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Finals > ENT > Flashcards

ENT Flashcards

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
Q

Describe the management of Meniere’s disease

A

Acute attacks: prochlorperazine, cyclizine, promethazine

Prophylaxis - betahistine

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26
Q

Describe the pathophysiology of obstructive sleep apnoea

A

Collapse of the pharyngeal airway during sleep - characterised by periods of not breathing

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27
Q

Describe the risk factors for obstructive sleep apnoea

A

Middle aged
Male
Obesity
Smoking/alcohol

28
Q

Describe the presentation of obstructive sleep apnoea

A

Usually reported by partner - episodes of apnoea in sleep

Snoring
Morning headache
Waking unrefreshed from sleep
Daytime sleepiness
Concentration problems

29
Q

Describe the management of obstructive sleep apnoea

A

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
Q

Describe the pathophysiology of otitis externa

A

Inflammation of the skin of the external auditory canal, which can be localised or diffuse

Acute (<3 weeks) or chronic

31
Q

Describe the aetiology of otitis externa

A

Bacteria - pseudomonas aeruginosa, S. aureus

Fungus - aspergillus, candida

Eczema

Seborrhoeic dermatitis

Contact dermatitis

32
Q

Describe the presentation of otitis externa

A

Ear pain
Ear discharge
Itchiness

Conductive hearing loss

33
Q

Describe the diagnosis of otitis externa

A

Clinical - otoscopy
-If tympanic membrane is perforated, suggests otitis media

34
Q

Describe the management of otitis externa

A

Mild: acetic acid
Moderate: topical neomycin + betamethasone OR topical gentamicin + hydrocortisone
Severe: Oral flucloxacillin

Fungus: topical clotrimazole

35
Q

Describe the risks associated with topical gentamicin in otitis externa

A

Aminoglycosides are ototoxic, so must ensure tympanic membrane is not perforated before prescribing

36
Q

Describe the pathophysiology of malignant otitis externa

A

Infection spreads to bone around ear, causing osteomyelitis of the temporal bone

37
Q

Describe the aetiology of malignant otitis externa

A

Diabetes

Immunosuppression (e.g. HIV, chemotherapy)

38
Q

Describe the presentation of malignant otitis externa

A

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
Q

Describe the management of malignant otitis externa

A

IV antibiotics

CT/MRI to assess spread

40
Q

Describe the complications of malignant otitis externa

A

Facial nerve palsy (and other cranial nerve pathologies)

Meningitis

Intracranial thrombosis

Death

41
Q

Describe the pathophysiology of otitis media

A

Infection of the middle ear, with bacteria entering via the eustachian tube

Usually preceded by a viral URTI

42
Q

Describe the aetiology of otitis media

A

S. pneumoniae - most common
H. influenzae
S. aureus

43
Q

Describe the presentation of otitis media

A

Ear pain
Hearing loss
Fever
Cough
Sore throat
Coryzal symptoms
Discharge - if tympanic membrane perforated

44
Q

Describe the examination findings in otitis media

A

Bulging, red, inflamed membrane on otoscopy

45
Q

Describe the management of otitis media

A

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
Q

Give the complications of otitis media

A

Mastoiditis

Otitis media with effusion

Hearing loss

Tympanic membrane rupture

Abscess

47
Q

Describe the pathophysiology of rhinosinusitis

A

Inflammation of the paranasal sinuses and nasal cavity.

Blockage of ostia (drainage holes from sinus)

Acute (<12 weeks) or chronic

48
Q

Describe the aetiology of rhinosinusitis

A

Infection - esp. following URTI

Allergy - e.g. allergic rhinitis, hayfever

Foreign body

Trauma

Polyps

49
Q

Describe the presentation of rhinosinusitis

A

Recent viral URTI

Nasal congestion/discharge

Facial pain/discharge/pressure/swelling

Loss of sense of smell

50
Q

Describe the diagnosis of rhinosinusitis

A

Clinical - may use nasal endoscopy

51
Q

Describe the management of rhinosinusitis

A

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
Q

Describe nasal spray technique

A

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
Q

Describe the pathophysiology of tonsillitis

A

Inflammation of the tonsils

54
Q

Describe the aetiology of tonsillitis

A

Usually viral

Bacterial:
-Strep. pneumoniae
-H. influenzae

55
Q

Describe the presentation of tonsillitis

A

Sore throat
Fever
Pain on swallowing

Red, inflamed tonsils

Exudate - of bacterial

Anterior cervical lymphadenopathy

56
Q

Describe the Centor criteria

A

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
Q

Describe the FeverPAIN score

A

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
Q

Give the management of tonsillitis

A

Admission if: immunocompromised, systemically unwell, stridor, resp. distress

No treatment if likely viral - consider delayed abx prescription

Phenoxymethylpenicillin
Clarithromycin (if penicillin allergy)

59
Q

Give the complications of tonsillitis

A

Peri-tonsillar abscess (AKA quinsy)

Otitis media

Post-strep glomerulonephritis

Post-strep reactive arthritis

60
Q

Describe vestibular neuronitis

A

Vertigo due to inflammation of the vestibular nerve, usually due to a viral infection, improves within a few weeks

61
Q

Describe labyrinthitis

A

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
Q

Describe the presentation of a posterior circulation stroke

A

Vertigo
Ataxia
Diplopia
Cranial nerve defects

Sudden onset

63
Q

Which features of vertigo point to a specific cause

A

Recent viral illness - labyrinthitis/vestibular neuronitis

Headache - vestibular migraine/CVA/tumour

64
Q

Describe a cerebellar examination

A

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
Q

Describe the management of vertigo

A

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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