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ENT Flashcards

1
Q

DDx of cervical lymphadenopathy

A 
EBV
HIV
Adenovirus
CMV
HZV
Steptococcal pharyngitis
NHL, HL, CLL
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2
Q

What travels through parotid?

A

Facial nerve (if facial nerve palsy = malignant parotid)

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3
Q

Causes of parotitis?

A 
Mumps
Stone
Sarcoid
Tumour
HIV
Wegeners
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4
Q

B/l swelling of parotids for 1w, low grade fever.

What Ix?

A

FBC, ESR/CRP, U+Es, Blood cultures. Viral serology.
Salivary antibody testing (salivary mumps IgM)
Pus swab
USS
Sialography
CT/MRI (r/o neoplasm)

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5
Q

Which salivary gland is commonly obstructed?

A

Submandibular

parotid is wider, more watery saliva

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6
Q

Parotid pain + swelling at meal times, colicky, relapse + remitting.
Likely dx?
Ix?

A

Obstruction

USS + contrast sialography

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7
Q

Mx of obstruction?

A

Conservative [good hydration, warm compress, massage]

Surgical removal

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8
Q

Red flags of salivary glands that would indicate malignancy

A 
Rapid increase in size
Ulceration
Fixation
Paraesthesia (facial nerve)
Past hx of skin cancer
Sjogrens
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9
Q

Ix for salivary gland tumour

A

USS
+ FNA
+ core biopsy

MRI for staging
CT for met spread

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10
Q

Complication of salivary gland tumour removal?

A

Damage to facial nerve
Recurrence
Freys syndrome (redness/swelling of cheek when eating)

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11
Q

Most common cause of vertigo?

A

BPPV

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12
Q

Pres of BPPV?

A

Vertigo provoked by head movement, worse when head tilted to on e side
Sudden onset attacks 20-30seconds
Assos N+V

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13
Q

Red flags in vertigo

A

Hearing loss
Tinnitus
Pain
Headache

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14
Q

Ix in BPPV?

A

Dix-Hallpike (positive on one side ONLY)
Otoscopy
Cranial nerve examination

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15
Q

What if Dix-Hallpike positive bilaterally?

A

Vestibular neuritis / central cause

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16
Q

DDx in vertigo

A 
BPPV
Vestibular labrythitis
MS
Menieres
Acoustic neuroma
Ramsay-Hunt
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17
Q

Mx of BPPV

A

Get out of bed slowly, reduce head movements

Epley’s manoeuvre

Dont drive when dizzy

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18
Q

Pres of Menieres?

A

Episodic auditory and vestibular disease –> Sudden onset vertigo (30mins), hearing loss, tinnitus and aural fullness [unilateral]

Drop attacks, positive Rombergs

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19
Q

Pathophysiology of Menieres?

A

Overprod / lack of absorption of endolymph

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20
Q

Ix in Menieres?

A

Mainly exclusion!

MRI, TFT, Syphillis serology

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21
Q

Initial hearing loss in Menieres?

A

Low frequency

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22
Q

Initial hearing loss in acoustic neuroma?

A

High frequency

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23
Q

Mx of Menieres?

A

Low salt diet + diuretics

Medical [topical meclozine; Meniett device; intratympanic corticosteroids]

Surgical [endolymphatic sac surgery]

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24
Q

Vestibular neuritis pres?

A

Acute vertigo

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25
Q

Labrythitis pres?

A

Acute vertigo + hearing loss

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26
Q

Cause of vestibular neuritis?

A

Usually due to reactivation of HSV in vestibular ganglion

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27
Q

cause of labrynthitis?

A

Post viral URTI (50%)

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28
Q

Pres of VN/L ?

A

Sudden, servere incapacitating vertigo (illusion of moving), N+V
NOT triggered by movement (Dix-Hallpike negative)

Hearing loss = labrythitis

URTI sx

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29
Q

Ix in VN/L

A

Otoscopy
CN examination
Rinnes/Webers

HINTS [Head impulse, nystagmus type, skew] to differentiate from stroke

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30
Q

HINTS indicating VN/L?

A

Unidirectional nystagmus, no vertical skew

In stroke - bidirectional nystagmus and a vertical skew are present

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31
Q

Mx of VN/L

A

Prochlorperazine for vertigo

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32
Q

Acoustic neuroma?

Where is it?

A

CN8 tumour of Schwann cell

Cerebellopontine angle

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33
Q

Pres of acoustic neuroma?

A

Unilat hearing loss, tinnitus (progressive)

Impaired facial sensation

Impaired balance

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34
Q

When do you see bilat acoustic neuroma?

A

NF T2

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35
Q

Ix in acoustic neuroma?

A

Audiology

MRI

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36
Q

Mx of acoustic neuroma?

A

Microsurgery

If small tumour and preserved hearing can watch and wait

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37
Q

Examination of sinus?

A

Palpate + assess nose

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38
Q

Cause of sinusitis?

A

S. pneumoniae
H. influenza
Moraxella
Catarrhalis (children)

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39
Q

Mx of sinusitis?

A

pcm/NSAIDs
Intranasal decongestant
Nasal douching
Warm face packs

If bacterial –> amoxicillin (7days)

40
Q

Comps of sinusitis?

A

Orbital cellulitis
Meningitis
Osteomyelitis

41
Q

Mx of chronic sinusitis?

A

Topical nasal steroids (beclamethasone)

42
Q

TMJ dysfunction

A

Pain (in front of tragus, radiating to ear)
Limited mouth opening
Joint noises

43
Q

Mx of TMJ dysfunction?

A

Reassurance
Rest
NSAIDs +/- muscle relaxants

44
Q

Cause of congenital hearing loss?

A

Rubella
CMV
Malformation

45
Q

Cause of post natal hearing loss?

A

Measles

Mumps

46
Q

Ix in deafness?

A

Audiometry

Tympanometry

47
Q

Sudden hearing loss? What to do?

A

Urgent referral to ENT

48
Q

Pres of otitis externa?

A

Erythematous ear canal + oedema + exudate
Mobile TM
Pain on moving tragus
Pre-auricular lymphadenopathy

49
Q

3 types of otitis externa?

A

acute otitis externa - bacterial (swimmers ear)

Chronic otitis externa - fungal

Necrotising otitis externa - P. aeruginosa in mastoid + temporal bones

50
Q

Mx of necrotising otitis externa?

A

Oral and topical quinolones for 6 - 8 weeks

eg ciprofloxacin

51
Q

Mx of otitis externa

A

analgesia
Neomycin drops

Oral abx if cellulitis / cervical lymphadenopathy

52
Q

Mx of fungal otitis externa

A

clotrimazole

53
Q

Mx of chronic otitis externa

A

Acetic acid

Corticosteroid ear drops (hydrocortisone)

54
Q

Prevention of otitis externa

A

Keep ear dry
NO COTTON BUDS
olive oil to prevent waxy build up

55
Q

Pres of acute otitis media

A

Hearing loss
Otalgia
Otorrhoea
Fever

56
Q

Ix in otitis media

A

Culture if d/c

CT/MRI to r/o complications

57
Q

Mx of otitis media

A

Analgeisa
Nasal steroids
Abx

58
Q

Otitis media with effusion. AKA?

59
Q

Pres of glue ear?

A

Conductive hearing loss
Aural fullness
Crackling tinnitus

60
Q

Pres of mastoiditis?

A

Intense pain behind ear
Fever
Boggy mass behind ear
External ear protrudes fwd

61
Q

Ix in mastoiditis?

A

FBC, Blood cultures
CT/MRI
LP if suspect has spread intracranially
Fluid extraction for gram stain + culture

62
Q

Mx of mastoiditis?

A

High dose broad spec IV Abx: 3rd gen cephalosporin (2 days)

Oral abx for 2 weeks

63
Q

What to do if cranial extension of mastoiditis?

A

Mastoidectomy + tympanoplasty

64
Q

What is cholesteatoma?

A

Keratinising squamous epithelium within middle ear (on attic)

65
Q

Comps of cholesteatoma?

A

Locally invasive into bones (mastoid + middle ear)

66
Q

Pres of cholesteatoma?

A

Progressive conductive hearing loss

Erosion - vertigo, headache, CN7 palsy, meningitis

Frequent otorrhoea (foul smelling)

67
Q

Ix for cholesteatoma?

68
Q

Mx of cholesteatoma?

A

Surgical removal

69
Q

Which nerve runs over temporal bone?

70
Q

Ix in oral cancer?

A

FNA
Biopsy
CT/MRI for staging

CT thorax

71
Q

Mx of oral cancer?

A

Surgical resection / brachytherapy

+/- cisplatin

72
Q

RFs for oral cancer?

A

Tobacco, alcohol, HPV, Asian

73
Q

Nasopharyngeal cancer?
RFs?
Problemo?

A

EBV, smoking, Asian

50% have cervical mets at presentation

74
Q

Pres of laryngeal cancer?

A

Chronic hoarseness, persistent cough, pain, dysphagia, lump, soar throat, wt loss

75
Q

Ix in chronic hoarseness?

A

CXR –> ?lung or ENT cancer

76
Q

Epiglottitis?
Causative organism?
Presentation?

A

HIb

Sore throat, drooling, fever, high temp, stridor, resp distress, TOXIC

77
Q

Seen on lateral XRay of epiglottitis?

A

Thumbprint sign

78
Q

Mx of epiglottitis?

A

IV abx +/- intubation

79
Q

Cause of quinsy?

A

Strep. pyogenes

Peritonsilar abscess!

80
Q

Mx of quinsy?

A

IV fluids, analgesia, IV abx (penicillin/cephalosporin/co-amox)

Needle aspiration, incision + drainage

81
Q

Ix in recurrent epistaxis?

A

FBC, coag

?malignancy - ENT for nasopharyngoscopy

82
Q

Mx severe epistaxis?

A

Nasal packing

Cautery [silver nitrate; electrocautery]

83
Q

Ix of nasal polyps?

A

Rhinoscopy by ENT

84
Q

Mx of nasal polyps?

A
  1. topical corticostroids + saline douche

2. endoscopic sinus surgery

85
Q

DDx of swallowing difficulties?

A

Obstructive [GORD, oesophagitis, cancer, stricture]

Neuro [CVA, achalasia, spasm, MND, MS, PD]

Other [Pharyngeal pouch, compression, CREST]

86
Q 
OSA.
RF?
Pres?
Score?
Mx?
A

Obesity, male, middle age, smoking, alcohol, FHx

Snoring, daytime sleepiness, macroglossia

Epworth sleepiness score

Wt loss. CPAP.

87
Q

Otosclerosis?
Presents when?
Causes?

A

Autosomal dominant

20 - 40

Normal bone replaced by vascular spongy bone –> progressive conductive deafness

88
Q

Mx of otosclerosis?

A

Hearing aid

Stapedectomy

89
Q

Ototoxic drugs?

A

Aminoglycosides (gentamicin)

Furosemide

Aspirin

Cytotoxics

90
Q

What would make you suspicious of a Quinsy?

A 
Prolonged
Sever pain on one side
Deviation of uvula
Difficulty opening mouth
Reduced neck movements
91
Q

Ramsay-Hunt?

Pres?

A

Reactivation of VZV in CN7

Rash in ear / mouth
Weakness
Dizziness / vertigo

92
Q

Mx of ramsay hunt?

A

Oral aciclovir

Corticosteroids

93
Q

Mx of unilateral vs bilateral nasal polyps?

A

Uni - urgent referral to ENT

Bilat - topical corticosteroids + routine referral

94
Q

How long does perforated ear drum usually take to heal?

A

6 - 8 weeks

95
Q

Samter’s triad?

A

Asthma + aspirin hypersensitivity + nasal polyposis

96
Q

Why cant you give amoxicillin in sore throat?

A

If its EBV –> scaring rash

Finals (20 decks)

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