ENT 👃🩺 Flashcards
1
Q
What is the skin prick test used for?
A
To test for allergies by placing diluted allergens on the skin and piercing it with a needle
It includes controls with histamine (positive) and sterile water (negative) and is interpreted after 15 minutes.
2
Q
What does a positive skin prick test indicate?
A
A wheal develops, indicating an allergy
This test is useful for food allergies and pollen allergies.
3
Q
What does the radioallergosorbent test (RAST) measure?
A
The amount of IgE that reacts with specific allergens
Results are graded from 0 (negative) to 6 (strongly positive) and are useful for food allergies and inhaled allergens.
4
Q
When are blood tests preferred over skin prick tests?
A
When skin prick tests are unsuitable, such as in extensive eczema or when taking antihistamines
Blood tests can provide necessary allergy information in these cases.
5
Q
What is skin patch testing used for?
A
To diagnose contact dermatitis
30-40 allergens are placed on the back and read by a dermatologist after 48 hours.
6
Q
Define oral allergy syndrome (OAS).
A
An IgE-mediated hypersensitivity reaction to specific raw, plant-based foods
It is linked to birch pollen and presents with oral symptoms after eating certain raw foods.
7
Q
What triggers oral allergy syndrome?
A
Cross-reaction with non-food allergens, primarily birch pollen
Cooking the food denatures the proteins and prevents symptoms.
8
Q
List common associations with oral allergy syndrome.
A
- Birch pollen allergy
- Rye grass pollen allergy
- Rubber latex allergy
These associations highlight the link between pollen allergies and OAS.
9
Q
What symptoms are common in oral allergy syndrome?
A
- Itching and tingling of the lips, tongue, and mouth
- Mild swelling and redness
- Nausea and vomiting in severe cases
Symptoms typically resolve within one hour of contact.
10
Q
How is oral allergy syndrome diagnosed?
A
Clinically, but further tests may rule out food allergies
Standard IgE RAST and skin prick testing can identify common allergens.
11
Q
What is the primary management for oral allergy syndrome?
A
Avoidance of culprit foods
Oral antihistamines can be taken if symptoms develop after ingestion.
12
Q
What are local allergic reactions to venom?
A
Redness, swelling, and pain at the site of venom exposure
Defined as spreading >10 cm from the site.
13
Q
What characterizes systemic allergic reactions to venom?
A
Cutaneous reactions distant from the exposure site, such as widespread redness and urticaria
Anaphylaxis may occur with or without systemic cutaneous reactions.
14
Q
What is the immediate management for anaphylaxis?
A
Intramuscular adrenaline, intravenous steroids, and antihistamines
Supportive care may also include oxygen and nebulised bronchodilators.
15
Q
What is venom immunotherapy (VIT)?
A
An effective immunotherapy for patients with a history of systemic reactions to venom
Recommended for those with raised levels of venom-specific IgE.
16
Q
What are the features of acute epiglottitis?
A
- Rapid onset
- High temperature
- Stridor
- Drooling of saliva
- Tripod position
It is a serious infection that can lead to airway obstruction.
17
Q
What is the primary diagnostic method for acute epiglottitis?
A
Direct visualization by senior airway-trained staff
X-rays may show swelling of the epiglottis (thumb sign).
18
Q
What management steps are critical for acute epiglottitis?
A
- Immediate senior involvement
- Possible endotracheal intubation
- Oxygen and intravenous antibiotics
Avoid examining the throat to prevent airway obstruction.
19
Q
Define chronic rhinosinusitis.
A
An inflammatory disorder of the paranasal sinuses lasting 12 weeks or longer
It affects up to 1 in 10 people.
20
Q
List predisposing factors for chronic rhinosinusitis.
A
- Atopy (hay fever, asthma)
- Nasal obstruction (septal deviation, polyps)
- Recent local infection
- Swimming/diving
- Smoking
These factors contribute to the development of chronic rhinosinusitis.
21
Q
What are the common features of chronic rhinosinusitis?
A
- Facial pain (frontal pressure)
- Nasal discharge (clear or purulent)
- Nasal obstruction
- Post-nasal drip
Symptoms can vary based on the underlying cause.
22
Q
What are red flag symptoms in chronic rhinosinusitis? (3)
A
- Unilateral symptoms
- Persistent symptoms despite treatment
- Epistaxis
These symptoms may indicate a more serious condition.
23
Q
What is croup?
A
An upper respiratory tract infection characterized by stridor in infants and toddlers
Caused by laryngeal edema and secretions, mainly due to parainfluenza viruses.
24
Q
What are the common features of croup?
A
- Barking cough
- Stridor
- Fever
- Coryzal symptoms
- Increased work of breathing
Symptoms tend to worsen at night.
25
What is the severity grading for croup?
Mild, Moderate, Severe
## Footnote
Severity is assessed based on symptoms such as stridor at rest and level of distress.
26
What is the recommended treatment for mild croup?
A single dose of oral dexamethasone (0.15mg/kg)
## Footnote
Prednisolone is an alternative if dexamethasone is unavailable.
27
What is the importance of the Hib vaccine in relation to epiglottitis?
The incidence of epiglottitis has decreased since the introduction of the Hib vaccine
## Footnote
It was traditionally considered a childhood disease but is now more common in adults.
28
What is the peak incidence age range for croup?
6 months - 3 years
29
During which season is croup more common?
Autumn
30
What are the characteristic features of croup?
* Barking, seal-like cough
* Stridor
* Fever
* Coryzal symptoms
* Increased work of breathing
31
What is the recommended management for all children with croup?
A single dose of oral dexamethasone (0.15mg/kg)
32
What are the three severity grades of croup?
* Mild
* Moderate
* Severe
33
What defines mild croup?
* Occasional barking cough
* No audible stridor at rest
* No or mild retractions
* Child is happy and plays
34
What defines moderate croup?
* Frequent barking cough
* Audible stridor at rest
* Retractions at rest
* Little distress
* Child can be placated
35
What defines severe croup?
* Frequent barking cough
* Prominent stridor at rest
* Marked retractions
* Significant distress or lethargy
* Tachycardia
36
What conditions warrant the admission of a child with croup?
* Moderate or severe croup
* < 3 months of age
* Known upper airway abnormalities
* Uncertainty about diagnosis
37
What imaging findings are associated with croup on a chest x-ray?
Subglottic narrowing (the 'steeple sign')
38
What are vestibular schwannomas also known as?
Acoustic neuromas
39
What is the classical history of vestibular schwannoma?
* Vertigo
* Hearing loss
* Tinnitus
* Absent corneal reflex
40
Which cranial nerve is affected in vestibular schwannoma leading to vertigo?
Cranial nerve VIII
41
What is a common investigation for suspected vestibular schwannoma?
MRI of the cerebellopontine angle
42
What is achalasia?
Failure of oesophageal peristalsis and relaxation of the lower oesophageal sphincter
43
What are the clinical features of achalasia?
* Dysphagia for both liquids and solids
* Heartburn
* Regurgitation
* Cough and aspiration pneumonia
44
What is the most important diagnostic test for achalasia?
Oesophageal manometry
45
What does a barium swallow show in achalasia?
'Bird's beak' appearance and grossly expanded oesophagus
46
What is the first-line treatment for achalasia?
Pneumatic (balloon) dilation
47
What is acute epiglottitis?
A rare but serious infection caused by Haemophilus influenzae type B
48
What are the key features of acute epiglottitis?
* Rapid onset
* High temperature
* Stridor
* Drooling of saliva
* 'Tripod' position
49
What is the 'thumb sign' associated with?
Swelling of the epiglottis in acute epiglottitis
50
What is the management for suspected acute epiglottitis?
* Immediate senior involvement
* Endotracheal intubation if necessary
* Oxygen
* Intravenous antibiotics
51
What red flag symptoms indicate a need for urgent endoscopy in dysphagia?
New-onset dysphagia
52
What are some causes of dysphagia?
* Oesophageal cancer
* Oesophagitis
* Oesophageal candidiasis
* Achalasia
53
What are the features of chronic rhinosinusitis?
* Facial pain
* Nasal discharge
* Nasal obstruction
* Post-nasal drip
54
What are the predisposing factors for chronic rhinosinusitis?
* Atopy
* Nasal obstruction
* Recent local infection
* Smoking
55
What is the management for recurrent or chronic sinusitis?
* Avoid allergens
* Intranasal corticosteroids
* Nasal irrigation with saline
56
What is Bell's palsy?
Acute, unilateral, idiopathic facial nerve paralysis
57
What is the recommended treatment for Bell's palsy?
Oral prednisolone within 72 hours of onset
58
What are the features of Meniere's disease?
* Recurrent episodes of vertigo
* Tinnitus
* Hearing loss
* Aural fullness or pressure
59
What is the management for acute attacks of Meniere's disease?
Buccal or intramuscular prochlorperazine
60
What are the causes of otitis externa?
* Infection (bacterial or fungal)
* Seborrhoeic dermatitis
* Contact dermatitis
* Recent swimming
61
What is the initial management for otitis externa?
Topical antibiotic or combined topical antibiotic with a steroid
62
What are the two types of epistaxis?
* Anterior
* Posterior
63
What is the management for stable patients with epistaxis?
First aid measures: sit forward, avoid lying down
64
What should be inquired about if a patient is abraded or atrophied?
Drug use
## Footnote
Inhaled cocaine is a powerful vasoconstrictor that may result in the obliteration of the septum.
65
What is hereditary haemorrhagic telangiectasia?
A genetic disorder that leads to abnormal blood vessel formation
## Footnote
It can cause frequent nosebleeds and other bleeding issues.
66
What is granulomatosis with polyangiitis?
A rare disease that causes inflammation of blood vessels
## Footnote
It can affect various organs, including the respiratory system.
67
What is the first step in managing a stable patient with epistaxis?
Ask the patient to sit with their torso forward and mouth open
68
What should be avoided to reduce the risk of aspirating blood during an epistaxis episode?
Lying down unless feeling faint
69
How long should the cartilaginous area of the nose be pinched to control bleeding?
At least 20 minutes
70
What topical antiseptic can be used to reduce crusting and the risk of vestibulitis?
Naseptin (chlorhexidine and neomycin)
71
What are contraindications for using Naseptin?
Peanut, soy, or neomycin allergies
72
What is a viable alternative to Naseptin for patients with allergies?
Mupirocin
73
What self-care advice should be given to patients to reduce the risk of re-bleeding?
Avoid blowing or picking nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks
74
If bleeding does not stop after 10-15 minutes of pressure, what should be considered?
Cautery or packing
75
When should cautery be used in the management of epistaxis?
If the source of the bleed is visible and cautery is tolerated
76
What should be done before applying silver nitrate for cautery?
Use a topical local anaesthetic spray (e.g. Co-phenylcaine) and wait 3-4 minutes
77
What should be avoided when applying cautery to prevent perforation?
Touching areas which do not require treatment and cauterising both sides of the septum
78
What should be done if cautery is not viable or the bleeding point cannot be visualised?
Use nasal packing
79
What is the recommended position for a patient during nasal packing?
Sitting with their head forward
80
What should be examined for continuing bleeding after nasal packing?
The patient's mouth and throat
81
What is the management for patients who are haemodynamically unstable or compromised?
Admit to the emergency department
82
What should be done for patients with a bleed from an unknown or posterior source?
Admit to hospital
83
What surgical procedure may be required for epistaxis that has failed all emergency management?
Sphenopalatine ligation in theatre
84
What is chronic rhinosinusitis?
An inflammatory disorder of the paranasal sinuses and linings of the nasal passages lasting 12 weeks or longer
## Footnote
Affects up to 1 in 10 people.
85
List at least three predisposing factors for chronic rhinosinusitis.
* Atopy (hay fever, asthma)
* Nasal obstruction (e.g. septal deviation, nasal polyps)
* Recent local infection (e.g. rhinitis, dental extraction)
* Swimming/diving
* Smoking
86
What are common features of chronic rhinosinusitis?
* Facial pain (frontal pressure worse on bending forward)
* Nasal discharge (clear if allergic, purulent if infected)
* Nasal obstruction
* Post-nasal drip
87
What is a recommended management strategy for recurrent or chronic sinusitis?
* Avoid allergens
* Intranasal corticosteroids
* Nasal irrigation with saline solution
88
Identify red flag symptoms for chronic rhinosinusitis.
* Unilateral symptoms
* Persistent symptoms despite 3 months of treatment
* Epistaxis
89
What is the role of the trigeminal nerve in facial pain?
It innervates the face and transmits pain sensations to the trigeminal nucleus in the brainstem
## Footnote
The trigeminal nerve has three main branches: ophthalmic (V1), maxillary (V2), and mandibular (V3).
90
What characterizes trigeminal neuralgia?
Severe lancinating facial pain along one or more branches of the trigeminal nerve
## Footnote
It is often idiopathic but can be due to compression of trigeminal roots.
91
State the definition of trigeminal neuralgia according to the International Headache Society.
A unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve.
92
What are common triggers for trigeminal neuralgia pain?
* Light touch
* Washing
* Shaving
* Smoking
* Talking
* Brushing teeth
93
List red flag symptoms indicating a serious underlying cause in facial pain.
* Sensory changes
* Deafness or other ear problems
* History of skin/oral lesions
* Pain only in the ophthalmic division
* Optic neuritis
* Family history of multiple sclerosis
* Age of onset before 40 years
94
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine
## Footnote
Referral to neurology is indicated if there is failure to respond to treatment or atypical features.
95
What is anaphylaxis?
A severe, life-threatening, generalised or systemic hypersensitivity reaction.
96
What are common causes of anaphylaxis?
* Food (e.g. nuts)
* Drugs
* Venom (e.g. wasp sting)
97
What features are indicative of anaphylaxis?
* Sudden onset and rapid progression of symptoms
* Airway, breathing, or circulation problems
98
What are the recommended doses for adrenaline in anaphylaxis for adults and children over 12 years?
500 micrograms (0.5ml 1 in 1,000)
## Footnote
Adrenaline can be repeated every 5 minutes if necessary.
99
What is the management for refractory anaphylaxis?
IV fluids for shock and consideration of an IV adrenaline infusion.
100
What is glue ear?
Otitis media with effusion; common in children, often leading to conductive hearing loss.
101
List risk factors for glue ear.
* Male sex
* Siblings with glue ear
* Higher incidence in Winter and Spring
* Bottle feeding
* Day care attendance
* Parental smoking
102
What is the most common presenting feature of glue ear?
Hearing loss
## Footnote
It is the commonest cause of conductive hearing loss in childhood.
103
What management options are available for glue ear?
* Active observation for 3 months
* Grommet insertion
* Adenoidectomy
104
What does Rinne's test assess?
Differentiates conductive from sensorineural deafness.
105
What is a positive Rinne's test result?
Air conduction (AC) is better than bone conduction (BC).
106
What does a negative Rinne's test indicate?
Bone conduction (BC) is greater than air conduction (AC), suggesting conductive deafness.
107
What does Weber's test assess?
Determines lateralization of sound to differentiate between conductive and sensorineural hearing loss.
108
In unilateral sensorineural deafness, where is the sound localized in Weber's test?
To the unaffected side.
109
What is the management for sudden-onset sensorineural hearing loss (SSNHL)?
Urgent referral to ENT and high-dose oral corticosteroids.
110
What is acute epiglottitis and its common cause?
A rare but serious infection caused by Haemophilus influenzae type B.
111
List features of acute epiglottitis.
* Rapid onset
* High temperature
* Stridor
* Drooling of saliva
* Tripod position
112
What is the recommended management for suspected acute epiglottitis?
* Immediate senior involvement
* Endotracheal intubation if necessary
* Oxygen
* Intravenous antibiotics
113
What are common causes of hoarseness?
* Voice overuse
* Smoking
* Viral illness
* Hypothyroidism
* Gastro-oesophageal reflux
* Laryngeal cancer
* Lung cancer
114
What referral guidelines exist for suspected laryngeal cancer?
Consider a suspected cancer pathway referral for people aged 45 and over with persistent unexplained hoarseness or an unexplained lump in the neck.
115
What is the umbrella term for head and neck cancer?
Head and neck cancer typically includes:
* Oral cavity cancers
* Cancers of the pharynx (oropharynx, hypopharynx, nasopharynx)
* Cancers of the larynx
## Footnote
Head and neck cancers encompass a variety of malignancies affecting the anatomical structures of the head and neck region.
116
What are common features of head and neck cancer?
Common features include:
* Neck lump
* Hoarseness
* Persistent sore throat
* Persistent mouth ulcer
## Footnote
These features can indicate potential malignancies and warrant further investigation.
117
What are the NICE suspected cancer pathway referral criteria for laryngeal cancer?
Consider referral for laryngeal cancer in individuals aged 45 and over with:
* Persistent unexplained hoarseness
* Unexplained lump in the neck
## Footnote
This referral should be made for an appointment within 2 weeks.
118
What criteria indicate a suspected cancer pathway referral for oral cancer?
Referral indications for oral cancer include:
* Unexplained ulceration in the oral cavity lasting more than 3 weeks
* Persistent and unexplained lump in the neck
## Footnote
Urgent referrals to a dentist are indicated for specific oral findings.
119
What is a characteristic feature of thyroid cancer that warrants referral?
An unexplained thyroid lump warrants a suspected cancer pathway referral for thyroid cancer.
## Footnote
This referral is also for an appointment within 2 weeks.
120
What is the most common cause of neck swellings?
Reactive lymphadenopathy is by far the most common cause of neck swellings.
## Footnote
This condition may be associated with local infections or general viral illnesses.
121
Which neck lump condition is characterized by rubbery, painless lymphadenopathy?
Lymphoma is characterized by rubbery, painless lymphadenopathy.
## Footnote
Additional features may include night sweats and splenomegaly.
122
What are common symptoms of obstructive sleep apnea-hypopnea syndrome (OSAHS)?
Common symptoms include:
* Daytime somnolence
* Compensated respiratory acidosis
* Hypertension
## Footnote
These symptoms can significantly affect quality of life and overall health.
123
What is the first line management for moderate or severe OSAHS?
Continuous positive airway pressure (CPAP) is the first line for moderate or severe OSAHS.
## Footnote
This treatment is critical for managing symptoms and improving sleep quality.
124
What is acute epiglottitis and its causative agent?
Acute epiglottitis is a rare but serious infection caused by Haemophilus influenzae type B.
## Footnote
Recognition and treatment are essential to prevent airway obstruction.
125
What is the classic triad of symptoms for infectious mononucleosis?
The classic triad includes:
* Sore throat
* Lymphadenopathy
* Pyrexia
## Footnote
This triad is seen in around 98% of patients with the condition.
126
What is the first line antiviral treatment for influenza?
The first line antiviral treatment for influenza is oseltamivir.
## Footnote
This is used particularly in at-risk groups within 48 hours of symptom onset.
127
What is the management approach for sore throat?
Management includes:
* Paracetamol or ibuprofen for pain relief
* Antibiotics are not routinely indicated
## Footnote
A single dose of oral corticosteroid may reduce severity and duration of pain.
128
What scoring system is used to assess likelihood of strep infection in adults with sore throat?
The Centor criteria and FeverPAIN criteria are used for this assessment.
## Footnote
These scoring systems guide the decision-making process regarding antibiotic usage.
129
What are the common symptoms of upper respiratory tract infections (URTIs)?
Common symptoms include:
* Nasal discharge
* Nasal obstruction
* Sore throat
* Headache
* Cough
* Tiredness
* General malaise
## Footnote
URTIs are often caused by viral infections.
130
What is whooping cough caused by?
Whooping cough is caused by the Gram-negative bacterium Bordetella pertussis.
## Footnote
It typically presents in children and is notable for prolonged coughing fits.
131
What phases are involved in the presentation of whooping cough?
The phases include:
* Catarrhal phase
* Paroxysmal phase
* Convalescent phase
## Footnote
Each phase has distinct symptoms and duration.
132
What is the diagnostic criteria for whooping cough?
Diagnostic criteria include:
* Acute cough lasting 14 days or more
* Paroxysmal cough
* Inspiratory whoop
* Post-tussive vomiting
## Footnote
These features help differentiate it from other respiratory illnesses.
133
What type of antibiotic is indicated for cough onset within the previous 21 days?
An oral macrolide (e.g. clarithromycin, azithromycin, or erythromycin)
## Footnote
This is to eradicate the organism and reduce the spread.
134
What should be offered to household contacts of a patient with whooping cough?
Antibiotic prophylaxis
## Footnote
This is to prevent the spread of the infection.
135
Does antibiotic therapy alter the course of whooping cough?
No
## Footnote
Antibiotic therapy has not been shown to alter the course of the illness.
136
What is the school exclusion period for children after starting antibiotics for whooping cough?
48 hours after commencing antibiotics or 21 days from onset of symptoms if no antibiotics
## Footnote
This is to reduce the risk of spreading the infection.
137
List some complications associated with whooping cough. (4)
* Subconjunctival haemorrhage
* Pneumonia
* Bronchiectasis
* Seizures
138
What vaccination program was introduced in 2012 for pregnant women?
Whooping cough vaccination program
## Footnote
This was introduced due to an outbreak that resulted in the death of 14 newborn children.
139
What is the effectiveness of the whooping cough vaccine in preventing newborns from developing the disease?
More than 90% effective
## Footnote
The vaccine significantly reduces the incidence of whooping cough in newborns.
140
At what stage of pregnancy are women offered the whooping cough vaccine?
Between 16-32 weeks pregnant
## Footnote
This timing is crucial for maternal and newborn protection.
141
What is acute epiglottitis and what causes it?
A rare but serious infection caused by Haemophilus influenzae type B
## Footnote
Prompt recognition and treatment are essential to prevent airway obstruction.
142
What is a key feature of epiglottitis diagnosis?
Direct visualisation by senior/airway trained staff
## Footnote
X-rays may also be used, particularly for foreign body concerns.
143
What does the 'thumb sign' indicate in a lateral view x-ray?
Swelling of the epiglottis in acute epiglottitis
## Footnote
This is a characteristic finding in epiglottitis.
144
What is the primary management step for patients with suspected epiglottitis?
Immediate senior involvement for emergency airway support
## Footnote
Endotracheal intubation may be necessary.
145
What is croup and which viruses are most commonly responsible?
A form of upper respiratory tract infection in infants and toddlers, primarily caused by parainfluenza viruses
## Footnote
It is characterized by stridor due to laryngeal edema.
146
What are the peak ages for croup incidence?
6 months to 3 years
## Footnote
Croup is more common during the autumn season.
147
What is a common feature of croup?
Barking, seal-like cough
## Footnote
Symptoms worsen at night and may include stridor and fever.
148
List the severity grading for croup.
* Mild: Occasional barking cough, no stridor at rest
* Moderate: Frequent barking cough, audible stridor at rest
* Severe: Frequent barking cough, prominent stridor at rest, significant distress
149
What should be done for children with moderate or severe croup according to NICE guidelines?
Admit any child with moderate or severe croup
## Footnote
This includes children under 3 months of age or those with known upper airway abnormalities.
150
What is Meniere's disease characterized by?
Excessive pressure and progressive dilation of the endolymphatic system
## Footnote
It is often seen in middle-aged adults but can occur at any age.
151
What are the main features of Meniere's disease?
* Recurrent episodes of vertigo
* Tinnitus
* Hearing loss (sensorineural)
* Sensation of aural fullness or pressure
152
What is the typical natural history of Meniere's disease?
Symptoms resolve in the majority of patients after 5-10 years
## Footnote
Most patients will still experience some degree of hearing loss.
153
What is tinnitus?
The perception of sounds in the ears or head that do not come from an outside source
## Footnote
It can be distressing and may indicate a serious underlying condition.
154
List some causes of tinnitus. (7)
* Idiopathic
* Meniere's disease
* Otosclerosis
* Sudden onset sensorineural hearing loss (SSNHL)
* Acoustic neuroma
* Drugs (e.g. aspirin, aminoglycosides)
* Impacted ear wax
155
What is the first-line investigation for pulsatile tinnitus?
Magnetic resonance angiography (MRA)
## Footnote
This is used to investigate potential underlying vascular causes.
156
What is the classical history of vestibular schwannoma?
Combination of vertigo, hearing loss, tinnitus, and absent corneal reflex
## Footnote
Features are predicted by the affected cranial nerves.
157
What is benign paroxysmal positional vertigo (BPPV) characterized by?
Sudden onset of dizziness and vertigo triggered by changes in head position
## Footnote
Each episode typically lasts 10-20 seconds.
158
What is the Epley manoeuvre used for?
Treatment for BPPV
## Footnote
It is successful in around 80% of cases.
159
What should patients with Meniere's disease inform the DVLA about?
They should inform the DVLA and cease driving until satisfactory control of symptoms is achieved
## Footnote
This is crucial for safety reasons.
160
What is a peritonsillar abscess typically a complication of?
Bacterial tonsillitis
161
List the features of a peritonsillar abscess.
* Severe throat pain lateralised to one side
* Deviation of the uvula to the unaffected side
* Trismus (difficulty opening the mouth)
* Reduced neck mobility
162
What urgent medical specialist should review patients with a peritonsillar abscess?
ENT specialist
163
What are the management options for a peritonsillar abscess?
* Needle aspiration
* Incision & drainage
* Intravenous antibiotics
* Tonsillectomy to prevent recurrence
164
What are some complications of tonsillitis?
* Otitis media
* Quinsy (peritonsillar abscess)
* Rheumatic fever
* Glomerulonephritis (very rarely)
165
What criteria does NICE recommend for considering tonsillectomy?
* Sore throats due to tonsillitis
* 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years
* Episodes are disabling and prevent normal functioning
166
List other established indications for tonsillectomy.
* Recurrent febrile convulsions secondary to tonsillitis
* Obstructive sleep apnoea secondary to enlarged tonsils
* Peritonsillar abscess unresponsive to standard treatment
167
What are the primary complications of tonsillectomy?
* Haemorrhage (2-3%)
* Pain
168
When does primary haemorrhage typically occur after tonsillectomy?
In the first 6-8 hours
169
What is benign paroxysmal positional vertigo (BPPV) characterized by?
Sudden onset of dizziness and vertigo triggered by changes in head position
170
What is the average age of onset for BPPV?
55 years
171
List the features of BPPV.
* Vertigo triggered by head position change
* May be associated with nausea
* Episodes last 10-20 seconds
* Positive Dix-Hallpike manoeuvre
* Rotatory nystagmus
172
What is the prognosis for BPPV?
Usually resolves spontaneously after a few weeks to months
173
What is the Epley manoeuvre used for?
Symptomatic relief in BPPV (successful in around 80% of cases)
174
What chronic condition affects up to 1 in 10 people?
Chronic rhinosinusitis
175
What are the predisposing factors for chronic rhinosinusitis?
* Atopy (hay fever, asthma)
* Nasal obstruction (e.g. septal deviation)
* Recent local infection (e.g. rhinitis)
* Swimming/diving
* Smoking
176
List the features of chronic rhinosinusitis.
* Facial pain (typically frontal)
* Nasal discharge
* Nasal obstruction
* Post-nasal drip
177
What are 'red flag' symptoms for chronic rhinosinusitis?
* Unilateral symptoms
* Persistent symptoms despite treatment
* Epistaxis
178
What virus is predominantly responsible for infectious mononucleosis?
Epstein-Barr virus (EBV)
179
What is the classic triad of symptoms for infectious mononucleosis?
* Sore throat
* Lymphadenopathy
* Pyrexia
180
What is the management for infectious mononucleosis?
* Supportive care
* Rest
* Hydration
* Simple analgesia
* Avoid contact sports for 4 weeks
181
What is Meniere's disease characterized by?
* Recurrent episodes of vertigo
* Tinnitus
* Hearing loss
* Aural fullness or pressure
182
What is the management for acute attacks of Meniere's disease?
Buccal or intramuscular prochlorperazine
183
What is a common consequence of obstructive sleep apnoea-hypopnoea syndrome (OSAHS)?
Daytime somnolence
184
What is the first-line treatment for moderate or severe OSAHS?
Continuous positive airway pressure (CPAP)
185
What is malignant otitis externa most commonly caused by?
Pseudomonas aeruginosa
186
What are the key features of malignant otitis externa?
* Severe deep-seated otalgia
* Temporal headaches
* Purulent otorrhea
* Possible dysphagia or facial nerve dysfunction
187
What is a common initial management strategy for otitis externa?
Topical antibiotic or combined topical antibiotic with a steroid
188
What is the most common cause of acute otitis media in children?
Bacterial infections secondary to viral upper respiratory tract infections
189
List the common sequelae of acute otitis media.
* Perforation of the tympanic membrane
* Chronic suppurative otitis media
* Hearing loss
* Labyrinthitis
190
What is glue ear also known as?
Otitis media with effusion
191
What are the treatment options for glue ear?
* Active observation
* Grommet insertion
* Adenoidectomy
192
What are vestibular schwannomas also referred to as?
Acoustic neuromas
193
What cranial nerve symptoms are associated with vestibular schwannoma?
* Cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
* Cranial nerve V: absent corneal reflex
194
What percentage of intracranial tumours do vestibular schwannomas account for?
Approximately 5%
## Footnote
Vestibular schwannomas are also known as acoustic neuromas.
195
What are the classical symptoms of vestibular schwannoma?
Vertigo, hearing loss, tinnitus, absent corneal reflex
## Footnote
Symptoms vary based on affected cranial nerves.
196
Which cranial nerve is associated with vertigo and unilateral sensorineural hearing loss in vestibular schwannoma?
Cranial nerve VIII
## Footnote
This nerve is also associated with unilateral tinnitus.
197
What symptom is associated with cranial nerve V in vestibular schwannoma?
Absent corneal reflex
198
Which cranial nerve is involved in facial palsy in vestibular schwannoma?
Cranial nerve VII
199
In which condition are bilateral vestibular schwannomas commonly seen?
Neurofibromatosis type 2
200
What should patients with a suspected vestibular schwannoma be referred for?
Urgent ENT evaluation
201
How are vestibular schwannomas typically characterized in terms of growth and behavior?
Slow growing, benign, often observed initially
202
What is the investigation of choice for vestibular schwannoma?
MRI of the cerebellopontine angle
203
What is an important diagnostic tool alongside MRI for vestibular schwannoma?
Audiometry
204
What percentage of patients with vestibular schwannoma will have a normal audiogram?
Only 5%
205
What are the management options for vestibular schwannoma?
Surgery, radiotherapy, observation
