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MRCP Part 1 > Ear nose and throat > Flashcards

Ear nose and throat Flashcards

1
Q

Which vertigo conditions have..

Normal hearing

Hearing loss

A

Normal: BPPV, Vestibular neuronitis

Loss: Labyrinthitis, meniere’s, acoustic neuroma

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2
Q

How do BPPV and VN differ on…

Duration

History

Investigation

A

BPPV // VN

<60s // <72hrs

Head movement // Viral URTI

Dix-Hallpike // Head impulse

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3
Q

What is the treatment for

BPPV

Vestibular neuronitis

A

Epley

Prochlorperazine

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4
Q

How do you differentiate between labyrinthitis and Meniere’s in terms of duration and hisory?

How do you treat them?

A

Labyrinthitis: ~72hrs, viral and ear infections

Meniere’s: 20m to hours, Fullness and imbalance

Both get prochlorperazine + antihistamines

Meniere’s has beta-histine for prevention

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5
Q

Constant dizzyness with unilateral hearing loss and facial palsy indicates what?

How do you investigate and manage the condition?

A

Acoustic neuroma (vestibular schwanomma)

2WW for MRI

<3cm: Radiotherapy

>3cm: Surgical excision

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6
Q

What ear conditions cause pain?

A

Otitis externa

Otitis media

Mastoiditis

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7
Q

How can you differentiate between otitis externa, media and mastoiditis in terms of

Symptoms

History

Otoscopy

A

OE // AOM // Mastoiditis

Discharge and itchy // conductive hearing loss, fever // Severe pain, protruding ear, systemic unweel

Hx swimming // URTI // otitis media

red swollen, flaky canal // buldging tympanic membrane // possible perforation, ear discharge

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8
Q

How do you treat otitis externa?

A

1st: topical antibiotics (acetic acid) +/- steroid

+ oral abx/antifungals if spreading

Failsure: ENT referral

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9
Q

What do you do with a diabetic with deep ear pain, discharge and temporal headaches

A

Urgently refer for CT and IV antibiotics

Likely malignant otitis externa

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10
Q

What organisms typically cause malignant otitis externa?

A

Pseudomonas

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11
Q

What antibiotic is first line in otitis media and when should you give it?

A

Amoxicillin 5-7 days (macrolide if allergic)

Give if…

  • >4 days
  • systemically unwell without admission need
  • Vulnerable (<2yrs, IC)
  • Perforation or discharge in canal

-

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12
Q

What is the treatment for mastoiditis?

A

IV antibiotics

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13
Q

What are the complications of mastoiditis?

A

Meningitis

Hearing loss

Facial nerve palsy

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14
Q

How does cholesteatoma difer from otitis or mastoiditis?

A

Non painful

Smelly discharge

Conductive hearing loss

Hx cleft palate

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15
Q

What does the following show on otoscopy?

A

Attic crust (red arrow), bone (blue arrow)

Cholesteatoma

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16
Q

How do you manage cholesteatoma?

A

Refer to ENT for CT petrous bones

17
Q

Painless conductive hearing loss in a young child indicates what and how do you treat it?

A

Glue ear

Grommet for 10 months

Adenoidectomy

18
Q

How does presbycussis and otosclerosis compare in terms of…

Hearing loss

Age of onset

Tinnitus

A

Presbycussis // Otosclerosis

Bilateral conductive // Bilateral sensory

Increases with age // 20-40s, family history

Common // Uncommon

19
Q

How do you confirm presbycusis?

A

-ve otoscopy, tympanometry and inflammatory markers

20
Q

How can you tell if tonsillitis would benefit from antibiotics

A

CENTOR >=3 OR FeverPAIN >=4

Fever >38 degrees

Purulence

Acute onset (FeverPain)

Inflammation

No cough

21
Q

For tonsilitis, what is the

Bacterial cause

Antibiotic therapy

A

Group A strep (pyogenes)

1st: Pen V (phenpen) 10 days (doxy, clarithromycin)

22
Q

When would a tonsillectomy be considered?

A

7 bouts in 1yr

5 bouts in 2 yrs

3 bouts in 3 yrs

23
Q

What is the management pathway for sinusitis

A

Conservative for 10 days

> 10 days, bacterial cause unlikely: Nasal spray

>10 days, bacterial cause likely: PhenPen

24
Q

How is post-tonsillectomy bleeding managed?

A

6-8hrs: Theatre

5-10 days: Admit for IV antibiotics

25
Q

How does mouth opening and uvula deviation play a role in sore throat

A

Trismus and deviation of uvula to one side indicates quinsy

Needs incision, drainage and IV antibiotics

26
Q

How can you tell between anterior and posterior nosebleed clinically?

A

Posterior is more likely bilateral and profuse

Posterior is venous (Wooruff) while anterior is arterial (Kiesselbachs)

27
Q

What is the management steps of nosebleed?

A
  1. Sit face forward and pinch cartilage for 20 mins
  2. Cauterise if visible, pack if fails
  3. Ligate/embolise
28
Q

When do you admit for nosebleed?

A

Profuse, bilateral or non-visualised

29
Q

Following nasal trauma, what is important to examine for?

A

Boggy septum

Boggy: Incise and drain haematoma <24hrs

Not: Splint + outpatient review

30
Q

Sore throat with enlarged ant and posterior chains with raised WCC and ALT indicates what condition?

How do you investigate and treat it?

A

Infectious mononucleosis

2 week monospot

Conservative

Avoid heavy contact due to splenic rupture risk

31
Q

What nature of nose symptoms are worrying?

A

Unilateral (eg mass leakage)

Urgent referral

MRCP Part 1 (32 decks)

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