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ENT Flashcards

1
Q

What is chronic rhinosinusitis

A

Inflammation of the paranasal sinuses lasting over 12 weeks

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2
Q

Presentation of chronic rhinosinusitis

A

Facial pain worse on bending forward
Nasal discharge
Mouthy breathing
Post nasal drip causing chronic cough

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3
Q

Management options of chronic rhinosinusitis

A

First line
- Intranasal corticosteroids
- Nasal irrigiation with saline solution
If severe and persistent
- Functional endoscopic sinus surgery

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4
Q

Red flag symptoms requiring ENT referral for chronic rhinosinusitis

A

Unilateral symptoms
Persistent symptoms despite 3 months of treatment
Epistaxis
If any of these then 2 week referral

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5
Q

Presentation of vestibular neuronitis

A

Vertigo and nausea following a viral infection
Horizontal nystagmus
NO hearing loss or tinnitus

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6
Q

Management of chronic vestibular neuronitis

A

Vestibular rehabilitation exercises- brandt daroff exercises
Avoid medications

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7
Q

Management of vestibular neuronitis

A

If mild= oral antihistamine like prochlorperazine or cylizine
If more severe then buccal or intramuscular prochlorperazine

NICE advise that symptomatic treatment can be used for up to 3 days. More extended use may slow down the recovery.

if the symptoms not improved after 1 week or resolved after 6 weeks, refer to ENT for further investigation or vestibular rehabilitation therapy (VRT)

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8
Q

Mastoiditis presentation

A

otalgia
fever
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

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9
Q

Management of mastoiditis

A

IV abx- ceftriaxone
May require myringotomy with grommet or mastoidectomy

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10
Q

What is ramsay hunt syndrome

A

Reactivation of VZV in the facial nerve

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11
Q

Presentation of ramsay hunt syndrome

A

Facial droop
Rash in the ear- can get over anterior 2/3 tongue
Ear pain
Can get vertigo and tinnitus

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12
Q

Management of ramsay hunt

A

Oral aciclovir and corticosteroids
Lubricating eye drops

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13
Q

Management of perforated tympanic membrane

A

Watch and wait to see if persists post 6 weeks
If does then ENT referral

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14
Q

Management if watch and wait did not work for perforated tympanic membrane

A

Myringoplasty- surgically repairing it

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15
Q

What abx give for AOM

A

Amoxicillin
Second line- clari

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16
Q

What is chronic supporative otitis media

A

Post AOM get tympanic membrane perforation with otorrhoea for over 6 weeks

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17
Q

Complications of AOM

A

mastoiditis
meningitis
brain abscess
facial nerve paralysis
Chronic supporative otitis media

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18
Q

Presentation of benign paroxysmal positional vertigo

A

Older than 55:
- vertigo triggered by change in head position (e.g. rolling over in bed or gazing upwards)
- may be associated with nausea
- each episode typically lasts 10-20 seconds

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19
Q

What is seen on positive dix hallpike

A

Patient gets vertigo alongside a rotary nystagmus

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20
Q

What is investigation for BPPV

A

dix hallpike

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21
Q

Management of BPPV

A

Epley manoeuver
Teaching patient exercises they can do at home- brandt daroff exercises

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22
Q

What are associations of nasal polyps

A

Asthma
Chronic rhinosinusitis
CF
Kartageners
Churg strauss
Aspirin sensitivity

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23
Q

What is aspirin sensitivity

A

When people take aspirin or other NSAIDs like ibuprofen they may get a reaction
- itchy rash
- nasal congestion
- watery eyes

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24
Q

What is in samters syndrome

A

Nasal polyps
Aspirin sensitivity
Asthma

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25
Q

How can nasal polyps present

A

Snoring
Difficulty breathing through nose
Rhinorrhoea
Loss of smell

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26
Q

Which nasal polyps need urgent referral ENT

A

Unilateral as should normally develop bilaterally
Bleeding
These signs may suggest nasopharyngeal cancer

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27
Q

Management of nasal polyps

A

If unilateral or bleeding then urgent ENT referral
If bilateral
- routine ENT referral for topical corticosteroids
- can consider polypectomy if medical tx fails

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28
Q

How distinguish labyrinthitis from vestibular neuronitis

A

Hearing loss or tinnitus can be present in labyrinthitis but NEVER in vestibular neuronitis

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29
Q

What is pathophysiology of otosclerosis

A

Genetic condition where get replacement of normal bone in ear by vascular spongy bone

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30
Q

Inheritance of otosclerosis

A

AD

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31
Q

Presentation of otosclerosis

A

Family history of hearing loss
Conductive hearing loss
Tinnitus

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32
Q

What do if someone diagnosed with sudden onset sensorineural hearing loss

A

Refer urgently to ENT to be seen within 24 hours

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33
Q

What will ENT do for sudden onset sensorineural hearing loss

A

MRI to exclude vestibular schwannoma
Audiology assessment
High dose oral corticosteroids

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34
Q

What is most common cause of sudden onset sensorineural hearing loss

A

Idiopathic

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35
Q

What is most likely salivary gland to become blocked with stones

A

Submandibular

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36
Q

What is sialadenitis

A

Inflammation of the salivary glands

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37
Q

Presentation of sialadenitis

A

Pain and swelling in mouth
Skin can become red above it
Poor taste in mouth

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38
Q

What are nasopharyngeal carcinomas

A

Squamous cell carcinomas which occur in the nasopharynx typically caused by EBV

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39
Q

What is main risk factor for nasopharyngeal carcinoma

A

Being from south china
EBV

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40
Q

Presentation of nasopharyngeal carcinoma

A

Lymphadenopathy
Otalgia
Unilateral otitis media
Nasal discharge
Epistaxis
Get cranial nerve palsies too if invades cavernous sinus

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41
Q

What is gingivitis and how does it present

A

Inflammation of the gums typically caused by poor dental hygiene
Simple gingivitis presents with bleeding and painless swelling of the gums

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42
Q

What can simple gingivitis progress to

A

Acute necrotising ulcerative gingivitis where get infection of anaerobic bacteria

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43
Q

What is presentation of Acute necrotising ulcerative gingivitis

A

Painful bleeding gums
Punched out ulcers in the gums
Halitosis

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44
Q

Management of simple gingivitis

A

Routine appointment with dentist
- mouthwash
- encourage good brushing

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45
Q

Management of acute necrotizing ulcerative gingivitis

A

Metronidazole
Urgent dental referral
Analgesia
Chlorhexidine mouth wash

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46
Q

What is pathophysiology of menieres disease

A

Build up of endolymph fluid in the ear

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47
Q

Presentation of menieres disease

A

Random attacks of vertigo
Associated with sensorineural hearing loss
Tinnitus
Get feeling of fullness in ear

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48
Q

Most likely cause of bacterial otitis media

A

Strep pneumonia
Other causes include HIB or moraxella

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49
Q

What neck lumps move upwards on swallowing

A

Thyroglossal cyst
Goitre

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50
Q

What is presentation of nasal septal haematoma

A

Post even slight trauma
Nasal obstruction sensation
Pain and rhinorrhoea

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51
Q

Nasal septal haematoma on examination

A

Bilateral red swelling arising from septum
Feels boggy

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52
Q

Management of nasal septal haematoma

A

Urgent ENT referral for surgical drainage

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53
Q

Labyrinthitis presentation

A

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

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54
Q

Management of labyrinthitis

A

Usually self limiting but can give prochlorperazine to help with vertigo

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55
Q

Presentation of presbycusis

A

Difficulty following conversations
Bilateral high frequency hearing loss

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56
Q

Which drugs are ototoxic

A

Aminoglycosides
Aspirin
Furosemide
Cytotoxic drugs
Quinines

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57
Q

What is an acoustic neuroma

A

Vestibular schwannoma aka
Benign tumour of the schwann cells which surround the vestibulocochlear nerve

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58
Q

How can acoustic neuromas present

A

Unilateral hearing loss
Unilateral tinnitus
Dizziness
Can get other facial nerve palsies if grows large enough
- CN5 get absent corneal reflex
- CN7 get facial nerve palsy

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59
Q

What is hypo vs hyperacusis

A

Hypo= poor hearing acuity
Hyper= extreme sensitivity to sounds

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60
Q

What is done if someone has hypoacusis

A

Referral to ENT for audiometric assessment. Will trial hearing aids then if not a cochlear implant will be trialled

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61
Q

Treatment options for sensorineural hearing loss

A

Hearing aids
Cochlear implant

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62
Q

What must a patient do prior to having a cochlear implant inserted

A

Trial hearing aids for 3 months

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63
Q

Complications of cochlear implant insertion

A

Meningitis
CSF leak
Infection
Facial nerve paralysis

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64
Q

Contraindications for cochlear implant

A

Lesions on CN 8 or brainstem
Chronic otitis media

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65
Q

Antibiotic for tonsillitis

A

Phenoxymethicillin V for 7 or 10 days
Clarithomycin in contraindicated

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66
Q

What is in centor criteria

A

No cough
Tonsillar exudate
Fever
Anterior cervical lymphadenopathy

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67
Q

What are indications for abx in tonsillitis

A

Systemic upset
Unilateral peritonsillitis
Rheumatic fever history
Increased risk from acute infection (e.g. immunodeficient child)
Centor 3 or above

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68
Q

Initial management of nose bleed

A

A-E to determine if haemodynamically stable
If stable then pinch soft part of the nose and lean forward for 20 minutes

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69
Q

What do if first aid successful in managing epistaxis

A

Use topical antiseptic- naseptin (chlorhexidine and neomycin) to reduce crusting
Consider admission if coagulopathy or severe comorbidity like HF

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70
Q

What do if in epistaxis first aid is unsuccessful

A

Look for site of bleed
- if can be visualised then cautery
- if cant be visualised then anterior packing

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71
Q

What need to use before cautery or anterior packing

A

Lidocaine anaesthetic spray

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72
Q

What is cause of ludwigs angina most commonly

A

Infection proceeding odontogenic procedure

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73
Q

Management of ludwigs angina

A

Immediate transfer to hospital
IV abx
Airway management

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74
Q

Presentation of ludwigs angina

A

Neck swelling
Dysphagia
Fever
Severe pain

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75
Q

What is urgent referral guideline for suspected laryngeal cancer

A

Unexplained persistent hoarseness if over 45
Unexplained neck lump

76
Q

What is first investigation do to if unexplained hoarseness

A

CXR to rule out apical lung tumour

77
Q

Causes of hoarseness

A

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

78
Q

Which drugs can cause tinnitus

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

79
Q

What is sialolithiasis

A

Salivary stones

80
Q

Where do most salivary stones occur

A

Submandibular glands blocking whartons duct

81
Q

What are salivary stones most often made from

A

Calcium phosphate

82
Q

Presentation of sialolithiasis

A

Colicky pain
Post prandial swelling of the gland
Dry mouth
Halitosis

83
Q

What are causes of gingival hypertrophy

A

CCB
Ciclosporin
Phenytoin
AML

84
Q

What is management for all post tonsillectomy bleeds

A

Immediate ENT referral

85
Q

What is management of primary tonsillectomy bleed

A

Immediate return to theatre

86
Q

What most often causes secondary tonsillectomy bleeds

A

Infection of the wound

87
Q

What is management of secondary tonsillectomy bleeds

A

Admission and abx
If very severe return to theatre

88
Q

What do if epistaxis has failed to respond to cautery or packing

A

Sphenopalatine artery ligation in theatre

89
Q

What is most common symptom of laryngopharyngeal reflux

A

Lump in throat felt in the midline that is felt worse on swallowing saliva not food or drink

90
Q

Presentation of laryngopharyngeal reflux

A

Lump in throat felt in the midline that is felt worse on swallowing saliva not food or drink
hoarseness (70%)
chronic cough (50%)
dysphagia (35%)
heartburn (30%)
sore throat

91
Q

What may be seen on examination of laryngopharyngeal reflux

A

Posterior pharynx may be red

92
Q

How diagnose laryngopharyngeal reflux

A

Clinical diagnosis provided no red flag symptoms
- persistent hoarseness
- unilateral discomfort
- malaena
- weight loss
- dysphagia
- odonyphagia to food

93
Q

Management of laryngopharyngeal reflux

A

Trial lifestyle first- typical GORD measures
The consider PPI or gavison

94
Q

What prompts urgent referral for head and neck cancer

A

Ulcer lasting over 3 weeks
Persitent lump in neck
Lump on lip or in oral cavity
Erythro or erythroleukoplakia

95
Q

What does the HINTS test do

A

Differentiate between central and peripheral causes of vertigo

96
Q

Central causes of vertigo

A

MS
Stroke
Tumour
Trauma

97
Q

Peripheral causes of vertigo

A

Anything related to the vestibulocochlear nerve

98
Q

How can head and neck cancer present

A

Oral cancer
- ulcer
- unexplained lump
- unexplained red or white patch
Pharynx or larynx
- persistent sore throat
- hoarseness
- neck lump

99
Q

How can nasopharyngeal cancer present with ear pain

A

A lot of pain in the head and neck can be referred to the ear

100
Q

What is linked to oropharyngeal squamous cell carcinoma

A

HPV

101
Q

Where do SCC occur in the oropharynx most commonly

A

The tonsil

102
Q

What is pathogen most likely to cause malignant otitis externa

A

Pseudomonas

103
Q

What is main risk factor for malignant otitis externa

A

Diabetic

104
Q

How does malignant otitis externa present

A

Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

105
Q

How manage otitis externa in diabetic

A

Ciprofloxacin drops to prevent progression to malignant otitis externa

106
Q

How manage malignant otitis externa

A

Do a CT scan
Start IV antibiotics which cover pseudomonas

107
Q

What do if have otitis externa that is non resolving and getting worse

A

Urgently refer to ENT to rule out or manage malignant otitis externa

108
Q

How are auricular haematomas managed

A

Same day assessment by ENT for incision and drainage to prevent cauliflower ear

109
Q

What is cause of stridor in a post neck operation patient

A

Haematoma

110
Q

What do in case of stridor in a post neck operation patient

A

There is haematoma obstructing trachea so need to cut sutures to release blood
Call for senior help too

111
Q

Which salivary gland is a tumour most liekly to be in

A

Parotid gland

112
Q

What is most likely tumour of parotid gland

A

Pleomorphic adenoma
Tumours in the parotid are 80% benign and pleomorphic adenoma most likely

113
Q

What is most common cause of bilateral parotid tumours

A

Warthins tumour

114
Q

How evaluate a parotid tumour

A

X-ray to exclude calculi
Saliography to delineate anatomy
USS guided fine needle aspiration most diagnostic

115
Q

Management of parotid tumours

A

Benign- superficial parotidectomy
Malignant- radical parotidectomy

116
Q

What can HIV patients present with in their parotids

A

Cysts in their parotids
Bilateral multicystic swellings of the paroid

117
Q

What is sarcoid parotid presentation

A

Xerostomia
Parotid gland swelling
Facial palsies
Occurs in about 5% of sarcoid patients

118
Q

How can impacted ear wax present

A

Not just with conductive hearing loss
Patients can also present with pain, tinnitus and vertigo

119
Q

Management of ear wax

A

Either drops or ear syringing
- olive oil
- sodium bicarbonate
- almond oil

120
Q

What may be seen on examination of the mouth in IDA

A

Glossitis

121
Q

What causes tongue to appear black, brown or green

A

Black hairy tongue

122
Q

What are causes of black hairy tongue

A

poor oral hygiene
antibiotics
head and neck radiation
HIV
intravenous drug use

123
Q

Management of black hairy tongue

A

Tongue swab to exclude candida
Tongue scrapings

124
Q

Management of menieres

A

ENT referral
Inform DVLA
In acute attacks- IM or buccal prochlorperazine
Prevention- betahistine and vestibular rehab

125
Q

How manage acute attacks of menieres

A

Buccal or intramuscular prochlorperazine
Admission is sometimes required

126
Q

How prevent attacks of menieres

A

Betahistine- histamine analogue
Vestibular rehabilitation exercises

127
Q

What is double sickening in sinusitis

A

If bacteria are responsible then can get an improvement in sx followed by a deterioration

128
Q

How can thyroglossal cyst present

A

Recurrent infections and abscesses

129
Q

Presentation of of pharyngeal pouch

A

Halitosis
Recurrent throat infections
Neck lump around the sternocleidomastoid muscle

130
Q

What do if erythema in otitis externa extends to the ear

A

Add oral flucloxacillin

131
Q

How does cholesteatoma present

A

Recurrent purulent discharge
Conductive hearing loss
If local invasion then
- vertigo
- facial nerve palsy

132
Q

What presents with dizziness on extension of the neck

A

Vertebrobasilar ischaemia

133
Q

What is rhinitis medicamentosa

A

Where after prolonged use of nasal decongestants there is hypertrophy of the nasal mucosa

134
Q

What presents with a white film over tonsils that bleeds on contact

A

Bacterial tonsillitis

135
Q

Differentials for facial pain

A

Trigeminal neuralgia
GCA
Sinusitis
Cluster headache

136
Q

Management of pleomorphic adenoma

A

Routine surgical resection

137
Q

What is rinnes test

A

Tuning fork placed over mastoid and then once it is no longer audible, it is placed over the ear to see if is audible

138
Q

What is webers test

A

Tuning fork placed on forehead and it is seen if louder in one ear or is heard the same in both

139
Q

What is a positive rinnes test

A

Air conduction>bone conduction meaning when can no longer hear by mastoid you can hear in ear

140
Q

What is a negative rinnes test

A

Bone conduction> air conduction

141
Q

How would conductive hearing loss present in webers and rinnes

A

Lateralisation in weber to affected side
On affected side would be negative rinnes- bone conduction>air conduction

142
Q

How would sensorineural hearing loss present in webers and rinnes

A

Lateralisation to good side
On both sides air conduction > bone conduction

143
Q

What is normal on an audiogram

A

Anything above 20dB

144
Q

What suggests sensorineural hearing loss on an audiogram

A

Both air and bone conduction hearing loss are low

145
Q

What suggests conductive hearing loss on an audiogram

A

Only air conduction is abnormal (above 20dB)
Bone conduction is normal

146
Q

What suggests mixed hearing loss on an audiogram

A

Both air and bone conduction are poor with air worse than bone- creating an air bone gap

147
Q

What is exostosis

A

Cold water and wind exposure leads to bony growths in the ear

148
Q

How manage unilateral glue ear in adult

A

Referral under 2 WW

149
Q

Differentiating menieres from chronic vestinular neuronitis

A

Menieres can present with tinnitus and hearing loss

150
Q

Presbycusis on audiogram

A

High pitched hearing affected

151
Q

What are cholesteatomas

A

Squamous cell granulomas

152
Q

Management of cholesteatoma

A

ENT referral for surgery

153
Q

Most common infectious causes of vestibular neuronitis

A

HSV
VZV

154
Q

What is important thing to bear in mind when prescribing prochlorperazine

A

Do not give for too long as can interfere with brains signals

155
Q

Bones in ear

A

Remembering tool= MIS- in order from tympanic membrane to cochlear
Malleus
Incus
Stapes

156
Q

Otitis externa management

A

Depends on severity
- if mild can give acetic acid
- if moderate give neomycin with corticosteroid
If diabetic cipro drops

157
Q

What do if otitis externa so severe is conductive hearing loss

A

Add in ear wick

158
Q

What do if treatment refractory otitis externa

A

Re-examine
Ear swab

159
Q

Important side effect to consider when using neomycin for otitis externa

A

Ototoxic

160
Q

Management of presbycusis

A

Hearing aids/cochlear implants etc

161
Q

Acute sinusitis management

A

Less than 10 days= supportive
Over 10 days consider intransal mometasone or back-up phenoxymethicillin if more severe
If systemically unwell then co-amox

162
Q

Causes of sinusitis

A

Infection- strep pneumoniae, haemophilus, rhinoviruses
Smoking
Allergies

163
Q

What do if medical treatment for polyps fails

A

Polypectomy done either intransally or endoscopically depending on how far into nose they are

164
Q

Where are most nosebleeds from

A

Littles area

165
Q

What do if blood in mouth from nose bleed

A

Spit out

166
Q

Infective causes of facial nerve palsy

A

Ramsay hunt
Lyme disease
HIV
Invasive ear infections

167
Q

Non infectious causes of facial nerve palsy

A

Systemic diseases
- sarcoid
- DM
- MS
- leukaemia
Tumours
- cholesteatoma
- parotid tumours
- acoustic neuroma

168
Q

What are the 3 salivary glands

A

Parotid (in cheeks)
Submandibular (more posteriorly under tongue)
Sublingual (more anteriorly under tongue)

169
Q

Causes of sialedinitis

A

Stones
Malignancy
Sarcoid
Viral- mumps
Bacterial- only if immunocompromised
Sjogrens

170
Q

Which medications increase risk of salivary stones

A

Diuretics
Anti-cholinergics

171
Q

Management of salivary stones

A

Refer to ENT
- stay hydrated
- NSAIDs for pain
- stop any precipitating meds

172
Q

Gold standard investigation for parotid tumours

A

USS guided FNA

173
Q

Causes of gingivitis

A

Poor brushing
Smoking

174
Q

How manage patient with leukoplakia

A

Stop smoking and reduce alcohol
Biopsy if persistent

175
Q

What is erythoplakia vs erythroleukoplakia

A

Erythroplakia is red raised lesions in mouth (red leukoplakia)
Erythroleukoplakia where mixture of red and white

176
Q

Management of erythroplakia and erythroleukoplakia

A

Refer under 2WW as highly premaligant

177
Q

Causes of gingival hyperplasia

A

Gingivitis
Scurvy
AML
Drugs- CCB, phenytoin, ciclosporin

178
Q

Management of oral lichen planus

A

Good hygiene- stop smoking
Topical steroids

179
Q

Oral lichen planus presentation

A

Wickhams striae- shiny purple raised patches with white lines across

180
Q

Causes of apthous ulcers

A

Crohns
Behcets
Vitamin deficiencies- iron, B12
HIV

181
Q

Management of apthous ulcers

A

Can be managed without intervention
If moderate pain- bonjela (choline salicylate) or lidocaine
If severe discomfort- buccal steroids applied to ulcer

182
Q

3 causes of tongue angioedema to remember

A

Allergy
ACE inhibitor
C1 esterase deficiency

183
Q

Management of oral candidiasis

A

Nystatin suspension or miconazole gel

184
Q

Management of quinsy

A

Co amoxiclav
Incision and drainage or aspiration

185
Q

How does otitis media with effusion present

A

Muffled hearing

186
Q

What is fluid behind the tympanic membrane with bubbles

A

Otitis media with effusion

187
Q

What is main thing horiztonal nystagmus is seen in

A

Vestibular neuronitis
Labyrinthitis

Finals (29 decks)

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