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Medicine > ENT > Flashcards

ENT Flashcards

1
Q

What is the usual causative organism in malignant/necrotising otitis externa?

A

Pseudomonas aeruginosa

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2
Q

Name the 2 main organisms involved in otitis externa

A

Pseudomonas and staph aureus

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3
Q

What is the pathophysiology behind a cholesteatoma?

A

TM perforation can happen in chronic otitis media. This leads to prolonged low middle ear pressure –> retraction pocket of pars tensa or flaccida –> enlarges, squamous epithelium builds up –> cholesteatoma

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4
Q

How does the discharge look in chronic otitis media?

A

Bloody, serous discharge

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5
Q

What is the treatment for cholesteatoma?

A

Mastoid surgery

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6
Q

You suspect CSF otorrhea - how can you confirm this?

A

Halo sign, increased glucose, B2 Tau

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7
Q

What imaging should you do for someone with suspected mastoiditis?

A

CT

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8
Q

What treatment should be given to someone with mastoiditis?

A

IV Abx, myringoplasty (hole in TM to relieve pressure), mastoidectomy

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9
Q

What infections can cause non-genetic deafness in utero?

A

CMV, rubella, toxoplasmosis, HSV, Syphilis

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10
Q

What is the pathophysiology behind otosclerosis?

A

New bone forms around the stapes footplate which leads to its fixation

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11
Q

Name some ototoxic medications that can lead to sensorineural deafness?

A

Streptomycin, vancomycin, gentamycin, chloroquine and hydroxychloroquine, vinca alkaloids

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12
Q

What is the head thrust used for?

A

It is a provocation test to elicit the symptoms of vertigo

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13
Q

What is the Dix-Hallpike test?

A

It is a provocation test to elicit the symptoms of vertigo

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14
Q

How do you carry out the Dix-Hallpike test?

A

Move pt quickly from sitting position to lying supine position w/ head turned to one side & extended over the end of the bed—look for nystagmus & ask about vertigo

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15
Q

Name 4 peripheral causes of vertigo

A

1) Meniere’s (episodic)
2) BPPV (few secs/mins)
3) Vestibular failure
4) Labyrinthitis (prolonged >24 hours)

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16
Q

Name 5 central causes of vertigo

A

Acoustic neuroma, MS, head injury, migraine, vertebrobasilar insufficiency

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17
Q

Which drugs can cause tinnitus?

A

Loop diuretics, tricyclics, aminoglycosides, aspirin, NSAIDs

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18
Q

How would the ear canal look in otitis externa?

A

Swollen narrow canal with discharge/ flaking skin.

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19
Q

How do you treat acute otitis externa?

A

Abx-steroid drops

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20
Q

How do you treat chronic otitis externa?

A

Anti-fungal steroid drops

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21
Q

How do you treat acute otitis media?

A

Oral Abx

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22
Q

How do you treat otitis media with effusion AKA glue ear?

A

Observe for 3 months as many resolve. May require tympanostomy AKA grommet

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23
Q

What does a blue X represent on pure tone audiogram?

A

Left, air conduction

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24
Q

What does a blue I represent on pure tone audiogram?

A

Left, bone conduction

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25
Q

What does a red X represent on pure tone audiogram?

A

Right, air conduction

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26
Q

What does a red I represent on pure tone audiogram?

A

Right, bone conduction

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27
Q

What does impedance audiogram measure?

A

Detects pressure changes in middle ear
Verifies state of TM
Assesses acoustic reflex pathways

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28
Q

What does tympanometry measure?

A

Measures sounds reflected from the TM as Dr adjusts pressure of air in air canal

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29
Q

What is the Jerger system?

A

It is used in impedance audiogram as a way of describing results

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30
Q

In the Jerger system, what does a Type A result mean?

A

Normal pressure in the middle ear

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31
Q

In the Jerger system, what does Type B result with a normal ear canal volume suggests?

A

Otitis media

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32
Q

In the Jerger system, what does Type B result with a small ear canal volume suggests?

A

Wax or debris occluding the ear canal

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33
Q

In the Jerger system, what does Type B result with a large ear canal volume suggests?

A

Hole in the tympanic membrane

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34
Q

In the Jerger system, what does Type C result mean? What diagnoses may this result point towards?

A

Negative pressure in the middle ear

Could be otitis media or Eustachian tube dysfunction

35
Q

What is the House-Brackmann scale used for?

A

To assess facial nerve function

36
Q

What does II on the House-Brackmann scale mean?

A

There is slight weakness

37
Q

What does III on the House-Brackmann scale mean?

A

Non-disfiguring weakness

38
Q

What does IV on the House-Brackmann scale mean?

A

Disfiguring weakness

39
Q

What does V on the House-Brackmann scale mean?

A

Minimal movement with asymmetric resting tone

40
Q

What does VI on the House-Brackmann scale mean?

A

Asymmetric

41
Q

Name 2 red flags that suggest a nasal tumour

A

Unilateral epistaxis, facial swelling

42
Q

What is the first step in the management of epistaxis?

A

Get patient to pinch the lower part of their nose for 20 minutes. Sit forward. Put an ice pack on the dorsum of the nose.

43
Q

Get patient to pinch the lower part of their nose for 20 minutes. Sit forward. Put an ice pack on the dorsum of the nose - FAILED, NEXT STEP?

A

Ask patient to blow out any clots and cauterize with silver nitrate

44
Q

Ask patient to blow out any clots and cauterize with silver nitrate - FAILED, NEXT STEP?

A

Apply a cotton ball soaked in adrenaline or local anaesthetic spray for 2 minutes.

45
Q

Apply a cotton ball soaked in adrenaline or local anaesthetic spray for 2 minutes. FAILED, NEXT STEP?

A

Advance an anterior nasal pack horizontally into the nose

46
Q

Which 4 vessels makes up Little’s area AKA Kiesselbach’s plexus?

A
  • Anterior ethmoidal artery
  • Sphenopalatine artery
  • Greater palatine artery
  • Superior labial artery
47
Q

What 3 steps may you do for a posterior nose bleed?

A

1) EUA
2) Endoscopic ligation of artery
3) Embolisation of an artery (risk of stroke so only do if it will be life-saving)

48
Q

A patient presents to GP with significant nasal deviation due to trauma - what should you do?

A

Refer him to ENT within 7-10 days of the injury

49
Q

A patient is sad cos they have broken their nose - if needed, when should their nose be reduced? How long does it normally take for fractured nasal bones to heal?

A

In adults, nasal fracture reduction should happen within 5-10 days of the injury
It usually takes 2-3 weeks for fractured nasal bones to heal

50
Q

What is the main cause of bacterial sore throats?

A

Group A B-haemolytic streptococci

51
Q

List 2 features that would suggest the cause of a sore throat is viral?

A

If coryza (rhinitis/ common cold) and a cough is present

52
Q

What is a quinsy, in whom does it tend to occur and how does it present?

A

Peritonsilar abscess. Usually occurs in adults. Presents as a unilateral swelling, difficulty swallowing, trismus (difficulty opening jaw).

53
Q

How do you treat a quinsy?

A

IV Abx and incision drainage

54
Q

In whom does a retropharyngeal abscess present in, how does it present, what is the treatment?

A

Children.
Inability to swallow and fever.
IV Abx +/- incision and drainage

55
Q

What investigation would you do in a patient presenting with hoarseness?

A

Laryngoscope to assess vocal cord mobility and inspect mucosa.

56
Q

What diagnosis does a ‘weak, breathy’ voice point towards? The patient is also coughing/aspirating

A

Vocal cord palsy

57
Q

What treatment might you do in someone with a unilateral recurrent laryngeal nerve palsy?

A

May need medialisation of the vocal cords via injections.
Can also do thyroplasty (alters position/length of vocal cords).
Reinnervation techniques possible.

58
Q

Where would you find a branchial cyst?

A

It is a smooth swelling in front of the anterior border of SCM

59
Q

How does a thyroglossal cyst present?

A

Painless, smooth, cystic midline lump. Can become tender if inflamed.

60
Q

What neck lump rises when you get the patient to stick their tongue out?

A

Thyroglossal cyst

61
Q

Which gland do salivary gland stones form in most commonly?

A

Submandibular duct system

62
Q

A man presents with a history of salivary gland stones. He comes in with pain and swelling on eating. What might have happened here?

A

Stricture formation

63
Q

What do you use to image foreign bodies in the lungs?

A

Rigid bronchoscopy

64
Q

How may a foreign body in a child’s nose present?

A

May present late with a history of persistent offensive discharge from 1 nostril

65
Q

How should you manage a child with a foreign body in their nose?

A
  • Use topical anaesthetic and vasoconstrictor
  • Blow through the mouth whilst obstructing the unaffected nostril
  • Use nasal speculum and forceps
  • Use strong suction
  • Use a balloon catheter
66
Q

Which branch of the facial nerve is responsible for lacrimation?

A

Greater petrosal nerve

67
Q

Which branch of the facial nerve has been lesioned in a patient who complains of heightened sensitivity to sounds?

A

Branch to stapedius - lesions leads to hyperacusis

68
Q

What does the chorda tympani do?

A

Provide taste to the anterior 2/3rds of the tongue

69
Q

What treatment would you offer patients with Bell’s Palsy?

A

Prednisolone and eye drops

70
Q

When would you consider prescribing someone with acute rhinosinusitis (common cold) intranasal steroids (e.g. mometasone)?

A

If symptoms persist over 5 days.

71
Q

How long must rhinosinusitis be present before it is considered ‘chronic’?

72
Q

How would you treat chronic rhinosinusitis without polyps?

A

Intranasal corticosteroids and nasal saline irrigation.

If no improvement after 4 weeks, culture and give long-term Abx

73
Q

Where is the most common site for nasal polyps?

A

Middle meatus

74
Q

What could happen if a benign maxillary polyp prolapses to fill the nasopharynx?

A 
Watery anterior rhinorrhoea
Sneezing 
Purulent postnasal drip 
Nasal obstruction 
Sinusitis 
Mouth-breathing, snoring
Headaches
75
Q

Describe a polyp

A

Pale, mobile and insensitive to gentle palpation

76
Q

Describe a turbinate

A

Pink, mobile and sensate

77
Q

What are the treatment options for nasal polyps?

A
  • Betamethasone drops
  • Long-term antibiotics
  • Endoscopic sinus surgery
78
Q

What are the treatment options for allergic rhinosinusitis?

A
  • Nasal saline irrigation
  • Antihistamines
  • If moderate: Intranasal corticosteroid sprays
  • Short-term prednisolone
  • Immunotherapy
79
Q

What is Samter’s triad?

A

Asthma, aspirin sensitivity, sinus inflammation with recurring nasal polyps

80
Q

What may Pott’s puffy tumour be a complication of?

81
Q

What treatment may be needed for a CSF leak due to an ethmoid fracture?

A

Patient should have 7 - 10 days of bed rest with their head elevated +/- lumbar drain
Surgery is often not needed
Cover with Abx and pneumococcal vaccine

82
Q

How do septal perforations present?

A

They irritate, whistle, crust and bleed.

83
Q

What are the treatment options for septal perforations?

A

Saline nasal irrigation
Petroleum jelly to edge of perforation
Septal prosthesis
Septoplasty corrects a deviated nasal septum

Medicine (15 decks)

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