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Finals > ENT > Flashcards

ENT Flashcards

1
Q

Suggest the complication of otitis media

A

Facial nerve palsy
Mastoiditis
Petrositis - Gradenigo syndrome
Labrynthitis
Meningitis
Sigmoid sinus thrombosis
Brain abcess

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2
Q

What are some causes for otlagia?

A

50% non otological e.g. grinding, TMJ
Trauma
Eczema
Furunculosis
NOE
Barotrauma

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3
Q

Suggest the most common infections in the ear canal

A

Pseudomonas then staphylococcal

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4
Q

How are OE infections managed?

A

Antibiotics + steroid
Aural toilet

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5
Q

What are some otitis media infections?

A

Pneumococcus
Haemophillus
Moraxella

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6
Q

How is otitis media managed?

A

If no systemic symptoms and simply pain, may recover in 24 hours without antibiotics and simple analgesia. However if systemically unwell, fever or <2 years old may benefit from amoxicillin. Consider a delayed prescription

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7
Q

What is benign or inactive COM?

A

A perforated ear drum
Dry
No active infection

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8
Q

What is chronic serous otitis media?

A

Characterised by continous serous drainage

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9
Q

What is chronic suppurative otitis media?

A

Diagnosed when there is persistent purulent draiange

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10
Q

What are the complications of a cholesteosteoma?

A

Facial nerve palsy
Mastoiditis
Hearing loss
Petrositis
Cerebral abcess

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11
Q

What is a cause of middle ear infections in adults?

A

Posterior space tumours

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12
Q

How should children with bilateral OME be managed?

A

3 month period of active observation and re-assess wit repeat hearing tests at 3 months. Consider after 3 months of ventillation tubes i.e. grommets or surgery.

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13
Q

How should children modify activities with grommets?

A

Swimming is permitted
However diving is not or forcing water

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14
Q

What are some causes of hearing loss in children?

A

50% genetic e.g. Jervell Lange, Klippel-Feil syndrome, Waardenburg syndrome, Alport

25% are non-genetic e.g. TORCH infections, meningitis, encephalitis, measles and mumps, ototoxic drugs

25% idiopathhic

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15
Q

What tests may be done in neonates for hearing impairment?

A

Otoacoustic emission testing
Auditory brainstem response (ABR)

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16
Q

What are the causes of tinnitus in patients?

A

Objective:
Vascular disorders: AV malformations, globus tumours,
high cardiac output states.

Subjective:
Menierre’s syndrome
Ototoxic drugs
Otitis media
SNHL
Noise induced damage

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17
Q

How is tinnitis treated?

A

Manage depression, anxiety and insomnia
Hearing aids
Psychological support
CBT

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18
Q

What are the features of acoustic neuroma?

A

Unilateral hearing loss
Unilateral tinnitis
Dizziness

MRI and pure tone audigram

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19
Q

What is the Jastreboff model?

A

It suggests there is a limbic and autonomic link with tinnitus annoyance

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20
Q

What type of nystagmus is seen in peripheral vertigo/ vestibular vs central vertigo?

A

Peripheral = horizontal
Central = vertical

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21
Q

What is Unterberger’s test?

A
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22
Q

What are the two types of vertigo?

A

Central and peripheral

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23
Q

What is BPPV?

A

<30 seconds are provoked by head turning
Dix-Hallpike test +ve
Self limited
Epley manoeuvre
Brandt Daroff exercises

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24
Q

What is Meniere’s?

A

2 or more episodes of vertigo lasting between 20 mins and 12 hours
Abnormality with endolymph
Fluctuating hearing loss, vertigo, tinnitus and fullness
Acute use prochlorperazine
Prophylaxis: beta histine

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25
Q

What is vestibular neuritis and labyrinthitis?

A

Sudden attacks of unilateral vertigo and vomiting in a previously well person, often following an URTI.
Lasts 1-2 days improving over the week
Vestibular suppresants Prochlorperazine or buccastem and rehabilitation
Labrynthitis has hearing loss

26
Q

What is FESS?

A

Functional endoscopic sinus surgery (FESS) is a minimally invasive surgery for serious sinus conditions. It is used to clear blockages in the sinuses and make breathing easier

27
Q

What drains to the superior meatus?

A

Posterior ethmoidal

28
Q

What drains to the inferior meatus?

A

Nasolacrimal duct

29
Q

What does the maxillary, anterior ethmoidal, middle ethmoidal and front sinus drain to?

A

Middle meatus

30
Q

What does the sphenoid sinus drain to?

A

Sphenoethmoidal recess

31
Q

When should manipulation of the nasal bones be performed?

A

Day 7-14
First check for a boggy swelling a septal haematoma

32
Q

What does CSF contain?

A

B2 tau transferrin and >0.5ml is gold standard for rhinorrhea

33
Q

How is CSF rhinorrhea managed?

A

Check for glucose and B2 tau protein
Give antibiotics and prophylaxis pneumococcal vaccine

34
Q

How is epistaxis managed?

A

Nosebleeds can be anterior or posterior
Can be life threatening
Assess blood loss: ABC, IVI, oyxgen sats
Which side? trauma? how much blood lost? on wafarin?
Pinch the lower part of the nose for 10 minutes
Place an icepack on the dorsum on the nose
Prepare to cauterize the nose with silver nitrate
Use headlight and Thudicum’s speculum
Anterior nasal pack

35
Q

Compare and contrast tonsillitis and quinsy?

A

Quinsy is a peritonsillar abscess

36
Q

What is the fever pain score?

A
37
Q

What are the complications of tonsilitis?

A

Peritonsilar abscess - presents with sore throat, dysphagia, peritonsilar bulge, uvular deviation, trismus and a muffled voice
Abscess of parapharangeal
Lemierre’s syndrome

38
Q

What is Lemierre’s syndrome?

A

Infectious thrombophlebitis of the internal jugular vein caused by fusobacterium and emboli

39
Q

What is the Paradise criteria?

A
40
Q

How is a primary haemorrhage and secondary haenorrhage different following tonsillectomy?

A

Primary <24 hours back to theatre
Secondary >24 hours observe in hospital and antibiotics

41
Q

What are the causes of stridor?

A

Congenital: Laryngomalacia
Inflammation: laryngitis, epiglossitis, group, anaphylaxis
Trauma: burns

42
Q

What are the causes of drooling?

A

Not necessarily with epiglossitis
Angiooedema. rabies, muscular problems, ingestion of foreign body

43
Q

List the causes of hoarseness

A

Vocal cord palsy
Spadmodia dysphonia
Cranial nerve palsy
Laryngitis
Vocal cord nodules
Laryngeal cancer
Reflux
Reinke’s oedema
Muscle tension dysphonia
Laryngeal vocal nerve palsy

44
Q

What are the questions you should ask with swallowing difficulties?

A
  1. Solids
  2. Liquids - can’t swallow liquids well e.g. achalasia, bulbar palsy
  3. Initiate swallowing - can’t initiate bulbar palsy
  4. Painful - malignant swelling
  5. Swelling on drinking - retropharnygeal abscess
45
Q

What is the most common cause of head and neck cancers?

A

HNSCC

46
Q

What are some risk factors for HNSCC?

A

Cigarette smoking
HPV
Alcohol
Vitamin A and C deficiencies
GORD

47
Q

What are some causes of dysphasia?

A

Achalasia
Strictures
Malignancy
Pharyngeal pouch
Globus hystericus/ pharyngeus

48
Q

What are some tests for swallowing defects?

A

Barium swallow
Endoscopy
Motility studies

49
Q

How are laryngeal cancers treated?

A

First line chemoradiotherapy
Second line surgery and radiotherapt

50
Q

What are the intracranial nerves of facial nerve palsy?

A

Chorda tympani = 2/3rds taste
Branches to stapedius = hyeracusis

51
Q

What are the causes of a cranial nerve palsy?

A

Intracranial: brainstem tumours, strokes, polio, MS, acoustic neuroma, meningitis
Intratemporal: Ramsay Hunt, cholesteatoma
Infratemporal: Parotid tumours
Others: Lyme disease and sarcoidosis

52
Q

What are the tests for a facial nerve palsy?

A

ESR, glucose, Lyme disease, check parotids for lumps and bumps

53
Q

What are some differentials for neck lumps?

A

Duration: if < 3 weeks likely reactive lympadenopathy

If midline:
<20 midline lump = dermoid cysts
<20 midline + elevates on tongue protrusion = thyroglossal cyst
>20 midline + elevates likely a thyroid mass/ goitre

If submandibular:
<20 self limiting = reactive lymphadenopathy
>20 = malignant lymphadenopathy
Could it be a submandiubular stone, tumour, or siadelinitis

If anterior triangle:
Lympadenopathy
Branchial cyst
Parotid tumours
Carotid artery aneurysm
Carotid artery tumour

If posterior triangle/ i.e. behind sternocleidomastoid
Cervical ribs
Pharyngeal pouches
Cystic hygroma
Lympadenopathy (TB, HIV)
If >20 lymphoma

54
Q

What is the most common parotid tumour?

A

Pleomorphic adenoma

55
Q

What is a high grade salivary tumour?

A

Mucoepidermoid carcinoma

56
Q

Which salivary gland tumour spreads along the nerve?

A

Adenoid cystic tumours

57
Q

Which salivary tumours tend to be bilateral?

A

Warthin’s tumour (adenolymphoma)

58
Q

How is Vincent’s angina treated?

A

This is ncerotising ulcerative gingivitis
Amoxicillin and netroniazole

59
Q

What are causes of gum hyperplasia?

A

Phenytoin, cyclosporin and nifedipine

60
Q

How can you distinguish between pain in the teeth?

A

Caused by sugar or heat - pulpitis
Worse with percussion = osteitis or abcess
Exacerbated by movement - abscess

61
Q

What are the causes of a black hairy tongue

A

poor oral hygiene
antibiotics
head and neck radiation
HIV
intravenous drug use

Finals (24 decks)

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