
Location of branchial cyst
Anterior to the sternocleidomastoid
Definition of chronic OME
Must be greater that 3 months
Management of epistaxis (6)
First aid/nasal compression Nasal cautery Nasal packing Ligation of sphenopalatine artery Ligation of external carotid artery Embolisation
Which part of the nose does the sphenopalatine artery supply?
Lateral wall
Hearing loss Meniere’s Disease
Low frequency sensorineural hearing loss
Key features in Quinsy (2)
Laterality of sore throat
Voice change
Management of Ramsay Hunt (2)
7 days of oral aciclovir
5 days of oral steroid
AB Management of Gingivitis
Metronidazole
Indications for Antibiotics in Otitis Media (4)
> 4 days duration
Systemically unwell
<2 years with bilateral OM
Perforation
Management of Otitis Media
Newborn
Cefotaxime
Organism in bacterial OM
H. influenzae
