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ENT Flashcards

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1
Q

What is Ménière’s disease? What triad is seen?

A
  • inner ear disorder
  • causes peripheral vertigo
  • triad: vertigo, sensorineural hearing loss, tinnitus
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2
Q

What is the aetiology of Meniere’s disease?

A
  • thought to be endolymphatic hydrops (excess fluid)
  • excess pressure and progressive dilatation of endolymphatic system
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3
Q

What are the features of Meniere’s disease?

A
  • recurrent spontaneous vertigo (20 mins - hrs)
  • progressive/fluctuating hearing loss
  • tinnitus
  • aural fullness
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4
Q

What may be seen on examination of Ménière’s disease?

A
  • nystagmus
  • low frequency sensorineural hearing loss
  • unilateral symptoms
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5
Q

What is the conservative management of Ménière’s disease?

A
  • ENT assessment
  • inform DVLA
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6
Q

What are the diagnosis criteria for Ménière’s disease?

A
  • ≥2 spontaneous episodes of vertigo lasting 20 mins - 12hrs
  • audiological assessment demonstrating low to moderate sensorineural hearing loss on affected side
  • aural fullness
  • can be diagnosed without hearing loss
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7
Q

What is medical management of Ménière’s disease?

A
  • preventative: betahistine: histamine analogue or vestibular rehabilitation
  • buccal/IM prochlorperazine for vertigo
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8
Q

What is surgical management of Ménière’s disease?

A
  • intratympanic injection of dexamethasone/methylprednisolone or gentamicin
  • gentamicin is ototoxic
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9
Q

What is OSA?

A
  • sleep disorder
  • recurrent episodes of upper airway obstruction during sleep > apnoea/hypoapnoea
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10
Q

What is hypoapnoea?

A
  • temporary decreases in breathing
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11
Q

What is the aetiology of OSA?

A
  • narrow upper airway: fat deposition or abnormal skeletal features
  • muscle relaxation during sleep
  • airway collapse > hypoxaemia and hypercapnia > arousal from sleep
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12
Q

What are risk factors for OSA?

A
  • obesity
  • craniofacial abnormalities
  • large tonsils
  • male
  • Marfan’s
  • Down’s
  • macroglossia
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13
Q

What are symptoms of OSA?

A
  • excessive daytime somnolence
  • chronic morning headache
  • arousal during sleep with choking/gasping
  • habitual snoring
  • restless sleep
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14
Q

What medical consequences may occur from OSA?

A
  • compensated respiratory acidosis
  • hypertension
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15
Q

How does OSA relate to driving?

A
  • patients with excessive sleepiness > 3mo must inform DVLA
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16
Q

Which scoring systems can assess OSA?

A
  • Epworth sleepiness scale
  • measures sleepiness in certain situations
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17
Q

What investigations may be done for OSA?

A
  • GOLD: polysomnography: if (hypo)apnoeic episodes exceed ≥15ph or ≥5 ph if symptoms/CV comorbidities
  • measures pulse ox, EEG, airflow
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18
Q

How is OSA managed?

A
  • weight loss
  • CPAP if moderate or severe
  • mandibular advancement devices reduce upper airway collapse
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19
Q

What is vestibular neuronitis?

A
  • cause of vertigo
  • develops following viral infection
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20
Q

What are the features of vestibular neuronitis?

A
  • recurrent vertigo attacks lasting hours or days
  • nausea + vomiting
  • horizontal nystagmus
  • NO hearing loss/tinnitus
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21
Q

How can you differentiate between posterior circulation stroke and vestibular neuronitis?

A
  • HiNTs exam
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22
Q

What is seen on HiNTs exam in vestibular neuronitis?

A
  • head impulse: corrective saccade
  • nystagmus: horizontal-torsional
  • test of skew: normal
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23
Q

What is the management of vestibular neuronitis?

A
  • buccal or IM prochlorperazine
  • short oral course of prochlorperazine or antihistamine: cyclizine
  • vesticular rehab if chronic
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24
Q

What is a vestibular schwannoma?

A
  • acoustic neuroma
  • tumour of vestibulocochlear nerve
  • arising from Schwann cells
  • account for 90% of cerebellopontine angle tumours
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25
What are the core features of a vestibular schwannoma?
- vertigo - hearing loss - tinnitus - absent corneal reflex
26
What features localise a vestibular schwannoma to a certain cranial nerve?
- CN VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus - CN V: absent corneal reflex - CN VII: facial palsy
27
What are risk factors for vestibular schwannoma?
- high dose ionising radiation to head and neck - neurofibromatosis type 2
28
How is a vestibular schwannoma investigated?
- pure-tone audiogram - GOLD: MRI of cerebellopontine angle
29
When and how is a vestibular schwannoma conservatively managed?
- small tumours with no impairment to facial nerve or hearing - elderly patients with comorbidities - surveillance with annual MRI head
30
What are the two surgical options for managing vestibular schwannoma?
- microsurgery - stereotactic radiosurgery using gamma rays if <3cm
31
How do acoustic neuromas at the internal auditory meatus differ to those at the cerebellopontine angle?
- internal auditory meatus: cause hearing loss and vestibular disturbance earlier on
32
Are acoustic neuromas unilateral or bilateral, and are they benign?
- unilateral - bilateral if associated with neurofibromatosis type 2 - benign and slow growing
33
What is BPPV?
- benign paroxysmal positional vertigo - commonest cause of vertigo
34
What is the pathophysiology of BPPV?
- posterior canal is MC affected - displacement of free-floating otoconia from the macula become trapped in posterior canal - this + endolymph stimulate hair cells even after head movements stop
35
What are risk factors for BPPV?
- older age - female - Meniere's - migraines/anxiety
36
What is the presentation of BPPV?
- brief episodes of vertigo lasting 30s-1min - symptoms provoked by head movements - e.g. rolling in bed, gazing up, bending forwards - nausea - lightheaded
37
What is the method to elicit BPPV?
- Dix-Hallpike manoeuvre - rapidly lower the patient to a supine position with extended neck
38
What is seen in a positive Dix-Hallpike manoeuvre?
- causes vertigo, rotatory and vertical nystagmus - latency period: onset of nystagmus after 5-20s - symptoms begin gradually and increase intensely - unilateral symptoms - on return to sitting, causes prolonged vertigo and reversal of nystagmus
39
What repositioning techniques may be taught to a patient to relieve BPPV?
- Epley manoeuvre - Brandt-Daroff exercises - Sermont manoeuvre
40
Which medications may be used in BPPV?
- antiemetics: prochlorperazine or cyclizine - vestibular sedatives: cinnarizine or betahistine
41
Does BPPV recur?
- around half have recurrence within 3-5yrs of diagnosis
42
What is chronic rhinosinusitis?
- affects up to 1 in 10 people - inflammatory disorder of paranasal sinuses and nasal passages - lasting 12 weeks or longer
43
What is the difference between acute, subacaute and chronic rhinosinusitis in terms of duration?
- acute: <4 weeks - subacute: 4-12 weeks - chronic: >12 weeks
44
What are the common viral causes of rhinosinusitis?
- rhinovirus - influenza - parainfluenza
45
What are common bacterial causes of rhinosinusitis?
- Strep pneumoniae - Haemophilus influenzae - Staph aureus - Moraxella catarrhalis
46
What are features of chronic rhinosinusitis?
- facial pain worse on bending forward - nasal discharge - nasal obstruction - postnasal drip
47
How can chronic rhinosinusitis be avoided?
- avoid allergen - intranasal corticosteroids - nasal irrigations with saline
48
What are red flag symptoms of rhinosinusitis?
- unilateral symptoms - persistence despite 3mo treatment - epistaxis
49
What is Ludwig's angina?
- progressive cellulitis - invades floor of mouth and soft tissues of neck - mostly results from odontogenic infections spreading to submandibular space
50
What are the features of Ludwig's angina?
- neck swelling - dysphagia - fever - potential for airway obstruction
51
How is Ludwig's angina managed?
- airway - IV Abx
52
What categories can epistaxis be split into?
- anterior and posterior
53
What are the causes of epistaxis?
- trauma - septal deviation - use of intranasal decongestants or steroids - nose picking or blowing - bleeding disorders - cocaine use - granulomatosis with polyangiitis - juvenile angiofibroma
54
What is the first aid management of epistaxis?
- ask patient to sit with torso forward and mouth open - decreases blood flow to nasopharynx - pinch cartilage firmly for >20mins
55
What is the followup management if first aid measures for epistaxis are successful?
- use topical antiseptic e.g. naseptin (chlorhexidine and neomycin) - reduces crusting and risk of vestibulitis
56
How is epistaxis treated if bleeding continues after 10-15 mins and the source is visible?
- cautery - use topical local anaesthetic spray e.g. co-phenylcaine - apply silver nitrate stick for 3-10s - dab clean with cotton but and apply naseptin
57
How is epistaxis treated if the bleeding point cannot be visualised?
- packing - local anaesthetic spray - pack with head forward - options: nasal tampons, balloon catheters, ribbon gauze - analgesia if painful
58
What is surgical management for epistaxis?
- sphenopalatine ligation - if life-threatening
59
Describe posterior epistaxis?
- more profuse - originate from deeper structures - occur in older patients - higher risk of aspiration and airway compromise
60
Describe anterior epistaxis
- visible bleeding source - occurs due to injury to Kiesselbach's plexus
61
What is the bimodal age distribution of epistaxis?
- under 10 - 45-65
62
What is infectious mononucleosis and what is the cause?
- glandular fever - Epstein-Barr or HHV-4 - also caused by CMV or HHV-6
63
What is the triad of symptoms in infectious mononucleosis? How long do symptoms take to resolve?
- sore throat - pyrexia - lymphadenopathy: anterior and posterior neck triangles - 2-4 weeks
64
What are 5 other features (other than the triad) in infectious mononucleosis?
- malaise - anorexia - headache - palatal petechiae - splenomegaly
65
Three features seen on bloods in infectious mononucleosis are: - hepatitis - transient ___ rise - ____cytosis - _________ anaemia (IgM)
Three features seen on bloods in infectious mononucleosis are: - hepatitis - transient **ALT** rise - ** lympho**cytosis - **cold haemolytic** anaemia (IgM)
66
What type of rash develops in most patients taking amoxicillin for infectious mononucleosis?
- maculopapular, pruritic rash
67
How is infectious mononucleosis diagnosed? How long into the illness should the test be done?
- heterophil antibody test (monospot) - FBC + monospot in 2nd week confirm diagnosis
68
How is infectious mononucleosis managed?
- supportive - rest, fluids, analgesia - avoid contact sports for 4 weeks to reduce risk of splenic rupture
69
What are causes of otitis externa?
- bacterial (Staph aureus, Pseudomonas aeruginosa) or fungal - seborrhoeic dermatitis - contact dermatitis - recent swimming is a trigger
70
What is otitis externa? How can it be classified into acute and chronic?
- inflammation of the external ear canal - Acute: <3 weeks - Chronic: >3 weeks
71
What are symptoms of otitis externa?
- Ear pain - Discharge - Itch - Hearing loss - Fever
72
What is seen on otoscopy in otitis externa?
- red, swollen or eczematous canal - tenderness - serous/purulent discharge
73
What advice is given to manage otitis externa conservatively?
- avoid water - avoid itching - avoid cotton buds
74
How is otitis externa managed medically?
- topical Abx or topical Abx + steroid - treat for 7 days, 14 if no improvement - ear wick if extensive swelling
75
Which antibiotic class should be avoided in a perforated eardrum in otitis externa? Which is an alternative?
- avoid aminoglycosides - use quinolones alternatively
76
When may oral flucloxacillin be considered in otitis externa?
- Cellulitis beyond external ear canal - compromised immunity and/or severe infection - recommended by ENT
77
What is malignant otitis externa? What causes it most commonly?
- infection in soft tissues and bony ear canal - Pseudomonas aeruginosa
78
What may malignant otitis externa progress to?
- progresses to temporal bone osteomyelitis
79
What are the features of malignant otitis externa?
- Diabetes/immunosuppression - severe, unrelenting, deep-seated otalgia - temporal headaches - purulent otorrhea - potential facial nerve dysfunction + dysphagia
80
How is malignant otitis externa diagnosed and managed?
- CT scan - IV abx covering Pseudomonas - if non-resolving refer to ENT
81
What are the causes of hoarseness?
- smoking - viral illness - hypothyroidism - GORD - laryngeal cancer - lung cancer
82
What are the criteria for 2ww ENT referral?
- age 45 and over - persistent unexplained hoarseness - unexplained lump in the neck
83
What are the features of head and neck cancer?
- neck lump - hoarseness - persistent mouth ulcers - persistent sore throat
84
What are the features of a thyroglossal cyst?
- usually presents age <20 - usually midline, between the isthmus of the thyroid and the hyoid bone - moves upwards with tongue protrusion - painful if infected
85
When should a 2ww for thyroid cancer be sent?
- after an unexplained thyroid lump
86
What are risk factors for acute sinusitis?
- nasal obstruction (septal deviation or polyps) - recent local infection - swimming/diving - smoking
87
What are features of acute sinusitis?
- frontal pressure facial pain, worse on bending forward - thick and purulent nasal discharge - nasal obstruction
88
What is the management of acute sinusitis?
- analgesia - intranasal corticosteroids if symptoms >10 days - oral abx : Pen V 1st line or co-amox if serious
89
What is a branchial cyst?
- benign defect of branchial arches - cyst with acellular fluid and cholesterol crystals
90
How do branchial cysts present on examination?
- unilateral, typically L sided - lateral but anterior to sternocleidomastoid - slowly enlarging - smooth, soft and fluctuant - non-tender
91
Do branchial cysts: - move on swallowing? - transilluminate?
- no movement on swallow - no transillumination
92
How is a branchial cyst investigated and managed?
- USS, ENT referral - fine needle aspiration - conservative or surgical management
93
What is presbycusis?
- sensorineural hearing loss - affects elderly individuals - slow progression
94
What are the causes of presbycusis?
- arteriosclerosis: reduced perfusion and oxygenation of cochlea - diabetes - noise exposure - drug exposure - stress - genetic
95
What are signs of presbycusis?
- speech difficult to understand - high volume on tv - loss of sound directionality - worsening symptoms in loud environments
96
How is presbycusis investigated?
- otoscopy - tympanometry - audiometry - bloods
97
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either: a ____ on the lip or in the oral cavity or a red or red and white patch in the oral cavity consistent with ____ or erythroleukoplakia.
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either: a **lump** on the lip or in the oral cavity or a red or red and white patch in the oral cavity consistent with **erythroplakia** or erythroleukoplakia.
98
What are the features of cholesteatoma?
- foul-smelling, non-resolving discharge - hearing loss others: - vertigo, facial nerve palsy
99
What is seen on otoscopy in cholesteatoma? How is it managed?
- attic crust of earwax - surgical removal by ENT
100
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either: - a ____ on the lip or in the oral cavity or - a red or red and white patch in the oral cavity consistent with ____ or erythroleukoplakia
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either: - a **lump** on the lip or in the oral cavity or - a red or red and white patch in the oral cavity consistent with **erythroplakia** or erythroleukoplakia.
101
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either: unexplained ulceration in the oral cavity lasting for more than 3 weeks or a persistent and unexplained lump in the neck.
102
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either: unexplained ____ in the oral cavity lasting for more than ____ weeks or a persistent and unexplained lump in the ____.
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either: unexplained **ulceration** in the oral cavity lasting for more than **3** weeks or a persistent and unexplained lump in the **neck**.
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