ENT Clinical Flashcards
What additional checks should be done if a baby has external ear abnormalities?
Chromosomal check
What is the most common bacterial cause of sore throat?
Streptococcus progenies (Group A haemolytic strep)
Which bacteria causes diphtheria?
Corynebacterium diphtheria
Which bacteria causes oral candida?
Candida albicans
What conditions does coxsackie virus cause?
Hand, foot and mouth, and herpangina
What is Rinne’s test?
Strike a tuning fork against an object, then press the vibrating fork on the pt’s mastoid bone. Normally, air conduction is better than bone conduction, however if there is a blockage then this will be reversed
What is Weber’s test?
Place the vibrating fork on the patients forehead and ask them where they hear it Normal: they hear it in the middle Abnormal: they hear it more on one side
What test findings will be found with conductive hearing loss?
- Rinne’s: bone conduction > air
- Weber’s: sound localises to affected ear
- Tympanometry
- Flat may indicate OME or fluid in the middle ear
- High peak may indicate perforation
- PTA – significant air-bone gap
What test findings can be expected with sensorineural hearing loss?
- Weber test: sound localises to normal ear
- Rinne test: air and bone conduction equally diminished
- PTA - No difference between bone and air conduction
What is Carhart’s Notch and what does it indicate?
Dip in PTA at 2K Hz, and indicatres ostersclerosis
What are the different criteria for normal hearing and loss in PTA?
- Normal: 0-25db
- Mild: 25-45db
- Moderate: 45-65dp
- Severe: 65-85db
- Profound: >85db
What is a tympanogram?
Put some sound in the ear then monitor the movement of the ear drum
What are the 6 D’s for symptoms of ear disease?
- Deafness
- Discomfort
- Dizziness
- Discharge
- Din din (tinnitus)
- Defective movement of face
What nerves can be involved in earache?
- CN V
- CN VII
- CN IX
- CN X
- C2 C3
What causes the pain in acute otitis media?
Pus coming from the eustachian tube which applied pressure on tympanic membrane, sometimes causing perforation
What two things can cause a CSF leak from the ear?
May occur due to congenital causes (walls of the ear haven’t come together) or a head injury (eg. a fracture)
What are the 2 types of cholesteatoma?
- Aquired
- Congenital (Derlacki)
- White mass behind an intact ear drum,
- is an embryological remnant which should have cleared at 20weeks
What are important differences with peadiatrics to know for airway obstruction?
- Floppy epiglottis
- Large head
- Neonates are obligate nasal breathers
- If you block their nose, they cant breath
- Relatively large tongue
- Small, soft larynx in higher position (C1)
- Weak neck muscles; floppy head
- Narrow subglottis (3.5 mm at the cricoid
What is the differences between stridora and stretor?
- Stridor: High pitched harsh noise due to turbulent airflow resulting from airway obstructions
- Lower that stretor
- Can occur on inspiration or expiration.
- Stretor: Low pitched sonorous sound arising from nasopharyngeal airway (like snoring)
- Upper respiratory tract
What is heliox?
Combination of helium and oxygen – which makes the air thinner and therefore easier to breath
What is the managment for paedtriatic airway obsrtuction?
- ABC: Resuscitation
- Oxygen
- Heliox
- Steroi
- Adrenalin
- Flexible fibre-optic endoscopy
- Secure airway with ET Tube/Tracheostomy
- Secure airway before anything else
- Treat underlying pathology
What is the difference between dizziness and vertigo?
- Dizziness: Non-specific term, which may cover vertigo, pre-syncope, disequilibrium, etc.
- Vertigo: a sensation of movement, usually spinning.
What is the main symptom for vestibular pathology?
Nystagmus
BPPV is the commonest cause of vertigo when looking in which direction?
Looking up
How can BPPV be distinguished from Vertebrobasilar insufficiency?
For a diagnosis of VBI need other symptoms of impaired circulation in posterior brain associated with the vertigo e.g. visual disturbance, Weakness, Numbness
What must be ruled out in nasal trauma and why?
Septal haematoma.
- Emergency because cartilage is avascular so takes nutrients from perichondrium
- If a haemorrhage occurs and the perichondrium strips off, then it may become necrosed and form an abscess
- This can lead to intra-cranial infection
How can temporal bone traum cause hearing loss?
- Conductive
- Fluid (blood or CSF) in ear canal/middle ear cavity
- Tympanic membrane rupture
- Ossicular damage
- Sensorineural
- Damage to cochlea
- Avuslion of CN VIII
What causes baggy eyes in age?
Weakening connective tissue in the orbital septum in lower lids, resulting in herniation of the fat pad forming bags
What does botulinium toxin (botox) do to combat ageing?
Paralses the muscles pulling on the skin causing wrinkles, eg. corrugator m. above bridge of nose
When should you carry out a primary closure vs a delayed primary closure?
- Primary closure: If it is small, superficial, non-infected or in an area where the scars are in a well hidden place
- Delayed primary closure: If larger, not clean edges or infected. Also need to ensure blood supply is enough.
If in doubt, leave it open
What is the difference between a skin graft and a skin flap?
Skin graft has no vascular connection (completely devascularised), free tissue movement, while skin flap has vascular connection
Which type of imaging modality is used for which type of hearing loss?
- MRI used in the imaging investigation of sensorineural deafness (?vestibular schwanoma)
- CT used in the investigation of conductive deafness (?choleasteatoma)
What is contained in the masticator space, and what pathologies affect it?
Contents:
- Mandible
- Muscles of mastication
- CN V
Pathologies:
- Dental abscess / cyst
- Invasion from oral cavity
What is contained in the carotid space, and what pathologies affect it?
Contents:
- Carotid artery
- Jugular vein
- Cranial & sympathetic n.
- Lymph nodes
Pathologies:
- Schwannoma
- Paraganglioma
- Lymph nodes
What are the 4 core S’ symptoms in nose codnitions?
- Stuff (blockage)
- Snot (discharge)
- Sore (facial pain)
- Smell (loss of)
What are the two classifications of allergic rhinitis?
- Persistant (dust mites, animal hair)
- Seasonal (pollen, fungal spores)
What are the three pillars of treatment of allegic disease?
- Allergen avoidance
- Symptomatic therapy
- Immunotherapy
Samter’s triad
- Nasal polyps
- Asthma (non-allergic)
- Aspirin intolerance
What are the common causes for unilateral ansal discharge in children and adults?
- Children = foreign body
- Adults = Nasal or paranasal tumour
Both require urgent referral
What is an important complication of infective rhinosinusitis?
Orbital cellulitis - ethmoidal sinuses are adjacent to the orbit so may cause eye swelling with pus. Risk of blindness
Where are cancers of the tongue most commonly located?
Side of the tongue
What type of the cancer are the majority of head and neck cancers?
Squamous
What are the red flag symptoms for head and neck cancer?
- Sore throat
- Hoarseness
- Stridor
- Difficulty swallowing
- Lump in neck
- Unilateral ear pain
