ENT Flashcards
(130 cards)
1
Q
colour and shape of right ear on audiometry
A
red
circles
2
Q
colour and shape of left ear on audiometry
A
blue
crosses
3
Q
bone conduction on audiometry
A
triangles
4
Q
conductive hearing loss on audiometry
A
gap between air & bone conduction
5
Q
sensorineural hearing loss on audiometry
A
NO gap between air an bone conduction
6
Q
noise exposure audiometry
A
sensorineural hearing loss at high frequency
7
Q
meniere’s disease audiometry
A
one sided low frequency sensorineural hearing loss
8
Q
otosclerosis audiometry
A
conductive hearing loss with dip at 2KHz
9
Q
Woman with cold, went on plane, now hearing loss, tympanic membrane intact
A
barotrauma
10
Q
surfers ear
A
exostosis
11
Q
Female who had permanent complete hearing loss in pregnancy - Dx?
A
otosclerosis
12
Q
presentation OME
A
poor listening poor speech language delay inattention poor school work
13
Q
signs of OME on otoscopy
A
variable - retracted or bulging drum
can be dull, grey or yellow in colour
14
Q
Ix OME
A
audiometry (conductive deafness)
tympanometry (flat, type B)
15
Q
Mx OME
A
- conservative - usually resolves in 3m
2. hearing aids or grommets
16
Q
causes of conductive deafness
A
external canal obstruction
ear drum perforation (barotrauma, infection)
ossicular chain problems (otosclerosis, infection)
17
Q
what is otosclerosis
A
replacement of bone by vascular spongy bone particularly at oval window
18
Q
inheritance of otosclerosis
A
autosomal dominant
19
Q
presentation otosclerosis
A
young woman conductive deafness tinnitus normal tympanic membrane \+ve FH
20
Q
Mx otosclerosis
A
hearing aid
stapedectomy
21
Q
causes of sensorineural deafness
A
otoxic drugs post-infection menieres presbycusis acoustic neuroma B12 deficiency
22
Q
what is presbycusis
A
aged related sensorineural hearing loss due to accumulated environmental noise toxicity
23
Q
presentation presbycusis
A
difficulty using telephone
difficulty following convo
24
Q
tympanometry in OME
A
Flat (type B)
25
tympanometry in presbycusis
normal middle ear function with hearing loss (Type A)
26
causes of otitis externa
```
moisture (swimmers)
narrow ear canal
trauma
absence of ear wax
high humidity
```
27
organisms causing otitis externa
bacterial:
pseudomonas aeruginosa
staph aureus
fungal:
aspergillus niger
28
who gets fungal otitis externa
divers
29
who gets malignant otitis externa (++ aggressive)
diabetics
30
Mx malignant otitis externa
IV Abx +/- debridement
31
Mx otitis externa
topical Abx/steroid
- ciprofloxacin/dexamethasone
- if debris: aural toilet
- if severe swelling: insert wick, then Abx
32
Ix malignant otitis externa
CT
33
cause of otitis media
complication of resp viruses
- strep pneumoniae
- haemophilus influenze
- moraxella catarrhalis
travels up eustachian tube causing inflammation and effusion. complicated by bacteria
34
presentation otitis media
```
+/- preceding URTI
otalgia
bulging tympanic membrane
fever
irritability
```
35
Mx otitis media
1. analgesia + observe for a few days
| 2. delayed Abx: amoxicillin 500mg tds for 5d +/- clavulanate
36
when should abx Tx be given immediately in otitis media
```
symptoms lasting >4d and not improving
systemically unwell
immunocompromised
<2y with bilateral otitis media
perforation and/or discharge
```
37
cholesteatoma
presence of keratinising squamous epithelium in the middle ear that is locally destructive
38
causes of cholesteatoma
retraction of pars flaccida +/- atrophy of pars tensa, which traps epithelium that can then proliferate
migration of squamous epithelium through defect in tympanic membrane
39
risk factors for cholesteatoma
congenital conditions - cleft palate
prior ear surgery
middle ear disease
eustachian tube dysfunction
40
presentation cholesteatoma
foul otorrhoea
conductive hearing loss
tinnitus
crust of keratin in upper pocket of middle ear "attic crust"
41
Mx of cholesteatoma
referral to ENT for MRI and surgery
42
vestibular schwannoma
benign cerebellopontine angle tumour growing from vestibular schwann cell layer
43
bilateral vestibular schwannoma - Dx?
NF type 2
44
presentation vestibular schwannoma
intermittent dizziness
giddiness
facial numbness
unilateral sensorineural HL
45
Ix vestibular schwannoma
MRI
46
Mx vestibular schwannoma
any of:
- observation
- focussed radiation
- surgery
47
BPPV
attacks of vertigo lasts >30 secs that are provoked by head turning
48
cause of BPPV
displacement of calcium particles in the semicircular canals
49
presentation BPPV
```
vertigo lasts a few mins
clear positional trigger
no ass HL or tinnitus
no aural fullness
nausea/light-headedness
```
50
Ix BPPV
hallpike's test
51
Mx BPPV
epley manoeuvre
52
meniere's disease
dilation of the endolymphatic spaces of the membranous labyrinth
53
cause of menieres disease
unknown
54
presentation of meniere's disease
```
vertigo lasting hours
unilateral fluctuating sensorineural hearing loss
tinnitus (roaring)
aural fullness
nystagmus
```
55
Ix menieres
endocochleography
| endolymph MRI
56
Mx menieres
acute attacks - supportive (anti emetics - prochlorperazine)
if severe - intratympanic gentamicin
prevention - salt restriction, betahistine, vestibular rehab exercises
57
labyrinthitis
inflammation of the labyrinth in the cochlea and the vestibular system in the inner ear
58
causes of labyrinthitis
viral - preceding URTI most common
bacterial - complication of otitis media most common
59
presentation labyrinthitis
```
vertigo - days
hearing loss
no aural fullness
n+v
nystagmus
```
60
Ix labyrinthitis
clinical Dx
61
Mx labyrinthitis
supportive - vestibular suppressants
- diazepam
- lorazepam
- meclizine
62
vestibular neuronitis
inflammation of the vestibular nerve following viral illness
63
presentation vestibular neuronitis
```
vertigo lasting weeks
no HL
no tinnitus
no aural fullness
nystagmus
```
64
Mx vestibular neuronitis
supportive - vestibular suppressants
- diazepam
- lorazepam
- meclizine
65
pt who is has sudden onset headache and very dizzy, never had before - Dx?
vestibular migraine
66
Vertigo and tingling in arms especially on looking up (pinching blood supply at basilar arteries)
vertebrobasilar insufficiency
67
Sudden onset sensorineural hearing loss - Mx?
urgent referral to ENT and high dose steroids
68
presentation bells palsy
abrupt onset
dry/watering eyes
no motor movement of CNVII distribution on one half
mouth sagging
69
Mx bells palsy
prednisolone 1mg/kg for 10d - prescribe within 72h of onset
| + artifical tears
70
what must pts with bells palsy be advised to do
tape eyes shut at night bcos they cant blink
71
ramsay hunt syndrome
reactivation ofvaricella zoster in CNVII ganglion
72
presentation ramsay hunt
```
auricular pain
CNVII palsy
vesicular rash around ear
vertigo
tinnitus
```
73
Mx ramsay hunt
oral antivirals
74
Mx of perforated tympanic membrane that has failed to heal within 6-8w
myringoplasty
75
pain on eating - who to refer to
dentist
76
sub-types of allergic rhinitis
seasonal/intermittent i.e. hayfever
- grass, flow, tree pollen
persistent/perennial
- house dust mites, cats, dogs
77
single crease on nose is a sign of -?
allergy (allergic rhinitis) from constant rubbing nose
78
Ix allergic rhinitis
IgE skin prick testing
RAST testing
- both will be +ve
79
Mx allergic rhinitis
1. antihistamine
2. intranasal corticosteroid
3. combo Tx
+ allergen avoidance
80
cause of non-allergic/vasomotor rhinitis
nasal hypersensitivity - imbalance between sympathetic and parasympathetic supply to nasal mucosa
81
Ix non-allergic rhinitis
IgE skin prick testing
RAST testing
- both will be -ve
82
Mx non-allergic rhinitis
1. intranasal antihistamine or intranasal corticosteroid
| 2. combo therapy
83
if rhinorrhoea is predominant symptom in rhinitis - Tx?
intranasal ipratropium
84
intranasal corticosteroids
budesonide
| beclometasone
85
anti-histamines
cetirizine
fexofenadine
loratadine
86
nasal decongestants
oxymetazoline
| pseudoephedrine
87
intranasal anticholinergics
ipratropium
88
farmer, has a cat and has recurrent rhinitis - Ix?
RAST
89
samter's triad
asthma
aspirin sensitivity
nasal polyps
90
nasal polyps - sensitive or not sensitive to touch?
not sensitive
91
nasal turbinates - sensitive or not sensitive to touch?
sensitive
92
nasal polyps - unilateral or bilateral most common
bilateral - unilateral considered neoplastic until proven otherwise.
93
nasal polyps presentation
nasal obstruction
rhinorrhoea
poor sense of taste and smell
94
Ix nasal polyps
anterior rhinoscopy or nasal endoscopy
unilateral - CT and biopsy
95
Mx nasal polyps
moderate - nasal corticosteroids
severe - oral corticosteroid. if not improving - endoscopic polypectomy
96
acute sinusitis - how long do symptoms need to last for
<4w
97
chronic sinusitis - how long do symptoms need to last for
>12 w
98
presentation sinusitis
```
facial fullness/tenderness
worse on bending forward
nasal discharge
post-nasal drip
nasal congestion
fever
```
99
Mx sinusitis
1. analgesia and decongestant (if <3d)
if persisting/worsening add Abx: amoxillin
100
Mx chronic sinusitis with nasal drip
CT sinus
and
sinusectomy
101
anterior or posterior nosebleeds - what is more common
anterior - kisselbachs area
102
posterior nosebleed
from posterior nasal cavity or nasopharynx
103
what arteries make up little's area
```
posterior ethmoidal
anterior ethmoidal
sphenopalatine
greater palatine
superior labial
```
104
Mx of nosebleed
if haemodynamically stable - first aid measures
- if this controls bleeding, then use topical antiseptic
- if this doesnt control bleeding:
cautery or packing
(cautery if bleeding area can be visualised, packing if area cant be visualised)
if cautery doesnt work, then do packing
105
nosebleeds - order of ligation of arteries
1. sphenopalatine
2. anterior ethmoidal
3. external carotid
106
most common bacterial cause of tonsillitis
group A strep
107
centor criteria - and how many indicated bacterial infection
```
no cough
fever
cervical lymphadenopathy
tonsillar exudate
3/4 = bacterial
```
108
feverPAIN criteria - and how many indicated bacterial infection
```
fever
Purulent tonsils
Attend rapidly (<3d)
Inflamed tonsils
No cough
```
109
Mx bacterial tonsillitis
Phenoxymethylpenicillin + Analgesia
if unable to swallow - admit for IV benzylpenicillin + fluids
110
complications of tonsillitis
otitis media
quinsy
rheumatic fever
glomerulonephritis
111
indications for tonsillectomy
sore throats are due to acute tonsillitis
episodes are disabling and prevent normal function
7 eps in last 1 y
5 eps in each of the last 2y
3 eps in each of the last 3y
"7 in 1, 5 in 2, 3 in 3"
112
presentation quinsy
```
pain worse 1 side
deviation of uvula towards affected side
trismus (lock jaw)
stertor
hot potato voice
```
113
Mx quinsy
```
needle aspiration
+
IV benzylpenicillin
+
IV dexamethasone
```
114
What not to give in someone with glandular fever and why
Amoxicillin - will get a rash
115
why should people with glandular fever avoid contact sport
risk of spleen rupture
116
pleomorphic adenoma
benign salviary gland tumour
middle age
female
slow growing painless lump
117
Mx pleomorphic adenoma
superficial parotidectom y
118
risk in superficial parotidectom y
CN VII damage (runs through parotid gland but doesnt supply it)
119
warthins tumour
benign salivary gland tumour
middle age
male
softer and more fluctuant than pleomorphic adenoma
120
most common parotid tumour in children <1y
haemangioma
121
triple assessment of a neck lump
1. history and examination
2. imaging: USS, CT, MRI or laryngoscopy
3 biopsy + FNA
122
associations with nasopharyngeal ca
```
EBV
southern china (salty fish diet) - rare in other parts of world
```
123
presentation nasopharyngeal ca
otalgia
cervical lymphadenopathy
recurrent epistaxis
124
Mx nasopharyngeal ca
radiotherapy
+/- chemo
+/- surgery
125
presentation oropharyngeal ca
sore throat
sensation of lump
referred otalgia
irritation by hot or cold food
126
Mx oropharyngeal Ca
radiotherapy
| +/- surgeyr
127
presentation laryngeal ca
progressive hoarseness, then stridor
pain swallowing
+/- haemoptysis
+/- ear pain
128
cause of younger patient with laryngeal ca
HPV+ve
129
Ix laryngeal ca
1. laryngoscopy + biopsy
2. HPV status
3. MRI staging
130
Mx laryngeal ca
radiotherapy + total laryngectomy + tracheostomy
