ENT Flashcards
The presence of an indurated ulcer involving the lateral tongue in a patient with a long-term smoking history should be considered what (until proven otherwise)?
Squamous cell carcinoma
If there is a suspected oral cavity malignancy, what examination is essential?
Cervical lymph node examination
What would your examination of a patient with a hemifacial paresis comprise of? Choose the 3 most appropriate options. Fundoscopy Otoscopy Palpation of the parotid gland and neck Palpation of the floor of mouth Movement of the facial muscles Assess facial sensation Palpation of the abdomen
Otoscopy, palpation fo parotid gland and neck, movement of the facial muscles.
Course of the facial nerve= from the skull base, within the middle ear cavity and temporal bone, to emerge via the stylomastoid foramen and then within the substance of the parotid gland
‘80% of parotid tumours are (benign/malignant), and 80% of these are ________’
Complete the sentence
Benign
Pleomorphic adenomas
Which 3 of the following statements about the facial nerve are true:
It provides special secretory innervation to the lacrimal glands
It provides motor innervation to the stapedius muscle
It provides motor innervation to the tensor tympani muscle
It supplies motor innervation to the intrinsic muscles of the tongue
The nerve exits the skull base via the foramen lacerum.
The nerve exits the skull base via the stylomastoid foramen
- It provides special secretory innervation to the lacrimal glands
- It provides motor innervation to the stapedius muscle
- The nerve exits the skull base via the stylomastoid foramen
Give 2 risk factors of Bell’s palsy?
Diabetes
Recent upper respiratory tract infection
Pregnancy
True/false: pleomorphic adenomas can be managed conservatively in the majority of patients?
False, they have the potential for malignant transformation, so may need excision.
Which 3 structures pass through the parenchyma of the parotid? External carotid artery Internal jugular vein Retromandibular vein Facial nerve Internal carotid artery Vagus nerve
External carotid artery
Retromandibular vein
Facial nerve
Match up thyroid nodule, thyroglossal duct cyst and dermoid cyst to each of the following.
1) Moves on BOTH swallowing AND tongue protrusion
2) Moves on swallow, does NOT move on tongue protrusion
3) Does NOT move on EITHER swallowing or tongue protrusion
1) Thyroglossal duct cyst
2) Thyroid nodule
3) Dermoid cyst
What is the most common type of thyroid malignancy: Follicular carcinoma Lymphoma Medullary carcinoma Papillary carcinoma Anaplastic carcinoma
Papillary carcinoma (75-80%)
Then follicular carcinoma (15-20%)
Hoarseness exceeding three weeks requires urgent investigation to exclude ?
Laryngeal malignancy
What is the single best investigation to rule out laryngeal malignancy?
Flexible naso-laryngoscopy
What 2 investigations are required for staging of laryngeal malignancy?
CT thorax and MRI neck
What is the most common histological subtype of laryngeal cancer?
Squamous cell carcinoma
T/F: carcinomas of the larynx most typically occur in the subglottis region?
F- 5% arise from subglottis, majority are in the glottis
Recurrent laryngeal nerve palsy is a cause of vocal cord paresis and resultant hoarseness. Which of the following is NOT commonly associated with recurrent laryngeal nerve palsy? Thyroid surgery Thyrotoxicosis Aortic aneurysm repair Carcinoma of the oesophagus Carcinoma of the bronchus Polio
Thyrotoxicosis
Single most effective analgesia for dental pain?
NSAID based analgesic
What imaging should be used to demonstrate a dental abscess?
Orthopantomogram radiograph
In a peritonsillar abscess (quinsy), the uvula is deviated toward/away from the site of infection?
Away
What is the most common causative organism of peritonsillar abscess?
Second?
Group A strep
Haem influenzae
What Abx is the treatment of choice for peritonsillar abscess?
What are 2 management options?
IV benzylpencillin (oral doesn’t penetrate the abscess)
Intra-oral incision and drainage or needle aspiration of peritonsillar space
What antibiotic should be avoided in infectious mononucleosis and why?
Amoxicillin (+co-amox)
Skin reaction- generalised maculopapular rash
What is the first line Abx for acute suppurative otitis media?
Amoxicillin
What are the two common causative organisms of otitis externa?
What is the first line treatment?
Pseudomonas aeruginosa, staph aureus
Ciprofloxacin/gentamicin ear drops (+steroid if really inflamed/severe)
Initial management for newly diagnosed glue ear in children?
Active surveillance- 70% resolve spontaneously after 3 months.
If glue ear hasn’t resolved spontaneously after 3 months, what is the management?
Grommet insertion under general anaesthesia
A 7 year old presents following an ear infection, with a painful mastoid and their ear on the left appears pushed forward and down. What complication is this likely to be?
Outline the management.
Acute mastoiditis.
Management= refer to ENT. Will need CT to look for abscess. Also blood cultures, bloods, culture any discharge.
Broad spectrum IV Abx (e.g. cefotaxime) +/- surgical drainage. Paracetamol/NSAID
Give 5 causes of conducive hearing loss.
- Otitis media with effusion
- Otosclerosis
- Tympanic membrane perforation
- External canal obstruction e.g. wax/foreign body
- Acute mastoiditis
- Cholesteatoma
What is the inheritance pattern of otosclerosis?
More common in F or M?
How does it present?
AD (so likely to have FH).
F>M. Onset 15-35yrs.
Slowly progressive bilateral hearing loss.
Do the symptoms of otosclerosis get better or worse in pregnancy and menstruation?
Worsen.
Due to increased oestrogen levels.
What is the investigation for otosclerosis?
Audiometry
Give 2 management options for otosclerosis?
Bilateral hearing aids
Surgical- stapedectomy or stapedotomy.
What is a cholesteatoma?
Destructive and expanding keratinised squamous cell debris which collects on ear drum and keeps growing
Where does a cholestatoma extend into?
Commonly into attic of ear , slowing destroying the middle ear and eroding bone.
Give 3 features of presentation of cholesteatoma?
Unilateral, watery smelly discharge from ear Gradual conductive hearing loss Unilateral ear discomfort Vertigo May get facial nerve palsy from invasion
What Ix for cholesteatoma?
Otoscopy –> attic crust
What is the management of cholesteatoma?
Seen by ENT. Aural toilet and surgical removal.
Which type of hearing loss would show air conduction worse than bone conduction on an audiogram?
Conductive hearing loss
Give 4 causes of sensorineural hearing loss.
- Noise induced
- Acoustic neuroma
- Infections e.g. encephalitis, meningitis, labrynthitis, MUMPS
- Meniere’s disease
- Ototoxicity e.g. gent, quinine, salicylates
Is an air-bone gap seen on audiogram of sensorineural hearing loss?
No, no significant air-bone gap.
What is a major risk factor for cholesteatoma?
Cleft palate- increases risk 100 fold!