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finals > ENT > Flashcards

ENT Flashcards

1
Q

function of semicircular canals

A

sense head movements

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2
Q

function cochlear

A

converts sound vibration -> nervous signal

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3
Q

webers test results

A

sensorineural loss = louder in normal ear
conductive loss = louder in affected ear

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4
Q

webers test

A

tuning fork in middle of forehead

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5
Q

rinnes test

A

air vs bone

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6
Q

rinnes test results

A

positive=normal=air conduction better
negative=bone conduction better=conductive cause

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7
Q

causes sensorineural hearin gloss

A

presbyacusis
noise exposure
menieres
labyrinthitis
acoustic neuroma
stroke
MS
tumour
meningiits
meds: loop diuretics, aminoglycoside abx, chemo

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8
Q

causes conductive hearing loss

A

wax
otitis media/externa
tumours
effusion
perforated tympanic membrane
otosclerosis
cholesteatoma
exostosis

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9
Q

audiometry symbols: X

A

L sided air conduction

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10
Q

audiometry symbols: O

A

R sided air conduction

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11
Q

audiometry symbols: ]

A

L sided bone conduction

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12
Q

audiometry symbols: [

A

R sided bone conduction

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13
Q

normal audiometry

A

all readings 0-20dB (top of chart)

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14
Q

sensorineural hearing loss audiometry

A

readings >20dB

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15
Q

conduction hearin gloss audiometry

A

air conduction (X, O) >20dB

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16
Q

mixed hearing loss audiometry

A

all readings >20dB and >15dB difference between bone and air (bone>air)

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17
Q

what is presbycusis

A

age-related hearin gloss
sensorineural

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18
Q

features presbycusis

A

gradual
high pitched sounds first
+/- tinnitus

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19
Q

cause presbycusis

A

due to hair loss cells in chochlear
loss neurons
atrophy stria vascularis
reduced endolymphatic potential

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20
Q

RF presbycusis

A

age
M
fhx
noise exposure
DM
HTN
smoking

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21
Q

mx presbycusis

A

hearing aids

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22
Q

causes sudden (<72hr) sensorineural hearin gloss

A

idiopathic
infection
menieres
meds
MS
migraine
stroke
acoustic neuroma
cogan’s syndrome (AI)

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23
Q

diagnosis sudden sensorineural heaing loss

A

loss >30dB in 3 consecutive frequencies

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24
Q

mx sensorineural hearing loss

A

emergency referral
steroids

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25
Q

role of eustachian tube

A

equalises pressure and drains fluid from middle ear

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26
Q

features eustachian tube dysfunction

A

reduced hearing
popping
full sensation
pain
tinnitus

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27
Q

ix eustachian tube dysfunction

A

tympanogram: peak admittance with negative ear canal pressures

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28
Q

mx eustachian tube dysfunction

A

none
valsalva
decongestants
antihistamines/steroid spray
surgery: grommets, balloon dilatation, eustachian tuboplasty

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29
Q

otosclerosis

A

remodelling malleus/incus/stapes
more common F <40y

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30
Q

features otosclerosis

A

conductive hearing loss
lower pitched sounds
tinnitus

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31
Q

mx otosclerosis

A

hearing aids
surgery: stapedectomy/stapedotomy

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32
Q

what is otitis media

A

infection middle ear

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33
Q

causes otitis media

A

strep pneumoniae
h.influenzae
moraxella catarrhalis
s.aureus

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34
Q

features otitis media

A

pain
reduced hearing
fever
bulging red tympanic membrane

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35
Q

mx otitis media

A

immediate abx if systemic sx
delayed abx or none if not
5-7d amoxicillin or clarithromycin

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36
Q

complications otitis media

A

otitis media with effusion
hearing loss
perforated tympanic membrane
labrinthitis
mastoiditis
abscess
facial nerve palsy
meningitis

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37
Q

causes otitis externa

A

bacterial: pseudomonas aeruginosa, staph aureus
fungal
eczema

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38
Q

features otitis externa

A

pain
discharge
itching
conductive hearing loss

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39
Q

mx otitis externa

A

mild=acetic acid
moderate=topical abx and steroid (neomycin, dex, acetic acid)

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40
Q

what abx is ototoxic

A

aminoglycoside
must exclude perforated tympanic membrane before topical use

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41
Q

malignant otitis externa

A

spreads to bones

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42
Q

RF malignant otitis externa

A

DM
immunocompromised
HIV

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43
Q

features malignant otitis externa

A

severe pain
headache
fever
granulation tissue in ear canal

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44
Q

mx malignant otitis externa

A

CT/MRI
IV abx

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45
Q

complications malignant otitis externa

A

facial nerve palsy
meningitis
intracranial thrombosis

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46
Q

features excess ear wax

A

conductive hearing loss
fullness
tinnitus

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47
Q

mx excess ear wax

A

drops (olive oil)
irrigation
microsuction

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48
Q

tinnitus

A

ringing or buzing in ears

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49
Q

cause tinnitus

A

background sensory signal produced by cochlear

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50
Q

causes tinnitus

A

primary=none
secondary=wax, infection, menieres, noise, meds, acoustic neuroma, MS, trauma, depression

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51
Q

what conditions is tinnitus associated with

A

anaemia
DM
thyroid
high lipids

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52
Q

what is objective tinnitus

A

the sound is caused by carotid artery or aortic stenosis, arteriovenous malformations, eustachian tube dysfunction

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53
Q

ix tinnitus

A

FBC
glucose
TSH
lipids audiology

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54
Q

tinnitus red flags

A

unilateral
pulsatile
hyperacusis
unilateral hearing loss
sudden hearing loss
vertigo
headaches
visual changes
neuro sx
suicidal ideation

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55
Q

mx tinnitus

A

hearing aids
sound therapy CBT

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56
Q

what is vertigo

A

patient feels like they or the room is moving

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57
Q

peripheral causes vertigo

A

vestibular system: BPPV, menieres, vestibular neuronitis, labyrinthitis

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58
Q

central causes vertigo

A

brainstem/cerebellum: posterior circulation infarct, tumour, MS, vestibular migraine

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59
Q

peripheral vs central vertigo

A

perioheral: sudden onset, short, tinnitus nausea
central: gradual onset, persistant, coordination impaired

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60
Q

O/E in vertigo

A

HINTS
head impulse (jerk head and eyes soccade) positive in peripheral
nystagmus: positive in central
test of skew (cover eye and verticle correction): positive in central

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61
Q

ix vertigo

A

if central cause suspected need CT/MRI

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62
Q

mx vertigo

A

tx cause
short term for peripheral: prochlorperazine, antihistamines

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63
Q

benign paroxysmal positional vertigo cause

A

displaced otoconia (calcium carbonate) into semicircular canals which disrupts flow endolymphs

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64
Q

features BPPV

A

vertigo due to head movements
no tinnitus

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65
Q

diagnosis BPPV

A

dix hallpike manoevre (triggers sx)

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66
Q

mx BPPV

A

epley manoevre
brandt-daroff exercises

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67
Q

vestibular neuronitis

A

inflammation vestibular nerve due to viral infection

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68
Q

features vestibular neuronitis

A

URTI
vertigo
N+V
balance problems
NO HEARING LOSS

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69
Q

mx vestibular neuronitis

A

prochlorperazine
cyclizine
vestibular rehab

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70
Q

inner ear

A

bony labyrinth
semicircular canals
vestibule
cochlea

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71
Q

labyrinthitis

A

inflammation inner ear

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72
Q

cause labyrinthitis

A

viral URTI

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73
Q

features labyrinthitis

A

acute onset vertigo
hearing loss
tinnitus

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74
Q

mx labyrinthitis

A

up to 3d prochlorperazine or cyclizine
abx if bacterial

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75
Q

menieres

A

build up of endolymph in labyrinth

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76
Q

features menieres

A

unilateral sensorineural hearing loss
vertigo (in clusters)
tinnitus
drop attacks
imbalance

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77
Q

mx menieres

A

acute attacks=prochlorperazine, cyclizine
prophylaxis=betahistine

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78
Q

acoustic neuroma

A

=vestibular schwannoma
benign tumour schwann cells surrounding the auditory nerve
occur at cerebellopontine angle

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79
Q

bilater acoustic neuroma

A

neurofibromatosis type II

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80
Q

features acoustic neuroma

A

40-60y
unilateral sensorineural hearing loss and tinnitus
dizziness/imbalance
fulless in ear
+/- facial nerve palsy

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81
Q

mx acoustic neuroma

A

conservative
surgery
radiotherapy

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82
Q

cholesteatoma

A

abnormal squamous epithelial cells in middle ear
non cancerous but locally invasive

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83
Q

features cholesteatoma

A

foul discharge
unilateral conductive hearing loss
infection
pain
vertigo
facial nerve palsy

84
Q

ix cholesteatoma

A

otoscopy=white debris/crust in tympanic membrane
CT

85
Q

mx cholesteatoma

A

surgery

86
Q

divisions facial nerve

A

temporal
zygomatic
buccal
marginal manddibular
cervical

87
Q

facial nerve function

A

motor: facial expressio, stapedius, posterior digastric, stylohyoid, platysma
sensory: taste to anterior 2/3 tongue
parasymp: submandibular and sublingual salivary glands, lacrimal gland

88
Q

features UMN facial nerve lesion

A

forehead spared

89
Q

cause UMN facial nerve lesion

A

stroke
tumour

90
Q

features LMN facial nerve lesion

A

forehead not spared

91
Q

cause LMN facial nerve lesion

A

bells palsy
ramsay hunt
infection: otitis media, HIV, lyme disease
systemic: DM, sarcoid, leukaemia, MS, guillain barre
tumour: acoustic neuroma, parotid, cholesteatoma
traum

92
Q

mx bells palsy

A

pred within 72h
lubricating eye drops
recovery can take 12m, 1/3 have residual weakness

93
Q

cause ramsay hunt syndrome

A

VZV

94
Q

features ramsay hunt syndrome

A

unilateral LMN VII palsy
vesicualr and painful rash around ear

95
Q

mx ramsay hunt syndrome

A

pred/aciclovir
lubricating eye drops

96
Q

where does epistaxis commonly come from

A

kiesselbacks plexus in litttles area

97
Q

mx epistaxis

A

squeeze nostrils and head forward
not stopped after 15m=nasal tampon or cautery with silver nitrate stick
naseptin (chlorhex and neomycin) for 10d to reduce inflammation and infeection

98
Q

paranasal sinuses

A

frontal
maxillary
ethmoid
sphenoid

99
Q

causes sinusitis

A

infection: viral URTI
allergy
obstruction
smoking

100
Q

features sinusitis

A

nasal congestion and discharge
facial pain/pressure/swelling
headache

101
Q

mx acute sinusitis

A

nothing for first 10d, then steroid nasal spray (mometasone) 14d or abx if bacterial (phenoxymethylpenicillin)

102
Q

mx chronic sinusitis

A

saline nasal irrigation
steroid nasal spray
functional endoscopic sinus surgery

103
Q

unilateral nasal polyps

A

RED FLAG

104
Q

bilateral nasal polyps associations

A

chroni rhinitis/sinusiits
asthma
CF
churg strauss
snoring

105
Q

mx nasal polyps

A

steroid drops/spray
surgery

106
Q

samters triad

A

nasal polyps
asthma
aspirin intolerance/allergy

107
Q

what happens in obstructive sleep apnoea

A

collapse pharyngeal airway

108
Q

RF obstructive sleep apnoea

A

age
M
obese
alcohol
smoking

109
Q

features obstrutive sleep apnoea

A

apnoea
snoring
daytime sleepiness
reduced oxygen sats in sleep

110
Q

what can obstrutive sleep apnoea lead to

A

HTN
HF
risk MI, stroke

111
Q

ix obstructive sleep apnoea

A

epworth sleepiness scale=daytime sleepines
sleep studies

112
Q

mx obstrutive sleep apnoea

A

ENT/sleep clinic
CPAP
uvulopalatopharyngiplasty

113
Q

causes tonsilitis

A

group A strep - pyogenes
strep pneumoniae
h.influenzae
morazella catarhallis
staph aureus

114
Q

waldeyers tonsillar ring

A

adenoids
tubal tonsils
palatine tonsils
lingual tonsils

115
Q

what is usually affected in tonsilitis

A

palatine tonsils

116
Q

features tonsilitis

A

sore throat
fever
swallowing pain
anterior cervical lymphadenopathy

117
Q

centor criteria

A

likelihood tonsilits is bacterial
fever >/= 38, tonsillar exudates, no cough, anterior lymphadenopathy

118
Q

interpreting centor criteria

A

> /= 3 likely bacterial tonsilitis

119
Q

fever PAIN score

A

likelihood bacterial

fever within 24h
purulence
attended within 3d sx
inflammed tonsils
no cough or coryza

120
Q

interpreting fever pain score

A

likely bacterial if >/= 4

121
Q

mx tonsilitis

A

pnehoxymethylpenicillin (or clarithromycin) if centor >/= 3 or fever pain >/= 4

122
Q

complications tonsilitis

A

quinsy
otitis media
scarlet fever
rheumatic fever
post strep glomerulonephritis
post strep reactive arthritis

123
Q

quinsy

A

peritonsillar abscess

124
Q

causes quinsy

A

strep pyogenes
staph aureus
h influenzae

125
Q

features quinsy

A

tonsillitis ->
trismus (cant open mouth), hot potato voice, swelling and erythema around tonsils

126
Q

mx quinsy

A

ENT refer
needle aspiration +/- dex and abx (co-amox

127
Q

indications for tonsillectomy

A

episodes sore throat:
>/= 7 / yr for 1yr
>/= 5 /yr for 2yr
>/= 3 / yr for 3yr
2 tonsillar abscesses
tonsils cause difficulty breathing

128
Q

complications tonsillectomy

A

sore throat
damage to teeth
infection
post tonsillectomy bleeding

129
Q

mx post tonsillectomy bleeding

A

emergency
IV access
hydrogen peroxide gargle
adrenaline swab
theatre

130
Q

anterior triangle

A

mandible=superior
midline neck=medial
sternocleidomastoid=lateral

131
Q

posterior triangle

A

clavicle=inferior
trapezius=posteriir
sternocleidomastoid=lateral

132
Q

neck lump differencital

A

abscess
lymphadenopathy
tumour
lipoma
goitre
salivary gland stones/infeection
carotid body tumour
haematoma
thyroglossal cyst
branchial cyst
children: cystic hygroma, dermoid cyst, haemangioma, venous malformation

133
Q

2ww for neck lump

A

unexplained >45y
persistant lump at any age

for USS

134
Q

carotid tumour

A

excessive growth glomus cells above carotid bifurcation

135
Q

features carotid tumour

A

painless
pulsatile
bruit
may compress CN IX/X/XI/XII or sympathetic NS ->horners

136
Q

ix carotid tumour

A

imaging=splaying-lyre sign

137
Q

features thyroglossal cyst

A

move up and down with tongue
midline
mobile soft

138
Q

branchial cyst formation

A

from 2nd branchial cleft

139
Q

features branchial cyst

A

> 10y
round and soft between angle of jaw and sternocleidomastoif (ant triangle)

140
Q

mx branchial cyst

A

none
surgery

141
Q

head and neck cancer

A

usually SCC

142
Q

where does head and neck cancer spread

A

lymph nodes

143
Q

RF head and neck cancer

A

smoking
chewing tobacco/betel quid
alcohol
HPV
EBV

144
Q

features head and neck cancer

A

lump
ulcer
hoarse voice
erythoplakia

145
Q

mx head and neck cancer

A

surgery
chemo
radio
cetuximab

146
Q

glositis

A

inflamed red tongue

147
Q

causes glositis

A

iron/B12/folat defiency
coeliac
injury

148
Q

causes angiodema

A

allergic rxn
ACE i
hereditary: CI esterase inhibitor deficiency

149
Q

RF oral candidiasis

A

inhaled corticosteroids
abx
DM
HIV
smoking

150
Q

mx oral candidiasis

A

miconazole gel
nystatin suspension
fluconazole tablet

151
Q

geographic tongue

A

patches of epithelium and papillae lost

152
Q

causes geographic tongue

A

none
stress
psoriasis
atopy
DM

153
Q

features strawberry tongue

A

red
swollen
enlarged white palpillae

154
Q

causes strawberry tongue

A

scarlet fever
kawasaki

155
Q

black hairy tongue

A

reduced shedding of keratin leading to elongated papillae which bacteria and food cause dark pigmentayion

156
Q

features black hairy tongue

A

dark pigmentation
sticky saliva
metallic taste

157
Q

cause black hairy tongue

A

dehydration
poor hygiene
smoking

158
Q

mx black hairy tongue

A

hydrate
hygiene

159
Q

leukoplakia

A

raised white hairy patches in mouth
increased risk SCC

160
Q

mx leukoplakia

A

biopsy and excision

161
Q

erythroplakia

A

red lesions in mouth

162
Q

erythroleukoplakia

A

red and white lesions in mouth

163
Q

mx erythroplakia and erythroleukplakia

A

need to exclude SCC - biopsy

164
Q

cause lichen planus

A

AI
inflammation

165
Q

features reticular lichen planus

A

wickhams striae
erosive
plaques

166
Q

mx lichen planus

A

hygiene
topical steroid

167
Q

gingivitis

A

gum inflammation

168
Q

features gingivitis

A

swelling
bleeding
halitosis
can lead to periodontitis ->teeth loss

169
Q

RF gingivitis

A

poor hygiene
smoking
DM
malnutrition
stress

170
Q

features acute necrotising ulcerative gingivitis

A

rapid onset
pain

171
Q

causes acute necrotising ulcerative gingivitis

A

anaerobic bacteria

172
Q

gingival hyperplasia

A

abnormal growth of gums

173
Q

causes gingival hyperplasia

A

gingivitis
pregnancy
Vit C deficeincy
AML
meds: CCB, phenytoin, ciclosporin

174
Q

aphthous ulcers features

A

small
painful
white
well punched out

175
Q

cause aphthous ulcers

A

none
IBD
coeliac
behcets
iron/B12/folate/vit d deficiency
HIV

176
Q

mx aphthous ulcers

A

none
topical: bonjela (choline salicylate), lidocaine, steroids
2ww if unexplained and been there for 3w

177
Q

head and neck red flags

A

dysphagia, odynophagia, dysphonia, wt loss, spitting blood, unilateral nasal obstruction, neck mass

178
Q

RF head and neck malignancy

A

SMOKING
alcohol, beta nut, HPV

179
Q

when to urgently refer mouth ulcers (red flag0

A

ulcer present for over 3w
persistent lump on lip
persistent red white lesions consistent with cancer

180
Q

when to urgently refer for dysphonia

A

persistent >/= 3w as potential SCC

181
Q

mx dysphonia

A

voice rest
steam inhalation
hydration
lifestyle
PPI

182
Q

unilateral tonsil enlargement

A

RED FLAG
adult=SCC
children=lymphoma (v rare)

183
Q

where may unilateral otalgia be referred from?

A

throat

184
Q

when to refer sore throat

A

routine ENT referral if persists for 6w and no improvement/new sx

185
Q

globus pharyngeus

A

sensation of lump in throat

186
Q

most common parotid masses

A

warthins: M>60y, bilateral, benign
pleomorphic adenoma: F, middle aged, removed as may turn malignant

187
Q

sialadenitis

A

infection salivary gland
old, dehydrated
mx: hydrate +/- abx

188
Q

shape of nodes in lymphoma

A

round

189
Q

shape of nodes reactive lymphadenopathy

A

oval

190
Q

neck lump clinic

A

hx
examination
USS
fine needle aspiration

191
Q

unilateral nasal obstruction

A

child: foreign body
teenage boy: juvenile angiofibroma (unilateral nosebleed)
adult: sinusoidal malignancy (blood dicharge)

192
Q

chinese and malaysian q stem stereotype

A

sinonasal malignancy due to ebv
(higher incidence in chinese)

193
Q

nasal polyposis

A

associated with allergic rhinitis
painless, reduced smell and taste
tx with intranasal steroids -> ENT for oral steroids

194
Q

predisposing factors to otitis externa

A

water
cotton buds
eczema

195
Q

fungal otitis externa

A

usually after systemic abx tx
black hyphae
canestan drops and clean

196
Q

malignant otitis externa

A

spread to bone
nerve palsys: VII first
need IV abx

197
Q

when to refer otitis externa

A

no response to tx
canal oedematous
needs aural toilet
suspicion invasive OE

198
Q

subperichondrial haematoma

A

trauma
needs aspiration or leads to cauliflower ear (fibrosis)

199
Q

foreign body in ear/nose

A

only 1 attemt at removal before urgent referral
dont use forceps for round things
can syringle with warm water

200
Q

nasal # mx

A

exclude other injuries
analegesia
routine referral (5-7d) if obvious deformity as need time for swelling to decrease, however hard to manipulate after 2-3 w(rhinoplasty needed)
urgernt referral if septal haematoma

201
Q

acute sinusitis complications

A

extracranial: orbital celluliits, potts puffy tumour (frontal sinusitis bursts forward)
intracranail: meningitis, brain abscess, cavernous sinus thrombosis

202
Q

preseptal celluliits progression

A

->orbital cellulitis->subperiosteal abscess->intraorbital abscess-> cavernous sinus thrombosis

203
Q

cause parotitis

A

elderly
paramyxovirus

204
Q

mx parotitis

A

metronidazole, fluclox, hydrate, pineapple

205
Q

deep neck space infection

A

increasing incidence
mixed organisms

206
Q

mx deep neck space infection

A

neck and chest CT
broad spectrum ab
surgical drainage
maintain away

finals (31 decks)

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