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Medicine > ENT > Flashcards

ENT Flashcards

1
Q

Criteria for antibiotics in otitis media

A

symptoms longer than 4 days, or not improving
systemically unwell
immunocompromised, or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
younger than 2 years old with bilateral otitis media
otitis media with perforation and/or discharge in the canal

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2
Q

symptoms longer than 4 days, or not improving
systemically unwell
immunocompromised, or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
younger than 2 years old with bilateral otitis media
otitis media with perforation and/or discharge in the canal are conditions for

A

giving antibiotics in otitis media

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3
Q

if antibiotics required to treat otitis media what is given?

A

amoxicillin, erythromycin/clarithromycin if penicillin allergic

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4
Q

amoxicillin, erythromycin/clarithromycin if penicillin allergic are given for

A

otitis media

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5
Q

common organisms causung otitis media

A

rhinovirus, staphylococcus, haemophilus, moroxella

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6
Q

rhinovirus, staphylococcus, haemophilus, moroxella are common organisms causing

A

otitis media

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7
Q

vertigo is defined as

A

the false sensation that the body or environemnt

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8
Q

the false sensation that the body or environemnt is moving defines

A

vertigo

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9
Q

causes of vertigo

A

viral labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease, vertebrobasilar ischaemia, acoustic neuroma, trauma, multiple sclerosis, ototoxicity e.g gentamicin

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10
Q

viral labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease, vertebrobasilar ischaemia, acoustic neuroma, trauma, multiple sclerosis, ototoxicity e.g gentamicin are causes of

A

vertigo

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11
Q

viral labyrinthitis

A

vertigo, recent viral infecion, sudden onset, nausea, vomiting, hearing may be affected

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12
Q

vertigo, recent viral infecion, sudden onset, nausea, vomiting, hearing may be affected in

A

viral labyrinthitis

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13
Q

vestibular neuronitis

A

recent viral infection, recurrent vertigo attacks lasting hours/days, no hearing loss

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14
Q

recent viral infection, recurrent vertigo attacks lasting hours/days, no hearing loss in

A

vestibular neuronitis

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15
Q

benign paroxysmal positional vertigo

A

gradual onset vertigo, triggered by change in head position, each episode lasts 10-20 seconds

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16
Q

gradual onset vertigo, triggered by change in head position, each episode lasts 10-20 seconds in

A

benign paroxysmal positional vertigo

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17
Q

Meniere’s disease

A

middle ages adults, recurent episodes of vertigo associated with hearing loss (sensorineural), tinnitus, sensation of fullness/pressure in one or both ears, nystagmus, positive Romberg’s test, episodes last minutes to hours, typically unilateral

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18
Q

middle ages adults, recurent episodes of vertigo associated with hearing loss (sensorineural), tinnitus, sensation of fullness/pressure in one or both ears, nystagmus, positive Romberg’s test, episodes last minutes to hours, typically unilateral in

A

Meniere’s disease

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19
Q

vertebrobasilar ischaemia

A

elderly patient, vertigo, dizziness on neck extension

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20
Q

elderly patient, vertigo, dizziness on neck extension in

A

vertebrobasilar ischaemia

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21
Q

acoustic neuroma

A

cranial nerve VIII: hearing loss, vertigo, tinnitus
cranial nerve V: absent corneal reflex (important sign)
cranial nerve VII: facial palsy
bilateral associated with neurofibromatosis type 2

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22
Q

hearing loss, vertigo, tinnitus, absent corneal reflex, facial palsy, associated with neurofibromatosis type 2 is

A

acoustic neuroma

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23
Q

three most common causes of hearing loss

A

ear wax, otitis media, otitis externa

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24
Q

ear wax, otitis media, otitis externa are the three most common causes of

A

deafness

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25
Q

presbycusis

A

age related sensorineural hearing loss, difficulty following conversations, audiometry shows bilateral high frequency hearing loss

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26
Q

age related sensorineural hearing loss, difficulty following conversations, audiometry shows bilateral high frequency hearing loss describes

A

presbycusis

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27
Q

otosclerosis

A

autosomal dominant, replacement of bone by vascular spongy bone, onset at 20-40 years, conductive deafness, tinnitus, ‘flamingo tinge’ to tympanic membrane, positive family history

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28
Q

autosomal dominant, replacement of bone by vascular spongy bone, onset at 20-40 years, conductive deafness, tinnitus, ‘flamingo tinge’ to tympanic membrane, positive family history describes

A

otosclerosis

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29
Q

glue ear/otitis media with effusion

A

peaks at 2 years old, conductive hearing loss, secondary problems e.g. speech, language, behavioural, balance problems

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30
Q

peaks at 2 years old, conductive hearing loss, secondary problems e.g. speech, language, behavioural, balance problems describes

A

glue ear/otitis media with effusion

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31
Q

drugs causing ototoxicity

A

aminoglycosides (gentamicin), furosemide, aspirin, cytotoxic agents

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32
Q

aminoglycosides (gentamicin), furosemide, aspirin, cytotoxic agents are drugs which cause

A

ototoxicity

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33
Q

noise damage

A

workers in heavy industries, bilateral, 4000Hz notch on audiogram, sensorineural hearing loss

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34
Q

workers in heavy industries, notch on audiogram at 4000Hz, sensorineural hearing loss

A

noise damage

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35
Q

acoustic neuroma is more correctly called

A

vestibular schwannoma

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36
Q

vestibular schwannoma

A

is the correct name for acoustic neuroma

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37
Q

reactive lymphadenopathy

A

most common cause of neck swelling, history of local infection, generalised viral illness

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38
Q

most common cause of neck swelling, history of local infection, generalised viral illness describes

A

reactive lymphadenopathy

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39
Q

lymphoma

A

rubbery, painless, lymphadenopathy, night sweats, splenomegaly

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40
Q

rubbery, painless, lymphadenopathy, night sweats, splenomegaly describes

A

lymphoma

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41
Q

thyroid swelling

A

moves upwards on swallowing, symptoms of hyper/eu/hypothyroidism

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42
Q

moves upwards on swallowing, symptoms of hyper/eu/hypothyroidism

A

thyroid swelling

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43
Q

thyroglossal cyst

A

more common in patients <20 years old, midline, between isthmus of the thyroid and the hyoid bone, moves upwards with tongue protrusion, painful if infected

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44
Q

more common in patients <20 years old, midline, between isthmus of the thyroid and the hyoid bone, moves upwards with tongue protrusion, painful if infected describes

A

thyroglossal cyst

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45
Q

isthmus of the thyroid

A

the bit of the thyroid gland that crosses the midline of the throat, about at the level of the shoulders

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46
Q

hyoid bone

A

top bone under the chin, above the Adam’s apple

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47
Q

the bit of the thyroid gland that crosses the midline of the throat, about at the level of the shoulders

A

isthmus

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48
Q

top bone under the chin, above the Adam’s apple

A

hyoid bone

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49
Q

pharyngeal pouch

A

more common in older men, posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles, usually not seen, if large midline lump, gurgles on palpation, dysphagia, regurgitation, aspiration, chronic cough

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50
Q

more common in older men, posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles, usually not seen, if large midline lump, gurgles on palpation, dysphagia, regurgitation, aspiration, chronic cough describe

A

pharyngeal pouch

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51
Q

cystic hernia/lymphangioma

A

congenital lymphatic lesion, left side, present before 2 years

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52
Q

congenital lymphatic lesion, left side, present before 2 years describes

A

cystic hernia/lymphangioma

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53
Q

branchial cyst

A

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

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54
Q

oval, mobile, cystic mass, between sternocleidomastoid muscle and pharynx, due to failure of obliteration of the second branchial cleft in embryonic development, early adulthood describes

A

branchial cyst

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55
Q

cervical rib

A

adult females, can lead to thoracic outlet syndrome

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56
Q

adult females, can lead to thoracic outlet syndrome

A

cervical rib

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57
Q

thoracic outlet syndrome

A

when the blood vessels between clavicle and first rib get compressed

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58
Q

when the blood vessels between clavicle and first rib get compressed describes

A

thoracic outlet syndrome

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59
Q

carotid aneurysm

A

pulsatile, lateral, doesn’t move on swallowing

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60
Q

pulsatile, lateral, doesn’t move on swallowing describes

A

carotid aneurysm

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61
Q

mnemonic to remember how to describe a lump

A

5 Students and 3 Teachers went to build a CAMPFIRE

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62
Q

5 Students and 3 Teachers went to build a CAMPFIRE to remember

A

how to describe a lump

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63
Q

5 students to comment on when you find a lump

A 
site - from a specific landmark
size
shape
skin
scar
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64
Q

3 teachers to comment on when you find a lump

A

tenderness - pain on touching
temperature - feel with back of hand
transillumination - especially for testicular masses

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65
Q

campfire to comment on when you find a lump

A

consistency - soft, spongy, firm
attachment - identify between which layers it is by moving the skin, then muscle etc over it
mobility - try to move lump horizontally and vertically
pulsatile - assess with two fingers, transmitted vs expansile
fluctuance - tap lump with fingers either side, fluctuant will displace fingers
irr/
reducible
enlarged lymph nodes

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66
Q

cause of Meniere’s disease

A

unknown

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67
Q

site of Meniere’s disease

A

inner ear

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68
Q

inner ear is the site of what disease

A

Meniere’s

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69
Q

Meniere’s disease is characterised by

A

the progressive dilation of the endolymphatic system

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70
Q

the progressive dilation of the endolymphatic system characterises

A

Meniere’s disease

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71
Q

the natural history of Meniere’s disease

A

symptoms resolve after 5-10 years, degree of residual hearing loss (sensorineural), psychological distress

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72
Q

symptoms resolve after 5-10 years, degree of residual hearing loss, psychological distress describes the natural history of

A

Meniere’s disease

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73
Q

management of Meniere’s disease

A

ENT assessment, inform DVLA, cease driving until satisfactory control of symptoms, buccal/intramuscular prochlorperazine for acute attacks, betahistine and vestibular rehabilitation exercises may be of benifit in prevention

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74
Q

ENT assessment, inform DVLA, cease driving until satisfactory control of symptoms, buccal/intramuscular prochlorperazine for acute attacks, betahistine and vestibular rehabilitation exercises may be of benifit in prevention describes the management of

A

Meniere’s disease

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75
Q

prochlorperazine

A

dopamine receptor antagonist, antipsychotic class, buccal or intramuscular for acute Meniere’s disease attacks, extrapyramidal side effects

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76
Q

dopamine receptor antagonist, antipsychotic class, buccal or intramuscular for acute Meniere’s disease attacks, extrapyramidal side effects

A

prochlorperazine

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77
Q

betahistine

A

used in the prevention of the symptoms of Meniere’s disease

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78
Q

used in the prevention of the symptoms of Meniere’s disease

A

betahistine

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79
Q

the effusion in glue ear is a transudate or an exudate?

A

transudate (systemic, low protein)

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80
Q

glue ear is caused by a

A

dysfunction eustatian tube

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81
Q

a dysfunctional eustation tube in children causes

A

glue ear/otitis media with effusion

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82
Q

otitis externa orgnaisms

A

staphylococcus, streptococcus, pseudomonas

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83
Q

staphylococcus, streptococcus, pseudomonas are common causative orgnaisms of

A

otitis externa

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84
Q

middle ear bones in order

A

malleus, incus, stapes

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85
Q

adult with glue ear think

A

nasopharyngeal cancer

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86
Q

think of nasopharyngeal cancer in

A

adults with glue ear/otitis media with effusion

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87
Q

sodium bicarbonate ear drops

A

softens ear wax

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88
Q

ear drops used to softens ear wax

A

sodium bicarbonate

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89
Q

obstructive sleep apnoea in young children may be caused by enlarged

A

tonsils and adenoids

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90
Q

enlarged tonsils and adenoids in young children may cause

A

obstructive sleep apnoea

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91
Q

cholesteatoma

A

squamous cells in the middle ear causing local destruction

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92
Q

squamous cells in the middle ear causing local destruction describes

A

cholesteatoma

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93
Q

features of cholesteatoma

A

foul smelling discharge, hearing loss, vertigo, facial nerve palsy, cerebellopontine angle syndrome, otoscopy = ‘attick crust’ seen in uppermost part of eardrum

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94
Q

foul smelling discharge, hearing loss, vertigo, facial nerve palsy, cerebellopontine angle syndrome, otoscopy = ‘attick crust’ seen in uppermost part of eardrumare features of

A

cholesteatoma

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95
Q

management of cholesteatoma

A

ENT referral for surgical removal

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96
Q

ENT referral for surgical removal is the management for

A

cholesteatoma

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97
Q

cerebellopontine angle syndrome

A

caused by a space occupying lesion at junction fo cerebellar and pons: ipsilateral deafness, nystagmus, reduced corneal reflex, V and VII nerve palsys, ipsilateral cerebellar signs

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98
Q

caused by a space occupying lesion at junction fo cerebellar and pons: ipsilateral deafness, nystagmus, reduced corneal reflex, V and VII nerve palsys, ipsilateral cerebellar signs

A

cerebellopontine angle syndrome

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99
Q

normal on an audiogram

A

above 20dB

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100
Q

above 20dB on an audiogram

A

normal

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101
Q

audiogram of sensorineural hearing loss

A

both bone (arrowheads) and air (circles or crosses) are >20dB

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102
Q

both bone (arrowheads) and air (circles or crosses) are >20dB on audiogram indicates

A

sensorineural hearing loss

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103
Q

audiogram of conductive hearing loss

A

only air (circles or crosses) are >20dB

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104
Q

only circles or crosses are >20dB

A

conductive hearing loss

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105
Q

audiogram of mixed hearing loss

A

both bone (arrowheads) and air (circles or crosses) are >20dB, with air significantly worse than bone

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106
Q

both bone (arrowheads) and air (circles or crosses) are >20dB, with air significantly worse than bone

A

mixed hearing loss

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107
Q

chronology of symptoms in otitis media acute

A

pain, pop, discharge

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108
Q

pain, pop, discharge is the chronology of

A

otitis media acute

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109
Q

what route to give antibiotics for otitis media acute

A

orally/systemically

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110
Q

what route to give antibiotice for otitis externa

A

topical/drops

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111
Q

chronology of events for otitis externa

A

pus, pain

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112
Q

pus, pain is the chronology of events for

A

otitis externa

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113
Q

stapes connects with

A

oval window

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114
Q

the cochlea is filled with

A

perilymph

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115
Q

perilymph lines the

A

cochlea

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116
Q

metaplasia

A

when one fully differentiated cell type changes into a different fully differentiated cell type in respose to a stimuli (occurs in otitis media with effusion)

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117
Q

when one fully differentiated cell type changes into a different fully differentiated cell type in respose to a stimuli describes

A

metaplasia

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118
Q

window of opportunity to develop speech

A

<6 years old

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119
Q

<6 years old is the window of opportunity

A

to develop speech, after that a cochlear implant will only enable the perception of sounds as Wernike’s + Broca’s areas haven’t developed

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120
Q

transient evoked otoacoustic emissions

A

used in newborn screening hearing test

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121
Q

used in newborn screening hearing test

A

transient evoked otoacoustic emissions

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122
Q

automated brainstem responce

A

secondary testing if neonates scores low on the transient evoked otoacoustic emission, hearing version of an EEG

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123
Q

secondary testing if neonates scores low on the transient evoked otoacoustic emission

A

automated brainstem response

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124
Q

management of glue ear/otitis media with effusion

A

grommets or hearing aids

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125
Q

grommets or hearing aids id the management of

A

glue ear/otitis media with effusion

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126
Q

caution with grommets

A

don’t get water in the ear - no swimming, wear plugs when showering, will fall out in 7-9/12
“water precautions”

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127
Q

water precautions must be adhered to when

A

domeone has grommets in their ears, or when a perforation is healing

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128
Q

mild hearing loss

A

20-40dB

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129
Q

20-40dB

A

mild hearing loss

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130
Q

moderate hearing loss

A

40-70dB

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131
Q

40-70dB

A

moderate hearing loss

132
Q

severe hearing loss

A

70-90dB

133
Q

70-90dB

A

severe hearing loss

134
Q

profound hearing loss

A

> 90dB

135
Q

> 90dB

A

profound hearing loss, required cochlear implant

136
Q

range of frequencies of human ear

A

20-20000Hz

137
Q

20-20000Hz

A

range of frequencies of the human ear

138
Q

range of frequencies of speech

A

250-8000Hz

139
Q

250-8000Hz

A

range of frequencies of speech

140
Q

5-10dB differnce between ears/air and bone conduction

A

insignificant, can say symetrical

141
Q

insignificant, can say symetrical audiometry difference

A

5-10dB

142
Q

carhart notch

A

at 2000Hz, indicated otosclerosis

143
Q

at 2000Hz, indicated otosclerosis

A

cahart notch

144
Q

management of otosclerosis

A

stapedectomy and prosthesis

145
Q

stapedectomy and prosthesis is the management for

A

otosclerosis

146
Q

Meniere’s hearing loss is worse at which frequencies

A

lower

147
Q

hearing loss worse at lower frequencies indicates

A

Meniere’s disease

148
Q

tympanometry

A

test of middle ear relative pressure

149
Q

test of middle ear relative pressure

A

tympanometry

150
Q

microtia

A

congenital malformation of pinna

151
Q

congenital malformation of pinna

A

microtia

152
Q

types of hearing aids

A

post auricular, bone conduction, cochlear implant, bone anchored hearing aid

153
Q

post auricular, bone conduction, cochlear implant, bone anchored are

A

types of hearing aid

154
Q

tachyphylaxis definition

A

increasing dose required to achieve same effect

155
Q

increasing dose required to achieve same effect

A

tachyphylaxis

156
Q

prolonged periods of using topical nasal decongestants can lead to

A

tachyphylexis

157
Q

tachyphylexis can develop when

A

using topical nasal decongestants e.g. oxymetazoline

158
Q

types of allergic rhinitis

A

seasonal e.g. hayfever, perennial (all year round) e.g. house mites, occupational

159
Q

seasonal, perennial, occupational are types of

A

allergic rhinitis

160
Q

first line management of allergic rhinitis

A

oral/intranasal antihistamines

161
Q

oral/intranasal antihistamines are first line management for

A

allergic rhinitis

162
Q

otalgia

A

ear pain

163
Q

ear pain

A

otalgia

164
Q

small bilateral nasal polyps

A

can be treated in primary care with saline nasal douche and intranasal steroids

165
Q

can be treated in primary care with saline nasal douche and intranasal steroids

A

small bilateral nasal polyps

166
Q

polyps due to rhinosinusitis are usually unilateral or bilateral?

A

bilateral

167
Q

complications of tonsillitis

A

otitis media, quinsy, rheumatic fever, glomerulonephritis

168
Q

otitis media, quinsy, rheumatic fever, glomerulonephritis are complications of

A

tonsillitis

169
Q

quinsy

A

peritonsillar abscess

170
Q

peritonsillar abscess is called

A

quinsy

171
Q

indications for tonsillectomy - NICE recommends meeting all of these

A

disabling sore throats due to tonsillitis, 5+ episodes of tonsillitis per year, symptoms for at least 1 year

172
Q

disabling sore throats due to tonsillitis, 5+ episodes of tonsillitis per year, symptoms for at least 1 year are

A

what NICE recommends need to be met (all) in order to justify a tonsillectomy

173
Q

other established indications for tonsillectomy

A

recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, quinsy if unresponsive to standard treatment

174
Q

recurrent febrile convulsions secondary to tonsillitis, obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils, quinsy if unresponsive to standard treatment are

A

other established indications for a tonsillectomy

175
Q

tonsillectomy complications

A

primary (within 24h) = haemorrhage, secondary = haemorrhage, pain, infection

176
Q

Ramsey Hunt syndrome also known as

A

herpes zoster oticus

177
Q

herpes zoster oticus also known as

A

Ramsey Hunt syndrome

178
Q

features of Ramsey Hunt syndrome/herpes zoster oticus

A

auricular pain, facial nerve palsy, vesicular rash around ear, vertigo, tinnitus

179
Q

auricular pain, facial nerve palsy, vesicular rash around ear, vertigo, tinnitus are features of

A

Ramsey Hunt syndrome/herpes zoster oticus

180
Q

management of Ramsey Hunt syndrome/herpes zoster oticus

A

oral aciclovir + corticosteroids

181
Q

oral aciclovir + corticosteroids given in

A

Ramsey Hunt syndrome/herpes zoster oticus

182
Q

sialadenitis

A

inflammation of the salivary gland

183
Q

inflammation of the salivary gland

A

sialadenitis

184
Q

sialadenitis is often secondary to a

A

stone impacted in the duct

185
Q

a stone impacted in the salivary duct can lead to

A

sialadenitis

186
Q

three main salivary glands

A

parotid, submandibular, sublingual

187
Q

parotid, submandibular, sublingual describe

A

the three main salivary glands

188
Q

otoscopy L vs R ear

A

half with cone of light + maleolus process (i.e. L/R) is same half as the ear (i.e. L/R ear)

189
Q

ear wax impaction

A

excessive build up of ear wax in canal, conductive hearing loss, sometimes pain

190
Q

excessive build up of ear wax in canal, conductive hearing loss, sometimes pain

A

ear wax impaction

191
Q

myringosclerosis

A

thickening + calcification of the tympanic membrane 2’ to inflammation, usually asymptomatic

192
Q

thickening + calcification of the tympanic membrane 2’ to inflammation, usually asymptomatic

A

myringosclerosis

193
Q

nosebleed management

A
  1. local compression over Little’s area
  2. nasal cautery (chemical or electrical)
  3. nasal packing - uncomfortable for PT, risks of P necrosis, post migration into the airway + aspiration of blood clots
  4. ligation of sphenopalatine a (life threatening haemorrhage)
194
Q

salivary duct calculus

A

Ca, submandibular gland > affected due to longer duct, antigravity drainage + > vicous secretions, pain + swelling when eating

195
Q

salivary duck calculus management

A

siologram > XR, conservative = increasing saliva produciton (sucking sweets), drinking H2O, massaging the area, silandoscopy, lithotripsy

196
Q

siologram > XR, conservative = increasing saliva produciton (sucking sweets), drinking H2O, massaging the area, silandoscopy, lithotripsy describes the managementof

A

salivary duck calculus

197
Q

tuning fork for hearing test

A

512Hz

198
Q

parts of the eardrum

A

pars tensa (lower part), pars flaccida (upper part)

199
Q

inspection of the ear

A

examine face for palsy/m weakness, , scars inflammation, trauma, pits/sinuses around pinna

200
Q

palpation of the ear

A

mastoid tip, mastoid bone, pinna, parotid, temperomandibular joint area

201
Q

otoscopy

A

inspect the meatus, tympanic menbrane

202
Q

doccument fondings from otoscopy

A

draw a picture of the tympanic menbrane

203
Q

Rinne’s test

A

512Hz tunig fork - air vs bone conduction, 1. can you hear both 2. which is louder

204
Q

+ve Rinne’s test

A

air > bone conduction, indicated N hearing or SNHL

205
Q

-ve Rinne’s test

A

bone > air, conductive HL

206
Q

false -ve Rinne’s test

A

v severe unilateral SNHL so much so that when tuning fork is placed on the mastoid it conducts round + is detected by the other cochlear

207
Q

Weber’s test

A

512Hz tuning fork - placed in centre of forehead, equal or localises to one ear

208
Q

equal hearing in Weber’s indicates

A

N hearing or equal SNHL/CHL

209
Q

Weber’s localises to

A

good ear in SNHL, bad ear in CHL

210
Q

512Hz tunig fork - air vs bone conduction, 1. can you hear both 2. which is louder

A

Rinne’s

211
Q

air conduction > bone condutcion

A

+ve Rinne’s test

212
Q

bone conduciton > air conduciton

A

-ve Rinne’s test

213
Q

512Hz tuning fork - placed in centre of forehead, equal or localises to one ear

A

Webber’s

214
Q

inspecting the nose

A

inspect from all angles, size of nostrils, size of septum

215
Q

test of airway patency (nose)

A

cold Lack’s depressor under nostrils + ask PT to exhale through nose

216
Q

otoscopy

A

comment on nasal septum, nose floor, lateral turbinate

217
Q

mouth inspection

A

lip border, (head torch/good light source) stick out tongue, Lack’s tongue depressors, inspect contents, hard, soft palate, tonsils, upper teeth, lateral mouth, tongue, floor of mouth, lower teeth, lower lateral buccal area

218
Q

number of adult teeth

A

32

219
Q

mouth palpation

A

bimanual, submanibuilar gland, mucosa, check for thickening, abnormalities, stones, cysts, ulcers

220
Q

neck inspection

A

fully exposed, swellings, skin lesions, skin discolouration, scars, lumps: size, site, shape, overlying skin (scar/colour), surface,margin, pulsatile, cross fluctiation

221
Q

neck palpation

A

from behind, start with abnormality (single/multiple, discrete/diffuse, surface, edge, T’c, consistency, fluctuation, compressibility, reducibility, pulsatility, fixation), stick out tongue

222
Q

nasendoscopy is used to examine the

A

nose, pharynx, larynx

223
Q

epistaxis

A

nosebleed

224
Q

types of epistaxis

A

1’ (majority of epistaxis, no obvious causal factor), 2’ (due to an identifiable cause), childhood, adult, acute, recurrent

225
Q

2’ causes of epistaxis

A

EtOH, aspirin, NSAIDs, antiplatelets (clopidogrel), anticoagulants (warfarin), herbal remidies (St John’s wort, fish oil), blood dyscrasias (thrombocytopaenia), coagulopathy (haemophillia, vWD), trauma (nasal #), tumour, Sx, septal perforation

226
Q

childhood epistaxis

A

common, tends to be 1’, ant inf bleeding of nasal septum (Little’s area)

227
Q

susceptibility to childhood epistaxis

A

nose picking, infection

228
Q

management of childhood epistaxis

A

pinch Little’s area (Hippocratic manoeuvre), examine nose (good light) once bleeding stopped, spray bleeds with LA + vasoconstrictor (lignocaine + phenylephrine), chemical cautery, diathermy

229
Q

prescribed to prevent recurrence of childhood epistaxis

A

course of chlorhexidine-neomycin cream

230
Q

adult 1’ epistaxis

A

> posteriorly than in children, > bleeding

231
Q

management of adult 1’ epistaxis

A

Hippocratic manoeuvre, IV access, contact ENT, examination, cautery of bleed, diathermy

232
Q

failure to control bleeding in 1’ adult epistaxis within

A

24h warrents referral to specialist rhinologist (endoscopy under GA, diathermy, ligation)

233
Q

2’ epistaxis management

A

identificaion/treatment of cause, Hippocratic manoeuvre

234
Q

pharmacological causes of 2’ epistaxis

A

NSAIDs, clopidogrel, aspirin, warfarin, herbal remidies, EtOH - loss of control, OD

235
Q

2’ epistaxis by trauma

A

craniofacial trauma required ENT referral, risk = ethmoidal #

236
Q

ethmoidal # presentation

A

black eyes, nasal #, dislocation with broadened nasal dorsum, episodes of epistaxis

237
Q

ethmoidal # management

A

ENT referral, assessment, Sx ligation, angiography

238
Q

ux, bloodstained discharge indication for

A

urgent ENT referral, ?malignancy

239
Q

ux nasal obstruction + epistaxis in pubertal/adolescent male think

A

juvenile nasopharyngeal angiofibroma (rare)

240
Q

hereditary haemorrhagic telangectasia

A

rare, AD, variable penetrance, severe recurent epistaxis, telangectasias on mucosal surface/oral cavity/lips, anaemia, spider naevi, AVM

241
Q

course of chlorhexidine-neomycin cream is used to

A

prevent recurrence of childhood epistaxis

242
Q

black eyes, nasal #, dislocation with broadened nasal dorsum, episodes of epistaxis

A

ethmoidal #

243
Q

juvenile nasopharyngeal angiofibroma (rare) presentation

A

ux nasal obstruction + epistaxis in pubertal/adolescent male

244
Q

rare, AD, variable penetrance, severe recurent epistaxis, telangectasias on mucosal surface/oral cavity/lips, anaemia, spider naevi, AVM

A

hereditary haemorrhagic telangectasia

245
Q

examples of congenital SNHL

A

syndromic, non-syndromic, gestational infection

246
Q

what types of gestational infection could cause congenital SNHL

A

TORCH infections (toxo, rubella, CMV, herpes)

247
Q

examples of acquired SNHL

A

perinatal jaundice, perinatal hypoxia, meningitis, measles, mumps, Sx, head injury, noise exposure, baro-trauma, aminoglycosides, cytotoxics, vestibular schwannoma, sudden SNHL, Meniere’s, presbycusis

248
Q

what’s baro-trauma

A

injuries caused by increasing air/water P e.g. scuba diving, flights

249
Q

examples of congenital CHL

A

ossicular abnormality, microtia, anotia, external auditory canal atresia

250
Q

anotia is

A

absence of external ear

251
Q

examples of acquired CHL

A

wax, OE, foreign body, middle ear effusion, chronic suppurative OM, ossicular disruption

252
Q

suddent SNHL is defined as

A

SNHL over 3/7, >30dD, in 3 contiguous frequencies

253
Q

suddent SNHL presentation

A

50-60 y.o., ux > bx

254
Q

sudden SNHL management

A

steroids, may resolve spontaneously

255
Q

syndromic, non-syndromic, gestational infection are examples of

A

congenital SNHL

256
Q

perinatal jaundice, perinatal hypoxia, meningitis, measles, mumps, Sx, head injury, noise exposure, baro-trauma, aminoglycosides, cytotoxics, vestibular schwannoma, sudden SNHL, Meniere’s, presbycusis are examples of

A

acquired SNHL

257
Q

ossicular abnormality, microtia, anotia, external auditory canal atresia are examples of

A

congenital CHL

258
Q

absence of external ear is called

A

anotia

259
Q

wax, OE, foreign body, middle ear effusion, chronic suppurative OM, ossicular disruption are examples of

A

acquired CHL

260
Q

SNHL over 3/7, >30dD, in 3 contiguous frequencies describes

A

sudden SNHL

261
Q

the most common complication of meningitis is

A

SNHL

262
Q

facial palsy UMN vs LMN

A

forehead is spared in UMN lesion as it has supply from both hemispheres

263
Q

facial n palsy presentation

A

ux m weakness, unable to close eye, dribbling from one side of mouth, unable to clear food from one cheek

264
Q

idiopathic facial n palsy aka

A

Bell’s palsy

265
Q

causes of facial n palsy

A

stroke (UMN), cholesteatoma, ear malignancy, parotid lesions, head injury (basal skull #), HSV, acute OM, malignant/necrotising OE, sarcoid, idiopathic (Bell’s palsy, LMN)

266
Q

management of Bell’s palsy

A

eye care+ protection = taping eye shut at night, artificial tears, high dose steroids (ASAP post-symptoms), antivirals

267
Q

ux m weakness, unable to close eye, dribbling from one side of mouth, unable to clear food from one cheek describes the presentation of

A

facial palsy

268
Q

Bell’s palsy aka

A

idiopathic facial n palsy

269
Q

stroke, cholesteatoma, ear malignancy, parotid lesions, head injury, HSV, acute OM, malignant/necrotising OE, sarcoid, idiopathic are causes of

A

facial n palsy

270
Q

eye care+ protection = taping eye shut at night, artificial tears, high dose steroids (ASAP post-symptoms), antivirals is the mangement of

A

Bell’s palsy

271
Q

causes of hoarseness/dysphonia

A

chronic sinusitis, pharyngitis, skull base lesion (trauma, ca), laryngeal ca, thyroid/parathyroid ca, vocal cord nodules, Reinke’s oedema, GORD, foreign body, bronchogenic ca, aortic arch aneurysm

272
Q

when to refer to ENT for hoarseness

A

3/52 w/o resolution

273
Q

acute laryngitis is a common feature of

A

URTI

274
Q

management of acute laryngitis

A

fluids, analgesia, anti-inflammatory drugs, voice rest (avoidance of whispering, shouting)

275
Q

duration of acute laryngitis

A

2/52

276
Q

causes of chronic laryngitis

A

smoking, EtOH, excessive/misuse of voice

277
Q

management of chronic laryngitis

A

voice rest, smoking cessation, SALT

278
Q

vocal cord palsy can lead to

A

hoarseness, aspiration

279
Q

vocal cords are supplied by

A

recurrent laryngeal n, branches of the vagus n

280
Q

causes of vocal cord paralysis

A

post thyroid/parathyroid Sx (direct n damange), mediastinal mass (bronchogenic ca), thyroid ca

281
Q

vocal cord nodules are caused by

A

repeated trauma to the edge of the cords, excessive untutored voice projection, leading to fibrosis

282
Q

management of vocal cord nodules

A

voice rest, SALT

283
Q

m tendon dysphonia describes

A

uncoordinated laryngeal m leading to voice problems

284
Q

management of m tendon dysphonia

A

SALT

285
Q

chronic sinusitis, pharyngitis, skull base lesion (trauma, ca), laryngeal ca, thyroid/parathyroid ca, vocal cord nodules, Reinke’s oedema, GORD, foreign body, bronchogenic ca, aortic arch aneurysm are potential causes of

A

hoarseness/dysphonia

286
Q

fluids, analgesia, anti-inflammatory drugs, voice rest describes the management of

A

acute laryngitis

287
Q

smoking, EtOH, excessive/misuse of voice can cause

A

chronic laryngitis

288
Q

voice rest, smoking cessation, SALT describes the management of

A

chronic laryngitis

289
Q

recurrent laryngeal n + branches of the vagus n supply

A

vocal cords

290
Q

post thyroid/parathyroid Sx (direct n damange), mediastinal mass (bronchogenic ca), thyroid ca can cause

A

vocal cord paralysis

291
Q

repeated trauma to the edge of the cords, excessive untutored voice projection, leading to fibrosis which are called

A

vocal cord nodules

292
Q

uncoordinated laryngeal m leading to voice problems is called

A

m tendon dysphonia

293
Q

CVS causes of imbalance

A

hypotension, TIA, stroke, arrhythmia, vertebrobasillar insufficiency, atherosclerosis

294
Q

iatrogenic causes of imbalance

A

vestibular sedatives, antihypertensives, aminoglycosides, EtOH

295
Q

trauma causes of imbalance

A

brain injury, temporal bone #, Sx

296
Q

ear causes of imbalance

A

BPPV, labrynthitis, Meniere’s DZ, middle ear DZ, perilymph fistula, impacted wax

297
Q

CNS causes of imbalance

A

migraine, brainstem ischaemia, MS, ca, epilepsy

298
Q

general medical causes of imbalance

A

ageing, degeneration, DM, anaemia, peripheral neuropathy, cervical spondylosis, psychiatric illness

299
Q

lightheadedness describes

A

feeling faint

300
Q

unsteadiness describes

A

gait abnormality

301
Q

feeling faint describes

A

lightheadedness

302
Q

gait abnormality describes

A

unsteadiness

303
Q

blunt trauma to the pinna can cause a

A

hamatoma

304
Q

management of a pinna haematoma

A

drainage, P dressing

305
Q

if a pinna haematoma is not managed quickly it can lead to

A

necrosis becuase of P, causing unsightly deformity aka cauliflower ear

306
Q

furunculosis is

A

infection of a hair folicle in the external ear

307
Q

furunculous presentation

A

local swelling, tender, painful

308
Q

malignant/necrotising OE presentation

A

severe, unremitting pain, not responding to simple analgesia

309
Q

malignant/necrotising OE is

A

progressive osteomyelitis of the temporal bone, resulting from OE

310
Q

PTs at risk of malignant/necrotising OE are

A

immunocompromised, DM

311
Q

OM occurs > commonly in children becuase

A

shorter, wider, more horizontal Eustachian tube, more immature immune defences

312
Q

OM presentation

A

otalgia (worse at night), fever, HL, otorrhoea

313
Q

OM management

A

most cases will resolve on their own, criteria for ABx

314
Q

infection of a hair folicle in the external ear describes

A

furunculosis

315
Q

severe, unremitting pain, not responding to simple analgesia describes

A

malignant/necrotising OE

316
Q

perforated tympanic membrane causes

A

infeciton, barotrauma, direct trauma

317
Q

Mx of perforated tympanic membrane

A

6-8/52 to heal by itself (water precautions), myringoplasty if fails to resolve

318
Q

most common tumour of parotid gland

A

pleomorphic adenoma (benign)

319
Q

second most common parotid gland tumour

A

Warthian tumour (benign)

320
Q

type of cancerous parotid tumour

A

adenocarcinoma

321
Q

features of benign pleomorphic adenoma

A

most comon parotid neoplasm, slow growing, lobular, 2-10% malignant degeneration

322
Q

most comon parotid neoplasm, slow growing, lobular, 2-10% malignant degeneration

A

benigm pleomorphic adenoma

323
Q

complications of thyroid Sx

A

anatomical: recurrent laryngeal n damage
bleeding: haematomas can lead to resp compromise
parathyroid gland damage: hypocalcaemia

324
Q

ABx in sinusitis

A

systemically unwell, signs of a > serious illness, at high risk of complications

325
Q

sinusitis and any of: periorbital oedema, displaced eyeball, diplopia, reduced VA

A

refer to hospital

326
Q

common causative agents for sinusitis

A

Strep pneumo, H. influenzae, rhinoviruses

Medicine (30 decks)

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