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ENT Flashcards

1
Q

Difference in viral labyrinthitis and vestibular neuronitis?

A

Viral labyrinthitis = hearing loss as well as dizziness

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2
Q

What is a branchial cyst?

A

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
Usually present in early adulthood

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3
Q

What is a cystic hygroma?

A

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age

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4
Q

What is a pharyngeal pouch?

A

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough

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5
Q

What is a thyroglossal cyst?

A

More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected

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6
Q

Management of menieres?

A

ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit

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7
Q

Features of menieres disease?

A

recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural). Vertigo is usually the prominent symptom
a sensation of aural fullness or pressure is now recognised as being common
other features include nystagmus and a positive Romberg test
episodes last minutes to hours
typically symptoms are unilateral but bilateral symptoms may develop after a number of years

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8
Q

Treatment for BPPV?

A

Epley manoeuvre

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9
Q

AC and BC tests results for conductive and sensorineural loss?

A

Sensorineural = AC > BC bilaterally, lateralise to other side to loss

Conductive BC > AC on affected side. lateralise to that side on webers

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10
Q

Centor criteria for red flag Sx of sore throat?

A

presence of tonsillar exudate

tender anterior cervical lymphadenopathy or lymphadenitis

history of fever

absence of cough

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11
Q

Treatment for otitis externa?

A

topical antibiotic or a combined topical antibiotic with a steroid. Antibiotic is often aminoglycoside. If the tympanic membrane is ruptured then an aminoglycoside is not used.

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12
Q

What drugs can cause tinnitus and hearing loss (ototoxicity).

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

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13
Q

Management of epistaxis

A

In order:

Adequate first aid for 20 minutes (squeeze both nasal ala firmly and sit forward. Ice in the mouth can help)

Topical adrenaline/local anaesthetic

Topical tranexamic acid

Nasal packing (e.g. with Rapid Rhino. Initially insert into the affected nostril. If unsuccessful, a pack in the other nostril may help. Posterior bleeds can be packed with a posterior pack, or with a Foley catheter).

Surgical intervention (sphenopalatine artery ligation).

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14
Q

Symptoms of post nasal drip?

A

Bad breath, feeling of mucus in back of throat, chronic cough

May have erythematous throat

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15
Q

Features of ramsay hunt syndrome?

A

Auricular (ear) pain is often the first feature

Facial nerve palsy

Vesicular rash around the ear

Other features include vertigo and tinnitus

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16
Q

What is Ramsay hunt syndrome?

A

Caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

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17
Q

Management of Ramsay hunt syndrome?

A

oral aciclovir and corticosteroids are usually given

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18
Q

What is presbyacusis? What are the normal findings on examination of hearing?

A

Age related hearing loss

Bilateral sensorineural pattern hearing loss:

Bilateral impairment
High-frequency hearing loss
Downward-sloping pure tone thresholds

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19
Q

How long would a perforation have to be present (following otitis media) for a referral to ENT?

A

6 weeks

20
Q

When should you refer a child with glue ear?

A

Symptoms are significantly affecting hearing, development or education.

Immediate referral in children with Downs syndrome or cleft palate

Persist beyond 6-12 weeks

21
Q

Management of acute sensorineural hearing loss?

A

Acute sensorineural hearing loss is an emergency and requires urgent referral to ENT for audiology assessment and brain MRI.

Start high dose oral steroids (60mg/day)

22
Q

Management of allergic rhinitis?

A

Allergen avoidance

if the person has mild-to-moderate intermittent, or mild persistent symptoms:
- oral or intranasal antihistamines

If the person has moderate-to-severe persistent symptoms, or initial drug treatment is ineffective:
- intranasal corticosteroids

A short course of oral corticosteroids are occasionally needed to cover important life events
there may be a role for short courses of topical nasal decongestants (e.g. oxymetazoline).

23
Q

If you are treating a sore throat what antibiotics and for how long?

A

Either phenoxymethylpenicillin or clarithromycin (if the patient is penicillin-allergic) should be given. Either a 7 or 10 day course should be given.

24
Q

Management of adult glue ear?

A

2ww - ?posterior nasal space tumour

25
Q

Chronic rhinosinusitis management? What if unilateral symptoms?

A

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

If unilateral symptoms then 2ww

26
Q

Indications for abx in otitis media?

A

Symptoms lasting more than 4 days or not improving

Systemically unwell but not requiring admission

Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease

Younger than 2 years with bilateral otitis media

Otitis media with perforation and/or discharge in the canal

27
Q

Management of patients with suspected menieres in primary care?

A

Referral to ENT for confirmation of diagnosis

28
Q

BPPV Viral labyrithitis and Vestibular neuronitis and Menieres have what eye movement feature?

A

(Horizontal) nystagmus

29
Q

Audiogram results for sensorineural and conductive hearing loss?

A

in sensorineural hearing loss both air and bone conduction are impaired

in conductive hearing loss only air conduction is impaired

30
Q

Risk factors for glue ear?

A

Male sex

Siblings with glue ear

Higher incidence in Winter and Spring

Bottle feeding

Day care attendance

Parental smoking

31
Q

Features of otosclerosis?

A 
Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
normal tympanic membrane*
positive family history
32
Q

Does menieres cause permanent hearing loss?

A

Usually it does cause mild hearing loss.

33
Q

Management of acute sinusitis?

A

Analgesia

Intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited.

NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days.

Oral antibiotics are not normally required but may be given for severe presentations.

34
Q

How long would you leave otitis media before treating and what would you treat with?

A

Guidelines would advocate treatment after a delay of 2-3 days if there is no improvement in symptoms.

Oral amox

35
Q

Unilateral or bilateral polyps is a red flag?

A

Unilateral

36
Q

Management of black hairy tongue?

A

Tongue scraping

Topical antifungals if Candida

37
Q

What can cause gigival hyperplasia?

A

phenytoin, ciclosporin, calcium channel blockers and AML

38
Q

Management of vestibular neuronitis and viral labyrinthitis?

A

Vestibular Neuronitis:

Vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms.

Buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases.

A short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases

Viral labyrinthitis:

Episodes are usually self-limiting.

Prochlorperazine or antihistamines may help reduce the sensation of dizziness

39
Q

What is malignant otitis externa (features)?

A

Diabetes (90%) or immunosuppression (illness or treatment-related)

Severe, unrelenting, deep-seated otalgia

Temporal headaches

Purulent otorrhea

Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

40
Q

Treatment of malignant otitis externa?

A

Non-resolving otitis externa with worsening pain should be referred urgently to ENT.

Intravenous antibiotics that cover pseudomonal infections (Ciprofloxacin, cephalosporins, carbapenems, aminoglycosides - (?would be avoided here))

41
Q

What is Siladenitis?

A

sialadenitis - inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct.

42
Q

What is lymphadenitis?

A

Enlargement of lymph glands due to inflammation (usually infection)

43
Q

Features of trigeminal neuralgia?

A

Unilateral facial pain characterised by brief electric shock-like pains, abrupt in onset and termination

May be triggered by light touch, emotion

44
Q

What medication is associated with nasal polyps?

A

Aspirin

45
Q

Causes of bilateral parotid swelling?

A

viruses: mumps

sarcoidosis (associated with cough)

Sjogren’s syndrome

lymphoma

alcoholic liver disease

46
Q

2ww rules for oral lesions?

A

Unexplained oral ulceration or mass persisting for greater than 3 weeks

Unexplained red, or red and white patches that are painful, swollen or bleeding

Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy

Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks

Unexplained persistent sore or painful throat

Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion

47
Q

Common cause for repeated Otitis externa (not malignant)?

A

Candida

MSRA (22 decks)

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