ENT Flashcards

1
Q

Benign paroxysmal positional vertigo

A

o crystals of calcium carbonate called otoconia that become displaced into the semicircular canals
o symptoms triggered by movement and last around a minute
o Dix-hallpike manoeuvre to diagnose, Epley manoeuvre to treat

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2
Q

Meniere’s disease

A

o excessive buildup of endolymph in the semicircular canals, causing a higher pressure than normal, disrupting the sensory signals.
o It causes attacks of hearing loss, tinnitus, vertigo and a sensation of fullness in the ear – last several hours, middle ages adults, not associated with movement, nystagmus, hearing deteriorates over time
o Treat with beta histamines

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3
Q

vestibular neuronitis

A

o Inflammation of vestibular nerve, usually linked with viral infection, acute vertigo that improves over a few weeks

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4
Q

labyrinthitis

A

o Inflammation of the inner ear, linked with viral infection, improves within few weeks, can cause hearing loss

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5
Q

central causes of vertigo

A
  • Posterior circulation infarction (stroke)- sudden onset and may be associated with other symptoms, such as ataxia, diplopia, cranial nerve defects or limb symptoms.
  • Tumour – gradual onset with associated symptoms
  • Multiple sclerosis – relapsing and remitting symptoms
  • Vestibular migraine - symptoms lasting minutes/hours with trigger, manage similar to migraine
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6
Q

what is an acoustic neuroma

A
  • benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear nerve) that innervates the inner ear
  • also called vestibular schwannomas
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7
Q

presentation of acoustic neuroma

A
  • 40-60 y/o with gradual onset of:
    o Unilateral sensorineural hearing loss (often the first symptom)
    o Unilateral tinnitus
    o Dizziness or imbalance
    o A sensation of fullness in the ear
    o Can be associated with facial nerve palsy (forehead not spared = LMN)
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8
Q

what condition is bilateral acoustic neuroma linked to

A

neurofibromatosis type 2

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9
Q

where is the most common site for epistaxis

A

Kiesselbach’s plexus, which is located in Little’s area- area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels

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10
Q

what can be prescribed after epistaxis to improve healing

A
  • Naseptin cream (chlorhexidine and neomycin) - contraindicated in peanut and soy allergy
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11
Q

otitis externa

A
  • Inflammation of the skin of external ear canal
  • Acute <3w, chronic >3w
  • Swimmers ear
  • Can be caused by bacterial infection, fungal, eczema, dermatitis
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12
Q

bacterial causes of otitis externa

A

pseudomonas aeruginosa (gram negative aerobic rod-shaped bacteria), staph.aureus

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13
Q

mild/moderate/severe management of otitis externa

A
  • mild - acetic acid 2% (can be used prophylactically)
  • moderate - otomize spray (neomycin, dex, acetic acid)
  • severe - oral flucloxacillin
  • if fungal then clotrimazole drops
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14
Q

malignant otitis externa

A
  • potentially life threatening
  • spreads to bone - osteomyelitis of temporal bone
  • at risk if immunocompromised
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15
Q

otitis media

A
  • Infection of middle ear – between tympanic membrane and inner ear
  • Bacteria enter through the eustachian tube
  • A viral upper resp infection often preceded bacterial infection of the middle ear
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16
Q

most common bacterial causes of otitis media

A

most common is strep.pneumoniae which causes sinusitis and tonsilitis
* H.influenza, M.catarrhalis, s.aureus

17
Q

management of otitis media

A
  • most resolve in 3 days with nothing
  • analgesia
  • amox if systemically unwell or immunocompromised
  • delayed prescription
18
Q

severe/rare complication of otitis media

A

mastoiditis

19
Q

rhinosinusitis

A
  • Inflammation of paranasal sinuses and nasal cavity
  • Acute <12w, chronic >12w
20
Q

paranasal sinuses

A
  • Frontal sinuses (above the eyebrows)
  • Maxillary sinuses (either side of the nose below the eyes)
  • Ethmoid sinuses (in the ethmoid bone in the middle of the nasal cavity)
  • Sphenoid sinuses (in the sphenoid bone at the back of the nasal cavity)
  • Drain into nasal cavity via ostia (holes)
21
Q

causes of rhinosinusitis

A

infection
allergies
obstruction to drainage by trauma/foreign body/polyp
smoking

22
Q

symptoms of sinusitis

A
  • Congestion, discharge, facial pain, pressure, swelling, anosmia
23
Q

management of sinusitis

A
  • No treatment if <10days (could use saline nasal washing) as most are viral and resolve within 2-3w
  • > 10 days could give high dose steroid nasal spray for 14 days with delayed abx (phenoxymethylpenicillin
24
Q

treatment of chronic sinusitis

A

saline nasal irrigation, steroid sprays, functional endoscopic sinus surgery

25
Q

most common bacterial cause of tonsilitis

A

group A strep (strep pyogenes) – treated effectively with pen V

26
Q

Waldeyer’s tonsillar ring

A
  • In pharynx there is a ring of lymphoid tissue
  • There are six areas of lymphoid tissue in Waldeyer’s ring, comprising of the adenoids, tubal tonsils, palatine tonsils and the lingual tonsil.
  • Palatine tonsils most affected
27
Q

FeverPAIN score

A
  • Fever during previous 24 hours
  • P – Purulence (pus on tonsils)
  • A – Attended within 3 days of the onset of symptoms
  • I – Inflamed tonsils (severely inflamed)
  • N – No cough or coryza
28
Q

management of tonsilitis

A
  • admission if immunocompromised, had airway difficulties or if peritonsillar abscess
  • FeverPAIN >3 consider abx or delayed prescription
  • pen V for 10 days or clarithromycin in penicillin allergy
29
Q

quinsy/peritonsillar abscess

A
  • Complication of tonsilitis
  • Trismus (unable to open mouth), hot potato voice, severe swelling and erythema
  • Treat with needle aspiration or surgical drainage, abx (often broad spec such as co-amox)
30
Q
A