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Finals > ENT > Flashcards

ENT Flashcards

1
Q

Conductive hearing loss test

A

Rinne - if bone louder than air

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2
Q

Acute otitis media signs

A 
Otalgia
malaise
Bulging tympanic membrane
Eustachian tube migration of URTI
RSV, bacteria include s.pneumoniae
Self resolves - abx if severe
Consider grommets in children
comp. perforated ear drum and discharge
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3
Q

Otitis media with effusion

A 
Hearing loss
almsot exclusively in children
Glue ear
non-infective
50% cleared in 3 months
if not, hearing aids/grommets
NO abx
Otoscopy - dull tympanic membrane, light reflex reflected upwards or absent light reflex
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4
Q

Chronic Otitis Media

A

Aural toilet - washing out the ear canal
Topical antibiotics/steroids - allow the perforation to heal

If the perforation is not healing/is too large to heal, can surgically repair it. This is called myringoplasty and involves taking cartilage from the tragus and using that to fill the space

comp. mastoiditis and hearing loss, facial nerve palsy

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5
Q

Cholesteatoma

A

destructive, hyperproliferating growth of keratinazing squamous epithelial cells

Otorrhoea - chronic, brown in colour without otalgia or fever

Conductive hearing loss - if damages the ossicles

Senosorineural hearing loss

Dizziness - damage to the semicircular canals

Facial nerve palsy - invasion of cranial nerve VII
CT and surgical removal

‘pearly white/grey appearance’ on otoscopy with painless, brown discharge

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6
Q

Otitis Externa

A

otalgia, otorrhoea with a swollen, erythematous ear
pseudomonas aeruginosa

Topical antibiotics (prolonged and IV if necrotising) and steroid

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7
Q

Vertigo - BPPV
Test?
Treatment?

A

Dix-Hallpike for test

Epley manouevre for clearance

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8
Q

Vertigo - Meniere’s Disease
Triad?
Length of vertigo?
Treatment?

A

Triad - vertigo, tinnitus and sensorineural hearing loss
Episodes last minutes to hours
Usually self resolves, may require steroid/ abx injections

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9
Q

Vertigo - vestibular neuronitis
Why
Length
Treatnebt

A

Often URTI
Lasts days
elf resovles usually

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10
Q

Referred ear pain - nerves

A

CN V
Disease of the teeth
TMJ disease (temporomandibular joint) eg. excessive grinding of the teeth
Parotid gland disease

CN VII
Herpez zoster infection
Bell’s Palsy

CN IX
Disease of the throat such as tonsillitis, pharyngitis
Oropharyngeal malignancy such as cancer of the tongue
Cervical nerves
Cervical arthritis

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11
Q

Rhinosinusitis

A

Rhinorrhoea (runny nose)
Nasal congestion
Reduced sense of smell
Facial pain/headache

Infection - This is most likely viral and common organisms include rhinovirus, RSV, parainfluenza virus. Can also be bacterial; s. pneumoniae and H. influenza

Allergy - This is an IgE mediated Type 1 hypersensitivity reaction. This is one of the symptoms of ‘hayfever’ and is more common in those with asthma and eczema

Other triggers - This can be cigarette smoke, environmental changes (such as cold or dry air), pollution, exercise

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12
Q

Tonsillitis definition

A

Infection of the palatine tonsils
pain, fever, dysphagia and cough

a frequency of more than 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms), referral to an ear, nose, and throat specialist is advised as this cohort may benefit from tonsillectomy.

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13
Q

FeverPAIN

Centor

A
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14
Q

Quinsy

A

Comp of bacterial tonsillitis
deviating the uvula away
Trismus (difficulty fully opening the jaw), unilateral symptoms and a ‘hot potato’ voice

Admission, IV abx, drainage

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15
Q

ENT cancers
RF
Inv

A

fine needle aspiration

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16
Q

Epistaxis

A

Anterior or posterior plexus - 90% anterior (Little’s area)

Greater palantine artery in older

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17
Q

Epistaxis emergency management

A 
A-E
Pinch cartilage, 20 mins
Cauterise with silver nitrate
Pack nose anterior (rapid rhino) or posterior (foley catheter) depending on where bleed is - tamponades
may require surgical ligation
18
Q

Emergency airway obstruction - causes

A

Cancers
Oropharyngeal
Laryngeal
Base of tongue

Infections
Epiglottitis
Deep neck space infections

Foreign body
Mostly seen in children

19
Q

Emergency airway obstruction - red flags

A

Stridor/Stertor

Cyanosis

Agitation

Respiratory distress

Wheeze

Decreased breath sounds on auscultation

20
Q

Emergency airway obstruction - management

A

Call for help
Nebulised adrenaline/salbutamol
Intubation
tracheostomy

21
Q

Emergency- epiglottitis

A

supraglottic tissue infection

Haemophilus Influenza type B infection usually

22
Q

Emergency - epiglottitis

Key symptoms

Management

A

3 D’s are the key symptoms:
Drooling
Distressed
Dysphagia

IV abx

Laryngoscopy - lateral neck radiograph

O2, Steroids - dex, 0.08-0.3 mg/kg/day

23
Q

Conductive hearing loss test

A

Rinne - if bone louder than air

24
Q

Vertebrobasilar ischaemia

A

Elderly patient

Dizziness on extension of neck

25
Q

Acoustic neuroma

A

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

26
Q

Viral labyrinthitis

A

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

27
Q

Reactive lymphadenopathy

A

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

28
Q

Lymphoma characteristics

A

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

29
Q

Thyroid swelling

A

May be hypo-, eu- or hyperthyroid symptomatically

Moves upwards on swallowing

30
Q

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

31
Q

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

32
Q

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

33
Q

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

34
Q

Cervical rib

A

More common in adult females

Around 10% develop thoracic outlet syndrome

35
Q

Carotid aneurysm

A

Pulsatile lateral neck mass which doesn’t move on swallowing

36
Q

Ramsay Hunt syndrome

A

(herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

Features
auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

Management
oral aciclovir and corticosteroids are usually given

37
Q

Alport’s syndrome

A

Hearing loss, famiyl history, progressive decline in renal function

38
Q

Furosemide toxicity

A

Ototoxicity, SNHL

39
Q

Otosclerosis

A

Slow conductive hearing loss, tinitus, family history

40
Q

Vertebrobasilar ischaemia

A

Elderly patient

Dizziness on extension of neck

41
Q

Acoustic neuroma

A

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

42
Q

Alternative exercises for BPPH

A

Brandt-Daroff

Finals (18 decks)

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