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Finals > ENT > Flashcards

ENT Flashcards

1
Q

When to give ABX in otitis media?

A

Symptoms >4 days
Systemically unwell
<2 years and bilateral
Perforation or discharge

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2
Q

ABX in otitis media?

A

5/7 amoxicillin or erythro/clarithro if allergic

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3
Q

Usual course of otitis media?

A

3 days but up to 1 week

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4
Q

Malignant otitis externa?

A

Unremitting pain and fever >39 Granulation tissue or bone seen near ear canal. Facial nerve paralysis

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5
Q

Achalasia presentation?

A

Dysphagia to both liquids and solids, can be pain on eating and heartburn

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6
Q

A barium swallow which shows a grossly expanded oesophagus that tapers at the lower oesophageal sphincter - what is this?

A

Achalasia

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7
Q

What can you give if pt cant take oral levodopa but needs something for acute symptoms

A

Dopamine agonist patch

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8
Q

Otitis media signs and symptoms?

A

otalgia, preceding URTI, bulging membrane, myringitis(erythema of membrane)

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9
Q

Acute otitis externa presentation?

A

presence of rapid onset (generally within 48 hours) of symptoms within the past 3 weeks, coupled with signs of ear canal inflammation

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10
Q

Most common organisms for otitis externa?

A

Pseudomonas or staph

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11
Q

Webers test localises to right hand side. Rinnes test is negative (bone>air) on right hand side what type of deafness?

A

Right conductive

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12
Q

If bone conduction is better than air conduction which deafness?

A

Conductive

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13
Q

Webers localises to right, rinnes positive (Air>bone) on right what deafness?

A

Left sensorineural

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14
Q

If air better than bone conduction what result is this ?

A

Normal but if webers lateralised to that side it is sensorineural of the other side

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15
Q

Webers localises to the left hand side , rinnes is positive on left (air>bone)?

A

Right sensorineural

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16
Q

Right conductive loss what test results?

A

Webers localises to the right, rinnes is negative (bone>air)

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17
Q

Left sided webers test and negative rinnes on this side, ? loss

A

Conductive loss on left

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18
Q

Transilluminant cyst in posterior triangle neck?

A

Cystic hygroma

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19
Q

Haemorrhage 5-10 days after tonsillectomy with fever what to do?

A

Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with antibiotics

Admit

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20
Q

Persistent unexplained hoarseness in a patient aged >45 years old

A

Urgent referral to ENT

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21
Q

Visible haematuria when to refer?

A

> 45

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22
Q

Non visible haematuria with dysuria or white cell count when to refer?

A

If over 60

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23
Q

Sudden and near complete loss of vestibular loss in a young person?

A

Vestibular neuronitis

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24
Q

Vestibuloneuronitis hearing changes?

A

None

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25
Q

Bilateral conductive hearing loss in young person?

A

Otosclerosis- family history present

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26
Q

What would make you think that an epistaxis was posterior rather than anterior?

A

Bleeding from both nostrils, profuse and cannot be found on nasal speculum

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27
Q

What to consider giving if nose bleed stops on its own?

A

Naseptin to prevent infection and crusting (vestibulitis)

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28
Q

When to consider cautery of nose bleed?

A

If can see spot, small area and does not stop after 10-15mins

29
Q

Consider nasal packing if?

A

Cautery unsuccessful or cannot see area of bleeding

30
Q

How often need tetanus?

A

Every ten years or so

31
Q

Clear unilateral leakage from nose think what?

32
Q

Imaging in nasal trauma/fracture?

A

Avoid as does not usually add to management

33
Q

When to refer nose trauma to ENT?

A

Haematoma
marked deviation
Widened intracanthal distance
Facial anaesthesia

34
Q

Nasal irrigation for what conditions?

A

Sinus, post nasal drip, allergic rhinitis

35
Q

First line treatments for rhinitis (allergic)?

A

Intranasal antihistamine or oral antihistamine such as loratadine ( slower onset)

36
Q

First line options for allergic rhinitis not working what to consider?

A

Steroid spray during allergen exposure eg fluticasone

benefit takes up to 2 weeks of use

37
Q

Very severe allergic rhinitis and disabling?

A

Short course of oral steroid

38
Q

When should sinusitis be seen in hospital?

A

Very severe systemic infection, orbital cellulitis, and reduced vision.
Swelling over frontal bones or meningism

39
Q

Sinusitis how long for symptoms before ABX? How long to start to get better?

A

10 days, usually get better within 2-3 weeks

40
Q

Decongestants and antihistamines in sinusitis?

A

No evidence

41
Q

Sinusitis symptoms for 10+ days and NO improvement consider?

A

High dose nasal steroid 200micrograms mometasone

42
Q

ABX for sinusitis?

A

Pen VK 500mg QDS 5/7
Or co-amox if bad!
Or doxy or clarithro if pen allergic

43
Q

Polyps when to refer?

A

Unilateral or bleeding etc diagnosis unclear, poor response to steroids

44
Q

Associations with nasal polyps?

A

Aspirin, CF, Churg strauss (eosiniphillic)

45
Q

Are nasal polyps allergic in nature?

46
Q

Carbimazole user presents with sore throat?

A

Stop drug check FBC urgently

47
Q

Alternative to Pen VK for tonsillitis?

A

Clarithro,

48
Q

What is the Fever PAIN score

A 
Fever in last 24hrs
Purulence
Attend rapidly 3/7
Inflamed
No cough
>4 prescribe
49
Q

Centor criteria?

A

Exudate, Lymph nodes
Fever >38
Absence of cough 3 or 4 consider prescribing

50
Q

Epiglottisis diagnosis?

A

‘tripod’ position of the patient, drooling, high fever, and a toxic appearance.
muffled voice and stridor

51
Q

Risks for epiglottitis?

A

Non vaccination HiB, middle age

52
Q

Important measure in acute epiglottitis?

A

Laryngoscopy and possibility of securing airway, can do lateral neck Xray

53
Q

Oral tumour likely type?

54
Q

Strongest risk for oral cancer?

A

Alcohol and smoking history, but HPV infection strongly implicated in non smokers/drinkers

55
Q

Red flags for trigeminal neuralgia?

A

Sensory change, desfness, skin or oral lesions, pain in ophthalmic division
optic neuritis
MS history
Onset <40years

56
Q

Trigeminal neuralgia symptoms?

A

Severe shock like pain in trigeminal nerve distribution- usually jaw or cheek

Unilateral usually
Short lived
recurrent
episodic

Cold air and light touch to face can provoke (occasional autonomic features)

57
Q

First line treatment for trigeminal neuralgia?

A

Titrate up carbamazepine arrange follow up

58
Q

Carbamazepine not tolerated or ineffective?

A

Refer do not offer other drugs

59
Q

Carbamazepine and oral contraceptive and DOACS?

A

Possibly makes ineffective

60
Q

Carbamazepine does what to CYP450

61
Q

CRAPGPS something me to rage what drugs?

A

Induce me

Carbemazepines Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbitone Sulphonylureas

62
Q

vertigo: not triggered by movement but exacerbated by movement
nausea and vomiting
hearing loss: may be unilateral or bilateral ?

A

Labyrinthitis - note hearing loss as opposed to non in vestibular neuronitis

63
Q

spontaneous unidirectional horizontal nystagmus towards the unaffected side
sensorineural hearing loss: shown by Rinne’s test and Weber test what could cause this?

A

Labyrinthitis

64
Q

Extra luminal causes of dysphagia?

A

Spondylosis and mediastinal mass

65
Q

Mechanical causes of dysphagia?

A

Malignancy, strictures, web, pharyngeal pouch

66
Q

Neuromuscular causes of dysphagia?

A

Achalasia, Spasm and myasthenia gravis

67
Q

All patients who present with difficulty swallowing do what?

A

Upper GI endoscopy may need a barium swallow too

Undertake an FBC

68
Q

Neuro causes of dysphagia?

A

Stroke, parkinsons, MS

Finals (16 decks)

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