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UKMLA Prep > ENT 👃🩺 > Flashcards

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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25
Q

What is the severity grading for croup?

A

Mild, Moderate, Severe

Severity is assessed based on symptoms such as stridor at rest and level of distress.

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26
Q

What is the recommended treatment for mild croup?

A

A single dose of oral dexamethasone (0.15mg/kg)

Prednisolone is an alternative if dexamethasone is unavailable.

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27
Q

What is the importance of the Hib vaccine in relation to epiglottitis?

A

The incidence of epiglottitis has decreased since the introduction of the Hib vaccine

It was traditionally considered a childhood disease but is now more common in adults.

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28
Q

What is the peak incidence age range for croup?

A

6 months - 3 years

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29
Q

During which season is croup more common?

A

Autumn

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30
Q

What are the characteristic features of croup?

A
  • Barking, seal-like cough
  • Stridor
  • Fever
  • Coryzal symptoms
  • Increased work of breathing
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31
Q

What is the recommended management for all children with croup?

A

A single dose of oral dexamethasone (0.15mg/kg)

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32
Q

What are the three severity grades of croup?

A
  • Mild
  • Moderate
  • Severe
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33
Q

What defines mild croup?

A
  • Occasional barking cough
  • No audible stridor at rest
  • No or mild retractions
  • Child is happy and plays
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34
Q

What defines moderate croup?

A
  • Frequent barking cough
  • Audible stridor at rest
  • Retractions at rest
  • Little distress
  • Child can be placated
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35
Q

What defines severe croup?

A
  • Frequent barking cough
  • Prominent stridor at rest
  • Marked retractions
  • Significant distress or lethargy
  • Tachycardia
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36
Q

What conditions warrant the admission of a child with croup?

A
  • Moderate or severe croup
  • < 3 months of age
  • Known upper airway abnormalities
  • Uncertainty about diagnosis
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37
Q

What imaging findings are associated with croup on a chest x-ray?

A

Subglottic narrowing (the ‘steeple sign’)

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38
Q

What are vestibular schwannomas also known as?

A

Acoustic neuromas

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39
Q

What is the classical history of vestibular schwannoma?

A
  • Vertigo
  • Hearing loss
  • Tinnitus
  • Absent corneal reflex
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40
Q

Which cranial nerve is affected in vestibular schwannoma leading to vertigo?

A

Cranial nerve VIII

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41
Q

What is a common investigation for suspected vestibular schwannoma?

A

MRI of the cerebellopontine angle

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42
Q

What is achalasia?

A

Failure of oesophageal peristalsis and relaxation of the lower oesophageal sphincter

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43
Q

What are the clinical features of achalasia?

A
  • Dysphagia for both liquids and solids
  • Heartburn
  • Regurgitation
  • Cough and aspiration pneumonia
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44
Q

What is the most important diagnostic test for achalasia?

A

Oesophageal manometry

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45
Q

What does a barium swallow show in achalasia?

A

‘Bird’s beak’ appearance and grossly expanded oesophagus

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46
Q

What is the first-line treatment for achalasia?

A

Pneumatic (balloon) dilation

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47
Q

What is acute epiglottitis?

A

A rare but serious infection caused by Haemophilus influenzae type B

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48
Q

What are the key features of acute epiglottitis?

A
  • Rapid onset
  • High temperature
  • Stridor
  • Drooling of saliva
  • ‘Tripod’ position
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49
Q

What is the ‘thumb sign’ associated with?

A

Swelling of the epiglottis in acute epiglottitis

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50
Q

What is the management for suspected acute epiglottitis?

A
  • Immediate senior involvement
  • Endotracheal intubation if necessary
  • Oxygen
  • Intravenous antibiotics
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51
Q

What red flag symptoms indicate a need for urgent endoscopy in dysphagia?

A

New-onset dysphagia

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52
Q

What are some causes of dysphagia?

A
  • Oesophageal cancer
  • Oesophagitis
  • Oesophageal candidiasis
  • Achalasia
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53
Q

What are the features of chronic rhinosinusitis?

A
  • Facial pain
  • Nasal discharge
  • Nasal obstruction
  • Post-nasal drip
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54
Q

What are the predisposing factors for chronic rhinosinusitis?

A
  • Atopy
  • Nasal obstruction
  • Recent local infection
  • Smoking
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55
Q

What is the management for recurrent or chronic sinusitis?

A
  • Avoid allergens
  • Intranasal corticosteroids
  • Nasal irrigation with saline
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56
Q

What is Bell’s palsy?

A

Acute, unilateral, idiopathic facial nerve paralysis

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57
Q

What is the recommended treatment for Bell’s palsy?

A

Oral prednisolone within 72 hours of onset

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58
Q

What are the features of Meniere’s disease?

A
  • Recurrent episodes of vertigo
  • Tinnitus
  • Hearing loss
  • Aural fullness or pressure
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59
Q

What is the management for acute attacks of Meniere’s disease?

A

Buccal or intramuscular prochlorperazine

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60
Q

What are the causes of otitis externa?

A
  • Infection (bacterial or fungal)
  • Seborrhoeic dermatitis
  • Contact dermatitis
  • Recent swimming
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61
Q

What is the initial management for otitis externa?

A

Topical antibiotic or combined topical antibiotic with a steroid

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62
Q

What are the two types of epistaxis?

A
  • Anterior
  • Posterior
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63
Q

What is the management for stable patients with epistaxis?

A

First aid measures: sit forward, avoid lying down

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64
Q

What should be inquired about if a patient is abraded or atrophied?

A

Drug use

Inhaled cocaine is a powerful vasoconstrictor that may result in the obliteration of the septum.

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65
Q

What is hereditary haemorrhagic telangiectasia?

A

A genetic disorder that leads to abnormal blood vessel formation

It can cause frequent nosebleeds and other bleeding issues.

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66
Q

What is granulomatosis with polyangiitis?

A

A rare disease that causes inflammation of blood vessels

It can affect various organs, including the respiratory system.

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67
Q

What is the first step in managing a stable patient with epistaxis?

A

Ask the patient to sit with their torso forward and mouth open

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68
Q

What should be avoided to reduce the risk of aspirating blood during an epistaxis episode?

A

Lying down unless feeling faint

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69
Q

How long should the cartilaginous area of the nose be pinched to control bleeding?

A

At least 20 minutes

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70
Q

What topical antiseptic can be used to reduce crusting and the risk of vestibulitis?

A

Naseptin (chlorhexidine and neomycin)

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71
Q

What are contraindications for using Naseptin?

A

Peanut, soy, or neomycin allergies

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72
Q

What is a viable alternative to Naseptin for patients with allergies?

A

Mupirocin

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73
Q

What self-care advice should be given to patients to reduce the risk of re-bleeding?

A

Avoid blowing or picking nose, heavy lifting, exercise, lying flat, drinking alcohol or hot drinks

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74
Q

If bleeding does not stop after 10-15 minutes of pressure, what should be considered?

A

Cautery or packing

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75
Q

When should cautery be used in the management of epistaxis?

A

If the source of the bleed is visible and cautery is tolerated

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76
Q

What should be done before applying silver nitrate for cautery?

A

Use a topical local anaesthetic spray (e.g. Co-phenylcaine) and wait 3-4 minutes

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77
Q

What should be avoided when applying cautery to prevent perforation?

A

Touching areas which do not require treatment and cauterising both sides of the septum

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78
Q

What should be done if cautery is not viable or the bleeding point cannot be visualised?

A

Use nasal packing

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79
Q

What is the recommended position for a patient during nasal packing?

A

Sitting with their head forward

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80
Q

What should be examined for continuing bleeding after nasal packing?

A

The patient’s mouth and throat

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81
Q

What is the management for patients who are haemodynamically unstable or compromised?

A

Admit to the emergency department

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82
Q

What should be done for patients with a bleed from an unknown or posterior source?

A

Admit to hospital

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83
Q

What surgical procedure may be required for epistaxis that has failed all emergency management?

A

Sphenopalatine ligation in theatre

84
Q

What is chronic rhinosinusitis?

A

An inflammatory disorder of the paranasal sinuses and linings of the nasal passages lasting 12 weeks or longer

Affects up to 1 in 10 people.

85
Q

List at least three predisposing factors for chronic rhinosinusitis.

A
  • Atopy (hay fever, asthma)
  • Nasal obstruction (e.g. septal deviation, nasal polyps)
  • Recent local infection (e.g. rhinitis, dental extraction)
  • Swimming/diving
  • Smoking
86
Q

What are common features of chronic rhinosinusitis?

A
  • Facial pain (frontal pressure worse on bending forward)
  • Nasal discharge (clear if allergic, purulent if infected)
  • Nasal obstruction
  • Post-nasal drip
87
Q

What is a recommended management strategy for recurrent or chronic sinusitis?

A
  • Avoid allergens
  • Intranasal corticosteroids
  • Nasal irrigation with saline solution
88
Q

Identify red flag symptoms for chronic rhinosinusitis.

A
  • Unilateral symptoms
  • Persistent symptoms despite 3 months of treatment
  • Epistaxis
89
Q

What is the role of the trigeminal nerve in facial pain?

A

It innervates the face and transmits pain sensations to the trigeminal nucleus in the brainstem

The trigeminal nerve has three main branches: ophthalmic (V1), maxillary (V2), and mandibular (V3).

90
Q

What characterizes trigeminal neuralgia?

A

Severe lancinating facial pain along one or more branches of the trigeminal nerve

It is often idiopathic but can be due to compression of trigeminal roots.

91
Q

State the definition of trigeminal neuralgia according to the International Headache Society.

A

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
Q

What are common triggers for trigeminal neuralgia pain?

A
  • Light touch
  • Washing
  • Shaving
  • Smoking
  • Talking
  • Brushing teeth
93
Q

List red flag symptoms indicating a serious underlying cause in facial pain.

A
  • 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
Q

What is the first-line treatment for trigeminal neuralgia?

A

Carbamazepine

Referral to neurology is indicated if there is failure to respond to treatment or atypical features.

95
Q

What is anaphylaxis?

A

A severe, life-threatening, generalised or systemic hypersensitivity reaction.

96
Q

What are common causes of anaphylaxis?

A
  • Food (e.g. nuts)
  • Drugs
  • Venom (e.g. wasp sting)
97
Q

What features are indicative of anaphylaxis?

A
  • Sudden onset and rapid progression of symptoms
  • Airway, breathing, or circulation problems
98
Q

What are the recommended doses for adrenaline in anaphylaxis for adults and children over 12 years?

A

500 micrograms (0.5ml 1 in 1,000)

Adrenaline can be repeated every 5 minutes if necessary.

99
Q

What is the management for refractory anaphylaxis?

A

IV fluids for shock and consideration of an IV adrenaline infusion.

100
Q

What is glue ear?

A

Otitis media with effusion; common in children, often leading to conductive hearing loss.

101
Q

List risk factors for glue ear.

A
  • Male sex
  • Siblings with glue ear
  • Higher incidence in Winter and Spring
  • Bottle feeding
  • Day care attendance
  • Parental smoking
102
Q

What is the most common presenting feature of glue ear?

A

Hearing loss

It is the commonest cause of conductive hearing loss in childhood.

103
Q

What management options are available for glue ear?

A
  • Active observation for 3 months
  • Grommet insertion
  • Adenoidectomy
104
Q

What does Rinne’s test assess?

A

Differentiates conductive from sensorineural deafness.

105
Q

What is a positive Rinne’s test result?

A

Air conduction (AC) is better than bone conduction (BC).

106
Q

What does a negative Rinne’s test indicate?

A

Bone conduction (BC) is greater than air conduction (AC), suggesting conductive deafness.

107
Q

What does Weber’s test assess?

A

Determines lateralization of sound to differentiate between conductive and sensorineural hearing loss.

108
Q

In unilateral sensorineural deafness, where is the sound localized in Weber’s test?

A

To the unaffected side.

109
Q

What is the management for sudden-onset sensorineural hearing loss (SSNHL)?

A

Urgent referral to ENT and high-dose oral corticosteroids.

110
Q

What is acute epiglottitis and its common cause?

A

A rare but serious infection caused by Haemophilus influenzae type B.

111
Q

List features of acute epiglottitis.

A
  • Rapid onset
  • High temperature
  • Stridor
  • Drooling of saliva
  • Tripod position
112
Q

What is the recommended management for suspected acute epiglottitis?

A
  • Immediate senior involvement
  • Endotracheal intubation if necessary
  • Oxygen
  • Intravenous antibiotics
113
Q

What are common causes of hoarseness?

A
  • Voice overuse
  • Smoking
  • Viral illness
  • Hypothyroidism
  • Gastro-oesophageal reflux
  • Laryngeal cancer
  • Lung cancer
114
Q

What referral guidelines exist for suspected laryngeal cancer?

A

Consider a suspected cancer pathway referral for people aged 45 and over with persistent unexplained hoarseness or an unexplained lump in the neck.

115
Q

What is the umbrella term for head and neck cancer?

A

Head and neck cancer typically includes:
* Oral cavity cancers
* Cancers of the pharynx (oropharynx, hypopharynx, nasopharynx)
* Cancers of the larynx

Head and neck cancers encompass a variety of malignancies affecting the anatomical structures of the head and neck region.

116
Q

What are common features of head and neck cancer?

A

Common features include:
* Neck lump
* Hoarseness
* Persistent sore throat
* Persistent mouth ulcer

These features can indicate potential malignancies and warrant further investigation.

117
Q

What are the NICE suspected cancer pathway referral criteria for laryngeal cancer?

A

Consider referral for laryngeal cancer in individuals aged 45 and over with:
* Persistent unexplained hoarseness
* Unexplained lump in the neck

This referral should be made for an appointment within 2 weeks.

118
Q

What criteria indicate a suspected cancer pathway referral for oral cancer?

A

Referral indications for oral cancer include:
* Unexplained ulceration in the oral cavity lasting more than 3 weeks
* Persistent and unexplained lump in the neck

Urgent referrals to a dentist are indicated for specific oral findings.

119
Q

What is a characteristic feature of thyroid cancer that warrants referral?

A

An unexplained thyroid lump warrants a suspected cancer pathway referral for thyroid cancer.

This referral is also for an appointment within 2 weeks.

120
Q

What is the most common cause of neck swellings?

A

Reactive lymphadenopathy is by far the most common cause of neck swellings.

This condition may be associated with local infections or general viral illnesses.

121
Q

Which neck lump condition is characterized by rubbery, painless lymphadenopathy?

A

Lymphoma is characterized by rubbery, painless lymphadenopathy.

Additional features may include night sweats and splenomegaly.

122
Q

What are common symptoms of obstructive sleep apnea-hypopnea syndrome (OSAHS)?

A

Common symptoms include:
* Daytime somnolence
* Compensated respiratory acidosis
* Hypertension

These symptoms can significantly affect quality of life and overall health.

123
Q

What is the first line management for moderate or severe OSAHS?

A

Continuous positive airway pressure (CPAP) is the first line for moderate or severe OSAHS.

This treatment is critical for managing symptoms and improving sleep quality.

124
Q

What is acute epiglottitis and its causative agent?

A

Acute epiglottitis is a rare but serious infection caused by Haemophilus influenzae type B.

Recognition and treatment are essential to prevent airway obstruction.

125
Q

What is the classic triad of symptoms for infectious mononucleosis?

A

The classic triad includes:
* Sore throat
* Lymphadenopathy
* Pyrexia

This triad is seen in around 98% of patients with the condition.

126
Q

What is the first line antiviral treatment for influenza?

A

The first line antiviral treatment for influenza is oseltamivir.

This is used particularly in at-risk groups within 48 hours of symptom onset.

127
Q

What is the management approach for sore throat?

A

Management includes:
* Paracetamol or ibuprofen for pain relief
* Antibiotics are not routinely indicated

A single dose of oral corticosteroid may reduce severity and duration of pain.

128
Q

What scoring system is used to assess likelihood of strep infection in adults with sore throat?

A

The Centor criteria and FeverPAIN criteria are used for this assessment.

These scoring systems guide the decision-making process regarding antibiotic usage.

129
Q

What are the common symptoms of upper respiratory tract infections (URTIs)?

A

Common symptoms include:
* Nasal discharge
* Nasal obstruction
* Sore throat
* Headache
* Cough
* Tiredness
* General malaise

URTIs are often caused by viral infections.

130
Q

What is whooping cough caused by?

A

Whooping cough is caused by the Gram-negative bacterium Bordetella pertussis.

It typically presents in children and is notable for prolonged coughing fits.

131
Q

What phases are involved in the presentation of whooping cough?

A

The phases include:
* Catarrhal phase
* Paroxysmal phase
* Convalescent phase

Each phase has distinct symptoms and duration.

132
Q

What is the diagnostic criteria for whooping cough?

A

Diagnostic criteria include:
* Acute cough lasting 14 days or more
* Paroxysmal cough
* Inspiratory whoop
* Post-tussive vomiting

These features help differentiate it from other respiratory illnesses.

133
Q

What type of antibiotic is indicated for cough onset within the previous 21 days?

A

An oral macrolide (e.g. clarithromycin, azithromycin, or erythromycin)

This is to eradicate the organism and reduce the spread.

134
Q

What should be offered to household contacts of a patient with whooping cough?

A

Antibiotic prophylaxis

This is to prevent the spread of the infection.

135
Q

Does antibiotic therapy alter the course of whooping cough?

A

No

Antibiotic therapy has not been shown to alter the course of the illness.

136
Q

What is the school exclusion period for children after starting antibiotics for whooping cough?

A

48 hours after commencing antibiotics or 21 days from onset of symptoms if no antibiotics

This is to reduce the risk of spreading the infection.

137
Q

List some complications associated with whooping cough. (4)

A
  • Subconjunctival haemorrhage
  • Pneumonia
  • Bronchiectasis
  • Seizures
138
Q

What vaccination program was introduced in 2012 for pregnant women?

A

Whooping cough vaccination program

This was introduced due to an outbreak that resulted in the death of 14 newborn children.

139
Q

What is the effectiveness of the whooping cough vaccine in preventing newborns from developing the disease?

A

More than 90% effective

The vaccine significantly reduces the incidence of whooping cough in newborns.

140
Q

At what stage of pregnancy are women offered the whooping cough vaccine?

A

Between 16-32 weeks pregnant

This timing is crucial for maternal and newborn protection.

141
Q

What is acute epiglottitis and what causes it?

A

A rare but serious infection caused by Haemophilus influenzae type B

Prompt recognition and treatment are essential to prevent airway obstruction.

142
Q

What is a key feature of epiglottitis diagnosis?

A

Direct visualisation by senior/airway trained staff

X-rays may also be used, particularly for foreign body concerns.

143
Q

What does the ‘thumb sign’ indicate in a lateral view x-ray?

A

Swelling of the epiglottis in acute epiglottitis

This is a characteristic finding in epiglottitis.

144
Q

What is the primary management step for patients with suspected epiglottitis?

A

Immediate senior involvement for emergency airway support

Endotracheal intubation may be necessary.

145
Q

What is croup and which viruses are most commonly responsible?

A

A form of upper respiratory tract infection in infants and toddlers, primarily caused by parainfluenza viruses

It is characterized by stridor due to laryngeal edema.

146
Q

What are the peak ages for croup incidence?

A

6 months to 3 years

Croup is more common during the autumn season.

147
Q

What is a common feature of croup?

A

Barking, seal-like cough

Symptoms worsen at night and may include stridor and fever.

148
Q

List the severity grading for croup.

A
  • 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
Q

What should be done for children with moderate or severe croup according to NICE guidelines?

A

Admit any child with moderate or severe croup

This includes children under 3 months of age or those with known upper airway abnormalities.

150
Q

What is Meniere’s disease characterized by?

A

Excessive pressure and progressive dilation of the endolymphatic system

It is often seen in middle-aged adults but can occur at any age.

151
Q

What are the main features of Meniere’s disease?

A
  • Recurrent episodes of vertigo
  • Tinnitus
  • Hearing loss (sensorineural)
  • Sensation of aural fullness or pressure
152
Q

What is the typical natural history of Meniere’s disease?

A

Symptoms resolve in the majority of patients after 5-10 years

Most patients will still experience some degree of hearing loss.

153
Q

What is tinnitus?

A

The perception of sounds in the ears or head that do not come from an outside source

It can be distressing and may indicate a serious underlying condition.

154
Q

List some causes of tinnitus. (7)

A
  • Idiopathic
  • Meniere’s disease
  • Otosclerosis
  • Sudden onset sensorineural hearing loss (SSNHL)
  • Acoustic neuroma
  • Drugs (e.g. aspirin, aminoglycosides)
  • Impacted ear wax
155
Q

What is the first-line investigation for pulsatile tinnitus?

A

Magnetic resonance angiography (MRA)

This is used to investigate potential underlying vascular causes.

156
Q

What is the classical history of vestibular schwannoma?

A

Combination of vertigo, hearing loss, tinnitus, and absent corneal reflex

Features are predicted by the affected cranial nerves.

157
Q

What is benign paroxysmal positional vertigo (BPPV) characterized by?

A

Sudden onset of dizziness and vertigo triggered by changes in head position

Each episode typically lasts 10-20 seconds.

158
Q

What is the Epley manoeuvre used for?

A

Treatment for BPPV

It is successful in around 80% of cases.

159
Q

What should patients with Meniere’s disease inform the DVLA about?

A

They should inform the DVLA and cease driving until satisfactory control of symptoms is achieved

This is crucial for safety reasons.

160
Q

What is a peritonsillar abscess typically a complication of?

A

Bacterial tonsillitis

161
Q

List the features of a peritonsillar abscess.

A
  • Severe throat pain lateralised to one side
  • Deviation of the uvula to the unaffected side
  • Trismus (difficulty opening the mouth)
  • Reduced neck mobility
162
Q

What urgent medical specialist should review patients with a peritonsillar abscess?

A

ENT specialist

163
Q

What are the management options for a peritonsillar abscess?

A
  • Needle aspiration
  • Incision & drainage
  • Intravenous antibiotics
  • Tonsillectomy to prevent recurrence
164
Q

What are some complications of tonsillitis?

A
  • Otitis media
  • Quinsy (peritonsillar abscess)
  • Rheumatic fever
  • Glomerulonephritis (very rarely)
165
Q

What criteria does NICE recommend for considering tonsillectomy?

A
  • 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
Q

List other established indications for tonsillectomy.

A
  • Recurrent febrile convulsions secondary to tonsillitis
  • Obstructive sleep apnoea secondary to enlarged tonsils
  • Peritonsillar abscess unresponsive to standard treatment
167
Q

What are the primary complications of tonsillectomy?

A
  • Haemorrhage (2-3%)
  • Pain
168
Q

When does primary haemorrhage typically occur after tonsillectomy?

A

In the first 6-8 hours

169
Q

What is benign paroxysmal positional vertigo (BPPV) characterized by?

A

Sudden onset of dizziness and vertigo triggered by changes in head position

170
Q

What is the average age of onset for BPPV?

A

55 years

171
Q

List the features of BPPV.

A
  • Vertigo triggered by head position change
  • May be associated with nausea
  • Episodes last 10-20 seconds
  • Positive Dix-Hallpike manoeuvre
  • Rotatory nystagmus
172
Q

What is the prognosis for BPPV?

A

Usually resolves spontaneously after a few weeks to months

173
Q

What is the Epley manoeuvre used for?

A

Symptomatic relief in BPPV (successful in around 80% of cases)

174
Q

What chronic condition affects up to 1 in 10 people?

A

Chronic rhinosinusitis

175
Q

What are the predisposing factors for chronic rhinosinusitis?

A
  • Atopy (hay fever, asthma)
  • Nasal obstruction (e.g. septal deviation)
  • Recent local infection (e.g. rhinitis)
  • Swimming/diving
  • Smoking
176
Q

List the features of chronic rhinosinusitis.

A
  • Facial pain (typically frontal)
  • Nasal discharge
  • Nasal obstruction
  • Post-nasal drip
177
Q

What are ‘red flag’ symptoms for chronic rhinosinusitis?

A
  • Unilateral symptoms
  • Persistent symptoms despite treatment
  • Epistaxis
178
Q

What virus is predominantly responsible for infectious mononucleosis?

A

Epstein-Barr virus (EBV)

179
Q

What is the classic triad of symptoms for infectious mononucleosis?

A
  • Sore throat
  • Lymphadenopathy
  • Pyrexia
180
Q

What is the management for infectious mononucleosis?

A
  • Supportive care
  • Rest
  • Hydration
  • Simple analgesia
  • Avoid contact sports for 4 weeks
181
Q

What is Meniere’s disease characterized by?

A
  • Recurrent episodes of vertigo
  • Tinnitus
  • Hearing loss
  • Aural fullness or pressure
182
Q

What is the management for acute attacks of Meniere’s disease?

A

Buccal or intramuscular prochlorperazine

183
Q

What is a common consequence of obstructive sleep apnoea-hypopnoea syndrome (OSAHS)?

A

Daytime somnolence

184
Q

What is the first-line treatment for moderate or severe OSAHS?

A

Continuous positive airway pressure (CPAP)

185
Q

What is malignant otitis externa most commonly caused by?

A

Pseudomonas aeruginosa

186
Q

What are the key features of malignant otitis externa?

A
  • Severe deep-seated otalgia
  • Temporal headaches
  • Purulent otorrhea
  • Possible dysphagia or facial nerve dysfunction
187
Q

What is a common initial management strategy for otitis externa?

A

Topical antibiotic or combined topical antibiotic with a steroid

188
Q

What is the most common cause of acute otitis media in children?

A

Bacterial infections secondary to viral upper respiratory tract infections

189
Q

List the common sequelae of acute otitis media.

A
  • Perforation of the tympanic membrane
  • Chronic suppurative otitis media
  • Hearing loss
  • Labyrinthitis
190
Q

What is glue ear also known as?

A

Otitis media with effusion

191
Q

What are the treatment options for glue ear?

A
  • Active observation
  • Grommet insertion
  • Adenoidectomy
192
Q

What are vestibular schwannomas also referred to as?

A

Acoustic neuromas

193
Q

What cranial nerve symptoms are associated with vestibular schwannoma?

A
  • Cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
  • Cranial nerve V: absent corneal reflex
194
Q

What percentage of intracranial tumours do vestibular schwannomas account for?

A

Approximately 5%

Vestibular schwannomas are also known as acoustic neuromas.

195
Q

What are the classical symptoms of vestibular schwannoma?

A

Vertigo, hearing loss, tinnitus, absent corneal reflex

Symptoms vary based on affected cranial nerves.

196
Q

Which cranial nerve is associated with vertigo and unilateral sensorineural hearing loss in vestibular schwannoma?

A

Cranial nerve VIII

This nerve is also associated with unilateral tinnitus.

197
Q

What symptom is associated with cranial nerve V in vestibular schwannoma?

A

Absent corneal reflex

198
Q

Which cranial nerve is involved in facial palsy in vestibular schwannoma?

A

Cranial nerve VII

199
Q

In which condition are bilateral vestibular schwannomas commonly seen?

A

Neurofibromatosis type 2

200
Q

What should patients with a suspected vestibular schwannoma be referred for?

A

Urgent ENT evaluation

201
Q

How are vestibular schwannomas typically characterized in terms of growth and behavior?

A

Slow growing, benign, often observed initially

202
Q

What is the investigation of choice for vestibular schwannoma?

A

MRI of the cerebellopontine angle

203
Q

What is an important diagnostic tool alongside MRI for vestibular schwannoma?

A

Audiometry

204
Q

What percentage of patients with vestibular schwannoma will have a normal audiogram?

A

Only 5%

205
Q

What are the management options for vestibular schwannoma?

A

Surgery, radiotherapy, observation

UKMLA Prep (41 decks)

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