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5th year > ENT > Flashcards

ENT Flashcards

1
Q

What is PTA,

A

PTA - headphones deliver tone at different frequencies and strengths in a sound proofed room - pt indicate when sound appears and disappears

Mastoid vibrator used to test bone conduction

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2
Q

Tympanometry?

A

Measures stiffness of ear drum
–> Evaluates middle ear function

Flat tympanogram: Mid ear fluid or perforation

Shifted tympanogram: +- mid ear pressure

(look up diagrams)

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3
Q

Evoked response audiometry?

A

Auditory stimulus + measurement of elicited brain stem response by surfance electrode.

Used for neonatal screening (If otoacoustic emission testing negative)

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4
Q

Otitis externa organisms + management?

A
  • Mainly pseudomonas
  • Staph aures
Mx:
Aural toilet with drops
- Betamethasone for non-infected eczematous OE
- Betamethasone + neomycin drops
- hydrocortisone + gentamicin drops
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5
Q

Otitis externa: PC + causes?

A

PC:
watery discharge
Itch
Pain and tragal tenderness

Causes:

  • Moisture (swimming)
  • Trauma
  • Absence of wax
  • Hearing Aid
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6
Q

Malignant otitis externa?

A

Life threatening infection which can lead to skull osteomyelitis
- 90% pts diabetic/immunocomp

PC

  • Severe otalgia, worse at night
  • Copious otorrhoea
  • granulation tissue in canal

Mx:

  • Surgical debridement
  • Systemic Abx
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7
Q

Bullous myringitis?

Organisms?

A

Painful haemorrhagic blisters (Bubbles filled with blood) form on the surface of the ear drum and burst, effusing blood.

  • Most commonly caused by strep pneumoniae
  • Commonly associated with mycoplasma pneumoniae & influenza infection
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8
Q

TMJ dysfunction: Symptoms, signs and Mx

A

Sx:

  • Ear ache (referred from auriculotemporal nerve)
  • Facial pain
  • Joint clicking/popping
  • Teeth grinding (bruxism)
  • Stress (c depression)

Signs: Joint tenderness exacerbated by lateral movements of an open jaw.

Ix: MRI

Mx: NSAIDs
Stabilising orthodontic occlusal prostheses

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9
Q

Otitis media types?

A

Acute

Glue ear/ Otitis media with effusion

Chronic: Effusion > 3mo if bilateral or 6mo if unilateral

Chronic suppurative OM: Ear discharge with hearing loss and evidence of central drum perforation

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10
Q

Otitis Media organisms?

A

Viral

Pneumococcus

Haemophilus

Moraxella

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11
Q

Acute Otitis Media Pc + Mx

A 
PC:
Usually children post viral URTI
Rapid onset ear pain + Tugging at ear
Irritability, anorexia and vomiting
Purulent discharge if drum perforates

O/E:

  • Bulging red TM
  • Fever
Mx:
Antipyretic analgesia + observe
- Oral amoxicillin > Augmention
- If complicated:
IV ABx
myringotomy/drainage > MCS
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12
Q

Acute Otitis Media: Complications

A

Intratemporal:

  • OME
  • Perforation of TM
  • Mastoiditis
  • Facial N.palsy

Intracranial:

  • Meningitis/ encephalitis
  • Brain abscess
  • Sub/epidural abscess

Systemic:

  • Bacteraemia
  • Septic arthritis
  • IE
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13
Q

OME PC, IX + RX

A

P/C:
Inattention at school
Poor speech development
Hearing impairment

O/e
Retracted dull TM
Fluid level

Ix:
- Audiometry: Flat tympanogram

Rx:
Conservative
- Usually resolves spontaneously : Wat & wait. Seasonal, self limiting.

Medical: Otovent; Hearing Aid

Surgical:

  • Consider grommets if persistent hearing loss (>30DB)
  • -> SE: Infections/tympanosclerosis
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14
Q

Chronic suppurative OM?

A

Painless discharge + hearing loss

O/E : TM perforation

Rx: Aural toilet
Abx/ steroid ear drops

Complication: Cholesteatoma

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15
Q

Mastoiditis?

A

Middle ear inflammation –> Destruction of mastoid air cells and abscess formation

PC:

  • Fever
  • Mastoid tenderness
  • Protruding auricle

Ix: CT

Rx:

  • IV ABx
  • Myringotomy +- mastoidectomy
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16
Q

Cholesteatoma + Complications

A

Locally destructive expansion of the stratified squamous epithelium within the middle ear

Complications:

  • Deafness (Ossicle destruction)
  • Meningitis
  • Cerebral abscess
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17
Q

Cholesteatoma classification, PC + Mx

A

classification:

1) Congenital
2) Acquired 2ndry to perforation in chronic suppurative OM

P/c:
Foul smelling white discharge
Headache, pain
CN involvement:
--> Vertigo
--> Deafness
--> Facial paralysis

O/E:
- Appears pearly white with surrounding inflammation

Mx: Surgery

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18
Q

Tinnitus define + Hx

A

Sensation of sound w/o external sound stimulation. Very common 1 in 10

Hx:
Character: Constant, Pulsatile?

Unilateral? - Acoustic neuroma

FH: Otosclerosis?

Alleviating/exacerbating factors, worse at night?

Cause? Head injury, noise, drugs, FH

Associations:

  • Vertigo –> Meniere’s/Acoustic neuroma
  • Deafness: Meniere’s, acoustic neuroma
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19
Q

Tinnitis Causes

A

Specific:

  • Meniere’s
  • Acoustic neuroma
  • Otosclerosis
  • Noise induced
  • Head injury
  • Hearing loss (presbyacsus) –> Most common bilateral

General:

  • Increased BP
  • Decreased HB

Drugs:

  • Aspirin
  • Aminoglycosides
  • Loop diuretics
  • EtOH
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20
Q

Vertigo Causes?

A

The illusion of movement

Peripheral/vestibular:

  • Meniere’s (hours)
  • BPV (minutes)
  • Labyrinthitis (weeks)

Central:

  • Acoustic neuroma
  • MS
  • Vertebrobasilar insufficiency/stroke
  • Head injury
  • Inner ear syphilis

Drugs:

  • Gentamicin
  • Loop diuretics
  • Metronidazole
  • Co-trimoxazole
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21
Q

Meniere’s disease?

A

Endolymphatic oedema

PC: Progressive SNHL + vertigo + tinitius

  • Aural fullness
  • N/V
  • Attacks occur in clusters and last up to 12h

Ix: Audiometry shoes low-freq SNHL which fluctuates

Mx:
Medical: Vertigo - Cyclizine

Surgical:

  • Gentamicin instillation via grommets
  • Saccus decompression
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22
Q

Vestibular neuronitis/ viral labrynthitis PC + Rx

A

PC:

  • Follows febrile illness (URTI)
  • Sudden vomiting
  • Severe vertigo exacerbated by head movement

Rx:

  • Cyclizine
  • Improvement in days
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23
Q

BPV?

A

Displacement of otoliths in semicircular canals, common after head injury

PC:

  • Sudden rotational vertigo Provoked by head turning
  • Nystagmus

Dx: Hallpike manoeuvre + observe for rotational nystagmus (towards affected year)

Mx:
- Self limiting - good prognosis and usually resolves spontaneously after a few weeks to months.
Symptomatic relief by:
- Epley manoeuvre (successful in around 80%) of cases)
- Teaching pt exercises they can do themselves at home eg. Brandt-Daroff exercises
- Betahistine: Histamine analogue

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24
Q

BPV causes?

A

1) Idiopathic
2) Head Injury
3) Otosclerosis
4) Post-viral

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25
Q

Conductive hearing loss causes?

A

Impaired conduction anywhere between auricle and round window

1) External canal obstruction:
- Wax
- Pus
- Foreign body

2) TM perforation:
- Trauma
- Infection

3) Ossicle defects
- Otosclerosis
- Infection
- Trauma

+ inadequate eustachian tube ventiliation of middle ear

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26
Q

Sensorineural hearing loss causes?

A

Defects of cochlea, cochlear N or brain

1) Drugs:
- Aminoglycosides
- Vancomycin

2) Post-infective
- Meningitis
- Measles
- Mumps
- Herpes

3) Misc:
- Meniere’s
- Trauma
- MS
- CPA lesion (acoustic neuroma)
- Reduced b12

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27
Q

Acoustic neuroma

Mx?

A

AKA vestibular schwannoma

Benign, slow growing tumour of superior vestibular N

  • Acts as SOL –> CPA syndrome (Accounts for 80% of CPA tumours)
  • Associated with NF2

Mx:

  • Gamma knife
  • Surgery (risk of hearing loss)
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28
Q

Acoustic neuroma triad & differentials?

A

PC:

  • Slow onset unilateral SNHL + Tinnitus + veritgo
  • Headache (increased ICP)
  • CN plasies: 5, 7, 8 (CPA)
  • Cerebellar signs

Differentials:

  • Meningioma
  • cerebellar astrocytoma
  • Mets
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29
Q

Otosclerosis?

A

Autosomal dominant
Characterised by fixation of stapes the at oval window

F>M 2:1

PC:

  • Begins in early adult life
  • Bilateral conductive deafness + tinnitus
  • HL improved in noisy places: Willis paracousis
  • Worsened by pregnancy
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30
Q

Presbyacussis?

A

Age-related hearing loss

Presentation:
>65
Bilateral
Slow onset
\+- tinnitus

Ix: PTA

Rx: Hearing aid

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31
Q

Congenital conductive hearing loss in kids?

A

Conductive:

  • Anomalies of pinna, external auditory canal, TM, or ossicles
  • Congenital cholesteatoma
  • Pierre-robin sequence
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32
Q

Congenital SNHL

A

SNHL:
AD: Waaredenburgs: SNHL, heterochromia + telecanthus

AR:

  • Alports (SNHL + Haematuria)
  • Jewell-Lange-Nielson: SNHL + Long QT

X-linked:
Alports

Infection: CMV, rubella, HSV, toxo, GBS

Ototoxic drugs

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33
Q

Perinatal causes of hearing loss ?

A 
Anoxia
Cerebral palsy
Kernicterus
Infection: Meningitis
?--> Congenital rubella syndrome?
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34
Q

Acquired causes of childhood hearing loss?

A

OM/OME
Infection: meningitis/measles
Head injury

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35
Q

Cauliflower ears?

A

Blunt trauma -> subperichondrial haematoma (Pinna haematoma)

Can lead to ischaemic necrosis of cartilage and subsequent fibrosis leads to cauliflower ears

Mx: Aspiration + firm packing to auricle contour

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36
Q

Exostoses?

A

Smooth symmetrical bony narrowing of external canals

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37
Q

Causes of TM perforation?

A

OM

Foreign body

Barotrauma

Trauma

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38
Q

Allergic rhinosinusitis signs + symptoms + Ix

A

seasonal (hay-fever) vs perennial

Pathoologgy: T1 HS IgE mediated inflammation from allergen exposure lead to mediator release from mast cells

Sx: Sneezing, pruritis, rhinorrhoea

Signs: Swollen, pale, boggy turbinates
- Nasal polyps

Ix:

  • Skin prick testing to find allergens
  • RAST tests
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39
Q

Allergic rhinosinusitis Mx

A

Allergen avoidance:

  • Regular washing bedding (inc toys) on high heat
  • Avoid going outside when pollen content high

1st line:
- Anti-histamines: Cetirazine
OR beclometasone/chromoglycate nasal spray

2nd line:
Intranasal steroids + anti-histamines

3rd line: Zafirlukast

4th line: Immunotherapy:
- Aim to induce desensitisation to allergen

Adjuvants:
- Nasal decongestants eg. pseudoephrine

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40
Q

Sinusitis: Pathophys + Organisms

Causes?

A

Viruses –> Mucosal oedema and reduced mucosal ciliary action –> Mucus retention + secondary bacterial infection

Acute: Pneumococcus, haemophilus , Moraxella

Chronic: S.aureus, anaerobes

Causes:

  • Majority are bacterial infection secondary to viral
  • 5% secondary to dental root infection
  • Diving/swimming in infected water
  • Anatomical susceptibility; deviated septum, polyps
  • Systemic disease:
  • -> Kartagener’s
  • -> Immunodeficiency
41
Q

Sinusitis Symptoms:

A

Pain (1-5(

  • Maxillary (cheek/teeth)
  • Ethmoidal (between eyes)
  • Increased on bending/straining

Discharge from nose - post nasal drip with foul taste

Nasal obstruction/congestion

Anosmia/ cacosmia

Systemic symptoms: fever

NB. Most important symptoms are actually discharge and congestion

42
Q

Sinusitis Ix + Mx

A

Ix: Nasendoscopy + CT

Mx:
Acute/single episode:
- Bed rest, decongestants, analgesia
- Nasal douching + topical steroids
- Abx (clarithro) of uncertain benefit

Chronic/recurrent:

  • Usually a structural or drainage problem
  • Stop smoking + Fluticasone nasal spray
  • Functional endoscopic sinus surgery if failed medical therapy
43
Q

Sinusitis complications?

A

Mucoceles –> Pyoceles (Mucus retention cysts)

Orbital cellulitis/abscess

Osteomyelitis eg. staph in frontal bone

Intracranial infection:

  • Meningitis, encephalitis
  • Abscess
  • Cavernous sinus thrombosis
44
Q

Nasal polyps: Sites + Symptoms

A

Pt: Males, >40

Sites:

  • Middle turbinates
  • Middle meatus
  • Ethmoids

Sx:

  • Watery, anterior rhinorrhoea
  • Purulent post-nasal drip
  • Nasal obstruction
  • Sinusitis
  • Headaches
  • Snoring

Signs: Mobile, pale, insensitive

45
Q

Nasal polyps associations

A 
Associations:
- Allergic/non-allergic rhinitis
- CF
Aspirin hypersensitivity
- Asthma
46
Q

Single unliateral polyp

A

May be a sign of rare but sinister pathology:

  • Nasopharyngeal Ca
  • Glioma
  • Lymphoma
  • Neuroblastoma
  • Sarcoma

Do CT and get histology

47
Q

Nasal polyps in children?

polyp Mx?

A

Rare Betamethasone drops for 2/7
- Short course of oral steroids

Endoscopic polypectomy

48
Q

Fractured nose: Ix & Mx?

A

Upper 3rd of nose has bony support
Lower 2/3 and septum are cartilaginous
–> cartilaginous injury won’t show and radiographs don’t alter Mx

Mx:

  • Exclude septal haematoma
  • Re-examine after 1 wk (reduced swelling)
  • Reduction under GA + post-op splinting best w/i 2 weeks
49
Q

Septal haematoma?

A

Septal necrosis + Nasal collapse if untreated
–> Cartilage blood supply comes from mucosa

Boggy swelling and nasal obstructon

Needs evacuation under GA with packing +- suturing

50
Q

Epistaxis causes?

A

80% idiopathic

Trauma: Nose picking, #s

Local infection: URTI

Pyogenic granuloma: overgrowth of tissue on
Little’s area due to irritation or hormonal factors

Osler-weber-rendu/ HHT

Coagulopathy: Warfarin, NSAIDs, Haemophilia, reduced platelets, vWD, EToH

Neoplasm

51
Q

Epistaxis: Initial Mx

A

nb in primary care: Naseptin nasal cream massaged onto area twice a day for 2 weeks is as effective as cautery

1) Wear PPE
2) Assess for shock and resuscitate appropriately
3) If not shocked:
- Sit up, head tilted down
- Compress nasal cartilage for 15 minutes

4) If bleeding not controlled - remove clots with suction or by blowing and try to visualise bleed by rhinoscopy

52
Q

Anterior Epistaxis

A

Usually septal haemorrhage from Little’s area (Kisselbach’s plexus)

Insert gauze soaked in vasoconstrictor + LA
- Xylometazoline + 2% lignocaine for 5 min

Bleeds can be cauterised with silver nitrate sticks

Persistent bleed should be packed with merocel pack

  • Refer to ENT if this fails or if you can’t visualise the bleeding point
  • They may insert a posterior pack or take pt to theatre for endoscopic control
53
Q

Posterior / Major epistaxis

A

Posterior packing (+ anterior pack)

  • -> Pass 18g Foley catheter through the nose into the nasopharnyx, inflate with 10ml water and pull forward until it lodges
  • Admit pt and leave for 48 hrs

Gold standard: Endoscopic visualisation + direct control eg. by cautery or ligation

54
Q

After epistaxis advice:

A

1) Don’t pick nose
2) Sit upright, out of sun
3) Avoid bending, lifting or straining
4) Sneeze through mouth
5) NO hot food or drink
6) Avoid EtOH and tobacco

55
Q

Osler-weber-Rendu/HHT?

Inheritance + features?

A

Autosomal DOMINANT
- 5 genetic subtypes

Telangiectasias in mucosa:

  • Recurrent spontaneous epistaxis
  • GI bleed (usually painless)

Internal telangiectasias and AVMs:

  • Lungs
  • Liver
  • Brain

Rarer:

  • Pulmonary HTN
  • Colon polyps: may –> CRC
56
Q

Tonsilitis Organisms + Signs

A

Viruses are most common (consider EBV)
GAS : Pyogenes
Staphs
Moraxella

Signs:

  • Lymphadeopathy esp. Juguludigastric node
  • Inflamed tonsils and oropharynx
  • Exudates
57
Q

Centor Criteria

A

Guideline for admin of Abx in acute sore throat/ tonsillitis/ pharnygitis

1 point for each of:

1) Fever
2) Tonsillar exudates
3) Tender anterior cervical adenopathy
4) No Cough

Mx: 0-1 no Abx (risk of strep or equal 3: Abx (Pen V 250mg QDS or erythromycin for 5/7)

58
Q

Tonsilitis Mx:

A

Swabbing of superficial bacteria is irrelevant and can lead to overdiagnosis

Analgesia: ibuprofen/Paracetamol + Difflam gargle (Local anesthetic/NSAID)

Consider Abx only with CENTOR
- Pen V 250mg PO QDS (125mg TDS in children) or erythromycin for 5/7

NOT amoxicillin: MACPAP RASH IN EBV

59
Q

Tonsillectomy indications?

A

Recurrent tonsilitis if all the below criteria are met:

  • Caused by tonsilitis
  • 5+ episodes/yr
  • Symptoms for >1yr
  • Episodes are disabling and prevent normal function

Airway obstruction eg. OSA IN children

Quinsy

Suspicious of Ca: Unilateral enlargement or ulceration

60
Q

Tonsillectomy: Methods + complications?

A

Methods: - Cold steel
- Cautery

Complications:

  • Reactive haemorrhage
  • Tonsillar gag may dmg teeth, TMJ or posterior pharngeal wall
61
Q

Kisselbach’s plexus arteries?

A

Anterior ethmoidal artery

Spenopalatine Artery

Facial Artery

62
Q

Strep throat complications

A

Peritonsillar abscess (quinsy)

Retropharyngeal abscess

Lemierre’s syndrome

Scarlet Fever

Rheumatic Fever

Post-streptococcal Glomerulonephritis

63
Q

Peritonsillar Abscess?

A

Typically occurs in adults

Symptoms:

  • Trismus (jaw tetanus)
  • Odonophagia
  • Halitosis

Signs:

  • Tonsillitis
  • Unilateral tonsillar enlargement
  • Contralateral uvula displacement
  • Cervical lymphadenopathy

Rx:
Admit
IV ABC
I&D under LA or tonsillectomy under GA

64
Q

Retropharyngeal abscess

A

Rare

PC:
Unwell child with stiff, extended neck who refuses to eat or drink
Fails to improve with IV ABx
Unilateral swelling of tonsil and neck

Ix:
Lat. neck x-rays shows soft tissue swelling
CT from skull-base to diaphragm

Rx:
IV Abx
I&D

65
Q

Lemierre’s syndrome

A

IJV thrombophlebitis with septic emboli, most commonly affecting the lungs

Organism: Fusobacterium necrophorum

Rx:
IV Abx: Pen G, Clinamycin, metro

66
Q

Scarlet fever?

A

‘Sandpaper’ like rash on chest, axillae or behind ears, 12-48hrs after pharyngotonsillitis

Circumoral pallor

Strawberry tongue

Rx: Start Pen V/G and notify HPA

67
Q

Rheumatic fever features

A

Carditis

Arthritis

Subcutaneous nodules

Erythema marginatum

Sydenham’s chorea

68
Q

PSGN

A

Malaise and smokey urine 1-2 weeks after pharyngitis

69
Q

Laryngitis?

A

Usually viral and self-limiting

Secondary bacterial infection may develop

Symptoms: Pain, hoarseness and fever

O/E: Redness & Swelling of vocal cords

Rx: Supportive, Pen V if necessary

70
Q

Laryngeal papilloma

A

Pedunculated vocal cord swellings caused by HPV

Presents with hoarseness

Usually occur in children

Rx: Laser removal

71
Q

Recurrent laryngeal N.palsy

A

Supplies all intrinsic muscles of larynx except cricothyroideus (Ext. branch of sup laryngeal n)
- Responsible for ab and adduction of vocal cord

Sx:
- Hoarseness
- Breathy voice with bovine cough
- Repeated coughing from aspiration (reduced supraglottic sensation)
Exertional dyspnoea (narrow glottis)

Causes:

  • 30% cancers: Larynx, thyroid, oesophagus, hypopharynx, bronchus
  • 25% iatrogenic: para/thyroidectomy, carotid endartectomy
  • Other: Aortic aneurysm, bulbar/pseudobulbar palsy
72
Q

Laryngeal SCC

A

2000/yr UK, associated with smoking/EtOH

PC: Male smoker, with progressive hoarseness –> Stridor.
Dys/odonophagia
Wt loss

Ix: Laryngoscopy + biopsy
MRI staging

Mx: Based on stage Radiotherapy/ laryngectomy

After total laryngectomy:

    • Pts have permanent tracheostomy
  • Speech valve
  • Electrolarynx
  • Oesophageal speech (Swallowed air)
73
Q

Laryngomalacia

A

Immature and floppy aryeepiglottic folds and glottis lead to laryngeal collapse on inspiration

PC: Stridor, PC w/i first weeks of life

Noticeable @ certain times

  • Lying on back
  • Feeding
  • Excited/upset

Problems can occur with concurrent laryngeal infections or with feeding

Mx: Usually no Mx required, but severe cases may warrant surgery

74
Q

Epiglottitits

A

Sx:
Sudden onset continuous stridor
Drooling
Toxic

Pathogens: Haemophilus B (HIB), GAS

Rx:
Don’t examine throat
Consult with anaesthetists and ENT surgeons
02 + Nebulised adrenaline
IV dexamethasone
Cefotaxime
Take to theatre to secure airway by intubation

75
Q

Foreign body

A

Sudden onset stridor in a previously normal child

  • BLS
  • Needle cricothyrotomy in children
  • Can only exclude foreign body in bronchus by bronchoscopy
76
Q

Subglottic stenosis

A

Subglottis - narrowest part of resp tract in children

Symptoms: Stridor + FTT

Causes:

  • Prolonged intubation
  • Congenital abnormalities
77
Q

Wax management?

A

GP:
Olive oil drops
Irrigation to syringe wax out

Secondary care:
- Microsuction

‘educate pt about wax’

  • not dirty
  • Self cleaning
78
Q

Most common causes of hearing loss?

A

Congenital:
Intrauterine infection: German measles, toxo, rubella

Acquired: Meningitis

79
Q

ENT tuning fork?

A

512hz (smallest one)

80
Q

Bells palsy Mx

A

Early prednisolone (lot’s of RCT evidence)

Some people think it’s viral so would consider aciclovir, however evidence for this is very weak

81
Q

Adenoid facies

A 
Overbite
underdeveloped thin nostrils
short upper lip
prominent upper teeth
crowded teeth
narrow upper alveolus 
high-arched palate
hypoplastic maxilla
82
Q

Samter’s triad?

A

Association of asthma, aspirin sensitivity and nasal polyposis

83
Q

Meniere’s Mx?

A

ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine may be of benefit

Acute Attacks: Buccal prochlorperazine

Prevention: Betahistadine

84
Q

Thyroid malignancy - Commonest subtype?

A

Papillary carcinoma :
Commonest sub-type
Accurately diagnosed on fine needle aspiration cytology
Histologically they may demonstrate psammoma bodies (areas of calcification) and so called ‘orphan Annie’ nuclei
They typically metastasise via the lymphatics and thus laterally located apparently ectopic thyroid tissue is usually a metastasis from a well differentiated papillary carcinoma.

85
Q

In which thyroid cancer is calcitonin raised?

A

These are tumours of the parafollicular cells ( C Cells) and are of neural crest origin.
The serum calcitonin may be elevated which is of use when monitoring for recurrence.
They may be familial and occur as part of the MEN -2A disease spectrum.
Spread may be either lymphatic or haematogenous and as these tumours are not derived primarily from thyroid cells they are not responsive to radioiodine.

86
Q

Acute necrotizing ulcerative gingivitis Mx?

A

refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia

87
Q

Absent corneal reflex + dizziness & right sided hearing loss?

A

Loss of corneal reflex - Think acoustic neuroma

88
Q

Otosclerosis?

A

Otosclerosis describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults

Onset is usually at 20-40 years - features include:
conductive deafness
tinnitus
normal tympanic membrane*
positive family history

Management
hearing aid
stapedectomy

*10% of patients may have a ‘flamingo tinge’, caused by hyperaemia

89
Q

Pseudophedrine - CI with which med?

A

MAOi - could potentially cause a hypertensive crisis

90
Q

Tonsillitis first line Tx?

A

7/10 day course of Phenoxymethylpenicillin

Erythromycin if pen allergic

IF 3 or more of Centor, 40-60% sore throat is caused by Group A Beta-haemolytic strep

91
Q

Motion sickness mx?

A

Motion sickness describes the nausea and vomiting which occurs when an apparent discrepancy exists between visually perceived movement and the vestibular systems sense of movement

Management
the BNF recommends hyoscine (e.g. transdermal patch) as being the most effective treatment. Use is limited due to side-effects
non-sedating antihistamines such as cyclizine or cinnarizine are recommended in preference to sedating preparation such as promethazine

92
Q

EBV associated malignancies?

A

Burkitt’s

Hodgkin’s

Nasopharyngeal carcinoma

93
Q

Trigeminal neuralgia - first line Tx?

A

Carbemazepine

  • Failure to respond to tx or atypical features (
94
Q

Pharyngeal pouch?

A

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
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

95
Q

Cystic hygroma?

A

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age

96
Q

Branchial cyst?

A

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood

97
Q

Rinne positive/negative

A

Rinne positive if Air>bone (Normal)

Rinne negative if Bone > Air (Abnormal) - CHL

98
Q 
How long do the following RTIs last?
Acute otitis media
Acute tonsillitis
Common cold
Acute rhinosinusitis
Acute cough/bronchitis
A 
acute otitis media: 4 days
acute sore throat/acute pharyngitis/acute tonsillitis: 1 week
common cold: 1 1/2 weeks
acute rhinosinusitis: 2 1/2 weeks
acute cough/acute bronchitis: 3 weeks
99
Q

Otitis externa Mx

A

Initially: topical antibiotic/ combined topical antibiotic + steroid

Secondline: Oral abx if infection spreading - oral fluclox

5th year (14 decks)

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