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ENT Flashcards

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1
Q

How should a pinna haematoma be managed?

A

Urgent drainage <24 hrs : aspiration or incision
Secure a dental roll in place + tight headband to prevent re-accumulation
PO Abx if infected
ENT clinic followup to ensure no deformity

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2
Q

What is the difference between pinna perichondritis and pinna cellulitis?

A

Perichondritis spares the earlobe, cellulitis affects whole ear
Perichondritis most commonly pseudomonas
Cellulitis most commonly staph aureus

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3
Q

What are the risk factors for otitis externa?

A 
Swimming
Cotton bud use
Canal obstruction
Humidity 
Allergy and skin disease
Immunocompromise
Prolonged topical antibiotics
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4
Q

What are the key bacteria involved in otitis external?

A

Staph aureus and pseudomonas

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5
Q

What are the symptoms of otitis external?

A 
Ear pain (pulling in children)
Tragal tenderness
Erythema and swelling
Otorrhoea
Sensation of fullness
Itching
Reduced hearing
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6
Q

What are differentials for otitis externa?

A 
Foreign body
Cellulitis
Otitis media
Dermatitis
Mastoiditis
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7
Q

How is otitis external managed?

A

KEEP EAR DRY
Mild cases may be treated with acetic acid 2%
7-10 days topical antibiotics with steroids e.g. sofradex
Oral abx if resistant
Analgesia
Microsuction

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8
Q

What are symptoms of malignant otitis externa?

A 
Severe deep otalgia
Foul smelling discharge
Headache
Vertigo
Hearing loss
Not responding to topical antibiotics

May have granulation tissue / exposed bone in the ear canal
Facial nerve palsy

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9
Q

How is malignant otitis externa managed?

A

High resolution CT of temporal bones

6 weeks IV and topical abx
May need surgical management of collections and abscesses

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10
Q

What are symptoms of mastoiditis?

A

Usually present days-weeks after otitis media
Fever, persistent throbbing otalgia
Redness
Swelling
Tenderness
Fluctuance and swelling of mastoid process
Lateral and inferior displacement of the pinna

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11
Q

How is mastoiditis managed?

A

IV ceftriaxone and steroids

May need surgical mastoidectomy to manage abscesses

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12
Q

What are the common causative organisms in otitis media?

A

Strep pneumoniae, Haemoglobin influenzae

RSV, rhinovirus

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13
Q

What are the symptoms of otitis media?

A

Often preceding URTI
Otalgia = primary presenting feature in adults
Fever
Spontaneous perforation of tympanic membrane
Purulent Otorrhoea

Ear pulling and poor feeding in small children
Bulging tympanic membrane
May have a fluid membrane

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14
Q

What is the management for otitis media?

A

Oral analgesia
Viral infections are self-limiting usually within 3 days

5-7d oral amoxicillin first line in suspicion of bacterial infection
Clarithromycin if penicillin allergic

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15
Q

What are the two types of chronic otitis media?

A

Mucosal- perforation of the tympanic membrane, chronic middle ear infection

Squamous- tympanic membrane retraction, accumulation of keratin, cholesteatoma

Characterised by ear discharge >2w without pain, fever or tinnitus

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16
Q

What are the symptoms of cholesteatoma?

A 
Conductive hearing loss
Ear discharge resistant to antibiotics
Crusting of retraction pocket 
Tinnitus 
Otalgia

With progression: vertigo, sensorineural hearing loss, facial nerve palsy, meningitis, abscess

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17
Q

How would you manage cholesteatoma?

A

Canal wall-up mastoidectomy

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18
Q

What are the causes of sudden sensorineural deafness?

A 
90% idiopathic
Meningitis/mumps/HIV
Extreme noise
Barotrauma
Acoustic neuroma
Ototoxic medication
Stroke/vasculitis
Labyrinthitis
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19
Q

What are the causes of chronic sensorineural deafness?

A

Presbyacusis
Environmental noise toxicity
Inherited disorders
Diabetic neuropathy

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20
Q

What are the causes of conductive deafness?

A 
Obstruction: foreign body, earwax
Cholesteatoma
Otosclerosis
Otitis media/glue ear
Otitis externa
Trauma- ossicle fracture
Facial nerve palsy (stapedius paralysis)
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21
Q

What is the most common cause of rhinosinusitis?

A

Viral URTI

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22
Q

What are the symptoms of rhinosinusitis?

A

Nasal congestion
Facial pain- worse on leaning forward
Sensation of fullness
Decreased sense of smell

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23
Q

How is rhinosinusitis managed?

A

Saline irrigation
Antihistamines + trigger avoidance in allergic causes
Topical nasal steroids

Only abx if symptoms suggestive of bacterial sinusitis complication/ symptoms >14 days

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24
Q

Which is a red flag: unilateral or bilateral nasal obstruction?

A

Unilateral

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25
How are nasal polyps managed?
Oral prednisolone Topical steroid e.g. fluticasone, beclometasone Nasal saline irrigation Surgical removal if refractory and bothersome
26
What is the recommended management algorithm for epistaxis?
``` Compression 10-15 min, lean forward + ice to try vasoconstrict If source visible: silver nitrate cautery (topical lidocaine first) If not: try anterior packing If no help: posterior pack Sphenopalatine artery ligation ``` Naseptin antiseptic ointment 1-2w to prevent crusting and keep clean Prevent blowing nose, hot showers + baths, exercise, spicy food
27
What are important investigations in epistaxis?
FBC + Clotting BP Rule out bleeding disorders Examination incl. rhinoscopy
28
What is the most common bacterium causing quinsy?
Streptococcus pyogenes
29
How does quinsy commonly present?
Following recent episode of bacterial tonsilitis Unilateral peritonsillar swelling, displacement of the uvula Sore throat, Fever, Malaise Muffled voice, dysphagia, drooling, difficulty breathing Trismus Neck swelling
30
How is quinsy managed?
``` Incision and drainage IV antibiotics- clindamycin IV steroids- dex IV fluids Analgesia ```
31
What is the management of epiglottitis?
``` Airway management + A-E IV cephalosporin antibiotics IV dexamethasone IV fluids Humidified oxygen ```
32
What is the most common type of thyroid cancer?
Papillary carcinoma
33
Which thyroid cancer is part of MEN-2?
Medullary carcinomas
34
How are papillary and follicular thyroid cancers managed?
total thyroidectomy followed by radioiodine (I-131) to kill residual cells yearly thyroglobulin levels to detect early recurrent disease
35
What are the differential causes of hoarse voice?
``` Laryngitis Pancoast tumours Largyngeal fold carcinoma Vocal cord palsy Vocal fold polyps ```
36
How does presbyacusis present?
Gradual and insidious hearing loss Loss of high frequency sounds first May have associated tinnitus Diagnosed by audiometry
37
What is the inheritance pattern of otosclerosis?
Autosomal dominant
38
What type of hearing loss occurs in otosclerosis?
Conductive
39
Which frequencies are most affected by otosclerosis?
Lower pitched sounds
40
What are treatment options for otosclerosis?
Conservative with use of hearing aids | Stapedectomy
41
What are the peripheral causes of vertigo?
``` BPPV Meniere's disease Vestibular neuronitis Labyrinthitis Acoustic neuroma HZV infection ```
42
What are the central causes of vertigo?
Posterior circulation stroke Tumour MS Vestibular migraine
43
How would you investigate vertigo?
``` Ear examination Neurological examination CV examination Cerebellar examination Romberg's/Dix-Hallpike/HINTS ```
44
What are the components of cerebellar examination?
DANISH ``` Dysdiadochokinesia Ataxic gait Nystagmus Intention tremor Speech Heel-shin test ```
45
What makes up a HINTS exam?
Exam to differentiate between central and peripheral causes of vertigo. Head Impulse Nystagmus Test of Skew
46
What symptomatic treatments can be given in vertigo?
Prochlorperazine | Antihistamines
47
What are the symptoms of BPPV?
Triggered by head movement | 20-60second episodes of vertigo and asymptomatic in between
48
How is BPPV diagnosed and managed?
Diagnosed using Dix Hallpike manoeuvre Managed using Epley manoeuvre
49
What are the symptoms of vestibular neuronitis?
Usually a recent viral URTI Vertigo Nausea and vomiting Balance problems NO LOSS OF HEARING
50
How is vestibular neuronitis managed?
Symptomatic treatment < 3 days- any longer may slow down recovery Symptoms should resolve on their own- intense for a few days then gradually improve over following weeks
51
What are the features of labyrinthitis?
``` Recent viral URTI Acute onset vertigo Hearing loss Tinnitus Nausea, vomiting Balance problems ```
52
What are the features of meniere's disease?
Usually presents between ages of 40 and 50 Unilateral symptoms Episodes of vertigo, hearing loss and tinnitus Vertigo lasting 20m-few hours not triggered by movement/posture Fluctuating episodes of unilateral SN hearing loss, gradually becomes more permanent, affects low frequencies first May have sensations of fullness in the ear, unexplained falls without LOC and imbalance Spontaneous unilateral nystagmus
53
What can be used for prophylaxis of meniere's disease attacks?
Betahistine
54
How do acoustic neuromas usually present?
``` Unilateral sensorineural hearing loss Unilateral tinnitus Dizziness or imbalance A sensation of fullness in the ear May have associated facial nerve palsy (LMN, forehead not spared) ```
55
In bacterial sinusitis, what is the first line antibiotic?
Phenoxymethylpenicillin
56
What is the most common cause of bacterial tonsillitis?
Group A strep (strep pyogenes) | Strep pneumoniae second
57
Which antibiotic is indicated for bacterial tonsilitis?
Phenoxymethylpenicillin (penicillin V) Clarithromycin in pen allergy
58
What is the Centor criteria?
Fever >38 degrees Tonsillar exudate Absence of cough Tender lymphadenopathy 3+ increases likely of bacterial and appropriate to give abx.
59
What is an alternative to the centor criteria?
``` Fever PAIN Fever Purulence Attended within 3 days of symptoms Inflamed tonsils No cough or coryza ``` Score 4+ likely bacterial
60
What are potential complications of tonsilitis?
``` Peritonsillar abscess Otitis media Scarlet fever Rheumatic fever Post-strep GN Post-strep reactive arthritis ```
61
What are the indications for tonsillectomy?
Episodes of tonsillitis: 7 or more in 1 year 5 per year for 2 years 3 per year for 3 years ``` Recurrent quinsy (2 episodes) Enlarged tonsils causing difficulty breathing, swallowing or snoring ```
62
How is post-tonsillectomy bleeding managed?
LIFE THREATENING due to aspiration of blood. Call the ENT registrar Get IV access Bloods including FBC, clotting screen, group & save, crossmatch Keep the patient calm and give adequate analgesia Sit them up and encourage them to spit out the blood Make NBM in case an anaesthetic and operation is required IV fluids for maintenance and resuscitation, if required In less severe: Hydrogen peroxide gargle or adrenalin soaked swab can be tried before returning to surgery
63
What are the borders of the anterior triangle?
Mandible forms the superior border Midline of the neck forms the medial border Sternocleidomastoid forms the lateral border
64
What are the borders of the posterior triangle of the neck?
Clavicle forms the inferior border Trapezius forms the posterior border Sternocleidomastoid forms the lateral border
65
What are the features of carotid body tumours?
Slow-growing lump: in anterior triangle, painless, pulsatile, bruit, mobile horizontally May cause Horner's syndrome Splaying of int and ext carotid arteries
66
What is a branchial cyst?
Congenital abnormality Soft, cystic swelling between angle of jaw and SCM in anterior triangle Will transilluminate Usually present after age of 10 Conservative or surgical management
67
What are red flags for head and neck cancers?
``` Lump in the mouth or on the lip Unexplained ulceration in the mouth lasting more than 3 weeks Erythroplakia or erythroleukoplakia Persistent neck lump Unexplained hoarseness of voice Unexplained thyroid lump ```
68
What is leukoplakia of the mouth?
Precancerous condition- SCC White patches - usually on side of tongue or cheeks Asymptomatic, irregular and raised patches which can't be scraped off
69
What is Erythroplakia of the mouth?
Similar to leukoplakia but red | Also pre-cancerous
70
What is lichen Planus?
autoimmune condition that causes localised chronic inflammation of the skin shiny, purplish, flat-topped raised areas with white lines across the surface

Finals Revision (23 decks)

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