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Ned's clinical summaries > ENT > Flashcards

ENT Flashcards

1
Q

tx of mild OE

A

clean ear canal

analgesic - paracetamol or ibuprofen

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2
Q

tx of moderate OE

A 
topical antibiotic (Gentamicin drops)
\+/- 
topical steroid (hydrocortisone)

clotrimazole if fungal

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3
Q

causatives of OE

A
  1. Pseudomonas

2. S.Aureus

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4
Q

causatives of malignant otitis and tx

A

P. Aeuruginosa

surgical debridement and systemic antibiotics

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5
Q

what do 90% of malignant otitis patients have

A

diabetes

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6
Q

most common causatives of AOM

A
  1. haemophilus influenza
  2. Strep. Pyogenes
  3. strep pneumoniae
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7
Q

if antibiotics required for AOM, what are you giving

A

amoxicillin

erythromycin if allergic

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8
Q

do most AOM need antibiotics?

A

nah - 60% resolve in 24 hours

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9
Q

when does otitis media with effusion occur

A

an effusion is present after regression of symptoms of acute OM

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10
Q

tx of cholesteatoma

A

mastoid surgery

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11
Q

how is OME discovered

A

hearing impairment noticed by parents is the presentation in 80%

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12
Q

tx for OME

A

usually resolves spontaneously
active observation for 3 months

consider insertion of grommet if the OME is still present after 3 months or is worsening

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13
Q

what accelerates otosclerosis

A

pregnancy

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14
Q

which condition is often better when there is background noise

A

otosclerosis

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15
Q

which condition shows a carhart notch and what is ti

A

otosclerosis

its a dip on audiometry at 2kHz

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16
Q

which condition is made worse when there is background noise

A

presbycusis

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17
Q

what is the most used treatment for sudden SN deafness

A

high dose prednisolone for 4 days, tapered over 8 days

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18
Q

what is tinnitus

A

the perception of sound in the absence of auditory stimulation

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19
Q

what do 2/3 of patients with tinnitus have

A

SN hearing loss

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20
Q

what does ringing, hissing or buzzing tinnitus tell y about the location

A

suggests an inner ear issue

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21
Q

how do you investigate tinnitus

A

audiometry

MRI to exclude acoustic neuroma

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22
Q

tx tinnitus

A

hearing aid

Psychological support

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23
Q

what are acoustic neuromas described as on histology

A

benign subarachnoid tumours

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24
Q

where do acoustic neuromas normal arise from

A

superior vestibular nerve Schwann cells

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25
Q

what nerves are at risk in an acoustic neuroma

A

CN 5,6,7

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26
Q

what does trigeminal nerve compression due to AN case

A

a numb face

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27
Q

what type of hearing loss does AN cause

A

SNHL

the AN acts as a SOL and compresses the cochlear nerve

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28
Q

what test do u request for all patients with unilateral deafness or tinnitus

A

MRI!

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29
Q

where is the notch on audiometry in noise induced HL

A

notch at 3,4 or 6kHz with a recovery at 8kHz

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30
Q

tx for NIHL

A

reduce risk of occupational exposure and give them ear defenders

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31
Q

how long does BPPV last

A

seconds to minutes

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32
Q

how long does meniere’s last

A

30 mins to 30 hrs

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33
Q

how long vestibular neuritis and labrynthitis last

A

30hr to a week

34
Q

diagnostic test for BPPV

A

dix-hallpike

35
Q

tx for BPPV

A

elpley manœuvre

vestibular suppressant medication does not work

36
Q

what is the pathology in menieres

A

dilation of the endolymphatic spaces of the membranous labyrinth

37
Q

which condition is nystagmus always present

A

meneires disease

38
Q

what is nystagmus

A

when your eyes pure flick about when you don’t mean it

either up and down or side to side

39
Q

which condition has ‘fullness’

A

meneieres

40
Q

Ix for menieres

A

MRI of posterior fossa

41
Q

acute tx for meneires

A

acute = prochloroperazine as a vestibular sedative

42
Q

prophylactic tx for meneires

A

betahistine

can also put gentamicin in ear as it is ototoxic - kill the inner ear to stop the symptoms

43
Q

what does vestibular neuritis usually follow

A

usually follows on from a viral infection

44
Q

what effect does damage to the parathyroid gland in parathyroid surgery cause

A

causes hypocalcemia

causes muscle cramps and a prolonged QT interval on ECG

45
Q

tx for vestibular neuritis/labrynthitis

A

vestibular suppressants - cyclizine

46
Q

can acoustic neuritis cause absence of corneal reflex

A

yes

47
Q

what should you consider if rhinosinusitis persists >5days

A

intranasal corticosteroid (mometasone)

48
Q

how do you investigate possible chronic rhinosinusitis with polyps

A

anterior rhinoscopy or nasal endoscopy

49
Q

how do you treat polyps causing rhinosinusutis

A

topical steroid - betamethasone - it shrinks the polyp

consider adding doxycycline

50
Q

what are paranasal sinuses lined by

A

ciliated mucosa

51
Q

what are the most common causatives of sinusitis

A

S. Pneumoniae
H. Influenza
S. Pyogenes
S.Aureus

52
Q

what Ix should you do in recurrent sinusitis

A

CT

53
Q

if bacterial sinusitis is suspected, what antibiotics do you give

A

phenoxymethylpenicillin

doxycycline if allergic

54
Q

which sinuses drain into middle meatus

A

maxillary
anterior ethmoidal
middle ethmoidal
frontal

55
Q

which sinuses drain into superior meatus

A

posterior ethmoidal

56
Q

which sinus drains into the spine-ethmoidal recess

A

sphenoid

57
Q

where does the naso-lacrimal duct drain to

A

inferior meatus

58
Q

how long to u have to wait before u can do MUA on a broken nose

A

10-14 days

59
Q

what does CSF rhinorrhoea test +ive for

A

glucose and B2 transferrin

60
Q

is viral the most common cause of sore throat

A

yeh

rhinovirus, parainfluenza, influenza A and B

61
Q

in infants and young children, what are the most common causes of sore throat

A
  1. RSV

2. HPIV 3

62
Q

which HPIV most commonly causes croup

A

HPIV 1

63
Q

what is the most common causative of bacterial sore throat

A

strep pyogenes

64
Q

if the sore throat persists >10 days, what should you give

A

phenoxymethylpenicillin

clarithromycin or erythromycin if penicillin allergic

65
Q

do you give amoxicillin in patients with suspected EBV sore throat

A

NO!! amoxicillin in EBV patients causes a widespread rash!

66
Q

what does 3/4 points on CENTOR suggest

A

bacterial sore throat due to strep pyogenes - give phenoxymethylpenicillin

67
Q

exotoxins from what cause scarlet fever

what does it look like

A

strep pyogenes

rash on chest and behind the ears, after a sore throat

tx = penicillin V

68
Q

what investigations are done for dysphagia

A

FBC, ESR, CXR

barium swallow, endoscopy with biopsy, oesophageal motility studies

69
Q

what type of cancer are 90% of head and neck cancers

A

SCC

70
Q

what Ix do you use to detect SOL

A

MRI

71
Q

what test shows vascularity in lumps of neck

A

US

72
Q

what midlineneck lump is most likely in <20y/o

A

dermoid cyst

73
Q

what are branchial cysts lined by and what do they contain

A

lined by squamous epithelium and contain cholesterol crystals

74
Q

which posterior neck lump illuminates brightly

A

cystic hygromas

75
Q

which salivary gland is most affected by sialolithiasis and why

A

submandibular - its secretions are richer in calcium and are thicker

76
Q

which AI condition causes diffuse enlargement of the parotid

A

sjogren’s syndrome

77
Q

where do 80% of all salivary gland tumours occur

A

the parotid gland

78
Q

what type of tumour are 80% of the parotid tumours

A

benign pleomorphic adenomas

79
Q

what percentage of submandibular tumours are malignant

A

50%

80
Q

how are pleomorphic adenomas diagnosed

A

FNA

Ned's clinical summaries (3 decks)

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