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FLASH FINALS > ENT > Flashcards

ENT Flashcards

1
Q

AOM organisms

A

Strep pneumoniae, H. influenzae, Moraxella catarrhalis

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2
Q

AOM treatment:

A

Self limiting:

If antibiotics given: Amoxicillin 5-7 days

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3
Q

AOM indications for antibiotics:

A

Symptoms longer than 4 days not improving
Systemically unwell
immunocompromised
Younger than 2 years w/ B/L otitis media
perforation

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4
Q

Acute sinusitis organisms

A

Strep pneumoniae, H. influenzae, Rhinovirus

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5
Q

Acute sinusitis treatment:

A 
Intranasal corticosteroids (>10 days symptoms) 
If antibiotics required (not routine):

Phenoxymethylpenicillin first line/ Co-amoxiclav if systemically unwell

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6
Q

Tonsilitis organism

A

Streptococcus pyogenes

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7
Q

Allergic rhinitis management:

A

mild to moderate symptoms = oral/intranasal antihistamines

severe symptoms or initial tx. ineffective: Intranasal corticosteroids

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8
Q

Audiogram below what dB is normal

A

20 dB

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9
Q

Black hairy tongue:
Predisposing factors:
Mx:

A

Defective desquamation of the filiform papillae -> not necessarily black in colour.
Poor oral hygiene, ABs, HIV, IVDU

Tongue scraping - topical anti fungal if candida

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10
Q

Branchial cysts contents:

A

A cellular fluid with cholesterol crystals encapsulated by stratified squamous epithelium

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11
Q

Branchial cysts location:

A

Lateral lump located anterior to SCM

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12
Q

Cholesteatoma neural tube defect association:

A

Cleft palate (100 fold increase)

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13
Q

Cholesteatoma appearance on otoscopy

Mx:

A

Attic crust

ENT referral for surgical removal

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14
Q

Chronic rhinosinusitis red flag symptoms:

A

Unilateral symptoms
Persistent symptoms despite 3 months of treatment
Epistaxis

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15
Q

Chronic sinusitis tx.

A

Intranasal steroids

Nasal irrigation with saline solution

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16
Q

Contraindications to Cochlear implant:

A

lesions of CN VII or brain stem causing deafness
Chronic infective otitis media
Cochlear aplasia

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17
Q

Most common causes of hearing loss:

A

Ear wax, otitis media and otitis externa

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18
Q

Drugs causing ototoxicity:

A

Gentamicin, Aspirin, furosemide, cytotoxic agents

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19
Q

Ear wax treatment:

A

Olive oil drops
Sodium bicarbonate
almond oil

Tx. should not be given in perforation or if the patient has grommets

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20
Q

Kiesselbachs plexus: anterior or posterior

A

Anterior

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21
Q

If epistaxis persists despite 10-15 minutes of continuous pressure:

A

Cautery 1st

packing may be used if cautery not viable or bleed cannot be visualised

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22
Q

Epistaxis that has failed all emergency management:

A

Sphenopalatine artery ligation in theatre

if that fails: ligation of external carotid

if that fails Embolisation

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23
Q

Drug causes of gingival hyperplasia:

Other cause of gingival hyperplasia:

A

Phenytoin
Ciclosporin
Calcium channel blockers (Nifedipine ++)

Acute myeloid leukaemia

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24
Q

Acute necrotising ulcerative gingivitis treatment:

A

Oral metronidazole for 3 days

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25
Q

Commonest cause of conductive hearing loss and elective surgery in childhood:

A

Glue ear (otitis media with effusion)

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26
Q

Otitis media with effusion (glue ear) treatment:

A

Grommet insertion - majority stop functioning at about 8 months.
Adenoidectomy

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27
Q

Voice hoarseness important investigation:

A

Chest X-ray (exclude apical lung lesions)

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28
Q

What is laryngopharyngeal reflux:

A

Condition caused by GORD resulting in inflammatory changes to the larynx mucosa.

Lump in throat (globus) with hoarseness or chronic cough

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29
Q

Laryngopharyngeal reflux treatment:

A

Lifestyle + PPI

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30
Q

Ludwigs angina management:

A

EMERGENCY
Airway management
IV antibiotics

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31
Q

Malignant otitis externa uncommon but most commonly found in:

A

DIABETICS (immunocompromised individuals)

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32
Q

Malignant otitis externa organism

A

Pseudomonas Aeruginosa

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33
Q

Malignant otitis externa Ix. and Tx.

A

CT scan
Urgent referral ENT
IV ABs that cover pseudomonas infections

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34
Q

Type of hearing loss in Menieres disease;

A

Sensorineural

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35
Q

Menieres disease tx. :

A

ENT referral
pt. to inform DVLA
Acute attacks - Buccal or IM prochlorperazine.
Prevention: Betahistine and vestibular rehab

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36
Q

Nasal polyps: what prompts further investigation -

A

Unilateral symtoms

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37
Q

Nasal polyps treatment:

A

Referral to ENT for full assessment

Topical corticosteroids to shrink polyp size

38
Q

Imaging for nasopharyngeal carcinoma

A

Combined CT and MRI

39
Q

Treatment for nasopharyngeal carcinoma

A

Radiotherapy is first line

40
Q

Nasopharyngeal carcinoma potential cranial nerve palsies:

A

CN III-VI

41
Q

Rubbery painless lymphadenopathy, pain drinking alcohol, night sweats and splenomegaly:

A

Lymphoma

42
Q

Midline mass, between isthmus of the thyroid and hyoid bone, moves upwards with protrusion of the tongue:

A

Thyrogloassal cyst

43
Q

Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles. Midline lump which gurgles on palpation. Dyshpagia, regurgitation, aspiration and chronic cough:

A

Pharyngeal pouch

44
Q

congenital lymphatic lesion found on the LEFT side of the neck classically. Most evident at birth:

A

Cystic Hygroma

45
Q

Oval mobile cystic mass that develops between the SCM and pharynx. Usually present in early adulthood.

A

Branchial cyst

46
Q

Neck lump assoc. with thoracic outlet syndrome

A

Cervical rib

47
Q

Initial management of Otitis externa

A

topical antibiotic (acetic acid) or combined topical antibiotic and steroid (Otomize - Dex, neomycin, acetic acid)

48
Q

Otitis externa second line options:

A

Consider contact dermatitis secondary to neomycin
Oral antibiotics (Flucoxacillin) if spreading.
Swab inside ear canal
Antifungal agent

49
Q

Otosclerosis management:

A

Hearing aid

Stapedectomy

50
Q

Most common gland for salivary gland tumours

A

Parotid (80%) w/ 80% benign

51
Q

Most common parotid neoplasm:

A

Benign pleomorphic adenoma (benign mixed tumour)

52
Q

Second most common benign parotid neoplasm which is also the most common BILATERAL benign neoplasm. occurs in later life (6th/7th decade). Rare malignant transformation

A

Warthins tumour (papillary cystoadenoma lymphoma)

53
Q

Parotid gland tumour which should be considered in the differential of a parotid mass in a child.
Accounts for 90% of parotid tumours in children <1 year of age.
Hypervascular on imaging

A

Haemangioma

54
Q

30% of MALIGNANT parotid tumours - most common in world

A

Mucoepidermoid carcinoma

55
Q

Most common parotid cancer in UK - assoc. with unpredictable growth pattern, perineurial spread

A

Adenoid cystic carcinoma

56
Q

Diagnostic evaluation of parotid tumours:

A

FNAC most cases
Sialography can delineate ductal anatomy
X-ray useful to exclude calculi
Superficial parotidectomy may be either diagnostic or therapeutic
Where malignancy is suspected approach should be definitive resection rather than excisional biopsy

57
Q

Sjogrens syndrome at increased risk of which neck lump

A

Lymphoma

58
Q

Treatment of perforated tympanic membrane:

A

NO treatment needed in a majority of cases as should heal on own within 6-8 weeks.
Common for ABs to prescribed in perforations following AOM
Myringoplasty if the membrane fails to repair itself

59
Q

Quinsy (peritonsilar abscess) treatment:

A

Urgent review from ENT.
Needle aspiration or incision and drainage with IV antibiotics
Tonsillectomy considered to prevent recurrence

60
Q

Post operative pain after tonsillectomy:

Haemorrhage post tonsillectomy

A

May increase for 6 days.

Haemorrhage must be reviewed by ENT urgently

61
Q

Primary haemorrhage post tonsillectomy (6-8 hours) treatment:

A

Immediate return to theatre

62
Q

Secondary haemorrhage post-tonsillectomy (5-10 days) treatment:

A

Often assoc with wound infection:

admission and antibiotics

63
Q

Ramsay Hunt syndrome cranial nerve affected

treatment:

A

CNVII

Oral Aciclovir and corticosteroids usually given

64
Q

Rinne’s test:

If bone conduction greater than air conduction

A

Conductive hearing problem

65
Q

Weber’s test: In unilateral SN hearing loss:

A

Sound is louder on the UNAFFECTED side

66
Q

Weber’s test: In unilateral conductive hearing loss:

A

Sound is louder on the AFFECTED side (SN adaptation?)

67
Q

Conductive hearing loss Rinne’s and Weber’s:

A

BC > AC in affected ear

sound lateralised to the AFFECTED EAR

68
Q

SN hearing loss Rinne’s and Weber’s:

A

AC > BC

Sound lateralises to UNAFFECTED ear

69
Q

Most common salivary glands for stones:

A

Submandibular

70
Q

Salivary gland stones px.

If infected

A

Recurrent unilateral pain and swelling on eating

Ludwig’s Angina

71
Q

Indications for antibiotics in sore throat:

A 
Systemic upset 
Unilateral peritonsilitis 
History of rheumatic fever
Increased risk from acute infection
3 or MORE CENTOR criteria
72
Q

CENTOR criteria

A 
Max score (4)
tender cervical lymphadenopathy or lymphadenitis
Absence of cough
peritonsilar exudate 
Fever

Must have score greater than 3 to prescribe antibiotics

73
Q

If antibiotics indicated in sore throat: what are you giving?

A

Phenoxymethylpenicillin (7 - 10 day course) or Clarithromycin (if pen. allergic)

74
Q

Sialadenitis infective organism

A

Staph aureus

75
Q

Salivary stones usual components:

A

Calcium phosphate or calcium carbonate

76
Q

Complications of thyroid surgery:

A

Anatomical - recurrent laryngeal nerve damage
Bleeding - can lead to rapid airway compromise
Damage to parathyroid glands resulting in HYPOcalcaemia

77
Q

Which conditions cause tinnitus

A 
Menieres 
Otosclerosis 
SSNHL (acoustic neuroma in 80%) 
Presbycusis 
Drugs (NSAIDs, aminoglycosides, loop diuretics, quinine) 
Impacted ear wax
78
Q

Assessment in tinitus

A

Audiological assessment
Imaging: MRI IAM
pulsatile tinnitus requires imagine as their may be an underlying vascular cause.

79
Q

Sudden-onset sensorineural hearing loss:
Referral?
imaging?
Treatment?

A

Urgent referral to ENT
MRI (exclude vestibular schwannoma)
High dose oral corticosteroids for all cases of SSNHL

80
Q

Complications of tonsillitis

A

Otitis media
Quinsy
Rheumatic fever and glomerulonephritis

81
Q

Indications for tonsillectomy:

A

Five or more episodes of sore throat that year
Sore throats are actually caused by tonsillitis
symptoms occurring for at least a year
disabling symptoms obstructing normal functioning

Other indications: recurrent febrile convulsions, secondary to episodes of tonsillitis
obstructive sleep apnoea, stridor or dysphagia

82
Q

Vertigo caused by recent viral infection:
Hearing may be affected, N&V:

Recurrent vertigo lasting hours or days, less likely to have hearing loss:

A

VIRAL labyrinthitis

Vestibular neuronitis

83
Q

Elderly patient, with dizziness on extension of the neck:

A

Vertebrobasilar ischaemia

84
Q

Loss of CORNEAL reflex
Hearing loss vertigo, tinnitus
assoc w/ NF2

A

Acoustic neuroma

85
Q

Vestibular neuritis treatment:

A

Buccal or IM prochlorperazine
short course of ORAL prochlorperazine in severe cases
vestibular rehabilitation in patients w/ chronic symptoms.

86
Q

May present as a painless lymphadenopathy because of its tendency for early spread: biopsy confirming SCC in lymph nodes:

A

Nasopharyngeal carcinoma

87
Q

Vasomotor sinusitis treatment:

A

Inhaled ipratropium

88
Q

CSF rhinorrhoea contents:

A

Positive glucose

Positive B2 Tau transferrin

89
Q

Unilateral otitis media may be the first symptom of which cancer:

A

Nasopharyngeal carcinoma

90
Q

How should non-resolving otitis externa be managed:

A

w/ urgent referral to ENT

FLASH FINALS (34 decks)

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