ENT Flashcards
(126 cards)
1
Q
ACOUSTIC NEUROMA
what is it?
A
a benign Schwann-cell derived tumour, which commonly arises from the eight cranial nerve
2
Q
ACOUSTIC NEUROMA
what is the pathophysiology?
A
Acoustic neuromas usually occur sporadically from Schwann cells of the vestibular branch of the eighth cranial nerve.
They are slow growing and often asymptomatic unless they put pressure on local structures
3
Q
ACOUSTIC NEUROMA
what are the risk factors?
A
neurofibromatosis type 2 - typically bilateral + earlier onset
4
Q
ACOUSTIC NEUROMA
are they most commonly bilateral or unilateral?
A
- unilateral is more common
- bilateral is common with NF2
5
Q
ACOUSTIC NEUROMA
what are the symptoms?
A
- unilateral sensorineural hearing loss
- tinnitus
- unsteadiness
- facial numbness
- facial weakness
- dry eyes/mouth
- dysarthria/dysphagia
6
Q
ACOUSTIC NEUROMA
what are the clinical signs?
A
- cerebellar signs - nystagmus, ataxia
- papilloedema
7
Q
ACOUSTIC NEUROMA
what are the investigations?
A
- audiological testing (unilateral sensorineural hearing loss)
- Gadolinium-enhanced MRI
8
Q
ACOUSTIC NEUROMA
what is the management?
A
- watch and wait (monitored annually with MRIs)
- stereotactic radiosurgery/therapy
- surgical removal
9
Q
ACOUSTIC NEUROMA
what are the complications?
A
mass effect
- trigeminal + facial neuropathies
- brainstem compression
- hydrocephalus
following surgery
- hearing loss
- facial weakness
- CSF leak
10
Q
BPPV
what is it?
A
an inner ear disorder characterised by episodes of positional vertigo.
11
Q
BPPV
what is the pathophysiology?
A
It is caused by otoconia (loose debris composed of calcium carbonate) within the semilunar canals of the inner ear. Attacks are triggered by head movements that result in movement of the otoconia, abnormal motion of endolymph and the feeling of vertigo.
12
Q
BPPV
what are the risk factors?
A
- increasing age
- female
- head trauma
- inflammation (labyrinthitis + vestibular neuritis)
- migraines
13
Q
BPPV
what are the symptoms?
A
VERTIGO
- spinning
- episodic
- sudden, severe and <30 seconds
- occurs on head movement
NAUSEA + VOMITING
14
Q
BPPV
what can trigger an attack?
A
- head movements e.g. rolling over in bed, reclining or gazing upwards
15
Q
BPPV
what are the clinical signs?
A
- positive Dix-Hallpike manoeuvre
- positive supine lateral head turn
- normal neuro exam
16
Q
BPPV
what is the diagnostic criteria?
A
ONE of the following:
- positive Dix-Hallpike manoeuvre
- positive supine lateral head turn
17
Q
BPPV
what is the management?
A
1st line
- conservative management
- Epley manoeuvre (contraindicated in neck injury + carotid stenosis)
2nd line
- vestibular suppressant medications (prochlorperazine/betahistine)
- vestibular rehab
refer to ENT
surgery
18
Q
EPISTAXIS
what is it?
A
Epistaxis refers to bleeding from the blood vessels within the nasal mucosa.
19
Q
EPISTAXIS
what are the causes?
A
- trauma (nose-picking is most common)
- inflammatory conditions
- post op bleeding
- tumours
- vascular malformations
- coagulopathy
- mitral stenosis
- drug use
20
Q
EPISTAXIS
where does the majority of bleeds originate?
A
95% originate from the Kiesselbach plexus in Littles area
21
Q
EPISTAXIS
what are the clinical features?
A
- bleeding from nose
- pain
- dizziness + pre-syncope
- anxiety
22
Q
EPISTAXIS
how can you distinguish whether the nose-bleed is anterior or posterior?
A
ANTERIOR
- visible source of bleed
- minor bleed
- initially unilateral bleed
- history of picking
- first aid controls bleed
POSTERIOR
- no visible source
- bleeding down back of mouth + throat
- bleeding initially bilateral
- visible blood in posterior pharynx
23
Q
EPISTAXIS
what are the investigations?
A
- examine nose
if severe:
- FBC, U&Es
- crossmatch, group + save
- coagulation studies
- nasoendoscopy
24
Q
EPISTAXIS
what is the general first aid management?
A
- sit leaning forwards
- pinch nasal nares for 10-20 minutes
- spit out blood in mouth
25
EPISTAXIS
what is the management of anterior epistaxis?
1st line = first aid measures
2nd line = nasal cautery
3rd line = anterior nasal packing for 24-48 hours + admit
26
EPISTAXIS
what is the management of posterior epistaxis?
1st line = first aid measures
2nd line = posterior nasal packing by ENT specialist
3rd line = surgery
27
EPISTAXIS
what is used for nasal cautery?
silver nitrate or electrocautery
28
EPISTAXIS
what is the discharge advice?
- do not lie flat for 24 hrs
- avoid nose blowing for 1 week
- avoid alcohol, spicy food + hot drinks for 2 days
- avoid strenuous exercise + straining for 1 week
- avoid dislodging scabs
29
OTITIS EXTERNA
what is it?
inflammation of the external auditory canal
30
OTITIS EXTERNA
what are the different categories?
Acute: lasts 3 weeks or less
Chronic: lasts 3 months or longer
31
OTITIS EXTERNA
what microorganisms most commonly cause it?
pseudomonas aeruginosa
s.aureus
32
OTITIS EXTERNA
what are the risk factors?
- swimming
- humid air
- young age
- diabetes
- trauma
- narrow external auditory meatus
- obstructed external auditory meatus
- eczema, psoriasis
- radiotherapy
33
OTITIS EXTERNA
which dermatological conditions can cause it?
seborrhoeic dermatitis
contact dermatitis
34
OTITIS EXTERNA
what are the symptoms?
- itch
- pain (ear, jaw, headache)
- hearing loss (conductive)
- discharge
35
OTITIS EXTERNA
what are the clinical signs?
- inflamed external auditory canal
- erythema
- scaly skin
- peri-auricular lymphadenopathy
- fever
36
OTITIS EXTERNA
what are the investigations?
- otoscopy
- swab for microbiological analysis
37
OTITIS EXTERNA
what is the management?
- analgesia (paracetamol, ibuprofen)
- topical therapy (acetic acid or ciprofloxacin with dexamethasone)
- ENT referral
- micro suction
38
OTITIS EXTERNA
what are the complications?
- pinna cellulitis
- chronic otitis externa
- myringitis
- necrotising otitis externa
39
OTITIS MEDIA
what is it?
inflammation of the middle ear with effusion and clinical features of a middle ear infection
40
OTITIS MEDIA
what are the most common causative pathogens?
BACTERIA
- s.pneumoniae
- H.influenzae
VIRUSES
- RSV
- rhinovirus
- adenovirus
41
OTITIS MEDIA
what is the pathophysiology?
It is associated with a preceding upper respiratory tract infection. Pathogen transmission via the eustachian tube to the middle ear may result in AOM.
42
OTITIS MEDIA
why are children more susceptible to infection?
less acute angle of eustachian tube results in increased transmission of pathogens
43
OTITIS MEDIA
what are the clinical features?
- otalgia (ear pain)
- fever
- hearing loss
in young children:
- tugging ear
- irritability
- difficulty feeding
44
OTITIS MEDIA
what is seen on otoscopy?
- red, yellow or cloudy tympanic membrane
- bulging tympanic membrane
- perforated membrane
- air fluid behind tympanic membrane
45
OTITIS MEDIA
what are the investigations?
otoscopy
46
OTITIS MEDIA
what is the management?
MOST PEOPLE
- conservative management with paracetamol/ibuprofen
if systemically unwell, high risk of complications, otorrhoea in child or <2 with bilteral AOM = antibiotics
47
OTITIS MEDIA
when should you consider antibiotics?
absolute indications
- systemically unwell
- signs and symptoms of more serious illness
- high risk of complications
- otorrhoea in child/young person
- age <2 with bilateral AOM
48
OTITIS MEDIA
which antibiotics may be prescribed?
5-7 day course
1st line = amoxicillin
2nd line = co-amoxiclav
penicillin allergy = clarithromycin/erythromycin
49
OTITIS MEDIA
what are the complications?
- glue ear
- tympanic membrane perforation
- mastoiditis
- meningitis
- facial nerve palsy
- chronic or recurrent infection
- hearing loss
50
TONSILLITIS
what is it?
acute inflammation of the palatine tonsils secondary to infection
51
TONSILLITIS
what are the causes?
- viral - rhinovirus
- bacterial - strep pyogenes
- recurrent - s.aureus
- non-infectious - GORD, smoking, hayfever
52
TONSILLITIS
what are the clinical features?
- sore throat
- pain on swallowing
- fever
- headache
- N+V
- tonsillar enlargement + erythema
- anterior cervical lymphadenopathy
53
TONSILLITIS
what are the investigations?
- primarily clinical diagnosis
- throat culture
54
TONSILLITIS
what scoring systems can be used to determine a diagnosis?
- CENTOR
- FEVERPAIN
used to determine likelihood of strep infection
55
TONSILLITIS
what is the CENTOR criteria?
- presence of tonsillar exudate
- tender anterior cervical lymph nodes
- history of fever
- absence of cough
1 point each
56
TONSILLITIS
what does the CENTOR score mean?
0-2 = 3-17% strep infection
3-4 = 32-56%
57
TONSILLITIS
what is the feverPAIN criteria?
- fever (during last 24 hrs)
- pus on tonsils
- attend rapidly (within 3 days of symptom onset)
- inflamed tonsils (severe)
- no cough or coryza
1 point each
58
TONSILLITIS
what do the scores for feverPAIN criteria mean?
likelihood of strep infection
0-1 = 13-18%
2-3 = 34-40%
4-5 = 62-65%
59
TONSILLITIS
what is the management?
ALL PATIENTS
- paracetamol + ibuprofen
- fluid intake
low feverPAIN (0-1) or centor (0-2) = no antibiotics
high feverPAIN (4-5) or centor (3-4) = antibiotics
- phenoxymethylpenicillin for 5-10 days
- clarithromycin for 5 days if penicillin allergic
60
TONSILLITIS
what are the complications?
- quinsy (peri-tonsillar abscess)
- AOM
- acute sinusitis
- post-strep glomerulonephritis
- acute rheumatic fever
61
QUINSY
what is it?
peritonsillar abscess, is a collection of pus in the peritonsillar space
62
QUINSY
what is the clinical presentation?
- sore throat
- fever
- trismus
- dysphagia
- altered voice
- peritonsillar swelling
- exudate
- drooling
displacement of uvula
63
QUINSY
what is the management?
surgery
IV antibiotics
IV steroids
64
MENIERES DISEASE
what is it?
a disorder of the inner ear that manifests itself with attacks of vertigo, tinnitus and hearing loss.
65
MENIERES DISEASE
what is the pathophysiology?
it is characterised by endolymphatic hydrops - distention + distortion of membranous endolymph system due to abnormal fluctuations in endolymph
66
MENIERES DISEASE
what are the risk factors?
- caucasian
- family history
- migraines
- autoimmune diseases e.g. SLE, rheumatoid arthritis
- head trauma
- viral infection
67
MENIERES DISEASE
what are the clinical features?
- vertigo (spinning/rocking)
- tinnitus
- fluctuating hearing loss
- aural fullness
- unsteadiness on feet
- nystagmus (unidirectional, horizontal-torsional)
- positive rombergs sign
68
MENIERES DISEASE
what are the investigations?
clinical diagnosis - must be made by ENT specialist
must have:
- >2 episodes of vertigo lasting >20 mins
- hearing loss confirmed by audiometry on >1 occasion
- no better alternative diagnosis
other investigations
- bloods - FBC, U&Es, TFTs, lipid profile, syphilis screen
- audiometry
- MRI
69
ACUTE RHINOSINUSITIS
what is it?
acute inflammation of the nose and paranasal sinuses.
70
ACUTE RHINOSINUSITIS
what are the causes?
most common = viral
VIRUSES
- rhinovirus
- parainfluenza virus
- influenza virus
BACTERIA
- s.pneumoniae
- h.influenzae
- m.catarrhalis
- s.aureus
- group A strep
71
ACUTE RHINOSINUSITIS
what are the clinical features?
- nasal discharge (purulent)
- nasal congestion
- facial pain/pressure
- reduced/loss of smell
- ear pain
- fever
- headache
- fatigue
72
ACUTE RHINOSINUSITIS
what features support a bacterial diagnosis?
- persistent clinical features with no improvement >10 days
- double worsening
- persistent severe symptoms for 3-4 consecutive days
73
ACUTE RHINOSINUSITIS
what is the management?
SUPPORTIVE
- paracetamol (anti-pyretic + analgesic)
- saline irrigation
- steam inhalation
ANTIBIOTICS
- 1st line = phenoxymethylpenicillin
- co-amoxiclav if systemically unwell
- doxycycline/clarithromycin if penicillin allergic
OTHERS
- intranasal glucocorticoids (mometasone)
- oral decongestants (phenylephrine)
- nasal decongestants (oxymetazoline)
- antihistamines
74
CHRONIC RHINOSINUSITIS
what is it?
inflammation of the nasal cavities and paranasal sinuses lasting > 12 weeks.
75
SINUSITIS
what are the risk factors?
Allergies
Smoking
Asthma
Nasal polyps
Immunodeficiency
76
SINUSITIS
what are the different types?
Acute: Symptoms last up to 4 weeks
Subacute: Symptoms last between 4 and 12 weeks
Chronic: Symptoms last more than 12 weeks
77
SINUSITIS
what are the clinical features?
- nasal congestion
- facial pain
- headache
- reduced sense of smell
- fever
78
SINUSITIS
what is the management?
1st line
- analgesia (paracetamol/ibuprofen)
- nasal decongestants (pseudoephedrine/phenylephrine)
- intranasal corticosteroids (mometasone/fluticasone)
- saline nasal irrigation
2nd line
- antibiotics if symptoms persist for >10 days (amoxicillin/doxycycline)
79
LABYRINTHITIS
what is it?
an acute disorder that arises due to inflammation of the membranous labyrinth of the inner ear
80
LABYRINTHITIS
what are the causes?
viral
bacterial
vasculitis-induced
81
LABYRINTHITIS
what are the clinical features?
- vertigo
- N+V
- hearing loss
- tinnitus
- imbalance
- nystagmus
- positive rombergs sign
82
LABYRINTHITIS
what are the investigations?
clinical diagnosis
other investigations to consider
- audiometry
- MRI brain
83
LABYRINTHITIS
what is the management?
- prochloperazine
- rest and rehydration
- antibiotics if bacterial
- corticosteroids if vasculitis-induced
84
VESTIBULAR NEURITIS
what is it?
is an acute, isolated and spontaneous disorder caused by inflammation of the vestibular nerve
85
VESTIBULAR NEURITIS
what are the causes?
viral infection
86
VESTIBULAR NEURITIS
what are the clinical features?
- vertigo
- N+V
- imbalance
- nystagmus
- unsteady gait
- positive rombergs sign
- normal otoscopic exam
87
VESTIBULAR NEURITIS
what is the management?
- vestibular rehabilitation therapy (VRT)
- prochlorperazine
88
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what is it?
glandular fever caused by epstein barr virus (EBV)
89
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what causes it?
epstein barr virus
90
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
how is it spread?
through saliva (known as the kissing disease)
91
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what is the epidemiology?
- young adults (15-24)
92
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what are the risk factors?
- sharing drinks/toothbrushes
- sexual contact
- blood transfusion/organ transplant
93
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what are the clinical features?
SYMPTOMS
- sore throat
- abdominal tenderness
- prodromal features (malaise, fever, fatigue, myalgia, anorexia, retro-orbital headache)
- widespread non-blanching maculopapular rash (if amoxicillin or ampicillin is administered)
SIGNS
- tonsillar enlargement (may have white exudate + palatal petechiae)
- bilateral posterior lymphadenopathy
- splenomegaly and hepatomegaly
94
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what are the investigations?
- FBC = lymphocytosis
- monospot test (in 2nd week) = confirm dx
to consider
- EBV serology (if monospot is negative or rapid diagnosis required)
- LFTs = often abnormal
- CMV/toxoplasmosis (if pt is pregnant or immunocompromised)
- HIV status
95
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what is the management?
1st line
- conservative (oral fluids, paracetamol/ibuprofen)
- avoid heavy lifting for 1st month (to reduce risk of splenic rupture)
96
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what happens if you give amoxicillin/ampicillin to a patient with glandular fever?
may lead to the development of a widespread non-blanching maculopapular rash around 48hrs after administration
the rash subsides following withdrawal of antibiotics
97
GLANDULAR FEVER (INFECTIOUS MONONUCLEOSIS)
what are the complications?
- splenic rupture
- glomerulonephritis
- haemolytic anaemia
- thrombocytopaenia
- chronic fatigue
- Burkitt's lymphoma
98
OBSTRUCTIVE SLEEP APNOEA
what is it?
sleep-related breathing disorder characterised by recurrent episodes of complete or partial obstruction of the upper airway during sleep
99
OBSTRUCTIVE SLEEP APNOEA
what is the pathophysiology?
The majority of patients with OSA have upper airway obstruction at the level of the tongue or the soft palate leading to loud snoring and apnoea episodes
The episodic airway obstruction is usually associated with oxyhaemoglobin desaturations and arousal from sleep which can lead to fatigue, daytime sleepiness, and early morning headaches which resolve with time
100
OBSTRUCTIVE SLEEP APNOEA
what are the risk factors?
- increasing age
- male
- obesity
- family history of OSA
- nasopharyngeal obstruction
- craniofacial abnormalities
- macroglossia
- neuromuscular disorders
- smoking
101
OBSTRUCTIVE SLEEP APNOEA
what are the symptoms?
- excessive daytime sleepiness
- snoring
- unexplained morning headache
- nocturnal enuresis
102
OBSTRUCTIVE SLEEP APNOEA
what are the clinical signs?
- jaw abnormalities
- mouth breathing or nasal speech
- raised BMI + large neck circumference
- HTN
103
OBSTRUCTIVE SLEEP APNOEA
what are the investigations?
- screening questionnaire
- sleep studies (polysomnography)
urgent referral to sleep clinic if affecting job (driver or safety-critical worker) or have co-morbid condition (COPD, HF)
104
OBSTRUCTIVE SLEEP APNOEA
what is the management?
1st line
- CPAP
- lifestyle changes (weight loss, stop smoking, reduce alcohol)
- inform DVLA
2nd line
- intra-oral mandibular advancement device
- upper airway surgery
105
OBSTRUCTIVE SLEEP APNOEA
what are the complications?
- MI
- stroke
- HTN
106
VERTIGO
what is it?
sensation that there is movement between the patient and the environment
may feel room or themself is moving
often a horizontal spinning sensation
107
VERTIGO
what is the pathophysiology?
- sensory inputs are responsible for balance and posture
- vision
- proprioception
- signals from vestibular system
Vertigo is a mismatch between these sensory inputs
108
VERTIGO
what are the different types?
- peripheral vertigo (usually affecting the vestibular system)
- central vertigo (usually involving the brainstem or cerebellum)
109
VERTIGO
what are the causes of peripheral vertgio?
- BPPV
- menieres disease
- vestibular neuritis
- labyrinthitis
110
VERTIGO
what are the causes of central vertigo?
- posterior circulation infarction (stroke)
- tumour
- MS
- vestibular migraine
111
VERTIGO
what is the difference in presentation of peripheral vs central vertigo?
PERIPHERAL
- sudden onset
- short (seconds/minutes)
- hearing loss/tinnitus present
- coordination intact
more severe nausea
CENTRAL
- gradual onset (except stroke)
- persistent
- no hearing loss/tinnitus
- coordination impaired
- only mild nausea
112
VERTIGO
what are the investigations?
- ear examination (look for infection/other pathology)
- neurological exam
- cardiovascular exam
- cerebellar exam
Special tests
- Rombergs test (screen for proprioception issues)
- Dix-Hallpike manoeuvre
113
VERTIGO
what investigations can be done to distinguish between peripheral and central vertigo?
HINTS examinations
- HI = Head Impulse test (helps to diagnose peripheral vertigo, will be normal if central)
- N = nystagmus (unilateral horizontal = peripheral, bilateral/vertical = central)
- T = test of skew (indicates central cause)
114
VERTIGO
what is the management?
CENTRAL
- referral for further investigation (CT or MRI head)
PERIPHERAL
- prochlorperazine
- antihistamines (cyclizine, cinnarizine and promethazine)
- if menieres disease = betahistine
if BPPV = epley manoeuvre
- vestibular migraine = triptans for acute, propranolol, topiramate or amitriptyline for prevention
115
PRESBYCUSIS
what is it?
type of sensorineural hearing loss that affects elderly
typically effects high frequency hearing bilaterally
116
PRESBYCUSIS
what are the risk factors?
- arteriosclerosis
- diabetes
- accumulated exposure to noise
- drug exposure (salicylates, chemotherapy)
- stress
- genetics
117
PRESBYCUSIS
what is the clinical presentation?
- speech becoming difficult to understand
- need for increased volume on the TV
- difficulty using telephone
- loss of directionality of sound
- worsening symptoms in noisy environments
- hyperacusis (heightened sensitivity to certain sound frequencies)
SIGNS
- possible Weber's test bone conduction to one side if not completely bilateral
118
PRESBYCUSIS
what are the investigations?
- otoscopy = normal
- tympanometry = normal middle ear function with hearing loss
- audiometry = bilateral sensorineural hearing loss
- blood tests = normal
119
OTOSCLEROSIS
what is it?
replacement of normal bone by vascular spongy bone.
causes progressive conductive deafness due to fixation of the stapes at the oval window
120
OTOSCLEROSIS
what is the cause?
autosomal dominant inherited condition
121
OTOSCLEROSIS
what is the epidemiology?
- onset usually at 20-40 years old
- positive family history
122
OTOSCLEROSIS
what is the pathophysiology?
normal bone is replaced with spongy vascular bone
causes progressive conductive deafness due to fixation of the stapes at the oval window
123
OTOSCLEROSIS
what is the inheritance pattern?
autosomal dominant
124
OTOSCLEROSIS
what type of hearing loss does it cause?
progressive conductive deafness
125
OTOSCLEROSIS
what is the clinical presentation?
- conductive deafness
- tinnitus
- normal tympanic membrane (10% have flamingo tinge)
- positive family history
126
OTOSCLEROSIS
what is the management?
- hearing aid
- stapedectomy
