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ENT Flashcards

1
Q

which arteries supply the nose and sinuses

A

ICA - ethmoid branch

ECA - facial + internal maxillary branches

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2
Q

where does bleeding usually arise in epistaxis?

A

little’s area [vessel anastamosis] in the nasal septum

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3
Q

give 5 risk factors for epistaxis

A
  1. anticoagulants, steroid sprays
  2. bleeding disorder/ thrombocytopenia
  3. deviated nasal septum
  4. irritants e.g. smoking
  5. allergies/inflamm
  6. infection
  7. trauma
  8. HTN
  9. neoplasia/polyp
  10. atherosclerosis
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4
Q

in an epistaxis patient, a FH of bleeding might suggest what disease

A

Hereditary hemorrhagic telangiectasia

[or hereditary bleeding disorder]

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5
Q

give 4 causes of facial pain

A 
teeth
sinusitis
temporomandibular joint dysfunction
salivary gland
migraine
trigem neur
trauma
atypical/idiopathic
cluster headache
angina
frontal bone osteomyelitis
ENT tumours
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6
Q

give 4 typical causes of gradual vision loss

A 
macular degeneration
glaucoma
cataract
diabetic retinopathy
HTN
optic atrophy
slow retinal detachment
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7
Q

presentation of age related macular degeneration

A

elderly
deteriorating central vision
difficulty making out images, faces. Reading, night vision.
fluctuation

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8
Q

pathogenesis of age related macular degeneration

A

drusen, new vessel proliferation [wet]
> retinal atrophy
> central retinal degeneration

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9
Q

risk factors for age related macular degeneration

A 
age
smoking
CV disease
FH
cataract surgery
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10
Q

difference in prognosis for wet and dry age-related macular degen

A

dry much slower progression.

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11
Q

causes of optic atrophy [pale disc]

A 
glaucoma
retinal artery occlusion
retinitis pigmentosa
MS
etc.
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12
Q

Mx of macular degen

A

dry - no Tx

wet - Anti-VEGF injections, Photodynamic therapy/laser

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13
Q

causes of dry eyes

A 
reduced secretion from lacrimal gland [age]
sjogren's
mumps
sarcoid
amyloidosis
lymphoma
leukaemia
haemochromatosis
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14
Q

hordeolum externum/ stye. Pathology + Tx

A

lash follicle infection/ abscess.

warm compress several times a day.

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15
Q

give 4 causes of ptosis

A 
Horner's syndrome
3rd nerve palsy
congenital
muscular dystrophy
myasthenia
[oedema, xanthelasma, tumour]
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16
Q

define xanthelasma

A

lipid deposition seen in hyperlipidaemia

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17
Q

what is blepharospasm

A

involuntary contraction of orbicularis oculi, often in response to pain

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18
Q

Mx of blepharospasm

A

botox

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19
Q

give 3 causes of vestibular [peripheral] vertigo and 3 causes of central vertigo

A

peripheral: BPPV, meniere’s, labyrinthitis, vestibular failure
central: acoustic neuroma, MS, head injury, migraine, vertebrobasilar insufficiency

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20
Q

other Sx of vestibular vertigo

A

loss of balance, N+V, hearing loss, tinnitus, nystagmus, sweating

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21
Q

distinguish BPPV, meniere’s, migraine, vestibular failure in terms of duration of vertigo

A

BPPV: seconds-minutes
menieres/migraine: 30 mins to 30 hrs
vestibular failure: 30 hours to 1 week

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22
Q

examinations that are useful in vertigo

A

neuro: cerebellar, reflexes, nystagmus, gait, Romberg’s
ears
hallpike, head thrust

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23
Q

what brings on BPPV sx

A

head turning

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24
Q

what is the pahtology behind BPPV

A

displaced otoconia stimulating the semi-circular canals

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25
mX of BPPV
self -limiting | epley manoeuvres
26
features of meniere's disease
``` sudden vertigo 2-4hrs nystagmus fullness in ears tinnitus SN hearing loss ```
27
Ix in meniere's
Electrocochleography | MRI posterior fossa
28
Mx in meniere's
``` Prochlorperazine betahistine prophylaxis surgery gent through gromet labyrinthectomy vestibular neurectomy ```
29
sudden attack of unilateral vertigo, vomiting, following URTI. lasting 1-2 days. nystagmus away from affected side. Diagnosis?
labyrinthitis [=acute vestibular failure/ vestibular neuritis]
30
Mx of labyrinthitis
reassure self limiting prochlorperazine [vestibular suppressant] cyclizine
31
Sx / features of temporomandibular joint dysfunction
earache facial pain joint clicking/popping related to teeth grinding stress
32
Mx of temporomandibular joint dysfunction
``` reassurance, analgesia dental physio CBT [surgery rare] ```
33
Ix in head and neck SC carcinoma
endoscopy needle aspiration + biopsy CT/MRI
34
risk factors for head and neck squamous cell carcinoma
``` smoking alcohol HPV GORD deprivation ```
35
Sx suspicious for head and neck squamous cell carcinoma
``` neck pain/ lump hoarse voice >6/52 sore throat >6/52 mouth bleeding mouth numbness sore tongue painless ulcers patches in the mouth earache/ effusion lumps [lip, mouth, gum] speech change dysphagia ```
36
give 5 causes of stridor
``` anaphylaxis croup laryngitis epiglottitis larygomalacia web/stenosis intubation thermal /chemical trauma hemangioma, papilloma ```
37
Mx of laryngotracheobronchitis [croup]
dex
38
Mx points for epiglottitis
``` keep Pt upright dont examine throat get anaesthetist + ENT surgeon intubate/surgical airway dex abx ```
39
excessive collapse and indrawing of supraglottic airwaysduring inspiration leading to stridor, breathing + feeding difficulties. Diagnosis?
larygomalacia
40
oropharyngeal carcinoma risk factors
male age smoking HPV
41
typical presentation of oropharyngeal carcinoma
smoker with a sore throat, sensation of lump, otalgia
42
imaging for oropharyngeal carcinoma
MRI
43
Mx for oropharyngeal carcinoma
surgery + radio
44
laryngeal cancer typical presentation
``` older male smoker progressive hoarseness stridor dysphagia Odynophagia haemoptysis otlagia ``` or young HPV
45
Ix.s in laryngeal cancer
laryngoscopy biopsy HPV status MRI staging
46
Mx of laryngeal cancer
radio laryngectomy gland dissection
47
tests for lump in the neck
``` US fine needle aspiration cytology CT mantoux virology [HIV/Hep/EBV] CXR [malignancy/hilar nodes] biopsy ```
48
what problems might cervical ribs [enlarged costal elements of C7] cause?
neuro Sx from pressure on brachial plexus | Raynauds - compressing subclavian artery
49
what are the 3 main pairs of salivary glands and where are they?
parotid - side of face in front of ear submandibular - below jaw in angle of mandible sublingual - in the floor of the mouth
50
which cranial nerve would you assess when examining the salivary glands
facial
51
causes of swelling of the parotid gland
sjogrens syndrome mumps, HIV sarcoid malignancy
52
risk factors for salivary gland malignancy
smoking | neck radiation
53
symptoms suggestive of salivary gland malignancy
``` hard fixed mass +/- pain oveerlying skin ulceration local lymphadenopathy no variation on eating [seen in inflammation/stone] facial nerve palsy ```
54
Mx salivary gland malignancy
surgery, radio
55
give 4 causes of dry mouth [xerostomia]
``` hypnotics, tricyclics antipsychotics BB diuretics mouth breathing dehydration ENT radiotherapy sjogrens SLE, scleroderma sarcoidosis HIV/AIDS parotid stones ```
56
causes of pre-lingual deafness other than genetic
``` intrauterine torch infection prem hypoxia kernicterus meningitis, enceph intraventricular hemorrhage measles, mumps ototoxic drugs e.g.NSAIDs trauma ```
57
indication for cochlear implant
children + adults profound S-N deafness dont benefit form conventional hearing aid
58
give 4 causes of conductive hearing loss
wax/pus/debris/foreign body developmental abnormalities drum perf [trauma/ infection] ossicular chain: Otosclerosis/infection/trauma inadequate Eustachian tube ventilation [effusion/CA]
59
give 4 causes of sensorineural hearing loss
``` ototoxic drugs e.g. gent infection [meningitis] cochlear vascular disease meniere's trauma presbyacusis ```
60
give 3 examples of ototoxic drugs
gent, vancomycin, streptomycin chloroquine, hydroxychloroquine vincristine cisplatin
61
infections that can lead to sensorineural hearing loss
``` meningitis mumps measles flu herpes syphilis ```
62
if unilateral sensorineural hearing loss, exclude...
acoustic neuroma cholesteatoma effusion from CA
63
30 year old pregnant woman presents with bilateral conductive hearing loss, worsening during pregnancy. She has a FH of same problem. She also describes tinnitus and says she sometimes feels the room is spinning. On examination, the drum is tinged pink. What is the diagnosis and how would you manage?
otosclerosis hearing aid or surgery or cochlear implant
64
what is presbyacusis? and what is the Mx?
age related bilateral high frequency SN hearing loss hearing aid
65
Ix in sudden sensori neural hearing loss
``` FBC, ESR/CRP, U+E, LFT, TSH autoimmune profile clotting fasting glucose cholesterol audiology ```
66
causes of subjective tinnitus
``` presbyacusis noise induced menieres less commonly wax/otosclerosis ototoxic drugs` otitis media ^/hypothyroid DM MS acoustic neuroma trauma anxiety/depression ```
67
investigations in tinnitus
audiometry tympanogram MRI [acoustic neuroma]
68
Mx of tinnitus
hearing aid if hearing loss too - mask tinnitus councelling sound therapy [fan or music to mask] CBT
69
give 5 causes of otalgia
otitis externa furunculosis mailgnant otitis externa barotrauma ``` TMJ dysfn. dental geniculate herpes primary glossopharyngeal neuralgia laryngeal CA tonsilitis/quinsy post-tonsillectomy soft tissue injury to neck cervical spondy/arth ```
70
Sx of otitis externa
discharge itch otalgia tragal tenderness
71
causes of otitis externa
``` excess canal moisture eczema > itching hearing aids self-removal of wax humidity narrow ear canal ```
72
chief organism in otitis externa
pseudomonas | also, staph A
73
Mx of otitis externa
clean ext. auditary meatus keep ear dry mild - hydrocort cream to pinna earcalm spray [antifungal/bact] moderate - swab, ABx/steroid drops severe - aluminium acetate wick
74
what is the risk of persistent unilateral otitis externa in elderly/DM/imm.supp.
malignant otitis externa
75
describe furunculosis
very painful staph abscess arising in a hair follicle within auditory canal
76
Mx of pinna cellulitis
oral abx
77
describe malignant otitis externa + usual organism
agressive life-threatening infection of the external ear that can lead to temporal bone destruction, osteomyelitis pseudomonas
78
Mx malignant otitis externa
surgical debridement systemic Abx Ig
79
give 4 causes of damage to the 8th cranial nerve
``` brainstem CVA noise damage pagets disease menieres herpes acoustic neuroma drugs [gent] ```
80
differnetials for a sore thrtoat
tonsilitis or pharyngitis: viral - common cold [rhino/coronovirus], flu, adenovirus, herpes simplex, EBV bacterial -group A strep, Hib [epiglott]
81
Mx of sore throat
PCM/ibuporofen, reassurance difflam centor 3+ = pen V
82
give 3 complications of tonsilities
``` sinusitis otitis media peritonsilar abscess [quinsy] parapharyngeal abscess lemierre syndrome ```
83
how does quinsy present and what is the Mx
sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus, muffled voice Abx, aspiration
84
differentials for unilateral tonsilar enlargement
peritonsillar/ parapharyngeal absess > shift | malignancy
85
what causes scarlet fever
exotoxins produced released from strep pyogenes [groupA beta haem strep]
86
typical presentation of scarlet fever
red pin prick blanching rash on chest, axillae, behind ears facial flushing, circumoral pallor, strawberry tongue 12-48 h after sore throat + fever
87
Mx of scarlet fever
pen V
88
indication for tonsillectomy
7 documented disabling episodes in last yr, or 5/yr for 2 yrs, or 3/yr for 3yrs malignancy or child w/ Obstructive sleep apnoea
89
complications of tonsilectomy
``` prim haemorrhage secondary haem (>24hrs) due to infection ```
90
sX of chronic rhinosinusitis with nasal polyps
``` watery anterior rhinnorhoea sneezing purulent postnasal drip nasal obstruction sinusitis moutoh breeathing snoring headache ```
91
mx of chronic rhinosinusitis with nasal polyps
topical betamethasone ?longterm doxy surgery
92
Mx of chronic rhinosinusitis without nasal polyps
intranasal steroid nasal saline irrigation [abx if not imprving] CT > suregry
93
mx of allergic rhinosinusitis
``` allergen avoidance nasal saline irrigation antihist if persistent, intranasal steroid spray short course pred ```
94
causes of ear discharge
otitis externa/media cholesteatoma CSF leak following trauma
95
presentation of otitis media
``` rapid onset pain [bulging of tymp.mem] fever irritability anorexia vomioting often post-urti purulent discharge ```
96
Mx of otitis media
analgesia | amoxi if systemically unwell/ imm.comp./ >4days
97
complications of otitis media
``` glue ear chronic otitis media [perf, recurrent infections] mastoiditis petrositis labyrinthitis facial palsy meningitis intracranial abscess ```
98
what is otitis media with effusion/ glue ear?
effusion present after regression of Sx of otitis media
99
sx of chronic otitis media
hearing loss ottorhoea fullness otalgia
100
Mx of chronic otitis media What is a complicaiton of chronic otitis media?
topical/ systemic Abx cleaning keep dry surgery - myringoplasty [repair drum] cholesteatoma
101
complications of cholesteatoma
``` meningitis cerebral abscess hearing loss mastoiditis facial nerve dysfn. ```
102
mx of cholesteatoma
mastoid surgery
103
define mastoiditis
destruction of air cells +/- abscess formation following middle ear inflamm
104
signs of mastoiditis
tenderness, swelling and redness behind the pinna fever protruding auricle
105
whta imaging and what Mx for mastoiditis
CT IV ABx, surgery
106
risk factors for otitis media
``` URTI bottle feeding passive smoking adenoids asthma malformations e.g. cleftpalate GORD ^BMI in adults ```
107
why investigate hoarseness of >3 months?
because it is the chief [and often only] symptom of layngeal carcinoma [especially in smokers!]
108
differentials for hoarseness give 4
``` viral URTI laryngeal carcinoma GORD vocal cord palsy laryngitis reinke's odema vocal cord nodules stress singing/shouting/overuse ```
109
causes of layrngitis
viral bacterial secondary to gORd secondary to RA
110
hypothyroid elderly female smoker complains of deep gruff voice, says she sounds like a man. Diagnosis?
Reinke's oedema [chronic cord irritation -> enlargement]
111
causes of laryngeal nerve palsy
CA - larynx, thyroid, oesoph, hypopharynx, bronchus iatrogenic - parathyroidectomy, oesophageal/pharyngeal pouch surgery TB aortic aneurysm
112
Ix in laryngeal nerve palsy
CXR CT +/- US thyroid +/- OGD
113
risk factors for glue ear
``` parental smoking male downs, cleft palate winter atopy primary ciliary dyskinesia ```
114
presentation of otitis media with effusion in children
``` hearing loss noticed by parents poor speech, language delay ear infections, URTIs poor behavior balance problems school problems ```
115
what might you see on otoscopy in glue ear
``` [variable] retracted or bulging drum dull, grey, yellow bubbles/fluid level superficial radial vessels reduced mobility with pneumatic attachment ```
116
otitis media w/ effusion Mx
autoinflation of eustacian tube | grommets
117
main complications of gromets
infection | tympanosclerosis
118
mx of gromet infection
aural cleaning topical Abx/steroid ear drops gromet removal may be needed
119
post op Mx of gromet/ advice
ok to swim but avoid diving + ear plug gromet will extrude after 3 to 6 months, then recheck hearing a quarter need re-insertion
120
where do acoustic neuromas arise from
superior vestibular nerve schwann cell layer
121
sx of acoustic neuroma
``` progressive ipsilateral tinnitus sensorineural deafness cerebellar signs + ^ICP signs if large giddy [vertigo rare] numb face [trigeminal] CN V/VI/VII may be affected ```
122
why sensorineural hearing loss in acoustic neuroma
cochlear nerve compression
123
differential for acoustic neuroma
meningioma
124
Mx of acoustic neuroma
surgery
125
Mx of epistaxis
ABCDE Pt pinch soft part of nose + sit forward ice pack on bridge silver nitrate cautery [1st - cotton ball soaked in adrenaline 2 mins / lidocaine spray] nasal pack - anterior then postnasal
126
serious posterior epistaxis Mx
``` anaesthesia diathermy pack arterial ligation embolisation [stroke risk] ```
127
advice to Pt after nosebleed
``` dont pick dont blow direct sneeze through open mouth avoid bending, lifting, straining no hot food/drink ``` if restarts - pinch soft bit + ice to bridge
128
Mx of septal haematoma in nasal injury
incision and drainage
129
casues of facial palsy, give 4
``` brainstem tumour stroke MS acoustic neuroma meningitis ``` otitis media ramsay hunt syndrome cholesteatoma parotid tumour trauma lyme disease sarcoid DM bells palsy
130
facial palsy, iX
``` ESR glucose lyme disease serology examine parotid for lumps examine ears for cholesteatoma/ramsay hunt MRI ```
131
give 2 things that ^risk of bells palsy [idiopathic facial palsy]
pregnancy | DM
132
Tx of bells palsy
pred | lubricate eye with drops
133
common causes of bilateral facial palsy
``` lyme disease GBS leukaemia sarcoidosis EBV trauma myasthenia gravis ```
134
how do you differentiate facial palsy of stroke and bells
stroke is forehead sparing

3B GH (16 decks)

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