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ICSM Year 6 > Surgery - ENT > Flashcards

Surgery - ENT Flashcards

1
Q

What is a normal result in pure tone audiometry?

A

All results above 20dB line

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2
Q

What is the difference between SNHL, conductive HL and mixed HL?

A

SNHL = both air and bone conduction are impaired (AC is better than BC)
Conductive HL: only air conduction is impaired
Mixed HL: air and bone condution both impaired, but BC is better than AC

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3
Q

How can middle ear function be evaluated?

A

Tympanometry - measures stiffness of ear drum

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4
Q

What is automated auditory brainstem response audiometry?

A

Auditory stimulus with measurement of elicited brain response by surface electrode

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5
Q

What are the components of the child hearing exams?

A

All babies get evoked otoacoustic emission testing
If not normal –>
Automated auditory brainstem response audiometry

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6
Q

What are the signs and symptoms of TMJ dysfunction?

A 
Otalgia (referred pain from auriculotemporal nerve) 
Facial pain 
TMJ joint clicking/popping 
Bruxism (teeth grinding) 
Stress
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7
Q

What condition does ‘swimmer’s ear’ refer to?

A

Acute diffuse otitits externa

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8
Q

How should necrotising otitis externa be managed?

A

Urgent ENT referral
CT head
IV ciprofloxacin

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9
Q

How should acute otitis externa be managed?

A

Topical abx +/- topical steroid –> oral flucloxacillin

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10
Q

What is the most common pathogen implicated in otitis media?

A

S. pneumoniae (as secondary to URTI)

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11
Q

How should acute otitis media without perforation be managed?

A

Delayed/no script unless:

  • symptoms >4 days and not improving
  • systemically unwell but not requiring admission
  • Immunocompromised
  • <2y with BL OM
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12
Q

How should acute otitis media with perforation be managed?

A

Oral amoxicillin 5 days

Review in 6w

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13
Q

What condition is known as ‘glue ear’?

A

Otitis media with effusion

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14
Q

How should glue ear be managed?

A

If no comorbidities: active observation for 6-12w, if no improvement –> ENT referral
If co-existent cleft palate/ Down’s –> refer to ENT

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15
Q

How long do grommets last?

A

Up to 12 months

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16
Q

What are the signs and symptoms of cholesteatoma?

A

Headache, pain
Foul smelling discharge from ear
Hearing loss

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17
Q

How should cholesteatoma be managed?

A

Refer for surgery

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18
Q

Recall 4 drugs that can cause tinnitus

A

Aspirin
Aminoglycosides
Loop diuretics
Ethanol

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19
Q

What is the most concerning cause of unilateral tinnitus?

A

Acoustic neuroma

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20
Q

Recall 3 vestibular causes of vertigo

A

Meniere’s
BPPV
Labyrinthitis

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21
Q

Recall 5 central causes of vertigo

A 
Vestibular schwannoma
MS
Stroke
Head injury 
Inner ear syphillis
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22
Q

What is Meniere’s?

A

Dilatation of endolymph spaces of membranous labyrinth

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23
Q

What are the symptoms of Meniere’s?

A 
Clustered attacks lasting <12 hours
Aural fullness
Progressive SNHL 
Vertigo + N&V + nystagmus 
Tinnitus
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24
Q

How is Meniere’s managed?

A

Medically:
Betahistine for vertigo
Cyclizine for emesis

Surgically:
Gentamicin installation via grommets

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25
Q

What are the symptoms of viral labyrinthitis/vestibular neuronitis?

A

Severe vertigo, nystagmus and vomiting following an URTI

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26
Q

How can you differentiate between vestibular neuronitis and viral labyrinthitis clinically?

A

Hearing may be affected in viral labyrinthitis but isn’t in vestibular neuronitis

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27
Q

How should viral labyrinthitis/ vestibular neuronitis be managed?

A

If severe: IV prochlorperazine

If less severe: PO cyclizine and prochlorperazine

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28
Q

What is BPPV?

A

Displacement of otoliths in semi-circular canals

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29
Q

What are the symptoms of BPPV?

A

Suden rotational vertigo for <30s provoked by head turning +/- nystagmus; chronic history

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30
Q

How can BPPV be investigated?

A

Dix-Hallpike manoevre –> up-beat torsional nystagmus

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31
Q

How can BPPV be managed?

A

Epley manoevre and betahistine

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32
Q

What is acoustic neuroma also known as?

A

Vestibular schwannoma

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33
Q

What are the symptoms of acoustic neuroma?

A

Slow-onset, unilateral SNHL, tinnitus +/- vertigo

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34
Q

How should possible acoustic neuroma be investigated?

A

Pure tone audiometry

MRI

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35
Q

What are the symptoms of otosclerosis?

A

Begins early adult life
BL conductive deafness and tinnitus
Hearing loss improves with noise but worsens with pregnancy, menstruation, menopause

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36
Q

How should otosclerosis be managed?

A

Hearing aid, stapes implant

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37
Q

What is the fancy name for age-related hearing loss?

A

Presbycusis

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38
Q

How should sudden SNHL be managed?

A

Refer to ENT in <24 hours, high dose PO prednisolone

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39
Q

How should allergic rhinosinusitis be managed?

A
  • Avoid causative allergen
  • For mild symptoms: PRN oral antihistamine (eg cetirizine) and PRN intranasal antihistamine (eg azelastine)
  • For severe symptoms:
    Intranasal CS (eg beclomethasone) and nasal irrigation
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40
Q

What are the red flags in sinusitis that would prompt an urgent ENT referral?

A

Unilateral symptoms
Persistent >3m despite treatment
Epistaxis

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41
Q

What are the indications for admission to hospital with sinusitis?

A 
Severe systemic infection 
Signs of dangerous complications of sinusitis eg: 
Periorbital/orbital cellulitis 
Meningitis 
Brain abscess
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42
Q

How should sinusitis be managed?

A

If symptoms <10 days –> advice and safetynetting
If symptoms >10 days –> 14 day course of high-dose nasal corticosteroid
Can give back-up prescription of abx

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43
Q

What are the symptoms of nasal polyps?

A 
Watery anterior rhinorrhoea 
Sinusitis 
Snoring 
Headaches 
Nasal obstruction
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44
Q

What is Samter’s triad?

A

Triad of nasal polyps, asthma and aspirin hypersensitivity
Therefore if person has nasal polyps and asthma, advise to avoid NSAIDs and aspirin as could cause a life-threatening reaction

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45
Q

What would make nasal polyps seem concerning?

A

If it is single and unilateral - as this may be a sign of a rare but sinister pathology

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46
Q

How should nasal polyps be managed?

A
  • Routine referral to ENT for exam
  • Medical: 4-6w course of topical steroids
  • Surgically: can be removed endoscopically
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47
Q

What is a septal haematoma?

A

Untreated nasal fracture –> septal necrosis and nasal collapse as cartillage blood supply comes from the mucosa –> boggy swelling with nasal obstruction

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48
Q

How should all nosebleeds be initially managed?

A

Sit up
Lean forwards
Mouth open
Compress nasal cartilage for 15 mins

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49
Q

What are the 2 most common causes of tonsilitis?

A

EBV and Group A strep

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50
Q

Recall the score used to determine whether tonsilitis is likely bacterial/viral

A 
CENTOR (only used if <3 days of pharyngitis) 
Cough absent
Exudate 
Nodes (cervical anterior) 
Temp >38 at any point
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51
Q

How high a centor score do you need to give abx and do a rapid strep test in tonsilitis?

A

3 or 4

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52
Q

What are the symptoms of infectious mononucleosis?

A 
Sore throat 
Fever 
Malaise 
LNopathy 
pharyngitis 
petechiae on soft palate 
splenomegaly
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53
Q

What antibiotic is used in bacterial tonsilitis?

A

Phenoxymethylpenicillin

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54
Q

How does diptheria classically appear?

A

Pseudomembranous ‘web’ at back of throat

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55
Q

When would you admit for tonsilitis?

A
  • Difficulty breathing
  • Clinical dehydration
  • Peri-tonsillar abscess (quinsy) or cellulitis
  • Marked systemic illness or sepsis
  • Suspected rare cause (e.g. Kawasaki disease, diphtheria)
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56
Q

How frequent does tonsilitis have to be to indicate tonsillectomy?

A

7 bouts in 1 year
5 bouts/ year for 2 years
3 bouts/year for 3 years

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57
Q

What are the signs that GAS infection has progressed to scarlet fever?

A

Rash (‘sandpaper’)

Strawberry tongue

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58
Q

What is the risk of scarlet fever?

A

May progress to rheumatic fever with a week latency period

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59
Q

How should scarlet fever be managed?

A

Notify PHE

Phenoxymethylpenicillin

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60
Q

What is the main RF for tonsilar SCC?

A

HPV infection

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61
Q

What are the symptoms of Bell’s palsy?

A

UL facial weakness
Otalgia
Ageusia (loss of taste)
Hyperacusis (due to stapedius palsy)

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62
Q

What is Bell’s sign?

A

Failure of eye closure –> dryness and conjunctivitis

Seen in Bell’s palsy

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63
Q

How should Bell’s palsy be investigated?

A

Serology, possible LP

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64
Q

How should Bell’s palsy be managed?

A

Eye care

Prednisolone (50mg PO OD for 10 days)

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65
Q

What is the aetiology of RamsayHunt syndrome?

A

Reactivation of the varicella zoster virus in the genticulate ganglion of CNVII

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66
Q

What are the symptoms of Ramsay Hunt syndrome?

A

Otalgia
Facial nerve palsy
Vesicular rash around ear
Vertigo + tinnitus

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67
Q

How should Ramsay Hunt syndrome be managed?

A

Valaciclovir PO
Steroids PO
If treated within 72 hours, 75% recover, otherwise only 1/3 fully recover

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68
Q

If a small parotid lump enlargens very quickly, what is the likely cause?

A

Stone that has blocked parotid duct

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69
Q

How long after a TM perforation should a referral to ENT be made if it hasn’t healed?

A

6-8w

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70
Q

Recall some differentials for the cause of salivary gland swelling

A 
Infective (TB/mumps) 
Neoplastic 
Calculi blockage 
Autoimmune (Sjogren's/IgG4) 
Sarcoidosis
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71
Q

How is a pharyngeal pouch managed?

A

Surgical repair with minimally-invasive stapling (Dohlman’s procedure)

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72
Q

What are the symptoms of pharyngeal pouch?

A

Hallitosis

Food getting stuck

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73
Q

What are the FeverPAIN criteria?

A

Fever (during previous 24 hours)

Purulence (pus on tonsils)

Attend rapidly (within 3 days after onset of symptoms)

severely Inflamed tonsils

No cough or coryza

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74
Q

Recall the 2 most common pathogens in otitis externa

A

Staph aureus

Pseudomonas

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75
Q

Recall the management of otitis externa

A

Take a swab and send for microbiology
TOPICAL antibiotics (abx used to cover pseudomas = gentamicin…) +/- steroid
Microsuction to clear debris (+/- pope wick)
Water precautions

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76
Q

How should necrotising otitis externa be managed?

A

admission and tazocin

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77
Q

Name 3 complications of otitis media

A

Facial nerve palsy
Chronic perforation
Mastoiditis

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78
Q

What is Ludwig’s angina?

A

Rapidly spreading infection of submandibular space
Classically “woody” to touch
Causes neck pain and drooling

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79
Q

Recall 4 predisposing factors to otitis externa

A

Swimming
Ear buds
Eczema
Diabetes

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80
Q

What type of mouth ulcer is typically described as centralised white ulcer and erythematous “halo”?

A

Apthous ulcers

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81
Q

What is this a typical history for?

“an indurated ulcer involving the lateral tongue in a patient with a long-term smoking history”

A

Squamous cell carcinoma

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82
Q

What is Heerfordt’s syndrome?

A

A rare manifestation of sarcoidosis characterized by the presence of facial nerve palsy, parotid gland enlargement, anterior uveitis, and low grade fever

Source: Capsule case 145

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83
Q

What is the most common type of parotid malignancy in adults?

A

Mucoepidermoid tumours

84
Q

What is Warthin’s tumour?

A

Benign parotid tumour that typically appears in older male smokers

85
Q

In epistaxis, how long should a rapid rhino stay in place?

86
Q

What is binocular vision post-facial trauma indicative of?

A

Depressed fracture of zygoma

87
Q

What intranasal treatments are used for the treatment vs prophylaxis of sinusitis?

A

Treatment: intranasal decongestant
Prophylaxis: intranasal corticosteroid

88
Q

What is a pope wick and how long can it be left in for?

A

A stent-like device for the ear canal if inflammation is so severe that ear drops cannot enter the canal otherwise. It can be left in for 72 hours.

89
Q

What are some red flags for otitis externa and what would you be worried about?

A
  • Pain out of proportion
  • Cranial nerve palsy
  • Worsening despite treatment

You would be worried about necrotising otitis externa (a.k.a malignant otitis externa)

90
Q

What is a cholesteatoma?

A

A benign accumulation of keratinising squamous cells in the middle ear

91
Q

What percentage of cholesteatomas are congenital?

92
Q

Why is otitis media common in young children?

A

The eustachian tubes are still quite horizontal in younger children so they do not drain the mucus as well, allowing build-up and growth of bacteria/viruses resulting in otitis media

93
Q

What part of the ear do grommets replace?

A

Eustachian tubes

94
Q

What is the downside to grommets?

A

Can cause tympanosclerosis, which causes the eardrum to fibrose and harden so that it does not vibrate normally with sound, impairing hearing

95
Q

What is otosclerosis?

A

Fusion of the ossicles in the middle ear so they do not vibrate as well, resulting in conductive hearing loss

96
Q

What are the 2 main differentials for unilateral sensorineural hearing loss?

A
  • Sudden sensorineural hearing loss
  • Vestibular schwannoma (acoustic neuroma)
97
Q

How should a suspected vestibular schwannoma be investigated?

A
  • MRI (internal auditory meatus)
  • Whilst waiting for MRI, cover with high dose steroids in case it is caused by sudden sensorineural hearing loss (if hearing loss was sudden, otherwise no need)
98
Q

What pattern of hearing loss does presbycusis cause?

A

Bilateral sensorineural

99
Q

What type of tissue are the tonsils?

100
Q

What are the different paranasal sinuses?

A
  • Frontal
  • Ethmoid
  • Maxillary
  • Sphenoid
101
Q

When would you image a nose fracture?

A
  • Depends on whether the patient meets NICE criteria
  • If you are worried about other fractures then you would
  • Similarly if the history involves potential head injury, you would also image if meeting criteria
102
Q

What window should manipulation of a nose fracture occur within?

A

7-14 days post-injury

103
Q

What are some SSx of a cavernous sinus thrombosis?

A
  • Ophthalmoplegia (vision loss, double vision)
  • Headache
  • Swelling, redness or pain around eyes
104
Q

What is FESS?

A

Functional endoscopic sinus surgery

105
Q

When would FESS be appropriate?

A

Used in patients with chronic rhinosinusitis where medical management has failed (usually trialled for at least 6 months)

106
Q

What medication can be given to rhinitis patients?

A

Xylometazoline (sympathomimetic)

107
Q

What is the maximum duration xylometazoline is given for?

A

5 days usually (7 on NICE/BNF) as otherwise can cause a rebound inflammation

108
Q

How would you investigate a cholesteatoma?

A

CT temporal bones

109
Q

What are the most common pathogens to cause otitis media?

A

2/3rds = viral (RSV, rhinovirus)
1/3rds = bacterial (strep pneumo, Hib)

110
Q

What are some red flags for otitis media and what would you be concerned about?

A
  • Sepsis with post auricular swelling
  • Cranial nerve palsy
  • Meningism
  • Altered consciousness

–> MASTOIDITIS

111
Q

How is mastoiditis managed?

A
  • IV antibiotics
  • If not resolving, may need a myringotomy to drain the middle ear
  • +/- mastoidectomy
112
Q

In what circumstance would otitis media with effusion be suspicious?

A

In an adult with unilateral symptoms - think malignancy

113
Q

What is the fancy name for grommet insertion?

A

Myringotomy

114
Q

What condition is otitis media with effusion associated with?

A

Cleft palate

115
Q

How long do grommets stay in for?

A

Up to 12 months, often self-extrude by 9 months

116
Q

What are some possible causes of a tympanic membrane rupture?

A
  • Trauma (barotrauma, noise etc)
  • Otitis media with effusion
  • Grommet insertion
117
Q

How long does a tympanic membrane rupture typically take to repair?

118
Q

What is the management of a tympanic membrane rupture?

A
  • Water precautions whilst healing
  • If not healing or persistent hearing loss/infections, consider myringoplasty
119
Q

How is the severity of a facial nerve palsy graded?

A

House-Brackmann scale

120
Q

What are some causes of a facial nerve palsy?

A
  • Trauma
  • Infection (OM, Ramsey-Hunt)
  • Neoplastic (parotid tumour)
  • Stroke (forehead-sparing, UMN)
  • Bell’s palsy (idiopathic)
121
Q

What are some causes of conductive hearing loss?

A
  • Foreign body
  • Ear wax build-up
  • Tympanic membrane performation
  • Otosclerosis
  • Cholesteatoma
122
Q

What is the difference between conductive and sensorineural hearing loss?

A

Conductive = occurs when sound waves do not reach the inner ear

Sensorineural = occurs when sound waves are not processed correctly

123
Q

What are some trigeminal causes of otalgia?

A
  • TMJ problems
  • Dental problems
  • Sinusitis
  • Trigeminal neuralgia

Due to radiation via the auriculotemporal nerve

124
Q

What are some facial nerve causes of otalgia?

A
  • Cerebellopontine lesions
  • Geniculate neuralgia
  • Bell’s palsy
  • Parotid infections
125
Q

What are some vagus nerve causes of otalgia?

A
  • Tumours in pharynx or larynx
  • GORD
  • Angina/MI
  • Thyroiditis
126
Q

What are some glossopharyngeal nerve causes of otalgia?

A
  • Tumours in PNS/pharynx
  • Tonsillitis
  • Oral apthous ulcers
127
Q

What are some spinal nerve causes of otalgia?

A
  • Spinal arthritis (cervical spine, C1/2/3)
  • Cervical tumours

Due to radiation via the lesser occipital and greater auricular nerves

128
Q

What causes vestibular neuronitis?

A

Inflammation of the vestibular nerve, associated with a recent viral illness

129
Q

What kind of vertigo do you typically get in vestibular neuronitis?

A

Rotatory vertigo that is continuous for 24 hours

130
Q

What results from Rhine’s and Weber’s tests would you expect in sensorineural HL?

A

Rhine’s - either positive or false
Weber’s - heard in the good ear

131
Q

What results from Rhine’s and Weber’s tests would you expect in conductive HL?

A

Rhine’s - bone conduction > air conduction
Weber’s - heard in the bad ear

132
Q

What are the functions of the nose?

A
  • Humidification
  • Filtering
  • Olfaction (smell)
  • Mucous production
  • Ventilation of middle ear via eustachian tube
  • Voice tract resonance
  • Drainage of nasolacrimal duct
133
Q

When would a septoplasty be indicated?

A

Due to septal/bony vault deviation but must be at least 6-12 months after injury

134
Q

What are some potential complications of acute rhinitis?

A
  • Meningitis
  • Cavernous sinus thrombosis
  • Orbital or pre-septal cellulitis
135
Q

What is the aim of FESS?

A
  • Remove diseased tissue
  • Clear obstructions
  • Restore function
136
Q

What are the borders of the anterior triangle in the neck?

A

Mandible, midline and SCM

137
Q

What are the borders of the posterior triangle in the neck?

A

SCM, clavicle and trapezius

138
Q

What neck lumps are seen in the midline?

A
  • Thyroglossal cyst
  • Thyroid pathology (goitre, enlargement)
  • Dermoid cyst
139
Q

What neck lumps are seen in the anterior triangle?

A
  • Lymphadenopathy
  • Branchial cyst
  • Laryngocoele
  • Parotid gland pathology (mumps, stones, tumour, infection)
  • Salivary gland pathology
  • Carotid pathology (aneurysm, tumour)
140
Q

What neck lumps are seen in the posterior triangle?

A
  • Lymphadenopathy
  • Cervical rib
  • Pharyngeal pouch
  • Cystic hygroma
141
Q

What are the 3 salivary glands in the face?

A
  • Sublingual
  • Submandibular
  • Parotid
142
Q

How is a branchial cyst investigated and managed?

A

Ix: neck USS –> CT
Mx: surgical excision if large

143
Q

What type of tumour is a cystic hygroma?

A

Lymphangioma (benign malformation of the lymphatic system)

144
Q

What is the concern regarding cystic hygromas?

A

Depending on their anatomical site, they have the potential to block the airway

145
Q

What is a thyroglossal cyst?

A

A remnant of the thyroglossal tract that should have been obliterated by birth

146
Q

How can a thyroglossal cyst be differentiated from other neck lumps?

A

Moves up on tongue protrusion/swallowing

147
Q

What is the Ix and Mx of a thyroglossal cyst?

A

Ix: USS and FNA
Mx: Sistrunks procedure

148
Q

What is a quinsy?

A

A peritonsillar abscess

149
Q

What are the SSx of a quinsy?

A
  • ‘hot potato’ voice
  • Unilateral pain
  • Trismus (unable to open mouth well)
  • Significant dysphagia
  • Uvula deviated
150
Q

What is the Mx of a quinsy?

A
  • Requires aspiration or incision&drainage
  • IV benpen and metronidazole
  • IV fluids
  • Stat dexamethasone dose
  • Analgesia
151
Q

What is meant by sialadenitis?

A

Infected salivary gland

152
Q

What is the Mx of sialadenitis?

A
  • Oral Abx
  • Sialagogues (to encourage salivary production such as citrus fruits)
  • Analgesia
153
Q

What are some causes of sialadenitis?

A
  • Viral - mumps, coxsackie, parainfluenza
  • Bacterial - staph aureus, anaerobic bacteria
  • Stones/calculus
  • Chronic scarring or strictures
  • Benign/malignant tumours
  • Granulomatous conditions - Sjogren’s, sarcoidosis, GPA
154
Q

What are some generalised red flags for ENT?

A
  • Persistent hoarse voice AND >45yrs
  • Unexplained neck lump (inc. thyroid lump)
  • Unexplained persistent swelling in salivary glands
  • Unexplained persistent painful throat
  • Unexplained mouth ulcer >3 weeks
  • White or red lesion in mouth or oropharynx
  • New dysphagia
155
Q

What are some risk factors for nasopharyngeal/oral malignancy?

A
  • Smoking
  • Alcohol
  • Betel Nut
  • Chronic dental infection
  • Immunosuppression
  • Sun exposure (lips)
  • Viral exposure - HPV (oropharynx), EBV (nasopharynx)
156
Q

What is the investigation and management of head&neck malignancies?

A
  • USS +/- FNA
  • Biopsy (if oral cavity/tongue)
  • Diagnostic panendoscopy +/- biopsy
  • CT
  • MRI

+ MDT discussion for Mx
Local excision or resection +/- neck dissection
Radiotherapy/chemotherapy

157
Q

What are the indications for a tracheostomy?

A
  • Long-term ventilation
  • Gradual weaning from ventilation
  • Airway obstruction or anticipated obstruction
158
Q

What are some common precipitants for epistaxis?

A
  • Anticoagulation
  • Haematological conditions that impair clotting
  • Heat
  • Dryness (e.g. AC, fans etc)
  • Irritants/smoke
  • Intranasal drug use
159
Q

What is the immediate Mx of epistaxis?

A
  • Upright position + suction
  • Wide bore IV access
  • Bloods including G&S
  • Fluid resuscitation
  • IV tranexamic acid
  • Consider blood products
160
Q

What is the pathway for managing epistaxis (in terms of stopping the bleeding)?

A

1) Nasal pinching for 15mins at least +/- ice packs
2) Nasal cautery (silver nitrate, only use on one side)
3) Anterior packing
4) Posterior packing
5) Surgical intervention

161
Q

What is the Mx of a post-tonsillectomy bleed?

A
  • If actively bleeding -> ENT senior + anaesthetics
  • Wide bore cannula, bloods, cross-match
  • IV fluids / blood products
  • Magills forceps + gauze + adrenaline
  • Hydrogen peroxide gargles
  • Tranexamic acid
  • Antibiotics

If doesn’t stop -> return to theatre

162
Q

What are some red flag foreign objects that need to be removed ASAP?

A
  • Button battery
  • Adhesives
  • Magnets
  • Insects (especially if inside the ear)
  • Caustic substances
163
Q

How is a foreign body in the ear managed?

A

Unless it is red flag object, semi-urgent f/u in 2 weeks to see if object has come out on its own

164
Q

How is a foreign body in the nose managed?

A

Semi-emergency (same day or next day) unless it is red flag object

Start with a ‘mothers kiss’ technique

165
Q

How is a foreign body in the throat managed?

A

Visible? – attempt removal with xylocaine spray, forceps, headlight and tongue depressor

Not visible?
* Lateral neck x-ray
* Flexible nasoendoscopy – if visible attempt removal
If still not visible and short history – reassure and safety net as likely not there anymore, may have left a scratch

166
Q

What are some drugs that are known to cause gingival hyperplasia?

A

CCBs (e.g. nifedipine, amlodipine)
Ciclopsorin
Phenytoin

167
Q

What is the acute management of vestibular neuritis?

A

Prochlorperazine - only use in acute phase otherwise can delay recovery by interfering with central compensatory mechanisms

168
Q

What test can be used to differentiate vestibular neuronitis from a posterior circulation stroke?

A

HiNTS exam (3 tests)

169
Q

What tests make up the HiNTS exam?

A
  • Head impulse test
  • Test of skew
  • Assessing nystagmus
170
Q

What is the management of acute necrotising ulcerative 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

171
Q

What is the management of a post-tonsillectomy bleed?

A

If a primary haemorrhage, requires immediate return to theatre to stop bleeding

If within 5-10 days of surgery, should be admitted for IV antibiotics as associated post-op wound infections

172
Q

What is the Mx of a pleomorphic adenoma?

A

Surgical resection (non-urgent) due to the risk of malignant transformation

173
Q

What is rhinitis medicamentosa?

A

Rebound nasal congestion which is associated with prolonged use of nasal decongestants

174
Q

What type of nystagmus is seen in BPPV?

175
Q

How are chronic symptoms of vestibular neuronitis managed?

A

Vestibular rehabilitation

176
Q

What neck lump characteristically contains cholesterol crystals?

A

Branchial cyst

177
Q

What exercises can be done at home to treat BPPV?

A

Brandt-Daroff exercises

178
Q

What is the management of an auricular haematoma?

A

Same day ENT assessment for early incision and drainage

179
Q

What is the most appropriate initial management of epistaxis where the site of bleeding is difficult to localise?

A

Anterior packing

180
Q

What characterises a primary and secondary post-tonsillectomy bleed?

A

Primary - within hours (6/8hrs) of the initial surgery
Secondary - within 5-10 days of surgery

181
Q

Where are vesicular lesions seen in Ramsay-Hunt syndrome?

A

Usually in the external auditory canal and pinna but can also be seen on the anterior 2/3rds of the tongue (facial distribution)

182
Q

What chemotherapy drug can cause ototoxicity?

183
Q

What is the typical management of adult hearing loss (with no sinister cause)?

A

3 month trial of acoustic hearing aids –> cochlear implant

184
Q

What can be used to shrink nasal polyps?

A

Topical corticosteroids

185
Q

What is the most common anatomical area for a nosebleed to occur?

A

Anterior nasal septum (Little’s area) - due to a confluence of 4 arteries in this area

186
Q

What is the Mx of Ramsay-Hunt syndrome?

A
  • High dose acyclovir
  • High dose steroids
  • Eye protection
187
Q

What is used for prophylaxis of Sx in Meniere’s disease?

A

Betahistine

188
Q

What drug class is betahistine in?

A

Histamine analogue

189
Q

What is meant by ‘double-sickening’ and what is it suggestive of?

A

A return of symptoms after a period of improvement - it is usually seen in bacterial sinusitis

190
Q

What is vertebrobasilar ischaemia?

A

Vertigo and dizziness on certain movements of the head, especially when looking up, as a result of reduced blood flow in the vertebrobasilar distribution

191
Q

What Abx should be prescribed for otitis externa in diabetic patients?

A

Ciprofloxacin

192
Q

Which virus is associated with nasopharyngeal cancer?

193
Q

Which virus is associated with oropharyngeal cancer?

194
Q

What is the maximum duration intranasal steroids should be used in chronic rhinosinusitis?

195
Q

Is an ear swab required in otitis externa?

A

No usually as most cases will be sensitive to the high Abx concentrations in ear sprays

196
Q

How long is prednisolone given for in sudden SNHL?

197
Q

What is meant by exostosis?

A

A benign bony growth in the external auditory canal that occurs as a result of repeated exposure to cold weather and wind, resulting in a conductive HL

198
Q

How long should an ulcer be present to be classed as ‘persistent’ and therefore require a 2ww referral?

199
Q

Which part of the eardrum is most important to visualise in cholesteatoma cases?

A

Pars flaccida (attic)

200
Q

Which antimalarial drug is known to cause tinnitus?

A

Quinine (but usually reverses on stopping)

201
Q

What are the two main contraindications to a cochlear implant?

A
  • Chronic infective OM
  • Mastoid cavity infection
202
Q

What is black hairy tongue and how is it managed?

A

A benign, usually asymptomatic condition where dark black/brown deposits accumulate on tongue (accumulation of keratin and dead cells) usually as a result of poor oral hygiene

Mx: good oral hygiene

203
Q

What pattern of inheritance does otosclerosis follow?

A

Autosomal dominant

204
Q

What is the immediate management of a post-tonsillectomy bleed causing stridor/airway compromise?

A

Cut the sutures to relieve pressure that is pushing on the trachea and arrange urgent return to theatre

205
Q

At what point are you recommended to refer for vestibular rehabilitation (balance specialist) in vestibular neuritis cases?

A

Symptoms > 1 week

206
Q

What is the head impulse test used for?

A

Can be used to differentiate between central and peripheral causes of vertigo. It will be positive in peripheral causes (e.g. vestibular neuritis) and negative in central causes (e.g. cerebellar stroke)

207
Q

Do all post-tonsillectomy bleeds need to referred?

A

Yes - all need to be urgently referred to ENT even if they don’t seem severe

ICSM Year 6 (21 decks)

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