ENT questions Flashcards
presentation acoustic neuroma
unilateral sensorineural hearing loss, tinnitus
dizziness or imbalance
feeling of fullness in ear
CN affected
CN affected in acoustic neuroma
CNV (corneal reflex), CNVII (facial palsy), CNVIII (vertigo, hearing loss, tinnitus)
which ear is louder in conductive hearing loss
sound heard louder on side of affected ear in conductive hearing loss
result of rinne’s test in conductive hearing loss
negative
bone conduction > air conduction
what pattern of hearing loss is found in acoustic neuroma
sensorineural
pathophysiology BPPV
calcium carbonate crystals displaced into semicircular canals
due to viral infection, head trauma, ageing
disruption of normal endolymph flow through canals
describe dix-hallpike manouvre
move patients head 45 degrees towards affected ear
lie down
observe for vertigo and rotatory nystagmus
most common cause epiglottitis
haemophilus influenzae type B
features epiglottitis
rapid onset
high temp
stridor
tripodding
management epiglottitis
senior involvement - intubation
oxygen + abx
presentation infectious mononucleosis
fever
sore throat
fatigue
hepato/splenomegaly
palatal petechiae
haemolytic anaemia - cold agglutinins
rash after taking amoxicillin
diagnosis infectious mononucleosis
heterophil antibody (monospot) in 2nd week illness
menieres disease pathophysiology
excessive pressure and progressive dilation of endolymphatic system
meniere’s disease features
vertigo
tinitus
hearing loss (sensorineural)
fullness in ear
typically unilateral
management meniere’s
inform DVLA
prophylaxis with betahistine
acutely - prochlorperazine
causes otitis externa
pseudomonas
stah aureus
features otitis externa
ear pain
itch
discharge
red, swollen canal
management otitis externa
keep ears dry
mild - moderate - combined abx and steroid drops
oral abx if systemic features
pope wicks if meatus occluded
what is malignant otitis externa
infection spread to bones - osteomyelitis of temporal bone
CN involvement
meningitis
intracranial thrombosis
common bacterial organisms otitis media
strep pneumoniae
haemophilus influenzae
moraxella
features otitis media
otalgia
fever
recent URTI
hearing loss
discharge if membrane perforates
middle ear effusion
erythema tympanic membrane
indication abx in otitis media
symptoms > 4 days
systemically unwell
immunocompromised or diseased
<2 years + bilateral
perforation and/or discharge in canal
abx and length in otitis media
5-7 days amoxicillin
if penicillin allergic - erythromycin or clarithromycin
management glue ear
grommets if amoxicillin fails
management rhinosinusitis
conservative
if symptoms >10 days - high dose nasal steroid
no improvement in 7 days - phenoxymethylpenicillin
nasal spray technique
tilt head forward
opposite hand to spray in opposite nostril
don’t sniff hard during spray
gentle inhale through nose after spray
shouldn’t taste in back of throat
most common cause tonsilitis
strep. pneumoniae
EBV
centor criteria
fever >38
tonsillar exudates
tender anterior cervical lymphadenopathy
no cough
abx for patients with 3/4 criteria
fever PAIN score
fever
purulence
attend rapidly (3 days or less)
inflamed tonsils
no cough
2-3 points - delayed abx
>3 - abx
surgery for tonsilitis criteria
> 5 episodes sore throat a year
symptoms occurring for > 1 year
episodes disabling
borders anterior triangle
superior - mandible
medial - neck midline
lateral - sternocleidomastoid
borders posterior triangle
anterior - sternocleidomastoid
posterior - trapezius
inferior - clavicle
features thyroglossal cyst
patients <20
moves upwards with protrusion of tongue
features cystic hygroma
evident at birth, present < 2 years
transilluminates
features branchial cyst
swelling between angle of jaw and sternocleidomastoid in anterior triangle
does not transilluminate
presents teens/twenties
features carotid body tumour/paraganglioma
pulsatile neck mass
can cause horner’s syndrome
symbols for air and bone conduction
bone - sides of brackets
air - circle (right) cross (left)
labyrinthitis vs vestibular neuronitis
both - vertigo due to recent viral infection
neuronitis - no hearing loss
paraneoplastic features adenocarcinoma of lung
gynaecomastia
hypertrophic pulmonary osteoarthropathy
what frequency hearing loss is lost in presbycusis
high-frequency lost
what does a noise-induced hearing loss audiogram look like
notch down at 4000Hz
meniere’s disease audiogram
low-frequency sensorineural hearing loss
