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3rd yr clinical > ENT > Flashcards

ENT Flashcards

1
Q

What are the typical features of BPPV

A

Vertigo triggered by change in head position and movement, associated with nausae and lasts between 10-20 secs

Episodes for several weeks then resolve for a while

Calcium carbonate crystals- viral infection head trauma or no clear cause

Positive dix hallpike - will have rotatory nystagmus and vertigo when done

Epley manoeuvre can give relief

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2
Q

What is prebycusis

A

Age related sensorineural hearing loss
Gradual onset

Loss of high pitched noise

Audiometry will show bilateral high frequency hearing loss

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3
Q

What is otosclerosis

A

Autosomal dominant condition
Conductive hearing loss due to bone remodelling

Mainly affects the base of the stapes

Hearing loss and tinnitus

Normal bone is replaced with spongey bone - conductive deafness, tinnitus

Management
Conservative hearing aids
Surgical- stapedectomy or stapedotomy

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4
Q

What is glue ear

A

Otitis media with effusion
Peaks at 2 yrs old
Hearing loss - common cause of conductive hearing loss in childhood
speech and language delay

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5
Q

What is Meniere’s disease

A

Endolymph build up

More common in middle aged adults

Vertigo, tinnnitus and sensorineural hearing loss
Sensation of fullness in the ear- trio- hearing loss, vertigo, tinnitus

Attacks will last several hours and not position related

Nystagmus during attacks - hearing will gradually deteriorate over time

Positive Romberg test and nystagmus

Treat with Betahistine to reduce attacks F

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6
Q

What drugs can cause ototoxicity

A

Gentamicin or other aminoglycosides, furosemide, aspirin

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7
Q

What are the features of noise damage hearing loss

A

Bilateral hearing loss worse at frequencies of 3000-600Hz

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8
Q

What are the features of an acoustic neuroma (vestibular scwannoma)

A

Depends on affected cranial nerve
CN VIII: Hearing loss, vertigo, tinnitus
CN V- Absent corneal reflex
CN V11: facial palsy

Bilateral acoustic neuromas are seen in neurofibromatosis type 2

Patients usually around 40-60

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9
Q

What are the features of viral labrinthitis

A

Usually between 40-70 yrs
Acute onset can be triggered by viral/ bacterial infection or systemic disease

Hearing loss distinguishes it from vestibular neuritis

Acute onset- vertigo not triggered by movement
Nausea and vomiting, hearing loss and tinitus
Preceeding upper resp tract infection

Unidirectional horizontal nystagmus towards unaffected side
Sensorineural hearing loss

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10
Q

What is the management of sudden onset sensorineural hearing loss

A

Urgent ENT referral
Usually idiopathic
Need a loss of at least 30 decibels in 3 different frequencies on audiogram

MRI scan needed to exclude vestibular schwannoma
High dose oral corticosteroids needed can also have intra-tympanic steroids

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11
Q

What shows for Rinne’s and Webers if hearing loss is conductive

A

Rinne’s
Bone conduction is greater than air conduction in the affected ear
Air conduction is better than bone conduction in the unaffected ear

Weber’s
Lateralises to the side of the affected ear

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12
Q

What are the features of Rinne’s and Weber’s if the hearing loss is sensorineural

A

Air conduction better than bone conduction bilaterally- Rinne’s positive

Lateralises to the unaffected ear

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13
Q

What are the features of acute otitis media

A

Associated with URTIs - strep penumonaie, haemophilus influenzae, moraxella catarrhalis, staph aureus

Otalgia, hearing loss, fever, bulging tympanic membrane
Pearly grey shiny

Management
Self limiting
Analgesia
If symptoms last more than 4 days or immunocompromised, perforated or discharge in the canal- give abx
5-7 days amoxicillin (clarith if allergy)
Eryth if pregnant and allergic to pen

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14
Q

What is the management of epistaxis

A

Sit forward with mouth open- pinch cartilage for 20 mins

Use topical antiseptic - Naseptin - CONTAINS PEANUTS

Cautery if source of bleeding is visible
Packing can be used if cautery not able

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15
Q

What are the features of vestibular neuronitis and how is it treated

A

Inflam of the vestibular nerve usually due to viral infection

Symptoms most severe for the first day or days xf
-Recurrent vertigo attacks lasting hours/days
-Nausea and vomiting
-Horizontal nystagmus
-No hearing loss/ tinnitus

Management
Buccal/ IM prochloperzine for rapid relief

Oral procholperazine or antihistamine if less severe

If chronic- vestibular rehab exercises

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16
Q

What is the treatment for auricular haematoma

A

Rugby players and wrestlers- avoid cauliflower ear

Need same day ENT assessment
Incision and drainage needed

17
Q

What are the features of the feverPAIN score for tonsilitis

A

1 point for each - max score 5
Fever over 38
Purulence
Attended within 3 days or less
Severely inflamed tonsils
No cough/ cold

10 day course of phenoxymethylpenicillin or clarithromycin

18
Q

What are the causes of sensorineural hearing loss

A

Sudden sensorineural hearing loss (less than 72 hrs)
Presbycusis (age related)
Noise exposure
Menireres disease
Labyrinthitis
Acoustic neuroma
Neurological conditions - stoke MS, brain tumours
Infections
Meds

Loop diuretics
Aminoglycoside antibiotics
Chemo

19
Q

What are the features of conductive hearing loss

A

Ear wax
Infection
Fluid in the middle ear
Eustachian tube dysfunction
Perf tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours

20
Q

What audiometry findings will be present in sensorineural hearing loss

A

Both air and bone conduction will be more than 20DB

Below the 20DB line

21
Q

What are the audiometry findings will be present in conductive hearing loss

A

Normal bone conduction readings between 0-20DB
Air conduction will be greater than 20DB

Below the 20 DB level

Think that 20DB is quiet so patients with hearing loss can’t hear this and will only hear louder sounds

22
Q

What are the features of eustachian tube dysfunction

A

Fluid can’t drain freely from the middle ear
Can be related to URTI, allergies or smoking

Reduced hearing, popping noise, fullness, pain, tinnitus

Otoscopy

Management
No treatment
Valsalva manoueurvre
Decongestant
Antihistamines and steroid nasal sprays

Surgery
Adenoidectomy
Grommets
Balloon dilatation eustachian tuboplasty

23
Q

What are the features of otitis externa

A

Can be acute or chronic
Swimmers ear

Bacterial (pseudomonas aeruginosa (gram neg rod shaped)/ staph aureus/ fungal infection/ eczema

Can treat pseudomonas aeruginosa- treat with gent/ quinolones/ ciprofloxacin

Don’t give aminosalicylates gent etc if there is a perforated tympanic membrane- ototoxic

Ear pain, discharge, itchy, conductive hearing loss

Management
Mild- acetic acid 2% - antifungal and antibacterial
Prophylactic before and after swimming

Moderate - topic antibiotic and steroid eg. neomycin and dex

Severe- oral abx

Ear wicks can be used

If fungal- clotrimazole ear drops

24
Q

What are the features of malignant otitis externa

A

Severe and life threatening
Spreads to bones around ear
Osteomyelitis of temporal bone
Diabetes, immunosuppression, HIV

Headache, severe pain and fever

Granulation tissue between the bone and cartilage in ear

Admit to hosp
Iv abx
Imaging

25
Q

What are some red flags associated with tinnitus

A

Unilateral
Pulsatile
Hyperacusis
Unilate hearing loss
Sudden onset hearing loss
Vertigo/ dizzy
Headaches
Neuro symptoms
Suicidal ideation

26
Q

What are some central causes of vertigo

A

Posterior circulation infarction- sudden onset- ataxia, diplopia, cranial nerve defects, limb symptoms

Tumours

MS- relapsing and remitting

Vestibular migraine– mins to ours- aura and headache

27
Q

What are the features of the cerebellar examination

A

DANISH
Dysdiadochokinesia
Ataxia gait (walk heel to toe)
Nystagmus
Intention tremor
Speech
Heel shin test

28
Q

What special tests are used to diagnose vertigo

A

Rombergs test- proprioception and vestibular function

Dix-Hallpike - diagnose BPPV

HINTS Head impulse, nystagmus, test of skew to distinguish peripheral and central vertigo

29
Q

What are the features of cholesteatoma

A

Squamous epithelial cells
Foul discharge
Unilateral conductive hearing loss

Infection pain vertigo facial nerve palsy

30
Q

How is bells palsy treated

A

Unilateral lower motor neurone

Treat with prednisone
50mg for 10 days
60mg for 5 days followed 5 days reducing regime of 10mg a day

Lubricating eye drops

31
Q

How is ramsay hunt treated and presented

A

VCZ
LMNL
Painful tender vesicular rash in ear
Pred and aciclvir

32
Q

How is a nose bleed managed

A

Sit up tilt head forward, squeeze nostrils spit out blood don’t swallow

Wait 10-15 mins
If doesn’t stop
Nasal packing- nasal tampons/ inflatable packs
Nasal cautery

After acute nosebleed- naseptin nasal cream 4x/ day for 10 days
Can’t give in peanut allergy

33
Q

What is the treatment for sinusitis

A

Nothing with symptoms for up to 10 days- viral can take 2-3 weeks to resolve

If symptoms not improving in 10 days give
High dose nasal steroid for 14 days
A delayed abx prescprtion if not improving in another 7 days - phenoxymethylpenicillin

Can predispose to nasal polyps- usually bilateral

Unilateral nasal polyp- red flag

34
Q

What are the features and treatment of tonsillitis

A

Viral infection usually
Bacterial causes- group A strep (Pen V)
Strep pneumonia, Hib, Morazella, staph aureus

Palatine tonsils usually affected

Sore throat, fever above 38, pain on swallowing- red inflamed tonsils, cervical lymphadenopathy

FeverPAIN score 4-5 65% probability of it being bacterial
Fever in 24 hrs
Purulemce
Attending within 3 days onset
Inflamed tonsils
No cough

Management
Simple analgesia if viral suspected
Fever pain >4 antibiotics- pen V 10 days or clarity if pen allergic

Complication- peritonsilar abscess- quincy

35
Q

What are the features of quincy

A

Peritonsilar abscess
Sore throat, painful swallow, fever, neck pain, ear pain, tender lymph nodes

Trismus- can’t open mouth
Change in voice - hot potato voice
Swelling

Bacteria- usually group A strep

Urgent ENT refer - needle aspiration and surgical incision
Dexamethasone to settle inflam and broad spec abx- coamoxiclav

36
Q

What are the features of infectious mononucleosis

A

EBV
Fever sore throat fatigue lymphadenopathy

Intense maculopapular rash in response to amoxicillin or cefalosporins

First line monospot test

Management supportive- avoid alcohol and contact sports

36
Q

What are the features of carotid body tumours

A

painless, pulsatile, bruit on auscultation, mobile side to side but not up and down

Carotid body tumours can compress nerves of the face- can cause a Horner’s syndrome
Ptosis, mitosis, anhidrosis

37
Q

What is the difference between a thyroglossal cyst and a brachial cyst

A

Thyroglossal cyst
Mobile, non tender, soft, fluctuant - Can become infected and painful

Brachial cysts- round soft cystic between angle of jaw and sternocleidomastoid

38
Q

How is squamous cell carcinomas of the head and neck

A

Cetuximab- monoclonal antibody

3rd yr clinical (22 decks)

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