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Maud- Phase 3b > ENT > Flashcards

ENT Flashcards

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1
Q

Examining the ear. What do you do to the pinna / post-auricular?

A

Pinna: inspect for Deformities / abnormal cartilaginous fragments
Scars/skin changes e.g CA / inflammation

Palpate: Pre/Post auricular lymph nodes. Tragus

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2
Q

On palpation the Tragus is tender. Potential cause?

A

Otitis Externa

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3
Q

What do you look for when examining the external ear?

A

Wax/ foreign body, skin changes/ erythema / discharge

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4
Q

Name 2 tuning fork tests for measuring hearing?

A

Rhinne test

Webber test

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5
Q

Placing a tuning fork against the mastoid process and when ptx. stops hearing it holding it infront of ear is known as…

A

Rhinne test

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6
Q

Patient is Rhinne Test Positive, what does this mean?

A

Air conduction heard better than bone conduction (Rh+)= normal/sensorineural HL

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7
Q

Patient is Rhinne Test negative, what does this mean?

A

Bone conduction heard better than air conduction (Rh-)= conductive HL

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8
Q

Placing a tuning fork on the forehead midline is known as what test?

A

Weber test

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9
Q

Rhines test indicates that a patient has right-sided conductive hearing loss (bone conduction heard louded than air conducution).
You perform webers test- placing the tuning fork in the middle of their head. Which side does the patient report it is heard loudest?

A

Heard loudest on right (same side as conductive hearing loss) as the left is subject to ambient sound.

(I think of it as if you have conductive hearing loss your brain has to turn up the sound input on the cochlea)

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10
Q

What is conductive hearing loss?

A

When there’s a problem transferring sound at some point on the pathway from the outer ear–> tympanic membrane –>middle ear

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11
Q

What is sensorineural hearing loss?

A

When there’s a problem with the inner ear e.g cochlea or vestiboulocochlear nerve

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12
Q

In Sensorineural loss which side is the sound loudest on in webers test?

A

Contralateral side

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13
Q

What structures make up the external ear?

A

Pinna, external auditory canal (meatus), lateral surface tympanic membrane

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14
Q

What makes up earwax

A

squamous debris, cerumen and sebum

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15
Q

What structures make up the middle ear?

A

medial surface tympanic membrane, tympanic cavity + eustachian tube, ossicles

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16
Q

Name the 3 ossicles

A

malleus, stapes, incus

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17
Q

Describe the normal appearance of tympanic membrane

A

grey, semitransulscent, lower part= pars tensa, upper part= pars flaccida

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18
Q

Which nerve passes through the middle ear? Function?

A

Chorda tympani

Branch of facial nerve provides taste to anterior 2/3 tongue

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19
Q

Describe the function of the cochlea

A

Hair cells convert mechanical energy from sound to electrical impulses passed down cochlea branch of CN8

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20
Q

Describe the function of the semi-circular canals

A

movement of endolymph in semicircular canals converted to electrical impulses carried by vestibular branch of CN8

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21
Q

What allows us to maintain visual fixation on an object despite head movement?

A

Vestibulo-ocular reflex

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22
Q

Differentials for otalgia (otological causes)

A

Perichondritis / acute otitis externa/ acute otitis media
Trauma / Tumour
Ramsay Hunt syndrome

RHS is paralysis of facial nerve and rash effecting the ear or mouth

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23
Q

Give 3 infective causes of otoligical otalgia

A

Perichondritis
Acute otitis externa
Acute otitis media
Herpes Zoster (ramsay hunt syndrome)

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24
Q

Give 3 non-otological causes of otalgia

A

Tonsil / Pharyngeal inflammation / CA
Temporomandibular joint dysfunction
Dental / Cervical Spine disease

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25
Patient presents with a chronic and offensive ear discharge. Likely diagnosis?
Cholesteatoma
26
Patients ottorhoea is mucoid, cause?
CSF leak from severe trauma
27
Itchy ear- likely cause?
Otitis externa
28
Purulent ottorhoea- likely cause?
Purulent disharge: | ear-drum perforation + infection / otitis externa
29
What type of patient is tinnitus more common in?
Tinnitis more common in ptx. with hearing loss
30
What is tinnitus
Buzzing/ringing/whooshing/humming in the absense of stimulus
31
``` Give a cause of conductive hearing loss relating to: External ear Tympanic membrane Middle ear space Ossicles ```
External ear: wax / otitis externa Tympanic membrane: trauma Middle ear space: effusion, infection, trauma, tumour Ossicles: trauma, otosclerosis
32
Differentials of sensorineural hearing loss?
Genetic / Idiopathic / Presbyacusis Infection: meningitis, MM(R) (pre-natal) Acoustic neuroma, Meniere's disease Trauma // Occupational / noise-induced
33
What are the three salivary glands?
Parotid, submandibular, sublingual
34
Causes of parotid swelling
mumps, stone in salivary duct, benign/malignant tumour, | Sjogren's, sarcoidosis, HIV
35
Patient presents with bilateral parotid swelling for 1 week and a low-grade fever, what diagnosis should you work to exclude?
Mumps
36
What investigations should you undertake for swollen parotids
FBC, ESR/CRP, UE Blood culture, Viral Seroligy Salivary antibody testing (mumps IgM) Imaging: USS / Sialography CT/MRI ?neoplasm
37
Give a viral and bacterial cause of parotitis?
``` viral= mumps bactereial= staph aureus ```
38
Symptoms of parotitis
painful, swollen, | fever, dry mouth
39
Management of mumps
Usually self-limiting
40
Management of suppurative parotitis?
abx +/- incision and drainage
41
What structures form the anterior triangle of the neck
Superior- inferior border of mandible Medial- sagittal line of body Lateral- medial border sternocleidomastoid
42
What are the three paired salivary glands?
Parotid, Sublingual, Submandibular
43
What important structure passes through the parotid gland?
Facial nerve
44
Most parotid gland tumours are...
benign (80%)
45
Risk factors for parotid gland tumour
Radiation exposure, EBV, smoking, genetics
46
S&S of parotid gland tumour
painless enlarging mass, facial nerve palsy, redness, ulceration
47
Which key symptom of a parotid gland tumour indicates that it is malignant?
Facial nerve palsy
48
Investigations of parotid gland tumour
Bloods- ?infective cause FNA cytology- ?malignant CT neck + thorax- staging
49
What is the management for a parotid gland tumour?
Partial/Total parotidectomy +/- adjuvant radiotherapy
50
What is sialadenosis?
Chronic, bilateral swelling of parotids Non-inflammatory, non-neoplastic Associated with sjogren's
51
Name a medication given to patients with hyposalivation?
Pilocarpine
52
What are the 4 tonsils surrounding the superior pharynx (waldeyer's ring)?
Pharyngeal, Tubal, Palatine, Lingual
53
What is xerostomia?
Dry mouth
54
What is sialectasis?
Cystic dilation of salivary gland ducts
55
Tonsilitis is most commonly viral or bacterial? | Give examples of each
*Viral- Rhino/corono/parainfluenza virus | Bacterial- group A beta haemolytic strep
56
What are the centor criteria for tonsilitis?
Tonsilar exudate, fever, tender lymphadenopathy, absence of cough Score 3/4= likely strep, give Abx
57
Commonest bacterial cause of tonsilitis?
Group A B-haemolytic strep
58
Management of viral / bacterial tonsilitis
Viral: sx relief (ibruprofen / paracetamol) Bacterial: sx relief and penicillin 10 days
59
What is quinsy? 3 S&S? Mx?
Asymmetrical peritonsilar abscess which pushes uvula to one side Dysphagia, hot potato voice, trismus, uvula deviation Drainage, tonsilitis mx Trismus= locked jaw
60
Cause of Glandular Fever?
EBV
61
Patient presents with sore throat, fever, malaise, lethargy, cervical lymphadenopathy, white film on tonsils and hepatosplenomegaly. Likely diagnosis? Mx?
Glandular fever | Analgesia, steroids, no contact sports +/-abx
62
Commonest form of laryngeal CA?
Squamous cell carcinoma
63
Risk factors for laryngeal CA?
smoking, alcohol, HPV, M>F
64
What are the risk factors for epistaxis
trauma, nose pickers, cold/hayfever, pregnancy, chemotherapy, anticoagulants, infection
65
Mx of epistaxis
ABCDE Topical: vasoconstrictors (e.g adrenaline), lidocaine, tranexamic acid, cautery Nose packing / gauze
66
Anterior nasal blood supply: Name of area Name of arteries
Kiesselbach's (little's) area. | LEGS: labial, ethmoidal (anterior), greater palpatine, sphenopalpatine
67
Differentials for anosmia
nasal obstruction, parkinsons, DM, alzheimer's, COVID-19
68
What is trismus?
lock jaw / reduced jaw movement
69
How many episodes of bacterial tonsilitis per year to have tonsilectomy?
7
70
Does the presence or absence of cough score a point on centor criteria and why?
Absence of cough scores Cough is more indicative of URTI than tonsilitis
71
What is tympanosclerosis?
Calcification of tymapanic membrane and middle ear
72
What is a potential treatment for fungal otitis externa?
Canestan | Co trimazole
73
What happens to the light reflex in AOM?
Lost because the tympanic membrane bulges towards you
74
O/E of ear you see black dots, what is the likely diagnosis?
Fungal infection aspergillis niger
75
What is a furuncle?
AKA boil | painful infection which forms around a hair follicle, contains pus
76
OE there is eczematous inflammation with otitis externa. Give 2 examples of drugs which could be used to treat this?
``` Gentisone (gentamicin + hydrocortisone) Otomize soray (neomycin, dexamethasone, acetic acid) ```
77
Give 3 drugs which are involved in the treatment of balance disorders?
Prochlorperazine (stematil)- labrynthitis | Cinnarizine (sturgeron) / Betahistine dihydrochloride (serc)- vertigo, tinnitus and menierre's
78
Give an example of a drug prescribed for acute otitis media?
Augmentin (amoxicillin and clavulanate potassium)
79
Give several differentials for a patient that presents with otorrhoea?
Serous- otitis externa Mucoid/purulent- otitis media Clear/blood stained- CSF (if head injury) Foul smelling- cholesteatoma
80
Give several differentials of otalgia: External? Middle ear? Referred?
External- trauma, otitis externa, furunculosis Middle ear- acute otitis media, acute mastoiditis Referred- teethh, larynx, pharynx, neck
81
Patient on webers test reports the sound is heard equally in both ears. What does this indicate?
Normal hearing
82
Rhinnes test reveals Left ear: air conduction heard louder than bone conduction Right ear: bone conduction heard louder than air conduction What does this indicate?
Right sided conductive hearing loss

Maud- Phase 3b (14 decks)

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