ENT Flashcards
(120 cards)
1
Q
what is BPPV?
A
vertigo triggered by change in head position e.g. rolling over in bed or gazing upwards
2
Q
diagnosis of BPPV?
A
Dix hallpike manoeuvre
3
Q
mx of BPPV?
A
Epley manoeuvre- moves debris out of semi-circular canals and back into utricle
4
Q
causes of vertigo?
A
BPPV
Meniere’s disease
vetibular neuronitis
acoustic neuroma
5
Q
What is Meniere’s disease
A
excess fluid in the inner ear
6
Q
features of Meniere’s disease?
A
recurrent episodes of tinnitus and hearing loss sensation of aural fullness nystagmus positive Romberg's test episodes last minutes to hours
7
Q
mx of Meniere’s disease?
A
inform DVLA
acute attacks -> buccal or IM prochlorazone
prevention-> betahistine and vestibular rehab exercises
8
Q
what is vestibular neuronitis?
A
infection of vestibular nerve- may follow URTI
9
Q
Features of VN?
A
recurrent vertigo attacks lasting hours or days
N&V
horizontal nystagmus away from the affected side
no hearing loss or tinnitus
10
Q
mx of VN?
A
- vestibular rehab exercises
- buccal or IM prochlorperazine is often used to provide rapid relief for severe cases
-a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
11
Q
what is vestibular schwannoma?
A
benign tumour of the schwann cells of the vestibulocochlear nerve
also known as acoustic neuroma
12
Q
features of vestibular schwannoma?
A
cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy
13
Q
what is bilateral vestibular schwannomas associated with?
A
neurofibromatosis type 2
14
Q
Ix of vestibular schwannoma?
A
MRI of the cerebellopontine angle
15
Q
mx of vestibular schwannoma?
A
surgery, radiotherapy or observation
16
Q
other causes of vertigo?
A
viral labyrinthitis posterior circulation stroke ototoxicity e.g. MS MS trauma
17
Q
differentials of facial pain?
A
bell's palsy sinusitis trigeminal neuralgia atypical facial pain ramsey hunt syndrome rhinosinusitis TMJ syndrome nasal injury
18
Q
what is bell’s palsy?
A
LMN facial nerve palsy (forehead affected)
acute, unilateral and idiopathic
19
Q
RFs for bells palsy?
A
pregnant women
20-40 years
20
Q
features of bell’s palsy?
A
LMN facial palsy- drooping face symptoms
post-auricular pain, altered taste, dry eyes, hyperacusis
21
Q
mx of bell’s palsy?
A
prednisolone 1mg/kg for 10 days within 72 hours on onset
eye care- artificial tears and eye lubricants
refer if suspicious
22
Q
what is sinusitis?
A
inflammation of the mucous membranes of the paranasal sinuses
23
Q
common infectious agents of sinusitis?
A
strep pneumoniae
h. influenzae
rhinovirus
24
Q
features of sinusitis?
A
- facial pain- typically frontal pressure pain which is worse on bending forward
- nasal discharge: usually thick and purulent
- nasal obstruction
25
mx of acute sinusitis?
analgesia
intranasal decongestants
oral Abx for severe presentations- phenoxymethylpenicillin or co-amoxiclav
26
what is trigeminal neuralgia?
a pain syndrome characterised by severe unilateral pain
27
causes of trigeminal neuralgia?
majority are idiopathic but compression of trigeminal roots by tumours or vascular problems may occur
28
features of trigeminal neuralgia?
electric shock-like pains brought on by light touch, washing, shaving etc
29
mx of trigeminal neuralgia?
1st line- carbamazepine
| failure to respond to treatment or atypical features e.g. <50 years old should prompt referral to neurology
30
what is atypical facial pain?
diagnosis of elimination, functional cause
| iunilateral pain, poorly localised, continuous
31
what is ramsay hunt syndrome?
herpes zoster oticus
| caused by reactivation of the varicella zoster virus in the geniculate ganglion of the 7th cranial nerve
32
features of ramsay hunt syndrome?
auricular pain is often first feature
facial nerve palsy
vesicular rash around ear
other features include vertigo and tinnitus
33
mx of ramsay hunt syndrome?
oral acyclovir and corticosteroids
34
RFs for ramsay hunt syndrome?
elderly, immunocompromised
35
what is rhinosinusitis?
inflammation in the nose and paranasal sinuses with >2 of :
- nasal blockage
- facial pressure
- loss of smell
- endoscopic or CT changes
also runny nose, sneezing, headaches
36
when to refer for biopsy in rhinosinusitis?
a single unilaterl polyp
37
mx of rhinosinusitis?
with polyps- beclomethasone, fluticasone, long term Abx, endoscopic sinus surgery
w/o polyps- intranasal corticosteroids, nasal saline irrigation
38
what is allergic rhinosinusitis?
caused by IgE mediated inflammation, can have nasal polyps and swollen turbinates
tx= loratadine, saline irrigation, intranasal corticosteroids (mometasone)
39
what is TMJ syndrome?
biopsychosocial disorder
| earache, facial pain and joint clicking
40
tx of TMJ syndrome?
simple analgesia
PT
CBT
oral splinting
41
what is Samter's triad?
association of asthma, aspirin sensitivity and nasal polyps
42
what is nasal septal haematoma?
an important complication of nasal trauma that should be looked for
describes the development of a haematoma between the septal cartilage and overlying perichondrium
43
features of nasal septal haematoma?
nasal obstruction
pain and rhinorrhoea
bilateral red swelling from nasal septum
44
mx of septal haematoma?
surgical drainage
IV antibiotics
if suspect CSF rhinorrhoea- test for glucose in fluid
45
complications of septal haematoma?
irreversible septal necrosis -> saddle-nose deformity
46
differentials for deafness
```
ear wax
otitis media (+ glue ear)
otitis externa
presbycusis
otosclerosis
Meniere's disease
drug ototoxicity
noise damage
acoustic neuroma
```
47
what is conductive deafness?
pathology in outer or middle ear e.g. glue ear, otosclerosis
bone conduction> air conduction on Rinnes
sound is localised to the affected side on webers
48
what is sersorineural deafness?
Sensorineural hearing loss occurs due to abnormalities in the cochlea, auditory nerve or other structures in the neural pathway leading from the inner ear to the auditory cortex.
ac>bc
Sound is localised to the unaffected side if unilateral sensorineural deafness
49
unilateral causes of sersorineural deafness?
Meniere's disease
| acoustic neuroma
50
bilateral causes of sersorineural deafness?
```
ototoxic antibiotics
chemo
measles
mumps
meningitis
noise exposure
trauma
```
51
what is otosclerosis?
AD
replacement of normal bone by vascular spongy bone
causes conductive deafness and tinnitus
52
name some ototoxic drugs?
aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents e.g. cisplastin
53
what is presbycusis?
age-related sensorineural hearing loss
| audiometry shows bilateral high-frequency hearing loss
54
what is acute otitis externa?
infection of the outer ear canal
| known as SWIMMERS ear
55
causes of otitis externa?
- infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
- seborrhoeic dermatitis
- contact dermatitis (allergic and irritant)
56
features of otitis externa?
discharge, itch, pain, tragal tenderness
57
Ix for otitis externa?
otoscopy
| swab for microscopy
58
tx of otitis externa
topical antibiotic or a combined topical antibiotic with a steroid
if the tympanic membrane is perforated aminoglycosides are traditionally not used*
if there is canal debris then consider removal
if the canal is extensively swollen then an ear wick is sometimes inserted
Second-line options include
consider contact dermatitis secondary to neomycin
oral antibiotics (flucloxacillin) if the infection is spreading
taking a swab inside the ear canal
empirical use of an antifungal agent
59
causes of chronic otitis externa?
combined staphylococcal and fungal infection
60
tx of otosclerosis?
stapedectomy and insertion of prosthesis
61
what is malignant otitis externa?
life-threatening
can progress to temporal bone osteomyelitis
needs CT, IV Abx and surgical debridement
62
RFs for malignant otitis externa?
diabetes, elderly, immunosuppression
63
causes of acute otitis media?
pneumococcus
H.influenzae
Moraxella catarrhalis
64
RFs for acute otitis media?
```
URTI
Bottle feeding
passive smoking
GORD
raised BMI
```
65
symptoms of acute otitis media?
otalgia, fever, irritability, anorexia, vomiting, discharge
66
Ix of acute otitis media?
otoscope- bulging tympanic membrane
67
tx of acute otitis media?
analgesia, decongestants
| amoxicillin if symptoms lasting more than 4 days or not improving, systemically unwell or immunocompromised
68
what is glue ear?
otitis media with effusion
69
causes of glue ear?
URTI, oversized adenoids, post-nasal space, tumour
70
Ix of glue ear?
otoscopy- fluid levels behind the ear drum, bulging drum or retracted
71
tx of glue ear?
usually mild and resolves spontaneously
popping ears
hearing aids
grommets or tympanostomy tube
72
what is a complication of chronic otitis media?
cholesteatoma
73
what is mastoiditis?
infection of the mastoid bone that often follows an ear infection
74
features of mascoiditis?
otalgia: severe, classically behind the ear
fever
unwell
swelling, erythema and tenderness over the mastoid process
the external ear may protrude forwards
ear discharge if the ear has perforated
75
Ix of mastoiditis?
increased ESR, FBC, blood cultures
| tympanocentesis- sample of fluid
76
tx of mastoiditis?
IV Abx for 1-2 days then oral Abx
ENT referral- surgical drainage
mastoidectomy
77
what is cholesteatoma?
an abnormal skin growth that develops in the middle ear behind the ear drum
build up of squamous epithelium
78
features of cholesteatoma?
foul discharge +/- deafness, headache, pain, facial paralysis, vertigo
79
tx of cholesteatoma?
surgery
80
what is furunculosis?
a very painful abscess arising from a hair follicle within the ear canal
caused by staphylococcus
tx= lancing (cut open)
81
mx of cellulitis of pinna
flucloxacillin
82
differentials of tinnitus?
otosclerosis
acoustic neuroma
hearing loss
drugs- aspirin, aminoglycosides, loop diuretics, quinine
83
red flag of tinnitus?
unilateral tinnitus= acoustic neuroma
84
tx of tinnitus
treat underlying cause
85
red flag for oral cancer
unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.
86
RFs for oral cancer?
smoking, alcohol
87
features of oral cancer?
non-healing ulcer, red/white plaques inside the mouth, painful lump, bleeding, numbness
88
ix of oral cancer?
biopsy
| CT/MRI
89
Tx of oral cancer?
surgery-excision
| photodynamic therapy
90
causes of epistaxis?
```
trauma
platelet disorders- thrombocytopenia, splenomegaly, leukaemia, ITP
Juvenile angiofibroma- benign tumour
Drug use
HHT
Granulomatosis with polyangiitis
```
91
origin of epistaxis?
anterior nasal septum (little's area) as it the confluence of 4 arteries
92
tx of epistaxis?
pinch lower nose
nasal packing
cauterise with silver nitrate
if setpal haematoma -> drain in theatre
93
name some viral causes of tonsillitis?
```
rhinovirus
coronavirus
parainfluenza
adenovirus
HSV
EBV
```
94
bacterial causes of tonsillitis
group A beta-haemolytic strep
95
what is the centor criteria?
```
guidance for Abx prescribing
fever
absence of cough
tonsillar exudate
cervical lymphadenopathy
```
96
tx of tonsillitis?
phenoxymethylpenicillin clarithromycin if allergic
| tonsillectomy
97
what is quinsy?
peritonsillar abscess
98
features of quinsy?
deviated uvula
purulent tonsils
difficulty opening jaw
painful swallowing
99
tx of quinsy?
Abx and aspiration
| tonsillectomy considered in 6 weeks
100
what is the most common type of oropharyngeal neoplasm?
>90% are SCC
| Occur anywhere from the oral cavity to the trachea
101
RFs for oropharyngeal neoplasm?
smoking, alcohol, vitamin A and C deficiency, HPV 16 and 18, GORD
102
Features of oropharyngeal neoplasm?
neck lump
hoarseness
persistent sore throat
persistent mouth ulcer
103
2 week wait for laryngeal cancer for ENT referral?
In people aged 45 and over with:
persistent unexplained hoarseness or
an unexplained lump in the neck
104
causes of stridor?
1. Congenital- laryngomalacia
2. Inflammatory/infective- laryngitis, croup, acute epiglottitis, anaphylaxis
3. Tumours- haemangionas, papillomas, oesophageal cancer
4. Trauma- intubation, burns
105
what is laryngomalacia?
cartilage of the upper larynx collapses inwards during inhalation, causing airway obstruction
106
what is laryngeal nerve palsy?
paralysis/impingement of the recurrent laryngeal nerve- responsible for movement of vocal cords
```
30% due to cancer
25% iatrogenic
15% idiopathic
CNS disease
TB
```
107
differentials of neck lumps in children?
congenital- brachial cyst, thyroglossal cyst, dermoid cyst
inflammatory- reactive lymphadenopathy, lymphadenitis
neoplastic- lymphoma, thyroid tumour, salivary gland tumour
108
what is the most common cause of neck lump?
archive lymphadenopathy
109
what is a red flag for 2 week referral for suspected thyroid cancer?
unexplained thyroid lump
110
what are the features of lymphoma?
rubbery, painless lymphadenopathy
- can get pain while drinking alcohol
- associated B symptoms
111
what happens to a thyroid swelling on swallowing?
moves upwards
112
features of a thyroglossal cyst?
most common in patients >20 years old
usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
113
what is a pharyngeal pouch?
more common in older men
represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
114
what is a cystic hygroma?
a congenital lymphatic lesion typically found in the neck, classically on the left side
90% present before the age of 2
115
what is a brachial cyst?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
116
what is a carotid aneurysm?
a pulsatile lateral neck mass which doesn't move on swallowing
117
what are the borders of the anterior triangle in the neck?
clavicle
sternocleidomastoid
mandible
118
what are the borders of the posterior triangle in the neck?
skull base
trapezius
sternocleidomastoid
119
what is a sialadenitis?
infection of the submandibular or parotid glands
usually in the elderly
tx- abx
120
what is sialolithiasis?
salivary gland stones
| pain after eating in the submandibular glands
