PHASE 3A/4 > ENT > Flashcards

ENT Flashcards

(55 cards)

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1
Q

what is an acoustic neuroma? which:
a) cells
b) nerve
does it arise from?

c) what nerve can be compressed?

A

benign tumour of the
a) schwann cells arising from…
b) vestibulocochlear nerve (inner ear)

c) facial nerve

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2
Q

which angle does an acoustic neuroma tumour occur at?

A

cerebellopontine angle

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3
Q

presentation of acoustic neuroma

A

GRADUAL ONSET…
- unilateral sensorineural hearing loss
- unilateral tinnitus
- dizziness/imbalance
- sensation of fullness

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4
Q

which nerve palsy is associated with an acoustic neuroma?

A

facial nerve palsy (forehead NOT spared)

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5
Q

1st line and gold std ix for acoustic neuroma

A

1st line - audiogram (sensorineural loss)

gold std - MRI head

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6
Q

presentation of BPPV

A
  • vertigo lasting <1 minute, brought on by specific movements/positions
  • hearing unaffected, no tinnitus
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7
Q

what manoeuvre can be done in primary care to investigate BPPV?

A

dix-hallpike manoeuvre

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8
Q

management of BPPV (2)

A

can watch and wait but also…
- epley manouevre
- brandt-daroff exercises

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9
Q

most common cause of epiglottitis

A

haemophilus influenzae type B (HiB)

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10
Q

presentation of epiglottitis

A
  • high fever
  • sore throat
  • dribbling
  • difficulty breathing
  • dysphagia
  • hoarse/muffled voice
  • tripod positioning
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11
Q

1st investigation for epiglottitis

A

(ONCE IN OT AND AIRWAY STABLE) - laryngoscopy

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12
Q

management of epiglottitis (4)

A
  1. secure airway
  2. IV abx - cefotaxime/ceftriaxone
  3. supplemental O2 (as needed)
  4. consider corticosteroids e.g. dex
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13
Q

complications of epiglottitis

A
  1. mediastinitis
  2. deep neck space infection e.g. parapharyngeal abscess
  3. resp distress > death
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14
Q

ix and timing of ix for infectious mononucleosis

A
  1. FBC (high wcc)
  2. monospot test

in the 2ND WEEK OF ILLNESS

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15
Q

how long should a patient refrain from playing contact sport after having infectious mono?

A

3 weeks

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16
Q

what is Meniere’s disease?

A

progressive disorder of the inner ear (unknown cause)

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17
Q

pathophys of Meniere’s disease

A

excess endolymph fluid > increased pressure and swelling in inner ear

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18
Q

presentation of Meniere’s disease

A

EPISODIC/RECURRENT:
- vertigo (most prominent)
- tinnitus
- hearing loss

lasts minutes/hours, remission in between

typically unilateral

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19
Q

medical management of meniere’s disease
a) acute attacks
b) prevention

A

a) buccal/IM prochlorperazine (anti-sickness)

b) betahistine (anti-vertigo)

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20
Q

advice for patients with Meniere’s disease

A

need to inform DVLA - can’t drive until control of sx

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21
Q

when should a patient with epistaxis be considered for admission/followed up?

A
  1. aged <2
  2. comorbidity e.g. severe HTN
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22
Q

when should a patient with epistaxis be admitted to ED? (red flags)

A
  • haemodynamically unstable
  • bleeding source unknown
  • profuse bleeding
  • bleeding from both nostrils
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23
Q

ix for obstructive sleep apnoea (3)

Study These Flashcards
A
  • Epworth sleepiness scale
  • multiple sleep latency test (MSLT)
  • sleep studies (polysomnography)
24
Q

what is swimmers ear?

Study These Flashcards
A

otitis externa

25
predisposing factors to otisis externa
- swimming - trauma e.g. cotton buds, earplugs
26
presentation of otitis externa
- ear pain - discharge - itchiness - conductive hearing loss if blocked NO inner ear sx e.g. vertigo, balance issues
27
otoscopy of otitis externa vs media
EXTERNA - erythema, swelling of ear canal - pus/discharge in ear canal MEDIA - bulging, red, inflamed TM - may see perforation
28
bacterial causes of otitis externa (2)
1. pseudomonas aeruginosa 2. s.aureus
29
non-bacterial causes of otitis externa (4)
1. fungal (esp if pt has had multiple courses abx) 2. eczema 3. seborrhoeic dermatitis 4. contact dermatitis
30
tx of bacterial otitis externa a) mild b) moderate c) severe/systemic d) perforated TM
a) acetic acid 2% b) topical antibiotic/steroid e.g. otomize spray c) oral fluclox/clarithromycin d) oral not topical abx!
31
complication and presentation of otitis externa
malignant otitis externa - more severe, persistent headache, severe pain, fever think in pts with RFs e.g. immunosuppressed, DM, HIV
32
most common bacterial cause of otitis media
strep pneumoniae
33
what often precedes otitis media in the history?
viral URTI
34
presentation of otitis media
- ear pain - reduced hearing - fever - URTI e.g. cough, coryzal sx, sore throat may have balance/vertigo sx
35
management of otitis media
- normally self-resolving, analgesics e.g. paracetamol and ibuprofen - 1st line abx if not improved = amoxicillin 5-7d
36
what is rhinosinusitis?
inflammation of the paranasal sinuses and the nasal cavity
37
acute vs chronic rhinosinusitis
acute = <12 weeks chronic = >12 weeks
38
causes of rhinosinusitis (4)
1. infection (think post viral URTI) 2. allergens e.g. hayfever 3. obstruction of mucosa drainage e.g. foreign body, trauma, polyps 4. smoking
39
presentation of rhinosinusitis
- recent viral URTI - nasal congestion - nasal discharge (clear suggests allergic, purulent suggests infection) - facial pain/headache, worse on bending - facial pressure - loss of smell
40
how to investigate rhinosinusitis
clinical diagnosis if sx persist despite tx, consider referral for nasal endoscopy/CT
41
management of acute rhinosinusitis what if sx aren't improving >10 days?
most viral - don't give abx should self-resolve within 2-3 weeks if not resolving, consider high-dose nasal steroid spray e.g. mometasone OR delayed abx prescription e.g. phenoxymethylpenicillin
42
medical and surgical management options for chronic rhinosinusitis
MED - saline nasal irrigation - steroid spray e.g. mometasone SURG - functional endoscopic sinus surgery (FESS)
43
bacterial causes of tonsillitis (3)
1. group A strep/strep pyogenes (commonest) 2. strep pneumoniae 3. staph aureus
44
viral cause of tonsillitis
h.influenzae
45
centor criteria a) what are the 4 points b) what score indicates bacterial cause
a) *fever >38 * exudate * no cough * tender anterior cervical lymph nodes b) score of 3 or more
46
FEVERPAIN criteria - what score indicates abx?
FEVER Purulence Attended within 3d of sx onset Inflamed tonsils No cough/coryza if 4 or more consider abx
47
treatment of tonsillitis what if the pt has a penicillin allergy?
penicillin V (phenoxymethylpenicillin) for 10 DAYS if allergic - erythro/clarithromycin
48
causes of vestibular neuronitis (2)
MC is inflammation of vestibular nerve secondary to viral infection also can be due to ischaemia of anterior vestibular a.
49
presentation of vestibular neuronitis
FOLLOWING VIRAL INFECTION... - sudden, recurrent vertigo attacks - horizontal nystagmus - NO hearing loss or tinnitus
50
ix for vestibular neuronitis/labyrinthitis - what is done to exclude a central cause of vertigo?
clinical diagnosis head pulse impulse test (HiNTS) to exclude central cause
51
HiNTS exam - how is it done? what result suggests a peripheral (e.g. vestibular neuronitis) vs central (e.g. posterior stroke) cause?
patient asked to stay focussed on examiners nose, hold patients head and sharply turn to the right - normal result is patient's eyes remain on examiners nose - peripheral cause will show corrective saccade - central cause will have no corrective saccade, eyes will remain in direction head is pointing
52
management of vestibular neuronitis/labyrinthitis a) less severe b) severe
a) oral prochlorperazine or antihistamine e.g. cyclizine b) buccal/IM prochlorperazine
53
what is labyrinthitis?
inflammation of labyrinth of inner ear - semicircular canals, vestibules and cochlea
54
presentation of labyrinthitis?
RECENT INFECTION THEN... - acute onset vertigo - hearing loss - tinnitus
55
differentiating between vestibular neuronitis and labyrinthitis
both will have vertigo but only labyrinthitis will have hearing loss and tinnitus
PHASE 3A/4
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