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ENT Flashcards

1
Q

What test can be done to assess if rhinorrhoea is CSF?

A

Beta Transferrin test
or
CT of sinuses

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2
Q

What things do you want to know regarding a neck lump?

A

Site, size, shape, surface

Consistency
Skin changes/ discharge
Fixation

Fluctuance 
Mobility 
Transillumination 
Temperature changes 
Pain
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3
Q

What grading scale is used to assess fascial nerve palsy?

A

House Brackmann Grading
I - normal
II - slight weakness on close inspection
III - obvious but not disfiguring
IV - Obvious weakness and disfiguring - incomplete closure of eye
V - Barely perceptible motion. asymmetry at rest
VI - complete paralysis

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4
Q

What can be worn to help humify air over a laryngeal stoma?

A

Buchanan Bib

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5
Q

What primary investigations would you want to conduct into a neck mass?

A

Full examination

Ultrasound + FNA/ Core aspiration

CT/ PET scan

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6
Q

What is the most common benign parotid lump?

A

Pleomorphic Adenoma
- has potential to become malignant

followed by:
Warthin’s (often bilateral)

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7
Q

What features suggest malignancy in a parotid lump?

A

Pain
Facial nerve palsy
Overlying skin changes
Associated lymphadenopathy

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8
Q

What is a key distinguishing feature between a thyroglossal cyst and a enlarged thyroid?

and what is the surgical procedure done to fix these?

A

The neck lump moves when swallowing or sticking tongue out
*thyroid nodules do not move

Sistrunk’s procedure `

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9
Q

How is the submandibular gland palpated?

A

Bimanual palpation

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10
Q

What are the red flags for head and neck cancer?

A 
Hoarseness for >6 weeks 
Ulceration and swelling of the oral mucosa >3 weeks 
Red and white patches in oral mucosa 
Dysphagia 
Neck masses >3 weeks 
Cranial nerve involvement 
Persistent otalgia with normal otoscopy 
Persistent nasal congestion that is unilateral. especially with discharge
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11
Q

List some differentials for a hoarse voice:

A

Laryngeal cancer

Laryngitis

Prebysphonia - old age

Reinke’s oedema

Vocal cord granulomas

Vocal cord nodules

Muscle tension

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12
Q

What is stertor?

A

This is a breathing noise made by upper respiratory difficult due to larynx pathology
- very similar to snoring

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13
Q

Stridor can be broken down into inspiratory, expiratory and biphasic, where does each correspond to in a pathology?

A

Inspiratory:
- larynx

Expiratory:
- tracheobronchial

Biphasic
- Subglottic/ glottis

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14
Q

What upper airway obstruction can occur in people born before 1992, and how does it present?

A

Supraglottitis

presents with sore throat with normal tonsils

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15
Q

How should a patient with an upper airway obstruction be managed?

A

Oxygen

  • airway manoeuvres
  • airway adjuvants

Senior help immediately

  • Anaesthetist
  • ENT

Nebulised adrenaline - 1:1000mg in 5mls of N saline

IV steroids
- dexamethasone 4mg

+/-

IV antibiotics

Nil by Mouth
- they may need surgery

**do not leave patient

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16
Q

At what level does a tracheostomy go?

A

3rd and 4th ring

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17
Q

In Tonsillitis what is the antibiotic of choice? and why?

also what additional features may suggest the other pathology?

A

Penicillin

  • due to the risk of them also having Glandular fever as well (secondary bacterial infection on top of the EBV)
  • avoid amoxicillin due to the rash
  • white exudate over the tonsils
  • lymphadenopathy
  • Hepatosplenomegaly (jaundiced?)
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18
Q

What is a peritonsillar abscess called? and what is a key symptoms associated with this? and how is it treated?

A

Quinsy

Trismus - decreased mouth opening
Often the uvula will be deviated.

Drained 
- aspiration under LA
IV antibiotics 
IV steroids 
\+/- 
Tonsillectomy
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19
Q

How does a parapharyngeal abscess present?

A

Sore throat
Reduced neck turning ability
systemically unwell
*typically in children

IV antibiotics

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20
Q

How does a retropharyngeal abscess present?

A

Sore throat - especially on neck movement
Swinging fever
Relatively well patient
Usually in children

  • CT scan is needed for definitive diagnosis
  • can cause severe airway obstruction in some conditions
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21
Q

What are some of the complications of otitis media?

A

Intracranial abscess formation

  • seizure
  • confusion
  • need neurosurgical review and imaging (CT)

Facial palsy

Mastoiditis 
- usually in children 
- IV Antibiotics 
\+/- 
- Surgery (so keep them NBM)

Meningitis

22
Q

What is a major complications of a URTI which causes visual changes to the eye, and how is it managed?

A

Orbital cellulitis

  • eye proptosis
  • red swollen eye
  • visual defects

**must check red vision

  • IV antibiotics
  • NBM
    +/- Surgery
23
Q

In facial palsy - when should antivirals NOT be given?

A

If no vesicles are seen then antivirals should not be given.
this is because they can actually make it worse

*look around the mouth and ear for these vesicles

24
Q

In traumatic facial palsy what is an important thing to document?

A

Onset of timing.

Sudden onset: suggests transection

Gradual onset: suggests oedema

25
Q

What is one of the first things that should be checked before carrying out the Halmaygi head thrust test?

A

If the patient has any pain or neck problems

26
Q

What are some of the complications of tonsillitis?

A

Otitis media

Quinsy - peritonsillar abscess

Rheumatic fever

Glomerulonephritis

PANDAS in children

27
Q

What clinical features of GORD causing laryngeal- pharyngeal reflux may be seen?

A

Posterior Commissure Oedema

Cobble stoning of posterior pharyngeal wall

28
Q

Give some differentials for tinnitus:

A

Idiopathic

Drugs

  • Salicylate
  • Quinine

Noise induced

Meniere’s disease (part of prodrome)

Otosclerosis

Vestibular schwannoma

29
Q

How can vestibular neuronitis be differentiated from labyrinthitis?
and what is the treatment for severe episodes of vertigo?

A

There is no hearing loss or tinnitus

Prochlorperazine

30
Q

What condition is exacerbated by pregnancy leading to increased conductive hearing loss:

A

Otosclerosis

31
Q

If a person has suspected otitis externa but symptoms progress despite topical antibiotics - what should be done next and why?
and which organism is most associated with this condition?

A

Referral to ENT

Suggestive of necrotising otitis externa (malignant otitis externa)

Pseudomonas aeruginosa

32
Q

Which drugs are highly associated with tinnitus?

A

NSAIDs
Aminoglycosides
Loop diuretics
Quinine

33
Q

What set of tests can be conducted to help establish if the cause of vertigo is due to a posterior circulatory stroke or a peripheral cause?

A

HINTs examination

  • Head Impulse test (Positive is suggestive of peripheral i.e. abnormal is good)
  • Nystagmus assessment (vertical, long duration suggests central)
  • Skew Eye test (cover of one eye which then bounces back, deviation suggests central cause)
34
Q

What features suggest a bacterial cause of pharyngitis and tonsilitis?

and what scoring system can be used to help establish this?

A

Fever >38

Exudate present

No cough

Tender anterior cervical lymphadenopathy

Centor Score
- <2 points make it unlikely to be bacterial
>3 points suggest bacterial

35
Q

What is the name given to a peritonsillar abscess? and how is it treated?

A

Quinsy

Incision and IV antibiotics

36
Q

What is a complication following allergic rhinitis following the use of nasal decongestants?

A

Rhinitis Medicamentosa

rebound hypertropy of the mucosa with use of nasal decongestants, especially Xylometazoline

they should not be used for more than 7 days.
After 10 days is average start of the medicamentosa

37
Q

What are the major risk factors for head and neck cancer?

A 
Smoking 
Alcohol 
HPV - 16,18 
Nitrosamines 
EBV
38
Q

What are some premalignant conditions of head and neck cancer?

A

Leukoplakia

Erythroplakia

Oral lichen planus

Actinic cheilitis

39
Q

How does Oral-pharyngeal cancer present?

A 
Odynophagia 
Dysphagia 
Stretor 
Otalgia 
Neck pain/ lump
40
Q

How does laryngeal cancer present and what are the subtypes?

A

Supraglottis
Glottis
Hypoglottis

Hoarse voice 
Stridor 
Persistent cough 
Dysphagia 
Otalgia 
Neck lump/ pain
41
Q

What investigations should be done into suspected head and neck cancer?

A

Flexible Nasal endoscopy
- this includes larynx

FNA aspiration of lesion
- including lymph nodes

MRI/ CT scan

42
Q

What are the treatment options for head, neck and mouth cancer?

A

General:

  • Radiotherapy
  • Surgical resection / Transoral laser therapy
  • Chemotherapy

Oral:
- Wide local Excision
+/-
Neck dissection

Oropharynx:
- Laser 
- Transoral robotic surgery 
\+/- 
- neck resection 
Larynx: 
- Transoral laser surgery 
- Laryngectomy 
\+/- 
- neck dissection
43
Q

List some congenital causes of neck lumps and distinguishing features:

A

Carotid body tumour

  • carotid paragangliomas
  • pulsating neck lump
  • bruit

Branchial cyst:

  • Anterior to SCM
  • Compressional symptoms

Cystic Hygroma:

  • Axilla/ Posterior
  • Transillumination

Infantile Haemangioma;

44
Q

What is the diagnostic and therapeutic maneuvers done for BPPV?

A

Dix- Hallpike Maneuver - diagnostic

Epley maneuver - treatment

45
Q

What does trismus mean?

A

Jaw locking

46
Q

What is the management of Meiner’s disease?

A

Conservative:

  • reduce salt intake
  • reduce caffeine
  • reduce cheese intake

Acute attacks
- Prochlorperazine

Betahistine
- vasodilator to improve endolymph

47
Q

What conditions should be suspected if there is referred ear pain, how do you know its referred and what nerves are involved?

A

If external ear and ear drum are normal the pain is not from the ear.

Parotid/ TMJ/ upper molar teeth - Cranial nerve V

Ramsay Hunt syndrome
- Cranial nerve VII

Malignancy of 1/3 posterior tongue, piriform, larynx, nasopharynx
- cranial IX, X

48
Q

List some LMN causes of facial palsy?

A

Bell’s palsy

Acute otitis media

Cholesteatoma

Viral infection

  • HSV-1
  • CMV
  • EBV
49
Q

What are the symptoms of otosclerosis?

A 
Onset 20-40 years old 
Conductive hearing loss 
Tinnitus 
Normal tympanic membrane 
AD family history
50
Q

Where is a nosebleed most likely to occur?

A

Keisselbach area/ Littel area

- anterior of the nose

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