ENT Flashcards
What is vestibular neuronitis?
vertigo post viral infection
What are the features of vestibular neuronitis?
-recurrent vertigo attacks that last hours or days
- N&V
- horizontal nystagmus
- NO hearing loss of tinnitus
What are the treatment options for Vestibular neuronitis?
- vestibular rehabilitation exercises ( preferred in chronic cases)
- prochlorperazine IM or buccal in severe cases, oral in less severe
What is laryngopharyngeal reflux?
changes to the mucosa of the pharynx/larynx due to GOR
What are symptoms of laryngopharyngeal reflux?
Globus
hoarseness
chronic cough
dysphagia
What are red flag symptoms for potential ENT cancers?
persistent, unilateral throat discomfort
dysphagia
odynophagia
persistent hoarseness
If a patient is 45YO+ and presenting with persistent hoarseness, what should you do?
Rapid ENT referral
chest X-RAY
Why do you do a chest x-ray when a patient presents with hoarseness?
rule of apical lung lesions
How to manage epistaxis when the bleeding site cannot be located?
Anterior packing
How to manage epistaxis?
1) Pinch the cartilaginous tissue for 20 mins
2) if can locate the bleeding, cauterise
3) if cannot locate the bleeding, anterior packing
What causes Ramsay Hunt Syndrome?
Herpes zoster oticus
reactivation of varicella zoster in the geniculate ganglion of the seventh cranial nerve
What are the symptoms of Ramsay hunt Syndrome?
-auricular pain
- facial nerve palsy
- vesicular rash around ear
- vertigo
- tinnitus
What is the treatment of Ramsay Hunt Syndrome?
Oral aciclovir 7 days
oral pred 5 days
What does bleeding 5-10 days post tonsillectomy mean?
infection
treated with antibiotics
What should happen if there is bleeding post- tonsillectomy?
Referral to ENT
What is glue ear?
Otitis media with effusion
What should happen if adult patient presents with unilateral glue ear?
Urgent referral to ENT
posterior nasal space tumour could be altering Eustachian tube pressure
What drugs cause gingival hyperplasia?
phenytoin
ciclosporin
calcium channel blockers (especially nifedipine
What are different examples of benign parotid masses?
- benign pleomorphic adenoma
–> Most common
–> proliferation of epithelial + myoepithelial cells of ducts - Warthin tumour
—> 2nd most common
–> strongly associated with smoking
–> males more common - Monomorphic adenoma
- haemangioma
–> parotid mass in child differential
Findings on otoscopy for acute otitis media
- bulging tympanic membrane
- loss of light reflex
- erythema of tympanic membrane
When do you give antibiotics in otitis media?
not first line
symptoms lasting 4+ days and not getting better
systemically unwell
younger than 2 with bilateral otitis media
otitis media with perforation
What antibiotics should be given in otitis media?
1st - Amoxicillin
allergy- clarithromycin
What is a branchial cyst?
a cyst filled with acellular fluid with cholesterol crystals encapsulated bu stratified squamous epithelium
Where are branchial cysts usually located?
anterior to sternocleidomastoid
How does Branchial cysts present on examination?
unilateral
anterior to sternocleidomastoid
smooth, soft ,fluctuant
non tender
slowly enlarging
How to manage first presentation of otitis media in children?
Observe for 3 months
What organism should you start thinking of have persistent Otitis externa even though antibiotics has been tried?
Candida Albicans
How long should symptoms of sinusitis be present before starting intra-nasal corticosteroids?
10 days
What maneuver is performed to distinguish between vestibular neuritis and posterior circulation stroke?
HiNTS
What is a posterior circulation stroke?
affects brainstem , cerebellum, thalamus and/or occipitoparietal lobe.
What should all patients with new onset sensorineural hearing loss be given?
high dose corticosteroids
How does cholesteatoma present?
conductive hearing loss
recurrent glue ear
smell discharge
Vesicles on tympanic membrane + weakness in face
Ramsay Hunt
What complication is commonly associated with Burkitts lymphoma?
Tumour lysis syndrome
What do you give if patient is penicillin allergic and has otitis media requiring medicine?
macrolide
