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MSRA > ENT > Flashcards

ENT Flashcards

1
Q

Allergic rhinitis Mx (4)

A
  1. Nasal irrigation with saline + advice

Mild-moderate
2. Intranasal antihistamines e.g azelastine hydrochloride PRN/ oral e.g loratadine/ ceterizine

Moderate- severe
3. Intranasal steroids e.g mometasone furoate, fluticasone furoate, or fluticasone propionate

Severe, uncontrolled
4. Consider short course of pred for 5-10 days

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2
Q

What is the first-line investigation for hearing difficulties? What is normal?

A

Audiograms

>20

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3
Q

Audiogram findings

Sensorineural hearing loss

A

Air and bone conduction are both impaired

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4
Q

Audiogram findings

Conductive hearing loss

A

Only air conduction is lost

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5
Q

Audiogram findings

Mixed hearing loss

A

Both are lost, but air conduction is worse than bone conduction

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6
Q 
What is BPPV?
Caused by
Duration of symptoms 
Age
Dx
Mx (3)
A 
Sudden onset of dizziness and vertigo triggered by changes in head position, usually lasts 10-20 seconds
Caused by crystals of calcium carbonate (otoconia) get displaced.
>55yo 
Dx Dix-Hallpike
Mx 
1. Epley manouvre
2. Betahistine
3. Vestibular rehabilitation
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7
Q

Black hairy tongue

What is it?

A

Defective desquamation (peeling) of the filiform papillae
(build-up of dead skin cells on tongue)
Colour can be brown/ green/ pink/ any colour

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8
Q 
Black hairy tongue
Predisposing factors (5)
A
  1. Poor oral hygiene
  2. HIV
  3. Abx use
  4. Head and neck radiation
  5. IVDU
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9
Q

Black hairy tongue

Mx (2)

A
  1. Swab to rule out candida and topical antifungals if +ve

2. Tongue scraping

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10
Q

Choleasteatoma
What is it?
Age

A

Non cancerous growth of squamous epithelium usually in the middle part of ear
Age 10-20yo

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11
Q

Choleasteatoma
Features (5)
Mx

A
  1. Hearing loss
  2. Foul smelling non resolving discharge
    If local invasion:
  3. Vertigo
  4. Facial paralysis
  5. Cerebellopontine angle syndrome/ unilateral hearing loss

Mx surgery - refer to ENT

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12
Q

What is cerebellopontine angle syndrome?

A

Unilateral hearing loss (85%), speech impediments, disequilibrium, tremors

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13
Q

Choleasteatoma

Dx - what do you see?

A

Otoscopy - attic crust seen in upper most part of eardrum

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14
Q 
Chronic rhinosinusitis - symptoms for how many weeks?
Predisposing factors (5)
A

> 12 weeks

  1. Swimming
  2. Smoking
  3. Recent infection
  4. Septal deviation/ polyps
  5. Atopy
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15
Q

Chronic rhinosinusitis

Features (5)

A
  1. Frontal pressure pain worse on bending forward
  2. Nasal discharge - clear, if thick and purulent then likely infection
  3. Post nasal drip - can lead to cough
  4. Nasal obstruction - mouth breathing
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16
Q

Chronic rhinosinusitis

Mx

A
  1. Avoid allergen
  2. Intranasal corticosteroids
  3. Nasal irrigation with saline
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17
Q

Red flags in chronic rhinosinusitis

A
  1. Unilateral symptoms
  2. Epistaxis
  3. Persistent symptoms after 3 months
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18
Q

Otitis externa

Causes

A
  1. Infection e.g Staphylococcus aureus/ Pseudomonas aeruginos/ fungal
  2. Seborrhoeic dermatitis
  3. Contact dermatitis
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19
Q

Otitis externa Rx (4)

A
  1. Topical abx - fluclox
  2. +/- topic steroid
  3. PO abx if severe
    If fails to respond to topical rx then for ENT referral
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20
Q

What is malignant otitis externa and which group of patients is it most common in? Mx

A

Elderly diabetics

Infection spreads to bony ear canal and the soft tissues deep to the bony canal –> IV abx

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21
Q

Otitis media
When to prescribe abx? (5)
Mx

A
  1. Symptoms >4days
  2. Systemically unwell, but not requiring admission
  3. Immunocompromised
  4. <2yo with bilateral otitis media
  5. Perforation or discharge in ear

Abx amoxi - 5/7

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22
Q

Otitis media

Tympanic membrane signs:

A

Distinctly red, yellow, or cloudy and may be bulging.

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23
Q

Explain Rine’s + Weber’s

A

512Hz tuning fork

Rine’s air conduction (AC) should be better than bone conduction (BC) = positive test
If BC louder than AC = negative test and conductive hearing loss

Weber’s
Place on forehead
If louder on right side, could have right sided conductive hearing loss or left sided sensorineural hearing loss

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24
Q

What is Ramsay Hunt syndrome
Caused by?
Features (6)

A 
Herpes Zoster 
1. Paralysis of facial nerve
2. Rash around ear
3. Blisters can form in ear canal 
4. Tinnitus + vertigo 
5. Hearing loss
6. Auricular pain 
Rx oral aciclovir + steroids
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25
Q

Vertigo ddx (4)

A
  1. BPPV
  2. Meniere’s
  3. Vestibular neuronitis
  4. Viral labyrinthitis
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26
Q

Vertigo caused by excess build up of endolymph
Lasts minutes to hours
Caused by excess build up of endolymph
1. Hearing loss, increased hearing loss between attacks
2. Tinnitus
3. Aural fullness/ pressure (usually unilateral)
4. Not positional
5. Spontaneous nystagmus
6. Positive Romberg’s test

A

Meniere’s disease

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27
Q 
Vertigo
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
A

Viral labyrinthitis

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28
Q 
Vertigo
Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds
No hearing loss
A

BPPV

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29
Q 
Vertigo
Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss
Horizontal nystagmus
A

Vestibular neuronitis

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30
Q

Vertigo
Elderly patient
Dizziness on extension of neck

A

Vertebrobasilar ischaemia

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31
Q

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

A

Acoustic neuroma/ vestibular schwannomas

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32
Q

Mx Meniere’s (2)

Driving

A 
Acute
1. Buccal/ IM prochlorperazine
Prevention
2. Betahistine
Cease driving until satisfactory control of symptoms is achieved
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33
Q

Duration of symptoms
BPPV
Meniere’s
Vestibular neuronitis

A

BPPS 10-20seconds
Meniere’s minutes to hours
Vestibular neuronitis hours to days

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34
Q

What is the HINTS exam used for?

What two conditions does it differentiate between?

A

Patient with hours to days of vertigo and spontaneous nystagmus
To help differentiate between vestibular neuronitis and a stroke/ brain issue

35
Q

What is the HINTS exam and how is it interpreted?

A

Made up of three tests

  1. Nystagmus
  2. Vertical skew
  3. Head impulse test
  4. Has to be unidirectional
  5. Nil vertical skew
  6. Positive head impulse test
    All three above findings = neuronitis
36
Q

Vestibular neuronitis

Mx

A

Acute
1. Buccal/ IM prochlorperazine

Prevention
1. PO prochlorperazine or PO antihistamine e.g cinnarazine, cyclizine, promethazine

37
Q 
Viral labyrinthitis
Signs 
(Hint: uni or birectional nystagmus?) 
(hearing loss or no hearing loss) 
(head impulse test normal or abnormal) 
(gait)
(skew test normal or abnormal)
A
  1. spontaneous unidirectional horizontal nystagmus towards the unaffected side
  2. sensorineural hearing loss
  3. abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
  4. gait disturbance: the patient may fall towards the affected side
  5. normal skew test
38
Q

Tonsillitis complications (4)

A
  1. Otitis media
  2. Quincy - peritonsillar abscess
  3. RhF
  4. Glomerulonephritis
39
Q

Tonsillitis

When would you refer a patient to ENT for consideration of tonsillectomy? (3)

A
  1. Recurrent tonsillitis
    - 7 episodes / year for 1 year
    - 5 episodes / year for 2 years
    - 3 episodes / year for 3 years
  2. Obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
  3. Recurrent febrile convulsions secondary to tonsillitis
40
Q

When would you prescribe abx for tonsillitis?

Which abx in normal pt, in pregnant/ pen allergic pt, length of time?

A 
Group A Strep (GAS) has been confirmed on rapid antigen testing
OR
Fever PAIN score >=4 
OR
CENTOR score >=3

Phenoxymethylpenicillin or erythro if pregnant or pen allergic 7-10 days

41
Q

What is the most common bacterium causing tonsillitis?

A

Group A Strep

Strep pyogenes

42
Q

What is the CENTOR score used for?

What is the score?

A

To assess likelihood of GAS causing pharyngitis/ assess likelihood of tonsillitis caused by GAS

Can't cough (+1)
Exudate/ swelling (+1) 
Nodes - tender/ swollen ant cervical lymph nodes (+1) 
Temp >38 (+1) 
OR Age 3-14 (+1)  OR >= 45yo (-1)
43
Q

Indications for abx for a sore throat

A
  1. Significant systemic upset
  2. Unilateral peritonsitis
  3. Hx of rheumatic fever
  4. Increased risk from acute infection e.g T1DM or immunodeficient
  5. CENTOR score >=3
44
Q

FeverPain criteria

A

PACTS

Purulence/ exudate
Acute onset within 3 days 
Cannot cough 
Temperate >38 in last 24 hours 
Severely inflamed tonsils
45
Q

Moves upwards with protrusion of the tongue

A

Thyroglossal cyst

46
Q

Sudden-onset sensorineural hearing loss
What do you do next?
What investigation is needed to rule out which likely condition?
Mx

A

Refer to ENT
MRI internal auditory meatuses (IAM) to rule out acoustic neuroma aka vestibular schwannoma
High dose oral steroids

47
Q 
Onset is usually at 20-40 years
Conductive deafness
Tinnitus
Normal tympanic membrane although 10% of patients may have a 'flamingo tinge', caused by hyperaemia
Positive family history

AD/AR
Mx (2)

A

Otosclerosis
Replacement of normal bone by vascular spongy bone
AD
FH

  1. Hearing aid
  2. Stapedectomy
48
Q

Age-related sensorineural hearing loss.
Pts may describe difficulty following conversations
Audiometry shows bilateral high-frequency hearing loss
= which condition?

A

Presbycusis

49
Q

Workers in heavy industry are particularly at risk

Hearing loss is bilateral and typically is worse at frequencies of 3000-6000 Hz =

A

Noise damage

50
Q

Acoutstic neuromas affect which three CNs?

Which condition are bilateral acoustic neuromas seen in?

A

CN VIII: hearing loss, vertigo, tinnitus
CN V: absent corneal reflex
CN VII: facial palsy
Neurofibromatosis type 2

51
Q

Non pulsatile tinnitus versus pulsatile tinnitus

What is the difference in investigation required

A

Pulsatile requires magnetic resonance angiography (MRA) as likely vascular cause

Non pulsatile does not require imaging unless it is unilateral or there are other neurological or ontological signs

52
Q 
What is glue ear also known as? 
Age peak
Presenting feature
Conductive/ sensorineural 
Other features (3)
A 
Also known as otitis media with effusion
2yo 
Conductive hearing loss 
Other features
1. Speech and language delay
2. Behavioural 
3. Balance problems
53
Q

Glue Ear Mx

A
  1. Grommet insertion

2. Adenoidectomy

54
Q

What is geographic tongue?
M/F more common?
Features (2)

A

Benign condition
More common in females
Erythematous areas with a white-grey border (looks like outline of a map)
Burning after eating food

55
Q

Facial ‘fullness’ and tenderness

Nasal discharge, pyrexia or post-nasal drip leading to cough = which condition?

A

Sinusitis

56
Q

Four causes of gingival hyperplasia (three are drugs)

A
  1. AML
  2. Phenytoin
  3. Ciclosporin
  4. CCB especially nifedipine
57
Q

Hoarseness
Causes (7)
Ix to consider and why

A
  1. voice overuse
  2. smoking
  3. viral illness
  4. hypothyroidism
  5. gastro-oesophageal reflux
  6. laryngeal cancer
  7. lung cancer

CXR to rule out any apical lung pathology

58
Q

Epistaxis
Acute management if haemodynamically stable (2)
What can be given and why after successful termination of epistaxis (1)

A
  1. Sit torso forward, mouth open
  2. Pinch soft part of nose for 20 minutes, mouth breathing
    If successful
  3. Topical antiseptic such as naseptin/ mupirocin (to reduce crusting/ vestibulitis)
59
Q

Epistaxis

When would admission/ follow up be needed?

A

If has any comorbidities e.g

  1. HTN
  2. CAD
  3. <2yo as could have bleeding disorder
60
Q

Epistaxis

Acute management if initial management if unsuccessful and ongoing bleeding after 10-15 minutes

A
  1. Cautery - if source of bleed can be seen
    OR
  2. Packing - if done in GP, send to hospital for review
61
Q

Factors that increase risk of re-bleed - epistaxis (5)

A
  1. Blowing or picking the nose
  2. Heavy lifting
  3. Exercise
  4. Lying flat
  5. Drinking alcohol or hot drinks
62
Q

2ww to ENT for suspected laryngeal cancer criteria

A

> =45yo

  1. Persistent unexplained hoarseness
  2. Unexplained lump in the neck
63
Q

2WW to oral surgery criteria (6)

A
  1. Unexplained oral ulceration/ mass persisting >3 weeks
  2. Unexplained painful/ swollen/ bleeding red/white patches
  3. Unexplained one-sided pain in head/ neck >4 weeks, associated with ear ache and normal otoscopy
  4. Unexplained recent neck lump, or prev undiagnosed lump that has changed over 3-6 weeks
  5. Unexplained persistent sore or painful throat
  6. Signs in the mouth >6 weeks that are not benign
64
Q

2WW for oral cancer review by a dentist

A
  1. a lump on the lip or in the oral cavity

2. a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.

65
Q

What is hairy leukoplakia?
Common in which patient group?
Caused by?

A

White patch on side of tongue with hairy appearance
Common in immunocompromised
Caused by EBV

66
Q

Nasal polyps
M/F
Associated conditions (6)

A

2-4 times more common in men
Not commonly seen in children or elderly

Associations

  1. Asthma (particularly late-onset asthma)
  2. Aspirin sensitivity
  3. Infective sinusitis
  4. CF
  5. Kartagener’s syndrome
  6. Churg-Strauss syndrome
67
Q

What is Samter’s triad?

A

Association of asthma, aspirin sensitivity and nasal polyposis

68
Q

Nasal polyps
Features (4)
Mx (2)

A

Nasal obstruction
Rhinorrhoea
Sneezing
Poor sense of taste and smell

Mx

  1. ENT referral
  2. Topical corticosteroids (shrink polyp size)
69
Q 
Nasal septal haematoma 
Caused by?
Features (3) 
O/E:
How can you differentiate between a nasal haematoma versus deviated septum?
A
  1. Relatively minor trauma

Features

  1. Sensation of nasal obstruction
  2. Pain
  3. Rhinorrhoea

O/E: bilateral, red swelling arising from nasal septum

Nasal haematoma = boggy
Deviated septums = firm

70
Q

Nasal septal haematoma
Mx (2)
What can happen if left untreated?

A

Management

  1. surgical drainage
  2. intravenous antibiotics

Irreversible septal necrosis may develop within 3-4 days Can result in a ‘saddle-nose’ deformity

71
Q

Name the condition
Rubbery, painless lymphadenopathy
Pain whilst drinking alcohol (rare)
Night sweats and splenomegaly

A

Lymphoma

72
Q

Name the condition
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

A

Thyroglossal cyst

73
Q

Name the condition
More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough

A

Pharyngeal pouch

74
Q

Pulsatile lateral neck mass which doesn’t move on swallowing

A

Carotid aneurysm

75
Q

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

A

Branchial cyst

76
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
Transilluminable

A

Cystic hygroma

77
Q

Parotid gland causes
Bilateral (5)
Unilateral (3)

A

Bilateral causes

  1. viruses: mumps
  2. sarcoidosis
  3. Sjogren’s syndrome
  4. lymphoma
  5. alcoholic liver disease

Unilateral causes

  1. tumour: pleomorphic adenomas
  2. stones
  3. infection
78
Q

Features parotid gland swelling (2)

A
  1. Swelling and pain worse on eating or talking

2. May be associated fever and a foul taste

79
Q

Name three salivary glands
Which is most common for a tumour?
Which is most common for stones?

A

Parotid (tumour - most adenomas, malignant is rare)
Submandibular (stones)
Sublingual

80
Q 
Parotid tumours 
Most common type
Age 
Features (1)
Mx (1) 
Risk
A

Pleomorphic adenomas
Middle aged
Feature
1. slow growing, painless lump

Mx
1. Superficial parotidectomy
Risk = CN VII damage

81
Q 
Stones
Most common in which gland?
Features (1) 
Ix (2)
Name of condition if it becomes infected?
A

Submandibular (80%)

Features
1. Recurrent unilateral pain & swelling on eating

Infected → Ludwig’s angina

Ix

  1. Xray
  2. Sialography

Rx
Surgical removal

82
Q

What is Ludwig’s angina?

A

Rare bacterial skin infection that occurs on the floor of the mouth, underneath tongue.
Often occurs after a tooth abscess

83
Q

What is sicca syndrome also known as?

A

Sicca syndrome AKA Sjogren’s

84
Q

Retracted ear drum =

A

Glue ear

MSRA (22 decks)

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