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Phase 4 Medicine > Ear, Nose and Throat > Flashcards

Ear, Nose and Throat Flashcards

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1
Q

Define otitis media

A

Describes infection of the middle ear (Space between tympanic membrane and inner ear)

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2
Q

What often precedes otitis media?

A

Viral Upper Respiratory tract infections

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3
Q

What is the most common bacterial cause of otitis media? Give 2 other causes

A

Streptococcus pneumoniae (most common)

Other;
Haemophilus influenzae
Moraxella catarrhalis

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4
Q

Give 4 clinical features of otitis media

A

Otalgia (ear pain) (children may tug/rub ear)

Fever (50% of cases)

Hearing loss

Symptoms of upper airway infection (cough, coryza, sore throat)

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5
Q

Give 1 complication of otitis media

A

Tympanic membrane perforation (discharge from ear)

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6
Q

What investigation is used to diagnose otitis media? Give 3 possible findings

A

Otoscopy

Possible findings;

Bulging red tympanic membrane > Loss of light reflex

Opacification or erythema of tympanic membrane

Perforation with purulent otorrhoea

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7
Q

Give 3 features required for diagnosis of otitis media

A

Acute onset of symptoms (ear pain)

Presence of middle ear effusion (bulging, otorrhoea)

Inflammation of tympanic membrane (erythema)

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8
Q

When should antibiotics be prescribed in a case of otitis media?

A

If;

Symptoms last >4 days and are not improving

Systemically unwell (but not requiring admission)

Immunocompromise or high risk for complications

Younger than 2 with bilateral otitis media

Otitis media with perforation and/or discharge in canal

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9
Q

What antibiotic is given to treat otitis media? (plus penicillin allergy)

A

Amoxicillin (for 5-7 days)

Erythromycin/clarythromycin (if pen allergy or pregnant)

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10
Q

Give 4 possible complications of otitis media

A

Mastoiditis

Meningitis

Brain abscess

Facial nerve paralysis

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11
Q
A
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12
Q

Give 4 causes of otitis externa

A

Swimming (aka swimmers ear)

Infection - Staph aureus, pseudomonas aeuroginosa)

Seborrheic dermatitis

Contact dermatitis

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13
Q

Give 2 common bacterial causes of otitis externa

A

Staphylococcus aureus

Pseudomonas aeruginosa

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14
Q

Give 4 clinical features of otitis externa

A

Ear pain

Discharge

Itchiness

Conductive hearing loss (if ear becomes blocked)

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15
Q

Give 4 examination findings (otoscopy) for otitis externa

A

Erythema and swelling in the ear canal

Tenderness in ear canal

Pus or discharge in ear canal

Lymphadenopathy around neck/ear

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16
Q

Give 2 investigations useful to conduct in a patient with otitis externa

A

Otoscopy (direct examination)

Ear swab (identify causative organism)

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17
Q

How is mild otitis media treated?

A

Acetic acid 2% (EarCalm)

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18
Q

How is moderate otitis media managed?

A

Topical antibiotic + Steroid (Otomize spray)

Spray includes; Neomycin + Dexamethasone + Acetic acid

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19
Q

What is it essential to exclude before prescribing aminoglycosides (gentamycin and neomycin) when treating otitis externa? and why?

A

Exclude perforated tympanic membrane.

As aminoglycosides are ototoxic

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20
Q

How is otitis externa managed in patients with severe or systemic symptoms?

A

Oral flucloxacillin or clarithromycin

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21
Q

Define malignant otitis externa

A

A severe and life-threatening form of otitis media.

Infection spreads to bones of ear canal and skull, progressing to osteomyelitis of the temporal bone.

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22
Q

Give 3 risk factors for malignant otitis externa

A

Diabetes

Immunosuppressant medications (chemo)

HIV

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23
Q

What key feature indicates malignant otitis externa?

A

Granulation tissue at junction between bone and cartilage in the ear canal

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24
Q

How is malignant otitis externa managed? (3)

A

Admission under ENT team

IV antibiotics

CT/MRI head to assess extent of infection

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25
Define vertigo
A false sensation that the body or environment is moving
26
Give 5 possible causes of vertigo
Viral labyrinthitis Vestibular neuronitis Benign paroxysmal positional vertigo Meniere's disease Acoustic neuroma
27
How is benign paroxysmal positional vertigo characterised?
Sudden onset of dizziness and vertigo triggered by changes in head position.
28
What is the average age of onset for BPPV?
55
29
Give 2 presenting features of BPPV
Vertigo triggered by change in head position (turning over in bed) Episodes lasting 10-20 seconds
30
Describe the pathophysiology of BPPV
Caused by calcium carbonate crystals being displaced into the semi-circular canals (most commonly the posterior semi-circular canal) Crystals disrupt the normal flow of endolymph through these canals, causing vertigo.
31
What test is used to diagnose BPPV?
Dix-Hallpike manoeuvre Involves moving pt's head to trigger vertigo.
32
What can be used to treat BPPV?
Epley manoeuvre
33
What is vestibular neuronitis?
Describes inflammation of the vestibular nerve, usually due to viral infection
34
Name the 3 parts of the inner ear
Semi circular canals Vestibule (middle section) Cochlea
35
Give 4 clinical features of vestibular neuronitis
Recent history of viral upper resp infection Recurrent vertigo attacks lasting hours/days Nausea and vomiting Horizontal nystagmus
36
What can be used to distinguish vestibular neuronitis from a posterior circulation stroke?
HiNTs exam (Head Impulse, Nystagmus, Test of Skew exam)
37
How is vestibular neuronitis managed? (3)
Oral Prochlorperazine or Antihistamine (cyclazine or promethazine) (for mild cases) Buccal or IM prochlorperazine (for rapid relief in severe cases) Vestibular rehabilitation exercises (for chronic symptoms - sx dont improve after 1 week or resolve after 6 weeks)
38
Describe Meniere's disease
Describes a disorder of the inner ear, characterised by excessive pressure and progressive dilation of the endolymphatic system (endolymphatic hydrops). Causes recurrent attacks of vertigo, hearing loss, tinnitus and a feeling of fullness in the ear
39
What triad of symptoms is seen in Meniere's disease?
Hearing loss (sensorineural) Vertigo Tinnitus (Unilateral episodes)
40
What is the typical age of onset for Meniere's disease?
40-50 years old
41
What type of hearing loss is seen in Meniere's disease?
Sensorineural hearing loss (unilateral)
42
Give 4 clinical features of Meniere's disease (inc triad)
Triad; Hearing loss, Vertigo, Tinnitus Aural fullness Nystagmus + Positive Romberg test Episodes last minutes to hours
43
Give 3 history features of meniere's disease
Symptoms resolve after 5-10 years Majority of patients are left with a degree of hearing loss Psychological distress is common
44
How is Meniere's disease managed? (4)
ENT assessment required to confirm diagnosis Patient should inform DVLA and cease driving until symptoms are controlled. Acute attacks - Buccal/IM prochlorperazine Prevention - Betahistine or vestibular rehabilitation exercises
45
Describe acoustic neuroma
Benign tumour of the Schwann cells surrounding the auditory nerve (vestibulocochlear) that innervates the inner ear
46
What nervous system are schwann cells found in? What is their function?
Peripheral Nervous System Function; provide the myelin sheath around neurones
47
Where do acoustic neuroma's commonly occur?
Cerebellopontine angle
48
Acoustic neuromas are usually unilateral. Bilateral acoustic neuromas indicate what?
Neurofibromatosis type II
49
Give 4 clinical features of acoustic neuroma
Unilateral sensorineural hearing loss Unilateral tinnitus Absent corneal reflex (CN V) Dizziness or imbalance
50
If an acoustic neuroma is affecting CN VIII (vestibulocochlear), what symptoms will the patient likely have? (3)
Vertigo Unilateral Sensorineural Hearing Loss Unilateral Tinnitus
51
If an acoustic neuroma is affecting CN V (Trigeminal), what symptoms will the patient likely have?
Absent corneal reflex
52
If an acoustic neuroma is affecting CN VII (Facial), what symptoms will the patient likely have?
Facial palsy
53
What is the investigation(s) of choice used to diagnose acoustic neuroma? (2)
MRI of cerebellopontine angle Audiometry (to assess hearing loss)
54
Describe Presbycusis
Age related hearing loss. Describes a type of sensorineural hearing loss. Tends to affect high-pitched sounds first. Hearing loss occurs gradually and symmetrically
55
Give 4 risk factors for Presbycusis
Increasing age Family history Loud noise exposure Smoking
56
Define Quinsy
Peritonsillar abscess that develops as a complication of bacterial tonsillitis
57
Give 4 features of a Quinsy
Severe throat pain, which lateralises to one side Deviation of uvula to the unaffected side Trismus (difficulty opening mouth) Reduced neck mobility
58
What bacteria most commonly causes Quinsy?
Streptococcus pyogenes (group A strep)
59
Why does Quinsy cause trismus? (Pain on opening mouth)
Due to inflammation of the pterygoid muscles
60
How is Quinsy managed? (3)
Urgent review by ENT specialist Needle aspiration/incision and drainage IV antibiotics (co-amoxiclav)
61
What lymph node is commonly affected in quinsy
Jugulodigastric lymoh nodes
62
What is considered to prevent recurrence of Quinsy?
Tonsillectomy
63
How many episodes of acute sore throat qualify a patient for tonsillectomy? (3)
7 or more in 1 year 5 per year for 2 years 3 per year for 3 years
64
Give 2 other indications for tonsillectomy (other than number of acute episodes)
Recurrent tonsillar abscesses (2 episodes) Enlarged tonsils causing difficulty breathing, swallowing or snoring
65
Give 4 complications of tonsillectomy
Sore throat (where tonsillar tissue is removed, can last 2 weeks) Damage to teeth Post-tonsillectomy bleeding Infection
66
Define labyrinthitis
Describes inflammation of the bony labyrinth of the inner ear, including the semi-circular canals, vestibule (middle section) and cochlear. Inflammation is usually due to a viral upper resp infection.
67
Give 3 clinical features of Labyrinthitis
Acute onset vertigo Hearing loss Tinnitus
68
Give 1 feature seen in both labyrinthitis and vestibular neuronitis
Acute onset vertigo
69
Give 2 features seen in labyrinthitis but not in vestibular neuronitis
Hearing loss Vertigo
70
Give 4 complications of tonsillitis
Otitis media Quinsy (peritonsillar abscess) Scarlet fever Post streptococcal glomerulonephritis
71
What is the most common cause of tonsillitis?
Viral infection
72
What is the most common bacterial cause of tonsillitis?
Group A Streptococcus Pyogenes
73
Which tonsils are typically affected in tonsillitis?
Palatine tonsils
74
What is it important to examine in children presenting with tonsillitis? (2)
Ears - Otoscopy (tympanic membranes) Cervical lymphadenopathy
75
Describe the Fever PAIN score for used to estimate whether tonsillitis is due to a bacterial cause
Fever - During last 24 hours P - Pus on tonsils A - Attended within 3 days of onset of symptoms I - Inflamed tonsils N - No cough/coryza
76
What Fever PAIN score warrants prescription with antibiotics?
Score >=4
77
What are the 1st and 2nd line antibiotics for bacterial tonsillitis?
1st - Penicillin V for 10 days (may be syrup in child) 2nd - Clarithromycin (if pen allergy)
78
What causes Ramsay Hunt Syndrome? How does it present?
Varicella Zoster Virus. Presents as unilateral Lower Motor Neurone facial nerve palsy with a painful/tender vesicular rash in the ear canal, pinna and round the ear.
79
How is Ramsay Hunt Syndrome managed?
Acyclovir + Prednisolone + Lubricating eye drops
80
What is the most likely location of bleeding for a patient presenting with nosebleeds?
Little's area (Kiesselbach's plexus)
81
Give 5 common causes of nosebleeds
Nose picking Colds/Sinusitis Vigorous nose-blowing Coagulation disorders (thrombocytopenia/Von willebrand disease) Anticoagulant medications (Aspirin, DOAC, warfarin)
82
Name 3 medications that could increase the risk of nosebleeds
DOAC Aspirin Warfarin
83
Describe the acute non-pharmacological/surgical management of nosebleeds (3)
Sit up and tilt head forwards (avoids blood flowing towards airway) Squeeze the soft part of the nostrils together for 10-15 mins Spit out any blood in the mouth, rather than swallowing
84
If a nosebleed does not stop after 10-15 minutes, the nosebleed is severe, is bleeding from both nostrils or they are harmodynamically unstable, what are the treatment options? (2)
Hospital admission; Nasal packing with nasal tampons or inflatable packs Nasal cautery using silver nitrate sticks
85
What is it useful to prescribe after treating an acute nosebleed? and why?
Naseptin nasal cream (Chlorhexidine and neomycin) 4x per day for 10 days. Reduces crusting, inflammation and infection
86
In whom is Naseptin nasal cream (chorohexidine and neomycin) contraindicated?
Patients with a peanut or soya allergy
87
What causes infectious mononucleosis (glandular fever)?
Epstein-Barr virus
88
What triad of symptoms is seen in infectious mononucleosis?
Sore throat Lymphadenopathy (anterior and posterior triangles of neck) Pyrexia
89
Give 4 clinical features of infectious mononucleosis (inc triad as 1)
Triad; Sore throat, Lymphadenopathy, Pyrexia Splenomegaly Malaise, anorexia, headacke Hepatitis
90
Taking what can cause patients with infectious mononucleosis to present with a maculopapular, pruritic rash?
Taking amoxicillin/ampicillin
91
What test is used to diagnose infectious mononucleosis?
Monospot test (Heterophil antibody test) NICE - Suggest FBC and Monospot test in 2nd week of illness to confirm diagnosis
92
Describe the management of infectious mononucleosis (3)
Rest during early stages, fluids and avoid alcohol Simple analgesia for aches or pains Avoid contact sports for 4 weeks after having glandular fever, to reduce risk of splenic rupture.
93
Define obstructive sleep apnea
Describes episodes of apnoea during sleep caused by collapse of the pharyngeal airway.
94
Give 4 risk factors of obstructive sleep apnoea
Male Obesity Alcohol Smoking
95
Give 5 clinical features of obstructive sleep apnoea
Episodes of apnoea during sleep (reported by their partner) Snoring Morning headache Daytime sleepiness/waking unrefreshed from sleep Concentration problems
96
Severe cases of obstructive sleep apnoea can cause what? (2)
Hypertension Heart failure
97
What scale is used to assess symptoms of sleepiness associated with obstructive sleep apnoea?
Epworth Sleepiness Scale
98
How is obstructive sleep apnoea managed? (4)
ENT referral/Specialist sleep clinic (sleep studies) Lifestyle advice (stop alcohol/smoking, lose weight) CPAP Surgery - Uvulopalatopharyngoplasty (UPPP)

Phase 4 Medicine (15 decks)

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