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Exams :) > ENT > Flashcards

ENT Flashcards

1
Q

Acute rhinosinusitis: symptomatic management (5)

A

Regular oral analgesia
Saline nasal preparations (drops, rinses, sprays)
Intranasal corticosteroids (e.g Nasonex/mometasone 100mcg = 2 sprays daily for 4/52)
Intranasal decongestants (use up to max 3 days –> rhinitis medicamentosa)
Intranasal ipratropium (for rhinorrhoea)

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2
Q

Acute bacterial rhinosinusitis criteria (5)
and Management (1)
if penicillin allergic (2)
If not improving after 5 days (1)

A

Criteria:

1) Discoloured, purulent discharge
2) Fever >38.0
3) Severe unilateral/localised pain
4) Elevated CRP/ESR
5) Double sickening

Rx
-Amoxicillin 500mg TDS 5/7, or 1g BD 5/7

Pen allergic
-Cefuroxime 500mg BD 5/7
Severe allergy - Doxycycline 100mg BD 5/7

Not improving
-Augmentin DF BD 5/7

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3
Q

Otitis externa pharmacological management - if fungal not and if fungal suspected

A

Dexamethasone/Framycetin/Gramicidin ear drops 3 drops TDS for 7/7 - fungal infection NOT suspected, OR if GROMMET or PERF in situ

If fungal - flumethasone/clioquinol drops 3 drops BD for 7/7

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4
Q

Otitis externa non pharm management (4)

A

Keep ear dry
Aural toilet w/ tissue spears 6 hourly
Avoid syringing w/ water
Keep dry 2 weeks after treatment (ear plugs, shoewr cap when bathing/swimming)

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5
Q

Bell’s Palsy treatment (1), if Ramsay Hunt present (1)

A

high dose prednisolone 1mg/kg (up to 75mg) daily for 5 days

+ antiviral if Ramsay Hunt (Valaciclocvir 500mg TDS for 5/7)

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6
Q

Acute Rheumatic Fever - ?what is it

?High risk groups

A

Abnormal immune response to Strep A infection (of throat/skin)

high risk:

  • ATSI rural/remote area
  • ATSI/Maori/Pacific Islander in overcrowded/low SES place
  • PHx of ARF or rheumatic heart disease, or recent FHx
  • Living in ARF endemic setting
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7
Q

Conductive hearing loss DDx (7)

A

-Otitis media
-Ear wax impaction
-Otitis externa
-Cholesteatoma
-Otosclerosis
-Foreign object
-TM perforation

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8
Q

Sensorineural hearing loss DDx (7)

A

-SSNHL
-Presbyacusis (bilat)
-Meniere’s Disease
-Acoustic neuroma (can be bilat)
-Labyrinthitis
-Noise damage/ototoxicity (bilat)
-Head trauma

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8
Q

Sensorineural hearing loss DDx (7)

A

-SSNHL
-Presbyacusis (bilat)
-Meniere’s Disease
-Acoustic neuroma (can be bilat)
-Labyrinthitis
-Noise damage/ototoxicity (bilat)
-Head trauma

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9
Q

Tinnitus Ix (2)

A

Pure tone audiometry (FOR ALL PTS)
CT if ?unilateral ?pulsatile (CT Angio or temporal bone)

Otosclerosis = progressive hearing loss + tinnitus

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10
Q

Tinnitus Mx options (4)

A

○ Reassurance
○ Hearing aids (if SNHL is bothersome)
○ Sound therapy (reduce perception of tinnitus)
- CBT

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10
Q

Vertigo general Mx measures (4)
BPPV Rx (3)

A

General measures
○ Anti-emetics e.g betahistine
○ Salt restriction
○ Avoid eTOH and coffee
○ Vestibular physio

BPPV
-Epley manoeuvre/Semont manoeuvre/Brandt-Daroff exercises
-Drugs (only use for 48hrs max)
–Prochlorperazine (stemetil) 5-10mg QID PRN
–Promethazine (phenergan) 25-50mg TDS PRN

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11
Q

Diagnosis?

Vertigo + hearing loss + tinnitus
Preceding URTI
Vertigo lasts seconds - minutes
Symptoms present days - weeks

A

Acute labyrinthitis

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12
Q

Diagnosis?

Preceding viral infection
Acute onset vertigo
NO hearing loss
Horizontal/torsional nystagmus
Severe symptoms, 2-3 days
Can use high dose pred to treat (1mg/kg up to 75mg)

A

Vestibular neuritis

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13
Q

Vertigo lasting >20 mins, hours
Tinnitus + hearing loss
+Rombergs, Fukuda stepping test, impaired heel-toe walking
Investigate for SNHL - audiometry
Rx - hydrochlorothiazide 25mg daily - reduce endolymphatic pressure with lowered salt/water content?

A

Meniere’s disease

no cure - progressive hearing loss expected. other Rx options - hearing aids, reduce salt <2g/day, intratympanic injections, positive pressure therapy, surgery

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14
Q

Facial pain DDx (8)

A

Migraine
Trigeminal neuralgia
Cluster/tension headache
TMJ Dysfunction
Sinus disease
Paroxysmal hemicrania
Dental source/infection
Salivary gland lesions

trigeminal autonomic cephalgias = unilateral, side-locked, a/w autonomic features (ptosis, tearing, rhinorrhoea, aural fullness, tinnitus, photophobia)
-Rx w/ indometacin
-DIFFERENT from trigeminal neuralgia - no autonomic features

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15
Q

Chronic rhinosinusitis Rx

A

Oral/intranasal antihistamine
+intranasal steroid BD
for 8 weeks

Short course steroids 25mg daily 5-10 days or tapering longer dose if polyps

Refer ENT if 6-8 week trial fails

Nasal polyps in kids = ?CF

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16
Q
  • Contraindications to ear syringing (4)
A

○ Otitis externa/media (current)
○ Tympanic membrane perforation (–> Rx w/ ciprofloxacin topical drops)
○ History of ear surgery
○ Unilateral deafness/only good ear

17
Q

Trigeminal Neuralgia management, 1st/2nd/3rd line options

Ix to consider? (1)

A

§ eTG says - 1st line - carbamazepine MR 100mg BD, assess response after 7/7
§ 2nd line - oxcarbazepine 300mg BD, assess post-7/7
§ 3rd line - baclofen 5mg DD/gabapentin 300mg nocte/pregab 75mg nocte/phenytoin 300mg daily/lamotrigine 25mg alternate daily

		MRI (?brain ?trigeminal nerve) - exclude secondary causes such as MS or tumour
18
Q

TMJ Dysfunction Clin features (5)

Diagnosis?

A

○ Mandibular pain, radiating to scalp or neck
○ Aggravated by chewing, yawning, long talking
○ Difficulty mouth opening, clicking/crepitus
○ Tension-like headache
○ Otalgia (+ tinnitus, aural fullness, vertigo)

usually clinical, MRI actually gold standard

19
Q

TMJ Dysfunction Management (6)

A

○ Patient education/reassurance
- Jaw rest/soft diet
- Warm compress/massage
- Jaw muscle stretching/massage w/ physio
- Intraoral occlusal splint overnight (?mouthgard)
○ CBT, sleep hygiene
○ NSAIDs 1st-line/Benzos for masticatory muscle spasm

20
Q

Undisplaced vs. displaced nasal fracture management

A
  • Undisplaced nasal fractures w/o functional symptoms - conservative Rx
    • Displaced fractures - refer ENT for reduction within two weeks (2 week window before displaced nasal bones begin uniting)
21
Q

Epistaxis management (3)

A

-Pressure to hold nose closed w/ thumb and forefinger (10-20 mins)
-Lean forwards
-Nasal packing (e.g RapidRhino) - leave in for 3-5 days

?No Abx prophylaxis

22
Q

Septal haematoma/abscess clin. features
-management

A

Bilateral septal swelling, boggy to palpate

Urgent referral to ED, drainage, IV Abx

23
Q

Facial fracture examination features (5)

A

-Palpate over mandible/zygoma/maxilla
-Assess mouth occlusion
-Intra-oral & nasal examination
-Visual acuity, range of eye movements
-Mid-face/forehead sensation

24
Q

Neck mass red flags (5)

Neck mass Ix (2)

A

○ Mass present >2 weeks
○ Recent voice change
○ Dysphagia/odynophagia
○ Ipsilateral otalgia/nasal obstruction/epistaxis
- Unexplained LOW/LOA

CT of neck w/ contrast + FNA

25
Q

Oral SCC clin. features

A
  • Non-healing ulcer
    -indurated/firm
    -irregular margins
    -raised, rolled edges
    -May not be painful
26
Q

Oral candidiasis risk factors (8)

A

-Poor hygiene/dry mouth (xerostomia)
-Dentures
-Immunodeficiency
-Diabetes
-Abx use
-Steroids (inhaled)
-Chemo/RadioTx
-Smoking

27
Q

?Diagnosis

Interlacing white lines (Wickham striae) on oral buccal mucosa
Can be asymptomatic or ulcerate
Most don’t need Rx, or topical steroids/retinoids/oral hygiene

A

Oral lichen planus

28
Q

Leukoplakia vs. Erythroplakia - definitions & management

A

Leukoplakia = “white plaques of questionable risk”
-NEEDS BIOPSY

Erythroplakia = ‘red’ discolouration, 90% rate of SCC/high-grade dysplasia –> URGENT REFER FOR BIOPSY

29
Q

Submucosal/jaw swelling DDx (7)

1st line Ix?

A

Mucocele
Fibroepithelial polyp
Pyogenic granuloma - raised, red, bleeds easily
Palatal abscess/cyst
Salivary gland tumours

Exsostes/tori (hard bony swellings)
Jaw cyst - periapical cysts most common

OPG to Ix

30
Q

Central cause vertigo DDx (4)

A

Cerebellar infarction/haemorrhage
Vertebrobasilra insufficiency
Vestibular migraine
Multiple sclerosis

31
Q

Ix of choice for r/o acoustic neuroma or demyelinating disease

A

Gadolinium-enhanced MRI Brain

32
Q

Allergic rhinitis - testing options

Management features (3)
-?For persistent nasal obstruction
-?For marked rhinorrhoea
-?For coexisting asthma

A

Total/specific IgE
§ Total = screening test
§ RAST = allergen-specific - directly measures quantity of specific IgE to particular antigen
§ MBS only 4 tests at once - so e.g dust mite mix, Alternaria mould, grass pollen mix, animal dander mix (pts can continue antihistamines prior to these tests)
○ Skin testing against specific antigen

Minimise exposure to allergen
-Oral/intranasal antihistamine
-+intranasal steroid

-Persistent nasal obstruction - intranasal antihist/steroid combo
-Rhinorrhoea - intranasal ipratropium
-Asthma - montelukast

33
Q

Diagnosis?

Gentle pressure of tragus - induces vertigo/nystagmus

A

Perilymphatic fistula

Rare cause of vertigo. Abnormal connection between inner and middle ear, from head or barotrauma

34
Q

Otitis media - high risk episode (2)

A

<2 years old + bilateral Acute Otitis Media
<2 years old + fever >38.5

35
Q

Otitis Media ATSI children guidelines - high risk factors (8)

A

-Living in remote community
-<2 y.o
-1st episode OM <6 months of age
-Persistent OME/current bilateral AOMwoP, recurrent AOMwoP, current AOMwiP/recurrent, current CSOM, Phx or FHx of CSOM
-Craniofacial abnormalities/cleft palate
-Down syndrome/developmental delay
-Immunodeficiency
-Hearing loss/visual impairment

36
Q

Acute Otitis Media dx criteria
-Treatment

A

Fluid behind TM + at least one of
-Bulging TM
-Injected TM
-Fever
-Recent purulent discharge
-Ear pain
-Irritability

If not high risk episode - monitor - review 4-7 days
If high risk - amoxicillin 50mg/kg daily in divided doses for 7 days
-If no improvement - increase dose to 90mg/kg
-If no improvement + penicillin resistant region - change to Aug DF
-If adherence poor/no fridge - stat dose azithro 30mg/kg + repeat dose 1/52 after

37
Q

Recurrent Acute Otitis Media - is prophylaxis recommended?

A

Routine prophylaxis NOT recommended

Recurrent = >3 eps in 6/12, >4 in last 12/12

If so - amoxi 50mg/kg daily for 3-6 months

38
Q

Acute Otitis Media w/ Perforation Rx

A

Amoxicillin 50-90mg/kg daily for 14 days or stat dose azithro 30mg/kg

If no improvement - max dose amoxi or 2nd dose azithro

39
Q

Oral burning/Burning Mouth Syndrome DDx (8)
?Rx

A

-Medication related (ACEi, Abx)
-Trauma (physical/chemical/thermal/RTx)
-Autoimmune - Sjogrens, oral lichen planus
-Cancer
-Idiopathic
-Infective e.g candidiasis
-Nutritional deficiency
-Diabetes

Rx - topical clonazepam, B12/zinc supp.

40
Q

Salivary gland swelling DDx (7 broad categories)

A

Neoplastic - lymphoma, adenocarcinoma etc.
Infection - viral (mumps, EBV), staph parotitis
Metabolic - Alcoholic liver disease, malnutrition/bulimia, obesity
Endocrine - Diabetes, hypothyroidism, Cushing’s
Meds - Anticholinergics, antipsychotics
Obstructive - stones, ranula
Autoimmune - Sjogrens

41
Q

Salivary gland swelling Ix (2)

A

Suspected inflammatory process –> USS
Suspected solid mass or neoplasm –> MRI/CT

42
Q

Oral Manifestations of Crohn’s disease (7)

A

-Lip swelling
-Deep linear ulcerations/apthous ulcers
-Cobblestoning of mucosa
-Mucosal tags
-Mucogingivitis
-Angular chelitis
-Pyostomatitis (oral pustules)

Exams :) (20 decks)

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