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Year 6 > ENT incorrects > Flashcards

ENT incorrects Flashcards

1
Q

A 45 year old woman is feeling unwell with a severe sore throat. She has schizophrenia and started taking clozapine 4 months ago.

Her temperature is 39.0°C. She has an ulcerated throat with tonsillar exudate.

Blood cultures have been sent.

What additional investigation is most likely to establish the underlying cause?

A

full blood count!!

risk of agranulocytosis with clozapine

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2
Q

vestibular neuronitis
symptoms? management?

A

dizziness
nausea and vomiting may be present
horizontal nystagmus is usually present

acute management = plorchloperazine

vestibular rehabilitaiton for chronic presentation

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3
Q

A 55-year-old man from Hong Kong presents with left sided otalgia and recurrent episodes of epistaxis. On examination his pharynx appears normal. Examination of his neck reveals left sided cervical lymphadenopathy. What is the most likely underlying diagnosis?

A

nasopharyngeal carcinoma

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3
Q

A 54-year-old woman attends the GP with a one-day history of hearing loss in her right ear. There is no discharge or pain. She has no history of dizziness or tinnitus.

Assessment by otoscopy shows wax in the right ear with no other obvious changes to the external auditory meatus or tympanic membranes bilaterally. Weber test lateralises to the left side. Rinne test shows air conduction louder than bone conduction bilaterally.

What is the most appropriate next step?

A

In this patient, Weber’s test lateralized to the left, which indicates a conductive hearing loss in the left ear or sensorineural loss in the right ear. Rinne’s test found air conduction was louder than bone conduction in both ears. Therefore this patient has a sensorineural hearing loss in the right ear.

Acute sensorineural hearing loss is an emergency and requires urgent referral to ENT for audiology assessment and brain MRI!!!! and treatment with high dose oral corticosteroids!!!

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4
Q

A 64-year-old woman with a one week history of pain above and lateral to her left eye. On examination she is tender over that area.

most likely diagnosis?

A

temporal arteritis

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5
Q

he HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

Central vertigo will have a normal head impulse test!, vertical or saccadic nystagmus and will display a vertical skew.

A
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6
Q

A 23-year-old woman presents one week after being prescribed a combined antibiotic and steroid spray for otitis externa. There has been no improvement in her symptoms and the erythema seems to have extended to the ear itself. What is the most appropriate treatment?

A

oral flucloxacillin!!
spreading erythema is an indication for oral antibiotics. Flucloxacillin is first-line.

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7
Q

A 31-year-old man presents with bilateral hearing loss and tinnitus. There is a family history of similar problems. Examination of the tympanic membranes is unremarkable. Audiometry shows bilateral conductive hearing loss.

most likely diagnosis?

A

otosclerosis

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8
Q

A 68-year-old man presents with acute onset dizziness accompanied by nausea and unsteadiness. He has a history of atrial fibrillation. On examination, he exhibits difficulty fixating on the examiner’s nose during the head impulse test, and a corrective saccade is observed.

What is the most likely diagnosis?

A

vestibular neuronitis -> positive head impulse test

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9
Q

A 33-year-old male presents to the GP complaining of a 4 month history persistent nasal discharge on his left hand side and facial pressure which is worse on bending forward. He often finds he has to breath through his mouth due to his nose being blocked. He has a past medical history of asthma and is a smoker with a 5 pack-year history.

What is the most appropriate management?

A

referral to ENT!!

Unilateral symptoms are a red flag for patients with chronic rhinosinusitis!!

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10
Q

A 53-year-old man presents to his general practitioner with a lesion on his tongue that he has observed for the last three months. The lesion is characterised by a white patch on the side of the tongue and has a corrugated, ulcerated appearance. It is asymptomatic. His past medical history includes Crohn’s disease and well-controlled HIV with an undetectable viral load for the past decade.

What is the most likely diagnosis?

A

persisitent mouth ulcer _> squamous cell carcinoma!!!

75 more questions to go!!

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11
Q

A perforated tympanic membrane caused by barotrauma is self-limiting

A
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12
Q
A
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13
Q

A 45-year-old woman presents to her GP with dizziness which started two days ago. She says it feels like the room is spinning around her. The symptoms are constant and are worse when she moves, so she has spent most of her time in bed. She reports feeling nauseous and vomiting once. She also reports hearing ringing in her ears for the past day.

When questioned by the GP, she mentions that she was ill last week with a cold.

On examination, Rinne’s test is positive in both ears, but Weber’s test localises to the left side.

What is the most likely diagnosis?

A

labyrinthitis!! - backed by recent viral ilness

menieres comes in episodes of minutes to hours. not continuous

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13
Q

chronic sinusitis that hasnt responded to steroids treatment?

A

Nasal irrigation with saline solution is a treatment option for chronic rhinosinusitis

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13
Q

presbycusis audiogram findings?

A

Bilateral high-frequency hearing loss. Air conduction better than bone

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14
Q

A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatment.

A

sarcoidosis
(facial nerve involvement)

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15
Q

18 month old girl

On examination, you note bulging tympanic membranes with surrounding erythema bilaterally.

What is the appropriate first-line management in this patient?

A

aMoxicillin!! = otitis Media!!!

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15
Q

A 32-year-old female is referred urgently to the ear, nose and throat (ENT) specialists with a 1-month-history of severe, unrelenting otalgia, associated with temporal headaches and purulent otorrhoea. She has a past medical history of type one diabetes mellitus and has no allergies. Examination identifies an erythematous external auditory canal and periauricular soft tissue on the left side which is exquisitely tender.

What is the most appropriate antibiotic management for this patient?

A

ciprofloxacin

malignant otitis externa

normal otitis externa =
topical antibiotic or a combined topical antibiotic with a steroid

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16
Q

You see a 3-year-old boy as a follow-up appointment. Two weeks ago he presented with left-sided otalgia associated with a purulent discharge. You prescribed amoxicillin and arranged to see him today. His mum reports that he is much better and says she has managed to keep the ear dry. On examination of the left side a perforation of the tympanic membrane is noted. What is the most appropriate action?

A

Advise to keep ear dry and see in a further 4 weeks time

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17
Q

You see a 40-year-old man with reduced hearing on the right side. You examine his ears and note the right ear canal is blocked with wax but the left ear is clear. What would be the expected findings on testing Rinne and Weber?

A

Weber: sound localises to the right; Rinne: BC > AC on the right and AC > BC on the left

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18
Q

The left tympanic membrane is opaque and inflamed, along with left ear proptosis and post-auricular inflammation. The right ear is unaffected.

He has no past medical history but is allergic to penicillin.

What is the most appropriate initial step in his management?

A

Arrange same-day hospital admission

mastoiditis!!!

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19
Q

Adults are generally required to have had a failed trial of hearing aids before having a cochlear implant

A
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20
Q

name drugs that cause gingival hyperplasia

A

phenytoin, ciclosporin, calcium channel blockers eg nifedipine and AML

21
Q

ototoxic drugs

A

aminoglycosides (e.g. Gentamicin), furosemide, aspirin, quinine

22
Q

A 56-year-old man presents with episodic facial pain and discomfort whilst eating. He has suffered from halitosis recently and he frequently complains of a dry mouth. He has a smooth swelling underneath his right mandible. What is the most likely underlying diagnosis?

A

Stone impacted in Whartons duct
46%

23
Q

A 13-year-old girl is brought in by her mother with epistaxis. This occurs intermittently and she has not identified any triggers. She has had previous surgery for enlarged adenoids and has a history of anaphylaxis to peanuts. The examination is unremarkable, no bleeding focus is identified

normal bloods. management?

A

Recommend first aid measures during nose bleeds

24
Q

The management for a child with a first presentation of otitis media with effusion is active observation for 3 months - no intervention is required

A
25
Q

A 5-year-old-boy presents with a persistent hearing loss. His mother reports concerns from his teachers that he does not seem to pay attention in class. She reports he often turns up the volume of the television while at home. On examination, the left eardrum is retracted and there is loss of the light reflex. You suspect otitis media with effusion and arrange pure tone audiometry which reveals moderate hearing loss particularly at low frequencies. He presented to your colleague 12 weeks previously with similar symptoms, with similar audiometry findings.

What is the next most appropriate management in primary care?

A

Refer a child with glue ear to ENT if they have persisting significant hearing loss on two separate occasions (usually 6-12 weeks apart)

26
Q

unilateral otitis media that doesnt respond to antibiotics. next step in management?

A

Refer under 2-week wait to ENT for suspected cancer - can be a presenting symptom of nasopharyngeal cancer

27
Q

perforated eardrum management?

A

Watch and wait -if persists beyond 6 weeks for ENT referral

28
Q

sinusitis first line management?

A

analgesia
Intranasal steroids should only be considered for sinusitis if symptoms have persisted for 10 days or more

29
Q

Rinne’s test negative means that bone conduction > air conduction and thus there is a conductive hearing loss in that ear

A
30
Q

Weber’s test lateralises to the left (the better-hearing ear), which occurs in unilateral sensorineural hearing loss of the opposite ear (right sided sensorineural hearing loss) OR left sided conductive hearing loss

A
31
Q

Elderly patient dizzy on extending neck. most likely diagnosis?

A

Vertebrobasilar ischaemia

32
Q

Children presenting with glue ear with a background of Down’s syndrome or cleft palate management?

A

referral to ENT

33
Q

A 46-year-old woman presents to the GP with a three-day history of severe vertigo and nausea. The vertigo is not provoked by movement, and she reports no tinnitus or hearing loss. Her past medical history is unremarkable, and her only medication is the combined oral contraceptive pill.

On examination, horizontal nystagmus is noted. There are no other neurological findings.

What is the most likely diagnosis?

A

vestibular neuronitis!!

hearing is normal

hearing loss = acute labyrynthitis

34
Q

A 49-year-old Caucasian male presents with a 12 week history of pus-like discharge from his ear. You decide to perform otoscopy. What is the most important part of the tympanic membrane to visualise?

A

attic -> to exclude cholesteatoma

35
Q

management of acute necrotizing ulcerative gingivitis (painful bleeding gums with halitosis and punched-out ulcers on the gums)?

A

Paracetamol + oral metronidazole + chlorhexidine mouthwash

36
Q

A 1-year-old boy is brought to the GP as his mother has noticed an unusual lump on his neck. She is not sure how long it has been there for. It is located in the anterior triangle just in front of the sternocleidomastoid muscle and is soft in texture. The lump does not transilluminate but is mobile.

A biopsy is performed and reveals cholesterol crystals in the fluid extracted.

What is the most likely underlying diagnosis?

A

branchial cyst

37
Q

name a bacteria that commonly causes otitis media

A

Haemophilus influenzae
60%

38
Q

treatment of ramsay hunt syndrome?

A

oral aciclovir and corticosteroids, eye protection

39
Q

A 65-year-old man in a stroke unit develops epistaxis. He has a history of atrial fibrillation and takes rivaroxaban.

His pulse is 88 bpm, his blood pressure is 119/80 mmHg, his respiratory rate is 18 /min, and his oxygen saturation is 98% breathing air. He has tried pinching his nose for 5 minutes, however, when he stops, the bleeding resumes. A bleeding site is not visible.

Which option is the best next step?

A

Advise pinching the nostrils firmly and leaning forward for 20 minutes!!

you need to do this for at least 20 minutes before considering nasal packing

40
Q

Persistent unexplained hoarseness in a patient aged >45 years old: consider urgent referral to ENT
Important for meLess important. duration!! of symptoms necessitates referral

A
41
Q

chronic rhinosinusitis treatment?

A

Nasal irrigation with saline solution

intranasal corticosteroids second line NOT oral!

red flag symptoms:
unilateral symptoms eg drainage or polyp
persistent symptoms despite compliance with 3 months of treatment
epistaxis

42
Q

A 54-year-old woman presents with a neck swelling. She is systemically well apart from some recent weight loss. On examination she is noted to have a midline, non-tender neck swelling which moves upwards when she swallows.

most likely diagnosis?

A

goitre

43
Q

benign pelomorphic adenoma management?

A

Routine surgical resection

44
Q

Otoscopy findings in otitis media can include opacification and bulging of the tympanic membrane and decreased mobility on pneumatic otoscopy.

A 20-year-old woman presents with a four-day history of increased hearing difficulty. She states that she recently recovered from the flu when she started experiencing mild ear pain and decreased hearing, which she has been taking paracetamol for. Rinne’s test is negative in her right ear, and during Weber’s test, the patient states that the sound is louder in her right ear. Pneumatic otoscopy reveals decreased mobility of the tympanic membrane. Observations reveal a heart rate of 78 bpm, a blood pressure of 107/67 mmHg, and a temperature of 37.4 ºC.

What is the most likely diagnosis?

A

otitis media

45
Q

A 42-year-old man presents with a 2 week history of a worsening sore throat, is complaining of painful swallowing. On examination you notice that he has difficulty opening his jaw, purulent tonsils and his uvula is deviated to the right. Given the likely diagnosis, how should this condition be managed?

A

oral antibiotics and surgical drainage of the abscess!!

46
Q

A 4-year-old girl is brought to see her GP by her mother. She has noticed that she has become more irritable over the last 5 days following a brief period of coryzal symptoms and has had a mild fever.

On otoscopic examination, the right tympanic membrane and ear canal appear normal but the left tympanic membrane is bulging and erythematous with loss of the light reflex. There is no ear discharge present.

Which of the following is most likely to have caused this presentation?

A

hemophilus influenzae

47
Q

Otoscopy reveals a cloudy and slightly retracted tympanic membrane on the left side, with an air-fluid level and bubbling observed behind the tympanic membrane. The external auditory canal appears non-erythematous.

What is the most appropriate management option for this patient?

A

Two week wait referral! => Unilateral glue ear in an adult needs evaluation for a posterior nasal space tumour

not acute otitis media which would present with otalgia and a fever. On otoscopy, one would expect to see a red and bulging tympanic membrane.

47
Q

The external ear is displaced anteriorly, and there is marked tenderness to palpation behind the ear. Otoscopy reveals a bulging tympanic membrane and middle ear effusion. Her heart rate is 132 bpm, respiratory rate 27/min, BP 90/60 mmHg, and temperature 38.5ºC.

Given the most likely diagnosis, what is the most appropriate treatment?

A

IV antibiotics!

signs of mastoiditis

48
Q

A 9-year-old boy is reviewed after falling off his skateboard two hours ago. He fell forward, breaking his fall with his right arm. On examination he has minor abrasions on his right forearm but no sign of a fracture. His nose is erythematous with some abrasions. Examination of the nostrils reveals a bilateral red swelling arising from the midline, which is slightly boggy. No other signs of a head injury are seen. What is the most appropriate management?

A

Arrange an urgent ENT review -> nasal septal hematoma!!!

49
Q

43-year-woman had a tonsillectomy one week ago. She presents to her GP one week later because she has noticed a small amount of blood pooling in her mouth from this morning. She believes that the blood is coming from the wound site.

The GP examines her mouth and throat and sees no other obvious source of the bleeding. A set of basic observations are all normal.

What is the most appropriate next step for the GP to take?

A

Admit to hospital for ENT review and antibiotic therapy

NOT surgery because

Haemorrhage 5-10 days after tonsillectomy is commonly associated with a wound infection and should therefore be treated with antibiotics

50
Q

name a heart failure drug that can cause tinnitus

A

Loop diuretics eg bumetanide, furosemide

51
Q

The majority of sudden-onset sensorineural hearing loss cause?

A

idiopathic

52
Q

Complications of thyroid surgery - damage to parathyroid glands can result in hypocalcaemia -> long QT

A
53
Q

Non-resolving otitis externa with worsening pain should be referred urgently to ENT

A

Year 6 (22 decks)

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