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Phase 3a/4 > ENT + opthalmology > Flashcards

ENT + opthalmology Flashcards

1
Q

what other symptoms to ask about in hearing loss

A

tinnitus
pain
discharge
vertigo
neurological symptoms

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2
Q

describe webers test and the results

A
  1. vibrate tuning fork
  2. put it on middle of forehead
    sensorineural hearing loss = louder in NORMAL ear
    conductive hearing loss = louder in DEAF ear (vibration directly to cochlear)
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3
Q

describe rinne’s test

A
  1. vibrate tuning fork
  2. place flat end on mastoid process (tests bone conduction)
  3. ask pt when they can no longer hear humming noise
  4. move it to outside ear (still vibrating) = air conduction
  5. repeat on other side
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4
Q

describe the results of rinne’s test

A

normal = pt can hear fork through air - air conduction is better = rinne’s POSITIVE

abnormal = pt cannot hear fork after removing from bone = rinne’s NEGATIVE = suggests CONDUCTIVE loss

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5
Q

name some causes of sensorineural hearing loss

A

sudden onset
presbycusis (age related)
noise exposure
menieres
labrynthitis
acoustic neuroma
neuro conditions
infections
medications (furosemide/gentamicin/cisplatin)

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6
Q

name some causes of conductive hearing loss

A

ear wax
fluid
infection
Eustachian tube dysfunction
perforated tympanic membrane
tumours

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7
Q

what is a cholesteatoma

A

abnormal collection of squamous epithelial cells in middle ear
non cancerous but can invade local tissue and erode bones of middle ear
can cause bad ear infections with FOUL discharge

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8
Q

what is the presentation and management of cholesteatoma

A

foul discharge from the ear
unilateral conductive hearing loss
?infection
?pain
?vertigo
CT head to confirm + surgical removal

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9
Q

what are the 4 sets of paranasal sinuses

A

frontal sinuses
maxillary sinuses
ethmoid sinuses
sphenoid sinuses

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10
Q

how to treat sinusitis if symptoms not improved after 10 days

A

high dose steroid nasal spray 14 days
OR
delayed phenoxymethylpenicillin prescription for if not improved after 7 further days

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11
Q

how to correctly use a nasal spray

A

head tilt slightly forward
opposite hand to nostril
DONT sniff hard during spray
gently inhale through the nose after the spray

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12
Q

name some causes of TMJD

A

stress/low mood
teeth grinding
chronic pain
trauma to teeth/face causing abnormal bite

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13
Q

what are the symptoms and signs of TMJD

A

symptoms:
pain in pre-auricular area radiate to jaw
crepitus of joint
locking of joint
difficulty fully opening the mouth

signs:
tenderness on palp of joint
crepitus on movement
locking of jaw

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14
Q

how is TMJD managed

A

conservatively - painkillers and jaw exercises
mouth guard for grinding
rare but can have surgery/botox injections?

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15
Q

what investigations should be done for tinnitus

A

bloods:
FBC
glucose (diabetes)
TSH
lipids

audiology
CT/MRI if vascular/neuro cause considered

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16
Q

what are some red flags with tinnitus

A

unilateral
pulsatile
pain with noise
unilateral hearing loss
vertigo/dizziness/headaches/visual sympts
suicidal ideation related to tinnitus

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17
Q

what is malignant otitis externa

A

severe/life threatening
infection spreads to bone –> osteomyelitis of temporal bone
usually occurs in immune suppressed
symptoms more severe
requires emergency admission and treatment with IV abx

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18
Q

what are the additional symptoms of a quinsy

A

trismus = cant open mouth
change in voice due to swelling (hot potato)
swelling and erythema

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19
Q

what is the management of a quinsy

A

needle aspiration
surgical incision and drainage
broad spectrum Abx
?dexamethasone

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20
Q

what is the main complication of a tonsillectomy

A

bleeding!!
up to 2 weeks after
risk of aspiration of blood

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21
Q

what type of cancers are head and neck cancers

A

squamous cell carcinoma

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22
Q

what are the risk factors for head and neck cancers

A

smoking
chewing tobacco or betel quid (paan)
alcohol
EBV
HPV 16

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23
Q

what are some red flags for head and neck cancer

A

unexplained lump or ulceration >3 weeks
erythoplakia (ulcer bleeds when scraped)
persistent neck lump/thyroid lump
unexplained hoarseness of voice

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24
Q

name the monoclonal antibody used in treating head and neck cancer

A

cetuximab

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25
Q

what is the most likely location of epistaxis

A

little’s area

keisselbach’s plexus

26
Q

how should nosebleeds be managed

A

sit up and tilt head forwards
squeeze soft part of nostrils together 10-15 mins
spit out blood

severe:
nasal packing
nasal cautery

27
Q

what is leukoplakia

A

white patches on buccal mucosa
precancerous = increase risk of squamous cell carcinoma

28
Q

what is erythroplakia

A

red lesion on buccal mucosa
higher risk of squamous cell carcinoma
bleed easily when scraped

29
Q

what is lichen planus

A

autoimmune condition = chronic inflammation of skin
purple raised areas with white lines (wickham’s striae)

good oral hygeine + no smoking + topical steroids

30
Q

vertigo
20-30 second spells
?viral infection
no hearing loss
no tinnitus

A

BPPV
Hallpike to Dx
Epleys to Tx
betahistine limited benefit
calcium carbonate crystals in semicircular canals

31
Q

vertigo - hours to days
N+V
struggling to balance
no tinnitus
no hearing loss
recent viral illness

A

vestibular neuronitis
only vestibular nerve affected
do HINTs to Dx
prochlorperazine + antihistamine
vestibular rehab for chronic

32
Q

important to differential for vestibular neuronitis and how to distinguish

A

posterior circulation stroke
do head impulse nystagmus test (HiNTs)
eye saccade = +ve for VN

33
Q

40-50 years old
vertigo - episodic clusters
hearing loss - fluctuates with vertigo
tinnitus
aural fullness

A

menieres disease
see ENT
audiology = sensorineural loss
acute attacks = prochlorperazine + antihistamines
prophylaxis = beta histine

34
Q

sudden onset
vertigo - not triggered by movement but exacerbated by it
N+V
hearing loss - uni or bi
tinnitus
recent URTI

A

viral labyrinthitis
vestibular nerve + labyrinth involved
sensorineural hearing loss
spontaneous nystagmus towards affected side
self-limiting
?prochlorperazine / antihistamine to reduce vertigo

35
Q

elderly patient
dizzy on extension of neck

A

vertebrobasilar ischaemia

36
Q

40-60 years old
gradual onset
hearing loss
tinnitus
vertigo
absent corneal reflex

A

acoustic neuroma/vestibular schwannoma
urgent ENT referral
MRI to Dx
Tx = conservative or surgery
importand ddx = meningioma

37
Q

hearing loss
aural fullness
popping sensation
pain/tinnitus

A

eustacian tube dysfunction
clinical Dx or can do audiometry/tympanometry
no Mx
?vasalva
?decongestants
?grommets

38
Q

what can cause otitis media

A

s.pneumoniae
h.influenzae
m.catarrhalis
s.aureush

39
Q

how does otitis media present

A

kids
pain
hearing loss
unwell
URTI
+/- vertigo
+/- discharge

40
Q

how does otitis media with effusion present

A

= glue ear!
most common in children <2
hearing loss/delay in speech
otoscopy = dull, loss of light reflex

41
Q

how is otitis media managed

A

3 days - 1 week resolve by self
Abx make no difference
simple analgesia
?delayed Abx = amoxicillin 5-7 days

42
Q

how is glue ear managed

A

in child first presentation = nothing
multiple in child = grommet or adenoidectomy

43
Q

ear pain
discharge
itchy
hearing loss
red/swollen inner ear

A

otitis externa
swimmers ear
otoscopy + ear swab
mild = acetic acid (antibac/antifungal)
moderate = otomize (neomycin, dexa, acetic acid)

44
Q

define acute and chronic otitis externa

A

acute = <3 weeks
chronic = >3 weeks

45
Q

what can cause otitis externa

A

p.aeruginosa (CF)
s.aureus

46
Q

what is it important to do before prescribing topical antibiotics for the ear

A

exclude tympanic membrane perforation
because gentamicin cause hearing loss

47
Q

describe the feverpain score

A

fever in past 24 hrs
purulence
attend w/n 3 days
inflamed tonisls
no cough/coryza

2-3 consider delayed Abx
4+ = give abx
= phenoxymethylpenicillin 10 days

48
Q

describe the CENTOR criteria

A

fever >38
tonsillar exudate
no cough
tender lymphadenopathy

1 point for each
3+ = 40-60% bacterial = ABx

49
Q

what is a serious complication of otitis media and who is more likely to get it

A

mastoiditis !!
s.pneumoniae/h.influenzae
children
LD/autism
immunocomp

50
Q

oh no! a 4 year old autistic child presents unwell, tugging at his right ear
on inspection there is a red swelling behind the ear and the ear appears more prominent than the left
on otoscopy the tympanic membrane appears bulging

what do you do now?

A

immediate urgent to ENT
ABCDE
Sepsis 6
HELP!
CT head to show ? progression to temporal bone

51
Q

21 year old student present generally unwell, with swollen cervical lymph nodes
what investigations do you want to do?
what management would you give?

A

monospot test = heterophile Antibodies
paul bunnel test

self limiting but give advice:
avoid alcohol
avoid contact sports

52
Q

what are the complications of EBV

A

burkitts lymphoma
splenic rupture
chronic fatigue
glomerularnephritis
haemolytic anaemia

53
Q

18 year old with a neck lump
mobile
non-tender
soft
moves with movement of tongue

A

thyroglossal cyst
can be sublingual!

54
Q

18 year old with a neck lump
midline
mobile
non-tender
soft
moves with movement of tongue

lump has turned hard and is emitting discharge!

A

infected thyroglossal cyst
Tx = antibiotics + surgical

55
Q

teenager with a neck lump
soft, round
no movement with tongue
doesnt transilluminate

A

branchial cyst
arise from second branchial cleft
Mx = conservative or surgery

56
Q

60 year old man
choking on food
regurgitating food
chronic cough
halitosis
feels a lump in the neck

A

pharyngeal pouch
do a barium swallow + fluroscopy
management is surgery

57
Q

4 month old
large neck lump
on LEFT side
fluctuant

A

cystic hygroma = lymphagioma
surgical excision

58
Q

68 year old
complaining because left eye drooping
ptosis + miosis
has a pulsatile lump in side of neck

A

carotid body tumour
surgical treatment

59
Q

causes of hornerys syndrome if anhidrosis in:
1. head /arm/trunk
2. just face
3. no anhidrosis

A
  1. stroke
  2. pancoast tumour / cervical rib
  3. absent = carotid artery tumour/pressure
60
Q

what eye complication following renal transplant

A

CMV retinitis
cotton wool spots
infiltrates
haemorrhages

61
Q

what are the branches of the facial nerve and how can you remember them

A

To Zanzibar By Motor Car
temporal
zygomatic
buccal
marginal mandibular
cervical

Phase 3a/4 (6 decks)

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