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ENT Flashcards

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1
Q

sensory inputs responsible for maintianing balance and posture are

A
  • vision
  • proprioception
  • signals from vestibular system
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2
Q

vestibular apparatus is located in

A

the inner ear

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3
Q

inner ear patho

A
  • 3 loops = semicircular canals, filled with endolymph
  • head turns and fluid shifts = detected by stereocilia
  • vestibular nerve carries to vestibular nucleus in brainstem and cerebellum
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4
Q

peripheral vs central

A
  • peripheral = affects vestibular system
  • central = brainstem/cerebellar involvement
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5
Q

4 most common causes peripheral vertigo

A
  • BPPV
  • menieres
  • vestibular neuronitis
  • labyrinthitis
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6
Q

4 most common causes central vertigo

A
  • posterior circulation infarct
  • tumour
  • MS
  • vestibular migraine
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7
Q

features peripheral vertigo

A
  • sudden onset
  • short duration
  • hearing loss can be present
  • coordination in tact
  • nausea more severe
    central = opposite
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8
Q

common triggers for BPPV

A
  • turning over in bed
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9
Q

patho of BPPV

A
  • crystals of calcium carbonate = otoconia
  • become displaced in semicircular canals
  • = disrupt normal flow of endolymph
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10
Q

dix hallpike manoevre

A
  • diagnoses bppv
  • sit up, head 45 to one side
  • rapidly lower backwards until hanging off and watch eyes
  • triggers rotational nystagmus and vertigo
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11
Q

epley manoevre

A
  • treat bppv
  • same as DH but when head off bed, rotate 90 degrees past central position and roll on side
  • sit up sidewats
  • flex 45 degrees
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12
Q

peripheral vertigo short term mx

A
  • prochloperazine
  • antihistamines
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13
Q

triad in menieres

A
  • hearing loss
  • vertigo
  • tinnitus
    unilateral episodes
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14
Q

patho menieres

A
  • excessive build up of endolymph in labrynth
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15
Q

what frequency hearing affected in menieres

A
  • low frequency affected first
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16
Q

other sx menieres

A
  • fullness
  • drop attacks
  • imbalance
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17
Q

prophylaxis menieres

A

betahistine

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18
Q

vestibular neuronitis presentation

A
  • recent viral illness (URTI)
  • nausea and vomiting
  • balance problems
  • vertigo
  • no loss of hearing
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19
Q

vestibular neuronitis management

A
  • Severe = buccal/IM prochlorperazine
  • vestibular rehab preferred if chronic
  • Oral prochlorperazine or antihistamine less severe
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20
Q

labyrinthitis sx

A
  • hearing loss
  • tinnitues
  • acute onset vertigo
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21
Q

2 most common bacterial causes otitis externa

A
  • pseudomonas aeruginosa = G-, rod
  • staph aureus
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22
Q

S+S externa

A
  • ear pain
  • discharge
  • itchiness
  • conductive hearing loss
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23
Q

exam externa shows

A
  • erythema and swelling
  • tender canal
  • pus
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24
Q

Mx externa

A
  • mild = acetic acid 2%
  • moderate = top abx and steroid = otomize spray
  • fungal = clotrimazole drops
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25
most common causes media
- strep pneumoniae - HI - staph aureus
26
S+S media
- ear pain - reduced hearing - fever - upper airway infection
27
normal tympanic membrane looks
pearly grey, translucent, slightly shiny
28
tympanic membeane in media
bulgin, red, inflamed - discharge if perforation
29
mx media
- most resolve with no abx - immediate abx if systemically unwell - delayed prescription if sx not better in 3 days - amoxicillin 5-7 days 1st line
30
acoustic neuromas are
benign tumours of schwann cells surrounding vestibulocochlear nerve - usually unilateral - also called cerebellopontine angle tumours
31
presentation acoustic neuroma
- unilateral sensorineural hearing loss - unilateral tinnitus - dizziness or imbalance - full ear
32
what sort of hearing loss in acoutic neuroma
sensorineural hearing loss
33
mx AN
- conservative - surgery - radiotherapy
34
most likely location of bleeding in epistaxis
- littles area
35
is bleeding in episaxis unilateral or bilateral
- usually unilateral - bilateral = bleeding posteriorly in nose
36
mx epistaxis
- >10 minutes = nasal packing - nasal cautery - naseptin qds for 10 days if tx
37
features of apnoea
- snoring - mornign ehadach e - waking up unrefreshed - daytime sleepiness - concentration problems epworth sleepiness scale
38
mx apnoea
- sleep studies - correct reversible factors - cpap
39
most common cause of bacterial tonsilitis
group A strep = strep pyogenes - 2nd = strep pneumoniae
40
tx bacterial tonsilitis
pehenoxymethylpenicillin
41
centor criteria
- fever over 38 - tonsillar exudates - absence of cough - tender ln
42
fever pain score
fever in 24 hrs purulence attented in 3 days sx inflamed tonsils no cough
43
prescribe abx in tonsilitis when
- centor >3 - fever pain >4
44
quinsy is
peritonsillar abscess
45
additional sx in quinsy
- trismus - change in voice - swelling and erythema
46
mx quinsy
- needle aspiration - surgical incision drainage - dex - abx pre and post surgery
47
tinnitus
- ringing in ears - primary = with senorineural eharing loss - secondary = identifiable cause
48
neck lump red flag referral when
- unexplained neck lump in 45 or more - persitent lump at any age - USS scan in lump growing in size
49
head and neck cancers are usually
squamous cell carcinomas
50
red flags for head and neck cancer
- lump in mouth or on lip - ulceration unexplaines 3w - erythroplakia - persistent neck lump - hoarseness - unexplained thyroid lump
51
monoclonal antibody in head and neck cancer
cetuximab
52
when are nasal polyps concerning
when they are unilateral = specialist referral
53
cholesteatoma
- non cancerous growth of squamous epithelium trapped in skull base - foul smelling discharge - hearing loss, conductive - attic crust on otoscopy = uppermost eardrum - ent refer
54
glue ear
- OM with effusion - Conductive hearing loss
55
Rinne and weber in conductive
- Rinne = negative = bone better than air - Weber = localises to affected ear
56
Rinne and weber sensioneural
- Rinne = +ve = Air better than bone - Weber = heard in unaffected ear
57
name of LN enlarged in tonsilitis
jugulodigastric
58
Barrets is
metaplasia from squamous to columnar epithelium in lower oesophagus - predisposes to adenocarcinoma
59
triad in infectious monomucelosis
- fever - pharyngitis - lymphadenopathy self limiting
60
infectious mono and amoxicillin?
itchy maculopapular rash in response to amoxicillin or cefalosporins
61
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