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4th year everything > ENT > Flashcards

ENT Flashcards

1
Q

Name the auditory ossicles

A

Stapes
Incus
Malleus

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2
Q

What is otitis externa?

A

Acute inflammation of the skin of the auditory meatus

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3
Q

What are the characteristic features of otitis externa?

A

Discharge, itch, pain (otalgia) and tragal tenderness

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4
Q

What organism is the most common cause of otitis externa?

A

Pseudomonas

Occasionally staph. aureus

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5
Q

Describe the different clinical entities of otitis externa; mild, moderate and severe

A

Mild - scaly erythematous skin, no narrowing of the external auditory canal

Moderate - painful ear, narrowing of external auditory canal, cream-white discharge

Severe - occluded external auditory canal

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6
Q

What is auditory furunculosis?

A

A very painful staphylococcal abscess arising from a hair follicle within the canal often with concurrent pinna cellulitis

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7
Q

What is malignant/necrotising otitis externa?

A

An aggressive, life-threatening infection of the external ear that can lead to temporal bone mass loss and base of skull osteomyelitis

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8
Q

What organism is the most common cause of malignant/ necrotising otitis externa?

A

Pseudomonas

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9
Q

What is auditory barotrauma?

A

Damage to the ear when the Eustachian tube is closed - due to pressure

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10
Q

What is temporomandibular joint dysfunction?

A

Dysfunction of the temporomandibular leading to facial, ear and mandibular pain

Stress-induced teeth grinding is thought to be the major aetiological factor

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11
Q

What is acute otitis media?

A

Inflammation of the midlle ear

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12
Q

How does otitis media present?

A

Rapid onset of otalgia, fever, irritability, nausea and vomiting and anorexia

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13
Q

What organisms are commonly responsible for otitis media?

A

Pseudomonas, haemophilus and moraxella

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14
Q

What complications may arise following an acute bout of otitis media?

A

Effusion

Chronic otitis media

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15
Q

What is cholesteatoma?

A

An abnormal, noncancerous skin growth that can develop in the middle section of your ear, behind the eardrum. It may be a birth defect, but it’s most commonly caused by repeated middle ear infections

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16
Q

What are the classical symptoms indicative of cholesteatoma?

A 
Foul discharge
Deafness
Headache
Pain
Facial paralysis and vertigo (may indicate CNS infiltration)
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17
Q

How is cholesteatoma treated?

A

Mastoid surgery may be needed to remove disease and make the skull safe from potential secondary complications (hearing preservation is a secondary consideration)

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18
Q

What complications can arise from cholesteatoma?

A

Meningitis, cerebral abscess, facial nerve dysfunction

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19
Q

What is mastoiditis?

A

Middle ear inflammation leading to air cell destruction in the mastoid bone with/without abscess formation

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20
Q

What are the signs of mastoiditis?

A

Fever, mastoid tenderness, protruding auricle and erythema

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21
Q

For patients with chronic suppurative otitis media, there are a few surgical options, describe both myringoplasty and mastoidectomy.

A

Myringoplasty - repair of the tympanic membrane alone

Mastoidectomy (for patients with mastoiditis/cholesteatoma) - mastoid surgery and tympanoplasty (surgical repair of tympanic membrane and ossicles)

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22
Q

What are the most common risk factors for otitis media?

A

URTI
Bottle-feeding
Passive smoking
Dummy/pacifier use

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23
Q

Explain conductive hearing loss

A

Impaired sound transmission via the external canal and middle ear ossicles to the foot of the stapes through a variety of causes

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24
Q

List some causes of conductive hearing loss:

A

External canal obstruction
Drum perforation
Ossicular chain dysfunction
Eustacian tube dysfunction

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25
Q

Explain sensorineural hearing loss

A

Resulting from defects central to the oval window inthe cochlear (sensory) and chochlear nerve (neural)

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26
Q

List some causes of sensorineural hearing loss:

A
  • Ototoxic drugs (e.g. streptomycin , gentamicin, vancomycine etc.)
  • Post-infective (meningitis, measles, flu etc.)
  • Cochlear vascular disease
  • Multiple scleroisis
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27
Q

What is the range of frequency for normal human hearing?

A

Between 20-20,000 Hz

Sound frequencies between 250-8000 Hz are most important for speech interpretation

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28
Q

What is presbyacusis?

A

Age-related bilateral high-frequency sensorineural hearing loss

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29
Q

What is tinnitus?

A

Perception of sound in the absence of auditory stimuli

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30
Q

What are the two types of tinnitus?

A

Objective (audible to the examiner) - due to AV malformations, high-output cardiac conditions etc.

Subjective (audible only to the patient) - due to conditions causing sensoroneural hearing loss i.e. Menieres disease

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31
Q

What is an acoustic neuroma?

A

Indolent and typically benign subarachnoid tumour that causes problems due to direct pressure

Arising most commonly from the superior vestibular nerve schwann cell layer

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32
Q

What symptoms may arise from an acoustic neuroma?

A

Progressive ipselateral tinnitus +/- sensorineural deafness

Nearby cranial nerves at risk of compression are V, VI, VII with dysfunction resulting in either facial numbness, ocular/facial paralysis respectively

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33
Q

What is vertigo?

A

Vertigo is a symptom - the sensation of the world moving around you/spinning

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34
Q

What is benign paroxysmal positional vertigo?

A

Commonest cause of peripheral vertigo. Episodes of sudden vertigo lasting >30s provoked by head-turning

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35
Q

What is the pathophysiology of benign paroxysmal positional vertigo?

A

Displacement of the otoliths stimulating the semi-circular canals

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36
Q

How is benign paroxysmal positional vertigo diagnosed and treated?

A

Diagnosis by the Dix-Hallpike manoeuvre

Treatment by vestibular habituation exercises and rarely vestibular nerve resection

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37
Q

What is Meniere’s disease?

A

Dilatation of the endolymphatic spaces of the membraneous labyrinth causes sudden attacks of vertigo lasting around 2-4hrs

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38
Q

How is Meniere’s disease treated?

A

Acute management : Prochlorperazine
Prophylaxis: Betahistine

If severe and intractable - labyrinthectomy (causes total ipselateral deafness)

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39
Q

What is acute vestibular failure/vestibular neuronitis?

A

Sudden attacks of unilateral vertigo and vomiting in a previously well person.

Often following an URTI

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40
Q

How is acute vestibular failure/vestibular neuronitis treated?

A

Vestibular suppressants - cyclizine and/or prochlorperazine

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41
Q

What symptoms should be screened for in a history regarding the nose?

A 
Nasal obstruction
Nasal discharge
Epistaxis
Facial pain 
Nasal deformity
AnosmiaSneezing
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42
Q

What aspects of past medical history are of importance when discussing the nose?

A 
Medical treatment 
Nasal surgery
Nasal trauma 
Asthma
Aspirin sensitivity
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43
Q

What occupation history may be of particular importance for rhinology?

A

Woodworkers

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44
Q

What social history may be of particular impotence for rhinology?

A

Cocaine use (degenerates nasal septum)

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45
Q

What instruments are used in a nasal examination?

A

Otoscope and endoscope for posterior cavity

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46
Q

What investigations can be carried out when a nasal pathology is suspected?

A

Bloods (FBC, ANCA in small blood vessel damage, ESR, ACE, RAST)
CT (gold standard)
Skin tests
Nasal smear
Rhinomanometry (not often used - assesses smell) Flexible/rigid nasendoscopy

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47
Q

List some common nasal disorders; Include traumatic, vascular, infectious, malignant and congenital

A 
Nasal trauma
Epistaxis (nose bleeds)
Rhinosinusitis (very common)
Nasal polyps/tumour 
Choanal atresia - nasal cavity not open in posterior aspect - leads to breathing issues
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48
Q

What is the treatment for nasal trauma?

A

Rhinoplasty

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49
Q

What is septal haematoma? How can it occur?

A

Swelling/bruising of the nasal septum. Can occur due to trauma of anterior nasal septum

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50
Q

What is the potential complication for septal haematoma?

A

If left untreated can become septic (therefore requires draining) Can lead to chronic nasal congestion Can cut off blood supply to cartilage -> necrosis -> saddle-nose deformity

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51
Q

What are the aetiologies of nasal polyps?

A 
Idiopathic
Chronic inflammation
Autonomic dysfunction
Genetic predisposition 
Allergic vs non-allergic
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52
Q

Nasal polyps are associated with which allergic conditions?

A

> 20-50% have asthma
8-26% have aspirin intolerance
50% have alcohol intolerance

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53
Q

What conditions may cause secondary polyposis to occur in the nose?

A 
Cystic fibrosis (6-48% have polyps)
Allergic fungal sinusitis (85% have polyps)
Churg-Strauss syndrome (autoimmune vasculitis)
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54
Q

What components are there to a nasal smear test; what can these reveal?

A

Microbiology - indicates infection
Eosinophils - indicates allergic component
Neutrophils - indicates chronic sinusitis

55
Q

What is the treatment of polyps?

A

Oral and nasal steroids - high dose prednisolone

Surgical - polypectomy or microdebrider

56
Q

What are the classifications and characteristics of adult sinusitis?

A

Acute - fast onset, duration of symptoms <12 weeks, completely resolves

Recurrent acute - 1-4 episodes of rhinosinusitis per year, complete recovery between episodes

57
Q

What is the difference between sinusitis and rhinosinusitis?

A

Sinusitis is the inflammation of the paranasal air sinuses

Rhinosinusitis is the inflammation of the nasal cavity and paranasal air sinuses

58
Q

What are the classifications and characteristics of adult rhinosinusitis?

A

Chronic - duration >12 weeks, persistent inflammation on imaging after a month of appropriate treatment

Acute exacerbation of chronic - worsening of existing symptoms/appearance of new symptoms

59
Q

What are the two most common microbes responsible for acute rhinosinusitis?

A

Strep. pneumoniae (31%)

H. influenzae (21%)

60
Q

New guidelines for the diagnosis of rhinosinusitis are based on:

A

Nasal blockage/discharge plus the addition of reduced sense of smell/headache

61
Q

What anitmicrobial therapy is available for the treatment of rhinosinusitis?

A

Beta-lactams - penicillins, cephalosporins

Macrolides - erythromycin, clarithromycin

62
Q

What class of antibiotics shows greater penetration into the sinuses?

A

Macrolides

63
Q

What treatment options are there for sinusitis?

A

Nasal decongestants, antibiotics (co-amoxiclav, clarithromycin), steroid nasal spray, steam inhalations

64
Q

What is Potts Puffy Tumour?

A

A life threatening complication of infectious sinusitis which develops into osteomyelitis of the frontal bone with associated subperiosteal abscess causing swelling and oedema over the forehead and scalp.

65
Q

What is the treatment protocol for PPT?

A

Emergancy referral for frontal sinus surgery

66
Q

Sinusitis can lead to the development of mucous filled cysts in the ethmoid air sinus, what is this called? What complications can arise?

A

Ethmoidal mucocele; presses on orbit causing double vision

67
Q

What is the treatment for ethmoidal mucoceles?

A

Endoscopic Sinus Surgery (ESS)

68
Q

What is the commonest cause of epistaxis?

A

Idiopathic

69
Q

What are other common causes of epistaxis?

A

Infectious, traumatic, allergic, hypertension, hereditary haemorrhagic telangiectasia, tumour

70
Q

Outline the management of epistaxis

A

ABCsCompression of nose - soft tissue for 20-30mins + can use ice packs for vasoconstriction

Vitals management - cannula + fluids

Bloods: Group + save, clotting

Physical exam of Little’s area (anterior rhinoscopy or posterior endoscopy)

Cauterisation - silver nitrate

Nasal Packs

Surgery

71
Q

What are nasal packs?

A

Either anterior or posterior

Used when bleeding has not stopped despite first aid/therapy to stop bleeding

Nose balloon inflated to physically stop bleeding

72
Q

What is the surgical intervention for epistaxis?

A

Ligation of artery to stop bleeding

Usually sphenopalatine artery (main blood supply of the nose)

73
Q

What is hereditary haemorrhagic telangiectasia?

A

Autosomal dominant disorder causing abnormal blood vessel development around the face (including the nose)

74
Q

What is the treatment for HHT?

A

Not standard epistaxis treatment; laser treatment and skin grafts are indicated

75
Q

What causes are there of nasal obstruction?

A 
Foreign body
Septal deviation
Septal haematoma
Tumour
Choanal atresia
Nasal congestion - infection
76
Q

What three things must you distinguish when presented with a child who has hearing loss?

A

Congenital vs acquired
Unilateral vs bilateral
Conductive vs sensorineural

77
Q

List the subjective assessments of hearing loss

A

6-18 months old: distraction test
12 months - 3 years old: visual reinforced audiometry
3-5 years old: play audiometry
5 years+ : pure tone audiometry

78
Q

List the objective assessment of the auditory system

A 
Otoacoustic emissions (all newborns have this screening hearing test) 
Auditory brainstem response 
Tympanometry (middle ear pressure)
79
Q

What is the most common cause of hearing loss in children?

A

Otitis media with effusion

80
Q

What are the risk factors for OM with effusion?

A

Infections at day care, smoking, cleft palate, Downs syndrome

81
Q

What is the treatment for OM with effusion?

A

Most resolve spontaneously

Hearing aids/grommets and adenoidectomy

82
Q

What are the signs and symptoms of OM with effusion?

A

Symptoms - hearing loss, speech delay, behavioural problems, academic decline, imbalance

Signs - dull tympanic membrane, fluid bubbles

83
Q

What is the cause of OM with effusion?

A

Eustachian tube failure
Muscular immaturity
Adenoidal hypertrophy
Resolving acute OM

84
Q

What is otitis externa?

A

Discharging ear caused by inflammation around the external auditory canal

85
Q

What is the treatment for otitis externa?

A

Aural micro-suction (drain and clean)

Topical antibiotics Water precautions (keep it dry)

86
Q

What are the principle microbes responsible for causing acute OM?

A

H. influenzae, strep pneumoniae, moraxella catarrhalis

87
Q

How is acute OM treated?

A

Co-amoxiclav

Grommets/ Adenoidectomy if recurrent

88
Q

What are the symptoms of acute OM?

A

Pain, fever, discharge

89
Q

What are the complications of acute OM?

A

Mastoiditis leading to brain abscess

90
Q

What is chronic OM and how is it treated?

A

Recurrent/persistent infection of middle ear caused, most commonly, by cholesteatoma.

Treated with mastoidectomy (open antrum and clean out)

91
Q

What are the clinical features of chronic OM?

A

Chronic discharge and hearing loss despite grommets in place

92
Q

What is the normal development time to aeration of the sinuses in children?

A

Ethmoids/maxillary: 0-4 months
Sphenoid: 3-7 years
Frontal: 8 years to adolescence

93
Q

When should you be suspicious of a foreign body in the nose?

A

Unilateral discharge

94
Q

What is choanal atresia?

A

Congenital bilateral blockage of the nasal passage

95
Q

What is the treatment for non-acute tonsillitis?

A

Viral - symptomatic treatment Bacterial - 24hrs IV antibiotics if persistent

96
Q

What is the treatment for acute tonsillitis?

A

Difficulty to breath requires steroids and IV antibiotics

97
Q

What complications can occur from tonsillitis?

A

Peritonsilar abscess (quincy)

98
Q

What is laryngomalacia?

A

Congenital condition caused by collapsing of soft immature cartilage of epiglottis so when they breathe it obstructs the airway

99
Q

What is the treatment for larygnomalacia?

A

Normally maintain saturation and eat well so just let them grow out of it (2/3 years)

100
Q

What is a branchial cyst?

A

A cyst formed from epithelial tissue of the lateral neck

101
Q

What is cystic hygroma?

A

Blockage of lymphatic drainage in the left posterior triangle of the neck; leading to cyst formation

102
Q

What is infective pharyngitis?

A

Pharyngeal inflammation, with sore throat

103
Q

What causes pharyngitis?

A

Usually viral cause: influenza, parainfluenza, rhinovirus

Bacterial: strep. pneumococcus

104
Q

What are the symptoms of tonsillitis?

A

Sore throat, difficulty swallowing, pyrexia, malaise, lymphadenopathy, exudative inflammation, tonsil enlargement

105
Q

What organisms cause tonsillitis?

A

Beta haemolytic streptococcus, pneumococcus, haemophilus influenza

106
Q

What is the management of tonsillitis?

A

Rest, analgesia, fluids, antibiotics (penicillin/ erythromycin)

Tonsillectomy if recurrent acute/ chronic tonsillitis

107
Q

What is quinsy?

A

Peritonsillar abscess

Due to the spread of infection from tonsils to lateral tissues

108
Q

What are the features of quinsy?

A

Drooling, trismus (pain opening mouth), patient appears more unwell

O/E: lateral swelling, displacement of uvula away from midline

109
Q

Treatment for quinsy?

A

Aspiration/ incision of abscessAntibioticsTonsillectomy if 2+ episodes

110
Q

What are the indications for tonsillectomy?

A 
Recurrent quinsy (2+ episodes)
Recurrent tonsillitis (5+ episodes in 1 year)
Malignancy
Obstructive sleep apnoea
111
Q

What conditions can an enlarged adenoid cause in children?

A 
Nasal obstruction
Glue ear (compromises Eustachian tube function)
Sleep apnoea
112
Q

What is obstructive sleep apnoea?

A

Upper airway collapse, snoring and episodes of breathing cessation

113
Q

What are the risk factors for sleep apnoea?

A

Obesity, large neck, alcohol, smoking, adenoid hypertrophy

114
Q

How do you investigate sleep apnoea?

A

Sleep study (polysomnography): monitors blood oxygen saturations, rest rate, heart rate

Epworth questionnaire

Nasendoscopy

115
Q

What are the symptoms of sleep apnoea?

A

Chronic snoring, daytime sleepiness, lethargy, poor concentration, poor memory, loss of libido

116
Q

Management of sleep apnoea?

A
  1. Lifestyle measures: Weight loss, reduce alcohol, withdraw any sedatives
  2. CPAP
  3. Nasal splint, mandibular advancement device
  4. Surgery (adenectomy in children)

Plus Treat any other nasal conditions reducing airflow

117
Q

What are the complications of sleep apnoea?

A

Pulmonary HTN, RV strain, heart failure, falling asleep whilst driving, road traffic accidents, negative effect on schooling in children

118
Q

What is stridor?

A

High pitched Noisy breathing on INSPIRATION due to disrupted airway flow

119
Q

What causes of stridor?

A

Due to instruction in larynx or trachea, due to:

Foreign body
Epiglottitis
Croup
Vocal cord palsy
Trauma
120
Q

What is the definition of allergy?

A

Hypersensitive disorder of the immune system

121
Q

How do hypersensitive allergic reactions occur?

A

Reaction occur to normally harmless substances known as allergens; these reactions are acquired

122
Q 
Give an example of an allergic:
Skin reaction
URT reaction 
LRT reaction
Systematic reaction
A

Skin - Urticaria/angioedema
Upper respiratory: Rhinitis
Lower respiratory - asthma
Systematic - anaphylaxis

123
Q

What is the pathophysiology of type 1 (hypersensitivity reactions)?

A

Sensitisation - Plasma cells produce IgE (binds to mast cells)
Re-exposure - mast cells degranulate releasing histamine, leukotrienes, prostaglandins and chemotactic factors

124
Q

What is the physiological effect of mast cell degranulation?

A

Causes vasodilation, increased vascular permeability, leukocyte infiltration (especially eosinophils)

125
Q

What is allergic rhinitis?

A

Allergic inflammation of the nasal airways

126
Q

What are the risk factors for allergic rhinitis?

A

Atopy, FHx, environmental factors

127
Q

What are the immediate and latent effects of allergic rhinitis?

A

Immediate - sneezing, itching, nasal blockage, rhinorrhoea

Latent - chronic obstruction, hyposmia, hyperactivity

128
Q

What are the two classifications of duration of allergic rhinitis?

A

Intermittent (symptoms lasting <4 days/week or < 4 consecutive weeks)

Persistent (>4 days/week and >4 consecutive weeks)

129
Q

What are the classifications of severity of allergic rhinitis?

A

Mild - symptoms present but not troublesome

Moderate-severe - sleep disturbance, impairment of activities, issues at school/work, troublesome symptoms

130
Q

What principle investigations are appropriate for allergic rhinitis?

A

Skin test - tests response to known allergens

RAST - tests presence of specific allergen IgE ni serum

131
Q

What other investigations are indicated for allergic rhinitis?

A

Total serum IgE
Nasal Allergen challenge
Nasal cytology

132
Q

What is the treatment of allergic rhinitis?

5

A 
Education about allergen avoidance
Topical intranasal steroids/ oral steroids
Antihistamines 
Sodium cromoglycate (anti-allergen)
Allergen immunotherapy Anti-IgE
133
Q

What are the symptoms of rhinitis?

A

Nasal congestion, rhinorrhoea, postnasal drip, sneezing, nasal irritation

4th year everything (43 decks)

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