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MBChB Finals > ENT > Flashcards

ENT Flashcards

1
Q

A 23-year-old woman presents one week after being prescribed a combined antibiotic and steroid spray for otitis externa. There has been no improvement in her symptoms and the erythema seems to have extended to the ear itself. What is the most appropriate treatment?

A

Oral flucloxacillin

The spreading erythema is an indication for oral antibiotics

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2
Q

What duration of antibiotics is given for tonsilitis with marked systemic upset?

A

Phenoxymethlpeniillin for 10 days

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3
Q

What is the most common cause of bacterial otitis media?

A

Haemophilus influenzae

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4
Q

What is the first line management of mastoiditis?

A

Mastoiditis is typically diagnosed clinically and requires IV antibiotics

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5
Q

List the CENTOR criteria

A
  • Tonsillar exudate
  • Tender anterior lymphadenopathy or lymphadenitis
  • History of fever
  • Absence of cough
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6
Q

Recurrent otitis externa following numerous antibiotic treatment should raise suspicion of what infectious organism?

A

Candida albicans

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7
Q

What are the clinical features of a thyroglossal cyst?

A
  • More common in patients < 20 years old
  • Usually midline, between the isthmus of the thyroid and the hyoid bone
  • Moves upwards with protrusion of the tongue
  • May be painful if infected
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8
Q

What are the clinical features of a pharyngeal pouch?

A
  • More common in older men
  • Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough
  • Associated with halitosis or throat infections
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9
Q

What are the clinical features of a cystic hygroma?

A
  • A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
  • Most are evident at birth, around 90% present before 2 years of age
  • Swelling will transluminate
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10
Q

What are the clinical features of a branchial cyst?

A
  • Usually presents in early adulthood
  • An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx (anterior triangle)
  • Lump won’t transluminate
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11
Q

What are the clinical features of a cervical rib?

A
  • More common in adult females
  • Around 10% develop thoracic outlet syndrome
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12
Q

What are the clinical features of a carotid aneurym?

A

Pulsatile lateral neck mass which doesn’t move on swallowing

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13
Q

What symptom distinguishes vestibular neuronitis from labyrinthitis?

A

Hearing will be unaffected in vestibular neuronitis

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14
Q

When do guidelines suggest oral antibiotics in otitis media?

A
  • Symptoms lasting more than 4 days or not improving
  • Systemically unwell but not requiring admission
  • Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
  • Younger than 2 years with bilateral otitis media
  • Otitis media with perforation and/or discharge in the canal
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15
Q

What findings on Rinne’s and Weber’s tests indicate normal hearing?

A
  • Rinne result: air conduction > bone conduction bilaterally
  • Weber result: same in both ears
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16
Q

What is the normal first line management for sinusitis?

A
  • Analgesia
  • Intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
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17
Q

When should intranasal steroids be considered for sinusitis?

A

If symptoms have persisted for 10 days or more

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18
Q

When would antibiotics be indicated in sinusitis?

A
  • The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’
  • ‘Double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection
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19
Q

You review a 23-year-old woman who presents with a three week history of bilateral nasal obstruction, cough at night and a clear nasal discharge. She had similar symptoms around this time last year and the only history of note is asthma. What is the most likely diagnosis?

A

Allergic rhinitis

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20
Q

What findings on Rinne’s and Weber’s tests indicate conductive hearing loss?

A
  • Rinne result: bone conduction > air conduction in affected ear, Air conduction > bone conduction in unaffected ear
  • Weber result: lateralises to affected ear
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21
Q

What diagnosis should you consider in a patient with globus, hoarseness and no red flags?

A

Laryngopharyngeal reflux

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22
Q

What is the management of Ramsay Hunt syndrome?

A

Oral aciclovir and corticosteroids

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23
Q

List 3 drugs associated with gingival hyperplasia

A
  • Phenytoin
  • Ciclosporin
  • Calcium channel blockers
24
Q

What findings on audiogram would indicate presbycusis?

A

Bilateral high-frequency hearing loss

25
Q

Describe the management of a perforated tympanic membrane caused by barotrauma

A

Self limiting so reassurance and followup

26
Q

A 25-year-old woman presents with a slowly enlarging mass on the side of the face. Clinical examination demonstrates that the mass is located in the tail of the parotid gland. There is no evidence of facial nerve involvement. What is the most likely cause?

A

Pleomorphic adenoma

27
Q

What clinical features would suggest a Warthin tumour?

A
  • Most common bilateral benign neoplasm of the parotid
  • Marked male as compared to female predominance
  • Occurs later in life (sixth and seventh decades)
28
Q

List 3 potential complications of thyroid surgery

A
  • Damage to recurrent laryngeal nerve
  • Bleeding which can lead to respiratory compromise
  • Damage to the parathyroid glands resulting in hypocalcaemia
29
Q

What ECG change is associated wth hypocalcaemia?

A

Isolated QTc elongation

30
Q

What is the most appropriate course of action for a patient with non-resolving unilateral ear discharge?

A

Suspect cholesteatoma - refer to ENT outpatient clinic

31
Q

A 56-year-old man presents with episodic facial pain and discomfort whilst eating. He has suffered from halitosis recently and he frequently complains of a dry mouth. He has a smooth swelling underneath his right mandible. What is the most likely underlying diagnosis?

A

Stone impacted in Wharthons duct

Symptoms are typical for sialolithiasis

32
Q

A 3-year-old boy is brought to surgery. His mum reports that he has been complaining of a sore left ear for the past 2-3 weeks. This morning she noticed some ‘green gunge’ on his pillow. On examination his temperature is 37.8ºC. Otoscopy of the right ear is normal. On the left side the tympanic membrane cannot be visualised as the ear canal is full with a yellow-green discharge. What is the most appropriate action?

A

Amoxicillin + review in 2 weeks

Presentation consistent with OME; presence of dischage suggests membrane may have perforated and so antibiotics are indicated

33
Q

A 42-year-old man presents to his general practitioner 6 weeks after developing a cold. Whilst all of his other symptoms have now resolved, the patient is experiencing persistent blockage of his left nostril associated with rhinorrhoea and sneezing. He is otherwise well.

On examination, a large polyp is seen in the left nostril. Examination of the right nostril is unremarkable.

What is the most appropriate next step in management?

A

Urgent referral to ENT

Unilateral polyps are a red flag symptom

34
Q

What antibiotic is indicated in diabetis with otitis externa?

A

Ciprofloxacin to cover Pseudomonas

35
Q

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

A

Idiopathic

36
Q

A 43-year-woman had a tonsillectomy one week ago. She presents to her GP one week later because she has noticed a small amount of blood pooling in her mouth from this morning. She believes that the blood is coming from the wound site.

The GP examines her mouth and throat and sees no other obvious source of the bleeding. A set of basic observations are all normal.

What is the most appropriate next step for the GP to take?

A

Admit to hospital for ENT review and antibiotic therapy

Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with antibiotics

37
Q

What kind of crystals do branchial cysts characteristically contain?

A

Cholesterol

38
Q

Describe the features and management of mild acute otitis externa

A
  • Mild discomfort and/or pruritus; no deafness or discharge
  • Consider prescribing topical acetic acid 2% spray
39
Q

What clinical features of acute otitis externa would make you consider a topical antibiotic +/- topical steroid?

A
  • A red, oedematous ear canal which is narrowed and obscured by debris
  • Conductive hearing loss
  • Discharge
  • Regional lymphadenopathy
  • Cellulitis spreading beyond the ear
  • Fever
40
Q

What is the most appropriate management for sudden-onset sensorineural hearing loss?

A
  • Urgent referral to ENT for audiology assessment and brain MRI
  • Drug treatment for idiopathic SSNHL involves high-dose oral corticosteroids (oral prednisolone 1mg/kg/day (maximum 60mg/day) for 7 days and then tapered over the next week)
41
Q

What findings on Rinne’s and Weber’s tests indicate left sensorineural deafness?

A
  • Rinne’s test: air conduction > bone conduction in both ears
  • Weber’s test: localises to the right side
42
Q

Describe the management of a haemorrhage within hours of tonsillectomy

A
  • Immediate return to theatre - primary haemorrhage
  • Ensure the airway remains patent in the meantime
  • ENT and anaesthetics should be called immediately
43
Q

What is ‘black hairy tongue’?

A
  • Black hairy tongue is a benign condition characterized by the elongation and discolouration of the filiform papillae on the dorsal surface of the tongue
  • The brown or black coating seen in this case is due to the accumulation of keratin and dead cells, as well as staining from food, drinks, or tobacco products
  • Although it may cause some discomfort or tickling sensation, it is generally asymptomatic and can be managed with good oral hygiene practices
44
Q

What is the most appropriate management for an unexplained persistent sore throat?

A

2-week wait referral to oral surgery

45
Q

What type of hearing loss is associated with otosclerosis?

A

Bilateral, conductive pattern hearing loss, sometimes with associated tinnitus

46
Q

Describe the management of nasal polyps

A
  • Intranasal corticosteroid spray or drops can be used to shrink nasal polyps
  • If topical steroids do not work oral steroids may be considered whilst awaiting ENT review
47
Q

Describe the clinical features of a goitre

A
  • Midline, non-tender neck swelling which moves upwards on swallowing
  • Patients with a goitre are often euthyroid or have minor symptoms
48
Q

Describe the management of persistent unexplained hoarseness in a patient aged >45 years old

A

Request a CXR and refer urgently to ENT

Any patient presenting with hoarseness who are being referred down the suspected cancer pathway should have a chest x-ray to exclude an apical lung lesion

49
Q

List 4 potential causes of drug ototoxicity

A

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

50
Q

How would you differentiate between Meniere’s disease and a vestibular schwannoma?

A

Will be symptom free episodes between ‘attacks’ in Meniere’s disease

51
Q

What is the most likely diagnosis for this finding on otoscopy?

A

Cholesteatoma

52
Q

Describe the findings on audiogram associated with sensorineural hearing loss

A
  • In patients with sensorineural hearing loss, both air and bone conduction readings will be more than 20 dB, plotted below the 20 dB line on the chart
  • This may affect only one side, one side more than the other or both sides equally
53
Q

Describe the findings on audiogram associated with conductive hearing loss

A
  • In patients with conductive hearing loss, bone conduction readings will be normal (between 0 and 20 dB)
  • However, air conduction readings will be greater than 20 dB, plotted below the 20 dB line on the chart
  • In conductive hearing loss, sound can travel through bone but is not conducted through air due to pathology along the route into the ear
54
Q

Describe the findings on audiogram associated with mixed hearing loss

A
  • Both air and bone conduction readings will be more than 20 dB in patients with mixed hearing loss
  • However, there will be a difference of more than 15 dB between the two (bone conduction > air conduction)
55
Q

What signs are used to represent air conduction on audiogram?

A
  • O = right ear unmasked
  • △ = right ear masked
  • X = left ear unmasked
  • ▢ = left ear masked
56
Q

What signs are used to represent bone conduction on audiogram?

A
  • < = right ear unmasked
  • [ = right ear masked
  • > = left ear unmasked
  • ] = left ear masked

MBChB Finals (18 decks)

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