ENT Flashcards
1
Q
What is otitis media and what what are the 3 different types
A
otitis media is an umbrella term referring to the a middle ear infection and inflammation
The 3 types are:
- acute otitis media
- otitis media with effusion
-Chronic suppurative otitis media
2
Q
who is AOM common in
A
Children
3
Q
name of common viral causative pathogen for AOM (4)
A
rhinovirus, adenovirus, enterovirus, RSV
4
Q
2 Name of common bacteria that causes AOM
A
Haemophilia influenza or strep pneumonia
5
Q
What does AOM usually present with
A
deep ear pain
sensation of blocked ear
sudden ear pain
Fever
Irritability
URTI symptoms
Discharge if TM perforated
6
Q
what is OME and another name for otitis media with effusion
A
aka glue ear
chronic inflammation of the middle ear with collection of fluid
7
Q
what is chronic suppurative otitis media
A
it is a chronic disorder where there is chronic rupture of the TM and ottorrhea
8
Q
One complication of chronic suppurative otitis media
A
associated with permanent hearing loss
9
Q
Pathophysiology of AOM
A
the bacterial infection occurs as result of the nasopharyngeal organisms migrating via the eustachian tube
There is also impaired conciliary action
10
Q
Name 6 Risk factors for AOM
A
Smoking
Young age
URTI
Bottle feeding and dummy use
Adenoids
Anatomical malformation
11
Q
What is the management for acute otitis media , conservative, 1st and 2nd line antibiotics
A
Self-limiting, paracetamol for pain, 1st: amoxicillin, 2nd: co-amoxiclav
12
Q
What are symptoms of cerumen impaction
A
conductive hearing loss
Aural fullness
otorrhea
Tinnitus
Dizziness
13
Q
Management for cerumen impaction
A
Use manual removal by using olive oil
Aural irrigation using syringe
Microsuction
14
Q
What is otitis externa and when is it classified as acute and chronic
A
Inflammation of the external ear canal
Acute= <3wks
Chronic = >3wks
15
Q
What are the 2 common bacterial causes for otitis externa
A
pseudomonas aeruginosa and staphylococcus aureus
16
Q
2 fungal causes for otitis externa
A
candida albicans or aspergillus niger
17
Q
What are 3 non infectious causes of otitis externa
A
caused by skin conditions like atopic dermatitis, psoriasis and acne
18
Q
6 RF for otitis externa
A
- Hot & Humidity
- Swimming
- Older age
- Dermatological issues
- Narrow ear canal
- Hx of ear surgery
19
Q
Name 5 SS of otitis externa
A
- Ear pain
- Discharge
- Itch
- Hearing loss
- Fever
20
Q
How is otitis externa diagnosed
A
Clinically
21
Q
What lymph node examination finding will be seen in otitis externa
A
lymphadenopathy in pre/post- auricular nodes
22
Q
What are the 2 general advice given to patients with otitis externa
A
- strict water precaution
- Avoid itching
23
Q
Medical management for Localised OE
A
- analgesia
- incision and drainage
- oral antibiotic → Flucloxacillin
24
Q
Medical management for Diffuse OE
A
- Analgesia
- Topical antibiotic with or without topical corticosteroid →Gentamicin, ciprofloxacin, neomycin +/- betamethasone, prednisolone
- Oral antibiotic→ flucloxacillin
25
What is necrotising otitis externa
OE can progress to an osteomyelitis in middle aged diabetic with prolonged pseudomonas aeruginosa infection
26
SS of necrotising OE
- Constant, deep otalgia
- Vertigo
- Profound hearing loss
- Fever
- Palsy
27
Investigation done for necrotising OE
CT scan
28
Antibiotic name and route and advice for necrotising OE
IV - Tazocin
Strict diabetic control
29
What is TM perforation
rupture of the tympanic membrane
30
Name some causes of TM perforation
Trauma
Foreign body
Infection
Acute and chronic otitis media
Middle ear barotrauma
31
SS of TM perforation
Otalgia
Ottorrhoea
Tinnitus
Bloody or purulent discharge
Perforated TM
Decreased hearing in affected ear
32
How is TM perforation diagnosed
Clinically using an otoscope
33
Management for TM perforation
Keep ear dry
Warm compress or analgesia can be used for ear pain
Antibiotic if infected
Last resort is surgery
34
What is glue ear
otitis media with effusion
35
how can glue ear present
the TM may appear amber/grey
air fluid bubbles behind TM
36
Management for glue ear
watchful waiting for 3 months
Do not offer antibiotics
Myringotomy to restore hearing
recurrent cases may need adenoidectomy
37
What is mastoiditis
Acute infection of the mastoid bone which surrounds the ear- retention of pus
38
what is the common causative pathogen in mastoiditis
streptococcus pneumonia
39
What is the pathophysiology of mastoiditis
Mastoiditis is associated with the progression of AOM with infection spreading from the middle ear into the mastoid air cell system via the mastoid antrum causing osteitis of mastoid bone
40
Name some RF for Mastoiditis
Recurrent AOM
Age
Learning difficulties
Immunocompromised
Anatomical abnormalities
41
3 common presentation in mastoiditis
Post auricle erythema, tenderness, swelling
42
4 SS in children less than 2years of age with mastoiditis
- ear pulling
- ear pain
- Irritability, fever, lethargy
- fever
43
SS in adults with mastoiditis
- Severe otalgia
- Otorrhoea
- Headache
- Hearing loss
- Fever
- Vertigo
44
Investigation needed for mastoiditis
FBC, U+E, CRP, Lactate and blood cultures
CT of temporal bones
45
Management in mastoiditis
- resus if needed
- Analgesia if needed
- IV antibiotics
46
What is Meiners disease
clinical syndrome affecting the inner ear, balance and hearing
47
What is the triad for Meiners disease
Vertigo, tinnitus and hearing loss
48
3 RF for Meiners disease
FHx
Viral infection
Head trauma
49
How does Meniere disease present
presents as an episodic attack with vertigo, haring loss, tinnitus and aural fullness
also have abnormal romberg's test and Nystagmus
50
Diagnostic criteria for Meniere disease
- > or equal to 2 vertigo episode lasting 20 minutes to 12 hours
- Fluctuating hearing, tinnitus or aural fullness of affected ear
- Hearing loss confirmed by audiometry
- Not better accounted for by alternative vestibular diagnosis
51
Management for Meniere disease
- Lifestyle and dietary changes (minimise salt and caffeine)
- Betahistine
- Vestibular sedative for vertigo (prochlorperazine
52
What is barotrauma
when ear drum becomes stretched and tense
53
what can barotrauma cause
ear pain and dulled hearing
54
why does barotrauma occur and when is it common
occurs due to unequal pressure that develops either side of the eardrum
common in landing aeroplanes or scuba divers
55
ways to prevent barotrauma in aeroplane
Suck sweets
Take deep breath in
Do not sleep when landing
Ear plugs
56
What is BPPV
Benign positional paroxysmal vertigo
disorder of inner ear characterised by repeated episodes of positional vertigo
57
what causes BPPV
- Caused by loose calcium carbonate debris in semi-circular canals causing motion of fluid of inner ear
- with head movement, debris move in the canals causing motion of fluid of inner ear (endolymph) which induces symptoms of vertigo
58
SS of BPPV
- Episodic vertigo
- Sudden onset
- Provoked by head movement
- Brief (<30 seconds)
- Nausea, vomiting
- Imbalance
- NO hearing loss or tinnitus
- Normal neurological & otoscopic exam
- Positive Dix-Hallpike manoeuvre
59
Management for BPPV
Particle repositioning manoeuvre (Epley manoeuvre)
60
What is another name for acoustic neuroma
Vestibular schwannoma
61
What is acoustic neruoma
It is a benign and slow growing tumour
62
Pathophysiology of acoustic neuroma
usually arise from schwann cells in vestibulocochlear nerve sheath causing hearing loss due to compression
63
Signs and symptoms of acoustic neuroma
- Unilateral hearing loss
- Facial numbness, weakness
- Dizziness
- Tinnitus
- Difficulty localising sound
- Headache
- Gait disturbance
- Nystagmus
64
2 investigation you do for acoustic neuroma
Audiogram
MRI of internal auditory meatus
65
Management for acoustic neuroma
Dependant upon size and growth
- watchful waiting
radiation
surgical resection
66
at what size is an acoustic neuroma considered life threatening
40mm or above
67
What is labyrinthitis
inflammation of of the labyrinth
68
what can labyrinthitis cause
hearing loss and problems with balance
69
Common causes of labyrinthitis
- viral infection
- bacterial
Autoimmune
70
ss of labyrinthitis
vertigo
nausea/vomiting
dizziness
hearing loss
tinnitus
71
What is acute sinusitis
symptomatic inflammation of paranasal sinuses for <12wks.
72
what is a common cause of acute sinusitis
viral URTI
73
Risk factors for acute sinusitis
allergic rhinitis
asthma
smoking
anatomical variation
74
SS of acute sinusitis
Hx of URI symptoms
nasal blockage
rhinorrhoea
Facial pressure
Maxillofacial sinus swelling
erthema
fever
75
Management for acute sinusitis
- Symptoms < or equal 10days
- NO antibiotic
- supportive care
- Symptoms > 10 days
- high dose nasal corticosteroids → mometasone
- backup antibiotic prescription → PenV or co-amoxiclav
76
What is allergic rhinitis
IgE mediated inflammatory disorder of the nose
77
What is the pathophysiology of allergic rhinitis
- APC process antigen into peptides
- APC presents peptides to helper T cells
- Helper T cells release interleukins (IL-4 and IL-3)
- IL-4 and IL-3 stimulates B-cell transformation to IgE antibody coat mast cells within nasal mucosa and basophils in the plasms
78
Signs and symptoms of allergic rhinitis
Sneezing, nasal itching, rhinnorrhea,nasal congestion, eye itching , nasal mucosa odema, hypertrophic nasal turbinates
79
Management for allergic sinusitis for Mild-moderate intermittent or mild persistent symptoms
- intranasal antihistamine (azelastine) or non-sedating oral antihistamine (cetirizine, loratadine)
- Intranasal chromone if antihistamine not tolerated (sodium cromoglicate)
80
Management for allergic sinusitis for Moderate-severe persistent or unresponsive symptoms
- Daily intranasal corticosteroid during periods of allergen exposure (mometasone furoate, fluticasone furoate, fluticasone propionate)
- Nasal irrigation with saline & allergen avoidance
- E.g. avoid walking in grassy open spaces if grass pollen allergen
81
Where does majority of epistaxis arise from
Majority arises from anterior nasal septum, location of kiesselbach plexus of vessels
82
Name some causes of epistaxis
Trauma
inflammation
clotting disorder
excessive alcohol consumption
nasal oxygen therapy
83
How to diagnose epistaxis
- Anterior rhinoscopy to identify bled location
- FBC, coagulation studies
84
Management plan for epistaxis
- Admit if suspect posterior epistaxis or haemodynamically unstable
- First aid measure
- upright and lean forward pinching cartilaginous nose
- Bleeding stops then prescribe topical antiseptic
- if bleeding does not stop then : do nasal cautery or nasal packing
85
what is chronic sinusitis
symptomatic paranasal sinus inflammation for more than 12 weeks
86
Risk factors for chronic sinusitis
asthma
ciliary impairment
aspirin insensitivity
smoking
immunocompromised
87
SS of chronic sinusitis
Hx of URI symptoms
nasal blockage
rhinorrhoea
Facial pressure
Maxillofacial sinus swelling
erthema
fever
88
Ix for chronic sinusitis
CT scans of sinuses
89
Management for chronic sinusitis
- control underlying condition
- stop smoking, avoid allergic triggers
- nasal saline irrigation
90
What are nasal polyps
Benign swelling of nasal mucosa of paranasal sinuses
often associated with chronic sinusitis
91
Risk factors for nasal polyps
- Asthma
- Eosinophilic granulomatous polyangiitis
- Aspirin sensitivity
- Genetics
92
Signs and symptoms of nasal polyps
Nasal obstruction
Nasal discharge
Facial pressure
anosmia
nasal discharge
93
Ix for nasal polyps
- clinical diagnosis
- Nasal endoscopy
- CT scan sinuses
94
1st line for nasal polyps
- Intranasal corticosteroid
- nasal saline irrigation
- +/- doxycycline
95
2nd line for nasal polyps
Surgical polypectomy
96
How to differentiate between septal haematoma or turbinate
- Gently palpate
- if boggy= haematoma
- if hard = displaced cartilage or turbinate
97
What is acute pharyngitis
inflammation of pharynx that cause discomfort
98
Signs and symptom of acute pharyngitis
Headache
nausea
vomiting
abdo pain
fever
99
What 2 things are pharyngitis most commonly associated with
pharyngeal exudate and cervical lymphadenopathy
100
What 2 scoring system do we use for pharyngitis
FeverPAIN and CENTOR
101
What does feverPain look at
Fever
Purulence
Attend rapidly
Inflamed tonsils
No cough or coryza
A score of 0 or 1 = 13-18% likelihood of isolating streptococcus.
A score of 2 or 3 = 34-40%
A score of 4 or 5 = 62-65%
102
What is the CENTOR criteria
Tonsillar exudate.
Tender anterior cervical lymphadenopathy or lymphadenitis.
History of fever (over 38°C).
Absence of cough.
- A score of 0, 1 or 2 is thought to be associated with a 3-17% likelihood of isolating streptococcus. A score of 3 or 4 is thought to be associated with a 32-56% likelihood of isolating streptococcus.
103
Management for pharyngitis
self limiting
if strep A- then phenoxymethylpenicillin
104
Common viral cause of tonsilitis (4)
influenza, parainfluenza, EBV, acute HIV
105
2 common bacterial cause of tonsilitis
Group A strep, Neisseria gonorrhoea
106
Name some signs and symptoms of tonsilitis
Sore throat
Odynophagia
cough and rhinorrhoea if viral
Fever
Tonsillar exudate if bacterial
cervical lymphadenopathy
107
supportive care Management for tonsilitis
Paracetamol, NSAID
Fluids
Throat lozenges
108
Management for tonsilitis (antibiotics) 1st and 2nd line and which to use if pregnant
1- phenoxymethylpenicillin
2- clarithromycin
if preg- erythromycin
109
What is an aphthous ulcer
ulceration of the oral mucosa with grey base
110
name some causes of an aphthous ulcer
stress
local injury
Zinc, vit b12, folate or iron deficiency
Crohns
coeliac
111
Management for an aphthous ulcer
saline mouth rinsing
topical corticosteroids
Milk of magnesia
112
when should an aphthous ulceration be send for a 2ww referal
if more than 21 days
113
signs and symptoms of laryngitis
Hoarseness
Odynophagia
Cough
Fever
Respiratory distress
114
what is oral candidiasis and common causative agent
Oral overgrowth of the normal GI flora yeast like fungus candida species → candida albicans (common)
115
Rf for oral candidiasis
extremes of ages
immunosuppression
medication - ICS
Diabetes
Poor dental hygiene
Smoking
deficiency
116
Signs and symptoms of oral candidiasis
Local burning, soreness or itching
Odynophagia
Oral thrush
Patches of curd-like yellow/white plaques on tongue, palate or pharynx
- Easily scraped off revealing erythematous base
Angular cheilitis
117
Management for oral candidiasis
Treat underlying cause
-for mild and localised infection :
topical miconazole gel or nystatin suspension
-for severe or extensive infection give oral fluconazole
118
signs and symptoms of oral HSV
painful blisters
Fever, malaise and sore throat, cervical lymphadenopathy if primary infection
119
Management for oral HSV
Topical antiviral OTC
Oral antiviral
minimise transmission risk
120
Risk factors for head and neck cancers
- Smoking cigarettes, cigars, pipes
- Chewing tobacco or betel
- Alcohol
- HPV 16
- Diet
- Exposure to chemicals
- Pre-cancerous conditions
▫ Leukoplakia
121
Name some general symptoms of a head and neck cancer
- Localised pain
- Localised swelling
- Difficulty breathing
- Bleeding
- Changes to eating or speaking
- Lymphadenopathy
122
What is a quinsy
- Abscess between the wall of the tonsil and wall of the pharynx
- Peritonsillar abscess
- Bacterial aetiology
- Complication of tonsillitis
123
Presentation of a quinsy
- Unilateral throat pain
- Odynophagia
- Unilateral otalgia
- Fever
- Erythematous, oedematous tonsil with contralateral uvular deviation
- Tonsillar exudate
- Trismus
- Muffled “hot potato” voice
- Cervical lymphadenopathy
124
Management for quinsy
abscess drainage
iv antibiotics
iv fluids
125
What is glandular fever
aka infectious mononucleosis
EBV
126
Presentation of glandular fever
- Sore throat
- Myalgias
- Fever
- Tonsillar hypertrophy and exudate
- Erythematous pharynx
- Soft palate petechiae
- Cervical lymphadenopathy
- Splenomegaly & Hepatomegaly
- Maculopapular rash
127
Ix for glandular fever
- Monospot test
- FBC
- Lymphocytosis
- LFTs
- AST/ALT elevated 2-3x ULN
128
Management for glandular fever
- Supportive care
- Symptoms expected for 2-4 weeks with fatigue lasting longer
- Avoid kissing, sharing eating/drinking utensils
- Avoid heavy lifting and contact/collision sports for 1st month of illness
129
What is oral leucoplakia
White plaques of oral mucosa
130
RF for oral leucoplakia
- Alcohol
- tobacco
- Immunosuppression
- Chronic candidiasis
131
Presentation of oral leucoplakia
- Asymtptamatic
- Bright white sharply defined patches
- Slightly raised above surrounding mucosa
- Cannot be rubbed away
132
What is sialadenitis
Infection of the major salivary glands by retrograde transmission of bacteria from oral cavity via the salivary duct
133
Signs and symptoms of sialadenitis
- Enlarged painful salivary gland,
- purulent drainage from duct orifice
- red/painful duct
- fever
- decreased salivary secretion
134
Management for sialadenitis
- Heat/cold compresses with massage
- Aggressive hydration
- Lemon drops or citrus juice to promote salivary flow
- Analgesia medication
135
What is normal/ positive rinne's test
Air conduction heard more than bone conduction
136
What is a normal Weber's test
Heard in the midline
137
Rinnes and webers result for conductive hearing loss
Negative rinne( bone more than air conduction)
AND
Hear in the bad ear
138
Rinnes and webers result for sensorineural hearing loss
Positive rinne( air more than bone conduction)
AND
Heard in the good ear
139
what is parotitis
swelling of the parotid glands
these are salivary glands located between your jaw and ear
140
what viral infection is parotitis most commonly associated with
mumps
141
name some general causes of parotitis
salivary gland stones
autoimmune
dental problems
viral
bacterial
