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Y6 Senior Surgery > ENT > Flashcards

ENT Flashcards

1
Q

sx of acute diffuse otitis externs

A 
fever 
lymphadenopathy 
diffuse swelling 
variable pain, pruritus 
pain on moving ear and jaw 
impaired hearing
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2
Q

how do you manage acute otitis externaal

A

topical antibiotics SOFRADEX + topical steroid

Oral Fluclox or Gent if severe

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3
Q

why are children more likely to have otitis media

A

short horizontal and poorly functioning eustachian tubes

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4
Q

who is otitis media most common in

A

youong children,
male
cleft palate
downs

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5
Q

how does otitis media present

A

pain in the ear and fever

may have reduction in hearing

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6
Q

hat causes otitis media

A

a VIRAL infection whhich swells the eustachian tube

this blocks the middle ear fluid drainage

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7
Q

how do you manage otitis media

A

Oral amox 5 days if:

  • more than 4 days of sx
  • less than 2 yo and bilateral
  • 1 perforation / discharge in canal

otherwise consider delayed / no prescription

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8
Q

what is a choleasteatoma

A

abnormal skin growth / cyst of epithelium in the middle ear

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9
Q

what causes choleasteatoma

A

congenital

due to perforation in chronic suppurative OM

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10
Q

sx choleasteatoma

A

EAR DISCHARGE (foul smelling white discharge)

OR

conductive hearing loss

may also have headache, pain, verttigo, facial paralysis

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11
Q

Who should you suspect choleasteatoma in

A

anyone with unexplained unilateral ear discharge not repsonsive to abx

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12
Q

how do you ix cholesteatoma

A

Otoscopy

or CT

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13
Q

how do you manage choleasteatoma

A

refer to ENT for surgery

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14
Q

what is tintinnus

A

sensation of sound WITHOUT external sound

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15
Q

causes of tintinnus

A

Vestibular system:

  • menieres
  • otosclerosis

Brain:

  • acoustic neuromoaa
  • head injury

General:

  • noise induced
  • presbycusis

drugs

  • aspirin
  • aminoglycosides
  • loop diuretics
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16
Q

differentials for vertigvo

A

vestibular:
- menieres
- BPPV
- labirinthitis

Central:

  • acoustic neuroma
  • MS
  • stroke
  • head injury
  • inner ear syphilis

Drugs:

  • gentamicin
  • loop diuretics
  • metronidazole
  • co-trimoxazole
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17
Q

what does Romberg +ve indicate?

A

vestibular or proprioceptive disorder

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18
Q

what is menieres diseasee

A

dilatation of endolymph spaces due to increaaed lymph fluid

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19
Q

how does menieres prsent

A 
CLUSTERED ATTACKS 
last <12h 
aurala fullness / pressure 
vertigo, NV, nystagmus 
tintinnus
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20
Q

what ix for meenieres

A

audiometry,

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21
Q

mx menieres

A

cyclizine (to treat emesis)
betahistine (to treat vertfgo)

surgical : use grommets to give gentamicin; saccus decompression

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22
Q

vestibular neuronitis history

A

following a febrl history (URTI)
sudden vertigo and vomiting
exacerbated by eye movements
NO HEARING LOSS

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23
Q

what s the difference between vestibular neuronitis and labirinthitis

A

vestibular neuronitis : NO HEARING LOSS

labirinthitis: hearing loss

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24
Q

how do you manage vestibular neuronitis and labiritinthis

A

prochlorperazine

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25
Q

which maneuvre confirms BPPV?

A

Dix-Hallpike

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26
Q

which maneuvre treats BPPV

A

Epley maneuvre

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27
Q

causes of hearing loss in adults

A

Conductive (between auricle and round window)

  • external ear obstruction (wax)
  • TM perforation (trauma, infection)
  • Ossicle defect (otosclerosis)

sensorineural (defect in cochlea, cochlear nerve or brain)

  • Drugs (aminoglycosides, vancomycin)
  • Infective (meningitis, measles, mumps, herpes)
  • menieres, trauma, MS; CPA lesion, low B12
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28
Q

what is an acoustic neuroma

A

benign slow growing tumour of superior vestibular nerve

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29
Q

what condition is acoustic neuroma associated with

A

NF2

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30
Q

sx acoustic neuroma

A 
slow onset unilateral SNHL
tintinnus 
vertigo 
headache 
CN palsy (5,7,8)
cerebellar signs
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31
Q

ix acoustic neutroma

A

MRI

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32
Q

otosclerosis aetiology

A

AUTOSOMAL DOMINANT

fixation of tapes at the oval window

33
Q

S/S otosclerosis

A 
begins in early adult lifwe 
bilateral conductive deafness 
tintinnus 
hearing loss improves with noise 
hearing loss worsens with pregnancy menstruation menopause
34
Q

mx otosclerosis

A

hearing ads

stapes implant

35
Q

mx allergic rhinosinusitis

A

mild sx: oral antihistamine (cetirizine) or intranasal antihistamine (azelastine) PRN

moderate-severe: Intranasal coorticosteroid

36
Q

what is sinusitis

A

infection of the maxillary sinuses from viral URTI > may lead to secondary bacterial infection

may occur with pain, swelling and tenderness on front of face

37
Q

how do you manage sinusitis

A

if sx <10 days, no antibiotics
sx > 10 days give high dose nasal corticossteroid for 14 days
abx if sx dont get better after 7 days

38
Q

how do you manage nasal polyp

A 
routiine referral to ENT 
medical therapy (topical betamethasone drops 4-6 weeks, followed by short course of oral steroids)
39
Q

common pathogens causing otitis externa

A

Staph aureus

Pseudomonas aeroginosa

40
Q

RF otitis externa

A

swimming in dirrty water
diabetes
old age
wax buildup

41
Q

what is necrotising otitis externa

A

progression of otitis externa through ear canal > bon > across skull base

ESSENTIALLY CAUSES OSTEOMYELITIS into mastoid and temporal bones

42
Q

sx necrotising otitiis external

A

severe pain in ear
exhudate
granulation tissue in ear
may cause CN palsy

43
Q

how do you manage necrotising otitis externa

A

urgent ENT referral
ADMIT
CT head, IV ABx

44
Q

what does TM look like in otitis media

A

red and bulging TM
loss of normal light reflex
perforation and pus

45
Q

what is another name for glue ear?

A

Otitis media with effusion

46
Q

SSx glue ear

A 
reduced hearing (conductive) 
NO other problems
47
Q

how do you ix glue ear, and what are findings

A

otoscopy (eardrum dull and retracted, fluid level visible()

audiometry (hearing test)

48
Q

how do you manage glue ear

A

observe for 3 months

if persistent, refer to ENT

49
Q

what is a dangerous complication of otitis media in children?

A

MASTOIDITIS

50
Q

Explain mastoiditis pèresentation

A

inflamed mastoids> mastoid pain
discharge
swelling behinid ear, ear pushed forward

51
Q

How do you manage mastoiditis

A

ADMIT
IV Abx
CT scan
may require incision and drainage

52
Q

causes of epistaxis

A

LOCAL

  • trauma (nose picking)
  • URTI, allergy
  • nasal polup

SYSTEMIC:

  • GPA (wegener’s)
  • coagulopathy
  • hereditary haemorrhagic telangectasi
53
Q

acute mx of epistaxis

A

sit up, lean forward, mouth open
Pinch soft area of nose (compress nasal cartilage)
Place ice on nose

54
Q

mx if epistaxis takes longer than 15 minutes to respove

A
  1. remove clots, gauze, rhinoscopy
  2. visualise bleeding> CAUTERISE
  3. bleeing cannot be visualised > PACKING (anterior / posterior with foley)
  4. refer to ENT
55
Q

2 key causes of tonsillitis

A
  • group A beta haemolytic strep

- EBV (MONO)

56
Q

what must you never give in suspected MONO

A

never give AMOXICILLIN

as it causes a widespread maculopapular rash

57
Q

what score can you usee for tonsillitis, and what does it detect

A

CENTOR score

Each point scores 1:

  • Tonsillar exhudate
  • Tender anterior cervical lymphadenopathy
  • Fever >38
  • no cough

if score 3/4, there is up to 50% chance that it is due to bacteria > prescribe antibiotics + rapid strep test

58
Q

sx tonsillitis

A

sore throat
fever
dysphagia, odynophagia
hoarness, rhinitis, fatigue, lethargy

59
Q

what shows on ENT exam for tonsillitia

A

enlarged tonsils, white exhudates, cervical lymphadenopathy

60
Q

when do you admit patient with tonsillitis

A
  • pain not tolerated withh analgesia
  • complete dysphagia
  • difficulty breating
  • clinically dehydrated
  • QUINSY
61
Q

what is QUINSY

A

PERI-TONSILLAR ABSCESS

62
Q

how does quinsy present

A

unilateral tonsil swelling with deviated ubvula

needs drainage + admission + IV Abx

63
Q

Mx of tonsillitis

A

Phenoxymethylpen 10 days (if indicated)

Clarythromycin if allergy

64
Q

what is a complication of GAS tonsillitis (i.e. what can onsillitis progress to in children)

A

Group A strep can progress to SCARLET FEVER

65
Q

how does Scarlet fever present

A

Sandpaper erythematous rash on neck and chest > sppreads to trunk and legs
Strawberry tongue

may later progress to rheumatic feber

66
Q

mx of scarlet fever

A

phenooxymethylpenicillin

67
Q

epiglottitis rf

A

UNVACCINATE child (as caused by H influenza)

68
Q

presentation of epiglottitis

A 
sitting forward
drooling 
sore throat 
dysphagia 
STRIDOR
69
Q

what is ludwigs angina

A

infction of submandibular space

70
Q

how does ludwig angina present

A

neck swelling - WOODY AND HARD TO TOUCH
dysphagia
fever
drooling

71
Q

what s age related heariing loss also called

A

presbycusis

72
Q

describe presbycusis presentation

A

over 65 yo
bilateral
slow onset
may have tinnitusss

73
Q

mx presbycusis

A

hearinig aiid

74
Q

what does a unilateral polyp require

A

URGENT ENT REFERRAL

as it is a red flag sx

75
Q

what must yoou do if TM rupture does not repair in 6-8 weeks

A

refer to ENT for MYRINGOPLASTY (repair of perforation)

76
Q

describe the hearing loss type in presbycusis

A

BILAT HIGH FREQUENCY HEARING LOSS

77
Q

where does most nosebleeding come from

A

the ANTERIOR nasal septum

78
Q

how do you manage quincy

A

Admit
IV antibioticss + drainage
consider tonsillectomy in 6 weeks

Y6 Senior Surgery (10 decks)

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