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ENT Flashcards

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
Q

what is Meniere’s disease

A

an auditory disease caused by over production of/impaired resorption of endolymph

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26
Q

presentation of meniere’s

A

sudden onset vertigo
low frequency roaring tinnitus
low frequency hearing loss
aural fullness

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27
Q

management of Meniere’s

A

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
Q

risk factors for laryngeal cancer

A

smoking, alcohol, GORD

29
Q

presentation of laryngeal cancer

A

hoarseness is the cardinal symptom

dysphagia, odynophagia, throat pain, supraglottic/glottic mass, lesions on vocal cords, neck mass

30
Q

investigations for laryngeal cancer

A

laryngoscopy
FNA of any masses
Neck CT
laryngeal biopsy

31
Q

management of laryngeal cancer

A

larynx sparring surgery (laser resection, cordectomy, partial laryngectomy)
total laryngectomy
chemo, radiotherapy
Speech therapy

subglotic tumours require a total + neck dissection (including thyroidectomy)

32
Q

commonly affected areas in oropharyngeal cancer

A

base of tongue
soft palate
palatine tonsillar fossa
pharyngeal wall

33
Q

risk factors of oropharyngeal cancer

A

alcohol and smoking

HPV

34
Q

presentation of oropharyngeal cancer

A

sore throat
oral pain
dysphagia
trismus

neck mass
Wt loss
oral lesions (ulcers, leucoplakia, erythroplakia)

35
Q

investigations for oropharyngeal cancer

A

biopsy
FNA of nodes
PET/CT head and neck

36
Q

risk factors for nasopharyngeal cancer

A 
EBV infection
smoking
alcohol
poor oral hygiene
salted fish
37
Q

presentation of nasopharyngeal cancer

A 
chronically blocked nose
recurrent epitaxis, rhinorrhoea
hearing impairment, tinnitus, ear pain
neck pain
cranial nerve palsies
38
Q

red flags for cancers of the head

A

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
Q

types of oesophageal cancer

A

80% adenocarcinoma(GORD and barret’s)

squamous cell carcinoma (smoking, alcohol)

40
Q

causes of tonsilitis

A

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
Q

signs of tonsillitis

A 
pain
redness
pus
white plaques
hepatosplenomegaly in glandular fever
42
Q

investigations for tonsillitis

A

CRP, WCC
LFTs - may be deranged in glandular fever
monospot - chesks for EBV infection
if pyrexic - throat swab and blood cultures

43
Q

what is the centor score

A

evaluates risk of tonsillitis form GAHSP

tonislar exudates, tender cervical nodes, history of fever, no cough

44
Q

management of tonsillitis

A

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
Q

what is a glomus tumour

A

paragangliomas in the middle ear, temporal bone, vagus nerve or the carotid body

46
Q

presentation of a glomus tumour

A

persistent pulsatile tinnitus
can also secrete catecholamines, presenting with hypertension
a pulsatile red mass behind the eardrum

47
Q

management of epiglottitis/supraglottitis

A

secure airway
oxygen
IV antibiotics (ceftriaxone)
dexamethasone

48
Q

what airway problem appears as a ‘cherry red swelling’

A

epiglottitis

49
Q

presentation of epiglottitis/supraglottitis

A

rapid onset fever
sore throat (out of proportion, tonsils appear normal)
classic tripod positioning
breathing difficulty

50
Q

causative organisms of epiglottitis/suprsglottitis

A

haemophilus influenzae B
strep pneumoniae
staph aureus

51
Q

which vessels make up kisslbach’s plexus

A

greater palatine
anterior ethmoid
sphenopalatine
superior labial

52
Q

types of bleeds in epistaxis

A

anterior (90%) - littles area - younger patients

posterior (10%) - sphenopalatine artery - older patients

53
Q

management of Epistaxis

A 
A-E
Trotter's method (15min)
nasal packing
AgNO3 cautery
surgical ligation
54
Q

clinical findings in allergic rhinitis

A

pale, oedematous and enlarged turbinates

nasal congestion and clear discharge

55
Q

management of allergic rhinitis

A

saline rinse/irrigation
petroleum based ointments (barrier method)
intranasal steroids
oral antihistamines
leukotriene receptor antagonists may help if asthmatic

56
Q

management of non-allergic rhinitis

A

saline douching/spray
nasal steroids - beclomethasone
intranasal antihistamine - azelastine
anticholinergic nasal spray

57
Q

describe the innervation of the larynx

A

innervated by the vagus nerve

branches into superior laryngeal nerve and recurrent laryngeal nerve

58
Q

causes for vocal fold paralysis

A 
post viral neuropathy
damage from surgery (thyroid, parathyroid, skull base, carotid)
malignancy (H&N, intrathoracic)
trauma
MS
59
Q

causes of hoarsness

A 
age related (prebyphonia)
laryngitis
laryngeal cancer
vocal cord polyp
vocal cord nodules
reinke's oedema
60
Q

management of vestibular neuritis

A

reassure that it is self limiting (several weeks)

anti-emetic: cyclizine or buccal prochlorperazine

61
Q

presentation of vestibular neuritis

A

vertigo
N&V
nystagmus
absence of tinnitus, hearing loss or focal neurological signs

62
Q

indications for tonsilectomy

A 
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
Q

complications of tonsillitis

A

quinsy (peritonsillar) abscess
parapharyngeal abscess
submental abscess
hamorrhage after tonsilectomy

64
Q

management of a quinsy

A 
incision and drainage
IV antibiotics
dexamethasone
analgesia
tonsillectomy if >2 a year
65
Q

what is a brachial cyst

A

a benign developmental defect of the brachial arches

a cyst filled with acellular fluid with cholesterol crystals

66
Q

presentation of a brachial cyst

A

typically presents in young adults/teens as asymptomatic neck lumps anterior to the SCM muscle

67
Q

describe a brachial cyst

A

unilateral - more common on the left side
non tender, slowly enlarging, smooth
no movement on swallowing or transillumination

finals (13 decks)

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