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Med School Finals > Ear, Nose & Throat (ENT) > Flashcards

Ear, Nose & Throat (ENT) Flashcards

1
Q

List some ototoxic medications.

A

Loop diuretics (e.g. furosemide)
Aminoglycosides (e.g. gentamicin)
NSAIDs (e.g. ibuprofen)
Salicylates (e.g. aspirin)
Platinum agents (e.g. cisplatin)
Antimalarials (e.g. quinine)

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2
Q

Rinne’s and Weber’s test results in conductive hearing loss?

A

Rinne’s = BC > AC in affected ear (“negative”)
Weber’s = sound localises to affected ear

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3
Q

Rinne’s and Weber’s test results in sensorineural hearing loss?

A

Rinne’s = AC > BC in both ears (“positive”)
Weber’s = sound localises to unaffected ear

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4
Q

Hearing threshold considered normal in audiometry?

A

0-20dB

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5
Q

Features of a sensorineural vs conductive hearing loss audiogram?

A

Sensorineural = AC and BC impaired
Conductive = AC impaired and “air-bone gap”

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6
Q

Top 3 bacterial causes of acute otitis media?

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella cataharrlis

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7
Q

Clinical and otoscopy features and management of acute otitis media?

A

Otalgia
Recent/current URTI
Otorrhoea (if perforation)
Otoscopy = bulging/red TM, loss of light reflex
Management = self-limiting, consider antibiotics if ≥4 days, perforation, systemically unwell, immunocompromised, bilateral OM in child

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8
Q

Antibiotic options for otitis media (if required)?

A

1st line = amoxicillin
2nd line = clarithromycin

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9
Q

Timescale for perforated tympanic membrane to heal and management if unresolved?

A

6-8 weeks
Myringoplasty

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10
Q

Clinical and otoscopy features and management of glue ear (otitis media with effusion)?

A

Hearing loss
Behavioural issues
Speech and language delay
Otoscopy = indrawn TM, bubbles, visible fluid level, loss of light reflex
Management = self-limiting, grommets if persistent

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11
Q

Chalky white tympanic membrane in patient with history of glue ear/grommet insertion?

A

Tympanosclerosis

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12
Q

Features of malignant otitis media and associated pathogen?

A

Immunocompromised patient (90% in diabetics)
SEVERE otalgia
Headache
Ottorhoea
Associated pathogen = pseudomonas

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13
Q

Complication of malignant otitis media?

A

Temporal bone osteomyelitis

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14
Q

Causes of otitis externa?

A

Staphyloccocus aureus
Pseudomonas aeruginosa
Fungal infection
Dermatitis (contact or seborrheic)

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15
Q

Clinical and otoscopy features and management of otitis externa?

A

Otalgia
Pruritus
Otorrhoea
Otoscopy = red/swollen/flaky ear canal
Management = aural toilet + topical antibiotic/steroid, ear wick if canal very swollen

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16
Q

Clinical and otoscopy features and management of cholesteatoma?

A

Foul-smelling otorrhoea
Otoscopy = attic crust
Management = surgical removal

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17
Q

Antibiotics used for otitis externa?

A

Ciprofloxacin
Neomycin
Gentamicin

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18
Q

Management for otitis externa not responding to topical treatment or worsening pain?

A

Take a swab
Refer to ENT

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19
Q

Features and management of mastoiditis?

A

Swollen/red mastoid process
Affected ear protruding forwards
Management = admission + IV antibiotics

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20
Q

Management of pinna haematoma and complication if untreated?

A

Drainage within 24 hours
Avascular necrosis leading to “cauliflower ear”

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21
Q

Clinical and otoscopy features and management of otosclerosis?

A

Hearing loss
Tinnitus
Strong family history (AD)
Worse during pregnancy
Otoscopy = flamingo flush/Schwartze (~10%)
Management = hearing aids, stapedectomy or stapedotomy

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22
Q

Key audiogram sign of otosclerosis?

A

Impaired BC at 2000Hz

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23
Q

Most common hearing loss in elderly, audiogram feature and management?

A

Presbycusis
Bilateral loss of high-frequency hearing
Hearing aids

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24
Q

Management options for ear wax?

A

Ear syringing
Softeners (e.g. olive oil, sodium bicarbonate 5%)
Microsuction

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25
Q

Pathology of benign paroxysmal positional vertigo (BPPV)?

A

Otoconia dislodge and float around semi-circular canals, stimulating hair cells in the Organ of Corti

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26
Q

Features of benign paroxysmal positional vertigo (BPPV)?

A

Sudden onset vertigo
Triggered by position
No auditory symptoms
Episodes last for secs to mins
+ve Dix Hallpike (vertigo and rotatory nystagmus)

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27
Q

Management of benign paroxysmal positional vertigo (BPPV)?

A

Epley manoeuvre (80% success)
Brandt-Daroff exercises

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28
Q

Pathology of Meniere’s disease?

A

Excess fluid in the endolymph (endolymphatic hydrops)

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29
Q

Features of Meniere’s disease?

A

Sudden onset vertigo
Tinnitus, hearing loss, fullness
Nausea and vomiting
Episodes last hours

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30
Q

Management of Meniere’s disease?

A

Acute attack = prochloperazine
Prophylaxis = betahistine

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31
Q

Features of vestibular labyrinthitis?

A

Sudden onset vertigo
Tinnitus, hearing loss
Nausea and vomiting
Horizontal nystagmus
Episodes lasting weeks
Recent/current URTI

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32
Q

Rule of 3 for vestibular labyrinthitis?

A

3 bed days
3 weeks off work
3 months off balance

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33
Q

Difference between vestibular neuritis and labyrinthitis?

A

Neuritis = CN VIII involvement with no hearing impairment (just vertigo)
Labyrinthitis = CN VIII + labyrinth involvement with hearing impairment

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34
Q

Test to differentiate central (e.g. stroke) from peripheral (e.g. vestibular neuritis) cause of vertigo?

A

HINTS exam:
Head Impulse, Nystagmus, Test of Skew

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35
Q

Type of nystagmus seen in vestibular neuritis vs. stroke?

A

Neuritis = horizontal unidirectional
Stroke = horizontal bidirectional

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36
Q

Classic features of Ramsay-Hunt syndrome (CN VII palsy) and management?

A

Otalgia
Facial paralysis
Vesicular rash around ear
Management = oral aciclovir + steroid

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37
Q

Most common cause of sudden sensorineural hearing loss (SSHL), audiometry criteria, other investigation and treatment?

A

Idiopathic (90%)
Loss of ≥30 dB in 3 consecutive frequencies
MRI/CT head
1st line = high-dose oral steroids
2nd line = intra-tympanic steroids

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38
Q

Features and management of vestibular schwannoma?

A

Unilateral hearing loss
Vertigo, tinnitus
Absent corneal reflex
<40mm = 6 monthly MRI
>40mm = surgery

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39
Q

Bilateral vestibular schwannomas?

A

Neurofibromatosis type II

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40
Q

Most common bone affected in a basal skull fracture?

A

Temporal bone

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41
Q

Classic features of a basal skull fracture fracture?

A

Battle’s sign (mastoid bruise)
Raccoon eyes
Haemotympanum
CSF rhinorrhoea
Cranial nerve palsy

42
Q

What does “sore throat” cover?

A

Pharyngitis
Laryngitis
Tonsilitis

43
Q

Centor criteria aim, features and score indicating antibiotic is needed?

A

Screens for GAS pharyngitis
Fever, tonsillar exudate, tender anterior cervical nodes, absence of cough
≥3 needs antibiotic

44
Q

Antibiotic management (if needed) for pharyngitis, laryngitis and tonsillitis?

A

1st line = phenoxymethylpenicillin (penicillin V)
2nd line = clarithromycin

45
Q

Complications of GAS throat infection?

A

Otitis media
Peritonsillar abscess (quinsy)
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis

46
Q

Most common cause of bacterial tonsillitis?

A

Streptoccoccus pyogenes (GAS)

47
Q

Indications for tonsillectomy?

A

≥7 episodes in the same year OR
≥5 episodes in previous 2 years OR
≥3 episodes in previous 3 years

48
Q

Management of post-tonsillectomy primary vs secondary haemorrhage?

A

Primary (<24 hours) = urgent return to theatre
Secondary (>24 hours) = admission + antibiotics

49
Q

Features and management of a peritonsillar abscess (quinsy)?

A

Throat pain (worse on affected side)
Odynophagia
Drooling
Trismus
Deviated uvula
Management = aspiration + IV antibiotics

50
Q

What is Lemierre’s syndrome, risk factor and complications?

A

Thrombophlebitis of internal jugular vein
Peritonsillar abscess
Septic emboli/sepsis

51
Q

Cause of rheumatic fever and scarlet fever?

A

GAS (strep pyogenes) infection

52
Q

Features and management of rheumatic fever?

A

Generally unwell (e.g. fever)
Polyarthritis (migratory)
Pancarditis and valve disease
Erythema marginatum
Subcutaenous nodules
Sydenham’s chorea
Management = NSAID + oral penicillin V

53
Q

Cells seen in rheumatic heart disease?

A

Aschoff bodies

54
Q

Features and management of scarlet fever?

A

Generally unwell (e.g. fever)
Strawberry tongue
Sandpaper texture rash
Desquamation
Manament = penicillin V

55
Q

School exclusion for children with scarlet fever?

A

24 hours after starting antibiotics

56
Q

Features of mononucleosis (glandular fever)?

A

Sore throat
Exudative tonsilitis
Lymphadenopathy
Palatal petechiae
Hepatosplenomegaly

57
Q

Haematological manifestations of EBV infection?

A

Lymphocytosis with atypical lymphocytes
Haemolytic anaemia (cold agglutins/IgM)

58
Q

Key test for mononucleosis (glandular fever)?

A

Heterophil antibody (Monospot test)

59
Q

School exclusion for children with glandular fever?

A

No need to stay off if well

60
Q

Classic reaction to ampicillin or amoxicillin in patient with mononucleosis (glandular fever)?

A

Pruritic, maculopapular rash

61
Q

Virus associated with nasopharyngeal cancer and B cell lymphomas?

A

Epstein-Barr virus (EBV)

62
Q

Red flags for nasopharyngeal carcinoma?

A

Eustachian tube dysfunction
Bloody nasal discharge
Persistent epistaxis
Unilateral nasal mass e.g. polyp

63
Q

Virus associated with oropharyngeal cancer?

A

HPV 16

64
Q

Red flags for oral cancer?

A

Lump in the mouth or lip
Ulcer lasting >3 weeks
Erythroplakia or erythroleukoplakia

65
Q

Timescale for head and neck symptoms to be urgently referred (2 week pathway)?

A

Persistent for >3 weeks

66
Q

Risk factors for Reinke’s oedema (vocal cord oedema)?

A

Smoking (most cases)
Hypothyroidism
Voice overuse
Laryngopharyngeal reflux

67
Q

Risk factors for head and neck cancer?

A

Smoking tobacco
Alcohol
Age > 40
HPV (16) and EBV
UV exposure
Poor dental hygiene

68
Q

Most common type of head and neck cancer?

A

Squamous cell carcinoma

69
Q

Midline neck lump which moves upwards on swallowing and tongue protrusion?

A

Thyroglossal cyst

70
Q

Midline neck lump that gurgles on palpation?

A

Pharyngeal pouch

71
Q

Neck lump between angle of jaw and sternocleidomastoid?

A

Branchial cyst

72
Q

Most common branchial cleft to form a cyst?

A

Second

73
Q

Lateral neck lump present at birth?

A

Cystic hygroma

74
Q

Neck lump associated with thoracic outlet syndrome?

A

Cervical rib

75
Q

What do salivary gland tumours cover?

A

Parotid (most common)
Sublingual
Submandibular

76
Q

Most common parotid gland tumour?

A

Pleomorphic adenoma

77
Q

Most common bilateral parotid gland tumour?

A

Warthin’s tumour

78
Q

Most common malignant parotid gland tumour?

A

Mucoepidermoid carcinoma

79
Q

Parotid tumour associated with perineural invasion?

A

Adenoid cystic carcinoma

80
Q

Systemic causes of bilateral parotid disease?

A

Mumps
HIV infection
Lymphoma
Sarcoidosis
Tuberculosis
Sjögren’s syndrome

81
Q

Rule of 80 for parotid tumours?

A

80% benign
80% pleomorphic adenomas
80% superficial lobe

82
Q

Most common location of sialolithiasis?

A

Wharton’s duct of the submandibular gland

83
Q

What is Ludwig’s angina and list some causes?

A

Cellulitis involving the floor of the mouth
Dental abscess
Sialolithiasis

84
Q

What does sinusitis vs rhinosinusitis involve?

A

Sinusitis = paranasal sinuses
Rhinosinusitis = paranasal sinuses + nasal cavity

85
Q

Most common causes of acute sinusitis?

A

Streptococcus pneumoniae
Haemophilus influenzae
Rhinovirus

86
Q

Features and management of acute sinusitis?

A

Recent/current URTI
Facial pain (worse bending forward)
Purulent nasal discharge
Loss of smell and taste
Management = self-limiting, intranasal steroid + antibiotic if > 10 days

87
Q

Timescale of acute vs chronic sinusitis?

A

Acute = <12 weeks
Chronic = >12 weeks

88
Q

Management of chronic sinusitis?

A

Nasal irrigation with saline solution
Intranasal steroid

89
Q

Features of allergic rhinitis?

A

Sneezing
Nasal pruritus
History of atopy
Clear nasal discharge
Associated allergic conjunctivitis

90
Q

Drug options for allergic rhinitis?

A

1st line = oral or intranasal antihistamine (1st gen)
2nd line = intranasal steroid
3rd line = oral steroid
N.B. nasal decongestants can also be used

91
Q

Nasal decongestant examples and side effects with prolonged use?

A

Oxymetazoline, phenylephrine, pseudoephedrine
Side effects = tachyphylaxis, rhinitis medicamentosa

92
Q

Antihistamine mechanism of action and 1st gen vs 2nd gen examples?

A

H1 receptor antagonist
1st gen = chlorphenamine, promethazine
2nd gen = cetirizine, loratadine, fexofenadine

93
Q

Which generation of antihitamines has a higher risk of sedation and anticholingergic side effects?

A

1st gen e.g. cyclizine

94
Q

Samter’s triad?

A

Aspirin sensitivity
Asthma
Nasal polyps

95
Q

Management of nasal polyps?

A

Topical steroid
Surgery if persistent

96
Q

Management of a nasal septal haematoma and complication if untreated?

A

Drainage within 24 hours
Avascular necrosis leading to “saddle-nose” deformity

97
Q

Management of epistaxis?

A

1st line = first aid (10-15 mins)
2nd line = cautery via silver nitrate sticks (if bleed source visible)
3rd line = nasal packing (if cautery fails or bleed source not visible)
4th line = sphenopalatine ligation
Naseptin for 10 days to reduce crusting and vestibulitis

98
Q

Drug options for oral candidasis?

A

1st line = miconazole gel or nystatin suspension
2nd line = oral fluconazole

99
Q

Management of acute necrotising ulcerative gingivitis?

A

Urgent dental referral
Analgesia (e.g. NSAIDs)
Oral metronidazole + chlorhexidine mouthwash

100
Q

Drugs which cause gingival hyperplasia?

A

Phenytoin
Ciclosporin
Calcium channel blockers (especially nifedipine)

Med School Finals (18 decks)

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