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Finals > ENT > Flashcards

ENT Flashcards

1
Q

what is presbycusis?

A

it is age related hearing loss - SNHL with high pitched tones first - loss of hair cells, neurons, atrophy and reduced endolymphatic potential

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2
Q

what are the risk factors for presbycusis?

A

age, male, FHx, noise, DM, HTN, smoking, ototoxic medications

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3
Q

how does presbycusis present?

A

gradual, insidious, high pitched hearing loss, dementia concerns, tinnitus

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4
Q

how is presbycusis investigated and managed?

A

audiometry
optimise environment, hearing aids, cochlear implants

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5
Q

what is SSNHL?

A

it is hearing loss over less than 72 hours that is unexplained
from infection, menieres, ototoxic changes, MS, stroke, AN, migraines

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6
Q

how is SSNHL investigated and managed?

A

audiometry, MRI, CT
immediate ent referral, treat cause, idiopathic: oral or intratympanic steroids

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7
Q

how does inhaled FB present and what are red flags?

A

cough, stridor, dyspnoea
airway compromise, oesophageal perforation, button battery ingestion, mediastinal widening on CXR

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8
Q

how is inhaled FB investigated and managed?

A

tongue depressor, nasoendoscopy, radiograph, CT neck, CXR
forceps, endoscopy, follow up, carbonated drinks, glucagon, hyoscine, prokinetics

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9
Q

what are predisposing factors and presentation of OSA?

A

marfans, large tonsils, obesity, macroglossia
partner complaints, daytime sleepiness, compensated respiratory acidosis, HTN

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10
Q

how is OSA investigated and managed?

A

Epworth sleepiness scale, multiple sleep latency test, polysomnography
lose weight, CPAP, intraoral devices, inform DVLA, pharmacological?

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11
Q

what are the two types of vertigo?

A

peripheral e.g. menieres - vestibular system
central e.g. tumour - cerebellum or brainstem

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12
Q

how does vertigo present?

A

central - gradual onset, persistent, no HL or tinnitus, impaired coordination, mild nausea and vice versa for peripheral

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13
Q

how is vertigo investigated and managed?

A

ear, neuro and CV tests
CT MRI
short term - prochlorperazine, antihistamines, betahistine, epley, triptans, propanolol, topiratmate, amitriptyline, DVLA

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14
Q

what is BPPV and how does it present?

A

it is vertigo triggered by head movement - calcium carbonate crystals displaced in semicircular canal and disrupt flow of endolymph
older, movement triggers vertigo, 20-60seconds, can recur, over few weeks and resolves, no HL or tinnitus

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15
Q

how is BPPV investigated and managed?

A

Dix Hallpike
Epley manoeuvre, Brandt Daroff exercises

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16
Q

how does ET dysfunction present and what causes it?

A

reduced or altered hearing, popping, fullness, pain, discomfort, tinnitus, worse when external air pressure changes
infection e.g. URTI, allergies, smoking

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17
Q

how is ET dysfunction investigated and managed?

A

otoscopy, audiometry, tympanometry, nasopharyngoscopy, CT
conservative, valsalva, decongestant spray, antihistamines, steroid nasal spray, surgery e.g. adenoidectomy, balloon dilatation

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18
Q

what is otosclerosis and how does it present?

A

it is the remodelling of the small bones in the middle ear - conductive hearing loss and hardening (mostly stapes)
HL, tinnitus, lower pitch first

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19
Q

how is otosclerosis investigated and managed?

A

otoscopy, webers and rinnes, audiometry, tympanometry, HRCT
conservative with hearing aids, surgical - stapedectomy/otomy, and prosthetic

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20
Q

what is vestibular neuronitis?

A

it is inflammation of the vestibular nerve from recent URTI, and presents with vertigo, N&V, balance issues, no neuro sx or loss of hearing

21
Q

how is vestibular neuronitis investigated and managed?

A

head impulse test
prochlorperazine, antihistamines up to 3d, vestibular rehabilitation therapy

22
Q

what is acoustic neuroma and how does it present?

A

it is benign tumour of the schwann cells around auditory nerve - usually in cerebellopontine angle of PNS and unilateral unless NF2
40-60y, gradual onset unilateral SNHL, tinnitus, dizziness, imbalance, fullness sensation, facial nerve palsy

23
Q

how is AN investigated and managed?

A

audiometry, MRI, CT
conservative, surgery, radiotherapy

24
Q

what is menieres disease?

A

it is recurrent vertigo, HL, tinnitus and aural fullness due to excess endolymph

25
Q

how is menieres investigated and managed?

A

ENT and audiology
prochlorperazine, antihistamine, betahistine

26
Q

what is labrynthitis?

A

it is usually due to URTI, OM or meningitis - acute onset vertigo with HL, tinnitus and viral sx

27
Q

how is labyrinthitis investigated and managed?

A

clinical, head impulse to rule out central cause
supportive, prochlorperazine, antihistamines, ABx

28
Q

what is the difference between UMN and LMN facial nerve palsy?

A

forehead is spared in UMN

29
Q

causes of UMN v LMN facial nerve palsies?

A

UMN - stroke, CVA, tumour, MND
LMN - tumours, systemic, infection, trauma

30
Q

what is bells palsy?

A

it is unilateral LMN - can take up to 12 month to recover
give prednisolone to treat, and lubricating eye drops

31
Q

what is ramsay hunt syndrome?

A

it is from VZV and LMN lesions
painful and tender vesicular rash
give prednisolone, aciclovir and lubricating eye drops

32
Q

what is glossitis?

A

it is an inflamed tongue - red, sore, atrophy, swelling
causes: B12, iron, folate deficiency
mx - underlying cause

33
Q

what is angioedema?

A

it is fluid in tissues - allergies, ACEi etc

34
Q

what is strawberry tongue?

A

it is swollen, red, enlarged white prominent rash on tongue from Kawasaki or Scarlet fever

35
Q

what is black hairy tongue?

A

it is exfoliation of keratin - elongated papillae, bacteria and food accumulate
causes - dehydration, dry mouth, poor hygiene
mx - hydration, brushing, stop smoking

36
Q

what is geographic tongue?

A

inflammatory - loses epithelium and papillae, relapsing remitting and can be due to stress, psoriasis etc
give topical steroids, antihistamines for discomfort

37
Q

what is oral candidiasis?

A

it is oral thrush - white patches - from INH corticosteroids, ABx, DM etc
give miconazole, nystatin or fluconazole

38
Q

what is leukoplakia?

A

white patches on buccal mucosa, pre cancerous to SCC - raised, irregular and fixed
so biopsy and stop smoking and alcohol, monitor and remove
erythroplakia the same but red - also precancerous

39
Q

what is gingival hyperplasia?

A

it is enlarged gums from gingivitis, vit C deficiency, AML etc

40
Q

what is lichen planus?

A

autoimmune condition with chronic inflammation resulting in shiny, purplish flat lesions with wickhams striae across - reticular, erosive or plaque
mx - hygiene, stop smoking, steroids

41
Q

what is gingivitis?

A

it is inflammation of the gums - swollen, bleeding, halitosis, pain
acute necrotising - severe, rapid onset
rfs - plaque, smoking, DM, malnutrition, stress
mx - hygiene, stop smoking, hygienist, chlorhexidine mouth wash, ABx, surgery

42
Q

what are aphthous ulcers?

A

they are small, painful, well circumcised punched out white lesions from stress trauma, IBD, coeliac etc
head in 2w or lidocaine, benzydamine, choline salicylate
if severe give hydrocortisone, beta or beclomethasone and refer if >3w and unexplained

43
Q

what is a quinsy?

A

it is a peritonsillar abscess with trapped pus, usually from tonsillitis - sore throat, dysphagia, fever, neck pain, swollen tender LNs, trismus, change in voice, swelling, erythema

44
Q

how is quinsy managed?

A

ABx, I&D, aspiration, dexamethasone

45
Q

what is the most common head and neck cancer?

A

SCC of mucosa - oral or nasal cavity, sinuses, glands, larynx, pharynx

46
Q

how does H&N cancer spread?

A

usually to LNs first - enlarged

47
Q

what are RFs for H&N cancer?

A

tobacco - chewing and smoking, betel quid, alcohol, HPV 16, EBV

48
Q

what are red flags of H&N cancer?

A

lump, unexplained ulceration >3w, erythroplakia or leukoplakia, neck lump, hoarseness

49
Q

how is head and neck cancer managed?

A

radio, surgery, targeted monoclonal AB eg. cetuximab - epidermal growth factor receptor, palliation

Finals (16 decks)

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