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Neuro and special senses > ENT > Flashcards

ENT Flashcards

1
Q

What are some benign tumours of the parotid gland?

A

Warthin tumour, pleomorphic adenoma

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2
Q

Where else would you want to assess if considering a parotid tumour?

A

Scalp for skin cancer, facial nerve and cervical lymph nodes

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3
Q

Which salivary glands tumour are more likely to be malignant? Parotid tumour or tumours of small salivary glands?

A

Small salivary glands

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4
Q

What are three important questions to ask in order to assess severity of someone presenting with an acute sore throat?

A

Difficulty swallowing, voice changes and trismus

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5
Q

How would you manage a patient with a moderate to severe unremitting unilateral sore throat for 3 weeks or more?

A

Urgent outpatient referral via the suspected cancer pathway

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6
Q

What is the most common cause for a painful discharging ear in an adult and a child?

A

Adult: otitis externa
Child: otitis media with tympanic perforation

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7
Q

If a child has acute otitis media with a perforated tympanic membrane (ASOM) how will you manage them?

A

Offer regular analgesia, ear drops containing an anaesthetic and analgesic for pain. May not require antibiotics- can do a delayed/back-up prescription to take id child does not improve in next 3 days

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8
Q

What are red flags associated with acute otitis media?

A

Sepsis with post auricular swelling, cranial nerve palsy, symptoms of meningism, altered consciousness state

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9
Q

Who is most commonly affected by acute otitis media?

A

Children under 7

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10
Q

What is the typical history/presentation of acute otitis media?

A

Gradually increasing ear pain with no discharge with a red bulging ear drum on otoscopy

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11
Q

What is the classic presentation of acute suppurative otitis media?

A

Gradually increasing otalgia followed by some discharge associated with a reduction in pain. Patinets may feel/hear a pop before noticing the discharge

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12
Q

A quick onset dysphagia with infective symptoms would imply what most likely condition?

A

Tonsillitis

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13
Q

A sudden onset dysphagia with neurological symptoms implies what?

A

A cerebrovascular ischaemic event

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14
Q

A gradual onset dysphagia over week to months in the presence of weight loss and smoking history implies what diagnosis?

A

Malignancy in oropharynx, hypopharynx or oesophagus

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15
Q

A long term (months to years) and relatively slow progressing dysphagia may lead you to consider what types of diagnoses?

A

Benign causes like a pharyngeal pouch
Chronic neurological disorder

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16
Q

If someone presents with otalgia with normal otoscopy and the pain is worse in front of the ear and worse on chewing. What is the likely diagnosis?

A

Temporo-mandicular joint dysfunction

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17
Q

What is the likely diagnosis of someone presenting with a right sided neck nodule that moves on swallowing. On examination, they are warm and well perfused, tachycardic, and appears to be staring.

A

they are likely thyrotoxic with a thyroid nodule

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18
Q

how can differentiate a thyroglossal cyst and a thyroid nodule on clinical examination?

A

thyroglossal cyst will move upwards on tongue protrusion

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19
Q

What is there an increased risk of when operating on patient who is hyperthyroid?

A

risk of thyrotoxic strom and increased risk of bleeding

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20
Q

what are risks of a full thyroidectomy?

A

bleeding, infection, recurrent laryngeal nerve damage, hypothyroidism, hypoparathyroidism (low calcium)

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21
Q

what are the paths of the recurrent larygeal nerves?

A

theintially descend and the right will loop under the right subclavian artery and the left will loop under the aortic arch. they then ascend deep to the thyroid and enter the larynx at the cricothyroid joint.

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22
Q

what is the most important blood test to carry out followinga complete thyroidectomy. How does this present?

A

calcium
low calcium presents as tingling around the lips and fingertips, if severely low then muscle spasms occur

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23
Q

what are some features of a parotid lump that may suggest malignancy?

A

facial nerve paresis, cervical lymphadenopathy that are hard and non-tender

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24
Q

what is freys syndrome which can occur following parotid surgery?

A

abnormal regeneration of the auriculotemporal branch of the mandibular nerve following injury, infection, or surgery in the vicinity of the parotid gland causes its parasympathetic fibres to supply the sweat glands so when eating the patient sweats around preauricular and temporal areas

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25
Q

what structure is at risk of damage during surgery in the posterior triangle of the neck? how will this affect the patient?

A

accessory nerve result in shoulder drop

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26
Q

which nerves can be damage during surgery to the submandibular salivary gland?

A

hypoglossal nerve which runs deep to the gland
the lingual nerve which overlies the duct
the cervical branch of the facial nerve runs superficially over the gland so can be damaged if using a platysma/high incision

27
Q

what is the medical treatment for chronic rhinosinusitis?

A

nasal steroid sprays and long course of antibiotics (6-8 weeks)

28
Q

what are potential complications of sinus surgery?

A

bleeding, infection, CSF leak (basal skull injury), vision loss or disturbance (ethmoid sinuses closely associated with the orbit)

29
Q

how can a septal haematoma be identified on clinical examination?

A

anterior rhinoscopy and palpation of the bulging septum

30
Q

Which recreational drug is commonly implicated in septal defects and how does it cause this damage?

A

cocaine
it causes loss of blood supply to the cartilage

31
Q

what is the management of a nasal septal haematoma?

A

Prompt referral to an Ear, Nose, and Throat (ENT) specialist for emergency incision and drainage

32
Q

how will a nasal septal haematoma appear on rhinoscopy?

A

a bilateral cherry-red swelling

33
Q

with BPPV what would we expect to see on Dix-Hallpike test?

A

Latency
Geotropic intorsional nystagmus
Fatigue
Habituation on repeating the test

34
Q

what are possible reasons for conductive hearing loss with cholesteatoma?

A

mucosal inflammation and discharge/debris in ear canal or erosion into the ossicles

35
Q

What could cause a patient with cholesteatoma to experience severe rotatory vertigo?

A

erosion into the balance organ causing a labrynthine fistula- causing dizziness on pressure change transmitted from the middle ear to the vestibular system

36
Q

What is ludwigs angina?

A

severe diffuse cellulitis of the floor of the mouth which can push the tongue posteriorly leading to airway compromise

37
Q

What is chronic rhinosinusitis?

A

An inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer

38
Q

What are some symptoms of chronic rhinosinusitis?

A

Facial pain- usually worse on bending forwards
Nasal discharge- usually clear, if thicker may suggest secondary infection
Nasal obstruction
Post-nasal drip which may produce chronic cough

39
Q

What is the initial management of chronic rhinosinusitis?

A

Avoid allergens/triggers, intranasal corticosteroids and nasal irrigation with saline

40
Q

Which exam can be used to distinguish between vestibular neuronitis and a posterior circulation stroke?

A

HiNTS exam

41
Q

What would be seen on a HiNTS exam if a patient had a peripheral cause of vertigo?

A

Corrective saccades in the head impulse test
A unidirectional nystagmus or none
No vertical skew

42
Q

What would be seen on a HiNTS exam if a patient had a central cause of vertigo?

A

Negative head impulse test, bidirectional or vertical nystagmus and vertical skew

43
Q

A negative head impulse test implies what kind of cause of vertigo?

A

Central

44
Q

What is the treatment of Ramsey hunt syndrome?

A

Oral aciclovir and prednisolone

45
Q

What are causes of gingival hyperplasia?

A

Phenytoin, ciclosporin, calcium channel blockers and AML

46
Q

What is the classic pathological finding of a branchial cyst?

A

A cellular fluid with cholesterol crystals

47
Q

What is the management of someone who is experiencing chronic symptoms of vestibular neuronitis?

A

Vestibular rehabilitation

48
Q

What associations are described in samter’s triad?

A

Nasal polyps, asthma and aspirin sensitivity

49
Q

What is the most common cause of sudden-onset sensorineural hearing loss?

A

Idiopathic

50
Q

What medication is given to someone presenting with sudden-onset sensorineural hearing loss and what scan will they have done?

A

High dose oral corticosteroids
MRI brain for vestibular schwannoma

51
Q

What is the surgery to repair a tympanic perforation, when would this be performed?

A

Myringoplasty
If the perforation does not eat by itself, which we would expect it to do after 8 weeks

52
Q

What are complications of a perforated tympanic membrane?

A

Hearing loss and increased risk of otitis media

53
Q

What is the initial management of a perforated tympanic membrane?

A

Watch and wait and refer to ENT if persists after 6 weeks. Advice to avoid getting water in the ear as can affect healing and increase infection risk

54
Q

Who is referred to ENT via the 2 week wait pathway for laryngeal cancer?

A

Patients over 45 with persistent unexplained hoarseness or an unexplained lump in the neck

55
Q

Intranasal steroid should only be considered for sinusitis if symptoms have persisted for how many days?

A

Over 10 days

56
Q

What is first line treatment for otitis externa?

A

Topical antibiotics with or without topical steroids

57
Q

What are features of laryngopharyngeal reflux?

A

Sensation of a lump in the throat, hoarseness, chronic cough, dysphagia, heartburn, sore throat

58
Q

What are some examples of ototoxic agents?

A

Gentamicin, quinine, furosemide, aspirin and platinum chemo therapies

59
Q

What are the names of exercises patients can do at home for BPPV?

A

Brandt-Daroff

60
Q

What can be associated with a recurrent laryngeal nerve palsy?

A

Thyroid surgery, polio, aortic aneurysm surgery, carcinoma of oesophagus/bronchus

61
Q

Likely to be seen on examination for a quinsy?

A

Uvula deviated away from Sid elf infection, unilaterally enlarged tonsil and peritonsillar swelling with mucosal cellulitis

62
Q

what is a Bezold’s abscess?

A

infection following mastoiditis, in which an abscess collects deep to the periosteum of the mastoid bone, and extends inferiorly within the fascia of the sternocleidomastoid muscle

63
Q
A

Neuro and special senses (4 decks)

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