ENT Flashcards
Hearing loss, vertigo and tinnitus which also presents with an absent corneal reflex is due to what pathology?
Acoustic neuroma
Absent corneal reflex due to affecting nearby cranial nerve 5
What are some drugs that can cause tinnitus?
Aspiring
Aminolglycosides
Loop diuretics
Quinine
What organism is most likely to be responsible for malignant otitis externa?
Pseudonomas aeruginosa
Which organism causes glandular fever?
Epstein Barr virus
Which blood test can diagnose Epstein Barr virus?
Paul Bunnel test
(EBV causes infectious mononucleosis of B lymphocytes so they produce an antibody which can be detected by the Paul Bunnel antigen)
In patients with glandular fever, which antibiotic should be avoided due to likelihood of causing an itchy maculopapular rash?
Amoxicillin / co-amoxiclav
How would uncomplicated otitis media be managed?
Analgesia
Antipyretics
(Only Abx if symptoms do not improve after 4 days)
Which nerve passes through the parotid gland?
Facial nerve
In which salivary gland is malignancy most likely?
Submandibular gland
Although most tumours occur in the parotid gland, but these are most likely to be benign
What is sialthiasis?
Salivary stones
In which glands are salivary stones most likely to occur?
Submandibular
Secretions here are thicker and richer in calcium
Facial nerve dysfunction affecting the forehead and the lower facial nerves is due to an upper or lower motor neurone lesion?
LMN
UMN is forehead sparing
In a sore throat when antibiotics are indicated, which antibiotic and for how long should it be prescribed?
Benzylpenicllim 10 days
Erythromycin if pen allergic
If antibiotics are indicated in otitis media, which is first line?
Amoxicillin
When are antibiotics indicated in otitis media?
If symptoms don’t improve after 4 days
If they are systemically unwell
If the tympanic membrane has perforated
If they are immunocompromised
A man present with bilateral tinnitus and hearing loss. There is family history of similar problems. Audiometry shows bilateral conductive hearing loss. What is the likely diagnosis?
Otosclerosis
Autosomal dominant
How can Bell’s palsy and Ramsay Hunt syndrome be differentiated between?
Both can cause facial weakness
Ramsay Hunt will present with otalgia and vesicles in the ear
What is the cause of Ramsay Hunt syndrome?
Reaction of varicella zoster virus in the geniculate ganglion of the facial nerve (CN VII)
What are some presenting features of Ramsay Hunt syndrome?
Ear pain
Vesicular rash
Facial nerve palsy
Vertigo and tinnitus
What is the most common cause of respiratory distress post thyroidectomy?
Haematoma
Presents within 24 hours (respiratory distress after 24 hours is likely due to hypoCa)
A patient reports paraesthesia and difficulty breathing 2 days post thyroidectomy. What is the most likely complication?
Hypocalcaemia secondary to parathyroid gland damage
What is the gold standard investigation for acoustic neuroma?
MRI head
Which condition classically presents with dry mouth, dry eyes and swollen parotid glands?
Sjögren’s syndrome
What is the inheritance pattern of otosclerosis?
Autosomal dominant
Does otosclerosis present with sensorineural or conductive hearing loss?
Progressive conductive hearing loss
Are the ossicles found in the outer, middle or inner ear?
Middle ear
They connect the tympanic membrane to the cochlea
What is the name of the branch of the facial nerve that travels through the middle ear cavity?
Chorda tympani
This supplies the tastebuds in the anterior 2/3rds of the tongue
If there is normal hearing in the right ear, but in the left ear bone conduction is greater than air conduction. Weber test also localises to the left ear. What does this indicate?
Conductive hearing loss of the left ear
Air conduction is greater than bone conduction bilaterally. However, Weber test localised to the right ear. What does this indicate?
Left sensorineural hearing loss
Rinne-ve = no conductive loss. If sensorineural loss then Weber will be loudest in unaffected ear
What is a myringotomy?
Surgical incision into the tympanic membrane to relieve pressure. E.g. in glue ear, then followed by grommet insertion
What is Samter’s triad?
Asthma + nasal polyps + NSAID (especially aspirin) insensitivity
Rhinosinusitis is classed as chronic when symptoms persist after how long?
12 weeks (Then subclassified as CRS with or without polyps)
How does rhinosinusitis present?
At least one symptom e.g. nasal congestion, nasal drip, facial pain, reduced smell
Plus either endoscopic signs or CT changes
The association of asthma, aspirin insensitivity and nasal polyps is known as what?
Samter’s triad
How could you manage a patient with nasal polyps?
Intranasal steroids (reduce polyps in most px)
Polypectomy (high rate of recurrence)
Turbinate trimming is resultant turbinate hypertrophy
What is Chvostek’s sign an indicator of?
Hypocalcaemia
Tapping over cheek will cause twitching of facial muscles
What are some signs and symptoms of hypocalcaemia?
Tetany, paraesthesia, muscle cramps Depression Chvostek’s sign Trousseau’s sign Prolonged QTc
What complications can result from thyroid surgery?
Bleeding (haematoma in confined space can lead to respiratory obstruction)
Recurrent laryngeal nerve damage
Parathyroid gland damage (hypoCa)
Epiphora refers to what?
Excess tear production
Which bone forms the cribiform plate?
Ethmoid bone
What nerve axons descend through the cribiform plate?
Olfactory nerve
What type of epithelial cells line the nasal mucosa?
Pseudostratified columnar epithelium with goblet cells
What is the role of the nasal conchae?
To warm and humidify the nasally inspired air
How should vocal cord nodules be treated?
Conservative: voice rest, speech therapy, avoid irritants eg smoking and alcohol
Surgical excision (If conservative measures fail)
What are some risk factors for laryngeal cancer?
Male
Increasing age
Alcohol
Smoking
What is Reinke’s oedema?
Swelling of the vocal cords
Sac like appearance of fluid filled vocal cords
Almost exclusive to female smokers that present with a very deep and hoarse voice
What are some differentials for a hoarse voice?
Larnygeal cancer Laryngitis Vocal cord palsy Reinke’s oedema Vocal cord nodules Reflux laryngitis
How should Reinke’s oedema be managed?
Conservatively e.g. stop smoking, voice rest, SALT
May require laser surgery
What are some differential diagnoses for dysphagia?
Intrinsic: larnygeal Ca, strictures, pharyngeal pouch, achalasia
Neurological: MS, bulbar palsy, myasthenia
Other: globus hystericus, cord palsy
What is the dose of intramuscular adrenaline for an 8 year old experiencing an anaphylactic reaction?
0.3ml of 1:1000 IM adrenaline
Can be repeated after 5 minutes
Can adenoid hypertrophy cause otitis media?
Yes by blocking the Eustachian tube
What age group is adenoid hypertrophy most common in?
Children
They are lymphatic tissue so enlarge during childhood then shrink before puberty
Which bronchus is an inhaled foreign body more likely to fall into?
The right bronchus as this is more vertically positioned
What is the likely diagnosis of a painless neck lump in children that transluminates brightly?
Cystic hygroma
