Phase 4 > ENT > Flashcards

ENT Flashcards

(118 cards)

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1
Q

Outer ear structures?

A

Pinna + external auditory meatus

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2
Q

Middle ear structures?

A
  • Tympanic membrane
  • Malleus, incus, stapes
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3
Q

Inner ear anatomy?

A
  • Semicircular canals
  • Cochlear apparatus
  • Vestibulocochlear nerve to auditory cortex
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4
Q

Hearing loss types?

A

Conductive
Sensorineural

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5
Q

Conductive hearing loss? Examples?

A
  • Outer + middle ear defects
  • E.g. wax, cholesteatoma, otitis media, osteosclerosis
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6
Q

Sensorineural hearing loss?

A
  • Cochlear or CNVIII pathology
  • E.g. labyrinthitis, Meniere’s, acoustic neuromas
  • Sudden SNHL → MC idiopathic
    • ENT referral + high dose PO prednisolone
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7
Q

Rinne test? How to do? Normal?

A

Air vs bone conduction
512Hz tuning fork on mastoid then external auditory meatus
Normal → EAM better than mastoid

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8
Q

Rinne test abnormal results?

A
  • CHL → Mastoid better
  • SNHL → Both quiet
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9
Q

Weber test? How to do? Normal result?

A

Lateralisation (place on forehead)
Normal → Equal on both sides

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10
Q

Weber test abnormal result?

A
  • CHL → Louder in abnormal side
  • SNHL → Louder in normal side
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11
Q

Cholesteatoma? Most common ages affected?

A

Non-cancerous growth of squamous epithelium trapped within skull base causing local destruction. MC 10-20y

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12
Q

Cholesteatoma RFs?

A

Cleft palate (x100), dysfunctional eustachian tube, trauma/surgery

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13
Q

Cholesteatoma presentation?

A

Painless watery brown offensive otorrhoea + progressive CHL
Vertigo, facial nerve palsy

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14
Q

Cholesteatoma investigations?

A

Otoscopy → Attic crust seen in upper half of tympanic membrane + retraction pocket
CT temporal bone

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15
Q

Cholesteatoma management?

A

ENT referral for surgery

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16
Q

Otosclerosis?

A

Replacement of normal bone to spongy bone, causing CHL due to fixation of the stapes at oval window.

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17
Q

Otosclerosis RFs?

A

FHx (auto dom), female, fertile, fat

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18
Q

Otosclerosis presentation?

A

20-40y with progressive bilateral CHL + tinnitus

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19
Q

Otosclerosis investigations?

A

Otoscopy → Schwartle sign
GS → High resolution CT

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20
Q

Otosclerosis management?

A

Hearing aids most commonly initially
Most require stapedectomy

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21
Q

Meniere’s disease?

A

Excessive endolymph accumulation in inner ear labyrinths leading to progressive dilation of the endolymphatic system.

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22
Q

Meniere’s disease natural progression? Prognosis?

A

Natural history - Symptoms resolve in the majority of patients after 5-10 years

The majority of patients will be left with a degree of hearing loss

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23
Q

Meniere’s disease RFs?

A

FHx, 40-60y, female, autoimmune disease

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24
Q

Meniere’s disease presentation?

A

Unilateral aural fullness, recurrent vertigo, SNHL, tinnitus

  • Drop attacks
  • Positive Romberg’s test
  • Horizontal torsional nystagmus
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25
Meniere’s disease investigations?
ENT referral and diagnostic criteria >2 vertigo episodes, fluctuating otological symptoms, low frequency SNHL on audiometry
26
Meniere’s disease management? Acute attacks? Prevention?
Non-curative, ENT care. Acute attacks → Buccal/IM prochlorperazine (severe), PO antihistamine (moderate) Prevention → Betahistine and vestibular rehabilitation exercises
27
Benign paroxysmal positional vertigo?
15-20s episodes of vertigo on head movement due to abnormal otolith migration into semicircular canals (mc posterior canals)
28
BPPV RFs?
Female, 50+, head trauma, malignancy, infection
29
BPPV presentation?
<1min vertigo triggered by sudden head movement + N+V
30
BPPV investigations?
Positive Dix-Hallpike maneouvre (rapidly lower the patient to the supine position with an extended neck) -Positive test recreates the symptoms of benign paroxysmal positional vertigo (rotatory nystagmus).
31
BPPV management?
Vestibular rehab - Epley manoeuvre Good prognosis, 50% recurrence
32
Post-viral ear? Conditions? Causes?
Infection that affects inner ear: Vestibular neuronitis Labyrinthitis Post URTI or HSV in 30-50y
33
Vestibular neuronitis?
Viral illness of vestibular nerve component only of CN8
34
Labyrinthitis?
Viral illness of vestibular + cochlear components of CN8
35
Post-viral ear presentation?
Vertigo, N+V, nystagmus for hours-days Romberg positive SNHL in labyrinthitis only
36
Post-viral ear investigations?
Clinical, audiometry, consider CT/MRI brain, positive HINTS
37
HINTS examination? Interpretation?
Head impulse, nystagmus, test of skew Peripheral - Unidirectional horizontal rotatory nystagmus -Worse on positional changes, SNHL, ENT sx Central - Bidirectional vertical downbeating nystagmus -Not worse on positional changes, neurological sx
38
Post-viral ear management?
Vestibular rehabilitation + antiemetics (IM/buccal prochlorperazine)
39
Post-viral ear complications?
Falls, BPPV
40
Acoustic neuroma?
Vestibular schwannoma at cerebellopontine angle. Benign tumour of Schwann cells that surround vestibulocochlear nerve.
41
Are acoustic neuromas unilateral or bilateral?
Usually unilateral - bilateral acoustic neuromas are associated with neurofibromatosis type 2.
42
Acoustic neuroma presentation?
Vertigo, SNHL, tinnitus, absent corneal reflex, Bell’s palsy -Affects cranial nerves V, VII, VIII
43
Acoustic neuroma investigations?
Refer urgently to ENT - 1st line - CT head - GS - MRI of cerebellopontine angle
44
Acoustic neuroma management?
Surgical removal
45
Ramsay-Hunt syndrome?
Herpes zoster oticus; VZV reactivated in geniculate ganglion resulting in CNVII palsy.
46
Causes of CNVII palsy?
Idiopathic, sarcoidosis, parotid tumour, VZV
47
Ramsay-Hunt syndrome presentation?
Auricular pain with vesicular rash around ear + facial nerve palsy Other - vertigo, tinnitus and hearing loss
48
Ramsay-Hunt syndrome investigations?
Clinical
49
Ramsay-Hunt syndrome management?
PO aciclovir, PO prednisolone + eye care
50
Auricular haematoma causes? Management? Complication?
Caused by contact sports, same day ENT referral for incision + drainage Complication - Cauliflower ear
51
Otitis media? Causes?
Middle ear infection caused by S. penumoniae, H. influenzae, RSV
52
Otitis media epidemiology?
Usually affects 3-36 months.
53
Otitis media presentation?
Acute unilateral ear pain, tugging, irritability + fever
54
Otitis media investigations?
Otoscopy → Erythematous bulging tympanic membrane
55
Otitis media management? When to admit?
- Only give antibiotics if systemic symptoms, <2y with BL sx 1. PO amoxicillin 125-250mg TDS for 7d - Penicillin allergy → Clarythromycin 2. Co-amoxiclav Admit if → Septic, mastoiditis, <3 months with 38 degree celcius fever
56
Otitis media complication? Investigation? Management?
Otitis media with effusion (glue ear) - Fluid accumulation in middle ear - Dx - Otoscopy shows air fluid level - Tx - Watch + wait for 3 months then grommets
57
Otitis externa? Common cause?
Inflamed eczematous external auditory meatus (swimmer’s ears), recent swimming is a common cause
58
Otitis externa types?
- Infection → Pseudomonas + S. aureus - Seborrhoeic dermatitis
59
Otitis externa presentation?
Itchy ear canal with discharge + pain
60
Otitis externa investigations?
Otoscopy → Eczematous ears with debris
61
Otitis externa management?
Washout with topical steroid + topical flucloxacillin 1-2w
62
Otitis externa complication?
Malignant/necrotising otitis externa
63
Malignant/necrotising otitis externa presentation, investigation and management?
- Sx - Severe ear pain, CHL, ipsilateral CN7 palsy - Dx - Otoscopy → Exposed bone - Tx - IV antibiotics 6-12 months
64
Who is malignant/necrotising otitis externa most common in?
Elderly diabetics
65
Mastoiditis? Common organism?
Infected mastoid air cells of Lenoir (S. pnuemoniae) typically from middle ear
66
Mastoiditis RFs?
Otitis media, 6-12 months, cholesteatoma
67
Mastoiditis presentation?
Ear pain, CHL, otorrhoea - Painful mastoid palpation, pinna may protrude forwards - Patient is typically very unwell
68
Mastoiditis investigations?
Clinical but CT head usually required
69
Mastoiditis management?
Urgent ENT referral IV antibiotics, consider mastectomy if abscess
70
Mastoiditis complications?
Meningitis, brain abscess
71
Wax impaction RFs and management?
Cotton bud use, earplug use Soften wax with live oil drops. Suction + irrigation
72
Rhinosinusitis?
Nasal and sinus mucosal inflammation. Clinical diagnosis
73
Rhinosinusitis types?
Acute is less than 12w or chronic (more than 12w).
74
Rhinosinusitis causes?
Mainly viral (rhinovirus) or seasonal (hay fever). Rarely bacterial
75
Rhinosinusitis presentation?
Recent coryzal with nasal congestion, frontal face headache Worse leaning forward
76
Rhinosinusitis management?
Self-limiting, spontaneous resolving - Hot drinks, decongestants (short courses - phenylephrine) - >10d → Nasal potent steroid
77
Nasal polyps?
Benign mucosal outgrowths
78
Nasal polyps causes?
CF, Samster’s triad, Kartagener’s, FHx
79
Nasal polyps presentation?
Nasal obstruction, rhinorrhoea, anosmia
80
Nasal polyps investigations?
ENT referral (red flag for nasopharyngeal cancer)
81
Nasal polyps management?
Bilateral → Intranasal steroid Unilateral → Refer as red flag for cancer
82
Nasal fracture presentation?
Hyper-mobile deformed nose with pain + bruising +/- epistaxis
83
Nasal fracture management?
Minor → If no functional symptoms can leave If symptomatic/cosmetic → Rhinoplasty
84
Nasal fracture complication?
Septal haematoma - Bilateral blood pooling in septum
85
Epistaxis? Pathophysiology?
Nosebleeds 90% anterior nasal septum + <10% posterior
86
Epistaxis RFs?
Trauma, nose-picking, bleeding disorders, snorting drugs
87
Epistaxis management?
Pinch nose for 10-15m + lean forward + mouth breathing - Anterior → Silver nitrate cautery then nasal packing if unsuccessful - Posterior → Post packing - Ongoing bleed → Arterial embolisation
88
Post-epistaxis advice?
Don’t lie flat for 24h, dont pick nose 7d, dont lift heavy 7d, dont drink alcohol 2d
89
Epiglottitis? Organism?
Rare but serious infection caused by H. Influenzae B.
90
Epiglottitis presentation?
Rapid onset with high temperature and generally unwell Stridor, drooling, tripoding (leaning forward, extending neck) Painful swallowing, hot potato voice, unwell/scared child
91
Epiglottitis investigations?
Made by direct visualisation (by senior staff) X-RAYS may be done: - Lateral view may show ‘thumb sign’ - PA view may show ‘steeple sign’
92
Epiglottitis management?
Immediate senior and specialist involvement Endotracheal intubation may be required If suspected - don’t visualise, let senior staff do it Oxygen, IV ceftriaxone, dexamethasone
93
Epiglottitis complication?
Epiglottic abscess
94
Head and neck cancer most common type?
MC squamous cell with early lymph node spread (important to identify early)
95
Head and neck cancer RFs?
HPV (16), smoking tobacco, alcoholism, EBV, GORD
96
Head and neck cancer presentation?
Constitutional symptoms + - Nasopharynx → UL effusive otitis media, UL nasal obstruction, mass, epistaxis - Oropharynx → >3w non-healing ulcer, neck lump, leukoplakia - Laryngeal → Dysphagia, odonophagia, hoarseness, neck lump
97
Head and neck cancer locations?
Nasopharynx Oropharynx Laryngeal
98
Head and neck cancer investigations?
2ww pathway: - 1st line → Flexible laryngoscope with FNA biopsy - GS → Rigid laryngoscope with core biopsy under GA - +/- CT/MRI/PET for TNM staging
99
Head and neck cancer management?
Local (stage 1/2) → WLE or radiotherapy Metastatic (stage 3/4) → Combination therapy
100
Head and neck cancer complication?
Of radiotherapy! Mucositis, mucosal atrophy, skin reaction
101
Thyroid cancer?
Rarely a functional cancer, TFTs usually normal, except calcitonin in medullary
102
Thyroid cancer RFs?
Female, neck radiation, FHx, MEN 2a + 2b
103
Thyroid cancer types?
- Papillary (80%) - Young F with previous radiation, 90% 10y survival after Tx - Follicular (15%) - Medullary cell (4%) - Flushing + diarrhoea, MEN2 - Anaplastic (1%) - Worst prognosis, aggressive, older F
104
Thyroid cancer presentation?
Neck lump, lymphadenopathy, dysphagia, hoarse voice
105
Thyroid cancer investigations?
1st line → Neck USS If suspicious → Fine needle aspiration (positive - core needle biopsy) Bloods → TFTs, calcitonin, Ca2+, PTH, FBC, U+E
106
Thyroid cancer management?
P/F/M → Total thyroidectomy + T4, radioactive ablation Anaplastic → Mostly palliative.
107
Ludwig’s angina?
Floor of mouth + neck soft tissue invasive cellulitis.
108
Ludwig’s angina presentation?
Fever, neck swelling, dysphagia +/- airway compromise in immunocompromised/dental pathology patients
109
Ludwig’s angina management?
Airway emergency; A-E, IV antibiotics
110
Pleomorphic adenoma?
Benign salivary gland tumour, mc parotid. Slow growing and affects young-middle aged F.
111
Pleomorphic adenoma presentation?
Salivary gland lump, salivary stones, CN7 palsy
112
Pleomorphic adenoma management?
Surgical excision (may transform to malignant)
113
Neck lumps classification?
Variable Anterior triangle Midline Posterior triangle
114
Variable neck lumps?
Lymphadenopathy (mc) due to recent infection or malignancy
115
Anterior triangle neck lumps?
Branchial cyst - Soft mass anterior to SCM in young adult Carotid aneurysms - Pulsatile lateral neck mass
116
Midline neck lump?
Thyroglossal cyst - Soft mass that moves with tongue protrusion
117
Posterior triangle neck lumps?
Cervical rib - Above clavicle, adult with thoracic outlet obstruction Cystic hygroma - Congenital lymphatic malformation at neck/head, transilluminates Zenker diverticulum - Pharyngeal out-pouched mucosa in older patients
118
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