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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
What condition are bilateral acoustic neuromas seen in
NF 2
26
Management of epistaxis
1. First aid - sit forward, pinch cartilage 2. Cautery if bleeding visible, packing if not 3. Sphenopalatine ligation in theatre
27
Epistaxis management if first aid successful
Consider topical antiseptic e.g. naseptin, mupirocin - reduce crusting and risk of vestibulitis
28
When to consider admission in epistaxis
Comorbidity, e.g. coronary artery disease, severe hypertension Underlying cause suspected Under 2 - more likely to have haemophilia or leukaemia
29
Features of geographic tongue
Eryhematous areas with white-grey border Burning after eating certain foods
30
Management geographic tongue
Reassurance about benign nature
31
Causes gingival hyperplasia
Phenytoin Ciclosporin CCBs, esp nifedipine AML
32
Most common causative organism malignant otitis externa
Pseudomonas aeruginosa
33
Features of malignant otitis externa
Diabetes (90%) or immunosupression Severe, unrelenting, deep seated otalgia Temporal headaches Purulent otorrhoea Possible dysphagia, hoarseness, and/or facial nerve dysfunction
34
Treatment Menieres disease
Acute attacks - buccal or IM prochlorperazine Prevention - betahistine and vestibular rehabilitation
35
Driving and Menieres disease
Patients must inform DVLA, not drive until satisfactory control of symptoms
36
Conditions associated with nasal polyps
Asthma Aspirin sensitivity Infective sinusitis Cystic fibrosis Kartagener's syndrome Churg-Strauss syndrome
37
Management of nasal polyps
All patients with suspected nasal polyps refer to ENT for full examination Topical corticosteroids
38
Most common pathogens causing otitis externa
Staphylococcus aureus Pseudomonas aeruginosa Fungal
39
Causes of bilateral parotid gland swelling
Mumps Sarcoidosis Sjorgen's syndrome Lymphoma Alcoholic liver disease
40
Causes of unilateral parotid gland swelling
Tumour - plemorphic adenomas Stones Infection
41
Categories of haemorrhage post-tonsillectomy
Primary, or reactionary occurring in first 6-8 hours Secondary, occuring 5-10 days
42
Treatment of primary post-tonsillectomy haemorrhage
Immediate return to theatre
43
Cause of secondary post-tonsillectomy haemorrhage
Often associated with wound infection
44
Treatment of secondary post-tonsillectomy haemorrhage
Admission and antibiotics Severe bleeding may need surgery
45
Most common site of salivary gland tumours
Parotid (superficial lobe)
46
Most common site of salivary gland stones
Submandibular
47
Most common type of salivary gland tumour
Pleomorphic adenoma (non malignant)
48
Features of malignant salivary gland tumour
- Short history - Painful - Hot skin - Hard - Fixation - CN 7 involvement
49
Features of salivary gland pleomorphic adenoma
Middle age Slow growing, painless lump
50
Indications for antibiotics in sore throat
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
Antibiotics sore throat
Phenoxymethylpencillin Clarithromycin if allergic
52
Management of sudden onset sensorineural hearing loss
Urgent referral to ENT MRI scan to exclude vestibular schwannoma High dose oral corticosteroidsW
53
What is thyroglossal cyst
Persistence of the thyroglossal duct (embryological connection between thyroid and the tongue)
54
Complications of thyroid surgery
Anatomical, e.g. laryngeal nerve damage Bleeding - due to confined space, may rapidly lead to respiratory compromise Damage to parathyroids → hypocalcaemia
55
Drugs causing tinnitus
Aspirin NSAIDs Aminoglycosides Loop diuretics Quinine
56
Indications for surgery for tonsillitis
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
Features of viral labyrinthitis
Recent viral infection Sudden onset Nausea and vomiting Hearing may be affected
58
Features of vestibular neuronitis
Recent viral infection Recurrent vertigo attacks lasting hours or days No hearing loss or tinnitus Horizontal nystagmus
59
Feaures of benign paroxysmal positional vertigo
Gradual onset Triggered by change in head position Each episode lasts 10-20 seconds
60
Features of vertebrobasiliar ischaemia
Elderly patient Dizziness on extension of neck
61
Features of acoustic neuroma
Hearing loss, vertigo, tinnitus Absent corneal reflex
62
Management vestibular neuronitis
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
Viral labyrinthitis vs vestibular neuronitis
Vestibular neuronitis only affects vestibular nerve, so no hearing impairment. Labyrinthitis affects vestibular nerve and labyrinth, so vertigo and hearing impairment
64
Examination findings of vestibular labyrinthitis
Spontaneous unidirectional horizontal nystagmus towards affected side Sensorineural hearing loss Abnormal head impulse test Gait disturbance
65
Management vestibular labyrinthritis
Episodes usually self limiting Prochlorperazine or antihistamines may help reduce sensation of dizziness

1 - MSRA (23 decks)

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