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AA Y4 Finals cards NE > ENT > Flashcards

ENT Flashcards

1
Q

What is the 1st line and 2nd line treatment for epistaxis management?

A

1st: silver nitrate cautery
2nd: nasal packing

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2
Q

In epistaxis management, which artery is 1st to be ligated?

A

Ligation of sphenopalatine artery

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3
Q

Which area of the nose does the sphenopalatine artery supply?

A

The lateral wall of the nose

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4
Q

How is quinsy managed?

A
  1. Urgent ENT review
  2. Needle aspiration and drainage + IV antibiotics
  3. Last resort = tonsillectomy
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5
Q

Which 2 features of a history make quinsy more likely than tonsillitis?

A
  1. Laterality of sore throat

2. Voice change

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6
Q

What antibiotic is used initially to treat infectious mononucleosis?

A

benzyl penicillin

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7
Q

What 3 conditions cause the tympanic membrane to appear:

  1. Red
  2. Yellow
  3. Pearly white
A
  1. Acute otitis media
  2. Oitis media with effusion
  3. Cholesteatoma
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8
Q

Which 3 nerves pass through the internal auditory meatus to the brainstem?

A
  1. Facial
  2. Vestibular
  3. Cochlear
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9
Q

Tonsillitis can mimic earache as referred pain from which CN?

A

CN9 - Glossopharyngeal nerve

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10
Q

What does ‘Type A’ on tympanography suggest ?

A

The tympanic membrane is moving normally

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11
Q

What is the difference between type B and type C in tympanography?

A

Type B - the membrane is not moving (flat)

Type C - the membrane is moving, but it is being contracted

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12
Q

Which conditions can cause type B on tympanography?

A

Flat, non moving membrane.

Otitis media with effusion, ossification

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13
Q

Which conditions can cause type C on tympanography?

A

Membrane is retracted

Caused by middle ear congestion

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14
Q

What is the difference between type As and type Ad on tympanography?

What can cause both type As and type Ad

A

Type As - too little movement (caused by otosclerosis)

Type Ad - too much movement (caused by perforation)

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15
Q

What is a very large risk factor for cholesteatoma?

A

Cleft palate - it is a huge risk factor

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16
Q

Typically, what age are patients who present with cholesteatoma

A

Aged between 10-20

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17
Q

What is the pathology behind otosclerosis

A

Autosomal dominant metabolic condition

Results in fixation of the footplate of the stapes to the oval window

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18
Q

Give 2 features of the typical presentation of otosclerosis

A
  1. A CHL that is usually better in crowded environments

2. It is exacerbated by pregnancy

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19
Q

What finding on audiometry would suggest otosclerosis?

A

Carhaart’s notch

dip in hearing seen at 2000Hz

When air-bone gap narrows in the middle

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20
Q

Which CHL can result as a consequence of repeated otitis media?

Is there any associated pain with this condition?

A

Otitis media with effusion/glue ear

Inflammation of the middle ear in the absence of infection

No pain is associated with this CHL.

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21
Q

Who does OME typically affect?

Describe 4 features of OME which may be present.

A

Typically affects young school children

  1. deafness
  2. speech delay
  3. behavioural problems
  4. poor/reduced school performance
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22
Q

In adults, what ear problem may be suggestive of nasopharyngeal cancer?

A

Unilateral otitis media with effusion

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23
Q

On tympanogram, how would OME present?

A

Type B - flat

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24
Q

How many months must a OME persist before patient should be referred to secondary care?

How can they be treated

A

> 3/12

They should normally resolve within 3/12

Tx: 1st line grommet insertion
2nd line: another grommet + adinoidectomy

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25
Q

Which 4 drugs can cause SNHL as a side effect?

A
  1. Gentamicin
  2. Loop diuretics
  3. Chemotherapy
  4. hydroxychloroquine
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26
Q

What SNHL will cause bilateral symmetrical, high frequency hearing loss?

A

Presbycusis

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27
Q

What are vestibular schwanommas and where do they occur?

A
  1. They are benign nerve sheath tumours

2. They occur on the 8th (vestibular) CN at the cerebellar-pontine angle

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28
Q

Which are more common? Unilateral or bilateral vestibular schwanommas?

Which is related to neurofibromatosis type 2

A

Unilateral VS are more common

Bilateral VS are due to neurofibromatosis type 2

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29
Q

Describe the onset of vestibular schwanommas? How do they affect hearing?

A

Gradual - they are a slow growing, benign tumour

They cause progressive SNHL with distortion of sound +/- tinnitus

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30
Q

Which dermatological manifestation is related to vestibular schwanommas?

A

Cafe au lait spots

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31
Q

How are vestibular schwannomas investigated and managed?

A

Ix - MRI

Tx - watchful waiting or surgical excision

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32
Q

How do vestibular schwannomas manifest clinically?

A
  1. unsteadiness
  2. unilateral headache
  3. deep earache
  4. vertigo
  5. loss of corneal reflex

CN 5, 7,8 affected

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33
Q

Which CN is responsible for the corneal reflex?

A

CN 5 (trigeminal)

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34
Q

Which 2 organisms most commonly cause bacterial otitis externa

A
  1. Staph aureus

2. pseudomonas

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35
Q

Which 2 organisms most commonly cause fungal otitis externa

A
  1. Aspergillus

2. Candida

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36
Q

Name the 1st line AB treatment for bacterial otitis external

A
  1. topical acetic acid + topical steroid

if infection continues to spread, use oral flucloxicillin

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37
Q

Which type of patients may present with malignant otitis externa?

What is the underlying pathogen?

How is this managed?

A

Immunocompromised patients

Pseudomonas

Referral to ENT and IV antibiotics

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38
Q

Describe the way in which malignant otitis externa presents

A

Deep seated, severe otalgia
Temporal headache
Purulent otorrhoea

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39
Q

What is the most common causative of acute otitis media

A

Viral

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40
Q

Name the 2 most common bacterial causatives of AOM

A
  1. Strep pneumoniae

2. H. Influenzae

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41
Q

In AOM, what physiological mechanism settles the initial pain felt

A

Rupture of the tympanic membrane
This reduces the pressure felt in the middle ear
Mucopurulent discharge follows on from rupture

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42
Q

To diagnose OM, what clinical finding is required?

A

Presence of middle ear effusion

This causes a bulging membrane

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43
Q

How is OME managed?

A

Mostly self limiting in 4 days

Only give ABs if >4 days, OM with perforation, <2y/o with bilateral OM or systemically unwell

1st line: 500mg amoxicillin TDS 5/7
2nd line: 500mg clarithromycin TDS 5/7

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44
Q

What can OM with perforation develop into?

What are complications of this?

A

Chronic suppurative otitis media

Hearing loss and labyrinthitis commonly occur

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45
Q

Describe the presentation of mastoiditis

A
  1. Otalgia behind the ear
  2. Tender mastoid
  3. Protrouding auricle
  4. Continual discharge
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46
Q

How is mastoiditis treated?

A

IV Tazocin +/- removal of mastoid

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47
Q

How is supraglottitis treated?

A

IV Ceftriaxone

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48
Q

What can supragolottitis occur secondary to?

How does it present?

A

Tonsilitis

  1. Drooling
  2. Severe dysphagia
  3. New onset stridor
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49
Q

When consulting, how can you differentiate between dizziness and vertigo?

A

Dizziness - sensation of lightheadedness (underlying cause not usually otological)

Vertigo - sensation of movement - spinning of either self, or the surrounding room

Presence of vertigo indicates otological disease

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50
Q

Out of the 3 main causes of vertigo, list them in order of how long each episode of vertigo lasts.

(shortest to longest)

A
  1. BPPV (seconds- minutes)
  2. Meniere’s disease (minutes- hours)
  3. Labyrinthitis (days/weeks)
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51
Q

Name the only cause of vertigo that presents with aural fullness?

(a sensation of blockage in the ear)

A

Meniere’s disease

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52
Q

Which is the only cause of vertigo that has a positional trigger?

A

BPPV

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53
Q

Which 2 causes of vertigo present with HL/Tinnitus

A
  1. Meniere’s disease

2. Labyrinthitis

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54
Q

What lifestyle advice is given for meniere’s disease?

A

Reduce salt, alcohol, caffeine and stress

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55
Q

What can be given in acute attacks of meniere’s disease?

A

Prochlorpromazine (IM or buccal)

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56
Q

What can be given for prophylaxis in Meniere’s disease?

A
  1. Beta histine

2. Vestibular rehab exercises

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57
Q

What causes BPPV

A

Detachment of one otoconia from the utricle, which becomes lodged in the semi-circular canals

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58
Q

Describe movements that can precipitate BPPV

A

Rotational movements like:

Looking up
Getting out of bed
Moving head quickly in one direction

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59
Q

Does BPPV present with HL?

A

NO

Vertigo with nausea and vomiting but no HL

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60
Q

For BPPV, name the diagnostic and therapeutic manoeuvres

A

Diagnostic: Dix- Hallpike

Therapeutic: Epley manœuvre

61
Q

How do labyrinthitis and vestibular neuronitis present?

A

Febrile illness that is usually viral
Prolonged vertigo
Associated N&V

Can occur secondary to URTI

main difference is that labrynthitis causes hearing loss, vestibular neuritis does not

62
Q

In terms of symptoms, how do labyrinths and vestibular neuronitis differ?

A

Labyrinthitis: hearing symptoms, acute onset

Vestibular neuronitis: no associated hearing symptoms, more likely to follow a URTI

63
Q

Despite being self limiting, what can be given in labyrinthitis and vestibular neuronitis to reduce symptoms?

A

Oral prochlorperazine to stop motion sickness

64
Q

The nose is supplied by the sphenopalatine, anterior ethmoidal and posterior ethmoidal arteries. Which of these arteries is supplied by the internal carotid, and which are supplied by the external carotid?

A

Sphenopalatine - external carotid

anterior and posterior ethmoidal arteries - internal carotid

65
Q

Which 3 arteries anastomose at Kiesselbach’s area?

A

Sphenopalatine (branch of the maxillary)
Anterior ethmoidal
Posterior ethmoidal

(both anterior and posterior ethmoidal arteries are branches of the ophthalmic artery)

66
Q

Where is the sensation of smell processed?

A

The temporal lobe

67
Q

Which neurodegenerative disorder can present with hyposmia?

A

Parkinson’s disease

68
Q

How do you manage epistaxis in a patient who is haemodynamically unstable?

A

Admit and cauterise - Sphenopalatine artery

69
Q

What are the 2 main causative organisms in bacterial rhinosinusitis?

A
  1. Strep Pneumoniae

2. H. Influenza

70
Q

Why should nasal decongestants be used for no longer than 7 days in a row? (2 reasons)

A
  1. They cause vasoconstriction so if used for prolonged period of time, can cause septal necrosis
  2. Can result in rebound congestion when they are stopped (rhinitis medicamentosa)
71
Q

If ABs are used in rhino-sinusitis (which is uncommon), which is used?

A

Phenoxymethylpenicillin (penicillin V)

72
Q

Do nasal polyps develop unilaterally or bilaterally?

A

Usually bilaterally

Unilateral polyps have a more sinister underlying cause

73
Q

Name the 3 components of Samter’s Triad

A
  1. Aspirin hypersensitivity
  2. Nasal polyps
  3. Asthma
74
Q

Both the general sensation and taste in the posterior 1/3 of the tongue are supplied by which nerve?

A

Glossopharyngeal (CN 9)

75
Q

Where is the facial nerve (CN 7) involved in innervation of the tongue?

A

It is responsible for taste in the anterior 2/3rd.

Via the chorda tympani (a branch of the facial nerve)

76
Q

Where is the trigeminal nerve involved in the innervation of the tongue?

A

It supplies general sensation to the anterior 2/3rds.

Via the lingual branch of CN 5

77
Q

Although tonsillitis is most commonly viral in nature, what are the 2 most common bacterial causatives?

A
  1. Strep Pyogenes (group A strep)

2. H. Infleunza

78
Q

If ABs are required in tonsillitis, what are 1st and 2nd line?

A

1st line: Penicillin V (10days)

2nd line: Clarithromycin (5days)

79
Q

What may Scarlett fever present as a complication of?

A

Tonsillitis

Scarlett fever usually presents within 3 weeks of tonsillitis

80
Q

Describe the clinical presentation of Scarlett fever

A
  1. Strawberry tongue

2. Red, rough textured rash on armpits, chest and groin - especially worse in skin folds

81
Q

How is Scarlett fever managed?

A

AB: Penicillin V

82
Q

Which ampicillin-containing antibiotic should be used to treat infectious mononucleosis?

A

NONE!

Ampicillin-containing antibiotics (amoxicillin and penicillin) will result in a widespread, generalised, macule-papular rash

83
Q

Give 4 predisposing factors to oral thrush

A
  1. Immunocompromised
  2. Chemotherapy
  3. Diabetes
  4. Inhaled steroids
84
Q

What is the most likely diagnosis in a patient with tonsillitis + grey-white pseudomembrane over the throat?

A

Diptheria

85
Q

Why may shock, neuropathy or cardiac compromise result in diphtheria?

A

Due to toxin release

86
Q

How is diphtheria managed?

A

Anti-toxin +/- antibiotic

87
Q

Describe the pathology in pharyngeal pouches

A

A diverticulum of the oesophagus through the inferior constrictor muscles of the pharynx

88
Q

Who is typically affected by pharyngeal pouches?

A

Elderly males

89
Q

What is the 1st line Ix and Mx option for pharyngeal pouches?

A

1st line Ix: Barium swallow

1st line Tx: surgical correction

90
Q

Define stridor

A

Harsh, monomorphic inspiratory wheeze due to partial occlusion of the airway

A medical emergency!

91
Q

What is the most common bacterial causative in epiglottitis?

What age group is it most commonly seen in?

A

H. Influenza

Seen in children aged 3-7

92
Q

What is the 1st line treatment for epiglottitis?

A
  1. Call the anaesthetist

2. Ceftriaxone 2g IV

93
Q

Describe larygnomalacia

A

The main congenital abnormality of the larynx

Cartilages of the larynx are soft and immature, which leads to collapse on inspiration

94
Q

How is laryngomalacia managed?

A

Most cases are self- limiting in 2 years

Some severe cases require corrective surgery

95
Q

What is the 1st line investigation for hoarseness?

A

Laryngoscopy

96
Q

Which neck lump presents with a central punctum

A

Sebaceous cyst

97
Q

Which neck lump is usually in the midline and moves up and down when sticking tongue out?

A

Thyroglossal cyst

98
Q

Where are branchial cysts usually located?

A

Below the anterior border of the sternoclemastoid muscle

99
Q

Which neck lump shows cholesterol crystals on FNA?

Are they prone to infection?

A

Branchial cysts

YES - they are prone to infection

100
Q

Which neck lump trans-illuminates brightly?

A

Cystic hygroma

101
Q

What age range are affected by cystic hygromas?

A

Children aged 1 or below

102
Q

Which salivary gland is most commonly affected by infection following blockage?

A

The parotid gland

103
Q

Where does Epstein-barr virus exclusively affect?

A

Nasopharyngeal

104
Q

Where does Human Papilloma Virus most commonly affect?

A

Oral, oropharyngeal and oesophageal

105
Q

What can unilateral nasal congestion and epistaxis be a sign of?

A

Head and neck cancer

106
Q

Sore throat and hoarseness for how long should be investigated for possible head and neck cancer?

A

> 6 weeks

107
Q

What is the most common nasal and nasal pharyngeal tumour?

A

Squamous cell carcinoma

108
Q

What is mainstay treatment in nasal tumours?

A

Radiotherapy

109
Q

What pathology underpins laryngeal cancer?

A

Squamous cell carcinoma

110
Q

Why should the anti-emetic, Prochloroperazine not be used long term?

A

It can have extra-pyramidal side effects

111
Q

For migraines, what drug class is taken in the acute phase?

A

Triptans

112
Q

For migraines, what drugs are offered for prophylaxis?

A

Propranolol or topiramate

113
Q

Which neck lump presents usually in childhood as a asymptomatic neck lump?

A

Branchial cyst

114
Q

Does a branchial cyst transilluminate or move on swallowing?

A

NO, it does neither

115
Q

Implantation of a cochlear implant involves destruction of which organ?

A

The organ of corti

116
Q

Name 3 drugs that are ototoxic

A
  1. Gentamicin
  2. Furosemide
  3. Aspirin
117
Q

Ramsay hunt syndrome involves reactivation of herpes zoster in which ganglion?

A

The geniculate ganglion of CN7

118
Q

How is Ramsay hunt syndrome’s presentation different from Bell’s palsy?

A

There is a vesicular rash around ear in Ramsay Hunt syndrome

119
Q

How is Ramsay Hunt syndrome treated?

A

Oral Acyclovir and corticosteroids

120
Q

In Ramsay Hunt syndrome, what sign presents 1st?

What symptoms follow?

A

Auricular pain

This is followed by facial nerve palsy and vertigo +/- tinnitus

121
Q

Describe the signs of Bell’s palsy?

A

Unilateral weakness of the face - face can droop to one side

Painless, loud sounds can be louder than usual

122
Q

Which CN is affected in Bell’s palsy?

A

CN 7 - Facial nerve

123
Q

which condition causes sudden and intense vertigo, is unilateral and has no hearing loss component?

A

vestibular neuronitis

Tx expectant with reassurance

prochlorperazine for symptomatic relief, in the acute phase only (it can delay recovery if used past this point)

124
Q

how long must an acute otitis media be present for in a child before antibiotics are indicated?

A

symtoms for more than 4 days with no improvements

or prescribe them immediately if systemically unwell, immunocompromised, <2 y/o with bilateral OM, or there is OM with perforation

125
Q

what is the 1st line antibiotic for AOM?

A

amoxicillin 5/7 days

erythromycin or clarithromycin if allergic

126
Q

who is the most common patient group to be affected by malignant otitis externa?
describe its presentation?

A

diabetics are most commonly affected

presents with a history of discharge and associated headache over a number of weeks, with tympanic membrane intact

127
Q

what is the causative of malignant otitis externa?

how is it treated?

A

pseudomonas aeuriginosa

Tx = ciprofloxacin

128
Q

compare the ABs used for malignant v uncomplicated otitis externa v otitis media?

A

malignant: ciprofloxacin.
uncomplicated: flucloxacillin

otitis media: amoxicillin

129
Q

what feature distinguishes vestibular neuronitis from labryrinthitis?

A

unaffected hearing in vestibular neuronitis

there is HL in labyrinthitis

130
Q

which neck lump is “brilliantly transilluminable”?

A

cystic hygroma

it is a collection of dilated lymph sacs that are fluctuant and transilluminable

131
Q

describe the typical features of a branchial cyst?

A

benign, unilateral neck mass that is lateral in location and does not move on tongue protrusion

it is situated superficial to the sternocleidomastoid muscle

132
Q

what is the classical pathological finding in branchial cysts?

A

acellular fluid with cholesterol crystals

133
Q

what is Ramsay hunt syndrome?

A

the reactivation of VZV in the 7th CN

causes ear pain, facial nerve palsy and a vesicular rash around the ear

134
Q

how is Ramsay hunt syndrome treated?

A

oral acyclovir and corticosteroids

135
Q

only after how many days of an uncomplicated acute sinusitis should antibiotics be considered?

A

after 10 days

up until this point, offer a nasal steroid

136
Q

what is the recommended initial management of otitis externa?

A

topical fusidic acid/acetic acid and dexamethasone

not a wait and see approach, as seen in otitis media

137
Q

eliciting what symptom on dix-hallpike is indicative of a positive test?

A

onset of rotatory nystagmus

onset of vertigo

138
Q

compare how vertigo is provoked in BPPV and meniere’s?

A

BPPV: vertigo provoked by a change in position

meniere’s: vertigo occurs spontaneously

139
Q

how should quinsy be managed?

A

IV antibiotics and surgical drainage

consider a tonsillectomy in 6 weeks time

140
Q

name 4 drugs known to be ototoxic?

A

gentamicin

quinine

furosemide

aspirin

also some chemo agents

141
Q

how are patients wit sudden onset SNL treated ?

A

high dose oral corticosteroids

142
Q

compare the presentation of parotid sialolithiasis and parotid pleomorphic adenoma?

A

parotid pleomorphic adenoma: slow growing, painless, mobile and well demarcated

parotid sialolithiasis: swollen gland which is painful when eating or thinking about food, shorter duration than PPA

143
Q

compare how haemorrhage following tonsillectomy is managed, depending if it is a primary or secondary haemorrhage?

A

primary haemorrhage (1st 24 hrs post tonsillectomy) = immediate return to theatre

secondary haemorrhage (5-10 days post tonsillectomy): admit and give antibiotics (usually due to wound infection)

144
Q

what is the preferred treatment for chronic symptoms in vestibular neuronitis?

A

vestibular rehabilitation

145
Q

in which nerve does the viral infection in vestibular neuronitis occur?

A

the vestibular portion of the 8th CN

146
Q

typically, how long will a perforated ear drum take to heal by itself?

A

will typically take 6-8 weeks to heal by itself

147
Q

compare the uses of prochlorperazine and betahistine in the management of meniere’s disease?

A

prochlorperazine: used in the acute stage
betahistine: used for prophylaxis

148
Q

in patients with chronic or recurrent ear discharge, what is the most important part of the tympanic membrane to visualise?
why?

A

the attic (pars flaccida)

must visualise it to exclude cholesteatoma

AA Y4 Finals cards NE (40 decks)

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