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ENT > History + Investigations > Flashcards

History + Investigations Flashcards

1
Q

What are the key symptoms to ask about in the nose?

A
  • Nasal obstruction
  • Runny nose (anterior rhinorrhoea)
  • Loss of sense of smell (hyposmia)
  • Nosebleeds (epistaxis)
  • Post nasal drip
  • Nasal itch
  • Sneezing
  • Ocular itching
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2
Q

What are the symptoms of allergic chronic rhinosinusitis?

A
  • Secondary to pollen allergy
  • Bilateral nasal obstruction
  • Watery anterior rhinorrhoea
  • Sneezing
  • All in summer months
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3
Q

What are the key symptoms associated with the ear?

A
  • Earache (otalgia)
  • Ear discharge (otorrhoea)
  • Hearing loss
  • Tinnitus (sensation of sound without any external stimulus)
  • Dizziness
  • Aural blockage
  • Itching
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4
Q

What are symptoms to ask about the throat?

A
  • Sore throat
  • Difficulty swallowing (dysphagia)
  • Pain on swallowing (odynophagia)
  • Hoarse voice (dysphonia)
  • Regurgitation
  • Feeling of a lump in throat
  • Burning in the throat
  • Weight loss
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5
Q

What conditions affect ENT?

A
  • Asthma (common in allergic chronic rhinosinusitis)
  • Diabetes mellitus
  • Sarcoidosis
  • TB
  • GPA
  • Neurofibromatosis type 2
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6
Q

What medications can cause ENT side effects?

A

Aspirin and other NSAIDs taken in high doses can cause tinnitus, also aminoglycosides and loop diuretics.

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7
Q

What structures border the anterior triangle?

A
  • Sternocleidomastoid muscle
  • Mandible
  • Midline of the neck
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8
Q

What structures are in the posterior triangle?

A
  • Posterior triangle lymph nodes

- Accessory nerve

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9
Q

What is the examination of the neck?

A
  1. Inspection: look for scars, obvious masses, fistulas, sinuses - look at each side and back of neck
  2. Palpation: stand behind patient, lymph node examination, palpate thyroid gland and larynx, parotid gland, trachea, anterior and posterior triangle
  3. Auscultation if you suspect a bruit
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10
Q

What do you do in an oral cavity examination?

A
  • The mucosa of cheeks
  • The roof of mouth
  • The dentician and gums
  • The dorsum of tongue
  • Ask patient to lift their tongue to roof of their mouth and inspect floor of mouth
  • Ask patient to move their tongue to the right and then to the left and examine the sides of the tongue
  • In some cases, it is also helpful to palpate the structures of the oral cavity
  • Systematic approach to inspecting oropharynx: anterior and posterior faucial pillars, the tonsils, the soft palate and uvula, posterior oropharyngeal wall
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11
Q

What is referred otalgia?

A

The glossopharyngeal nerve supplies sensation to the throat and ear. This means it is not uncommon for people with sore throat to get otalgia, this is called referred otalgia. You need to examine the ear in these cases.

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12
Q

What are common causes of referred otalgia?

A
  • Dental infection
  • Pharyngeal pathology
  • Temperomandibular joint
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13
Q

What do you look for in inspection of the outer ear?

A
  • Deformity
  • Discharge
  • Scars
  • Sinuses
  • Skin conditions
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14
Q

What is chronic rhinosinusitis?

A

The nasal cavity and lungs are lined by the same type of epithelium (respiratory). They should be regarded as part of the same airway and as such diseases of one can affect the other and vice versa. Always ask patients with chronic rhinosinusitis about their chest and if necessary refer to chest physician.
Some people with chronic rhinosinusitis and asthma are sensitive to aspirin.

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15
Q

What is Samter’s triad?

A
  1. Asthma
  2. Recurring nasal polyps
  3. Aspirin sensitivity
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16
Q

What are the features of Meniere’s disease?

A
  • Recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural)
  • Vertigo usually prominent symptom
  • Sensation of aural fullness
  • Nystagmus
  • Episodes last minutes to hours
  • Symptoms usually unilateral but may become bilateral over several years
  • Weber’s test localises to contralateral ear (localising to same ear is conductive hearing loss in affected ear, localising to contralateral ear is sensorineural hearing loss in affected ear)
  • Symptoms resolves in majority of patients after 5-10 years, majority will be left with a degree of hearing loss
17
Q

What is the management for Meniere’s disease?

A
  • ENT assessment is required to confirm diagnosis
  • Inform DVLA: stop driving until symptoms are under control
  • Acute attacks: buccal or IM prochlorperazine, admission sometimes needed
  • Prevention: betahistine and vestibular rehabilitation exercises
18
Q

What are the features of vestibular neuronitis?

A
  • Recurrent vertigo attacks lasting hours or days
  • Nausea and vomiting may be present
  • Horizontal nystagmus is usually present
  • No hearing loss or tinnitus (cochlear system not affected)
19
Q

What are differential diagnosis for vestibular neuronitis?

A
  • Viral labyrinthitis (both vertigo and hearing impairment) - ask if they have/had the flu/a cold
  • Posterior circulation stroke: the HINTS (head impulse, nystagmus, test of skew) exam can be used to distinguish vestibular neuronitis from posterior circulation stroke
20
Q

What is the management for vestibular neuronitis?

A
  • Vestibular rehabilitation exercises are preferred treatment for patients experiencing chronic symptoms
  • Buccal or IM prochlorperazine - rapid relief for severe cases
  • Short oral course prochlorperazine (chronic use can delay recovery as it interferes with central compensatory mechanism) or an antihistamine (cinnarizine, cyclizine or promethazine) may be used to alleviate less severe cases
21
Q

What are the features of BPPV?

A
  • Usually onset is 55 years
  • Vertigo triggered by change in head position e.g. rolling in bed
  • Typically 10-20 sec episodes
  • May be nauseous
  • Positive Dix-Hallpike manoeuvre
22
Q

What is the management of BPPV?

A
  • Good prognosis, usually resolves spontaneously after a few weeks/months
  • Symptom relief - Epley manoeuvre (successful in ~80%)
  • Vestibular rehabilitation e.g. Brandt-Daroff exercises
  • Medication e.g. betahistine, often given but doesn’t really help
  • Recurrence in 50% 3-5yrs after diagnosis
23
Q

What are the results for Weber’s test?

A
  • The quieter ear could be a sensorineural problem (cochlea)

- Louder side could be an air conduction problem (bone conduction louder than air conduction)

24
Q

What are the results for Rinne’s test?

A
  • Normally air conduction heard for longer than bone conduction
  • Sensorineural hearing loss - can’t hear bone or air
  • Air conduction loss - can hear on the bone but not when holding by the ear
25
Q

What are causes of conductive hearing loss?

A
  • Otosclerosis
  • Wax
  • Foreign body
  • Cholesteatoma
  • Perforated TM
  • OE
  • OM
26
Q

What are the causes of sensorineural hearing loss?

A
  • Acoustic neuroma
  • Viral labyrinthitis
  • Meniere’s disease
  • Presbycusis
  • Ototoxic drugs (aminoglycosides - gentamicin)
  • Viral (CMV)
  • Noise induced
  • Stroke
  • Genetic (Conexin 20)
  • Trauma
  • Autoimmune vasculitis
27
Q

What medications cause ototoxicity?

A
  • Aminoglycosides e.g. gentamicin
  • Furosemide
  • Aspirin/NSAIDs
  • Chemotherapy

ENT (8 decks)

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