ENT/ opthal

Question 1

what is ottitis media and signs and symptoms of it.

Answer 1

acute inflammation of the inner ear
generally see a bulging tympanic membrane due to build up

lines with respsiratory mucosa and commensally colonised–> vulnerable as the airway.

Signs and symptoms= ear pain, reduced hearing, balance issues, dizzyness, otorrhea (if membrane rupture) UTRI signs.
infants may be unable to feed, repeatedly touching the ear, crying.

Question 2

risk factors for Acute ottittis media and investigations

Answer 2

age, FH, day care attendance, bottle feeding, exposure to smoke

Breast feeding is protective

peak incidence is under 2 years old.

Ix: otoscope, visual inspection of ears and throat, tuning form for hearing loss,

Question 3

pathophysiology of AOM

Answer 3

usually started by inflammation of some sort- viral is common

inflammation obstructs the eustasion tube

this causes an increace in the negative pressure of the middle ear (you will gt pain + conductive hearing loss) and build up of secretions. This allows bacteria to thrive and cause an infeciton.

this causes a bulging tympanic membrane due to the purulent secretions- this causes severe otalgia and fever.

Question 4

common causative organisms of AOM and treatment oft it

Answer 4

S. puemoniae (most common)

H. influenza

Rx:
try and Rx conservatively

Symptoms lasting more than 4 days or not improving after 48 hours
Systemically unwell
Immunocompromised patient
Child less than 2 years with bilateral otitis media
OAM w/ perforation ± otorrhea
1st line = amoxicillin
Alternative => erythromycin, clarithromycin (macrolides) or cefuroxime, ceftriaxone (cephalosporins)

indications for surgery-
recurrency- (insertion of tympany tube)
tympanocentesis (aspiration) - if no response to rx
severe pain + pus- myringotomy (incision in membrane)

Question 5

complications of AOM

Answer 5

conductive hearing loss
labrynthitis

vestibular dysfunction

rupture of tymp membrane

cholesteatoma

mastoiditis (most common- spread to bone)

recurrency- can lead to chronic supperative otitis media

Question 6

what are the two types of chronic ottitis media

Answer 6

Chronic suppurative otitis media (CSOM) –> drainage from middle ear through perf membrane (6-12/52) - common in children

Chronic ottitis media with effusion (COME) –> chronic effusion in tympanic cavity abscence of infection (more than 3/12) - common in tottlers

CSOM is infective, COME is not

Question 7

signs and symptoms of CSOM and COME Rx of each and a special consideration to have for COME

Answer 7

CSOM–> painless otorrhea, hearing loss. Rx with ciprofloxacin + dex drops. graft if failure

COME–> fullness/ pressure in the ear, hearing loss 20-40Db. Rx with tympanostomy tubes.

in adults COME should promt high suspicion of nasopharyngeal malignancy.

Question 8

Cholesteatoma what is it and what does it do.

Answer 8

Special form of chronic otitis media in which keratinizing squamous epithelium grows from the TM or the auditory canal into the middle ear mucosa or mastoid

abnormal epithelium in abnormal location –> lots of inflam destroying other structures around it.- bone erosion, facial nerve palsies, sigmoid sinus thrombosis

Question 9

types of cholesteoma

Answer 9

aquired- chronic infecitions
congenital- born with it (being born with cleft lip inc risk 100X)

subdivision of aquired:
primary- eustachian tube dysfunction - tymp membrane retracts inwards
2’- migration of epithelium inwards through a perf TM.

Question 10

invesigations + management of cholesteoma

Answer 10

Ix: imaging to ax bone destruction- mastoid x-ray. Temporal CT scan.
audiometric tests

Mx: surgary is always indicated–> tympanomastodctomy –> excise cholesteoma –> repair middle ear.

Question 11

overview of otitis externa- including causative organisms + the different types

Answer 11

inflam of skin and subdermis of external ear canal +/- pinna or tympanic membrane.

acute- <6/52 - pseudamonas aeruginosa, staph aureus.
chronic >3/12 fungal- asperguillus/ candida albicans.
malignant- progressive infection causing osteomyelitis.

Question 12

risk factors for OE and S+S

Answer 12

Acute- skin conditions, otitis media, trauma, foreign body, water exposure

Chronic- DM/ immunodef, prolonged abx use

malignant- immunodef, age, radiotherapy, ear surgery.

S+S itch/ pain, discharge or dry scaly skin, hearing loss, granulation tissue in canal, facial nerve palsy.

Question 13

Rx of otitis externa

Answer 13

Acute- keep dry, avoid swimming, dry after showering
acetic acid ear drops for 7 days. if indicated Abx for 7-14/7 +/- dex drops.

chronic- swab, clean, antifungals/ biotics as appropriate (topical)

Question 14

tonsilitis overview , Risk factors, aetiology, S+S

Answer 14

an acute infection of the parencyma of palatine tonsils

RF- 5-15 yers - contact with infected people

Viral mostly- rhinovirus, bacterial is less common but important to pick up.

S+S- pain on swallow, fever, tonsillar inflammation, sudden onset sore throat, cough, rhititis, coryzal symptoms.

Question 15

what are the centor criteria to tell if tonsilitis is bacterial

Answer 15

Fever > 38
pus
attendance within 3 days of symptoms
indlammation of the tonsils
no cough

Question 16

Ix and Mx of tonsilitis

Answer 16

Throat culture and rapid strep antigen test (culture takes a while)

Rx: if no strep- analgesics
if strep - analgesics, steds

if less than 5 amoxicillin
over 5- penicillin/ clarithromycin.

if chronic- tonsilectomy.

Question 17

pharyngitis overview, RF, epidaemiology

Answer 17

inflammation of the pharynx +/- exudate

Risk factors- Grp A strep in nose/ contact
sexual activity/ abuse
ingestion of non-domestic meats
immunodef

epidaemiology- bacterial - grp a strep common in winter/ spring. viral summer/ autumn- Ebv, adenoirus, flu

Question 18

signs and symptoms of pharyngitis

Answer 18

if no cough, nasal congestion, discharge- bacterial

painful throat
pharyngeal exudate
cervical adenopathy
fever
headache, N+V, abdo pain.

Question 19

IF + Rx of pharyngitis

Answer 19

Ix: rapid grp A strep antigen
culture
serum mono-spot for EBV

Rx: analgesics, abs if relavent
tolsilectomy

Question 20

laryngitis overview, RF+ aetiology.

Answer 20

inflam of the larynx (croup)- oedema of the true vocal chords.

acute (<3/52) or chronic.

RF: URTI, HIB + diptheria vaccene absence. travel, immunodef, long abx/ inhailed steds, heavy vocal use, tobacco

Almost always viral- parainfluenza

Question 21

S+S of laryngitis, Ix + Rx

Answer 21

hoarse voice, dry cough, fever, lymphnode enlargement, accessory resp muscle use in narrowed airways, insp stridor

Ix: laryngoscopy
biopsy
swab + culture

Mx:
secure airway if compromised,
supportive care, cough suppression

Question 22

what is infectious mononucleosis

Answer 22

AKA EBV/ glandular fever

found in saliva

more severe symptoms in teenagers or young adults.

• symptomatic infection with EBV is called infectious mononucleosis.

(if treated with abx- amox/ cephlasporins get a really itchy rash)

Question 23

S+s Ix and Mx of mono

Answer 23

S+S= fever, sore throat, faigue, lymphadenopathy, tonsillar enlargement, splenomegaly.

Ix: heterophile antibodies (add them to horse/ sheep RBC and if they react then +ve test)
EBV IgM- suggests acute infection
IgG- suggests immunity.

Mx: self limiting, 2-3 weeks and gets better, no contact sports (spleen) no alcohol.

can get splnic rupture, chronic fatigue, glomerulonephritis

Question 24

what are nasal polyps, RF, who does it occur in, S+S

Answer 24

benign growths in the nose or sinuses- hand like teardrop/ grapes

RF= asthma, aspirin sensitivity, allergic fungal sinusitis, CF, vit D def.

occurs in young + middle ages adults.

S+S= irritation/ swelling >12/52
runny nose
persistant stuffiness
postnasal drip
dec smell
loss of taste/ smell
facial pain/ headache
pain in upper teeth
pressure over forehead
snoring
nosebleeds

Question 25

pathopahysiology, Ix, Rx of nasal polyps

Answer 25

nasal mucosa becomes inflaimed, polyps fill with inflammatory fluid. (assoc with allergy/ infection)

Ix: physical, nasal endoscopy, imaging CT if deeper.
allergy tests/ CF tests. Blood fro vit D

Mx: nasal corticosteds, oral/ injectable steds. dupilumab injection - reduced size.
antihistamines for prevention of recurrence. surgery to remove

Question 26

complication and prevention of nasal polyps

Answer 26

complications-
OSA
asthma flares
sinus infections

Prevention-
manage allergies + asthma
avoid nasal irritants
good hygene
humidifiers
nasal rinse OTC.

Question 27

what is rhinosinusitis what is its characteristic disease pattern

Answer 27

usually caused by URTI. this causes impaired ciliary clerance- proliferation in the sinuses

double worsening- i.e the disease gets better and then worse again

need a triple symptoms to diagnose- purulent nasal discharge, facial fullness, nasal obstruction.

Rx is co-amoxiclav or amoxacillin

Question 28

conjunctivitis, definition, RF + DD

Answer 28

inflammation of the conjunctiva (lining inside of eyelids + sclera. _ most common cause of pink eye.

its V contageous

RF: exposure to someone with it.
environmental insults
allergen exposure,
one eye infection.

important DD is subconjunctival haemorrhage

Question 29

aetiology of conjunctivitis

Answer 29

Bacterial infection–> purulent discharge (eyelids can stick together)

staph aureus, strep pneumonia, H influenza, Neisseria gonorrhoeae

can also get viral- much more watery discharge (adenovirus, vzv.

in young adults or newborns can also get chlamydia- (from vagina to eye) - needs urgent treatment to save eyesight.

most causes are adenovirus.

Question 30

signs and symptoms of conjunctivitis + Ix + Rx

Answer 30

pink eye, discharge, crust, chaemosis, burning, photophobia, itching, bilateral, normal vision.

Ix:
rapid adenovirus immunoassay
culture, usually a clinical diagnosis.

Rx:
viral is usually self limiting, - wash with sterile water and wipe ONCE with cotton wool ball
rarely give Abx for bacterial
eyedrops and antihistamines can help if allergic.