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ENT Flashcards

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1
Q

Describe the pathophysiology of acoustic neuroma

A

Benign tumour of Schwann cells surrounding the auditory nerve

Usually unilateral
-If bilateral is suggestive of neurofibromatosis type II

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2
Q

Describe the presentation of acoustic neuroma

A

Unilateral sensorineural hearing loss
Unilateral tinnitus
‘Fullness’ in ear

Facial nerve palsy
Dizziness/imbalance

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3
Q

What does a positive Rinne’s test suggest?

A

Air and bone conduction reduced equally - test appears normal

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4
Q

Describe the results of Rinne’s and Weber’s testing in acoustic neuroma

A

Sensorineural hearing loss

Rinne’s positive - air and bone conduction reduced equally

Weber’s - sound louder on unaffected side

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5
Q

Describe the diagnosis of acoustic neuroma

A

Audiometry - sensorineural hearing loss

MRI/CT brain - shows tumour

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6
Q

Describe the management of acoustic neuroma

A

Conservative - if surgery inappropriate or no symptoms

Surgery - classic scar behind ear

Radiotherapy

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7
Q

Describe the risks of acoustic neuroma surgery

A

Permanent hearing loss/dizziness

Facial weakness

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8
Q

Describe the presentation of BPPV

A

Vertigo on head movement (lasts 20-60 seconds)

Asymptomatic between attacks

Does not cause hearing loss/tinnitus

Usually in older population

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9
Q

Describe the pathophysiology of BPPV

A

Calcium carbonate crystals - otoconia - become displaced in the semicircular canals

These crystals disrupt the normal flow of endolymph through the canals, confusing the vestibular system

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10
Q

Describe the Dix-Hallpike maneouvre

A

To diagnose BPPV

Rapidly lower patient from seated position with head turned laterally 45 degrees - positive test illicits an attack or nystagmus

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11
Q

Describe the Epley maneouvre

A

To treat BPPV

Extension of Dix-Hallpike maneouvre which moves crystals to untroublesome area

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12
Q

Describe the pathophysiology of epiglottitis

A

Inflammation and swelling of the epiglottis typically caused by Haemophilus infleunza infection

May swell and obstruct airway

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13
Q

Describe the epidemiology of epiglottitis

A

Unvaccinated children!!!

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14
Q

Describe the presentation of epiglottitis

A

Sore throat
Drooling
Stridor
Tripod position - sat forward with hands on knees

Fever
Difficult or painful swallowing

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15
Q

Describe the diagnosis of epiglottitis

A

CLINICAL - treat if high suspicion

Lateral neck XR - ‘thumb sign’, exclude foreign body

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16
Q

Describe the management of epiglottitis

A

IV ceftriaxone + dexamethasone

AIRWAY MANAGEMENT - may require intubation/tracheostomy

DO NOT DISTRESS THE PATIENT - may prompt airway closure
-Do not examine or make them upset

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17
Q

Give a complication of epiglottitis

A

Epiglottic abscess

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18
Q

Describe the pathophysiology of glandular fever

A

Infectious mononucleosis

Infection with EBV, commonly spread by sharing saliva

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19
Q

Describe the presentation of glandular fever

A

Classical: adolescent with sore throat who develops itchy rash after taking amoxicillin

Fever
Sore throat
Fatigue

Lymphadenopathy
Tonsillar enlargement
Splenomegaly - may rupture

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20
Q

Describe the management of glandular fever

A

Usually self-limiting - lasting 2-3 weeks

Avoid alcohol - EBV interfered with hepatic alcohol metabolism

Avoid contact sports - risk of splenic rupture

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21
Q

Describe the diagnosis of glandular fever

A

Monospot test/Paul-Bunnell test - almost 100% specific for glandular fever

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22
Q

Describe the pathophysiology of Meniere’s disease

A

Excessive build-up of endolymph in the labyrinth

Raised pressure results in disrupted sensory signals

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23
Q

Describe the presentation of Meniere’s disease

A

Hearing loss (sensorineural)
Tinnitus
Vertigo (not triggered by movement - unlike BPPV)

Typically 40-50 years
Unilateral symptoms
Fullness in ear
Imbalance
“Drop attacks” - unexplained falls without LOC

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24
Q

Describe the diagnosis of Meniere’s disease

A

Clinical - requires ENT referral

Audiology assessment

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25
Describe the management of Meniere's disease
Acute attacks: prochlorperazine, cyclizine, promethazine Prophylaxis - betahistine
26
Describe the pathophysiology of obstructive sleep apnoea
Collapse of the pharyngeal airway during sleep - characterised by periods of not breathing
27
Describe the risk factors for obstructive sleep apnoea
Middle aged Male Obesity Smoking/alcohol
28
Describe the presentation of obstructive sleep apnoea
Usually reported by partner - episodes of apnoea in sleep Snoring Morning headache Waking unrefreshed from sleep Daytime sleepiness Concentration problems
29
Describe the management of obstructive sleep apnoea
Epworth sleepiness scale - determine daytime sleepiness and relate to occupation - i.e. those in high risk jobs (incl. HGV driver) should have immediate referral ENT/Sleep clinic referral Correct reversible factors - weight, alcohol CPAP - maintains airway patency Uvulopalatopharyngoplasty (surgery)
30
Describe the pathophysiology of otitis externa
Inflammation of the skin of the external auditory canal, which can be localised or diffuse Acute (<3 weeks) or chronic
31
Describe the aetiology of otitis externa
Bacteria - pseudomonas aeruginosa, S. aureus Fungus - aspergillus, candida Eczema Seborrhoeic dermatitis Contact dermatitis
32
Describe the presentation of otitis externa
Ear pain Ear discharge Itchiness Conductive hearing loss
33
Describe the diagnosis of otitis externa
Clinical - otoscopy -If tympanic membrane is perforated, suggests otitis media
34
Describe the management of otitis externa
Mild: acetic acid Moderate: topical neomycin + betamethasone OR topical gentamicin + hydrocortisone Severe: Oral flucloxacillin Fungus: topical clotrimazole
35
Describe the risks associated with topical gentamicin in otitis externa
Aminoglycosides are ototoxic, so must ensure tympanic membrane is not perforated before prescribing
36
Describe the pathophysiology of malignant otitis externa
Infection spreads to bone around ear, causing osteomyelitis of the temporal bone
37
Describe the aetiology of malignant otitis externa
Diabetes Immunosuppression (e.g. HIV, chemotherapy)
38
Describe the presentation of malignant otitis externa
Otitis externa PLUS: -Headache -Fevere -Severe pain Granulation at junction between bone and cartilage in ear - seen as ring roughly halfway along ear canal
39
Describe the management of malignant otitis externa
IV antibiotics CT/MRI to assess spread
40
Describe the complications of malignant otitis externa
Facial nerve palsy (and other cranial nerve pathologies) Meningitis Intracranial thrombosis Death
41
Describe the pathophysiology of otitis media
Infection of the middle ear, with bacteria entering via the eustachian tube Usually preceded by a viral URTI
42
Describe the aetiology of otitis media
S. pneumoniae - most common H. influenzae S. aureus
43
Describe the presentation of otitis media
Ear pain Hearing loss Fever Cough Sore throat Coryzal symptoms Discharge - if tympanic membrane perforated
44
Describe the examination findings in otitis media
Bulging, red, inflamed membrane on otoscopy
45
Describe the management of otitis media
Most resolve spontaneously in 3-7 days Simple analgesia Antibiotics: -Amoxicillin - first line -Clarithromycin - in penicillin allergy -Erythromycin - in pregnant women allergic to penicillin
46
Give the complications of otitis media
Mastoiditis Otitis media with effusion Hearing loss Tympanic membrane rupture Abscess
47
Describe the pathophysiology of rhinosinusitis
Inflammation of the paranasal sinuses and nasal cavity. Blockage of ostia (drainage holes from sinus) Acute (<12 weeks) or chronic
48
Describe the aetiology of rhinosinusitis
Infection - esp. following URTI Allergy - e.g. allergic rhinitis, hayfever Foreign body Trauma Polyps
49
Describe the presentation of rhinosinusitis
Recent viral URTI Nasal congestion/discharge Facial pain/discharge/pressure/swelling Loss of sense of smell
50
Describe the diagnosis of rhinosinusitis
Clinical - may use nasal endoscopy
51
Describe the management of rhinosinusitis
Most resolve in 2-3 weeks without antibiotics High dose nasal steroid (e.g. mometasone) Saline nasal irrigation Functional endoscopic sinus surgery - to remove obstruction
52
Describe nasal spray technique
Spray using opposite hand (e.g. L hand to R nostril) Dont inhale too hard (to prevent steroid going to back of nose) Tilt head forward slightly Ask patient if they can taste the steroid after using - if so, they are inhaling too hard
53
Describe the pathophysiology of tonsillitis
Inflammation of the tonsils
54
Describe the aetiology of tonsillitis
Usually viral Bacterial: -Strep. pneumoniae -H. influenzae
55
Describe the presentation of tonsillitis
Sore throat Fever Pain on swallowing Red, inflamed tonsils Exudate - of bacterial Anterior cervical lymphadenopathy
56
Describe the Centor criteria
Estimates the likelihood that tonsillitis is bacterial in nature, and as such whether antibiotics are required. Score >3 implies antibiotic use. 1 point for each of: -Fever >38 -Tonsillar exudate -Absence of cough -Tender anterior cervical lymphadenopathy
57
Describe the FeverPAIN score
Estimates the likelihood that tonsillitis is due to bacterial infection. Score 4-5 implies antibiotics are recommended. 1 point for each of: -Fever -Purulence -Attended within 3 days of symptom onset -Inflamed tonsils -No cough or coryza
58
Give the management of tonsillitis
Admission if: immunocompromised, systemically unwell, stridor, resp. distress No treatment if likely viral - consider delayed abx prescription Phenoxymethylpenicillin Clarithromycin (if penicillin allergy)
59
Give the complications of tonsillitis
Peri-tonsillar abscess (AKA quinsy) Otitis media Post-strep glomerulonephritis Post-strep reactive arthritis
60
Describe vestibular neuronitis
Vertigo due to inflammation of the vestibular nerve, usually due to a viral infection, improves within a few weeks
61
Describe labyrinthitis
Inflammation of structures of the inner ear, usually due to viral infection. Improves within a few weeks Can cause hearing loss - distinguishes from vestibular neuronitis
62
Describe the presentation of a posterior circulation stroke
Vertigo Ataxia Diplopia Cranial nerve defects Sudden onset
63
Which features of vertigo point to a specific cause
Recent viral illness - labyrinthitis/vestibular neuronitis Headache - vestibular migraine/CVA/tumour
64
Describe a cerebellar examination
DANISH -Dysdiadochokinesia -Ataxia (gait) -Nystagmus (eye movements) -Speech -Heel-shin test (coordination) Dix-Hallpike maneouvre Romberg's test - arms by side and close eyes -Swaying when eyes closed only = proprioceptive deficit -Swaying with eyes open and closed = cerebellar deficit
65
Describe the management of vertigo
CT/MRI if thought to be central cause Prochlorperazine Antihistamine (e.g. cyclizine) Betahistine - prophylaxis in Meniere's Epley maneouvre (BPPV)

Finals (11 decks)

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