ENT Flashcards
How are nasal septal haematomas managed?
Incision, drainage and Abx
Why are nasal septal haematomas managed aggressively?
Because of the risk of septal necrosis within 3-4 days - this can then result in ‘saddle-nose’ deformity
What is the audiogram conduction pattern in sensorineural hearing loss?
Both air and bone conduction are impaired
What is the audiogram conduction pattern in conductive hearing loss?
Only air conduction is impaired
What is the audiogram conduction pattern in mixed hearing loss?
Both air and bone conduction are impaired, air tending to be worse than bone
What is the difference between viral labyrinthitis and vestibular neuritis?
Viral labyrinthitis = hearing loss
Describe the nystagmus in viral labyrinthitis:
Spontaneous, unidirectional, horizontal and towards the unaffected side
How can epistaxis be managed if packing fails?
Surgically, by means of a sphenopalatine ligation
What is the name of the plexus of blood vessels in the nose that can be responsible for anterior epistaxis?
Kiesselbach’s plexus
What pathologies can present with epistaxis?
Splenomegaly
Leukaemia
Waldenstrom’s macroglobulinaemia
ITP
Juvenile angiofibroma - adolescent males
Hereditary haemorrhagic telangiectasia - elderly
Granulomatosis with polyangiitis
Pyogenic granuloma
In which patient groups should you use Naseptin with caution?
Peanut, soy or neomycin allergies
What is an alternative to Naseptin?
Mupirocin
What activities should be avoided to reduce the risk of re-bleeding after a period of epistaxis?
Blowing or picking the nose
Heavy lifting
Exercise
Lying flat
Drinking alcohol or hot drinks
What are the Centor criteria?
Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
Fever
Absence of cough
What is the chance of isolating strep with a Centor score of 0-2?
3-17%
What is the chance of isolating strep with a Centor score of 3-4?
32-56%
What are the FeverPAIN criteria?
Fever over 38°C
Purulence (pharyngeal/tonsillar exudate)
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
What is the alternative to phenoxymethylpenicillin for those that are penicillin allergic?
Clarithromycin
How would normal hearing present on Rinne’s and Weber’s testing?
Rinne’s - A>B bilaterally
Weber’s - midline
How would sensorineural hearing loss present on Rinne’s and Weber’s testing?
Rinne’s - A>B bilaterally
Weber’s - lateralises to unaffected ear
How would conductive hearing loss present on Rinne’s and Weber’s testing?
Rinne’s - B>A in affected ear, A>B in unaffected ear
Weber’s - lateralises to affected ear
What is Samter’s Triad?
Asthma
Aspirin sensitivity
Nasal polyposis
How is otosclerosis inherited?
Autosomal dominantly
What type of hearing loss does otosclerosis cause?
Conductive
What type of hearing loss does Stickler syndrome cause?
Sensorineural
What is the triad of Meniere’s disease?
Vertigo
Hearing loss
Tinnitus
What is a branchial cyst?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
How would a thyroid lump move on swallowing?
Upwards
How would a thyroglossal cyst move on protrusion of tongue?
Upwards
Which manoeuvre diagnoses BPPV?
Dix-Hallpike
Which manoeuvre treats BPPV?
Epley
How should simple otitis externa be managed?
Mild (no signs of hearing loss/discharge) - topical acetic acid
Severe - combined topical Abx/steroid
How do you manage Ramsay-Hunt Syndrome?
Oral aciclovir and steroids
What is the likely cause of recurrent otitis externa?
Candida albicans
At what frequency do patient’s with noise-induced hearing loss ‘trough’ - before recovery - on audiogram?
4000Hz
How do you treat patient’s at the severer end of otitis externa?
1/52 of topical Abx +/- steroid
From what vessels does posterior epistaxis originate?
Sphenopalatine artery
What is Schwartz’s sign indicative of?
Otosclerosis
How is tonsillitis treated?
Phenoxymethylpenicillin 10 days
What is sialolithiais?
An obstructing salivary stone - most commonly occurs in the submandibular gland, characteristically produces pain and swelling after eating
What are the different types of thyroid cancer?
Papillary - 60-70% - young patients, betwen 20-40, lymphatic spread, excellent prognosis
Follicular - 20-25% - middle-aged patients, blood spread, good prognosis
Anaplastic - 10-15% - elderly patients, aggressive local extension, poor prognosis
Medullary (C-cell) - 5-10%, usually elderly, but sometimes familial
How does chrondrodermatitis nodularis present?
Solitary firm nodule with a central crust and surrounding erythema, usually unilateral and tender, may be difficult to sleep on affected side
How does relapsing polychondritis present?
Recurrent episodes of cartilage inflammation, with or without destruction. Inflammation tends to spare lobes of ear (because of lack of cartilage) and looks like cellulitis. Can lead to cauliflower ears/saddle deformity of the nose
What is the most common type of oropharyngeal cancer?
SCC
What are the most common causative organisms in a peritonsillar abscess?
- Streptococcus pyogenes
- Viridans strep/S. aureus/Haemophilus
When should children be referred to ENT for consideration for grommets?
If they have BILATERAL otitis media with effusion (also known as glue ear) or severe hearing loss –>refer to ENT + give Abx (also give Abx if there is evidence of perforation in unilateral disease)
When should patient’s with sudden-onset sensorineural hearing loss (SSNHL) be referred to ENT?
For same-day assessment
Majority of cases re idiopathic, but MRI will be performed to exclude vestibular schwannoma. High-dose steroids are used in all patients with SSNHL
Which drugs may be responsible for tinnitus?
- Aspirin/NSAIDs
- Loop diuretics
- Aminoglycosides
- Quinine
What are the causes of gingival hyperplasia?
- Phenytoin
- Ciclosporin
- Calcium channel blockers
- AML
What do you use to treat otitis externa in diabetics, and why?
Ciprofloxacin, to cover against pseudomonas
Should a suspected diagnosis of Meniere’s be confirmed by ENT?
Yes –> routine referral
When should antibiotics be given in otitis media?
- Sx > 4 days or not improving
- Systemically unwell but not requiring admission
- Immunocompromise/high risk of complications
- <2y/o with b/l otitis media
- Otitis media with perforation and/or discharge in the canal
How is the diagnosis of mastoiditis made, and how is it treated?
Clinically
With IV abx