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ENT Flashcards

1
Q

When should you not give treatments for ear wax?

A

Grommits

Suspected perforation

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2
Q

Treatment for ear wax

A

Olive oil
Sodium bicarb 5%
Almond oil

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3
Q

Management of sudden onset sensorineural hearing loss

A

Urgent ENT referral
High dose steroids
MRI to exclude vestibular neuroma

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4
Q

Associations with nasal polyps

A

Asthma

Aspirin sensitivity

Infective sinusitis

Cystic fibrosis

Kartagener’s syndrome

Churg Strauss syndrome

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5
Q

Features of nasal polyps

A

Nasal obstruction
Rhinorrhoea
Sneezing
Poor taste and smell

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6
Q

Red flags for nasal polyps

A

Unilateral symptoms

Bleeding

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7
Q

Management of nasal polyps

A

ENT examination

Topical corticosteroids to shrink them

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8
Q

When to 2ww refer patients with suspected laryngeal cancer?

A

Age over 45 with

  • persistent hoarseness
  • unexplained lump in the neck
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9
Q

Causes of hoarseness

A

Voice overuse

Smoking

Viral illness

Hypothyroidism

GORD

Laryngeal cancer

Lung cancer

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10
Q

When to 2ww refer patients with suspected oral cancer?

A

Unexplained ulceration in oral cavity >3 weeks

Persistent lump in neck

Lump on lip or oral cavity

Red/white patch in oral cavity consistent with
erythroplakia or erythroleukoplakia

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11
Q

When to 2ww refer patients for suspected thyroid cancer?

A

Unexplained thyroid lump

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12
Q

What is surfer’s ear called?

A

Exostosis

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13
Q

What is exostosis also called?

A

Surfer’s ear

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14
Q

Features of exostosis/surfer’s ear

A

Repeated ear infections
Decreased hearing
Water plugging

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15
Q

Features of nasopharyngeal carcinoma

A

Cervical lymphadenopathy

Otalgia

Unilateral serous otitis media

Nasal obstruction, discharge or epistaxis

Cranial nerve palsies

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16
Q

Management of epistaxis if first aid is successful

A

Topical naseptin (Chlorhexidine and neomycin)

Reduces risk of vestibulitis and crusting

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17
Q

Who can’t have naseptin?

A

Allergies to peanut, soy or neomycin

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18
Q

Management of TMJ dysfunction

A

Soft foods
Simple analgesia
Short course of benzodiazepines
Review by dentist

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19
Q

Complications of tonsillectomy

A

Pain

Haemohrragic

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20
Q

Indications for tonsillectomy

A

5 or more episodes per year
Symptoms occurring for at least a year
Episodes are disabling and prevent normal functioning

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21
Q

Inheritance of otosclerosis

A

autosomal dominant

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22
Q

Features of otosclerosis

A 
Onset age 20-40
Conductive deafness
Tinnitus
10% have 'flamingo tinge' on TM
Positive family history
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23
Q

Management of otosclerosis

A

Hearing aid

Stapedectomy

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24
Q

What does a nasal septal haematoma look like?

A

Bilateral red swelling from nasal septum

Septum firm

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25
Q

Consequences of nasal septal haematoma

A

Septal necrosis

causes ‘saddle nose’ deformity

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26
Q

Criteria for adults to get a cochlear implant

A

3 month trial of hearing aids with no/little benefit

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27
Q

Where do you find a branchial cyst?

A

Lateral neck lump, anterior to sternocleidomastoid muscle

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28
Q

Features of branchial cyst

A

Unilateral (typically left)

Slowly enlarging

Smooth, soft, fluctuant

Non-tender

No movement on swallowing

No transillumination

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29
Q

Management of perforated tympanic membrane

A

None as will heal in 6-8 weeks
Avoid water in the ear
Review to ensure resolution and refer if doesn’t

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30
Q

Management of auricular haematoma

A

Same day assessment by ENT

I+D of haematoma to prevent ‘cauliflower ear’

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31
Q

Causes of gingival hyperplasia

A

Phenytoin

Ciclosporin

CCBs e.g. nifedipine

Acute myeloid leukaemia

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32
Q

Explain the centor criteria

A

1 point for each:

  • tonsillar exudate
  • tender anterior cervical lymphadenopathy or lymphadenitis
  • history of fever
  • absence of cough
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33
Q

Centor criteria and the likelihood of isolating streptococci

A

0-2 = 3-17%

3-4 = up to 56%

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34
Q

Antibiotics for sore throat

Antibiotics if penicillin allergic

A

Phenoxymethylpenicillin

Clarithromycin if penicillin allergic

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35
Q

Sensorineural hearing loss on audiometry

A

AC and BC equally reduced

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36
Q

Mixed hearing loss on audiometry

A

AC and BC both reduced

AC reduced more

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37
Q

What is Ramsay Hunt syndrome?

A

Reactivation of VZV in the 7th cranial nerve ganglion

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38
Q

Features of ramsay hunt syndrome

A

Auricular pain
Facial nerve palsy
Vesicular rash around ear

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39
Q

Management of ramsay hunt syndrome

A

oral aciclovir

corticosteroids

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40
Q

Management of black hairy tongue

A

Tongue scrapping

Topical antifungals if candida

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41
Q

Black hairy tongue - predisposing factors

A

Poor oral hygiene

Antibiotics

Head and neck radiation

HIV

IVDU

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42
Q

Management of simple gingivitis

A

Routine dental review

43
Q

Management of acute necrotising ulcerative gingivitis

A

Refer to dentist
Start oral metronidazole
Chlorhexidine or hydrogen peroxide mouth wash

44
Q

Features of acute necrotising ulcerative gingivitis

A

Painful bleeding gums with halitosis and punched out ulcers on gums

45
Q

What is erythroplakia?

A

erythematous area on a mucous membrane that cannot be attributed to any other pathology

46
Q

What is leukoplakia?

A

White area on a mucous membrane that cannot be attributed to any other cause

47
Q

What is erythroleukoplakia?

A

Lesions on a mucous membrane that have white and red lesions, without obvious cause

48
Q

Risks associated with erythroplakia

A

Transformation to squamous cell carcinoma is 50%

49
Q

Risks associated with leukoplakia

A

Transformation to squamous cell carcinoma is 5%

50
Q

What can you not prescribe with pseudoephedrine?

A

Monoamine oxidase inhibitor

Could cause hypertensive crisis

51
Q

Red flags for oral ulcerations

A

Ulcer for >3 weeks

Unexplained red/white patches

Symptoms or signs persisting for more than 6 weeks and benign lesion can’t be diagnosed

52
Q

Management of mouth ulcers

A

Hydrocortisone lozenges
Antimicrobial mouthwash
Topical anaesthetic

53
Q

Associations with mouth ulcers

A

Stopping smoking

Stress

High socioeconomic status

Oral trauma e.g. excessive brushes

Hormonal changes related to menstruation

54
Q

Presentation of glue ear

A

Peaks at age 2
Presents with hearing loss
May have language delay, behavioural and balance problems

55
Q

Management of allergic rhinitis

A

Mild - oral/intranasal antihistamines
Severe - intranasal steroids
Oral steroids for significant life events

56
Q

1st line management of otitis externa

A

topical antibiotic with steroids

57
Q

2nd line management of otitis externa

A

swab ear, clear debris, ear wick

empirical use of antifungal

oral flucloxicillin if spreading

58
Q

Cholesteatoma - features

A

foul-smelling, non-resolving discharge
hearing loss
vertigo
facial nerve palsy

59
Q

What is a cholesteatoma?

A

Non-cancerous growth of squamous epithelium that is trapped in skull base causing local destruction

60
Q

Neck lumps - lymphoma features

A

Rubbery, painless lymphadenopathy
Night sweats
Splenomegaly

61
Q

Neck lumps - thyroid swelling features

A

moves upwards on swallowing

62
Q

Neck lumps - thyrogossal cyst features

A

<20 years old
midline
moves up on tongue protrusion
painful if infected

63
Q

Neck lumps - carotid aneurysm features

A

pulsatile neck mass, doesn’t move on swallowing

64
Q

Neck lumps - pharyngeal pouch features

A

Older men
Gurgles on palpation
Dysphagia, regurgitation, aspiration, cough

65
Q

Neck lumps - cystic hygroma features

A

Congenital lymphatic lesion

Most are evident at birth, 90% present by age 2

66
Q

Neck lumps - branchial cyst features

A

Oval mobile cystic mass

Presents early adulthood

67
Q

Main cause of a neck lump

A

Reactive lymph node

68
Q

Features of viral labyrinthitis

A

Recent viral infection
Sudden onset
N+V
Hearing is affected

69
Q

Drugs causing ototoxicity

A

Gentamicin
Furosemide
Aspirin
Cytotoxic agents

70
Q

Features of vertebrobasilar ischaemia

A

Elderly patient

Dizzy on extending neck

71
Q

Meniere’s disease - features

A

Recurrent episodes of vertigo, tinnitus and sensorineural hearing loss

Aural fullness

Nystagmus

Episodes last minutes to hours

Unilateral symptoms

72
Q

Meniere’s disease - acute attack management

A

buccal or IM prochlorperazine

73
Q

Meniere’s disease - DVLA rules

A

Tell DVLA

Stop driving until symptoms well controlled

74
Q

Meniere’s disease - prevention of attacks

A

Beta histine

Vestibular rehabilitation exercises

75
Q

What is presbycusis?

A

Age-related sensorineural hearing loss

76
Q

Presbycusis on audiometry

A

Bilateral high frequency hearing loss

77
Q

Features of vestibular neuronitis

A

Recurrent vertigo attacks lasting hours/days

N+V

Horizontal nystagmus

hearing is NOT affected

78
Q

Management of vestibular neuronitis

A

Prochlorperazine

Vestibular rehabilitation exercises

79
Q

What else is an acoustic neuroma called?

A

vestibular schwannoma

80
Q

Acoustic neuroma - features

A

Vertigo, hearing loss, tinnitis (due to CN VIII)

Absent corneal reflex (due to CN V)

Facial palsy (due to CN VII)

81
Q

What is associated with bilateral acoustic neuromas?

A

Neurofibromatosis type 2

82
Q

Acoustic neuroma - investigations

A

MRI cerebellopontine angle

Audiometry abnormal in 95%

83
Q

Malignant otitis externa - features

A

Diabetic or immunosuppressed
Severe unrelenting deep seated otalgia
Purulent otorrhoea

84
Q

What is malignant otitis externa?

A

When infection spreads to become temporal bone osteomyelitis

85
Q

What is laryngopharyngeal reflux?

A

gastro oesophageal reflux causes inflammatory changes to the larynx mucosa

86
Q

Laryngopharyngeal reflux - symptoms

A

Lump in the throat “globus”, worse when swallowing saliva

Hoarseness

Chronic cough

Dysphagia

Heartburn

Sore throat

87
Q

Laryngopharyngeal reflux - red flags for urgent referral

A

Persistent unilateral throat discomfort
Dysphagia, odynophagia
Persistent hoarseness

88
Q

Laryngopharyngeal reflux - management

A

Avoid fatty foods, caffeine, chocolate, alcohol

PPI

Sodium alginate liquids (gaviscon)

89
Q

Chronic rhinosinusitis - features

A

Facial pain

Nasal discharge - clear

Nasal obstruction

Post-nasal drip

90
Q

Chronic rhinosinusitis - management

A

Avoid allergen
Intranasal steroid
Nasal irrigation with saline solution

91
Q

Chronic rhinosinusitis - red flags for urgent referral

A

Unilateral symptoms
Persistent symptoms despite 3 months of treatment
Epistaxis

92
Q

Acute sinusitis - features

A

Facial pain
Nasal discharge - thick, purulent
Nasal obstruction

93
Q

Acute sinusitis - management

A

Analgesia
Intranasal steroids if symptoms >10 days
Oral antibiotics if severe

94
Q

Antibiotics for acute sinusitis

A

Phenoxymethylpenicillin

Co-amoxiclav if systemically unwell

95
Q

Benign paroxysmal positional vertigo - features

A

Vertigo triggered by change in head position (e.g. rolling over in bed)
Associated with nausea
Episodes last 10-20 seconds

96
Q

Benign paroxysmal positional vertigo - diagnosis

A

Dix-Hallpike manoeuvre causes rotatory nystagmus

97
Q

Benign paroxysmal positional vertigo - management

A 
Epley manoeuvre (successful in 80%)
Vestibular rehabilitation exercises - Brandt-Daroff exercises
98
Q

What is the name of the vestibular rehabilitation exercises used in BPPV?

A

Brandt-Daroff exercises

99
Q

Benign paroxysmal positional vertigo - prognosis

A

Usually self resolves over a few weeks/months

50% will have recurrence in 3-5 years

100
Q

Acute otitis media - features

A

Otalgia
Fever in 50%
Hearing loss
Ear discharge if TM perforates

101
Q

Acute otitis media - otoscopy findings

A

Bulging TM so loss of light reflex
Opacification/erythema of TM
Perforation with purulent otorrhoea

102
Q

Indications for antibiotics in acute otitis media

A

Symptoms >4 days

Systemically unwell

Immunocompromised or significant co-morbidity

<2 years with bilateral otitis media

Otitis media with perforation and/or discharge in the canal

103
Q

Antibiotic choice in acute otitis media

Antibiotic choice if penicillin allergic

A

Amoxicillin

Erythromycin if penicillin allergic

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