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1 - MSRA > ENT > Flashcards

ENT Flashcards

1
Q

Features of neck lumps caused by reactive lymphadenopathy

A

History of local infection or generalised viral illness

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2
Q

Features of neck lump caused by lymphoma

A
  • Rubbery, painless lymphadenopathy
  • Pain when drinking alcohol (very uncommon)
  • Associated night sweats and splenomegaly
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3
Q

Features of neck lump caused by thyroid swelling

A
  • May be hypo, eu, or hyperthyroid symptomatically
  • Moves upwards on swallowing
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4
Q

Features of neck lump caused by thyroglossal cyst

A
  • More common in patients <20 years old
  • Usually midline, between isthmus of thyroid and hyoid bone
  • Moves upwards with tongue protrusion
  • May be painful if infected
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5
Q

Features of neck lump caused by pharyngeal pouch

A
  • More common in older men
  • If large, midline lump that gargles on palpation
  • Dysphagia, regurgitation, aspiration, and chronic cough
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6
Q

Features of neck lump caused by cystic hygroma

A
  • Left side of neck
  • Most evident at birth, 90% before 2 years of age
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7
Q

Features of neck lump caused by branchial cyst

A
  • Oval, mobile cystic mass between sternocleidomastoid muscle and pharynx
  • Present in early adulthood
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8
Q

Features of neck lump caused by cervical rib

A
  • More common in adult females
  • Can cause thoracic outlet syndrome (10%)
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9
Q

Features of neck lump caused by carotid aneurysm

A
  • Pulsatile lateral neck mass
  • Doesn’t move on swallowing
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10
Q

Most common causes acute otitis media

A

Streptococcus pneumoniae
Haemophilus influenzae
Morazella catarrhalis

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11
Q

Indications for antibiotics in otitis media

A

Symptoms lasting 4 days or not improving
Systemically unwell
Immunocompromised or high risk of complications - significant heart, lung, kidney, liver, neuromuscular disease
Younger than 2 with bilateral
Otitis media with perforation and/or discharge in canal

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12
Q

Antibiotics for otitis media

A

Amoxicillin

Erythromycin or clarithromycin if pen allergic

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13
Q

Most common causes acute sinusitis

A

Streptococcus pneumoniae
Haemophilus influenzae
Rhinoviruses

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14
Q

Treatment acute sinusitis

A

Intranasal decongestants or nasal saline
Intranasal corticosteroids if symptoms 10+ days
Oral antibiotics if severe

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15
Q

Antibiotics acute sinusitiis

A

Phenoxymethylpenicillin first line
Co-amox if systemically very unwell, high risk of complications

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16
Q

BPPV treatment

A

Epley manoeuvre
Vestibular rehabilitation (Brandt-Daroff exercises)
Betahistine

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17
Q

Audiometry presbycusis

A

Bilateral high frequency hearing loss

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18
Q

What is otosclerosis

A

Inherited condition, replacement of normal bone by vascular spongy bone

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19
Q

Inheritance otosclerosis

A

Autosomal dominant

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20
Q

Features of otosclerosis

A

Age of onset 20-40
Conductive deafness
Tinnitus
‘Flamingo tinge’ to tympanic membrane

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21
Q

Features of Meniere’s disease

A

Recurrent episodes of vertigo, tinnitus, and hearing loss
Sensation of aural fullness
Nystagmus
Positive Romberg test

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22
Q

Drugs causing ototoxicity

A

Aminoglycosides
Furosemide
Aspirin
Cytotoxic agents

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23
Q

Audiogram features noise damage

A

Bilateral, worse at frequencys 3000-6000Hz

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24
Q

Features of acoustic neuroma

A

Hearing loss, vertigo, tinnitus
Absent corneal reflex
Facial palsy

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25
Q

What condition are bilateral acoustic neuromas seen in

A

NF 2

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26
Q

Management of epistaxis

A
  1. First aid - sit forward, pinch cartilage
  2. Cautery if bleeding visible, packing if not
  3. Sphenopalatine ligation in theatre
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27
Q

Epistaxis management if first aid successful

A

Consider topical antiseptic e.g. naseptin, mupirocin - reduce crusting and risk of vestibulitis

28
Q

When to consider admission in epistaxis

A

Comorbidity, e.g. coronary artery disease, severe hypertension
Underlying cause suspected
Under 2 - more likely to have haemophilia or leukaemia

29
Q

Features of geographic tongue

A

Eryhematous areas with white-grey border
Burning after eating certain foods

30
Q

Management geographic tongue

A

Reassurance about benign nature

31
Q

Causes gingival hyperplasia

A

Phenytoin
Ciclosporin
CCBs, esp nifedipine
AML

32
Q

Most common causative organism malignant otitis externa

A

Pseudomonas aeruginosa

33
Q

Features of malignant otitis externa

A

Diabetes (90%) or immunosupression
Severe, unrelenting, deep seated otalgia
Temporal headaches
Purulent otorrhoea
Possible dysphagia, hoarseness, and/or facial nerve dysfunction

34
Q

Treatment Menieres disease

A

Acute attacks - buccal or IM prochlorperazine
Prevention - betahistine and vestibular rehabilitation

35
Q

Driving and Menieres disease

A

Patients must inform DVLA, not drive until satisfactory control of symptoms

36
Q

Conditions associated with nasal polyps

A

Asthma
Aspirin sensitivity
Infective sinusitis
Cystic fibrosis
Kartagener’s syndrome
Churg-Strauss syndrome

37
Q

Management of nasal polyps

A

All patients with suspected nasal polyps refer to ENT for full examination
Topical corticosteroids

38
Q

Most common pathogens causing otitis externa

A

Staphylococcus aureus
Pseudomonas aeruginosa
Fungal

39
Q

Causes of bilateral parotid gland swelling

A

Mumps
Sarcoidosis
Sjorgen’s syndrome
Lymphoma
Alcoholic liver disease

40
Q

Causes of unilateral parotid gland swelling

A

Tumour - plemorphic adenomas
Stones
Infection

41
Q

Categories of haemorrhage post-tonsillectomy

A

Primary, or reactionary occurring in first 6-8 hours
Secondary, occuring 5-10 days

42
Q

Treatment of primary post-tonsillectomy haemorrhage

A

Immediate return to theatre

43
Q

Cause of secondary post-tonsillectomy haemorrhage

A

Often associated with wound infection

44
Q

Treatment of secondary post-tonsillectomy haemorrhage

A

Admission and antibiotics
Severe bleeding may need surgery

45
Q

Most common site of salivary gland tumours

A

Parotid (superficial lobe)

46
Q

Most common site of salivary gland stones

A

Submandibular

47
Q

Most common type of salivary gland tumour

A

Pleomorphic adenoma (non malignant)

48
Q

Features of malignant salivary gland tumour

A
  • Short history
  • Painful
  • Hot skin
  • Hard
  • Fixation
  • CN 7 involvement
49
Q

Features of salivary gland pleomorphic adenoma

A

Middle age
Slow growing, painless lump

50
Q

Indications for antibiotics in sore throat

A

Features of marked systemic upset secondary to acute sore throat
Unilateral peritonsillitis
History of rheumatic fever
Increased risk from acute infection
3 or more Centor criteria present

51
Q

Antibiotics sore throat

A

Phenoxymethylpencillin

Clarithromycin if allergic

52
Q

Management of sudden onset sensorineural hearing loss

A

Urgent referral to ENT
MRI scan to exclude vestibular schwannoma
High dose oral corticosteroidsW

53
Q

What is thyroglossal cyst

A

Persistence of the thyroglossal duct (embryological connection between thyroid and the tongue)

54
Q

Complications of thyroid surgery

A

Anatomical, e.g. laryngeal nerve damage
Bleeding - due to confined space, may rapidly lead to respiratory compromise
Damage to parathyroids → hypocalcaemia

55
Q

Drugs causing tinnitus

A

Aspirin
NSAIDs
Aminoglycosides
Loop diuretics
Quinine

56
Q

Indications for surgery for tonsillitis

A

7 episodes in 1 year, 5/year for 2 years, 3/year for 3 years
Recurrent feb con secondary to tonsillitis
Obstructive sleep apnoea, stridor, or dysphagia secondary to enlarged tonsils
Peritonsillar abscess unresponsive to standard treatment

57
Q

Features of viral labyrinthitis

A

Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected

58
Q

Features of vestibular neuronitis

A

Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss or tinnitus
Horizontal nystagmus

59
Q

Feaures of benign paroxysmal positional vertigo

A

Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds

60
Q

Features of vertebrobasiliar ischaemia

A

Elderly patient
Dizziness on extension of neck

61
Q

Features of acoustic neuroma

A

Hearing loss, vertigo, tinnitus
Absent corneal reflex

62
Q

Management vestibular neuronitis

A

Buccal or IM prochlorperazine for rapid relief in severe cases
Short oral course of prochlorperazine or antihistamine in less severe cases
Vestibular rehabilitation exercises in chronic

63
Q

Viral labyrinthitis vs vestibular neuronitis

A

Vestibular neuronitis only affects vestibular nerve, so no hearing impairment. Labyrinthitis affects vestibular nerve and labyrinth, so vertigo and hearing impairment

64
Q

Examination findings of vestibular labyrinthitis

A

Spontaneous unidirectional horizontal nystagmus towards affected side
Sensorineural hearing loss
Abnormal head impulse test
Gait disturbance

65
Q

Management vestibular labyrinthritis

A

Episodes usually self limiting
Prochlorperazine or antihistamines may help reduce sensation of dizziness

1 - MSRA (17 decks)

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