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ICSM Year 6 Helen Lashwood > Surgery - Ear, nose and throat > Flashcards

Surgery - Ear, nose and throat Flashcards

1
Q

What is a normal result in pure tone audiometry?

A

All results above 20dB line

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2
Q

What is the difference between SNHL, conductive HL and mixed HL?

A

SNHL = both air and bone conduction are impaired (AC is better than BC)
Conductive HL: only air conduction is impaired
Mixed HL: air and bone condution both impaired, but BC is better than AC

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3
Q

How can middle ear function be evaluated?

A

Tympanometry - measures stiffness of ear drum

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4
Q

What is automated auditory brainstem response audiometry?

A

Auditory stimulus with measurement of elicited brain response by surface electrode

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5
Q

What are the components of the child hearing exams?

A

All babies get evoked otoacoustic emission testing
If not normal –>
Automated auditory brainstem response audiometry

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6
Q

What are the signs and symptoms of TMJ dysfunction?

A 
Otalgia (referred pain from auriculotemporal nerve) 
Facial pain 
TMJ joint clicking/popping 
Bruxism (teeth grinding) 
Stress
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7
Q

What condition does ‘swimmer’s ear’ refer to?

A

Acute diffuse otitits externa

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8
Q

How should necrotising otitis externa be managed?

A

Urgent ENT referral
CT head
IV ciprofloxacin

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9
Q

How should acute otitis externa be managed?

A

Topical abx +/- topical steroid –> oral flucloxacillin

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10
Q

What is the most common pathogen implicated in otitis media?

A

S. pneumoniae (as secondary to URTI)

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11
Q

How should acute otitis media without perforation be managed?

A

Delayed/no script unless:

  • symptoms >4 days and not improving
  • systemically unwell but not requiring admission
  • Immunocompromised
  • <2y with BL OM
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12
Q

How should acute otitis media with perforation be managed?

A

Oral amoxicillin 5 days

Review in 6w

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13
Q

What condition is known as ‘glue ear’?

A

Otitis media with effusion

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14
Q

How should glue ear be managed?

A

If no comorbidities: active observation for 6-12w, if no improvement –> ENT referral
If co-existent cleft palate/ Down’s –> refer to ENT

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15
Q

How long do grommets last?

A

Up to 12 months

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16
Q

What are the signs and symptoms of cholesteatoma?

A

Headache, pain
Foul smelling discharge from ear
Hearing loss

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17
Q

How should cholesteatoma be managed?

A

Refer for surgery

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18
Q

Recall 4 drugs that can cause tinnitus

A

Aspirin
Aminoglycosides
Loop diuretics
Ethanol

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19
Q

What is the most concerning cause of unilateral tinnitus?

A

Acoustic neuroma

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20
Q

Recall 3 vestibular causes of vertigo

A

Meniere’s
BPPV
Labyrinthitis

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21
Q

Recall 5 central causes of vertigo

A 
Vestibular schwannoma
MS
Stroke
Head injury 
Inner ear syphillis
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22
Q

What is Meniere’s?

A

Dilatation of endolymph spaces of membranous labyrinth

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23
Q

What are the symptoms of Meniere’s?

A 
Clustered attacks lasting <12 hours
Aural fullness
Progressive SNHL 
Vertigo + N&V + nystagmus 
Tinnitus
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24
Q

How is Meniere’s managed?

A

Medically:
Betahistine for vertigo
Cyclizine for emesis

Surgically:
Gentamicin installation via grommets

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25
Q

What are the symptoms of viral labyrinthitis/vestibular neuronitis?

A

Severe vertigo, nystagmus and vomiting following an URTI

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26
Q

How can you differentiate between vestibular neuronitis and viral labyrinthitis clinically?

A

Hearing may be affected in viral labyrinthitis but isn’t in vestibular neuronitis

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27
Q

How should viral labyrinthitis/ vestibular neuronitis be managed?

A

If severe: IV prochlorperazine

If less severe: PO cyclizine and prochlorperazine

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28
Q

What is BPPV?

A

Displacement of otoliths in semi-circular canals

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29
Q

What are the symptoms of BPPV?

A

Suden rotational vertigo for <30s provoked by head turning +/- nystagmus; chronic history

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30
Q

How can BPPV be investigated?

A

Dix-Hallpike manoevre –> up-beat torsional nystagmus

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31
Q

How can BPPV be managed?

A

Epley manoevre and betahistine

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32
Q

What is acoustic neuroma also known as?

A

Vestibular schwannoma

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33
Q

What are the symptoms of acoustic neuroma?

A

Slow-onset, unilateral SNHL, tinnitus +/- vertigo

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34
Q

How should possible acoustic neuroma be investigated?

A

Pure tone audiometry

MRI

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35
Q

What are the symptoms of otosclerosis?

A

Begins early adult life
BL conductive deafness and tinnitus
Hearing loss improves with noise but worsens with pregnancy, menstruation, menopause

36
Q

How should otosclerosis be managed?

A

Hearing aid, stapes implant

37
Q

What is the fancy name for age-related hearing loss?

A

Presbycusis

38
Q

How should sudden SNHL be managed?

A

Refer to ENT in <24 hours, high dose PO prednisolone

39
Q

How should allergic rhinosinusitis be managed?

A
  • Avoid causative allergen
  • For mild symptoms: PRN oral antihistamine (eg cetirizine) and PRN intranasal antihistamine (eg azelastine)
  • For severe symptoms:
    Intranasal CS (eg beclomethasone) and nasal irrigation
40
Q

What are the red flags in sinusitis that would prompt an urgent ENT referral?

A

Unilateral symptoms
Persistent >3m despite treatment
Epistaxis

41
Q

What are the indications for admission to hospital with sinusitis?

A 
Severe systemic infection 
Signs of dangerous complications of sinusitis eg: 
Periorbital/orbital cellulitis 
Meningitis 
Brain abscess
42
Q

How should sinusitis be managed?

A

If symptoms <10 days –> advice and safetynetting
If symptoms >10 days –> 14 day course of high-dose nasal corticosteroid
Can give back-up prescription of abx

43
Q

What are the symptoms of nasal polyps?

A 
Watery anterior rhinorrhoea 
Sinusitis 
Snoring 
Headaches 
Nasal obstruction
44
Q

What is Samter’s triad?

A

Triad of nasal polyps, asthma and aspirin hypersensitivity
Therefore if person has nasal polyps and asthma, advise to avoid NSAIDs and aspirin as could cause a life-threatening reaction

45
Q

What would make nasal polyps seem concerning?

A

If it is single and unilateral - as this may be a sign of a rare but sinister pathology

46
Q

How should nasal polyps be managed?

A
  • Routine referral to ENT for exam
  • Medical: 4-6w course of topical steroids
  • Surgically: can be removed endoscopically
47
Q

What is a septal haematoma?

A

Untreated nasal fracture –> septal necrosis and nasal collapse as cartillage blood supply comes from the mucosa –> boggy swelling with nasal obstruction

48
Q

How should all nosebleeds be initially managed?

A

Sit up
Lean forwards
Mouth open
Compress nasal cartilage for 15 mins

49
Q

What are the 2 most common causes of tonsilitis?

A

EBV

GAS

50
Q

Recall the score used to determine whether tonsilitis is likely bacterial/viral

A 
CENTOR (only used if <3 days of pharyngitis) 
Cough absent
Exudate 
Nodes (cervical anterior) 
Temp >38 at any point
51
Q

How high a centor score do you need to give abx and do a rapid strep test in tonsilitis?

A

3 or 4

52
Q

What are the symptoms of infectious mononucleosis?

A 
Sore throat 
Fever 
Malaise 
LNopathy 
pharyngitis 
petechiae on soft palate 
splenomegaly
53
Q

What antibiotic is used in bacterial tonsilitis?

A

Phenoxymethylpenicillin

54
Q

How does diptheria classically appear?

A

Pseudomembranous ‘web’ at back of throat

55
Q

When would you admit for tonsilitis?

A
  • Difficulty breathing
  • Clinical dehydration
  • Peri-tonsillar abscess (quinsy) or cellulitis
  • Marked systemic illness or sepsis
  • Suspected rare cause (e.g. Kawasaki disease, diphtheria)
56
Q

How frequent does tonsilitis have to be to indicate tonsillectomy?

A

7 bouts in 1 year
5 bouts/ year for 2 years
3 bouts/year for 3 years

57
Q

What are the signs that GAS infection has progressed to scarlet fever?

A

Rash (‘sandpaper’)

Strawberry tongue

58
Q

What is the risk of scarlet fever?

A

May progress to rheumatic fever with a week latency period

59
Q

How should scarlet fever be managed?

A

Notify PHE

Phenoxymethylpenicillin

60
Q

What is the main RF for tonsilar SCC?

A

HPV infection

61
Q

What are the symptoms of Bell’s palsy?

A

UL facial weakness
Otalgia
Ageusia (loss of taste)
Hyperacusis (due to stapedius palsy)

62
Q

What is Bell’s sign?

A

Failure of eye closure –> dryness and conjunctivitis

Seen in Bell’s palsy

63
Q

How should Bell’s palsy be investigated?

A

Mainly Clinical
electroneuronography
Serology for borrelia burgdorferi (Lyme)

64
Q

How should Bell’s palsy be managed?

A

Eye care

Prednisolone (50mg PO OD for 10 days)

65
Q

What is the aetiology of Ramsay Hunt syndrome?

A

Reactivation of the varicella zoster virus in the genticulate ganglion of CNVII

66
Q

What are the symptoms of Ramsay Hunt syndrome?

A

Otalgia
Facial nerve palsy
Vesicular rash around ear
Vertigo + tinnitus

67
Q

How should Ramsay Hunt syndrome be managed?

A

Valaciclovir PO
Steroids PO
If treated within 72 hours, 75% recover, otherwise only 1/3 fully recover

68
Q

If a small parotid lump enlargens very quickly, what is the likely cause?

A

Stone that has blocked parotid duct

69
Q

How long after a TM perforation should a referral to ENT be made if it hasn’t healed?

A

6-8w

70
Q

Recall some differentials for the cause of salivary gland swelling

A 
Infective (TB/mumps) 
Neoplastic 
Calculi blockage 
Autoimmune (Sjogren's/IgG4) 
Sarcoidosis
71
Q

How is a pharyngeal pouch managed?

A

Surgical repair with minimally-invasive stapling (Dohlman’s procedure)

72
Q

What are the symptoms of pharyngeal pouch?

A

Hallitosis

Food getting stuck

73
Q

What are the FeverPAIN criteria?

A

Fever (during previous 24 hours)

Purulence (pus on tonsils)

Attend within 3 days from sx onset

Inflamed tonsils (severe)

No cough or coryza

74
Q

Recall the 2 most common pathogens in otitis externa

A

Staph aureus

Pseudomonas

75
Q

Recall the management of otitis externa

A

Take a swab and send for microbiology
TOPICAL antibiotics (abx used to cover pseudomas = gentamicin…)
Microsuction to clear debris

76
Q

Name 3 complications of otitis media

A

Facial nerve palsy
Chronic perforation
Mastoiditis

77
Q

What is Ludwig’s angina?

A

Rapidly spreading infection of submandibular space
Classically “woody” to touch
Causes neck pain and drooling

78
Q

Recall 4 predisposing factors to otitis externa

A

Swimming
Ear buds
Eczema
Diabetes

79
Q

What type of mouth ulcer is typically described as centralised white ulcer and erythematous “halo”?

A

Apthous ulcers

80
Q

What is this a typical history for?

“an indurated ulcer involving the lateral tongue in a patient with a long-term smoking history”

A

Squamous cell carcinoma

81
Q

What is Heerfordt’s syndrome?

A

A rare manifestation of sarcoidosis characterized by the presence of facial nerve palsy, parotid gland enlargement, anterior uveitis, and low grade fever

Source: Capsule case 145

82
Q

What is the most common type of parotid malignancy in adults?

A

Mucoepidermoid tumours

83
Q

What is Warthin’s tumour?

A

Benign parotid tumour that typically appears in older male smokers

84
Q

In epistaxis, how long should a rapid rhino stay in place?

A

24 hours

85
Q

What is binocular vision post-facial trauma indicative of?

A

Depressed fracture of zygoma

86
Q

What intranasal treatments are used for the treatment vs prophylaxis of sinusitis?

A

Treatment: intranasal decongestant
Prophylaxis: intranasal corticosteroid

ICSM Year 6 Helen Lashwood (20 decks)

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