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PM Finals > ENT > Flashcards

ENT Flashcards

1
Q

Bacterial causes of otitis media

A

Streptococcus pneumonia
Moraxella Catarrhalis
Haemophillus pneumonia

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2
Q

3 signs to diagnose acute otitis media

A

Acute onset of symptoms

Presence of middle ear effusion-> bulging TM, otorrhoea, decreased mobility of TM

Inflammation of TM (erythema)

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3
Q

Management of acute Ottis media (& Abx criteria)

A

self limiting usually!! & analgesia

  • Seek medical advice if symptoms do not improve after 3 days

Antibiotics prescribed immediately if:
- more than 4 days of symptoms/ not improving
- systemically unwell
- immunocompromised
- younger <2 w bilateral OM
- OM w perforation/ canal discharge

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4
Q

If Abx given for acute Ottis media, first line & duration?

A

5-7 days of amoxicillin

penicillin allergy: erythromycin or clarithromycin

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5
Q

Acute sinusitis infectious agents

A

Strep pneumonia
Haemophillus influenza
Rhinovirus

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6
Q

Management of acute sinusitis

A
  • analgesia
  • intranasal corticosteroids if symptoms present for over 10 days
  • oral Abx if severe: systemically unwell, high risk of complications, double sickening
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7
Q

Mx of allergic rhinitis

A
  • allergen avoidance
  • mild/ moderate: oral or intranasal antihistamines
  • moderate/ severe persistent: intranasal corticosteroids

short course oral corticosteroids for important life events

(maybe oral decongestants but only for short courses -> tachyphylaxis and rhinitis medicamentosa)

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8
Q

Why should topical nasal decongestants (give example) not be used for prolonged periods?

A

Oxymetazoline

Tachyphylaxis - increasing dose are required to achieve same effect

Rhinitis medicaments - Rebound hypertrophy of nasal mucosa

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9
Q

What is the threshold of normal hearing on an audiogram?

A

20dB

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10
Q

Management of BPPV

A

Epley manoeuvre (80% success)

Brandt-Daroff exercises - vestibular rehabilitation

(medication - betahistine is of limited value)

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11
Q

What is black hairy tongue & management?

A

defective desquamation of the filiform papillae - may be black, brown, green, pink or another colour.

RFs: poor oral hygiene, abx, radiation, HIV, IV drug use

Mx
swab tongue to exclude Candida
topical antifungals if Candida

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12
Q

Branchial cyst morphology

A

px- early adulthood
asymptomatic
lateral neck lump, anterior to sternocleidomastoid muscle

acellular fluid with cholesterol crystals , encapsulated by stratified squamous epithelium

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13
Q

differentials of neck lumps in children (congenital, inflammatory, neoplastic)

A

congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation

inflammatory: reactive lymphadenopathy, lymphadenitis,

neoplastic: lymphoma, thyroid tumour, salivary gland tumour

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14
Q

chronic rhino sinusitis definition

A

inflammatory disorder of the paranasal sinuses and linings of the nasal passages

lasts 12 weeks or longer!!

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15
Q

Mx of recurrent or chronic sinusitis

A

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

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16
Q

red flags for rhino sinusitis symptoms

A

unilateral
persistent despite 3mo compliant tx
epistaxis

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17
Q

Criteria for suitability of cochlear implant

A

severe to profound hearing loss

children: audiological assessment , difficulty developing basic auditory skills

adults: completed a trial of appropriate hearing aids for at least 3 months

surviving spiral ganglion neurones

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18
Q

Causes of severe-to-profound hearing loss In children

A

Genetic (accounts for up to 50% of cases).
Congenital e.g. following maternal cytomegalovirus, rubella or varicella infection.
idiopathic (accounts for up to 30% of childhood deafness).
Infectious e.g. post meningitis.

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19
Q

Causes of severe-to-profound hearing loss In adults

A

Viral-induced sudden hearing loss.

Ototoxicity e.g. following administration of aminoglycoside antibiotics or loop diuretics.

Otosclerosis

Ménière disease

Trauma

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20
Q

otosclerosis inheritance pattern

A

Autosomal dominant

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21
Q

which frequencies are affected in noised damage hearing loss?

A

frequencies of 3000-6000 Hz

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22
Q

Ototoxic drugs

A

aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents

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23
Q

Cos affected in acoustic neuroma?

A

CN 8, 5, 7

NF type 2

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24
Q

Tx for ear wax

A

Irrigation or Ear drops:
- olive oil
- sodium bicarb
- almond oil

(CI to mx: perforation/ grommets)

25
Q

Mx of epistaxis (haemodynamically stable)

A

First aid measures:
- ask pt to sit w torso forward & mouth open
- pinch (cartilaginous) soft area of nose firmly for 20 mins

First aid measures successful:
- topical antiseptic (Naseptin - chlorhexidine & neomycin or Mupirocin) - reduce crusting and the risk of vestibulitis
- admission if potential underlying cause (comorbidity or under 2-leukaemia?)

Unsuccessful:
- cautery if bleed source visible & antiseptic
- packing if source not visible
- failed everything: sphenopaletine ligation

26
Q

Naseptin cream should be cautioned in which patients

A

contains peanut oil so
patients that have peanut, soy or neomycin allergies

27
Q

Causes of gingival hyperplasia

A

Drug causes of gingival hyperplasia
- phenytoin
- ciclosporin
- calcium channel blockers (especially nifedipine)

Other causes of gingival hyperplasia include
- acute myeloid leukaemia (myelomonocytic and monocytic types)

28
Q

Red flag of unilateral glue ear?

A

Unilateral glue ear in an adult needs evaluation for a posterior nasal space tumour -> ENT 2ww

29
Q

Gingivitis mx

A

simple gingivitis:
- dentist review

acute necrotising ulcerative gingivitis:
- dentist referral &…
- oral metronidazole for 3 days
- chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
- simple analgesia

30
Q

Glue ear tx options

A
  • active observation for 3 months if first presentation
  • grommet insertion
  • adenoidectomy
31
Q

2ww criteria for laryngeal cancer

A

aged 45 and over with:
- persistent unexplained hoarseness or
- unexplained lump in the neck

32
Q

2ww criteria for oral cancer

A

suspected cancer 2ww:
- unexplained ulceration in the oral cavity >3 weeks or
- persistent and unexplained lump in the neck.

urgent referral 2ww to dentist :
- a lump on the lip or in the oral cavity or
- a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.

33
Q

malignant ottis media cause

A

Pseudomonas aeruginosa

in immunocompromised ppl - 90% in diabetics

34
Q

non-resolving otitis media mx

A

potentially malignant otitis externa so…
Urgent referral to ENT
CT scan
IV antibiotics that cover pseudmonal infections

35
Q

Ix& Mastoiditis mx

A

clinical dx, but CT if complications suspected

IV antibiotics

36
Q

Mx of Meniere’s

A
  • ENT assessment to confirm dx
  • Patients should inform DVLA: cease driving until satisfactory control of symptoms
  • Acute: buccal or IM prochlorperazine (admission sometimes required)
  • Prevention: betahistine and vestibular rehabilitation exercises maybe of benefit
37
Q

oral lesion 2ww refer to oral surgery criteria:

A
  • oral ulceration/ mass > 3 weeks
  • red/ white patches which are painful, swollen, bleeding
  • unilateral head/ neck pain > 4 weeks, associated w ear ache
  • recent neck lump/ previously undiagnosed lump that has changed over a period of 3 to 6 weeks
  • persistant sore or painful throat
  • abnormalities in oral cavity > 6wks, which cannot be diagnosed as a benign lesion
38
Q

RFs for oral ca

A

> 40, smokers, heavy drinkers, chew tobacco or betel nut (Areca nut)

39
Q

Samter’s triad

A

asthma
aspirin sensitivity
nasal polyposis

40
Q

nasal polyps tx

A

red flag: unilateral symptoms or bleeding

Mx:
- referred to ENT for a full examination
- topical corticosteroids shrink polyp size in 80% of pts

41
Q

nasopharyngeal carcinoma aetiology

A

squamous cell carcinoma
rare, except Southern China
Epstein Barr virus

42
Q

Nasopharyngeal carcinoma px

A

ear: unilateral serum otitis media , otalgia
nose: nasal obstruction, discharge, epistaxis
CN palsies: 3-6

(dx- CT head, mx- radiotherapy)

43
Q

pharyngeal pouch anatomy

A

posteromedial herniation between thyropharyngeus and cricopharyngeus muscles

44
Q

cystic hygroma px?

A

congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side

px birth-2yrs

45
Q

Causes of otitis externa

A

infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal

seborrhoeic dermatitis

contact dermatitis (allergic and irritant)

recent swimming is a common trigger of otitis externa

46
Q

otitis externa mx

A

topical antibiotic w or without steroid

if doesn’t work —> ENT referral

if perforated (aminoglycosides not used - ENT say this is BS)

(careful if elderly diabetic- malignant otitis media needing IV abx ?)

47
Q

types of benign parotid tumours

A

most common: Benign pleomorphic adenoma or benign mixed tumour - malignant transformation common

Warthin tumor (papillary cystadenoma lymphoma or Adenolymphoma) - also benign, lymphocytic infiltrate and cystic epithelial proliferation , males

monomorphic adenoma

Heamangioma - mainly in children less than 1

48
Q

Malignant parotid gland tumors

A

Muciepidermoid carcinoma
Adenoid cystic carcinoma
Mixed tumours
Acinic cell carcinoma
Adenocarcinoma
Lymphoma

49
Q

perforated tympanic membrane tx

A
  • advice - will heal after 6-8 wks. Avoid getting water in ear
  • abx if following acute otitis media
  • myringoplasty if tympanic membrane doesn’t heal by itself
50
Q

ramsy hunt tx

A

oral aciclovir and corticosteroids

51
Q

salivary gland types and content

A

parotid (serous) - most tumours
submandibular (mixed) - most stones
sublingual (mucous)

52
Q

sore throat (pharyngitis, tonsillitis, and laryngitis) mx

A
  • paracetamol or ibuprofen for pain relief
  • Abx not routinely indicated but if indicated
    —>phenoxymethylpenicillin (or clarithromycin if pen allergy), 7-10 day course

Abx indications
- marked systemic upset
- unilateral peritonsillitis
- rheumatic fever hx
- increased risk from acute infection (child with diabetes mellitus or immunodeficiency)
- 3 or more Centor criteria are present

53
Q

Centor criteria

A
  • tonsillar exudate
  • tender anterior cervical lymphadenopathy or lymphadenitis
  • fever
  • absence of cough

score = Likelihood of isolating Streptococci
0-2 = 3 to 17%
3-4 = 32 to 56%

54
Q

FeverPAIN criteria

A

Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza

55
Q

drug causes of tinnitus

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

56
Q

indications of tonsillectomy. all of the following:

A

sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)

the person has five or more episodes of sore throat per year

symptoms have been occurring for at least a year

the episodes of sore throat are disabling and prevent normal functioning

57
Q

vestibular neurinitis mx

A

rapid relief for sever cases buccal or IM prochlorperazine

less severe: short oral course of prochlorperazine

chronic: vestibular rehabilitation exercises

58
Q

malignant otitis externa tx

A

urgent ENT referral (non-resolving OE w worsening pain)

IV antibiotics covering pseudomonas infections:
- ciprofloxacin - topical
- flucloxacillin - for systematic infection

59
Q
A

PM Finals (21 decks)

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