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ENT Flashcards

1
Q

AOM organisms

A

Strep pneumoniae, H. influenzae, Moraxella catarrhalis

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2
Q

AOM treatment:

A

Self limiting:

If antibiotics given: Amoxicillin 5-7 days

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3
Q

AOM indications for antibiotics:

A

Symptoms longer than 4 days not improving
Systemically unwell
immunocompromised
Younger than 2 years w/ B/L otitis media
perforation

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4
Q

Acute sinusitis organisms

A

Strep pneumoniae, H. influenzae, Rhinovirus

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5
Q

Acute sinusitis treatment:

A 
Intranasal corticosteroids (>10 days symptoms) 
If antibiotics required (not routine):

Phenoxymethylpenicillin first line/ Co-amoxiclav if systemically unwell

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6
Q

Tonsilitis organism

A

Streptococcus pyogenes

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7
Q

Allergic rhinitis management:

A

mild to moderate symptoms = oral/intranasal antihistamines

severe symptoms or initial tx. ineffective: Intranasal corticosteroids

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8
Q

Audiogram below what dB is normal

A

20 dB

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9
Q

Black hairy tongue:
Predisposing factors:
Mx:

A

Defective desquamation of the filiform papillae -> not necessarily black in colour.
Poor oral hygiene, ABs, HIV, IVDU

Tongue scraping - topical anti fungal if candida

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10
Q

Branchial cysts contents:

A

A cellular fluid with cholesterol crystals encapsulated by stratified squamous epithelium

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11
Q

Branchial cysts location:

A

Lateral lump located anterior to SCM

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12
Q

Cholesteatoma neural tube defect association:

A

Cleft palate (100 fold increase)

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13
Q

Cholesteatoma appearance on otoscopy

Mx:

A

Attic crust

ENT referral for surgical removal

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14
Q

Chronic rhinosinusitis red flag symptoms:

A

Unilateral symptoms
Persistent symptoms despite 3 months of treatment
Epistaxis

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15
Q

Chronic sinusitis tx.

A

Intranasal steroids

Nasal irrigation with saline solution

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16
Q

Contraindications to Cochlear implant:

A

lesions of CN VII or brain stem causing deafness
Chronic infective otitis media
Cochlear aplasia

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17
Q

Most common causes of hearing loss:

A

Ear wax, otitis media and otitis externa

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18
Q

Drugs causing ototoxicity:

A

Gentamicin, Aspirin, furosemide, cytotoxic agents

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19
Q

Ear wax treatment:

A

Olive oil drops
Sodium bicarbonate
almond oil

Tx. should not be given in perforation or if the patient has grommets

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20
Q

Kiesselbachs plexus: anterior or posterior

A

Anterior

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21
Q

If epistaxis persists despite 10-15 minutes of continuous pressure:

A

Cautery 1st

packing may be used if cautery not viable or bleed cannot be visualised

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22
Q

Epistaxis that has failed all emergency management:

A

Sphenopalatine artery ligation in theatre

if that fails: ligation of external carotid

if that fails Embolisation

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23
Q

Drug causes of gingival hyperplasia:

Other cause of gingival hyperplasia:

A

Phenytoin
Ciclosporin
Calcium channel blockers (Nifedipine ++)

Acute myeloid leukaemia

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24
Q

Acute necrotising ulcerative gingivitis treatment:

A

Oral metronidazole for 3 days

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25
Commonest cause of conductive hearing loss and elective surgery in childhood:
Glue ear (otitis media with effusion)
26
Otitis media with effusion (glue ear) treatment:
Grommet insertion - majority stop functioning at about 8 months. Adenoidectomy
27
Voice hoarseness important investigation:
Chest X-ray (exclude apical lung lesions)
28
What is laryngopharyngeal reflux:
Condition caused by GORD resulting in inflammatory changes to the larynx mucosa. Lump in throat (globus) with hoarseness or chronic cough
29
Laryngopharyngeal reflux treatment:
Lifestyle + PPI
30
Ludwigs angina management:
EMERGENCY Airway management IV antibiotics
31
Malignant otitis externa uncommon but most commonly found in:
DIABETICS (immunocompromised individuals)
32
Malignant otitis externa organism
Pseudomonas Aeruginosa
33
Malignant otitis externa Ix. and Tx.
CT scan Urgent referral ENT IV ABs that cover pseudomonas infections
34
Type of hearing loss in Menieres disease;
Sensorineural
35
Menieres disease tx. :
ENT referral pt. to inform DVLA Acute attacks - Buccal or IM prochlorperazine. Prevention: Betahistine and vestibular rehab
36
Nasal polyps: what prompts further investigation -
Unilateral symtoms
37
Nasal polyps treatment:
Referral to ENT for full assessment | Topical corticosteroids to shrink polyp size
38
Imaging for nasopharyngeal carcinoma
Combined CT and MRI
39
Treatment for nasopharyngeal carcinoma
Radiotherapy is first line
40
Nasopharyngeal carcinoma potential cranial nerve palsies:
CN III-VI
41
Rubbery painless lymphadenopathy, pain drinking alcohol, night sweats and splenomegaly:
Lymphoma
42
Midline mass, between isthmus of the thyroid and hyoid bone, moves upwards with protrusion of the tongue:
Thyrogloassal cyst
43
Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles. Midline lump which gurgles on palpation. Dyshpagia, regurgitation, aspiration and chronic cough:
Pharyngeal pouch
44
congenital lymphatic lesion found on the LEFT side of the neck classically. Most evident at birth:
Cystic Hygroma
45
Oval mobile cystic mass that develops between the SCM and pharynx. Usually present in early adulthood.
Branchial cyst
46
Neck lump assoc. with thoracic outlet syndrome
Cervical rib
47
Initial management of Otitis externa
topical antibiotic (acetic acid) or combined topical antibiotic and steroid (Otomize - Dex, neomycin, acetic acid)
48
Otitis externa second line options:
Consider contact dermatitis secondary to neomycin Oral antibiotics (Flucoxacillin) if spreading. Swab inside ear canal Antifungal agent
49
Otosclerosis management:
Hearing aid | Stapedectomy
50
Most common gland for salivary gland tumours
Parotid (80%) w/ 80% benign
51
Most common parotid neoplasm:
Benign pleomorphic adenoma (benign mixed tumour)
52
Second most common benign parotid neoplasm which is also the most common BILATERAL benign neoplasm. occurs in later life (6th/7th decade). Rare malignant transformation
Warthins tumour (papillary cystoadenoma lymphoma)
53
Parotid gland tumour which should be considered in the differential of a parotid mass in a child. Accounts for 90% of parotid tumours in children <1 year of age. Hypervascular on imaging
Haemangioma
54
30% of MALIGNANT parotid tumours - most common in world
Mucoepidermoid carcinoma
55
Most common parotid cancer in UK - assoc. with unpredictable growth pattern, perineurial spread
Adenoid cystic carcinoma
56
Diagnostic evaluation of parotid tumours:
FNAC most cases Sialography can delineate ductal anatomy X-ray useful to exclude calculi Superficial parotidectomy may be either diagnostic or therapeutic Where malignancy is suspected approach should be definitive resection rather than excisional biopsy
57
Sjogrens syndrome at increased risk of which neck lump
Lymphoma
58
Treatment of perforated tympanic membrane:
NO treatment needed in a majority of cases as should heal on own within 6-8 weeks. Common for ABs to prescribed in perforations following AOM Myringoplasty if the membrane fails to repair itself
59
Quinsy (peritonsilar abscess) treatment:
Urgent review from ENT. Needle aspiration or incision and drainage with IV antibiotics Tonsillectomy considered to prevent recurrence
60
Post operative pain after tonsillectomy: | Haemorrhage post tonsillectomy
May increase for 6 days. | Haemorrhage must be reviewed by ENT urgently
61
Primary haemorrhage post tonsillectomy (6-8 hours) treatment:
Immediate return to theatre
62
Secondary haemorrhage post-tonsillectomy (5-10 days) treatment:
Often assoc with wound infection: | admission and antibiotics
63
Ramsay Hunt syndrome cranial nerve affected | treatment:
CNVII | Oral Aciclovir and corticosteroids usually given
64
Rinne's test: | If bone conduction greater than air conduction
Conductive hearing problem
65
Weber's test: In unilateral SN hearing loss:
Sound is louder on the UNAFFECTED side
66
Weber's test: In unilateral conductive hearing loss:
Sound is louder on the AFFECTED side (SN adaptation?)
67
Conductive hearing loss Rinne's and Weber's:
BC > AC in affected ear | sound lateralised to the AFFECTED EAR
68
SN hearing loss Rinne's and Weber's:
AC > BC | Sound lateralises to UNAFFECTED ear
69
Most common salivary glands for stones:
Submandibular
70
Salivary gland stones px. | If infected
Recurrent unilateral pain and swelling on eating | Ludwig's Angina
71
Indications for antibiotics in sore throat:
``` Systemic upset Unilateral peritonsilitis History of rheumatic fever Increased risk from acute infection 3 or MORE CENTOR criteria ```
72
CENTOR criteria
``` Max score (4) tender cervical lymphadenopathy or lymphadenitis Absence of cough peritonsilar exudate Fever ``` Must have score greater than 3 to prescribe antibiotics
73
If antibiotics indicated in sore throat: what are you giving?
Phenoxymethylpenicillin (7 - 10 day course) or Clarithromycin (if pen. allergic)
74
Sialadenitis infective organism
Staph aureus
75
Salivary stones usual components:
Calcium phosphate or calcium carbonate
76
Complications of thyroid surgery:
Anatomical - recurrent laryngeal nerve damage Bleeding - can lead to rapid airway compromise Damage to parathyroid glands resulting in HYPOcalcaemia
77
Which conditions cause tinnitus
``` Menieres Otosclerosis SSNHL (acoustic neuroma in 80%) Presbycusis Drugs (NSAIDs, aminoglycosides, loop diuretics, quinine) Impacted ear wax ```
78
Assessment in tinitus
Audiological assessment Imaging: MRI IAM pulsatile tinnitus requires imagine as their may be an underlying vascular cause.
79
Sudden-onset sensorineural hearing loss: Referral? imaging? Treatment?
Urgent referral to ENT MRI (exclude vestibular schwannoma) High dose oral corticosteroids for all cases of SSNHL
80
Complications of tonsillitis
Otitis media Quinsy Rheumatic fever and glomerulonephritis
81
Indications for tonsillectomy:
Five or more episodes of sore throat that year Sore throats are actually caused by tonsillitis symptoms occurring for at least a year disabling symptoms obstructing normal functioning Other indications: recurrent febrile convulsions, secondary to episodes of tonsillitis obstructive sleep apnoea, stridor or dysphagia
82
Vertigo caused by recent viral infection: Hearing may be affected, N&V: Recurrent vertigo lasting hours or days, less likely to have hearing loss:
VIRAL labyrinthitis Vestibular neuronitis
83
Elderly patient, with dizziness on extension of the neck:
Vertebrobasilar ischaemia
84
Loss of CORNEAL reflex Hearing loss vertigo, tinnitus assoc w/ NF2
Acoustic neuroma
85
Vestibular neuritis treatment:
Buccal or IM prochlorperazine short course of ORAL prochlorperazine in severe cases vestibular rehabilitation in patients w/ chronic symptoms.
86
May present as a painless lymphadenopathy because of its tendency for early spread: biopsy confirming SCC in lymph nodes:
Nasopharyngeal carcinoma
87
Vasomotor sinusitis treatment:
Inhaled ipratropium
88
CSF rhinorrhoea contents:
Positive glucose | Positive B2 Tau transferrin
89
Unilateral otitis media may be the first symptom of which cancer:
Nasopharyngeal carcinoma
90
How should non-resolving otitis externa be managed:
w/ urgent referral to ENT

FLASH FINALS (34 decks)

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