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Year 6 - Surgery > Surgery: ENT > Flashcards

Surgery: ENT Flashcards

1
Q

What bones can you see during otoscopy?

A

The handle of the malleus and the long process of the incus

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2
Q

What forms the majority and minority of the ear drum?

A

Majority - pars tensa

Minority - pars flaccida

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3
Q

How many layers make up the pars tensa?

A

Three - outer keratinising squamous, middle vascularised fibrous connective tissue, inner nonkeratinising squamous

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4
Q

If you’re ever struggling to see what’s going on where should you pay close attention to?

A

The pars flaccida ie the attic

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5
Q

What is the centre point of the tympanic membrane?

A

Umbo which is where any growth begins

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6
Q

What joint pokes into the ear canal and forms the anterior recess?

A

TMJ

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7
Q

Which nerve runs over the top of the stapes?

A

Facial

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8
Q

How does otitis externa present?

A

Discharge +/- pain and may get closing of the EAC w swelling

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9
Q

Which individual should you beware of w otitis externa and why?

A

The elderly diabetic as it may lead to skull base osteomyelitis

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10
Q

What bacteria are responsible for otitis externa?

A

Staph or Strep -> klebsiella, e coli, pseudomonas

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11
Q

Which group of abx are ototoxic?

A

Aminoglycosides

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12
Q

What can otitis externa as the result of strep become? And tx?

A

Spreading cellulitis of the face which requires admission and IV abx

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13
Q

How does acute otitis media present?

A

Pain -> Discharge

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14
Q

Which individual should you beware of w acute otitis media and why?

A

The immunocompromised diabetic male teenager w a headache as they’re more at risk of intracranial comps

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15
Q

What are the features of the ear drum that is affected w acute otitis media?

A

It bulges out towards you esp the pars flaccida + the tympanic membrane is erythematous and injected w dilated blood vessels

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16
Q

What can acute otitis media progress to?

A

Mastoiditis

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17
Q

What are worrying signs in a child w mastoiditis?

A

Look: a clear defined swelling, displacement of the pinna, loss of post auricular creases

Feel: boggy + fluctuant

Move: take the pt to theatre for abscess drainage

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18
Q

What happens if you don’t do anything for a mastoiditis?

A

It can progress to form a posterior mastoid fistula, track down a muscle and become a neck abscess, track back and become a brain abscess

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19
Q

By what route does the pus get from the mastoid into the brain?

A

Through or alongside the veins

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20
Q

What do veins in the head and neck lack?

A

Valves

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21
Q

What is glue ear?

A

Otitis media w effusion

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22
Q

Which individual should you beware of w OME and why?

A

Unilateral glue ear in an adult may indicate nasopharyngeal cancer

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23
Q

What does OME look like down the otoscope?

A

The tympanic membrane looks stretched around the malleus handle and sucked inwards

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24
Q

Tx of OME

A

Arrange a hearing test, watch and wait for 12wks as 90% get better by themselves, otherwise surgical insertion of a grommet

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25
Q

Acute Perf

A

Due to trauma (head injury, barotrauma, cotton buds) + acute otitis media

Often spontaneous recovery which heals from bleeding edges inwards

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26
Q

Chronic Perf

A

If the edge rolls over it will not heal and become chronic

It can be dry/wet if it is wo/w exudate which inc risk of infection

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27
Q

What should you beware of w trauma to the ear?

A

Injured ossicles and inner ear resulting in hearing loss up to 60dB

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28
Q

Tx of TM perf

A

Keep the ear clean and dry, leave alone for 12wks, if persistent surgical mx

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29
Q

Are pts w TM perf allowed to fly?

A

Yes

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30
Q

What is a cholesteatoma?

A

Destructive cyst of middle ear made of keratinised squamous epithelium

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31
Q

What does a cholesteatoma look like on otoscopy?

A

Wax high up in the ear w white shiny appearance

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32
Q

Comps of Cholesteatoma

A

If it grows into the mastoid it will erode local structures - ossciles, facial nerve, chorda tympani, lateral semicircular canal, middle cranial fossa

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33
Q

What would you worry about if a pt w recurrent unilateral ear infections presents w loss of taste?

A

A cholesteatoma that has erroded the chorda tympani

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34
Q

What surgical approach would you take to tx a cholesteatoma?

A

From behind the ear through the mastoid

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35
Q

Which structures should you beware of when approaching from behind the ear? (2)

A

Sigmoid sinus + dura on posterior cranial fossa

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36
Q

Why is unilateral sensorineural hearing loss a red flag?

A

Vestibular Schwannoma

‘If they need the volume high don’t forget the MRI’

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37
Q

Rhinitis v Rhinosinusitis v Acute Sinusitis

A

Rhinitis - inflam of mucosa inside nose, allergic or non-allergic, asthma of the nose

Rhinosinusitis - above + paranasal sinuses usually chronic +/- polyposis

Acute Sinusitis - painful bacterial infection

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38
Q

Rhinitis: Allergic vs Non-Allergic

A

Allergic: seasonal, sx of irritation, mucosa swollen pale bluish

Non-Allergic: year round, block and thick mucus, mucosa swollen speckled pink

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39
Q

What is the instrument used to open the nostril to examine the nose?

A

Thudichum Nasal Speculum

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40
Q

What structures are viewed when looking in a nostril?

A

Septum, inferior turbinate, nasal vestibule

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41
Q

What do children w allergic rhinitis do to

relieve the itch and running watery mucus?

A

The Allergic Salute

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42
Q

What can the allergic salute lead to?

A

The Allergic Crease

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43
Q

How do you dx allergic rhinitis?

A

Clinical Examination + Allergy Testing

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44
Q

How do you classify allergic rhinitis?

A

Mild: normal sleep + no impairment of daily activities

Mod-Sev: abnormal sleep + impairment of daily activities

Intermittent: <4d/wk + <4wks

Persistent: >=4d/wk + >=4wks

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45
Q

Tx of allergic rhinitis

A

Mild Intermittent: avoid allergen, saline nasal douche, non-sedating antihistamine

Mod-Sev Intermittent: add intranasal steroid spray +/- leukotriene receptor antagonist

Mild Persistent: add topical cromone to potentiate the steroid or add an antihistamine

Mod-Sev Persistent: immunotherapy

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46
Q

How do you dx rhinosinusitis?

A

Nasal block + facial pressure, hyposmia, examination findings w nasal endoscope

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47
Q

When does rhinosinusitis become chronic?

A

> 12wks

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48
Q

Where do nasal polyps tend to arise from?

A

The middle turbinate

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49
Q

You find pale fleshy blobs on speculum: swollen turbinate vs polyps

A

Upon prodding it turbinates are highly sensitive + CT scan

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50
Q

Samter’s Triad

A

Asthma
Nasal Polyps
Aspirin Sensitivity

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51
Q

Which pts should you beware of w chronic rhinosinusitis?

A

If sx are unilateral may indicate tumour which the CT scan should pick up

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52
Q

Tx of chronic rhinosinusitis

A

Long term topical steroids to prevent recurring polyps +/- surgery

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53
Q

How does acute sinusitis px?

A

Bilateral facial pain w purulent discharge following a viral URTI

‘Double Sickening’

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54
Q

Which pts should you beware of w acute sinusitis?

A

The immunocompromised diabetic male teenager, may have spread into cranial cavity, scan if px w headache

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55
Q

Tx of acute sinusitis

A

Analgesia, abx, one off nasal decongestant

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56
Q

What is the problem w prolonged use of nasal decongestants?

A

Rhinitis Medicamentosa + Tachyphylaxis

They work by reducing blood supply to the nose, when it wears off rebound inc of blood flow and congestion, therefore when you have to use more to get the same desired affect

It’s a slow recovery ~12wks whilst the nose unblocks

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57
Q

What is the spectrum of sleep-disordered breathing?

A

Simple snoring

Upper airway resistance syndrome

Obstructive sleep apnoea mild-mod-sev

Alveolar hypoventilation syndrome

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58
Q

What is the pathophysiology of SDB?

A

Extreme neg intrathoracic pressure, central venous pooling, raised CVP+ICP, increased right+left heart pressure, pulm HTN+cor pulmonale

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59
Q

How would you mx SDB?

A

Hx: ask intimate partner + Epworth scale

O/e: check for airway collapse + lymphoid hypertrophy

Ix: flexible endoscopic exam +/- sedation

Tx: wt loss, red alcohol, legal+safety, mandibular advancement device, CPAP available following sleep study, cause dependent surg

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60
Q

Which questionnaire measures risk of daytime somnolence?

A

Epworth Scale

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61
Q

What is the legal and safety aspect surrounding SBD?

A

Driving or working w heavy machinery

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62
Q

Ddx of enlarged neck LNs (5)

A 
Reactive
Metastatic
Lymphoma
Sarcoid
TB
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63
Q

What is the workup for neck lymphadenopathy?

A

Hx, examine neck/lungs/ENT inc flexi endoscopy, imaging w USS+FNAC, CT for malignancy, CXR for sarcoid

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64
Q

Tx for cancer in the neck

A

H+N Cancer MDT

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65
Q

Which muscle does the ant tonsil pillar enclose?

A

Palatoglossus

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66
Q

Which muscle does the post tonsil pillar enclose?

A

Palatopharyngeus

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67
Q

What are the posterior pillars a good landmark for?

A

Tonsils + Airway Difficulty

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68
Q

What is the last bit of the mandible before it becomes the ramus?

A

Retromolar Trigone

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69
Q

Which is the most common cancer of H+N?

A

Tonsil

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70
Q

What is tonsil and oropharynx cancer a/w?

A

Young - HPV

Old - Smoking

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71
Q

How does nasopharyngeal cancer typically present?

A

As a neck lump

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72
Q

Which oral cancers are a/w chewing tobacco?

A

Gingiva + Palate

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73
Q

Where does nasopharyngeal cancer develop?

A

Fossa of Rosenmüller ie the pharyngeal recess

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74
Q

Which ethnic group are at inc risk of nasopharyngeal cancer?

A

SE Asia

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75
Q

Which virus are nasopharyngeal cancers a/w?

A

EBV

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76
Q

How does laryngeal cancer typically present?

A

Hoarseness +/- worsening dysphagia, aspiration, red tongue movement, neck lump, smoker

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77
Q

How many weeks of hoarseness requires an urgent ENT referral?

A

6wks -> Endoscopy

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78
Q

What happens if early sx of laryngeal cancer isn’t ix?

A

May px as an airway emerg requiring a tracheostomy

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79
Q

What should you do if you find leukoplakia?

A

Biopsy to dx how bad the dysplasia is

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80
Q

What do oral papillomas look like?

A

They have a ‘bunch of grapes’ or ‘soap-bubble’ appearance

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81
Q

Do papillomas have the potential for malignant transformation?

A

Yes

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82
Q

What should you always do before removing a thyroglossal cyst?

A

An USS to ensure theres other thyroid tissue

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83
Q

Which procedure is used to mx thyroglossal cysts surgically?

A

Sistrunk’s, removal of the whole tract and middle third of hyoid, prevents recurrence

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84
Q

What is a branchial cyst?

A

Embryological remnant from the development of the pharyngeal arches: internal surface (endoderm-pouches) + external surface (ectoderm-clefts)

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85
Q

What are the pharyngeal pouches formed by the arches?

A

I: eustachian tube + middle ear

II: palatine tonsil

III: inferior parathyroid glands + thymus

IV: superior parathyroid glands, ultimobranchial body (along w 5th), musculature and cartilage (along w 6th)

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86
Q

How do branchial cysts px?

A

Young adult with a smooth firm fluctuant swelling classically a third the way down ant border of SCM

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87
Q

What would be the ddx for a branchial cyst?

A

Lipoma

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88
Q

Cyst vs Lipoma

A

Transilluminate

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89
Q

Sinus vs Fistula

A

Further abnormalities in the embryology

Sinus: blind ending epithelial tract to one surface

Fistula: abnormal communication b/w two epithelial surfaces

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90
Q

Mx of Branchial Cyst

A

Dx: USS

Tx: complete excision of cyst and any underlying tract

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91
Q

Pleomorphic Adenoma vs Warthin’s Tumour

A

Both benign parotid tumours

PA: any age + slow growing

WT: older men, a/w smoking, ~15% bilateral

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92
Q

What should you examine following clinical suspicion of a parotid swelling?

A

The facial nerve as malignant tumours may invade resulting in a palsy

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93
Q

Ddx of Parotid Swelling

A

Infection: mumps, syphilis, TB

Inflammation: stones + sarcoidosis

Malignancy: benign, malignant, metastatic, lymphoproliferative

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94
Q

Mx of Parotid Tumour

A

Dx: USS+FNAC

Tx: watch and wait -> surgery

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95
Q

Ddx of Submandibular Swelling

A

Infection, Stone, Pleomorphic Adenoma

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96
Q

Mx of Submandibular Swelling

A

Dx: hx, bimanual palpation, USS+FNAC

Tx: stone retrieval or gland excision

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97
Q

What is perichondritis?

A

Spreading infection of the pinna classically from an insect bite

98
Q

What can perichondritis lead to if left untreated?

A

Osteomyelitis via spread through the temporal bone

99
Q

Tx of Perichondritis

A

Remove insect remnants/piercings and broad spectrum abx

100
Q

What is a pinaa haematoma?

A

Blood collects in subperichondrial space resulting in cartilage ischaemia

101
Q

What can a pinna haematoma lead to if left untreated?

A

Cauliflower Ear

102
Q

Tx of Pinna Haematoma

A

Tx the head injury, look in the ear for other injury, incise and drain the pinna

103
Q

Why is oil > water used to flush the ear?

A

It won’t be absorbed by the insect

104
Q

What must be ruled out before dx bells palsy? (4)

A

Stroke
Parotid Ca
Cholesteatoma
Ramsay-Hunt Syndrome

105
Q

Tx of Bells Palsy

A

Eye drops and patch alongside steroid tx +/- vaciclovir

106
Q

Epistaxis: Ant vs Post

A

Ant: 90%, young, trauma irritants preg

Post: 10%, elderly, vasculopathy hypertension atherosclerosis

107
Q

What is the name of the anastomosis b/w the ethmoid and sphenopalatine arteries?

A

Ant: Kiesselbach’s plexus ie Little’s area

108
Q

Tx for Ant Epistaxis

A

Squeeze soft part of the nose for ten mins w the head leaning forwards + if recur consider AgNO3 cautery

109
Q

Tx for Post Epistaxis

A

Pack back>up, probable admission, drug hx, check pharynx for clots, bloods inc G+S

110
Q

What are the diff packing options for post epistaxis?

A

Rapid Rhino
Brighton Balloon
BIPP Ribbon

111
Q

What is the most important part of tx for a fractured nose?

A

Timing: move back on day 0 or ~10 ie before/after the swelling

112
Q

Comp of Nose #

A

Septal Haematoma -> Saddle Nose Deformity

113
Q

What should you worry about w a head injury in a child?

A

NAI

114
Q

How can you tell if the uvula if acc deviated?

A

Look at the base not the tip

115
Q

Where should you first attempt quinsy drainage?

A

Where the lines from the side of the tongue and base of the uvula intersect

116
Q

What is the standardised progression of a quinsy?

A

Tonsillitis, peritonsillar cellulitis, quinsy, parapharyngeal abscess, retropharyngeal abscess, mediastinitis

117
Q

What voice are pts w a quinsy typically said to have?

A

‘Hot Potato’

118
Q

What is Ludwig’s angina?

A

A deep expanding infection around the mylohyoid usually following dental infection

119
Q

How does Ludwig’s angina px? (3)

A

Rounded neck swelling, tongue displacement, stridor

120
Q

Tx of Ludwig’s Angina

A

Secure airway, IV fluids and abx, CT scan and ultimately admit for abscess drainage

121
Q

What position are pts w epiglottitis or other lower airway obstrc said to sit in?

A

Tripod position: neck pushed forward, leaning forward, supporting themselves on their knees

122
Q

Why has the incidence of epiglottitis declined?

A

The HiB vaccine

123
Q

What senior help should you get for a pt w epiglottitis? And tx?

A

A+E, ENT, Anaesthetist

Give adrenaline nebs and consider heliox

124
Q

What is heliox? And why is it effective?

A

80% Helium + 20% Oxygen

As helium has a lower density than nitrogen it makes breathing through a smaller space easier due to Pascal’s law

125
Q

Stridor vs Stertor

A

Stridor: insp (supraglottis-glottis), biphasic (subglottis), exp (tracheal-bronchi)

Stertor: snoring

126
Q

Where is the narrowest diameter in the airway?

A

Subglottis

127
Q

What are possible causes of stridor? (4)

A

Infection
Inflammation
Foreign Body
Trauma

128
Q

What is the most important thing to check in a pt w stridor?

A

Sats > Noise: if the pt starts to tire or the sats drop this is when you escalate

129
Q

What is the life saving emerg trachy?

A

Cricothyroidotomy

Skin - Fat - Membrane - Air

130
Q

What are your thoughts if a pt px w otitis externa has a perf TM?

A

Media -> Externa

131
Q

When would you use a pack > cautery for an epistaxis?

A

Profuse bleeding w site difficult to localise

132
Q

What cancers is the EBV involved with?

A

Nasopharyngeal + Hodgkin’s

133
Q

When do you refer for tonsillectomy?

A

Recurrent acute tonsillitis or quinsy, chronic tonsillitis >3m w halitosis, any airway obstrc

134
Q

Pt px w biting R inner cheek when closing mouth, R lower teeth numbness, R lower jaw pain

A
  • Examine oral cavity, oropharynx, mandible
  • Perform secondary survey for concurrent injuries
  • Assess for motor dysfunction + sensory disturbances
  • Referral to the maxillofacial surgical team
135
Q

What are Le Fort fractures?

A

Fracture of the pterygoid plates resulting in the separation of all or a portion of the midface from the skull base

136
Q

Px of zygomatic arch fracture

A

Cheek paraesthesia and interference of mandibular movements if it impinges upon the coronoid process of the mandible

137
Q

Px of mandibular fracture (5)

A

Bite malalignment, trismus, pain+numbness along distribution of inf alveolar nerve, buccal haematoma, dental malocclusion

138
Q

Mx of mandibular fracture (2)

A

An orthopantomogram (OPG) and urgent referral to the maxillofacial surgical team

139
Q

The classification of Le Fort fractures

A

I - Horizontal
II - Pyramidal
III - Transverse

140
Q

Def of ulcer

A

A discontinuation in the epithelial surface

141
Q

Px of aphthous ulceration

A

Discrete ulcers of gingival mucosa characterised by a centralised white ulcer w erythematous halo

142
Q

Ddx of aphthous ulceration

A

Herpes virus, smoking cessation, squamous cell carcinoma, Bechets syndrome, Crohn’s disease

143
Q

What size criteria characterises a major aphthous ulcer?

A

> 1cm Diameter

144
Q

How do you stage primary oral cavity lesions?

A

MRI of the neck

145
Q

Mx of aphthous ulceration

A

Simple oral analgesia and topical anaesthetics

Swab for HSV infection if suspected

Assess for pathological cervical lymphadenopathy

Consider 2w referral to maxillofacial department

146
Q

Which factors make you suspicious of SCC?

A

Indurated, lateral aspect of the tongue, failure to resolve, long term smoking hx

147
Q

What is the path of the facial nerve?

A

Pons, 1cm internal acoustic meatus, 3cm facial canal, stylomastoid foramen, parotid gland where it divides into terminal motor branches

148
Q

How should you examine hemifacial paresis?

A

Otoscopy, palpation of parotid gland and neck, movement of facial muscles

149
Q

What does the facial nerve innervate?

A

Motor - facial muscles, posterior belly of the digastric, stylohyoid, stapedius

Sensory - small area around the concha of the auricle + anterior 2/3 of the tongue

Parasympathetic - lacrimal, mucous, salivary glands

150
Q

Which branch of the facial nerve innervates the lacrimal and mucous glands?

A

The greater superficial petrosal nerve

151
Q

Which branch of the facial nerve innervates the anterior 2/3 of the tongue (foliate papillae) and salivary glands?

A

The chorda tympani

152
Q

Which nerve supplies the posterior 1/3 of the tongue (vallate papillae)?

A

The glossopharyngeal nerve

153
Q

Where is the internal acoustic meatus situated?

A

The petrous part of the temporal bone

154
Q

What segments is the facial canal divided into?

A

Labyrinthine, tympanic, mastoidal

155
Q

Which salivary glands does the chorda tympani innervate?

A

Sublingual + Submandibular

156
Q

Which nerve supplies the parotid gland?

A

The glossopharyngeal nerve

157
Q

Which mucous glands does the facial nerve innervate?

A

Nasal, palatine, pharyngeal

158
Q

What are the five terminal branches of the facial nerve?

A 
Temporal
Zygomatic
Buccal
Mandibular
Cervical
159
Q

The intracranial branches of the facial nerve

A

The greater petrosal, nerve to stapedius, chorda tympani

160
Q

The extracranial branches of the facial nerve

A

The posterior auricular, nerves to digastric and stylohyoid, terminal motor branches

161
Q

Consequences of intracranial lesion of facial nerve

A

Ipsilateral reduced lacrimal fluid production, hyperacusis, loss of taste, reduced salivation, muscle weakness

162
Q

Consequences of extracranial lesion of facial nerve

A

Only motor function is affected

163
Q

Causes of intracranial lesion of facial nerve

A

Middle ear pathology such as tumour or infection

164
Q

Causes of extracranial lesion of facial nerve

A

Parotid gland pathology such as tumour, parotitis or surgery, herpes virus infection, compression during forceps delivery

165
Q

What is Bell’s palsy?

A

Facial nerve palsy w no definitive cause

166
Q

What are give away signs of hemifacial paresis?

A

Loss of frontal forehead and melolabial creases and ipsilateral conjunctivitis secondary to incomplete eye closure

167
Q

What’s the difference b/w UMN and LMN lesions?

A

UMN is forehead sparing

168
Q

Causes of UMN palsies

A

CVA, MS, SOL

169
Q

Causes of LMN palsies

A

Bell’s, Parotids, Heerfort’s

170
Q

What is the 80% anecdote regarding parotid tumours?

A

80% are benign and of these 80% are pleomorphic adenomas

171
Q

What are mucoepidermoid carcinomas?

A

The most common parotid malignancy in adults which px w parotid mass and concurrent facial nerve palsies

172
Q

What is Heerfort’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

173
Q

How do mucoepidermoid carcinomas spread?

A

The lymphatic system

174
Q

What are the RFs of Bell’s palsy?

A

Diabetes, recent URTI, pregnancy

175
Q

What are Warthin’s tumours?

A

Benign w no malignant potential that px as painless well circumscribed swelling involving the tail of the parotid gland

176
Q

How can you localise the lesion in a 7th n palsy?

A

Plus: 6th - Pons or 5/8th - Cerebellopontine Angle

177
Q

What is vestibular neuronitis?

A

Acute isolated, spontaneous, prolonged vertigo of peripheral origin +/- N+V w/o hearing loss, tinnitus, focal neuro sx

178
Q

Ddx of Vertigo

A

Peripheral: bppv, vestibular neuronitis, labyrinthitis, Meniere’s

Central: migraine, stroke, cerebellar tumour, MS

179
Q

When should you refer pts w vertigo?

A

Additional neuro sx, not improving after wk of tx, persists for >6wks

180
Q

What is the preferred tx for vestibular neuronitis?

A

Short term prochlorperazine for sx + vestibular rehab exercises

181
Q

How do you distinguish vestibular neuronitis vs posterior circulation stroke?

A

HiNTs

182
Q

What is Ludwig’s angina?

A

Progressive cellulitis due to odontogenic infection spreading into the submandibular space

183
Q

Why is Ludwig’s angina an emergency?

A

It can rapidly result in airway obstrc

184
Q

Which drugs are ototoxic?

A 
Aminoglycosides
Quinine
Aspirin
Furosemide
Cytotoxics
185
Q

What are the three most common causes of hearing loss?

A

Wax, otitis media, otitis externa

186
Q

What is presbycussis?

A

Age related sensorineural hearing loss w bilateral high freq loss on audiometry

187
Q

What are the features of vestibular schwannomas?

A

CN V: absent corneal reflex

CN VII: facial nerve palsy

CN VIII: hearing loss, tinnitus, vertigo

188
Q

What does bilateral acoustic neuromas suggest?

A

NF2

189
Q

How is otosclerosis inherited? And usual age of onset?

A

Autosomal dominant + usually 20-40yo

190
Q

What does otosclerosis cause?

A

The replacement of normal bone to vasc spongy bone results in a bilateral conductive pattern +/- tinnitus

191
Q

What colour is the tympanic membrane in 1/10 pts w otosclerosis?

A

‘Flamingo Tinge’

192
Q

BPPV Manoeuvres

A

Dx: Dix-Hallpike + Tx: Epley

193
Q

Which HPV is linked w tonsillar SCC?

A

HPV-16

194
Q

What does normal hearing look like on an audiogram?

A

Anything above the 20dB ie <20dB is essentially normal

195
Q

Audiogram: Sensorineural v Conductive v Mixed

A

Sensorineural: both air and bone impaired

Conductive: only air is impaired

Mixed: both again but air worse than bone

196
Q

What is black hairy tongue? And tx?

A

Defective desquamation of the filiform papillae, swab for Candida, tx w scrapings +/- topical antifungals

197
Q

What are the CIs for cochlear implant? (5)

A

Chronic infective otitis media, mastoid cavity, TM perf, cochlear aplasia, deafness from CN VIII or brainstem lesion

198
Q

What is the cause for the majority of SSNHL?

A

Idiopathic

199
Q

Why should a MRI be done following SSNHL?

A

Exclude vestibular schwannoma

200
Q

Mx for SSNHL

A

Urgent ENT referral + high dose oral corticosteroids

201
Q

What is the biggest RF for malignant otitis externa?

A

Diabetes Mellitus

202
Q

Which bacteria most commonly causes malignant otitis externa?

A

Pseudomonas aeruginosa

203
Q

What does a sev sore throat + uvular deviation to the unaffected side suggest?

A

Quinsy

204
Q

How does epiglottitis typically px? (3)

A

Extended head, drooling, tripoding

205
Q

Why should you refrain from examining a pt w epiglottitis?

A

It may induce laryngospasm and obstrc the airway

206
Q

What is otalgia w/o ear signs a red flag for?

A

H+N Malignancy

207
Q

What causes Ramsay Hunt syndrome?

A

Reactivation of VZV in the geniculate ganglion of CN VII

208
Q

When would refrain from tx ear wax? And when would you refer to ENT?

A

No tx if TM perf or grommet in situ + refer is sx >6wks

209
Q

Samter’s Triad

A

Asthma
Aspirin Sensitivity
Nasal Polyposis

210
Q

Which drugs causes gingival hyperplasia? (3)

A

Nifedipine
Phenytoin
Ciclosporin

211
Q

What are the features of Menieres disease?

A

Recurrent eps of vertigo, tinnitus and hearing loss a/w feeling of aural fullness

212
Q

What is found o/e of Menieres disease?

A

Nystagmus + Pos Rombergs

213
Q

Mx of Menieres Disease

A

Consrv: inform DVLA

Acute: buccal/IM prochlorperazine

Prevention: betahistine + vestibular rehab exercises

214
Q

How is 1°/2° haemorrhage following tonsillectomy managed?

A

1°: immediate return to theatre

2°: admission + abx +/- surgery

215
Q

Why do viral URTIs typically precede otitis media?

A

It disturbs the normal nasopharyngeal microbiome allowing bacteria to infect the middle ear via the Eustachian tube

216
Q

Which bacteria cause acute otitis media? (3)

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

217
Q

What are the possible otoscopy findings of acute otitis media?

A

Bulging TM, loss of light reflex, opacification erythema perf of TM

218
Q

What is chronic suppurative otitis media?

A

Perf of TM w otorrhoea for >6wks

219
Q

When should you prescribe abx for acute otitis media? (5)

A

Sx >4days or not improving, sys unwell, immunocomp or high risk of comps, <2yo w bilateral, perf or discharge

220
Q

Comps of acute otitis media (4)

A

Mastoiditis
Meningitis
Brain Abscess
Facial Nerve Paralysis

221
Q

Outline the centor criteria

A

Inc score more likely to be strep: fever, absence of a cough, exudate, tender lymphadenopathy

222
Q

Outline the FeverPAIN criteria

A

Inc score more likely to be strep: fever, absence of a cough, sx onsent <3d, purulence, sev inflamed tonsils

223
Q

Abx for bacterial tonsilitis

A

Phenoxymethylpenicillin or erythromycin 7-10d course

224
Q

Which abx covers pseudomonas?

A

Ciprofloxacin

225
Q

Abx for otitis media + externa

A

Media: Amoxicillin
Externa: Flucloxacillin

226
Q

What benign tumour can cause epistaxis in adolescent males?

A

Juvenile Angiofibroma

227
Q

What rare autosomal dominant disorder can cause prolonged epistaxis in elderly?

A

HHT

228
Q

Rinne Test: pos vs neg

A

It’s normal to be pos ie AC>BC vs abnormal to be neg ie BC>AC

229
Q

What is the rule of 80s for salivary tumours?

A

80% are in the parotid

80% of those are benign

80% of those are pleomorphic adenomas w Warthin’s tumour being the next most common

230
Q

Which salivary gland gets the most stones?

A

Submandibular

231
Q

What can go wrong w the salivary glands?

A

Infection
Inflammation
Malignancy

232
Q

Gingivitis: simple vs acute necrotising ulcerative

A

Simple: painless red swelling w bleeding on contact - seek routine regular review w dentist

Acute: painful bleeding gums w halitosis and punched out ulcers - requires para, 3d oral metronidazole, chlorhexidine mouth wash whilst waiting for dentist

233
Q

What should you avoid for 6wks w EBV?

A

Contact Sports

234
Q

Outline the Centor Criteria

A

One point for: fever, no cough, tonsillar exudate, ant cervical lymphadenopathy

If 0-2 no abx vs 3-4 strep testing and empirical abx both w symptomatic tx

235
Q

Which pts w hearing loss require urgent referral to ENT?

A

SSNHL <3d

Unilateral hearing loss a/w focal neurology eg altered sensation or facial droop

Hearing loss a/w head or neck injury, necrotising otitis externa, Ramsay Hunt syndrome

236
Q

Ix of SSNHL

A

An MRI to exclude vestibular schwannoma

237
Q

Tx of SSNHL

A

High dose oral corticosteroids by ENT

238
Q

What are the ddx for hearing loss following trauma?

A

Perforated TM (conductive) + Base of Skull # (sensorineural)

239
Q

How can nasopharyngeal cancer px?

A

Unilateral middle ear effusion esp if a smoker and from SE Asia

240
Q

Cystic Hygroma vs Branchial Cyst

A

CH: 1yo - soft, non tender and transilluminates

BC: 20yo - smooth, non tender and fluctuant

241
Q

Mx of Auricular Haematoma

A

Same day assessment by ENT for incision and drainage

Year 6 - Surgery (6 decks)

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