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Medicine AMK knowledge > ENT > Flashcards

ENT Flashcards

1
Q

What is the key difference in clinical features between meniere’s disease and BPPV?

A

Meniere’s disease manifests itself with attacks of vertigo, tinnitus and hearing loss, whereas in BPPV vertigo and tinnitus are not present.

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2
Q

What type of hearing loss would be seen in a patient with menieres disease?

A

Unilateral sensorineural (low frequency)

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3
Q

How is meniere’s disease managed?

A

Avoid triggers
Medical prophylaxis of betahistine
Medical ablation with aminoglycosides eg gentamycin intratympanically
Labyrinthectomy as last resort

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4
Q

What is ramsay hunt syndrome?

A

the reactivation of herpes zoster in the geniculate ganglion.

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5
Q

The following symptoms are characteristic of which disease?

Vesicular rash on the ipsilateral ear
Vesicular rash on the ipsilateral hard palate and anterior two-thirds of the tongue
Hearing loss
Ipsilateral facial weakness
Post-auricular/ear pain
Difficulty chewing
Incomplete eye closure
Drooling
Tingling (cheek/mouth)
Hyperacusis (heightened sensitivity to sound)
A

Ramsay Hunt Syndrome

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6
Q

The following signs are characteristic of which disease?

Vesicular rash on the ear
Loss of nasolabial fold
Drooping of the eyebrow
Drooping of the corner of the mouth
Asymmetrical smile
A

Ramsay Hunt Syndrome

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7
Q

What is the management for Ramsay Hunt Syndrome?

A

Analgesia: simple pain relief with paracetamol and NSAIDs (in the absence of contraindications)

Corticosteroids: typically oral prednisolone, example regime would be 40mg OD for 7 days.

Anti-virals: typically oral acyclovir, example regime would be 800mg five times a day for 7 days.

Eye care: drops (i.e. lubricating drops and ointments), advice on taping the eye when sleeping and sunglasses outdoors. Any patient with incomplete eye closure (House-Brackmann ≥ IV) should be referred to ophthalmology

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8
Q

What distinguishes vestibular neuronitis from labyrinthitis?

A

Unaffected hearing in vestibular neuronitis

hearing affected in labyrinthitis

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9
Q

Which disease are the following clinical features suggestive of?

preceding upper respiratory tract infection, vertigo, nausea and vomiting. Hearing is unaffected.

A

vestibular neuronitis

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10
Q

Which disease are the following clinical features suggestive of?

Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected

A

Viral labyrinthitis

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11
Q

Which disease are the following clinical features suggestive of?

Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2

A

Acoustic neuroma

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12
Q

What are the Rinne and Weber’s test results for conductive hearing loss?

A

Rinne: Bone conduction > air conduction in affected ear
Air conduction > bone conduction in unaffected ear

Weber: Lateralises to affected ear

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13
Q

What are the Rinne and Weber’s test results for sensorineural hearing loss?

A

Rinne: Air conduction > bone conduction bilaterally

Weber: Lateralises to unaffected ear

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14
Q

How are post tonsillectomy haemorrhages managed?

A

All should be referred for assessment by ENT

6-8hrs post surgery requires return to theatre
5-10 days post surgery requires admission + Abx

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15
Q

What type of hearing loss does exostosis cause?

A

Conductive hearing loss on affected side

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16
Q

What is the most common cause of bacterial otitis media?

A

Haemophilus influenzae

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17
Q

What is the appropriate management course for auricular haematomas?

A

same-day assessment by ENT

incision and drainage has been shown to be superior to needle aspiration

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18
Q

How should mastoiditis be managed?

A

Transfer to the local paediatric unit for IV antibiotic treatment

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19
Q

What is mastoiditis a rare complication secondary to?

A

Untreated otitis media

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20
Q

Which disease are the following clinical features suggestive of?

otalgia: severe, classically behind the ear
there may be a history of recurrent otitis media
fever
the patient is typically very unwell
swelling, erythema and tenderness over the mastoid process
the external ear may protrude forwards
ear discharge may be present if the eardrum has perforated

A

Mastoiditis

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21
Q

What is the appropriate management for a perforated eardrum?

A

Watch and wait. if not healed within 6 weeks, refer to ENT.

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22
Q

Which disease is associated with the following clinical features?

conductive hearing loss that is also associated with chronic, smelly ear discharge and recurrent glue ear.

A

Cholesteatoma

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23
Q

What are first line antibiotics for otitis media?

A

Amoxicillin

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24
Q

Which antibiotic is commonly used to treat impetigo, cellulitis, osteomyelitis, otitis externa, diabetic foot infections and infected leg ulcers?

A

Flucloxacillin

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25
Q

Which medications risk causing tinnitus at high doses?

A

Aspirin and other NSAIDs eg ibuprofen, naproxen.

Other medications which can cause tinnitus include loop diuretics and aminoglycosides.

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26
Q

The following clinical features are characteristic of which disease?

pain on palpation of the tragus, itching, discharge and hearing loss

A

Otitis externa

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27
Q

What is the first line antibiotic treatment regime for tonsillitis?

A

Phenoxymethylpenicillin/ 10 days

28
Q

What type of neck lump is described by the following?:

By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness.

A

Reactive lymphadenopathy

29
Q

What type of neck lump is described by the following?:

Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly

A

Lymphoma

30
Q

What type of neck lump is described by the following?:

May be hypo-, eu- or hyperthyroid symptomatically
Moves upwards on swallowing

A

Thyroid swelling

31
Q

What type of neck lump is described by the following?:

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

A

Thyroglossal cyst

32
Q

What type of neck lump is described by the following?:

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

A

Pharyngeal pouch

33
Q

What type of neck lump is described by the following?:

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

A

Cystic hygroma

34
Q

What type of neck lump is described by the following?:

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

A

Branchial cyst

35
Q

What type of neck lump is described by the following?:

More common in adult females
Around 10% develop thoracic outlet syndrome

A

Cervical rib

36
Q

What type of neck lump is described by the following?:

Pulsatile lateral neck mass which doesn’t move on swallowing

A

Carotid aneurysm

37
Q

Which is the biggest risk factor for malignant otitis externa?

A

Diabetes melitis

38
Q

Which cause of vertigo does the following describe?:

Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affectedRecent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
A

Viral labrynthitis

39
Q

Which cause of vertigo does the following describe?:

Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss

A

Vestibular neuronitis

40
Q

Which cause of vertigo does the following describe?:

Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds

A

BPPV

41
Q

Which cause of vertigo does the fallowing describe?:

Associated with hearing loss, tinnitus and sensation of fullness or pressure in one or both ears

A

Meniere’s disease

42
Q

Which cause of vertigo does the following describe?:

Elderly patient
Dizziness on extension of neck

A

Vertebrobasilar ischaemia

43
Q

Which cause of vertigo does the following describe?:

Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2

A

Acoustic neuroma

44
Q

What is the first line treatment for otitis externa?

A

Topical antibiotics with or without steroid

Topical ciprofloxacin + dexamethasone

45
Q

What are the common causes of gingival hyperplasia?

A

phenytoin, ciclosporin, calcium channel blockers and AML

46
Q

When are intranasal corticosteroids considered in sinusitis?

A

When sx have persisted for 10 days or more

47
Q

The following are characteristics of which condition:

inflammation of the middle ear
occurs in winter following URTI
common in children 0-4yrs

A

Acute otitis media

48
Q

The following are symptoms of which condition:

Irritability, fever
Noeonates: difficulty feeding
Young child: holding/ tugging ear
Older child: otalgia, hearing loss

A

Acute otitis media

49
Q

The following findings are characteristic of which condition?

Otoscope: red/yellow/ cloudy and bulging tympanic membrane

Air-fluid level behind tympanic membrane

A

Acute otitis media

50
Q

How is acute otitis media managed?

A

Self limiting (3-7d) - analgesia, antipyretics, safety net

If sx worsen after 3-7d, give abx eg amoxicillin

51
Q

What is a severe complication of acute otitis media?

A

Mastoiditis - btreat if sx worsening after 3-7d

52
Q

The following is characteristic of which condition?

Inflammation of external auditory canal

Most commonly caused by bacterial infection - Pseudomonas aeruginosa and Staphylococcus aureus

Can occur at any age, but most common from 7-12yrs

chronic if lasts more than 3/52

Known as ‘swimmers ear’

A

Acuite otitis externa

53
Q

The following symptoms are associated with which condition?

Ear pain and itch

Inflamed external canal, scaly skin

A

Acute otitis externa

54
Q

How is acute otitis externa managed?

A

Paracetamol/ ibuprofen

Topical abx +/- topical steroid

Avoid swimming 7-10d

55
Q

Which ENT condition is caused by the reactivation of herpes zoster?

A

Ramsay hunt syndrome

56
Q

The following symptoms are characteristic of which condition?

Facial nerve palsy

Vesicular rash affecting ipsilateral ear, hard palate and anterior 2/3 of tongue

Hearing loss

Facial droop

A

Ramsay hunt syndrome

57
Q

How is ramsay hunt syndrome managed?

A

Analgesia

Oral pred 40mg od 7/7

Oral aciclovir 800mg 5xd/7d

58
Q

The following features are characteristic of what condition?

ideopathic inner ear disorder

women aged 30-60 y/o

A

Minieres disease

59
Q

The following symptoms are characteristic of which disorder?

Vertigo

Tinnitus

Hearing loss

Sometimes nausea and vomiting

Episodes last for minutes-hrs (remission in between)

A

Minieres disease

60
Q

What does an audiogram for mineres disease show?

A

Transient sensorineural unilateral low freq hearing loss

61
Q

How is mineres disease managed?

A

Betahistine

?medical ablation/ surgical labyrinthectomy

62
Q

The following symptoms are characteristic of which disorder?

Short episodes of positional vertigo lasting <1min

Specific movement triggers eg turning over in bed

Nausea and vomiting may result

A

BPPV

63
Q

What investigation is diagnostic for BPPV?

A

Dix hallpike

64
Q

What is the treatment for BPPV?

A

Epley manouvre

65
Q
A

Medicine AMK knowledge (24 decks)

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