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Phase 3A Revision > ENT > Flashcards

ENT Flashcards

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1
Q

What is conductive hearing loss?

A

Problem with transmission of sound from the environment to the inner ear

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2
Q

What is sensorineural hearing loss?

A

Problem with the sensory system or the vestibulocochlear nerve

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3
Q

How is Weber’s test performed?

A

Tuning form is placed in the centre of the forehead
Patient is asked if the sound is louder in either side

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4
Q

How is Weber’s test interpreted?

A

Normal = Sound heard equally in both sides

Sensorineural hearing loss = sound louder in normal ear

Conductive hearing loss = sound louder in affected ear

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5
Q

How is Rinne’s test performed?

A

Tuning fork is placed on the mastoid process (bone conduction)
Tuning fork moved to in front of the ear when sound can no longer be heard (air conduction)

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6
Q

How is Rinne’s test interpreted?

A

Normal = Sound can be heard again once fork is in front of ear (air conduction better than bone)

Abnormal = Sound cannot be heard again (bone better than air)

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7
Q

What are causes of sensorineural hearing loss?

A

Sudden sensorineural hearing loss
Presbycusis (age-related)
Noise exposure
Meniere’s disease
Labyrinthitis
Acoustic neuroma
Neurological cause e.g., MS, stoke, tumour
Neurological infections e.g., meningitis
Medication e.g., furosemide, gentamycin, chemotherapy

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8
Q

What are the causes of obstructive hearing loss?

A

Ear wax
Infection e.g., otitis media/externa
Effusion
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses (bony growth into the ear canal)
Local tumours

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9
Q

What is presbycusis?

A

Age related sensorineural hearing loss

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10
Q

What is the pattern of hearing loss in presbycusis?

A

High-pitches affected first
Gradual
Symmetrical

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11
Q

What are the risk factors for presbycusis?

A

Age
Male gender
Family history
Loud noise exposure
Diabetes
Hypertension
Ototoxic medication
Smoking

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12
Q

What is sudden sensorineural hearing loss?

A

Hearing loss over less than 72 hours with no other explanation
Otological emergency

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13
Q

What is otosclerosis?

A

Remodelling of the small bones in the ear causing conductive hearing loss

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14
Q

How does otosclerosis present?

A

Can be unilateral or bilateral
Hearing loss
Tinnitus
Lower-pitch sounds first (opposite of presbycusis)

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15
Q

What is the management for otosclerosis?

A

Conservative with hearing aids
Surgical (stapedectomy or stapedotomy)

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16
Q

What is an acoustic neuroma?

A

Benign tumours of the Schwann cells surrounding the vestibulocochlear nerve

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17
Q

How does acoustic neuroma present?

A

Usually unilateral
Sensorineural hearing loss
Tinnitus
Dizziness/imbalance
Sensation of fullness
Facial nerve palsy if tumour grows and causes compression

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18
Q

What is the management of acoustic neuroma?

A

Conservative if no symptoms or if surgery is inappropriate
Surgery
Radiotherapy

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19
Q

What are the complications of acoustic neuroma surgery?

A

Damage to vestibulocochlear nerve –> hearing loss and dizziness
Damage to facial nerve –> palsy

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20
Q

What is a cholesteatoma?

A

Abnormal collection of squamous epithelial cells in the middle ear
Non-cancerous but can invade local structures

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21
Q

How does cholesteatoma present?

A

Foul discharge from ear
Unilateral conductive hearing loss
Infection
Pain
Vertigo
Facial nerve palsy

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22
Q

What is the management of cholesteatoma?

A

Surgical removal

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23
Q

Where does epistaxis originate from?

A

Kiesselbach’s plexus in Little’s area

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24
Q

What are the causes of epistaxis?

A

Nose picking
Colds
Sinusitis
Vigorous nose blowing
Trauma
Changes in the weather
Coagulation disorders
Anticoagulation medication
Cocaine use
Tumours

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25
How does epistaxis present?
Usually unilateral bleeding Bilateral bleeding suggests a posterior bleed with increased risk of aspiration
26
What is the management of epistaxis?
Usually resolves Recurrent and significant bleeds may require further investigation for underlying cause First aid --> cautery --> packing --> ligation
27
What is classed as a severe nosebleed?
Not stopped after 10-15 minutes
28
How does eustachian tube dysfunction present?
Reduced or altered hearing Popping noises/sensations Sensation of fullness Pain/discomfort Tinnitus Symptoms worsen when external air pressure changes (e.g., flying, mountain climbing, diving)
29
What is the management of eustachian tube dysfunction?
No treatment and wait for spontaneous resolve if not severe Valsalva manoeuvre (hold nose and blow) Decongestant nasal spray Antihistamines/steroid nasal spray Surgery if persistent or severe --> adenoidectomy, grommets, balloon dilation
30
What is the cause of infective mononucleosis?
EBV infection Spread by saliva of affected individuals by kissing/sharing cups etc
31
How does infective mononucleosis present?
Teenagers and young adults Fever Sore throat Fatigue Lymphadenopathy
32
What investigations are performed for infective mononucleosis?
Monospot test IgM (acute infection) or IgG (immunity) to EBV
33
What is the management of infective mononucleosis?
Supportive
34
What are 2 complications of infective mononucleosis?
Liver impairment --> Avoid alcohol Increased risk of splenic rupture --> Avoid contact sports
35
Why should amoxicillin not be given in infectious mononucleosis?
Can cause a macular papular rash
36
What is obstructive sleep apnoea?
Collapse of the pharyngeal airway causing episodes of apnoea during sleep
37
What are risk factors for obstructive sleep apnoea?
Middle age Male Obesity Alcohol Smoking
38
What are the features of obstructive sleep apnoea?
Episodes of apnoea during sleep --> often reported by partner Snoring Morning headache Waking up unrefreshed Daytime sleepiness Concentration problems Reduced O2 saturation during sleep
39
What is the management of obstructive sleep apnoea?
Referral to ENT or sleep clinic Correct reversible risk factors --> lose weight, stop smoking, avoid alcohol CPAP Surgical reconstruction of soft palate
40
What is the most common causative organism of otitis externa?
Pseudomonas aeruginosa Also staph aureus
41
How does otitis externa present?
Ear pain Discharge Itchiness Conductive hearing loss if ear becomes blocked
42
What is the management of otitis externa?
Acetic acid 2% spray if mild If moderate, topical antibiotic and steroid (neomycin, dexamethasone and acetic acid (otomize spray)) If severe, oral flucloxacillin or clarithromycin
43
What is a complication of otitis externa?
Malignant otitis externa Infection spreads to bones in canal and skull Causes temporal osteomyelitis
44
What is the most common causative organism of otitis media?
Streptococcus pneumoniae (most common) Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus
45
How does otitis media present?
Ear pain Reduced hearing Malaise and fever Symptoms of URTI Balance issues/vertigo Discharge is tympanic membrane ruptured
46
What is the management for otitis media?
Most resolve without antibiotics in 3-7 days Analgesia Monitor for mastoiditis If indicated, amoxicillin or clarithromycin (penicillin allergy) or erythromycin (penicillin allergy and pregnant)
47
What pattern of nasal polyps is a red flag?
Unilateral --> suggests tumour
48
What conditions are associated with nasal polyps?
Chronic rhinitis/sinusitis Asthma Cystic fibrosis Eosinophilic granulomatosis with polyangiitis
49
How do nasal polyps present?
Chronic rhinosinusitis Difficult nasal breathing Snoring Nasal discharge Anosmia
50
What is the management of nasal polyps?
Refer if unilateral Intranasal topical steroid Surgery
51
How does rhinosinusitis present?
Recent viral URTI Nasal congestion/discharge Facial tenderness/pressure Headache Facial swelling Anosmia
52
What is the management of rhinosinusitis?
Most cases are viral and resolve in 2-3 weeks If symptoms last longer than 10 days, delayed Penicillin V + high dose nasal spray
53
What is the most common cause of tonsilitis?
Viral
54
What is the most common bacterial cause of bacterial tonsilitis?
Group A streptococcus (Strep pyogenes) --> Most common Streptococcus pneumoniae --> 2nd most common Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus
55
How does tonsilitis present?
Sore throat Fever > 38 Pain on swallowing Red, inflamed, enlarged tonsils with/without exudate Anterior cervical lymphadeopathy
56
What is the Centor criteria?
Score used to determine the probability that tonsilitis is due to a bacterial cause
57
What scores points in the Centor criteria?
Fever > 38 Tonsillar exudate Absence of cough Tender lymphadenopathy 3 or more points = 40-60% chance of bacterial tonsilitis
58
What scores points in FeverPAIN?
Fever in last 24 hours Purulence Attended within 3 days of onset Inflamed tonsils No cough or coryza 2-3 = 34-40% probability of bacterial cause 4-5 = 62-65% probability of bacterial cause
59
What is the management of tonsilitis?
Likely viral = safety net, simple analgesia If likely bacterial, Penicillin V for 10 days Admission if systemically unwell, has respiratory distress or evidence of peritonsillar abscess
60
What are complications of tonsilitis?
Peritonsillar abscess (Quincy) Otitis media Scarlet fever Rheumatic fever Post-streptococcal glomerulonephritis/reactive arthritis
61
Which vaccine has reduced the prevalence of epiglottitis?
Haemophilus influenzae B
62
What features suggest possible epiglottitis?
Sore throat and stridor Drooling Tripod position High fever Difficulty/painful swallowing Muffled voice Scared/quiet child Septic/unwell appearance
63
What investigations should be performed for epiglottitis?
None - do not want to distress child Lateral neck xray would show thumb sign
64
How is epiglottitis managed?
Alert most senior anaesthetist and paediatrician Leave the child in a comfortable environment as to not distress them ABCDE --> manage airway Once airway is secure, IV abx (e.g., ceftriaxone) and dexamethasone
65
What is difference between central and peripheral vertigo?
Central vertigo affects the brainstem or cerebellum Peripheral vertigo affects the vestibular system
66
What is the pathophysiology of BPPV?
Calcium carbonate crystals become displaced in the semi-circular canals when the head is moved
67
What are the causes of BPPV?
Viral infection Head trauma Ageing Idiopathic
68
What symptoms are present in BPPV?
Vertigo that is positional --> movement required to confuse the vestibular system Lasts around 1 minute before symptoms settle Lasts over several weeks before resolving, but can reoccur NO hearing loss or tinnitus
69
What test is used to diagnose BPPV?
Dix-Hallpike manoeuvre
70
How is the Dix-Hallpike manoeuvre performed?
The patient sits upright on a flat examination couch with their head turned 45 degrees to one side (turned to the right to test the right ear and left to test the left ear) Support the patient’s head to stay in the 45 degree position while rapidly lowering the patient backwards until their head is hanging off the end of the couch, extended 20-30 degrees Hold the patient’s head still, turned 45 degrees to one side and extended 20-30 degrees below the level of the couch Watch the eyes closely for 30-60 seconds, looking for nystagmus Repeat the test with the head turned 45 degrees in the other direction
71
What manoeuvre is used to treat BPPV?
Epley manoeuvre
72
How is the Epley manoeuvre performed?
Follow the steps of the Dix-Hallpike manoeuvre, having the patient go from an upright position with their head rotated 45 degrees (to the affected side) down to a lying position with their head extended off the end of the bed, still rotated 45 degrees Rotate the patient’s head 90 degrees past the central position Have the patient roll onto their side so their head rotates a further 90 degrees in the same direction Have the patient sit up sideways with the legs off the side of the couch Position the head in the central position with the neck flexed 45 degrees, with the chin towards the chest At each stage, support the patient’s head in place for 30 seconds and wait for any nystagmus or dizziness to settle
73
What is the pathophysiology of Meniere’s disease?
Excessive build up of endolymph in the semi-circular canals
74
How does Meniere’s disease present?
Triad of hearing loss, vertigo and tinnitus
75
How is Meniere’s disease managed?
Symptom management --> prochlorperazine, antihistamines Prophylaxis --> Betahistine
76
What is the presentation of vestibular neuronitis?
Acute onset vertigo --> constant and triggered by head movement History of recent viral URTI Nausea and vomiting Balance problems NO problems with hearing
77
WHhat test is used to diagnose vestibular neuronitis or labyrinthitis?
Head impulse test
78
How is the head impulse test performed?
Patient fixes gaze on doctor’s nose Doctor jerks patient’s head 10-20° in one direction and slowly returns to midline Normal should be able to maintain focus Abnormal patients’ eyes will saccade (rapidly move back and forth) until eventually returning to centre Will be normal in central vertigo or current absence of symptoms
79
What is management of vestibular neuronitis?
Prochlorperazine Antihistamines Referral if symptoms don't improve
80
How does labyrinthitis present?
Acute onset vertigo Can be associated with hearing loss and tinnitus Viral illness symptoms
81
What is the management of labyrinthitis?
(Same as vestibular neuronitis) Prochlorperazine Antihistamines Antibiotics if bacterial cause
82
What is the difference between the presentations of labyrinthitis and vestibular neuronitis?
Labyrinthitis affects hearing, whereas vestibular neuronitis does not
83
What are the causes of central vertigo?
Posterior circulation stroke Tumour Multiple sclerosis Vestibular migraine
84
How does central vertigo present?
Sustained, non-positional vertigo
85

Phase 3A Revision (23 decks)

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