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ENT Flashcards

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USMLE® Step 1 flashcards
1
Q

Herpes Simplex Virus types

A

1 (oral lesions) and 2 (gential)

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2
Q

Herpes Simplex Virus signs/symptoms

A

vesicles 1-2 mm and ulcers on lips, buccal mucosa and hard palate

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3
Q

Herpes simplex virus Mx

A

Aciclovir

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4
Q

Herpangina

A

enterovirus via faecal oral route - coxsackie virus

  • vesicles/ulcers on soft palate
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5
Q

Hand, foot and mouth

A

coxsackie

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6
Q

Apthous ulcers

A

Recurring painful ulcers of the mouth that are round or ovoid and have inflammatory halo.

Confined to mouth, absence of systemic disease

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7
Q

sore throat and lethargy persist into the second week, especially if the person is 15-25 years of age ….

A

EBV

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8
Q

Throat: signs for admission or referral?

A

Throat cancer is suspected (persistent sore throat, especially if there is a neck mass)

Sore or painful throat lasts for 3 to 4 weeks. There is pain on swallowing or dysphagia for more than 3 weeks

Red, or red and white patches, or ulceration or swelling of the oral/pharyngeal mucosa persists for more than 3 weeks

Stridor/respiratory difficulty is an emergency

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9
Q

Acute Otitis Media

A

inflammation of middle ear accompanied by the symptoms and signs of acute inflammation with / without an accumulation of fluid

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10
Q

AOM bacteria causes

A

Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Moraxella catarrhalis and Staphylococcus aureus

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11
Q

AOM signs/symptoms

A

Ear pain, reduced hearing (conductive) in affected ear

Ear drum red and inflamed.

Drum is bulging towards you due to pus and pressure on other side

general symptoms of upper airway infection such as fever, cough, coryzal symptoms, sore throat and feeling generally unwell.

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12
Q

AOM Mx

A

80% resolve in 4 days without antibiotics.

Simple analgesia for pain and fever

First line – amoxicillin

Second line – erythromycin

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13
Q

Otitis externa

A

Inflammation of the outer ear canal

Almost always infective

Common causes include water, cotton buds, skin conditions

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14
Q

Otitis externa signs/symptoms

A

Redness and swelling of the skin of the ear canal

It may be itchy

Can become sore and painful. There may be a discharge, or increased amounts of ear wax

If the canal becomes blocked by swelling or secretions, hearing can be affected

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15
Q

OE bacterial causes

A

Staph aureus
Proteus spp
Pseudomonas aeruginosa

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16
Q

OE Mx

A

Topical aural toilet (clean the EAM)

Swab to microbiology and prescription of antimicrobial reserved for unresponsive or severe cases

Treat depending on culture results

Topical clotrimazole (trade name canesten) for Aspergillus niger,

Gentamicin 0.3% drops

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17
Q

Malignant otitis externa

A

extension of otitis externa into the bone surrounding the ear canal (i.e. the mastoid and temporal bones).

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18
Q

Malignant otitis signs/symptoms

A

pain and headache, more severe than clinical signs
Granulation tissue at bone-cartilage junction of ear canal
- exposed bone
- facial nerve palsy

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19
Q

Otitis Media with Effusion

A

Inflammation of the middle ear accompanied by accumulation of fluid without the symptoms and signs of acute inflammation

associated with Eustachian tube dysfunction or obstruction (e.g. enlarged adenoids)

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20
Q

otitis media with effusion signs/symptoms

A 
deafness 
poor school behaviour
behavioural problems 
speech delay 
no ear pain (otalgia)

TM retraction, reduced TM mobility and altered TM colour

Visible ME fluid/bubbles

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21
Q

otitis media with effusion diagnosis

A

Otoscopy
tunning fork
audiometry
tympanometry

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22
Q

otitis media with effusion Mx

A 
watchful waiting (3 months)
 - otoscopy, PTA and tympanomtery

Referral

  • Persistent (> 3/12), bilateral OME
  • CHL >25dB

< 3: grommets
> 3: grommets
> 3 (2nd intervention): grommets and adenoidectomy

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23
Q

Cholesteatoma

A

Presence of keratin within middle ear (Keratinizing squamous epithelium within the middle ear cleft)

Retraction pocket – squamous epithelium builds up on it

Erodes surrounding bone

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24
Q

Cholesteatoma signs/symptoms

A
  • Causes hearing loss, discharge, complications
  • Chronic, smelly aural discharge
  • Facial nerve paralysis
  • tympanic membrane full of white, cheesy material
  • retracted ear drum?
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25
Q

Otosclerosis

A

Gradual onset conductive hearing loss

Stapes footplate becomes fixed in oval window due to abnormal bone formation

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26
Q

Otosclerosis Mx

A

Hearing aid
Correction by stapedectomy – remove the stapes and prothesis
Usually patients have no history at all of problems with ears.

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27
Q

Presbycusis

A

progressive, sensorineural hearing loss that occurs with age.

It results from a gradual loss of cochlea hair cells and degeneration in the cochlea nerve.

  • Loss of outer hair cells (sensory)
  • Loss of ganglion cells (neural)
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28
Q

Presbycusis low or high frequency

A

high

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29
Q

Noised induced hearing loss occurs at what level?

A

4000Hz

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30
Q

Drug-Induced Hearing Loss

A
  • Gentamicin and other aminoglycosides
  • Chemotherapeutic drugs - Cisplatin, Vincristine
  • Aspirin and NSAIDs (in overdose)
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31
Q

Vestibular schwannoma (acoustic neuroma)

A
  • Slow-growing benign schwannoma of the vestibular nerve (subarachnoid tumours)
  • Benign tumour arising in Internal Auditory Meatus
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32
Q

Vestibular schwannoma (acoustic neuroma) signs/symptoms

A

• Progressive sensorineural hearing loss, tinnitus and imbalance
• Asymmetric
Loss of corneal reflex
• Nearby Cranial nerves V, VI, VII at risk

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33
Q

Acoustic neuroma Mx

A

o Serial observation: periodic neuro exam, hearing aid and periodic MRI.
o Stereotactic radiosurgery: involves image-guided accurate delivery of radiation to small volumes of brain, to reduce area subjected to radiation.
o Microsurgical excision: surgery is performed via a retrosigmoid approach in the prone position.

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34
Q

Benign Positional Paroxysmal Vertigo

A

Causes: Head trauma, ear surgery, idiopathic

Pathophysiology: Otoconia (crystals – break off) from utricle (horizontal) and are displaced into semi-circular canals.

Most commonly into posterior SCC.

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35
Q

BPPV signs/symptoms

A

Lasts seconds to a few minutes e.g. looking up and turning in bed - often worse to one side
- Repeated, brief periods of vertigo with movement, that is, of a spinning sensation upon changes in the position of the head.

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36
Q

VERTEBROBASILAR INSUFFICIENCY

A

Visual disturbance, weakness and numbness (impaired circulation to the posterior brain associated with the vertigo)

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37
Q

BPPV diagnosis

A

Dix Hallpike test (observe for rotational nystagmus)

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38
Q

BPPV management

A
  1. Epley Maoeuvre
  2. Semont Manouvre
  3. Brandt-Daroff exercises
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39
Q

Vestibular Neuronitis/Labyrinthitis

A

infection of the vestibular nerve in the inner ear. It causes the vestibular nerve to become inflamed, disrupting your sense of balance.

Probable viral aetiology

40
Q

Vestibular Neuronitis/Labyrinthitis signs/symptoms

A
  • Prolonged vertigo
  • Associated tinnitus or hearing loss in labyrinthitis – not in vestibular neuritis
  • Maybe viral prodromal symptoms
  • Was your first attack severe, lasting hours with nausea and vomiting?
  • Nystagmus away from the affected side
41
Q

VN/L Mx

A

Supportive management with vestibular sedatives e.g.

  • rapidly relieve severe N&V: buccal prochlorperazine, or an intramuscular injection of prochlorperazine or cyclizine.
  • To alleviate less severe N&V and vertigo, consider prescribing a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine teoclate).
42
Q

Meniere’s disease

A

idiopathic endolymphatic hydrops, is one of the most common causes of dizziness originating in the inner ear.

43
Q

Meniere’s disease signs/symptoms

A

recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours)

  • New tinnitus (or worsening) on the affected side
  • Aural fullness on the affected side
  • Does one ear feel full or do you notice a change to your hearing (or tinnitus) around the time of the dizzy spell
  • Documented SNHL on at least one occasion (low frequency SN loss)
44
Q

Meniere’s Mx

A

IV labyrinthine sedatives and fluids

  • rapidly relieve severe N&V: buccal prochlorperazine, or an intramuscular injection of prochlorperazine or cyclizine.
  • To alleviate less severe N&V and vertigo, consider prescribing a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine teoclate).
  • betahistine

refractory

  • Intratympanic gentamicin via grommets
  • Vestibular nerve resection last resort
45
Q

Acute tonsillitis causes (bacterial and viral)

A
  • EBV, rhino, adeno, entero, influenza and parainfluenza (undertake normal activity)
  • step pyogenes, H. influenza. s.aureus, strep pneuomonia (systemic upset and fever: unable to work)
46
Q

Centor criteria

A

1) History of fever
2) Tonsillar exudates (small white patches)
3) Tender anterior cervical adenopathy
4) Absence of cough
2/3 points: antibiotics if it progresses
4/5 - treat empirically

47
Q

FeverPAIN

A 
Fever
Pus on tonsils 
Attend rapidly (3 or less days)
Inflammed tonsils 
No cough
48
Q

Tonsillitis Mx

A

supportive (if antibiotics)

  • 10 days of phenoxymethylpenicillin
  • clarithromycin if pen allergic
  • erythromycin for pregnant woman with pen allergy

if admitted (IV fluids, antibiotics and steriods)

49
Q

Tonsillectomy rules

A

a frequency of more than 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms)

50
Q

Peritonsilar abscess (Quincy)

A

Complication of Acute tonsillitis

Bacteria between muscle and tonsil produce pus (in the egg and the egg cup)

3-7 days of preceding acute tonsillitis

51
Q

Quincy signs/symptoms

A

Unilateral throat pain and odynophagia
trismus
medial displacement of tonsil and uvula

52
Q

Quincy Mx

A

aspiration and antibiotics

53
Q

Glandular fever signs/symptoms

A
  • Gross tonsillar enlargement with membranous exudate
  • Marked cervical lymphadenopathy
  • Palatal petechial haemorrhages
  • Generalised lymphadenopathy
  • Hepatosplenomegaly due to being systemic
  • Linked to chronic fatigue syndrome
  • Jaundice and rash
54
Q

Glandular fever diagnosis

A
  • Blood count and film: Atypical lymphocytes in peripheral blood
  • +ve Monospot or Paul-Bunnell test
  • Low CRP (<100)
  • Epstein-Barr virus IgM
  • Heterophile antibody
  • Liver function tests
55
Q

Glandular fever Mx

A
  • Bed rest – paracetamol
  • Avoid sport
  • Symptomatic treatment
  • Do NOT prescribe ampicillin: diagnostic generalised macular rash will result!
  • Antibiotics – stop secondary bacterial infection
  • Steroids – reduce inflammatory
  • DO NOT GIVE AMOXICILLIN TO TONSILITIS
56
Q

Candida Albicans causes

A

Cause: endogenous (post antibiotics, immunosuppressed, smokers, inhaled steroids

57
Q

Candida Albicans Mx

A

Miconazole 1st line
Nystatin suspension 2nd line
oral fluconazole 50mg if extensive

58
Q

Diphtheria

A

Corynebacterium diphtheriae

Severe sore throat with a grey white membrane across the pharynx.

The organism produces a potent exotoxin which is cardiotoxic and neurotoxic

59
Q

Rhinitis

A

Infective: Viral upper respiratory tract infection

Non-infective: Allergic and non-allergic

60
Q

Allergic rhinitis classification

A

Intermittent (symptoms <4 days per week or symptoms for <4 weeks) e.g. hayfever
- normal sleep, no impairment of daily activities, sport, leisure & normal work and school, no troublesome symptoms

Persistent (symptoms >4 days per week or symptoms for >4 weeks)
- one or more items: abnormal sleep, impairment of daily activities, sport, leisure, missing work or school, troublesome symptoms

61
Q

Allergic rhinitis Mx

A

1) allergen avoidance

Mild-moderate:

  • anti-histamine: cetirizine
  • intranasal chromone: sodium cromoglicate if anti-histamine contra

Moderate-severe - persistent
- Topical nasal steroids: fluticasone furoate, or fluticasone propionate.
- topical steroids and anti-histamine
- topical anti-cholinergic: ipratropium bromide
surgery

severe

  • For adults — prednisolone 0.5 mg/kg in the morning for 5–10 days.
  • For children — prednisolone 10–15 mg in the morning for 3–7 day

Immunotherapy

62
Q

Vasomotor rhinitis

A

blood vessels inside your nose dilate, or expand.

• Dilation of the vessels in the nose produces swelling and can cause congestion.

63
Q

Nasal polyps

A

inflammation and oedema of the sinus nasal mucosa

Tends to occur in the middle meatus

Often associated with non-allergic asthma and aspirin tolerance

64
Q

Nasal Polyps Mx

A

topical steroids and then oral steroids

Surgery

65
Q

Nasal Fracture

A

clincial diagnosis - dont need to x ray

review in 5-7 days and consider digital manipulation/rhinoplasty

66
Q

Septal Haematoma

A

septal hematoma is a collection of blood in the septum, or space between the two nostrils. If under perichondrium it prevents blood flow and death to cartilage

67
Q

Nasal epistaxis Mx

A

First aid:

  • upper body tilted forward and mouth open
  • pinch soft part of nose
  • ice

Bleeding does not stop after 10-15 mins of nasal pressure

  • nasal cautery (silver nitrate)
  • nasal packing

Bleeding controlled?

  • FBC, G&S
  • do not consider sedation if naso pack

Bleeding not controlled

  • admit, FBC, G&S
  • arterial ligation

systemic treatment

  • reverse anti-coags
  • correct clotting abs
  • platelt transfusion
  • reduce hypertension
68
Q

CSF leak

A

site of fracture at cribriform plate

69
Q

Acute sinusitis Mx

A
  1. Av. length illness 2.5 weeks.
  2. Nasal decongestants (Oxymetazoline or Pseudo-ephedrine)
  3. Topical corticosteroid (fluticasone propionate nasal spray)

Antibiotics (>10 days duration)

  • 1st line: phenoxymethylpenicillin 500mg 4 times per day for 5 days
  • 2nd line: intolerant or allergic to pen: doxycycline (not under 12)
  • preganant - erythromycin
70
Q

Pinna haematoma + Mx

A

sub perichondral - if left will die

Aspirate
Incise and drain
pressure dressing

71
Q

Lacerations

A 
Debridement – cut out dead or bad stuff 
Closure 
o	Primary
o	Reconstruction
Usually Local anaesthetic 
Antibiotics – cartilage
72
Q

Temporal bone fracture history (important)

A
  • Injury mechanism
  • Hearing loss and vertigo
  • Facial palsy
  • CSF leak
  • Associated injuries
73
Q

Temporal bone fracture exam

A
  • Bruising – Battle sign
  • Condition of TM and ear canal
  • CN VII
  • Hearing test – not able to come to a clinic to do a test though. Most HDU
74
Q

Temporal bone classification fracture

A

Longitudinal vs transverse

75
Q

Sudden Sensorineural hearing loss Mx

A

Treat as emergency
Weber test – tuning fork on forehead. Sound away from affected ear
• Steroids 1mg/kg and consider intratympanic treatment
• Then refer up and possibly steroids into the ear

76
Q

Foreign bodies Mx

A

Batteries - immediately

Live animals – drown with oil can be removed next day

If swallowed – must be removed – require GA

77
Q

Deep Neck Space Infection

A

Extension of infection from tonsil or oropharynx into deeper tissues

History: sore throat, unwell, limited neck movement

Examination: Febrile, trismus, red / tender neck

78
Q

Deep Neck Space Infection Mx

A
  • Admit
  • Iv access, bloods,
  • Fluid rehydration
  • Intravenous antibiotics, such as co-amoxiclav or clindamycin (if allergic to penicillin)
  • May need theatre for incision & drainage unless abscess is small and improves with cons treatment.
  • Airway compromise may be imminent so need to drain infection
79
Q

Facial (maxillary) trauma signs/symptoms

A 
Pain
Decreased visual acuity and diplopia 
Hypoaesthesia in infraorbital region 
Periorbital ecchymosis (racoon eyes)
Oedema 
Enopthalmos
Restriction of ocular movement
Bony step of orbital rim
80
Q

Airway obstruction - infective or foreign bodies Mx

A
  • A,B,C: Resuscitation
  • Oxygen high flow
  • Heliox (79% Helium+ 21% Oxygen – easier to breathe due to the helium)
  • Steroid: Nebulised Budesonide 2mg and Dexamethasone 0.15-0.6 mg/kg
  • Adrenaline: Nebulised Adrenaline 1:10000 (5ml)
  • Flexible fibre-optic endoscopy – what is going on? But do not aggravate a precarious airway
  • Secure airway with ET Tube/Tracheostomy
  • Treat underlying pathology
81
Q

Head and Neck Cancers types

A
  • Squamous cell carcinoma by far the commonest type of cancer but there are regional variations
  • Nasopharyngeal carcinoma – South China , related to EBV
  • Laryngeal carcinoma – typically cigarettes & alcohol aetiology
  • Oropharyngeal carcinoma – in ‘West’ commonly associated with HPV (produces proteins E6 and E7 which disrupts p53 and RB pathways)
  • Oral Cavity carcinoma – Southern Asia , chewing tobacco
82
Q

Head/neck cancers - signs/symptoms

A
  • Dysphonia – >3 weeks warrants urgent referral for laryngoscopy
  • Dysphagia – particularly if progressive
  • Odynophagia – pain on swallowing
  • (Unilateral) otalgia – if no other cause (remember referred pain)
  • Neck lump
  • Can present with airway obstruction - Stridor
83
Q

Head/Neck Cancers Ix

A 
USS: lymph nodes
FNA
CT: neck and chest 
MRI: deep lobe of partoid and nasopharynx 
PET: mets
84
Q

Laryngeal cancer Mx

A

1) Early (T1 & T2) >90% 5 year survival
- Transoral laser surgery
- Radiotherapy

2) Advanced (T3 and T4)
- Partial or Total laryngectomy (curative but high morbidity)
- Chemo & Radiotherapy
- Neck nodes will need treatment, either chemo-radiotherapy or surgery to remove

85
Q

Oropharyngeal cancer management depends on TNM classification & HPV status

A

1) Early (T1 & T2): >90% 5 year survival
- Chemo-radiotherapy
- Transoral surgery
2) Advanced (T3 and T4)
- Chemo-radiotherapy
- Neck nodes will need treatment, either chemo-radiotherapy or surgery to remove

86
Q

Nasopharyngeal Cancer (EBV)

A

30-40% have unilateral ear symptoms

Up to 50% have nasal symptoms
• Up to 70% have palpable neck lymphadenopathy
• CN III, IV, V2, V3, VI involvement
• Presents with a lump in the neck (painless, posterior triangle
• Hearing deficit (because the cancer has blocked the Eustachian tube) leading to glue ear
• Is monitored by measurement of EBV antibodies

Chemo/radiotherpay

87
Q

Schneiderian papilloma

A

Benign Tumour

  • Inverted and oncocytic on lateral walls and paranasal sinuses, exophytic on nasal septum
88
Q

Laryngeal Polyps

A

Reactive change in laryngeal mucosa secondary to vocal abuse (singers), infection and smoking. Occ. in hypothyroidism.

Nodules are usually seen in young women and are bilateral on middle 1/3 to posterior 1/3 on vocal cord.

Polyps are unilateral and pedunculated.

89
Q

Contact Ulcer

A

Benign response to injury
Posterior vocal cord
Chronic throat clearing, voice abuse, gastrooesophageal reflux (GORD), intubation

90
Q

Squamous Papilloma

A

Two peaks of incidence - <5years and between 20-40 years
Related to HPV exposure – types 6 and 11
Children – aggressive disease
Adults – often solitary and possibly not related to HPV 6 & 11.

91
Q

Salivary gland mass Ix

A

USS + FNC: Lymph node, thyroid
CT: Local relations
MRI: deep lobe of parotid and VII

92
Q

Mass in parotid

A

likely to be benign: pleomorphic adenoma

93
Q

Submandibular and sublingual glands malignancy and types of tumour

A

Malignant more likely

1) Mucoepidermoid carcinoma (worldwide)
2) Adenoid cystic carcinoma (UK)

94
Q

Mass in salivary glands Mx

A

Superficial or total parotidectomy

95
Q

Warthin’s Tumour

A
  • Second most common benign tumour
  • Usually males over 50.
  • Rare outwith the parotid. Strong association with smoking. Often bilateral and multicentric.

Medical Diseases (18 decks)

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