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Fourth Year > Surgical specialties - ENT > Flashcards

Surgical specialties - ENT Flashcards

1
Q

Usual infective agents associated with acute otitis externa?

A
  • Strep.
  • Staph.
  • Pseudomonas.
  • Fungi.
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2
Q

How may hearing loss occur with acute otitis externa?

A

Oedema of the external auditory meatus and accumulation of debris.

Relapse is also often due to residual debris in meatus.

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3
Q

Why should prolonged use of antibiotics/ steroids be avoided in otitis externa?

A

Promotes secondary fungal otitis e.g. Aspergillus.

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4
Q

How is itching controlled in acute otitis externa?

A

1% hydrocortisone cream applied with a cotton bud - AFTER infection has been treated.

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5
Q

What is furunculosis?

A

Infection of a hair follicle in outer ear canal.

AKA severe acute otitis externa.

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6
Q

Symptoms and signs of furunculosis?

A
  • Severe throbbing pain.
  • Pyrexia.
  • Seropurulent otorrhoea (rupture of abscess).
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7
Q

Describe the pathophysiology of malignant otitis externa?

A
  • Aggressive otitis externa.
  • Spreading osteomyelitis of temporal bone due to infection by Pseudomonas pyocyaneus.
  • Marked granulations of ear canal.
  • Infection spreads, involving middle ear and lower cranial nerves.
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8
Q

Who is typically affected by malignant otitis externa?

A

Immunocompromised e.g. elderly diabetics.

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9
Q

How is malignant otitis externa investigated?

A

CT and isotope scanning to determine extent of osteomyelitis.

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10
Q

How is malignant otitis externa treated?

A
  • Local aural toilet.
  • Insertion of wicks + anti-pseudomonal + high dose antibiotics.
  • Occasionally surgical debridement if progression despite conservative treatment.
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11
Q

What is myringitis bullosa?

A

Localised otitis externa - blisters form on eardrum and deep meatus.

(pts will complain of excruciating earache).
(treatment is symptomatic).

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12
Q

What is perichondritis?

A

Infected cartilage following severe otitis externa or trauma, causing a swollen, red and tender pinna.

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13
Q

Signs/ symptoms of perichondritis?

A
  • Swollen, red, tender pinna.
  • Oedema may spread to face.
  • Enlarged pre-tragal lymph nodes.
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14
Q

How is perichondritis managed?

A
  • Local astringents e.g. magnesium sulphate.

- Systemic antibiotics to prevent permanent cartilage damage and poor cosmesis.

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15
Q

Pathophysiology of acute otitis media.

A
  • Usually due to URTI ascending via eustachian tube.
  • Eardrum retracts as eustachian tube is blocked and fluid (inflammatory exudate) fills middle ear.
  • Pressure causes pain, eardrum congests and bulges.
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16
Q

Signs/ symptoms of acute otitis media?

A
  • Recent URTI.
  • Otalgia.
  • Congested, bulging eardrum.
  • Fever, tachycardia.
  • Eardrum rupture - bloodstained discharge and relief from pain.
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17
Q

When are antibiotics indicated in acute otitis media?

A

If spontaneous resolution/ improvement of symptoms does not occur with 48 hours.

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18
Q

Management of acute otitis media?

A
  • Analgesia.
  • Nasal decongestant.
  • Keep ear dry (swab, mop discharge).
  • If failure to resolve within 48 hours: broad-spec ABx to cover Haemophilus and Strep.
  • Recurrent - myringotomy, grommet insertion, adenoidectomy considered.
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19
Q

What is acute otitic barotrauma?

A

Occurs during descent in aircrafts.

Causes severe otalgia, sometimes rupture of eardrum with bloody otorrhoea.

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20
Q

What is Ramsay Hunt syndrome (Herpes zoster oticus)?

A

Facial nerve ganglion becomes infected with shingles.

- Severe pain, vesicles in ear canal and concha, +/- facial palsy.

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21
Q

How is Ramsay Hunt syndrome (Herpes zoster oticus) treated?

A
  • Anti-virals: aciclovir.

Early recognition and treatment may prevent permanent damage to facial nerve.

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22
Q

If examination of pinna, ear canal and eardrum is normal - otalgia will be a referred pain and may originate from which structures?

A
  • Oropharynx and tongue (CN IX, V).
  • Larynx and hypopharynx (CN X).
  • Cervical spine (C2,3).
  • Oesophagus (CNX).
  • Nose and sinuses (CN V).
  • Teeth, parotid, temporo-mandibular joint (CN V).
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23
Q

What skin conditions are associated with acute otitis externa with otorrhoea?

A
  • Psoriasis.
  • Eczema.
  • Seborrhoeic dermatitis.
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24
Q

How does chronic otitis externa differ from acute?

A
  • Chronic: usually bilateral, painless, relapsing. Skin of canal is permanently thickened and easily traumatized.
  • Acute: otalgia, otorrhoea, ass. with skin conditions e.g. eczema.
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25
Q

Why are antibiotic drops not advised in chronic otitis externa?

A
  • Only if there is acute inflammation.

- May precipitate an allergic reaction or predispose to fungal infection.

26
Q

Management of chronic otitis externa?

A
  • Remove any debris.
  • Keep dry.
  • Antibiotic drops only if acute inflammation present.
27
Q

What are the two forms of chronic otitis media?

A

Chronic suppurative otitis media:

  • Tubotympanic disease (mucosal disease).
  • Atticoantral disease (bone loss + serious complications).
28
Q

Signs/ symptoms of chronic otitis media?

A
  • Otorrhoea.
  • Hearing loss.
  • Defect of eardrum.
  • Rarely otalgia.
29
Q

What is chronic suppurative otitis media - tubotympanic disease?

A

Rupture of tympanic membrane in acute otitis media fails to heal > persistent perforation despite aural toilet and topical steroid ear-drops.

Inactive or active depending if discharging or not.

30
Q

Management of tubotympanic chronic suppurative otitis media?

A
  • ABx ear drops e.g. ofloxacin, ciprofloxacin (not currently licensed in UK).
  • Hearing aid.
  • Surgery if recurring discharge / swimmer/ impaired hearing.
31
Q

What is atticoantral chronic suppurative otitis media?

A

Chronic eustachian tube dysfunction > retractions and perforations of tympanic membrane in attic region or involving the annulus.

32
Q

Why is atticoantral chronic suppurative otitis media potentially life-threatening?

A

Associated with cholesteatoma - destructive and ass. with serious complications e.g. unrecognized bone destruction leading to intracranial complications.

33
Q

What are the eosinophilic associated causes of inflammatory rhinitis?

A
  • Allergic rhinitis.
  • NARES.
  • Nasal polyps.
  • Chronic eosinophilic sinus syndrome.
  • Aspirin sensitivity.
34
Q

What are the neutrophilic associated causes of inflammatory rhinitis?

A
  • Bacterial sinusitis.
  • Adenoiditis.
  • Cystic fibrosis.
35
Q

What may cause inflammatory rhinitis not associated with eosinophils or neutrophils?

A
  • Viral rhinitis.
  • Granulomatosis with Polyangiitis (Wegener’s).
  • Sarcoidosis.
  • Midline granuloma.
36
Q

What are the irritant forms of non-inflammatory rhinitis?

A
  • Vasomotor.
  • Irritant.
  • Cholinergic hypersecretory.
  • Gustatory.
37
Q

What are the non-irritant forms of non-inflammatory rhinitis?

A
  • Hypothyroid.
  • B-blocker.
  • Anti-hypertensives.
  • Pregnancy.
  • Atrophic rhinitis.
38
Q

Allergic, non-infective rhinitis can be divided into?

A
  • Intermittent rhinitis.

- Persistent rhinitis.

39
Q

Non-allergic, non-infective rhinitis can be divided into?

A
  • Idiopathic rhinitis (vasomotor).

- Polyps.

40
Q

How are asthma and rhinitis linked?

A
  • Segmental bronchial allergen provocation leads to inflammation in the nose in allergic rhinitis.
  • Nasal provocation leads to increased blood and bronchial.

> Generalised induction of inflammatory mediators.

41
Q

How is the development of nasal symptoms in allergic asthma and rhinitis prevented during the pollen season?

A
  • Inhaled corticosteroids (topical treatment of lungs).
42
Q

How do the Th1/2/3 pathways differ from normal in allergic rhinitis?

A
  • Exaggerated Th2 pathway i.e. Eosinophils and B cells (> IgE) - Type I.
  • Impaired Th3 pathway.
  • Impaired Th2 pathway i.e. macrophages - type IV.
43
Q

House dust mite faeces bind to mast cells in the nose, causing?

A

Mast cells produce:

  • Histamine.
  • Leukotrienes
44
Q

Name the 5 parts of the temporal bone.

A
  • Mastoid.
  • Styloid process.
  • Tympanic bone.
  • Squamous part.
  • Petrous part.
45
Q

Most common thyroid carcinoma?

A

Papillary thyroid carcinoma.

46
Q

Which thyroid carcinoma is associated with “Orphan-Annie” (ground-glass) nuclei with psammoma bodies?

A

Papillary thyroid carcinoma.

(psammoma bodies are calcified spherical bodies). Be aware that it can also appear as solid balls of neoplastic follicular cells with fibrous stroma.

47
Q

Describe “orphan-Annie” nuclei.

A

Hypochromatic empty nuclei devoid of nucleoli.

48
Q

Histopathologic appearance of follicular thyroid carcinoma?

A

Usually microfollicular pattern.

- Many uniform, colloid-filled follicles resembling a normal thyroid.

49
Q

Follicular thyroid carcinoma may have the same appearance as what other pathology on fine needle aspiration?

A

Follicular adenoma.

50
Q

Hashimoto’s thyroiditis is associated with increased risk of which thyroid malignancy?

A

Lymphoma of the thyroid.

51
Q

Medullary thyroid carcinomas are associated with which endocrine conditions?

A

MEN 2A and 2B.

52
Q

Medullary thyroid carcinomas arise from which cells?

A

Parafollicular C cells.

53
Q

Medullary thyroid carcinomas secrete what?

A

Calcitonin.

54
Q

Microscopic appearance of medullary thyroid carcinoma?

A

Polygonal to spindle-shaped cells.

- Associated with amyloid deposits derived from abnormal calcitonin molecules.

55
Q

Microscopic appearance of anaplastic thyroid carcinoma?

A

Large, pleomorphic giant cells.

56
Q

Which thyroid cancer has the best prognosis?

A

Papillary thyroid carcinoma.

57
Q

Which thyroid cancer has the worst prognosis?

A

Anaplastic thyroid cancer.

58
Q

What usually causes death in those with anaplastic thyroid carcinoma?

A

Aggressive local growth.

59
Q

Common autosomal dominant disorder of conductive hearing loss which characteristically worsens during pregnancy.

A

Otosclerosis.

60
Q

30 y/o F complains of worsening hearing loss in pregnancy. No FHx of hearing loss.

OE - tympanic membrane is intact. Pure tone audiometry shows conductive hearing loss with a Carhart notch.

What is the most likely pathology?

A

Otosclerosis.

  • Fixation of stapes bone.
61
Q

Why does otosclerosis occasionally skip generations?

A

Incomplete penetrance.

Fourth Year (28 decks)

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