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Y6 Senior Surgery COPY > ENT > Flashcards

ENT Flashcards

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1
Q

sx of acute diffuse otitis externs

A

fever
lymphadenopathy
diffuse swelling
variable pain, pruritus
pain on moving ear and jaw
impaired hearing

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2
Q

how do you manage acute otitis externaal

A

topical antibiotics SOFRADEX + topical steroid

Oral Fluclox or Gent if severe

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3
Q

why are children more likely to have otitis media

A

short horizontal and poorly functioning eustachian tubes

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4
Q

who is otitis media most common in

A

youong children,
male
cleft palate
downs

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5
Q

how does otitis media present

A

pain in the ear and fever

may have reduction in hearing

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6
Q

hat causes otitis media

A

a VIRAL infection whhich swells the eustachian tube

this blocks the middle ear fluid drainage

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7
Q

how do you manage otitis media

A

Oral amox 5 days if:

  • more than 4 days of sx
  • less than 2 yo and bilateral
  • 1 perforation / discharge in canal

otherwise consider delayed / no prescription

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8
Q

what is a choleasteatoma

A

abnormal skin growth / cyst of epithelium in the middle ear

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9
Q

what causes choleasteatoma

A

congenital

due to perforation in chronic suppurative OM

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10
Q

sx choleasteatoma

A

EAR DISCHARGE (foul smelling white discharge)

OR

conductive hearing loss

may also have headache, pain, verttigo, facial paralysis

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11
Q

Who should you suspect choleasteatoma in

A

anyone with unexplained unilateral ear discharge not repsonsive to abx

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12
Q

how do you ix cholesteatoma

A

Otoscopy

or CT

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13
Q

how do you manage choleasteatoma

A

refer to ENT for surgery

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14
Q

what is tinittus

A

sensation of sound WITHOUT external sound

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15
Q

causes of tinittus

A

Vestibular system:

  • menieres
  • otosclerosis

Brain:

  • acoustic neuromoaa
  • head injury

General:

  • noise induced
  • presbycusis

drugs

  • aspirin
  • aminoglycosides
  • loop diuretics
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16
Q

differentials for vertigvo

A

vestibular:
- menieres
- BPPV
- labirinthitis

Central:

  • acoustic neuroma
  • MS
  • stroke
  • head injury
  • inner ear syphilis

Drugs:

  • gentamicin
  • loop diuretics
  • metronidazole
  • co-trimoxazole
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17
Q

what does Romberg +ve indicate?

A

vestibular or proprioceptive disorder

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18
Q

what is menieres diseasee

A

dilatation of endolymph spaces due to increased lymph fluid

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19
Q

how does menieres prsent

A
  • recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural).
  • a sensation of aural fullness/pressure
  • nystagmus and a positive Romberg test
  • nausea and vomiting
  • episodes last minutes to hours
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20
Q

what ix for meenieres

A

audiometry,

confirms low-mid frequency sensorineural hearing loss

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21
Q

mx for acute attacks of menieres

A
  • If severe symptoms → hospital admission for IV labyrinthine sedatives + fluids
  • to treat emesis: buccal or IM prochlorperazine/cyclclizine
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22
Q

preventative treatment for menieres

A

o Trial of betahistine – can reduce attacks
o Vestibular rehabilitation exercise

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23
Q

vestibular neuronitis history

A

following a febrl history (URTI)
sudden vertigo and vomiting
exacerbated by eye movements
NO HEARING LOSS

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24
Q

what s the difference between vestibular neuronitis and labirinthitis

A

vestibular neuronitis : NO HEARING LOSS

labirinthitis: hearing loss

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25
how do you manage vestibular neuronitis and labiritinthis
prochlorperazine
26
which maneuvre confirms BPPV?
Dix-Hallpike
27
which maneuvre treats BPPV
Epley maneuvre
28
causes of hearing loss in adults
Conductive (between auricle and round window) - external ear obstruction (wax) - TM perforation (trauma, infection) - Ossicle defect (otosclerosis) sensorineural (defect in cochlea, cochlear nerve or brain) - Drugs (aminoglycosides, vancomycin) - Infective (meningitis, measles, mumps, herpes) - menieres, trauma, MS; CPA lesion, low B12
29
what is an acoustic neuroma
benign slow growing tumour of superior vestibular nerve
30
what condition is acoustic neuroma associated with
NF2
31
sx acoustic neuroma
slow onset unilateral SNHL tintinnus vertigo headache CN palsy (5,7,8) cerebellar signs
32
ix acoustic neutroma
MRI
33
otosclerosis aetiology
AUTOSOMAL DOMINANT | fixation of tapes at the oval window
34
S/S otosclerosis
begins in early adult lifwe bilateral conductive deafness tintinnus hearing loss improves with noise hearing loss worsens with pregnancy menstruation menopause
35
mx otosclerosis
hearing ads | stapes implant
36
mx allergic rhinosinusitis
mild sx: oral antihistamine (cetirizine) or intranasal antihistamine (azelastine) PRN moderate-severe: Intranasal coorticosteroid
37
what is sinusitis
infection of the maxillary sinuses from viral URTI > may lead to secondary bacterial infection may occur with pain, swelling and tenderness on front of face
38
how do you manage sinusitis
if sx <10 days, no antibiotics sx > 10 days give high dose nasal corticossteroid for 14 days abx if sx dont get better after 7 days
39
how do you manage nasal polyp
``` routiine referral to ENT medical therapy (topical betamethasone drops 4-6 weeks, followed by short course of oral steroids) ```
40
common pathogens causing otitis externa
Staph aureus | Pseudomonas aeroginosa
41
RF otitis externa
swimming in dirrty water diabetes old age wax buildup
42
what is necrotising otitis externa
progression of otitis externa through ear canal > bon > across skull base ESSENTIALLY CAUSES OSTEOMYELITIS into mastoid and temporal bones
43
sx necrotising otitiis external
severe pain in ear exhudate granulation tissue in ear may cause CN palsy
44
how do you manage necrotising otitis externa
urgent ENT referral ADMIT CT head, IV ABx
45
what does TM look like in otitis media
red and bulging TM loss of normal light reflex perforation and pus
46
what is another name for glue ear?
Otitis media with effusion
47
SSx glue ear
``` reduced hearing (conductive) NO other problems ```
48
how do you ix glue ear, and what are findings
otoscopy (eardrum dull and retracted, fluid level visible() | audiometry (hearing test)
49
how do you manage glue ear
observe for 3 months | if persistent, refer to ENT
50
what is a dangerous complication of otitis media in children?
MASTOIDITIS
51
Explain mastoiditis pèresentation
inflamed mastoids> mastoid pain discharge swelling behinid ear, ear pushed forward
52
How do you manage mastoiditis
ADMIT IV Abx CT scan may require incision and drainage
53
causes of epistaxis
LOCAL - trauma (nose picking) - URTI, allergy - nasal polup SYSTEMIC: - GPA (wegener's) - coagulopathy - hereditary haemorrhagic telangectasi
54
acute mx of epistaxis
sit up, lean forward, mouth open Pinch soft area of nose (compress nasal cartilage) Place ice on nose
55
mx if epistaxis takes longer than 15 minutes to respove
1. remove clots, gauze, rhinoscopy 2. visualise bleeding> CAUTERISE 3. bleeing cannot be visualised > PACKING (anterior / posterior with foley) 4. refer to ENT
56
2 key causes of tonsillitis
- group A beta haemolytic strep | - EBV (MONO)
57
what must you never give in suspected MONO
never give AMOXICILLIN | as it causes a widespread maculopapular rash
58
what score can you use for tonsillitis, and what does it detect
**CENTOR** score --> do they have group a streptococci (strep throat) Each point scores 1: - Tonsillar exudate - Tender anterior cervical lymphadenopathy - Fever >38 - no cough if score 3/4, there is up to 50% chance that it is due to bacteria > prescribe antibiotics + rapid strep antigen test test
59
feverpain criteria
o Fever over 38°C. o Purulence (pharyngeal/tonsillar exudate). o Attend rapidly (3 days or less) o Severely Inflamed tonsils o No cough or coryza 1 point each
60
causes of tonsillitis
usually viral: rhinovirus, adenovirus, influenza bactera: GAS (strep throat), mycoplasma pneumonia
61
sx tonsillitis
sore throat fever dysphagia, odynophagia headache hoarness, rhinitis, fatigue, lethargy
62
medical management of tonsillitis caused by GBHS
1. Analgesia 2. Antibiotics: first line ~ phenoxymethylpenicillin (Penicillin V)5-10 days second line ~ clarithromycin as second line (if allergic)
63
what shows on ENT exam for tonsillitis
* tonsillar: exudate (white = bacteria), enlargement, erythema * cervical lymphadenopathy
64
general management advice for tonsillitis
o Encourage fluid intake o Ibuprofen/ paracetamol = antipyretic or analgesia o Salt water gargling, medicated lozenges o Avoid hot drinks - can exacerbate pain
65
when do you admit patient with tonsillitis
- pain not tolerated withh analgesia - complete dysphagia - difficulty breating - clinically dehydrated - QUINSY
66
what is QUINSY
PERI-TONSILLAR ABSCESS
67
how does quinsy present
unilateral tonsil swelling with deviated ubvula | needs drainage + admission + IV Abx
68
Mx of tonsillitis
Phenoxymethylpen 10 days (if indicated) | Clarythromycin if allergy
69
what is a complication of GAS tonsillitis (i.e. what can onsillitis progress to in children)
Group A strep can progress to SCARLET FEVER
70
how does Scarlet fever present
Sandpaper erythematous rash on neck and chest > sppreads to trunk and legs Strawberry tongue may later progress to rheumatic feber
71
mx of scarlet fever
phenooxymethylpenicillin
72
epiglottitis rf
UNVACCINATE child (as caused by H influenza)
73
presentation of epiglottitis
sitting forward drooling sore throat dysphagia STRIDOR
74
what is ludwigs angina
infction of submandibular space
75
how does ludwig angina present
neck swelling - WOODY AND HARD TO TOUCH dysphagia fever drooling
76
what is age related hearing loss also called
presbycusis
77
describe presbycusis presentation
over 65 yo bilateral sensironeural high frequency hearing loss slow onset may have tinnituss
78
mx presbycusis
hearinig aiid
79
what does a unilateral polyp require
URGENT ENT REFERRAL | as it is a red flag sx
80
what must yoou do if TM rupture does not repair in 6-8 weeks
refer to ENT for MYRINGOPLASTY (repair of perforation)
81
describe the hearing loss type in presbycusis
BILAT HIGH FREQUENCY HEARING LOSS
82
where does most nosebleeding come from
the ANTERIOR nasal septum
83
how do you manage quincy
Admit IV antibioticss + drainage consider tonsillectomy in 6 weeks

Y6 Senior Surgery COPY (11 decks)

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