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Finals Studying - Condensed > ENT > Flashcards

ENT Flashcards

1
Q

colour and shape of right ear on audiometry

A

red

circles

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2
Q

colour and shape of left ear on audiometry

A

blue

crosses

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3
Q

bone conduction on audiometry

A

triangles

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4
Q

conductive hearing loss on audiometry

A

gap between air & bone conduction

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5
Q

sensorineural hearing loss on audiometry

A

NO gap between air an bone conduction

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6
Q

noise exposure audiometry

A

sensorineural hearing loss at high frequency

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7
Q

meniere’s disease audiometry

A

one sided low frequency sensorineural hearing loss

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8
Q

otosclerosis audiometry

A

conductive hearing loss with dip at 2KHz

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9
Q

Woman with cold, went on plane, now hearing loss, tympanic membrane intact

A

barotrauma

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10
Q

surfers ear

A

exostosis

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11
Q

Female who had permanent complete hearing loss in pregnancy - Dx?

A

otosclerosis

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12
Q

presentation OME

A 
poor listening 
poor speech
language delay
inattention 
poor school work
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13
Q

signs of OME on otoscopy

A

variable - retracted or bulging drum

can be dull, grey or yellow in colour

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14
Q

Ix OME

A

audiometry (conductive deafness)

tympanometry (flat, type B)

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15
Q

Mx OME

A
  1. conservative - usually resolves in 3m

2. hearing aids or grommets

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16
Q

causes of conductive deafness

A

external canal obstruction
ear drum perforation (barotrauma, infection)
ossicular chain problems (otosclerosis, infection)

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17
Q

what is otosclerosis

A

replacement of bone by vascular spongy bone particularly at oval window

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18
Q

inheritance of otosclerosis

A

autosomal dominant

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19
Q

presentation otosclerosis

A 
young woman 
conductive deafness
tinnitus
normal tympanic membrane 
\+ve FH
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20
Q

Mx otosclerosis

A

hearing aid

stapedectomy

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21
Q

causes of sensorineural deafness

A 
otoxic drugs 
post-infection 
menieres
presbycusis 
acoustic neuroma 
B12 deficiency
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22
Q

what is presbycusis

A

aged related sensorineural hearing loss due to accumulated environmental noise toxicity

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23
Q

presentation presbycusis

A

difficulty using telephone

difficulty following convo

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24
Q

tympanometry in OME

A

Flat (type B)

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25
Q

tympanometry in presbycusis

A

normal middle ear function with hearing loss (Type A)

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26
Q

causes of otitis externa

A 
moisture (swimmers) 
narrow ear canal 
trauma 
absence of ear wax 
high humidity
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27
Q

organisms causing otitis externa

A

bacterial:
pseudomonas aeruginosa
staph aureus

fungal:
aspergillus niger

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28
Q

who gets fungal otitis externa

A

divers

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29
Q

who gets malignant otitis externa (++ aggressive)

A

diabetics

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30
Q

Mx malignant otitis externa

A

IV Abx +/- debridement

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31
Q

Mx otitis externa

A

topical Abx/steroid
- ciprofloxacin/dexamethasone

  • if debris: aural toilet
  • if severe swelling: insert wick, then Abx
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32
Q

Ix malignant otitis externa

A

CT

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33
Q

cause of otitis media

A

complication of resp viruses

  • strep pneumoniae
  • haemophilus influenze
  • moraxella catarrhalis

travels up eustachian tube causing inflammation and effusion. complicated by bacteria

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34
Q

presentation otitis media

A 
\+/- preceding URTI 
otalgia 
bulging tympanic membrane 
fever
irritability
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35
Q

Mx otitis media

A
  1. analgesia + observe for a few days

2. delayed Abx: amoxicillin 500mg tds for 5d +/- clavulanate

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36
Q

when should abx Tx be given immediately in otitis media

A 
symptoms lasting >4d and not improving 
systemically unwell
immunocompromised 
<2y with bilateral otitis media 
perforation and/or discharge
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37
Q

cholesteatoma

A

presence of keratinising squamous epithelium in the middle ear that is locally destructive

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38
Q

causes of cholesteatoma

A

retraction of pars flaccida +/- atrophy of pars tensa, which traps epithelium that can then proliferate

migration of squamous epithelium through defect in tympanic membrane

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39
Q

risk factors for cholesteatoma

A

congenital conditions - cleft palate
prior ear surgery
middle ear disease
eustachian tube dysfunction

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40
Q

presentation cholesteatoma

A

foul otorrhoea
conductive hearing loss
tinnitus
crust of keratin in upper pocket of middle ear “attic crust”

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41
Q

Mx of cholesteatoma

A

referral to ENT for MRI and surgery

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42
Q

vestibular schwannoma

A

benign cerebellopontine angle tumour growing from vestibular schwann cell layer

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43
Q

bilateral vestibular schwannoma - Dx?

A

NF type 2

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44
Q

presentation vestibular schwannoma

A

intermittent dizziness
giddiness
facial numbness
unilateral sensorineural HL

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45
Q

Ix vestibular schwannoma

A

MRI

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46
Q

Mx vestibular schwannoma

A

any of:

  • observation
  • focussed radiation
  • surgery
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47
Q

BPPV

A

attacks of vertigo lasts >30 secs that are provoked by head turning

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48
Q

cause of BPPV

A

displacement of calcium particles in the semicircular canals

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49
Q

presentation BPPV

A 
vertigo lasts a few mins 
clear positional trigger
no ass HL or tinnitus 
no aural fullness 
nausea/light-headedness
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50
Q

Ix BPPV

A

hallpike’s test

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51
Q

Mx BPPV

A

epley manoeuvre

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52
Q

meniere’s disease

A

dilation of the endolymphatic spaces of the membranous labyrinth

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53
Q

cause of menieres disease

A

unknown

54
Q

presentation of meniere’s disease

A 
vertigo lasting hours 
unilateral fluctuating sensorineural hearing loss 
tinnitus (roaring) 
aural fullness 
nystagmus
55
Q

Ix menieres

A

endocochleography

endolymph MRI

56
Q

Mx menieres

A

acute attacks - supportive (anti emetics - prochlorperazine)
if severe - intratympanic gentamicin

prevention - salt restriction, betahistine, vestibular rehab exercises

57
Q

labyrinthitis

A

inflammation of the labyrinth in the cochlea and the vestibular system in the inner ear

58
Q

causes of labyrinthitis

A

viral - preceding URTI most common

bacterial - complication of otitis media most common

59
Q

presentation labyrinthitis

A 
vertigo - days 
hearing loss
no aural fullness 
n+v 
nystagmus
60
Q

Ix labyrinthitis

A

clinical Dx

61
Q

Mx labyrinthitis

A

supportive - vestibular suppressants

  • diazepam
  • lorazepam
  • meclizine
62
Q

vestibular neuronitis

A

inflammation of the vestibular nerve following viral illness

63
Q

presentation vestibular neuronitis

A 
vertigo lasting weeks 
no HL 
no tinnitus 
no aural fullness
nystagmus
64
Q

Mx vestibular neuronitis

A

supportive - vestibular suppressants

  • diazepam
  • lorazepam
  • meclizine
65
Q

pt who is has sudden onset headache and very dizzy, never had before - Dx?

A

vestibular migraine

66
Q

Vertigo and tingling in arms especially on looking up (pinching blood supply at basilar arteries)

A

vertebrobasilar insufficiency

67
Q

Sudden onset sensorineural hearing loss - Mx?

A

urgent referral to ENT and high dose steroids

68
Q

presentation bells palsy

A

abrupt onset
dry/watering eyes
no motor movement of CNVII distribution on one half
mouth sagging

69
Q

Mx bells palsy

A

prednisolone 1mg/kg for 10d - prescribe within 72h of onset

+ artifical tears

70
Q

what must pts with bells palsy be advised to do

A

tape eyes shut at night bcos they cant blink

71
Q

ramsay hunt syndrome

A

reactivation ofvaricella zoster in CNVII ganglion

72
Q

presentation ramsay hunt

A 
auricular pain 
CNVII palsy 
vesicular rash around ear 
vertigo 
tinnitus
73
Q

Mx ramsay hunt

A

oral antivirals

74
Q

Mx of perforated tympanic membrane that has failed to heal within 6-8w

A

myringoplasty

75
Q

pain on eating - who to refer to

A

dentist

76
Q

sub-types of allergic rhinitis

A

seasonal/intermittent i.e. hayfever
- grass, flow, tree pollen

persistent/perennial
- house dust mites, cats, dogs

77
Q

single crease on nose is a sign of -?

A

allergy (allergic rhinitis) from constant rubbing nose

78
Q

Ix allergic rhinitis

A

IgE skin prick testing
RAST testing
- both will be +ve

79
Q

Mx allergic rhinitis

A
  1. antihistamine
  2. intranasal corticosteroid
  3. combo Tx

+ allergen avoidance

80
Q

cause of non-allergic/vasomotor rhinitis

A

nasal hypersensitivity - imbalance between sympathetic and parasympathetic supply to nasal mucosa

81
Q

Ix non-allergic rhinitis

A

IgE skin prick testing
RAST testing
- both will be -ve

82
Q

Mx non-allergic rhinitis

A
  1. intranasal antihistamine or intranasal corticosteroid

2. combo therapy

83
Q

if rhinorrhoea is predominant symptom in rhinitis - Tx?

A

intranasal ipratropium

84
Q

intranasal corticosteroids

A

budesonide

beclometasone

85
Q

anti-histamines

A

cetirizine
fexofenadine
loratadine

86
Q

nasal decongestants

A

oxymetazoline

pseudoephedrine

87
Q

intranasal anticholinergics

A

ipratropium

88
Q

farmer, has a cat and has recurrent rhinitis - Ix?

A

RAST

89
Q

samter’s triad

A

asthma
aspirin sensitivity
nasal polyps

90
Q

nasal polyps - sensitive or not sensitive to touch?

A

not sensitive

91
Q

nasal turbinates - sensitive or not sensitive to touch?

A

sensitive

92
Q

nasal polyps - unilateral or bilateral most common

A

bilateral - unilateral considered neoplastic until proven otherwise.

93
Q

nasal polyps presentation

A

nasal obstruction
rhinorrhoea
poor sense of taste and smell

94
Q

Ix nasal polyps

A

anterior rhinoscopy or nasal endoscopy

unilateral - CT and biopsy

95
Q

Mx nasal polyps

A

moderate - nasal corticosteroids

severe - oral corticosteroid. if not improving - endoscopic polypectomy

96
Q

acute sinusitis - how long do symptoms need to last for

A

<4w

97
Q

chronic sinusitis - how long do symptoms need to last for

A

> 12 w

98
Q

presentation sinusitis

A 
facial fullness/tenderness 
worse on bending forward
nasal discharge
post-nasal drip 
nasal congestion 
fever
99
Q

Mx sinusitis

A
  1. analgesia and decongestant (if <3d)

if persisting/worsening add Abx: amoxillin

100
Q

Mx chronic sinusitis with nasal drip

A

CT sinus
and
sinusectomy

101
Q

anterior or posterior nosebleeds - what is more common

A

anterior - kisselbachs area

102
Q

posterior nosebleed

A

from posterior nasal cavity or nasopharynx

103
Q

what arteries make up little’s area

A 
posterior ethmoidal 
anterior ethmoidal 
sphenopalatine 
greater palatine 
superior labial
104
Q

Mx of nosebleed

A

if haemodynamically stable - first aid measures
- if this controls bleeding, then use topical antiseptic
- if this doesnt control bleeding:
cautery or packing
(cautery if bleeding area can be visualised, packing if area cant be visualised)

if cautery doesnt work, then do packing

105
Q

nosebleeds - order of ligation of arteries

A
  1. sphenopalatine
  2. anterior ethmoidal
  3. external carotid
106
Q

most common bacterial cause of tonsillitis

A

group A strep

107
Q

centor criteria - and how many indicated bacterial infection

A 
no cough 
fever
cervical lymphadenopathy 
tonsillar exudate
3/4 = bacterial
108
Q

feverPAIN criteria - and how many indicated bacterial infection

A 
fever
Purulent tonsils 
Attend rapidly (<3d) 
Inflamed tonsils 
No cough
109
Q

Mx bacterial tonsillitis

A

Phenoxymethylpenicillin + Analgesia

if unable to swallow - admit for IV benzylpenicillin + fluids

110
Q

complications of tonsillitis

A

otitis media
quinsy
rheumatic fever
glomerulonephritis

111
Q

indications for tonsillectomy

A

sore throats are due to acute tonsillitis
episodes are disabling and prevent normal function
7 eps in last 1 y
5 eps in each of the last 2y
3 eps in each of the last 3y
“7 in 1, 5 in 2, 3 in 3”

112
Q

presentation quinsy

A 
pain worse 1 side
deviation of uvula towards affected side 
trismus (lock jaw) 
stertor 
hot potato voice
113
Q

Mx quinsy

A 
needle aspiration 
\+ 
IV benzylpenicillin 
\+ 
IV dexamethasone
114
Q

What not to give in someone with glandular fever and why

A

Amoxicillin - will get a rash

115
Q

why should people with glandular fever avoid contact sport

A

risk of spleen rupture

116
Q

pleomorphic adenoma

A

benign salviary gland tumour
middle age
female
slow growing painless lump

117
Q

Mx pleomorphic adenoma

A

superficial parotidectom y

118
Q

risk in superficial parotidectom y

A

CN VII damage (runs through parotid gland but doesnt supply it)

119
Q

warthins tumour

A

benign salivary gland tumour
middle age
male
softer and more fluctuant than pleomorphic adenoma

120
Q

most common parotid tumour in children <1y

A

haemangioma

121
Q

triple assessment of a neck lump

A
  1. history and examination
  2. imaging: USS, CT, MRI or laryngoscopy
    3 biopsy + FNA
122
Q

associations with nasopharyngeal ca

A 
EBV 
southern china (salty fish diet) - rare in other parts of world
123
Q

presentation nasopharyngeal ca

A

otalgia
cervical lymphadenopathy
recurrent epistaxis

124
Q

Mx nasopharyngeal ca

A

radiotherapy
+/- chemo
+/- surgery

125
Q

presentation oropharyngeal ca

A

sore throat
sensation of lump
referred otalgia
irritation by hot or cold food

126
Q

Mx oropharyngeal Ca

A

radiotherapy

+/- surgeyr

127
Q

presentation laryngeal ca

A

progressive hoarseness, then stridor
pain swallowing
+/- haemoptysis
+/- ear pain

128
Q

cause of younger patient with laryngeal ca

A

HPV+ve

129
Q

Ix laryngeal ca

A
  1. laryngoscopy + biopsy
  2. HPV status
  3. MRI staging
130
Q

Mx laryngeal ca

A

radiotherapy + total laryngectomy + tracheostomy

Finals Studying - Condensed (22 decks)

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