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Medicine > ENT > Flashcards

ENT Flashcards

1
Q

Epistaxis that has failed all emergency management may require?

A

sphenopalatine ligation in theatre

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2
Q

causes of epistaxis?

A
  1. nose blowing/picking
  2. trauma/foreign bodies
  3. bleeding disorders; immune thrombocytopenia,waldenstorms macroglobulinemia
  4. juvenile angiofibroma
  5. cocaine
  6. hereditary haemorrhage telangiectasia
  7. granulomatosis with polyangitis
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3
Q

management of epistaxis

A
  1. torso forward and their mouth open
  2. Pinch the cartilaginous (soft) area of the nose firmly
  3. this should be done for at least 20 minutes
  4. also ask the patient to breathe through their mouth.

If first aid measures are successful
consider using a topical antiseptic (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis
Mupirocin is a viable alternative

If bleeding does not stop after 10-15 minutes of continuous pressure on the nose consider cautery or packing;
cautery should be used initially if the source of the bleed is visible and cautery is tolerated

it is not so well-tolerated in younger children!

ask the patient to blow their nose in order to remove any clots. Be wary that bleeding may resume.
use a topical local anaesthetic spray (e.g. Co-phenylcaine) and wait 3-4 minutes for it to take effect
identify the bleeding point and apply the silver nitrate stick for 3-10 seconds until it becomes grey-white.only cauterise one side of the septum as there is a risk of perforation.

cautery is not viable or the bleeding point cannot be visualised.

anaesthetise with topical local anaesthetic spray (e.g. Co-phenylcaine) and wait for 3-4 minutes
pack the patient’s nose while they are sitting with their head forward,
examine the patient’s mouth and throat for any continuing bleeding, and consider packing the other nostril as this increases pressure on the septum and offending vessel.
patients should be admitted to hospital for observation and review, and to ENT if available

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4
Q

admission and follow up care may be considered in patients under if?

A

a comorbidity (e.g. coronary artery disease, or severe hypertension) is present, an underlying cause is suspected
they are aged under 2 years (as underlying causes such as haemophilia or leukaemia are more likely in this age group)

or bleeding not being stopped despite of measures taken above

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5
Q

first line antibiotic for tonsillitis?

and if penicillin allergic?

A

Phenoxymethylpenicillin(7-10 days)

Clarithromycin
both 7-10 days course

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6
Q

classic signs and symptoms of acute tonsillitis:

A

fever, sore throat and cervical lymphadenopathy.

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7
Q

Centor criteria;

Antibiotic be given immediately if the patient is scoring 3 or more

A
  1. presence of tonsillar exudate
  2. tender anterior cervical lymphadenopathy
  3. history of fever
  4. absence of cough
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8
Q

tx for EBV?

A

Analgesia and abundant fluid administration.

most commonly found in adolescents and not children,

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9
Q

Lateralization of weber test

A

in unilateral sensorineural deafness, sound is localised to the unaffected side

in unilateral conductive deafness, sound is localised to the affected side

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10
Q

Rinne test

A

tuning fork is placed over the mastoid process until the sound is no longer heard, followed by repositioning just over external acoustic meatus

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11
Q

Dix-Hallpike manoeuvre

A

Diagnostic

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12
Q

Epley manoeuvre

A

for tx

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13
Q

positive Dix-Hallpike manoeuvre, indicated by:

A

patient experiences vertigo
rotatory nystagmus

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14
Q

Tx of BPPV

A
  1. Epley manoeuvre
  2. vestibular rehabilitation exercises, for example
    Brandt-Daroff exercises
  3. Medication;betahistine
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15
Q

risk factors for ch rhino sinusitis

A

papa 1. atopy: hay fever, asthma
you 2. nasal obstruction e.g. Septal deviation or nasal polyps
3. recent local infection e.g. Rhinitis or dental extraction
4. swimming/diving
5. smoking

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16
Q

features of ch rhinosinusitis

A

frontal pressure pain which is worse on bending forward

nasal discharge:
usually clear if allergic
thicker, purulent discharge suggests secondary infection

nasal obstruction: e.g. ‘mouth breathing’

post-nasal drip

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17
Q

Management of recurrent or chronic sinusitis

A
  1. avoid allergen/smoking cessation
  2. 3 months course of intranasal corticosteroids(fluticasone for mometasone)
  3. nasal irrigation with saline solution
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18
Q

Red flags symptoms of ch rhino sinusitis.

‘Unilateral’ symptoms like rt sided nasal observation with rhinoorhea/bleeding/blood stained discharge we have to refer to ENT

A
  1. unilateral symptoms(suspicion of neoplasia)
  2. persistent symptoms despite compliance with 3 months of treatment
  3. epistaxis
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19
Q

when should we refer a pt to ent who has persistent sore throat and smoking history.

A

sore throat for more than 4 weeks

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20
Q

features associated with head and neck cancer

A

neck lump
hoarseness
persistent sore throat
persistent mouth ulcer

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21
Q

to find out if we should prescribe antibiotics for a sore throat pt use what?

A

cantor criteria

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22
Q

Indications for antibiotics in ENT?

A
  1. features of marked systemic upset secondary to the acute sore throat
  2. unilateral peritonsillitis
  3. a history of rheumatic fever
  4. an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
  5. patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
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23
Q

1-month-history of severe, unrelenting otalgia, associated with temporal headaches and purulent otorrhoea. She has a past medical history of type one diabetes mellitus
Examination identifies an erythematous external auditory canal and periauricular soft tissue on the left side which is exquisitely tender.
Painful tragus on touching.
dx?

A

Otitis extrerna

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24
Q

what do we treat otitis extena in diabetics/immunocomrpomised with?

what is the treatment of otitis externa(pt coming from Spain,having itchy and sore throat, visible tympanic membrane and no discharge)?

A

I/v cipro

topical corticosteroid and aminoglycoside.

and if tympanic membrane is perforated,aminoglycosides are not used.

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25
Q

what causes otitis externa?

A

pseudomonas areginosa

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26
Q

if otitis externa is left untreated it leads to?

A

temporal bone osteomyelitis

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27
Q

tets for otitis externa?

A

ct scan

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28
Q

when will the pt be referred urgently to ENT incase of otitis external?

A

non-resolving otitis externa with worsening pain

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29
Q

Acute unilateral sensorineural hearing loss developed (within 30 days) is an emergency and requires referral(same day) to ENT for audiology assessment and brain MRI.

And in case of more than 30 days urgent referral to ENT.
WHY?

A

This is because serious pathology such as a vestibular schwannoma needs to be ruled out immediately

high dose steroids (60mg/day) for seven days improves prognosis, so all patients should start treatment as soon as possible.

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30
Q

Where problems are associated with wax accumulation, topical treatments such as what are affective?

A

olive oil can be tried first to soften the wax. t

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31
Q

tx for all cases of SNHL?

A

HIGH dose oral steroids

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32
Q

chronic, smelly ear discharge and recurrent glue ear
HL
no otalgia
dx?

A

Cholesteatoma;
Otoscopy;
pearly white lump ‘attic crust’ - seen in the uppermost part of the ear drum
Management
patients are referred to ENT for consideration of surgical removal

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33
Q

ear pain
itching
occasionally discharge from the affected ear.
affects swimmers.
It can cause a conductive hearing loss
dx?

A

Otitis externa

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34
Q

20-40 years
strong family history of early-onset hearing loss.
progressive conductive hearing loss and tinnitus
Normal tympanic membrane, sometimes flamingo tinge.
dx?
and tx?

A

Otosclerosis

Hearing aid and stapedectomy

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35
Q

Patients may be asymptomatic
unilateral conductive hearing loss.
chalky patch on the tympanic membrane seen on otoscopy or there may be total middle ear destruction.
dx?

A

Tympanosclerosis

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36
Q

reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
DX?

A

Ramsay Hunt Syndrome/Herpes Zoster Oticus

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37
Q

Ramsay Hunt Syndrome/Herpes Zoster Oticus
Features?

A
  1. auricular pain is often the first feature
  2. facial nerve palsy
  3. vesicular rash(red spots) around the ear;ear canal or soft palate)
    other features include
  4. vertigo and tinnitus
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38
Q

tx of Ramsay Hunt Synd?

A

“oral aciclovir”(not I/V) and corticosteroids are usually given

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39
Q

what is glue ear?

A

otitis media with an effusion/serous otitis media
tympanic membrane is retracted.
peaks at age 2
Conductive hearing loss is usually the presenting feature

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40
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

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41
Q

tx for glue ear?

A

management;
referral for hearing test/ENT IF EDUCATION OR LIFESTYLE IS BEING AFFECTED BY THE SYMPTOMS
otherwise
(children should be observed for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period. )

def tx;
grommet insertion
Adenoidectomy

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42
Q

causes of otitis externa

A

bacteria; staph aureus, pseudomonas
sebborhic or contact dermatitis
Recent swimming

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43
Q

treatment of otitis externa

A

topical ab or combined topical ab with a steroid
OR
Alternatively, aluminium acetate drops can be as effective as antibiotics drops.

2nd line; oral flux.

If a patient fails to respond to topical antibiotics then the patient should be referred to ENT.

if they think it has extended to be a malignant otitis external then I/v antibiotics should be used

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44
Q

when should we refer the pts to ENT incase of polyps?

A

all patients with suspected nasal polyps should be referred to ENT for a full examination.

OR

If there is a unilateral polyp causing symptoms of post nasal drip, nasal obstruction(because incase of unilat we need to r/o malignancy).

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45
Q

Samters triad?

A

he association of asthma, aspirin sensitivity and nasal polyposis

46
Q

small bilateral nasal polyps are seen these can be treated in primary care with a

A

saline nasal douche and intranasal steroids

47
Q

1 of the example of CHL

A

Otosclerosis;
tympanic members,flamingo tinge
positive family hx

48
Q

1 of the example of SNHL

A

Presbycusis;
Age related progressive b/l HL at high frequencies.

No erythema and tympanic membrane is intact on tympanometry.

Word recognition is relatively preserved, but many eventually develop poor word distinction (particularly in crowded, noisy settings).

Need for increased volume on the television or radio
Difficulty using the telephone

Downward-sloping of pure tone thresholds.

49
Q

PEAKS AT 2 age
HL is the presenting feature
comments cause of CHL in children
DX?

A

Glue ear

50
Q

Drug ototoxicity is caused by?

A

FAG;
aminoglycosides (e.g. Gentamicin),
furosemide(NOT BENDRO),
aspirin
and a number of cytotoxic agents

51
Q

A history of unilateral earache with no obvious cause/unremarkable otoscope, persisting for more than 4 weeks warrants referral to ENT under the 2-week wait to investigated for possible underlying malignancy. This is especially important in a smoker, who is at greater risk for head and neck malignancy.

A
52
Q

Features of otitis media

A
  1. acute onset
  2. Otalgia
  3. Fever
  4. HL
  5. otoscopy findings;
    bulging tympanic membrane; loss of light reflex/
    erythema of tympanic memb/
    perforation with purulent otorrhea
53
Q

which antibiotic to treat otitis media

perforated tympanic membrane and otitis media are 2 diff things;
perforation is when only tympanic membrane is torn, developed a whole and otitis media is when an infection develops in the middle ear through that.

Treatment of perforated tympanic membrane due to otitis media where the members is not visible due to discharge.

A

5-7 day course of amoxicillin is first-line. In patients with penicillin allergy, erythromycin or clarithromycin should be given.
INDICATIONS;
1.
But we only give antibiotics incase of infection persisting for more than 4 days.
2. Systemically unwell but not requiring admission.
3. Immunocompromised.
4. Younger than 2 years with bilateral otitis media
5. Otitis media with perforation and/or discharge in the canal

will usually heal after 6-8 weeks, avoid getting water in the ear during this time.

myringoplasty may be performed if the tympanic membrane does not heal by itself

54
Q

pathophysiology of otitis media

A

Secondary to bacteria, particularly Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

55
Q

initial and 2nd line management of epistaxis in children

A

pinch nasal bones and bend forwards for 20mins
if unsuccessful
nasal packing

56
Q

difference between vestibular neuritis
viral labrynthitis
BPPV and
Meniere’s dis

A

BPPV episodes lasts for = few mins

VN; episodes of dizziness, nausea and vertigo lasts =only for hours

viral labrynthitis; =constant symptoms of a shorter duration
(1. prolonged and persistent for the first few days, rest can not take it away
2.hearing loss might occur BUT VERY RARE
3. comes on suddenly after a recent viral infection)

Menieres dis; lasting mins to hrs
vertigo,vomiting,aural fullness, hl,tinnitus

scenario like dizziness/vertigo plus hearing loss for hours? meniere’s or labrynthitis

meniere’s because labrynthtitis rarely causes HL

57
Q

how to differentiate VN fro m other causes of vertigo?

A

In VN there’s is only nausea, vertigo,horizontal nystagmus
BUT NO
tinnitus and HL

58
Q

How to differentiate between vestibular neuritis and PCStroke

A

HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

59
Q

tx of VN?

A

Chronic prob; rehab exercises.
Acute rapid relief; I/M or buccal prochlorperazine.
In less severe cases; short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine).

60
Q

causes of hoarseness

A

MOUTH AREA;
voice overuse
smoking

viral illness

NECK AREA
hypothyroidism
gastro-oesophageal reflux

CANCERS
laryngeal cancer
lung cancer

61
Q

When investigating patients with hoarseness, which investigtation should not be forgotten?

A

chest x-ray should be considered to exclude apical lung lesions.

62
Q

what is sialdinitis?

A

inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct. The duct from the submandibular gland drain into the floor of the mouth and purulent discharge from this duct causes a foul taste in the mouth.

63
Q

what kind of tumours are pleomorphic adenoma?

A

common in middle age
slow growing, painless lump

64
Q

what kind of tumour is warthin’s tumour?

A

males, middle age
softer, more mobile and fluctuant

65
Q

most common tumour in mouth is?

A

sabmandibular

66
Q

what is an ear canal bony growth that is seen most commonly in cold-water swimmers

A

osteoma

67
Q

symptoms of osteomalacia

A

ear pain an eventual cond hearing loss

68
Q

causes of presbycusis

A

diabetes
genetics
drug exposure(Salicylates, chemotherapy agents
stress

69
Q

facial pain behind the nose
throbbing in nature
frontal pressure
exacerbation on leaning forward
dx?

A

sinusitis

70
Q

acute sinusitis time period?

A

10 days

71
Q

tx for acute sinusitis

A

antibiotics are not indicated
analgesia
abundant fluids
intranasal decongestants or nor saline

72
Q

symptoms of acute sinusitis more than 10 days tx?

A

intranasal corticosteroids

or

phenoxymethylpenicillin first-line
co-amoxiclav if ‘systemically very unwell

‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection

73
Q

sinusitis is caused by which organisms?

A

Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.

74
Q

in case of malignant otitis externa?

A

I/V antibiotics are required unlike the simple otitis externa

75
Q

All mouth ulcers persisting for greater than 3 weeks should be sent to?

A

oral surgery as a 2 week wait referral.

76
Q

which other lesions or problems warrants a referral to oral surgery as a 2 week wait referral?

A
  1. Unexplained red, or red and white patches that are painful, swollen or bleeding.
  2. 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
  3. Unexplained persistent sore or painful throat
77
Q

Predisposing factors of hairy tongue?

A

poor oral hygiene
antibiotics
head and neck radiation
HIV
intravenous drug use

78
Q

some facts about meniere’s disease.

A

equal incidence in both males and females

rhomerg’s test is positive

symptoms resolve in the majority of patients after 5-10 years.

ENT assessment is required to confirm the diagnosis

patients should inform the DVLA.

acute attack; buccal or intramuscular prochlorperazine.

prevention: betahistine and vestibular rehabilitation exercises may be of benefit

79
Q

only HL with no pain or discharge but with left middle ear effusion.
dx?

A

glue ear/otitis media with effusion

80
Q

management of glue ear in an adult(usually it is more common in children peak age 2)

A

refer to ENT as 2 week wait to r/o tumours in post nasal space which are blocking the Eustachian tube.

81
Q

Parotid gland swelling
b/l causes?

A
  1. viruses: mumps(but it resolves within days so the history in stem will be short)
  2. sarcoidosis (look for pulmonary symptoms like dry cough and night sweats in the stem)
  3. Sjogren’s syndrome(no pul symps)
  4. lymphoma
  5. alcoholic liver disease
82
Q

Parotid gland swelling
unilateral causes?

A
  1. tumour: pleomorphic adenomas
  2. stones
  3. infection
83
Q

otoscopy is for?

A

infections

84
Q

audiogram is for?

A

meniere’s dis

management strategies if there is a suspicion of meniere’s disease;

if the prominent symptom is hl over the vertigo/tinnitus attacks=then the first thing to do is to refer for audiogram.

if the complaints are general like vertigo, tinnitus and hl then the first thing to do id to refer to ent.

85
Q

dizziness, vertigo triggered by position,after 55,no nystagmus at present.
Which test is the best?

A

Dix Halpike.
pehlay nystagmus nae hota lekin is test mein ho jata hai rotatory nytsagmus aur dizziness wagera js say ye show hota hai k dx confirm ho gaya hai BPPV ka

86
Q

tympanic membrane retracted

A

in glue ear

87
Q

MIDDLE EAR OSTEOMA can cause ?

A

Nerve paresis

88
Q

repeated otitis media can lead to ?

A

cholesteatoma

89
Q

how do nasal tumours present?

A

nosebleeds
persistent blocked nose
blood stained mucus draining from the nose and a decreased sense of smell.

90
Q

bg of hypercholetsrolemia and ex smoker
room spinning
nausea
constant dizziness
high bp
nystagmus
mild past pointing and dysdiadokokinesia
dx?

A

post stroke

an urgent hosp admission is needed to get an MRI done after CT Head as MRI is more affective at visualizing post part of the brain

91
Q

which drug causes gingival hyperplasia?

A

phenytoin
cal channel blockers
ciclosporin

92
Q

which cord cause gingival hyperplasia?

A

AML

93
Q

All the causes of CHL

A

C2GO3T;

Cholesteatma
cerumen impaction
glue ear
otitis externa
otitis media with effusion
otosclerosis
tympanosclerosis

94
Q

causes of SNHL

A

presbycusis
stickler syndrome
acoustic neuroma
VN
VL
Menieres

95
Q

HI -> bilateral red swelling arising from the midline, which is slightly boggy. No other signs of a head injury are seen. What is the most appropriate management

A

NOTES FROM PLAB :(

minor trauma

bilateral red swelling in the nose

causing nasal obstruction

boggy in nature

tx; drain and abs

comps if untreated: necrosis, abcess, saddle nose deformity

96
Q

Tender around temples
Raised ESR
DX?

A

Temporal arteritis

97
Q

complications of otitis media

A

perforation of tympanic membrane leading to otorrhea

HL

Labrynthitis

(we have to refer to the secondary in the following complications if developed as a result of primary prob;otitis media)

mastoiditis(ear displaced anteriorly)

meningitis

brain access

facial nerve paralysis

98
Q

Uncomplicated tympanic membrane perforation

A

managed with watchful waiting for a month.

Most perforations will resolve spontaneously in 4-8 weeks.

99
Q

Interpretation of Rinne and Weber tests

A

normal;
air conduction is better than bone conduction on rings test
and the weber test will be midline,lateralzed to both of the ears.

CHL;
rinnes=bone conduction >air cond
weber=lateralizes to the affected side

SNHL;
rinnes=air conduction>bone cond
weber will lateralize to the unaffected side.

100
Q

common cause of speech and language delay in young children

A

Glue ear

101
Q

geographic tongue
management?

A

is benign
reassurance

102
Q

Notes from PLAB :(

A

Epidermoid Cyst; firm, round,central puncutm

Cystic hygromas; congenital lymphatic lesion, left side lump on neck or axilla,
soft ,painless, transilluminate brightly.
Usually presents before 2 years of age.

Branchial cleft cyst; smooth,painless,do not transilluminate.
usually present in adulthood

lymphoma; fever,wt loss, night sweats, spleenomegaly

differentiate it from tb, painless rubbery lymph nodes

thyroid swelling; moves upward on swallowing

thyroglossal cyst; moves on tongue protrusion

carotid aneurysm; pulsatile, does not move on swallowing.

cervical rib=10% develop thoracic outlet synd

phatrygeal pouch=dysphagia,aspiration,regurg,cough

reactive lymphadenopathy;
hx of local infections

103
Q

which condition categorised in CHL worsens in pregnancy?

A

Otosclerosis

104
Q

otosclerosis is associated with which genetic category?

A

autosomal dominant

105
Q

otosclerosis happens during which age group?

A

20-40yrs

106
Q

could otosclerosis be b/l?

A

yes it can cause b/l CHL

107
Q

tx of otosclerosis

A

hearing aid
stapedectomy

108
Q

A 54-year-old male smoker
one day history of sore throat
hoarse voice.
no cough.
He has been unable to swallow for the last 3 hours and is
temperature of 38ºC.
He has trismus.
oropharynx; no obvious abnormality and his tonsils are normal.
bilateral cervical lymphadenopathy
Dx?

A

Acute sore throat with no obvious oropharyngeal signs, associated with symptoms such as inability to swallow, sepsis, or trismus warrants urgent ENT evaluation to look for a deeper airway infection (e.g. supraglottitis)

109
Q

Tx of Suproglottitis

A

IV antibiotics
IV dexamethasone
adrenaline nebulisers.
Patients should be in an airway monitored bed (ENT ward) or ITU if required.

110
Q

people who have a history of glandular fever
and have received amoxicillin

A

a non allergic maculopapular rash can develop.

111
Q

Unilateral facial nerve palsy
with sparing of the forehead
cause?

A

sparing of the forehead means that the patient is able to raise the eyebrows.
Possible CVA

112
Q

U/l facial nerve palsy with forehead being affected
?cause

A

Bells palsy

Medicine (18 decks)

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