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ENT Flashcards

1
Q

Four main features of vestibular neuronitis

A
  1. Vertigo
  2. Nausea + vomiting
  3. Horizontal nystagmus
  4. NO hearing loss or tinnitus
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2
Q

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

A

HiNTs exam

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3
Q

Management of vestibular neuronitis (vertigo, N+V, nystagmus, NO hearing loss or tinnitus)

A
  1. Buccal or IM prochlorperazine
  2. Oral prochlorperazine or antihistamine for less severe cases for 1 week only then review
  3. Chronic symptoms for 6 weeks or more - vestibular rehabilitation exercises
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4
Q

Criteria for cochlear implant

A
  • Children - issues developing basic auditory skills
  • Adults - trialled hearing aids for at least 3 months with no improvement
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5
Q

Differences between allergic rhinitis:
(a) seasonal
(b) perennial
(c) occupational

A

(a) seasonal - same time each year
(b) perennial - throughout the year
(c) occupational - work place allergens

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6
Q

Management of allergic rhinitis

A
  1. Oral or intranasal anti-histamines if mild to moderate symptoms
  2. Intranasal corticosteroids if moderate to severe symptoms
  3. Short course of corticosteroids to cover important life events

Note short courses of topical nasal decongestants can lead to rebound symptoms if used for long time

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7
Q

3 red flags for sinusitis

A
  1. unilateral symptoms
  2. persistent symptoms despite compliance with 3 months of treatment
  3. epistaxis
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8
Q

More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected

what neck lump is this

A

thyroglossal cyst

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9
Q

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age

what neck lump is this

A

cystic hygroma

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10
Q

An oval, mobile cystic mass that develops between SCM muscle and pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
Can present after URTI

what neck lump is this

A

brachial cyst

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11
Q

Patients with this neck lump - 10% of them develop thoracic outlet syndrome. What is the lump/mass?

A

Cervical rib

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12
Q

Management of otitis externa

A
  1. Topical antibiotic or combined with steroid
  2. If tympanic membrane is perforated then avoid aminoglycoside
  3. If canal is swollen then ear wick is sometimes inserted
  4. If infection spreading then use oral flucloxacillin +/- antifungal
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13
Q

If a patient fails to respond to topical antibiotics in otitis externa what is the management

A

Oral antibiotics (flucloxacillin)
Refer to ENT

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14
Q

What are recommended as indications for consideration of adenotonsillectomy

A
  • Sore throats due to tonsillitis
  • episodes are disabling and prevent normal functioning
  • 7 or more sore throats in last year; or
  • 5 or more in each of last two years; or
  • 3 or more in each of last three years
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15
Q

3 complications of tonsillitis

A
  1. otitis media
  2. quinsy - abscess
  3. rheumatic fever + glomerulonephritis
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16
Q

complications of tonsillectomy:
(a) primary <24 hours
(b) secondary >24 hours to 10 days

A

haemorrhage and pain for both

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17
Q

Diagnostic manoeuvre for BPPV

A

Dix-Hallpike manoeuvre

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18
Q

BPPV management

A
  1. Epley manoeuvre (80% success)
  2. Vestibular rehabilitation i.e. Brandt-Daroff exercises at home
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19
Q

Glue ear describes what

A

Otitis media with effusion

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20
Q

Glue ear - otitis media with effusion can lead to hearing loss. What is the treatment

A
  1. Monitor for 6-12 weeks as spontaneous resolution is common
  2. If hearing loss persists on 2 separate occasions (e.g. 1 week + 12 weeks) then refer to ENT for hearing tests
  3. Grommet insertion
  4. Adenoidectomy
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21
Q

What type of cancer is nasopharyngeal cancer

A

Squamous cell carcinoma

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22
Q

What virus is nasopharyngeal carcinoma associated with

A

EBV

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23
Q

Meinere’s disease features

A

Vertigo
Tinnitus
Hearing loss
Sensation of aural fullness

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24
Q

Treatment for Meniere’s disease
ACUTE ATTACKS

A

buccal or IM prochlorperazine

(prevention = betahistine + vestibular rehab exercises)

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25
Q

Prophylaxis treatment of Meniere’s disease

A

Betahistine
Vestibular rehab exercises

Acute Rx = buccal or IM propchlorperazine

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26
Q

All post-tonsillectomy haemorrhages should be managed through…

A

immediate ENT referral

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27
Q

Nasal septal haematoma shows bilateral red swelling from nasal septum. These feel boggy

What treatment is needed?

A

Surgical drainage
IV antibiotics

If left untreated, septal necrosis may develop

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28
Q

Recurrent epistaxis without red flags can be treated with

A

Naseptin cream

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29
Q

Silver nitrate cautery can be attempted in primary care for nosebleeds if what is identified

A

A clear bleeding point!

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30
Q

Naseptin nosebleed cream is contraindicated in what 3 allergies

A

peanut
soy
neomycin

Mupirocin is an alternative

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31
Q

If bleeding in nosebleed does not stop after 10-15 minutes of continuous pressure on the nose consider what 2 options

A
  1. cautery - if the source of bleeding is visible
  2. packing - admit to hospital with ENT review
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32
Q

Globus (sensation of lump in throat), hoarseness and no red flags

What is the diagnosis

A

laryngopharyngeal reflux

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33
Q

Management of laryngopharyngeal reflux

A

Lifestyle measures - triggers include fatty foods, caffeine, chocolate and alcohol
PPIs
Sodium alginate liquids (e.g. Gaviscon)

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34
Q

What is the cause for the majority of sudden-onset sensorineural hearing loss?

A

Idiopathic

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35
Q

Sudden onset unilateral sensorineural hearing loss - management

A

urgent referral to ENT

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36
Q

Sudden onset unilateral sensorineural hearing loss treatment

A

High dose corticosteroidsM

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37
Q

Why do MRIs tend to be done for patients with sudden onset unilateral sensorineural hearing loss?

A

To rule out vestibular schwanonoma

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38
Q

Management of otitis media

A

Antibiotics are given if:
- symptoms >4 days
- systemically unwell
- immunocompromised
- younger than 2 years with bilateral otitis media
- otitis media with perforation and/or discharge in canal

39
Q

what is the antibiotic of choice for otitis media

A

amoxicillin 5-7 day course

40
Q

complications of otitis media

A
  • perforation of tympanic membrane with otorrhoea
  • chronic suppurative otitis media
  • hearing loss
  • labyrinthitis
  • mastoiditis

(brain abscess, meningitis, paralysis)

41
Q

what is the definition of chronic suppurative otitis media

A

otitis media with perforation of tympanic membrane with otorrhoea for >2-6 weeks

42
Q

Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected

what is the diagnosis

A

viral labyrinthitis

43
Q

Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss

what is the diagnosis

A

vestibular neuronitis

44
Q

Associated with hearing loss, tinnitus and sensation of fullness or pressure in one or both ears

what is the diagnosis

A

Meniere’s disease

45
Q

Elderly patient
Dizziness on extension of neck

what is the diagnosis

A

vertebrobasilar ischaemia

46
Q

Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2

what is the diagnosis

A

acoustic neuroma

47
Q

How to confirm diagnosis of Meniere’s diseas

A

ENT assessment

48
Q

Do patients need to inform DVLA for Meniere’s disease

A

YES

Stop driving until satisfactory control of symptoms

49
Q

Management of mouth ulcers

A
  1. avoid triggers
  2. symptomatic treatment for pain and swelling e.g. hydrocortisone steroid lozenges (topical), antimicrobial mouthwash or topical analgesia
  3. mouth ulcer for >3 weeks - refer to ENT
50
Q

What are red flags for mouth apthous ulcers

A
  1. Persisting >3 weeks
  2. Unexplained red and white patches that are painful, swollen or bleeding
  3. Lesion for more than 6 weeks with no other diagnosis
51
Q

which neck lump typically contains cholesterol crystals

A

branchial cyst

unilateral, usually on left
lateral, anterior to SCM muscle
smooth, non-tender

52
Q

Ramsay Hunt syndrome is caused by the reactivation of what virus and where

A

VZV virus in geniculate ganglion of 7th cranial nerve

53
Q

Features of Ramsay Hunt Syndrome (reactivation of VZV in CN7)

A
  • auricular pain
  • facial nerve palsy
  • vesicular rash around ear
  • vertigo + tinnitus
54
Q

Where are vesicular rash lesions seen in Ramsay Hunt syndrome (VZV reactivation of CN7)

A

Around ear
Anterior 2/3rds of tongue

55
Q

Management of ramsay hunt syndrome (reactivation of VZV in CN7)

A

Oral acyclovir
Corticosteroids

56
Q

What 5 drugs can cause tinnitus

A
  1. Aspirin
  2. NSAIDs
  3. Aminoglycosides
  4. Loop diuretics
  5. Quinine
57
Q

Otosclerosis causes progressive conductive deafness. what inheritance mode is it?

A

autosomal dominant

58
Q

Otosclerosis leads to progressive deafness + it is autosomal dominant. It causes normal bone to be replaced by vascular spongy bone.

What type of deafness does it cause

A

conductive

59
Q

Conductive deafness
Tinnitus
Tympanic membrane - flamingo tinge
Positive family history

What is the diagnosis

A

Otosclerosis

60
Q

What disease shows flamingo tinge of tympanic membrane

A

Otosclerosis

61
Q

Management of otosclerosis

A

Hearing aid
Stapedectomy

62
Q

Positive dix-hallpike manoeuvre shows what kind of nystagmus

A

rotatory

63
Q

what type of hearing loss do you get with Menieres disease

A

sensorineural

64
Q

what is the most common cause of vertigo

A

BPPV

65
Q

management of simple gingivitis

A

advise routine review by dentist
no need for Abx

66
Q

management of acute necrotising ulcerative gingivitis

A

refer to dentist
while give oral metronidazole for 3 days
chlorhexidine or hydrogen peroxide mouthwash
simple analgesia

67
Q

Presbycusis describes…

A

age-related sensorineural hearing loss

patients find it hard to follow conversations

68
Q

what does audiometry show for presbycusis (age-related sensorineural hearing loss)

A

bilateral high-frequency hearing loss

69
Q

Glue ear can lead to what in children

A

speech and language delay

70
Q

Acoustic neuromas can lead to what effects in cranial nerves

A

CN8 - hearing loss, vertigo, tinnitus
CN10 - absent corneal reflex
CN12 - facial palsy

71
Q

NICE indications for antibiotics with sore throat

A
  1. systemic upset
  2. unilateral peritonsillitis
  3. history of rheumatic fever
  4. risk of acute infection e.g. immunodeficiency
  5. 3 or more Centor criteria
72
Q

what are 4 centor criteria

A
  1. no cough
  2. presence of tonsillar exudate
  3. tender anterior cervical lymphadenopathy
  4. history of fever
73
Q

feverpain criteria

A

fever >38
purulent/exudate
attends within 3days or less
severely inflamed tonsils
no cough/coryza

74
Q

main treatment options for ear wax

A

irrigation - microsuction
eardrops - olive oil, sodium bicarb or almond oil

MANUAL SYRINGING IS NO LONGER RECOMMENDED BY NICE

75
Q

what contraindications are there for ear syringing /irrigation for ear wax

A

grommet in situ
or perforation

76
Q

nasal polyps are associated with which conditions

A

asthma
aspirin sensitivity
sinusitis
cystic fibrosis
Kartagener’s syndrome
Churg-Strauss (EGPA)

77
Q

Samter’s triad is made up of

A

asthma
aspirin sensitivity
nasal polyps

78
Q

nasal polyps management

A

referral to ENT
topical corticosteroids

79
Q

most common pathogen causing malignant otitis externa

A

pseudomonas

80
Q

malignant otitis externa can progress into…

A

temporal bone osteomyelitis

81
Q

treatment of malignant otitis externa

A
  1. non-resolving otitis externa with worsening pain should be referred urgently to ENT
  2. IV antibiotics to cover pseudomonas
82
Q

Otoscopy shows attic crust - in the uppermost part of ear drum

what is the diagnosis

A

cholesteatoma

83
Q

Being born with which neurological defect increases the risk of cholesteatoma by x10

A

Cleft palate

84
Q

Foul-smelling, non-resolving discharge
Hearing loss
Attic crust on otoscopy

What is the diagnosis

A

Cholesteatoma

refer to ENT for surgical removal

85
Q

Hoarseness - when should these be referred to ENT

A

Age 45 and over with persistent unexplained hoarseness

86
Q

auricular haematomas management

A

same-day assessment by ENT
incision + draining > needle aspiration

87
Q

treatment of acute sinusitis

A
  1. analgesia
  2. intranasal corticosteroids if symptoms longer than 10 days
  3. antibiotics (phenoxymethylpenicillin or co-amoxiclav) if severe presentations
88
Q

sudafed (psuedoephedrine) is contraindicated with what type of medications

A

monoamine oxidase inhibitors

can cause hypertensive crisis

89
Q

perforated tympanic membrane management

A
  1. usually self-resolves within 6-8 weeks. avoid water in this time. monitor and review then
  2. antibiotics are given if perforation is after acute otitis media
  3. myringoplasty if it does not heal itself
90
Q

4 causes of Gingival hyperplasia

A
  1. phenytoin
  2. ciclosporin
  3. CCBs especially nifedipine
  4. AML
91
Q

Unilateral serous middle otitis media that is not improving, management?

A

Urgent 2ww ENT referral

this is a red flag for nasopharyngeal carcinoma

92
Q

Children presenting with glue ear with a background of what 2 conditions should be referred to ENT

A

Down’s syndrome
Cleft palate

93
Q

Ludwig’s angina is a type of …

A

progressive cellulitis of mouth and soft tissues of neck

94
Q

Ludwig’s angina is a life threatening emergency because..

A

airway obstruction can occur

Rx - refer to A&E for airway management and IV Abx

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