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Year 4 > ENT > Flashcards

ENT Flashcards

1
Q

Name 3 predisposing factors for perichondritis of the pinna

A

Acute otitis externa, piercing, haematoma

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2
Q

What bacterium is usually associated with perichonidritis of the pinna?

A

Staph aureus, pseudomonas aeruginosa

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3
Q

How do you treat otitis externa?

A

Topical ear drops (antibiotic + steroid) plus analgesia

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4
Q

What type of hearing loss is associated with chronic wax build up?

A

Conductive

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5
Q

Name 3 functions of ear wax

A

Waterproofing, assists cleaning, some pretections against insects/bacteria/fungi

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6
Q

Name the ossicles (lateral-> medial)

A

Malleus, incus, stapes

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7
Q

Who is usually affected by acute otitis media with effusion? How common?

A

Aged 2 and 5 yrs

15-40% point prevalence from infancy 5

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8
Q

What does acute otitis media with effusion look like otoscopically? Treatment?

A

Tympanic membrane dull/opaque, fluid bubbles may be seen behind it
Usually settles without intervention
Otherwise: antibiotics, steroids, decongestants, autoinflation, gromits

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9
Q

What is a cholesteatoma?

A

Squamous epithelium trapped in skull base, that can erode or destroy important structures within the temporal bone
Usually affects attic area

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10
Q

How does a cholesteatoma present?

A

Intermittent painless offensive othorhea, conductive hearing loss, dizziness

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11
Q

Treatment of cholesteatoma + risks

A

Surgery

Labyrinthine fistula, brain herniation, bleeding

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12
Q

Severe complications of chronic cholesteatoma

A

Sigmoid sinus thrombosis, epidural abscess, meningitis, long term vertigo

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13
Q

Give 2 ways perforation of the tympanic membrane presents

A

Audible whistling sounds during sneezing, otorrhea. If painful: cholestaetoma or infection

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14
Q

What surgery is used to treat a perforated tympanic membrane?

A

Fat plug tympanoplasty

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15
Q

What is tinnitus?

A

Perception of sound without stimulus

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16
Q

What is vertigo?

A

Sensation that the world is spinning.whirling

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17
Q

Give three ways in which an acoustic neuroma may present to an ENT surgeon

A

Facial nerve palsy, hearing loss, tinnitus, balance disturbance

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18
Q

What is the gold standard investigation for an acoustic neuroma?

A

Gadolinium enhanced MRI

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19
Q

What is Meniere’s?

A

Triad of symptoms

Vertigo, hearing loss, tinnitus

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20
Q

What is BPPV? Treatment?

A

Benign paroxysmal positional vertigo
Caused by a grain of calcium dislodged in the semicircular canal
Vertigo when they turn to a specific side in bed
Epley manoeuvre

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21
Q

What is an exostosis?

A

Bony outgrowths into the ear canal (eg surfer’s ear)

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22
Q

What should you worry about with excessive ear pain ?

A

Malignant otitis externa

Necrotic bony infection, seen in the immunocompromised

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23
Q

Treatment of labrinthitis

A

Exercise helps

Antiemetics only acute treatment

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24
Q

Why do the elderly present with dizziness?

A

Visual loss, poor muscle tone, vestibular degeneration, brain ischaemic changes, benzodiazepines. Give them exercise!

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25
Q

What is Ramsay Hunt syndrome?

A

Herpes zoster infection
Rash in ear canal or back of mouth
Dizzy/deaf
Early acyclovir

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26
Q

Between what frequencies is a pure tone audiogram commonly measured?

A

0-25db

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27
Q

What do circles and triangles mean on an audiogram?

A

Circles: air conduction
Triangles: bone conduction

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28
Q

Masked bone conduction is represented how on an audiogram?

A

Filled in shapes

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29
Q

Name 3 investigative hearing tests

A

Pure tone audiogram
Speech audiometry
Acoustic reflex testing

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30
Q

What is the major cause of hearing loss in adults? What type of loss?

A

Age related hearing loss

Sloping loss of upper frequencies

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31
Q

5 categories of hearing ability

A

Normal, mild, moderate, severe, profound

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32
Q

Which side should an unmasked bone conduction test be on?

A

Doesn’t matter

Skull is a fused bone so sound travels to both ears

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33
Q

What 3 things does a tympanogram measure?

A

Compliance of ear drum
Volume of ear canal
Middle ear pressure

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34
Q

4 causes of tinnitus?

A

Meniere’s
Damage to the inner canal
Otosclerosis
Salicylate poisoning

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35
Q

How do you test the hearing of an newborn and 18 months old?

A

Otoacoustic emissions at birth

Auditory brainstem response

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36
Q

4 roles of the nose

A

Humidify, warm and filter air
Primary immune response (lysozyme/adenoid tonsils)
Taste and smell
To breathe

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37
Q

Name the 4 paranasal sinuses

A

Frontal
Ethmoid
Maxillary
Sphenoid

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38
Q

Name the type of mucosa found in the paranasal sinuses

A

Ciliated pseudostratified columnar epithelium

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39
Q

How can you determine nasal air flow?

A

Metal tongue depressor under nose, breathe normally, comment on misting

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40
Q

Where do nose bleeds usually come from?

A

Little’s area

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41
Q

Name 3 techniques for the management of epistaxis

A

Cauterisation (silver nitrate/diathermy/laser)
Pressure on tip of nose
Packing (nasal tampon/gauze)
Endoscopic SPA ligation

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42
Q

Name the arteries that meet in Little’s area

A

Sphenopalatine artery
Posterior and anterior ethmoidal arteries
Greater palatine
Superior labial artery

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43
Q

What is loss of sense of small called?

A

Anosmia

44
Q

4 common causes of anosmia

A

Polyps
Trauma
Cocaine abuse
Old age

45
Q

Unilateral foul nasal discharge in a child..

A

Is a foreign body until proved otherwise

46
Q

Unilateral nasal discharge in an adult..

A

Foreign body, rhinolith, tumour

47
Q

4 common aero-allergens associated with allergic rhinitis

A

Pollen, fungal spores, dog and cat fur, house dust mites

48
Q

Treatment of allergic rhinitis

A

Avoidance of allergen
Antihistamines
Nasal douches

49
Q

What is SMR?

A

Submucous resection of the septum

50
Q

SMR vs septoplasty

A

SMR: older technique. Preserves bilateral mucoperichondrial flaps and cartilaginous supports.
Septoplasty: correction of the deflected nasal septum, minimal removal of septal cartilage and/or bone

51
Q

SMD?

A

Submucous diathermy of turbinates

52
Q

What is a nasal polyp? Treatment?

A

Swelling of the lining of the nose, due to allergic inflammation. They contain inflammatory fluid and are non sensate.
Nasal steroid spray

53
Q

Unilateral nasal polyps are significant because..

A

Could be a tumour or foreign body

54
Q

What is the triad that includes nasal polyps?

A

Rhinosinusitis, bronchial asthma and nasal polyps

55
Q

What is the most common cause of obstructive sleep apnoea syndrome (OSAS) in children vs adults?

A

Children: Enlarged adenoids and tonsils
Adults: Obesity

56
Q

How do you investigate obstructive sleep apnoea? Treatment?

A

Polysomnography

Nasal CPAP at night for children. Lose weight and don’t sleep on front in adults

57
Q

Most common infective agent for epiglottitis?

A

Haemophilus influenza B (HiB)

Rare now due to HiB vaccine

58
Q

Croup/laryngotracheal bronchitis infective agents

A

Parainfluenza 1/2/3
Adenovirus
Respiratory syncytial virus

59
Q

Treatment of epiglottitis?

A

Humidified oxygen, being ready to intubate or perform cricothyroidotomy if needed

60
Q

Treatment of larynotracheal bronchitis

A

Corticosteroids and nebulised adrenaline, oxygenation and monitoring

61
Q

Most common infective agent for tonsilitis

A

Group B haemolytic streptococcus pyogenes

62
Q

How many episodes of tonsilitis is needed to warrant tonsilectomy?

A

7/1 year
5/2 consecutive years
3/ 3 consecutive years

63
Q

What is quinsy? Treatment?

A

Peritonsillar abscess
Aspiration, incision and drainage
Antibiotics

64
Q

Cause of glandular fever? Presentation?

A

EBV (epstein barr virus)

Lymphadenopathy, sore throat, pharyngitis, palatal petechiae, fungal looking tonsilitis

65
Q

Where are the adenoids?

A

Above soft palate

Posterior wall of nasopharynx

66
Q

What is stertor?

A

Noisy inspiration due to obstruction above the larynx

67
Q

What is stridor?

A

Noise from obstruction at level of larynx

Can be inspiratory, expiratory & biphasic

68
Q

3 signs associated with acute mastoiditis

A

Mastoid area erythema, proptosis of auricle, fever

69
Q

4 aetiological agents in head and neck cancer

A

Sun damage
Smoking
Alcohol
Betul chewing

70
Q

What type of carcinoma is most common in head and neck malignancy?

A

SCC

71
Q

Earliest sign of a laryngeal malignancy

A

Hoarse voice

72
Q

Worrying clinical signs/symptoms in head and neck malignancy

A

Difficulty swallowing
Hoarse voice
Chronic mouth ulcer

73
Q

3 indications for a tracheostomy

A

Emergency airway management
ITU longterm ventilation
Mass in larynx

74
Q

Common types of tracheostomy tubes

A

Non fenestrated single cannula tube with cuff: acute. Dual cannula tube with cuff for chronic. Made of polyurethane/PVC

75
Q

Where does the parotid gland open?

A

Inner surface of cheek, opposite second molar

76
Q

Most common type of tumour affects the parotid gland

A

Pleomorphic adenoma

77
Q

Complications of a parotidectomy

A

Facial nerve palsy

Salivary fistula

78
Q

What nerves are at risk in a submandibulectomy

A

Hypoglossal, lingual, ansa cervicalis

79
Q

8 differentials of a neck lump

A

Enlarged lymph node, cyst, tumour, lymphoma, lipoma, thyroid swelling, aneurysm, abscess

80
Q

Gold standard for investigation of a neck lump

A

Ultrasound guided fine needle aspiration with cytology

81
Q

Describe the external auditory canal

A

2.5cm long
Outer 1/3 hairy, cartilage, secreted wax, non migratory
Inner 2/3 migratory skin, bone, thin sensitive skin

82
Q

How do you know which ear you are looking at?

A

The umbo is the foot, the lateral malleolar process is the knee of a man on a horse

83
Q

2 parts of tympanic membrane

A

Pars tensa, pars flaccida

84
Q

Name the 3 parts of the cochlear

A

Vestibular canal
Cochlear duct
Tympanic canal

85
Q

What senses sound?

A

Hair cell displacement-> cochlear neurones/ganglia = organ of corti
Tonotropic arrangement in cochlear

86
Q

How do you differentiate between conductive/sensorineural hearing loss with tuning forks

A

Rinne test: mastoid and outside. Conductive hearing loss, bone conduction will be heard better.

Weber test: Sensorineural, sounds is perceived in good ear. In conductive hearing loss sound will be perceived in the affected ear. (primed for sensation)

87
Q

Whats the vestibule?

A

Saccule and utricle

Balance organs

88
Q

Function of semicircular canal

A

Detects angular acceleration in 3 different planes

89
Q

Function of labyrinth

A

Sense of position in space and change in position

Helps maintain gaze (gyroscopic stabilisation of vision)

90
Q

What is oscilopsia?

A

The world moves as I walk

Like video camera footage

91
Q

What forms the nasal septum?

A 
Ethmoid
Nasal bone
Septal cartilage
Maxilla
Palatine bone
Vomer
92
Q

What can nasal sinusitis lead to in children

A

Periorbital cellulitis-> vision affected/ brain abscess

93
Q

What is found in the sphenoid sinus?

A

Internal carotid artery
Optic nerve
Cavernous sinus
CN II, IV, VI

94
Q

Sinus functions

A

Vocal resonance
Decreased skull weight
Crumple zone to protect other structures

95
Q

Name 2 ways of examining nose

A

Nasendoscope

Thudicum speculum

96
Q

Name palpable neck anatomy

A

Hyoid bone
Thyroid cartilage
Cricoid cartilage
Trachea

97
Q

Where do you palpate lymph nodes

A 
Cervical chain
Occipital
Posterior auricular
Parotid
Submandibular
Posterior triangle
Supraclavicular
98
Q

Time frame for neck lump/voice change/dysphagia

A

4-6 weeks-> 2 week wait referral

99
Q

Describe the ladder of reconstruction

A
  • Secondary healing (secondary intention, esp scalp and floor of mouth)
  • Direct closure (crescent shape and suture)
  • Skin graft (using planer, from thigh)
  • Obturation and implants (eg for hard palate, must occlude hole)
  • Local flaps
  • Pedicled flaps (artery, vein and tissue supplied)
  • Free flaps (esp bone from fibula)
100
Q

Biggest risk factor for oral cancer

A

HPV

101
Q

Branches of facial nerve

A 
Temporal
Zygomatic
Buccal
Mandibular
Cervical
(posterior auricular)
102
Q

What is the problem with a total thyroidectomy

A 
Gets rid of parathyroid glands too 
Hypocalcaemia
Spasms, twitching
Cardiac arrest
Bone weakness later
103
Q

How do you tell that hearing loss of sensorineural on audiometry?

A

Same hearing loss with bone conduction as with air conduction

104
Q

Name the branches of the external carotid

A 
Some anatomists like freaking out poor medical students
Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal
105
Q

Give 3 causes of saddle nose deformity

A

Cauterisation of both sides of septum
Cocaine abuse
Granulomatous disease (wagner’s)
Trauma

Year 4 (9 decks)

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