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Pass Med > ENT > Flashcards

ENT Flashcards

1
Q

Classical triad of PD + other features

A

Rigidity
Resting tremor
Bradykinesia

Shuffling gait
Mask like face
Micorgraphia
Dementia

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2
Q

Normal pressure hydrocephalus presentation

A

Characterised by progressive mental impairment and dementia
Difficulty walking
Impaired bladder control
Gait disturbance is often most noticeable symptom
No rigidity/ tremor

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3
Q

Progressive supranuclear palsy

A

Starts with impairment of balance- falls
Vertical gaze palsy
Symmetrical onset
Poorly responsive to levodopa

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4
Q

Corticobasal syndrome

A

Begins as a movement disorder
Unilateral absence of moment
Muscle rigidity with tremor
Progressive neurological disorder that can also affect cognition

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5
Q

Multi system atrophy

A 
Shy drawer is a type 
Fts; Parkinsonism 
Autonomic disturbance- post hypotension, atomic bladder
Cerebrellar signs 
Poor response to levodopa
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6
Q

NICE guidelines - sore throat and antibiotics

A

Features of marked systemic upset secondary to acute sore throat
Unilateral peritonsillitits
Hx of RF
Increased risk from acute infection- diabetes/ immunodeficiency
Patients with acute sore throat/ when 3 or more center criteria are present

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7
Q

Centor criteria

A

Tonsillar exudate
Tender anterior cervical LN or lymphadenitits
Hx of fever
Absence of cough

3 or more 40-60% chance strep group A beta haemolytic

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8
Q

Ménière’s disease

A 
Disorder of inner ear of unknown cause
Characterised by excessive pressure and progressive dilation of the endolymphatic system. 
More common in middle aged adults
May be seen at any age
M & F equally effected
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9
Q

Features of Ménière’s disease

A

Recurrent episodes of vertigo tinnitus and sensorineural hearing loss . VERTIGO. PROMINENT SYMPTOM
Sensation of aural fullness or pressure common
Nystagmus and positive Romberg test
Episodes lasts minutes to hours
Typically unilateral but bilateral symptoms may develop after a number of years

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10
Q

NATURAL HX of menieres

A

Symptoms resolves in the majority of patients after 5-10 years
Usually left with a degrees of hearing loss
Psychological distress is common

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11
Q

Mgmt of Ménière’s disease

A

ENT assessment to confirm diagnosis
Acute atttacks- buccaneers or IM prochlorperazine
Prevention; betahistine and vestibular rehab

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12
Q

Nasal tumors

A

Nosebleeeds, persistent blocked nose
Blood strained mucus
Decreased sense of smell

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13
Q

Smokers cough

A

Chronic cough that occurs as a result of damage and destruction of cilia

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14
Q

Nasal polyp

A

Nasal obstruction, sneezing, rhionorrhoea, poor sense of taste and smell
Sinister if unilateral symptoms or bleeding

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15
Q

Post nasal drip

A

Excessive mucus production but nasal mucosa

Excess mucus accumulates in the throat and bad of nose- chronic cough and bad breath

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16
Q

Causes of tinnitus

A 
Otoscloeroiss 
Acoustic neuroma 
Hearing loss 
Drugs- aspirin, aminoglycosides, loop diuretics and Quinine 
Impacted ear wax
Chronic suprrurative OM
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17
Q

Otosclerosis

A 
Onset 29-40 
Conductive deafness
Tinnitus 
Normal tympanic membrane- 10% flamingo tongue
Positive family history 
10% flamingo tinge- hyperaemia 
Hearing aid 
Stapedectomy
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18
Q

Acoustic neuroma

A 
Hearing loss
Vertigo 
Tinnitus
Absent corneal reflex
Neurofibromatosis type 2

CNV absent corneal reflex
CN VII facial palsy
CNVIII hearing loss vertigo tinnitus

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19
Q

Cholesteatoma

A 
Consist of squamous epithelium trapped within the skull base causing local destruction
Most common in patients 10-20
Main fts- foul discharge
Hearing loss
Vertigo 
Facial nerve palsy
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20
Q

Glue ear

A

OM with effusion
Peaks at 2
Hearing loss is usually the presenting feature
Secondary problems such as speech and language delay

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21
Q

Ototoxic drugs

A

Aminogglycosides- gentamicin
Furosemide
Aspirin

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22
Q

Perforated TM

A

Most common cause is infection
May lead to hearing loss
Increased risk of OM
No tx usually needed- 6-8 weeks to heal - try and avoid water in ear
Antibiotics inf perforation happened after infection
Myringoplasty if it wont heal

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23
Q

Reactive lymphadenopathy

A

Most common cause of neck swellings

May be a history of local infection or generalized viral illness

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24
Q

Lymphoma

A

Rubbery, painless lymphadenopathy
Pain when drinking alcohol- VERY UNCOMMON
Night sweats and splenomegaly

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25
Q

Thyroid swelling

A

May be hypo eu or hyper

Moves upward on swallowing

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26
Q

Thyrglossal cyst

A

Common under 20
Usually midline between isthmus of thyroid and hyoid one
Moves upwards with protrusion of the tongue
May be painful if infected

27
Q

Pharyngeal pouch

A

More common in older men
Posteromedial herniation between thyropharyngeus and cricipharyngeus muscles.
Usually not seen unless large, then a midline lump- gurgles on palpating
Typical symptoms are dysphasia regurg aspiration and cough, halitosis and throat infections

28
Q

Cystic hygroma

A

Congenital lymphatic lesion typically found in the neck, classically on the left side
Most evident at birth
90% present by 2yrs
Fluctuant and transilluminable

29
Q

Brachial cyst

A

An oval mobile cystic mass that develops between the SCM and pharynx
Develop due to failure of obliteration of the second brachial cleft in embryonic development
Present in early adulthood

30
Q

Cervical rib

A

More common in adult females

10% develop thoracic outlet syndrome

31
Q

Carotid aneurysm

A

Pulsatile lateral neck mass which doesn’t move on swallowing

32
Q

Nasopharyngeal carcinoma

A

Squamous cell carcinoma of the nasopharyngeal
Rare on most parts of the world apart from s. China
Associated with EBV

33
Q

Causes of vertigo

A 
Viral labyrinthitis 
Vestibular neuronitits
BPPV
Ménière’s disease
Bertebrobasilar ischemia 
Acoustic neuroma 
Trauma 
MS
Ototoxicity
34
Q

Viral labyrinthitis

A

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

35
Q

Vestibular neuronitis

A

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

36
Q

BPPV

A 
Gradual onset.. Average age of onset 55years
Triggered by change in head position
Each episode lasts 10-20 seconds
May have nausea 
Positive dix hallpike manoeuvre

Tx; spontaneous resolution weeks to months
Epley manoeuvre- successful in 805

37
Q

Vertebrobasialr ischaemia

A

Elderly patient

Dizziness on extension of neck

38
Q

Complications of thyroid surgery

A

Anatomical- recurrent laryngeal nerve damage
Bleeding- respiratory compromise
Damage to parathyroid glands- hypocalcemia

39
Q

Ramsay- Hunt syndrome

A

Shingles affecting the facial nerve

Auricular pain- first features
Facial nerve palsy
Vesicular rash around ear
Vertigo and tinnitus

Oral aciclovir and corticosteroids

40
Q

Sinusitis

A

Inflammation of the mucous membranes of the paranasal sinuses
Usually strep pneumonia, h influenza, rhinovirus

Fts nasal discharge
Facial pain- pressure frontal- worse bending forward
Post nasal drip

Analgesia
Inhaled decongesations
OAB not normally indicated

41
Q

Nasal polyps

A

1% of adults
2-4 more times common in males

Associations
Asthma * Samters triad
Aspirin sensitivity * 
Infective sinusitis 
CF

Fts
Nasal obs
Rhinorrhoea
Sneezing- poor taste and smell

Refer ENT

42
Q

2 week referral to oral surgery if

A

Unexplained oral ulceration persisting for more 3weeks
Unexplained red/ white patches painful swollen and bleeding
Unexplained lump persisting more 3 weeks

43
Q

Otalgia

A

In absence of any ear sings is a ref flag for head and neck malignancy

44
Q

Complications of tonsillitis

A

Otitis media
Quinsy
Rheumatic fever and glomerulonephritis very rarely

45
Q

INdications for tonsillectomy

A

NICE- fiver or more episodes per year

Disabling and prevent normal functioning

46
Q

Complications of tonsillectomy

A

Primary <24hrs- haemorrhage in 2-3%, pain

Secondary- same

47
Q

Hoarseness

A 
Causes ;
Voice overuse
Smoking
Viral illness
Hypothyroidism
GORD
Laryngeal cancer
Lung cancer

Always do CXR

Referral if >45 persistent and unexplained hoarseness

48
Q

Benign tumours ENT

A

80% of all salivary gland tumours occur in the parotid gland and 80% of these are benign .
Median age 50’s

49
Q

Examples of benign tumours

A

Benign pleomorphic adenoma or benign mixed tumour
Warthin tumour
Monoporphic adenoma
Haemiangioma

50
Q

Benign pleomorphic adenoma or benign mixed tumour

A

Most common parotid neoplasm 80%
Slow growing lobular
Recurrence of 1-5%
Malignant degeneration in 2-10% of adenoma

51
Q

Warthin tumour

A 
Second most common benign parotid tumor 
Most common bilateral benign neoplasm of the parotid 
Male predominance
6th 7 th decade
Malignancy trasnformation is rare
52
Q

Monomorphic adenoma

A

Less than 5% of tumours

Slow growing

53
Q

Haemangioma

A

Differential for a parotid mass in ac hold
90% of parotid tumours in children less than 1 year
Hypervascular on imaging
Spontaneous regression may occur

54
Q

Malignant tumours

A

Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Mixed tumours

55
Q

Sjögren’s syndrome

A

Autoimmune
Parotid enlargement, xerostomia and keratoconjuncitvitis sicca
90% female
Bilateral non tender englargement of gland
Increased risk of subsequent lymphoma

56
Q

Sarcoidosis

A

Paroid involvement in 6%
Bilateral
Gland non tender
Xerostomia

57
Q

Black hairy tongue

A

Common due to defective desquamation of the filliform papillae
Tongue may be brown, green, pink , other

RF; poor oral hygiene, OAB, head and neck radiation, HIV, IV drug
Mgmt; tongue scraping to exclude candida

58
Q

Sudden sensorineural hearing loss

A

Majority of cases is idiopathic

Some evidence that high does steroids 60mg/dat for 1/52 improves prognosis. Urgent ENT referral

59
Q

Epidermoid cysts

A

Common cutaneous cysts proliferation of epidermal cells
Typically asymptomatic
Firm round central punctual may be present

60
Q

Gingivitis

A

Secondary to poor dental hygiene
Presentation can range from simple gingivits( painless red swelling of gum margin which bleeds on contact) to acute necrotizing ulcerative gingivits (painful bleeding gums with halitosis and punched out ulcers on gums

Refer to dentist
3days if metronidazole/amoxicillin
Cholrhexidine mouthwash

61
Q

Sialadenitis

A

Inflammation of the salivary gland often secondary to obstruction by a stone impacted in the duct

62
Q

Salivary glands

A

Parotid glands are anterior and inferior to each ear
Submandibular lie below the angle of the jaw
Sublingual lie beneath the tongue

63
Q

Nasal septal haematoma

A

Complication of nasal trauma
Development of a haematoma between the septal cartilage and the overlying perichondrium
Features; may be precipitated by minor trauma
Sensation of nasal obstruction
Pain and rhionorrhoea
Bilateral red swelling
Feels boggy

Surgical drainage
Iv antibiotics

If untreated- septal necrosis, saddle nose deformity

Pass Med (8 decks)

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