ENT + opthalmology Flashcards by Ella Frame

what other symptoms to ask about in hearing loss

tinnitus
pain
discharge
vertigo
neurological symptoms

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describe webers test and the results

vibrate tuning fork
put it on middle of forehead
sensorineural hearing loss = louder in NORMAL ear
conductive hearing loss = louder in DEAF ear (vibration directly to cochlear)

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describe rinne’s test

vibrate tuning fork
place flat end on mastoid process (tests bone conduction)
ask pt when they can no longer hear humming noise
move it to outside ear (still vibrating) = air conduction
repeat on other side

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describe the results of rinne’s test

normal = pt can hear fork through air - air conduction is better = rinne’s POSITIVE

abnormal = pt cannot hear fork after removing from bone = rinne’s NEGATIVE = suggests CONDUCTIVE loss

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name some causes of sensorineural hearing loss

sudden onset
presbycusis (age related)
noise exposure
menieres
labrynthitis
acoustic neuroma
neuro conditions
infections
medications (furosemide/gentamicin/cisplatin)

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name some causes of conductive hearing loss

ear wax
fluid
infection
Eustachian tube dysfunction
perforated tympanic membrane
tumours

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what is a cholesteatoma

abnormal collection of squamous epithelial cells in middle ear
non cancerous but can invade local tissue and erode bones of middle ear
can cause bad ear infections with FOUL discharge

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what is the presentation and management of cholesteatoma

foul discharge from the ear
unilateral conductive hearing loss
?infection
?pain
?vertigo
CT head to confirm + surgical removal

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what are the 4 sets of paranasal sinuses

frontal sinuses
maxillary sinuses
ethmoid sinuses
sphenoid sinuses

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how to treat sinusitis if symptoms not improved after 10 days

high dose steroid nasal spray 14 days
OR
delayed phenoxymethylpenicillin prescription for if not improved after 7 further days

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how to correctly use a nasal spray

head tilt slightly forward
opposite hand to nostril
DONT sniff hard during spray
gently inhale through the nose after the spray

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name some causes of TMJD

stress/low mood
teeth grinding
chronic pain
trauma to teeth/face causing abnormal bite

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what are the symptoms and signs of TMJD

symptoms:
pain in pre-auricular area radiate to jaw
crepitus of joint
locking of joint
difficulty fully opening the mouth

signs:
tenderness on palp of joint
crepitus on movement
locking of jaw

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how is TMJD managed

conservatively - painkillers and jaw exercises
mouth guard for grinding
rare but can have surgery/botox injections?

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what investigations should be done for tinnitus

bloods:
FBC
glucose (diabetes)
TSH
lipids

audiology
CT/MRI if vascular/neuro cause considered

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what are some red flags with tinnitus

unilateral
pulsatile
pain with noise
unilateral hearing loss
vertigo/dizziness/headaches/visual sympts
suicidal ideation related to tinnitus

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what is malignant otitis externa

severe/life threatening
infection spreads to bone –> osteomyelitis of temporal bone
usually occurs in immune suppressed
symptoms more severe
requires emergency admission and treatment with IV abx

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what are the additional symptoms of a quinsy

trismus = cant open mouth
change in voice due to swelling (hot potato)
swelling and erythema

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what is the management of a quinsy

needle aspiration
surgical incision and drainage
broad spectrum Abx
?dexamethasone

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what is the main complication of a tonsillectomy

bleeding!!
up to 2 weeks after
risk of aspiration of blood

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what type of cancers are head and neck cancers

squamous cell carcinoma

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what are the risk factors for head and neck cancers

smoking
chewing tobacco or betel quid (paan)
alcohol
EBV
HPV 16

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what are some red flags for head and neck cancer

unexplained lump or ulceration >3 weeks
erythoplakia (ulcer bleeds when scraped)
persistent neck lump/thyroid lump
unexplained hoarseness of voice

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name the monoclonal antibody used in treating head and neck cancer

cetuximab

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what is the most likely location of epistaxis

little's area | keisselbach's plexus

how should nosebleeds be managed

sit up and tilt head forwards squeeze soft part of nostrils together 10-15 mins spit out blood severe: nasal packing nasal cautery

what is leukoplakia

white patches on buccal mucosa precancerous = increase risk of squamous cell carcinoma

what is erythroplakia

red lesion on buccal mucosa higher risk of squamous cell carcinoma bleed easily when scraped

what is lichen planus

autoimmune condition = chronic inflammation of skin purple raised areas with white lines (wickham's striae) good oral hygeine + no smoking + topical steroids

vertigo 20-30 second spells ?viral infection no hearing loss no tinnitus

BPPV Hallpike to Dx Epleys to Tx betahistine limited benefit calcium carbonate crystals in semicircular canals

vertigo - hours to days N+V struggling to balance no tinnitus no hearing loss recent viral illness

vestibular neuronitis only vestibular nerve affected do HINTs to Dx prochlorperazine + antihistamine vestibular rehab for chronic

important to differential for vestibular neuronitis and how to distinguish

posterior circulation stroke do head impulse nystagmus test (HiNTs) eye saccade = +ve for VN

40-50 years old vertigo - episodic clusters hearing loss - fluctuates with vertigo tinnitus aural fullness

menieres disease see ENT audiology = sensorineural loss acute attacks = prochlorperazine + antihistamines prophylaxis = beta histine

sudden onset vertigo - not triggered by movement but exacerbated by it N+V hearing loss - uni or bi tinnitus recent URTI

viral labyrinthitis vestibular nerve + labyrinth involved sensorineural hearing loss spontaneous nystagmus towards affected side self-limiting ?prochlorperazine / antihistamine to reduce vertigo

elderly patient dizzy on extension of neck

vertebrobasilar ischaemia

40-60 years old gradual onset hearing loss tinnitus vertigo absent corneal reflex

acoustic neuroma/vestibular schwannoma urgent ENT referral MRI to Dx Tx = conservative or surgery importand ddx = meningioma

hearing loss aural fullness popping sensation pain/tinnitus

eustacian tube dysfunction clinical Dx or can do audiometry/tympanometry no Mx ?vasalva ?decongestants ?grommets

what can cause otitis media

s.pneumoniae h.influenzae m.catarrhalis s.aureush

how does otitis media present

kids pain hearing loss unwell URTI +/- vertigo +/- discharge

how does otitis media with effusion present

= glue ear! most common in children <2 hearing loss/delay in speech otoscopy = dull, loss of light reflex

how is otitis media managed

3 days - 1 week resolve by self Abx make no difference simple analgesia ?delayed Abx = amoxicillin 5-7 days

how is glue ear managed

in child first presentation = nothing multiple in child = grommet or adenoidectomy

ear pain discharge itchy hearing loss red/swollen inner ear

otitis externa swimmers ear otoscopy + ear swab mild = acetic acid (antibac/antifungal) moderate = otomize (neomycin, dexa, acetic acid)

define acute and chronic otitis externa

acute = <3 weeks chronic = >3 weeks

what can cause otitis externa

p.aeruginosa (CF) s.aureus

what is it important to do before prescribing topical antibiotics for the ear

exclude tympanic membrane perforation because gentamicin cause hearing loss

describe the feverpain score

fever in past 24 hrs purulence attend w/n 3 days inflamed tonisls no cough/coryza 2-3 consider delayed Abx 4+ = give abx = phenoxymethylpenicillin 10 days

describe the CENTOR criteria

fever >38 tonsillar exudate no cough tender lymphadenopathy 1 point for each 3+ = 40-60% bacterial = ABx

what is a serious complication of otitis media and who is more likely to get it

mastoiditis !! s.pneumoniae/h.influenzae children LD/autism immunocomp

oh no! a 4 year old autistic child presents unwell, tugging at his right ear on inspection there is a red swelling behind the ear and the ear appears more prominent than the left on otoscopy the tympanic membrane appears bulging what do you do now?

immediate urgent to ENT ABCDE Sepsis 6 HELP! CT head to show ? progression to temporal bone

21 year old student present generally unwell, with swollen cervical lymph nodes what investigations do you want to do? what management would you give?

monospot test = heterophile Antibodies paul bunnel test self limiting but give advice: avoid alcohol avoid contact sports

what are the complications of EBV

burkitts lymphoma splenic rupture chronic fatigue glomerularnephritis haemolytic anaemia

18 year old with a neck lump mobile non-tender soft moves with movement of tongue

thyroglossal cyst can be sublingual!

18 year old with a neck lump midline mobile non-tender soft moves with movement of tongue lump has turned hard and is emitting discharge!

infected thyroglossal cyst Tx = antibiotics + surgical

teenager with a neck lump soft, round no movement with tongue doesnt transilluminate

branchial cyst arise from second branchial cleft Mx = conservative or surgery

60 year old man choking on food regurgitating food chronic cough halitosis feels a lump in the neck

pharyngeal pouch do a barium swallow + fluroscopy management is surgery

4 month old large neck lump on LEFT side fluctuant

cystic hygroma = lymphagioma surgical excision

68 year old complaining because left eye drooping ptosis + miosis has a pulsatile lump in side of neck

carotid body tumour surgical treatment

causes of hornerys syndrome if anhidrosis in: 1. head /arm/trunk 2. just face 3. no anhidrosis

1. stroke 2. pancoast tumour / cervical rib 3. absent = carotid artery tumour/pressure

what eye complication following renal transplant

CMV retinitis cotton wool spots infiltrates haemorrhages

what are the branches of the facial nerve and how can you remember them

To Zanzibar By Motor Car temporal zygomatic buccal marginal mandibular cervical