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AMK > ENT > Flashcards

ENT Flashcards

1
Q

Most common site of epistaxis

A

Little’s area

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2
Q

Vessel most commonly causing epistaxis

A

Ethmoid artery

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3
Q

Management epistaxis

A

Sit forwards and pinch nose
Manage with fluids

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4
Q

Which drug has epistaxis as a common s/e

A

isotretinoin

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5
Q

What is trigeminal neuralgia caused by?

A

Compression of nerve root

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6
Q

Treatment of trigeminal neuralgia

A

Carbamazepine

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7
Q

Sx trigeminal neuralgia

A

Stabbing pain - unilateral
Mandibular OR maxillary region

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8
Q

Sx sinusitis

A

Dull pain
Worse on bending
Tender nasal skin

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9
Q

Sinus commonly affected by sinusitis

A

Maxilalry

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10
Q

Cause of post-herpetic neuralgia

A

Varicella zoster

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11
Q

Treatment post-herpetic neuralgia

A

Analgesia
Gabapentin

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12
Q

Sx post-herpetic neuralgia

A

Facial pain >3 months
Burning pain
Altered sensation in area

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13
Q

Benign paroxysmal positional vertigo

A

caused by change in head position, lasts seconds - minutes and accompanied by nausea

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14
Q

Dx BPPV

A

Dix-Hallpike test - rotate and extend head and observe for nystagmus

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15
Q

Mx BPPV

A

Epley manœuvre

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16
Q

Viral labyrinthitis sx

A

Recent URTI - sudden onset N and V, hearing loss and vertigo

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17
Q

Acoustic neuroma

A

Benign tumour of Schwann cells of vestibulocochlear nerve

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18
Q

Sx acoustic neuroma

A

Unilateral sensorineural hearing loss, no corneal reflex
+/- facial palsy if CN7 involved

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19
Q

Vestibulocochlear neuronitis

A

Infection of vestibulocochlear nerve after URTI

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20
Q

Sx vestibular neuronitis

A

Sudden onset, nausea and vomiting, no tinnitus

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21
Q

Treatment vestibular neuritis

A

prochlorperazine

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22
Q

Ménière’s disease

A

Excess fluid in inner ear

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23
Q

Management Meniere’s disease

A

acute: prochlorperazine, chronic: betahistine

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24
Q

Sx meniere’s disease

A

Vertigo, tinnitus, hearing loss, aural pressure

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25
Q

Treatment tonsillitis

A

Penicillin or tonsillectomy

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26
Q

Otitis externa cause

A

Swimming

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27
Q

Tx otitis externa

A

Flucloxacillin

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28
Q

Malignant otitis externa

A

Severe, deep otalgia and headaches

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29
Q

Cause malignant otitis externa

A

Pseudomonas aeruginosa

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30
Q

Otitis media

A

Bulging tympanic membrane

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31
Q

Sx otitis media

A

Otalgia, pulling ear, coryza sx

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32
Q

cyst that moves on tongue movement

A

thyroglossal cyst

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33
Q

Pleomorphic adenoma

A

benign tumour of salivary gland

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34
Q

Adenoid cystic carcinoma

A

Most common malignant tumour of salivary glands

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35
Q

Causes of conductive hearing loss

A

otitis externa, wax, foreign body, abnormalities of ossicles

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36
Q

sensorineural hearing loss causes

A

MMR, jaundice, meningitis, otitis media,

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37
Q

Causative organism sinusitis

A

strep pneumoniae

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38
Q

Which CN is affected by Ramsay-Hunt syndrome

A

7

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39
Q

Sx Ramsay Hunt

A

Auricular pain, facial nerve palsy, vesicular rash around ear

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40
Q

Tx Ramsay Hunt

A

Aciclovir

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41
Q

Causes of sensorineural hearing loss

A

presbyacusis
Noise exposure
inflammatory disease - measles/mumps etc
gentamicin

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42
Q

causes of conductive hearing loss

A

ear drum perforation
otosclerosis

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43
Q

What is presbyacusis

A

Loss of hair cells on cochlear associated with normal ageing - normally presents over 60
Higher frequencies lost first

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44
Q

carbamazepine MOA

A

binds to sodium channels to increase refractory period

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45
Q

Causes of referred otalgia

A

OA and RA
tonsillitis
teeth issues
URTI or sinusitis

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46
Q

what is sensorineural hearing loss

A

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

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47
Q

what is conductive hearing loss

A

pathology is in outer or middle ear - abnormal ossicles, otitis etc

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48
Q

Sx otitis externa

A

Ear pain, itching, purulent discharge, fever

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49
Q

What is malignant otitis externa?

A

Spread to mastoid and temporal bones

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50
Q

Tx malignant otitis externa

A

ciprofloxacin

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51
Q

Causative organism of tonsillitis

A

strep pyogenies

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52
Q

sx tonsillitis

A

sore throat
tonsillar exudate
pyrexia

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53
Q

What is a quinsy?

A

Peritonsillar abscess

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54
Q

Sx quinsy

A

asymmetrical uvula
severe sore throat

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55
Q

What is vertebrobasilar ischaemia?

A

Elderly pt gets dizziness on extending neck due to compression of basilar artery

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56
Q

What is vestibular neuritis

A

Infection of vestibular nerve following URTI

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57
Q

Sx vestibular neuronitis

A

Sudden onset vertigo, nausea and vomiting, horizontal nystagmus
NO HEARING LOSS OR TINNITUS

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58
Q

Sx acute otitis media

A

ear pain resolving if TM perforates, fever, lethargy, URTI sx, red TM
Children tugging ears

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59
Q

causes of acute otitis media

A

Can be secondary to URTI or caused by bacteria like strep pneumoniae

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60
Q

Tx acute otitis media

A

Normally self-limiting but can give amoxicillin

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61
Q

what is otitis media with effusion

A

glue ear - chronic inflammation of middle ear

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62
Q

sx otitis media with effusion

A

hearing loss, ear pain, crackling/popping in ear aural fullness, with-drawn TM with no light reflex

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63
Q

Tx otitis media with effusion

A

None

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64
Q

What is otosclerosis?

A

Replacement of normal bone with spongy vascular bone

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65
Q

Sx of otosclerosis

A

Conductive HL - stapes fixed to oval window
Tinnitus
Flamingo TM

66
Q

mx labyrinthitis

A

prochlorperazine

67
Q

What is a cholesteatoma?

A

Non-cancerous growth of squamous epithelium trapped under skull
Cleft palate is risk factor

68
Q

Sx cholesteatoma

A

Foul smelling discharge, HL
Vertigo and facial palsy if CN involvement
‘attic crust’ ear drum

69
Q

Signs of tumour in pharyngeal pouch

A

bad breath, dysphagia, chronic cough

70
Q

nasal cell obstruction + nasal discharge + epistaxis + disturbance of smell

A

squamous cell carcinoma

71
Q

clear nasal discharge

A

allergic rhinitis

72
Q

When is surgery preferred over medicine for tonsillitis?

A

If:
- sore throat caused by tonsillitis
- 5+ episodes a year
- symptoms have been around for more than a year
- symptoms are disabling

73
Q

Which drugs can have tinnitus as a side effect?

A

NSAIDs, aspirin, loop diuretics

74
Q

Cause of sudden-onset sensorineural hearing loss

A

vestibular schwannoma

75
Q

What should you do with patients with sudden-onset sensorineural hearing loss?

A

Urgent ENT referral - MRI and corticosteroids needed

76
Q

When should you give antibiotics if pt has sore throat?

A

systemic upset, tonsillitis, increased risk of infection

77
Q

Antibiotics of choice for sore throat and duration

A

Phenoxymethylpenicillin or clarithromycin if allergic
7-10 days

78
Q

What type of hearing loss is presbyacusis?

A

Bilateral sensorineural

79
Q

Primary haemorrhage after tonsillectomy

A

6-8h post surgery

80
Q

Secondary haemorrhage after tonsillectomy

A

5-10 days post surgery

81
Q

How do you treat a perforated tympanic membrane?

A

Most causes will self-resolve but keep out of water
If due to otitis media, give ABx

82
Q

What is allergic rhinitis?

A

Inflammatory disorder where the nose is sensitised to allergens - can be seasonal, perennial (throughout year) or occupational (through work)

83
Q

Sx rhinitis

A
  • Sneezing
  • Nasal obstruction
  • Nasal discharge
  • Nasal drip
  • Pruritus
84
Q

Treatment rhinitis

A
  • 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
Q

How would sensorineural deafness appear on an audiogram?

A

Bone and air reduced

86
Q

How would conductive deafness appear on an audiogram?

A

Air conduction reduced

87
Q

What are auricular haematomas?

A

Collection of blood in auricle, common in rugby players/wrestlers

88
Q

How do you manage auricular haematoma?

A

Same day ENT referral, normally need some kind of draining

89
Q

What is a branchial cyst?

A

Developmental defect of branchial arches
A cyst fills with fluid and cholesterol crystals

90
Q

Sx branchial cyst

A

Unilateral
Smooth, non-tener
Anterior to SCM
No movement on swallowing
No transillumination

91
Q

Treatment branchial cyst

A

ENT referral, needs ABs or surgery

92
Q

What is a cholesteatoma?

A

Overgrowth of squamous epithelium at skull base

93
Q

Sx cholesteatoma

A

Foul-smelling, plentiful discharge, hearing loss and vertigo

‘Attic crust’

94
Q

Tx cholesteatoma

A

ENT referral for surgery

95
Q

What is rhinosinusitis?

A

Inflammation of the nose and sinuses lasting >12 weeks

96
Q

sx rhinosinusitis

A

Facial pain worse on bending forward

Nasal discharge

Nasal obstruction

Post-nasal drip

97
Q

mx rhinosunisitis

A

allergen avoidance, intranasal corticosteroids

98
Q

Inherited hearing loss

A

Otosclerosis - autosomal dominant

99
Q

Drugs causing deafness

A

Gentamicin, furosemide and aspirin

100
Q

VIII palsy (acoustic neuroma)

A

vertigo, hearing loss, tinnitus

101
Q

V palsy (acoustic neuroma)

A

Absent corneal reflex

102
Q

VII palsy (acoustic neuroma)

A

facial palsy

103
Q

Sx impacted ear wax

A

Pain, conductive HL, tinnitus, vertigo

104
Q

Tx impacted ear wax

A

Ear drops or irrigation (almond/olive oil, sodium bicarbonate)

105
Q

Contraindication to ear irrigation

A

Grommets in situ

106
Q

Differentials for face pain

A

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
Q

What is geographic tongue?

A

Benign condition mostly in females, erythematous areas with a pale border

108
Q

What to do if pt bleeds after tonsillectomy?

A

Urgent ENT referral

109
Q

what is gingival hyperplasia?

A

overgrowth of gums so they partially/completely cover teeth

110
Q

tx gingival hyperplasia

A

improve oral hygiene or refer for surgery if severe

111
Q

what is gingivitis

A

mild form of gum disease that causes inflammation of gingiva

112
Q

sx gingivitis

A

simple: painless, red, swollen gums that bleed on contact
acute: painful, bleeding gums, halitosis

113
Q

treatment gingivitis

A

oral hygiene
metronidazole if severe

114
Q

medicinal causes of gingival hyperplasia

A

Ciclosporin, phenytoin, calcium channel blockers, AML, poor dental hygiene

115
Q

what is glue ear?

A

otitis media with effusion

116
Q

sx glue ear

A

conductive HL
speech and language delay, problems with balance

117
Q

treatment for glue ear

A

grommets

118
Q

NICE referral for laryngeal cancer

A

persistent hoarseness/neck lump

119
Q

NICE referral oral cancer

A

unexplained ulcer >3 weeks
persistent neck lump
red and white patches in mouth

120
Q

NICE referral thyroid cancer

A

unexplained neck lump

121
Q

ENT referral hoarseness

A

> 45 with persistent unexplained hoarseness or neck lump

122
Q

What is laryngopharyngeal reflux?

A

GORD causes inflammatory changes to the larynx

123
Q

Symptoms of laryngopharyngeal reflux

A
  • Sensation of a lump in the throat in the midline
  • Hoarseness
  • Coughing
  • Dysphagia
  • Examination of neck is normal
124
Q

Treatment laryngopharyngeal reflux

A

Fatty foods, coffee, PPI if needed

125
Q

What is Ludwig’s angina?

A

Cellulitis spreads through the mouth and soft tissues of the neck and can cause airway obstruction

126
Q

Tx Ludwig’s angina

A

Urgent treatment needed - stabilise airway and give IV ABx

127
Q

DVLA and Meniere’s disease

A

Inform DVLA, stop driving until symptoms under control

128
Q

sx nasal polyps

A

nasal obstruction, rhinorrhoea, sneezing, poor taste/smell

129
Q

tx nasal polyps

A

unilateral sx are red flag
all should be seen by ENT
topical corticosteroids can be used

130
Q

treatment for perforated tympanic membrane

A

Normally no tx, heals within 6-8 weeks but should be kept away from water during this time

131
Q

Sensitivity to which drug is commonly associated with nasal polyps?

A

aspirin

132
Q

treatment sinusitis

A

normally SR, intranasal corticosteroids if >10 days, phenoxymethylpenicillin if severe

133
Q

when should you refer people with a mouth ulcer?

A

> 3 weeks

134
Q

brandt-daroff exercises

A

vestibular rehabilitation in BPPV

135
Q

flamingo tympanic membrane

A

otosclerosis

136
Q

treatment dental abscess

A

amoxicillin

137
Q

management epistaxis

A

initial pinch nose for 15-20 mins - if this doesn’t work, packing or cautery

138
Q

which age group do you refer to ED after nose bleed?

A

<2

139
Q

cluster headaches

A

normally concentrated around one eye, periods of pain lasting 15m-2h lasting for 4-12 weeks

140
Q

at-risk group of malignant otitis externa

A

diabetics

141
Q

mx malignant otitis externa

A

urgent ENT

142
Q

sudden onset sensorineural hearing loss tx

A

corticosteroids

143
Q

how long does it normally take perforated tympanic membrane to heal?

A

6-8 weeks - no swimming during this time

144
Q

what is Ramsay hunt syndrome

A

reactivation of varicella zoster virus in CN7

145
Q

indications for Abx for sore throat

A

systemic upset, PMH rheumatic fever, immunosuppressed, 3+ Centor score (tonsillar exudate, anterior lymphadenopathy, fever, no cough)

146
Q

ABx for sore throat

A

phenoxymethylpenicillin

147
Q

what is otitis externa

A

infection of outer ear canal caused by staph aureus - associated with swimming

148
Q

ix otitis externa

A

otoscopy shows normal tympanic membrane with erythematous ear canal

149
Q

tx otitis externa

A

mild = acetic acid, moderate = topical gentamicin and hydrocortisone

150
Q

what is malignant otitis externa

A

Otitis media spreads to osteomyelitis of temporal bone, caused by pseudomonas aeruginosa

151
Q

sx malignant otitis externa

A

deep otalgia and headaches + ear discharge

152
Q

mx malignant otitis externa

A

urgent ENT referral

153
Q

acute sinusitis vs chronic rhinosinusitis

A

chronic = >12 weeks

154
Q

mx acute sinusitis

A

analgesia and intranasal corticosteroids if >10 days

155
Q

sx acute sinusitis/chronic rhinosinusitis

A

facial pain, nasal obstruction, nasal discharge, post-nasal drip

156
Q

what kind of tracheostomy is used in ITU?

A

percutaneous tracheostomy

157
Q

risk of long-term mechanical ventilation

A

tracheo-oesophageal fistula

158
Q

cause of tonsillitis

A

group A strep

159
Q

thyroglossal swelling vs cyst

A

swelling moves upwards on swallowing, cyst moves upwards on tongue protrusion

160
Q

pharyngeal pouch sx

A

bad breath, dysphagia, cough

161
Q

branchial cyst sx

A

unilateral mass anterior to SCM, non-tender fluctuant and smooth

AMK (33 decks)

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