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ENT Flashcards

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1
Q

most common causative bacteria in otitis externa

A

pseudomonas aeruginosa

staphylococcus aureus

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2
Q

causes of otitis externa

A

trauma (scratching, aggressive cleaning)
chemical irritants
swimming
allergy (neomycin eardrops common)

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3
Q

presentation of otitis externa

A 
ear pain
tragal tenderness
otorrhea 
aural fullness
itching
decreased hearing
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4
Q

clinical findings in otitis externa

A

normal otoscopy and tympanometry (unless AOM present)

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5
Q

investigations of otitis externa

A

ear culture of exudate/debris

consider CT of temporal bone if suspecting malignant otitis externa

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6
Q

features of malignant otitis externa

A

pain disproportionate to findings (often keeps patient awake at night)
granulation tissue along the floor of the external auditory canal
diabetic or immunocompromised

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7
Q

management of otitis externa

A

topical antibiotics - ciprofloxacin/neomycin ear drops
analgesia - paracetamol
systemic Abx if refractory to topicals - ciprofloxacin

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8
Q

most common causative organisms in AOM

A

strep. pneumoniae

haemophilus influenzae

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9
Q

presentation of AOM

A

preceding upper respiratory infection, commonly viral
otalgia
fever
if effusion = decreased hearing
in young children - irritability, increased crying, sleep disturbance

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10
Q

management of AOM

A

paracetamol/NSAIDs
amoxicillin (erythromycin if resistant)
tympancocentesis

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11
Q

complications of AOM

A

tympanic membrane rupture
mastoiditis
bullous myringitis

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12
Q

pathophysiology of AOM

A

viral URTI -> inflammation of nasal passages/eustation tube/middle ear -> impaired mucocillary action and ventilatory function -> build up of nasopharyngeal flora ->effusion which allows growth of bacteria -> inflammatory response -> suppuration and pressure leads to pain and fever ->perforation of TM leading to purulent discharge

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13
Q

define cholesteatoma

A

presence of keratinising squamous epithelium within the middle ear
this grows and expands causing resorption of underlying bone
the epithelium gets trapped, infected and proliferates into a cholesteatoma

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14
Q

presentation of cholesteatoma

A

conductive hearing loss with a background of chronic OM

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15
Q

management of cholesteatoma

A

surgical removal +/- ossicles reconstruction

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16
Q

features of chronic OM

A 
hearing loss
chronically discharging (>6weeks) ear in the absence of fever and otalgia
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17
Q

management of chronic OM

A

topical antibiotics

TM perforations should heal spontaneously but if large = surgery (myringoplasty or tympanoplasty)

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18
Q

causes of facial palsy

A

Bell’s
lyme disease
gullain-barre
sarcoidosis

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19
Q

define Bell’s palsy

A

acute unilateral peripheral facial nerve palsy (in those with otherwise normal history and examination)
thought to be a reactivation of HSV type 1 within the geniculate ganglion

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20
Q

management of bells palsy

A

prednisolone
eye protection - artificial tears, ophthalmic lubricant
antiviral therapy if severe - valaciclovir

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21
Q

define osteosclerosis

A

abnormal bone growth around the stapes leading to stapes fixation

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22
Q

presentation of osteosclerosis

A

gradual conductive hearing loss with vertigo and tinnitus

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23
Q

what is carhart’s notch

A

a dip in bone conduction at 2000Hz on audiogram

associated with osteosclerosis

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24
Q

management of osteosclerosis

A

hearing aids

stapedectomy

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25
what is Meniere's disease
an auditory disease caused by over production of/impaired resorption of endolymph
26
presentation of meniere's
sudden onset vertigo low frequency roaring tinnitus low frequency hearing loss aural fullness
27
management of Meniere's
dietry changes (low Na intake, limit caffeine and alcohol) diuretics - hydrochlorothiazide antiemetics, antihistamines, anticholinergics, corticosteroids (for vertigo) surgery (endolymphatic sac surgery, vestibular nerve section, labyrinthectomy)
28
risk factors for laryngeal cancer
smoking, alcohol, GORD
29
presentation of laryngeal cancer
hoarseness is the cardinal symptom dysphagia, odynophagia, throat pain, supraglottic/glottic mass, lesions on vocal cords, neck mass
30
investigations for laryngeal cancer
laryngoscopy FNA of any masses Neck CT laryngeal biopsy
31
management of laryngeal cancer
larynx sparring surgery (laser resection, cordectomy, partial laryngectomy) total laryngectomy chemo, radiotherapy Speech therapy subglotic tumours require a total + neck dissection (including thyroidectomy)
32
commonly affected areas in oropharyngeal cancer
base of tongue soft palate palatine tonsillar fossa pharyngeal wall
33
risk factors of oropharyngeal cancer
alcohol and smoking | HPV
34
presentation of oropharyngeal cancer
sore throat oral pain dysphagia trismus neck mass Wt loss oral lesions (ulcers, leucoplakia, erythroplakia)
35
investigations for oropharyngeal cancer
biopsy FNA of nodes PET/CT head and neck
36
risk factors for nasopharyngeal cancer
``` EBV infection smoking alcohol poor oral hygiene salted fish ```
37
presentation of nasopharyngeal cancer
``` chronically blocked nose recurrent epitaxis, rhinorrhoea hearing impairment, tinnitus, ear pain neck pain cranial nerve palsies ```
38
red flags for cancers of the head
hoarseness > 6weeks ulceration or swelling in mucosa > 3 weeks red or white patches in oral mucosa dysphagia persistent unilateral nasal blockage (especially if purulent discharge) neck lump > 3 weeks
39
types of oesophageal cancer
80% adenocarcinoma(GORD and barret's) | squamous cell carcinoma (smoking, alcohol)
40
causes of tonsilitis
70% viral (HSV, influenza, parainfluenza) 30% bacterial (grp A haemolytic strep pneumoniae, haemophilus influenzae, s aureus) EBV can cause a severe tonsillitis called glandular fever
41
signs of tonsillitis
``` pain redness pus white plaques hepatosplenomegaly in glandular fever ```
42
investigations for tonsillitis
CRP, WCC LFTs - may be deranged in glandular fever monospot - chesks for EBV infection if pyrexic - throat swab and blood cultures
43
what is the centor score
evaluates risk of tonsillitis form GAHSP tonislar exudates, tender cervical nodes, history of fever, no cough
44
management of tonsillitis
paracetamol/NSAIDs penicillin admit if can't eat or drink (IV fluids and IV benzylpenicillin) tonsillectomy if glandular fever avoid alcohol and contact sports (liver injury)
45
what is a glomus tumour
paragangliomas in the middle ear, temporal bone, vagus nerve or the carotid body
46
presentation of a glomus tumour
persistent pulsatile tinnitus can also secrete catecholamines, presenting with hypertension a pulsatile red mass behind the eardrum
47
management of epiglottitis/supraglottitis
secure airway oxygen IV antibiotics (ceftriaxone) dexamethasone
48
what airway problem appears as a 'cherry red swelling'
epiglottitis
49
presentation of epiglottitis/supraglottitis
rapid onset fever sore throat (out of proportion, tonsils appear normal) classic tripod positioning breathing difficulty
50
causative organisms of epiglottitis/suprsglottitis
haemophilus influenzae B strep pneumoniae staph aureus
51
which vessels make up kisslbach's plexus
greater palatine anterior ethmoid sphenopalatine superior labial
52
types of bleeds in epistaxis
anterior (90%) - littles area - younger patients | posterior (10%) - sphenopalatine artery - older patients
53
management of Epistaxis
``` A-E Trotter's method (15min) nasal packing AgNO3 cautery surgical ligation ```
54
clinical findings in allergic rhinitis
pale, oedematous and enlarged turbinates | nasal congestion and clear discharge
55
management of allergic rhinitis
saline rinse/irrigation petroleum based ointments (barrier method) intranasal steroids oral antihistamines leukotriene receptor antagonists may help if asthmatic
56
management of non-allergic rhinitis
saline douching/spray nasal steroids - beclomethasone intranasal antihistamine - azelastine anticholinergic nasal spray
57
describe the innervation of the larynx
innervated by the vagus nerve | branches into superior laryngeal nerve and recurrent laryngeal nerve
58
causes for vocal fold paralysis
``` post viral neuropathy damage from surgery (thyroid, parathyroid, skull base, carotid) malignancy (H&N, intrathoracic) trauma MS ```
59
causes of hoarsness
``` age related (prebyphonia) laryngitis laryngeal cancer vocal cord polyp vocal cord nodules reinke's oedema ```
60
management of vestibular neuritis
reassure that it is self limiting (several weeks) | anti-emetic: cyclizine or buccal prochlorperazine
61
presentation of vestibular neuritis
vertigo N&V nystagmus absence of tinnitus, hearing loss or focal neurological signs
62
indications for tonsilectomy
``` high risk of malignancy OSA recurrent tonsillectomy (7 or more a year, more than 5 a year for 2 years, more than 3 a year for 3 years) 2 quinsy abscess in year ```
63
complications of tonsillitis
quinsy (peritonsillar) abscess parapharyngeal abscess submental abscess hamorrhage after tonsilectomy
64
management of a quinsy
``` incision and drainage IV antibiotics dexamethasone analgesia tonsillectomy if >2 a year ```
65
what is a brachial cyst
a benign developmental defect of the brachial arches | a cyst filled with acellular fluid with cholesterol crystals
66
presentation of a brachial cyst
typically presents in young adults/teens as asymptomatic neck lumps anterior to the SCM muscle
67
describe a brachial cyst
unilateral - more common on the left side non tender, slowly enlarging, smooth no movement on swallowing or transillumination

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