ENT MCQ 2021 Flashcards
Peri-orbital (Pre Septal Cellulitis)
95% of cases it is from
insect bite
scratch
ezcema
who is peri orbital cellulitis more common in ?
more common in children
Which is more common and which is more serious pre septal vs orbital
Periorbital is more common
orbital far more serious.
If clinicians are unsure, should treat sa though it is orbital
clinical presentaiton PS cellulitis
common bacteria
unilateral ocular pain
eyelid swelling
erythema
Strep pneumoniae, Staph aurueus
TReatement periorbital cellulitis
Oral antibiotics - Trimethoprim or clindamycin ++++ Amoxicillin
5-7 days
Diagnosis based on: preseptal cellulitis
clinical features + CT (if unsure and worried about orbital cellulitis)
Congenital dislocation of HIp: What are three things that make it more common?
Higher incidence in 1) breech presentation 2) first born children
3) oligohydramnios 🡪 all due to decreased intrauterine space
What infection can lead to orbital cellulitis?
Maxillary sinusitis
Orbital Cellulitis: What occurs
decreased VA
Diplopopia
decreased extraocular movement
SInusitis: Maxillary is most common: what are two types?
acute sinusitis <1 month
chronic sinusitis > 3 months
sinusitis presentation
facial pressure, fever headache and rhinorrhea (purluent dischargefrom nose)
acute bacterial sinusitis signs
fever
leukocytosis
purulent nasal discharge
Most cases of acute sinusitis are VIRAL/self limiting but if acute bacterial sinusitis what is treatment?
decongenstants antihistamines
antibiotics - Amoxicliin (or if not working augment (+clauvanate 10 days
Maxillary Sinusitis Differentials:
PAIN ONLY - frontal pain headaches that are severe without nasal symptoms indicates?
migrainous neuralgia (cluster headaches)
TMJ
Trigeminal neuralgia
migraines
Recurrent attacks of acute maxillary sinusitis: Surgical options?
FESS: antrostomy: permnanet intransal opening into antrum through meatus
What can cause maxillary sinusitis tooth wise?
other cuases
apical infection of tooth
anything rhino in nature:
nasal polypoisosis
deflected nasal septum
turbiante hypertrophy
diagnosis of chronic sinusitis based on:
Evidence of inflammation on endoscopy or CT
Signs on CT of sinusitis
opacity of the antrum(maxillary) due to infection
RED FLAGS FOR SINUSITIS
Facial Swelling/Periorbital swelling is a red FLAG
Intracranial:
meningitis
cavernous sinus thrombosis
orbital abcess/ frontal bone abcess
frontal bone osteomyelitis
Extracranial:
Periorbital cellulitis
Chronic sinusitis non operative treatment:topical and systemic
if mucopurulent?
Topical corticosteroids
prednisone 30mg (esp. polyp patients)
Antibiotics if mucopurulent
GLandular Fever vs tonsilitis
draw box out
what disease is chronic sinusitis associated with
asthma (+ polyps)
What is samsters triad?
where asthma, nasal polyps (+ rhinosinusitis) + aspirin allergy
How is samsters triad tested for ?
Allergy testing for skin
eosinophilia
How is chronic sinusitis diagnosed?
CT
pus swab
mucociliary function assessment
allergy testing skin (seeinf for eosinophilia
Samsters triad/nasal polyp treatment?
Functional endoscopic sinus surgery (FESS)
Topical steroids
Oral prednisone
infectious pharyngitis bacterial:
bacteria age seen on examination lymph nodes spleen lab investigation
pain radiation
complications
Bacteria; GAS, N gonorrhoea, M pneumonia
older children (20% of all cases)
large red pockets of pus
anterior (cervical) triangle lymph nodes tender
spleen normal
Labs: Bacterial swab and culture
radiates to ear
can cause peritonsillar abcess!!!1
EBV:
bacteria age seen on examination lymph nodes spleen lab investigation
radiation of pain
EPV/CMV
older children (20% of all cases)
on examination: pharngitis (same as ) enlarged tonsils/post nasal space can obstruct airways + white membrane covering the tonsils
posterior triangle lymph nodes lymphadenopathy
Spleen: hepatosplenomegaly
Lab: Monospot test (heterophile antibiodies) CBC,
pain raidates to ear
Treatment strep vs EBV
Strep: Amoxicillin
EBV?viral: fluids, rest
Amoxicillin: Do you give in EBV?
No as it can cause widespread rash
Strep throat guidelines: Who must assess risk for RF?
maori/pacific
3-45
low SES
past history of rhuematic fever
What criteria is used for strep throat risk guidelines?
Centor criteria
Facial Palsys: What must all facial palsies have ?
otological assessment
what is commonest cause of facial palsy?
Bells palsy
What occurs in bells palsy?
Lower motor neuron disease of cranial nerve 7 the facial nerve :
ipsilateral unilateral paralysis of all facial muscles (cannot close eye on that side)
What are two types of palsies of face?
central and peripheral
central: preservation of upper half of facial movemnets (UMN)
peripheral: loss of forehead and brow and lower face (LMN)
two types of LMN facial palsies
bells palsy
Ramsay Hunt
2 absolute and 2 relative indications for tonsillectomy
Oropharyngeal Airway obstruction
Peritonsillar Abcess
histology indicating neoplasm
recurrent acute tonsilitis
chronic tonsilitis
4 commonest complicaitons for tonsillectomy
Pain throat and otalgia Infection Primary Haemorrhage Secondary Haemorrhage general anasthetic problems
bells Palsy: Aetiology
clinical presentaiton
treeatment
Herpes Simplex virus of cranial nerve 7
LMN facial nerve unilateral ispilateral paralysis of facial muscles
Hyperacusis is a hearing disorder
TReatment:
Steroids + acyclovir
eye patching
bells Palsy: Aetiology
clinical presentaiton
treeatment
Herpes Simplex virus of cranial nerve 7
LMN facial nerve unilateral ispilateral paralysis of facial muscles
Hyperacusis is a hearing disorder
TReatment:
Steroids + acyclovir (self limiting)
eye patching
Ramsay Hunt syndrome: What is this?
lmn of facial nerve sue to varicella zoster infection of facial nerve and vestibulocochlear nerve
Ramsay Hunt presentation
unilateral paralysis of one side of the face.
vesicular dermatome rash usually near ear
LMN 8 = sensori neural hearing loss + tinnitus
Conductive hearing loss:
Bone conduction normal (bone conduction system bypasses the conductive structures of the outer and middle ear, so it can send sound vibrations directly to the cochlea) and air conduction reduced
Sensorineural hearing loss
both bone conduction (nerve) and air conduction reduced.
exotoses what is it
broad based bony tissue in external auditory canal typically due to swimming in cold water
complications of exotoses
accumulate wax and epithelium
can lead to otitis externa as complication
complications of exotoses
accumulate wax and epithelium
can lead to otitis externa as complication with conductive hearing loss
two common causes of facial palsy in children
acute otitis media
bells palsy
3 indications for tracheostomy
Upper airway obstruction
Respiratory failure /
To provide pulmonary toilet where can remove with suctions
Retropharyngeal abcess clinical presentation
stiff neck
malaise
difficulty swallowing
risks of retropharyngeal abcess
infection can pass down behind esophagus and into mediastinum
airway obstruction
sepsis
Retropharyngeal abcess clinical presentation
stiff neck
malaise
difficulty swallowing /painful swalloing
sore throat
diagnosis of retropharyngeal abcess
CT definitive
Xray
treatment:
tonsillectomy to drain abcess - risk of abscess rupture during tracheal intubation - needing tracheotomy
chronic retropharyngeal abcess usually secondary to?
tuberculosis
chronic retropharyngeal abcess in adults usually secondary to?
tuberculosis
retropharyngeal abcess age
6 months to 6 years
Audiogram:
vertical
horizontal
hearing level in DBHL intensity of sound 0-25 adult
0-15 infant
frequency of pitch 250Hz and 6000Hz is normal speaking
conductive vs sensorineural causes
conductive: disease of middle or external ea - AOE, AOM, exotoses, perforations, cholestoma, atelectasis
SNL: inner ear, acoustic nerve or the CNS - caused by aminoglycosides or loop diuretics
TYmpanogram types and causes
A=
A= normal - peak AS= small peak = less compliant otosclerosis AD = Very HIGH peak = ossicular chain discontinuity B = flat no obvious peak indicates effusion or perforation C= negative pressure slid to the left = indicates eustachian tube dysfunction - before or after
what is tympanogram testing
compliance/ flexibility of the eardrum to changing ear pressures
ossicular chain discontinuity what is this ?
seperation of the middle ear ossicles.
Bat ears: what causes this
fold of antihelix is absent or poorly formed in prominent ear
treatment bat ears and when is best age
4-6 years
surgical otoplasty correction with reshaping cartilage of the pinna
Otitis Externa: causes
swimming, allergy, trauma, excema
symptoms otitis externa
pain, itchiness and discharge
signs AOE
erythema
increasing oedema
canal debris
possibly conductive hearing loss
signs that AOE has progressed
severe pain that is worse with ear movement
signs:
lumen obliteration
purulent otorrhea
involvement of periauricular soft tissue
otitis externa most common pathogens and treatment (4 princples)
psudeonomonas aeruginosa and staph aureus
Frequent canal cleaning (“aural toilet”) Topical antibiotics Pain control Instructions for prevention Keep ear dry No instrumentation of EAC
treatment for psudenomnas
topical or ciproflaxcin
what may otitis externa require?
packing: pope wick soaked antibiotic + steroid
Once the swelling reduces the pack can be removed and the patient continued on drops depending on progress
Acute otitis media:
location
common organisims
middle ear and mastoid
S pneumoniae, H influenze and M. catarrhalis
AOM complications: name 2 and treatment
Perforated tympanic membrane leading to Tympanic scarring /tympanosclerosis
Mastoiditis
what causes tympanosclerosis
history of ventilation tubes
acute otitis media
otorrhoea (ear discharge)
mastoiditis : what is this
infection of the “air cells” in mastoid typically after suppurative acute otitis media
Complications of mastoiditis
meningitis
intracranial abcess
dural sinus thrombosis
Imaging mastoiditis
soft tissue opaeuety in mastoid cavity on the mastoid cavity
what is seen clinically mastoiditis
otorrhoea, tenderness over mastoid, post auricular swelling with protruding ear + AOM seen on microscopcy
treatment mastoiditis
IV antibiotics and mastoidectomy
complications of ventilation tubes
infection retention early extrusion peristent perforation swimming issues
what is management for persistent AOM?
ventilation tubes
Epiglottits clinical presentation
stridor
drooling
fever
hoarseness
Epiglottis caused by
Bacterial H influenzae B
tracheostomy complications
haemorrhage
recurrent laryngeal nerve injury
pneumothorax
Reinke’s Oedema Causes
swollen vocal cords:
smoking
GERD
hypothyroidism
voice trauma
Epiglottits treatment + what should you be wary of ?
Bag mask - intubation
Nebulised adrenaline
Antibiotics
silent airway= means patient is not moving enough air, can be life threatening
Paediatric sensorineural hearing loss:
Causes
Congenital: 50% genetic/ environmental
-waardenburg syndrome + branchio-otorenal syndrome
Acquired: Maternal infection: TORCH
neonatal ICU child
Sensorineural hearing loss: Most common cause in adults
Presbyacusis (most common)
acoustic neuroma
noise damage
