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4MB Medicine (My version) > ENT > Flashcards

ENT Flashcards

1
Q

What is meant by conductive hearing loss?

A

Failure of sound to be conveyed from the external ear to the inner ear

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2
Q

List common aetiology for conductive hearing loss

A 
Wax
Foreign body
Otitis externa
Eardrum perforation
Ossicular damage (otosclerosis)
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3
Q

What is meant by sensorineural hearing loss?

A

Failure of sound to be transduced from inner ear

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4
Q

List common aetiology for sensorineural hearing loss

A

Congenital
Ageing (presbycusis)
Meniere’s disease
Vestibular schwannoma

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5
Q

A positive Rinne’s test is a normal finding. True/False?

A

True

Sound/vibration should be louder over the auditory canal compared to bone conduction

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6
Q

If sound localises to the affected ear in a Weber’s test, what type of hearing loss is this?

A

Conductive

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7
Q

If sound localises to the unaffected ear in a Weber’s test, what type of hearing loss is this?

A

Sensorineural

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8
Q

A patient with a +ve Rinne test in both ears and sound localising to the left ear on Weber’s test indicates what type of hearing loss?

A

Right sensorineural hearing loss

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9
Q

A patient with a +ve Rinne test in the right ear and sound localising to the left ear on Weber’s test indicates what type of hearing loss?

A

Left conductive hearing loss

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10
Q

Other than Rinne and Weber hearing tests, what other investigations could you do for hearing loss?

A

Pure tone audiometry
(child normal = 0-15dB, adult normal = 0-20dB)
Tympanogram measures middle ear pressure
(normal = bell-shaped curve)

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11
Q

What is otitis externa?

A

Inflammation of the skin of the ear canal/external ear

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12
Q

List aetiology/risk factors for otitis externa

A 
Moisture, humidity
Swimming
Trauma (scratching, cleaning)
Absence of wax
Narrow ear canal
Hearing aids
Pseudomonas, Staph aureus
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13
Q

List clinical features of otitis externa

A 
Severe pain, tender pinna and tragus
Auricular lymphadenopathy
Minimal discharge/debris
Swollen ear canal
Conductive hearing loss
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14
Q

Outline management of otitis externa

A

Aural toilet
Topical gentamicin + steroid drops
Strip of ribbon soaked in glycerine-ichthammol/aluminium acetate

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15
Q

What is barotrauma/aerotitis?

A

Occluded Eustachian tube does not allow middle ear pressure to equalise, particularly during aircraft descent or diving

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16
Q

List clinical features of aerotitis

A 
Severe pain as drum indraws
Bleeding
Vertigo
Tinnitus
Deafness
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17
Q

Outline management of aerotitis

A

Avoid flying with URTI
Nasal decongestants (xylometazoline)
Repeated yawns/swallows/jaw movements
Valsalva maneuvre

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18
Q

List clinical features of TMJ dysfunction

A

Earache
Facial pain
Joint clicking/popping
Stress, psychological impact

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19
Q

Outline management of TMJ dysfunction

A 
NSAID (diclofenac)
Orthodontic prostheses
Cognitive behavioural therapy
Physiotherapy
Acupuncture
Surgery
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20
Q

What is otitis media?

A

Inflammation of the middle ear cavity

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21
Q

List aetiology/risk factors for otitis media

A 
Children
Viral
Bacterial: H. influenzae, Pneumococcus, Moraxella
Blocking of Eustachian tube
Preceding URTI
Bottle feeding
Smoking/passive smoking
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22
Q

List clinical features of otitis media

A

Acute: rapid onset earache, fever, irritability, vomiting
Chronic: fluid discharge lasting several months
Purulent discharge
Crescendo-decrescendo otalgia
Tender mastoid
Conductive hearing loss

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23
Q

Describe the appearance of the tympanic membrane in otitis media

A

Bulging, opaque eardrum

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24
Q

Outline management of otitis media

A

NSAID

Amoxicillin for up to 10 days if unresolving

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25
Q

What is cholesteatoma?

A

Presence of keratinising stratified squamous epithelium in the middle ear

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26
Q

List aetiology/risk factors for cholesteatoma

A

Congenital
Eardrum perforation, retracted eardrum
Down’s syndrome
Turner’s syndrome

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27
Q

List clinical features of cholesteatoma

A 
Foul-smelling discharge
Deafness
Headache
Cheesy discharge
Itch
Tinnitus
Vertigo
Facial paralysis, meningitis (indicates cerebral infiltration)
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28
Q

Outline management of cholesteatoma

A

Surgical excision

Good ear hygiene

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29
Q

What is otitis media with effusion/glue ear?

A

Fluid in the middle ear cavity due to Eustachian tube dysfunction or maldevelopment

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30
Q

List aetiology/risk factors for glue ear

A 
URTI
Oversized adenoids
Narrow nasopharynx
Boys
Atopy
Down's syndrome
Cleft palate
Passive smoking
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31
Q

List clinical features of glue ear

A 
Conductive hearing loss
Impact on learning and development
Exudate
Tinnitus
Irritability
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32
Q

What would the eardrum look like in glue ear?

A

May be retracted or bulging
Bubbles/fluid level seen
Reduced drum mobility

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33
Q

Outline management of glue ear

A

Monitor for up to 3 months
Oral/topical steroid
Grommet insertion +/- adenoidectomy

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34
Q

What is tinnitus?

A

Sensation of ringing/buzzing in the ear due to altered central processing and/or nerve damage

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35
Q

List aetiology/risk factors for tinnitus

A 
Any ear disease
Presbycusis
Noise-induced
Trauma
Otosclerosis
Meniere's disease
CVS disease
Psych disturbance
Alcoholism
Drugs (aspirin, loop diuretics, metformin, quinine)
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36
Q

If someone presents with unilateral tinnitus, what scan must you do?

A

MRI to exclude schwannoma

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37
Q

Outline management of tinnitus

A 
Mainly supportive
Hearing aids
Cognitive behavioural therapy
Tinnitus training/counselling
Hypnotics, melatonin
Baclofen
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38
Q

List aetiology/risk factors for vertigo

A 
Meniere's disease
BPPV
Vestibular failure/insufficiency/neuritis
Labyrinthitis
Acoustic neuroma
Multiple sclerosis
Head injury
Trauma
Drugs (gentamicin, diuretics, co-trimoxazole, metronidazole)
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39
Q

What is benign paroxysmal positional vertigo (BPPV)?

A

Displacement of otoconia in (posterior) semicircular canal causes transient dizziness

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40
Q

List aetiology/risk factors for BPPV

A 
Idiopathic
Middle ear disease
Head injury
Otosclerosis
Viral disease
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41
Q

List clinical features of BPPV

A

Dizziness upon sudden rotational movement
Lasts up to 30 seconds
May feel nauseous
Nystagmus on Hallpike test

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42
Q

Outline management of BPPV

A

Epley manoeuvre
Self-limiting
Physiotherapy, Brandt-Dorff exercise
Reduce alcohol intake

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43
Q

What is Meniere’s disease?

A

Dilation of endolymphatic spaces of the membranous labyrinth causes attacks of dizziness

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44
Q

List clinical features of Meniere’s disease

A 
Unpredictable vertigo
Attacks in clusters
May last up to 12 hours
Nausea, vomiting
Feeling of fullness in the ear
Bilateral tinnitus
Sensorineural hearing loss
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45
Q

Outline management of Meniere’s disease

A 
Acute: cyclizine,
Betahistine, cinnarizine
Gentamicin grommet
Reduce salt and caffeine
Operative decompression, labyrinthectomy
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46
Q

Which type of infection in particular does vestibular neuritis usually follow from?

A

Herpes simplex type 1

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47
Q

List clinical features of vestibular neuritis

A

Sudden vertigo
Vomiting
May last days
Deafness if labyrinthitis

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48
Q

Outline management of vestibular neuritis

A

Cyclizine
Usually improves within days/weeks
Methylprednisolone may help

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49
Q

What is acoustic neuroma/vestibular schwannoma?

A

Slow-growing benign tumour of CN VIII vestibular branch, usually found at the cerebellopontine angle

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50
Q

List clinical features of acoustic neuroma

A

Progressive ipsilateral tinnitus
Sensorineural hearing loss
Facial numbness, pain

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51
Q

What condition should be suspected in a child presenting with bilateral sensorineural hearing loss?

A

Neurofibromatosis type 2

52
Q

List common aetiology/risk factors for chronic nasal obstruction in children

A 
Large adenoids
Rhinitis
Choanal atresia
Postnasal space tumour
Foreign body
53
Q

List common aetiology/risk factors for chronic nasal obstruction in adults

A 
Deflected nasal septum
Rhinitis
Polyps
Sinusitis
Granuloma (TB, vasculitis, syphilis)
Tricyclic use
54
Q

When should you refer someone urgently for suspected nasal obstruction?

A

Unilateral
Foul smelling/bloody discharge
Numbness
Tooth loss

55
Q

Outline management of non-allergic rhinitis

A

Ipratropium nasal spray
Cautery
Surgical reduction of inferior turbinates

56
Q

What is the pathophysiology of allergic rhinitis?

A

IgE mediated inflammation triggered by allergen in nasal mucosa, resulting in mast cell degranulation and release of histamine and inflammatory mediators

57
Q

List clinical features of allergic rhinitis

A 
Nasal irritation
Rhinhorrhoea
Sneezing
Itch
Soft-palate irritation
Swollen turbinates
Pale mucosa
Nasal polyps
58
Q

What investigations would you do for allergic rhinitis?

A

Skin tests

RAST test for specific IgE

59
Q

Outline management of allergic rhinitis

A

Antihistamines
Topical steroid (fluticasone propionate)
CysLT antagonist (montelukast)
Mast cell stabiliser (cromoglicate)

60
Q

The maxillary sinus drains into which nasal meatus?

A

Middle meatus

61
Q

The anterior ethmoidal sinus drains into which nasal meatus?

A

Middle meatus

62
Q

The middle ethmoidal sinus drains into which nasal meatus?

A

Middle meatus

63
Q

The posterior ethmoidal sinus drains into which nasal meatus?

A

Superior meatus

64
Q

The sphenoidal sinus drains where?

A

Sphenoethmoidal recess

65
Q

The frontal sinus drains into which nasal meatus?

A

Middle meatus

66
Q

List aetiology/risk factors for sinusitis

A 
Viral leading to bacterial infection
Pseudomonas, H. influenzae
Drainage problems
Dental root infection
Swimming in infected water
Anatomic susceptibility (septal deviation, prominent uncinate)
Polyps
Kartagener's syndrome
Immunodeficiency
67
Q

List clinical features of sinusitis

A 
Pain over sinuses, worse on bending
Tender face
Purulent rhinorrhoea
Nasal congestion
Fever
Anosmia
Sensation of a bad smell
68
Q

What investigation would you do for sinusitis?

A

Rigid endoscopy + CT

69
Q

Outline management of sinusitis

A

Acute: self-limiting, bed rest, nasal decongestant
Co-amoxiclav, topical steroid if beyond 5 days
Chronc: FESS drainage if failed medical management

70
Q

What are nasal polyps?

A

Sinus inflammation and oedema causes mucosal prolapse, consisting of ciliated columnar epithelium with a thickened basement membrane

71
Q

List aetiology/risk factors for nasal polyps

A 
Rhinitis
Chronic sinusitis
Cystic fibrosis
Aspirin therapy
Asthma
72
Q

List clinical features of nasal polyps

A 
Watery rhinorrhoea
Glistening swelling
Non-tender
Anosmia
Snoring
Gentle palpation shows insensitive and mobile mass
73
Q

Outline management of nasal polyps

A

Intranasal steroid
Short course oral prednisolone
Endoscopic polypectomy

74
Q

List clinical features of a fractured nose

A 
Epistaxis
Rhinorrhoea
Pain
Loss of consciousness
Diplopia if orbital floor involvement
"steps" felt on palpation
Exclude haematoma (boggy swelling)
75
Q

Outline management of fractured nose

A

Evacuate under GA and pack if haematoma
Co-amoxiclav
Fracture reduction and splintage within 2 weeks
Nose counselling

76
Q

How does CSF rhinorrhoea arise?

A

Fracture through the roof of the ethymoid labyrinth disrupts meninges, causing CSF leak

77
Q

What investigation would you do for CSF rhinorrhoea?

A

Nasal discharge tests
+ve for glucose
B-transferrin in CSF immunoelectrophoresis

78
Q

List aetiology/risk factors for epistaxis

A 
Trauma
Local infection
Blood dyscrasias (reduced haemostasis)
Haemophilia
Alcoholism
Septal perforation
Neoplasm
Cold weather
NSAIDs, anticoagulants
79
Q

Which area on the nose is a frequent site of haemorrhage?

A

Little’s area, formed by anastomosis of anterior ethmoidal, sphenopalatine and facial arteries

80
Q

Outline first aid measures for epistaxis

A 
Sit up
Keep head straight/tilted DOWN
Firm pressure on cartilaginous septum for 15 mins
ABCDE approach
Suction may be required
81
Q

Outline definitive management for epistaxis

A

Remove clot with suction/blow nose
Ice pack
Gauze soaked in xylometazoline and lidocaine
Silver nitrate cautery for obvious anterior bleed
Nasal tampons/rhino packs if persistent

82
Q

List post-epistaxis advice for patients

A 
Don't pick nose
Sit upright, keep out of sun
Avoid bending/lifting/straining
Sneeze through mouth
No hot food or drink
No alcohol or tobacco
83
Q

List aetiology/risk factors for tonsillitis

A

Viral (EBV, influenza, rhinovirus, adenovirus)

Bacterial (Group A Strep, Staph, Moraxella, Chlamydia, Mycoplasma)

84
Q

List clinical features of tonsillitis

A 
Sore throat
Lymphadenopathy
Malaise
Systemic upset
Odynophagia
85
Q

What is the Centor criteria for tonsillitis/bacterial sore throat?

A 
Cough absent (1)
Exudate (1)
Nodes enlarged (1)
Temperature (1)
OR (young (1) OR old (-1))
-1 to 1: no antibiotic or culture
2-3: culture and treat if +ve
4+: rapid test and treat
86
Q

Outline management of tonsillitis

A

Bed rest
Analgesia (paracetamol)
Difflam gargle
Fluids
Penicillin/clarithromycin (NOT amoxicillin)
Tonsillectomy if recurrent over years + well-documented, usually if 5+ episodes a year or disabling or chronic over 3 months

87
Q

What is quinsy?

A

Potentially life-threatening complication of tonsillitis where infection moves outside the tonsillar capsule

88
Q

List clinical features of quinsy

A 
Odynophagia
Unilateral throat pain
Trismus
Reduced concavity of palate
Displacement of uvula to contralateral side
Hot potato voide
Unable to swallow saliva
89
Q

Outline management of quinsy

A

Incise and aspirate under LA
Penicillin
Tonsillectomy

90
Q

Which virus is the typical cause of glandular fever/infectious mononucleosis?

A

EBV

91
Q

List clinical features of glandular fever

A 
Tonsillitis
Feel washed out
Malaise
Tonsillar enlargement
Membranous exudate, "cheese on toast" appearance
Lymphadenopathy
92
Q

What investigations would you do for glandular fever?

A

+ve Monospot test
+ve Paul-Bunnell test (Heterophile) antibody
EBV IgM
CRP less than 100

93
Q

Outline management of glandular fever

A

Supportive care and symptom relief (pain relief)
Penicillin may be used
Systemic steroid if severe

94
Q

What organism causes diphtheria?

A

Coynebacterium diphtheria

95
Q

List clinical features of diphtheria

A 
Tonsillitis
Pharyngitis
Grey-white pseudomembrane over the fauces
Swollen bull neck
Polyneuritis and shock may occur later
Nasal discharge
Excoriated upper lip
Tachycardia (may indicate myocarditis)
96
Q

What investigations would you do for diphtheria

A

Swab culture of pseudomembrane

PCR

97
Q

Outline management of diphtheria

A

Antitoxin within 48h
Benzylpenicillin/erythromycin
Supportive treatment

98
Q

What is stridor?

A

Noisy inspiration due to partial obstruction at larynx or distal large airways

99
Q

List aetiology/risk factors for stridor

A 
Congenital (laryngomalacia, laryngeal web/stenosis)
Tumours
Trauma
Intubation
Foreign body
Cord paralysis
Infection
100
Q

Which organisms are the main cause of croup?

A

Mainly viral (parainfluenca)
Klebsiella
Diphtheria

101
Q

List clinical features of croup

A 
Stridor
Barking cough
Pulsus paradoxus
Cyanosis
Reduced cognition
102
Q

Outline management of croup

A

Self-limiting
Humidification, steam +/- antibiotics
Admit if severe in children (antibiotics, humidified O2, nebulised adrenaline, dexamethasone)

103
Q

Which organisms are the main causes of acute epiglottitis?

A

H. influenzae

Strep pyogenes

104
Q

List clinical features of acute epiglottitis

A 
Sore throat
Fever
Dyspnoea
Neck tenderness
Hoarseness
Drooling
Head tilted forward, tongue out
May develop respiratory arrest
105
Q

Outline management of acute epiglottitis

A 
Manage in ITU, blood culture
Ibuprofen
Oxygen, nebulised adrenaline
IV dexamethasone
IV penicillin G + ceftriaxone
Cricothyrotomy kit may be needed
106
Q

List aetiology/risk factors for hoarseness

A 
GORD
Dysphagia
Smoking
Stress
Excessive singing, voice overuse
Vasculitis
TB, syphilis
Goitre
Tumour (pancoast, larynx, thymus)
Infection
Myasthenia
Acromegaly
Laryngeal nerve palsy
107
Q

List aetiology/risk factors for laryngeal nerve palsy

A

Cancer (laryngeal, thyroid, oesophageal, bronchial)
Iatrogenic (intubation, thyroid/parathyroid surgery, oesophageal surgery)
Polio
Syringomyelia
Tuberculosis
Aortic aneurysm

108
Q

Outline management of laryngeal nerve palsy

A

Contralateral cord may compensate in unilateral cases
Bioplastique injections
Thyroplasty
Tracheostomy

109
Q

Histologically, what are the typical types of nasopharyngeal cancer?

A 
Squamous carcinoma
Non squamous (angiofibromas, lymphoepitheliomas, lymphosarcoma)
110
Q

List aetiology/risk factors for nasopharyngeal cancer

A 
Abnormal HLA profiles
EBV
Tobacco
Formaldehyde exposure
Salted fish weaning early on
25% of all malignancies in China
111
Q

List clinical features of nasopharyngeal cancer

A 
Epistaxis
Diplopia
Conductive deafness
Referred pain
Nasal obstruction
Neck lump
112
Q

List clinical features of Bell’s palsy

A 
Mouth sag
Dribbling
Taste impairment
Watering or dry eye
Reduced facial expressions and movements
113
Q

Outline management of Bell’s palsy

A 
Protect the eye
Artificial tears for dryness
Prednisolone
Hooks/cheek plumpers
Facial reanimation procedures
114
Q

What is Ramsay Hunt syndrome?

A

Herpes zoster oticus affecting CN VII in the ear

115
Q

List clinical features of Ramsay Hunt syndrome

A 
Severe otalgia
Zoster vesicles
CN VII palsy
Vertigo
Sensorineural hearing loss
116
Q

Outline management of Ramsay Hunt syndrome

A

Valaciclovir

Prednisolone

117
Q

List the main neck lumps in the midline

A

Dermoid cyst
Thyroglossal cyst
Thyroid mass

118
Q

List the main neck lumps in the anterior triangle

A

Lymphadenopathy
Lymphoma
Branchial cysts
Cystic hygromas

119
Q

List the main neck lumps in the posterior triangle

A

Lymphadenopathy
Lymphoma
Metastases
Cervical rib

120
Q

What investigations would you do for general neck lumps?

A 
USS for consistency
CT for defining anatomically
CXR
Virology, Mantoux
Consider FNA
Refer to ENT within 2 weeks if suspected malignancy
121
Q

List the main pathologies to affect salivary glands

A 
Infection
Obstructing calculus
Mumps
Inflammation (parotitis)
Tumours
122
Q

80% of salivary gland tumours affect the parotids. True/False?

A

True

123
Q

What investigations would you do for suspected salivary gland tumour?

A

FNA cytology
Sialograms
Biopsy

124
Q

List aetiology/risk factors for xerostomia

A 
Drugs (tricyclics, antipsychotics, hypnotics, B-blockers, diuretics)
Mouth breathing
Dehydration
ENT radiotherapy
SLE, Sjogren's, scleroderma
Sarcoidosis
HIV, AIDS
125
Q

List clinical features of xerostomia

A 
Dry, atrophic mucosa
Fissuring
Difficulty eating/speaking
Struggle to wear dentures
Reduced saliva
Salivary gland swelling
Dental caries
Candida

4MB Medicine (My version) (19 decks)

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