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Year 4 > ENT > Flashcards

ENT Flashcards

1
Q

What is the role of the semicircular canals

A

Sensing head movement - the vestibular system

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2
Q

What is the function of the cochlea

A

Converting the sound vibration into a nervous signal

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3
Q

Management of sudden onset hearing loss Occurring within 72 hours

A

Urgent need refer to ENT

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4
Q

How is sudden onset sensory neural hearing loss treated

A

high dose cortical steroids

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5
Q

Weber’s test results in sensorineural hearing loss

A

Sound will be Louder in the normal ear as a normal ear it’s better sensing the sound

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6
Q

The Web is test results in conductive hearing loss

A

The sound is louder in the affected ear because the affected ear becomes more sensitive

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7
Q

rinne positive

A

Air conduction is better than born conduction which is normal

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8
Q

When bone conduction is better than air conduction this suggests

A

A conductive cause for the hearing loss

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9
Q

What are the causes of sensory neural hearing loss

A

Sudden sensorineural hearing loss (over less than 72 hours)
Presbycusis (age-related)
Noise exposure
Ménière’s disease
acoustic neuroma

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10
Q

Which three common medications can cause sensorineural hearing loss

A

Loop diuretics (e.g., furosemide)
Aminoglycoside antibiotics (e.g., gentamicin)
Chemotherapy drugs (e.g., cisplatin)

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11
Q

What are the causes of conductive hearing loss

A

Ear wax (or something else blocking the canal)
Infection (e.g., otitis media or otitis externa)
Fluid in the middle ear (effusion)
Eustachian tube dysfunction
Perforated tympanic membrane
Otosclerosis
Cholesteatoma
Exostoses
Tumours

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12
Q

rinne and weber results table

A

image

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13
Q

audiogram interpretation

A

Anything below 20dB is abnormal (i.e. bad)
A significant difference between AC and BC is >10dB (this is what was taught at our med school)

  1. Sensorineural = both AC and BC bad with no significant difference between them
  2. Conductive = AC bad, BC normal, significant difference between
  3. Mixed = AC bad, BC bad, significant difference between
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14
Q

Presbycusis =

A

Age-related sensor renewal hearing loss. Affects high pitch sounds first

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15
Q

key rf for presbycusis

A

Exposure to loud noise over time

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16
Q

Pres of presbycuis

A

> Speech becoming difficult to understand
Need for increased volume on the television or radio
Difficulty using the telephone
Loss of directionality of sound
Worsening of symptoms in noisy environments
Hyperacusis: Heightened sensitivity to certain frequencies of sound (Less common)
Tinnitus (Uncommon)

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17
Q

diagnosing presbycusis

A

> audiometry - worse hearing at higher freq, SN pattern
Audiometry: Bilateral sensorineural pattern hearing loss

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18
Q

management of presbycuis

A

> Hearing aids -> Cochlear implants if not sufficient

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19
Q

causes of SSHL

A

> 90% are idiopathic
Acoustic neuroma, Ménière’s disease, MS, migraine

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20
Q

Investigations for SSHL

A

> Audiometry - A diagnosis of SSNHL requires a loss of at least 30 decibels in three consecutive frequencies on an audiogram.
MRI or CT head to exclude a stroke or acoustic neuroma

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21
Q

Presentation of Eustation tube dysfunction

A

> Reduced hearing
‘popping noises
Fullness sensation in the ear
Symptoms tend to get worse when the external air pressure changes in the middle ear cannot equalize for example flying climbing scuba diving

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22
Q

Most cases of et dysfunction resolve rapidly but in the case of persistent symptoms investigations can be done such as

A

Tympanometry - measuring air pressure differences
Audiometry
Nasopharyngoscopy

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23
Q

Treatment of ET dysfunction

A

> no Mx
Valsaba maneuver Deep congestion nasal sprays short term only
Surgery for severe cases

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24
Q

Inheritance of otosclerosis

A

auto dominant

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25
Q

What is Otosclerosis

A

Remodeling of the small bones in the middle ear leading to conductive hearing loss. Many affects the base of the Stapes

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26
Q

features of otosclerosis

A

> Onset usually at 20 to 40 years
Conductive hearing loss, tinnitus, positive family history

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27
Q

mx of OS

A

hearing aid
stapedectomy

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28
Q

Which frequency sounds are most affected in os

A

Effects the hearing of lower pitch sounds more than higher pitch sounds - reverse of the presbycusis

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29
Q

Examination findings in OS

A

> Webbers is normal if the auto sclerosis is bilateral or is louder in the more affected ear
Renee’s will show conductive hearing loss

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30
Q

Which pathogens typically cause ortitis media

A

Streptococcus pneumonaie,Haemophilus influenzaeandMoraxella catarrhalis

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31
Q

Features of otitis Media

A

> otalgia, hearing loss
fever
recent viral URTI
Ear discharge if the temp panic membrane perforates

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32
Q

Otoscopy findings in otitis Media

A

> Bulging tympanic membrane -> loss of light reflex
opacification of membrane
perforation

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33
Q

What are the criteria used to diagnose otitis media

A

> Acute onset of symptoms - otalgia or ear tugging
Presence of a middle ear effusion - bulging, ottorhoea, decreased mobility on otoscopy
Inflammation of tympanic membrane

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34
Q

what is the most common cause of otitis media

A

Streptococcus

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35
Q

Management of acute or otitis media

A

> It’s generally self limiting doesn’t that does not require an antibiotic prescription
Analgesia for pain relief
Advised to seek medical help if symptoms worse than or do not improve after three DAYS

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36
Q

what necessitates an immediate antibiotic prescription in acute otitis media

A

Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

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37
Q

First line antibiotic in Ottitis Media

A

a 5-7 day course ofamoxicillin is first-line. In patients with penicillin allergy, erythromycin or clarithromycin should be given.

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38
Q

Comps of OM

A

mastoiditis
meningitis
brain abscess
facial nerve paralysis

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39
Q

Causes of OE

A

> infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
seborrhoeic dermatitis
contact dermatitis (allergic and irritant)

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40
Q

What is a common trigger for OTITIS external

A

Recent swimming

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41
Q

features of OE

A

ear pain, itch, discharge
otoscopy: red, swollen, or eczematous canal

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42
Q

MX OF OE

A

topical antibiotic or a combined topical antibiotic with a steroid
if the tympanic membrane is perforated aminoglycosides are traditionally not used - ototoxocity risk

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43
Q

recurrent otitis external following the use of multiple courses of antibiotics should raise suspicion of

A

Fungal otitis externa - use CLOMITRAZOLE ear drops

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44
Q

When is a referral to ENT required for otitis externa

A

Failure to respond to topical antibiotics

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45
Q

ear wicks for OE

A

Maybe used if the canal is very swollen it is a sponge that contains topical treatment

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46
Q

what is malignant ortitis externa

A

Life threatening form of otitis external where the infection spreads to the bone - Leads to osteomyelitis of the temporal born of the skull

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47
Q

What are the key risk factors for malignant OE

A

Diabetes, IS, HIV

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48
Q

Most common cause of malignant OE

A

Pseudomonas aeruginosa

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49
Q

Features of MOE

A

Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

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50
Q

Tx of Malignant OE

A

non-resolving otitis externa with worsening pain should be referred urgently to ENT
Intravenous antibiotics that cover pseudomonal infections

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51
Q

Key finding that indicates malignant OE

A

Granulation tissueat the junction between the bone and cartilage in the ear canal

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52
Q

Mx of MOE

A

Admission to hospital under the ENT team
IV antibiotics
Imaging (e.g., CT or MRI head) to assess the extent of the infection

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53
Q

3 Methods of removing ear wax

A

Ear drops – usually olive oil or sodium bicarbonate 5%
Ear irrigation – squirting water in the ears to clean away the wax
Microsuction – using a tiny suction device to suck out the wax

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54
Q

Causes of secondary tinnitus

A

> ear wax
MN
meds
acoustic neuroma

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55
Q

primary tinnitus

A

no identifiable cause and often occurs with sensori neural hearing loss

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56
Q

MN sx

A

Associated with hearing loss, vertigo, tinnitus and sensation of fullness or pressure in one or both ears

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57
Q

acoustic neuroma sx

A

Hearing loss, vertigo, tinnitus
Absent corneal reflex is an important sign
Associated with neurofibromatosis type 2

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58
Q

drugs -> tinnitus

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

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59
Q

pulsatile tinnitus

A

pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause. Magnetic resonance angiography (MRA) is often used to investigate pulsatile tinnitus

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60
Q

ix for tinnitus

A

> test for under;ying causes: Anemia,diabetes, thyroid disorders, lipids for hyperelliptemia

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61
Q

red flags for tinnitus

A

Unilateral tinnitus
Pulsatile tinnitus
Hyperacusis (hypersensitivity, pain or distress with environmental sounds)
Associated unilateral hearing loss
Associated sudden onset hearing loss
Associated vertigo or dizziness
Headaches or visual symptoms
Associated neurological symptoms or signs (e.g., facial nerve palsy or signs of stroke)
Suicidal ideation related to the tinnitus

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62
Q

causes of vertigo

A

> BPPV
viral labyrinithitis
vestibular neuronitis
MN
Vertiobrobasilar ischaemia
AN

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63
Q

Features of viral labyrinithis

A

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

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64
Q

vestibular neuronitis

A

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

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65
Q

BPPV

A

Gradual onset, peripheral cause of vertigo
Triggered by change in head position
Each episode lasts 10-20 seconds

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66
Q

Vertebrobasilar ischaemia

A

Elderly patient
Dizziness on extension of neck

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67
Q

test for BPPV

A

positive dix-hallpike manouvre - rotatory nystagmus

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68
Q

tx of BPPV

A

> Epley manouvre
brandt-daroff exercises
Betahistine

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69
Q

cause of BPPV

A

calcium carbonate crystals - otoconia become displaced in SCC which disrupts flow of endolymph

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70
Q

what is vestibular neuronitis

A

inflammation of vestibular nerve - usually following viral infection

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71
Q

labyrinithis vs neuronitis

A

Labyrinthitis – Loss of hearing
Neuronitis – No loss of hearing

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72
Q

features of vest neuronitis

A

recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

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73
Q

How can we distinguish vestibular neuronitis from posterior circulation stroke

A

theHead impulse tests exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

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74
Q

VN - For peripheral vertigo, short-term options for managing symptoms include:

A

Prochlorperazine
Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

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75
Q

Tx for chronic VN

A

vestibular rehabilitation exercises are the preferred treatmentfor patients who experience chronic symptoms

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76
Q

What can be used to provide rapid relief for severe cases of VN

A

buccal or intramuscularprochlorperazineis often used to provide rapid relief for severe cases

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77
Q

labyrinithis =

A

Inflammation of the Bonilla of the inner ear including the semicircular canals vistabule and cochlear usually following a viral upper respiratory tract infection

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78
Q

symptoms of labyrinithis

A

> Acute onset vertical following viral infection
hearing loss, tinitus

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79
Q

signs of labyrinithis

A

spontaneous unidirectional horizontal nystagmus towards the unaffected side
sensorineural hearing loss: shown by Rinne’s test and Weber test
abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
gait disturbance: the patient may fall towards the affected side

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80
Q

mx of labyrinithis

A

episodes are usually self-limiting
prochlorperazine or antihistamines may help reduce the sensation of dizziness - up to 3 day course

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81
Q

key comp of meningitis

A

Hearing loss - All meningitis patients are offered ideology assessment as soon as they have recovered to assess for hearing impairment

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82
Q

Which type of labrinitis causes more hearing impairment

A

Bacterial particularly associated with meningitis

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83
Q

triad of menieres

A

Hearing loss - and feeling of fullness in ear
recurrent Vertigo
Tinnitus

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84
Q

pathophys of menieres

A

build of endolymph in the labyrinth -> increased pressure -> endolymphatics hydrops

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85
Q

spont nystagmus may be seen following an attack of

A

MN - one directional spont nystagmus

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86
Q

MN and driving

A

patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved

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87
Q

managing acute attacks of MN

A

Prochlorperazine
Antihistamines (e.g., cyclizine, cinnarizine and promethazine)

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88
Q

MN prophylaxis

A

betahistine

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89
Q

what is an acoustic neuroma

A

benign tumors of the Schwan cells surrounding the vestibular cochlear nerve

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90
Q

Bilateral acoustic neuromus indicate

A

neurofibromatosis type II.

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91
Q

symptoms of vestibular schwannoma/ AN

A

vertigo, hearing loss, tinnitus and an absent corneal reflex.

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92
Q

The symptoms of a acoustic neuroma will depend on which cranial nerves are affected

A

cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
cranial nerve V: absent corneal reflex
cranial nerve VII: facial palsy

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93
Q

AN Ix

A

> urgent ENT ref
MRI of the cerebellopontine angle is the investigation of choice
audiometry

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94
Q

cholesteatoma

A

Collection of squamous epithelium cells in the middle ear which is noncancerous but can invade local tissues. Significantly associated with being born with a cleft lip

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95
Q

features of cholesteatoma

A

foul-smelling, non-resolving discharge
hearing loss - unilateral conductive

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96
Q

features of cholesteatoma that come with local invasion

A

vertigo, facial nerve palsy

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97
Q

attic crust finding in

A

cholesteatoma

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98
Q

mx of cholesteatoma

A

> refer for ENT for surgical removal

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99
Q

causes of sinusitis

A

Infection, particularly following viral upper respiratory tract infections
Allergies, such as hayfever (with allergic rhinitis)
Obstruction of drainage, for example, due to a foreign body, trauma or polyps
Smoking

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100
Q

features of sinusitis

A

facial pain
typically frontal pressure pain which is worse on bending forward
nasal discharge: usually thick and purulent
nasal obstruction

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101
Q

mx of sinusitis

A

analgesia
intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days

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102
Q

severe sinusitus Mx

A

> Oral antibiotics- phenoxymethyl penicillin is first line

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103
Q

Double sickening suggests a? cause of sinusitis

A

bacterial cause - initial viral sinusitis worsens due to secondary bacterial infection

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104
Q

what is chronic rhinocinositis

A

Sinusitis that lasts longer than 12 weeks

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105
Q

Management of recurrent or chronic sinusitis

A

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

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106
Q

red flags of chronic sinusiis

A

unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis

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107
Q

nasal polyps are associated with

A

Chronic rhiinitis

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108
Q

What feature of polyps would be concerning for malignancy and would require a two week wait referral

A

unilateral polyps or bleeding

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109
Q

samters triad =

A

asthma + aspirin sensitivity + nasal polyposis

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110
Q

features of nasal polyps

A

nasal obstruction
rhinorrhoea, sneezing
poor sense of taste and smell
difficulty breathing thru nose

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111
Q

mx of nasal polyps

A

> All patients with nasal polyps should be referred to ent for a full examination
topical steroids shrink polyps
if medical mx fails -> surgery

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112
Q

predisposing factors for OSA

A

> Obesity
macroglossia: acromegaly, hypothyroid, amyloid
large tonsils

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113
Q

features of OSA

A

> Episodes of apnoea during sleep (reported by their partner)
daytime sleepiness
morning headache

114
Q

scoring system for OSA

A

Epworth sleepiness scale

115
Q

diagnostic test for OSA

A

sleep studies (polysomnography)

116
Q

Mx of OSA

A

> weight loss
CPAP
intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated

117
Q

when should DVLA be informed of OSA

A

theDVLA should be informedif OSAHS is causing excessive daytime sleepiness

118
Q

tonsillitis is usuall caused by

A

viral infection

119
Q

most common cause of bacterial tonsillitis

A

group A streptococcus(Streptococcus pyogenes - treated w phenoxymethylprnicillin

120
Q

TP of tonsillitis

A

Sore throat
Fever (above 38°C)
Pain on swallowing

121
Q

examination findings in tonsillitis

A

Write informed and enlarged tonsils with or without exudates. Anterior cervical lymphadenopathy can occur

122
Q

when should ab be given for tonsillitis

A

> Centor score > 3 = bacterial tonsillitis
scored on:Fever over 38ºC
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)

123
Q

feverPAIN scoring for tonsillitis

A

Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza

124
Q

When should antibiotics be given for tonsillitis

A

antibioticsif theCentor scoreis≥ 3, or theFeverPAINscore is≥ 4.

125
Q

Which antibiotics should be prescribed for tonsillitis

A

phenoxymethylpenicillinorclarithromycin(if the patient is penicillin-allergic) should be given.

126
Q

indications for ab - nice

A

features of marked systemic upset secondary to the acute sore throat
unilateral peritonsillitis
a history of rheumatic fever
an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present

127
Q

mx of viral tonsillitis

A

paracetamol or ibuprofen for pain relief
antibiotics are not routinely indicated

128
Q

what is quinsy

A

peritonsillar abscess - comp of tonsillitis

129
Q

symptoms of quinsy

A

severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility

130
Q

mx of quinsy

A

> urgent ENT review
needle aspiration or incision & drainage + intravenous antibiotics

131
Q

hot potato voice =

A

Change invoice scene in Quinsy from pharyngeal swelling

132
Q

most common cause of quinsy

A

strep pyogenes

133
Q

number of tonsillitis episodes needing tonsilectomy

A

7 or more in 1 year
5 per year for 2 years
3 per year for 3 years

134
Q

other indications for tonsillectomy

A

Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficulty breathing, swallowing or snoring

135
Q

comps of tonsillitis

A

> sore throat
post tonsillectomy bleeding - can be life threatening from blood aspiration

136
Q

mx of post tonsillectomy haemorrhages

A

All post-tonsillectomy haemorrhages should be assessed by ENT.

137
Q

Management of primary post tonsillectomy hemorrhage

A

Occurs within six to eight hours following surgery is managed by immediate return to theater

138
Q

Management of secondary post tonsillectomy hemorrhage

A

occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics.

139
Q

pulsatile neck lumps

A

Carotid body tumors

140
Q

which neck lump moves w swallowing

A

thyroid lumps

141
Q

which neck lump moves w sticking tongue out

A

thyroglossal cysts)

142
Q

which neck lump transilluminates with light

A

(e.g., cystic hygroma – usually in young children)

143
Q

neck lump red referral criteria

A

An unexplained neck lump in someone aged 45 or above
A persistent unexplained neck lump at any age

144
Q

tests for a neck lump

A

> FBC & blood film
HIV
thyroid function test
ANA- SLE

145
Q

Imaging for neck lumps

A

US first line, CT/MRI next, fine needle aspiration, biopsy

146
Q

4 causes of lymphadenopathy

A

> reactive LN - after viral URT infection
infected LN
Inflammatory conditions - lupus
malignancy

147
Q

Which lymph nodes are most concerning for malignancy

A

enlarged supraclavicular

148
Q

features of LN -> malignancy

A

Unexplained (e.g., not associated with an infection)
Persistently enlarged (particularly over 3cm in diameter)
Abnormal shape (normally oval shaped where the length is more than double the width)
Hard or “rubbery”
Non-tender
Tethered or fixed to the skin or underlying tissues
Associated symptoms, such as night sweats, weight loss, fatigue or fevers

149
Q

infective mono

A

> Causes lymphadenopathy
infection w EBV
spread by saliva

150
Q

triad of mono

A

sore throat
lymphadenopathy: may be present in the anterior and posterior triangles of the neck,
pyrexia

151
Q

other features seen in mono

A

malaise, anorexia, headache
palatal petechiae
splenomegaly - occurs in around 50% of patients and may rarely predispose to splenic rupture
hepatitis, transient rise in ALT
lymphocytosis:

152
Q

Which type of hemolitic anemia is seen in mono

A

cold agglutins (IgM)

153
Q

How is mono diagnosed

A

heterophil antibody test (Monospot test

154
Q

A maculopapular rash following amoxicillin indicates

A

a maculopapular, pruritic rash develops in around 99% of patients who take ampicillin/amoxicillin whilst they have infectious mononucleosis

155
Q

How is mono managed

A

> Supportive management, simple analgesia

156
Q

What should patients with mono avoid for 4 weeks

A

avoid playing contact sports for 4 weeks after having glandular fever to reduce the risk of splenic rupture

157
Q

Lymphedema seen in lymphoma

A

lymphadenopathy in neck, axilla (armpit) or inguinal (groin) region - non tender and rubbery

158
Q

Key finding in a lymph node biopsy in patients with Hodgkin’s lymphoma

A

reid Steinberg cell

159
Q

Features of a carotid body tumor

A

> most benign
In the upper anterior triangle of the neck (near the angle of the mandible)
Painless
Pulsatile
Associated with a bruit on auscultation
Mobile side-to-side but not up and down

160
Q

How else can a carotid body tumor present

A

> Compression of cranial nerves
Horners syndrome

161
Q

Finding on imaging in carotid body tumor

A

splaying(separating) of theinternalandexternal carotidarteries (lyre sign).

162
Q

lipomas

A

> benign tumors of adequate tissue
Typically soft painless mobile and do not cause skin changes

163
Q

Features suggestive of sarcomatous change - liposaecoma

A

Size >5cm
Increasing size
Pain
Deep anatomical location

164
Q

The features of a thyroglossal cyst

A

Soft nontender mobile cyst in the midline of the neck . Move up and down with movement of the tongue

165
Q

Management of thyroglossal cyst

A

Most are surgically removed to prevent infections

166
Q

Neck mass that moves up and down with tongue movement indicates

A

Thyroglossal cyst

167
Q

Where do brachial cysts originate from

A

Second brachial cleft

168
Q

Management options for brachial cyst

A

Conservative or surgical excision where there are recurrent infection or if it is causing other problems

169
Q

lymphatix malformations

A

Usually located posterior to the sternocleidomastoid
The painless, fluid filled, lesions usually present prior to the age of 2#
They are typically hypoechoic on USS

170
Q

infantile hemangioma

A

May present in either triangle of the neck
Grow rapidly initially and then will often spontaneously regress
Plain x-rays will show a mass lesion, usually containing calcified phleboliths

171
Q

Reactive lymphedemopathy occurs a following

A

This is the most common cause of neck swelling. History of local infection or generalized viral illness

172
Q

Presentation of a lymphoma

A

> rubbery, painless lymphadenopathy
Pain when drinking alcohol
may be associated night sweats and splenomegaly

173
Q

A thyroid swelling moves on

A

Moves upwards on swallowing

174
Q

phaeyngeal pouch

A

> More common in older men
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough, hallitosis

175
Q

Cystic hygroma Is typically found in

A

Children under two years of age typically found on the left side

176
Q

When do brachial cysts tend to present

A

Usually early adulthood

177
Q

features of head and neck cancer

A

neck lump
hoarseness
persistent sore throat
persistent mouth ulcer

178
Q

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with:

A

persistent unexplained hoarseness or
an unexplained lump in the neck

179
Q

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:

A

unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.

180
Q

ref criteria thyroid cancer

A

Unexplained thyroid lump

181
Q

Risk factors for head and neck cancer

A

Smoking
Chewing tobacco
alcohol
HPV - 16 #
EBV

182
Q

Red flags for head and neck cancer

A

Lump in the mouth or on the lip
Unexplained ulceration in the mouth lasting more than 3 weeks
Erythroplakia or erythroleukoplakia
Persistent neck lump
Unexplained hoarseness of voice
Unexplained thyroid lump

183
Q

Glossitis

A

Inflamed tongue that looks smooth

184
Q

What are the causes of glossitis

A

Iron, B12, folate deficiency, coeliac

185
Q

What are the top three causes of angiodema

A

Allergic reactions
ACE inhibitors
C1 esterase inhibitor deficiency (hereditary angioedema)

186
Q

What increases risk of oral thrush

A

Diabetes, inhaled cortical steroids, antibiotics, smoking

187
Q

Two key causes of strawberry tongue

A

Scarlet fever
Kawasaki disease

188
Q

leukplakia =

A

premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers

189
Q

mx of leukoplakia

A

biopsy and reg follow up to exclude transformation to sq cell carcinoma

190
Q

Erythroplakia & erythroleukoplakia

A

red lesions, high risk of SCC -> urgent 2WWW

191
Q

Wickams striae are seen in

A

lichen planua

192
Q

gingivitis =

A

swollen gums, bleeding after brushing, painful gums and bad breath (halitosis).

193
Q

What can untreated gingivitis lead to

A

periodontitis

194
Q

RF for gingivitis

A

plaque, smoking, malnutrition

195
Q

What is glue ear

A

Ottitis media W effusion

196
Q

Risk factors for Glue ear

A

male sex, bottle feeding, ;arental smoking

197
Q

features of glue ear

A

> Hearing loss is the presenting feature
secondary problems such as speech and language delay, behavioural or balance problems may also be seen

198
Q

tx of glue ear

A

> active observation for 3 months
grommet insertion
adenoidectomy

199
Q

glue ear in adults - suspect

A

nasopharyngeal carcinoma espec if unilateral

200
Q

NP carcinoma is

A

sq cell carcinoma, assoc w EBV

201
Q

Features of NP carcinoma

A

> otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
CN palsies
cervical lymphadenopathy

202
Q

imaging for NP carcinoma

A

Combined CT and MRI.

203
Q

First line treatment for NP carcinoma

A

radiotherapy

204
Q

Cholesterol crystals are found in

A

brachial cysts

205
Q

brachial cyst vs cystic hyoma

A

brACHial cysts
A = anterior triangle
CH = cholesterol crystals

Cystic hyGLOWma = transilluminates

206
Q

What indicates mastoditis rather than acute otitis media

A

post-auricular swelling. - Mastoiditis is a medical emergency due to the potential risk of meningitis

207
Q

What is not consistent with the diagnosis of otosclerosis

A

Onset after the age of 50

208
Q

how long can prochlorperazine be used for vestibular neuronitis

A

few days max

209
Q

ludwigs angina

A

> Type of cellulitis that invades the floor of the mouth and the soft tissues of the neck
Mostly from dental infections
neck swelling, dysphagia, fever

210
Q

Management of Ludwig’s angina

A

Immediately transferred to hospital as airway management is crucial

211
Q

CENTOUR mneumonic

A

C- Cervical lymphadenopathy/ lympahdenitis
E- exudate of tonsils
N- no cough
T- temperature

212
Q

children w glue ear w ? -> ENT ref

A

Children presenting with glue ear with a background of Down’s syndrome or cleft palate should be referred to ENT

213
Q

elderly patient dizzy on extending neck ->

A

verterbrobasilar ischaemia

214
Q

mx of tympanic membrane perforation

A

watch n wait 6 weeks

215
Q

sign of glue ear

A

viscousbubblesbehind thetympanicmembrane.

216
Q

which drugs cause a gingival hyperplasia

A

Gingival hyperplasia: phenytoin, ciclosporin, calcium channel blockers and AML

217
Q

watch is the most common cause of sudden onset sensory neural hearing loss

A

The majority of sudden-onset sensorineural hearing loss is idiopathic in nature

218
Q

brachial cyst vs cystic hyoma

A

Anterior location contains cholesterol crystals

219
Q

unilateral glue ear/ middle ear effusion ->

A

Urgent referral to ENT

220
Q

What would point to MN over labyrinithis or neuronitis

A

If it is episodic it is MN

221
Q

RHS

A

> Herpes zosta reactivation in the facial nerve

222
Q

sx of RHS

A

> auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

223
Q

Mx of RHS

A

oral aciclovir and corticosteroidsare usually given

224
Q

When should a perf be reassessed

A

4 weeks

225
Q

first line in post tonsillectomy hemorrhage

A

Refers right to ENT they can prescribe antibiotics

226
Q

What is an auricular hematoma

A

Common in rugby players and wrestlers, Direct trauma which leads to a build of her blood

227
Q

mx of auricular haematoma

A

Same day assessment by Ent

228
Q

Use of procloperazine in vestibular neuronitis

A

Should be used in the acute phase only as it delays recovery by interfering with central compensatory mechanisms

229
Q

What is the main side-effect of using topical decongestants for prolonged periods?

A

Intranasal decongestants (e.g. oxymetazoline) should not be used for prolonged periods as increasing doses are required to achieve the same effect (tachyphylaxis)

230
Q

mx of septal haematomas

A

urgent ENT ref

231
Q

And Tosca be finding of glue ear

A

OME is characterised by a retracted tympanic membrane (as opposed to the bulging membrane seen in acute otitis media) with visible fluid build-up behind it. T

232
Q

what is the management of a child with a first presentation of a Titus media with effusion

A

active observation for 3 months - no intervention is required

233
Q

What infection can occur following cat scratch

A

Bartonella

234
Q

What can precipitate Otto’s sclerosis

A

Pregnancy

235
Q

what is the most important part of the tympanic membrane to visualize

A

In patients with chronic or recurrent ear discharge, ensure the attic is visualised to exclude cholesteatoma

236
Q

Most common area of epistaxis

A

Little’s area- Anterior nasal septum

237
Q

rhinitis medicamentosa

A

Rhinitis medicamentosa is a condition of rebound nasal congestion brought on by extended use of topical decongestants - cease use

238
Q

Double sickening suggests

A

bac sinusitis

239
Q

How should otitis external and diabetics be treated

A

Otitis externa in diabetics: treat with ciprofloxacin to coverPseudomonas

240
Q

first line in OE

A

antibiotic and steroid EG neomyosin and dexamethasone ear spray

241
Q

Mneumonic for hearing loss

A

> SU - SN localizes to the unaffected side
CA - conductive -> affected size

242
Q

definitive tx for acute angle closure glaucoma

A

Laser peripheral iridotomy is the definitive treatment for acute angle-closure glaucoma

243
Q

Consider ? if a patient with rheumatoid arthritis presents with a painful red eye

A

Consider scleritis if a patient with rheumatoid arthritis presents with a painful red eye

244
Q

new onset dysphagia ->

A

red flag symptomthat requires urgent endoscopy, regardless of age or other symptoms.

245
Q

Mx of SN hearing loss

A

> hearing aids/ ADL - mild to moderate
cochlear implant - severe to profound not benefitting from hearing aids

246
Q

indications for cochlear implant

A

In children, audiological assessment and/or difficulty developing basic auditory skills.
In adults, patients should have completed a trial of appropriate hearing aids for at least 3 months

247
Q

risks of cochlear implant

A

nfection, facial paralysis due to nerve injury intra-operatively, cerebrospinal fluid (CSF) leakage, and meningitis - should have up to date injections to strep and haemophilis

248
Q

CI to the cochlear implant

A

Lesions of cranial nerve VIII or in the brain stem causing deafness
Chronic infective otitis media, mastoid cavity or tympanic membrane perforation
Cochlear aplasia

249
Q

Mx of tinnitus

A

> investigate underlying cause
amplication device - if hearing loss
psych therapy & tinnitus support

250
Q

Anterior versus posterior nosebleeds

A

> anterior: Visible source of bleeding usually occurs due to an insult to the capillaries
posterior: More profuse and originate from deeper structures

251
Q

Pause of nosebleeds seen in Adolescent males

A

juvenile angiofibroma
benign tumour that is highly vascularised
seen in adolescent males

252
Q

cocaine use -> nose bleeds

A

Nasal septum may look abraded or atrophied

253
Q

mx of epistaxis - haemodynamically stable

A

> first aid - Sitting torso also forward with the mouth open or pinching the soft area of the nose of 20 minutes
If a first aid is successful then use topical antiseptic like Niceptin to reduce crusting and risk of vestibuliitis

254
Q

naseptin safety info

A
255
Q

When should admission be considered in the context of Nosebleed

A

> comorb - like severe HTN, CAD
Child under two

256
Q

If bleeding does not stop after 10-15 minutes of continuous pressure on the nose consider

A

> Cautery - Should be used as the initial measure if the source of bleeding is visible and caught tree is tolerated (involves silver N)
Packing may be used if Cautrey is not tolerated or bleeding point cannot be visualized

257
Q

Nosebleeds and hemodynamically unstable patients

A

control bleeding with first aid measures in the interim
patients with a bleed from an unknown or posterior source (i.e. the bleeding site cannot be located on speculum, bleeding from both nostrils or profuse) should be admitted to hospital.

258
Q

Epistaxis that has failed all emergency management

A

sphenopalatine ligationin theatre

259
Q

anterior packing used when

A
260
Q

eyes saccading on HINTS ->

A

Indicates an abnormally functioning vestibular system eg vestibular labyrinthis or vestibular neurinitis

261
Q

keeping eyes fixed on HINTS ->

A

this is normal and means that the patient either has no current symptoms or a central cause is causing the symp

262
Q

Peripheral versus central vertigo

A

Peripheral problem, usually affecting the vestibular system
Central problem, usually involving the brainstem or the cerebellum -> sustained non positional vertigo

263
Q

causes of central vertigo

A

> posterior circulation infarction
tumour
MS
vestibular migraine

264
Q

post circ stroke

A

sudden onset and may be associated with other symptoms, such as ataxia, diplopia, cranial nerve defects or limb symptoms

265
Q

vertigo & driving

A

patients must not drive and must inform the DVLA if they are liable to “sudden and unprovoked or unprecipitated episodes of disabling dizziness”.

266
Q

symptoms of nasal septum haematoma

A

may be precipitated by relatively minor trauma
the sensation of nasal obstruction is the most common symptom
pain and rhinorrhoea are also seen
on examination, classically a bilateral, red swelling arising from the nasal septum

267
Q

nasal septal haematoma vs deviated nasal septum

A

Nasal septal haematomas are typically boggy whereas septums will be firm

268
Q

mx of nasal septal haematoma

A

surgical drainage
intravenous antibiotics

269
Q

Who gets auricular hematomas

A

Rugby players and wrestlers

270
Q

mx of auricular hematomas

A

auricular haematomas need same-day assessment by ENT - prevent development of cauliflower ear

271
Q

types of allergic rhinitis

A

seasonal: symptoms occur around the same time every year. Seasonal rhinitis which occurs secondary to pollens is known as hay fever
perennial: symptoms occur throughout the year
occupational: symptoms follow exposure to particular allergens within the work place

272
Q

features of allergic rhinitis

A

> sneezing
bilateral nasal obstruction
clear nasal discharge
post-nasal drip
nasal pruritus

273
Q

mx of Mild to moderate allergic rhinitis

A

avoid Allergen and oral or intranasal antihistamines

274
Q

Management of moderate to severe allergic rhinitis or if initial drug treatment is ineffective

A

Intranasal steroids

275
Q

Summary of management of allergic rhinitis

A

> Intranetal antihistamines
If this doesn’t work intranasal steroids
oral Steroids can be used temporarily

276
Q

Allergic rhinitis - why can topical nasal congestions not be used for prolonged periods-

A

e.g. oxymetazoline). Tachyphylaxis & rebound hypertrophy of nasal mucosa

277
Q

tachyplaxis =

A

Increased doses are needed to achieve the same effect

278
Q

rhinitis medicamentosa

A

Complication of using nasal decongestants which involves rebound hypertrophy of the nasal mucosa

279
Q

2 www criteria

A

> unresolved neck lumps > 3 weeks
hoarseness > 6 weeks
dysphagia > 3 weeks
ulcer > 3 weeks
unilateral nasal obstruction

280
Q

tongue protrusion vs swallowing

A

> tongue protrusion: thyroglossal cyst
swallowing: thyroid goitre

Year 4 (9 decks)

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