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year 3 conditions > ENT > Flashcards

ENT Flashcards

1
Q

management fo a septal haematoma “ bilateral cherry-red swelling arising from the nasal septum”

A

emergency incision and drainage

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2
Q

labyrinthitis vs Menieres

A

both have tinnitus, vertigo, hearing loss
Menieres comes in 1-2 hour episodes and is not curable
labyrinthitis epodes can last longer eg days and you can recover/is curable
labyrinthitis = recent history of cold/infection, intense for few days then goes away slowly
Menieres = no obvious recent trigger, comes and goes

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3
Q

what condition characteristically causes hearing loss which is better when there is background noise

A

otosclerosis

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4
Q

in which condition do pts often speak quietly as their voice sounds louder in their head

A

otosclerosis

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5
Q

generalised hearing loss, pain, recent UTRI. possible discharge if tympanic membrane ruptured, bulging/ruptured tympanic membrane

A

otitis media (infection of middle ear)

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6
Q

what is a cholesteatoma and what happens if it gets infected

A

growths of keratinising squamous cells that form in the attic of the ear (area of middle ear behind tympanic membrane) - shows as a visible white mass behind the eardrum
non cancerous but can be erosive to surrounding structures
if infected: produce chronic foul-smelling discharge, and debris fills the ear canal, causing hearing loss, facial nerve paralysis, intracranial abscess

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7
Q

what is warthins tumour

A

benign, fast growing tumour of parotid gland
common in elderly men

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8
Q

what is a adenoid cystic carcinoma

A

malignant tumours of the parotid gland
are more likely to invade the surrounding structures such as the facial nerve, leading to the facial nerve palsy

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9
Q

what is a pleomorphic adenoma

A

most common tumour of parotid gland
usually benign
rarely invades the facial nerve and rarely causes facial nerve palsy

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10
Q

swelling of parotid glands
dry eyes
dry mouth
likely diagnosis

A

sjogrens syndrome

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11
Q

vestibular neuritis vs labyrinthitis

A

vestibular neuritis
- only vestibular nerve affected
–> vertigo, balance problems

labyrnthitis
- labyrinth also affected
–> hearing loss, balance problems

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12
Q

what is otalgia

A

ear pain

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13
Q

Tx for otitis externa vs otitis media

A

otitis externa:
topical abx drops

otitis media:
analgesia (usually viral cause)
if symptoms dont improve or child is systemically unwell, give abx or even admit in hospital

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14
Q

how to tell difference between otitis media and externa

A

using otoscope
- exerna will show infection on canal but normal tympanic membrane
- media will show infection on membrane

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15
Q

otitis media symptoms

A

Rapid onset of deep-seated ear pain
Fever
Irritability
Anorexia
Vomiting
Impaired hearing
Systemic illness
Aural fullness followed by discharge when the tympanic membrane perforates, leading to relief of pain
Injection of blood vessels and diffuse erythema of the tympanic membrane

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16
Q

what is subcutaneous sumatriptan used for

A

abortive (symptomatic) therapy of migraines

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17
Q

laryngitis symptoms

A

hoarseness, cough, and a sore throat
no difficulty swallowing or cervical lymphadenopathy

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18
Q

epiglottitis symptoms

A

rapid onset of severe sore throat,
high fever,
difficulty swallowing,
respiratory distress,
stridor

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19
Q

laryngitis vs pharyngitis

A

laryngitis: inflammation of voice box
-Irritating cough
-Hoarseness
-A change in the sound of your voice (dysphonia) or the inability to speak (aphonia)
-Sore, dry, or tickly throat
-Difficulty swallowing

pharyngitis: inflammation of back of throat
- Fever
-Painful swollen glands
-Throat redness
-Pain which can radiate into the ear

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20
Q

sensations of shortness of breath, nasal obstruction, and dryness
after having nasal / turbinate surgery
but no physical problems seen in the nose
diagnosis?

A

empty nose syndrome

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21
Q

Mx of empty nose syndrome

A

nasal irrigation
nasal saline / emollients
psychological support
if severe, reconstructive surgery

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22
Q

describe air and bone condition of sound in conductive vs sensineural hearing loss vs mixed hearing loss

A

conductive
- reduced air conduction, normal bone conduction

sensineural
- reduced air and bone conduction

mixed
- there is a difference between air and bone conduction, but neither is normal

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23
Q

Tx for otitis externa, mild, moderate, severe

A

mild:
acetic acid + hydrocortisone ear drops

moderate:
ciprofloxacin + hydrocortisone ear drops

severe:
Treated using a strip of ribbon gauze known as “Pope” wicks which can be used for the application of topical antibiotics (classically gentamicin) enabling deeper penetration
or oral abx if cant get into canal / severe infection, low immunity

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24
Q

why should amoxicillin be avoided in tonsillitis

A

strep throat and Epstein-Barr virus (EBV) present very similarly
If EBV is misdiagnosed as strep throat and amoxicillin is prescribed, a maculopapular rash commonly occurs

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25
Q

which nerve provides sensation to skin

A

trigeminal

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26
Q

risks with surgery around mastoid process

A

damage and permanent paralysis of facial nerve - runs in close proximity to mastoid process

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27
Q

what is geotropic nystagmus

A

nystagmus beating toward the ground

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28
Q

what is apogeotropic nystagmus

A

nystagmus beating away from the ground

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29
Q

what is a quinsy and why is it an emergency

A

abscess between the tonsil and the roof of the mouth
presents as fever, sore throat, inability to open mouth, thick muffled voice, tender mass in peritonsillar area
This requires urgent assessment as it can lead to
sepsis,
erosion
spread of the abscess into the head cavities,
airway obstruction
life-threatening haemorrhage

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30
Q

what is a Mucoepidermoid carcinoma

A

the most common malignant salivary gland tumour
Local invasion and lymph node are common and therefore present with facial nerve palsy and other symptoms

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31
Q

pt has lump overlying her right angle of mandible that is slowly growing in size.
She has no other symptoms
likely diagnosis?

A

pleomorphic adenoma
most common benign parotid tumour and in general does not cause neurovascular invasion of local structures

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32
Q

what is presbycusis

A

age related hearing loss

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33
Q

what does presbycusis look like on audiogram

A

bilateral symmetrical sensineural hearing loss at higher frequencies

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34
Q

how does noise induced hearing loss change with frequency

A

loss of hearing on the audiogram is maximal at 4000Hz before recovering at higher frequencies

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35
Q

type of hearing loss with otosclerosis

A

conductive - hear better when there is background noise

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36
Q

management of quinsy

A

drainage and abx

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37
Q

what is quinsy a complication of

A

acute tonsillitis

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38
Q

fever, sore throat, trismus (inability to open the mouth), hot potato voice, and a palpable, tender mass in the peritonsillar area
tonsillitis history
diagnosis

A

quinsy

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39
Q

how do rinne and webers test differentiate between sensineural and conductive hearing loss

A

negative rinne test :
conductive hearing loss

webers:
If the hearing loss is conductive, the sound will be heard best in the affected ear.
If the loss is sensorineural, the sound will be heard best in the normal ear

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40
Q

what is a positive rinne test and is it normal or abnormal

A

air conduction is heard louder than bone
normal

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41
Q

rinnes positive
webers heard best in right ear
what is the type of hearing loss and in which ear

A

sensioneural hearing loss in left ear

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42
Q

viral vs allergic rhinitis

A

viral
- shorter duration (approx a week)
- fever
- sore throat
- malaise

allergic
- longer duration (over week)
- sneezing
- watery eyes
- itchy nose and eyes
- nasal congestion

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43
Q

how does background noise affect conductive vs sensineural hearing loss

A

conductive: better with background noise
sensineural: worse with background noise

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44
Q

what type of hearing loss is presbycusis

A

sensineural

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45
Q

what type of hearing loss does Menieres cause

A

sensineural

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46
Q

what does a single nasal polyp suggest

A

nasopharyngeal cancer

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47
Q

what is a tympanostomy / grommet

A

time placed into eardrum/tympanic membrane in children who have chronic middle ear infections (otitis media), prevents fluid accumulation in middle ear

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48
Q

what does tympanostomy/grommets and otitis media history predispose to

A

tympanosclerosis

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49
Q

what does a non healing, painful, bleeding mouth ulcer raise suspicion of

A

squamous cell carcinoma

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50
Q

what oral signs would you see in vit C deficiency

A

loose teeth and poor gingival health

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51
Q

what is oral leukoplakia

A

white lesion on oral mucosa
cancer precursor

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52
Q

when is tonsillectomy considered for a pt

A

if a patient suffers more than 5 episodes of tonsillitis per year for 2 years, if the episodes interfere with daily life.

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53
Q

what is an acoustic neuroma

A

a type of non-cancerous (benign) brain tumour

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54
Q

likely cause of progressively worsening hearing loss, tinnitus and vertigo

A

acoustic neuroma - symptoms worsen as it grows

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55
Q

likely diagnosis of progressively worsening bilateral conductive hearing loss with no vertigo or tinnitus

A

otosclerosis

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56
Q

definitive Tx for otosclerosis

A

stapedectomy
(hearing aids and steroids are used to mange symptoms but dont fix the abnormal bone growth)

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57
Q

voice hoarseness
throat pain
ear pain
likely diagnosis

A

aqueous cell carcinoma of larynx

58
Q

what is CSF rhinorrhea and what is it usually caused by

A

leak of CSF through the nose
usually secondary to base of skull fracture

59
Q

what organ dysfunction can recurrent epistaxis be a sign of

A

liver disease causing clotting issues –> order LFTs

60
Q

what does a history of “bad tonsillitis at age 16” suggest the pt had

A

infectious mononucleosis caused by EBV

61
Q

what is a rare, but malignant cause of unilateral glue ear in adults

A

nasopharyngeal carcinoma

62
Q

which cancer does infectious mononucleosis/EBV increase risk of

A

nasopharyngeal carcinoma

63
Q

non-tender and “rubbery” lymph nodes
night sweats and weight loss
likely diagnosis

A

Hodgkin’s Lymphoma

64
Q

acoustic neuroma symptoms

A

sensineural hearing loss,
tinnitus,
dizzines

65
Q

progressive bilateral conductive hearing loss
intact tympanic membrane
no discharge
family history of same thing
likely diagnosis

A

otosclerosis

66
Q

what should be done if a child with tonsillitis has problems breathing or swallowing

A

could indicate Quincy, so admit to hospital and give IV abx and do drainage

67
Q

inheritance pattern of HHT

A

autosomal dominant

68
Q

what is a dermoid cyst and where is it found

A

small, painless lump which contains epithelial lining so can grow hair or teeth
found on head and neck - esp outer 1/3 of eyebrow

69
Q

lump lateral to midline of neck, in anterior triangle
painful around meal times
doest move on tongue protusion

A

sialadenitis - infection of salivary gland

70
Q

congenital large swelling in neck of child, swells in infection
do not move on tongue protrusion nor auscultate or transilluminate
likely diagnosis

A

branchial cyst

71
Q

what is the most common cause of neck umps in children

A

branchial cyst

72
Q

best scan for vestibular shwannoma aka acoustic neuroma

A

MRI head

73
Q

what is the most common cause of hearing loss/impairment post head injury

A

perforated tympanic membrane

74
Q

give 2 signs which can be seen of a basal skull fracture

A

racoon eyes
bruising of mastoid

75
Q

most common causes of stridor

A
  • laryngomalacia - congenital condition where some larynx tissue falls onto and partially blocks airway
  • vocal cord/larynx paralysis
76
Q

what is glue ear

A

middle part of the ear canal fills up with fluid

77
Q

what is vertigo and dizziness on sudden and certain head movements associated with

A

BPPV

78
Q

what is proptosis

A

exophthalmos

79
Q

what is ophthalmoplegia

A

paralysis of the extraocular muscles that control the movements of the eye

80
Q

mild vs moderate otitis externa

A

mild has no pain or discharge, moderate has both

81
Q

what condition causes
optic neuritis, which leaves decreased vision in the affected eye and a relative afferent pupillary defect
and
unilateral sensorineural hearing loss

A

MS

82
Q

best investigation for MS

A

MRI head and spine

83
Q

what does Tympanometry showing a type B (flat) curve with normal canal volume suggest

A

otitis media with effusion (OME)

84
Q

if a child chokes and CXR shows a circular radio-opaque foreign body with a halo, what is it

A

button battery

85
Q

Eustachian tube dysfunction symptoms

A

aural fullness, mild hearing loss, tinnitus, and clicking or popping noises

86
Q

treatment for chronic otitis externa

A

remove debris from ear
topical abx

87
Q

management of cholesteatoma or mastoid abscess

A

mastoidectomy

88
Q

what’s persistent bleeding and crusting from one nostril with unilateral nasal obstruction a red flag symptom for

A

sinonasal carcinoma

89
Q

managment of swollen red ear after trauma

A

aspiration

90
Q

what type of nose bleed is a nasal ballon catheter used for

A

posterior bleeds

91
Q

Mx of anterior nose bleed if compression doesn’t work

A

if can see site of bleed: nasal cautery
if cant see site if bleed or cautery fails: nasal packing

92
Q

tensor tympani innervation

A

vestibularcoclear nerve

93
Q

what does painless cervical lymphadenopathy suggest and how do you investigate it

A

malignancy
Fine-needle aspiration cytology (FNAC)

94
Q

when is antibiotics considered for children with titis media under 2 years old

A

bilateral otitis media
or systemic infection
or symptoms >3 days

95
Q

what is Ramsay hunt syndrome and what is it characterised by

A

reactivation of the varicella zoster virus in the geniculate ganglion
characterised by
unilateral Facal nerve palsy
vestibulocochlear nerve symptoms eg tinnitus, unilateral hearing impairment
lesions visible with crusting in or behind the ear

96
Q

what is the cause of discharge from ear that demonstrates a halo sign when dropped onto filter paper

A

basal skull fracture - cerebrospinal fluid leaks through the fracture out of the auditory canal

97
Q

what are the signs of cancer of parental sinus

A

adult presenting with chronic rhinosinusitis for first tumour
blood stained nasal discharge
swelling over sinus

98
Q

Ix for cholestateoma

A

HRCT

99
Q

a blocked nose
a runny nose
a feeling that mucus is slowly dripping down the back of your throat (postnasal drip)
a reduced sense of smell or taste
snoring
feeling like having a cold but not getting better
likely diganosis?

A

nasal polyps

100
Q

first line tx for nasal polyps

A

nasal steroid drops

101
Q

Tx for allergic rhinitis

A

1) antihistamine
2) intranasal steroids if antihistamines are ineffective / recurrent episodes

102
Q

what does scanty discharge mean

A

a little bit of discharge

103
Q

what is the most important part of management for mild/moderate otitis externa

A

keep ear dry for 7-10 days

104
Q

noise induced hearing loss on audiogram

A

follows a similar pattern of symmetrical bilateral hearing loss worse at higher frequencies
a ‘spike’ or peak at 4 kHz before the hearing loss slightly improves at the next regular frequency of 8 kHz.

105
Q

pt presents with neck swelling, doesn’t move on tongue protrusion or swallowing
had a cold a couple weeks ago before lump appeared
likely diagnosis

A

branchial cyst - often undetectable until grows in size due to infection

106
Q

what does tympanogram demonstrating a flat (type B) tympanogram curve suggest

A

is indicative of fluid behind the tympanic membrane - eg middle ear congestion

107
Q

which virus is associated with oral pharyngeal and laryngeal cancer

A

HPV type 16

108
Q

first lien tx for acute mastoiditis

A

IV abx
the if doesn’t work investigate via CT - could have an abcess and need mastoidectomy

109
Q

what is most common causative agent for otitis externa

A

pseudomonas aeruginosa

110
Q

why should you od a nasal endoscopy and CT if as pt presents with swollen nose after trauma and difficulty breathing

A

rule out any septal haematoma, which if left untreated can result in necrosis and deformity of the nasal cartilage

111
Q

what does positive Schwarze sign on otoscope suggest

A

otoslcerosis

112
Q

headache, sensineural hearing loss, eye problems
likely diagnosis

A

vestibular shwannoma

113
Q

why is haemophilia uncommon in females

A

its an X linked recessive condition

114
Q

most likely condition if recurrent epistaxis runs in family

A

Hereditary haemorrhagic telangiectasia

115
Q

Tx for acute otitis media

A

analgesia
can give delayed abx prescription
only give abx straight away if systemically unwell and fever, or immunocompromised

116
Q

list some features of EPGA (eosinophilic granulomatosis polyangiitis)

A

asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive
cardiomyopathy
kidney disease
gastrointestinal involvement

117
Q

pt has many bilateral nasal polyps
adult-onset asthma,
symptoms of nasal obstruction
likely diagnosis

A

EGPA (eosinophilic granulomatosis polyangiitis)

118
Q

EGPA (eosinophilic granulomatosis polyangiitis) vs GPA (granulomatosis polyangiitis)

A

EGPA:
bilateral nasal polyps
adult-onset asthma,
symptoms of nasal obstruction

GPA:
saddle nose,
nosebleeds and crusting
marked systemic upset (arthritis, renal impairment, nervous system)

119
Q

what steps should be taken if GP presents with sudden sensineural hearing loss

A

urgent referral to ENT - emergency

ENT specialist can provide advice and commence high-dose steroids which are around 85% effective if started within 24-48 hours of onset. Anti-viral medication may also be considered

120
Q

which scan is required for a neck lump

A

ultrasound - as allows you to do ultrasound guided biopsy
then if its malignant can do a staging CT

121
Q

if a pt presents with bilateral jaw joint pain but no other signs what is the likely diagnosis

A

temporomandibular joint dysfunction
This is a biopsychosocial disorder that is thought to be caused by stress. the majority of cases improve without specific treatment

122
Q

what is a cystic hygroma

A

a birth defect that appears as a sac-like structure with a thin wall that most commonly occurs in the head and neck area of an infant

123
Q

likely diagnosis if a pt with acute otitis media presents with unusual sleepiness/drowsiness, projectile vomiting, severe headache, seizures

A

intracerebral abscess

124
Q

likely diagnosis for progressively worsening sensineural hearing loss

A

vestibular schwannoma

125
Q

type of hearing loss on cholesteatoma

A

conductive hearing loss

126
Q

likely cause of a submandibular gland mass that hast caused any facial weakness or cervical lymphadenopathy

A

pleomorphic adenoma

127
Q

most common type of oral cancer

A

squamous cell carcinoma

128
Q

in which group of people is an oral squamous cell carcinoma more common

A

males who identify as homosexual as this population has a higher incidence of human papillomavirus of the mouth, which is a risk factor for carcinoma

129
Q

what sign in a pt with recurrent rhinosunsitis indicates possible nasal neoplasm and requires urgent ENT referral

A

Unilateral bloodstained nasal discharge

130
Q

which condition causes the formation of benign vascular tumours, called hemangioblastomas, throughout the body

A

von Hippel Lindau disease

131
Q

which condition is characterised by intestinal hamartomas, which may present with features in keeping with gastrointestinal bleeding, such as melaena. also can have blue or dark brown macule around oral mucosa

A

Peutz-Jegher Syndrome

132
Q

what is Caharts notch on an audiogram and which condition is it characteristic of

A

dip at 2kHz
otosclerosis

133
Q

appearance of tympanic membrane in otosclerosis

A

normal

134
Q

appearance of tympanic membrane in tympanosclerosis

A

white plaques

135
Q

most common malignant tumour of parotid gland?
(presents as hard mass on gland, facial drooping)

A

Mucoepidermoid carcinoma

136
Q

painless, mobile, and cystic swelling in the lateral aspect of the neck
diagnosis

A

branchial cyst
- not lipoma as not usually found on neck and doesn’t have cystic appearance

137
Q

what does SCOOP stand for in approach to managing haematoma over thyroid surgery site

A

Skin exposure;
Cut sutures;
Open skin;
Open muscles;
Pack wound

138
Q

how to differentiate pleomorphic adenoma vs warthins tumour

A

both are benign neoplasms
but warthins tumour is mire common in.
older males, smoking history, can occur bilaterally

139
Q

first line Tx for noise induced hearing loss

A

hearing aids

140
Q

neck mass, progressive facial swelling, painless
likely diagnosis

A

benign neoplasm eg pleomorphic adenoma or warthins tumour

141
Q

where in the head/neck does HPV 16 often cause SSC

A

oropharynx

142
Q

how does oral lichen planus present

A

white, lacy patches inside the mouth

year 3 conditions (17 decks)

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