Passmed Flashcards
What investigation should patients with suspected laryngeal cancer and horse voice have before attending urgent ENT clinic to rule out another cause?
Chest x ray to rule out an apical lung lesion
What are the causes of a horse voice?
voice overuse smoking viral illness hypothyroidism gastro-oesophageal reflux laryngeal cancer lung cancer
What is the most appropriate treatment method for a patient presenting with profuse epistaxis where the bleeding site is unable to be localised?
Anterior nasal packing
Cautery and cryotherapy require the bleeding site to be visible
How should a patient presenting with a 6 week history of a 1cm by 1cm mouth ulcer be refered?
A 2 week wait referral for oral surgery as any ulcers lasting longer than 3 weeks are suspicious
Rinne’s test: Left ear: air conduction > bone conduction
Right ear: air conduction > bone conduction
Weber’s test: Lateralises to the left side
What do these test results imply?
They imply a right sensorineural hearing loss
In what situations would antibiotics be advised over conservative management for acute otitis media?
If there is a perforation
If the patient is systemically unwell
If there is immunocompromise
What are the centor criteria for tonisllitis?
This is for it being bacterial:
- temp over 38
- exudate on tonsils
- Absence of cough
- tender anterior lymphadenopathy
What are the presenting features of nasopharangeal carcinoma?
Cervical lymphadenopathy Otalgia Unilateral otits media Nasal obstruction/epistaxis Cranial nerve palsies
What is the appropriate management for bacterial tonsillitis?
Phenoxymethylpenicillin for 10 days
What are the cebtor criteria for tonsillitis?
Tonsillar exudate
Lack of cough
History of fever
Tender anterior cervical lymphadenopathy
When should antibiotics be prescribed for otitis media?
If it is present for more than 4 days
Bilateral in under 2s
Systemic upset
Otitis media with perforation or discharge
A 42-year-old man with a 3 month history of chronic cough presents with a persistent headache, what is the diagnosis?
This patient has chronic sinusitis. The cough is secondary to a post-nasal drip
What is tachyphlaxis?
the phenomenon of having to use increasing doses over a prolonged period to provide the same effect. happens with nasal decongestants
What is a red flag for epistaxis?
Recurrent unilateral bleeding
What is ludwig’s angina?
Cellulitis of the floor of the mouth
How does webers test localise in conductive hearing loss?
To the size that is affected
When reading an audiogram what is normal?
Normal is anything above 20dB
What is seen on otoscopy for cholesteatoma?
An attic crust in the upper part of the ear drum
What kind of hearing loss does otosclerosis cause?
This is a genetic condition that causes a bilateral conductive pattern of hearing loss due to ossification of the ossicular chain
What is the management for acute otitis externa?
For mild cases topical acetic acid 2% spray
For more severe cases 7 days antibiotics with or without a topical steroid
What is the treatment of bleeding in the first 24 hours following tonsilectomy?
Immediate return to theatre due to risk of further bleeding
How are polyps usually treated?
Intranasal steroids can shrink polyps by up to 80%
How should a single unilateral polyp be treated?
It is important to exclude malignancy
How should sinusitis without systemic upset be treated?
If the symptoms have been present for 10 days or longer then consider intranasal corticosteroids
What is the usual healing time for a perforated eardrum?
6-8 weeks
A 10-year-old child presents with enlarged tonsils that meet in the midline. Oropharyngeal examination confirms this finding and you also notice peticheal haemorrhages affecting the oropharynx. On systemic examination he is noted to have splenomegaly. What is the diagnosis?
Infectious mononucleosis (glandular fever)
What is a tonsillar swelling that is only on one side?
Quinsy
What is the treatment for a non healing tympanic perforation?
myringoplasty which is an operation performed to repair the perforation. This is appropriate as spontaneous healing has failed to occur. Following a perforation healing should occur within 6-8 weeks however in this situation it has failed to occur after 6 months, making waiting another 6-8 weeks inappropriate
What is the treatment of a quinsy?
Should consider surgical drainage and IV antibiotics
Tonsilectomy should be considered in 6 weeks
What is the management of sudden sensorineural hearing loss in adults?
Refer urgently to ENT and start high dose steroids
ENT will MRI to check for an acoustic neuroma
