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phase 3b > ENT COPY > Flashcards

ENT COPY Flashcards

1
Q

What are the 3 bones in the middle ear called?

A

Malleus
Inucus
Stapes

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2
Q

What are the 2 muscles in the middle ear called?

A

Stapedius muscle

Tensor tympanic muscle

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3
Q

What are the 2 functions of the inner ear?

A

To convert mechanical signals from the middle ear into electrical signals for conduction via nerve
To maintain balance by detecting position and motion

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4
Q

How can you tell the difference between conductive and sensorineural hearing loss?

A

Weber’s test - Vibrating 256Hz tubing fork. Louder in the abnormal hear in conductive hearing loss and in the normal ear in sensorineural hearing loss.
Rinne’s test - Vibrating 256Hz tubing fork. Normally louder when held at external acoustic meatus than on mastoid bone. Opposite in conductive hearing loss.

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5
Q

What are the most common bacterial causes of acute otitis media?

A

haemophilus influenzae
streptococcus pneumoniae
moraxella catarrhalis
streptococcus pyogenes

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6
Q

How does acute otitis media present?

A

Pain
Fever
Irritability
Discharge from affected ear (if perforated)

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7
Q

TM appearance for acute otitis media?

A

Red, bulging, oedematous

Pus seen behind TM

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8
Q

Treatment for acute otitis media?

A

Analgesia
Watchful waiting
Delayed prescription of amoxicillin 5 days

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9
Q

What are the risk factors for otitis media with effusion (glue ear)?

A 
Age 1-6 years
Older sibling
Male
Parental smoking
Day care attendance
Immune deficiency
Allergy
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10
Q

Location in which part of the tympanic membrane is most likely to lead to mastoiditis?

A

Periphery, specifically upper ear drum

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11
Q

How does glue ear present?

A

(Otitis media with effusion)

Ear pain
Hearing loss (mispronouncing words, speech delay)
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12
Q

TM appearance for otitis media with effusion?

A

Opaque ear drum
Loss of light reflex
Indrawn/retracted TM

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13
Q

What is the management of otitis media with effusion?

A

Watch and wait for 3 months as most resolve
Surgery (grommets) is:
- persistent bilateral OME >3 months
- hearing loss >25dB in best ear
- language, educational, social developmental delay
Adenoidectomy if recurrent

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14
Q

What is chronic suppurative otitis media?

A

Ear with tympanic membrane perforation in setting of recurrent or chronic infections

Recurrent infections -> ulceration and oedema -> breakdown of epithelial lining

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15
Q

Risk factors for chronic suppurative otitis media?

A

Multiple AOM episodes
Living in crowded environment
Day care
Congenital abnormality eg cleft lip/palate, down’s syndrome

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16
Q

How does chronic suppurative otitis media present?

A

> 2 weeks ear discharge (bloody)
Hearing loss
Ear pain
Ear fullness

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17
Q

What is the management of chronic suppurative otitis media?

A

Keep dry
Aural cleaning
topical quinalone: ciprofloxacin

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18
Q

What are the complications of chronic suppurative otitis media?

A 
Cholesteatoma
Chronic hearing loss
Mastoiditis
Labyrinthitis 
Abscess formation
Facial paralysis
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19
Q

Common causative pathogens of otitis external?

A

Pseudomonas
Escherichia coli
Staphylococci

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20
Q

Risk factors for otitis externa?

A 
Swimming/Water sports
Humidity
Trauma
Cotton bud use
Diabetes
Immunosuppression
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21
Q

What is the presentation of otitis externa?

A 
Ear pain
Itching
Purulent discharge
Pre-auricular lymphadenopthy
\+/- hearing loss
\+/- fever
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22
Q

Investigation for otitis externa

A

Swab discharge for MC+S

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23
Q

Management of otitis externa

A

All: aural cleaning
mild: hydrocortisone cream on pinna, ear calm spray (2% acetic acid ) as anti-fungal
mod: topical Abx and steroid drops (otosporin)
Severe: ear wick
Referral to ENT for diagnosis and exclusion of complications

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24
Q

Complications of otitis externa

A

Temporary hearing loss
Chronic otitis externa
Necrotising OE
Cellulitis

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25
Q

Causes of referred ear pain

A

Tonsillitis
Cervical arthritis
TMJ disorders

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26
Q

What score’s are used to determine if a patient needs antibiotics for tonsillitis?

A

Centor score or FeverPAIN

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27
Q

What factors are taken into consideration on the centor score?

A
  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenitis
  • History of fever (over 38°C)
  • Absence of cough
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28
Q

What is the 1st choice antibiotic for tonsillitis?

A

Pen V (phenoxymethylpenicillin)

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29
Q

What is the first 1st line antibiotic for tonsillitis in a penicillin allergic patient?

A

Erythromycin or clarithromycin

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30
Q

How might you treat a patient systematically unwell with tonsillitis?

A

IV Benzylpenicillin stat
Steroids
IV Fluids

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31
Q

What is Ramsay Hunt Syndrome?

A

Herpes zoster oticus
Acute peripheral facial neuropathy associated with erythematous vesicular rash of the skin of the ear canal.
Infection of the facial nerve (CNVII)

32
Q

What pathogen causes Ramsay Hunt Syndrome?

A

Varicella Zoster Virus

33
Q

Symptoms of Ramsay Hunt Syndrome?

A

PURPLE acronym
P - Pain in face, head, ear or mouth
U - Unsteady (vertigo/dizziness)
R - Red rash, vesicles in mouth, ear, throat, hairline
P - Palsy (LMN facial palsy, forehead not spared)
L - Loss of hearing, tinnitus
E - Exception, there is not always a rash)

34
Q

Treatment of Ramsay Hunt Syndrome?

A

Acyclovir
Steroids
Analgesia

35
Q

Complications of Ramsay Hunt Syndrome?

A

Lasting neurological damage in approx 30%.

36
Q

Investigations for Ramsay Hunt Syndrome?

A

Bloods: Antibodies for VZV
Saliva: PCR for VZV
MRI: Inflammation of facial nerve

37
Q

What is mastoiditis?

A

Inflammation of the mastoid lining of the mastoid antrum and mastoid air system inside the mastoid process of the temporal bone.

38
Q

What organisms are the most common cause of mastoiditis?

A

streptococcus pneumoniae
streptococcus pyogenes
staphylococcus aureus
moraxella catarrhalis

39
Q

What is the clinical presentation of mastoiditis?

A

Red, painful, swollen mastoid process
Fever
Ear pain
Headache

40
Q

Investigation for mastoiditis

A

Blood cultures
MRI - to confirm diagnosis and look for extra cranial complications
Fluid from middle ear due to perforated drums or by intervention (tympanocentesis) for MC+S
LP - if intracranial spread is suspected

41
Q

Management of mastoiditis

A

IV broad spec antibiotics eg ceftriaxone
Analgesia
Surgery (myringotomy +/- tympanostomy) to drain pus from middle ear

42
Q

Complications of mastoiditis

A

Hearing loss due to labyrinthitis, facial nerve palsy, abscess formation, meningitis, epidural or brain abscess

43
Q

Through what 2 anatomical connections can bacteria gain access to the membranous labyrinth?

A

Between CNS and subarachnoid space via internal auditory canal and cochlear aqueductThrough congenital or acquired defects of the bony labyrinth

44
Q

How does labyrinthitis present?

A

Sudden, spontaneous, severe and incapacitating vertigo. Not triggered by movement but can be exacerbated by movement.
N+V
Hearing loss
Tinnitus

45
Q

What investigations would you do for labyrinthitis?

A

MC+S if ear discharge

CT of temporal bone

46
Q

Management of labyrinthitis

A

Antiemetics eg prochlorperazine (buccal or deep intramuscular injection if severe)
Surgery: Myringotomy

47
Q

Complications of labyrinthitis

A

Falls
Unilateral hearing loss
BPPV

48
Q

What condition is associated with acoustic neuromas?

A

Neurofibromatosis type 2

49
Q

What is the inheritance of neurofibromatosis type 2?

A

Autosomal dominance

50
Q

What cell type to acoustic neuromas arise from?

A

Schwaan cells

51
Q

How would an acoustic neuroma present?

A

Progressive tinnitus ± sensorineural deafness
Larger tumours - increased ICP symptoms
Any trigeminal involvement - numb face
+ear ache, balance changes

52
Q

Investigations for acoustic neuroma?

A

Audiogram

MRI

53
Q

What types of drugs can cause hearing loss?

A

Aminoglyosides (gentamycin, streptomycin, neomycin)
NSAIDS
Loop diuretics
Quinine

54
Q

What is the most common bacterial cause of pharyngitis?

A

Group A streptococcus

55
Q

What investigations can be done for patients with suspected pharyngitis?

A

Rapid antigen test for GAS

Throat swab for MMC+S

56
Q

What is the antibiotic of choice for confirmed group a strep pharyngitis?

A

Phenoxymethylpenicillin

57
Q

Presentation of quinsy

A

general: fever, malaise
mouth: saliva drooling, bad breath, trismus,

Pain: throat, swallowing, ear, head

58
Q

What symptom indicates pharyngitis over tonsillitis?

A

Trismus

59
Q

What is the management of quinsy?

A 
Same day referral to ENT
IV fluids
Analgesia
IV antibiotics
Needle aspiration, incision and drainage
60
Q

What condition is characterised by the triad of vertigo, tinnitus and hearing loss?

A

Meniere’s disease

61
Q

What is the most common salivary gland tumour?

A

Pleomorphic adenoma

Benign, slow-growing, rubbery

62
Q

2 most common locations for epistaxis to occur

A

Ant bleed: Kiesselbach’s plexus (Littles area) - ant/post ethmoid arteries, superior labial art and greater palatine art.
Post bleed: sphenopalatine artery - underlying pathologies like HTN

63
Q

What are the 5 parts of the temporal bone?

A 
Mastoid
Styloid process
Tympanic bone
Squamous part
Petrous part
64
Q

Differentials for parotid swelling

A 
Pleomorphic ademoma
Parotid abscess
Lymphoma
Adenocarcinoma of the parotid
Parotid adenitis
65
Q

What is taken into account in the FeverPAIN score?

A 
Fever >38
Purulent exudate 
Acute 
Inflamed tonsils (severely)
No cough
66
Q

Nerves responsible for referred ear pain

A

CN V: dental disease and TMJ dysfunction
CN VII: geniculate herpes
CN IX/X: posterior 1/3rd of tongue, pyriform fossa, larynx, throat (tonsillitis)
C2 C3: neck soft tissue injury and cervical spondylosis/arthritis

67
Q

What is a cholesteatoma and how is it managed?

A

Ingrowth of skin of eardrum in sac form
Skin in middle/outer ear meant to be respiratory but becomes squamous
Treatment: Mastoidectomy

68
Q

What is osteosclerosis?

A

new bone growth causes fusion of stapes footplate to oval window

69
Q

How would you manage osteosclerosis?

A

hearing aid

surgery: stapedectomy or stapedotomy

70
Q

How would you manage Menieres disease

A

prochlorperazine for acute attacks
Betahistine prophylaxis
Grommet.

71
Q

Why would you avoid prescribing amoxicillin in a patient with tonsillitis?

A

Causes pathognomonic rash in anyone whos illness due to EBV

72
Q

21 year old female with several week hx of malaise and fatigue now has a sore throat, OE you also notice a macular non pruritic rash on her back, what is your suspected diagnosis?

A

Infective mono nucleosis

73
Q

What is the most common organism to cause mononucleosis

A

EBV

74
Q

How does mononucleosis present?

A

Fever, fatigue, malaise (can last several months)
Sore throat: enlarged tonsils, exudative
Macular non pruritic rash
Lymphadenopathy
Nausea and anorexia
Later signs: hepato/splenomegaly, jaundice

75
Q

mononucleosis investigations

A
  • Monospot test and Paul-Bunnell test: detects heterophile antibodies, positivity increases during first 6 weeks (could be -ve early)
  • If -ve for heterophile antibodies after 6 weeks but have symptoms = heterophile negative IM - test for EBV specific antibodies
76
Q

how would you manage mononucleosis?

A 
Avoid contact sports for 3 weeks incase splenic rupture
Avoid alcohol
Paracetamol
IV fluids 
steroids if tonsils super big
77
Q

why would you not prescribe amoxicillin in mono?

A

Causes pathognomonic rash- EBV

phase 3b (15 decks)

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