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1MSRA - Learning Points > ENT > Flashcards

ENT Flashcards

1
Q

What are the symptoms of acoustic neuroma/vestibular schwannoma?

A

Sensorineural hearing loss, tinnitus, vertigo

+ V1 affected usually (loss of sensation face, loss of corneal reflex)

+ VII affected (face weakness)

Benign tumour of VIII, which affects V and VII as it grows

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2
Q

What is the gold standard investigation for acoustic neuroma/vestibular schwannoma?

A

MRI with contrast

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3
Q

Vertigo only, following URTI?

A

Vestibular neuronitis

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4
Q

Vertigo plus hearing loss or tinnitus after URTI?

A

Labyrinthitis

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5
Q

Triad of sensorineural hearing loss, vertigo, tinnitus plus feeling of ear fullness?

A

Ménière’s disease

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6
Q

Conductive hearing loss, discharge and small mass top of tympanic membrane?

A

Cholesteatoma

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7
Q

What is glue ear?

A

Otitis media with effusion

Common in 2 year olds, insert grommet if persists

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8
Q

Mx of perforated ear drum?

A

Watch and wait for 6 weeks, avoid water

If no improvement, ENT referral

ABx only given if caused by otitis media

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9
Q

what is the prognosis of Ménière’s disease?

A

attacks last mins-hours

Disease has relatively long course - lasts for 5-10 years

Most patients left with degree of hearing loss :(

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10
Q

What is the Mx of Meniere’s?

A

Buccal/IM prochlorperazine

ENT referral for diagnosis

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11
Q

when is a HINTS exam indicated?

A

in cases of vertigo and nystagmus when neuro exam is otherwise all normal, it’s used to differentiate the cause of acute vestibular syndrome being central (STROKE) vs peripheral (e.g. vestibular neuronitis).

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12
Q

What would HINTS exam show in vestibular neuronitis?

A

Head impulse - abnormal
Nystagmus - unidirectional to affected side
Skew test - negative

In stroke, impulse normal, nystagmus bidirectional and skew test positive.

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13
Q

What is the difference clinically between OE and OM?

A

Externa - ear pain, itchy, discharge, red ear canal

Media - ear pain, fever, potential hearing loss, bulging TM (loss of light reflex). Preceding URTI.

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14
Q

Common consequences of OM?

A

TM perforation

CSOM (when following perforation, there’s ongoing discharge for 6 weeks)

Labyrinthitis

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15
Q

Complications of OM?

A

Meningitis, Brain abscess, mastoiditis, hearing loss

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16
Q

Otitis externa bacteria

A

S.Aureus and Pseudomonas

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17
Q

OM bacteria

A

HMS

HiB
Moraxella
Streptococcus pneumoniae

18
Q

What should you do if you find unilateral nasal polyp?

A

ENT 2ww referral

19
Q

which specific pathogen are diabetics susceptible to?

A

Pseudomonas Aeruginosa

20
Q

Otitis externa + immunosuppression/diabetes?

A

Malignant otitis externa (spreading infection)

Treat with IV Ciprofloxacin to cover pseudomonas

21
Q

When is Abx treatment indicated in OM?

A

after 3 days

if bilateral and under 3yrs

if systemically unwell/any complications

22
Q

Which nerve can be affected in parotid gland and/or ear pathology?

A

Facial nerve!
Runs through parotid

parotid tumour or its removal can affect facial nerve

23
Q

Parotid glands - 80% of

A

salivary gland tumours

24
Q

Submandibular glands - 80% of

A

salivary gland stones

25
Q

Triad of fever, sore throat and cervical lymphadenopathy?

What might happen if you give Abx?

A

GLANDULAR FEVER

Abx may cause maculopapular rash

26
Q

What is the 2ww referral criteria for oral lesions?

A

unexplained oral ulceration for 3 weeks

unexplained white or red painful areas

persistent unexplained sore throat

unexplained or change in previously undiagnosed neck lump

unilateral head/neck pain that’s been going on for more than 4 weeks

27
Q

Medication to prevent attacks of Meniere’s?

A

Betahistine

(whereas prochlorperazine used for relief of acute attacks

28
Q

Different types of neck lumps and features?

A

Moves upwards with swallowing - thyroid

Moves with protrusion of tongue - thyroglossal cyst

Bilateral swelling - likely reactive lymphadenopathy

Rubbery swellings - lymphoma

Fluctuant cyst between SCM and pharynx = Branchial cyst

29
Q

Features of CENTOR score?

A

Cough absent
Swollen OR tender anterior cervical lymphadenopathy
Temp >38
Tonsillar exudate

30
Q

When do you prescribe antibiotics in otitis media?

A

If lasting >3 days / systemically unwell / bilateral otitis media and less than 2yrs old / TM perforation / high risk (i.e. immunosuppressed or comorbid)

31
Q

What are the causes of conductive hearing loss?

A

Essentially 1) stuff in ear canal 2) TM issue 3) stuff in middle ear 4) issue with ear bones

Therefore,

Wax, foreign material
Perforated TM
Middle ear effusion
Otosclerosis

32
Q

What is otosclerosis?

A

Bilateral conductive hearing loss, which is autosomal dominant.

The ear bones turn from solid to spongy.

33
Q

What are the causes of hoarse voice?
And when should you refer to 2ww ENT?

A

Benign causes include infection, overuse of voice, smoking, acid reflux

Serious causes - laryngeal cancer, lung cancer

Therefore, if hoarse voice unexplained and persistent for 3 weeks in 45 years or older -> 2ww ENT

34
Q

What are the complications of thyroid surgery?

A

Damage to nerve, blood vessels or parathyroid gland

Recurrent laryngeal nerve damage / bleeding / parathyroid damage causing hypocalcaemia (remember Karim Meehan’s apprehension regarding thyroidectomy)

35
Q

Following nasal trauma, aside from fracture, which other important complication must you exclude?

A

Septal haematoma, which if untreated, can cause septal necrosis within 3-4 days and permanent saddle nose deformity

36
Q

What does septal haematoma look like? Where is the blood collected?

A

Bilateral red boggy swelling seen from the septal midline (can differentiate from ‘deviated septum’ which is hard on palpation)

The blood is collected between the septum and the perichondrium. This issue is that this build up can exert pressure on the septum, causing ischaemia and necrosis.

37
Q

1st line management of chronic rhino sinusitis?

A

Saline nasal irrigation

Can also try 3 month course of nasal steroid spray

38
Q

Which Abx used in otitis media if indicated?

A

Amoxicillin

39
Q

Why is penicillin V preferred to amoxicillin for bacterial throat infections?

A

Because amoxicillin causes maculopapular rash if glandular fever

40
Q

Causes of parotid swelling?

A

Bilateral - infection, inflammation
(mumps, sarcoidosis, Sjogren’s)

Unilateral - tumour, stones
(if parotid, more likely to be tumour, whereas submandibular salivary gland swelling more likely to be stone)

41
Q

What are the red flags for URTI which require ENT evaluation?

A

Unable to swallow, breathe
Trismus
Septic

(this raises concern of deeper infection - e.g. supraglottitis)

42
Q
A

1MSRA - Learning Points (20 decks)

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