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PLABABLE 2.0 > ENT > Flashcards

ENT Flashcards

1
Q

Management of recurrent epistaxis with visible blood vessels in the anteroinferior part of the nasal septum BILATERALLY + NO active bleeding.

A

Nasal cautery at ONE side of the septum initially

If no active bleeding: Topical treatment with Naseptin (Chlorhexidine + Neomycin)

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2
Q

Why is cautery with silver nitrate not advised when there is active bleeding in the mgt of epistaxis?

A

AgNO3 will just be washed out if there is active bleeding

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3
Q

Why is cautery not done bilaterally if the active bleeding is noted on both nostrils?

A

There is risk of septal perforation if you do cautery on both sides

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4
Q

Mgt of recurrent epistaxis with visible blood vessels in the anteroinferior part of the nasal septum bilaterally + ACTIVELY bleeding on presentation to GP

A

Anterior nasal packing BILATERALLY

Instruct the patient to breathe per mouth. Nasal packing is left in for 24-48 hours

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5
Q

Important risk factor for oral thrush

A

Immunosuppresion (recent use of antibiotics, long-term steroids intake, DM)

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6
Q

Differentiate leukoplakia from oral thrush in terms of rubbing out of the white marks

A

Oral thrush - can be rubbed out

Leukoplakia - cannot be rubbed out

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7
Q

What is the management for oral thrush?

A

If patient is a smoker, stop smoking.
Good inhaler technique if patient uses inhaler. (Spacer device and rinse mouth with water every inhalation).
Oral Fluconazole 50mg x 7 days or Fluconazole oral suspension

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8
Q

Management for Leukoplakia

A

Stop smoking and BIOPSY (leukoplakia is pre-malignant)

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9
Q

Mainstay of treatment for oral lichen planus (purple, pruritic, polygonal, papular rash)

A

Topical steroids

For oral lichen planus - benzydamine gargle or spray

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10
Q

Ear foreign body removal: insect

A

Kill with lidocaine or olive oil or mineral oil then water irrigation

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11
Q

Ear foreign body removal: Seeds

A

Suction by catheter or hook

NO-NO to instill oil as it would be more difficult to remove

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12
Q

Ear foreign body removal: Super glue

A

Can be removed after 1-2 days after desquamation

BUT! Refer to ENT if ear drum is involved

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13
Q

Earwax buildup

A

Instill olive oil to soften hard wax

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14
Q

Batteries inside the ear

A

Refer to ENT, they should be removed within 24 hours

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15
Q

Any spherical object inside the ear

A

Remove by a hook

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16
Q

Swollen cervical lymph nodes (painless lump in the upper neck) + eustachian tube obstruction (recurrent nasal bleeds, nasal obstruction, otitis media) + conductive HL + tinnitus

A

Nasopharyngeal CA

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17
Q

Persistent sore throat over weeks + progressive hoarseness of voice + dysphagia + feeling of a persistent lump in the throat + palpable lump in the anterolateral portion of the neck

A

Tonsil carcinoma

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18
Q

Tonsilar cancer patient presents with pain in the throat + trismus

A

Cancer might have spread to the Mandible

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19
Q

Post-tonsillitis or sore throat + drooling of saliva + otalgia + hot potato voice + uvular deviation

A

Peritonsillar abscess

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20
Q

DIG of Plummer-Vinson syndrome

A

Dysphagia
Iron-deficiency Anemia
Glossitis

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21
Q

Why is PVS importanT?

A

Risk factor for oropharyngeal CA. Common in post-menopausal women

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22
Q

Treatment for otiitis externa

A

Topical Gentamicin + Hydrocortisone

OR

Acetic acid

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23
Q

Significant in the history of a patient who presents with otitis externa

A

History of travel, swimming or high humidity + Initial complaint of itching followed by pain in the ear

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24
Q

First investigation for a patient who sustained trauma to the ear presenting with intense otalgia, bleeding from the ear, tinnitus and temporary hearing loss

A

Otoscopy (to rule out TM perforation)

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25
Q

According to the guidelines in England, this is the 1st line treatment for otitis externa. 2nd line?

A

1st line - Acetic acid 2% spray

2nd line - topical Gentamicin + Hydrocortisone

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26
Q

Usual metastatic spread of tonsillar carcinoma

A

Mandible

Remember that tonsillar carcinoma presents with long-standing dysphagia with hoarseness of voice. If this patient, presents with trismus, suspect metastatic spread to the mandible.

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27
Q

Investigation of choice for mandibular lumps and salivary gland masses

A

Fine needle aspiration cytology

28
Q

Secondary to sarcoidosis, TB or lymphoma, this presents with a triad of dry mouth, dry eyes and enlarged salivary glands

A

Miculikz syndrome

29
Q

Swelling in the submandibular region + pain aggravated when chewing + sour taste in the mouth + decreased mobility of jaw

A

Chronic sialadenitis

30
Q

Symptoms of Meniere’s disease

A

DVT + Fullness

Deafness + Vertigo + Tinnitus + Fullness

*** fullness is more specific for Meniere’s disease (BUT!!! Important to remember that when fullnesss is associated with cranial nerve involvement, think of acoustic neuroma

31
Q

How does SNHL in the left ear present with Rinne and Webber?

A

Rinne: AC > BC

Weber lateralises to the RIGHT

32
Q

What do you request if a patient presents with sensorineural hearing loss?

A

MRI (NOT otoscopy)

33
Q

AC > BC, what are the two only possible diagnoses?

A

Normal (no Weber lateralisation)

SNHL (Weber lateralisation to the opposite side of the lesion)

34
Q

Differentiate vestibular neuritis from labyrinthitis.

A

Both present with 3Vs: vertigo, viral URTI and vomiting.

Labyrinthitis: presents with TINNITUS AND HEARING LOSS

35
Q

Commonest cause of conductive hearing loss in children. Diagnostic test of choice. Management?

A

Otitis Media with effusion

Audiogram

Advice patients to stop smoking (if parents are smokers)

Other Management:
If first visit or recent diagnosis: REASSURE (spontaneously resolves)
If persists over 3 mos: Grommets insertion
IF surgery is contraindicated or rejected: Hearing aid

36
Q

What is the indication of hearing aid for patients who present with acute otitis media with effusion?

A

If surgery is rejected or contraindicated

37
Q

When would you offer Gommets insertion for a patient who presents with Otitis media with effusion?

A

If otitis media persists after three months

38
Q

Chalky white patches over the eardrum

A

Tympanosclerosis

39
Q

Common cause of malignant otitis externa

Drug of choice

A

Pseudomonas

Ciprofloxacin

40
Q

Diagnostic test of choice for malignant otitis externa

A

CT scan

41
Q

Commonest viral cause of otitis media

A

RSV

42
Q

Painless lump in the anterior midline neck + moves with tongue protrusion

A

Thyroglossal duct cyst

43
Q

Fluctuant lump that transilluminates

A

Cystic hygroma

44
Q

Lump that moves up with swallowing

A

Goitre vs. Large thyroid nodule

45
Q

Hearing test for patient below 6 months

A

OAE or ABR

46
Q

When is distraction testing used for hearing test?

A

6-18 months

47
Q

Hearing test indicated for 2-4 years old

A

Speech Discrimination

Or Conditioned Response Audiometry

48
Q

Hearing test indicated for more than 5 years

A

Pure Tone Audiogram

49
Q

In laryngitis, weakness of voice occurs AFTER or DURING respiratory infection?

A

DURING

50
Q

When do you start phenoxymethylpenicllin as treatment for acute tonsillitis?

A

3 out 4 Centor Criteria = bacterial tonsillitis

  1. T > 37.8
  2. Tender and enlarged anterior cervical LNs
  3. Tonsillar exudates/pus
  4. No associated cough
51
Q

Asymptomatic + solitary, painless, firm and mobile swelling at the angle of mandible which grows very slowly? Management?

A

Superificial parotidectomy OR enucleation

Likely Pleomorphic adenoma - most common cause of salivary gland tumor which appears as a lump just behind the angle of the mandible

52
Q

DVT vs 3Vs

A

DVT - Meniere’s disease vs. acoustic neuroma

3Vs - vestibular neuritis vs. labyrinthitis

53
Q

Elderly + Smoker + dysphagia + unilateral otalgia + unilateral red lesion with central ulcer that bleeds on touch

A

Tonsillar Cancer

54
Q

Indications of tonsillectomy

A

7,5,3 for 1,2,3

7 episodes per year for 1 year
5 episodes per year for 2 years
3 episodes per year for 3 years

55
Q

Appropriate test for deafness in neonates

A

ABR

56
Q

Differentiate presbycusis from otosclerosis

A

Presbycusis

  • elderly
  • hearing loss in noisy environment
  • sensorineural

Otosclerosis

  • young adult
  • conductive
  • hearing loss in quiet environment
  • (+) family history
57
Q

Hoarseness of voice + HISTORY of smoking

A

Always suspect Laryngeal Cancer

58
Q

Gold standard for the diagnosis of obstructive sleep apnea

A

Polysomnography

59
Q

Initial diagnostic test for OSA

A

Pulse oximetry, overnight study of breathing pattern

60
Q

Conservative treatment of OSA

A

Weight reduction

Or decrease alcohol intake

61
Q

1st line treatment for moderate to severe OSA

A

CPAP

62
Q

How do you manage tonsillectomy complications?

A

Within the first 24 hours after tonsillectomy, if patient presents with bleeding, patient must be returned back to OR theatre as the following may possibilities may have occurred: displaced tie, inadequate hemostasis and loss of eschar.

From Days 2-10, if patient presents with bleeding after tonsillectomy, patient must be admitted and given IV antibiotics.

63
Q

Hoarseness of the voice + smoker + white patch leukoplakia in the vocal cords

A

MSD of the larynx (mild squamous dysplasia)

Mgt: Stop smoking

REMEMBER!!! Hoarseness in a smoker, you have to rule out laryngeal cancer. Mild squamous dysplasia of the larynx presents with hoarseness of the voice with accompanying white patch leukoplakia in the vocal cords with a patient with a significant history of smoking.

64
Q

When should DVLA be informed regarding your patient with OSA?

A

If patient is diagnosed with moderate to severe OSA.

If patient is diagnosed with mild OSA, however, patient still has excessive sleepiness after 3 months.

65
Q

Involvement of the mandible of a squamous cell cancer of the tonsils would present as

A

TRISMUS

66
Q

Squamous cell cancer of the tonsils with metastasis to the mandible would result in:

A

Mandible

67
Q

Spherical white mass on otoscopy behind an intact membrane + hearing loss + purulent discharge + 30’s to 40’s

A

Acquired cholesteatoma

PLABABLE 2.0 (33 decks)

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