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MSRA 2022 > ENT > Flashcards

ENT Flashcards

1
Q

What is malignant otitis externa and who is at increased risk?

A

Spread of infection to become osteomyeltitis of the temporal bone. ^ risk in elderly, diabetics.
Needs urgent referral to ENT if suspect (ie if several episodes of otitis externa resistant to topical treatment) for CT Temporal bone and IV abx

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2
Q

What is the typical presentation of otitis externa?

A

Otalgia, itchy ear canal, discharge.

O/E: red swollen ear canal

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3
Q

What is the 1st line treatment for otitis externa?

A

TOPICAL abx or TOPICAL abx + steroids.

Avoid aminoglycosides if TM perforation as risk of ototoxicity

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4
Q

What are the absolute indications for tonsillectomy (SIGN criteria)

A

Recurrent infections (7 episodes/year, 5 episodes/year for 2 years, 3 episodes/year for 3 years, 2 works or more missed school/work per year)
Peritonsillar abscess (in child tonsillectomy 4-6 wks after the 1st episode, in adults after the 2nd episode of peritonsillar abscess)
Tonsillitis causing febrile seizures
Hypertrophy of tonsils causing airway obstruction (inc obstructive sleep apnoea), difficulty in swallowing, difficulty with speech
Suspicion of malignancy if unilaterally enlarged tonsil (lymphoma in children, epidermoid carcinoma in adults)

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5
Q

What is the classical presentation of a pharyngeal pouch

A

Pharyngeal pouch = Zenker’s diverticulum = almost like a hernia of pharyngx through Kilian’s dehiscence (weak patch of posterior pharyngeal wall)
Risk factors = older age, MALES
Presentation = dysphagia, regurgitation, hallitosis, neck swelling that gurgles when palpated, aspiration

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6
Q

When should you refer a mouth ulcer to oral surgery?

A

Any mouth ulcer that has lasted > 3 weeks should be urgently referred to an oral surgeon for assessment within 2 weeks.

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7
Q

What is Webers and Rinnes and how to interpret them?

A

To distinguish and localise sensorineural v conductive hearing loss

Webers = place tuning fork on forehead:

  • Normal = sound heard in the centre
  • Conductive hearing loss = sound heard loudest in the BAD EAR (because it can conduct through the bone!)
  • Sensorineural hearing loss = sound heard loudest in the GOOD ear

Rinnes = place tuning fork in front of and then behind the ear
Normal = Air conduction > bone conduction
Conductive hearing loss = bone conduction > air conduction
Snesorineural hearing loss = Air conduction > bone conduction

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8
Q

What is the typical presentation of a thyroglossal cyst?

A

Midline non-painful neck lump that moves up on tongue protrusion!

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9
Q

What is the typical presentation of leukoplakia?

A

White thickenings /plaques on the oral mucosa that CANNOT BE SCRAPED OFF (differentiates it from candidiasis)
= a premalignancy so should be biopsied.

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10
Q

What is the typical presentation of a branchial cyst?

A

slowly enlarging mass anterior to sternocleidomastoid.

DOES NOT move with swallowing / tongue protrusion (helps to differentiate from thyroglossal cyst)

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11
Q

How should all patients presenting with unilateral sensorineural hearing loss be investigated, regardless of if no accompanying symptoms?

A

MRI of the internal auditory meatus to exclude acoustic neuroma

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12
Q

What is the typical presentation of otosclerosis?

A

Autosomal dominant, so has a family history component
Progressive conductive hearing loss due to ^ bone turnover in the inner ear leading to sclerosis.
No Tx -> bilateral hearing aids

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13
Q

What is a myringoplasty?

A

Surgery to repair tympanic membrane perforation

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14
Q

What is the window after a broken nose to remanipulate under anaesthetic

A

14 days to manipulate under anaesthetic -> should be seen in ENT ~ day 7 once the swelling has gone down to see if manipulation is appropriate.

After day 14, rhinoplasty is needed

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15
Q

1st line antibiotic for acute otitis media?

A

Amoxicillin

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16
Q

What is the 1st line investigation for FUNCTIONAL assessment of solitary nodules?

A

Radioisotope scanning

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17
Q

What is the typical presentation of BPPV?

A

SUDDEN onset and short-lasting rotatory vertigo associated with certain head positioning.
IF THERE IS HEARING LOSS ASSOCIATED, IT IS NOT BPPV!!
Due to crystals in the semi-circular canal

Dx = Dix-Halpike maneuvre (recreates the symptoms) 
Tx = Epley maneuvre
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18
Q

What is the typical presentation of Meniere’s disease?

A

On/off attacks of vertigo lasting several hours + aural fullness + vomiting + hearing loss.

Tx = betahistine to reduce freq of attacks
and prochlorperazine or cyclizine for symptom control during the acute attacks

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19
Q

What is the typical presentation of larnygomalacia?

A

Low pitched stridor in the infant worse during sleeping, feeding, excitement or concurrent URTI.
Floppy laryngeal folds, normally self-resolves by age 2

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20
Q

Polyps v turbinates?

A

Polyps are smooth and painless!

Turbinates are red and painful!

21
Q

Typical presentation of cholesteatoma?

A

Congenital cholesteatoma = chronic purulent discharge from the ear in children that doesn’t respond to abx -> because the discharge is due to the breakdown of the bone not infection!

Acquired cholesteatoma = due to trauma to the TM ie a few decades after having grommets, repeated infections etc

Both can present with facial nerve injury to local invasion!

22
Q

typical presentation of presbyacusis?

A

age-related sensorineural hearing loss
= the MOST COMMON cause of sensorineural hearing loss
= BILATERAL, HIGH FREQ IS LOST FIRST.

23
Q

typical presentation of noise-induced hearing loss?

A

may be unilateral or bilateral

tends to be on SPECIFIC frequency

24
Q

typical presentation of Reinke’s oedema?

A

bilateral build up of fluid next to the vocal cord
seen in either longstanding reflux or singers
Dx = direct visualisation

25
Q

Indications for ENT referral in Bell’s palsy?

A
  • Bilateral Bells
  • Recurrent Bells
  • NO improvement after 1 month
  • Unclear diagnosis

(refer to ophthalmology if can’t close eye and cornea exposed)

26
Q

What is the typical presentation of otosclerosis?

A

unilateral / bilateral gradual conductive hearing loss due to fusion of the stapes to the oval window.
mainly womenmenopause, pregnancy or menstruation can precipitate it. strong fam hx
O/E conductive hearing loss, normal TM or Schwartz sign (pink tinged TM)
Tx = stapectomy

27
Q

Differentiating dizziness?

A

VESTIBULAR / PERIPHERAL
Attacks lasting secs-mins - BBPV or cervical vertigo
Attacks lasting hours -> Menieres disease (hearing loss + tinnitus + aural fullness + spontaneous nystagmus -> likely 2ndary to excessive endolymph in the vestibular apparatus, gradual deterioration in hearing with each attack -> Tx -> symptom control during the attack = prochlorperazine or cyclizine. prevention to reduce freq of attacks = betahistine )
Attacks lasting days -> labyrinthitis (associated hearing loss) or vestibulitis (viral infection, no associated hearing loss, self-resolves)

CENTRAL VERTIGO (all get a SUSTAINED, NON-POSITIONAL VERTIGO) 
Posterior circulation stroke (SUDDEN onset vertigo +/- ataxia, diplopia, other CN defects) 
Tumour (gradual onset vertigo + evidence of ^ ICP)
Multiple sclerosis (relapsing + remitting vertigo) 
Vestibular migraine (last minutes to hours with visual aura + headache)
28
Q

Causative organism behind epiglottitis (if child unvaccinated)?

A

HIB (haemophilus influenza type B)

29
Q

Carcinoma of the oesophagus pattern?

A

upper 2/3rds = squamous

lower 1/3 - adenocarcinoma (progression from barretts)

30
Q

typical cause and presentation of rhinoscleroma?

A

Klebsiella

chronic enlarging nose due to chronic infection -> more common in african origins

31
Q

What is the 1st line management of a quinsy?

A

either incision and drainage OR aspiration with a hypodermic needle

32
Q

Bipap v CIPAP ?

A 
CPAP = continuous positive pressure -> used in obstructive sleep apnoea 
BiPap = 2 levels of pressure (1x on inspiration, 1x on expiration) to help ventilate -> used in COPD exacerbations
33
Q

the borders of the anterior triangle of the neck?

A

medial border of SCM, inferior border of the mandible, the midline

34
Q

the borders of the posterior triangle of the neck?

A

posterior border of SCM, anterior border of trapezius and the middle third of the clavicle

35
Q

typical presentation of a POSTERIOR epistaxis?

A

less common but more serious
often bilateral, can see blood running down into throat
Mx - may need balloon tamponade

36
Q

Mx of suspected nasal fracture?

A

If boggy assymetrical septum -> suspect septal haematoma - needs immediate drainage to avoid septal necrosis
then review after 7 days to consider MUA.

After 14 days = too late for MUA, need rhinoplasty

37
Q

typical presentation of Frey’s syndrome ?

A

post-parotid gland surgery

parasympthetic fibres re-wire wrong -> sweat from your face rather than salivate

38
Q

Exposure to what decibel of sounds leads to noise associated hearing loss?

A

prolonged exposure to 85 decibels or above

39
Q

typical presentation of mastoiditis ?

A

tender boggy swelling posterior to the pinna
often a complication of untreated otitis media
Tx -> IV abx

40
Q

how should you test hearing in a neonate?

A

otoacoustic emissions (put a little microphone in their external meatus)

41
Q

presentation of vocal cord nodule v vocal cord granuloma

A

both present with hoarse voice but if there is a pain as well this is suggestive of granuloma

42
Q

which drugs are associated with auditory symptoms?

A

Quinine + aspirin -> tinnitus

Gentamicin + Frusemide -> hearing loss

43
Q

What treatments are effective for Guillain-Barre?

A

IV immunoglobulin or plasma exchange

44
Q

When would nasal congestion in an adult warrant an urgent ENT referral?

A 
Unilateral obstructing mass 
Numbness 
Bleeding 
Associated tooth loss 
Suspected tumour
45
Q

Red flags for a neck lump in an adult?

A
  • Hard / fixed lump
  • Associated dysphonia / dysphagia / stridor or ear pain
  • Associated systemic features
  • Epistaxis
  • Unilateral nasal congestion
  • Cranial nerve palsies
46
Q

Red flags for a neck lump in a child?

A
  • Supraclavicular mass
  • > 2cm
  • prev hx of malignancy
47
Q

Neck lump differentials?

A

INFECTIVE -> reactive lymphadenopathy, sialedenitis (salivary gland infection)
NEOPLASTIC -> lymphoma, mets, skin lesion, carotid body tumour / carotid paraganglioma (painless, pulsatile neck lump with bruit)
CONGENITAL ->
* cystic hydroma / cystic lymphangioma -> presents <2yrs -> benign fluid-filled sac in axilla or posterior triangle that transilluminates
* branchial cyst -> unilateral mass anterior to SCM that does not move on tongue protrusion
* thyroglossal cyst -> painless midline mass that elevates on protrusion of the tongue
THYROID GOITRE

48
Q

Investigating a neck lump?

A

1st line = USS + FNA

UNLESS suspect a lymphoma in which case an open biopsy or core biopsy is preferred to FNA

MSRA 2022 (23 decks)

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