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Conditions Flashcards

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1
Q

Peripheral vertigo causes

A

BPPV
Meniere’s
Ramsay Hunt syndrome
Labyrinthitis
Vestibular neuritis
Acoustic neuroma
Superior semicircular canal dehiscence
Cholesteatoma

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2
Q

Central vertigo causes

A

Cerebrellar infarction/haemorrhage
Vertebrobasilar insufficiency
Vestibular migraine
Multiple sclerosis

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3
Q

Conductive hearing loss causes

A

Cerumen
OE
Exostosis
Psoriasis
OM
Cholesteatoma
Otosclerosis
TM perforation

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4
Q

SNHL causes

A

Hereditary
Presbycusis
Meningitis
Thyrotoxicosis
Ototoxic drugs
Meniere’s disease
Noise exposure
Acoustic neuroma
Barotrauma
CVA

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5
Q

Severity of hearing loss

A

Mild; 20-40db
Moderate; 41-60db
Severe; 61-90db

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6
Q

Barotrauma

A

Pressure/pain/SNHL/tinnitus/vertigo
Tx; conservative, analgesia
Prevention; nasal decongestants/antihistamines, valsalva, chewing

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7
Q

Eustachian tube dysfunction

A

Hearing loss, aural fullness, otalgia, tinnitus, popping noise
retracted pars flaccida, shortened handle of malleus
Tx; conservative, autoinsufflation

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8
Q

Cholesteatoma

A

Invading cyst into TM/middle ear/mastoid
Conductive HL, foul discharge, otalgia, vertigo, facial weakness
Unsafe perforation; superior or posterior edge of TM, assoc granulation tissue
Tx mastoid surgery

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9
Q

Otalgia causes

A

Infection
Trauma
FB
Cerumen
Osteomyelitis
Temporal arteritis
Ramsay Hunt syndrome
Odontogenic
TMJ
Trigeminal neurlagia

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10
Q

Otitis externa

A

Swimming, Eczema, psoriasis
P aeruginosa, S aureus, candida/aspergillus
Tx
- Dry aural toilet 6hrly until dry
- Bacterial; otodex (dex/framycetin/gramcidin) 3 drops TDS 7/7
- Fungal; debride/aural ++, otocomb (triamcinolone/neomycin/gramcidin/nystat)
- Systemic; fluclox 500mg QID 7-10/7
Prevention; acetic acid + isopropyl alcohol after swimming, ear plugs

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11
Q

Types of otitis media

A

Acute OM; middle ear inflamm + effusion PLUS one of; red TM, discharge, fever, pain, irritability
OME: fluid behind TM without acute sx (glue ear)
Episodic OME: <3/12
Chronic OME: >3/12
Recurrent AOM: >=3 episodes in 6/12 or >=4 in 12/12
Chronic suppurative OM: persistent discharge with perforation >2/52

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12
Q

AOM Abx indication

A

<6mo
<2yo and bilateral
Systemic features
Otorrhoea in children
Immunocompromised
High risk ATSI

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13
Q

AOM SDM Abx

A

Self limiting
Consider Abx if nil improvement after 48hrs
Sx last 2-3 days regardless of Abx
Abx only shortens duration by 12hrs
Discuss harms of ABx

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14
Q

AOM Abx tx

A

Amoxicillin 15mg/kg TDS 5/7
If no response - switch to amox/clav 22.5+3.2mg/kg BD 5/7
->if allergic - cefuroxime 15mg/kg BD 5/7 or bactrim 4+20mg/kg BD 5/7

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15
Q

Indications for Abx in ATSI for AOM

A

Remote/rural
<2yo or first episdoe <6/12 age
Persistent OME
Bilateral AOMwoP
AOMwiP
Hx recurrent AOMwiP
Hx of CSOM
Down syndrome/cleft palate/immunodeficiency
<2yo with T>38.5 or bilateral AOM = high risk episode

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16
Q

AOM Abx ATSI

A

AOMwoP; amoxicillin 50mg/kg/day in 2-3 doses 7/7
-> nil improvement -> 90mg/kg/day
-> nil improvement -> augmentin 90mg/kg 7/7
-> poor compliance - single dose azithromycin 30mg/kg and repeat at day 7 if not improved
AOMwiP; amoxicillin 50-90mg/kg/day 14/7 of stat dose azithromycin 30mg/kg

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17
Q

Recurrent AOM ATSI

A

Amoxicillin 50mg/kg/day 3-6/12 if <2yo - refer ENT if nil improvement

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18
Q

Chronic OME ATSI

A

Amoxicillin 50mg/kg/day 2-4/52
ENT if >3/12 or hearing loss >20dB in better ear
Refer for language support/ speech pathology

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19
Q

Tympanostomy tube otorrhoea ATSI mx

A

Dry mopping
Cipro 0.3% 5 drops BD 7/7
Review weekly for 4/52

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20
Q

Chronic suppurative OM ATSI

A

Dry mopping/suction
Ciprofloxacin ear drops 5 drops BD -> add amoxicillin 50-90mg/kg/day for 3/7 after ear dry- review weekly until discharge resolve - then 4 weeks after resolution of sx

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21
Q

OME

A

<3/12
- normal hearing - observe
- speech delay/learning issues/TM retraction/cholesteatoma - ENT
>3/12; audiometry and ENT
Consider prolonged Abx if prolonged hearing impairment

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22
Q

Causes of tinnitus

A

Cerumen
OE
Otosclerosis
OM
Cholesteatoma
Vestibular schwannoma
Meniere’s
Neuritis
Ototoxic meds (frusemide, aspirin, aminoglycosides)
Vascular anomalies
Nasopharyngeal carcinoma

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23
Q

Tinnitus history

A

Pulsatile vs nonpulsatile
Unilateral; e.g. schwannoma
Otalgia/otorrhoea/vertigo - indicates secondary cause
Sudden onset SNHL - require prompt steroids and ENT
Noise exposure
Medication
Bothersome vs nonbothersome
Assoc anxiety/depression

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24
Q

Tinnitus examination

A

Weber
Rinne
Carotid/periauricular auscultation - if pulsatile

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25
Tinnitus mx
Hearing aids for SNHL - can amplify and mask tinnitus Sound therapy via audiologist - device to emit sounds that pt focuses on CBT
26
Tinnitus Ix
Audiology Head/neck imaging if; unilateral, pulsatile (CT angiography), asymmetric hearing loss >10db (MRI cerebellopontine angle and internal acoustic meatus for schwannoma), focal neuro deficit, otosclerosis (CT temporal bone)
27
External auditory exostosis
Blocked feeling, recurrent OE, otalgia, conductive hearing loss Mx; ear plugs, surgical removal for severe/sx or Grade 3/recurrent infection/hearing loss
28
Voice hoarseness causes
Thyroid disease - deep Reflux - raspy Functional - intermittent Vocal cord mass - gravelly Soft; VC paralysis/Parkinson's Fatigueable; mysaesthenia, Parkinsons
29
Red flags of voice hoarseness
Smoking hx Otalgia Dysphagia/odynophagia Stridor Haemoptysis Fevers/weight loss Neck mass REFER TO ENT
30
TMJ dysfunction
Causes; bruxism, stress, OA/RA/ankylosing spondylitis Sx; TMJ pain, small mouth opening, crepitus, headache, otalgia/tinnitus/vertigo/fullness, crepitus when palpating ear canal whilst opening mouth, auscultation of TMJ whilst opening (crepitus = articular disc displacement) Ix; orthopantomogram (OPG) Tx; jaw rest (soft foods), avoid chewing, warm compress/massage, CBT, sleep hygiene, stress reduction, NSAID, intra-articular celestone injection, botox, jaw physio
31
Neck mass hx
Red flags; >2 weeks, voice change, dysphagia, odynophagia, ipsilateral otalgia, nasal obstruction, weight loss
32
Risk factors for head/neck Ca
smoker alcohol >40yo hx malignancy hx of cutaneous lesions
33
Neck mass exam
Size >1.5cm more likely malignant FIxed masses more likely malignant Firmness skin ulceration Otoscopy; effusion may indicate nasopharyngeal carcinoma Rhinosocopy Oral cavity exam Flexible nasopharyngolaryngoscopy
34
Neck mass Ix
1st line; CT with contrast + FNA
35
Acute cervical lymphadenitis
Staph, group A strep, site of entry (mouth, scalp) Tx - Most cases self limiting - IF bacterial signs (unilateral tender fluctuant) - cefalexin 12.5mg/kg QID 7/7
36
Epistaxis mx
Pinch nostrils - lean forward Pressure 10-20min Merocel (nasal tampon) for anterior packing Rapid rhino; anterior/posterior packing if posterior epistaxis - consider foley catheter All pt with packing -> PO amoxicillin to prevent toxic shock - leave for 3-5 days Septal haematoma - urgent ED referral for IVAbx and drainage
37
Uncomplicated nasal fracture mx
Closed reduction under LA 10-14/7 post injury Paediatric; 3-5 days post injury
38
Allergic rhinitis classification
Frequency - Intermittent sx <4 days/week or <4 consec weeks - Persistent; sx >4 days/week ADN >4 consec weeks Severity - Mild; sx present but not troublesome, nil impairment - Mod-severe; troublesome sx, sleep disturbance, impaired ADL/school/work
39
Causes of allergic rhinitis
Non-allergic rhinitis Sinusitis Recurrent URTRI Nasal septal deviation Nasal polyps Foreign bodies Rhinitis medicamentosa Occupational; animal, woods, industrial, food processing
40
Allergic rhinitis Ix
Nasal polyps in children - test for CF Nasal polyps adults - test asthma/aspirin sensitivity If sx not responding after 1/12 - assess for IgE triggers via RAST
41
Allergic rhinitis tx options
Avoidance of triggers Intranasal steroids 4/52 minimum (1st line if mild) - fluticasone 55mcg daily 4/52 -> 27.5mcg Intranasal antihistamine - Azelastine 1mg/ml 1 spray BD OR levocabastine 0.5mg/ml 2 sprays BD Combination steroid/antihistamine - Azelastine + fluticasone propionate 125+50mcg 1 spray BD (dymista) Oral anthistamine; loratadine 10mg daily Montelukast; use with antihistamine + intranasal steroid - 10mg daily Intranasal ipratropium; marked rhinorrhoea - use with steroid/antihistamine - Ipratropium 44mcg 2 sprays TDS Immunologist for sublingual immunotherapy ENT for inferior turbinate reduction
42
Allergic rhinitis tx persistent mod-severe
Intranasal steroids PLUS oral/intranasal antihistamine AND/OR montelukast If rhinorrhoea present - add intranasal ipratropium
43
Causes of chronic rhinitis
OCP Sildenafil Aspirin/NSAID Antidepressants Benzos Rhinitis medicamentosa
44
Symptomatic therapy for sore throat
Panadol NSAID Lozenges Severe sx; prednisolone 60mg 1-2/7
45
Indications for Abx for tonsillitis/strep pharyngitis
2-25yo ATSI rural/remote, Maori, Pacific Islander Pt with existing RHD Pt with Scarlet Fever Severe sx of pharyngitis
46
Tx tonsillitis
Phenoxymethylpenicillin 500mg BD (child 15mg/kg) 10/7 OR IM benzathine benzylpenicillin stat 1.2million UNIT
47
Complications of GAS tonsillitis/pharyngitis
ARF Poststrep reactive arthritis Scarlet fever Acute glomerulonephritis Cellulitis/abscess Sepsis Meningitis
48
Peritonsillar abscess (quinsy)
Prednisolone 1mg/kg stat dose Hydration Analgesia Surgical drainage IV benzylpenicillin 1.2g (child 50mg/kg) IV QID for 2/7 post surgical drainage then switch PO phenoxymethylpenicillin to complete 10/7 total ABx
49
Oral manifestation of IBD
Lip swelling Cobblestoning of buccal mucosa Mucogingivitis Aphthous-like ulcers Angular cheilitis Tx; immunosuppressants, topical steroids, avoid NSAIDs
50
Causes of oral burning
Medication Trauma Autoimmune; Sjogren's, lichen planus Neoplastic; CNS pathology Burning mouth syndrome Candidiasis B12/folic acid/iron deficiency Diabetes/hypothyroidism
51
Causes of salivary gland swelling
Lymphoma Mumps EBV Cocksackie infection Staph - acute suppurative sialdenitis Alcohol Bulimia Diabetes Sialolith Sjogren's syndrome
52
Ix of salivary gland swelling
If suspect inflammatory cause -> USS then consider sialography or MR sialography If suspect solid mass/neoplasm -> MRI/CT then FNAC
53
Causes of salivary gland hypofunction
Drugs; anticholinergic, antihistamine, antiHTN Sjogren's, sarcoidosis, amyloidosis T2DM HIV/Hep C Anxiety Dehydration Age Mouth breathing
54
Mx dry mouth
Brush/floss, avoid sugar/acidic food Salivary substitution; rinse (biotene) Salivary flow stimulation; sugar free gum, pilocarpine
55
Mx sialolithiasis
Hydration Moist heat to area Massage gland Milk the duct Suck on lollies to promote salivary flow Secondary infection; dicloxacillin 500mg QID ENT referral if failed conservative mx
56
Mx aphthous ulcer
Hydrocortisone 1% TDS Benzydamine 1% gel 2-3hrly for pain relief If persisting >2 week - consider malignancy
57
Atrophic glossitis causes
B12/folic acid/iron deficiency Dry mouth Sjogren syndrome Oral candida Coeliac disease
58
Oral candidiasis mx
Amphotericin B 10mg lozenge sucked then swallow QID post meal 14-7 until 2-3 after sx resolve Nystatin oral 100,000 u/mL 1ml topical then swallow QID post meals 14/7 and continue 2-3/7 after sx resolve Miconazole 2% oral gel 2.5ml topical then swallow QID post meals 14/7 then for 7/7 after sx resolve if HIV; fluconazole 50-100mg 7-14/7
59
Mx angular cheilitis
Topical clotrimazole 1% cream BD 14/7 then continue 14/7 after sx consider add on hydrocortisone 1% cream BD for inflammation
60
Oral lichen planus clinical features
Reticular; interlacing white lines - Wickham's striae pattern Erosive; ulceration, atrophy, erythema - needs MAXFACS referral to rule out malignancy DDx; Can be lichenoid reaction from drug; NSAID, antiHTN, oral hypoglycaemics
61
Oral lichen planus mx
Betamethasone dipropionate 0.05% cream BD post meals Immunosuppressants; cyclosporine, tacrolimus ointments DMARDs; MTX Abx; dapsone Retinoids; isotretinoin
62
Leukoplakia
White patch/plaque that cannot be characterised by any other disease Potentially premalignant/malignant DDx; carcinoma in situ (IEC), nicotine stomatitis, candidiasis, oral lichen planus, frictional keratosis, cheek biting, lupus Risk; smoking, alcohol, betel quid chewing Must have biopsy
63
Oral hairy leukoplakia
EBV infection of tongue Common in immunocompromised Not malignant Asymp white plaques on lateral tongue that don't wipe off Dx biopsy Nil tx needed- may resolve
64
Peripheral vertigo signs
Nystagmus; unidirectional, fast toward normal ear, horizontal with torsional component (never purely torsional or vertical) Visual fixation suppressed Unidirectional instability with walking Deafness/tinnitus may be present Positive Head impulse test
65
Central vertigo signs
Nystagmus; sometimes reverse direction, any direction, if purely vertical or torsional this is central Visual fixation not suppressed Deafness/tinnitus absent usually Neuro signs; diplopia, ataxia, dysathria, dysphagia, weakness
66
Mx vertigo
Betahistine Nausea; prochlorperazine 5-10mg QID 2/7 Vomiting; Prochlorperazine 12.5mg IM Salt restriction Avoid alcohol/coffee Vestibular rehab with physio
67
BPPV
Brief episodes vertigo, nausea, nystagmus (rotational) Dx; Dix-Hallpike Mx - Epley - Home Brandt-Daroff exercises - Referral vestibular physio
68
Labyrinthitis
Preceding viral infection Vertigo, hearing loss (distinguishes from BPPV) Nil tx required if suppurative - refer ED for drainage of otitis media
69
Meniere's disease clinical features
Vertigo min-hrs- attacks in clusters Nausea/vomiting Fluctuating hearing loss - SNHL Tinnitus - unilateral Aural fullness; ipsilateral worse during or before attack Drop attacks; elderly, late stages Risk factors; fhx, autoimmune, recent viral illness
70
Meniere's disease Ix
MRI with gadolinium to exclude retrocochlear pathology (acoustic neuroma, demyelinating disease)
71
Meniere's disease Tx
Nil cure betahistine Low salt <2g dailiy Diuretic; hydrochlorothiazide 25mg daily - once asymp 6/12 taper off Audiologist for amplification Intratympanic injection steroid/gentamicin Surgical drainage of endolymph
72
Vestibular neuronitis
Inflammation of vestibular nerve - preceding viral URTI, herpes zoster Rapid onset severe vertigo, n/v, gait instability - NIL hearing issues Tx - bed rest - antiemetics - Prednisolone 1mg/kg 5/7 then taper over 15/7 for severe cases
73
Acute rhinosinusitis sx
<4/52 duration Nasal blockage/congestion/discharge Facial pain/pressure Reduction/loss of smell Acute bacterial; THREE of - purulent discharge - severe pain - T>38 - Raised CRP/ESR - Double sickening Orbital involvement; ophthalmoplegia, diplopia, reduced VA
74
Acute rhinosinusitis tx
first 3-4/7 illness- tx as viral Consider tx for bacterial if sx >7-10/7 without improvement or if double sickening Intranasal saline Intranasal decongestants <5 days duration Intranasal ipratropium if rhinorrhoea prominent Intranasal steroids Acute bacterial - conservative for 5/7 - Abx; amoxicillin 500mg TDS 5/7 OR if allergic doxycycline 100mg BD 5/7 -> if nil improvement > augmentin BD 5/7
75
Red flag clinical features of acute rhinosinusitis
Bleeding Meningitis Altered neurology Orbital involvement; diplopia, reduced VA, painful ophthalmoplegia, peri-orbital oedema
76
Complications of acute rhinosinusitis
Pre-septal cellulitis Orbital cellulitis Orbital abscess Cavernous sinus thrombosis Meningitis Intracranial abscess
77
Chronic rhinosinusitis sx
>12/52 Samter's triad; NSAID sensitivity, asthma, polyps if child <12yo - refer to paed ENT
78
Chronic rhinosinusitis tx
Allergy avoidance Mild; oral/intranasal antihistamine Mod-severe; oral/intranasal antihistamine PLUS steroid If nasal polyps - burst prednisolone 25mg 5-10/7 prior to specialist review Refer specialist if polyps or not responding after 1/12 FESS procedure by ENT
79
Tympanostomy tube otorrhoea ATSI mx
Dry mopping Cipro 5 drops BD 7/7 Review weekly for 4/52

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