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3B GH > ENT > Flashcards

ENT Flashcards

1
Q

which arteries supply the nose and sinuses

A

ICA - ethmoid branch

ECA - facial + internal maxillary branches

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2
Q

where does bleeding usually arise in epistaxis?

A

little’s area [vessel anastamosis] in the nasal septum

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3
Q

give 5 risk factors for epistaxis

A
  1. anticoagulants, steroid sprays
  2. bleeding disorder/ thrombocytopenia
  3. deviated nasal septum
  4. irritants e.g. smoking
  5. allergies/inflamm
  6. infection
  7. trauma
  8. HTN
  9. neoplasia/polyp
  10. atherosclerosis
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4
Q

in an epistaxis patient, a FH of bleeding might suggest what disease

A

Hereditary hemorrhagic telangiectasia

[or hereditary bleeding disorder]

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5
Q

give 4 causes of facial pain

A 
teeth
sinusitis
temporomandibular joint dysfunction
salivary gland
migraine
trigem neur
trauma
atypical/idiopathic
cluster headache
angina
frontal bone osteomyelitis
ENT tumours
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6
Q

give 4 typical causes of gradual vision loss

A 
macular degeneration
glaucoma
cataract
diabetic retinopathy
HTN
optic atrophy
slow retinal detachment
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7
Q

presentation of age related macular degeneration

A

elderly
deteriorating central vision
difficulty making out images, faces. Reading, night vision.
fluctuation

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8
Q

pathogenesis of age related macular degeneration

A

drusen, new vessel proliferation [wet]
> retinal atrophy
> central retinal degeneration

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9
Q

risk factors for age related macular degeneration

A 
age
smoking
CV disease
FH
cataract surgery
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10
Q

difference in prognosis for wet and dry age-related macular degen

A

dry much slower progression.

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11
Q

causes of optic atrophy [pale disc]

A 
glaucoma
retinal artery occlusion
retinitis pigmentosa
MS
etc.
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12
Q

Mx of macular degen

A

dry - no Tx

wet - Anti-VEGF injections, Photodynamic therapy/laser

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13
Q

causes of dry eyes

A 
reduced secretion from lacrimal gland [age]
sjogren's
mumps
sarcoid
amyloidosis
lymphoma
leukaemia
haemochromatosis
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14
Q

hordeolum externum/ stye. Pathology + Tx

A

lash follicle infection/ abscess.

warm compress several times a day.

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15
Q

give 4 causes of ptosis

A 
Horner's syndrome
3rd nerve palsy
congenital
muscular dystrophy
myasthenia
[oedema, xanthelasma, tumour]
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16
Q

define xanthelasma

A

lipid deposition seen in hyperlipidaemia

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17
Q

what is blepharospasm

A

involuntary contraction of orbicularis oculi, often in response to pain

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18
Q

Mx of blepharospasm

A

botox

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19
Q

give 3 causes of vestibular [peripheral] vertigo and 3 causes of central vertigo

A

peripheral: BPPV, meniere’s, labyrinthitis, vestibular failure
central: acoustic neuroma, MS, head injury, migraine, vertebrobasilar insufficiency

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20
Q

other Sx of vestibular vertigo

A

loss of balance, N+V, hearing loss, tinnitus, nystagmus, sweating

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21
Q

distinguish BPPV, meniere’s, migraine, vestibular failure in terms of duration of vertigo

A

BPPV: seconds-minutes
menieres/migraine: 30 mins to 30 hrs
vestibular failure: 30 hours to 1 week

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22
Q

examinations that are useful in vertigo

A

neuro: cerebellar, reflexes, nystagmus, gait, Romberg’s
ears
hallpike, head thrust

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23
Q

what brings on BPPV sx

A

head turning

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24
Q

what is the pahtology behind BPPV

A

displaced otoconia stimulating the semi-circular canals

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25
Q

mX of BPPV

A

self -limiting

epley manoeuvres

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26
Q

features of meniere’s disease

A 
sudden vertigo 2-4hrs
nystagmus
fullness in ears
tinnitus
SN hearing loss
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27
Q

Ix in meniere’s

A

Electrocochleography

MRI posterior fossa

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28
Q

Mx in meniere’s

A 
Prochlorperazine 
betahistine prophylaxis
surgery
gent through gromet
labyrinthectomy
vestibular neurectomy
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29
Q

sudden attack of unilateral vertigo, vomiting, following URTI. lasting 1-2 days. nystagmus away from affected side. Diagnosis?

A

labyrinthitis [=acute vestibular failure/ vestibular neuritis]

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30
Q

Mx of labyrinthitis

A

reassure self limiting
prochlorperazine [vestibular suppressant]
cyclizine

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31
Q

Sx / features of temporomandibular joint dysfunction

A

earache
facial pain
joint clicking/popping related to teeth grinding
stress

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32
Q

Mx of temporomandibular joint dysfunction

A 
reassurance, analgesia
dental
physio
CBT
[surgery rare]
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33
Q

Ix in head and neck SC carcinoma

A

endoscopy
needle aspiration + biopsy
CT/MRI

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34
Q

risk factors for head and neck squamous cell carcinoma

A 
smoking 
alcohol
HPV
GORD
deprivation
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35
Q

Sx suspicious for head and neck squamous cell carcinoma

A 
neck pain/ lump
hoarse voice >6/52
sore throat >6/52
mouth bleeding
mouth numbness
sore tongue
painless ulcers
patches in the mouth
earache/ effusion
lumps [lip, mouth, gum]
speech change
dysphagia
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36
Q

give 5 causes of stridor

A 
anaphylaxis
croup
laryngitis
epiglottitis
larygomalacia
web/stenosis
intubation
thermal /chemical trauma
hemangioma, papilloma
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37
Q

Mx of laryngotracheobronchitis [croup]

A

dex

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38
Q

Mx points for epiglottitis

A 
keep Pt upright
dont examine throat
get anaesthetist + ENT surgeon
intubate/surgical airway
dex
abx
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39
Q

excessive collapse and indrawing of supraglottic airwaysduring inspiration leading to stridor, breathing + feeding difficulties. Diagnosis?

A

larygomalacia

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40
Q

oropharyngeal carcinoma risk factors

A

male
age
smoking
HPV

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41
Q

typical presentation of oropharyngeal carcinoma

A

smoker with a sore throat, sensation of lump, otalgia

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42
Q

imaging for oropharyngeal carcinoma

A

MRI

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43
Q

Mx for oropharyngeal carcinoma

A

surgery + radio

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44
Q

laryngeal cancer typical presentation

A 
older 
male 
smoker
progressive hoarseness
stridor
dysphagia
Odynophagia
haemoptysis
otlagia

or young HPV

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45
Q

Ix.s in laryngeal cancer

A

laryngoscopy
biopsy
HPV status
MRI staging

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46
Q

Mx of laryngeal cancer

A

radio
laryngectomy
gland dissection

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47
Q

tests for lump in the neck

A 
US
fine needle aspiration cytology
CT
mantoux
virology [HIV/Hep/EBV]
CXR [malignancy/hilar nodes]
biopsy
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48
Q

what problems might cervical ribs [enlarged costal elements of C7] cause?

A

neuro Sx from pressure on brachial plexus

Raynauds - compressing subclavian artery

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49
Q

what are the 3 main pairs of salivary glands and where are they?

A

parotid - side of face in front of ear
submandibular - below jaw in angle of mandible
sublingual - in the floor of the mouth

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50
Q

which cranial nerve would you assess when examining the salivary glands

A

facial

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51
Q

causes of swelling of the parotid gland

A

sjogrens syndrome
mumps, HIV
sarcoid
malignancy

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52
Q

risk factors for salivary gland malignancy

A

smoking

neck radiation

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53
Q

symptoms suggestive of salivary gland malignancy

A 
hard fixed mass
\+/- pain
oveerlying skin ulceration
local lymphadenopathy
no variation on eating [seen in inflammation/stone]
facial nerve palsy
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54
Q

Mx salivary gland malignancy

A

surgery, radio

55
Q

give 4 causes of dry mouth [xerostomia]

A 
hypnotics, tricyclics
antipsychotics
BB
diuretics
mouth breathing
dehydration
ENT radiotherapy
sjogrens
SLE, scleroderma
sarcoidosis
HIV/AIDS
parotid stones
56
Q

causes of pre-lingual deafness other than genetic

A 
intrauterine torch infection
prem
hypoxia
kernicterus
meningitis, enceph
intraventricular hemorrhage
measles, mumps
ototoxic drugs e.g.NSAIDs
trauma
57
Q

indication for cochlear implant

A

children + adults
profound S-N deafness
dont benefit form conventional hearing aid

58
Q

give 4 causes of conductive hearing loss

A

wax/pus/debris/foreign body
developmental abnormalities
drum perf [trauma/ infection]
ossicular chain: Otosclerosis/infection/trauma
inadequate Eustachian tube ventilation [effusion/CA]

59
Q

give 4 causes of sensorineural hearing loss

A 
ototoxic drugs e.g. gent
infection [meningitis]
cochlear vascular disease
meniere's
trauma
presbyacusis
60
Q

give 3 examples of ototoxic drugs

A

gent, vancomycin, streptomycin
chloroquine, hydroxychloroquine
vincristine
cisplatin

61
Q

infections that can lead to sensorineural hearing loss

A 
meningitis
mumps
measles
flu
herpes
syphilis
62
Q

if unilateral sensorineural hearing loss, exclude…

A

acoustic neuroma
cholesteatoma
effusion from CA

63
Q

30 year old pregnant woman presents with bilateral conductive hearing loss, worsening during pregnancy. She has a FH of same problem. She also describes tinnitus and says she sometimes feels the room is spinning. On examination, the drum is tinged pink. What is the diagnosis and how would you manage?

A

otosclerosis

hearing aid or surgery or cochlear implant

64
Q

what is presbyacusis? and what is the Mx?

A

age related
bilateral
high frequency SN hearing loss

hearing aid

65
Q

Ix in sudden sensori neural hearing loss

A 
FBC, ESR/CRP, U+E, LFT, TSH
autoimmune profile
clotting
fasting glucose
cholesterol
audiology
66
Q

causes of subjective tinnitus

A 
presbyacusis
noise induced
menieres
less commonly wax/otosclerosis
ototoxic drugs`
otitis media
^/hypothyroid
DM
MS
acoustic neuroma
trauma
anxiety/depression
67
Q

investigations in tinnitus

A

audiometry
tympanogram
MRI [acoustic neuroma]

68
Q

Mx of tinnitus

A

hearing aid if hearing loss too - mask tinnitus
councelling
sound therapy [fan or music to mask]
CBT

69
Q

give 5 causes of otalgia

A

otitis externa
furunculosis
mailgnant otitis externa
barotrauma

TMJ dysfn.
dental
geniculate herpes
primary glossopharyngeal neuralgia
laryngeal CA
tonsilitis/quinsy
post-tonsillectomy
soft tissue injury to neck
cervical spondy/arth
70
Q

Sx of otitis externa

A

discharge
itch
otalgia
tragal tenderness

71
Q

causes of otitis externa

A 
excess canal moisture
eczema > itching
hearing aids
self-removal of wax
humidity
narrow ear canal
72
Q

chief organism in otitis externa

A

pseudomonas

also, staph A

73
Q

Mx of otitis externa

A

clean ext. auditary meatus
keep ear dry

mild - hydrocort cream to pinna
earcalm spray [antifungal/bact]

moderate - swab, ABx/steroid drops

severe - aluminium acetate wick

74
Q

what is the risk of persistent unilateral otitis externa in elderly/DM/imm.supp.

A

malignant otitis externa

75
Q

describe furunculosis

A

very painful staph abscess arising in a hair follicle within auditory canal

76
Q

Mx of pinna cellulitis

A

oral abx

77
Q

describe malignant otitis externa + usual organism

A

agressive life-threatening infection of the external ear that can lead to temporal bone destruction, osteomyelitis

pseudomonas

78
Q

Mx malignant otitis externa

A

surgical debridement
systemic Abx
Ig

79
Q

give 4 causes of damage to the 8th cranial nerve

A 
brainstem CVA
noise damage 
pagets disease
menieres
herpes
acoustic neuroma
drugs [gent]
80
Q

differnetials for a sore thrtoat

A

tonsilitis or pharyngitis:

viral - common cold [rhino/coronovirus], flu, adenovirus, herpes simplex, EBV

bacterial -group A strep, Hib [epiglott]

81
Q

Mx of sore throat

A

PCM/ibuporofen, reassurance
difflam
centor 3+ = pen V

82
Q

give 3 complications of tonsilities

A 
sinusitis
otitis media
peritonsilar abscess [quinsy]
parapharyngeal abscess
lemierre syndrome
83
Q

how does quinsy present and what is the Mx

A

sore throat, dysphagia, peritonsillar bulge, uvular deviation, trismus, muffled voice

Abx, aspiration

84
Q

differentials for unilateral tonsilar enlargement

A

peritonsillar/ parapharyngeal absess > shift

malignancy

85
Q

what causes scarlet fever

A

exotoxins produced released from strep pyogenes [groupA beta haem strep]

86
Q

typical presentation of scarlet fever

A

red pin prick blanching rash on chest, axillae, behind ears
facial flushing, circumoral pallor, strawberry tongue
12-48 h after sore throat + fever

87
Q

Mx of scarlet fever

A

pen V

88
Q

indication for tonsillectomy

A

7 documented disabling episodes in last yr, or 5/yr for 2 yrs, or 3/yr for 3yrs

malignancy or child w/ Obstructive sleep apnoea

89
Q

complications of tonsilectomy

A 
prim haemorrhage
secondary haem (>24hrs) due to infection
90
Q

sX of chronic rhinosinusitis with nasal polyps

A 
watery anterior rhinnorhoea
sneezing
purulent postnasal drip
nasal obstruction
sinusitis
moutoh breeathing
snoring
headache
91
Q

mx of chronic rhinosinusitis with nasal polyps

A

topical betamethasone
?longterm doxy
surgery

92
Q

Mx of chronic rhinosinusitis without nasal polyps

A

intranasal steroid
nasal saline irrigation
[abx if not imprving]
CT > suregry

93
Q

mx of allergic rhinosinusitis

A 
allergen avoidance
nasal saline irrigation
antihist
if persistent, intranasal steroid spray
short course pred
94
Q

causes of ear discharge

A

otitis externa/media
cholesteatoma
CSF leak following trauma

95
Q

presentation of otitis media

A 
rapid onset
pain [bulging of tymp.mem]
fever
irritability
anorexia
vomioting
often post-urti
purulent discharge
96
Q

Mx of otitis media

A

analgesia

amoxi if systemically unwell/ imm.comp./ >4days

97
Q

complications of otitis media

A 
glue ear
chronic otitis media [perf, recurrent infections]
mastoiditis
petrositis
labyrinthitis
facial palsy
meningitis
intracranial abscess
98
Q

what is otitis media with effusion/ glue ear?

A

effusion present after regression of Sx of otitis media

99
Q

sx of chronic otitis media

A

hearing loss
ottorhoea
fullness
otalgia

100
Q

Mx of chronic otitis media

What is a complicaiton of chronic otitis media?

A

topical/ systemic Abx
cleaning
keep dry
surgery - myringoplasty [repair drum]

cholesteatoma

101
Q

complications of cholesteatoma

A 
meningitis
cerebral abscess
hearing loss
mastoiditis
facial nerve dysfn.
102
Q

mx of cholesteatoma

A

mastoid surgery

103
Q

define mastoiditis

A

destruction of air cells +/- abscess formation following middle ear inflamm

104
Q

signs of mastoiditis

A

tenderness, swelling and redness behind the pinna
fever
protruding auricle

105
Q

whta imaging and what Mx for mastoiditis

A

CT

IV ABx, surgery

106
Q

risk factors for otitis media

A 
URTI
bottle feeding
passive smoking
adenoids
asthma
malformations e.g. cleftpalate
GORD
^BMI in adults
107
Q

why investigate hoarseness of >3 months?

A

because it is the chief [and often only] symptom of layngeal carcinoma

[especially in smokers!]

108
Q

differentials for hoarseness give 4

A 
viral URTI
laryngeal carcinoma
GORD
vocal cord palsy
laryngitis
reinke's odema
vocal cord nodules
stress
singing/shouting/overuse
109
Q

causes of layrngitis

A

viral
bacterial
secondary to gORd
secondary to RA

110
Q

hypothyroid elderly female smoker complains of deep gruff voice, says she sounds like a man. Diagnosis?

A

Reinke’s oedema [chronic cord irritation -> enlargement]

111
Q

causes of laryngeal nerve palsy

A

CA - larynx, thyroid, oesoph, hypopharynx, bronchus

iatrogenic - parathyroidectomy, oesophageal/pharyngeal pouch surgery

TB

aortic aneurysm

112
Q

Ix in laryngeal nerve palsy

A

CXR
CT
+/- US thyroid
+/- OGD

113
Q

risk factors for glue ear

A 
parental smoking
male
downs, cleft palate
winter
atopy
primary ciliary dyskinesia
114
Q

presentation of otitis media with effusion in children

A 
hearing loss noticed by parents
poor speech, language delay
ear infections, URTIs
poor behavior
balance problems
school problems
115
Q

what might you see on otoscopy in glue ear

A 
[variable]
retracted  or bulging drum
dull, grey, yellow
bubbles/fluid level
superficial radial vessels
reduced mobility with pneumatic attachment
116
Q

otitis media w/ effusion Mx

A

autoinflation of eustacian tube

grommets

117
Q

main complications of gromets

A

infection

tympanosclerosis

118
Q

mx of gromet infection

A

aural cleaning
topical Abx/steroid ear drops
gromet removal may be needed

119
Q

post op Mx of gromet/ advice

A

ok to swim but avoid diving + ear plug

gromet will extrude after 3 to 6 months, then recheck hearing

a quarter need re-insertion

120
Q

where do acoustic neuromas arise from

A

superior vestibular nerve schwann cell layer

121
Q

sx of acoustic neuroma

A 
progressive ipsilateral tinnitus
sensorineural deafness
cerebellar signs + ^ICP signs if large
giddy [vertigo rare]
numb face [trigeminal]
CN V/VI/VII may be affected
122
Q

why sensorineural hearing loss in acoustic neuroma

A

cochlear nerve compression

123
Q

differential for acoustic neuroma

A

meningioma

124
Q

Mx of acoustic neuroma

A

surgery

125
Q

Mx of epistaxis

A

ABCDE

Pt pinch soft part of nose + sit forward
ice pack on bridge

silver nitrate cautery [1st - cotton ball soaked in adrenaline 2 mins / lidocaine spray]

nasal pack - anterior then postnasal

126
Q

serious posterior epistaxis Mx

A 
anaesthesia
diathermy
pack
arterial ligation
embolisation [stroke risk]
127
Q

advice to Pt after nosebleed

A 
dont pick
dont blow
direct sneeze through open mouth
avoid bending, lifting, straining
no hot food/drink

if restarts - pinch soft bit + ice to bridge

128
Q

Mx of septal haematoma in nasal injury

A

incision and drainage

129
Q

casues of facial palsy, give 4

A 
brainstem tumour
stroke
MS
acoustic neuroma
meningitis

otitis media
ramsay hunt syndrome
cholesteatoma

parotid tumour
trauma

lyme disease
sarcoid
DM
bells palsy

130
Q

facial palsy, iX

A 
ESR
glucose
lyme disease serology
examine parotid for lumps
examine ears for cholesteatoma/ramsay hunt 
MRI
131
Q

give 2 things that ^risk of bells palsy [idiopathic facial palsy]

A

pregnancy

DM

132
Q

Tx of bells palsy

A

pred

lubricate eye with drops

133
Q

common causes of bilateral facial palsy

A 
lyme disease
GBS
leukaemia
sarcoidosis
EBV
trauma
myasthenia gravis
134
Q

how do you differentiate facial palsy of stroke and bells

A

stroke is forehead sparing

3B GH (16 decks)

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