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AMC MCQ > Otorhinolaryngology (ENT) > Flashcards

Otorhinolaryngology (ENT) Flashcards

Ear: - Sensorineural & Conductive hearing loss - Tumours of ear Nose: -Rhinitis

1
Q

NasoOropharyngeal squamous cell carcinomas (OPSCC)

A
  • In the head and neck, OPSCC are associated with HPV
    -Ebstein Barr virus (suspect 2nd)
  • Arise in the soft palate, tonsils, base of
    tongue, pharyngeal wall, and vallecula, the fold located between the base of tongue
    and the epiglottis. Often present with neck masses
  • Classic symptoms of odynophagia and otalgia (usually no other clinical complaints)
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2
Q

Squamous cell carcinomas risk factors

A
  • smoking & drinking (strongest)
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3
Q

Oropharyngeal squamous cell carcinomas (OPSCC) differentials

A
  • Branchial cleft cyst carcinomas (exceptionally rare and its diagnosis should be one of exclusion rather than presumption)
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4
Q

Oropharyngeal squamous cell carcinomas (OPSCC) diagnosis

A

-Test for HPV
- CT head & neck (assessing the degree of local infiltration, involvement of regional
lymph nodes, and presence of distant metastases or second primary tumours)

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5
Q

1st line treatment for moderate to severe rhinitis?

A

Intranasal corticosteroid glucocorticoid (fluticasone)

-include antihistamines, leukotriene-receptor blockers, and topical glucocorticoids

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6
Q

Types of Rhinitis

A
  • Allergic
  • vasomotor (perennial and
    is not associated with itching)
  • infectious (nasal turbinates red and inflamed)
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7
Q

Allergic rhinitis

A
  • Caused by allergens that trigger a local hypersensitivity reaction (Specific IgE antibodies attach to circulating mast cells or basophils)
  • Rhinorrhoea and pruritus
  • nasal turbinates appear pale and
    boggy
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8
Q

If all conservative approaches to rhinitis have been unsuccessful, what the next step?

A

Immunotherapy:
- requires identification of specific antigen by dermal or serum testing
- 3-to-5-year course (treatment duration of less than a year is ineffective)

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9
Q

Pleomorphic adenoma diagnosis

A
  • CT to assess for deep lo be involvement
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10
Q

Pleomorphic adenoma management

A
  • If there’s no deep lobe involvement: superficial parotidectomy (treatment of choice for most cases)
  • If there’s deep lobe involvement: Total parotidectomy
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11
Q

clinical features of otitis media

A
  • one-week history of unwellness with URTI
  • unilateral earache
  • tympanic membrane red and bulging
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12
Q

Acute Otitis media risk factors

A
  • Age (6-18 months)
  • Lack of breastfeeding
  • Day care attendance
  • Smoke exposure
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13
Q

Pathogens that give arise to acute otitis media

A
  • Streptococcus pneumoniae
  • Nontypeable (?) Haemophilus influenzae
  • Moraxella catarrhali
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14
Q
A
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15
Q

Chronic Suppurative Otitis Media treatment

A

Ear toileting + ciprofloxacin ear drops

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16
Q

Complications of Otitis media

A

Acute mastoiditis

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17
Q

Acute mastoiditis initial treatment

A

sample from the ear discharge should be taken for culture DONE BY ENT

flucloxacillin + a third-generation cephalosporin

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18
Q

Acute otitis media treatment

A
  • Amoxicillin 1st choice (used for 1 week)
  • 2nd line: amoxicillin-clavulanate
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19
Q

Acute otitis media px that’s allergic to penicillin

A
  • clindamycin
  • azithromycin
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20
Q

Aboriginal px with otitis media management

A

Antibiotics straight away

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21
Q

Chronic suppurative otitis media treatment

A

Assess if tympanic membrane intact or perforated:
If intact: ciprofloxacin ear drops to treat on going infection
If perforated: initial treatment ear toilet with povidone-iodine solution, followed by
dry mopping with rolled toilet papers2 to 3 times a day using 20ml syringe with plastic tubing. In addition, ciprofloxacin ear drops

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22
Q

Untreated a tympanic membrane perforation secondary to chronic otitis media

A
  • Marginal perforation with discharge
  • Perforation that is surrounded by granulation tissue
  • Continuously discharging central perforation
  • Perforation associated with a cholesteatoma
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23
Q

Benign growth of the squamous epithelium squamous epithelium and
accumulation of keratin debris within the middle ear

A

Cholesteatoma

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24
Q

Cholesteatoma risk factors

A
  • history of recurrent acute otitis media
  • chronic middle ear effusion
  • tympanostomy tube placement
  • history of cleft palate
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25
Q

Cholesteatoma features

A
  • pearly white mass in the anterosuperior quadrant of the TM
  • chronic otorrhea (runny ear)
  • conductive hearing loss
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26
Q

Cholesteatoma treatment

A

surgical excision

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27
Q

Chronic sinusitis

A
  • Symptoms that persist beyond 3 months (symptoms that improve with therapy
    then reoccur    )
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28
Q

Chronic sinusitis treatment

A
  • 2-3 weeks amoxicillin/clavulanate or fluoroquinolones
  • if above are unsuccessful, high-dose
    amoxicillin or a cephalosporin for 14 to 21 days
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29
Q

Chronic sialadenitis features

A
  • recurrent jaw pain
  • swelling of the affected salivary gland
  • minimal saliva expression
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30
Q

Salivary duct calculi are composed predominantly of

A

calcium salts

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31
Q

Chronic sialadenitis investigation

A
  • Intraoral plain X-ray (80% stones are
    radio-opaque)
  • CT
  • US (best used for parotid glands)
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32
Q

Parotid gland tumour features

A
  • painless firm and mobile mass (same side)
  • facial nerve dysfunction (same side)
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33
Q

Parotid gland tumour investigation

A

CT head & neck

34
Q

Midline neck swelling which moves with tongue protrusion

A

Thyroglossal cyst

35
Q

Painless neck lumps in adults

A
  • Malignant unless proven otherwise
  • FNAC and CT investigations of choice first
    -Excisional biopsy after CT
36
Q

Lateral neck swelling which doesn’t move with tongue protrusion

A

Branchial cysts

37
Q
A
38
Q

Sleep apnoea features

A

– Excessive daytime sleepiness.
– Fatigue.
– Snoring at night.
– Choking or gasping while asleep.
– Morning headaches.
– Moodiness, irritability or depression
- Impaired vigilance
- Depression
- Narcolepsy

39
Q

Difference between obstructive sleep apnoea and central sleep apnoea

A
  • sleep maintenance insomnia (experiencing a lot of prolonged
    awakenings during the night or one long wakeful period associated with daytime tiredness)
40
Q

Sleep apnoea treatment

A

Continuous positive airway pressure (CPAP)
- sleep studies & respiratory specialist referral for diagnosis confirmation of the

41
Q

Sleep apnoea most important risk factor

A

Congestive cardiac failure (most important)
- obesity (50%)
- myotonic dystrophy
- Ehlers-Danlos syndrome
- smoking

42
Q

Sleep apnoea stroke mechanisms

A
  • Large swings in blood pressure
  • Increased coagulopathy
  • Development of atrial fibrillation
  • Local vibrational damage to the carotid artery bifurcation
  • Paradoxical emboli through the asymptomatic patent foramen ovale opening during transient sleep-related hypoxia with pulmonary hypertension.
43
Q

Anterior triangle of the neck mass

A

BCC
- Branchial cyst
- Carotid body tumour
- Carotid aneurysm

44
Q

Branchial Cyst

A
  • 20 – 40 y/o
  • Location: inferior to the EAM and
    anterior to the sternomastoid muscle
  • diagnosis: Mainly clinical
  • management: Excision
45
Q

Carotid body tumour

A
  • 40 – 60 y/o
  • Location: opposite thyroid cartilage
  • Pulsatile mass that moves laterally
  • Management: referral for excision
46
Q

Posterior triangle of the neck mass

A

CPP
- Cystic hygroma
- Cervical rib
- Pancoast tumour
- (Naso/oropharyngeal squamous cell carcinomas)

47
Q

Cystic hygroma

A

Paediatric condition (developmental
remnant)
* Transluminal mass
Treatment:
* refer Surgery
* Sclerosis

48
Q

Pancoast tumour

A

-Tumour of lung APEX
- non-small cell cancer.
- Unilateral or bilateral

49
Q

Pancoast tumour Complications

A

Mainly compression of:

  1. Subclavian artery: subclavian syndrome
  2. Brachial plexus: painful paraesthesia
  3. Sympathetic ganglion: Horner’s syndrome
  4. brachiocephalic vein compression
  5. phrenic nerve: cough
  6. recurrent laryngeal nerve: hoarseness
50
Q

Pancoast tumour treatment

A
  • Surgery
  • Radiotherapy if life-threatening (subclavian syndrome)
  • Chemotherapy if surgery too difficult
51
Q

Horner’s Syndrome

A
  • Anhidrosis
    – pseudo enophthalmos
  • Ptosis
  • Miosis
52
Q

Midline of the neck mass

A

**TTD **
- Thyroid nodule
- Thyroglossal cyst
- Dermoid cyst

53
Q

Thyroglossal cyst

A

Paeds remnant
- most common cause of midline
neck masses
- will move upwards with protrusion of the tongue

54
Q

Dermoid cyst

A
  • teratoma that contains an array of
    developmentally mature, solid tissues
  • Management: imaging (CT) and
    surgical resection
55
Q

Epistaxis management

A
  1. Sitting forward to prevent blood dripping down the throat.
  2. Compress the cartilaginous portion of nose for 5 -10 minutes
    without interruption
56
Q

Most common cause of epistaxis

A

Local incidental trauma

57
Q

Recurrent epistaxis in a sleep apnoeic patient

A

CPAP use
- recommend warming & humidification of CPAP
- nasal saline irrigation

58
Q

Painless swelling in front of the ear and slight drooping of mouth

A

Parotid gland carcinoma Parotid gland carcinoma

59
Q

Ramsay Hunt syndrome

A
  • Also termed herpes zoster oticus (reactivation of varicella-zoster virus)
  • acute peripheral facial neuropathy
    Triad of symptoms:
    1. ipsilateral facial paralysis (lower motor neuron cranial nerve 7)
    palsy
    2. ear pain
    3. erythematous vesicular rash of the skin of the ear canal, auricle, and mucous membrane of the oropharynx.
  • may be a loss of taste at anterior two-thirds of the tongue and hyperacusis
60
Q

Ramsay Hunt syndrome treatment

A
  • antiviral therapy and corticosteroid
    within 72 hours of presentation (rash onset).
  • Oral Acyclovir (800 mg five times per day), valaciclovir (1 g three times per day for 7–10 days) and famciclovir (250 mg three times per day)
  • valaciclovir and famciclovir have replaced acyclovir as drug of choice
  • oral corticosteroids combined with antivirals (eg, 40 mg prednisolone daily for 7 days, tapering to 5 mg daily over the next 2 weeks – total of 14 days)
61
Q

Cancer of the oral cavity

A
  • > 50 years
  • Heavy smoker
    -Heavy drinker
    If no ulcerations or lesions present, follow up in 12 months
62
Q

Rinne test

A
63
Q

Weber test

A
64
Q

Diseases of the middle ear

A

Otitis media
Otosclerosis

65
Q

Types of sensorineural hearing loss

A
  • Meniere’s
  • Labyrinthitis
  • Vestibular neuritis
66
Q

Sensorineural deafness diseases are all found in

A

inner ear

67
Q

Types of conductive hearing loss

A
  • Otitis media
  • Otosclerosis
  • Cholesteatoma
  • TM perforation
  • Head trauma
68
Q

Under normal circumstances, bone conduction is ________ than air conduction

A

worse

69
Q

Under the Weber test, sensorineural loss localises to

A

the good ear, therefore the bad ear won’t be able to hear it as well

70
Q

Ménière’s syndrome diagnosis

A

vertigo + vomiting + tinnitus + aural fullness + sensorineural deafness

Abrupt onset. Attacks
last 30 minutes to
several hours.

71
Q

Ménière’s syndrome. Acute severe attack TREATMENT

A

Diazepam ±
Prochlorperazine, or if
episodic, a thiazide
diuretic

IF Anticipation of
attack (Aural fullness,
tinnitus) : Prochlorperazine

72
Q

Ménière’s syndrome: Prophylaxis

A

Hydrochlorothiazide or
Triamterene
+
amiloride (K+ sparing
diuretic) combination

73
Q

Labyrinthitis diagnosis

A

acute onset vertigo provoked with changes in head position + tinnitus + hearing loss + URTI

74
Q

URTI + vertigo + loss of balance + nystagmus + change in head position + reduced caloric test

A

Vestibular neuritis

75
Q

Vestibular neuritis cause

A

Herpes Zoster URTI

76
Q

Investigation of choice in a patient suspected with hearing loss + tinnitus + vertigo

A

Pure tone audiometry (audiogram)

77
Q

BPPV investigation

A

Hallpike manoeuvre

78
Q

BPPV treatment

A

Epley manoeuvre

79
Q

Red flags for
dizziness/vertigo

A

– Neurological signs

– Ataxia out of proportion to vertigo

– Nystagmus out of proportion to vertigo

– Central nystagmus

– Central eye movement abnormalities

80
Q

Vestibular Neuronitis

VS

Labyrinthitis

A

Vestibular Neuronitis:
Acute vertigo
Nausea
Vomiting

Labyrinthitis: PLUS
Hearing loss ± Tinnitus

81
Q

Vestibular Neuronitis and Labyrinthitis MANAGEMENT

A

Bed rest

Prochlorperazine
or
Ondansetron
or
Promethazine
or
Diazepam

for the first 2 days

82
Q
A

AMC MCQ (55 decks)

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