Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA > ENT - Passmed > Flashcards

ENT - Passmed Flashcards

1
Q

Most common bacteria causing bacterial otitis media?

A

Haemophilus Influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some causes of conductive hearing loss

A
  • Foreign body
  • Otitis media
  • Otitis externa
  • Perforated ear drum
  • Otosclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List some causes of otitis externa

A
  • Infection: bacterial (Staph aureus, Pseudomonas aeruginosa) or fungal
  • Serborrheic dermatitis
  • Contact dermatitis (allergic and irritant)
  • Recent swimming
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Features of otitis externa?

A
  • Otalgia, itch, discharge
  • Otosocopy - red, swollen or eczematous ear canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Outline management for otitis externa

A
  • Topical antibiotic or combined antiobitic with a steroid (note if TM is perforated typically aminoglycosides are not used). If you suspect fungal otitis externa use canesten drops
  • If there is canal debris - consider removal
  • If the canal is extensively swollen sometimes a pope ear wick is used
  • Swab the ear
    SECOND LINE:
  • Oral antibiotics e.g. fluclox if infection is spreading
  • Empirically use antifungal agent

In suspected otitis malignant otitis externa (elderly diabetics, cranial nerve involvement etc)
- IV antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List some complications of tonsillitis

A
  • Otitis media
  • Quinsy
  • Rheumatic fever and glomerulonephritis very rarely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Outline the indications for tonsillectomy

A
  • 7,5,3 rule - 7 episodes per year for one year
  • 5 episodes per year for 2 years
  • 3 episodes per year for 3 years
  • Suspected malignancy (irregular often asymmetrical tonsillar enlargement, etc)
  • Recurrent febrile convulsions secondary to episodes of tonsillitis
  • Obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
  • Peritonsillar abscess (quinsy) if unresponsive to standard treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is a primary post-tonsillectomy bleed and when is secondary?

Also what are primary and then what are secondary bleeds most commonly caused by?

A

Primary = < 24 hours - most commonly due to inadequate haemostasis
Secondary = 24 hours to 10 days - most commonly due to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common symptom in nasal septal haematoma?

Then list some more features

A

Sensation of nasal obstruction

Pain
Rhinorrhoea
Bilateral, red swelling arising from the nasal septum
Can be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can nasal septal haematomas be differentiated from nasal deviation?

A

Surgical drainage
IV antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the complication that happens when you don’t manage nasal septal haematoma?

A

If untreated, irreversible septal necrosis may develop within 3-4 days. Due to pressure related ischaemia of the cartilage resulting in necrosis. Can result in saddle-nose deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What decibel level is normal in audiograms?

A

0-20dB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List some differentials for facial pain

A
  • Trigeminal neuralgia - severe lancinating pain along one or more branches of the trigeminal nerve
  • Sinusitis - facial pain accompanied by symptoms such as nasal discharge or congestion suggesting sinusitis
  • Dental problems - dental caries or abscesses can cause localised facial pain
  • Tension type headache
  • Migraine
  • GCA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Triad of symptoms in Meniere’s disease?

A

Vertigo, tinnitius and hearing loss (sensorineural)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What pattern of hearing loss can occur in Meniere’s disease?

A

Sensorineural hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Apart from the triad of vertigo, tinnitus and hearing loss, what other features can be present in Meniere’s disease?

A

Nystagmus
Romberg’s +ve
Sensation of aural fullness or pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Outline the management of Meniere’s disease, including advice, what is given for acute attacks and what is given for prevention of attacks?

A
  • Inform the DVLA - cease driving until satisfactory control of symptoms
  • Acute attacks - buccal or IM prochlorperazine
  • Betahistine and vestibular rehabilitation exercises
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What 3 -itis s can be involved in sore throat?

A
  • Pharyngitis
  • Tonsillitis
  • Laryngitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

NICE indications for antibiotics in sore throat?

A
  • Feature of marked systemic upset secondary to the acute sore throat
  • Unilateral peritonsillitis
  • History of rheumatic fever
  • Increased risk from acute infection (e.g. child with diabetes mellitus or immunodeficiency)
  • Patients with acute sore throat / acute pharyngitis / acute tonsillitis when 3+ centor criteria are present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 4 different categories that score a point on the Centor criteria?

A
  • Presence of tonsillary exudate
  • Tender anterior cervical lymphadenopathy or lymphadenitis
  • History of fever
  • Absence of cough

Note 3+ - give antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the different categories that score a point in the FeverPAIN criteria?

A
  • Fever > 38C
  • Purulence (pharyngeal / tonsillar exudate)
  • Attend rapidly ( 3 days or less)
  • Severely inflamed tonsils
  • No cough of coryza
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which antibiotics are given in people who fulfill Centor or FeverPAIN criteria?

A
  • Phenoxymethylpenicillin OR clarithromycin if penicillin allergic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

List some causes of vertigo

A
  • Viral labyrinthitis
  • Vestibular neuronitis
  • BPPV
  • Meniere’s disease
  • Vertebrobasilar ischaemia
  • Acoustic neuroma
  • Posterior circulation stroke
  • Trauma
  • MS
  • Ototoxicity e.g. gentamicin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Nasal polyps more common in men or women?

A

2-4x more common in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

List some associations for nasal polyps

A
  • Asthma (particularly late-onset asthma)
  • Aspirin sensitivity
  • Infective sinusitis
  • Cystic fibrosis
  • Kartagener’s syndrome
  • Churg-Strauss sydrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the triad in Samter’s triad?

A
  • Nasal obstruction
  • Rhinorrhoea, sneezing
  • Poor sense of taste and smell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What features require further investigation in nasal polyps?

A
  • Unilateral symptoms
  • Bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the treatment options in nasal polyps?

A
  • Topical corticosteroids shrink polyps size in around 80% of patients
  • Polypectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Asthma, aspirin sensitivity and nasal polyposis are part of what triad?

A

Samter’s triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What to do with someone with unexplained unilateral otalgia for > 4 weeks with unremarkable otoscopy?

A

Refer under 2 week wait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Features of head and neck cancer?

A
  • Neck lump
  • Hoarseness
  • Persistent sore throat
  • Persistent mouth ulcer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

NICE guidelines for suspected cancer pathwar referral criteria under 2WW for laryngeal cancer?

A

45 + yrs with:
- Persistent unexplained hoarseness
- Unexplained lump in the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

NICE guidelines for suspected cancer pathwar referral criteria under 2WW for oral cancer?

A
  • Unexplained ulceration in the oral cavity for more than 3 weeks
  • Persistent and unexplained lump in the neck
  • Lump on the lip or in the oral cavity
  • Red or red and white patch in the oral cavity consistent with eryroplakia or erythroleukoplakia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

NICE guidelines for suspected cancer pathwar referral criteria under 2WW for thyroid cancer?

A

Unexplained thyroid lump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Features of post-nasal drip?

A

Mucus accumulates in the throat or in the back of the nose resulting in a chronic cough and bad breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

A 44-year-old man comes to see you describing a constant feeling of mucus in the back of the throat. He also describes that he has had a cough for 6 months and often has bad breath -especially in the mornings. He reports that he is otherwise well but admits to smoking 10 cigarettes a day.

On examination, the ears appear normal and the throat appears slightly erythematous with no tonsillar swelling.

What is the most likely diagnosis?

A

Post-nasal drip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the prognosis of BPPV?

A

Good prognosis - usually resolves spontaneously after a few weeks to months

However roughly half of people with BPPV will have a recurrence of symptoms 3-5 years after their diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Average age of onset of BPPV?

A

55yrs

39
Q

What is the Dix Hallpike manouevre, and how is it done?

A
  • Test to diagnose BPPV
  • Rapidly lower the patient to the supine position with an extended neck
40
Q

Management options for BPPV?

A

Epley manoeuvre (succesful in ~ 80% of cases)
Vestibular rehabilitation e.g. Brandt-Daroff exercises

41
Q

List of causes of tinnitus?

A
  • Idiopathic
  • Meniere’s disease
  • Otosclerosis
  • Sudden onset sensorineural hearing loss
  • Acoustic neuroma
  • Hearing loss
  • Drugs
  • Impacted ear wax
42
Q

In what cases do you do imaging in tinnitus, and what are the imaging options you use?

A
  • Non-pulsatile tinnitus does not require imaging unless unilateral or there are other neurological or otological signs - MRI of internal auditory meatus is first line
  • Pulsatile tinnitus requires imaging to rule out vascular cause - MRA (magnetic resonance angiography)
43
Q

Management options for tinnitus?

A

Depends on the cause, but otherwise in general:
- Amplification devices - more beneficial if associated hearing loss
- Pyschological therapy e.g. CBT
- Tinnitus support groups

44
Q

What is a key clinical examination finding in acoustic neuroma? Note this examination finding also helps differentiate it from Meniere’s disease (as both otherwise present with hearing loss, vertigo and tinnitus)?

A

Absent corneal reflex

45
Q

List some drugs / drug classes that can cause tinnitus

A

Aspirin NSAIDs
Aminoglycosides
Loop diuretics
Quinine

46
Q

When to consider admission in epistaxis?

A
  • Comorbidity e.g. Coronary Artery Disease, or severe hypertension is present, an underlying cause suspected
    -Age < 2 years (as underlying causes e.g. haemophilia or leukaemia more likely in this age group)
  • Haemodynamically unstable - admit to ED
  • Bleeding from unknown or posterior source (i.e. the bleeding site cannot be located on speculum, bleeding from both nostrils or profuse) should be admitted to hospital
47
Q

What is the last line consideration for management of epistaxis - surgical option?

A

Sphenopalatine ligation in theatre

48
Q

What is a risk factor associated with cholesteatoma that increases the risk by around 100x?

A

Congenital cleft palate

49
Q

Features of cholesteatoma?

A

Foul smelling, non-resolving discharge
Hearing loss
There may be a history of chronic otitis media

Other features determined by local invasion:
- Vertigo
- Facial nerve palsy
- Cerebellopontine angle syndrome

Otoscopy - ‘attic crust’ seen in uppermost part of the ear drum

50
Q

True or false, cholesteatoma is not a cancerous growth?

A

True - it is a non-cancerous growth of squamous epithelium trapped within the skull base causing local destruction

51
Q

What age group do cholesteatomas typically present in?

A

10-20 year olds

52
Q

What is this?

A

Cholesteatoma - ‘attic crust’

53
Q

What is the pathological process in otosclerosis?

A

Replacement of normal bone with vascular spongy bone. Causes progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant

54
Q

What is the inheritance patter in otosclerosis?

A

Autosomal dominant - so typically affects young adults

55
Q

Features of otosclerosis?

A
  • Conductive deafness
  • Tinnitus
  • Tympanic membrane - normal in most patients, but 10% may have a ‘flamingo tinge’ caused by hyperaemia
  • Positive family history
56
Q

What are the management options in otosclerosis?

A
  • Hearing aid
  • Stapedectomy
57
Q

3 most common bacteria that can cause acute otitis media?

A

Strep pneumoniae, Haemophilus Influenzae, Moraxhella Catarrhalis

58
Q

Features in acute otitis media?

A
  • Otalgia
  • Fever in 50% of cases
  • Hearing loss
  • Recent viral URTI symptoms e.g .coryza
  • Ear discharge may occur if the tympanic membrane perforates
59
Q

Possible otoscopy findings in otitis media?

A
  • Bulging tympanic membrane - loss of light reflex
  • Opacification or erythema of the tympanic membrane
  • Perforation with purulent otorrhoea
  • Decreased mobility if using a pneumatic otoscope
60
Q

After how long to advise parents to seek help in suspected otitis media?

A

3 days

61
Q

When to prescribe antibiotics in otitis media?

A
  • Symptoms lasting > 4 days or not improving
  • Systemic unwell but not requiring admission
  • Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease
  • < 2 yrs old with bilateral otitis media
  • Otitis media with perforation and / or discharge in the canal
62
Q

Which antibiotic is given for otitis media?

A

5-7 day course of amoxicillin
If allergic - erythromycin or clarithromycin is given

63
Q

What are some common sequelae of otitis media, and some other complications?

A
  • Perforation of the tympanic membrane - which can develop into chronic suppurative otitis media
  • Hearing loss
  • Labyrinthitis

Complications:
- Mastoiditis
- Meningitis
- Brain abscess
- Facial nerve paralysis

64
Q

What is the definition of chronic suppurative otitis media?

A

Perforation of the tympanic membrane with otorrhoea for > 6 weeks

65
Q

List some causes of hoarseness

A
  • Voice overuse
  • Smoking
  • Viral illness
  • Hypothyroidism
  • GORD
  • Laryngeal cancer
  • Lung cancer
66
Q

When investigating patients with hoarseness, what investigation must be done?

A

Chest x-ray, to exclude apical lung lesions

67
Q

Presbycusis is sensorineural or conductive hearing loss?

A

Sensorineural

68
Q

What will be seen in the following in Presbycusis?
Otoscopy?
Tympanometry?
Audiometry?

A
  • Otoscopy - Normal, to rule out otosclerosis, cholesteatoma, and conductive hearing loss
  • Tympanometry - Normal middle ear function with hearing (type A)
  • Audiometry - Bilateral sensorineural pattern hearing loss
69
Q

Key different clinical sign between viral labyrinthitis / vestibular neuronitis?

A

Hearing may be affected in viral labyrinthitis vs no hearing loss in vestibular neuronitis

70
Q

In vertebrobasilar ischaemia, dizziness is particularly marked on what movement

A

Extension of the neck

71
Q

True or false, in black hairy tongue the tongue can only be black?

A

False - can be brown, green, pink or another colour

72
Q

List some predisposing factors for black hairy tongue

A
  • Poor oral hygiene
  • Antibiotics
  • Head and neck radiation
  • HIV
  • IVDU
73
Q

How to manage black hairy tongue?

A

Swab the tongue to exclude Candida
Tongue scraping
Topical antifungals if Candida

74
Q

List causes of bilateral parotid gland swelling

A

Viruses: mumps
Sarcoidosis
Sjogren’s
Lymphoma
Alcoholic liver disease

75
Q

List causes of unilateral parotid swelling

A

Tumour - pleiomorphic adenomas
Stones
Infection

76
Q

Risk factors for glue ear?

A
  • Male sex
  • Siblings with glue ear
  • Higher incidence in Winter and Spring
  • Bottle feeding
  • Day care attendance
  • Parental smoking
77
Q

Features of glue ear?

A
  • Hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)
  • Secondary problems such as speech and language delay, behavioural or balance problems may also be seen
78
Q

Glue ear peaks at what age?

A

2

79
Q

Treatment options for glue ear?

A
  • Active observation - first presentation of OME - observe for 3 months
  • Grommet insertion - to allow air to pass into the middle ear - doing the job the eustachian tube normally does
  • Adenoidectomy
80
Q

In which salivary glands are tumours most commonly present?

A

Parotid

81
Q

In which salivary glands are stones most common?

A

Submandibular

82
Q

80% rule of tumours of the salivary glands?

A

80% Parotid, 80% of these = Pleiomorphic adenomas, 80% Superficial lobe

83
Q

Features of malignant salivary gland tumours?

A

Short history, painful, hot skin, hard, fixation, CN VII involvement

84
Q

What is the greatest risk with superficial parotidectomies?

A

CN VII damage

84
Q

…. …. make up 80% of salivary gland tumours, whereas …. …. make up 10%

A good way to differentiate them clinically is?

A

Pleiomorphic adenomas make up 80% of salivary gland tumours, whereas Warthin’s tumours make up 10%

Warthin’s tumours are softer, more mobile and fluctuant

85
Q

Features of stones in salivary glands?

A

Recurrent unilateral pain and swelling on eating
May become infected - Ludwig’s angina

86
Q

What is the key investigation for stones in salivary glands?

A

Plain X-rays, Sialography

87
Q

Management of stones in salivary glands?

A

Surgical removal

88
Q

Apart from tumours, stones give some other causes of enlargement of the salivary glands

A
  • Acute viral infection e.g. mumps
  • Acute bacterial infection e.g. 2nd to dehydration diabetes
  • Sicca syndrome and Sjogren’s (e.g. RA)
89
Q

How long after tonsillectomy may pain increase?

A

6 days

90
Q

What is the timeline for how soon after surgery primary then secondary post-tonsillectomy haemorrhage occurs?

A

Primary - first 6-8 hours following surgery
Secondary - 5-10 days after surgery

91
Q

How to manage secondary post-tonsillectomy bleeds?

A

Secondary haemorrhage is often associated with wound infection.
Treatment = admission and antibiotics, severe bleeding may require surgery

92
Q
A

MSRA (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions