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ENT Flashcards

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1
Q

What are the two types of epistaxis (nosebleeds)?

A

Anterior and posterior

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1
Q

What is anterior epistaxis due to?

A

Injury to Kiesselbach’s plexus in the nasal cavity (in Little’s area)

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2
Q

What are some common triggers of epistaxis?

A

Nose picking
Nose blowing
Colds
Snorting cocaine
Trauma
Tumours
Bleeding disorders
Anticoagulants

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3
Q

Where do posterior nosebleeds originate from?

A

Originate from deeper structures

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4
Q

Why are posterior nosebleeds higher risk?

A

Usually more profuse
Higher risk of aspiration/airway compromise

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5
Q

What is first-line first aid management of epistaxis?

A

Sit with torso forward and mouth open
Pinch soft area of nose firmly for 10-15 mins

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6
Q

If first aid attempts with nose bleeds does not work, what are the management options?

A

Nasal packing
Nasal cautery with silver nitrate sticks

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7
Q

What should be prescribed after a nosebleed resolves?

A

Naseptin/nasal antibiotic cream

Reduce crusting/infection/inflammation

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8
Q

Most common bacteria causing acute sinusitis?

A

Strep. pneumoniae
Haemophilus influenzae
Rhinovirus

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9
Q

Risk factors for acute sinusitis (4)?

A

Nasal obstruction
Recent local infection (rhinitis/dental)
Swimming/diving
Smoking

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10
Q

Features of acute sinusitis?

A

Facial pain - worse on bending forward
Nasal discharge
Nasal obstruction

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11
Q

Management for sinusitis?

A

Analgesia
Nasal corticosteroids (if sx >10d)
PO Abx if systemically unwell

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12
Q

Which score is used to assess if antibiotics are indicated in tonsillitis?

A

CENTOR - assess chance of streptococci

absence of Cough
tonsillar Exudates
tender cervical Nodes
Temperature >38

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13
Q

When does CENTOR indicate abx needed for tonsillitis?

A

If score 3+ = high risk

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14
Q

Presentation of bacterial tonsillitis?

A

Sore throat
Odonyophagia
Pustular tonsils
Pyrexia/fatigue
Lymphadenopathy

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15
Q

Management of bacterial tonsillitis?

A

Phenoxymethylpenicllin (Pen V) 5-10d
(Clarithromycin 2nd line)

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16
Q

When is tonsillectomy indicated according to NICE?

A

7x in 1 year
5x in 2 years
3x in 3 years

2 episodes of quinsy

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17
Q

What is a qunisy?

A

Peritonsillar abscess = pus between tonsil capsule and lateral pharyngeal wall

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18
Q

Symptoms of peritonsillar abscess?

A

Sore throat, odynophagia, dysphagia
Trismus
‘Hot potato voice’
Referred otalgia

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19
Q

What are some examination findings in a quinsy?

A

Unilateral swelling
Deviated tonsil+uvula (to opposite side)

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20
Q

Management of quinsy?

A

Needle aspiration and drainage
IV antibiotics
Analgesia, soft food

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21
Q

Features of atopic eczema?

A

Itchy, erythematous rash
Erythema, dry skin, scaling
FLEXURE surfaces
Onset usually <2y

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22
Q

Management of atopic eczema?

A

Avoid known triggers
Emollients liberally as often as needed
Topical steroid for active areas (potency ladder)

Moderate eczema:
+ Topical calcineurin inhibitors

Severe eczema:
+ Topical calcineurin inhibitors
+ Phototherapy
+ Immunosuppressants

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23
Q

What is eczema herpeticum?

A

HSV infection of eczema

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24
How is eczema herpeticum managed?
Aciclovir (PO or IV if severe)
25
What is BPPV?
Benign paroxysmal positional vertigo: Sudden onset dizziness + vertigo triggered by changes in head
26
What are some common triggers for BPPV?
Rolling over in bed
27
What is the cause of BPPV?
Calcium carbonate crystals displaced in semicircular canals
28
What can diagnose BPPV?
Dix-Hallpike manoeuvre
29
What is the Dix-Hallpike manoeuvre?
1. Sit pt upright with head turned 45 degrees (looking over shoulder) 2. Rapidly lower to lying backwards with head hanging off the couch 3. Watch eyes for nystagmus 30s 4. Repeat on other side
30
What manoeuvre can treat BPPV?
Epley manoeuvre
31
What is the Epley manoeuvre?
1. Dix-Hallpike 2. When lying, roll head to face opposite way 3. Pt roll onto side and rotate head to face the floor 4. Pt sit up with legs off couch 5. Position head to central position with neck flexed chin on chest
32
Presenting features of otitis media (5)?
Otalgia (children pull at ears) Fever (50% cases) Hearing loss Recent viral URTI Discharge
33
Examination findings in otitis media?
Bulging tympanic membrane Loss of light reflex Perforation with purulent otorrhoea
34
Management of otitis media?
Analgesia Rest Antibiotics if necessary
35
When should abx be prescribed in otitis media?
Immediately: - Sx >4d or not improving - Systemically unwell - Immunocompromised - Under 2yrs - Perforation Consider delayed prescription
36
Which abx prescribed in otitis media?
Amoxicillin 5-7d Clarithromycin/Erythromycin if pen allergy
37
Possible complications of otitis media (5)?
OM with effusion Hearing loss Perforated tympanic membrane Mastoiditis Labrynthitis
38
Most common causative organisms of otitis media (3)?
H. influenzae Moraxella catarrhalis Staph. aureus
39
Possible causes of otitis externa (4)?
Infection (bacterial/fungal) Eczema Seborrhoeic dermatitis Swimming
40
Clinical features of otitis externa (4)?
Ear pain Itchy Discharge Conductive hearing loss
41
Common bacterial causes of otitis externa?
Staph. aureus Pseudomonas
42
What can be seen on examination in otitis externa?
Erythema and swelling in ear canal Tenderness Pus/discharge
43
Management of otitis externa?
Mild - OTC acetic acid 2% Topical abx + topical steroid If severe/systemic sx = PO abx
44
What should be avoided if there is a perforated tympanic membrane in otitis externa?
Aminoglycosides (neomycin/gentamicin) Ototoxic = hearling loss
45
When should pt with otitis externa be referred to ENT?
If fails to respond to topical abx
46
What is malignant otitis externa?
Rare type of otitis externa where infection progresses to bone and causes osteomyelitis
47
Who is at risk of malignant osteomyelitis (3)?
Immunocompromised patients Diabetes HIV
48
What is chronic rhinosinusitis?
Inflammation of paranasal sinuses lasting >12 weeks
49
Features of chronic rhinosinusitis?
Facial pain Nasal discharge Nasal obstruction/mouth breathing Post-nasal drip
50
Management of recurrent or chronic sinusitis?
Avoid allergens Intranasal steroids Nasal irrigation with saline solution
51
What is Ramsay Hunt syndrome?
Varicella zoster virus in the ganglion of the facial nerve
52
What are the presenting features of Ramsay Hunt syndrome?
Facial nerve palsy Vesicular rash around ear Auricular pain
53
Management of Ramsay Hunt syndrome?
Aciclovir and prednisolone
54
Most common cause of vertigo following a viral infection?
Vestibular neuronitis
55
Presenting features of vestibular neuronitis (5)?
Recurrent vertigo attacks lasting hours/days N+V Horizontal nystagmus NO hearing loss/tinnitus Following viral infx
56
Management of vestibular neuronitis?
Severe = Buccal or IM prochlorperazine Mild = short course PO prochlorperazine/antihistamine Chronic sx = vestibular rehab exercises
57
Presenting features of labyrinthitis?
Acute onset vertigo Hearing loss Tinnitus +/- viral sx
58
Management of labyrinthitis?
Prochlorperazine Antihistamines
59
Clinical features of Meniere's disease?
Vertigo Tinnitus Hearing loss (sensorineural) Fullness in ear
60
Management of Meniere's disease?
ENT assessment Acute attack = prochlorperazine/antiemetics Prevention = betahistine
61
Cause of Meniere's disease?
Excessive buildup of endolymph = pressure
62
What is acoustic neuroma?
Schwannoma of vestibulocochlear nerve (Vestibular schwannoma) Benign
63
Where do vestibular schwannoma/acoustic neuromas occur anatomically?
Cerebellopontine angle
64
Presentation of acoustic neuroma?
Hearing loss (sensorineural) Tinnitus Vertigo Fullness in ear +/- facial nerve palsy
65
Which conditions are associated with acoustic neuromas?
Bilateral acoustic neuromas = neurofibromatosis type 2
66
Management of suspected acoustic neuroma?
Urgent referral to ENT MRI of cerebellopontine angle Surgery/radiotherapy
67
What is cholesteatoma?
Non-cancerous growth of squamous epithelium in middle ear
68
Clinical presenting features of cholesteatoma?
Foul-smelling, non-resolving discharge Hearing loss (conductive) +/- Vertigo Facial nerve palsy Pain
69
What is seen on otoscopy in cholesteatoma?
'Attic crust' - buildup on upper ear drum
70
Management of suspected cholesteatoma?
Refer to ENT CT head Surgical removal
71
What are the Rinne's and Weber's tests?
Weber's = middle forehead, which louder? Rinne's = louder on bone or in air?
72
What are normal Rinne's and Weber's tests?
Rinne's = air conduction better than bone Weber's = heard equally in both ears
73
What is conductive vs sensorineural hearing loss?
Conductive = issue w/ sound travelling to inner ear (but sensory system working correctly) Sensorineural = issues with sensory system or vestibulocochlear nerve in inner ear
74
Rinne and Weber results in conductive hearing loss?
Rinne = bone louder than air in affected ear Weber = lateralise to affected ear
75
Rinne and Weber results in sensorineural hearing loss?
Rinne = air louder than bone bilaterally Weber = lateralise to unaffected ear
76
Which virus causes infectious mononucleosis?
EBV
77
Triad of symptoms in infectious mononucleosis (+ other presenting symptoms)?
Sore throat Lymphadenopathy Pyrexia Fatigue Tonsillar enlargement Splenomegaly Hepatitis
78
How long do symptoms typically last in infectious mononucleosis?
2-4 weeks
79
How is infectious mononucleosis diagnosed?
Monospot test (heterophil antibody test) IgG/IgM for EBV
80
Specific rash presentation in infectious mononucleosis?
Pruritic rash develops after taking amoxicillin while have infectious mononucleosis
81
Management of infectious mononucleosis?
Supportive Rest Fluids Analgesia
82
Advice regarding contact sports in infectious mononucleosis?
Avoid contact sports for 4w due to risk of splenic rupture
83
What is the two week wait referral for neck lumps?
Unexplained new lump in 45y+ Persistent neck lump at any age
84
Features of lymphoma lump?
Rubbery, painless lymphadenopathy
85
Features of thyroid swelling?
Moves upwards on swallowing
86
Features of a thyroglossal cyst?
Midline lump Moves upwards with protrusion of tongue Painful if infected
87
Features of cystic hygroma?
Congenital lymphatic lesion on neck
88
Features of branchial cyst?
Oval, mobile mass Between sternocleidomastoid muscle and the pharynx
89
Which drugs can cause tinnitus?
NSAIDs/aspirin Aminoglycosides Loop diuretics
90
What can be given as prophylaxis in Meniere's disease?
Betahistine
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