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ENT > Passmedicine > Flashcards

Passmedicine Flashcards

1
Q

when are antibiotics indicated in a sore throat

A

features of marked systemic upset secondary to the acute sore throat
unilateral peritonsillitis
a history of rheumatic fever
an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present

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2
Q

what is the centor criteria

A

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

3 or more = antibiotics

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3
Q

antibiotics given for tonisllitis are

A

If antibiotics are indicated then either phenoxymethylpenicillin or erythromycin (if the patient is penicillin allergic) should be given. Either a 7 or 10 day course should be given

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4
Q

name drugs that are ototoxic

A

gentamicin
furesomide
aspirin

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5
Q

what is tachyphlaxis

A

After using topical decongestants for prolonged periods increasing doses are needed to provide the same effect, a phenomenon known as tachyphylaxis.

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6
Q

management of allergic rhinitis

A

allergen avoidance
oral or intranasal antihistamines are first line
intranasal corticosteroids
course of oral corticosteroids are occasionally needed
there may be a role for short courses of topical nasal decongestants (e.g. oxymetazoline). They should not be used for prolonged periods as increasing doses are required to achieve the same effect (tachyphylaxis) and rebound hypertrophy of the nasal mucosa may occur upon withdrawal

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7
Q

what is malignant otitis externa

A

Uncommon type of otitis externa that is found in immunocompromised individuals (90% cases found in diabetics)

Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal
Progresses to temporal bone osteomyelitis

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8
Q

infective organism in malignant otitis externais

A

pseudomonas

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9
Q

treatment of malignant otitis externa is

A

ciprofloxacin

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10
Q

symptoms of malignant otitis externa

A

Diabetes (90%) or immunosuppression (illness or treatment related)
Severe, unrelenting, deep-seated otalgia
Temporal headaches
Purulent otorrhea
Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

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11
Q

severe pain and protrusion of the ear forwards, with a tender, boggy and often reddened mass behind the ear

A

acute mastoiditis - admit!

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12
Q

indications for tonsillectomy

A

sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
the person has five or more episodes of sore throat per year
symptoms have been occurring for at least a year
the episodes of sore throat are disabling and prevent normal functioning
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

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13
Q

type of hearing loss in base of skull fracture

A

sensorineural

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14
Q

type of hearnig loss in tympanic membrane perforation

A

conductivr

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15
Q

midline lump moves with tongue protrusion

A

thyroglossal cyst

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16
Q

features of ramsey hunt syndrome

A

auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

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17
Q

management of menieres

A

acute attacks = buccal or IM prochlorperazine

prophylaxis = betahistine or vestibular rehab

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18
Q

most common gland affected by Sialolithiasis

A

submandibular - whartons duct is blocked

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19
Q

most common causative organisom of Sialadenitis

A

staph aureus

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20
Q

what is samters triad

A

asthma + aspirin sensitivity + nasal polyposis

21
Q

what is seen on otoscpoy in a cholestostoma

A

crusting in the attic

22
Q

management of a quinsy

A

surgical drainage and iv antibiotic

consider tonsillectomy in 6 weeks

23
Q

trismus

A

difficulty opening mouth

24
Q

most common cause of otitis media

A

haemophillus influenzae

Streptococcus pneumoniae and Moraxella catarrhalis

25
Q

A 50-year-old lady presents with symptoms of a dry mouth that has been present for the past few months. She also has a sensation of grittiness in her eyes. On examination she has a diffuse swelling of her parotid gland. There is no evidence of facial nerve palsy

A

Sjrogerns

26
Q

A 50-year-old female presents with bilateral parotid gland swelling and symptoms of a dry mouth. On examination she has bilateral facial nerve palsies. This improved following steroid treatment.

A

sarcoidosis

27
Q

inications for antibiotics in acute otitis media

A

Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

28
Q

what is ramsay hunt syndrome

A

shingles affecting the facial nerve

29
Q

management of ramsay hunt

A

oral aciclovir and oral steroids

30
Q

managment of perforated tympanic membrane

A

no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time
give antibiotics if occurig in the context of AOM (amox)
myringoplasty is surgical treatment

31
Q

medications that cause gingival hyperplasia

A

phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)

32
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.

A

post nasal drip

33
Q

what does rinne negative mean

A

bone is loader than air - either conductive loss

34
Q

rinne positive meants

A

air better than bone - sensorineural or normal

35
Q

medications that cause tinnitus

A

Aspirin
Aminoglycosides
Loop diuretics
Quinine

36
Q

treatment of acute ulcerating gingivitis

A

refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia

37
Q

antibiotic treatment of tonislittis

A

If antibiotics are indicated then either phenoxymethylpenicillin or erythromycin (if the patient is penicillin allergic) should be given. Either a 7 or 10 day course should be given

38
Q

oral ulcer present for 6 weeks

A

refer to oral surgery if ulcer persists more than 3 weeks on a 2 week referral basis

39
Q

cancer referral to ENT criteria

A

A suspected cancer pathway referral to an ENT specialist should be considered for people aged 45 and over with:
persistent unexplained hoarseness or
An unexplained lump in the neck.

40
Q

investigation that always needs to be done prior to ENT referral for suspected cancer

A

chest xray

41
Q

what is as sistrunk procedure

A

thyroglossal cyst

42
Q

how should you manage a nasal fracture

A

either reset immediately before swelling develops
or reset 7-14 days after fracture when swelling has settled under local
after 14 days callouses develop and septal deviation is corrected under GA
if this fails then elective septorhinoplasty in 6 months

43
Q

paroxysmal hemicrania

A

headache lasting a few minutes
tirggered buy turning hed
autonomic symptoms eg pstosis and eye watering rhinorrea

44
Q

epistaxis and sheep

A

orf

45
Q

chromium exposure and whistling

A

septal perf

46
Q

trumpet player presents with an uncomfortable feeling in the front of his neck when he plays the trumpet. His friends have also notice a lump at the same location while he plays. On examination there is a smooth reducible mass in the anterior triangle. Coughing causes the mass to increase.

A

A laryngocele - rare cause of neck lump in wind instruments players. High pressure in the larynx causes an out pouching of the laryngeal mucosa.

47
Q

indications for antibiotics in otitis media

A

Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

48
Q

antibtioc given in otitis media is

A

amoxicillin

erythromicin if allergic

ENT (13 decks)

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