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ENT Flashcards

1
Q

2 types of hearing loss

A
  1. Conductive : problem with sound travelling from environment to inner ear
  2. Sensorineural : problem with sensory system or vestibulocochlear nerve in the inner ear
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2
Q

Causes of sensorineural hearing loss

A

-> Sudden sensorineural hearing loss (over less than 72 hours)
-> Presbycusis (age-related)
-> Noise exposure
-> Ménière’s disease
-> Labyrinthitis
-> Acoustic neuroma
-> Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
-> Infections (e.g., meningitis)
-> Medications

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3
Q

what medications can cause hearing loss ?

A

~ Loop diuretics - rare (e.g., furosemide)
~ Aminoglycoside antibiotics (e.g., gentamicin)
~ Chemotherapy drugs (e.g., cisplatin)

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4
Q

Causes of adult onset conductive hearing loss

A
  • Ear wax (or something else blocking the canal)
  • Infection (e.g., otitis media or otitis externa)
  • Fluid in the middle ear (effusion)
  • Eustachian tube dysfunction
  • Perforated tympanic membrane
  • Otosclerosis
  • Cholesteatoma
  • Exostoses
  • Tumours
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5
Q

what is presbycusis and what kind of hearing loss is it

A
  • Age related hearing loss
  • Sensorineural
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6
Q

Explain the type of hearing loss in presbycusis

A
  • High-pitched sounds first and more notably than lower pitched sounds
  • Occurs gradually and symmetrically
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7
Q

8 RF for Presbycusis

A

Increased Age (biggest)
Male gender
Family history
Loud noise exposure (Key RF!)
Diabetes
Hypertension
Ototoxic medications
Smoking

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8
Q

Explain the presentation of presbycusis

A
  • Gradual and insidious
  • Speech difficult to hear due to it affecting HIGH pitched sounds more
  • May be associated with tinnitus
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9
Q

How is presbycusis diagnosed 3 steps to management

A
  • Audiometry = sensorineural hearing loss pattern with normal or near normal hearing at lower frequencies an worsenign hearing loss at higher frequencies
  • Optimise the environment, hearing aids, cochlear implants
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10
Q

Definition of sudden sensorineural hearing loss (SSNHL)

A

Hearing loss over less than 72 hours

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11
Q

Most common cause of SSNHL

A

Idiopathic (90%)

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12
Q

Diagnosis of SSNHL

A
  • Loss of at least 30 decibels in 3 consecutive frequencies on an audiogram
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13
Q

Management of SSNHL GP and then ENT management if idiopathic

A
  • Immediate referral to ENT within 24 hours
  • No underlying cause = high dose oral pred 7 days
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14
Q
  • Reduced or altered hearing
  • Popping noises or sensations in the ear
  • A fullness sensation in the ear
  • Pain or discomfort
  • Tinnitus
  • SX worse when external air pressure changes

Diagnosis and 3 common causes

A

Eustachian Tube Dysfunction

  1. Viral URTI
  2. Allergies (e.g. hayfever)
  3. Smoking
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15
Q

what would be seen on tympanometry in eustachian tube dysfunction

A
  • The air pressure in the middle ear may be lower than the ambient air pressure because new air cannot get through the tympanic membrane to equalise pressures
  • As a result = tympanogram will show peak admittance with negative ear canal pressures
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16
Q

Treatment options for Eustachian tube dysfunction and the main procedure

A
  1. Valsalva manoeuvre
  2. Decongestant nasal sprays (short term only)
  3. Antihistamines and a steroid nasal spray for allergies or rhinitis
  4. Surgery may be required in severe or persistent cases
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17
Q

3 main surgical options for Eustachian Tube Dysfunction

A
  • Treating any other pathology that might be causing symptoms, for example, adenoidectomy (removal of the adenoids)
  • Grommets
  • Balloon dilatation Eustachian tuboplasty
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18
Q

Define otosclerosis and the

A

Remodelling of the small bones in the middle ear, leading to conductive hearing loss

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19
Q

How is ostosclerosis inherited and when does it usually present ?

A
  • AD
  • Before the age of 40
  • Can be precipitated by pregnancy in those with genetic predisposition
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20
Q

Typical presentation of otosclerosis

A
  • <40 yrs
  • Unilateral or bilateral hearing loss, tinnitus
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21
Q

What kind of hearing loss is seen in otosclerosis

A
  • Conductive
  • Affects lower pitched sound more than higher.
  • Hears female speech more easily than males.
  • Hears voices loud in comparison to environment leading them to talk quietly
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22
Q

what will be seen on examination in otosclerosis

A
  • Otoscopy = normal
  • Weber’s = normal if bilateral OR louder in more affected ear.
  • Rinne’s = conductive hearing loss. Sound will be easily heard when on mastoid but they will not hear the sound in air
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23
Q

Initial investigation of choice for diagnosing otosclerosis and what will it show ?

A
  • Audiometry = conductive hearing loss
  • Bone conduction readings will be normal (0-20 dB)
  • Air conduction readings will be greater than 20 dB, plotted below the 20 dB line
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24
Q

What will be seen on tympanometry and high resolution CT in otosclerosis

A

-> Tympanometry = reduced admittance of sound.
-> High resolution CT = detect the boney changes

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25
Q

Management options for otosclerosis

A
  1. Conservative = hearing aids
  2. Surgical (stapedectomy and stapedotomy)
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26
Q

Explain the two surgical options used in otosclerosis

A

-> Stapectomy = remove stapes bones and replacing with prosthesis
-> Stapedotomy = removing part of stapes bone but leaving footplate.

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27
Q

What is otitis media

A

Infection in the middle ear

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28
Q

Most common bacterial causes of otitis media

A

Streptococcus pneumoniae

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29
Q

Presentation of otitis media

A
  • Ear pain
  • Reducing hearing
  • Generally unwell (e.g. fever)
  • URTI (cough, coryzal Sx and sore throat)
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30
Q

What is seen on examination in otitis media

A

Bulging, red and inflammed tympanic membrane (is normally “pearly grey”

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31
Q

Complications of otitis media

A
  • Otitis media with effusion
  • Hearing loss (usually temporary)
  • Perforated tympanic membrane (with pain, reduced hearing and discharge)
  • Labyrinthitis (causing dizziness or vertigo)
  • Mastoiditis (rare)
  • Abscess (rare)
  • Facial nerve palsy (rare)
  • Meningitis (rare)
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32
Q

When are antibiotics given for otitis media and what is given

A
  • Sx >4 days
  • Systemically unwell
  • Immunocomprimised
  • <2 yrs with bilateral otitis media
  • Otitis media with perforation and / discharge
  • Amoxacillin 5-7 days (Erythromycin / clarithromycin if allergic)
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33
Q

Define otitis externa

A
  • Inflammation of the skin in the external ear canal
  • “Swimmer’s ear”
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34
Q

2 most common bacterial causes of otitis externa

A

-> Pseudomonas aeruginosa : gram negative aerobic rod
-> Staphylococcus aureus

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35
Q

Presentation of otitis externa

A
  • Ear pain
  • Discharge
  • Itchiness
  • Conductive hearing loss (if the ear becomes blocked)
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36
Q

what is seen on examination in otitis externa

A

~ Erythema and swelling in the ear canal
~ Tenderness of the ear canal
~ Pus or discharge in the ear canal
~ Lymphadenopathy (swollen lymph nodes) in the neck or around the ear

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37
Q

Management of otitis externa

A

-> MIild : over the counter acetic acid 2%
-> Moderate : topical antibiotic and steroid
->Severe : oral flucloxacillin or clarithromycin

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38
Q

what is malignant otitis externa

A
  • Severe and life threatening form of otitis externa
  • Infection spreads to bone surrounding the ear canal and skull
  • Can cause osteomyelitis of the temporal bone
  • Happens in elderly diabetics
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39
Q

Give 3 underlying RF for malignant otitis externa

A
  • Diabetes
  • Immunosuppressant medications (e.g., chemotherapy)
  • HIV
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40
Q

what is a key finding in malignant otitis externa

A

Granulation tissue at the junction between the bone and cartilage in the ear canal

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41
Q

Management of malignant otitis externa

A
  • Admission to hospital under the ENT team
    -IV antibiotics
  • Imaging (e.g., CT or MRI head) to assess the extent of the infection
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42
Q

5 complications of otitis externa

A
  • Facial nerve damage and palsy
  • Other cranial nerve involvement (e.g., glossopharyngeal, vagus or accessory nerves)
  • Meningitis
  • Intracranial thrombosis
  • Death
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43
Q

3 main methods for removing ear wax (medical term = cerumen)

A

-> Ear drops – usually olive oil or sodium bicarbonate 5%
-> Ear irrigation – squirting water in the ears to clean away the wax
-> Microsuction – using a tiny suction device to suck out the wax

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44
Q

9 causes of secondary tinnitus

A
  1. Impacted ear wax
  2. Ear infection
  3. Ménière’s disease
  4. Noise exposure
  5. Medications (e.g., loop diuretics, gentamicin and chemotherapy drugs such as cisplatin)
  6. Acoustic neuroma
    7.Multiple sclerosis
  7. Trauma
  8. Depression
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45
Q

4 systemic conditions associated with tinnitus

A

Anaemia
Diabetes
Hypothyroidism or hyperthyroidism
Hyperlipidaemia

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46
Q

what 2 kinds of problems can cause vertigo

A

-> Peripheral problem, usually affecting the vestibular system
-> Central problem, usually involving the brainstem or the cerebellum

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47
Q

4 most common vestibular causes of vertigo

A

Benign paroxysmal positional vertigo
Ménière’s disease
Vestibular neuronitis
Labyrinthitis

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48
Q

4 central problems that can cause vertig0

A
  • Any pathology affecting the cerebellum or brainstem disrupts signals from the vestibular system and causes vertigo.

Posterior circulation infarction (stroke)
Tumour
Multiple sclerosis
Vestibular migraine

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49
Q

what 5 symptoms suggest a peripheral cause of vertigo

A
  • Onset : sudden
  • Duration : short
  • Hearing loss or tinnitus : often present (except BPPV)
  • Co-ordination : intact
  • Nausea : more severe
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50
Q

what 5 symptoms suggest a central cause of vertigo

A
  • Onset : gradual (except stroke)
  • Duration : persistent
  • Hearing loss or tinnitus : usually not
  • Co-ordination : impaired
  • Nausea : mild
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51
Q

what examination can be used to distinguish between central and peripheral vertigo ? specifically vestibular neuronitis from posterior circulation stroke

A

HINTS examation

-HI : Head Impulse
- N : Nystagmus
- TS : Test and Skew

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52
Q

How does Benign Paroxysmal Positional Vertigo present ?

A
  • Recurrent episodes of vertigo triggered by head movements (typically rolling over, gazing upwards)
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53
Q

Cause of BPPV

A
  • Crystals of calcium carbonate (Otoconia) that becomes displaced into the semicircular canals
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54
Q

How is BPPV diagnosed

A
  • Dix-Hallpix manoeuvre
  • Rapidly lower pt to supine poition with an extend neck
  • Will recreate symptoms / cause rotatory nystagmus
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55
Q

Management of BPPV and what medication can be provided ?

A
  • Epley manoeuvre
  • Betahistine
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56
Q

What is vestibular neuronitis

A
  • Inflammation of the vestibular nerve, usually caused by a viral infection
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57
Q

Presentation of vestibular neuronitis

A
  • Acute onset of vertigo
  • Recent history of viral URTI
  • Often associated with N&V and balance problems
  • Horizontal nystagmus often present
  • No hearing loss or tinnitus
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58
Q

which peripheral causes pf vertigo are associated with hearing loss or vertigo ?

A
  • Labyrinthitis or Meniere’s

Neuronitis = NO hearing loss

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59
Q

what test can be used to diagnose of peripheral cause of vertigo ?

A

Head impulse test

  • Patient sits upright and fixes gaze on examiners nose
  • Rapidly jerk head 10-20 degrees in one direction before slowly returning to centre and repeating in opposite direction.
  • Abnormal vestibular functioning = eyes will saccade (rapidly move back and forth) before fixing back on examiner
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60
Q

Short term management options for vertigo symptoms of vestivular neuronitis

A

-> Prochlorperazine
-> Antihistamines (e.g., cyclizine, cinnarizine and promethazine)
-> Used for up to 3 days

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61
Q

what is labyrinthitis ?

A
  • Inflammation of the bony labyrinth of the inner ear, including semicircular canals, vestibule and cochlea
  • Usually cause by viral URTI
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62
Q

Presentation of labyrinthitis

A
  • Acute onset vertigo NOT triggered by head movements but axacerbated by them
  • Hearing loss
  • Tinnitus
  • N&V
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63
Q

Management of labyrinthitis

A

Short term use of prochlorperazine or antihistamines to treat the symtpoms

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64
Q

what can labyrinthitis rarely be caused by

A

Bacterial infection, secondary to otitis media or meningitis

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65
Q

what is meniere’s disease and the traid of symptoms

A
  • Excessive build up of endolymph in the labyrinth of inner ear
  • Causing recurrent attacks of vertigo and symptoms of hearing loss and tinnitus
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66
Q

Typical presentation of Meniere’s disease

A
  • 40-50 yr old pt
  • Unilateral episodes or vertigo, hearing loss and tinnitus
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67
Q

Explain the vertigo seen in Meniere’s disease

A
  • Comes in episodes
  • Lasts 20 mins to several hours before settling
  • Episodes occur in clusters over several weeks, followed by prolonged periods without vertigo
  • The vertigo is not triggered by movement or posture
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68
Q

Explain the hearing loss seen in meniere’s disease

A
  • Fluctuates before gradually becoming more permanenet
  • It is sensorineural
69
Q

Explain the tinnitus seen in meniere’s disease

A
  • Occurs in episodes with the vertigo before becoming more permanent
  • Usually unilateral
70
Q

Give 4 other symptoms seen in meniere’s disease

A
  • A sensation of fullness in the ear
  • Unexplained falls (“drop attacks”) without loss of consciousness
  • Imbalance, which can persist after episodes of vertigo resolves
  • Spontaneous nystagmus in acute attack (usually unidirectional)
71
Q

Management of acute attack in Meniere’s disease

A
  • Buccal or IM prochlorperazine
72
Q

Prophylaxis of Meniere’s disease

A

Betahistine

73
Q

what is an acoustic neuroma and where do they occur ?

A
  • Benign tumours of the Schwann cells surrounding the vestibulocochlear nerve
  • Occur at the cerebellopontine angle
74
Q

What are bilateral acoustic neuromas associated with ?

A

Neurofibromatosis type II

75
Q

Explain the presentation of an acoustic neuroma

A
  • 40-60 yr old pt with gradual onset :
  • > Unilateral sensorineural hearing loss (often the first symptom)
    -> Unilateral tinnitus
    -> Dizziness or imbalance
    -> A sensation of fullness in the ear
76
Q

If large enough, what might an acoustic neuroma be associated with

A

Facial nerve palsy - LMN = no forehead sparing

77
Q

what kind of hearing loss does an acoustic neuroma cause ?

A

Sensoineural

78
Q

3 management options for an acoustic neuroma

A
  1. Conservative management with monitoring may be used if there are no symptoms or treatment is inappropriate
  2. Surgery to remove the tumour (partial or total removal)
  3. Radiotherapy to reduce the growth
79
Q

2 risk associated with the treatment of an acoustic neuroma

A

-> Vestibulocochlear nerve injury, with permanent hearing loss or dizziness
-> Facial nerve injury, with facial weakness

80
Q

Definition of cholesteatoma

A

Abnormal collection of squamous epithelial cells in the middle ear

81
Q

Tpical presenting symptoms of cholesteatoma

A
  • Foul discharge from the ear
  • Unilateral conductive hearing loss
82
Q

what might be seen on otoscopy in cholesteatoma ?

A

Abnormal build up of whitish debris or crust in the upper tympanic membrane

83
Q

Diagnosis and management of cholesteatoma

A
  • CT head to diagnose
  • Surgical removal
84
Q

Red flag symptom nasal polyps

A
  • If they are unilateral !
85
Q

5 conditions associated with nasal polyps

A
  • Chronic rhinitis or sinusitis
  • Asthma
  • Samter’s triad (nasal polyps, asthma and aspirin intolerance/allergy)
  • Cystic fibrosis
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
86
Q

Management of nasal polyps

A
  • Medical : intranasal topical steroid drops
  • Surgical : intranasal polypectomy if visible, endoscopic if further in the nose
87
Q

cause of OSA

A

Collapse of pharyngeal airway

88
Q

5 RF for OSA

A

Middle age
Male
Obesity
Alcohol
Smoking

89
Q

7 features of OSA

A
  • Episodes of apnoea during sleep (reported by their partner)
  • Snoring
  • Morning headache
  • Waking up unrefreshed from sleep
  • Daytime sleepiness
  • Concentration problems
  • Reduced oxygen saturation during sleep
90
Q

what can severe OSA case

A
  • HTN and HF
  • Increase risk of MI and stroke
91
Q

what scale is used to assess symptoms of sleepiness associated with OSA and then how is it diagnosed

A
  • Epworth sleepiness scale
  • Sleep studies
92
Q

Stepwise management of OSA

A
  1. Correct reversible RF (weight loss)
  2. CPAP
  3. Surgery -uvulopalatopharyngoplasty
93
Q

neck lump red flag two week wait referral

A
  • An unexplained neck lump in someone aged 45 or above
  • A persistent unexplained neck lump at any age
94
Q

when is an urgent USS required for a neck lump that is growing in size ?

A
  • Within 2 wks in pts 25 and olfer
  • Within 48 hrs in pts under 25
95
Q

first line investigation for a neck lump

A

USS

96
Q

Presentation and cause of infectious mononucleosis

A

-> Cause : EBV
-> Presentation : fever, sore throat, fatigue and lymphadenopathy
-> Or with an intensely itchy maculopapular rash in response to amoxicillin or cefalosporins

97
Q

first line investigation and treatment of infectious mononucleosis

A
  • Monospot test
  • Supportive and advised to avoid alcohol (liver impairment) and contact sports (spenic rupture)
98
Q

key finding from lymph node biopsy in Hodgkin’s lymphoma

A

Reed-Sternberg cells

99
Q

A lump in the anterior triangle of the neck that moves with swallowing

A

Thyroid lump

100
Q

Slow growing lump that is :

  • In the upper anterior triangle of the neck (near the angle of the mandible)
  • Painless
  • Pulsatile
  • Associated with a bruit on auscultation
  • Mobile side-to-side but not up and down
A

Carotid body tumour : formed by excessive growth of glomus cells

101
Q

characteristic finding on imaging in carotid body tumours

A

Splaying (separating) of the internal and external carotid arteries = Lyre sign

102
Q

Lump in the midline of the neck that is mobile, non tender, soft, fluctuant and moves up when you stick out the tongue

A

Thyroglossal cyst

103
Q
  • Soft, cystic swelling in the anterior triangle of the neck
  • Anterior to the sternocleidomastoid
A

Branchial cyst

104
Q

Where is a brachial cyst most likely to originate from

A

Second branchial cleft

105
Q

Give 6 RF for head and neck cancer

A

Smoking
Chewing tobacco
Chewing betel quid (a habit in south-east Asia)
Alcohol
Human papillomavirus (HPV), particularly strain 16
Epstein–Barr virus (EBV) infection

106
Q

Give 6 red flag symptoms for head and neck cancer

A
  • Lump in the mouth or on the lip
  • Unexplained ulceration in the mouth lasting more than 3 weeks
  • Erythroplakia or erythroleukoplakia
  • Persistent neck lump
  • Unexplained hoarseness of voice
  • Unexplained thyroid lump
107
Q

what is the most common type of head and neck cancer and what monoclonal antibody is often used to treat it

A
  • Squamous cell carcinoma
  • Cetuximab -> targets epidermal growth factor receptor
108
Q

Give the tope 3 causes of angioedema

A
  • Allergic reactions
  • ACE inhibitors
  • C1 esterase inhibitor deficiency (hereditary angioedema)
109
Q

Give 5 causes of glossitis

A

Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure

110
Q

5 factors that predispose someone to developing oral candidiasis

A
  • Inhaled corticosteroids
  • Antibiotics
  • DM
  • Immunodeficiency (consider HIV)
  • Smoking
111
Q

3 treatment options for oral candidiasis

A
  • Miconazole gell
  • Nystatin suspension
  • Fluconazole tablets
112
Q

2 causes of a strawberry tongue

A

Scarlet fever
Kawasaki disease

113
Q

Presentation of leukoplania and what does it increase the risk of ?

A
  • White patches on the buccal mucosa
  • Precancerous and increases risk of squamous cell carcinoma of the mouth
114
Q

Presentation and association of erythroplakia

A
  • Red lesions on the buccal mucosa
  • Squamous cell carcinoma
115
Q
  • Shiny, purplish, flat-topped raised areas wuth white lines across the surface (Wickham’s striae)
  • Women >45
A

Lichen planus (autoimmune condition causing chronic inflammation)

116
Q

5 RF for gingivitis

A

Plaque build-up on the teeth
Smoking
Diabetes
Malnutrition
Stress

117
Q

Definition and 5 causes of gingival hyperplasia

A
  • Abnormal growth of gums

RF :
- Gingivitis
- Pregnancy
- Vitamin C deficiency (scurvy)
- Acute myeloid leukaemia
- Medications, particularly calcium channel blockers, phenytoin and ciclosporin

118
Q

5 underlying conditions that can cause apthous ulcers

A

Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
Coeliac disease
Behçet disease
Vitamin deficiency (e.g., iron, B12, folate and vitamin D)
HIV

119
Q

topical treatments for apthous ulcers

A
  • Choline salicylate (e.g., Bonjela)
  • Benzydamine (e.g., Difflam spray)
  • Lidocaine
120
Q

treatment of more severe ulcers

A

-> Hydrocortisone buccal tablets applied to the lesion
-> Betamethasone soluble tablets applied to the lesion
-> Beclomethasone inhaler sprayed directly onto the lesion

121
Q

when will a two week wait referral be sent for apthous ulcers ?

A

unexplained ulceration lasting over 3 wks

122
Q

Explain how a right sided sensorineural deficit would present based on weber’s and rinne’s

A
  1. Rinne’s test left : air > bone
  2. Rinne’s test right : air > bone
  3. Weber’s test : localises to the left
123
Q

Presentation of allergic rhinitis

A
  • Bilateral nasal obstruction, cough at night, clear nasal discharge
124
Q

Management of allergic rhinitis

A
  • Mild to moderate : oral / intranasal antihistamines
  • Moderate to severe : intranasal corticosteroids
  • Short course of topical nasal decongestants
125
Q

Why are topical nasal decongestants (e.g. oxymetazoline) only used for short periods ?

A
  • Increasing doses are needed to achieve same effect
  • Rebound hypertrophy of the nasal mucosa (rhinitis medicamentosa) may occur upon withdrawal.
126
Q

Presentation of vertebrobasilar ischaemia

A

Elderly patient
Dizziness on extension of neck

127
Q

When would you refer uregently to ENT for suspected laryngeal cancer ?

A

People 45 and over with :

persistent unexplained hoarseness or
An unexplained lump in the neck.

128
Q

Presentation and management of nasal septal haematoma

A
  • Bilateral, red, boggy swelling arising from the nasal septum following trauma
  • Surgical drainage and antibiotics
129
Q

Management of nasal septal haematoma

A
  • Urgent referral to ENT
  • Surgical drainage
  • Intravenous antibiotics
130
Q

Symptom relief in vestibular neuronitis

A
  • Short oral course of prochlorperazine
  • If severe : buccal or IM prochlorperazine
131
Q

Who is often affected by malignant otitis externa and what is the most common cause

A
  • Immunocomprimised (90% DM)\
  • Pseudomonas aeruginosa
132
Q

Presentation of malignant otitis externa

A
  • Severe, unrelenting, deep-seated otalgia
  • Temporal headaches
  • Purulent otorrhea
  • Possibly dysphagia, hoarseness, and/or facial nerve dysfunction
133
Q

What antibiotic will cover for malignant otitis externa cause by pseudomonal infectons

A

Ciprofloxacin

134
Q

A pt presents with asthma and nasal polyps, what medication is important to avoid and why ?

A
  • ASPIRIN
  • Samter’s triad = asthma, nasal polyps and aspirin sensitivity
134
Q

Presentation of nasopharyngeal carcinoma

A
  • Systemic = cervical lymphadenopathy
  • Local - otalgia, unilateral serous otitis media, nasal obstruction, discharge and / or epistaxis
135
Q

what is ludwig’s angina ?

A
  • Cellulitis occurring on the floor of the mouth and soft tissues of the neck
136
Q

who is at risk of ludwig’s angina

A
  • Immunocompromised patients with poor dentition
  • Recent dental extraction
137
Q

What cranial nerve will be affected in the differing presenting features of an acoustic neuroma

A
  • VIII : vertigo, unilateral sensorineural hearing loss and tinniuts
  • V : absent corneal reflex
  • VII : facial palsy
138
Q

Investigation of choice for acoustic neuroma

A

MRI of cerebellopontine angle

139
Q

How does otitis media with effusion present ?

A
  • Muffled hearing and viscous bubbles behind tympanic membrane
140
Q

Management of unilateral glue ear in adult

A

Urgent ENT referral to rule out posterior nasal space tumour

141
Q

Presentation of Ramsay Hunt

A
  • Ear pain and facial nerve palsy
  • Vesicular rash on otoscopy
  • Preceding flu-like symptoms
142
Q

Management of ramsay Hunt

A

Oral aciclovir and corticosteroids (pred)
Only IV if systemically unwell

143
Q

Presentation of an auricular haematoma

A
  • Direct trauma
  • Ear : ecchymotic, swollen, loss of normal anatomy to anterosuperior pinna
144
Q

Management of auricular haematoma

A
  • Urgent ENT referral
145
Q

What in the stem of the question would point towards nasopharyngeal carcinoma

A

Southern china ethnic origin

146
Q

What does Ludwig’s angina present

A

Neck swelling, dysphagia and fever

147
Q

Management of Ludwig’s engina

A
  • Immediate transfer to hospital
  • Airway management and IV Abx
148
Q

What are 3 red flag symptoms for chronic rhinosinusitis that would require urgent ENT referral

A
  1. Unilateral symptoms
  2. Epistaxis
  3. Persitent Sx, despire compliance with 3 mnths f Tx
149
Q

2 treament options for chronic rhinosinusitis

A

Intranasal corticosteroids
Nasal irrigation with saline solution

150
Q

3 features of chronic rhinosinusitis

A
  1. Facial pain : frontal pressure, worse leaning forward
  2. Nasal discharge
  3. Nasal obstruction
  4. Post-nasal drip : produces chronic cough.
151
Q

If initial first aid measures are unsuccessful, what is the management of epistaxis in which then source of bleed is visible ?

A

Cautery

152
Q

If initial first aid measures are unsuccessful, what is the management of epistaxis in which the bleeding point cannot be visualised

A

Anterior packing

153
Q

Camera test used in eustachian tube dysfunction

A

Nasopharyngoscopy

154
Q

What is primary tinnitus and what kind of hearing loss is experienced with it

A
  • No identifiable underlying cause
  • Sensorineural
155
Q

4 systemic causes of tinnitus

A

Anaemia
DM
Hyper / hypo thyroid
Hyperlipidaemia

156
Q

If tinnitus was to be pulsatile, give 3 underlying causes

A

Carotid artery stenosis
Aortic stenosis
AV malformations

157
Q

3 drugs that can cause tinnitus

A

Loop diuretics
Gentamicin
Cisplatin

158
Q

3 management options for primary tinnitus

A

Hearing aids
Sound therapy
CBT

159
Q

trauma to the side of the head, followed by conductive hearing loss

A

Perforated eardrum

160
Q

Persistent mouth ulcer, refractory to treatment

A

Suspicion of squamous cell carcinoma

161
Q

Tonsilar squamous cell carcinoma is associated with what causative organism ?

A

HPV

162
Q

If a perforated tympanic membrane doesn’t heal itself in 6-8 wks what can be done ?

A

Myringoplasty

163
Q

when would intranasal corticosteroids be considered for sinusitis ?

A

Symptoms for >10 days

164
Q

what is first line for sinusitis

A

phenoxymethylpenicillin

165
Q

what is double-sickening

A

pt initially has viral sinusitis but then worsens due to secondary bacterial infections

166
Q

Presentation of acoustic neuroma in SBA

A

3 mnth Hx of vertigo, hearing loss and loss of corneal reflex on affected side

167
Q

Most common site for epistaxis to arise from

A

Little’s area in the anterior septum - site of kiesselbach’s plexus suppled by 4 arteries

168
Q
A

Finals (92 decks)

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