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Medical Finals 2020 > ENT > Flashcards

ENT Flashcards

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USMLE® Step 1 flashcards
1
Q

What are some indications for antibiotic use in otitis media?

A
  • bulging tympanic membrane
  • bilateral OM in a child <2 years
  • lasting >4 days
  • ottorhoea in a child
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2
Q

Give some post-operative complications of a tonsillectomy

A

Pain - can increase for up to 6 days
Haemorrhage - usually in first 6-8 hours - urgent return to theatre
Secondary haemorrhage - 5-10 days, wound infection association, treat with admission and antibiotics

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3
Q

What is the presentation of a cholesteatoma?

A
  • Offensive discharge
    0 Hearing loss, gradual conductive, unilateral
  • vertigo and facial paralysis can occur if it erodes into bone
  • It is a destructive, expanding keratinised debris collection of squamous cells
  • Results in inflammation, discharge, vertigo, hearing loss
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4
Q

What is preauricular sinus?

A

Foul smelling discharge
Common congenital condition in which an epithelial defect forms around the external ear
Small require no treatment, large may become blocked and develop and infection

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5
Q

How might an acoustic neuroma present?

A
  • Gradual progressive unilateral deafness and tinnitus
  • Vertigo (if vestibular nerve involvement)
  • vestibular schwanoma
  • MRI must be done in unilateral hearing loss to rule this out
  • Mx watch and wait if small, stereotactic radiosurgery or microsurgery
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6
Q

What is Ramsay Hunt syndrome?

A

Herpes zoster oticus
Vesicular lesions on anterior 2/3rd of the tongue and soft palate
Auricular pain
Facial nerve palsy
Vertigo, tinnitus
Treat with oral acyclovir and corticosteroids (PO Pred)

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7
Q

Give some differentials to facial pain.

A 
Sinusitis (cold, facial 'fullness', nasal discharge)
Trigeminal neuralgia (sharp, shooting pains, triggered by touch, unilateral)
Temporal arteritis (pain over trigeminal distribution)
Cluster headache (regular for 4-12 weeks, an 15mins to 2 hr duration, intense eye pain, redness, lacrimation, lid swelling)
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8
Q

Give some differentials for a neck lump

A 
Reactive lymphadenopathy (post-infection, common)
Lymphoma (rubebry, painless, night sweats, splenomegaly)
Thyroid swelling (moves upwards on swallowing)
Thyroglossal cyst (moves upwards on protrusion on the tongue)
Pharygeal pouch (posteromedial herniation, dysphagia, regurgitation, gurgling lump)
Cystic hygroma (congenital lymphatic neck lump)
Cervical rib (extra rib, risk of thoracic outlet syndrome)
Carotid aneurysm (pulsatile neck mass)
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9
Q

What features are included in the CENTOR criteria?

A

Tonsillar exudate
Tender lympadenopathy
History of fever
Absence of cough

3+ give antibiotics

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10
Q

What is your management for a perforated tympanic membrane and would anything change your management?

A

Reassure and follow-up, self-limiting

Amoxicillin if sign of infection

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11
Q

What is Rinne’s and Weber’s and what does a positive test indicate?

A

Weber’s - midline, tuning for 512Hx, normal hearing should be in the middle, if sounds louder in one ear then this indicates conductive hearing loss in that ear, or sensorineural hearing loss in other ear
Rinne’s - mastoid tip, should be louder in air next to ear, if not indicates conductive deafness

AIR CONDUCTION SHOULD BE BETTER THAN BONE CONDUCTION

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12
Q

What is the anterior and posterior triangle of the neck?

A

Anterior - sternocleidomastoid, mandible and midline

Posterior - trapezius, clavicle, sternocleidomastoid

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13
Q

What is the difference between otitis externa and otitis media and what symptoms occur in each?

A

Externa - inflammatory of external auditory canal, otalgia, otorrhoea, ear discharge
Media - effusion of middle ear, hearing loss, itching, pain => can be acute or chronic or with glue ear

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14
Q

What is the causative organism in ear infections?

A

Pseudomonas

Staph aureus

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15
Q

What are some complications of acute otitis media?

A 
Abscesses
CNS infections
Sinus thrombosis
Mastoiditis
Labyrithitis
COM - chronic otitis media
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16
Q

What is Ludwig’s angina?

A

Cellulitis of the mouth that develops in immunocompromised patients with poor dentition
Swelling of lymph nodes, purexia

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17
Q

What does the monospot test look for?

A

EBV - mononucleosis

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18
Q

What risk factor exists for malignant otitis externa?

What is the usual causative organism?

A

Diabetics

Normall caused by pneumococcus

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19
Q

What are some ear-related causes of vertigo?

A

Viral labyrinthitis (recent viral infection, acute, n+v, hearing, nystagmus)
Meniere’s (tinnitus, aural fullness)
Vestibular neuronitis (recent viral infection, recurrent vertigo, NO hearing loss)
BPPV (nystagmus associated with moving in bed)
Vestibular schwannoma (focal neurology association, unilateral hearing loss)

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20
Q

What medications are given for otitis externa and in what form?

A

Topical antibiotic - cipro/fluclox

2nd line - PO flucloxacillin

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21
Q

What is a common cause of bacterial otitis media?

A

H. influenzae
Strep pneumoniae
Morazella catarrhalis

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22
Q

When should antibiotics be prescribes in otitis media?

A 
Symptoms >4 days
Systemically unwell
Immunocompromise
<2 years with bilateral otitis media
Performation and/or discharge in canal

Amoxicillin

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23
Q

What is otosclerosis?

A
  • Genetic condition (AD inheritance)
  • Fusion of middle ear ossicular chain
  • Leads to progressive conductive deafness in middle-age, bilateral
  • worsens in pregnancy and menstruation because of oestrogen increase
  • ‘Flamingo tinge’ to tympanic membrane
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24
Q

What are some causes of hearing loss?

A

Presbycusis - age related sensorineual hearing loss, high frequency bilateral loss
Otosclerosis - conductive, low frequency, middle-age, genetic
Glue ear
Meniere’s disease - vertigo, tinnitus
Drug ototoxicity - gentamycin
Noise damage - bilateral, frequencies of 3000-6000
Acoustic neuroma - unilateral

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25
Q

What drugs could cause tinnitus?

A

Quinine
Loop diuretics
Aminoglycosides
Aspirin

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26
Q

What are complications of malignant necrotising otitis externa?

A

Meningitis
Cerebral abscess
Dural sinus thrombosis

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27
Q

What is acute mastoiditis and it’s treatment?

A

Infection of the mastoid bone, occurs as a complication of acute otitis media
Treat with broad spectrum antibiotics
Corticol mastoidectomy if unsuccessful

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28
Q

What is the difference between conductive and sensorinueral hearing loss?

A

Conductive - affects the middle of outer ear

Sensorinureal - affects cochlear of CNVIII

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29
Q

What are some common causes of deafness in children?

A

Hereditary - Perre Robin, Alport, Usher’s, Treacer-Collins
Maternal infection - rubella, CMV
Perinatal - anoxia, birth trauma, cerebral palsy
Postnatal - meningitis, lead poisoning

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30
Q

What should always be done in asymmetrical hearing loss?

A

MRI

Rule out acoustic neuroma

31
Q

What are the three components that affect balance?

A

Vision
Proprioception
Vestibular apparatus

32
Q

What is your management for acute labyrinthitis?

A 
Inflammation of labyrinth - vertigo, deafness, tinnitus
Bed rest
Demenhydrinate
Prochlorperazine
IV abx if infection
33
Q

What is the curative manoeuvre for BPPV?

A

Epley’s

34
Q

What do you expect to see on Hallpike’s Test for Benign Paroxysmal Positional Vertigo?

A

Positional nystagmus that fatigues

35
Q

What are the three staple features of meniere’s disease?

A

Vertigo episodes
Tinnitus
Hearing loss

36
Q

What does the vertigo occur typically in BPPV?

A

When rolling over in bed or sharp head turns

37
Q

Give some management options for Meniere’s Disease

A

Reduce salt and caffeine intake
Beta-histime
Diuretics (furosemide, bendroflumethiazide)
Cloproperazine for acute attacks

38
Q

What is the more common location of epistaxis?

A

Anterior - Little’s Area

39
Q

What is your management for sinusitis?

A

Analgesia
Topical nasal steroids
Antibiotics - amoxicillin, metronidazole
Nasal douching

40
Q

What are some risk factors for epistaxis?

A 
Dry climate
Deviated nasal septum
Vessel rupture
Coagulation disorders
Septal perforation
41
Q

How do you treat epistaxis?

A

Cautery (AgNO3 (silver nitrate)

Packing

42
Q

What is a Ringer’s Tumour?

A

A benign tumour of the nose - inverted papilloma

43
Q

A septal haematoma is a complication of what and how do you manage it?

A

Nasal trauma #
Necrosis of nasal septum, risk of perforation or saddle-nose deformity
Requires urgent drainage
Prophylactic antibiotics

44
Q

What would a 2-3 on the FEVER Pain or CENTOR criteria result in?

A

Consider delayed antibiotics

45
Q

What are common bacterial causative organisms of tonsillitis?

A

Group A beta-haem strep
Staph aureus
Strep pneumonia
Mycoplasma pneumonia

46
Q

What are common viral causes of tonsillitis?

A 
Herpes simplex
Adenovirus
Rhinovirus
Influenza
RSV
EBV
47
Q

What are indications for tonsillectomy?

A 
Recurrent tonsillitis
>7 in a year
>5 each year for 2 years
>3 each year for 3 years
Unilateral tonsillar changes
48
Q

What is Quincy and how is it treated?

A

Peritonsillar abscess
Presents with sore throat, dysphagia, a ‘hot potato’ voice (patient can’t open their mouth fully)
Aspiration

49
Q

What is the organism that causes glandular fever?

A

Infectious mononucleaosis

50
Q

What should be advised to patients with glandular fever?

A

No contact sports as risk of splenic rupture

No alcohol

51
Q

What is the organism that causes epiglottitis?

A

Haemphilus influenza

52
Q

What is your management priority in epiglottitis?

A

Secure the airway - call an anaethetist, intubation or tracheostomy may be necessary

53
Q

What type of cancers are laryngeal carcinomas?

A

Squamous cell carcinomas - risk factors include smoking, alcohol and HPV

54
Q

What does a nasal septal haematoma look like on examination?

A

Bilateral red swelling from midline
Slightly boggy
Post-trauma
Urgent ENT review for surgical drainage and IV antibiotics

55
Q

How might a nasopharyngeal carcinoma present?

What is an at-risk ethnic group?

A 
Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction/discharge/epistaxis
Cranial nerve palsies III-VI

Southern China

56
Q

What are epidermoid cysts?

A 
Common
Cutanous cyst
Asymptomatic, can occur at any age
Firm, round nodules
Central punctum
57
Q

What is a lipoma?

A

Transillumination is equal to surrounding tissue
Intradermal
Soft and mobile
Asymptomatic

58
Q

What is your management order in haemorraging epistaxis?

A

Compression - sit forwards with mouth open, pinch the cartilaginous tissue for 15 minutes and breath through their mouth
If site identifiable: cautery with silver nitrate
Anterior packing

59
Q

How do you distinguish vestibular neuritis from labyrinthitis?

A

Vestibular neuritis - vestibular nerve is involved and there is NOT HEARING IMPAIRMENT
Labyrinthitis - when both the vestibular nerve and labyrinth and involved

60
Q

What is a worrying feature of nasal polyps?

A

Unilateral - refer to ENT, risk of malignancy

61
Q

What is presbycusis?

A

Occurs in older people
The loss of outer hair cells in the cochlear
Gradual progressive bilateral hearing loss
Loss of high frequencies first

Mx - hearing aids or cochlear implant

62
Q

What hearing loss pattern occurs in noise induced hearing loss?

A

Excess sound history
Gradual bilateral hearing loss
Not progressive
Tympanic membrane looks normal

63
Q

What must be done in Meniere’s Disease?

A

Inform the DVLA

64
Q

Ear pain + fever + conductive hearing loss is typically…?

A

Acute otitis media

65
Q

What are some symptoms of glandular fever?

A 
Tonsillar enlargement
Petechiae on palate
Lymphadenopathy
Fever
Sore throat
66
Q

What is the main difference between labyrinthitis and vestibular neuritis?

A

L - inflammation of labyrinth as well so there is hearing loss
VN - no hearing loss

Similarities - incapacitating rotational vertigo not triggered by head movement, nausea and vomiting, self-limiting
Advise not to drive

67
Q

What are some risk factors for throat cancer (oropharyngeal cancer)?

A

Alcohol
Smoking
Age
HPV

68
Q

What is the most common histology of laryngeal cancer?

A

Squamous Cell Carcinoma

69
Q

What investigations are done in oropharyngeal cancer? List 6

A 
Nasal endoscopy
Biopsy
Fine Needle Biopsy
CT Scan
MRI scan
PET scan
Bloods
70
Q

What is your management plan for oropharyngeal cancer?

A

Radiotherapy (if small)

Surgery (if larger, can be curative or symptom relief)

71
Q

What are some clinical features of chronic otitis media?

A

Recurrent otorrhoea, conductive hearing loss

72
Q

Do you get tinnitus in labyrinthitis?

A

No, just vertigo and hearing loss

73
Q

What are some complications of an acoustic neuroma due to cranial nerves being affected?

A

Cranial nerve VIII – vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
Cranial nerve V – absent corneal reflex
Cranial nerve VII – facial palsy

74
Q

What is your investigation of choice for a vestibula schwannoma?

A

MRI of cerebellopontine angle

Medical Finals 2020 (25 decks)

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