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Phase3 Specialties - Imperial College London MBBS > MLA ENT > Flashcards

MLA ENT Flashcards

1
Q

What is the most common bacterial cause of otitis externa?

A

Pseudomonas aeurginosa

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2
Q

What are the risk factors of otitis externa?

A

Swimming, Eczema, psoriasis, diabetes mellitus, immunosuppression

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3
Q

Otitis externa is characterised by pain where?

A

Tragus tenderness

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4
Q

What is the investigation of choice of malignant otitis externa?

A

CT middle ear

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5
Q

What is the first line management for otitis externa?

A

Acetic acid 2% ear drops for up to 7 days

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6
Q

Which topical antibiotic is first line for the management of otitis externa?

A

Ciprofloxacin

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7
Q

What is the causative organism for otitis media?

A

Haemophilus influenzae

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8
Q

What is the best predictor of acute otitis media?

A

Ear pain (otalgia)

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9
Q

What are the antibiotic criteria for acute otitis media?

A
  • Otorrhoea, and aged <2 years with bilateral infection.
  • Back-up antibiotic prescription – if symptoms do not improve within 3 days or significantly worsen.
  • 5–7-day course of amoxicillin (or clarithromycin).
  • Systemic upset
  • Immunocompromised or high risk of complications secondary to significant heart, lung, kidney, liver or neuromuscular disease.
  • Otitis media with perforation and/or discharge of the canal
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10
Q

On which day of unresolved symptoms of acute otitis media should antibiotics be required?

A

On day 4 onwards

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11
Q

What is the first line investigation for glue ear?

A

Pneumatic otoscopy

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12
Q

What is the first line of investigation for hearing loss in glue ear?

A

Auditory brainstem response and tympanometry

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13
Q

How long is the monitoring and observation period for glue ear?

A

3 months

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14
Q

What is the management option for patients with persistent bilateral otitis media with effusion and hearing loss?

A

Hearing aid

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15
Q

What is the surgical intervention for patients with glue ear?

A

Myringotomy and insertion of grommets

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16
Q

What are the complications associated with grommets (glue ear)?

A

Complications associated with Grommets:
* Otorrhoea (Consider ciprofloxacin for 5-7 days).
* Tympanosclerosis
* Perforation
* Fibrosis
* Cholesteatoma
* Bleeding

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17
Q

Which cell type is involved in cholesteatoma?

A

keratinising squamous epithelium

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18
Q

Which part of the ear is affected by Cholesteatoma?

A

Middle ear

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19
Q

What four symptoms are associated with Cholesteatoma?

A
  1. Recurrent/persistent unilateral purulent ear discharge (malodorous and scanty)
  2. Ear pain
  3. Vertigo
  4. Facial weakness
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20
Q

What is the first line investigation for Cholesteatoma?

A

Otoscopy

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21
Q

What is the diagnostic investigation for patients with Cholesteatoma?

A

CT/MRI of the temporal bone

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22
Q

What is the definitive management for Cholesteatoma?

A

Surgical removal

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23
Q

What is the common anatomical site for an acoustic neuroma?

A

Cerebellopontine angle

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24
Q

Which genetic disorder is a major risk factor for predisposing to the development of bilateral acoustic neuromas?

A

Neurofibromatosis type 2

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25
Q

What type of hearing loss is associated with an acoustic neuroma?

A

Unilateral high-frequency sensorineural hearing loss

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26
Q

What are the symptoms associated with acoustic neuroma?

A

Vertigo
Tinnitus
Headaches
Unilateral high-frequency sensorineural hearing loss

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27
Q

Which cranial nerve palsies are associated with acoustic neuroma?

A

Facial nerve, trigeminal nerve and the glossopharyngeal nerve

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28
Q

What investigation is indicated for assessing hearing loss in patients with acoustic neuroma?

A

Pure-tone audiometry

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29
Q

What is the diagnostic investigation to confirm acoustic neuroma?

A

Contrast-enhanced MRI of the internal acoustic meatus.

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30
Q

What is the management of acoustic neuroma?

A

stereotactic radiotherapy/surgical resection (>3 cm)

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31
Q

What type of monitoring should be performed during surgical resection of an acoustic neuroma?

A

Intraoperative facial nerve monitoring

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32
Q

What are the surgical complications associated with acoustic neuroma?

A

include CSF leak, postoperative neurological complications (e.g., facial nerve palsy), infection, and cerebral haemorrhage.

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33
Q

What type of hearing loss is associated with presbycusis?

A

Bilateral high-frequency sensorineural hearing loss

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34
Q

Which inner ear hair cells are affected in presbycusis?

A

Outer hair cells

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35
Q

What is the mainstay of management for presbycusis?

A

Hearing aids

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36
Q

What are the key features of vestibular neuronitis?

A
  1. Rotational vertigo
  2. Nausea/vomiting
  3. Horizontal nystagmus
  4. Falls - veer to the affected side
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37
Q

What symptom differentiates vestibular neuronitis from labyrinthitis?

A

Sensorineural hearing loss and tinnitus

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38
Q

What is the HiNTS exam?

A

Head impulse
Nystagmus
Test of Skew

Differentiates a peripheral from a central cause (posterior circulation stroke)

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39
Q

What is the first-line drug indicated for rapid symptomatic relief in patients with vestibular neuronitis?

A

Buccal prochlorperazine, or an intramuscular injection of prochlorperazine/cyclizine

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40
Q

What management option is available in patients with unresolved balance (in vestibular neuronitis)?

A

Vestibular rehabilitation

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41
Q

How long does it take for a tympanic membrane perforation to heal?

A

6-8 weeks

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42
Q

What is the most common bacterial cause of rhinosinusitis?

A

Streptococcus pneumonia

43
Q

Facial pain leaning forward and nasal discharge is associated with what diagnosis?

A

Rhinosinusitis

44
Q

What is the first line management for Rhinosinusitis?

A

Self-care measures including analgesia, trial of nasal saline and deongestants

45
Q

When should high-dose nasal corticosteroids be prescribed in patients with Rhinosinusitis ?

A

> 10 days of persistent symptoms or increasing frequency >5 days

46
Q

What are the referral criteria for chronic sinusitis?

A

o Unilateral symptoms
o Persistent symptoms >3 months
o Polyps
o Recurrent OM
o Unusual opportunistic infections (immunocompromised)

47
Q

Which area of the nose is predisposed to epistaxis?

A

Little’s area

48
Q

Which artery is implicated in posterior nose bleeding?

A

Sphenopalatine artery

49
Q

Which hereditary vascular condition is associated with epistaxis?

A

Hereditary haemorrhagic telangiectasia

50
Q

What is the first line management for epistaxis?

A

Pinch the cartilaginous part of the nose for 10-15 minutes

51
Q

What is the second line management (after nose pinching) for epistaxis?

If bleeding origin is visualised

A

Nasal cautery

52
Q

How is nasal cautery performed?

A

Silver nitrate stick

53
Q

What should be prescribed prior nasal cautery?

A

lidocaine with phenylephrine

54
Q

What should be prescribed for 10 days following nasal cautery?

A

Naseptin

55
Q

If a bleeding point cannot be visualised what is the next best management?

A

Nasal packing

56
Q

What is the next step in management for patients with persistent epistaxis despite nasal packing?

A

Arterial embolisation or ligation of the sphenopalatine artery under GA

57
Q

Which drugs cause tinnitus?

A
  • Aspirin/NSAIDs
  • Aminoglycosides
  • Loop diuretics
  • Quinine
58
Q

What is the investigation of choice for pulsatile tinnitus?

A

magnetic resonance angiography

59
Q

What is the investigation of choice for nasal polyps?

A

Flexible nasal endoscopy

60
Q

What is the management for nasal polyps (first line)?

A

1st line: Saline douching and betamethasone drops (2/52)

61
Q

What is the first line management for ear impaction?

A

topical sodium bicarbonate 5% ear drops, olive or almond oil drops and sodium chloride 0.9% nasal drops

62
Q

What is the second line management for ear impaction following sodium bicarbonate 5% ear drops?

A

Ear irrigation using an electronic irrigator

63
Q

What is the most common cause of tonsillitis?

A

Group A beta-haemolytic streptococcus

64
Q

What is the FeverPAIN criteria?

A
  • Fever (during the previous 24 hours)
  • Purulence (pharyngeal/tonsillar exudate)
  • Attend rapidly (within 3 days after onset of symptoms)
  • Severely inflamed tonsil
  • No cough or coryza
65
Q

A feverPain Score of 2-3 indicates what?

A

Consider rapid antigen testing

Back up ABx prescription within 3-5 days

66
Q

What FeverPain score warrants immediate antibiotic prescription?

A

4 or 5

67
Q

What is the first choice antibiotic for tonsillitis?

A

Phenoxymethylpenicillin

68
Q

How many tonsillitis episodes per year indicate a tonsillectomy?

A

7 or more episodes

69
Q

How many tonsillitis episodes in 2 years indicate a tonsillectomy?

A

5 episodes

70
Q

How many tonsillitis episodes in 3 years indicate a tonsillectomy?

A

3 episodes

71
Q

What is a complication associated with tonsillitis?

A

Quinsy - peritonsillar abscess

72
Q

Which disease is associated with sepsis following a sore throat?

A
  • Lemierre disease
73
Q

What is the management of primary haemorrhage (<24 hours) following a tonsillectomy?

A

Immediate return to theatre

74
Q

What is the management of secondary haemorrhage (>24 hours to 10 days) following a tonsillectomy?

A

Admission and antibiotics

75
Q

What are the two characteristic features associated with quinsy?

A

Trismus (inability to open jaw)

Uvula deviation to the unaffected side

76
Q

what is the first line management of peritonsillar abscess?

A

Needle aspiration and intravenous antibiotics (metronidazole, benzylpenicillin, analgesia).

77
Q

What is the investigation of choice for a deep space infection?

A
  • CT neck with IV contrast
78
Q

What term describes a submandibular space absccess?

A

Ludwig’s angina

79
Q

What is the 1ST LINE management of a deep space neck infection?

A

Broad spectrum ABx AND IV dexamethasone.

80
Q

What is the definitive management of a deep space neck infection?

A

Surgical drainage and washout of DNSI

81
Q

What is the inheritance pattern for otosclerosis?

A

Autosomal dominant (20-40 years onset)

82
Q

What is the characteristic appearance of the tympanic membrane in a patient with otosclerosis?

A

Flamingo tinge

83
Q

What type of hearing loss is associated with otosclerosis?

A

Conductive deafness

84
Q

What is the management of otosclerosis?

A
  • Hearing aid
  • Stapedectomy
85
Q

A branchial cyst is filled with what?

A

Acellular fluid with cholesterol crystals

86
Q

Where do branchial cysts reside?

A

Lateral and Anterior to the sternocleidomastoid muscle

87
Q

Do branchial cysts move on swallowing?

A

No

88
Q

What is the management of a branchial cyst?

A

Surgical excision or conservative management

89
Q

What is the immediate management for a nasal septal haematoma?

A

Surgical drainage

90
Q

What is the most common benign neoplasm of the parotid gland?

A

Pleomorphic adenoma

91
Q

Which parotid gland tumour is associated with smoking and exhibits a male predominance in the elderly (+ bilateral)?

A

Warthin Tumour

92
Q

Which neck abnormality is associated with halitosis, aspiration and dysphagia?

A

Zenker Diverticulum (Pharyngeal Pouch)

93
Q

What is the investigation of choice to diagnose Zenker Diverticulum (Pharyngeal Pouch)?

A
  • Barium swallow with video-fluoroscopy
94
Q

What is the management for a symptomatic pharyngeal pouch?

A

diverticulectomy with myotomy

95
Q

What is the referral criteria to the suspected cancer pathway for patients with vocal hoarseness?

A

Persistent unexplained vocal hoarseness (>3 weeks) in patients aged >45 years or unexplained neck lump

96
Q

What is the pre-operative investigation for patients with laryngeal carcinoma?

A

Flexible fibre optic examination or CT/MRI to assess degree of cartilage invasion

97
Q

What is the definitive management of laryngeal carcinoma?

A
  • Total laryngectomy
98
Q

What is the common composition of calculi in the salivary glands?

A

calcium phosphate and hydroxyapatite

99
Q

What drugs are risk factors for Sialolithiasis ?

A
  • Diuretics
  • Anticholinergics
  • Antidepressants
100
Q

What is the clinical presentation of Sialolithiasis?

A
  • Intermittent facial swelling and pain (post-prandial colicky pain) – exhibiting a unilateral presentation.
  • Bimanual palpation: Calculi within the duct orifice – felt in the duct.
101
Q

What is the first line investigation for Sialolithiasis?

A

Ultrasound/plain film radiograph

102
Q

What is the definitive investigation for suspected Sialolithiasis?

A

Sialography

103
Q

What is the definitive management for recurrent Sialolithiasis?

A
  • Fluoroscopic removal
  • Sialoendoscopy for stones <5 mm
  • Extracorporeal shockwave lithotripsy
  • Salivary gland excision
104
Q

What is the 1st line management of Sialolithiasis?

A

Oral hydration, analgesia, sialagogues e.g., lemon juice or sour sweets to promote saliva production + milking and massaging the affected gland.

Phase3 Specialties - Imperial College London MBBS (12 decks)

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