ENT Flashcards

Question

Chronic otitis media organisms

Answer 1

haemophillus influenza less common: Pseudomonas aeruginosa Staph aureus Streptococcus Anaerobic bacteria

Answer 2

Micro suck and inspection of the ear under microscope Topical antibiotic and steroid drops for 7-10 days if active infection Strict water precautions If medical strategies not effective or the ear discharge is particularly affecting pts life then myringoplasty can be performed - surgical repair of the ear drum

Answer 3

inﬂammatory condition aﬀecting the middle ear for a period greater than 3 months. Active or inactive and 2 types, mucosal and squamous epithelial COM. Active mucosal disease - perforated tympanic membrane allows infection to develop in the middle ear Active squamous epithelial disease results from cholesteatoma formation Inactive mucosal disease -dry perforation Inactive squamous epithelial -shallow self cleaning retracted tympanic membrane. can present with Recurrent intermittent discharge arising from ear hearing loss may be present mucosal usually to do with pars tensa squamous usually pars flaccida

Answer 4

Deep retraction of the tympanic membrane that has keratin accumulated in it and can develop into a keratin cyst Usually forms due to chronic Eustachian tube dysfunction Discharge from the can be offensive Hearing loss Doesnt respond to antibiotic drops or oral antibiotics Imbalance The keratin cyst can expand and erode the ossicles and eventually damage structures adjacent to the middle ear

Answer 5

Vascular tumour that presents as a red mass behind an intact tympanic membrane Patient may have pulsatile tinnitus

Answer 6

topical abx and steroid drops if infection present pure tone audiogram to determine degree of hearing loss close inspection and cleaning of the ear under the microscope

Answer 7

mastoidectomy - opening the mastoid air cells, removing the cholesteatoma from the middle ear followed by reconstructing of the ossicles and tympanic membrane CT guided

Answer 8

Infection Bleeding No improvement in hearing Complete loss of hearing, called a dead ear (if the inner ear is damaged) Tinnitus Vertigo Facial nerve injury, resulting in facial palsy Altered taste (chorda tympani nerve damage) Recurrence of disease needing revision surgery

Answer 9

inflammatory condition of the middle ear in which there is development of a middle ear effusion. This causes a conductive hearing loss. It is not an infection although it may follow an infection.

Answer 10

retraction - pars flaccida (attic) perforations - pars tensa

Answer 11

Vertigo - inflammation spread to labyrinth Hearing loss - conductive or SN Acute otitis externa Facial weakness - facial nerve involvement

Answer 12

Meningitis - by eroding through the tegmen Subdural abscess - spread from infection to extradural then subdural Temporal lobe abscess Sigmoid sinus thrombosis

Answer 13

earache ear discharge hearing affected fever often young child often associated URTI tympanic membrane looks inflamed

Answer 14

Ultrasound Scan Fine needle aspiration cytology CT

Answer 15

Vascular Infective/inflammatory (trauma unlikely) Autoimmune - thyroid (metabolic none) (iatrogenic unlikely) Neoplastic Congenital

Answer 16

Carotid body tumours Carotid artery aneurysms

Answer 17

- Lymphadenopathy (Bacterial – suppurative (e.g. Streptococcus, Staphylococcus) Viral (e.g. Epstein Barr, Cytomegalovirus) Fungal TB Toxoplasmosis) - Neck abscess - Sialadenitis (salivary gland inflammation)

Answer 18

Sarcoidosis Kawasaki disease Sinus histiocytosis Castleman’s syndrome

Answer 19

Nodule Goitre May be benign or malignant Thyroiditis

Answer 20

Benign - salivary gland tumours - Lipoma - Sebaceous cyst Malignant - Metastatic squamous cell carcinoma (SCC) - Lymphoma - Malignant salivary gland tumour

Answer 21

Dermoids Thyroglossal duct cyst Branchial cysts Teratomas Larygocoele Haemangloma Plunging ranula (fluid collection under the tongue

Answer 22

smoking alcohol betel nut chewing Human Papilloma Virus (+EBV in nasopharyngeal)

Answer 23

- Panendoscopy and biopsy ie. an examination under anaesthetic of the pharynx, laryx & upper oesophagus. - CT skull base to diaphragm to assess the extent of the primary tumour and to identify any regional or distant metastases - MDT discussion

Answer 24

- hoarseness > 6 weeks - oral swelling > 3 weeks - dysphagia > 3 weeks - neck mass > 3 weeks - unilateral nasal obstruction, particularly when associated with purulent discharge - cranial neuropathies - orbital massess

Answer 25

- All red or red and white patches of the oral mucosa. - Ulceration of oral mucosa persisting for more than three weeks. - Unexplained tooth mobility not associated with periodontal disease.

Answer 26

Overuse Acute laryngitis Chronic laryngitis secondary to reflux Use of asthma inhalers Smoking Squamous cell carcinoma of the larynx Vocal cord palsy of which there are many aetiologies inc recurrent laryngeal and vagus nerve palsies

Answer 27

benign inflammatory lesions of the vocal fold and usually result from overuse. may settle with appropriate speech therapy but can be removed surgically

Answer 28

oedema of the vocal folds with gelatinous material within most common in women who are smokers treatment is cessation of smoking, control of gastroesophageal reflux and, in refractive cases, incision of the vocal fold with evacuation of the gelatinous material.

Answer 29

radiotherapy - curative or palliation surgery - curative intent chemotherapy - not usually curative for head and neck palliative? need for rehabilitation? swallow, voice choices for treatment determined by patient factors (age, comorbidity, previous treatment, lifestyle) and tumour factors (site, size, staging, previous treatment)

Answer 30

Follicular adenoma Hyperplastic nodules Thyroid cysts

Answer 31

Papillary carcinoma Follicular carcinoma Medullary carcinoma Anaplastic carcinoma

Answer 32

Physiological – Pregnancy, puberty Degenerative – Multinodular goitre Thyroiditis – Most commonly Hashimoto’s thyroiditis Grave’s Disease

Answer 33

- thyroid lump in a child - rapidly growing painless lump - unexplained hoarseness - stridor - enlarged cervical lymph nodes

Answer 34

Thyroidectomy +/- lymph node resection External beam radiotherapy or Immunotherapy - inoperable or recurrent disease or distant disease that has failed to respond to previous radioactive iodine therapy Radioactive iodine therapy - post-operatively for larger tumours or those with unfavourable histological features / distant spread (chemotherapy not used in thyroid malignancy)

Answer 35

structural inflammatory infective

Answer 36

rhinosinusitis septal deviation nasal polyps foreign body in the nose Granulomatosis with polyangitis - systemic disorder that can affect the cartilage of the nose adenoids

Answer 37

bilateral nasal obstruction associated with anterior rhinorrhea and sneezing often atopic history can be worse in summer O/E oedema of the nasal mucosa and a watery discharge in the nose.

Answer 38

RAST testing (Radioallergosorbent) - identifies allergies to specific allergens

Answer 39

Antihistamines if specific allergies identified + other allergy management techniques such as avoidance Topical nasal steroid as a spray - mainstay as treatment

Answer 40

short term relief in acute rhinosinusitis (maximum 1 week)

Answer 41

only if no response to medical treatment

Answer 42

topical nasal steroid + short course of prednisolone if not effective then Functional endoscopic sinus surgery + carry on topical steroid afterwards

Answer 43

Acute rhinosinusitis (ARS) lasts less than 12 weeks with complete resolution of symptoms. Chronic rhinosinusitis (CRS) lasts more than 12 weeks without complete resolution of symptoms.

Answer 44

external inspection anterior nose - Thuddicums speculum posterior nose - flexible nasal endoscope

Answer 45

Littles area/ Kiesselbach's plexus - formed by 3 arteries; anterior ethmoid artery, the sphenopalatine artery and the greater palatine artery

Answer 46

if a prominent vessel identified as the source of epistaxis can only be done to one side of septum cauterised holding the silver nitrate stick in each position for 15 seconds. The vessel itself can then be cauterised. Antiseptic cream, such as Naspetin, should then be applied and given to the patient to apply twice daily for 2 weeks.

Answer 47

for a few weeks; avoid hot drinks avoid very hot baths/showers avoid picking the nose avoid very hot and spicy foods if recurrence; apply pressure for 15 mins and if this fails attend A&E

Answer 48

A-E check airway and breathing circulation; IV access, haemodynamically stable? FBC, coag profile, group and save apply pressure if identifiable cauterise source of bleeding continued bleeding? anterior nasal packing continued bleeding? posterior nasal packing continued bleeding? ligate artery in surgery

Answer 49

-most common cause is trauma i.e. punching -pmhx of hypertension, anticoagulant or antiplatelet therapy - inflammation of the nasal mucosa - rarely malignancy

Answer 50

squamous cell carcinoma most commonly occurs in individuals of Chinese origin

Answer 51

mainly due to bleeding from Little's area primarily due to trauma in most cases stops with pressure and can be prevented from bleeding recurring using cream such as naspetin or bactroban

Answer 52

used for epistaxis sometimes anti fibrinolytic agent. contraindicated - blood clots, bleeding in the brain, or urine, heart valve problems, visual problems secondary to bleeding, irregular heartbeat, irregular unexplained menstrual bleeds, using birth control medication or devices, taking medication such as clotting factors and medication containing tretinoin

Answer 53

replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults sometimes shows up in pregnancy Management hearing aid stapedectomy

Answer 54

urgent referral to ENT - red flag for nasopharyngeal carcinoma

Answer 55

symptoms - nasal obstruction - rhinorrhoea, sneezing - poor sense of taste and sme Management -all patients with suspected nasal polyps should be referred to ENT for a full examination -topical corticosteroids shrink polyp size in around 80% of patients

Answer 56

spontaneous vertigo accompanied by unilateral hearing loss and tinnitus

Answer 57

high dose corticosteroids and referral to ENT

Answer 58

unilateral symptoms persistent symptoms despite 3 months treatment epistaxis

Answer 59

typically develops following a viral infection with recurrent vertigo attacks lasting hours or day, usually nystagmus and sometimes associated vomiting no hearing loss or tinnitus treated with prochlorperazine or an antihistamine needs to be distinguished from a posterior circulation stroke - use HINTs test

Answer 60

Reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve. - auricular pain progresses to include a vesicular rash around the ear, tinnitus and vertigo. Facial nerve palsy may also occur. treatment oral aciclovir 7 days and oral prednisolone 5 days

Answer 61

sensorineural hearing loss of higher frequencies

Answer 62

sensorineural particularly at frequencies 3000-6000Hz

Answer 63

Recent viral infection Sudden onset vertigo Nausea and vomiting Hearing may be affected

Answer 64

- symptoms for >4 days or not improving - systemically unwell - immunocompromised or at high risk of secondary infections - acute otitis media with perforation 5-7 days of amoxicillin is first line

Answer 65

3 or more Absence of cough Fever Anterior cervical lymphadenopathy Presence of tonsillar exudate

Answer 66

Vestibular rehabilitation - make urgent referral

Answer 67

Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine

Answer 68

analgesia intranasal corticosteroids if symptoms present >10 days oral Abs not normally required but may be given for severe presentations

Answer 69

onset of vertigo and rotatory nystagmus

Answer 70

asthma aspirin sensitivity nasal polyposis

Answer 71

typically spread from a middle ear infection pt v unwell with fever, middle ear symptoms + post auricular inflammation and ear proptosis needs admission and IV Abx

ENT Flashcards

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