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Module 3 > Ears, Nose & Throat (ENT) > Flashcards

Ears, Nose & Throat (ENT) Flashcards

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1
Q

A patient presents with unilateral hearing loss. The PA performs the Weber’s test and the patient hears the buzzing noise coming from their normal, unaffected ear. What type of hearing loss is this?

A

Sensorineural

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2
Q

A patient presents with unilateral hearing loss. The PA performs the Weber’s test and the patient hears the buzzing noise coming from their affected ear. What type of hearing loss is this?

A

Conductive

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3
Q

A patient presents with unilateral hearing loss. The PA performs the Rinne’s test and the patient hears the noise loudest when the tuning fork is held away from the ear (in the air). What type of hearing loss is this?

A

Sensorineural

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4
Q

A patient presents with unilateral hearing loss. The PA performs the Rinne’s test and the patient hears the noise loudest when the tuning fork is held on their mastoid bone of their affected ear. What type of hearing loss is this?

A

Conductive

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5
Q

What is the most common bacterium that causes acute otitis externa?

A

Pseudomonas aeruginosa

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6
Q

Unremitting otalgia, exposed bone, facial nerve palsy and a fever are signs of

A

Malignant/necrotising otitis externa

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7
Q

What are the risk factors for otitis externa?

A

Dermatitis, swimmers, trauma to ear canal, hearing aids/plugs, diabetes, immunosuppression

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8
Q

An inflamed external auditory meatus is a sign of

A

Otitis externa

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9
Q

What chromosomal condition increases the likelihood of earwax/cerumen impaction?

A

Down’s Syndrome

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10
Q

Where does fluid build up in acute otitis media?

A

Behind the tympanic membrane/ear drum

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11
Q

Name 2 common bacteria that cause acute otitis media in children

A

H. influenzae and S. pneumoniae

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12
Q

Name 2 common viruses that cause acute otitis media in children

A

Rhinovirus and RSV

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13
Q

What is a rare (5%) complication of acute otitis media?

A

Tympanic membrane perforation

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14
Q

When can antibiotics be prescribed for a patient with acute otitis media?

A
  1. Patient is systemically unwell
  2. High risk of complications (i.e. eardrum perforation)
  3. Children < 2 years with bilateral infection
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15
Q

What is another term for chronic otitis media?

A

Glue ear/chronic otitis media with effusion

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16
Q

What is the most common cause of acquired hearing loss in children?

A

Chronic otitis media/glu ear

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17
Q

What is are the risk factors for chronic otitis media?

A

Smoking (passive - affects children) and recurrent ear/URTI infections

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18
Q

What is the chronic otitis media recovery rate?

A

90%

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19
Q

A child has recent PMH of acute otitis media presents to A&E with erythema and tenderness behind the ear, fever and hearing loss. What is the diagnosis?

A

Mastoiditis

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20
Q

What is the management for mastoiditis?

A

IV antibiotics, myringotomy/tympanostomy and mastoidectomy

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21
Q

A cholesteatoma is made up of what type of epithelium?

A

Keratinising squamous epithelium - goes on to erode bone through release of osteolytic enzymes and increased pressure.

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22
Q

A patient presents with painless, foul-smelling otorrhoea, progressive unilateral conductive hearing loss and a retracted tympanum. What is the diagnosis?

A

Cholesteatoma

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23
Q

What is the most common type of pathogen that causes labyrinthitis?

A

Virus

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24
Q

A patient presents with acute vertigo, dizziness and otorrhoea. What is the diagnosis?

A

Labyrinthitis

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25
Meniere's disease is caused by an excess of what type of fluid in the Reisner's membrane?
Endolymph - potassium rich fluid
26
A patient complains of random attacks of vertigo, tinnitus and sudden loss of balance over the last 3 months. What is the diagnosis?
Meniere's Disease
27
What type of pathogen commonly caused sinusitis?
Virus
28
A patient complains of a 7-day history of headache, facial pain and a fever that were worse at the start but have gradually began to ease. What type of sinusitis is this?
Viral sinusitis as the symptoms peaked initially and have been resolving < 10 days
29
A patient complains of facial pain, headache, purulent nasal discharge and dental pain for over 10 days. What type of sinusitis is this?
Bacterial sinusitis as the symptoms > 10 days and the patient has purulent nasal discharge, nasal obstruction, dental pain and facial pain/headache.
30
Severe sinusitis in a systemically well patient is treated with what type of antibiotic?
Phenoxymethylpenicillin
31
Where do nosebleeds arise from in the anterior septum?
Little's area at Kiesselbach plexus
32
Nasal polyps can be caused by
Cystic fibrosis, nasal cancer, asthma, chronic rhinosinusitis
33
Acute pharyngitis is commonly caused by what viruses?
EPV, adenovirus, enterovirus, influenza, parainfluenza
34
What seasons does viral pharyngitis occur in?
Summer and autumn
35
What seasons does bacterial pharyngitis occur in?
Winter and early spring
36
Cough, nasal congestion and rhinorrhoea are all signs of what type of pharyngitis?
Viral pharyngitis
37
A patient complains of a sore throat. They have no other cough, nasal congestion or rhinorrhoea. What type of pharnygitis is this?
Bacterial pharyngitis
38
What bacteria causes pharyngitis?
Group A beta haemolytic streptococcus bacteria
39
What is the most common causative agent of tonsillitis?
Rhinovirus
40
A patient complains of a feeling of malaise. Upon examination, the patient has tonsillar exudate and anterior cervical lymphadenopathy. Is this tonsillitis bacterial or viral?
Viral tonsillitis because the patient has no cough or rhinitis.
41
What are the 4 points of Centor Criteria?
1. Fever > 38 degrees 2. Tonsillar exudate 3. No cough 4. Tender anterior cervical lymphadenopathy Score = 3+ implies bacterial infection (40-60% chance)
42
What bacteria causes bacterial tonsillitis?
Group A beta haemolytic streptococcus
43
What inflammatory or autoimmune conditions can cause mouth ulcers?
Crohn's, Coeliac's, Behcet's Syndrome
44
What bacteria causes life-threatening laryngitis?
H. influenzae
45
What is the most common pathogen that causes laryngitis?
Virus
46
A patient presents with a hoarse voice, fever and a sore throat. They complain they had a recent chest infection. What is the diagnosis?
Laryngitis - often occurs after a UTRI and presents with a hoarse voice, sore throat and fever.
47
A patient with a PMH of T2DM presents with white plaques adherent to the oral mucosa. When scraped, the cracks bleed slightly. What is the diagnosis?
Oral candidiasis
48
What bacteria commonly caused epiglottis?
H. influenzae B
49
A mother brings her 2 year old child to the GP surgery. She says her child's voice is muffled and they're finding it difficult to swallow food. On examination, they're breathing with their arms forward (tripod breathing). What is the management?
Call 999, child must be intubated by anaesthetist and ENT doctor.
50
A man presents to the GP surgery with fever, a hoarse voice and a sore throat that has been getting worse for over a week. What is the diagnosis?
Quinsy/peritonsillar abscess. The patient must be referred urgently/same day.
51
What complications are associated with quinsy?
Necrotising fasciitis, pericarditis, pleural effusions.
52
A 21 year old female presents to the GP complaining of anorexia, fatigue and a sore throat. She has noticed petechiae in her mouth. On examination, she has tender cervical lymphadenopathy and a non-pruritic erythematous macular rash. What is the diagnosis?
Infectious mononucleosis/glandular fever
53
What is the management of infectious mononucleosis?
Avoid contact sports (splenic rupture risk), avoid alcohol, supportive care.
54
What antibiotics should be avoided as they cause an itchy maculopapular rash in glandular fever?
Ampicillin and amoxicillin
55
What are the common causes of parotitis?
Mumps (RNA paramyoxivirus), parotid duct stone
56
A 50 year-old man presents with progressive unilateral sensorineural hearing loss and dizziness. He has a PMH of neurofibromatosis type II. What is the diagnosis?
Acoustic neuromas/vestibular schwannomas.
57
What type of cancer is nasopharyngeal/oropharyngeal cancer?
Squamous cell carcinoma
58
What is an ototoxic antibiotic?
Gentamicin
59
2 common bacterial causes of otitis externa
Pseudomonas aeruginosa and Staph aureus
60
What acid can break down earwax/cerumen?
Acetic acid
61
5 RF for otitis media
1. Children 2. Recent URTI 3. Smoking/passive smoking 4. Eustachian tube dysfunction/deformities 5. Allergies
62
What can be offered to someone with bad AOM but not severe?
Prescription of back-up antibiotics
63
Safety netting for someone with AOM (4 points)
1. Take analgesia/drink lots of fluid/rest as AOM takes 3 days to pass 2. If symptoms persist after 3 days or become worse or you feel systemically unwell - seek help 3. Back-up prescription of antibiotics can then be taken 4. If symptoms still persist 2-3 days after antibiotics, or worsen, seek help
64
1st and 2nd line Abx for AOM
1st: Amoxicillin or clarithromycin 2nd: Co-amoxiclav
65
Altered taste and facial weakness, alongside tinnitus is a sign of
Cholesteatoma
66
5 RF for cholesteatoma
1. Males 2. Middle ear disease/previous history of AOM 3. Ear surgery/trauma 4. Congenital conditions 5. Bisphosphonates
67
What number is the facial nerve?
VII/7
68
Most common cause of bacterial labyrinthitis
AOM
69
Acute vertigo and tinnitus can be a sign of
Labyrinthitis
70
Spontaneous vertigo with no N&V may be a sign of
Meniere's
71
2 main causes of vertigo
Central or peripheral/inner ear
72
What distinguishes BPPV from other conditions? (3 points)
1. Vertigo attacks happen when head position changes 2. No hearing problems 3. No tinnitus
73
Acute sinusitis time frame
< 12 weeks
74
Most common cause of acute sinusitis and what number of cases are caused by this?
Virus - 98 in every 100 people
75
3 criteria to admit someone to hospital with sinusitis
1. Very systemically unwell 2. Orbital complications 3. Intracranial complications
76
2 medications for sinusitis lasting more than 10 days
Nasal ICS and antibiotics
77
1st line antibiotic for sinusitis
Phenoxymethylpenicillin
78
What immune response is allergic rhinitis?
IgE mediated
79
Allergic rhinitis is another word for
Hayfever
80
When should someone go to hospital with a nosebleed?
After 10-15 minutes of leaning forwards/applying firm pressure/packing nose
81
An acoustic neuroma affects what nerve?
Vestibulocochlear nerve
82
What type of cancer is nasopharyngeal cancer and what ethnic background does it tend to affect?
Squamous and Chinese/North African
83
Leukoplakia that is persistent could be a sign of
Oral cancer
84
Adenovirus in pharyngitis causes
Pharyngoconjunctival fever
85
A sore throat caused by enterovirus, and small lesions in the mouth and palms/soles of hands/feet is a sign of
Hand, foot and mouth disease
86
Group A Strep pharyngitis can cause
Scarlet fever
87
Acute tonsillitis affects the
Parenchyma of the palatine tonsils
88
The Centor criteria is particularly assessing for what bacteria?
Group A beta haemolytic strep.
89
Clarithromycin and erythromycin should be avoided in what 3 conditions/medications
1. Prolonged QT interval drugs: Sotalol 2. History of QT interval/Torsades de Pointes/v. fibrillation 3. Hypokalaemia
90
Red flag in a patient with a mouth ulcer
Solitary ulcer > 3 weeks = oral malignancy
91
Most common cause of laryngitis
Rhinovirus
92
Quinsy commonly occurs after
Strep. pharyngitis
93
Trismus and neck pain could suggest
Quinsy
94
What 3 should be avoided in suspected EBV?
Amoxicillin, contact sport, alcohol
95
In adults > 40, what 2 features may suggest glandular fever?
Fever and jaundice
96
Mumps is caused by what virus?
Paramyxovirus
97
Parvovirus B19 causes
Slapped cheek syndrome
98
Ig found in mumps
IgM
99
2 symptoms of leukoplakia
1. White oral lesion | 2. Strongly adhered to oral mucosa

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