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ENT Flashcards

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USMLE® Step 1 flashcards
1
Q

Deafness

  1. Conductive - causes (5)
  2. Sensorineural - causes (4)
  3. Presbycusis - definition
  4. Presbycusis - cause
  5. Otosclerosis - definition
  6. Otosclerosis - treatment
  7. Ototoxic drugs (4)
  8. Ototoxicity - symptoms
A
  1. Wax, acute otitis media, otitis externa, otosclerosis, perforated ear drum
  2. Presbycusis, noise induced, congenital, vestibular schwannoma (aka acoustic neuroma), ototoxicity
  3. Deterioration in hearing as patients age (chronic sensorineural)
  4. Loss of sensitivity of delicate hair cells in the cochlea
  5. Abnormal bone formed around stapes foot plate
  6. Stapedectomy
  7. Aminoglycosides (e.g. streptomycin), cisplatin (chemo), furosemide, quinine
  8. Deafness, vertigo
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2
Q

Deafness - examination

  1. Whisper test - how far away to stand
  2. Weber - where to put tuning fork
  3. Louder in one ear means
  4. Dead ear finding
  5. Rinne’s - tests what
  6. AC > BC
  7. BC > AC
  8. Tympanometry test - tests what
A
  1. 1m
  2. Forehead
  3. Conductive loss in same ear or sensorineural loss in opposite
  4. False negative test
  5. Checks air compared to bone conduction
  6. Normal middle/outer ear function
  7. Conductive deafness
  8. The compliance of middle ear structures
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3
Q

Hearing aids

  1. Indication for bone anchored hearing aids (2)
A
  1. Chronic infection, shape of the ear canal
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4
Q

Emergency childhood ENT

  1. Croup - AKA
  2. Main management
  3. Epiglottitis - usual cause
  4. Don’t do what
  5. Management
A
  1. Acute laryngotracheobronchitis
  2. Dexamethasone single dose, nebulised ventolin, paracetamol
  3. Haemophilus influenzae B (HIB)
  4. Persist in examining the child’s throat
  5. Admit and give IV amoxicillin
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5
Q

ENT history - key questions

  1. Ear (5)
    Other (2)
  2. Nose (5)
    Other (4)
  3. Throat (5)
    Other (3)
  4. Relevant systemic diseases
A
  1. Otalgia, otorrhea, hearing loss, tinnitus, dizziness
    Ear blockage, ear itch
  2. Nasal obstruction, anterior rhinorrhea, hyposmia, epistaxis, facial pain
    Post-nasal drip, nasal itch, ocular itch, sneezing
  3. Dysphagia, sore throat, odynophagia, dysphonia, regurgitation
    Feeling of lump in throat, burning in throat, weight loss
  4. Allergic chronic rhinosinusitis, DM, HTN, TB, sarcoid, GPA, type 2 neurofibromatosis
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6
Q

Rhinitis

  1. Pathophysiology
  2. Chronic finding
  3. Test
  4. Management (1st line)
  5. Treatment if non resolving small nasal polyps in rhinitis
  6. Treatment if large polyps
A
  1. Type 1 allergic reaction - release of inflammatory mediators
  2. Nasal polyps
  3. Radioallergosorbent test - detects allergis
  4. Antihistamine and nasal steroid spray (takes 6m to take effect)
  5. Prednisolone
  6. Nasal polypectomy
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7
Q

ENT - random definitions

  1. Synechia
  2. Epiphora
  3. Myringoplasty
A
  1. Adhesions in the nasal cavity
  2. Damage to nasal lacrimal duct
  3. Repair of the tympanic membrane perforation
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8
Q

Otitis externa

  1. Definition
  2. Risk factors (4)
  3. Common organisms
  4. Symptoms (4)
  5. Examination signs (3)
  6. Management - if no infection signs
  7. Management - if Pseudomonas
  8. Early complications + sign (2)
  9. Complication if chronic
  10. Complication in immunocompromised
  11. Malignant otitis externa - responsible organism
  12. Risk factors
  13. Symptoms
  14. Management - medical
  15. If ear closed up and need topical ABX
  16. Monitoring requirements
  17. Surgical
A
  1. Diffuse inflammation of the skin lining the outer ear canal
  2. Narrow external canal, trauma, eczema / psoriasis, swimming
  3. Staphylococcus pyogenes, staphylococcus aureus, candida albicans, E.coli
  4. Irritation, discharge, pain (tismus), mild deafness
  5. Meatal tenderness, moist/purulent debris, smelly/keratotic, red desquamated skin
  6. Analgesia
  7. Topical flucloxacillin
  8. Perichondritis (‘cauliflower ear’); cartilage inflammation, + facial cellulitis (if spreads to skin); otomycosis (following topical ABX use)
  9. Canal stenosis with hearing loss
  10. Osteomyelitis of temporal bone ‘malignant’
  11. Pseudomonas aeruginosa
  12. Immunosuppression, DM
  13. CN 7 inflammation/weakness
  14. Topical + IV ABX via in-dwelling cannula for 6 weeks
  15. Use OTOWICK (ear stent) for 48 hours
  16. Regular assessments: CRP/ESR, MRI skull base
  17. Mastoidectomy
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9
Q

Perforated ear drum

  1. Causes (3)
  2. Symptoms (4)
  3. Management - surgical
A
  1. Trauma, iatrogenic (grommet surgery), recurrent infections
  2. Pain (transient), conductive deafness, tinnitus, vertigo
  3. Myringoplasty
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10
Q

Acute otitis media

  1. Length
  2. Causative organisms (2)
  3. Symptoms
  4. 1st line management
  5. Considered recurrent when
  6. OM - otoscope findings
  7. OM with effusion - otoscope findings
A
  1. 1-5 days
  2. Streptococcus pneumonia, H. influenzae
  3. Earache, conductive deafness, otorrhoea, systemic illness, no canal inflammation
  4. Analgesics (usually self limiting) (if ABX later then 5 days amoxicillin)
  5. 4+ episodes in 6 months
  6. Bulging, red, inflamed membrane, maybe perf/fluid
  7. Dull TM with air bubbles/fluid level behind it, or normal
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11
Q

Cholesteatoma

  1. Definition
  2. Commonest cause
  3. Symptoms
  4. Commonest location
  5. Potential complication
  6. Investigation
  7. Potential imaging (2) + indications
  8. Management - if infection present
  9. Management - definitive
A
  1. Accumulation of squamous keratin epithelium
  2. Chronic eustachian tube dysfunction
  3. Painless unilateral hearing loss
  4. Behind pars flaccida in middle ear
  5. Cyst expansion into middle ear - ossicular erosion
  6. Pure tone audiogram
  7. CT if planning mastoid surgery, MI if expected intracranial complication
  8. Topical ABX/steroid drops
  9. Mastoidectomy
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12
Q

Tonsillitis

  1. Criteria to use to decide whether to give ABX
  2. Components (4)
  3. Bacterial - commonest organism + management
  4. Complication of severe bacterial, + organism
  5. Presentation (4)
  6. Examination
  7. Management
A
  1. Centor
  2. Tonsillar exudate, tender anterior lymphadenopathy or lymphadenitis, fever, NO cough (give if 3/4)
  3. Group A strep, use Penicillin V (phenoxyethylpenicillin)
  4. Peritonsillar abscess (Quinsy) - strep. pyogenes
  5. Hot potato voice, fever, bad dysphagia, referred otalgia
  6. Trismus, furred buccal mucosa, foetor (bad breath)
  7. IV AB and drainage of the abscess
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13
Q

Pharyngeal pouch

  1. Location on neck
  2. Specific feature
  3. Presentation
A
  1. Posteromedial
  2. Gurgles on palpation
  3. Dysphagia, regurgitation, aspiration, chronic cough
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14
Q

Neck lump

  1. History
  2. Important risk factor questions (5)
  3. Red flags (6)
  4. Investigations
  5. Midline if <20
  6. Midline if >20
  7. Midline, bony hard
  8. Midline, below hyoid + moves up on tongue protrusion
  9. Midline, moves up on swallowing
  10. Lateral - general differentials
  11. Submandibular triangle - differentials
  12. Anterior triangle - differentials
  13. Posterior triangle - differentials
  14. If on left side and present from birth
  15. Complication of this removal
  16. Lymphadenopathy - infective causes
A
  1. Preceeding symptoms (tonsillitis, pharyngitis, cold), duration, change in size, associated features (pain, redness, discharge), other lumps
  2. Smoking/alcohol, recent foreign travel, HIV status, dental problems, TB contact
  3. Dysphagia, hoarseness, odynophagia, weight loss, fevers, night sweats
  4. USS neck, CT neck and chest, FNAC
  5. Dermoid cyst
  6. Thyroid isthmus mass
  7. Chondroma
  8. Thyroglossal cyst
  9. Goitre
  10. Lymph node, solitary thyroid nodule, lipoma, cystic hygroma /branchial cyst
  11. Lymphadenopathy, salivary stone, sialadenitis
  12. Branchial cyst (high, anterolateral, behind SCM), parotid tumour, laryngocoele (bigger on blowing), pulsatile (carotid artery pathology e.g. carotid body tumour, anterior)
  13. Pancoast tumour, cervical rib, pharyngeal pouch, cystic hygroma (low, lymph filled, at base, seen in kids)
  14. Cystic hygroma
  15. Accessory nerve damage
  16. Streptococcus, staphylococcus, EBV, CMV, TB, toxoplasmosis
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15
Q

Goitre

  1. Commonest cause of large
  2. Goitre in Hashimoto’s
  3. Goitre in Graves’
A
  1. Diffuse multinodular
  2. Small, firm
  3. Smooth and soft +/- bruits
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16
Q

Vertigo

  1. Definition
  2. Due to pathology of (2)
  3. Inner ear - causes
  4. CN 8 - causes
  5. Test to confirm CN 8 pathology
  6. Meniere’s disease - cause
  7. Presentation
  8. BPPV - cause
  9. Diagnosis
  10. Management
  11. Acute labyrinthitis - symptoms
  12. Cause (2)
  13. Duration
  14. Management
A
  1. Illusion of rotatory movement
  2. Inner ear, CN 8
  3. BPPV, menieres, otitis media, labyrinthitis
  4. Acoustic neuroma, ototoxic drugs, HZV
  5. Caloric test - cold water in ear causes nystagmus
  6. Fluid overload due to failure of endolymph reabsorption
  7. Episodic vertigo, fluctuating deafness, tinnitus, recurrent attacks
  8. Occurs on head movement due to disruption of debris in semicircular canal
  9. Fatiguable nystagmus during Hallpike manoeuvre
  10. Epley manoeuvres
  11. Abrupt onset, severe vertigo, nausea, vomiting, prostration, no deafness or tinnitus
  12. Virus, vascular lesion
  13. Severe improves in days, full recover 3-4 weeks
  14. Reassure, sedate
17
Q

Dizziness

  1. Tests - bedside
  2. Tests - blood
  3. Tests - imaging
A
  1. Lying and standing BP, ECG, obs, hearing tests
  2. FBC, ESR
  3. Brain scan
18
Q

Referred otalgia

Causes (5)

A
  1. Sore throat (CN 9)
  2. Temperomandibular joint
  3. Chronic rhinosinusitis
  4. Dental infection
  5. Pharyngeal pathology
19
Q

Oral cavity exam

  1. Eight steps

Oral squamous cell carcinoma

  1. Metastasis sites (4)
  2. Risk factors (6)
  3. Red flax warranting maxfax referral (3)
A
  1. Mucosa of cheeks
  2. Roof of mouth
  3. Dentition/gums
  4. Dorsum of tongue
  5. Lift tongue (mouth floor)
  6. Move tongue (examine sides)
  7. Sometimes palpate OC structures
  8. Inspect oropharynx
  9. Oral cavity, Larynx, EAC (chronic inflammation/previous irradiation), Nasopharynx (SE Asians)
  10. Smoking, alcohol, HIV, EBV, GORD, betel nut
  11. Red/white oral mucosa patches, oral mucosa ulceration > 3 weeks, unexplained tooth mobility
20
Q

Neck anatomy

  1. Anterior triangle - borders
  2. Important structures
  3. Posterior triangle - borders
  4. Neck exam - palpated structures
A
  1. Midline of neck, SCM muscle, inferior mandible border
  2. Carotid sheath, thyroid gland, submandibular gland, lymph nodes
  3. SCM, anterior trapezius, middle 1/3 of clavicle
    Lymph nodes, accessory nerve (CN 11)
  4. Tip of chin (submental/submandibular); Mastoid process (anterior SCM border); Thyroid and larynx (if pathology, assess water swallow); Posterior Triangle (up SCM to mastoid, then rest); Parotid gland; Fossae
21
Q

Ear examination

  1. To do beforehand (3)
  2. Outer - areas to examine
  3. Outer - looking for what
  4. Otoscopy - external auditory canal
  5. Otoscopy - typanic membrane (what and how)
A
  1. Sit patient sideways; Examine good ear first; Ask if bad ear is tender
  2. Pinna, surrounding skin, post-auricular sulcus
  3. Deformity, discharge, scars, sinuses, skin conditions
  4. Diameter, debris, swelling
  5. Examine TM in quadrants; include pas flaccida. Perforations, retractions, keratin, cavity
22
Q

Ear anatomy

  1. Corda tympani branch of the facial nerve - function
  2. Cochlear channels - aka (+ 3 channels)
  3. Hair cells involved in cochlear nerve depolarisation
  4. Neurotransmitter involved
  5. Outer hair cells within Organ of Corti - function
  6. Auditory cortex - location
A
  1. PNS to lacrimal gland; taste from anterior 2/3 of tongue
  2. Scala (Vestibuli, Tympani, Media)
  3. Inner hair cells
  4. Glutamate
  5. Modulate the signal generated by the Organ of Corti
  6. Superior temporal gyrus; extends to lateral sulcus and transverse temoral (Heschl’s) gyrus
23
Q

Chronic otitis media

  1. Definition
  2. What does this imply
  3. Commonest causative organisms (4)
  4. Types (2) + causes
  5. Complications - extra-temporal (4)
  6. Complications - intra-temporal (4)
  7. How it may cause hearing loss (2)
  8. Management - conservative
  9. Management - medical
  10. Management - surgical
A
  1. Present for 3+ months
  2. Perforated eardrum; failed to heal and ongoing infection
  3. Pseudomonas aeruginosa, staphylococcus aureus, streptococcus, anaerobic bacteria (e.g. peptostreptococcus)
  4. Mucosal (from perforated TM; dry); squamous (from cholesteatoma formation)
  5. Meningitis (erodes through tegmen, exposes dura), subdural abscess, temporal lobe abscess (septic thrombi/RVS), sigmoid sinus thrombosis (direct infection/RVS)
  6. Intermittent vertigo (vestibular inflammation), hearing loss, acute otitis externa (discharge and skin irritation), facial weakness (bony erosion - CN 7 exposure and damage)
  7. Conductive (TM/ossicle damage), sensorineural (cochlear nerve inflammation)
  8. Water precautions, regular aural toilet
  9. Topical ciprofloxacin
  10. Myringoplasty (surgical TM repair)
24
Q

Glomus jugulaire

  1. What it is
  2. Commonest symptom
  3. Otoscopy finding
A
  1. Vascular tumour in middle ear
  2. Pulsatile tinnitus
  3. Red mass behind TM
25
Q

Structure perforated in barotrauma

A

Round window (part of medial wall of inner ear)

26
Q

Tympanic membrane

  1. Parts (2)
  2. PF - location
  3. PT - location
  4. Typanosclerosis - what is it, cause
A
  1. Pars tensa, pars flaccida
  2. Above malleus lateral process
  3. Below malleus lateral process
  4. Calcium deposits following healing of previous infection
27
Q

Impacted wax- symptoms (3)

A

Hearing loss, visible wax, no pain/discharge

28
Q

Otorrhoea

  1. What it is
  2. Causes (2)
  3. History
A
  1. Discharge
  2. Inflammation, infection
  3. Duration
    Associated otalgia, hearing loss, dizziness, tinnitus
    Treatment so far
    PMH: water in ear, surgery to ear, allergic chronic rhinosinusitis, asthma, DM
29
Q

Salivary gland

  1. Acute swelling - differentials
  2. Chronic bilateral swelling - co-existing symptoms
  3. Chronic bilateral swelling - differentials
A
  1. Mumps, HIV (bilateral), stone (unilateral, recurrent, pain/swelling on eating)
  2. Dry eyes/mouth, autoimmune disease
  3. Hypothyroidism, Sjogren’s syndrome, fixed (ALL, other tumour, sarcoid, amyloid, GPA)
30
Q

Dysphonia

  1. History
  2. Examination - areas (4)
  3. Vocal fold paralysis - causes (4)
A
  1. Problems/pain swallowing, weight loss, GORD symptoms, nasal symptoms (e.g. PND), systemic upset
  2. Oral cavity, oropharynx, larynx (flexible endoscope), oropharynx, neck (lymphadenopathy/thyroid disease)
  3. Reinke’s oedema, GORD, SCC (white keratin lesions), polyps
31
Q

Nasal obstruction

  1. Causes (3 groups)
  2. History - questions
  3. Deviated septum - management
  4. Potential complication
A
  1. Structural (e.g. septal deformity), inflammatory (e.g. chronic rhinosinusitis), infective
  2. Unilatera/bilateral, duration, intermittent/constant, PMH (trauma/nasal surgery), orther nasal symptoms
  3. Septoplasty
  4. Maxillary nerve branch damage - upper teeth/nose floor numbness
32
Q

Chronic rhinosinusitis

  1. Diagnostic criteria
  2. Signs/symptoms within criteria
  3. Symptoms
  4. Blood test to identify allergies to specific allergens
  5. Management - medical (3)
  6. Management - associated infection
  7. Management - surgical
  8. Surgical management - complications
  9. Nasal polyps - medical management
  10. Bacterial cause
A
  1. EPOS criteria
  2. Nose/paranasal sinus inflammation and nasal blockage, with 1 of (facial pain/pressure, hyposmia/anosmia, polyps, mucopurulent discharge, CT changes)
  3. Bilateral nasal obstruction, anterior rhinorrhoea - watery discharge, sneezing, nasal mucosa oedema
  4. RAST (radioallergosorbent)
  5. Topical nasal steroid (e.g. flixonate beconase) if >10 days, saline nasal irrigation, antihistamines
  6. Macrolide e.g. clarithromycin
  7. Sinus surgery
  8. Blindness (ethmoidal air cell can wrap around CN 2), CSF leak/meningitis, epiphora (damage to nasolacrimal duct), orbital injury, synechiae, hyposmia/anosmia
  9. Short course prednisolone
  10. Streptococcus pneumoniae
33
Q

Mucocilliary function

  1. Test used to assess
  2. How it is performed
A
  1. Saccharine test
  2. Placed 1cm behind anterior end of inferior turbinate
    Usually swept backwards and tasted after 10-20 minutes
34
Q

Epistaxis

  1. Causes (4)
  2. Commonest origin (85%)
  3. Other origin
  4. History
  5. Recurrent chronic epistaxis - medical management
  6. How it works
  7. How to use

Severe epistaxis - management

  1. Stage 1
  2. Stage 2
  3. Stage 3
  4. Stage 4
  5. Risk of bilateral SNC
  6. PP - length of time
  7. PP - additional drug given
A
  1. Idiopathic (85%), trauma, nasal mucosa inflammation / malignancy (SCC), haematological (DIC, ICP)
  2. Little’s area/Kiesselbach plexus (ant. nasal septum)
  3. Woodruff’s plexus (posterior end of middle turbinate)
  4. Frequency, duration, side affected
    Dripping - down nose/throat/both
    What do they do when it starts e.g. apply pressure
    PMH - previous bleeds, HTN, rhinitis, bleeding disorders, GPA, sarcoidosis
    DH - warfarin, aspirin, clopidogrel, clexane (LMWH)
  5. Naseptin (bactroban) ointment
  6. Treats staph colonisation causing inflammation
  7. Use for 1-2 weeks - stops crust forming (contains peanuts)
  8. Visualise bleeding point
  9. Cauterise or anterior pack
  10. If AP, then posterior pack (foley catheter)
  11. Surgery (Artery ligation - mainly sphenopalatine or anterior ethmoidal)
  12. Septal perforation
  13. 48 hours
  14. Prophylactic PO antibiotics

Medical School (28 decks)

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