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ENT Flashcards

1
Q

What’s apnea-hypopnea index (AHI)

A

Average that represents the combined number of apneas and hypopneas that occur per hour of sleep.

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2
Q

How does allergic rhinitis occur

A

By allergens that trigger a local hypersensitivity reaction. Specific IgE antibodies triggers a cascade of inflammatory mediators.
Nasal terminates appear pale and boggy ( rather than red and inflamed as in infected rhinitis)
Avoidance measures alone are often ineffective
Symptom relief- antihistamines and intranasal corticosteroids

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3
Q

Vasomotor rhinitis

A

It’s a non allergic rhinitis
Secondary to a hyperactive nerve in the nasal canal.
It activates in response to a chronic allergy, chronic inflammation, structural issues .
When nerve is hyperactive it overstimulates terbinates to swell and secrete excessively.
Can try a trial of ipratropium bromide ( also there’s a new method of cryotherapy done to the nerve to reduce the hyperactivity. Done in opd setting)

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4
Q

What’s rhinitis medicamentosa

A

That’s a recurrence of nasal congestion due to overuse of topical nasal decongestants

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5
Q

What’s hay fever

A

The Common name for Allergic rhinitis produced by seasonal aeroallergens
Symptoms- nasal congestion, rhinorrhea, sneezing and itching of nose and eyes.
Medical treatments are antihistamines( treats allergen induced sneezing,nasal itching and rhinorrhea ) , leukotriene receptor modulators and topical glucocorticoids

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6
Q

Role of antigen immunotherapy in severe allergic rhinitis

A

Specific antigen must be identified before commencing the allergy shot
Duration less than a year is ineffective, normally 3-5 year course is completed

Immunotherapy could be beneficial for asthma but not commonly used
There’s NO evidence that immunotherapy against bacterial pathogens decrease incidence of sinusitis of respiratory infections

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7
Q

What’s the midline upper neck cystic mass which moves with swallowing

A

Thyroglossal cyst

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8
Q

How to manage pleomorphic adenoma

A

It’s a benign tumor (no chemo or radiotherapy needed)
Tx of choice is superficial parotidectomy
Recurrence with simple enucleation is 20-45%, but less than 5% in S.Parotidectomy.
Commonly total parotidectomy (more extensive) doesn’t reduce risk of recurrence and is associated with high risk of facial nerve dysfunction and other complications.
Total parotidectomy is done for benign tumors that holds deep lobe and high grade malignant parotid tumors.

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9
Q

6yo girl, unwell for 1 week with URTI + L/S earache, L ear tympanic membrane perforation of 1-2mm noted and some dry blood in ear canal. What’s the next step

A

Scenario suggestive of Acute otitis media with TM perforation
1st line is Amoxicillin for 1 week duration and review in 1 week to asses resolution of symptoms
ENT surgical referral is not needed as TM heals by itself in AOM

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10
Q

What’s the first line med for severe allergic rhinoconjunctivitis

A

Intranasal corticosteroids

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11
Q

Chronic rhino sinusitis symptoms

A

Following symptoms for more than 12 weeks
1.Nasal blockage( obstruction or congestion)
2.Mucopurulent nasal discharge( anterior of posterior drip)
3.Facial pain or pressure
4.Reduction of sense of smell

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12
Q

How to treat chronic rhino sinusitis ?

A
  1. topical steroids and nasal irrigation for 8 weeks
  2. Antibiotics - acute rhino sinusitis that do not improve in 7 days or worsens over time.
    (Amoxicillin is first line )
  3. If symptoms doesn’t improve with amoxicillin therapy within 6 weeks- start respiratory fluoroquinolone ( levofloxacin or Moxifloxacin )
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13
Q

Management of active epistaxis

A
  1. Position sitting forward to prevent blood dripping down the throat
  2. Compress the little’s area for about 10mins without interrupting
  3. If not effective apply local anesthesia and pack the nose with ribbon gauze
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14
Q

What are the possible tumor sites related to metastatic nodes

A
  1. Posterior triangle- nasopharyngeal carcinoma
  2. Upper jugular chain- oral cavity, oropharynx and larynx
  3. Isolated supraclavicular nodes- tracheobronchial, distal esophageal or stomach carcinoma
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15
Q

Disadvantages of uss

A

1.Operator dependency
2.Sound wave not transmitted via bone and air. So can’t visualize structures behind bone and air

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16
Q

What are the mechanisms of stroke due to chronic OSA

A

1.Large swings in BP
2.Increased coagulopathy
3.Development of atrial fibrillation
4.Local vibrational damage to carotid artery bifurcation
5.Paradoxical emboli through asymptomatic patent foramen ovals opening during transient sleep related hypoxia with pulmonary hypertension

Hyperlipidemia is not a mechanism

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17
Q

Commonest cause of epistaxis

A

Local incidental trauma

Then facial trauma, foreign bodies, nasal or sinus infection , prolonged inhalation of dry air

Hypertension is rarely the direct cause of nasal bleeding

Rarely NSAIDs or hay fever may cause epistaxis

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18
Q

Features of chronic suppurative otitis media

A

CSOM is the infection of middle ear with perforated tympanic membrane

Very common in preschool children
Hx of cold symptoms months ago
Profuse yellow discharge from an ear for few weeks
Ear drum could be perforated

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19
Q

Treatment of CSOM

A

Ear toilet with providing idone solution , followed by dry mopping with rolled toilet papers. Can be done 2 to 3 times a day

Ciprofloxacin ear drops also can be used secondly

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20
Q

Features of nasopharyngeal carcinoma Mets to the lymph nodes

A

Nasopharyngeal ca has tendency to spread to LN without exhibiting any systemic symptoms. It is seen that about 20% nasopharyngeal ca , initial mode of presentation is multiple BL nodes in posterior triangle of neck

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21
Q

What’s sternocleidomastoid tumor

A

A benign swelling within the sternocleidomastoid muscle, which joins the base of the skull to the collar bone
In anterior triangle of the neck

In some babies this muscle is shorter than the other. So at birth they come with tilted head which results in birth trauma and breech deliveries

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22
Q

Bronchial cysts

A

Congenital epithelial cysts
Arise from lateral part of the neck due to failure of obliteration of the Second branchial cleft in embryonic development
Usually soft non tender and in anterior triangle

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23
Q

What’s tuberculous lymphadenitis

A

In posterior triangle of the neck
Painless and long standing

24
Q

Carotid body tumor

A

Slowly growing painless swelling of anterior triangle of the neck

25
Q

RF of obs sleep apnea

A

1.Obesity
2.Myotonic dystrophy
3.Ehlers- Danlos syndrome
4.Smoking
5.Hypothyroidism
6.Acromegaly

26
Q

What’s central sleep apnea and what are the RF

A

Lack of drive to breathe during sleep , resulting in repetitive periods of insufficient ventilation and compromised gas exchange
RF are congestive heart failure and stroke

27
Q

Features of OSA

A

1.Daytime sleepiness
2.Narcolepsy
3.Impaired vigilance
4.Hypertension
5.Fatigue
6.Snoring at night
7.Choking or gasping while sleep
8.Morning headaches
9.Moodiness,irritability, depression

Must be referred to a respiratory specialist for confirmation of diagnosis

Sleep maintenance insomnia ( many people experience a lot of awakenings during the night or one long wakeful period . If the awakenings are long and associated with daytime tiredness that’s called sleep maintenance insomnia ) is seen in central sleep apnea

28
Q

What’s narcolepsy

A

It’s a chronic neurological disorder that affects brain’s ability to control sleep-wake cycles
Patients may experience uneven or interrupted sleep that may involve waking up frequently during the night
They may cause sudden attacks of sleep, sudden loss of muscle tone, hallucinations (like day dreaming)

29
Q

Fever,ear ache, cough for last four days. Otoscope shows red and bulging TM

A

AOM Without perforation of TM

30
Q

In chronic supportive otitis media with TM perforation, is surgery mandatory

A

No surgical repair is elective and not mandatory

31
Q

In COM with perforation
1.A dry central perforation
2.Continuous discharging central perforation
3.Perforation associated with cholesteoma

A

Dry central perforation will not progress to complications , even if it doesn’t heal.surgical repaid is elective
Other types of perforations are not safe and need special attention

Continuously discharging central or marginal perforation indicates granulation and osteitis and bone destruction

Cholesteoma is not a neoplasm but a cystic lesion that contains amorphous debris.
It’s formed through chronic infection and perforation of eardrum with ingrowth of squamous epithelium forming a nest which becomes cystic.
By progressive enlargement cholesteatoma can erode the ossicles, labyrinth and adjacent bone and carries the risk of cerebral abscess formation and meningitis

32
Q

Painless swelling with associated facial nerve involvement

A

Most likely parotid gland carcinoma ( facial nerve palsy never presents with a benign condition like pleomorphic adenoma)

33
Q

What’s warthin tumor

A

Second commonest benign parotid tumor
Primarily in 60-70y patients
Usually at the tail of parotid gland near the angle of mandible
Only tumor virtually restricted to the parotid gland

34
Q

High risk patient of oral cancer how often should screen

A

Every 12 monthly should be screened

35
Q

Explain acute labrynthitis

A

Acute vertigo , nausea ,vomiting , tinnitus and hearing loss. Change in head position provokes vertigo( lasts for few seconds to minutes)
History of preceding viral URTI in 50% patients

36
Q

What’s Ménière’s disease

A

Acute onset vertigo, tinnitus and hearing loss, ear fullness ( due to increased endolymph pressure in labyrinth)

Associated positive family history+

Much less common compared to labyrinthitis

37
Q

What’s vestibular neuronitis

A

Inflammation of vestibular nerve often by viral infection (preceding viral URTI or herpes zoster)

Acute onset Vertigo ,imbalanceness nausea and vomiting are present.
but NO HEARING LOSS OR TINNITUS favors either BPPV or vestibular neuronitis.
But caloric test and horizontal nystagmus with fast part towards unaffected side suggests vestibular neuronitis.

Symptoms worsens with head positioning

38
Q

What is acoustic neuroma

A

AKA Vestibular schwannomas
Intracranial tumors arise from the Schwann cell sheath of either vestibular or cochlear nerve.
As acoustic neuromas increase in size they eventually occupies a large portion of the cerebellopontine angle.
Usually unilateral, B/L tumors almost always suggest neurofibomatosis type2.

Prominent feature is the unilateral GRADUAL hearing loss. Tinnitus , imbalanceness, contralateral sensory disturbances.
Vertigo is NOT SEEN ( bcos as the tumor grows gradually there’s enough time for compensation) and facial nerve involvement seen due to compression in CPA

Produce hearing loss through two mechanisms-
Direct injury to cochlear nerve( occurs more chronically)
Interruption to cochlear nerve blood supply ( occurs much faster but seen in about 15%)

39
Q

What’s lateral medullary syndrome

A

AKA Wallenberg syndrome , AKA Posterior inferior cerebella artery (PICA) syndrome
Has vertigo, hearing loss, tinnitus
Cross body sensory impairment
Horner’s syndrome, dysphagia, dysarthria, dysphonia

40
Q

What’s pure tone audiometry

A

Standard test to assess hearing loss in adults
It helps to assess conductive hearing loss(CHL)( air conduction)
And sensorineural hearing loss(SNHL) (bone conduction)

41
Q

Rinne and Weber test

A

Done for provisional assessment of hearing loss
In a normal person air conduction(AC) is better than bone conduction(BC), so when BC is better than AC conductive hearing loss(CHL) is suspected.
Not reliable as pure audiometry

42
Q

What speech discrimination test

A

A part of formal audiometry
Assess the patients ability to hear words correctly and it’s a good indication of integrity of cochlear nerve

43
Q

What’s electrocochleography

A

Measurement of electrical potentials generated in inner ear as a result of sound stimulations.
This is often used to determine if the cochlear has excessive amount of fluid pressure. ( excess fluid pressure can can cause symptoms such as hearing loss, ear fullness, tinnitus, dizziness)

44
Q

What’s acute mastoiditis(AM)

A

Rare but the commonest suppurative complication of acute otitis media(AOM) and maybe associated with intracranial complications
It’s always a clinical diagnosis with following findings
1. History of AOM
2. Post auricular inflammation signs like erythema, edema, tenderness
3. Protruding auricle or external auditory canal edema

Mainstay of treatment is IV Flucloxacillin + a third generation cephalosporin
(But before antibiotics should take a sample form ear discharge for microscopy)
Then if TM is intact tympanocentesis or Myringotomy should do to obtain samples and to relieve middle ear pressure( by and ENT consultant)
CT has to be done later to evaluate the extent of the complications of mastoiditis. Audiometry maybe later used after treatment to assess hearing status and medicolegal issues.

45
Q

Recurrent epistaxis with CPAP use and BL crusting and excoriation on nasal septum,but not active bleeding on examination

A

After starting CPAP many patients develop dryness, obstruction, epistaxis due to mucosal damage caused by cold , dry and pressurized air from CPAP machine. On examination nasal mucosa is dry and erythematous with crusting.

Treatment-
Warming and humidifying air through CPAP machine
Nasal saline irrigation (to moisturize the nasal mucosa and to clear dry secretions)

If excoriation is associated with recurrent epistaxis ,a focal lesion and crusting with excoriations - biopsy is indicated to exclude malignancies.
Corticosteroids are effective in allergic rhinitis but here no place for them bcos that may further thin the walls which could worsen the epistaxis
Oxymetazoline ( topical vasoconstrictor) can be used in acute epistaxis where direct pressure doesn’t stop the bleeding. But it can’t be used as a preventive drug for epistaxis

46
Q

What’s the pathogenesis of cholesteatoma

A

Presentation-
Persistant otorrhea, conductive hearing loss,on examination pearly white mass behind intact tympanic membrane

Development of retraction pockets in TM due to chronic middle ear infections or recurrent AOM or tympanostomy tube placement.
These pouches traps squamous epithelial cells and debris , leading to otorrhea if infected or conductive hearing loss if growth expands to the nearby ossicles.
In examination pearly white mass on anterosupirior quadrant of TM or a visible retraction pocket with draining debris is seen
Treatment is surgical excision

47
Q

Otitis externa is characterized by

A

Maceration and inflammation in the external ear canal

48
Q

Painful swelling under the jaw, more painful and prominent after eating. Bimanual shows slightly tender mass on the region

A

Chronic sialadinitis.
Most commonly Due to duct obstruction by a salivary duct calculi.
Postprandial pain and swelling commonly seen
On palpation gland is enlarged , maybe tender. Manipulation should be minimized to avoid the calculi from pushing further into the gland which makes it harder to do the transoral excision.

Common in submandibular gland- long tortuous duct, mixed mucus and serous composition, draining against gravity

Intraoral plain X-ray is most commonly used. Then USS(duct dilatation,to identify stones as small as 1mm) and sialogram( size, location) are also used

49
Q

What’s Orthopantomogram(OPG)

A

Panoramic dental X-ray of upper and lower jaws
Has no role is salivary gland diseases

50
Q

Painless form and mobile preauricular mass with ipailateral facial nerve involvement. What’s the work up

A

Most important to consider malignant parotid tumor that invaded facial nerve.
When a salivary gland tumor is suspected imaging starts with CT and MRI of head and neck ( to assess location, local extensions and invasion, detect nodal and systemic Mets )
FNAC is used after that for confirmation of diagnosis and before surgery
Chest X-ray and CT of chest and abdomen are done for staging later.

51
Q

Painless, firm and mobile neck mass for 6 months, FNAC is inconclusive , what’s the next best step

A

Painless lateral neck/collarbone lumps in adults are malignant until proven otherwise.

After history and examination best to perform FNAC and CT scan.
How ever if FNAC is inconclusive CT scan is preformed and then excision biopsy is performed.

Red flags for hard and neck ca-
1. Mass present for >2 weeks
2. Recent change in the voice
3. Dysphagia or odynophagia
4. LOA, LOW
5. Ipsilateral otalgia, nasal obstruction or epistaxis

RF for head and neck ca-
1. Smoking
2. Alcohol use
3. Age>40y
4. Hx of head and neck malignancy
5. Hx of head and neck cutaneous lesions

52
Q

BPPV

A

Usually wake up with the condition and notice while trying to sit up properly
Physical examination is unremarkable

53
Q

What are the most contributing factors for SCC in head and neck

A

Smoking and alcohol

54
Q

Commonest RF for nasopharyngeal ca

A

Commonest is Epstein Barr virus ( EBV). Others are HPV infection and genetically.

55
Q

What’s the second most common cause for tonsillar lump

A

Lymphoma

56
Q

What’s a CI for silogram

A

Active infection( bcos it can exacerbate the extent of the infection)

57
Q

Acute siladenitis

A

Unilateral erythema and tender swelling over aubmandibular gland highly suggestive of above.

80% calculi are radio opaque( most parotid gland calculi are radiolucent)
X-ray is the first ix, then CT or USS are done.

ENT (1 decks)

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