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Finals Revision > ENT > Flashcards

ENT Flashcards

1
Q

What is conductive hearing loss?

A

Sensory system is working fine but the sound is not reaching it - problem with the sound travelling

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2
Q

What is sensorineural hearing loss?

A

Problem with the sensory system or vestibulocochlear nerve

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3
Q

What are the three bones in the middle ear?

A

Malleus
Incus
Stapes

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4
Q

What is Weber’s test?

A

Tuning fork in the centre of patient’s forehead
Which ear is loudest
In sensorineural: sound louder in normal ear
In conductive: sound louder in affected ear

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5
Q

What is Rinne’s test?

A

Tuning fork to mastoid process
Move to in front of ear
Normal is for air conduction to be better than bone conduction
Abnormal is bone conduction is better
Abnormal suggests conductive hearing loss

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6
Q

What are causes of sensorineural hearing loss?

A

Sudden sensorineural hearing loss (over less than 72 hrs)
Presbycusis (age-related)
Noise exposure
Ménière’s disease
Labyrinthitis
Acoustic neuroma
Neurological conditions
Infections
Medications (loop diuretics, amino glycoside antibiotics, chemo - furosemide, gentamicin, cisplatin)

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7
Q

Causes of conductive hearing loss

A

Ear wax
Infection
Fluid in the middle ear
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours

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8
Q

Causes of conductive hearing loss

A

Ear wax
Infection
Fluid in the middle ear
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours

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9
Q

What is plotted on the x axis in an audiogram?

A

Frequency

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10
Q

What is plotted on the y axis in an audiogram?

A

decibels (but with loud at the bottom and quiet at the top)
So better hearing is higher up on the y axis

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11
Q

What do X ] O and [ stand for in audiometry?

A

X - left sided air conduction
] left sided bones conduction
O right sided air conduction
[ right sided bone conduction

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12
Q

What is the normal hearing range for audiometry?

A

Between 0 and 20 dB

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13
Q

What is the difference on audiometry between sensorineural and conductive hearing loss?

A

Sensorineural: both bone and air conduction will be lower
Conductive: only air conduction is lower than normal
Mixed: Both are lower than normal but air conduction is more lower than bone

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14
Q

What is presbycusis?

A

Age-related hearing loss
Sensorineural, high pitched sounds first

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15
Q

What is the pathophysiology of presbycusis?

A

Several different mechanisms
Loss of hair cells in the cochlea
Loss of neurones in the cochlea
Atrophy of the stria vascular
Reduced end-lymphatic potential

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16
Q

What is one way of managing idiopathic sudden sensorineural hearing loss?

A

Oral or intra-tympanic steroids

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17
Q

What can happen when there is Eustachian tube dysfunction?

A

Unequal air pressure
Middle ear can fill with fluid
Reduced or altered hearing
Popping noises or sensations
A fullness sensation in the ear
Pain or discomfort
Tinnitus

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18
Q

What is tympanometry?

A

Creating different air pressures in the canal and measuring sound absorbed and reflected
Sounds is absorbed best when the air pressure matches the ambient air pressure
In Eustachian tube dysfunction, a tympanogram will show peak admittance (absorption) with negative ear canal pressures

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19
Q

What are the treatment options for Eustachian tube dysfunction?

A

Valsalva manoeuvre
Decongestant nasal sprays
Antihistamines and steroid nasal spray
Surgery (adenoidectomy, grommets, balloon dilatation eustachian tuboplasty)

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20
Q

What is otosclerosis?

A

Remodelling of the small bones in the middle ear leading to conductive hearing loss

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21
Q

Is otosclerosis more common in men or women?

A

Women

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22
Q

What is the normal presentation for otosclerosis?

A

Unilateral or bilateral hearing loss or tinnitus
Affecting lower-pitched sounds more than higher pitched sounds
Sensorineural is intact so patients can experience their voice as being loud even if they are talking quietly

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23
Q

What is a stapedectomy in otosclerosis management?

A

Surgical removement of the stapes bone and replaces it with a prosthesis

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24
Q

What is the presentation of vestibular neuritis?

A

Acute onset of vertigo
Recent history of viral URTI
Often associated with nausea and vomiting and balance problems
Essential to differentiate between peripheral and central causes - any neurological symptoms, consider a posterior circulation infarction
Don’t get tinnitus or hearing loss - if present consider labyrinthitis or menieres disease

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25
Q

What is the head impulse test in vestibular neuronitis?

A

Patient sat upright and fixing gaze on examiners nose
Examiner rapidly jerks it 10-20 degrees left or right while the patient continues looking at the examiner’s nose. Repeat opposite direction.
Abnormal result: eyes will saccade (rapidly move back and forth).
Normal: no current symptoms or central cause

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26
Q

What is the management for vestibular neuronitis?

A

Prochlorperazine
Antihistamines (e.g. cyclising, cinnarizine, promethazine)

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27
Q

What is the presentation of labyrinthitis?

A

Acute onset vertigo
Hearing loss
Tinnitus
Recent viral URTI or meningitis

28
Q

What is the management for labyrinthitis?

A

Prochlorperazine
Antihistamines

29
Q

What are the triad of symptoms in Menieres disease?

A

Hearing loss
Vertigo
Tinnitus

30
Q

What is the pathophysiology of Ménière’s disease?

A

Excessive buildup of endolymph in the labyrinth of the inner ear (end-lymphatic hydrops)

31
Q

What is the classic presentation of Menieres disease?

A

Middle aged person
Unilateral episodes of vertigo, hearing loss and tinnitus
Hearing loss is sensorineural and affects low frequencies first
Nystagmus can be seen
Can cause drop attacks without loss of consciousness

32
Q

What is used in prophylaxis of menieres?

A

Betahistine

33
Q

Where does bleeding usually originate in nosebleeds?

A

Kiesselbach’s plexus, located in Little’s area (remember the area most affected by little fingers picking noses)

34
Q

What does bilateral nose bleeding indicate?

A

Bleeding posteriorly in the nose - higher risk of aspiration of blood

35
Q

What is the management for nosebleeds?

A

Sit up and tilt head forwards
Squeeze the soft part of the nostrils together for 10-15 mins
Spit out any blood in mouth, rather than swallowing.
If it does not stop after 10-15 mins or is bilateral = hospital admission

36
Q

What is the hospital treatment for nosebleeds?

A

Nasal packing with nasal tampons or inflatable packs
Nasal cautery using silver nitrate sticks

Naseptin after treatment to reduce inflammation (chlorhexidine and neomycin)

37
Q

What is naseptin contraindicated in?

A

Peanut and soya allergy

38
Q

Are nasal polyps usually bilateral or unilateral?

A

Bilateral
Unilateral is red flag for tumour

39
Q

What are nasal polyps associated with?

A

Chronic rhinitis or sinusitis
Asthma
Samter’s triad (nasal polyps, asthma, aspirin intolerance/allergy)
Cystic fibrosis
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

40
Q

How do people with nasal polyps present?

A

Chronic rhinosinusitis
Difficulty breathing through the nose
Snoring
Nasal discharge
Loss of sense of smell

41
Q

What do nasal polyps look like?

A

Pale grey/yellow growth on the mucosal wall

42
Q

What is the management for nasal polyps?

A

Intranasal topical steroid drops or spray
Intranasal polypectomy
Endoscopic nasal polypectomy

43
Q

What is quinsy?

A

Peritonisllar abscess
Untreated or partially treated tonsillitis
Presents similarly to tonsillitis

44
Q

What are the three additional symptoms that indicate peritonsillar abscess?

A

Trismus (unable to open mouth)
Change in voice (‘hot potato voice’)
Swelling and erythema

45
Q

What are the three organisms that can cause a peritonsillar abscess?

A

Strep progenies (group A strep)
Staph aureus
H. influenzae

46
Q

What type of cancer is most head and neck cancer?

A

Squamous cell carcinoma

47
Q

How are head and neck cancer’s usually found?

A

Abnormal lymphadenopathy

48
Q

What are risk factors for head and neck cancer?

A

Smoking
Chewing tobacco
Chewing betel quid (south-east Asia)
Alcohol
HPV
EBV

49
Q

What are the red flags for head and neck cancer?

A

Lump in mouth or lip
Unexplained ulceration in the mouth lasting more than 3 weeks
Erythroplakia or erythroleuoplakia
Persistent neck lump
Unexplained hoarseness of voice
Unexplained thyroid lump

50
Q

What monoclonal antibody is used in treated squamous cell carcinomas of the head and neck?

A

Cetuximab - targets epidermal growth factor receptor
Also used in bowel cancer

51
Q

What does glossitis look like?

A

Red, sore and swollen tongue with atrophy of the papillae making it look smooth

52
Q

What are the causes of glossitis?

A

Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure

53
Q

What are the top three causes of angioedema in the tongue?

A

Allergic reactions
ACEi
C1 esterase inhibitor deficiency (hereditary angioedema)

54
Q

What is a geographic tongue?

A

Patches of the tongue lose the epithelium and papillae making it look like a map.
Relapsing and remitting

55
Q

What can geographic tongue be associated with?

A

Stress and mental illness
Psoriasis
Atopy
Diabetes

56
Q

What are the two key causes of strawberry tongue?

A

Scarlet fever
Kawasaki disease

57
Q

What causes a black hairy tongue?

A

Decreased shedding of keratin from the tongue’s surface.
Papillae elongate and look like hairs, with bacteria and food causing the dark pigmentation
Sticky saliva and metallic taste

Causes: dehydration, dry mouth, poor oral hygiene, smoking

58
Q

What is leukoplakia?

A

White patches in the mouth, often on the tongue or inside of cheeks
Precancerous condition
Asymptomatic, irregular and slightly raised

59
Q

What is erythroplakia?

A

Red lesions in the mouth - associated with high risk of squamous cell carcinoma

60
Q

What is lichen planus?

A

Autoimmune condition that causes chronic inflammation of the skin
Shiny purplish, flat topped raised areas with white lines across the surface (Wickham’s striae)
Usually in women over 45

61
Q

What are the three patterns that lichen planus can take?

A

Reticular - web like
Erosive - bright red and sore
Plaques - larger continuous areas of white mucosa

62
Q

What is acute necrotising ulcerative gingivitis?

A

Painful rapid onset of gingivitis usually caused by anaerobic bacteria

63
Q

What are the risk factors for gingivitis?

A

Plaque build up
Smoing
Diabetes
Malnutrition
Stress

64
Q

Which is gingival hyperplasia?

A

Abnormal growth of the gums

65
Q

What can cause gingival hyperplasia?

A

Gingivitis
Pregnancy
Vit C def
AML
Medications, particularly calcium channel blockers, phenytoin and ciclosporin

66
Q

What can apthous ulcers be an indication of?

A

IBD
Coeliac
Behçet’s disease
Vitamin deficiency
HIV

Finals Revision (20 decks)

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