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FINALS: PASSMED/QUESMED > ENT > Flashcards

ENT Flashcards

1
Q

When should prochlorperazine be used in vestibular neuronitis?

A

In the acute phases only as it can delay recovery if used long term

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2
Q

What can be used to distinguish vestibular neuronitis from a posterior circulation stroke?

A

HiNTs exam - head impulse test, test of skew and assessing nystagmus

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3
Q

What are the red flags of chronic rhinosinusitis?

A

unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis

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4
Q

Vestibular neuronitis vs acute labyrinthitis?

A

Hearing will not be affected in VN

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5
Q

Ear swelling/rash behind the ear in someone with ?otitis media

A

Same day referral to Paeds ?Mastoiditis

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6
Q

Horizontal nystagmus is a sign of what?

A

Vestibular neuronitis

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7
Q

How should a perforated ear drum be managed?

A

Refer to ENT if persists beyond 6 weeks

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8
Q

What is a C/I to prescribing naseptin cream?

A

peanut, soy or neomycin allergies

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9
Q

conductive hearing loss, tinnitus and positive family history

A

Otosclerosis

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10
Q

bilateral high-frequency hearing loss suggests what?

A

Prebycusis

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11
Q

What are the 2 common post op complications of tonsillectomy?

A
  • Pain
  • Haemorrhage
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12
Q

How does haemorrhage present following tonsillectomy?

A

Primary: Within 6-8 hours following surgery -> needs immediate return to theatre
Secondary: 5-10 days after surgery usually associated with wound infection -> treated with admission/abx

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13
Q

When should intranasal steroids be considered for sinusitis?

A

If symptoms have been present for 10 days or more

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14
Q

What is the management of acute sensorineural hearing loss?

A

Urgent referral to ENT for audiology and brain MRI

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15
Q

What is Ludwigs angina?

A

A progressive cellulitis which invades floor of the mouth and soft tissues of the neck usually following dental infection

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16
Q

How does Ludwigs angina present?

A
  • Neck swelling
  • Dysphagia
  • Fever
  • Needs immediate referral to hospital for airway management and IV Abx
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17
Q

Management of post op stridor for thyroidectomy?

A

Urgent removal of sutures and call for senior help

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18
Q

What does post thyroidectomy stridor suggest?

A

Post op bleed which build pressure behind suture line and compresses trachea causing stridor

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19
Q

What are the NICE indications for tonsillectomy?

A
  • Sore throats due to tonsillitis
  • 5 or more episodes per year
  • Symptoms occurring for atleast 1 year
  • Episodes of sore throat are preventing normal function
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20
Q

What is the most common cause of bacterial otitis media?

A

H influenzae

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21
Q

What does pain on palpation of the tragus, itching, discharge and hearing loss suggest?

A

Otitis externa

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22
Q

What is the management of a patient with persistent hoarse voice?

A

Refer to ENT

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23
Q

What causes gingival hyperplasia?

A

phenytoin, ciclosporin, calcium channel blockers and AML

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24
Q

When should Abx be given for acute otitis media?

A
  • Symptoms lasting more than 4 days or not improving
  • Systemically unwell but not requiring admission
  • Immunocompromise or high risk of complications
  • Younger than 2 years with bilateral otitis media
  • Otitis media with perforation and/or discharge in the canal
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25
Q

Which drugs cause tinnitus?

A
  • Aspirin/NSAIDs
  • Aminoglycosides e.g gentamicin
  • Loop diuretics
  • Quinine
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26
Q

What is the most important part of the tympanic membrane to visualise in patients with chronic discharge?

A

Attic - rule of cholesteatoma

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27
Q

After referral to ENT, patients with sudden onset sensorineural loss should be given what?

A

high-dose oral corticosteroids

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28
Q

What is an indication of positive Dix-Hallpike?

A

Rotatory nystagmus

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29
Q

What can be used to shrink nasal polyps?

A

Intranasal steroid spray/drops

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30
Q

What is the biggest risk factor for malignant otitis externa?

A

Diabetes Mellitus

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31
Q

What is the most common cause of sudden onset sensorineural hearing loss?

A

Idiopathic

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32
Q

What is a complication of nasal trauma?

A

Nasal septal haematoma

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33
Q

What is a nasal septal haematoma?

A
  • Bilateral red swelling arising from the nasal septum
  • Needs ENT referral for surgical drainage and IV Abx
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34
Q

What are signs of more severe otitis externa?

A
  • a red, oedematous ear canal which is narrowed and obscured by debris
  • conductive hearing loss
  • discharge
  • regional lymphadenopathy
  • cellulitis spreading beyond the ear
  • fever
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35
Q

How should otitis externa be managed?

A

Topical Abx or Abx + Steroids

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36
Q

How to interpret audiograms?

A
  1. is there anything below 20dB
    yes = move to step 2
    no = normal hearing
  2. is there a gap? (b/w air and bone conduction)
    yes = conductive or mixed hearing loss
    no = sensorineural hearing loss
  3. is one below or both below the 20dB line
    one = conductive
    both = mixed
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37
Q

What would be the results of audiometric testing for presbycusis?

A

Bilateral high-frequency hearing loss with air conduction better than bone

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38
Q

Patient with black/brown/green tongue?

A
  • Think black hairy tongue
  • More common in those with poor hygiene/IV drug users/HIV
  • Treated with tongue scraping/antifungals if candida
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39
Q

What can occur after trauma to the ear?

A

Auricular haemtoma - needs same day assessment by ENT for drainage

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40
Q

What is the first line oral abx for otitis externa?

A

Oral Flucloxacillin

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41
Q

What is the management of otitis externa in diabetics?

A

Ciprofloxacin ear drops to cover for Pseudomonas

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42
Q

Elderly patient dizzy on extending neck/moving head up?

A

Vertebrobasilar ischaemia

43
Q

Managament of Children presenting with glue ear with a background of Down’s syndrome or cleft palate

A

Refer to ENT

44
Q

Epistaxsis management?

A
  1. Direct compression
  2. Nasal cautery
  3. Nasal packing
  4. Aggressive therapies such as balloon catheter
45
Q

Why do FBC when someone has epistaxis?

A
  • Assess HB
  • Assess platelet count
46
Q

What is the term for pain upon swallowing?

A

Odynophagia

47
Q

What is the name of the lymph node commonly enlarged in tonsillitis?

A

Jugulodigastric lymph node

48
Q

What does difficulty swallowing solids suggests vs solids and liquids?

A

Solids - stricture issue (benign or malignant)
Both - motility issue

49
Q

Management of oesophageal carcinoma

A
  • Surgery
  • Chemoradiotherapy
50
Q

Recurrent otitis externa despite antibiotic treatment?

A

Candida

51
Q

Unilateral symptoms in someone with chronic rhinosinusitis?

A

Urgent referral to ENT

52
Q

dysphagia, regurgitation, halitosis, and a bulging neck on swallowing

A

Pharyngeal pouch

53
Q

Branches of the facial nerve

A

Two Zebras Bite My Cake
Temporal
Zygomatic
Buccal
Mandibular
Cervical

54
Q

What are long term impacts of Bells?

A
  • Damage to eye
  • Inability to close eye
  • Altered taste
  • Psychological impacts
55
Q

What is vertigo?

A

The illusion of movement

56
Q

Pathophysiology of BPPV

A

Debris in the semi circular canals which are disrupt movement of endolymph

57
Q

How do childrens and adult eustachian tubes differ?

A

Childrens is shorter, narrower and more horizontal

58
Q

What are the 4 paranasal sinuses?

A

Ethmoid, Frontal, Maxillary, Sphenoid

59
Q

What are risk factors for head and neck cancers?

A
  • Smoking
  • HPV 16
  • EBV
  • Immunosuppression
  • FH
60
Q

Loss of corneal reflex

A

Acoustic neuroma

61
Q

Unilateral glue ear in an adult

A

Refer to ENT to rule out posterior nasal space tumour

62
Q

Prophylaxis of sinusitis?

A

Intranasal corticosteroids

63
Q

What does ulnar deviation in someone with tonsillitis suggest?

A

Peritonsilar abscess- Quinsy

64
Q

Atypical lymphocytes on blood film are suggestive of what?

A

Infective mono

65
Q

palatal petechiae + cervical lymphadenopathy are suggestive of what?

A

Glandular fever

66
Q

What can deranged LFTs with sore throat be indicative of>

A

Infective mononucleosis

67
Q

What anaemia can infective mono cause?

A

Cold Haemolytic anaemia - IgM

68
Q

OSA can cause what?

A

HTN

69
Q

What are risk factors for OSA?

A
  • Obesity
  • Macroglossia (acromegaly, hypothyroidism)
  • Large tonsils
  • Marfans
70
Q

What acid base problem can OSA cause?

A

Compensated respiratory acidosis

71
Q

Epistaxis which fails all management may require ligation of what?

A

Sphenopalatine ligation

72
Q

What are signs of quinsy?

A
  • Deviation of uvula to unaffected side
  • Trismus
  • Reduced neck mobility
  • Bulging of the soft palate
73
Q

Which organism cause quinsy?

A

Strep pyogenes

74
Q

Management options for nasal fractures?

A
  • See in clinic in a week to allow swelling to subside
  • Manipulate under anaesthetic
75
Q

Discharge from nose which tests positive for beta-2 transferrin?

A

CSF

76
Q

Why should haematomas be aspirated as soon as possible?

A

Risk of avascular necrosis

77
Q

What is a cholesteatoma?

A

Overgrowth of keratinised squamous epithelium in the middle ear

78
Q

What can suggest cholesteatoma on otoscopy?

A
  • Discharge
  • Attic crust
  • Retracted/Perforated tympanic membrane
79
Q

What are complications of cholesteatoma?

A
  • Facial nerve palsy
  • Meningitis
  • Abscess
  • Deafness
  • Recurence
80
Q

What are signs of thyroglossal cyst?

A
  • Moves up when protruding tongue
  • Mobile
  • Non tender
81
Q

What causes trismus in quinsy?

A

Pus causes the pterygoid muscles to go into spasm which prevents a patient from opening their mouth

82
Q

Post tonsillectomy haemorrhage?

A

Refer for same day ENT assessment even if bleeding has resolved

83
Q

Hearing impairment post head trauma?

A

Perforated tympanic membrane

84
Q

What is the name for a malignant tumour of the parotid gland?

A

Adenoid cystic carcinoma

85
Q

Most common bacteria which cause otitis externa?

A
  • Staph aureus
  • Pseudomonas
86
Q

What can be exacerbated in pregnancy?

A

Otosclerosis

87
Q

Pink tinge to tympanic membrane?

A

Schwarze sign -> otosclerosis

88
Q

What can be a S/E of removal of mastoid abscess?

A

Unilateral facial weakness -> facial nerve runs close to the mastoid

89
Q

Which sinus is most commonly involved in chronic sinusitis when mucus drains out upon leaning forward?

A

Maxillary

90
Q

Which virus is associated with squamous cell carcinoma of the oropharynx?

A

HPV

91
Q

What is the pathophysiology of Menieres?

A

Excessive build up of endolymph in inner ear which increases pressure and disrupts sensory signals -> sensorineural hearing loss

92
Q

What are symptoms of Ramsay-Hunt?

A
  • Vesicular rash
  • Facial weakness
  • Vertigo
  • Headaches
  • Fever
  • Tinnitus
93
Q

What is a complication of untreated tonsillitis?

A
  • Parapharyngeal abscess
  • Lemeirre’s syndrome: infective thrombophlebitis
94
Q

What is the most common tumour of parotid gland?

A

Pleomorphic adenoma -> benign

95
Q

Bilateral conductive hearing loss and tinnitus in young person?

A

Think otosclerosis

96
Q

Snoring in someone with chronic sinusitis?

A

Nasal polyps have formed -> nasal steroid drops needed

97
Q

Management of otosclerosis?

A
  • Hearing aids
  • Stapedectomy is gold standard
98
Q

Unilateral glue ear?

A

Red flag -> nasopharyngeal carcinoma

99
Q

Chinese person with history of EBV infection and one sided hearing loss?

A

Nasopharyngeal tumour

100
Q

p16 is a marker for what?

A

HPV -> squamous cell carcinoma of oropharynx

101
Q

What is temporo-mandibular joint dysfunction?

A

Pain in jaw with difficulty moving it as well as clicking/popping in the jaw when opening mouth

102
Q

What can trigger temporomandibular dysfunction?

A

Trauma to the jaw
Stress

103
Q

Management of TMD?

A

Resting, address triggers and ENT referral if severe

FINALS: PASSMED/QUESMED (22 decks)

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