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Clinical Medicine > ENT 👀 > Flashcards

ENT 👀 Flashcards

1
Q

signs of hereditary hemorrhagic telangiectasia

A

nose bleeds
and red freckles on lips, face, fingertips, tongue and inside surfaces of the mouth.

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2
Q

what is a Quinsy (peritonsillar abscess)

A

a complication that develops from untreated acute tonsillitis

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3
Q

on clinical examination of a patient with a peritonsillar abscess what would you see

A

uni-tonsillar bulge and uvula deviation.

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4
Q

sore throat
headache
pyrexia
lymphadenopathy

A

tonsilitis

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5
Q

do you order blood tests when investigating tonsillitis

A

only if they are immunodeficient

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6
Q

what is the Centor criteria for acute tonsillitis

A

history of fever
no cough
tonsillitis exudates
tender anterior cervical lymphadenopathy

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7
Q

how many centor criteria needs to be fulfilled and other criteria to be able to prescribe antibiotics for tonsillitis

A

3 or more centor criteria

other features include:
marked systemic upset
immunodeficiency
history of rheumatic fever

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8
Q

what is the most complication of tonsillitis

A

recurrent tonsiliitis

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9
Q

how does peritonsillar abscess present

A

presents with difficulty swallowing, sore throat, muffled voice and trismus

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10
Q

what is the first line antibiotic for bacterial tonsillitis

A

phenoxymethylpenicillin

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11
Q

describe acute otitis media

A

inflammation of the middle ear with effusion
occurs primarily in children
often associated with URTI

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12
Q

sx of acute otitis media

A

Neonates

Irritability
Difficulty feeding
Fever

Young children

Holding or tugging ear
Irritability
Fever

Older children and adults

Otalgia (ear pain)
Hearing loss
Fever

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13
Q

features of chronic otitis media - glue ear

A

persistent pain lasting weeks
drum looks abnormal and reduced mobility of membrane

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14
Q

features of chronic suppurative otitis media

A

perforation of the tympanic membrane with otorrhoea for > 6 weeks

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15
Q

when do you admit patients for otitis media

A

any children under 3 months with temp over 38

children with suspected acute complications

children who are very systemically unwell

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16
Q

mx of otitis media when admission or antibiotics are not needed

A

paracetamol or ibuprofen

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17
Q

when do you offer antibiotics for otitis media and what course do you offer

A

children who are systemically unwell but don’t require admission or those at high risk of complications

5-7 day course of amoxicillin

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18
Q

extra-cranial complications of otitis media

A

facial nerve paralysis
mastoiditis - most common

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19
Q

intra-cranial complications of otitis media

A

meningitis
sigmoid sinus thrombosis
intracranial brain abscess

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20
Q

how would mastoiditis present

A

as a boggy mass over the mastoid process tender to palpation
systemically unwell
intense ear pain

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21
Q

sx of labyrinthitis

A

vertigo
nausea
vomiting
imbalance

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22
Q

how does meningitis present

A

sepsis
headache
vomiting
photophobia
phonophobia

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23
Q

how does sigmoid sinus thrombosis present

A

sepsis
swinging pyrexia
meningitis

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24
Q

how would a brain abscess present

A

sepsis and neurological signs

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25
Q

characteristic features with allergic rhinitis

A

nasal pruritus, sneezing, rhinorrhoea and nasal congestion

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26
Q

what is allergic rhinitis often associated with

A

allergic conjunctivitis

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27
Q

what is allergic rhinitis

A

where your nose gets irritated by something you’re allergic to

28
Q

what type of hypersensitivity reaction is allergic rhinitis

A

type 1
it is an IgE mediated response to allergens

29
Q

mx of allergic rhinitis
initial measures

A

avoiding triggers
nasal irrigation with saline
intra-nasal or oral anti-histamines

30
Q

mx of allergic rhinitis if initial measures are ineffective

A

intra-nasal steroids
oral steroid for sever and/or short term cases

31
Q

why is BPPV predominately seen in elderly population

A

due to deposition of calcium deposits within the semicircular canals

32
Q

clinical features of BPPV

A

provoked by movements of head usually to one side when turning in bed or looking up

episodes last 30 seconds to 1 minute

no hearing loss or tinnitus

33
Q

how to diagnose BPPV

A

dix-hallpike manoeuvre

the test is positive if you observe new nystagmus after

34
Q

how to manage BPPV

A

epley manoeuvre

35
Q

what is cholesteatoma?

A

serious and rare complication of chronic otitis media and commonly occurs in younger patients

36
Q

what causes cholesteatoma?

A

caused by abnormal accumulation of skin, squamous epithelium within the middle ear cleft and mastoid air cells

37
Q

clinical features of cholesteatoma

A

presents foul smelling discharge, headache and otalgia
will present on examination of tympanic with an area of white in the attic behind the tympanic membrane

38
Q

what complications occur from cholesteatoma

A

facial nerve palsy and CNS complications

39
Q

what would you see with otoscopy on a patient with acute otitis media

A

red, yellow or cloudy tympanic membrane
bulging tympanic membrane
air-fluid level behind tympanic membrane

40
Q

what does a normal tympanic membrane look like

A

slight translucency with a colour sometimes described as pearly-grey

41
Q

describe otitis externa

A

inflammation of external auditory canal
can be categorised into acute <3weeks or chronic >3 months
aka swimmers ear

42
Q

risk factors for otitis externa

A

swimming
humid air
young age
diabetes
trauma

43
Q

symptoms of otitis externa

A

itch
tenderness
hearing loss
discharge

44
Q

treatment of otitis externa

A

analgesia and topical therapies - topical abx

45
Q

most common microbiological cause of otitis externa

A

pseudomonas aeruginosa
gram negative rod

46
Q

management of persistent glue ear

A

2-6 weeks of amoxicillin
grommet insertion if that fails, bilateral, and persistent

46
Q

management of persistent glue ear

A

2-6 weeks of amoxicillin
grommet insertion if that fails, bilateral, and persistent

47
Q

mx mastoiditis

A

admission for IV abx and monitoring

48
Q

Symptoms and signs of basal skull fracture

A

Head injury
Reduced consciousness
Battles sign = bruising of mastoid process
Raccoon eyes = bruising around eyes
Rhinorrhoea = CSF leaking from ear
Cranial nerve palsy
Bleeding from nose/ears
Haemotympanum - blood visible behind tympanic membrane

49
Q

Classically affects one at between 30-60
vertigo, tinnitus with fluctuating hearing loss
episodic nature

A

Classically affects one at
Between 30-60
Characterised by attacks of sudden paroxysmal vertigo with associated deafness and tinnitus
Normally occur in clusters with periods of remission

50
Q

Normal Webers test result

A

Patient can hear the sound equally in both ears

51
Q

If patient had sensorineural hearing loss what would their Webers test result be

A

Sound will be louder in the normal ear

52
Q

If patient had conductive hearing loss what would their Webers test result be

A

Sound will be louder in affected ear

53
Q

Normal rinnes test result (rinnes positive)

A

When patient can hear the sound again when the tuning fork is hovered over their ear (air conduction)
Air conduction should be better

54
Q

Abnormal rinnes test (rinnes negative)

A

When bone conduction is better than air conduction
So the sound is not heard after removing the tuning fork from the mastoid process
This suggest conductive hearing loss

55
Q

Clinical features of hereditary haemorrhagic telangiectasia

A

Characterised by telangiectasis on nasal mucosae, lips and gastrointestinal tract
Epistaxis
Anaemia sx
GI blood loss

56
Q

What is a thyroglossal cyst

A

Fluid filled sac located in the thyroglossal duct
Generally midline cysts and move on tongue protrusion and swallowing
Typically detected in early childhood

57
Q

What is a branchial cyst

A

Most common cause of neck lumps in children
Typically undetectable until the cyst swells in size commonly due to infection
Do not move on tongue protrusion nor auscultation or transilluminate

58
Q

What is the Pathophysiology of tympanosclerosis

A

Associated with long term otitis media and grommet insertion
Result of calcium phosphate plaques leaving white patches on the tympanic membrane

59
Q

What is otosclerosis

A

Most common cause of progressive deafness in young adults
Usually bilateral and causes conductive deafness (better with background noise)
Frequently associated with tinnitus

60
Q

A non healing mouth ulcer that is both painful and bleeding raises high suspicion of what

A

An oral cancer
Squamous cell carcinoma is the most common type

61
Q

causes of cervical lymphadenopathy

A

LIST
Lymphoma
Infection
Sarcoidosis
Tumours/Tuberculosis

62
Q

what is this presentation diagnostic of?
acute, spontaneous vertigo,
nausea and vomiting,
and unsteadiness all often following a viral infection

positive head impulse, unidirectional nystagmus and no abnormal test of skew

A

vestibular neuronitis

63
Q

management of vestibular neuronitis

A

prochlorperazine

64
Q

what foreign object needs emergency removal

A

button batteries

65
Q

when does a vestibular schwannoma become malignant and symptomatic

A

if they are 40mm+ in size and this requires surgery

Clinical Medicine (26 decks)

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