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ENT Flashcards

1
Q

Epistaxis management

recurrent + visible blood vessels on nasal septum bilaterally + NO active bleeding

A

1- nasal cautery @ 1 side or topical naseptin (chlorhexidine & neomycin)
Can’t do cautery on both sides at same time

Avoid cautery with silver nitrate when there is active bleeding

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2
Q

Epistaxis management

recurrent + visible blood vessels on nasal septum bilaterally + ACTIVE bleeding

A

anterior nasal packing bilaterally
- left for 24-48 hrs
Encourage mouth breathing

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3
Q

Oral lichen planus

Treatment

A

Lace like appearance
Topical steroids - benzydamine mouthwash/spray recommended
If extensive - oral steroids

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4
Q

Ear Foreign body removal

- insect

A

1- kill with 2% lidocaine/ olive oil/mineral oil or alcohol drops
Syringe out water irrigation or olive oil

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5
Q

Ear FB removal

- seed

A

Rapid access - not urgent referral to ENT
Removal by suction with catheter or by hook

Do not irrigate - can cause it to swell

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6
Q

Ear FB removal

-super glues

A

Remove manually in 1-2 days - after desquamation

Refer to ENT if eardrum involved

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7
Q

Ear was build up

A

Olive oil to soften hard wax

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8
Q

Batteries in ear

A

Refer ent , should be taken without 24 hrs

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9
Q

Any spherical object in the ear should be removed by. -

A

Hook

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10
Q

RFs for nasopharyngeal carcinoma

A

EBV
Smoking
Alcohol

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11
Q

Features of nasopharyngeal ca

A

Swollen cerviacal LNs - painless
Eustachian tube obstruction
CHL , tinnitus

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12
Q

Tonsil ca spreads to

A

Mandible

- pain in the throat + trismus - spasm of jaw muscles

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13
Q

Quinsy / peritonsillar abscess

Features

A 
Usually after hx of tonsillitis 
Severe trismus 
Drooling saliva 
Otalgia 
Uvular deviation 
Hot potato voice
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14
Q

Quinsy treatment

A

Admit for IV antibiotics - benzylpenicillin

I&D

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15
Q

Majority of sinusitis caused by

A

Viral infection

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16
Q

Treatment sinusitis

A

Mostly self limiting
Symptomatic relief
- nasal decongestant containing ephedrine
Paracetamol/ ibuprofen
Nasal steroids if sx >10 days w/o improvement

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17
Q

Plummer Vinson syndrome
Features (3)
It is a RF for -
Common in -

AKA Paterson Kelly / sideropenic dysphagia

A

IDA + gloss it is + dysphagia (due to post-cricoid oesophageal web )
Koilonychia

RF for oropharyngeal ca

Common in postmenopausal women

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18
Q

Treatment of Plummer Vinson

A

Balloon dilation

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19
Q

Paranasal sinus tumour

Features

A 
Pressure/pain/tenderness/swelling - cheek upper teeth 
Blood in nasal discharge 
Nasal obstruction 
Hx of chronic sinusitis 
If orbit involved - epiphora , diploia
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20
Q

Treatment otitis media

A

Viral - analgesics, supportive

Bacterial - oral amoxicillin

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21
Q

Otitis external
Features
Treatment

A

Itching - pain
Travel tenderness

T-
1- acetic acid 2%, 1 spray TID 7 days
2- topical gentamicin
3- aminoglycoside + topical corticosteroid 3 drops TID 7-14 days
Aminogly - gentamicin
= avoid if TM rupture - ototoxic ; use cipro instead

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22
Q

Fist investigation in ear trauma

A

Otoscopy

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23
Q

Investigation for mandibular lump / salivary gland mass

A

US FNAC

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24
Q

Chronic sialadenitis

A

Submandibular swelling - more painful and prominent on chewing
Usually 2ry to sialolithiasis
Sour taste in my mouth , dry mouth
Decreased jaw mobility

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25
Q

Mikulicz syndrome

A

Triad of
Symmetrical enlargement of all salivary glands
Lacrimal gland enlargement - narrowing of palpebral fissures
Dryness of mouth - parchment like

2ry to sarcoidosis , TB or lymphoma

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26
Q

Rinne test vs Weber test

A 
Both use 512 hz 
Normal AC > BC twice as long 
Rinne:
CHL - BC> AC 
SNHL - AC > BC - not twice as long

Weber :
CHL - sound heard best in abnormal ear
SNHL - hear best in normal ear

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27
Q

Ménière’s disease

Features

A 
DVT + fullness
Deafness - usually unilateral SNHL
vertigo 
Tinnitus
Fullness/ pressure in ear 
\+/- nausea and vomiting 
Lasts mins to hrs
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28
Q

Treatment of Ménière’s

A

Prochlorperazine - buccal or IM
Or
Promethazine , cyclizine, cinnarizine

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29
Q

SNHL means

Investigations

A

Defect in cochlea - hair cells in inner ear , cochlear nerve or brain stem
MRI

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30
Q

Vestibular neuritis
Features
Treatment

A

VN - vestibular nerves inflammation , vestibular neuropathy
3 Vs - vertigo, vomiting , viral URTI
No hearing loss!

Treatment - prochlorperazine

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31
Q

Labyrinthitis
Features
Treatment

A

Inflammation of vestibular nerve AND labyrinth
Attacks of vertigo nausea and vomiting aggravated by moving head
Preceded by URTI
SNHL +- tinnitus

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32
Q

Vestibular neuritis vs BPPV

A

VN - hours - day s

BPPV - minutes

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33
Q

Otitis media with effusion / glue ear

A

Commonest cause of CHL in children
TM - retracted (more common) or bulging
- bluish gre , dull to yellow +- an air fluid level
CHL

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34
Q

Treatment of OME

A

1st visit / recent dx
- reassure and review in 3 months

> 3 months & bilateral

  • grommets insertion
  • if CI - ear aids

Advise parents to stop smoking

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35
Q

Commonest cause of progressive CHL in young adults (15-45 yrs old)

A

Otosclerosis

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36
Q

Bluish grey or yellow TM with air fluid level

A

OME

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37
Q

Flamingo pink blush TM (Schwartz sign)

A

Otosclerosis

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38
Q

Inflamed TM cartwheel appearance of vessels

A

Acute suppurative OM

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39
Q 
Otosclerosis 
-cause 
- genetics 
-uni/bilateral 
- male:female
-hearing loss
Accelerated by
A 
Increased stapes bony growth (turnover)
50% genetic 
80% bilateral 
F>M 2:1
CHL 
Accelerated by - pregnancy
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40
Q

Otosclerosis treatment

A

No cure
Stapedectomy or stapedotomy with prosthesis insertion
Not fit for surger - bilateral hearing aids

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41
Q

Chalky white patches over eardrum

A

CHL

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42
Q

Acquired cholesteatoma
Features
Complications

A

Collection of keratinising squamous epithelium in middle ear
Expands and can erode adj structures - TM perforation and ossicle damage
Pearly white mass behind TM
Chronic foul discharge.
Hx recurrent otitis media
CHL

43
Q

Congenital vs acquired cholesteatoma

A

Congenital - child 6mo to 5 years

Usually no recurrent hx of OM or TM perforation

44
Q

Management of cholesteatoma

A

Referral ENT for surgical removal

45
Q

Acoustic neuroma / vestibular Schwannoma

A 
Pressure effect on CN 
8th - DVT deafness, vertigo, tinnitus
7- facial palsy/drooping
6- diplopia same side
5- loss of corneal reflex
\+- ICP sx
46
Q

Imaging for Acoustic neuroma / vestibular Schwannoma

A

MRI cerebellopontine angle / MRI internal auditory meats

MRI brain

47
Q

MRI in Ménière’s disease

A

Normal

48
Q

Malignant otitis externa
Usually caused by -
Features-

A 
Aggressive infection - NOT cancer
Pseudomonas infection of auditory canal - gangrene & necrosis 
Necrosis can extend deep 
- facial n palsy 50%
Severe pain , foul discharge, CHL
49
Q

Malignant otitis externa
Imaging
Management

A

CT scan

Urgent referral to ENT - it can be fatal
50% death if untreated

IV antibiotics - cipro

50
Q

Malignant otitis externa - important RF

A

Immunocompromised

51
Q

Commonest organism in OM

A

RSV , rhinovirus
H influenza
S.pneumoniae
S.pyogenes

52
Q

Dx of BPPV

A

Hallpike’s manoeuvre

53
Q

Epley’s manoeuvre

A

Treatment of BPPV

BPPV mostly resolves spontaneously

54
Q

BPPV involves what part of the ear

A

Posterior Semi circular canal - usually but not exclusively

55
Q

BC >AC - bilateral;
Weber not lateralised
In a child , can’t hear teacher well in class
Think of ___

A

OME

56
Q

Hearing test in children

< 6 months

A

Otoacoustic emission

Audiological brainstem response

57
Q

Hearing test

6-18 mo

A

Distraction testing

58
Q

2- 4 years

Hearing test

A

Speech discrimination or

Conditioned response audiometry

59
Q

> 5 - hearing test used

A

Pure tone audiogram

60
Q

Ear furuncle
- common organism
-RFs
Treatment

A

S. Aureus
DM , immunocompromised
Mostly resolves spontaneously
Or give flucloxacillin

If large - I & D

61
Q

Furuncle vs carbuncle

A

Furuncle - infection of hair follicle

Carbuncle - group of hair follicles next

62
Q

Arrange or refer for hearing assessment in following conditions
(6)

A

Any parental concern about hearing loss at any time - despite normal tests before !
Professional doctor’s concern
Temporal bone fracture
Bacterial meningitis
Severe unconjugated indirect hyperbilirubinemia
Delayed speech and language milestones

63
Q

Itching in ear followed by ear pain and serum discharge

A

Otitis externa

64
Q

Nasal trauma
Later develops nasal pain tenderness general malaise and fever
Dx?

A

Nasal septal abscess

- possible infected nasal hematoma

65
Q

Functional dysphonia

A

Voic disturbance in absence of any structural abnormality of larynx and vocal cords

66
Q

Presbycusis

Features

A 
Can’t hear high frequency sounds 
Affects elderly 
Bilateral SNHL 
Difficulty understanding speech and follow convo 
Poor hearing esp in noisy environment
67
Q

Presbycusis treatment

A

Bilateral digital hearing aids that increase high frequency sound

68
Q

Otosclerosis vs presbycusis

A

Otosclerosis - CHL, can’t hear LOW freq sounds
Presbycusis - SNHL , can’t hear HIGH frequency sounds

Oto - young 15-45 yrs , can hear better in noisy environments

69
Q

First aid measure - epistaxis

A

Pinch nose - cartilaginous soft tissue , open mouth
Hold 10-15 mins
If hemodynamically unstable - send to a&e

70
Q

Acute tonsillitis

Viral vs bacterial - centor criteria

A 
Centor criteria
1- Fever >38 
2-  tender and enlarged anterior cervical LNs 
3- tonsillar exudates/pus 
4- no associated cough
71
Q

1st line bacterial otitis media

A

Amoxicillin

72
Q

1st line bacterial tonsillitis

A

Phenoxymethylpenicllin - penicillin V

73
Q

1st line in bacterial sinusitis

A

Phenoxymethylpenicillin - penicillin V

74
Q

Asthmatic patient on long term oral steroid

+ hoarseness of voice

A

Think of laryngeal candidiasis 2ry to prolonged steroid intake.

75
Q

Most common type of parotid tumour

A

Benign pleomorphic adenoma

= benign mixed tumour

76
Q

Features of benign pleomorphic adenoma

A 
Painless 
Firm 
Mobile 
Grows slowly 
Solitary 
Asymptomatic
77
Q

Treatment benign pleomorphic adenoma

A

Superficial parotidectomy or enucleation

78
Q

Risk of malignant transformation of benign pleomorphic adenoma

A

2-10% risk

79
Q

Parotid enlargement

DDX

A

Sjögren’s syndrome

Mumps

80
Q

Mumps is infective during what period

How long is the IP

A

7 days before and 9 days after parotid swelling starts

14-21 days

81
Q

Mumps complications

A

Orchitis
Meningoencephalitis
Pancreatitis
Hearing loss - usually unilateral transient HL

82
Q

Temporomandibular mandibular joint

Features

A

Pain in ear cheek mandible

Increases on chewing + bruxism

83
Q

Noise induced hearing loss

A

2nd most common form of SNHL (1-presbycusis)
Cause - exposure to loud sounds
Form of occupational hearing loss - bilateral SNHL

84
Q

Mixed hearing loss seen in

A

Paget’s disease

Osteogenesis imperfecta

85
Q

Insect removal from ear
Initial step
Next step

A

Initial - kill with lidocaine or alcohol

Next - Instill mineral or olive oil

86
Q

Indication for tonsillectomy

A

> 7 episodes tonsillitis / year
5/yr for 2 years
3/year for 3 years

87
Q

How do you know the TM is bulging?

A

Absent light reflex

88
Q

RF for laryngeal ca

A

Smoking
Asbestos, formaldehyde
Poor fruit and veggie diet
HPV16 - oral pharyngeal and laryngeal ca

89
Q

Samter’s triad

A

Asthma + aspirin sensitivity + nasal polyps

90
Q

Initial & gold standard diagnosis fro obstructive sleep apnoea

A

Initial - pulse oximetry, overnight breathing study pattern

Gold standard - polysomnography

91
Q

Treatment OSA

A

Conservative - wt loss, reduce alcohol intake
Mod/sever - CPAP = 1st line
Rarely surgery to alleviate pharyngeal obstruction

DVLA should be informed if its causing excessive daytime sleepiness

92
Q

Complications of tonsillectomy

A

1ry bleeding - first 24 hrs = return to theatre
2ry /reactive bleeding - >24 hrs post op (1-10 days)
- infection - admit for IV antibiotics

Antiseptic mouth washes also indicated

93
Q

Large hematoma of the ear pinna treatment

A

I&D

+ co amoxiclav 1 week - prophylaxis

94
Q

Buccal ulcer with palpable cervical LNs

Dx?

A

Think SCC

95
Q

CHL seen in

A 
Otosclerosis 
Tympanosclerosis 
OME “glue ear”
Malignant otitis extrerna 
Cholesteatoma
96
Q

SBHL seen in

A

Presbycusis
Ménière’s disease
Acoustic neuroma
Noise induced hearing loss

97
Q

Suspected ca pathway referral (appt within 2 weeks ) to ENT specialist considered for:

A

Aged 45 + older with “
Persistent unexplained hoarseness of voice >3 weeks
Unexplained lump in neck

98
Q

Perichondritis

  • organism
  • causes
A

Pseudomonas

Infection if hematoma, complication of severe otitis externa, laceration, mastoid surgery, high ear piercing

99
Q

Perichondritis treatment

A

Oral ABx - fluoroquinolone +- aminoglycoside & semisynthetic penicillin

100
Q

Fluoroquinolones:

A

Cipro
Ofloxacin
Levofloxacin

101
Q

When should DVLA be informed in OSA

A

Already diagnosed mod-sever OSAor

Mild OSA diagnosed + excessive daytime sleepiness not controlled for >3 months

102
Q

Nasal fracture dx

A

Imaging unreliable
It’s a clinical diagnosis
Speculum exam done

103
Q

Treatment allergic rhinitis

A

Xylometazoline - intranasal
- should not be used > 7 days - can cause rebound nasal congestion
Advise pt to stop and medicine free interval

104
Q

Antibiotic indicated in sinusitis

A

Phenoxymethylpenicillin
If very unwell - co amoxiclav
If allergic - doxy or clarithromycin

Revision (31 decks)

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