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SBA passmed Flashcards > ENT > Flashcards

ENT Flashcards

1
Q

what are red flag symptoms of rhinosinusitis

A

Unilateral symptoms
Persistent symptoms despite compliance with 3 months of treatment
epistaxis

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2
Q

what is the criteria for urgent referral of hearing loss

A

Sudden onset ( over 3 days or less) unilateral / bilateral hearing loss occured within past 30 days with no external / middle ear causes

Unilateral hearing loss + focal neurology

hearing loss + head/ neck injury
hearing loss + severe infection ( Necrotising Otitis Externa/ Ramsay Hunt syndrome)

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3
Q

What scan is done on urgent referral to ENT for hearing loss ? what condition is it trying to investigate?

A

MRI, Vestibular Schwannoma

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4
Q

air conduction louder than bone conduction suggests which type of hearing loss

A

Sensorineural hearing loss

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5
Q

how is Quinsy managed

A

IV Antibiotics and surgical drainage

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6
Q

give 5 features of viral labyrinthitis

A

sudden onset horizontal nystagmus
hearing disturbances
nausea
vomiting
vertigo

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7
Q

which type of hearing loss does ear wax cause

A

conductive hearing loss

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8
Q

what is the first line management of impacted ear wax

A

olive oil drops followed by ear syringing

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9
Q

what is a benign tumor of the parotid gland known as

A

Pleomorphic adenoma

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10
Q

what are 2 clinical features of a Pleomorphic adenoma

A

gradual onset, painless unilateral swelling of parotid gland
movable on examination

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11
Q

what is Samter’s triad

A

Asthma
aspirin sensitivity
nasal Polyposis

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12
Q

what is a red flag indication in Nasal polyps

A

unilateral polyps

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13
Q

name 6 conditions that can lead to Nasal polyps

A

Asthma
Aspirin sensitivity
Infectivity sinusitis
CF
Kartagener’s syndrom
Churg Strauss syndrome

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14
Q

give 3 features of nasal polyps

A

nasal obstruction
rhinorrhoea, sneezing
poor sense of taste and smell

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15
Q

following referral to ENT , patients with sudden onset sensorineural hearing loss are treated with ____________

A

high dose oral corticosteroids

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16
Q

what is a Rinne’s positive

A

air conduction better than bone conduction - as is in a healthy individuals and individuals with significant sensorineural hearing loss

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17
Q

what is a normal weber’s test

A

sound is heard equally in both ears

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18
Q

what is a sign of sensori-neural hearing loss on Weber’s test

A

sound is heard louder on the side of the intact ear ( opposite to affected one)

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19
Q

what is a sign of conductive hearing loss on Weber’s test

A

sound is heard louder on the side of affected ear

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20
Q

when is Rinne’s test negative

A

conducting hearing loss

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21
Q

what is the management of patients with nasal polyps

A

ENT referral and topical steroids

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22
Q

what is an alternative for phenoxymethylpenicillin for a bacterial sore throat

A

Clarithromycin

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23
Q

_________ is an example of conductive hearing loss associated with chronic smelly ear discharge and history of glue ear

A

Cholesteatoma

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24
Q

what is presbycusis

A

age related Sensorineural hearing loss

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25
Q

what is the nature of inheritance of otosclerosis

A

Autosomal dominant

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26
Q

when is the onset of otosclerosis? give 3 features and 1 clinical sign

A

conductive deafness
tinnitus
positive fhx
- flamingo tinge to tympanic membrane

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27
Q

give 4 drugs that can cause deafness

A

Aminoglycosides ( Gentamicin)
Furosemide
aspirin
cytotoxic agents

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28
Q

how do you manage auricular haematomas

A

same day assessment for ENT

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29
Q

what is the most common cause of sudden onset sensorineural hearing loss

A

idiopathic

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30
Q

which swelling most suggests malignancy of cervical lymph nodes

A

enlarged supra-clavicular nodes

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31
Q

what is the first line investigation for Mono

A

Monospot test

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32
Q

name a monoclonal antibody used in the management of squamous cell carcinomas of head and neck

A

cetuximab

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33
Q

which strain of HPV is linked with oral cancer

A

Strain 16

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34
Q

next step in management of persistent mouth ulcer

A

refer under 2 week wait

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35
Q

what sign is indicative of a positive Dix- Hallpike manouvre

A

Rotatory nystagmus

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36
Q

what is an important complication of nasal trauma

A

Nasal septal haematoma

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37
Q

what is the classical sign of a nasal septal haematoma

A

bilateral red swelling arising from nasal septum

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38
Q

what is the management of nasal septal Haematoma

A

Surgical drainage and IV Abx

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39
Q

what is a complication of nasal septal haematoma ? which deformity can it result in

A

irreversible septal necrosis leading to saddle nose deformity

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40
Q

which people commonly present with auricular haematomas

A

rugby players, wrestlers

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41
Q

what type of cyst moves upwards with tongue protrusion

A

thyroglossal cyst

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42
Q

what is ‘’ double sickening’’ ? What condition is it associated with ?

A

initial period of recovery followed by a sudden worsening of symptoms , Bacterial sinusitis

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43
Q

what is the main significant complication of a tonsillectomy

A

bleeding

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44
Q

In which patients is malignant otitis externa most common

A

diabetes

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45
Q

what organism causes malignant Otitis externa

A

Pseudomonas Aeruginosa

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46
Q

what is a complication of malignant otitis externa

A

temporal bone osteomyelitis

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47
Q

what investigation is done to diagnose malignant otitis externa

A

CT Scan

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48
Q

which neurological sign can malignant otitis externa precipitate

A

facial nerve dysfunction

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49
Q

give 3 features of malignant Otitis Externa

A

severe Otalgia
temporal headache
purulent otorrhoea
dysphagia, hoarseness

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50
Q

what is the management of malignant Otitis Externa

A

refer non-resolving –> ENT
IV Abx to cover Pseudomonal infections

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51
Q

how is Otosclerosis managed

A

hearing aid
Stapedectomy

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52
Q

what is the management of Ramsay Hunt syndrome

A

Oral aciclovir
Corticosteroids

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53
Q

what is the initial management of vestibular neuronitis

A

Buccal / IM Prochlorperazine

54
Q

what pattern of hearing loss is seen in Presbycusis

A

Bilateral sensori-neural pattern hearing loss

55
Q

what is the management of recurrent / chronic sinusitis

A

avoid allergen
Intra-nasal Corticosteroids
nasal irrigation with saline

56
Q

give 3 contraindications for consideration of cochlear implant

A
  • Chronic Infective Otitis media / mastoid cavity/ tympanic membrane perforation
  • lesions of cranial nerve VIII / or in Brainstem causing deafness
  • cochlear Aplasia
57
Q

give 4 causes of gingival hyperplasia

A

phenytoin
ciclosporin
CCB’s such as nifedipine
AML

58
Q

what is the most common cause of a perforated tympanic membrane

A

infection

59
Q

what is the management of tympanic membrane rupture

A

self resolving in 6-8 weeks

60
Q

what is the management of tympanic membrane perforation if membrane does not heal by itseld

A

Myringoplasty

61
Q

give 4 complications of tonsillitis

A

otitis media
quincy
rheumatic fever
glomerulonephritis

62
Q

otitis media with effusion is also known as _______.

A

Glue ear

63
Q

what is the commonest cause of conductive hearing loss of in childhood

A

Glue ear

64
Q

which test can be used to distinguish vestibular from posterior circulation stroke

A

HiNTs

65
Q

What is the criteria used to diagnose Otitis media

A

Presence of middle ear effusion
Otalgia / ear tugging
inflammation of tympanic membrane

66
Q

which area is a common site for Epistaxis to originate and why

A

Little’s area in the nasal septum because it is the confluence of 4 arteries

67
Q

management of epistaxis where bleed site is difficult to localise

A

Anterior packing

68
Q

which infection can occur following cat scratch

A

bartonella infection

69
Q

which exercises can be performed by a patient at home to treat BPPV

A

Brandt daroff exercises

70
Q

how is otitis media with perforation managed

A

5-7 day course of amoxicillin

71
Q

how is otitis externa managed in a patient with diabetes

A

ciprofloxacin ear drops

72
Q

4 features of mastoiditis

A

otalgia
fever
protruding ear
post-auricular tenderness

73
Q

what is the first line treatment of otitis externa

A

Topical antibiotic and topical steroid for 1-2 weeks

74
Q

give 3 common bacterial causes of otitis media

A

streptococcus pneumoniae
H. influenzae
Moraxella Catarrhalis

75
Q

what type of hearing loss is presbycusis

A

sensorineural deafness

76
Q

what is the first line treatment of acute sinusitis

A

analgesia and intranasal decongestants

77
Q

what are the conditions for prescription of intranasal corticosteroids in the management of acute sinusitis

A

symptoms need to have been present for 10 days

78
Q

tonsillar SCC is associated with which infection

A

HPV

79
Q

unilateral middle ear effusion can be a presenting symptoms of _______________

A

nasopharyngeal cancer

80
Q

give the three most common causes of acute otitis media

A

Strep. Pneumonia
Haemophilus Influenzae
Moraxella Catarrhalis

81
Q

under what circumstances would you prescribe antibiotics for acute otitis media

A

<2 with bilateral infection
symptoms lasting > 4 days and not improving
systemic signs
immunocompromise
Otitis media with perforation / discharge

82
Q

what is the initial management for epistaxis

A

adequate first aid - pinch nostrils firmly and lean forward for 20 minutes

83
Q

how do you manage epistaxis if first aid provided for 10-15 mins does not work

A

cautery : if source of bleed is visible
packing : if bleeding point cannot be visualised

84
Q

how do you manage epistaxis that has failed all emergency management

A

Ligation of the sphenopalatine artery in theatre

85
Q

name 4 medications that can cause tinnitus

A

Aspirin / NSAIDs
aminoglycosides
quinine
loop diuretics

86
Q

what are the referral guidelines for suspected laryngeal cancer

A

consider referral to ENT for those 45 and over with -

persistent unexplained hoarseness
unexplained neck lump

87
Q

what is the first line management of otitis externa

A

topical antibiotic or combined topical antibiotic with a steroid

88
Q

what is the prophylaxis of Meniere’s disease

A

Betahistine and Vestibular rehabilitation

89
Q

which medications cause ototoxicity

A

Furosemide
Aminoglycoside
Vancomycin
Quinine
Aspirin
Cisplatin

FAVQAC

90
Q

what is the stepwise management of glue ear ?

A
  1. Active observation ( first presentation) for 3 months - unresolving then refer to ENT

** refer immediately to ENT if Down syndrome, Cleft palate

  1. Grommet insertion
  2. Adenoidectomy
91
Q

what is the pathophysiology + symptoms of sialolithiasis

A

stones in submandibular gland blocking duct of Wharton

discomfort while eating
postprandial swelling

92
Q

what is the most common parotid malignancy

A

Benign pleomorphic adenoma

93
Q

what is the second most common benign parotid tumour

A

Warthin’s tumour

94
Q

which parotid disorders might cause facial paralysis

A

Sarcoidosis
Parotitis
Adenoid cystic adenoma
sialadentitis
mucoepidermoid carcinoma

SPASM

95
Q

how does glue ear normally present ?

A

hearing loss
peaks at age of 2
secondary problems such as speech and language delay, behavioural or balance problems may also be seen

96
Q

what is the most common cause of sudden sensorineural hearing loss? What investigations are performed? How is it managed?

A

majority of cases - idiopathic
MRI scan generally performed
High dose corticosteroids

97
Q

what are the key features of vestibular neuronitis ?

A

recurrent vertigo, nausea and vomiting
horizontal nystagmus
NO HEARING LOSS / TINNITUS

98
Q

what is the acute and chronic management of vestibular neuronitis

A

acute : buccal / IM prochlorperazine

chronic : vestibular rehabilitation exercise

99
Q

what is the cause of black hairy tongue? what are its predisposing factors? how is it investigated and management?

A

occurs due to defective desquamation of the filiform papillae.
predisposing factors include : poor oral hygiene, abx, HIV, IVDU
tongue should be swabbed for Candida
management is by tongue scraping / topical antifungals

100
Q

what does the Centor criteria include?

A

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

101
Q

what is the fever pain score?

A

Fever
Purulent tonsils
attend rapidly ( 3 days / less)
Inflamed tonsils
No cough / coryza

102
Q

what are the symptoms of Meniere’s disease?

A

recurrent episodes of vertigo, tinnitus and sensorineural hearing loss.
sensation of aural fullness
unilateral symptoms

103
Q

how does a branchial cyst present ? How is it different from a thyroglossal cyst ?

A

Smooth, fluctuant, non-tender, non translucent mass located anterior to left sternocleidomastoid muscle that does not move on tongue protrusion. Contains cholesterol crystals.

Thyroglossal cysts are typically midline and move with tongue protrusion.

104
Q

what is Ludwig’s angina ? How does it present ? How is it managed?

A

Form of progressive cellulitis that invades the floor of the mouth / soft tissues of the neck. Usually due to odontogenic infections.

Features include :

neck swelling
dysphagia
fever

management is emergency - airways, IV Abx

105
Q

what are the features of allergic rhinitis ?

A

sneezing
bilateral nasal obstruction
clear nasal discharge
post nasal drip
nasal pruritis

106
Q

what is the management of allergic rhinitis?

A

allergen avoidance
oral / intranasal antihistamines if there are mild / moderate symptoms
intranasal corticosteroids if patient has moderate / severe symptoms

107
Q

what are the side effects of topical nasal decongestants such as oxymetazoline

A

increasing doses required to meet same requirements - tachyphylaxis
rebound hypertrophy of nasal mucosa ( rhinitis medicamentosa)

108
Q

what are the complications of a thyroidectomy?

A

anatomical : recurrent laryngeal nerve damage
bleeding
hypocalcaemia causing QT elongation

109
Q

how is otitis media with perforated tympanic membrane managed

A

antibiotics

110
Q

what are the guidelines for a 2 week wait referral for oral cancer?

A
  • unexplained ulceration for > 3 weeks
  • persistent / unexplained neck lump
  • lump on lip
  • red / white patch in oral cavity consistent with erythroplakia / erythroleukoplakia
111
Q

what is the main complication of a tonsillectomy? How is it managed depending on the timeline?

A

Haemorrhage
first 6-8 hours : Immediate return to theatre
5-10 days post surgery : admission and antibiotics

112
Q

how do you manage bleeding and stridor post thyroid surgery

A

urgent removal of sutures
call for help
this is due to risk of respiratory compromise due to laryngeal oedema

113
Q

what are the causes of sensorineural hearing loss

A

Sudden
Meniere’s
Noise
labyrinthitis
acoustic neuroma
medications
neurological conditions
infections

114
Q

what are the causes of conductive hearing loss

A

ear wax
infection
fluid
eustachian tube dysfunction
choleastoma
tumours

115
Q

what is the DVLA advice surrounding Meniere’s disease

A

cease driving until satisfactory control of symptoms is achieved

116
Q

how does a cystic hygroma generally presents?

A

congenital lymphatic lesion typically found in the neck on the left side. Generally trans illuminates and sacs are fluctuant

117
Q

recurrent otitis externa despite numerous antibiotic treatment should raise suspicion for __________

A

Candida

118
Q

what is the key feature of peritonsillar abscess

A

deviation of uvula towards unaffected side

119
Q

How does vertebrobasilar ischaemia present?

A

elderly patient with dizziness on extension of the neck

120
Q

how does otitis externa present on otoscopy

A

red, swollen or eczematous canal

121
Q

how would you distinguish warthin’s tumour from pleomorphic adenoma

A

pleomorphic adenoma is slow growing and benign whereas Warthin’s tumour presents with nearby structure invasion, skin ulceration, skin tethering

122
Q

what is sialadenitis and how does it present

A

inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct causing tender mass and foul taste

123
Q

how does nasopharyngeal carcinoma generally present

A

painless lymphadenopathy in the posterior triangle of the neck

124
Q

what initial investigation needs to be performed when investigating someone for hoarseness ?

A

chest xray

125
Q

how is labyrinthitis different from vestibular neuronitis?

A

labyrinthitis is when both the vestibular nerve and the labyrinth are both involved, whereas only the vestibular nerve is involved in vestibular neuronitis.

126
Q

what are the symptoms of labyrinthitis

A

vertigo
N+V
Hearing loss
tinnitus

127
Q

what are the signs of labyrinthitis

A

spontaneous unidirectional nystagmus towards unaffected side
sensorineural hearing loss
abnormal head impulse
gait disturbance

128
Q

what does a typical BPPV history contain

A

vertigo triggered by change in head position
nausea
each episode lasting 10-20 seconds

129
Q

what is a cholesteatoma ? What are it’s main features ? How does it present on otoscopy and how would you manage it?

A

It is a non-cancerous growth of squamous epithelium that is trapped within the skull base causing local destruction.

Main features include :

foul smelling, non resolving discharge
hearing loss

vertigo, facial nerve palsy and cerebellopontine angle syndrome may also be present.

otoscopy shows : attic crust

management

refer to ENT for surgical removal

130
Q

what is a RF for choleastoma?

A

cleft palate

131
Q
A

SBA passmed Flashcards (30 decks)

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