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ALM5 > ENT MCQ 2021 > Flashcards

ENT MCQ 2021 Flashcards

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1
Q

Peri-orbital (Pre Septal Cellulitis)

95% of cases it is from

A

insect bite
scratch
ezcema

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2
Q

who is peri orbital cellulitis more common in ?

A

more common in children

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3
Q

Which is more common and which is more serious pre septal vs orbital

A

Periorbital is more common
orbital far more serious.
If clinicians are unsure, should treat sa though it is orbital

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4
Q

clinical presentaiton PS cellulitis

common bacteria

A

unilateral ocular pain
eyelid swelling
erythema

Strep pneumoniae, Staph aurueus

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5
Q

TReatement periorbital cellulitis

A

Oral antibiotics - Trimethoprim or clindamycin ++++ Amoxicillin

5-7 days

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6
Q

Diagnosis based on: preseptal cellulitis

A

clinical features + CT (if unsure and worried about orbital cellulitis)

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7
Q

Congenital dislocation of HIp: What are three things that make it more common?

A

Higher incidence in 1) breech presentation 2) first born children
3) oligohydramnios 🡪 all due to decreased intrauterine space

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8
Q

What infection can lead to orbital cellulitis?

A

Maxillary sinusitis

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9
Q

Orbital Cellulitis: What occurs

A

decreased VA
Diplopopia
decreased extraocular movement

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10
Q

SInusitis: Maxillary is most common: what are two types?

A

acute sinusitis <1 month

chronic sinusitis > 3 months

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11
Q

sinusitis presentation

A

facial pressure, fever headache and rhinorrhea (purluent dischargefrom nose)

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12
Q

acute bacterial sinusitis signs

A

fever
leukocytosis
purulent nasal discharge

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13
Q

Most cases of acute sinusitis are VIRAL/self limiting but if acute bacterial sinusitis what is treatment?

A

decongenstants antihistamines

antibiotics - Amoxicliin (or if not working augment (+clauvanate 10 days

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14
Q

Maxillary Sinusitis Differentials:

PAIN ONLY - frontal pain headaches that are severe without nasal symptoms indicates?

A

migrainous neuralgia (cluster headaches)
TMJ
Trigeminal neuralgia
migraines

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15
Q

Recurrent attacks of acute maxillary sinusitis: Surgical options?

A

FESS: antrostomy: permnanet intransal opening into antrum through meatus

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16
Q

What can cause maxillary sinusitis tooth wise?

other cuases

A

apical infection of tooth
anything rhino in nature:

nasal polypoisosis
deflected nasal septum
turbiante hypertrophy

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17
Q

diagnosis of chronic sinusitis based on:

A

Evidence of inflammation on endoscopy or CT

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18
Q

Signs on CT of sinusitis

A

opacity of the antrum(maxillary) due to infection

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19
Q

RED FLAGS FOR SINUSITIS

A

Facial Swelling/Periorbital swelling is a red FLAG

Intracranial:

meningitis
cavernous sinus thrombosis
orbital abcess/ frontal bone abcess
frontal bone osteomyelitis

Extracranial:
Periorbital cellulitis

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20
Q

Chronic sinusitis non operative treatment:topical and systemic

if mucopurulent?

A

Topical corticosteroids

prednisone 30mg (esp. polyp patients)

Antibiotics if mucopurulent

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21
Q

GLandular Fever vs tonsilitis

A

draw box out

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22
Q

what disease is chronic sinusitis associated with

A

asthma (+ polyps)

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23
Q

What is samsters triad?

A

where asthma, nasal polyps (+ rhinosinusitis) + aspirin allergy

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24
Q

How is samsters triad tested for ?

A

Allergy testing for skin

eosinophilia

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25
How is chronic sinusitis diagnosed?
CT pus swab mucociliary function assessment allergy testing skin (seeinf for eosinophilia
26
Samsters triad/nasal polyp treatment?
Functional endoscopic sinus surgery (FESS) Topical steroids Oral prednisone
27
infectious pharyngitis bacterial: ``` bacteria age seen on examination lymph nodes spleen lab investigation ``` pain radiation complications
Bacteria; GAS, N gonorrhoea, M pneumonia older children (20% of all cases) large red pockets of pus anterior (cervical) triangle lymph nodes tender spleen normal Labs: Bacterial swab and culture radiates to ear can cause peritonsillar abcess!!!1
28
EBV: ``` bacteria age seen on examination lymph nodes spleen lab investigation ``` radiation of pain
EPV/CMV older children (20% of all cases) on examination: pharngitis (same as ) enlarged tonsils/post nasal space can obstruct airways + white membrane covering the tonsils posterior triangle lymph nodes lymphadenopathy Spleen: hepatosplenomegaly Lab: Monospot test (heterophile antibiodies) CBC, pain raidates to ear
29
Treatment strep vs EBV
Strep: Amoxicillin | EBV?viral: fluids, rest
30
Amoxicillin: Do you give in EBV?
No as it can cause widespread rash
31
Strep throat guidelines: Who must assess risk for RF?
maori/pacific 3-45 low SES past history of rhuematic fever
32
What criteria is used for strep throat risk guidelines?
Centor criteria
33
Facial Palsys: What must all facial palsies have ?
otological assessment
34
what is commonest cause of facial palsy?
Bells palsy
35
What occurs in bells palsy?
Lower motor neuron disease of cranial nerve 7 the facial nerve : ipsilateral unilateral paralysis of all facial muscles (cannot close eye on that side)
36
What are two types of palsies of face?
central and peripheral central: preservation of upper half of facial movemnets (UMN) peripheral: loss of forehead and brow and lower face (LMN)
37
two types of LMN facial palsies
bells palsy | Ramsay Hunt
38
2 absolute and 2 relative indications for tonsillectomy
Oropharyngeal Airway obstruction Peritonsillar Abcess histology indicating neoplasm recurrent acute tonsilitis chronic tonsilitis
39
4 commonest complicaitons for tonsillectomy
``` Pain throat and otalgia Infection Primary Haemorrhage Secondary Haemorrhage general anasthetic problems ```
40
bells Palsy: Aetiology clinical presentaiton treeatment
Herpes Simplex virus of cranial nerve 7 LMN facial nerve unilateral ispilateral paralysis of facial muscles Hyperacusis is a hearing disorder TReatment: Steroids + acyclovir eye patching
41
bells Palsy: Aetiology clinical presentaiton treeatment
Herpes Simplex virus of cranial nerve 7 LMN facial nerve unilateral ispilateral paralysis of facial muscles Hyperacusis is a hearing disorder TReatment: Steroids + acyclovir (self limiting) eye patching
42
Ramsay Hunt syndrome: What is this?
lmn of facial nerve sue to varicella zoster infection of facial nerve and vestibulocochlear nerve
43
Ramsay Hunt presentation
unilateral paralysis of one side of the face. vesicular dermatome rash usually near ear LMN 8 = sensori neural hearing loss + tinnitus
44
Conductive hearing loss:
Bone conduction normal (bone conduction system bypasses the conductive structures of the outer and middle ear, so it can send sound vibrations directly to the cochlea) and air conduction reduced
45
Sensorineural hearing loss
both bone conduction (nerve) and air conduction reduced.
46
exotoses what is it
broad based bony tissue in external auditory canal typically due to swimming in cold water
47
complications of exotoses
accumulate wax and epithelium | can lead to otitis externa as complication
48
complications of exotoses
accumulate wax and epithelium | can lead to otitis externa as complication with conductive hearing loss
49
two common causes of facial palsy in children
acute otitis media | bells palsy
50
3 indications for tracheostomy
Upper airway obstruction Respiratory failure / To provide pulmonary toilet where can remove with suctions
51
Retropharyngeal abcess clinical presentation
stiff neck malaise difficulty swallowing
52
risks of retropharyngeal abcess
infection can pass down behind esophagus and into mediastinum airway obstruction sepsis
53
Retropharyngeal abcess clinical presentation
stiff neck malaise difficulty swallowing /painful swalloing sore throat
54
diagnosis of retropharyngeal abcess
CT definitive | Xray
55
treatment:
tonsillectomy to drain abcess - risk of abscess rupture during tracheal intubation - needing tracheotomy
56
chronic retropharyngeal abcess usually secondary to?
tuberculosis
57
chronic retropharyngeal abcess in adults usually secondary to?
tuberculosis
58
retropharyngeal abcess age
6 months to 6 years
59
Audiogram: vertical horizontal
hearing level in DBHL intensity of sound 0-25 adult 0-15 infant frequency of pitch 250Hz and 6000Hz is normal speaking
60
conductive vs sensorineural causes
conductive: disease of middle or external ea - AOE, AOM, exotoses, perforations, cholestoma, atelectasis SNL: inner ear, acoustic nerve or the CNS - caused by aminoglycosides or loop diuretics
61
TYmpanogram types and causes | A=
``` A= normal - peak AS= small peak = less compliant otosclerosis AD = Very HIGH peak = ossicular chain discontinuity B = flat no obvious peak indicates effusion or perforation C= negative pressure slid to the left = indicates eustachian tube dysfunction - before or after ```
62
what is tympanogram testing
compliance/ flexibility of the eardrum to changing ear pressures
63
ossicular chain discontinuity what is this ?
seperation of the middle ear ossicles.
64
Bat ears: what causes this
fold of antihelix is absent or poorly formed in prominent ear
65
treatment bat ears and when is best age
4-6 years | surgical otoplasty correction with reshaping cartilage of the pinna
66
Otitis Externa: causes
swimming, allergy, trauma, excema
67
symptoms otitis externa
pain, itchiness and discharge
68
signs AOE
erythema increasing oedema canal debris possibly conductive hearing loss
69
signs that AOE has progressed
severe pain that is worse with ear movement signs: lumen obliteration purulent otorrhea involvement of periauricular soft tissue
70
otitis externa most common pathogens and treatment (4 princples)
psudeonomonas aeruginosa and staph aureus ``` Frequent canal cleaning (“aural toilet”)  Topical antibiotics  Pain control  Instructions for prevention  Keep ear dry  No instrumentation of EAC ```
71
treatment for psudenomnas
topical or ciproflaxcin
72
what may otitis externa require?
packing: pope wick soaked antibiotic + steroid | Once the swelling reduces the pack can be removed and the patient continued on drops depending on progress
73
Acute otitis media: location common organisims
middle ear and mastoid S pneumoniae, H influenze and M. catarrhalis
74
AOM complications: name 2 and treatment
Perforated tympanic membrane leading to Tympanic scarring /tympanosclerosis Mastoiditis
75
what causes tympanosclerosis
history of ventilation tubes acute otitis media otorrhoea (ear discharge)
76
mastoiditis : what is this
infection of the "air cells" in mastoid typically after suppurative acute otitis media
77
Complications of mastoiditis
meningitis intracranial abcess dural sinus thrombosis
78
Imaging mastoiditis
soft tissue opaeuety in mastoid cavity on the mastoid cavity
79
what is seen clinically mastoiditis
otorrhoea, tenderness over mastoid, post auricular swelling with protruding ear + AOM seen on microscopcy
80
treatment mastoiditis
IV antibiotics and mastoidectomy
81
complications of ventilation tubes
``` infection retention early extrusion peristent perforation swimming issues ```
82
what is management for persistent AOM?
ventilation tubes
83
Epiglottits clinical presentation
stridor drooling fever hoarseness
84
Epiglottis caused by
Bacterial H influenzae B
85
tracheostomy complications
haemorrhage recurrent laryngeal nerve injury pneumothorax
86
Reinke's Oedema Causes
swollen vocal cords: smoking GERD hypothyroidism voice trauma
87
Epiglottits treatment + what should you be wary of ?
Bag mask - intubation Nebulised adrenaline Antibiotics silent airway= means patient is not moving enough air, can be life threatening
88
Paediatric sensorineural hearing loss: | Causes
Congenital: 50% genetic/ environmental -waardenburg syndrome + branchio-otorenal syndrome Acquired: Maternal infection: TORCH neonatal ICU child
89
Sensorineural hearing loss: Most common cause in adults
Presbyacusis (most common) acoustic neuroma noise damage

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