MLA ENT Flashcards
1
Q
What is the most common bacterial cause of otitis externa?
A
Pseudomonas aeurginosa
2
Q
What are the risk factors of otitis externa?
A
Swimming, Eczema, psoriasis, diabetes mellitus, immunosuppression
3
Q
Otitis externa is characterised by pain where?
A
Tragus tenderness
4
Q
What is the investigation of choice of malignant otitis externa?
A
CT middle ear
5
Q
What is the first line management for otitis externa?
A
Acetic acid 2% ear drops for up to 7 days
6
Q
Which topical antibiotic is first line for the management of otitis externa?
A
Ciprofloxacin
7
Q
What is the causative organism for otitis media?
A
Haemophilus influenzae
8
Q
What is the best predictor of acute otitis media?
A
Ear pain (otalgia)
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
10
Q
On which day of unresolved symptoms of acute otitis media should antibiotics be required?
A
On day 4 onwards
11
Q
What is the first line investigation for glue ear?
A
Pneumatic otoscopy
12
Q
What is the first line of investigation for hearing loss in glue ear?
A
Auditory brainstem response and tympanometry
13
Q
How long is the monitoring and observation period for glue ear?
A
3 months
14
Q
What is the management option for patients with persistent bilateral otitis media with effusion and hearing loss?
A
Hearing aid
15
Q
What is the surgical intervention for patients with glue ear?
A
Myringotomy and insertion of grommets
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
17
Q
Which cell type is involved in cholesteatoma?
A
keratinising squamous epithelium
18
Q
Which part of the ear is affected by Cholesteatoma?
A
Middle ear
19
Q
What four symptoms are associated with Cholesteatoma?
A
- Recurrent/persistent unilateral purulent ear discharge (malodorous and scanty)
- Ear pain
- Vertigo
- Facial weakness
20
Q
What is the first line investigation for Cholesteatoma?
A
Otoscopy
21
Q
What is the diagnostic investigation for patients with Cholesteatoma?
A
CT/MRI of the temporal bone
22
Q
What is the definitive management for Cholesteatoma?
A
Surgical removal
23
Q
What is the common anatomical site for an acoustic neuroma?
A
Cerebellopontine angle
24
Q
Which genetic disorder is a major risk factor for predisposing to the development of bilateral acoustic neuromas?
A
Neurofibromatosis type 2
25
What type of hearing loss is associated with an acoustic neuroma?
Unilateral high-frequency sensorineural hearing loss
26
What are the symptoms associated with acoustic neuroma?
Vertigo
Tinnitus
Headaches
Unilateral high-frequency sensorineural hearing loss
27
Which cranial nerve palsies are associated with acoustic neuroma?
Facial nerve, trigeminal nerve and the glossopharyngeal nerve
28
What investigation is indicated for assessing hearing loss in patients with acoustic neuroma?
Pure-tone audiometry
29
What is the diagnostic investigation to confirm acoustic neuroma?
Contrast-enhanced MRI of the internal acoustic meatus.
30
What is the management of acoustic neuroma?
stereotactic radiotherapy/surgical resection (>3 cm)
31
What type of monitoring should be performed during surgical resection of an acoustic neuroma?
Intraoperative facial nerve monitoring
32
What are the surgical complications associated with acoustic neuroma?
include CSF leak, postoperative neurological complications (e.g., facial nerve palsy), infection, and cerebral haemorrhage.
33
What type of hearing loss is associated with presbycusis?
Bilateral high-frequency sensorineural hearing loss
34
Which inner ear hair cells are affected in presbycusis?
Outer hair cells
35
What is the mainstay of management for presbycusis?
Hearing aids
36
What are the key features of vestibular neuronitis?
1. Rotational vertigo
2. Nausea/vomiting
3. Horizontal nystagmus
4. Falls - veer to the affected side
37
What symptom differentiates vestibular neuronitis from labyrinthitis?
Sensorineural hearing loss and tinnitus
38
What is the HiNTS exam?
Head impulse
Nystagmus
Test of Skew
Differentiates a peripheral from a central cause (posterior circulation stroke)
39
What is the first-line drug indicated for rapid symptomatic relief in patients with vestibular neuronitis?
Buccal prochlorperazine, or an intramuscular injection of prochlorperazine/cyclizine
40
What management option is available in patients with unresolved balance (in vestibular neuronitis)?
Vestibular rehabilitation
41
How long does it take for a tympanic membrane perforation to heal?
6-8 weeks
42
What is the most common bacterial cause of rhinosinusitis?
Streptococcus pneumonia
43
Facial pain leaning forward and nasal discharge is associated with what diagnosis?
Rhinosinusitis
44
What is the first line management for Rhinosinusitis?
Self-care measures including analgesia, trial of nasal saline and deongestants
45
When should high-dose nasal corticosteroids be prescribed in patients with Rhinosinusitis ?
>10 days of persistent symptoms or increasing frequency >5 days
46
What are the referral criteria for chronic sinusitis?
o Unilateral symptoms
o Persistent symptoms >3 months
o Polyps
o Recurrent OM
o Unusual opportunistic infections (immunocompromised)
47
Which area of the nose is predisposed to epistaxis?
Little's area
48
Which artery is implicated in posterior nose bleeding?
Sphenopalatine artery
49
Which hereditary vascular condition is associated with epistaxis?
Hereditary haemorrhagic telangiectasia
50
What is the first line management for epistaxis?
Pinch the cartilaginous part of the nose for 10-15 minutes
51
What is the second line management (after nose pinching) for epistaxis?
If bleeding origin is visualised
Nasal cautery
52
How is nasal cautery performed?
Silver nitrate stick
53
What should be prescribed prior nasal cautery?
lidocaine with phenylephrine
54
What should be prescribed for 10 days following nasal cautery?
Naseptin
55
If a bleeding point cannot be visualised what is the next best management?
Nasal packing
56
What is the next step in management for patients with persistent epistaxis despite nasal packing?
Arterial embolisation or ligation of the sphenopalatine artery under GA
57
Which drugs cause tinnitus?
- Aspirin/NSAIDs
- Aminoglycosides
- Loop diuretics
- Quinine
58
What is the investigation of choice for pulsatile tinnitus?
magnetic resonance angiography
59
What is the investigation of choice for nasal polyps?
Flexible nasal endoscopy
60
What is the management for nasal polyps (first line)?
1st line: Saline douching and betamethasone drops (2/52)
61
What is the first line management for ear impaction?
topical sodium bicarbonate 5% ear drops, olive or almond oil drops and sodium chloride 0.9% nasal drops
62
What is the second line management for ear impaction following sodium bicarbonate 5% ear drops?
Ear irrigation using an electronic irrigator
63
What is the most common cause of tonsillitis?
Group A beta-haemolytic streptococcus
64
What is the FeverPAIN criteria?
* 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
A feverPain Score of 2-3 indicates what?
Consider rapid antigen testing
Back up ABx prescription within 3-5 days
66
What FeverPain score warrants immediate antibiotic prescription?
4 or 5
67
What is the first choice antibiotic for tonsillitis?
Phenoxymethylpenicillin
68
How many tonsillitis episodes per year indicate a tonsillectomy?
7 or more episodes
69
How many tonsillitis episodes in 2 years indicate a tonsillectomy?
5 episodes
70
How many tonsillitis episodes in 3 years indicate a tonsillectomy?
3 episodes
71
What is a complication associated with tonsillitis?
Quinsy - peritonsillar abscess
72
Which disease is associated with sepsis following a sore throat?
* Lemierre disease
73
What is the management of primary haemorrhage (<24 hours) following a tonsillectomy?
Immediate return to theatre
74
What is the management of secondary haemorrhage (>24 hours to 10 days) following a tonsillectomy?
Admission and antibiotics
75
What are the two characteristic features associated with quinsy?
Trismus (inability to open jaw)
Uvula deviation to the unaffected side
76
what is the first line management of peritonsillar abscess?
Needle aspiration and intravenous antibiotics (metronidazole, benzylpenicillin, analgesia).
77
What is the investigation of choice for a deep space infection?
* CT neck with IV contrast
78
What term describes a submandibular space absccess?
Ludwig's angina
79
What is the 1ST LINE management of a deep space neck infection?
Broad spectrum ABx AND IV dexamethasone.
80
What is the definitive management of a deep space neck infection?
Surgical drainage and washout of DNSI
81
What is the inheritance pattern for otosclerosis?
Autosomal dominant (20-40 years onset)
82
What is the characteristic appearance of the tympanic membrane in a patient with otosclerosis?
Flamingo tinge
83
What type of hearing loss is associated with otosclerosis?
Conductive deafness
84
What is the management of otosclerosis?
* Hearing aid
* Stapedectomy
85
A branchial cyst is filled with what?
Acellular fluid with cholesterol crystals
86
Where do branchial cysts reside?
Lateral and Anterior to the sternocleidomastoid muscle
87
Do branchial cysts move on swallowing?
No
88
What is the management of a branchial cyst?
Surgical excision or conservative management
89
What is the immediate management for a nasal septal haematoma?
Surgical drainage
90
What is the most common benign neoplasm of the parotid gland?
Pleomorphic adenoma
91
Which parotid gland tumour is associated with smoking and exhibits a male predominance in the elderly (+ bilateral)?
Warthin Tumour
92
Which neck abnormality is associated with halitosis, aspiration and dysphagia?
Zenker Diverticulum (Pharyngeal Pouch)
93
What is the investigation of choice to diagnose Zenker Diverticulum (Pharyngeal Pouch)?
* Barium swallow with video-fluoroscopy
94
What is the management for a symptomatic pharyngeal pouch?
diverticulectomy with myotomy
95
What is the referral criteria to the suspected cancer pathway for patients with vocal hoarseness?
Persistent unexplained vocal hoarseness (>3 weeks) in patients aged >45 years or unexplained neck lump
96
What is the pre-operative investigation for patients with laryngeal carcinoma?
Flexible fibre optic examination or CT/MRI to assess degree of cartilage invasion
97
What is the definitive management of laryngeal carcinoma?
- Total laryngectomy
98
What is the common composition of calculi in the salivary glands?
calcium phosphate and hydroxyapatite
99
What drugs are risk factors for Sialolithiasis ?
* Diuretics
* Anticholinergics
* Antidepressants
100
What is the clinical presentation of Sialolithiasis?
* 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
What is the first line investigation for Sialolithiasis?
Ultrasound/plain film radiograph
102
What is the definitive investigation for suspected Sialolithiasis?
Sialography
103
What is the definitive management for recurrent Sialolithiasis?
* Fluoroscopic removal
- Sialoendoscopy for stones <5 mm
* Extracorporeal shockwave lithotripsy
* Salivary gland excision
104
What is the 1st line management of Sialolithiasis?
Oral hydration, analgesia, sialagogues e.g., lemon juice or sour sweets to promote saliva production + milking and massaging the affected gland.
