ENT Flashcards

Question

tx acute necrotizing ulcerative gingivitis

Answer 1

refer the patient to a dentist, meanwhile the following is recommended: oral metronidazole* for 3 days chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash simple analgesia *the BNF also suggest that amoxicillin may be used

Answer 2

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with: persistent unexplained hoarseness or an unexplained lump in the neck

Answer 3

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either: unexplained ulceration in the oral cavity lasting for more than 3 weeks or a persistent and unexplained lump in the neck. Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either: a lump on the lip or in the oral cavity or a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.

Answer 4

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.

Answer 5

voice overuse smoking viral illness hypothyroidism gastro-oesophageal reflux laryngeal cancer lung cancer

Answer 6

a type of progressive cellulitis that invades the floor of the mouth and soft tissues of the neck. Most cases result from odontogenic infections which spread into the submandibular space. Features neck swelling dysphagia fever It is a life-threatening emergency as airway obstruction can occur rapidly as a result. Management airway management intravenous antibiotics

Answer 7

when an infection spreads from the middle to the mastoid air spaces of the temporal bone.

Answer 8

otalgia: severe, classically behind the ear there may be a history of recurrent otitis media fever the patient is typically very unwell swelling, erythema and tenderness over the mastoid process the external ear may protrude forwards ear discharge may be present if the eardrum has perforated

Answer 9

diagnosis clinical Ct if complications suspected

Answer 10

facial nerve palsy hearing loss meningitis

Answer 11

1% in adults in UK 2-4x more common in men and not in children or elderly

Answer 12

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

Answer 13

nasal obstruction rhinorrhoea, sneezing poor sense of taste and smell

Answer 14

referred to ENT for full examination topical corticosteroid to shrink

Answer 15

classically a bilateral, red swelling arising from the nasal septum this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm

Answer 16

surgical drainage IV abx

Answer 17

squamous cell associated with EBV

Answer 18

cervical lymphadenopathy Otalgia Unilateral serous otitis media Nasal obstruction, discharge and/ or epistaxis Cranial nerve palsies e.g. III-VI

Answer 19

radiotherapy

Answer 20

reactive lymphadenopathy lymphoma thyroid swelling thyroglossal cyst pharyngeal pouch cystic hygroma branchial cyst cervical rib carotid aneurysm

Answer 21

Up to 80% of all salivary gland tumours occur in the parotid gland and up to 80% of these are benign. There is no consistent correlation between the rate of growth and the malignant potential of the lesion. However, benign tumours should not invade structures such as the facial nerve. With the exception of Warthins tumours, they are commoner in women than men. The median age of developing a lesion is in the 5th decade of life.

Answer 22

Plain x-rays may be used to exclude calculi Sialography may be used to delineate ductal anatomy FNAC is used in most cases Superficial parotidectomy may be either diagnostic of therapeutic depending upon the nature of the lesion Where malignancy is suspected the primary approach should be definitive resection rather than excisional biopsy CT/ MRI may be used in cases of malignancy for staging primary disease

Answer 23

For nearly all lesions this consists of surgical resection, for benign disease this will usually consist of a superficial parotidectomy. For malignant disease a radical or extended radical parotidectomy is performed. The facial nerve is included in the resection if involved. The need for neck dissection is determined by the potential for nodal involvement.

Answer 24

HIV infection sjogren's sarcoidosis

Answer 25

no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time abx if following AOM

Answer 26

severe throat pain, which lateralises to one side deviation of the uvula to the unaffected side trismus (difficulty opening the mouth) reduced neck mobility

Answer 27

urgent referral by ENT needle aspiration or incision & drainage + intravenous antibiotics tonsillectomy should be considered to prevent recurrence

Answer 28

Pleomorphic adenoma (also known as a benign mixed tumour) is a benign tumour of the parotid gland. It is the most common tumour of the parotid gland and typically appears at the age of 40-60 years.

Answer 29

Pain The pain may increase for up to 6 days following a tonsillectomy. Haemorrhage Haemorrhage is a feared complication following tonsillectomy. All post-tonsillectomy haemorrhages should be assessed by ENT. Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre. Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.

Answer 30

high frequency

Answer 31

The precise cause is unknown however is likely multifactorial Arteriosclerosis: May cause diminished perfusion and oxygenation of the cochlea, resulting in damage to inner ear structures Diabetes: Acceleration of arteriosclerosis Accumulated exposure to noise Drug exposure (Salicylates, chemotherapy agents etc.) Stress Genetic: Certain individuals may be programmed for the early ageing of the auditory system

Answer 32

chronic, slowly progressing history of: Speech becoming difficult to understand Need for increased volume on the television or radio Difficulty using the telephone Loss of directionality of sound Worsening of symptoms in noisy environments Hyperacusis: Heightened sensitivity to certain frequencies of sound (Less common) Tinnitus (Uncommon)

Answer 33

Possible Weber's test bone conduction localisation to one side if sensorineural hearing loss not completely bilateral

Answer 34

Otoscopy: Normal, to rule out otosclerosis, cholesteatoma and conductive hearing loss (Foreign body, impacted wax etc.) Tympanometry: Normal middle ear function with hearing loss (Type A) Audiometry: Bilateral sensorineural pattern hearing loss Blood tests including inflammatory markers and specific antibodies: Normal

Answer 35

caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

Answer 36

auricular pain is often the first feature facial nerve palsy vesicular rash around the ear other features include vertigo and tinnitus

Answer 37

oral aciclovir and corticosteroids

Answer 38

centor score - presence of tonsillar exudate tender anterior cervical lymphadenopathy or lymphadenitis history of fever absence of cough if 3 or 4 - 32-56% chance its bacterial FeverPAIN score - Fever over 38°C. Purulence (pharyngeal/tonsillar exudate). Attend rapidly (3 days or less) Severely Inflamed tonsils No cough or coryza 4 or 5 - 62%-65 .....phenoxymethylpenicillin or clarithromycin for 10 days

Answer 39

80% of all salivary gland calculi occur in the submandibular gland 70% of these calculi are radio-opaque Stones are usually composed of calcium phosphate or calcium carbonate Patients typically develop colicky pain and post prandial swelling of the gland Investigation involves sialography to demonstrate the site of obstruction and associated other stones Stones impacted in the distal aspect of Wharton's duct may be removed orally, other stones and chronic inflammation will usually require gland excision

Answer 40

urgent referral ENT majority are iditopathic MRI - vestibular schwannoma high dose oral corticosteroids

Answer 41

More common in patients < 20 years old. Features usually midline, between the isthmus of the thyroid and the hyoid bone moves upwards with protrusion of the tongue may be painful if infected

Answer 42

Anatomical such as recurrent laryngeal nerve damage. Bleeding. Owing to the confined space haematoma's may rapidly lead to respiratory compromise owing to laryngeal oedema. Damage to the parathyroid glands resulting in hypocalcaemia.

Answer 43

meniere's disease otosclerosis sudden onset sensorineural hearing loss - acoustic neuroma hearing loss drugs impacted ear wax

Answer 44

audiological assessment for hearing loss enerally, non-pulsatile tinnitus does not require imaging unless it is unilateral or there are other neurological or ontological signs. MRI of the internal auditory meatuses (IAM) is first-line pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause. Magnetic resonance angiography (MRA) is often used to investigate pulsatile tinnitus

Answer 45

investigate and treat any underlying cause amplification devices more beneficial if associated hearing loss psychological therapy may help a limited group of patients examples include cognitive behavioural therapy tinnitus support groups

Answer 46

meets all criteria: sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections) the person has five or more episodes of sore throat per year symptoms have been occurring for at least a year the episodes of sore throat are disabling and prevent normal functioning

Answer 47

recurrent febrile convulsions secondary to episodes of tonsillitis obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils peritonsillar abscess (quinsy) if unresponsive to standard treatment

Answer 48

viral labyrinthitis vestibular neuronitis BPPV meniere's disease vertebrobasilar ischaemia acoustic neuroma other - posterior circulation stroke, trauma, MS, ototoxicity

Answer 49

recurrent vertigo attacks lasting hours or days nausea and vomiting may be present horizontal nystagmus is usually present no hearing loss or tinnitus

Answer 50

viral labyrinthitis posterior circulation stroke: the HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

Answer 51

buccal or IM prochlorperazine short course of oral proclorperazine or antihistamine vestibular rehab exercises

Answer 52

nflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs. Labyrinthitis can be viral, bacterial or associated with systemic diseases. Viral labyrinthitis is the most common form of labyrinthitis.

Answer 53

vestibular neuritis is used to define cases in which only the vestibular nerve is involved, hence there is no hearing impairment; Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.

Answer 54

acute vertigo: not triggered by movement but exacerbated by movement nausea and vomiting hearing loss: may be unilateral or bilateral, with varying severity tinnitus preceding or concurrent symptoms of upper respiratory tract infection

Answer 55

spontaneous unidirectional horizontal nystagmus towards the unaffected side sensorineural hearing loss: shown by Rinne's test and Weber test abnormal head impulse test: signifies an impaired vestibulo-ocular reflex gait disturbance: the patient may fall towards the affected side

Answer 56

episodes are usually self-limiting prochlorperazine or antihistamines may help reduce the sensation of dizziness