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Y4: ENT > Vertigo > Flashcards

Vertigo Flashcards

1
Q

Acute sinusitis

1) what is it
2) commonest infectious agents
3) predisposing factors?

A

1) inflammation of the mucous membranes of the paranasal sinuses
2) Strep pneumonaie, Haemophilis influenza and rhinoviruses
3) nasal obstruction (polyps, septal deviation), recurrent local infection (rhinitis, dental extraction), swimming, smoking

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2
Q

T/F: the sinuses are usually sterile

A

T

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3
Q

features of acute sinusitis?

A

nasal d/c (thick and purulent)
facial pain: frontal, worse on bending forwards
nasal obstruction

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4
Q

Rx of acute sinusitis?

A

analgesia
intranasal corticosteroids if symptoms >10 days

antibiotics only if severe

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5
Q

T/F: antibiotics are routinely used in acute sinusitis

A

false - only for severe presentations

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6
Q

when might intranasal corticosteroids be used in acute sinusitis

A

if symptoms persist >10 days

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7
Q

T/F: vast majority of cases of acute tonsillitis are viral

A

false - over 50% bacterial

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8
Q

commonest organism in acute tonsillitis?

A

Strep pyogenes

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9
Q

CENTOR criteria?

What merits antibiotics?

A

Fever (>38)
Tender anterior cervical lymphadenopathy
Tonsillar exudate
Absence of a cough

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10
Q

complications of tonsillitis?

A

Peritonsillar abscess (Quinsy)
Otitis media
Rheumatic fever and glomerulonephritis (rare)

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11
Q

indications for tonsillectomy?

A 
Must meet ALL of the following: 
≥5 episodes/ year
Symptoms for at least 1 year
Interfering with normal functioning 
Sore throat is due to tonsillitis
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12
Q

complications post-tonsillectomy?

management?

A

primary haemorrhage (<24h): usually inadequate haemostasis&raquo_space; immediate return to theatre

secondary haemorrhage (1-10 days): usually due to infection&raquo_space; admission and antibiotics (surgery if severe)

ALL cases require ENT referral (even if resolved by time of presentation).

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13
Q

peritonsillar abscess (quinsy)

1) features
2) treatment?

A

1) tonsillar deviation away from affected side, voice changes, severe unilateral throat pain
2) IV Abx and drainage

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14
Q

peritonsillar abscess (quinsy)

1) features
2) treatment?

A

1) uvular deviation away from affected side, severe throat pain lateralising to one side, trismus, reduced neck mobility
2) urgent ENT review, IV Abx + drainage (tonsillectomy considered after 6 weeks)

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15
Q

T/F: most cases of acute otitis media are viral in origin

A

false- although typically preceded by viral URTI, mainly caused by bacteria esp S. pneumoniae, H. influenza and Moraxella catarrhalis

(viral URTIs are thought to disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube)

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16
Q

acute otitis media

1) features
2) otoscopy findings
3) if using pneumatic otoscopy

A

1) otalgia (may pull at ear), fever in 50%, hear loss, recent viral URTI, ear d/c if perforates
2) bulging TM > loss of light reflex, opacification or erythema of TM, purulent otorrhoea (perforation)
3) reduced mobility

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17
Q

Treatment of acute otitis media?

A

Analgesia, most self resolve. Seek help if not resolved after 3 days.

Antibiotics if

  • <2 and b/l
  • perforated/ dc in canal
  • systemically unwell
  • immunocompromised/ high risk of complications
  • > 4 days symptoms
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18
Q

1st line antibiotic in acute otitis media?

if pen allergic?

A

amoxicillin (5-7 days)

erythromycin/ clarithromycin if pen allergic

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19
Q

define chronic suppurative otitis media? (CSOM)

A

ear pain with otorrhoea for >12 weeks

20
Q

define chronic suppurative otitis media? (CSOM)

A

ear pain with otorrhoea for >6 weeks

21
Q

common sequelae of acute otitis media?

A

perforation > CSOM
learing loss
labyrinthitis

22
Q

causes of otitis externa?

A

infection: bacteria (S aureus, Pseudomonas) or fungal
Seborrhoeic dermatitis
Contact dermatitis

23
Q

features of otitis externa?
otoscopy findings?
particularly common in which athletes?

A

ear pain, itch, discharge

otoscopy: red, swollen, or eczematous canal

swimming - ‘swimmers ear’

24
Q

1st line Rx of otitis externa?

A

topical antibiotic/ combined topical antibiotic + steroid

ear wick sometimes used if canal extensively swollen

25
Q

what is malignant otitis externa? who gets it?

A

severe otitis externa

immunocomprised individiuals e.g. DM

26
Q

what is malignant otitis externa? who gets it?

A

extension of infection into the bony ear canal and soft tissues deep to bony canal

immunocomprised e.g. elderly diabetics

27
Q

commonest pathogen causing malignant otitis externa

A

pseudomonas aeruginosa

28
Q

features of malignant otitis externa?

A

Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

29
Q

treatment of malignant otitis externa?

A

ENT referral

IV Abx to cover pseudomonas (e.g. ciprofloxacin)

30
Q

treatment of malignant otitis externa?

A

urgent ENT referral

IV Abx to cover pseudomonas (e.g. ciprofloxacin)

31
Q

what is chronic rhinosinusitis

A

inflammation of mucosa of paranasal sinuses lasting >12 weeks

32
Q

what is chronic rhinosinusitis

A

inflammation of mucosa of paranasal sinuses and lining of nasal passages lasting >12 weeks

33
Q

predisposing factors to chronic rhinosinusitis?

A

atopy: hay fever, asthma
nasal obstruction e.g. Septal deviation or nasal polyps
recent local infection e.g. Rhinitis or dental extraction
swimming/diving
smoking

34
Q

features of chronic rhinosinusitis?

A

facial pain: frontal, worse on leaning forward
nasal d/c: usually clear if allergic or vasomotor. Purulent suggests secondary infection.
Nasal obstruction (mouth breathing)
postnasal drip (may cause chronic cause)

35
Q

Rx of chronic rhinosinusitis?

A

allergic avoidance
intranasal corticosteroids
nasal irrigation with saline solution

36
Q

red flag symptoms in chronic rhinosinusitis?

A

unilateral symptoms
symptoms persisting despite 3 months of treatment
epistaxis

37
Q

features of allergic rhinitis?

A 
sneezing
bilateral nasal obstruction
clear nasal discharge
post-nasal drip
nasal pruritus
38
Q

Rx of allergic rhinitis

1) general
2) mild-mod
3) mod-severe
4) what is sometimes needed to cover important life events

A

1) allergen avoidance
2) oral/ intranasal antihistamines
3) intranasal corticosteroids
4) oral corticosteroids

39
Q

what is rhinitis medicamentosa?

A

rebound hypertrophy of nasal mucosa following withdrawal from long term topical nasal decongestants e.g. oxymetazoline

40
Q

T/F: topical nasal decongestants should not be used for prolonged periods in allergic rhinitis

A

true - can lead to tachyphylaxis and also rhinitis medicamentosa

41
Q

presentation of mastoiditis?

A 
otalgia: severe, behind ear
Hx of recurrent otitis media
fever
pt very unwell
swelling, erythema and tenderness over mastoid process
external ear may protrude forwards
ear d/c may if perforation
42
Q

Black hairy tongue

1) what ees it
2) predisposing factors?
3) the tongue should be swabbed to exclude ____
4) treatment?

A

1) defective desquamation of filliform papillae
2) HIV, poor dental hygiene, recent antibiotics, immunocompromised
3) candida
4) tongue scraping,

43
Q

Black hairy tongue

1) what ees it
2) predisposing factors?
3) the tongue should be swabbed to exclude ____
4) treatment?

A

1) defective desquamation of filiform papillae
2) HIV, poor dental hygiene, antibiotics, head and neck radiation, IVDU
3) candida
4) tongue scraping, topical antifungal if candida

44
Q

features of Ramsay Hunt syndrome?

A

otalgia

vesicular rash in ear canal/ anterior 2/3 of tongue

45
Q

features of Ramsay Hunt syndrome?

A

auricular pain often first
facial nerve palsy
vesicular rash around the ear (or anterior 2/3 of tongue)
vertigo and tinnitus

46
Q

Rx of Ramsay Hunt syndrome?

A

oral aciclovir and corticosteroids

47
Q

1st line antibiotic in acute sinusitis? (used for severe cases)

A

Phenoxymethylpenicillin

Co-amoxiclav if systemically very unwell/ high-risk of complications

Y4: ENT (7 decks)

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