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Year 4 Key Stuff > Surgical Specialties A - ENT Year 4 Assessment Questions > Flashcards

Surgical Specialties A - ENT Year 4 Assessment Questions Flashcards

1
Q

QUESTION 1 - 73 year old man with epistaxis

A

External pressure to the nose for 20 minutes and ice would be the initial management of epistaxis

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2
Q

QUESTION 1 - 73 year old man with epistaxis

A

After trying pressure and ice Clot removal e.g. suction or nose blowing Apply a cotton soaked ball - adrenaline to cause vasoconstriction and lidocaine for analgesia Cauterise using silver nitrate Rhino pack if bleeding continues Endoscopic ligation of sphenopalatine artery Ligation of the external carotid artery Embolisation - can cause stroke - LAST LINE

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3
Q

QUESTION 1 - 73 year old man with epistaxis

A

Anterior ethmoidal artery, Posterior ethmoidal artery, Sphenopalatine artery, Greater palatine artery, and the Septal branch of the superior labial artery. (branch of the facial artery)

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4
Q

QUESTION 1 - 73 year old man with epistaxis

A

Continued bleeding Visual disturbance CSF leak

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5
Q

QUESTION 1 - 73 year old man with epistaxis

A

Principal region supplied by the sphenopalatine artery is the lateral wall of the nasal cavity

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6
Q

27 year old woman with runny, blocked nose and snoring

A

Exposure to animals Drinking alcohol Seasonal (worse in hayfever season)

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7
Q

27 year old woman with runny, blocked nose and snoring

A

Allergic rhinitis

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8
Q

27 year old woman with runny, blocked nose and snoring

A

Skin prick test would be 1st line to identify the allergic RAST - radioallergosorbent test would be next - looks for specific IgE

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9
Q

27 year old woman with runny, blocked nose and snoring Which of the types of hypersensitivity is involved in allergic rhinitis? Which type of antibody is found in allergic rhinitis?

A

Allergic rhinitis - immediated hypersensitivity Type 1 Type 1 - IgE

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10
Q

What are the treatment steps for allergic rhinitis? ( up to oral steroids)

A

Allergen avoidance is step one Then antihistamines eg loratadine If symptoms persist - intranasal corticosteroids Can try leukotrienes after this eg montelukast Oral steroids only short course for rapid relief of symptoms

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11
Q

Why would oral steroids be used?

A

Oral steroids only short course for rapid relief of severe symptoms ie exams

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12
Q

27 year old woman with runny, blocked nose and snoring State in order of treatment for allergic rhinitis

A

Corticosteroid mechanism of action used in allergy - binding to receptors within the cell which cause the nucelus to down regulate the production of inflmmatory mediators

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13
Q

QUESTION 3

A

ALL OF THE ABOVE

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14
Q

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A

FBC and Chest Xray

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15
Q

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A

Inform the patient of the results and state they are worrying and though they will be seen in ENT, you are going to ask the resp clinic to see them. Mention it may bea cancer.

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16
Q

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A

Give smoking cessation advice or refferal Refer to SALT Refer to ENT for a further opinion on hoarseness Arrange for community dietician Ask macmillan nurse to visit

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17
Q

QUESTION 4

A

Recurrent acute otitis media Chronic OME Otitis externa Cholesteatoma

18
Q

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A

Recurrent otalgia Recurrent ear discharge Hearing loss All could happen with chronic OME

19
Q

How many months must symptoms be persistent for a diagnosis of OME?

20
Q

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A

Retracted and dull - the negative pressure in the eustachian tube would be pulling the membrane back

21
Q

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A

* O - right ear air conduction * X - left ear air conduction * Triangle - bone conduction ANSWER _ Bilateral conductive hearing loss, worse left side * Bone conduction higher than air hear * Shows that when using a bone vibration patient can hear better than when just using air - this means there is a conductive hearing loss as there is a problem with the passage of sound to the inner ear

22
Q

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A

Type B - a flat tracing on tympanogram ususally shows either fluid filled ear or a perforation

23
Q

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A

Option B - no, permission is needed from parents

24
Q

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A

ALl of them

25
Q

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A

FBC and electrolytes CT scan of neck, chest and liver LFTs FNA cytology of neck node Biopsy of tonsil mass

26
Q

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A

Refer to head and neck MDT Panendoscopy and biopsies under GA (A panendoscopy is the examination of the upper aerodigestive tract (pharynx, larynx, upper trachea and oesophagus). It may also involve the removal or biopsy of any abnormal tissue found.)

27
Q

Apart from smoking, alcohol and rarer occupational exposures what other aetiological factor is now recognised as important in head and neck cancer?

28
Q

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A

ALL THE QUESTIONS

29
Q

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A

Meniere’s disease Aural fullness Last hours NO POSITIONAL TRIGGER

30
Q

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A

O - air conduction right ear X - air conduction left ear Triangle - bone conduction [ - masking to prevent non-test ear from affecting test results Low frequency conductive hearing loss is seen on this audiogram

31
Q

Would this audiogram be consistent with a diagnosis of Ménière’s Disease? Is Ménière’s Disease a common cause for vertigo? Which of the vestibular conditions below causes brief episodes of rotatory vertigo? * • Vestibular neuronitits * • Benign positional paroxysmal vertigo * • Menieres Disease * • Vestibular Schwannoma *

A

No because Menieres causes a SNHL Not common BPPV causes brief episodes of otatory vertigo

32
Q

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A

Laterality of sore throat Voice change

33
Q

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A

Infectious mononculeiosus Tonsilitis

34
Q

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A

Lymphocytosis on blood film

35
Q

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A

Liver enzymes

36
Q

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A

Phenoxymethylpenicillin first line if patient can swallow If not then Benzylpenicilllin

37
Q

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A

Anti-EBV IgG absent, anti-EBV IgM present IgG measures past disease IGM measures active disease

38
Q

What is the manageemnt of quinsy? What if pen allergic?

A

Peritonsilar abscesss Benzylpenicillin IV or Penicillin V oral Total duration IV/PO: 10 days Penicillin allergy: Clindamycin oral (10 days) If unable to swallow IV Clindamycin If not resolving at 48 hours consider adding metronidazole to penicillin. for anaerobic cover (Cindamycin gives adequate anaerobic cover

39
Q

What are the components of the centor criteria for differentiating between viral and bacterial tonsilitis?

A

Centor criteria absence of Cough tonsilar Exudate cervical Node enlargement Temp Fever - approx 38

40
Q

What extra does the modified centor criteria contain?

A

If the child is less than 15 then add a point If over 45 then deduct a point

41
Q

A new score FEVERPain has been introduced to also help diagnose tonsiltiis How does this scoring system work? What score recommends use of antibitoics by NICE and Antibitoic man NHS?

A

The FeverPAIN criteria are: score 1 point for each (maximum score of 5) - consider ABx if score >/=4 Fever over 38°C. Purulence (pharyngeal/tonsillar exudate). Attend rapidly (3 days or less) Inflamed tonsils (severe) No cough or coryza

Year 4 Key Stuff (22 decks)

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