ENT Flashcards
Which cranial nerve supplies the intrinsic muscles of the tongue?
Hypoglossal
Which facial bone contributes significantly to both lateral walls of the nasal cavity and the nasal septum?
Ethmoid
Which muscle connects the tongue to the temporal bone?
Styloglossus
Attachment points for the temporalis muscle?
Lateral surface of the skull and coronoid process
Which nerve supplies both taste and somatic sensation to a part of the tongue?
Glossopharyngeal
Management of sudden SN hearing loss with no trigger?
High dose prednisolone PO
If this fails: intra-tympanic dexamethasone
Gradual and symmetrical bilateral hearing loss in older patient?
Presbycusis
Unilateral hearing loss better with background noise and quiet voice?
Otosclerosis
Singular nasal polyp in asthma patient?
Sign of NP cancer
Urgent ENT referral
Down syndrome, recurrent ear infection and air-bone conduction gap on audiogram?
Bilateral conductive hearing loss
Likely caused by glue ear
Management of bacterial otitis externa
Ciprofloxacin ear drops
If cipro resistant, sofradex ear drops
How to differentiate between stroke and TIA?
Stroke does not resolve
First line management of unilateral nosebleed of 30 mins?
Nasal cautery
Define tympanosclerosis
Calcium phosphate plaques forming in the lamina propria of the tympanic membrane after increased fibroblast activity depositing collagen
Investigation of suspected nasophar cancer?
Flexible nasal endoscopy
Ear discharge with halo sign on filter paper?
Basal skull fracture (CSF leak causing halo)
Unilateral conductive hearing loss would cause what signs on Rinne’s?
Negative Rinne’s test on the ipsilateral side
Most common parotid gland malignancy
Mucoepidermoid carcinoma
Management of suspected paranasal sinus cancer
2 week ref to ENT
Paget’s is assoc with what ENT condition
Conductive hearing loss
History of atopy, 5 cigs per day, pressure behind face - no systemic symtpoms?
Chronic sinusitis
- saline nasal irrigation
- steroid nasal sprays or drops (e.g., mometasone or fluticasone)
- functional endoscopic sinus surgery (FESS)
First line for tonsillitis with penicillin allergy
Clarithromycin
Diagnostic investigation of cholesteatoma
CT head
- plans for surgical removal of cholesteatoma
Labrynthitis vs vestibular neuritis?
Lab = hearing loss
VN = no hearing loss
What 4 extra-ENT tests should you run in tinnitus?
FBC for anaemia
Glucose for DM
TSH for thyroid disorder
Lipids or hyperlipidaemia
Dix-Hallpike vs Epley in BPPV?
Dix-Hallpike is diagnostic (Dix=Dx)
Epley is for management
What causes a black and hairy tongue?
Decreased exfoliation of keratin from tongue surface
- dehydration, dry mouth, poor oral hygeine, smoking
Pathophysiology of Ménière’s disease
Excessive buildup of endolymph in labyrinth of inner ear
Short term management for vestibular neuritis
Prochlorperazine
Antihistamine
(can be used up to 3 days)
Management to reduce frequency of Ménière’s attacks
Betahistine
Most common bacterial cause of OME
Group A strep (strep pyogenes)
Most common bacterial causes of otitis externa
Pseudomonas aeruginosa
Staph aureus
Painless, pulsatile neck lump in anterior triangle with bruit and only side-to-side mobility?
Paraganglioma
- imaging shows splaying of internal/external carotids
- manage with surgical removal
Presentation of eustachian tube dysfunction?
Reduced/altered hearing, popping, pain, tinnitus, fullness
- symptoms worsen with pressure changes
Management of acute otitis externa
Neomycin, dexamethasone, acetic acid spray
Management of acute necrotising ulcerative gingivitis
Metronidazole
Review by dentist
Differentiating between a facial palsy and stroke?
Upper motor neurone = foreheaad can move, STROKE
Lower motor neurone = forehead can’t move on one side, prob not stroke
Management of vestibular schwannoma
Benign but can develop
Small/medium tumours = repeat scan in 6 months
Larger than 40mm/fast growing = surgical resection
First line management of TMJD
Explanation and reassurance (due to stress)
- may refer to CBT or physio
- potentially dental occulsion therapy or surgery
When is CT indicated in mastoiditis?
If no improvement with admission ad IV antibiotics
- to assess invasion into neuro structures
When to reverse anticoagulation in patients with AF and epistaxis?
Minor bleeding, INR above target range - stop warfarin, give vit K (+PT complex if major haemorrhage)
Which parotid gland cancer can invade and cause facial nerve palsy?
Adenoid cystic carcinoma
Incision drainage or needle aspiration for quinsy?
Aspiration
- decreases likelihood of injury to carotid
What would indicate immediate hospital admission in a child with tonsillitis?
Signs of dehydration
- dry tongue, no eating or drinking for prolonged tme
Airway compromise
Systemically unwell
Management of pinna haematoma
Antibiotics + Incision with primary closure
- then compression banding
Management of pinna haematoma
Antibiotics + Incision with primary closure
- then compression banding
Which tumour of parotid gland is well-circumscribed, usually bitlateral (can happen at diff times) and assoc with smoking?
Warthin’s tumour
Loop diuretic (rarely) causing SN hearing loss
Furosemide
Progressive hearing loss with intermittent attacks that sound like Ménière’s?
Vestibular schwannoma
Reinke’s oedema presenting with voice hoarseness is linked to which disorder
Hypothyroidism
When to prescribe antibios in acute rhinosinusitis?
10 days of persistent symptoms or presence f worrying symptoms
Visual symptom assoc with vestibular schwannoma
Loss of corneal reflex
After how long a course of amoxicillin is grommet insertion indicated in glue ear?
2-6 weeks
How can throat cancer cause otalgia?
Referred pain via V3 of trigeminal nerve
Non-tender and rubbery lymph nodes suggests?
Hodgkin’s lymphoma
When should vestibular schwannomas be operated on?
> 40mm
Sensorineural deafness found at 2 years is most likely caused by?
Congenital cytomegalovirus
14y/o boy with hearing loss, tinnitus and dizziness with no aural fullness could suggest
Otosclerosis
Tenderness over hyoid bone assoc with stridor…
Supraglottitis
- manage with nebulised adrenaline and IV dexamethasone
When should you do nasal packing?
If cautery fails
If bleeding is not visible
Management of vestibular neuronitis
Oral prochlorperazine
Which type of NF is assoc with bilateral vestibular schwannoma?
NF2
How to differentiate between presentation of VN and Ménière’s disease?
VN - tends to come on more suddenly
Ménière’s - episodic and fluctuating hearing loss
