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ENT Flashcards

1
Q

CENTOR Criteria

A

Absence of cough
Swollen and tender anterior cervical nodes
Temperature
Tonsillar exudates or swelling

+1 if between 3-14
-1 if over 45

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2
Q

Surfers Ear

A

Exocitosis

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3
Q

Otosclerosis

A

Accelerated by pregnancy

Autosomal dominant
Age 20-40

Conductive deafness
Tinnitus
Normal tympanic membrane
Positive family history

Manage - hearing aid, stapedectomy

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4
Q

Epiglottitis

A

Stridor
Drooling
Send to A&E

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5
Q

Headache fever worse on leaning forward

A

Frontal Sinusitis

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6
Q

Mastoiditis

A

Otalgia, severe and classically behind ear
Recurrent otitis media
Fever
Swelling erythema and tender over mastoid process
External ear may protrude forward
Ear discharge if eardrum perforated

Medical emergency - risk of meningitis

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7
Q

Otitis Media

When to give antibiotics

A 
Symptoms over four days or not improving
Systemically unwell
Immunicompromised 
Younger than 2yrs and bilateral
Perforation and/or discharge in the canal
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8
Q

Otitis media

Antibiotics

A

5 day amoxicillin

Penicillin allergy - erythromycin

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9
Q

Perforated tympanic membrane

Treatment

A

Usually heal after 6-8 weeks
Avoid water in this time

Prescribe antibiotics if perforation after episode of acute otitis media

Myringioplasty if doesn’t heal by itself

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10
Q

Causes of otitis externa

A

Infection (bacterial Staph A, Psuedomonas aeruginosa or fungal)

Seborrhoeic dermatitis

Contact dermatitis (allergic and irritant)

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11
Q

Features of otitis externa

A

Ear pain
Itch
Discharge
Otoscopy : red, swollen, or eczematous canal

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12
Q

Treatment of otitis externa

A

Initially

Topical antibiotic or combined topical antibiotic with steroid

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13
Q

Malignant otitis externa

A

Uncommon
In immunocompromised

PSEUDOMONAS AERUGINOSA

Progresses to temporal bone osteomyelitis

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14
Q

History of malignant otitis externa

A

DIABETES or immunosuppression

Severe unrelenting deep seated otalgia
Temporal headaches
Purulent otorrhoea
Possibly dysphasia, hoarseness and/or facial nerve dysfunction

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15
Q

Treatment of malignant otitis externa

A

Anti pseudomonal antimucrobial agents - CIPROFLOXACIN
Topical agents
Hyperbaric oxygen in refractory cases

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16
Q

Cholesteatoma

A

Squamous epithelium trapped in skull causing local destruction. Age 10-20

Foul smelling discharge + hearing loss

Other features of local invasion = vertigo, facial nerve palsy, cerebellopontine angle syndrome

Otoscopy - ATTIC crust in upper part

Manage - urgent ENT referral for consideration of surgical removal

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17
Q

Causes of tinnitus

A 
Menieres
Otosclerosis
Acoustic neuroma
Hearing loss
Drugs
Impacted ear wax
Chronic suppurations otitis media
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18
Q

Drugs causing tinnitus

A

Aspirin
Aminoglycosides
Loop diuretics
Quinine

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19
Q

Acoustic neuroma

Symptoms

A

Hearing loss, vertigo, tinnitus
Absent corneal reflex
Associated with neurofibromatosis type 2

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20
Q

Webers test

If sound heard better in DEAFER ear

A

Conductive

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21
Q

Webers test

If sound heard better in BETTER ear

A

Sensorineural

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22
Q

Rinnes

AC better than BC

A

Positive

Middle and outer ears normal

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23
Q

Rinnes

BC better than AC

A

Conductive deafness

As defective function of outer or middle ear

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24
Q

Mixed hearing loss

A

Both air and bone conduction impaired. Air often worse than bone

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25
Q

Presbyacusis

A

Age related SENSORINEURAL hearing loss

Bilateral high frequency hearing loss

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26
Q

Glue ear (otitis media with effusion)

A

Peaks at age 2
Hearing loss presenting feature
Secondary problems with speech and language, balance etc

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27
Q

Ototoxicity drugs

A

Aminoglycosides eg Gentamycin
Furosemide
Aspirin
Cytotoxic agents

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28
Q

Noise damage

A

Worse at 3000-6000Hz

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29
Q

Acoustic neuroma (vestibular schwannoma)

A

Features can be predicted by affected cranial nerves

CN VIII: hearing loss, vertigo, tinnitus

CN V: absent corneal reflex

CN VII: facial palsy

Bilateral acoustic neuromas seen in neurofibromatosis type 2

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30
Q

Viral Labyrinthitis

A

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

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31
Q

Vestibular neuronitis

A

Recent viral infection
Recurrent vertigo lasting hours or days
May have nausea and vomiting
No hearing loss or tinnitus

Vestibular rehab

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32
Q

BPPV

A

Gradual onset
Triggered by head position change
10-20s
Positive Dix Halpike

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33
Q

Menieres

A

Hearing loss, tinnitus, aural fullness

Nystagmus and positive Romberg

ENT assessment to confirm diagnosis
Inform DVLA and cease driving until controlled

Acute attacks - prochlorperazine
Prevent - betahistine and vestibular rehabilitation

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34
Q

Vertebrobasilar ischaemia

A

Elderly

Dizzy on neck extension

35
Q

BPPV treatment

A

Epley manoeuvre (80%)

Limited value - betahistine

36
Q

Ramsay Hunt syndrome

(Herpes zoster oticus)

Reactivation of VZV in CN VII

A

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

Oral acyclovir and corticosteroids

37
Q

Infectious agents in acute sinusitis

A

Strep Pneumoniae, Haemophilus influenzae, rhinoviruses

38
Q

Features of acute sinusitis

A

Facial pain - worse on leaning forward
Nasal discharge
Nasal obstruction
Post nasal drip - may produce chronic cough

39
Q

Management of acute sinusitis

A

Analgesia
Intranasal decongestants

Not usually antibiotics but if warranted phenoxymethylpenicillin first line

Intranasal steroid should be considered if symptoms lasted over 10days so far

40
Q

Management of recurrent or chronic sinusitis

A

Intranasal corticosteroids often beneficial

41
Q

Allergic rhinitis

Types

A

Seasonal - same type every year. Hay fever is seasonal rhinitis secondary to pollens

Perennial - symptoms throughout year

Occupational - symptoms follow exposure to allergens in workplace

42
Q

Features of allergic rhinitis

A 
Sneezing
Bilateral nasal obstruction
Clear nasal discharge
Post nasal drip
Nasal pruritus
43
Q

Management of allergic rhinitis

A

Allergen avoidance

Oral or intranasal antihistamines first line
Intranasal corticosteroids
May need oral corticosteroids

May be a role for topical nasal decongestants but long term tachyphylaxis occurs and need bigger dose for same effect and rebound hypertrophy of nasal mucosa after stopping

44
Q

Diagnosing allergic rhinitis

A

RAST

45
Q

Nasal septal haematoma

A

Bilateral red swelling from nasal septum usually after Garima
Boggy

Manage with surgical drainage - septoplasty and IV antibiotics

Irreversible septal necrosis and saddle nose deformity may occur in 3-4 days

46
Q

Nasal polyps

Associations

A

Asthma
Aspirin sensitivity

Infective sinusitis
Cystic fibrosis
Kartageners syndrome
Churg Strauss syndrome

47
Q

Nasal polyps

Features

A

Nasal obstruction
Rhinorrhoea
Sneezing
Poor sense of taste and smell

Unusual and require further investigations if..
Unilateral
Bleeding

48
Q

Nasal polyps

Management

A

All patients with nasal polyps should be referred to ENT

Topical corticosteroids shrink polyp size in 80%

49
Q

Mouth lesions

Two week wait referrals to oral surgery if…

A

Unexplained oral ulceration or mass for over 3weeks
Unexplained red or red and white patches that are painful swollen or bleeding
Unexplained one sided head and neck pain for over 4 weeks with ear pain but normal otoscopy
Unexplained recent neck lump or lump that has changed over 3-6weeks
Unexplained persistent sore or painful throat
Signs in oral cavity that can’t be certain to be benign for over 6 weeks

50
Q

Acute tonsillitis

A

Fever
Malaise
Pharyngitis
Lymphadenopathy

Tonsils usually oedematous and yellow or white pustules

Over half all cases bacterial - usually Strep pyogenes

51
Q

SIGN criteria for tonsillectomy

A

Over five episodes of tonsillitis a year for two years

Or over 7 in the last year

Or over 3 in the last three years

Other

  • recurrent febrile convulsions secondary to tonsillitis
  • obstructive sleep apnoea, stridor or dysphasia secondary to enlarged tonsils
  • quinsy unresponsive to standard treatment
52
Q

Complications of tonsillectomy

A

Primary (under 24hrs)
Haemorrhage in 2-3% and pain

Secondary (24hrs to 10days)
Haemorrhage (due to infection) and pain

53
Q

Quinsy

Features

A

Severe throats pain which lateralises to one side

Deviation of uvula to unaffected side

Trismus

Reduced neck mobility

54
Q

Quinsy

Management

A

Urgent ENT review

Need aspiration under local anaesthesia

55
Q

Sore throat

(pharyngitis, tonsillitis, laryngitis)

Management

A

Paracetamol or ibuprofen for pain

Not routinely antibiotics
Should not routinely do throat swabs and rapid antigen tests

56
Q

Sore throat

Indications for antibiotics

A

Marked systemic upset secondary to sore throat
Unilateral peritonsillitis
History of rheumatic fever
Increased risk (child with diabetes or immunodeficiency)
3 or more CENTOR criteria

57
Q

Neck Lumps

Reactive lymphadenopathy

A

Common

History of local infection or generalised viral illness

58
Q

Neck Lumps

Lymphoma

A

Rubbery painless lymphadenopathy

Pain with alcohol (although uncommon)

Associated with night sweats and splenomegaly

59
Q

Neck Lumps

Thyroid swelling

A

Symptomatic of hypo eu or hyperthyroid

Moves up on swallow

60
Q

Neck Lumps

Thyroglossal cyst

A

More common under 20yrs
Usually midline - between isthmus of thyroid and hyoid bone
Moves upwards with tongue protrusion
May be painful if infected

61
Q

Neck Lumps

Pharyngeal pouch

A

More common in older men
Gurgles on palpating if large
Typically dysphagia, Regurgitation, aspiration and chronic cough.
May cause bad breath

62
Q

Neck Lumps

Cystic hygroma

A

Congenital lymphangioma found in neck. Usually left side

Most present before age 2yrs

63
Q

Neck Lumps

Brachial cyst

A

Oval, mobile mass between sternocleidomastoid muscle and pharynx
Embryonic
Usually present in early adulthood

64
Q

Neck Lumps

Carotid aneurysm

A

Pulsatilla lateral neck mass which doesn’t move on swallow

65
Q

Causes of hoarseness

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

While investigating consider CXR

66
Q

Referral guidelines

Suspected laryngeal cancer

A

Over 45 with
Persistent unexplained hoarseness
Or
An unexplained neck lump

67
Q

Nasopharyngeal carcinoma

A

Squamous cell
More common in southern china
Associated with EBV

Cervical lymphadenopathy, otalgia, unilateral serous otitis media, nasal obstruction, discharge and or epistaxis, cranial nerve palsy

Combined CT and MRI

Radiotherapy first line

68
Q

Immunocompromised patient with poor dentition

A

Airway compromise from cellulitis of floor of mouth

Ludwigs angina

69
Q

Common cause of bacterial otitis media

A

Haemophilia influenzae

70
Q

Causes of gingival hyperplasia

A

Phenytoin
Ciclosporin
CCB
AML

71
Q

Samters Triad

A

Asthma
Aspirin sensitivity
Nasal polyps

72
Q

Coxsackie

A

Sore throat

Pustules hands and feet

73
Q

Dysphagia and anaemia

A

Patterson Kelly Brown

Oesophageal web

74
Q

Bird beak swallow

A

Achalasia

75
Q

Sinusitis for under three days

A

Decongestants

Not abx

76
Q

Orphan Annie nuclei

A

Papillary thyroid cancer

77
Q

6 weeks later still hoarse

A

Urgent ENT

78
Q

Vasomotor rhinitis

A

Elderly, thin clear discharge

79
Q

Epiglottitis

A

Stridor and drooling

In child call 999

80
Q

Which nerve interferes with cough if damaged

A

Recurrent laryngeal

81
Q

Chronic sinusitis and discharge

A

CT Sinus

82
Q

Tilt test

A

Used to diagnose vasovagal syncope or neurocardiogenic syncope (also known as common faints)

83
Q

In EBV infection do not give

A

Amoxicillin - rash

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