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MRCS - ENT Nov > ENT Essentials > Flashcards

ENT Essentials Flashcards

1
Q

when do adenoids usually regress by

A

aged 13

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2
Q

causes of hypertrophy of adenoids

A

acute infection
allergy
inflammatory conditions

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3
Q

symptoms of enlarged adenoids

A

nasal obstruction - mouth breathing, snoring, hyponasal speech
Nasal discharge
OSA
otalgia from eustachian tube obstruction
deafness from AOM and otitis media with effusion

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4
Q

Diagnosing adenoid enlargement

A

clinically
FNE

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5
Q

Indications for adenoidectomy

A

nasal obstruction
Glue ear
recurrent AOM
OSA

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6
Q

Methods for performing adenoidectomy

A

curettage
suction diathermy
coblation

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7
Q

contraindications to adenoidectomy

A

URTI recently
uncontrolled bleeding disorders
Cleft palate - either overt or submucosal

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8
Q

why is cleft palate a contraindication to adenoidectomy?

A

adenoids assist in closure of nasopharynx from oropharynx - velopharyngeal insufficiency can result

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9
Q

Complications of adenoidectomy

A

soft palate damage
haemorrhage
subluxation of atlanto-axial joint
eustachian tube stenosis
hypernasal speech - treat with speech therapy and give it time, otherwise pharyngoplasty

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10
Q

treatment of post adenoidectomy bleed

A

return to theatre
post nasal pack

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11
Q

what % of blood volume can children lose before increase in SVR and HR

A

30%

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12
Q

define age associated hearing loss

A

prev. known as presbyacusis
progressive bilateral SNHL where other causes have been excluded

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13
Q

describe the pathophysiology of age associated hearing loss

A

reduction in number of inner and outer hair cells, particularly at basal end of cochlea

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14
Q

indications for an MRI if SNHL?

A

asymmetry on PTA of 15dB or more at any 2 adjacent test frequencies

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15
Q

commonest pattern on PTA of age associated hearing loss

A

sloping, high frequency SNHL

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16
Q

Aim of treatment of age associated hearing loss

A

assess degree of disability
provide hearing aid
rehabilitate patient

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17
Q

rehabilitation available for age associated hearing loss?

A

lip reading classes
auditory training

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18
Q

Define barotrauma

A

damage to body structures due to changes in atmospheric pressure

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19
Q

Causes of barotrauma (3)

A

flying
diving
hyperbaric oxygen therapy

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20
Q

Describe boyles law

A

as ambient pressure increases, volume of a gas decreases

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21
Q

advice to prevent barotrauma

A

dont sleep during aircraft descent
encourage eating and drinking i.e. ET opening
topical decongestants or oral decongestants if needed
Control any co-existant rhinitis prior to flying

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22
Q

why are divers advised not to dive if have an URTI

A

ETD - if unable to equalise pressures may get a perforation - cold water caloric - resulting acute vertigo and vomiting can be fatal in a diving situation

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23
Q

Causes of cervical lymphadenopathy

A

infection - URTI, dental, EBV, Kawasaki
inflammatory - SLE, sarcoidosis
Neoplastic - lymphoma, mets from H&N primary, mets from skin cancer or distant sites

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24
Q

Investigations for cervical lymphadenopathy

A

FNA
US
CT/MRI
Bloods

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25
Q

Sulphur granules on FNA cytology?

A

actinomycosis

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26
Q

what is heerfordt’s syndrome

A

bilateral parotid swelling, anterior uveitis, facial palsy and fever –> sarcoidosis

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27
Q

diagnosis of sarcoidosis

A

CXR
ACE
serum calcium (elevated)
caseating granuloma on biopsy
negative tuberculin test

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28
Q

treatment of sarcoidosis

A

steroids

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29
Q

ENT presentation of SLE

A

cervical lymphadenopathy
recurrent mouth ulcers
motility disorders of oesophagus

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30
Q

diagnosis of SLE

A

ANA on serology

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31
Q

treatment of SLE

A

NSAIDs
Steroids
immunosuppresants
hydroxychloroquine
methotrexate

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32
Q

diagnosis of lymphoma

A

Can be suspected from FNA but needs formal biopsy

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33
Q

level 2 nodes are

A

upper jugular nodes

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34
Q

level 3 nodes are

A

mid jugular nodes

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35
Q

level 4 nodes are

A

lower jugular

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36
Q

level 5 nodes are

A

posterior triangle

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37
Q

level 6 nodes are

A

anterior compartment group

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38
Q

level 7 nodes are

A

superior mediastinal group

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39
Q

first echelon draining lymph nodes for primaries are

A
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40
Q

define cholesteatoma

A

collection of migrating keratinising squamous epithelium trapped within the middle ear or mastoid

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41
Q

describe pathophysiology of congenital cholesteatoma

A

arises from epithelial cell rests in forming middle ear which would usually have disappeared at 17 weeks gestation, usually present as a pearly white mass behind an intact TM

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42
Q

describe how a cholesteatoma causes its complications

A

proteolytic enzymes released by outermost layer of cholesteatoma erode adjacent bone, ossicles, exposing inner ear, facial nerve, meninges of brain
deafness due to damage of bones in middle ear but also erosion of labyrinth (would be associated with dizziness due to damage to vestibular apparatus) - usually damages lateral SCC causing positive fistula sign
invasion of facial nerve directly
brain abscess, meningitis, venous thrombosis from direct spread of cholesteatoma to brain

43
Q

why is cholesteatoma easily infected

A

contents of cholesteatoma have no blood supply so easily infected by any bacteria

44
Q

presentation of cholesteatoma

A

hearing loss
foul smelling otorrhoea
may have otalgia

45
Q

investigations for cholesteatoma

A

PTA
CT temporal bones
MRI for recurrence monitoring
Biopsy only needed if suspect malignancy

46
Q

how to perform masking

A

tragal rub - occlusion of auditory canal by putting pressure on tragus with rubbing motion
Barany box

47
Q

what is bings test

A

similar to rinne’s test - tuning fork strunk and placed on mastoid then ipsilateral meatus occluded by examiners finger and subject asked if noise is quieter or louder

48
Q

external parts of a cochlear implant

A

microphone
speech processor
transmitter coil

49
Q

differential diagnosis of cough

A

laryngopharyngeal reflux
post nasal drip
CRS
laryngeal hypersensitivity
laryngeal dysfunction
allergic response
airway stenosis

50
Q

Management of laryngopharyngeal reflux

A

lifestyle changes - avoiding certain food and drink, food diary, avoiding large meals at bedtime, avoiding caffeine at bedtime because relaxes lower oesophageal sphincter
medication - PPI, antacids
investigate for causes such as hiatus hernia and refer to appropriate team

51
Q

management of drooling

A

watchful waiting
anticholinergic agents to dry secretions such as hyoscine patches, oral glycopyrrolate
SLT physical therapies
Botox into salivary glands occasionally
surgery - rare but removal of glands for example or adenotonsillectomy

52
Q

organisms responsible for epiglottitis

A

haemophilus influenza type B
streptococcus pyogenes
streptococcus pneumoniaw
staphylococcus aureus

53
Q

Which vessel usually responsible for traumatic epistaxis and why

A

nasal trauma often involves the vomer and superior part of nasal septum which is supplied by a branch of anterior ethmoidal artery - therefore ligation of SPA and anterior ethmoidal may be required in traumatic epistaxis

54
Q

causes of epistaxis

A

iatrogenic (nasal surgery, intranasal steroids)
trauma (fractures, foreign body, nose picking)
inflammatory (rhinitis, sinusitis)
neoplastic (pyogenic granuloma, juvenile angiofibroma, SCC)
idiopathic
anticoagulants
bleeding disorders
HHT
HTN

55
Q

inheritance of HHT

A

AD

56
Q

treatment of HHT epistaxis

A

KTP laser
septodermoplasty
Young’s procedure
tamoxifen
bevacizumab (inhibits vascular endothelial growth factor)

57
Q

commonest abnormalities which cause a prominent ear

A

poorly developed antihelical fold
overly developed prominent deep conchal bowl

58
Q

treatment of bat ears

A

small babies with modest deformity - ‘ear buddies’ - splints which enourage pinna to adopt appropriate shape
earfold nitinol implants
pinnaplasty

59
Q

risk factors for perichondritis

A

local trauma (burns/bites/piercings)
OE

60
Q

commonest organism responsible for perichondritis

A

pseudomonas aeruginosa
staph aureus

61
Q

what is chondrodermatitis nodularis helicis and treatment

A

tender red nodule on ear
usually due to area of localised damage to cartilage skeleton from trauma or inflammatory reaction to cold temperatures
keep ear warm, excision biopsy

62
Q

name of syringe used for ear syringing

A

higgison syringe

63
Q

exostoses vs osteoma

A

osteoma - benign tumour of bone arising from tympanosquamous or tympanomastoid suture line
exostoses - more common, hyperostoses of tympanic bone of external canal

64
Q

define fistula

A

communication between 2 epithelial lined surfaces

65
Q

define sinus

A

epithelial lined blind ending tract

66
Q

when does the branchial apparatus appear

A

4th week of foetal development

67
Q

consequence of persistance of a branchial cleft or pouch

A

simple sinus opening externally or internally respectively

68
Q

consequence of persistence of both a cleft or a pouch

A

development of a fistula with internal and external openings, joined by a fistula tract

69
Q

what is the first branchial arch responsible for forming

A

malleus, incus, mandible, maxilla

70
Q

what is formed from first arch pouch

A

eustachian tube
middle ear

71
Q

what is formed from first arch cleft

A

external auditory meatus

72
Q

how do first branchial arch fistulas present

A

very uncommon
but usually large with superior opening in external auditory canal and inferior opening in neck between tragus and hyoid bone

73
Q

what does the second branchial arch form

A

stapes, stylohyoid ligament, posterior portion of hyoid bone

74
Q

what does the second arch pouch form

A

bed of tonsillar fossa

75
Q

how does a second branchial arch fistula form

A

skin opening in neck at anterior border of SCM and internal opening in tonsillar fossa

76
Q

investigation of second branchial arch fistula

A

fistulogram
CT with contrast
MRI

77
Q

how would 3rd and 4th branchial arch fistula present

A

uncommon
skin opening in neck, internal opening in pyriform fossa or pharynx

78
Q

what is an oroantral fistula

A

communication between oral cavity and maxillary sinus - caused by infection, cancer, developmental clefts, cocaine abuse, tooth extraction (most commonly)

79
Q

management of oroantral fistula

A

small - conservative management or simple primary closure
larger - buccal or palatal mucoperiosteal flap

80
Q

what suggests a FB in pharynx

A

increasing odonophagia
pain on gentle side to side manipulation of larynx
history

81
Q

how does button battery cause trauma

A

button battery in contact with tissue on both sides of battery creates an electric current between the terminals, causes sodium hydroxide to build up in tissues, causes caustic burn

82
Q

complications of button battery

A

nose - septal perforation
ear - external ear canal skin destruction, TM destruction
phayrngeal perforation
oesophageal perforation

83
Q

what to do after FB removal from nasal cavity

A

reexamine afterwards to ensure no second FB more posteriorly

84
Q

how to determine if there is an oesophageal perforation post FB

A

gastrografin swallow or omnipaque 500 swallow

85
Q

soft food bolus in oesophagus management

A

admit
IV buscopan
diazepam
fizzy drink
barium swallow to look for cause of obstruction

86
Q

management of sharp FB in oesophagus

A

rigid oesophagoscopy
if a mucosal tear, keep in hospital post procedure, IV abx, 4 hours NBM post procedure

87
Q

CXR findings of FB in trachea/bronchi

A

show the FB if radoiopaque
consolidation/collapse/hyperinflation/mediastinal shift

88
Q

management of fb in bronchi

A

bronchoscopy

89
Q

how to remove fb in bronchi of young children

A

ventilating hopkins rod bronchoscopes

90
Q

t1 vs t2 mri images

A

t1 - csf/globe fluid signal dark, fat white
t2 - fluid white, fat also white

91
Q

contrast agent used in mri

A

gadolinium

92
Q

imaging choice for cholesteatoma

A

hrct temporal bones - shows well defined mass in middle ear cleft with or without ossicular erosion

93
Q

what is an ager nasi cell

A

pneumatisation of agger mound which can extend into frontal recess and cause mechanical obstruction

94
Q
A

pneumatised middle turbinate, when enlarged can narrow middle meatus and osteomeatal complex, resulting in obstruction. inflammation and fluid opacification can also occur in concha bullosa resulting in bullitis

95
Q
A

haller cell
ethmoid air cells which have projected inferiorly along the medial aspect of the orbital floor and obstruct the maxillary ostium if enlarged

96
Q

exercises used in acute labyrinthitis and when to start them

A

cooksey cawthorne exercises but only commence once initial phase of symptoms have settled. Can accelerate recovery and central compensation.

97
Q

what is a labyrinthine fistula

A

bony erosion of labyrinthine capsule to expose/rupture endosteum of labyrinth - endosteum is a thin layer of periosteum separating membranous labyrinth from dense cortical bone covering SCCs, breach results in perilymph fistula and may cause vertigo and a dead ear

98
Q

what is tullio phenomenon

A

vertigo in presence of loud sounds - associated with semicircular canal dehisence

99
Q

speech options for laryngectomy patients

A

oesophageal voice
prosthetic speech valve
electrolarynx

100
Q

laser stands for

A

light
amplification by the
stimulated
emission of
radiation

101
Q

safety precautions laser

A

designated laser environment with appropriate sinage (signs on all theatre access doors when laser in use, with theatre doors locked/signs saying dont enter)
laser safety officer and supervisor appointed and trained appropriately
all laser users should attend regular update courses
anaesthetic consideration - non inflammable anaesthetic agent, ensure ET cuff inflated with saline not air
patient - saline soaked drapes on face and taped eyes/safety goggles
all theatre personnel to wear safety goggles
regular maintenance and checking of aiming beam and laser output
non refelctie scopes
adequate suction availability

102
Q

complications of mastoid surgery

A

facial nerve injury
hearing loss
tinnitus
vertigo
change in taste
dural injury
vascular injury - sigmoid sinus, petrous carotid artery

103
Q

complications and management of complications of temporal bone fractures

A

facial palsy - steroids, monitor, surgical decompression
CSF otorrhoea/rhinorrhoea - bed rest, head elevation, stool softeners, LD if not settling, if persists more than 10 days surgical exploration
perilymph fistula - surgical exploration
TM perforation - conservatively with water precautions, if not healed after 6-8 weeks tympanoplasty
EAC fracture - conservative, but may result in canal stenosis and cholesteatoma
ossicular damage - monitor for some time then tympanotomy

MRCS - ENT Nov (7 decks)

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