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AKT > ENT > Flashcards

ENT Flashcards

1
Q

Vestibular neuronitis
Features (4)

Mx (3)

A

Vertigo recurrent attacks lasting hours or days
N&V
Horizontal nystagmus
No hearing loss or tinnitus

  1. Mx buccal/ IM prochlorperazine
  2. Antihistamine e.g cinnarizine/ cyclizine
  3. Vestibular rehabilitation if chronic
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2
Q

Recent viral infection
Sudden onset
N&V
Hearing affected =

A

Viral labyrinthitis

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3
Q

Meniere’s features (3)
Uni or bi
Sx resolve after how long?
Mx (2)
Driving
Prevention mx (2)

A

Hearing loss
Tinnitus
Fullness/ sensation/ pressure in one or both ears
Unilateral
5-10 years

  1. ENT assessment
    No driving until control of sx - DVLA to be informed
  2. IM/buccal prochlorperazine
    Prevention: betahistine + vestib rehab
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4
Q

Dizziness on extension of neck
Elderly patient
=

A

Vertebrobasilar ischaemia

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5
Q

Hearing loss
Vertigo
Tinnitus
Absent corneal reflex
=

A

Acoustic neuroma

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6
Q

Acoustic neuroma features (4)

A

Hearing loss
Tinnitus
Vertigo
Absent corneal reflex

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7
Q

Tonsillectomy criteria (4)

Complications
<24 hours
>24 hours

A

> =5 episodes per year
Sore throat secondary to tonsillitis and not URTI
Sx for at least 1 year
Disabling sx and prevent normal function

<24 hours haemorrhage secondary to inadequate haemostasis
>24 hours secondary to infection

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8
Q

Tonsilitis complications (4)

A

Otitis media
Quinsy (peritonsillar abscess)
Rheumatic fever
Glomerulonephritis

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9
Q

Otosclerosis
Age
Features (4)
Mx (2)

A

20-40yo
Conductive deafness
Tinnitus
Normal TM/ flamingo tinge
Positive FH
Mx hearing aid + stapedectomy

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10
Q

Medical name for surfer’s ear
Secondary to?
Features (3)

A

Exostosis
Secondary to repeated exposure to cold water
Repeated ear infection, reduced hearing, water plugging

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11
Q

Sudden onset sensorineural hearing loss
Mx (2)
Ix (1) to r/o which condition?

A

Urgent referral to ENT
High dose PO steroids
MR to r/o vestibular schwannoma (acoustic neuroma)

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12
Q

Sore throat
Indications for abx (5)

A

Systemic upset
Unilateral peritonsilitis
Hx of rheumatic fever
Increased risk from acute infection e.g child with DM or immunosuppressed
Centor criteria 3 or more

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13
Q

CENTOR criteria
When to treat?

A

Cough - no cough
Exudate
Nodes lymph
Temperature
3 or more

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14
Q

FeverPain criteria
FPAIN

Tonsilitis mx (1+ if pen allergic) for how long?

A

Fever
Purulence
Attend rapids (3 days or less)
Inflamed tonsils
No cough

Phenoxymethylpenicillin or clarithro if pen allergic 7-10 days

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15
Q

Rinne’s test explained

A

Tuning fork over mastoid process until no longer heard then position over external acoustic meatus

Positive test AC better than BC
Negative test BC > AC (conductive hearing loss)

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16
Q

Weber’s explained

A

Place tuning fork on the forehead
If you can hear it louder in one ear then the opposite ear has a sensorineural hearing loss

In unilateral conductive deafness sound is localised to the affected side

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17
Q

What is Ramsay Hunt syndrome caused by?

Features (5)

Mx (2)

A

Varicella zoster (herpes zoster)

Auricular pain
Facial nerve palsy
Vesicular rash around ear
Vertigo
Tinnitus

Mx PO aciclovir and steroids

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18
Q

Presbycusis type of hearing loss

A

Bilateral sensorineural hearing loss

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19
Q

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

A

Cystic hygroma

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20
Q

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

A

Thyroglossal cyst

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21
Q

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

A

Branchial cyst

22
Q

Features of nasopharyngeal carcinoma (6)

A

More common in individuals from Southern China
Cervical lymphadenopathy
Otlagia
Serous otitis media unilat
Nasal obstruction/ discharge/ bleeding
CN palsies III-VI

23
Q

Mx nasal septal haematoma (2)

A

Surgical drainage
IV abx

24
Q

What is Samter’s triad?

A

Association of asthma, aspirin sensitivity and nasal polyposis

25
Q

Mx nasal polyps (2)

A

All patients should be referred to ENT
Topical corticosteroids shrink polp size

26
Q

2ww criteria for mouth lesions (6)

A

Unexplained oral ulceration or mass persisting > 3 weeks

Unexplained red, or red and white patches that are painful, swollen or bleeding

Unexplained one-sided pain in the head and neck area > 4 weeks, assoc with ear ache & normal otoscopy

Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks

Unexplained persistent sore or painful throat

Sx in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion

27
Q

What is Ludwig’s angina?
Features (3)

A

Progressive cellulitis invading the floor of the mouth and soft tissues
Neck swelling, dysphagia, fever

28
Q

Red flags throat (3)

A

persistent, unilateral throat discomfort
dysphagia, odynophagia (i.e. with food rather than just saliva)
persistent hoarseness

29
Q

Suspected laryngeal cancer referral guidelines

A

45yo => with
1. persistent unexplained hoarseness
2. unexplained lump in the neck

30
Q

When to give abx in otitis media? (5)

A

Sx >4 days or not improving
Systemically unwell
Immunocompromised
<2yo with bilateral otitis media
Otitis media with perforation/ discharge

31
Q

Acute sinusitis - when would intranasal steroids be considered?

A

Sx >10 days

32
Q

Mx allergic rhinitis (3)

A

PO or intranasal antihistamines
intranasal steroids
PO steroids

33
Q

Mx auricular haematomas (2)

A

Same day assessment by ENT
I+D

34
Q

Black hairy tongue predisposing factors (5)

Mx (2)

A

HIV
IVDU
Poor oral hygiene
Abx
Head and neck ca

Swab for candida - give topical antifungals if needed
Tongue scraping

35
Q

Unilateral, smooth, soft, fluctuant, non tender, mass, on the left side lateral and anterior to the sternocleidomastoid muscle - slowly enlarging =

Age range
Gender

Ix
Mx

A

Branchial cyst
Late childhood or early adulthood
M>F

Ix USS
Mx ENT FNA

36
Q

Attic crust =
Other features (2)
Age range
Being born with what increases the risk of this
Mx

A

Cholesteatoma

Foul smelling, non resolving discharge
Hearing loss
10-20
Cleft palate
Mx ENT surgery

37
Q

RF for glue ear
Gender
FH
Season
Feeding
x2 other

A

Male
Siblings with glue ear
Higher incidence in winter and spring
Bottle feeding
Day care attendance
Parental smoking

38
Q

Glue ear peaks at what age?
Presenting feature
Mx (2)

A

2yo
Hearing loss
Mx grommet insertion/ adenoidectomy

39
Q

Necrotizing ulcerative gingivitis mx (4)

A

Refer to dentist
PO metro 3/7
Chlorhexidine or hydrogen peroxide mouth wash
Simple analgesia

39
Q

Name three drugs that can cause gingival hyperplasia

A

Phenytoin
Ciclosporin
CCB (nifedipine)

40
Q

Are anterior or posterior bleeds more common in the elderly?

Mx epistaxis (2)

What to do if bleeding doesn’t stop after 10-15 mins? (5)

A

Posterior

  1. Sit with torso forward, pinch soft area of nose for 20 mins, breathe through open mouth
  2. Topical antiseptic e.g naseptin (chlorhexidine and neomycin) to reduce crusting

Cautery
Blow nose
Topical local anaesthetic spray e.g co-phenylcaine
Silver nitrate
Packing

41
Q

Dental abscess mx abx of choice (1)
If severe abx of choice (1)

A

Amoxi or phenoxy
If severe/ spreading/ systemic sx then add metro

41
Q

Name three medications that can cause ototoxicity

A

Gentamicin
Furosemide
Aspirin

42
Q

Bilateral acoustic neuromas are seen in?

A

Neurofibromatosis type 2

43
Q

Who is eligible for cochlear implant? (2)
(HINT children, adults criteria)

A

Children - difficulty in developing basic auditory skills
Adults - who have trialled hearing aids for 3 months

44
Q

CI to cochlear implant (3)

A

Lesion of CNVIII or brainstem
Chronic infective otitis media or TM perforation
Cochlear aplasia

45
Q

Define chronic rhinosinusitis

Predisposing factors (5)

A

Inflammation of paranasal sinuses >12 weeks

Atopy, nasal obstruction, recent local infection, swimming, smoking

46
Q

Mx chronic rhinosinusitis (3)

A

Avoid allergen
Intranasal steroids
Nasal irrigation with saline solution

47
Q

Red flags nose symptoms (3)

A

Unilateral
Persistent sx despite compliance with 3 months treatment
Epistaxis

48
Q

Associations with nasal polyps (6)

A

asthma (particularly late-onset asthma)
aspirin sensitivity
infective sinusitis
cystic fibrosis
Kartagener’s syndrome
Churg-Strauss syndrome

AKT (52 decks)

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