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PA- FCM > ENT > Flashcards

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

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2
Q

who is AOM common in

A

Children

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3
Q

name of common viral causative pathogen for AOM (4)

A

rhinovirus, adenovirus, enterovirus, RSV

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4
Q

2 Name of common bacteria that causes AOM

A

Haemophilia influenza or strep pneumonia

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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

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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

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7
Q

what is chronic suppurative otitis media

A

it is a chronic disorder where there is chronic rupture of the TM and ottorrhea

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8
Q

One complication of chronic suppurative otitis media

A

associated with permanent hearing loss

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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

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10
Q

Name 6 Risk factors for AOM

A

Smoking
Young age
URTI
Bottle feeding and dummy use
Adenoids
Anatomical malformation

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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

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12
Q

What are symptoms of cerumen impaction

A

conductive hearing loss
Aural fullness
otorrhea
Tinnitus
Dizziness

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13
Q

Management for cerumen impaction

A

Use manual removal by using olive oil
Aural irrigation using syringe
Microsuction

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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

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15
Q

What are the 2 common bacterial causes for otitis externa

A

pseudomonas aeruginosa and staphylococcus aureus

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16
Q

2 fungal causes for otitis externa

A

candida albicans or aspergillus niger

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17
Q

What are 3 non infectious causes of otitis externa

A

caused by skin conditions like atopic dermatitis, psoriasis and acne

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18
Q

6 RF for otitis externa

A
  • Hot & Humidity
  • Swimming
  • Older age
  • Dermatological issues
  • Narrow ear canal
  • Hx of ear surgery
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19
Q

Name 5 SS of otitis externa

A
  • Ear pain
  • Discharge
  • Itch
  • Hearing loss
  • Fever
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20
Q

How is otitis externa diagnosed

A

Clinically

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21
Q

What lymph node examination finding will be seen in otitis externa

A

lymphadenopathy in pre/post- auricular nodes

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22
Q

What are the 2 general advice given to patients with otitis externa

A
  • strict water precaution
  • Avoid itching
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23
Q

Medical management for Localised OE

A
  • analgesia
  • incision and drainage
  • oral antibiotic → Flucloxacillin
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24
Q

Medical management for Diffuse OE

A
  • Analgesia
  • Topical antibiotic with or without topical corticosteroid →Gentamicin, ciprofloxacin, neomycin +/- betamethasone, prednisolone
  • Oral antibiotic→ flucloxacillin
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25
Q

What is necrotising otitis externa

A

OE can progress to an osteomyelitis in middle aged diabetic with prolonged pseudomonas aeruginosa infection

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26
Q

SS of necrotising OE

A
  • Constant, deep otalgia
  • Vertigo
  • Profound hearing loss
  • Fever
  • Palsy
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27
Q

Investigation done for necrotising OE

A

CT scan

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28
Q

Antibiotic name and route and advice for necrotising OE

A

IV - Tazocin
Strict diabetic control

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29
Q

What is TM perforation

A

rupture of the tympanic membrane

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30
Q

Name some causes of TM perforation

A

Trauma
Foreign body
Infection
Acute and chronic otitis media
Middle ear barotrauma

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31
Q

SS of TM perforation

A

Otalgia
Ottorrhoea
Tinnitus
Bloody or purulent discharge
Perforated TM
Decreased hearing in affected ear

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32
Q

How is TM perforation diagnosed

A

Clinically using an otoscope

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33
Q

Management for TM perforation

A

Keep ear dry
Warm compress or analgesia can be used for ear pain
Antibiotic if infected
Last resort is surgery

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34
Q

What is glue ear

A

otitis media with effusion

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35
Q

how can glue ear present

A

the TM may appear amber/grey
air fluid bubbles behind TM

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36
Q

Management for glue ear

A

watchful waiting for 3 months
Do not offer antibiotics
Myringotomy to restore hearing
recurrent cases may need adenoidectomy

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37
Q

What is mastoiditis

A

Acute infection of the mastoid bone which surrounds the ear- retention of pus

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38
Q

what is the common causative pathogen in mastoiditis

A

streptococcus pneumonia

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39
Q

What is the pathophysiology of mastoiditis

A

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

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40
Q

Name some RF for Mastoiditis

A

Recurrent AOM
Age
Learning difficulties
Immunocompromised
Anatomical abnormalities

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41
Q

3 common presentation in mastoiditis

A

Post auricle erythema, tenderness, swelling

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42
Q

4 SS in children less than 2years of age with mastoiditis

A
  • ear pulling
  • ear pain
  • Irritability, fever, lethargy
  • fever
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43
Q

SS in adults with mastoiditis

A
  • Severe otalgia
  • Otorrhoea
  • Headache
  • Hearing loss
  • Fever
  • Vertigo
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44
Q

Investigation needed for mastoiditis

A

FBC, U+E, CRP, Lactate and blood cultures
CT of temporal bones

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45
Q

Management in mastoiditis

A
  • resus if needed
  • Analgesia if needed
  • IV antibiotics
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46
Q

What is Meiners disease

A

clinical syndrome affecting the inner ear, balance and hearing

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47
Q

What is the triad for Meiners disease

A

Vertigo, tinnitus and hearing loss

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48
Q

3 RF for Meiners disease

A

FHx
Viral infection
Head trauma

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49
Q

How does Meniere disease present

A

presents as an episodic attack with vertigo, haring loss, tinnitus and aural fullness
also have abnormal romberg’s test and Nystagmus

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50
Q

Diagnostic criteria for Meniere disease

A
  • > 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
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51
Q

Management for Meniere disease

A
  • Lifestyle and dietary changes (minimise salt and caffeine)
  • Betahistine
  • Vestibular sedative for vertigo (prochlorperazine
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52
Q

What is barotrauma

A

when ear drum becomes stretched and tense

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53
Q

what can barotrauma cause

A

ear pain and dulled hearing

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54
Q

why does barotrauma occur and when is it common

A

occurs due to unequal pressure that develops either side of the eardrum
common in landing aeroplanes or scuba divers

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55
Q

ways to prevent barotrauma in aeroplane

A

Suck sweets

Take deep breath in

Do not sleep when landing

Ear plugs

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56
Q

What is BPPV

A

Benign positional paroxysmal vertigo
disorder of inner ear characterised by repeated episodes of positional vertigo

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57
Q

what causes BPPV

A
  • 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
Q

SS of BPPV

A
  • 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
Q

Management for BPPV

A

Particle repositioning manoeuvre (Epley manoeuvre)

60
Q

What is another name for acoustic neuroma

A

Vestibular schwannoma

61
Q

What is acoustic neruoma

A

It is a benign and slow growing tumour

62
Q

Pathophysiology of acoustic neuroma

A

usually arise from schwann cells in vestibulocochlear nerve sheath causing hearing loss due to compression

63
Q

Signs and symptoms of acoustic neuroma

A
  • Unilateral hearing loss
  • Facial numbness, weakness
  • Dizziness
  • Tinnitus
  • Difficulty localising sound
  • Headache
  • Gait disturbance
  • Nystagmus
64
Q

2 investigation you do for acoustic neuroma

A

Audiogram
MRI of internal auditory meatus

65
Q

Management for acoustic neuroma

A

Dependant upon size and growth
- watchful waiting
radiation
surgical resection

66
Q

at what size is an acoustic neuroma considered life threatening

A

40mm or above

67
Q

What is labyrinthitis

A

inflammation of of the labyrinth

68
Q

what can labyrinthitis cause

A

hearing loss and problems with balance

69
Q

Common causes of labyrinthitis

A
  • viral infection
  • bacterial
    Autoimmune
70
Q

ss of labyrinthitis

A

vertigo
nausea/vomiting
dizziness
hearing loss
tinnitus

71
Q

What is acute sinusitis

A

symptomatic inflammation of paranasal sinuses for <12wks.

72
Q

what is a common cause of acute sinusitis

A

viral URTI

73
Q

Risk factors for acute sinusitis

A

allergic rhinitis
asthma
smoking
anatomical variation

74
Q

SS of acute sinusitis

A

Hx of URI symptoms
nasal blockage
rhinorrhoea
Facial pressure
Maxillofacial sinus swelling
erthema
fever

75
Q

Management for acute sinusitis

A
  • Symptoms < or equal 10days
    • NO antibiotic
    • supportive care
  • Symptoms > 10 days
    • high dose nasal corticosteroids → mometasone
    • backup antibiotic prescription → PenV or co-amoxiclav
76
Q

What is allergic rhinitis

A

IgE mediated inflammatory disorder of the nose

77
Q

What is the pathophysiology of allergic rhinitis

A
  • 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
Q

Signs and symptoms of allergic rhinitis

A

Sneezing, nasal itching, rhinnorrhea,nasal congestion, eye itching , nasal mucosa odema, hypertrophic nasal turbinates

79
Q

Management for allergic sinusitis for Mild-moderate intermittent or mild persistent symptoms

A
  • intranasal antihistamine (azelastine) or non-sedating oral antihistamine (cetirizine, loratadine)
  • Intranasal chromone if antihistamine not tolerated (sodium cromoglicate)
80
Q

Management for allergic sinusitis for Moderate-severe persistent or unresponsive symptoms

A
  • 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
Q

Where does majority of epistaxis arise from

A

Majority arises from anterior nasal septum, location of kiesselbach plexus of vessels

82
Q

Name some causes of epistaxis

A

Trauma
inflammation
clotting disorder
excessive alcohol consumption
nasal oxygen therapy

83
Q

How to diagnose epistaxis

A
  • Anterior rhinoscopy to identify bled location
  • FBC, coagulation studies
84
Q

Management plan for epistaxis

A
  • 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
Q

what is chronic sinusitis

A

symptomatic paranasal sinus inflammation for more than 12 weeks

86
Q

Risk factors for chronic sinusitis

A

asthma
ciliary impairment
aspirin insensitivity
smoking
immunocompromised

87
Q

SS of chronic sinusitis

A

Hx of URI symptoms
nasal blockage
rhinorrhoea
Facial pressure
Maxillofacial sinus swelling
erthema
fever

88
Q

Ix for chronic sinusitis

A

CT scans of sinuses

89
Q

Management for chronic sinusitis

A
  • control underlying condition
  • stop smoking, avoid allergic triggers
  • nasal saline irrigation
90
Q

What are nasal polyps

A

Benign swelling of nasal mucosa of paranasal sinuses
often associated with chronic sinusitis

91
Q

Risk factors for nasal polyps

A
  • Asthma
  • Eosinophilic granulomatous polyangiitis
  • Aspirin sensitivity
  • Genetics
92
Q

Signs and symptoms of nasal polyps

A

Nasal obstruction
Nasal discharge
Facial pressure
anosmia
nasal discharge

93
Q

Ix for nasal polyps

A
  • clinical diagnosis
  • Nasal endoscopy
  • CT scan sinuses
94
Q

1st line for nasal polyps

A
  • Intranasal corticosteroid
  • nasal saline irrigation
  • +/- doxycycline
95
Q

2nd line for nasal polyps

A

Surgical polypectomy

96
Q

How to differentiate between septal haematoma or turbinate

A
  • Gently palpate
  • if boggy= haematoma
  • if hard = displaced cartilage or turbinate
97
Q

What is acute pharyngitis

A

inflammation of pharynx that cause discomfort

98
Q

Signs and symptom of acute pharyngitis

A

Headache
nausea
vomiting
abdo pain
fever

99
Q

What 2 things are pharyngitis most commonly associated with

A

pharyngeal exudate and cervical lymphadenopathy

100
Q

What 2 scoring system do we use for pharyngitis

A

FeverPAIN and CENTOR

101
Q

What does feverPain look at

A

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
Q

What is the CENTOR criteria

A

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
Q

Management for pharyngitis

A

self limiting
if strep A- then phenoxymethylpenicillin

104
Q

Common viral cause of tonsilitis (4)

A

influenza, parainfluenza, EBV, acute HIV

105
Q

2 common bacterial cause of tonsilitis

A

Group A strep, Neisseria gonorrhoea

106
Q

Name some signs and symptoms of tonsilitis

A

Sore throat
Odynophagia
cough and rhinorrhoea if viral
Fever
Tonsillar exudate if bacterial
cervical lymphadenopathy

107
Q

supportive care Management for tonsilitis

A

Paracetamol, NSAID
Fluids
Throat lozenges

108
Q

Management for tonsilitis (antibiotics) 1st and 2nd line and which to use if pregnant

A

1- phenoxymethylpenicillin
2- clarithromycin
if preg- erythromycin

109
Q

What is an aphthous ulcer

A

ulceration of the oral mucosa with grey base

110
Q

name some causes of an aphthous ulcer

A

stress
local injury
Zinc, vit b12, folate or iron deficiency
Crohns
coeliac

111
Q

Management for an aphthous ulcer

A

saline mouth rinsing
topical corticosteroids
Milk of magnesia

112
Q

when should an aphthous ulceration be send for a 2ww referal

A

if more than 21 days

113
Q

signs and symptoms of laryngitis

A

Hoarseness
Odynophagia
Cough
Fever
Respiratory distress

114
Q

what is oral candidiasis and common causative agent

A

Oral overgrowth of the normal GI flora yeast like fungus candida species → candida albicans (common)

115
Q

Rf for oral candidiasis

A

extremes of ages
immunosuppression
medication - ICS
Diabetes
Poor dental hygiene
Smoking
deficiency

116
Q

Signs and symptoms of oral candidiasis

A

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
Q

Management for oral candidiasis

A

Treat underlying cause
-for mild and localised infection :
topical miconazole gel or nystatin suspension
-for severe or extensive infection give oral fluconazole

118
Q

signs and symptoms of oral HSV

A

painful blisters
Fever, malaise and sore throat, cervical lymphadenopathy if primary infection

119
Q

Management for oral HSV

A

Topical antiviral OTC
Oral antiviral
minimise transmission risk

120
Q

Risk factors for head and neck cancers

A
  • Smoking cigarettes, cigars, pipes
  • Chewing tobacco or betel
  • Alcohol
  • HPV 16
  • Diet
  • Exposure to chemicals
  • Pre-cancerous conditions
    ▫ Leukoplakia
121
Q

Name some general symptoms of a head and neck cancer

A
  • Localised pain
  • Localised swelling
  • Difficulty breathing
  • Bleeding
  • Changes to eating or speaking
  • Lymphadenopathy
122
Q

What is a quinsy

A
  • Abscess between the wall of the tonsil and wall of the pharynx
    • Peritonsillar abscess
  • Bacterial aetiology
  • Complication of tonsillitis
123
Q

Presentation of a quinsy

A
  • Unilateral throat pain
  • Odynophagia
  • Unilateral otalgia
  • Fever
  • Erythematous, oedematous tonsil with contralateral uvular deviation
  • Tonsillar exudate
  • Trismus
  • Muffled “hot potato” voice
  • Cervical lymphadenopathy
124
Q

Management for quinsy

A

abscess drainage
iv antibiotics
iv fluids

125
Q

What is glandular fever

A

aka infectious mononucleosis
EBV

126
Q

Presentation of glandular fever

A
  • Sore throat
  • Myalgias
  • Fever
  • Tonsillar hypertrophy and exudate
  • Erythematous pharynx
  • Soft palate petechiae
  • Cervical lymphadenopathy
  • Splenomegaly & Hepatomegaly
  • Maculopapular rash
127
Q

Ix for glandular fever

A
  • Monospot test
  • FBC
    • Lymphocytosis
  • LFTs
    • AST/ALT elevated 2-3x ULN
128
Q

Management for glandular fever

A
  • 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
Q

What is oral leucoplakia

A

White plaques of oral mucosa

130
Q

RF for oral leucoplakia

A
  • Alcohol
  • tobacco
  • Immunosuppression
  • Chronic candidiasis
131
Q

Presentation of oral leucoplakia

A
  • Asymtptamatic
  • Bright white sharply defined patches
  • Slightly raised above surrounding mucosa
  • Cannot be rubbed away
132
Q

What is sialadenitis

A

Infection of the major salivary glands by retrograde transmission of bacteria from oral cavity via the salivary duct

133
Q

Signs and symptoms of sialadenitis

A
  • Enlarged painful salivary gland,
  • purulent drainage from duct orifice
  • red/painful duct
  • fever
  • decreased salivary secretion
134
Q

Management for sialadenitis

A
  • Heat/cold compresses with massage
  • Aggressive hydration
  • Lemon drops or citrus juice to promote salivary flow
  • Analgesia medication
135
Q

What is normal/ positive rinne’s test

A

Air conduction heard more than bone conduction

136
Q

What is a normal Weber’s test

A

Heard in the midline

137
Q

Rinnes and webers result for conductive hearing loss

A

Negative rinne( bone more than air conduction)
AND
Hear in the bad ear

138
Q

Rinnes and webers result for sensorineural hearing loss

A

Positive rinne( air more than bone conduction)
AND
Heard in the good ear

139
Q

what is parotitis

A

swelling of the parotid glands
these are salivary glands located between your jaw and ear

140
Q

what viral infection is parotitis most commonly associated with

A

mumps

141
Q

name some general causes of parotitis

A

salivary gland stones
autoimmune
dental problems
viral
bacterial

PA- FCM (10 decks)

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