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My Final Year 4 Revision > ENT > Flashcards

ENT Flashcards

1
Q

I’ve been told I was going deaf…

A

It was very difficult to hear

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2
Q

Ok I’ll stop…

A

These jokes are too ear-itating

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3
Q

Back to the flash cards…

A

Ear we go!

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4
Q

What symptoms are related to the nose?

A 
Obstruction 
Rhinorrhoea
Hyposmia 
Epistaxis
Facial pain

-also sneeze, post nasal drip

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5
Q

What symptom are related to the ear?

A 
Earache 
Ear discharge 
Hearing loss 
Tinnitus 
Dizziness
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6
Q

What symptoms are related to the throat?

A 
Dysphagia 
Odynophasia 
Hoarseness
Sore throat 
Regurgitation
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7
Q

What can cause otalgia not in the ear?

A

Pharynx
Dental infections
TMJ

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8
Q

What differential are there for otorrhoea?

A

Acute otitis externa
Cholestoma
Impacted wax
Acute otitis media -rarer

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9
Q

RF for otitis externa?

A

Skin conditions

instrument insertion or water into canal

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10
Q

Wha tis first line for otitis externa?

A

Oral analgesia
keep ear dry
swab ear
Topical abs + steroid

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11
Q

What complications are there of otitis externa

A

Osteomyelitis

Canal stenosis

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12
Q

Ear drum perforation management.

A

Conservative - 6w wait until referral to ENT
Medical - Topical Abx if infection
Surgical - myringoplasty

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13
Q

What are the symptoms of a cholesteoma?

A

Discharge
Otalgia
Conductive hearing loss
Off balance

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14
Q

What is glomus jugular?

A

A paragangioma - a benign growing tumour

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15
Q

How should a cholestoma be investigated?

A

Microscopy
Treat infection
Pure tone audiogram

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16
Q

What imaging is used for planning ENT surgery?

A

Usually CT over MRI

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17
Q

What surgical treatment is there for cholestoma?

A

Mastoidectomy

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18
Q

Red flag symptoms for H&N cancers?

A

6w hx of hoarsenes

3w hx of swelling, dysphagia, nasal obstruction, neck mass

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19
Q

What to ask with a dysphonia?

A

Smoking
Alchohol
Infection - EBV, HPV
GORD

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20
Q

What features of a thyroid lump would suggest a malignancy?

A

Child
Red flags - hoarseness, stridor
Rapidly enlarging mass and cervicle lymph nodes

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21
Q

What happens to TFT with a thyroid malignancy?

A

TFTs are usually normal

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22
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma

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23
Q

What must be explained in order for a patient to give consent to a procedure?

A

Explanation of procedure
Intended benefits
Risks
Alternative treatment

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24
Q

What can cause enlarged turbinates with inflammation on nasal examination?

A

GPA
Chronic rhinosinusitis without polyps
Sarcoidosis

25
Q

What investigations should be done for Chronic rhinosinusitis?

A

RAST testing for allergies

26
Q

How is rhinosinusitis treated

A

Topical nasal steroid + saline nasal irrigation.

Antihistamine with allergy

27
Q

How are nasal polyps treated?

A

Medical - Topical and oral steroids

Surgical - if recurrent

28
Q

Questions about neck lumps

A

DurationChange in sizeAssociated features- pain, redness, dischargeLumps elsewhere Preceding symptoms Recent travel esp TBoccupation Cat scratch Radiation exposure Red flags- persistent sore throat, hoarseness, dysphagia, odynophagia, Weight Loss, fevers, night sweatsSmoking Alcohol consumption HIV status Dental problems

29
Q

Investigations of a neck lump

A

USS with fine needle aspiration CT can be useful

30
Q

Red flags in neck lump

A

persistent sore throat, hoarseness, dysphagia, odynophagia, Weight Loss, fevers, night sweats

31
Q

Elderly maleNeck lump for three months Increasing in sizePersistent sore throatChange in voice Heavy smoker Heavy drinker Next steps Diagnosis?

A

Do full exam Flexible nasopharynolaryngoscopy If lump going do USS and FNACDiscuss at MDTNeck cancer eg SCC mets

32
Q

Risk factors for SCC if head and neck

A

Betel nut chewing Smoking HPVEBVAlcohol

33
Q

Elderly man Hoarse voice

A

Head and neck cancerSpreading to larynx

34
Q

Other questions to ask when hoarseness present

A

DysphagiaOdynophagiaWeight lossHeart burn or indigestion Post nasal drip Systemic upset

35
Q

Urgent referral needed for throat when

A

Hoarseness for more than six weeksOral swellings for more than six weeks Dysphagia got more than three weeksUnresolving neck masses for more than three weeks Cranial neuropathiesOrbital masses

36
Q

Causes of hoarseness

A

Overuse of larynx Acute laryngitisChronic laryngitis secondary to reflux Use of asthma inhalerSmokingSCC of larynx Vocal cord Palsy

37
Q

Treat for SCC mets

A

Radiotherapy- multiple small doses, can be curative or palliativeSurgical resectionChemo- not curative but can be used to shrinkThen if unsuccessful look at palliative

38
Q

Middle aged female. Non smoker. Neck lump. Differentials

A

Thyroid lump (follicular adenoma, hyperplastic nodules, thyroid cysts, malignancy- papillary carcinoma, follicular carcinoma, etc)GoitreThyroglossal cystCervical lymphadenopathy Dermoid cyst

39
Q

Signs that thyroid lump seem more likely

A

Enlarged cervical lymph nodesUnexplained hoarsenessStridor- indicates narrowing of airwayRapidly enlarging painless massThyroid nodule in child

40
Q

Key investigations for neck lumps

A

Ultrasound and FNACIf can we then need staging scans

41
Q

Three broad categories for nasal Blockage

A

StructuralInflammatoryInfective

42
Q

Nasal blockage questions

A

Both sides or just one How long has it felt blockedIntermittent or constantIs it ever clearAny trauma to nose recently or in pastPrevious nasal surgeryOther nasal symptoms- sneezing, rhinorrhoea, facial pain, post nasal drip, epistaxisWhat meds does pt take

43
Q

If nasal blockage and history of trauma- what is wrong and next step?

A

Probably a deviated septum but still good to rule out the other causes as blockage may be mulitfactorial. If deviated septum that is symptomatic - septoplasty

44
Q

Risks of septoplasty

A

The need for future surgeriesFailure to improve symptomsAltered appearanceSeptal perforationNumbness of upper teethAnosmia or hyposmia- rare and often transient Numbness of the noseBleeding and infection

45
Q

Middle aged woman. Nasal obstruction. 15 year history of symptoms. Worse in past four months. Associated with sneezing and rhinorrhea. Asthma and eczema in HxFurther questions, further investigations and likely diagnosis

A

Worse at any time of yearSense of smellTried any medsAllergies?Examine the nose.Probably a chronic rhinosinusitis. With or without polyps as would need to scope to visualise

46
Q

Further testing after a chronic rhinosinusitis diagnosis

A

Scope to look for polypsRAST testing to identify allergies and antigens through blood

47
Q

Management of chronic rhinosinusitis

A

Saline nasal irrigation, antihistamines (only when clear evidence of allergies), advise to avoid allergens, topical nasal steroids

48
Q

Lumps and bumps in the nose

A

PolypsSeptal haematoma Nasaopharyngeal carcinoma - typical unilateral symptoms Inferior turbinates

49
Q

If suspecting polyps what is the next step

A

CT scan of sinuses if surgery required and need to see extent of diseaseShort course pred to shrink polyps and provide some relief of symptomsTopical nasal steroids

50
Q

Purulant nasal discharge Nasal obstruction Facial pain and fullnessUp to four weeks of symptoms

A

Acute rhinosinusitis

51
Q

Clear nasal discharge- what could it be

A

Viral rhinosinusitis secretions Allergic rhinosinusitis Could be CSF! Check for glucose. If glucose present then is CSF

52
Q

Purulent discharge with other signs of rhinosinusitis- differential and treatment

A

Bacterial rhinosinusitis Treat with clarithromycin

53
Q

Epistaxis - Questions to ask in history

A

Frequency DurationWhich side of noseIs blood dripping out or down throatHistory of previous bleeds including easy bruising Previous treatmentPMH- GPA, bleeding disorders, rhinitisDrug history- clopidogrel, warfarin, aspirinTrauma including digital trauma

54
Q

Examination of nose in epistaxis

A

External nose for signs of trauma, surgery or deformities eg saddle nose deformitiesAnterior rhinoscopyPosterior rhinoscopy Use a Thuddicum’s speculum or an otoscope

55
Q

Most likely source of epistaxis

A

Little’s area - highly vascular and quite exposed Kiesselbach’s plexus lies within little’s area

56
Q

Treatment and advice for epistaxis

A
  1. Advise do not blow nose for a week, do not clean the nose, avoid hot baths, do not drink hot tea or coffee for 72 hours, no strenuous exercise for a week2. Naseptin ointment - reduces crusting in nose (contains peanuts so check allergies)3. Silver nitrate cautery 4. If epistaxis recurs then apply firm pressure for 15 minutes . If this fails go to A&E
57
Q

Young male. Punched in face yesterday, initially stopped bleeding but started again. Prolonged episode and big clots evident. No meds. What do you do?

A

ABCDE!!!Get IV access for cannulationExamine the nose and get adequate protection as blood may spray. Suction may be used to visualise the area. If origin found then cauterise. If not then need to move on to nasal packing and admit to ENT and get help. Test- FBC, Coag profile, group and save

58
Q

Factors that could cause epistaxis in adults

A

Trauma including digital traumaHTNCoagulopathiesMeds eg aspirin, warfarin, clopidogrelInflammation Rare- malignancy eg SCC.

59
Q

Epistaxis in child- usual cause and next steps

A

Usually from Little’s area from digital trauma. Treat Using naseptin (check allergies) or bactroben. These have antibacterial properties Discourage digital trauma

My Final Year 4 Revision (16 decks)

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