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MD Finals > ENT/Optho > Flashcards

ENT/Optho Flashcards

1
Q

Systemic diseases with nasal symptoms.

A

Wegners - destructive vascultis, c-ANCA, kidneys and lungs.

Sarcoidosis - nasal obstruction, ACE+ve, hilar lymphadenopathy.

Churg-Strauss - vasculitis/asthma, pANCA

Chronic infective disease - TB, leporsy, syphilis.

CF - chronic sinusitis + polyposis - in children, polyps are indicative of CF.

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2
Q

Important points in otology history.

A 
Hearing loss. 
Tinnitus - perception of noise in ears. 
Discharge - otorrhoea. 
Vertigo - illusion of movement. 
Previous ear surgery.
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3
Q

Causes of sensorineural hearing loss.

A 
Age related hearing loss (presbycusis). 
Congenital hearing loss. 
Infection - meningitis. 
Trauma/noise exposure. 
Drugs - aminoglycosides/chemotherapy.
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4
Q

Causes of conductive hearing loss.

A

Rarely, wax.
Otitis media with effusion (glue ear).
Perforation of tympanic membrane.
Cholesteatoma - retention of squamous debris within middle ear space.
Otosclerosis - fixation of stapes footplate in oval window.
Congenital anomalies of external ear canal/middle ear.

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5
Q

Causes of tinnitus.

A 
Loud noise exposure - bilat, irreversible. 
Vesibular schwannoma - unilat
Drugs - aspirin.
Menieres disease.
Vascular leasion - pulsatile. 
Hypertension. 
Anaemia.

Pysch support in tinnitus - retraining therapy.
Hypnotics at night may help.

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6
Q

Causes of vertigo.

A

BBPV - 30 second attacks, Hallpike positive
Menieres disease - fluctuating, aural fullness, tinnitus+ vertgo for hours
Vestibular neuronitis - persistant vertigo, days to weeks
Central - migraine, cerebellar disease
Drugs + alcohol

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7
Q

Causes of otalgia.

A 
OE - serous
AOM - when complicated by a perforation classically mucoid. 
COM - Per>3 months
Foreign body with secondary infection. 
Neoplasm.
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8
Q

Acoustic neuroma.

A

Benign growth of schwann cells along the vestibular nerve.
Unilateral hearing loss +/- tinnitus +/- balance disturbance.
Neurological symptoms as enlarged and obstructs CSF.
MRI of meatus and cerebellopontine angle.
Mx - surgery/radiotherapy.

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9
Q

Otitis externa.

A

Inflammation of the skin of the EAM.
Itch and pain.
Swimming, trauma, inherited.
Aural toilet, topical steroids with antibiotics.
Diabetic patients need special can - can develop osteomyelitis of temporal bone.

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10
Q

Otosclerosis.

A

AD with incomplete penetrance.
Fixation of stapes in oval window - prevents sound conduction.
Flat, conductive hearing loss.
Hearing aid or stapedotomy.

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11
Q

Cholesteatoma.

A

Chronic otitis media.
Squamous tissues in middle ear.
Active - discharging and inflammed.
Inflammation resorbs the underlying bone with subsequent secondary enlargement.
Congenital or acquired.
Complications - hearing loss, tinnitus, vertigo, facial palsy.

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12
Q

Chronic OM.

A

Perforation >3 months + no squamous debris.
AKA mucosal type.
Active - discharging - topical antibiotics and steroids.
Inactive - no discharge, keep dry.
Repair of TM is recurrent infection or swimmer.
Complications - hearing loss, develop cholesteatoma, intracranial infection.

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13
Q

Acute OM.

A

Acute inflammation of the middle ear <3 weeks, causing pain, fever and hearing loss.
Viral or strep pneumo, heam influenzae, morexella
Paracetamol
Antibiotics if <2 years or >48-72 hours of fever
Complications - OME, mastoiditis, facial nerve palsy.

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14
Q

Glue ear.

A

OME - otitis media with effusion.
Common in children due to Eustachian tube function.
TM - dull, retracted, bubble seen.
Mild temporary conductive hearing loss.
Investigations - otoscopy, PTA, tympanometry (measure mobility of TM).
Management - none unless bilateral >3 months = Grommets/hearing aids.

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15
Q

Menieres Disease.

A

aka Endolymphatic hydrops.
Episodic vertigo with increase in tinnitus, hearing loss and aural fullness.
Cause unknown.
Attacks last 1-24 hours, progressive hearing loss.
Medical management - low salt/caffeine diet, diuretics, betahistine.
Surgery - gent application to middle ear.

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16
Q

Top 5 ototoxic drugs.

A 
Aminoglycosides eg gentamicin. 
Loop diuretics eg furosemide. 
Cytotoxics eg cisplastin. 
Beta-blockers eg atenolol. 
Salicylates eg aspirin (reversible on withdrawing).
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17
Q

Top 5 findings on otoscopy in children.

A

Otitis media with effusion (OME) glue ear - fluid level behind retracted ear drum.
Acute otitis media - red bulging ear drum, pyrexia.
Grommet - ventilation tube in ear drum.
Perforation - acute or chronic, with or without discharge from ear.

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18
Q

Paediatric ENT emergencies.

A

Forgein body - unilateral nasal discharge, ear on otoscopy.
Lymphadenitis - neck lump, secondary to URTI, antibiotics - can form abscesses.
Periorbital cellulitis - swollen eyelids, eye signs, secondary to sinus infection, risk of blindness.
Acute mastoiditis - swelling behind, ear, secondary to otitis media, IVAbx and surgery.
Stridor - acute epiglottis/inhaled forgein body - ENT, anaesthetics, paeds.

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19
Q

Downs Syndrome.

A 
Trisomy 21. 
OME. 
Sleep apnoea. 
Subglottic narrowing. 
Hearing loss.
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20
Q

Pierre Robins.

A

Microganthia.
Macroglossia.
Cleft palate.
Airway obstruction.

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21
Q

Goldenhar Syndrome.

A

Hemifacial microsomia.
External canal atresia.
SNHL.

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22
Q

Waardenburg Syndrome.

A

Pigmentory abnormalities.
White forelock.
SNHL.

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23
Q

Tretcher Collins Syndrome.

A

Manidibulofacial dysostosis.
Microtitia.
Micrganthia.
Macrostoma.

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24
Q

Name the salivary glands.

A

Parotid.
Submandibular.
Sublingual.

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25
Q

Phases of swallowing.

A

Voluntary phase.

Pharyngeal phase.

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26
Q

What are the 2 types of tinnitus?

A

Objective - can be perceived by others which is due to sounds created in the body.

Subjective - only perceived by the affected individual, can be due to a wide range of causes.

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27
Q

What are some causes of loss of balance?

A

Common - vestibular neuritis/labyrinthitis, menieres, thiamine deficiency, ototoxic drugs.

Uncommon - acoustic neuroma, vestibular hypofunction

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28
Q

Conductive hearing loss.

A

Impaired conduction anywhere between the auricle and the round window.

External obstruction - wax/pus/foreign body.
TM perf - trauma/infection.
Ossicle defects - otosclerosis/infection/trauma.

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29
Q

Sensorineural hearing loss.

A

Defects of the cochlea, cochlear nerve or brain.

Drugs - vanc/gent.
Post-infective - meningitis/measles/mumps.
Menieres/trauma/MS.

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30
Q

Otosclerosis.

A

AD - incomplete penetrance.
Fixation of stapes to the oval window.
Improved in noisy places - Wills paracoussis.
Mx - Hearing aid or stapes implant.

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31
Q

Presbyacussis.

A 
Age related hearing loss. 
SN loss. 
Progressive damage of the organ of corti. 
Loss of higher frequencies initially. 
Mx - hearing aids or cochlear implants.
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32
Q

Noise induced hearing loss.

A

> 85dB
Sudden loud sound results in damage to the cilia hair cells.
Repeated noises - SNHL.
Loud noise - perf - conductive.

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33
Q

Hearing adjuvants.

A

Hearing aid - conductive and sensorineural HL. Mild to moderate.

Cochlear implants - SNHL. Moderate to severe.

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34
Q

Indications for a Tracheostomy.

A

Long term ventilation - >3 weeks.
Acute upper airway obstruction.
Between cricoid cartilage and sternal notch.

35
Q

Indications for a Cricothyrotomy.

A 
Emergency procedure. 
Through cricothyroid membrane to obtain airway access, 
If ETT has failed. 
Obstruction - tumour, angioedema. 
Laryngospasm.
36
Q

Common pathogens in acute tonsillitis.

A

Viral, <5 and young adults.
Bacterial 5-15.
Viral - adenovirus, EBV.

37
Q

Complications of acute tonsillitis.

A

Peritonsillar abscess - quinsy.
Retropharyngeal abscess.
Post-strep GN.

38
Q

Epiglottitis.

A 
Hib. 
Group A strep. 
RISK FACTOR NOT BEING IMMUNISED. 
Sudden onset, high fever, drooling. 
Dysphagia/drooling/distress.

Mx - dont examine through, o2 and ned adrenaline, IV dex and IV cefotaxime.

39
Q

Laryngitis.

A

Usually viral and self-limiting.
Rhino, adno and influenza virus.
Secondary bacterial infection may occur.
Laryngoscopy - red and inflammed vocal cords.
Mx - vocal rest, steam inhalation.
Penicillin V if necessary in bacterial superinfection.

40
Q

Pharyngitis.

A

Acute - usually viral or IM.

Chronic - may be related to chronic sinusitis, bronchitis or reflux.

41
Q

Infectious Mononucleosis. .

A 
Glandular fever. 
95% are seropositive. 
EBV virus - spread via saliva. 
Infects B lymphocytes via the CD21. 
4-8 weeks incubation. Symptoms 2-4 weeks. 
Splenomegaly, fever, fatigue, malaise. 
Pharyngitis/tonsilitis/bilat cervical lymphadenopathy. 
Macpap rash.

Ix - Monospot Test, elevated LDH and liver transaminases, >10% atypical lymphocytes/lymphocytosis.

Mx - avoid . contact sports for 3 weeks, fluids, analgesics and antipyretics.

42
Q

Complications of Mono.

A

NS - GBS/meningoencephalitis/CN palsies
Haem -TTP/HUS/DIC.
Splenic rupture, acute renal failure, AOM.

43
Q

Pathology of OSAS.

A

Obstruction of upper airways. Apnoea. Low PaO2. Increased pCo2.

44
Q

Investigation of OSAS.

A

Polysomnography.

Bloods - polycythaemia.

45
Q

Management of OSAS.

A 
Lose weight. 
Stop smoking. 
Sleep hygiene. 
Lateral sleeping position. 
CPAP @ night via a nasal mask. 
Surgery - tonsillectomy.
46
Q

What is the definition of an orbital blow out fracture?

A

Orbital contents are typically forced through a fractured orbital floor.

47
Q

What is the presentation of an orbital blow out fracture?

A

Unilateral periorbital pain, oedema +/- ecchymosis.
En or exopthalmos.
Orbital rim step off.
Epistaxis.

48
Q

What is the management of an orbital blow out fracture?

A

Opthalmic consultation.
Anitbiotics.
Steroids to reduce swelling.
Topical vasoconstrictor for epistaxis.

49
Q

What are the signs of a basal skull fracture?

A

Leakage of CSF from SAS through an external opening.
Due to a dural tear - may show halo sign (rapidly expanding ring of clear fluid surrounding blood)
Subcut haematoma.

50
Q

What are the signs of an anterior basal skull fracture?

A

CSF rhinorrhoea
Raccoon eyes
Cranial nerve 1,5,6,7,8 palsies

51
Q

What are the signs of a posterior basal skull fracture?

A

CSF otorrohea
Haemotypanum
Battles sign
Cranial nerve 6,7,8 palsies

52
Q

What is the most common deep neck infection?

A

Peri-tonsillar abscess/quinsy.

53
Q

Quinsy.

A

Develop from tonsillitis.
Strep pyogenes.

Hot potato voice.
Trismus.
Uvula shifted to opposite side, with inferior and medial displacement.
Unilateral fluctuant, swollen red tonsil.
Same sided cervical lymphadenopathy.

54
Q

What is the management of a Quinsy?

A

IVAbx.

Incision and drainage or needle aspiration.

55
Q

When would a tonsillectomy be indicated in a quinsy?

A

Unresponsive to drainage and abx.
Quinsy before.
Airway obstruction.

56
Q

Parapharyngeal abscess.

A 
Children <5. 
Caused by dental infections. 
Medial displacement of the lateral pharyngeal wall. 
CT. 
IV ABx and drainage.
57
Q

Retropharyngeal abscess.

A

Children <5.
Spread from URTI.
Unilateral swelling of the posterior pharyngeal wall (possible fluctuance)
Neck asymmetry, anterior cervical lymphadenopathy (inability to extend neck)
Dx - lateral x-ray - widened prevertebral space on CT

58
Q

What is the 2 mechanisms of angioedema?

A

Bradykinin - hereditary/ACEi induced

Histamine - NSAIDs.

59
Q

What is the presentation of angioedema?

A

Facial oedema - mouth, eyelids, tongue
Laryngeal involvement - SOB, stridor, potentially life threatening.
Possible swelling of extremities and urogenital area.

60
Q

What are some common causes of angioedema?

A

ACE inhibitors - common

Hereditary - rare

61
Q

What is the management of angioedema?

A 
Secure airway
Adrenaline. 
Steroids. 
Antihistamines. 
Discontinue ACE-inhibitors.
62
Q

How can you rule out a facial fracture in those with a fractured nose?

A

Teeth mal-alignment

Diplopia. .

63
Q

What are the investigations for fractured nose?

A

None - cartilaginous injury wont show on x-ray and radiographs wont alter management.

64
Q

What is the management for a fractured nose?

A 
EXCLUDE SEPTAL HAEMATOMA
Re-examine after 1 week - reduced swelling. 
Reduction (anaesthetic) and splinting
Early ENT referral - reduction. 
Late - septorhinoplasty.
65
Q

What are the complications of a fractured nose?

A

Septal haematoma.

Nasal obstruction.

66
Q

What is a nasal septal haematoma?

A

Rare complication of nasal bone fracture.

67
Q

What is the presentation of a nasal septal haematoma?

A 
Nasal obstruction. 
Blue-red bulge from nasal septum. 
May be uni or bilateral. 
Overlying oedema. 
Occlusion of nare.
68
Q

What is the management of nasal septal haematoma?

A

Incision and drainage.

Packing.

69
Q

What is the prognosis of a nasal septal haematoma?

A

Prompt intervention is required to prevent cartilaginous necrosis of the septum/saddle deformity.
Can perforate the septum.

70
Q

What are some causes of epistaxis?

A 
80% unknown 
Trauma - nose picking/fracture
Foreign body 
Local infection - URTI
HHT
Coagulopathy
71
Q

Osler-Weber-Rendu/HHT.

A

AD
Telangectasia in mucosa.
Internal ones and AVM.

72
Q

Pinna haematoma.

A

Result from blunt force trauma, usually from sports.

Blood accumulates in the subperichondral space and can result in decreased blood flow, necrosis and infection.

73
Q

What are some differentials for pinna haematoma?

A

Perichondritis.
Abscess.
Relapsing polychondritis.

74
Q

What is the management of pinna haematoma?

A

Evacuation - needle decompression/I+D/ .
Compression dressing - dental rolls, casting agent.
Antibiotics.

75
Q

Malignant otitis externa.

A

Life threatening infection which can lead to skull osteomyelitis.

90% are immunocompromised.

Severe otalgia, worse at night.
Copious ottorohoea.
Granulation tissue in the canal.

76
Q

What is the management of malignant otitis externa?

A

Surgical debridement.

Systemic ABx.

77
Q

Bells Palsy.

A

Inflammation and oedema from entrapment of cranial nerve 7 in narrow facial canal.
HSV1.

78
Q

What is the presentation of Bells Palsy?

A 
Sudden onset 
Complete, unilateral weakness
Numbness of pain around the ear. 
Decreased taste. 
Hyperacussis - stapedius palsy.
79
Q

What is the management of Bells Palsy?

A

Protect the eye,
Prednisolone.
Variciclovir if HZV suspected.

Complete lesions - 80% full recover, 20% delayed or permanent.

80
Q

Ramsey Hunt Syndrome.

A

Reactivation of VZV in the geniculate ganglion of CN7.

81
Q

What is the presentation of RHS?

A

Preceding ear pain.
Vesicular rash in the EAC
Ipsilately facial weakness, ageusia and hyperacusis.

82
Q

What is the management of RHS?

A

Varicylovir and prednisolone

83
Q

What are some causes of facial nerve palsy?

A 
Unilateral - Bells palsy, RHS
Bilateral - Lyme disease, GBS, Leukaemia
Intracranial lesions - MS, SOL
Intratemporal lesions - OM, cholesteatoma, RHS
Infratemporal - parotid tumours 
Systemic - DM, IV, botulism.

MD Finals (7 decks)

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