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PLAB > ENT > Flashcards

ENT Flashcards

1
Q
  • vertigo lasting < 30 seconds
  • on changing head position/rolling over bed
  • geotropic rotatory nystagmus, fatigue able
  • nausea
  • no hearing loss
  • no tinnitus

Diagnosis?
Structure affected?

A

BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

structure affected: posterior semi-circular canal.

Test: Dix Hallpike Maneuver positive.

MX
- Epley’s maneuver (reposition otoliths)
- Brandt- Daroff exercise at home
- no need for medications

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2
Q

chalky white patches seen on eardrum.

Diagnosis?

A

TYMPANOSCLEROSIS

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3
Q
  • recent pregnancy
  • increasing hearing loss unilateral
  • bone conduction better than air conduction
  • Weber’s test lateralizes to same ear.

Diagnosis?

A

OTOSCLEROSIS

pregnancy accelerates progression.

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4
Q
  • vertigo lasting few hours
  • not provoked by movements
  • tinnitus
  • hearing loss
  • feeling of pressure/fullness
  • nausea/vomiting
  • MRI normal
A

MENIERE’S DISEASE

Perform audiometry in clinic before ROUTINE REFERRAL

MX
- buccal or IM prochlorperazine
- other: cyclizine, cinnarizine, promethazine
- prevention of attack: betahistine TID for 3 months

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5
Q
  • has tonsilitis/recent URTI
  • cervical LN
  • red bulging TM
  • light reflex absent
  • fever
  • ear pain FOLLOWED by discharge
  • vomiting

Diagnosis?

A

ACUTE OTITIS MEDIA

MX
no need antibiotics unless:
- less than 2 yrs old bilateral complaint
- severe case
- discharge after perforation (Mx: reassure and review in 6 weeks + antibiotics&raquo_space;> if not healed then&raquo_space; tympanoplasty)

  • Amoxicillin
  • if allergic: erythromycin/clarithromycin
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6
Q
  • child increasing TV volume
  • does not respond to parents calling them
  • withdrawal in school
  • lack of concentration
  • bone conduction better than air conduction in both ears

Diagnosis?

A

OTITIS MEDIA WITH EFFUSION

RISK FACTOR: parental smoking

otoscope: dull grey tympanic membrane, air fluid level, absence of light reflex, retracted TM

Tests:
- Audiometry
- Tympanometry

MX
1st: Reassure and review in 3 months.
2nd: if persists for more than 3 months > grommets.
3rd: hearing aids

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7
Q
  • unilateral pain
  • headache
  • foul smelling discharge
  • post auricular swelling and erythema
  • fever
  • loss of post auricular sulcus

Diagnosis?
Management?

A

MASTOIDITIS

MX
- Iv antibiotics immediately
- CBC, CRP, ear discharge swab
- after 24 hrs if no improvement/abscess suspected > contrast CT scan of petrous bone and brain
- Mastoidectomy

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8
Q
  • hx of trauma to nose
  • difficulty breathing
  • nasal pain
  • fever

Diagnosis?

A

NASAL SEPTAL ABSCESS

MX
-Incision and drainage of septal hematoma to prevent abscess formation

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9
Q
  • hx of sore throat and dysphagia
  • unilateral bulge lateral to tonsil
  • soft palate swelling with exudates
  • drooling
  • difficulty opening mouth due to trismus
  • hot potato voice
  • uvular deviation

Diagnosis?
Mangement?

A

PERITONSILLAR ABSCESS - QUINCY

MX
- Urgent admission
- Iv antibiotics (IV Benzylpenicillin)
- Aspiration for culture
- if no improvement in 24 hrs&raquo_space;> I and D

  • don’t choose referral to ENT as option&raquo_space; will delay management leading to deep neck space infections
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10
Q
  • hx of URTI
  • vertigo
  • no hearing loss

Diagnosis?

A

VESTIBULAR NEURITIS

MX
- oral/buccal/IV prochlorperazine

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11
Q

Wax obstruction

Management?

A

1st: give olive oil drops/almond oil/ Nacl drops/ sodium bicarbonate 5% drops for 3-5 days.

2nd: Irrigation

If unsuccessful > continue drops for 3-5 days more then try irrigation again.

Instill water, wait 15 mins and then irrigate.

refer to ENT.

Some patients go to private clinics for micro suction (much safer than irrigation)

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12
Q
  • midline neck mass
  • moves on tongue protrusion

Diagnosis?

A

THYROGLOSSAL CYST

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13
Q
  • recurrent sinusitis

Gold standard investigation?

A

4 or more episodes in 1 year

Best investigation: CT of head and sinuses

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14
Q
  • dysphagia
  • hx of smoking/alcohol
  • oral lesion with central ulceration that bleeds on touch at palatine tonsil
  • long time sore throat
  • hoarse voice
  • weight loss (may/may not have)

Diagnosis?

A

TONSILLAR CANCER

signs of malignancy BUNIE:

B: bleeding
U: ulceration
N: nodules
I: Induration
E: erosion

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15
Q
  • dysphagia
  • pain on swallowing
  • hx of asthma and on steroids for long time
  • hoarse voice

Causative organism?

A

Candida albicans

steroids predispose to fungal infections and can cause laryngeal candidiasis which results in hoarseness of voice.

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16
Q
  • diabetic/immunocompromised
  • small tender mass on external canal
  • no discharge

Diagnosis?

A

FURUNCLE

cause: staph aureus

MX
- may resolve spontaneously
- flucloxacillin
- I and D

17
Q
  • diabetic, poorly controlled
  • severe pain
  • intense headache
  • skin around ear is black
  • foul smelling discharge
  • conductive hearing loss
  • facial nerve palsy
  • granulation seen on floor of canal

Diagnosis?

A

MALIGNANT OTITIS EXTERNA

needs URGENT referral.

MX
- CT temporal bone
- IV antibiotics

18
Q
  • elderly
  • decreased hearing
  • difficulty understanding speech
  • worse in noisy environment
  • eardrum is normal
  • bilateral sensorineural loss and worse at high frequencies

Diagnosis?

A

PRESBYACUSIS

MX
high frequency specific hearing aids

19
Q
  • progressive sensorineural hearing loss, vertigo, tinnitus (CN 8)
  • absent corneal reflex, reduced facial sensation (CN 5)
  • diplopia on looking to the side (CN 6)
  • facial palsy (CN 7)

Diagnosis?

A

ACOUSTIC NEUROMA/VESTIBULAR SCHWANNOMA

tumor originates from Schwann cells of vestibulocochlear nerve. (CN 8)

MRI of cerebellopontine angle/internal auditory meatus

20
Q
  • high BMI
  • daytime sleepiness
  • snoring
  • morning headaches
  • difficulty driving

Diagnosis?

A

OBSTRUCTIVE SLEEP APNOEA

  • stop driving
  • Epworth sleepiness scale to quantify the likelihood of patient falling asleep in certain conditions.

MX
initial: pulse oximetry and overnight study of breathing pattern
gold standard: polysomnography

  • reduce weight
  • reduce alcohol consumption
  • CPAP
  • rare cases may require tonsillectomy/adenoidectomy/tracheostomy
21
Q
  • daytime sleepiness
  • sleep paralysis
  • sleep disruption
  • hallucinations
  • brief loss of muscle tone during laughter

Diagnosis?

A

NARCOLEPSY

C: cataplexy
H: Hallucinations
E: excess daytime sleeping
S: sleep paralysis
S: sleep disruption

22
Q
  • swimming
  • hx of travel to high humidity place
  • pus/serous discharge from ear
  • pain
  • Itchy
  • tragal tenderness
  • TM normal

Diagnosis?
Management?

A

OTITIS EXTERNA

MX
- acetic acid 2% spray for 7 days
- topical gentamycin + hydrocortisone = Gentisone-HC
- topical aminoglycoside (not if TM perforated > use ciprofloxacin instead)
- neomycin sulphate + corticosteroids 3 drops for 7-14 days.

MALIGNANT OTITIS EXTERNA/NECROTIZING OTITIS EXTERNA
- severe
- headache
- purulent foul-smelling discharge
- conductive hearing loss
- granular tissue on floor of ear canal

MX
- urgent same day referral
- the ENT team will arrange CT scan of temporal bones first then IV antibiotics
- if systemically unwell then start IV antibiotics first

23
Q
  • recurrent epistaxis
  • no bleed right now
  • wants to prevent future episodes

Management?

A

Topical Naseptin
(chlorhexidine + neomycin)

24
Q
  • long standing foul smelling purulent ear discharge
  • unilateral
  • tried antibiotics but no improvement
  • may or may not have perforated TM
  • hx of recurrent otitis media
  • conductive hearing loss
  • keratin accumulation at the UPPER PART of the TM/ pearly white mass behind TM

Diagnosis?

A

CHOLESTEATOMA

MX
- Semi urgent referral
- ENT team will arrange CT scan and audiology assessment.

  • if erosion&raquo_space; facial nerve palsy and vertigo
25
Q
  • hx of trauma to pinna
  • hematoma formed
  • normal TM
  • no hearing loss

Management?

A

I and D + antibiotics
(co-amoxiclav for 1 week)

if no I and D&raquo_space;> Avascular necrosis&raquo_space;> Cauliflower ear

26
Q
  • auditory hallucinations
  • feels like music is played
  • no hearing voices

Diagnosis?
Investigation?

A

MUSICAL EAR SYNDROME

  • Pure tone audiometry
27
Q
  • swelling in submandibular region, pus can be seen when compressed
  • more prominent and painful on chewing/during meals
  • hx of sour taste
  • dry mouth
    tenderness
  • decreased jaw mobility
  • weight loss
  • dental pain
  • keratitis
  • SOB
  • Lymphadenopathy
  • fever/rigors/chills/malaise&raquo_space; septicemia
  • may or may not have palpable stone (precursor may be sialolithiasis)

Diagnosis?

A

CHRONIC SIALANDENITIS/KUTTNER’S TUMOUR

28
Q
  • painless, firm, mobile mass over angle of mandible.
  • increasing in size over past few months

Diagnosis?

A

PLEOMORPHIC ADENOMA

  • most common cause of salivary gland tumors.
  • benign parotid tumor
  • slow growing and painless

PLAB (6 decks)

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