ENT Flashcards
1
Q
Most common site of epistaxis
A
Little’s area
2
Q
Vessel most commonly causing epistaxis
A
Ethmoid artery
3
Q
Management epistaxis
A
Sit forwards and pinch nose
Manage with fluids
4
Q
Which drug has epistaxis as a common s/e
A
isotretinoin
5
Q
What is trigeminal neuralgia caused by?
A
Compression of nerve root
6
Q
Treatment of trigeminal neuralgia
A
Carbamazepine
7
Q
Sx trigeminal neuralgia
A
Stabbing pain - unilateral
Mandibular OR maxillary region
8
Q
Sx sinusitis
A
Dull pain
Worse on bending
Tender nasal skin
9
Q
Sinus commonly affected by sinusitis
A
Maxilalry
10
Q
Cause of post-herpetic neuralgia
A
Varicella zoster
11
Q
Treatment post-herpetic neuralgia
A
Analgesia
Gabapentin
12
Q
Sx post-herpetic neuralgia
A
Facial pain >3 months
Burning pain
Altered sensation in area
13
Q
Benign paroxysmal positional vertigo
A
caused by change in head position, lasts seconds - minutes and accompanied by nausea
14
Q
Dx BPPV
A
Dix-Hallpike test - rotate and extend head and observe for nystagmus
15
Q
Mx BPPV
A
Epley manœuvre
16
Q
Viral labyrinthitis sx
A
Recent URTI - sudden onset N and V, hearing loss and vertigo
17
Q
Acoustic neuroma
A
Benign tumour of Schwann cells of vestibulocochlear nerve
18
Q
Sx acoustic neuroma
A
Unilateral sensorineural hearing loss, no corneal reflex
+/- facial palsy if CN7 involved
19
Q
Vestibulocochlear neuronitis
A
Infection of vestibulocochlear nerve after URTI
20
Q
Sx vestibular neuronitis
A
Sudden onset, nausea and vomiting, no tinnitus
21
Q
Treatment vestibular neuritis
A
prochlorperazine
22
Q
Ménière’s disease
A
Excess fluid in inner ear
23
Q
Management Meniere’s disease
A
acute: prochlorperazine, chronic: betahistine
24
Q
Sx meniere’s disease
A
Vertigo, tinnitus, hearing loss, aural pressure
25
Treatment tonsillitis
Penicillin or tonsillectomy
26
Otitis externa cause
Swimming
27
Tx otitis externa
Flucloxacillin
28
Malignant otitis externa
Severe, deep otalgia and headaches
29
Cause malignant otitis externa
Pseudomonas aeruginosa
30
Otitis media
Bulging tympanic membrane
31
Sx otitis media
Otalgia, pulling ear, coryza sx
32
cyst that moves on tongue movement
thyroglossal cyst
33
Pleomorphic adenoma
benign tumour of salivary gland
34
Adenoid cystic carcinoma
Most common malignant tumour of salivary glands
35
Causes of conductive hearing loss
otitis externa, wax, foreign body, abnormalities of ossicles
36
sensorineural hearing loss causes
MMR, jaundice, meningitis, otitis media,
37
Causative organism sinusitis
strep pneumoniae
38
Which CN is affected by Ramsay-Hunt syndrome
7
39
Sx Ramsay Hunt
Auricular pain, facial nerve palsy, vesicular rash around ear
40
Tx Ramsay Hunt
Aciclovir
41
Causes of sensorineural hearing loss
presbyacusis
Noise exposure
inflammatory disease - measles/mumps etc
gentamicin
42
causes of conductive hearing loss
ear drum perforation
otosclerosis
43
What is presbyacusis
Loss of hair cells on cochlear associated with normal ageing - normally presents over 60
Higher frequencies lost first
44
carbamazepine MOA
binds to sodium channels to increase refractory period
45
Causes of referred otalgia
OA and RA
tonsillitis
teeth issues
URTI or sinusitis
46
what is sensorineural hearing loss
pathology in cranial nerves or cochlea
irreversible due to hair cell damage on organ of corti
Both bone and air reduced but air better than bone
47
what is conductive hearing loss
pathology is in outer or middle ear - abnormal ossicles, otitis etc
48
Sx otitis externa
Ear pain, itching, purulent discharge, fever
49
What is malignant otitis externa?
Spread to mastoid and temporal bones
50
Tx malignant otitis externa
ciprofloxacin
51
Causative organism of tonsillitis
strep pyogenies
52
sx tonsillitis
sore throat
tonsillar exudate
pyrexia
53
What is a quinsy?
Peritonsillar abscess
54
Sx quinsy
asymmetrical uvula
severe sore throat
55
What is vertebrobasilar ischaemia?
Elderly pt gets dizziness on extending neck due to compression of basilar artery
56
What is vestibular neuritis
Infection of vestibular nerve following URTI
57
Sx vestibular neuronitis
Sudden onset vertigo, nausea and vomiting, horizontal nystagmus
NO HEARING LOSS OR TINNITUS
58
Sx acute otitis media
ear pain resolving if TM perforates, fever, lethargy, URTI sx, red TM
Children tugging ears
59
causes of acute otitis media
Can be secondary to URTI or caused by bacteria like strep pneumoniae
60
Tx acute otitis media
Normally self-limiting but can give amoxicillin
61
what is otitis media with effusion
glue ear - chronic inflammation of middle ear
62
sx otitis media with effusion
hearing loss, ear pain, crackling/popping in ear aural fullness, with-drawn TM with no light reflex
63
Tx otitis media with effusion
None
64
What is otosclerosis?
Replacement of normal bone with spongy vascular bone
65
Sx of otosclerosis
Conductive HL - stapes fixed to oval window
Tinnitus
Flamingo TM
66
mx labyrinthitis
prochlorperazine
67
What is a cholesteatoma?
Non-cancerous growth of squamous epithelium trapped under skull
Cleft palate is risk factor
68
Sx cholesteatoma
Foul smelling discharge, HL
Vertigo and facial palsy if CN involvement
'attic crust' ear drum
69
Signs of tumour in pharyngeal pouch
bad breath, dysphagia, chronic cough
70
nasal cell obstruction + nasal discharge + epistaxis + disturbance of smell
squamous cell carcinoma
71
clear nasal discharge
allergic rhinitis
72
When is surgery preferred over medicine for tonsillitis?
If:
- sore throat caused by tonsillitis
- 5+ episodes a year
- symptoms have been around for more than a year
- symptoms are disabling
73
Which drugs can have tinnitus as a side effect?
NSAIDs, aspirin, loop diuretics
74
Cause of sudden-onset sensorineural hearing loss
vestibular schwannoma
75
What should you do with patients with sudden-onset sensorineural hearing loss?
Urgent ENT referral - MRI and corticosteroids needed
76
When should you give antibiotics if pt has sore throat?
systemic upset, tonsillitis, increased risk of infection
77
Antibiotics of choice for sore throat and duration
Phenoxymethylpenicillin or clarithromycin if allergic
7-10 days
78
What type of hearing loss is presbyacusis?
Bilateral sensorineural
79
Primary haemorrhage after tonsillectomy
6-8h post surgery
80
Secondary haemorrhage after tonsillectomy
5-10 days post surgery
81
How do you treat a perforated tympanic membrane?
Most causes will self-resolve but keep out of water
If due to otitis media, give ABx
82
What is allergic rhinitis?
Inflammatory disorder where the nose is sensitised to allergens - can be seasonal, perennial (throughout year) or occupational (through work)
83
Sx rhinitis
- Sneezing
- Nasal obstruction
- Nasal discharge
- Nasal drip
- Pruritus
84
Treatment rhinitis
- Mild-moderate: oral/intranasal antihistamines
- Moderate: intranasal corticosteroids
- Oral corticosteroids needed to cover special events
- Nasal decongestants can be used but not for extended periods of time
85
How would sensorineural deafness appear on an audiogram?
Bone and air reduced
86
How would conductive deafness appear on an audiogram?
Air conduction reduced
87
What are auricular haematomas?
Collection of blood in auricle, common in rugby players/wrestlers
88
How do you manage auricular haematoma?
Same day ENT referral, normally need some kind of draining
89
What is a branchial cyst?
Developmental defect of branchial arches
A cyst fills with fluid and cholesterol crystals
90
Sx branchial cyst
Unilateral
Smooth, non-tener
Anterior to SCM
No movement on swallowing
No transillumination
91
Treatment branchial cyst
ENT referral, needs ABs or surgery
92
What is a cholesteatoma?
Overgrowth of squamous epithelium at skull base
93
Sx cholesteatoma
Foul-smelling, plentiful discharge, hearing loss and vertigo
‘Attic crust’
94
Tx cholesteatoma
ENT referral for surgery
95
What is rhinosinusitis?
Inflammation of the nose and sinuses lasting >12 weeks
96
sx rhinosinusitis
Facial pain worse on bending forward
Nasal discharge
Nasal obstruction
Post-nasal drip
97
mx rhinosunisitis
allergen avoidance, intranasal corticosteroids
98
Inherited hearing loss
Otosclerosis - autosomal dominant
99
Drugs causing deafness
Gentamicin, furosemide and aspirin
100
VIII palsy (acoustic neuroma)
vertigo, hearing loss, tinnitus
101
V palsy (acoustic neuroma)
Absent corneal reflex
102
VII palsy (acoustic neuroma)
facial palsy
103
Sx impacted ear wax
Pain, conductive HL, tinnitus, vertigo
104
Tx impacted ear wax
Ear drops or irrigation (almond/olive oil, sodium bicarbonate)
105
Contraindication to ear irrigation
Grommets in situ
106
Differentials for face pain
Sinusitis: dull, worse on bending forward
Trigeminal neuralgia: unilateral face pain, electric shock pain, triggered by light touch/emotion
Cluster headache: pain occurs 1/2 times a day for a short duration, pain around eye
Temporal arteritis: pain around eyes/temples, raised ESR
107
What is geographic tongue?
Benign condition mostly in females, erythematous areas with a pale border
108
What to do if pt bleeds after tonsillectomy?
Urgent ENT referral
109
what is gingival hyperplasia?
overgrowth of gums so they partially/completely cover teeth
110
tx gingival hyperplasia
improve oral hygiene or refer for surgery if severe
111
what is gingivitis
mild form of gum disease that causes inflammation of gingiva
112
sx gingivitis
simple: painless, red, swollen gums that bleed on contact
acute: painful, bleeding gums, halitosis
113
treatment gingivitis
oral hygiene
metronidazole if severe
114
medicinal causes of gingival hyperplasia
Ciclosporin, phenytoin, calcium channel blockers, AML, poor dental hygiene
115
what is glue ear?
otitis media with effusion
116
sx glue ear
conductive HL
speech and language delay, problems with balance
117
treatment for glue ear
grommets
118
NICE referral for laryngeal cancer
persistent hoarseness/neck lump
119
NICE referral oral cancer
unexplained ulcer >3 weeks
persistent neck lump
red and white patches in mouth
120
NICE referral thyroid cancer
unexplained neck lump
121
ENT referral hoarseness
>45 with persistent unexplained hoarseness or neck lump
122
What is laryngopharyngeal reflux?
GORD causes inflammatory changes to the larynx
123
Symptoms of laryngopharyngeal reflux
- Sensation of a lump in the throat in the midline
- Hoarseness
- Coughing
- Dysphagia
- Examination of neck is normal
124
Treatment laryngopharyngeal reflux
Fatty foods, coffee, PPI if needed
125
What is Ludwig's angina?
Cellulitis spreads through the mouth and soft tissues of the neck and can cause airway obstruction
126
Tx Ludwig's angina
Urgent treatment needed - stabilise airway and give IV ABx
127
DVLA and Meniere's disease
Inform DVLA, stop driving until symptoms under control
128
sx nasal polyps
nasal obstruction, rhinorrhoea, sneezing, poor taste/smell
129
tx nasal polyps
unilateral sx are red flag
all should be seen by ENT
topical corticosteroids can be used
130
treatment for perforated tympanic membrane
Normally no tx, heals within 6-8 weeks but should be kept away from water during this time
131
Sensitivity to which drug is commonly associated with nasal polyps?
aspirin
132
treatment sinusitis
normally SR, intranasal corticosteroids if >10 days, phenoxymethylpenicillin if severe
133
when should you refer people with a mouth ulcer?
>3 weeks
134
brandt-daroff exercises
vestibular rehabilitation in BPPV
135
flamingo tympanic membrane
otosclerosis
136
treatment dental abscess
amoxicillin
137
management epistaxis
initial pinch nose for 15-20 mins - if this doesn't work, packing or cautery
138
which age group do you refer to ED after nose bleed?
<2
139
cluster headaches
normally concentrated around one eye, periods of pain lasting 15m-2h lasting for 4-12 weeks
140
at-risk group of malignant otitis externa
diabetics
141
mx malignant otitis externa
urgent ENT
142
sudden onset sensorineural hearing loss tx
corticosteroids
143
how long does it normally take perforated tympanic membrane to heal?
6-8 weeks - no swimming during this time
144
what is Ramsay hunt syndrome
reactivation of varicella zoster virus in CN7
145
indications for Abx for sore throat
systemic upset, PMH rheumatic fever, immunosuppressed, 3+ Centor score (tonsillar exudate, anterior lymphadenopathy, fever, no cough)
146
ABx for sore throat
phenoxymethylpenicillin
147
what is otitis externa
infection of outer ear canal caused by staph aureus - associated with swimming
148
ix otitis externa
otoscopy shows normal tympanic membrane with erythematous ear canal
149
tx otitis externa
mild = acetic acid, moderate = topical gentamicin and hydrocortisone
150
what is malignant otitis externa
Otitis media spreads to osteomyelitis of temporal bone, caused by pseudomonas aeruginosa
151
sx malignant otitis externa
deep otalgia and headaches + ear discharge
152
mx malignant otitis externa
urgent ENT referral
153
acute sinusitis vs chronic rhinosinusitis
chronic = >12 weeks
154
mx acute sinusitis
analgesia and intranasal corticosteroids if >10 days
155
sx acute sinusitis/chronic rhinosinusitis
facial pain, nasal obstruction, nasal discharge, post-nasal drip
156
what kind of tracheostomy is used in ITU?
percutaneous tracheostomy
157
risk of long-term mechanical ventilation
tracheo-oesophageal fistula
158
cause of tonsillitis
group A strep
159
thyroglossal swelling vs cyst
swelling moves upwards on swallowing, cyst moves upwards on tongue protrusion
160
pharyngeal pouch sx
bad breath, dysphagia, cough
161
branchial cyst sx
unilateral mass anterior to SCM, non-tender fluctuant and smooth
