General Flashcards
(221 cards)
1
Q
does the inner ear feel pain?
A
no
2
Q
if otalgia is coming from middle or outer ear, the drum looks dodge. if the drum is normal, it’s likely
A
referred pain
3
Q
name 2 otological causes of otalgia
A
acute otitis media
otitis externa
furuncule
necrotising otitis media
4
Q
name 3 referred causes of otalgia
A
dental pathology
TMJ dusfunction
OA of cervical spine
throat infection
oropharyngeal malig
5
Q
what is most common organism causing otitis externa
A
pseudomonas
6
Q
two signs of otitis externa on examination
A
debris (white/cheesy); oedema of canal
7
Q
what condition is assoc w otitis externa?
A
eczema
8
Q
treatment for otitis externa?
A
microsuction
gentamicin ear drops
+/- steroid
9
Q
fungal otitis externa treatment?
A
clotrimazole 14ds
10
Q
what can be used to prevent recurrent otitis externa
A
acetic acid ear spray (bad env for pseudomonas)
11
Q
staph abscess on a hair follicle = what?
A
furuncule
12
Q
what is treatment for furuncle?
A
oral fluclox
maybe incision and drainage
13
Q
what is furuncule?
A
staph abscess on hair follicle
exquisitely tender
14
Q
osteomyelitis of skull base extending into ear canal = what?
A
necrotising otitis externa
15
Q
necrotising otitis externa = what?
A
osteomyelitis of skull base extending into ear canal
16
Q
an elderly diabetic w white debris in ear canal, oedematous. TERRIBLY painful and unremitting, unresponive to topical gentamicin drops. diagnosis?
A
necrotising otitis externa
needs debridement in hosp and long course of IV Abx
17
Q
name some common viral causes of otitis media
A
RSV, rhinovirus, parainfluenza
18
Q
name some bac causes of otitis media
A
strep pneum, h.flu, moraxella
19
Q
red bulging ear drum on examination makes you think
A
otitis media
20
Q
name two complications of acute otitis media
A
mastoiditis
chronic suppurative otitis media (drum perforates permanent)
meningitis, brain abscess, labrynthitis
21
Q
management of acute otitis media
A
self limiting within 72hrs
22
Q
when to give Abx in acute otitis media? which Abx?
A
systemically unwell or worsening after 72hrs
amoxicillin 5ds
23
Q
presentation of acute otitis media
A
children
cold/coryza / fever /cough –> deafness, earache, tugging
pain then discharges relieves
24
Q
what is most common form of epistaxis?
A
anterior haemorrhage (95%)
25
most common area for nosebleeds?
little's area (anastamosis of vessels in nasal septum)
26
are anterior or posterior nosebleeds worse?
posterior - elderly, riskier for airway compromise
27
name some causes of epistaxis
```
trauma (xs nose blowing, foreign bod insertion)
drugs - cocaine, anticoags
coagulopathy
malig
wegener's
```
htn = rf
28
what kind of malignancy causes epistaxis
juvenile angiofibroma
29
bleeding from one nostril = what kind of haemorrhage
anterior haemorrhage
30
bleeding from both nostrils and throat?
posterior haemorrhage
31
what symptoms should you ask about in young males w epistaxis to rule out juvenile angiofibroma?
headache?
rhinorrhoea?
anosmia?
32
tell me some history questions for nosebleed
```
time of onset
estimated blood loss
triggers
facial pain /otalgia
headache/rhinorrhoea/anosmia
```
drug hx - coke, anticoags, aspirin
fhx - hereditary haemorrhagic telangiectasia
33
what symptoms should you ask about to establish risk of nasopharyngeal tumour in epistaxis?
facial pain / otalgia
34
tell me about what examination you do in epistaxis
A-E!!
esp airway and circulation
anterior rhinoscopy w headlight + suction
inspect in mouth too
35
most normal nosebleeds dont need blood tests, but in severe epistaxis what bloods do u take?
FBC, clotting, G&S/crossmatch
36
if haemodynamically unstable in epistaxis when you do A-E?
fluids
| transfusion if nec
37
tell me how to do first aid for nosebleeds!
digital pressure on nostrils
ice on forehead/bridge
keep head forward
38
why digital pressure on nostrils not bridge in nosebleeds
that's little's area
39
if first aid doesnt work, what next for nosebleed
cautery w silver nitrate
40
if first aid and cautery don't work, what next for nosebleed?
nasal packing
41
what nasal packing to use for anterior haemorrhage?
rapid rhino
42
what nasal packing to use for posterior haemorrhage ?
foley catheter
43
if first aid and cautery and nasal packing dont work, what next?
theatre (ligation of artery)
44
what cream helps prevent further bleeding after nosebleeds?
Naseptin
45
what is vertigo?
sensation that surroundings are spinning
| often w nausea + loss of balance
46
what is the labyrinth?
bony inner ear
| semicircular canals + vestibule (utricle/saccule) + cochlea
47
name some central causes of vertigo
MIGRAINE ; EPILEPSY ; ACOUSTIC NEUROMA ; HEAD INJURY ; ALCOHOL INTOX
48
name some central causes of vertigo
VESTIBULAR NEURITIS ; VIRAL LABYRINTHITIS ; BPPV ; MENIERE'S ; RAMSAY HUNT ; VESTIBULAR MIGRAINE ; OTOTOXIC DRUGS
49
name 2 ototoxic drugs
furosemide
| gentamicin
50
what is ramsay hunt syndrome?
herpes zoster in facial nerve
51
how does romberg's test help in assessing vertigo?
shows proprioception - vestibular function
52
what is the Unterbergers test?
march on spot with eyes closed, if turn on spot then vestibular pathology
theres also Head Impulse Test for vestibular dysfunction
53
if balance problems long term with vertigo, what can be offered?
vestibular rehab!
54
vertigo is v sudden onset and not positional. management?
urgent referral to ENT
55
vertigo is causing such severe vomiting that can't tolerate fluids. management?
admit
56
vertigo assoc w central neuro symps inc new headache. management?
neuro referral
57
vertigo in the GP with undetermined cause, pt stable. management?
refer to ENT / neuro, non urgent.
58
describe symptomatic treatment of vertigo - 3 drugs that sound rather similar
prochlorperazine
cyclizine
promethazine
59
what is vestibular neuritis?
inflammation of the vestibular nerve
60
infl of vestibular nerve = what?
vestibular neuritis
61
what causes vestibular neuritis?
reactivation of latent HSV1 in vestibular nerve
| often preceded by URTI
62
what is labyrinthitis ?
inflammation of vestibular nerve plus labyrinth involvement (urticle, saccule, cochlea, semicircs) so may have hearing loss and tinnitus as well as vertigo
63
is most labyrinthitis viral?
yes
| preceded by URTI
64
spontaneous sudden severe incapacitating vertigo not exacerbated by movement with hearing loss and tinnitus in someone who's just had a cold
labyrinthitis
65
lie still in a dark room with your eyes closed and wait for it to pass when youve got
labyrinthitis
66
how long does labyrinthitis usually take to resolve itself?
days-wks
67
what can u give for symptomatic relief of vertigo in labyrinthitis?
prochloperazine / promethazine
68
too much endolymph in labyrinth aka endolymphatic hydrops aka...
meniere's disease
69
what is meniere's disease
too much endolymph. endolymphatic hydrops
70
what are the symptoms of meniere's disease?
vertigo attacks 2-3hrs long (every few months)
| tinnitus, hearing loss, sensation of aural fullness
71
joan is having attacks of vertigo every few months. they last about 2-3hrs and are assoc w tinnitus, hearing loss and aural fullness. diagnosis?
meniere's disease
refer to ENT to confirm diagnosis
72
what will be seen on audiometry with meniere's disease?
sensorineural hearing loss
73
what drug can be given as preventative for meniere's disease?
betahistine
74
what is the pathophysiology of Benign Paroxymal Positional Vertigo?
otoliths detach from utricle and rattle in semicircular canals
mostly posterior semicircs bc anatomy :)
75
otoliths detach from utricle and rattle in semicircular canals. what's this?
BPPV
76
rugby players and elderly women stereotypically get which ENT condish
BPPV
77
name some symptoms of BPPV
```
vertigo attacks lasting 20-30 seconds
better if head still
rolling over in bed
no hearing loss
no tinniturs
```
78
do you get hearing loss and tinnitus in BPPV?
no
79
do you get hearing loss and tinnitus in meniere's disease?
yes
80
do you get hearing loss and tinnitus in labyrinthitis?
yes
81
describe the dix-hallpike test
hoosh down onto couch + look for upbeating nystagmus+ pt experiences vertigo
82
you do the dix-hallpike test on a pt you suspect might have BPPV. you see downbeating nystagmus. management?
refer rapidly. its a red flag
83
a pt thinks they have BPPV but then they tell you they only have unilateral hearing loss and tinnitus. management
refer rapidly. unilateral is a red flag
84
name some red flags that mean its something more worrying than BPPV
downbeating nystagmus
new onset headache
focal neuro/gait ataxia
unilateral hearing loss/tinnitus
85
how does the epley manoevre actually work its magic?
hooshes otoliths back into utricle
86
y'alright kate hun?
yeh :)
87
which nerve supplies all the intrinsic muscles of the larynx exc cricothyroid?
recurrent laryngeal
| cricothyroid supplied by superior laryngeal
88
hoarsness may be a warning of impending ariway obstruction, in....
acute epiglottitis
anaphylaxis
trauma
- dont examine throat. call anaesthetics/ENT
89
name a few malignant causes of hoarseness
laryngeal ca
| thyroid ca, lung ca, lymphoma
90
hoarseness = dysphonia = impaired quality of voice. commonest cause is?
muscle tension dysphonia
| stress + reflux. SALT
91
name 3 neuro causes of hoarseness
stroke
parkinsons
MND
92
contributing factors to hoarseness include URTI, GORD, voice overuse. also name 2 iatrogenic causes of hoarseness
thyroid / cardiothoracic surgery
| tracheal intubation
93
name 4 benign lesions of vocal cords causing hoarseness?
vocal cord nodules
polyps
laryngeal papillomas (HPV)
Reinke's oedema
94
what do singers get from overuse?
vocal cord nodules
95
deep hoarse voice in smokers?
reinke's oedema
96
what HPV strains increase risk of laryngeal carcinoma?
HPV 16, 18
97
what kind of cancer is laryngeal carcinoma?
squamous cell
mainly affects glottis.
98
name some RFs for layngeal carcinoma?
```
smoking
alcohol
male
>40
low fruit/veg
HPV 16/18
```
99
when to refer for hoarseness?
hoarseness >3wks - urgent CXR in GP to decide to refer to ENT or lung Ca
100
investigation for layngeal carcinoma in ENT?
flexible laryngoscopy
| CT
101
how does laryngeal carcinoma present?
chronic hoarseness
+/- persistent cough, lump in neck, dysphagia
102
surgery for advanced laryngeal carcinoma?
partial/total laryngectomy
103
general management advice for benign vocal cord lesions?
```
vocal hygiene (hydration, avoid straining voice, stop smoking/alcohol)
SALT
```
104
tell about acute laryngitis.
mostly viral.
hoarseness / cough / fever / sore throat/neck
self limiting, reassurance.
105
usual viral culprits causing sore throat?
rhinovirus, coronavirus, adenovirus, influenza, para
106
sore throat =
inflammation of upper resp tract. - pharynx, larynx, tonsils, epiglottis
107
name 4 complications of tonsilitis
quinsy
scarlet fever
rheumatic fever
post-strep glomerulonephritis
108
what are the 4 criteria of the Centor score
Fever
Exudates
Absent cough
Tender anterior cervical lymphadenopathy
109
what does a score of 3/4 on Centor indicate?
consider Abx for strep throat
might want to give delayed (e.g. if symps not settled in wk)
110
are throat swavs recomended in tonsilitis?
no
might want monospot for glandular fever tho
111
name some safety nets for tonsilits
difficulty breathing
stridor
cant swallow fluids
systemically unwell
112
when do you qualify for tonsillectomy?
7 eps in past yr
| 5 eps in past 2yrs
113
what Abx do you give for Centor 3/4 tonsillitis?
Pen V 10 days
| or clarithromycin
114
Fever
Exudates
Absent cough
Tender anterior cervical lymphadenopathy
this is what?
Centor score
115
what can FBC show in glandular fever?
lymphocytosis
116
glandular fever aka
infectious mononucleosis
117
if im saying to you.... low grade fever, sore throat w exudative enlarged tonsils, cervical lymphadenopathy, maybe even hepatosplenomegaly... you're thinking
infectious mononucleosis
118
heterophile antibodies =
monospot test, glandular fever
119
why shouldnt you play rugby when youve got glandular fever?
dont want to squish your enlarged spleen
120
what virus causes infectious mononucleosis?
EBV
121
name 3 srs complications of glandular fever
splenic rupture
airway obstruction
guillain barre
122
treatment for glandular fever?
paracetamol + ibuprofen
plenty of fluids
safety netting
may need steroids if difficulty breathing/swallowing
123
how long does glandular fever usually take to resolve itself
2-4wks
| fatigue is last to go
124
quinsy aka
peritonsillar abscess
125
pus btw tonsilar capsule + lateral pharyngeal wall =
quinsy / peritonsillar abscess
126
quinsy can be complication of what
tonsilitis
| infectious mononucleosis
127
fetid breath, sore throat bad on one side, drooling, trismus, "hot potato voice" = ?
peritonsillar abscess
128
name some symptoms of peritonsillar abscess
```
fetid breath
sore throat unilateral
drooling
trismus
hot potato voice
```
129
what is trismus ?
cant open mouth because of inflammation
lockjaw
130
you examine a young woman who has cervical lymphadenopathy on the left, a bulge above and lateral to her left tonsil, and her uvula displaced to the right. she's trying to complain of left sided sore throat but her voice sounds like a hot potato. diagnosis?
peritonsillar abscess/quinsy
| --> SAME DAY ENT REFERRAL
131
management of peritonsillar abscess ?
SAME DAY ENT REFERRAL
IV fluids, analgesia, IV penicillin
incision & drainage or needle aspiration
132
name two complications of peritonsillar abscess
rupture of abscess - aspiration pneum :~(
| necrotising fascitis :~(
133
SAME DAY ENT REFERRAL
IV fluids, analgesia, IV penicillin
incision & drainage or needle aspiration
this is the management of what?
peritonsillar abscess
134
name the 4 sets of sinuses
frontal
maxillary
sphenoid
ethmoid
sinusitis = infl of their membranous lining
135
findings on examination in sinusitis?
not much to find except pain on pressure
136
acute facial discomfort, blocked nose, reduced smell. sounds like what ? (a non-resolving cold.. )
acute sinusitis
137
acute sinusitis is defined as what
7-30ds
viral usually is quicker (<10ds)
138
management of acute sinusitis?
paracetamol/ibuprofen
warm face packs
nasal decongestants
>10ds - consider nasal corticosteroids or rarely Abx
refer if imm comp, recurrent, systemic inf severe
139
name some complications of sinusitis?
orbital cellulitis!!
meningitis
pott's puffy tumour (osteomyelitis of frontal bone, heck)
140
define chronic sinusitis plz
>12wks
141
dull facial ache and nasal purulence for months. sounds like what?
chronic sinusitis
142
what structural factor can lead to chronic sinusitis
nasal polyps
| narrow openings
143
what is the treatment for chronic sinusitis?
nasal steroids
| if severe/unresponsive, oral pred
(ENT surgery to widen openings)
144
dark ulcers in nose in a diabetic pt
invasive fungal sinusitis!
aspergillus. ENT refer.
145
who gets barosinusitis
scuba diverz
146
women clarinet players aged 20-50 yrs with schizophrenia get
Temporomandibular joint dysfunction
pathophysiology poorly understood
147
what are the three cardinal symptoms of temporomandibular joint dysfunction ?
pain
restricted jaw motion
joint noise
+/- otalgia / headache
148
a 45 yr old clarinet player presents w pain in jaw, restricted jaw motion, and joint noise. diagnosis?
TMJ dysfunction
149
name some conditions which predispose to TMJ dysfunction
chronic pain
bruxism / over/underbite
OA and RA
gout
150
how do you palpate temporomandibular joint?
fingers in pre-auricular area, ask pt to open mouth
- joint clicks/grating
palpate head and neck for tenderness
measure distance of painless vertical mouth opening
151
give me four differentials for TMJ dysfunction
dental pain
trigeminal neuralgia
migraine
giant cell arteritis
152
Kate, talk to me about management of TMJ dysfunction
```
reassurance
rest jaw - soft food, massage
relaxation techniques
bite guards for bruxism
NSAIDs... even amitryp
```
~~ IA steroids
153
profound hearing loss =
>95db
154
conductive hearing loss is where
external to middle ear
155
sensorineural hearing loss is where
inner ear (cochlea, cochlear nerve), brainstem
156
name 2 viruses that can cause hearing loss congenitally
rubella
| CMV
157
name 2 viruses that can cause hearing loss postnatally
mumps, measles
158
you can categorise causes of conductive deafness into occlusion, infection, perforation and growths. give an example of occlusion.
wax, foreign bod
159
you can categorise causes of conductive deafness into occlusion, infection, perforation and growths. give an example of infection.
otitis externa, otitis media, sinusitis
160
you can categorise causes of conductive deafness into occlusion, infection, perforation and growths. give an example of perforation.
chronic otitis media, trauma
161
you can categorise causes of conductive deafness into occlusion, infection, perforation and growths. give an example of growths.
tumours, cysts,
| otosclerosis, cholesteatoma
162
describe Weber's
fork on forehead
163
describe Rinne's
fork on mastoid then ear
164
bone conduction >air conduction = ?
conductive
165
what is otosclerosis?
normal bone replaced by vascular spongy bone - conductive deafness
166
normal bone replaced by vascular spongy bone = ?
otosclerosis
167
flamingo tinge on tympanic membrane...
otosclerosis
168
what is cholesteatoma?
keratinising squamous epithelium within middle ear - may be locally destructive to bones
169
keratinising squamous epithelium in middle ear = ?
cholesteatoma
170
cholesteatoma erodes bones w osteolytic enzymes. leads to foul smelling otorrhoea and what kind of hearing loss?
conductive
171
sensorineural deafness can be categorised into noise-induced, ototoxic, immunological and infection. describe noise-induced.
bilateral, gradual. assoc w tinnitus. refer for legal if occupational.
172
sensorineural deafness can be categorised into noise-induced, ototoxic, immunological and infection. give an example of ototoxic
furosemide, gentamicin, quinine
| +/- tinnitus and balance probs
173
sensorineural deafness can be categorised into noise-induced, ototoxic, immunological and infection. give an example of immunological.
HIV WITH CMV
responds to oral pred
174
sensorineural deafness can be categorised into noise-induced, ototoxic, immunological and infection. give an example of infection.
otitis interna, encephalitis, meningitis
175
apart from noise-induced, ototoxic, immunological and infection, give 2 more examples of causes of sensorineural deafness.
presbyacusis (age related!)
| MS
176
age related sensorineural hearing loss = ?
presbyacusis
177
give three investigations used to investigate hearing loss
pure tone audiometry
tympanometry
otoacoustic emission testing
178
which investigation measures cochlear function?
otoacoustic emission testing
179
which investigation measures whether conductive, sensorineural or mixed?
pure tone audiometry
| 'air-bone gap'
180
which investigation measures stiffness of eardrum to evaluate middle ear function?
tympanometry
181
what does tympanometry measure?
stiffness of eardrum to evaluate middle ear function
182
what does pure tone audiometry measure
whether conductive sensorineural or mixed hearing loss
| 'air-bone gap'
183
what does otoacoustic emission testing measure?
cochlear function
184
if suspect presbyacusis, refer where?
audiology
if absence of underlying pathology, hearing aids
185
if sudden hearing loss, or hearing loss in imm comp, or hearing loss assoc focal neuro, refer where?
ENT
186
neck lumps =
cancer until proven otherwise
187
what's the most common cause of neck lumps ?
reactive lymph nodes
| but cancer until proven otherwise
188
give me 3 categories of neck lumps
malignant
reactive lymphadenopathy
congenital/developmental
189
name 2 features of a malignant neck lump
hard mass
rapid enlargement
lymph nodes are soft and mobile
190
name some malignant causes of lymph nodes
```
laryngeal cancer
thyroid cancer
virchows node met
skin cancer
lymphoma
leukaemia
```
191
name some causes of reactive lymphadenopathy
TB
| HIV, EB
192
name some congenital/developmental causes of neck lumps
thyroglossal cyst
branchial cyst
pharyngeal pouch
193
a developmental neck lump presents in late teens, big painless mobile
branchial cyst
194
neck lump moves when stick tongue out, its in the midline.
thyroglossal cyst
195
neck lump in old man with halitosis, gurgles on palpation
pharyngeal pouch
196
apart from malignant, reactive lymphadenopathy, and congenital/developmental causes, name another cause of neck lumps
salivary gland infection
- mumps (parotid)
- acute sildadenitis
- sialolithiasis
197
what is sialolithiasis?
stone in salivary gland, meal time pain, submandibular
198
throw around some investigations that might be useful for neck lumps, depending on presentation. just throw them around
```
FBC and ESR
TFTs
viral serology e.g. EBV, HIV
throat swab
CXR
US + fine needle aspiration thyroid
```
199
any new neck mass persisting beyond __ wks should be referred.
6wks
200
any new neck mass persisting beyond 6 wks should be referred. true or false
true
201
67 yr old man presents with new neck lump, weight loss and hoarsness
2ww (laryngeal ca, lung ca?)
202
75yr old woman presents with new neck lump, night sweats, weight loss, fever and pruritis
2ww (lymphoma)
203
oral cancer are mainly what kind
squamous cell carcinoma
204
oral cancer secondaries come from
lung GI or lymphoma
205
5 RFs for oral cancer
>50 male smoking alcohol low fruit/veg
206
talk to me about oral cancer presentation
sore ulcer not healing
lump in mouth/neck
leukoplakia
erythroplakia
207
what is erythroplakia ?
red patches in mouth
208
what is leukoplakia?
white patches in mouth
209
56 yr old male presents with sore ulcer on buccal mucosa not healing for the past 7wks. you also notice some leukoplakia on the underside of his tongue. you refer on 2ww for suspected oral ca. first investigation?
biopsy
then if cancer, CT thorax (for all head/neck cancers)
210
2ww for suspected oral cancer IF:
unexplained ulcer in oral cavity >3wks
| persistent unexplained lump in neck
211
2ww referal to dentist for assessment if lump on lip/oral cavity or
red/white patch (erythroleukoplakia)
212
management of early oral ca?
surgical resection, brachytherapy + cisplatin
213
management of advanced oral ca?
surgical resection + reconstruction
external beam radio
cisplatin
214
does oral cancer have a high recurrence?
yes
215
tell me briefly about nasopharyngeal carcinoma
EBV!! Asians, smoking.
| blood tinged sputum. nasal obstruction. tinnitus/unilateral conductive hearing loss.
216
name a cancer that can cause unilateral conductive hearing loss
nasopharyngeal carcinoma
| EBV
217
pharyngeal ca is less common than nasopharyngeal. risk from smoking and HPV. can present w otalgia or hoarseness, dysphagia.
yar
218
how can you distinguish between viral labrynthitis and vestibular neuritis?
labrynthitis is hearing loss and tinnitus as well as vertigo (involves whole labrynth), vestibular neuritis is just vertigo
219
preventing vertigo attacks
betahistine, vestibular rehab
220
managing vertigo acute attacks
buccal or IM prochlorperazine
221
what kind of nystagmus might you see in vestibular neuritis
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