Post exam 1 Flashcards
Overdose, dilated pupils with widened QRS. Patient refuses to disclose what medication was overdosed. What was the agent?
Amitriptyline
History of atopy, with pollen being the trigger. Now spring and both eyes are watery, red and sore. – allergic conjunctivitis. Treatment?
Anti-histamine eye drops
House fire inhaled. Patient needs increased ventilatory pressures, what is the reason?
Surfactory deficiency
Medial epicondyle
Flex the wrist
Lateral epicondyle
Extends the wrist
Patient due for colonic resection surgery, when do you give prophylactic antibiotics?
8-12 hours?????
histology results of: glandular cells with cellular atypia, something about nuclei and something else.
Adenocarcinoma of the lung
Went on holiday and swam in the ocean, now pain when pressing on tragus and canal looks macerated. Nothing wrong with tympanic membrane. What’s the treatment?
??
Long thoracic nerve innervates which muscle
Serratus anterior
Radio femoral delay - which condition?
Coarctation of the aorta
Dermatomyositis antibody
Anti-Jo1
Treatment of chronic rhinosinusitis?
Topical corticosteroid
Ix for TMJ?
MRI
Necrotising otitis externa mx?
urgent ENT referral; ix: CT head;
Ciprofloxacin
Acute otitis media with perforation
- Oral amoxicillin, 5 days
- Review in 6 weeks (should heal in 6-8 weeks – if not, refer to ENT myringoplasty)
o Management (acute otitis externa):
Topical antibiotics (‘sofradex’) ± topical steroid oral ABx (flucloxacillin)
Wicking and removal of debris
Acute otitis media without perforation:
* Immediate prescription indications?
- Symptoms lasting more than 4 days (normally ~3 days) or not improving
- Systemically unwell but not requiring admission
- Immunocompromise or high risk (heart, lung, kidney, liver, or NM disease)
- Younger than 2 years with bilateral otitis media
- Otitis media with perforation and/or discharge in the canal
- Otherwise delayed script / no prescription (amoxicillin, PO, 5 days)
s/s cholesteatoma?
- Signs & symptoms 98% = ear discharge OR conductive hearing loss: 10-20yo
Mx cholesteatoma?
Surgery
o Unilateral tinnitus?
acoustic neuroma/vestibular schwannoma.
Vestibular schwannomas (also called acoustic neuromas) associated with what?
Neurofibromatosis 2
Meniere’s disease
Tinnitus, vertigo, hearing loss, sensation of fullness
Vestibular neuronitis?
No hearing loss
Acoustic neuroma signs?
Unilateral hearing loss, loss of corneal reflex, neurofibromatosis 2
Mx of vestibular neuronitis?
o Management:
Acute phase:
* Severe buccal / IM prochlorperazine
* Less severe PO cyclizine or prochlorperazine (stopped after few days – can delay recovery)
Chronic vestibular rehabilitation exercises [referral to balance specialist – 2ww]
Otosclerosis:
AD condition
* Bilateral conductive deafness + tinnitus
* HL improves with noise (“Willis’ paracousis”)
* HL worsens with pregnancy, menstruation, menopause
Ix: PTA (dip at 2kHz – “Cahart’s notch”)
Hearing aid and implant
Mx of allergic rhinosinusitis?
o Mild-moderate intermittent symptoms; mild persistent symptoms:
1st line: PRN oral antihistamine (cetirizine, loratadine) or PRN intranasal antihistamine (azelastine)
2nd line: PRN intranasal sodium cromoglicate
o Moderate-severe persistent symptoms; initial treatment ineffective:
Main issue (nasal blockage / polyps) intranasal corticosteroid (beclomethasone), nasal irrigation
Main issue (sneezing / discharge) intranasal corticosteroid or oral antihistamine
Sinusitis is where?
Maxillary sinuses
Red flags (urgent ENT referral) of sinusitis?
unilateral S/S, persistent >3m S/S despite tx, epistaxis
Mx of sinusitis?
o Symptoms lasting >10 days:
High-dose nasal corticosteroid for 14 days (if >12yo, e.g. mometasone)
* May improve symptoms but unlikely to affect duration of illness
* Could cause systemic side-effects
ABx not indicated (as per guidelines) but can give back up prescription (if given, only use if symptoms don’t get better in 7 days or if symptoms get rapidly worse):
* 1st line: phenoxymethylpenicillin (clarithromycin if penicillin-allergic)
* 2nd line: co-amoxiclav
o Samter’s/ASA triad?
Nasal polyps, asthma, aspirin hypersensitivity
o Single, unilateral polyp
may be a sign of a rare but sinister pathology… ix: CT, histology
- Management of polyps?
o Routine referral to ENT for examination (do medical therapy in the meantime)
o Medical (topical steroids (betamethasone drops) 4-6w short course of oral steroids)
o Surgical (endoscopic polypectomy)
When to manage nose fracture?
o Immediate, before swelling reduce immediately
o Swelling re-examine after 1 week (↓ swelling) EUA ± MUA reduction + post-op splinting (<2 weeks)
Treatment of epistaxis?
1st remove clots gauze (soaked in vasoconstrictor + local anaesthetic) ix: rhinoscopy
Bleeding visualised silver nitrate cautery (3-10 seconds, dab clean, add naseptin/muciprocin)
Bleeding cannot be visualised packing (anterior or posterior and anterior packing)
* Anterior pack (pack as per instructions)
* Posterior pack (18G foley to nasopharynx, inflate, pull back until lodging)
* Admit for up to 48 hours ± ENT review; examine patient’s mouth and throat for bleeding
Continue bleeding NBM and refer to ENT (? ligation of sphenopalatine artery)
Tonsilitis?
“Centor Score” determines likelihood of bacterial over viral (only used if ≤3 days of pharyngitis):
o +1 = Exudate/swelling on tonsils
o +1 = Tender/swollen anterior cervical lymph nodes
o +1 = Temperature >38C (at any point)
o +1 = Cough absent
0, 1, 2 = 3-17% chance GAS, no ABx
3, 4 = 32-56% chance GAS, ABx + rapid strep test
Tonsilitis causes?
o Group A β-haemolytic streptococcus (GAS) – N.B. rare under 3yo or ≥45yo, common 3-14yo
o EBV (i.e. bacterial or viral) – no amoxicillin treatment (as you can get a generalised maculopapular eruption)
Glandular fever?
S/S: sore throat, fever, malaise, lymphadenopathy, pharyngitis, petechiae on soft palate, splenomegaly
If persistent (>3w) change in voice, refer for what?
laryngoscopy
o Specific cases to watch out for (take urgent FBC): tonsilitis?
DMARDs – could cause immunodeficiency
Carbimazole – idiosyncratic neutropoenia
‘web’/pseudomembrane at back of throat
Diptheria
; tx: penicillin + anti-toxin
Bleed post-tonsillectomy
Post-op delayed bleed same-day ENT assessment
Post-op <24 hours bleed immediate return to theatre
- Tonsillar SCC rf?
HPV infection
s/s of ramsay hunt syndrome?
o S/S: otalgia, facial nerve palsy, vesicular rash around ear (incl. inside ear), vertigo, tinnitus
Warthin tumour
M > F (the only one)
60-80yo
most common bilateral benign neoplasm
Lymphocytic infiltrate, cystic epithelial proliferation
Benign pleomorphic adenoma
80% of parotid neoplasms, young patient
Slow-growing, lobular, poorly encapsulated
Mx: superficial parathyroidectomy
Haemangioma
90% of parotid tumours in child <1yo
Hypervascular imaging
Spontaneous regression may occur
Monomorphic adenoma
Slow growing
One morphological cell type (i.e. basal cell adenoma)
Mucoepidermoid carcinoma
30% of all parotid malignancies
Low potential for local invasion
Slow growing (low grade) OR high grade (fast)
Adenoid cystic carcinoma
Unpredictable growth + tendency for perineural spread
Distant metastasis common
5-year survival at 35%
Adenocarcinoma
Develops from secretory portions of the gland
5-year survival depends on the stage at presentation
- Pinna haematoma mx?
o Mx: incision + drainage
- TM perforation:
o Mx: watch & wait for 6-8 weeks (if not healed, refer to ENT)
- Nasopharyngeal carcinoma:
Associated with EBV
Cervical lymphadenopathy Unilateral serous otitis media
Otalgia Nasal obstruction, discharge or epistaxis
Cranial nerve palsies
Mx of nasopharyngeal carcinoma?
o Ix: combined CT/MRI
o Mx: radiotherapy
- Ludwig’s angina:
o Aetiology: a rare infection of the floor of the mouth and soft tissue of the neck
RFs: dental surgery
o S/S: neck swelling, dysphagia, fever
o Ix: clinical
o Mx: urgent admission + airway management + IV ABx
