Surgery - ENT Flashcards
(249 cards)
1
Q
what is the role of semicircular canals in the ear? what are they filled with?
A
- to sense head movement| - endolymph
2
Q
what is the eustachian tube? what are its 2 roles?
A
NAME?
3
Q
role of the cochlea?
A
converts sound vibration into nerve signal
4
Q
when is hearing loss classed as “sudden onset”?
A
when it occurs in less than 72 hours
5
Q
what might hearing loss with associated pain / discharge indicate?
A
outer / middle ear infection
6
Q
how is weber’s test performed?
A
- get tuning fork vibrating - place in middle of pt’s forehead - ask if they can hear the sound and which ear it is louder in
7
Q
what is the result for weber’s test in sensorineural hearing loss?
A
sound is louder in the normal (unaffected) ear
8
Q
what is the result for weber’s test in conductive hearing loss?
A
- sound is louder in the affected ear| - deaf ear feels the need to “turn up the volume”
9
Q
how is rinne’s test performed?
A
- get tuning fork vibrating - put it on the mastoid process and ask if they can hear it (bone conduction)- when they can no longer hear it, move the tuning fork 1cm from their ear and ask again (air conduction)- repeat for opp ear
10
Q
what is a normal rinne’s test result?
A
NAME?
11
Q
what is the finding of an abnormal (negative) rinne’s test? what might this indicate
A
- sound NOT heard again once tuning fork moved off of bone (bone > air)- conductive hearing loss
12
Q
causes of adult onset sensorineural hearing loss?
A
- presbycusis- noise exposure- meniere’s disease- labyrinthitis- acoustic neuroma- neuro conditions - infection (e.g. meningitis)- drugs
13
Q
neurological causes of sensorineural hearing loss?
A
NAME?
14
Q
drug causes of sensorineural hearing loss?
A
NAME?
15
Q
causes of adult-onset conductive hearing loss? hint: blockage
A
- ear wax - foreign body in ear canal- infection (otitis media / externa) - middle ear effusion- eustachian tube dysfunction- perforated tympanic membrane- osteosclerosis- cholesteatoma- exostoses- tumours
16
Q
what are exostoses?
A
benign bone growths in the ear
17
Q
what is presbycusis?
A
age-related sensorineural hearing loss
18
Q
pathophysiology of presbycusis?
A
loss of hair cells and neurones in cochlea
19
Q
risk factors for presbycusis?
A
NAME?
20
Q
presentation of presbycusis?
A
NAME?
21
Q
how is presbycusis diagnosed?
A
audiometry
22
Q
management of presbycusis?
A
- optimise environment (reduce ambient noise)- hearing aids- cochlear implants (2nd line)
23
Q
what is sudden sensorineural hearing loss (SSNHL)? commonest cause?
A
- hearing loss over less than 72 hours unexplained by other causes - emergency!!!- 90% cases are idiopathic
24
Q
conductive causes of sudden-onset hearing loss?
A
NAME?
25
causes of SSNHL?
- idiopathic- infection - meniere's disease- drugs- MS- migraine- stroke- acoustic neuroma - cogan's syndrome
26
diagnostic criteria on audiometry in SSNHL?
at least 30 dL in 3 consecutive frequencies
27
investigations in SSNHL?
- audiometry| - MRI / CT head to rule out stroke / acoustic neuroma
28
management of SSNHL?
- immediate referral to ENT - treat underlying cause (e.g. ABx for infection) - steroids if idiopathic (PO, intra-tympanic injection)
29
which other conditions might eustachian tube dysfunction be related to?
#NAME?
30
presentation of eustachian tube dysfunction?
#NAME?
31
when does eustachian tube dysfunction worsen? give some examples
#NAME?
32
investigations for eustachian tube dysfunction?
- not needed if obvious- tympanometry - audiometry- nasopharyngoscopy - otoscopy (r/o otitis media) - CT
33
management of eustachian tube dysfunction?
#NAME?
34
surgical options for eustachian tube dysfunction?
#NAME?
35
what is otosclerosis? what does it result in?
- remodelling of small bones in middle ear| - conductive hearing loss
36
risk factors for otosclerosis?
#NAME?
37
presentation of otosclerosis?
- bilateral hearing loss (low-pitched lost first)- bilateral tinnitus- reports own voice sounding louder, so speaks quietly
38
findings O/E in otosclerosis?
- normal otoscopy- normal weber's (if bilateral)- negative rinne's (bone > air)
39
investigation of choice (and findings) in otosclerosis?
audiometry shows hearing loss at lower frequencies
40
management of otosclerosis?
- hearing aids| - stapedectomy / stapedotomy
41
what is otitis media often preceded by?
URTI
42
commonest causative organism(s) of otitis media? hint: think pneumonia
- streptococcus pneumoniae (pneumococcus)| - then: H. influenzae
43
presentation of otitis media in adults?
#NAME?
44
otoscopy findings in otitis media?
- bulging, red tympanic membrane| - discharge in ear canal if membrane has burst
45
management of otitis media?
- most resolve spontaneously over 3 days - paracetamol / ibuprofen for pain / fever- consider ABx (immediate or delayed)
46
when should you consider immediate ABx in otitis media?
#NAME?
47
when should you consider delayed ABx in otitis media? when can these be claimed?
- 3d after prescribing| - when you suspect they'll worsen soon
48
ABx of choice for otitis media? hint: remember allergies!
- 5-7d course of amoxicillin| - clarithromycin if penicillin allergic
49
give a common and a rare example of a complication in otitis media?
- otitis media with effusion| - mastoiditis (palpate mastoid process for this)
50
describe the pathophysiology of otitis externa
inflammation of the skin of the external ear canal
51
causes of otitis externa?
#NAME?
52
give 2 bacterial causes of otitis externa?
- pseudomonas aeruginosa| - staph aureus
53
presentation of otitis externa?
#NAME?
54
signs O/E of otitis externa?
#NAME?
55
when might pus in the external ear canal be due to otitis media rather than otitis externa?
when the tympanic membrane has been perforated
56
investigations for otitis externa?
- otoscopy| - ear swab (not used often)
57
management of mild otitis externa?
acetic acid 2%
58
treatment for moderate otitis externa?
- add topical ABx + steroid| - e.g. neomycin + betamethasone + acetic acid 2% (called "otomize")
59
what must you exclude before treating moderate otitis externa? hint: ABx SEs
- must check the tympanic membrane is not perforated| - because it needs macrolides which can be ototoxic
60
treatment of severe otitis externa?
#NAME?
61
management of fungal otitis externa?
clotrimazole ear drops
62
what is malignant otitis externa? main complication of this?
- infection which has spreads to bones outside of ear canal| - osteomyelitis of temporal bone
63
risk factors for malignant otitis externa? hint: immunocompromise
#NAME?
64
presentation of malignant otitis externa?
#NAME?
65
key finding of malignant otitis externa?
granulation tissue at junction between bone and cartilage
66
management of malignant otitis externa?
#NAME?
67
presentation of impacted ear wax?
#NAME?
68
how is impacted ear wax diagnosed?
seen on otoscope covering tympanic membrane
69
management of impacted ear wax?
#NAME?
70
what is primary tinnitus associated with?
sensorineural hearing loss
71
causes of secondary tinnitus? hint: there's a LOT
- impacted ear wax- ear infection- meniere's disease- noise exposure- drugs- acoustic neuroma- MS- trauma - depression
72
drug causes of tinnitus?
#NAME?
73
systemic signs associated with tinnitus?
#NAME?
74
what is objective tinnitus?
sound is demonstrable O/E (it is actually there)
75
examples of causes of objective tinnitus?
- carotid artery stenosis (causing a bruit)- aortic stenosis- AVM- eustachian tube dysfunction (popping / clicking sounds)
76
red flag features of tinnitus?
#NAME?
77
prognosis of tinnitus?
tends to improve alone without any intervention
78
management of tinnitus?
#NAME?
79
what is vertigo?
the sensation that either the patient or their environment is moving
80
vestibular causes of vertigo?
- BPPV- meniere's disease- vestibular neuronitis- labyrinthitis
81
pathophysiology of benign paroxysmal positional vertigo (BPPV)?
#NAME?
82
course of disease in BPPV?
#NAME?
83
diagnostic test for BPPV?
dix-hallpike manoeuvre
84
treatment of BPPV?
- epley manoeuvre| - brandt-daroff exercises
85
presentation of meniere's disease?
- hearing loss- tinnitus - vertigo - fullness in ear feeling- "drop attacks" (unexplained falls)- unidirectional nystagmus
86
pathophysiology of acute vestibular neuritis?
viral infection (usually URTI) causing inflammation of the vestibular nerve
87
what is ramsay-hunt syndrome? how does it present?
#NAME?
88
central causes of vertigo?
anything affecting cerebellum or brainstem:- posterior stroke- tumour- MS - vestibular migraine
89
how does vertigo from a central cause present?
it will be sustained and non-positional
90
presentation of vestibular migraine?
#NAME?
91
give an example of a trigger for BPPV
turning over in bed
92
presentation of meniere's disease? hint: triad
#NAME?
93
pathophysiology of meniere's disease?
excessive buildup of endolymph in the labyrinth of the inner ear
94
typical patient history in meniere's disease?
- 40-50 year old| - unilateral episodes of vertigo, hearing loss and tinnitus
95
how does the vertigo in meniere's disease present?
- episodic- lasts 20 mins - few hours- not triggered by movement or posture
96
what type of hearing loss is seen in meniere's disease?
#NAME?
97
how is meniere's disease diagnosed?
- clinically| - followed up by audiology assessment
98
management of acute attacks of meniere's disease?
- prochlorperazine| - antihistamines (e.g. cyclizine)
99
prophylaxis in meniere's disease?
betahistine
100
what is an acoustic neuroma?
benign tumour of schwann cells surrounding the vestibulocochlear nerve
101
in which condition are bilateral acoustic neuromas seen?
neurofibromatosis type II
102
where do acoustic neuromas grow?
cerebellopontine angle
103
typical history of acoustic neuroma?
#NAME?
104
which palsy might be associated with acoustic neuroma?
facial nerve palsy
105
how is acoustic neuroma diagnosed?
- MRI or CT| - MRI is more detailed so preferred
106
management of acoustic neuroma?
#NAME?
107
complications of treating meniere's disease?
- CN8 damage (permanent HL, dizziness)| - CN7 injury (facial weakness)
108
what is a cholesteatoma?
abnormal collection of squamous epithelial cells in the middle ear
109
is a cholesteatoma worrying?
- not malignant| - can erode middle ear bones, predisposing to infection
110
early presentation of cholesteatoma?
- foul ear discharge| - unilateral conductive hearing loss
111
later features of cholesteatoma?
all caused by expansion:- infection- pain- vertigo- CN7 palsy
112
investigations and findings for cholesteatoma?
#NAME?
113
management of cholesteatoma?
surgical removal
114
presentation of facial nerve palsy?
unilateral facial weakness
115
important differential for facial nerve palsy?
stroke!
116
is there forehead sparing in CN7 palsy? why / why not?
- it is an LMN lesion| - therefore no, the forehead is not spared
117
is there forehead sparing in stroke? why / why not?
- it is an UMN lesion| - therefore, yes the forehead is spared
118
what is bell's palsy?
idiopathic unilateral LMN CN7 palsy
119
prognosis for bell's palsy?
- most patients recover in weeks| - some have residual weakness
120
management of bell's palsy?
- if presented within 72h of symptom onset, then prednisolone - lubricating eye drops
121
eye complication from bell's palsy? how is it prevented?
#NAME?
122
which organism causes ramsay-hunt syndrome?
herpes zoster
123
presentation of ramsay-hunt syndrome?
#NAME?
124
treatment for ramsay-hunt syndrome?
ideally within 72h:- prednisolone- acicloviralso lubricating eyedrops
125
which systemic diseases can give a CN7 palsy?
#NAME?
126
what is the most likely site of bleed in epistaxis?
little's area
127
causes of nosebleeds?
#NAME?
128
management of nosebleeds?
- sit up, tilt head forwards - squeeze soft part of nostrils together for 15 mins - spit out any blood in mouth- after 10-15 mins: nasal packing (tampons) or nasal cautery (with silver nitrate)
129
what can be prescribed after a nosebleed? why is this useful?
- naseptin cream (chlorhexidine and neomycin)| - stops crusting and infection
130
when is sinusitis classed as chronic?
when it lasts >12 weeks
131
what are the 4 types of paranasal sinus?
#NAME?
132
causes of sinusitis?
- infection (typically post-viral URTI)- allergies (allergic rhinitis)- obstruction of drainage- smoking- asthma = RF
133
what could cause obstruction of drainage from the paranasal sinuses?
#NAME?
134
presentation of acute sinusitis?
#NAME?
135
findings O/E in sinusitis?
#NAME?
136
key condition associated with chronic sinusitis?
nasal polyps
137
investigations in sinusitis?
#NAME?
138
management of acute sinusitis?
- if systemic infection / septic then hosp admission- no Tx for first 10 days - after this:- mometasone nasal spray 200mcg BD for 14d- delayed ABx prescription if no improvement in 7d after steroid
139
prognosis for most cases of acute sinusitis?
- good| - self-resolving in 2-3 weeks
140
management of chronic sinusitis?
#NAME?
141
describe correct administration of a nasal spray
#NAME?
142
what is a nasal polyp? where is it found?
- growth of nasal mucosa| - nasal cavity or sinuses
143
are nasal polyps typically uni or bilateral? do they grow fast or slow?
- bilateral and slow growing| - unilateral polyps are a red flag for Ca!!!
144
which other conditions are associated with nasal polyps?
- chronic sinusitis- asthma- samter's triad- CF- eosinophilic granulomatosis with polyangiitis (churg-strauss)
145
what is samter's triad?
1. nasal polyps2. asthma 3. aspirin intolerance / allergy
146
presentation of nasal polyps?
#NAME?
147
which types of examination are useful in nasal polyps?
- nasal speculum| - nasal endoscopy (done by specialist)
148
management of nasal polyps?
- unilateral polyps always need specialist referral to r/o Ca- intranasal steroid drops / spray- intranasal polypectomy- endoscopic nasal polypectomy (if further up nose / in sinuses)
149
pathophysiology of obstructive sleep apnoea (OSA)?
collapse of pharyngeal airway during sleep
150
typical history in OSA?
- pt's partner reports that the pt stops breathing for up to a few mins at night - pt unaware of this
151
risk factors for OSA?
#NAME?
152
features of OSA?
#NAME?
153
complications of severe OSA?
#NAME?
154
what is the epworth sleepiness scale used for?
to assess symptoms of sleepiness in OSA
155
what should you check in anyone with OSA?
- occupation| - sleepiness could make them dangerous at work, e.g. lorry driver
156
management of OSA?
#NAME?
157
most common causative organism in bacterial tonsillitis? second most common one?
- group A strep (strep pyogenes)| - pneumococcus
158
commonest cause of tonsillitis?
viral infection
159
which tonsils are most likely to be affected in tonsillitis?
palatine tonsils
160
presentation of acute tonsillitis?
- sore throat- fever >38C- pain on swallowing
161
(potential) findings O/E of tonsillitis?
#NAME?
162
which 2 scoring systems can be used to work out whether tonsillitis is viral or bacterial?
- centor criteria| - feverPAIN score
163
criteria in the feverPAIN score?
- fever in last 24h- purulent tonsils - attended within 3d of symptom onset- inflammation, severe- no cough / coryza
164
when should you consider admitting a patient with tonsillitis?
for any of the following:- immunocompromised- systemically unwell- dehydrated- stridor- resp distress- evidence of quinsy / cellulitis
165
when should ABx be considered in tonsillitis?
- centor score: 3 or more- feverPAIN score: 4 or more- immunocompromised - Hx of rheumatic fever- significant comorbidities
166
first line antibiotic in bacterial tonsillitis?
- penicillin V (phenoxymethylpenicillin)| - if penicillin allergic: clarithromycin
167
safety netting advice in viral tonsillitis?
return if:- pain has not settled in 3d- fever >38.3C after 3d
168
complications of tonsillitis?
#NAME?
169
what is a quinsy? how could it occur?
#NAME?
170
demographic most commonly affected by tonsillitis?
children
171
presentation of quinsy?
#NAME?
172
most common causative organism of quinsy?
group A strep (strep pyogenes)
173
management of quinsy?
#NAME?
174
indications for tonsillectomy?
based on no. of cases of tonsillitis:- 7+ in 1y- 5+ per year for 2y- 3+ per year for 3yother indications- 2 episodes of quinsy- enlarged tonsils causing difficulty breathing, swallowing or snoring
175
complications of tonsillectomy?
- post-tonsillectomy bleeding- sore throat for up to 2w- damage to teeth- infection - risks with GA
176
how could a post-tonsillectomy bleed be life-threatening?
if blood is aspirated
177
management of post-tonsillectomy bleeding?
#NAME?
178
differentials for a neck lump in an adult? hint: there's a LOT
#NAME?
179
additional differentials for neck lump in a young child?
#NAME?
180
what are the 2WW criteria for referral of a neck lump?
- unexplained neck lump in anyone aged >45| - persistent, unexplained neck lump at any age
181
when should an urgent USS be performed on a neck lump? timeframes for this scan?
- when it is growing in size - within 2w if over 25- within 48h if under 25- referral to 2WW depending on USS findings
182
which blood tests may be requested for a neck lump? why?
- FBC, blood film (leukaemia, infection)- HIV test- monospot test (EBV antibodies) - TFTs- ANA (SLE)- LDH (hodgkin's lymphoma, very non-specific)
183
investigations for a neck lump?
- bloods- USS (1st line imaging)- nuclear medicine scan- biopsy
184
causes of lymphadenopathy? give examples of each
#NAME?
185
features of lymphadenopathy suggestive of Ca?
- unexplained- persistently enlarged >3cm in size- abnormal shape- hard / "rubbery"- non-tender- tethered to skin / underlying tissue- any associated B symptoms
186
causative organism in infectious mononucleosis?
epstein barr virus (EBV)
187
how does EBV spread?
through saliva (kissing, sharing cups, toothbrushes)
188
presentation of infectious mononucleosis?
#NAME?
189
first line investigation of infectious mononucleosis?
monospot test
190
which immunoglobuin indicates acute infection with infectious mononucleosis? which indicates immunity?
- IgM = acute infection| - IgG = immunity
191
management of infectious mononucleosis?
#NAME?
192
typical demographics affected by hodgkin's lymphoma?
- bimodal age distribution- one peak around age 20 - another around age 75
193
key presenting feature of lymphoma? where might this be found?
- lymphadenopathy- "rubbery" nodes- pain in the nodes upon drinking alcohol- neck- axillary nodes- inguinal nodes
194
features of lymphoma?
quite non-specific:- fatigue- lymphadenopathy- pallor (anaemia)- petechiae / abnormal bruising (thrombocytopenia) - abnormal bleeding- hepatosplenomegaly - B symptoms
195
finding on lymph node biopsy in hodgkin's lymphoma?
reed-sternberg cells
196
how is lymphoma staged?
ann arbor staging system
197
list the 3 B symptoms
#NAME?
198
causes of goitre?
- graves disease (hyper)- toxic multinodular goitre (hyper)- hashimoto's thyroiditis (hypo)- iodine deficiency (rare)- lithium
199
what is a goitre?
generalised swelling of the thyroid
200
differentials for individual lumps in the thyroid?
#NAME?
201
causes of enlarged salivary glands?
#NAME?
202
describe the lump found in a carotid body tumour
#NAME?
203
how might a carotid body tumour give horner's syndrome?
by compressing on the vagus nerve (CN10)
204
finding on imaging of carotid body tumour?
- "splaying" of internal and external carotids| - called lyre's sign
205
what is a lipoma?
benign fat tumour
206
findings O/E of a lipoma?
#NAME?
207
management of carotid body tumours?
surgical removal
208
management of lipomas?
- reassurance| - may be surgically removed
209
pathophysiology of thyroglossal cyst?
#NAME?
210
key differential of a thyroglossal cyst?
ectopic thyroid tissue
211
findings O/E of a thyroglossal cyst?
#NAME?
212
management of thyroglossal cysts?
surgical removal
213
main complication of thyroglossal cysts?
- infection| - lump becomes hot, tender and painful
214
presentation of a branchial cyst?
#NAME?
215
typical demographic affected by branchial cysts?
#NAME?
216
management of branchial cysts?
- conservative| - surgical excision if problematic
217
where could a head and neck Ca grow?
#NAME?
218
risk factors for head and neck Ca?
- smoking - chewing tobacco- paan!- alcohol- HPV (esp strain 16)- EBV infection
219
red flag features suggestive of head and neck Ca?
- lump in mouth / on lip- unexplained mouth ulcers lasting >3m- erythroplakia (unexplained red lesion)- persistent neck lump- unexplained hoarse voice- unexplained thyroid lump
220
management of head and neck Ca?
#NAME?
221
what cell type are most head and neck cancers?
squamous cell carcinoma
222
causes of glossitis?
#NAME?
223
3 key causes of angioedema?
#NAME?
224
risk factors for oral candiaisis?
#NAME?
225
management of oral candidiasis?
- miconazole gel- nystatin suspension - fluconazole tablets (if severe / recurrent)
226
describe geographic tongue
irregularly shaped patches form on tongue from loss of papillae
227
causes of geographic tongue?
#NAME?
228
2 key causes of strawberry tongue?
- scarlet fever| - kawasaki disease
229
causes of black hairy tongue?
#NAME?
230
what is leukoplakia?
- precancerous condition| - gives white patches on tongue / inside cheeks
231
describe the patches found in leukoplakia
- asymptomatic- irregular - slightly raised - fixed in place (can't be scraped off)
232
investigation for leukoplakia?
biopsy to look for dysplasia / Ca
233
management of leukoplakia?
#NAME?
234
describe the lesions seen in lichen planus
- shiny- purplish- flat-topped raised areas- white lines across surface (wickham's striae)
235
which demographics are more likely to be affected by lichen planus?
- those >45| - women
236
management of oral lichen planus?
#NAME?
237
presentation of gingivitis?
#NAME?
238
what is periodontitis? what is its main complication?
- chronic and severe inflammation of gums around teeth| - tooth loss!
239
RFs for gingivitis?
#NAME?
240
management of gingivitis?
- good oral hygiene- stop smoking- "scale and polish" to remove tartar - chlorhexidine mouthwash- metronidazole / dental surgery if needed
241
causes of gingival hyperplasia?
- gingivitis- pregnancy- vit C def (scurvy)- acute myeloid leukaemia (AML)- drugs
242
drug causes of gingival hyperplasia?
#NAME?
243
which conditions can give rise to aphthous ulcers?
- IBD - coeliac disease- behcet's disease- vitamin / mineral deficiency- HIV
244
which vitamin / mineral deficiencies could cause aphthous ulcers?
#NAME?
245
management of simple aphthous ulcers?
- most self-resolve in 2w- bonjela- difflam spray- lidocaine
246
management of severe aphthous ulcers?
- hydrocortisone buccal tablets| - betamethasone tablets / inhaler
247
what is the 2WW criteria with regard to aphthous ulcers?
pts with unexplained ulceration lasting >3w need a referral
248
when should you consider giving ABx in tonsillitis?
- centor score >3| - feverPAIN score >4
249
pathophysiology of meniere's disease?
build-up of excessive endolymph in semicircular canals
