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Y3 GP > ENT > Flashcards

ENT Flashcards

1
Q

Give 3 risk factors for otitis externa

A
  • hot and humid climates
  • swimming
  • diabetes
  • immunocompromise
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2
Q

How does otitis externa present?

A
  • Pain and itching of ear
  • sometimes discharge and hearing loss
  • sometimes fever and lymphadenopathy
  • erythematous, odematous ear canal with exudate
  • mobile tympanic membrane
  • pain on movement of tragus or auricle
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3
Q

Name a serious complication of otitis externa

A

Mastoiditis
Can also spread to temporal bones, more common in elderly, diabetics and immunocompromised. It is treated with 6-8 weeks of a quinolone and needs urgent ENT refferal if suspected.

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4
Q

How is otitis externa treated?

A

Neomycin (antibiotic drops)

Severe cases may require a wick coated in steroids and abx to be inserted by ENT

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5
Q

How quickly should otitis externa resolve with treatment?

A

6 days

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6
Q

What is the difference between acute otitis media (AOM) and otitis media with effusion (OME)?

A

AOM is caused by bacteria or virus, there is pus in middle ear causing pain. In 5% the tympanic membrane bursts, pain goes and you get discharge,
OME is a chronic inflammatory condition causing a build up of fluid behind the tympanic membrane - see loss of light reflex, drum colour changes, air/ fluid levels, retracted or bulging (less common)

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7
Q

When should pts with otitis media be admitted?

A
  • under 3 months with fever >38
  • children with suspected acute complication such as meningitis, mastoiditis or facial nerve palsies
  • consider referral in those systemically unwell or less than 3 months
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8
Q

How should acute otitis media be managed? When and which abx should be given?

A
  • NSIAD for pain relief
  • delayed or no abx for those systemically well- advice should resolve within 3 days
  • 5 days amoxicillin for those who are systemically unwell but don’t require admission or where symptoms have persisted for <3 days
  • if child getting hearing problems or more than 4 in a year, refer for grommet consideration
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9
Q

What signs suggest a sore throat has a bacterial cause?

A
  • tonsillar exudate
  • tender anterior
    cervical lymph nodes
  • absence of cough
  • attend within 3 days
  • fever
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10
Q

Name 2 complications of a bacterial sore throat

A
  • pneumoccal infection: scarlet fever, post streptococcal glomerular nephritis, rheumatic fever
  • quinsy
  • otitis media
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11
Q

What safety net advice should be given for a sort throat

A

Seek urgent medical advice if:

  • difficulty breathing or stridor
  • start to drool
  • muffled voice
  • severe ain
  • dysphagia
  • unable to swallow fluids
  • become systemically unwell
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12
Q

Who should receive immediate abx for a sore throat? What abx are used?

A
  • high fever pain score (this alone is not an indication)
  • systemically very unwell
  • signs of peritonsillar abscess of cellulitis
  • immunosurpressed
  • valvular heart disease
  • significant comorbidity (heart, lung, renal disease)
    Give 10 days phenoxymethylpenicilin
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13
Q

Why should amoxicillin be avoided in aldolescents and young people with sore throats?

A

it will produce a rash if the cause is infective mononucleosis, even in absence of penicillin allergy

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14
Q

How quickly should a sore throat get better?

A

90% better in a week irrespective of abx.
Abx reduce symptom duration by 1 day.
Delayed abx may be given if FEVER PAIN score is high, otherwise they should not be prescribed.

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15
Q

How does BPPV present? What test is used to diagnose it?

A
  • vertigo lasting 20-30 seconds provoked by head movements (esp rolling over in bed)
  • nausea is common
  • hearing is not affected
  • diagnose with dix hallpike test
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16
Q

How is BPPV managed?

A
  • epley manouver
  • brandt daroff exercises if they dont want the epley
  • may self resolve over several weeks
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17
Q

How does menieres disease present?

A
  • Vertigo, tinnitis and fluctuating hearing loss with sensation of aural pressure
  • transient in early staged
  • Attacks last 30 mins- 2/3 hrs
  • episodes occur in clusters of 6-11 per year
  • usually unilateral initially but bilateral can develop over many years
  • sensorineural hearing loss
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18
Q

What is menieres disease?

A

build up of excess fluid in labrynth of vestible (causing vertigo) and/ or cochlea (causing hearing loss)

19
Q

What investigation is needed for unilateral suspected menieres?

A

MRI, to exclude acoustic neuroma.

20
Q

What is driving advice for menieres and BPPV?

A

Menieres- need to inform DVLA and they will make assessment
BPPV- dont drive when dizzy or if driving may prove an attack but dont need to inform DVLA

21
Q

What is the difference between vestibular neuritis and labrynthitis?

A

Vestibular neuritis is inflammation of vestibular nerve only, meaning you get vertigo only (no hearing loss or tinnitus).
Labrynthitis is they whole vestibular aparatus (vestibule and cochlear), so get vertigo and sensorineural hearing loss +/- tinnitus.

22
Q

How do vestibular neuritis and labrynthitis present?

A
  • sudden, spontaneous severe incapacitiating vertigo persisting for several days
  • not triggered, but exacerbated by movement
  • N+V is common
  • hearing loss is uni or bilateral in labrynthitis (not vestibular neuritis), no feeling of fullness (Ménières)
  • tinnitus can occur in labrynthitis also
  • often proceeded by URTI
23
Q

Name 3 drugs which can cause acute vertigo?

A
  • ototixic drugs such as aminoglycosides and loop diuretics, chemo
  • amlodipine
  • SSRIs
  • diazepams
  • antiepileptics
24
Q

How do vestibular migraines present?

A

Recurrent spontaneous vertigo attacks lasting 5 mins- 72 hrs, with migraine headache before during or after. Hearing is mildly and transiently affected

25
Q

How should labrynthitis and vestibular neuritis be managed?

A
  • Consider admission or urgency ENT referal if sudden unilateral hearing loss (this could indicate acute ischaemia of labrynth or brain stem)
  • otherwise reassure that it will improve over the next 1-3 weeks and they should try to be active as soon as they can even if makes vertigo worse as speeds up vestibular compensation.
  • Safety net for stroke symptoms
  • prochlorperazine or antihistamines may help but only use short term
  • vestibular rehab if persists
26
Q

How do acoustic neuromas present?

A

ANY UNILATERAL SENSORINEURAL HEARING LOSS IS CAUSED BY ACOUSTICNEUROMA UNTIL ORVEN OTHERWISE.
Typically progressive or acute unilateral hearing loss, tinnitus, impaired facial sensation and balance problems.

27
Q

How are acoustic neuromas managed?

A

MRI and referal

Microsurgery, stereotactic surgery or observation (many dont grow) are of choice

28
Q

What features suggest the vertigo has a central cause?

A
  • persistant, severe or prolonged vertigo (although this may indicate severe menieres or vestibular neuritis)
  • new onset headache
  • focal neurological symptoms (nerve palsies, dysarthria, ataxia)
  • central- type nystagmus
  • inability to stand balanced even with eyes open
  • less severe N+V
  • hearing usually normal (except in brainstem stroke)
  • no sensation of pressure in ear
29
Q

Give 3 central and 3 peripheral causes of vertigo

A

central- cerebrovascular disease, migraine, MS, acoustic neuroma, diplopia, alcohol intoxification
Peripheral- labrynthitis, BPPV, vestibular neuritis, menieres disease, ototoxicity, ramsay hunt syndrome

30
Q

When should a pt with sinusitis be admitted to hospital?

A
  • severe systemic infection
  • periorbital odema or cellulitis, displaced eyeball, double vision, reduced visual acuity
  • frontal bone swelling, signs of meningitis, severe frontal headache or frontal neurological signs
31
Q

How should acute sinusitis which does not need admission to hospital be managed?

A
  • do not prescribe abx if symptoms for less than 10 days
  • if symptoms for >10 days and no improvement, give high dose nasal steroids (mometasone) for 14 days and maybe delayed course of abx
  • paracetamol and ibuprofen for pain
  • steam inhalation and nasal decongestants may help but have little evidence
  • if symptoms worsen rapidly, become systemically unwell or don’t improve after 3 weeks then come back
32
Q

How is acute sinusitis diagnosed?

A

Non resolving cold (>1 week) + tenderness over frontal, maxillary or ethmoid sinuses on palpation

33
Q

Give 3 complications of sinusitits?

A

orbital cellulitis
meningitis
brain absess
osteomyelitis

34
Q

How long does sinusitis have to last to be classed as chronic?

A

12 weeks

35
Q

Give 3 differentials for chronic sinusitis?

A
  • rhinitis (allergic or non allergic)
  • foreign body
  • nasal polyps (with which it may be associated)
  • fungal sinusitis
  • tumour
36
Q

How is chronic sinusitis managed?

A
  • refer to ENT
  • little evidence for long term abx and steroid nasal sprays but are often used
  • balloon catheters, debridement and other surgeries are performed under ENT
37
Q

Give 5 causes of conductive hearing loss

A
  • foreign body
  • cerumen impaction
  • infection (otitis externa/ media)
  • Tympanic membrane perforation (trauma, barotrauma, otitis media
  • tumours (fibromas, cholesteatoma)
  • otosclerosis
38
Q

When should tympanic membrane perforations be refered to ENT

A

When theyre larger than 2mm, or suspicion of more extensive injury

39
Q

Give 5 causes of sensorineural hearing loss

A
  • presbyacusis
  • noise induced hearing loss
  • ototoxic hearing loss
  • immune conditions (autoimmune disease, CMV infections due to HIV)
  • acoustic neuroma
  • menieres disease
  • idiopathic unilateral sudden sensorineural hearingloss
  • auditory neuritis, MS, diabetes, trauma are rarer causes
40
Q

How does idiopathic unilateral sudden sensorineural hearingloss present and how is it managed

A

Sudden sensorineural hearingloss associated w/ tinnitus, vertigo and aural fullness.
Refer urgently as need oral steroids within 3 weeks of onset to help preserve and improve hearing.

41
Q

How is presbyacusis managed?

A

Hearing aids and assistive listening devices (flashing alarms, vibrating alarm clocks).
Cochlear implants- approved if severe bilateral hearingloss not improved by hearing aids.

42
Q

How should menieres be managed? (4)

A
  • tell DVLA
  • alleviate acute attacks with prochlorperazine, cinnarizine, cyclizine or promethazine (buccal or im if vomiting)
  • Im steroids followed by tapering oral steroids for severe acute attacks
  • if vomiting, they may need admitting for fluids
  • prevent attacks by avoiding triggers (avoid caffeine, alcohol, tobacco, choc)
  • betahistine may also help prevent attacks
  • vestibular rehab can help pt deal with attacks
  • there are other specialist things they do
43
Q

How should otitis media with effusion be managed?

A
  • watchful waiting for 3 months as most self resolved (ideallly using pure tone audiometry at least 3 months apart as well as tympanometry.)- if persists refer to ENT
  • non sugical options: autoinflation with ballon passed up nose or with hearing aids
  • surgical: grommets and adenotonsillar adenectomy may help also
  • advise to parents: When speaking to the child, face them, slow the rate of speech, raise the level, and speak clearly. Turn off competing auditory stimuli, such as music or television. Daily reading helps language development. Books with explanatory pictures are useful. Discuss seating arrangements with the school, ideally placing the child near the teacher.

Y3 GP (10 decks)

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