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Medicine > ENT > Flashcards

ENT Flashcards

1
Q

What are 3 important complications of neck surgery?

A

Recurrent laryngeal nerve palsy (hoarseness: unilateral)
Bleeding (haematomas can rapidly cause respiratory compromise due to laryngeal oedema in confined space)
Damage to parathyroids (hypocalcaemia)

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2
Q

Management of acute otitis media

A

Analgesia
Amoxicillin if over 48h
Average duration about 4 days

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3
Q

Mx Eustachian tube dysfunction

A

Regular warm drinks +/- decongestants

Steroid nasal spray

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4
Q

Mx otitis externa

A

Keep dry

Abx ear drops/ spray

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5
Q

Mx perforated ear drum

A

Consider amoxicillin 1 week, refer if not improving (2-6 weeks)

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6
Q

Mx temoromandibular joint pain

A

analgesia, reassurance, relaxation

dentist if persists

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7
Q

Red flags for tinnitus

A

Unilateral
Head injury/ evidence of raised ICP
Suicidal ideation: chronic tinnitus is risk factor

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8
Q

Mx suspected dental abscess

A

See dentist
5-7 days amox if suspect abscess/ root canal infection
Add metronidazole if severe infection suspected

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9
Q

What is the FeverPAIN score?

A

Likelihood of strep infection causing tonsillitis:

Fever
Purulence
Attend within 3 days
Inflamed tonsils ++
No cough/ coryzal sx
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10
Q

Abx for strep throat

A

Pen V

reduces symptoms by 1 day!

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11
Q

Referral for tonsillectomy criteria

A

7 in 1 year
5 per year for 2 years
3 per year for 3 years

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12
Q

Most common bug causing otitis externa

A

Pseudomonas (swimmer’s ear) - can be other bacteria or herpes

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13
Q

Signs otitis externa

A

Otalgia
Swelling/ erythema: external ear, ear canal
Pain on manipulation of auricle
Debris in canal/ otorrhea

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14
Q

Mx otitis externa

A

KEEP EAR DRY
Mild: cleaning, dilute ascetic acid drops
Most: topical abx

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15
Q

What is malignant otitis externa?

A

Fulminant bacterial otitis externa

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16
Q

Who tends to get malignant otitis externa?

A

elderly with DM (doesnt seem to affect others with immunosuppression)

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17
Q

Which bug commonly causes malignant otitis externa?

A

Pseudomonas aeruginosa

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18
Q

Signs of malignant otitis externa

A

Classic feature: nub of granulation tissue on floor of external ear canal at bony-cartilaginous junction

Severe pain - excessive purulent d/c - maybe exposed bone

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19
Q

Mx malignant otitis externa

A

Monitor DM
extensive debridement
IV abx

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20
Q

Complications malignant otitis externa

A

Invasion of surrounding tissue to produce cellulitis
Osteomyelitis of temporal bone
Mastoiditis

Later: facial nerve palsy, meningitis, brain abscess

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21
Q

What does CT show in malignant otitis externa?

A

temporal bone erosion and inflammation

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22
Q

What tumours mos commonly form on the ear/ ear canal?

A

SCC

Sometimes BCC/ melanoma

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23
Q

Mx perf ear drum

A

Keep dry
Use systemic abx if signs of infection/ contamination
otherwise, most heal spontaneously

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24
Q

What is a cholesteatoma?

A

Epidermal inclusion cyst of the middle ear/ mastoid, containing desquamated keratin debris (may be acquired or congenital)

25
Q

Complications of cholesteatomas

A

Ossicular erosion (conductive hearing loss)
local invasion, causing vertigo and sensorineural hearing loss
facial paralysis
CNS dysfunction/ infection

26
Q

Mx cholesteatoma

A

surgery aiming to reconstruct ossicular chain

27
Q

Microbe causes of acute otitis media

A

usually Strep pneumoniae (33%)
H. influenzae
other shit

28
Q

Inheritance of otosclerosis

A

AD

29
Q

What kind of signs in otosclerosis?

A

Conductive hearing loss with normal TM

Schwartze’s sign: erythema around stapes from hypervascularity

30
Q

Most common causes of sensorineural hearing loss

A

PRESBYCUSIS - leading cause
acoustic injury from loud noises
congenital (TORCHES: maternal toxoplasmosis, rubella, MMV, herpes, syphilis)

In kids, most common cause is bacterial meningitis

31
Q

Anterior epistaxis vessels

A

Kiesselbach’s plexus (more common ~90%, usually associated with trauma)

32
Q

Posterior epistaxis vessels

A

Sphenopalatine artery (elderly, HTN, tumour, anticoag)

33
Q

Mx epistaxis
Anterior packing for epistaxis
Posterior packing
Next steps

A

ABCDE
Pressure, head forward
A: gauze strips
P: Foley catheter

Silver nitrate (need LA, stings)
Embolisation or ligation of arteries
34
Q

Early + late signs nasal ca

A

Early: nasal obstruction, blood-tinged mucus, epistaxis

Late: localised pain, cranial nerve deficits, facial/ palate asymmetry, loose teeth

35
Q

Complications of tonsillitis

A

Peritonsillar abscess (quinsy)
Retropharyngeal abscess (causing airway compromise)
Rheumatic fever
Post-strep GN

36
Q

Signs of quinsy

A

fever, odonophagia, hot potato voice
cervical lymmphadenopathy
Bulging, erythematous tonsillar pillar
swelling of the uvula and displacement

37
Q

Mx quinsy

A

IV abx

surgical excavation

38
Q

Which salivary glands most commonly involved in pathology

A

Parotid and submandibular

Sublingual rarely affected

39
Q

Which glands commonly affected by calculi?

A

Submandibular

40
Q

How does calculi present?

A

Pain before and during eating

41
Q

How is calculi confirmed?

A

can maybe palpate
duct may be erythematous with purulent d/c
visible on x-ray

(mx by excising)

42
Q

Signs and symptoms of mandibular fracture?

A

Pain!
Disfigurement, malocclusion
lacerations of gingiva
haematoma in floor of mouth

43
Q

Which nasal fractures need to go to theatre?

A

Septal haematoma: boggy painful bilateral swelling which is compressible
cartilage can become ischaemic leading to saddle nose (cartilage loss)

44
Q

How many parathyroid glands?

A

4

45
Q

Common tumour marker for parathyroid carcinoma

A

beta-HCG

46
Q

Signs suggesting parathyroid carcinoma

A

palpable mass + hypercalcaemia + PTH

47
Q

Describe thyroglossal cyst

A

Mid-line, under hyoid bone
Connected to base of tongue
Cyst may become infected or dscharge

48
Q

Why is radioiodine uptake necessary before removing thyroglossal cyst?

A

May contain some/ all thyroid tissue

49
Q

Rule of 80 re neck lumps

A

80% in children are benign

80% in adults over 40 are malignant

50
Q

What is branchial cyst?

A

congenital abnormality - usually not apparent until adult life when an infection may precipitate problems

upper anterior border of SCM

mx aspiration (contains cholesterol crystals)

51
Q

What level of hearing is normal on audiogram

A

anything above 20 dB

52
Q

mx sinusitis

A

steroid spray

abx only if systemically unwell

53
Q

causes of conductive hearing loss

A

wax, perf, OmE, Eustachian tube blockage

54
Q

BPPV test and mx

A 
Dix-Hallpike = test
Epley = mx
55
Q

Sx BPPV

A

seconds of dizziness, usually due to moving head
no hearing loss
no tinnitus

56
Q

Sx acute labyrinthitis

A

sudden onset vertigo
can be severe with N&V
no hearing loss
no tinnitus

57
Q

Sx menieres

A

progressive

vertigo with nausea, tinnitus, progressive hearing loss, ear fullness

58
Q

acoustic neuroma sx

A 
unilateral hearing loss 
vertigo
focal deficits
sx raised ICP
associated with neurofibromatosis type 2

Medicine (30 decks)

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