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ENT Flashcards

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1
Q

most common otitis external organisms

A

pseudomonas - bc swimmers
stap aureus

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2
Q

otitis externa presentation

A

itchy painful ear
watery discharge
tragus tenderness
conductive hearing loss if pretty inflamed
may have fever and cervical lymphadenopathy

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3
Q

rx of acute otitis external
- lifestyle, medical

A

avoid swimming for 7 days, wear ear plugs or tight fitting swim cap
Keep shampoo and soap out of ears when showering
Dont use earphones/earplugs

aural toilet eg with irrigation so topical treatments work
paracetamol
if >12 give topical acetic acid for 7 days
Can give topical abx based on clinical judgement

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4
Q

Presentation of malignant otitis external

A

unremitting pain,
purulent ear discharge,
systemic illness,
hearing loss,
granulation tissue in the ear canal,
- possible facial nerve palsy
- can lead to meningitis

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5
Q

Rx of malignant otitis externa

A

ENT referral! for admission for IV abx

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6
Q

Who is at risk of malignant otitis externa

A

diabetics
immunocompromised eg on chemo
elderly
HIV

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7
Q

Acute otitis media common organisms

A

viral - after viral URTI
strep pneumoniae
haemophillus influenzae
mortadella caterrhalis

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8
Q

Acute OM presentation

A

in kids - tugging at ear, irritability, fever, recent hx of URTI

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9
Q

Acute OM O/E

A

red bulging TM, may be perforated
fever

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10
Q

When do you give abx for acute OM

A

Symptoms lasting more than 4 days or not improving
Immunocompromised
<2 with bilateral otitis media
Otitis media with TM perforation.

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11
Q

Complications of acute OM

A

mastoiditis
TM perf
facial nerve palsy
meningitis
sepsis

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12
Q

OME presentation

A

SAL delay
inattention at school

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13
Q

OME O/E

A

Retracted TM
Yellow
Fluid level/air bubbles

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14
Q

Rx of OME

A

most resolve spontaneously.
If not, grommets

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15
Q

Presentation of mastoiditis
Investigation
Rx

A

pain behind ear, sticky out ear, feels ‘boggy’ behind the ear

CT temporal bones

Admit for IV abx, myringotomy +/- mastoidectomy

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16
Q

What is cholesteatoma and its presentation

A

Locally destructive expansion of stratified squamous epithelium within the middle ear.

Smelly ottorhoea, ear pain, hearing loss, facial paralysis

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17
Q

complications of cholesteatoma

A

ossicle erosion - deafness
meningitis
cerebral abscess

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18
Q

Rx of ramsey hunt

A

Oral acyclovir and oral prednisolone
Need lubricating eye drops

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19
Q

What is ramsey hunt and presentation

A

shingles affecting the facial nerve
facial nerve palsy
vesicular rash in ear that may extend to 2/3 anterior tongue and palate

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20
Q

Fever PAIN score use and break down

What does centor have in addition

A

used to predict whether tonsillitis has been cause by strep or not

Fever in last 24hrs
Purulent tonsils
Attend in <3 days
Inflammation severe
No cough or coryza

Centor adds age - 1+ if 3-14, 0 if 15 - 44, -1 if >44

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21
Q

Rinnes and weber results in sens and cond

A

sens - lateralises to other ear. AC>BC
Cond - lateralisises to ear. BC>AC

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22
Q

peripheral and central causes of vertigo

A

Peripheral - Menderes, bppv, labrynthitis,

Central - stroke (POCS), meningitis, MS, vestibular migraine, SOL

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23
Q

differentiating between peripheral and central causes of vertigo

A

Central has vertical nystagmus (RED FLAG)
Rarely associated with tinnitus or hearing loss

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24
Q

what is inflamed in labrynthitis

presentation

Rx

Study These Flashcards
A

semi circular canals, vestibule and cochlear

Acute onset vertigo, tinnitus and hearing loss most commonly preceded by a viral URTI. N+V

prochlorperazine and antihistamine for max 3 days

25
presentation of vestibular neuritis and course rx what ay they go on to develop
acute onset of vertigo and n+v. Often incapacitating for few days then gets better over 2-6 weeks Rx - prochlorperazine and antihistamine for 3 days BPPV
26
BPPV pathophys which way will nystagmus move in dix hallpike rx including name of exercises to do at home
otoconia (crystals of calcium carbonate) dislodge into semicircular canals causing disruption to endolymph flow towards affected ear employ manoeuvre. Cawthorne cooksey exercises
27
How is epley manoeuvre performed
head at 45 degrees with neck extended. Then turn 90 degrees to other side. then another 90 degrees by getting pt to roll on to side. Then pt sits up
28
first line abx treatment for AOM if meets criteria for abx
penicillin or clarithro if pen allergic
29
acute vs prophylactic rx of menieres
acute - prochlorperazine and antihistamine prophylaxis - betahistine
30
rx of cholesteatoma
ent referral for surgery
31
which window is the stapes connected to
oval window
32
what condition can cause low pitch hearing loss (opposite to presbycusis)
otosclerosis
33
ix results for otosclerosis - audiometry, tympanometry, high res CT
conductive hearing loss stiff, non compliant tm bony changes
34
rx of otosclerosis
hearing aids or surgery for stapes prosthesis
35
who is affected by otosclerosis
under 40s
36
risk factors for presbycusis
increased age male fix loud noise exposure diabetes htn ototoxic meds
37
rx of presbycusis
Optimising the environment, for example, reducing the ambient noise during conversations, lights instead of doorbells Hearing aids Cochlear implants (in patients where hearing aids are not sufficient)
38
what is acoustic neuroma a tumour of where in the brain do they occur
schwann cells around vestibularcochlear nerve cerebellopontine angle
39
what do b/l acoustic neuromas almost always indicate
neurofibromatosis type 2
40
presentation of acoustic neuroma
The typical patient is aged 40-60 years presenting with a gradual onset of: Unilateral sensorineural hearing loss (often the first symptom) Unilateral tinnitus Dizziness or imbalance A sensation of fullness in the ear
41
abx choice for bacterial tonsillitis and course length
penicillin V for 10 days
42
rx of post tonsillectomy bleeding as an fy1
call on call ent surgeon encourage to spit blood not swallow give fluids take bloods - fbc, clotting, cross matt, g+s NBM incase theatre needed
43
symptoms of quinsy
'hot potato' voice inability to open mouth swelling and erythema sore throat painful swallowing fever tender lymphadenopathy
44
rx of quinsy
refer to hospital for ent needle aspiration or surgical incision and drainage broad spec abx
45
first aid rx for active nose bleed other advice after
sit forward squeeze soft part of nose spit don't swallow don't pick nose med review if needed stay out of sun
46
rx of epistaxis if: - after 15 mins first aid is successful - after 15 mins first aid is unsuccessful and the bleed site is visible - after 15 mins first aid is unsuccessfuland the bleed site is not visible - if doesn't stop at all
- topical naseptin antiseptic - cautery - packing - sphenopalatine ligation
47
who can't have naseptin antiseptic after a nose bleed what is an alternative
if peanut allergy can use muciprocin
48
examination and presentation of thyroglossal cyst inc location of neck
moves up on swallowing and tongue protrusion asymptomatic
49
branchial cyst presentation inc age group and inc location of neck
typically presents in young adults when an URTI causes it to increase in size usually painless anterior or posterior triangle
50
cystic hygroma presentation and location in neck
diagnosed at birth or prenatally. Typically presents in left posterior triangle. Benign but often require surgery
51
red flag of nasal polyp
unilateral polyp
52
what other conditions are nasal polyps commonly associated with
chronic rhinits/sinusitis asthma cystic fibrosis
53
who are nasal polyps rare in
<10s consider neoplasms or cystic fibrosis
54
rx of sudden snesironeural hearing loss (<72 hrs with no obvious cause)
urgent referral to ENT <24hrs Classed as an otological emergency high dose oral corticosteroids used
55
hypocalacaemia on an ecg (complication of thyroid surgery - parathyroid damage)
long QTc
56
rx of uncomplicated sinusitis rx of complicated inc what makes it complicated
uncomplicated - analgesia, keep hydrated complicated - if >10 days - intranasal corticosteroids - abx not usually used unless severely unwell or 'double sickening' ie had a viral and now got worse again
57
rx of recurrent or chronic sinusitis
nasal irrigation with saline avoid any allergens
58
what can secondary haemorrhage after tonsillectomy indicate rx
infection admit and give abx
59

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