ENT Flashcards
(103 cards)
1
Q
When should you not give treatments for ear wax?
A
Grommits
Suspected perforation
2
Q
Treatment for ear wax
A
Olive oil
Sodium bicarb 5%
Almond oil
3
Q
Management of sudden onset sensorineural hearing loss
A
Urgent ENT referral
High dose steroids
MRI to exclude vestibular neuroma
4
Q
Associations with nasal polyps
A
Asthma
Aspirin sensitivity
Infective sinusitis
Cystic fibrosis
Kartagener’s syndrome
Churg Strauss syndrome
5
Q
Features of nasal polyps
A
Nasal obstruction
Rhinorrhoea
Sneezing
Poor taste and smell
6
Q
Red flags for nasal polyps
A
Unilateral symptoms
Bleeding
7
Q
Management of nasal polyps
A
ENT examination
Topical corticosteroids to shrink them
8
Q
When to 2ww refer patients with suspected laryngeal cancer?
A
Age over 45 with
- persistent hoarseness
- unexplained lump in the neck
9
Q
Causes of hoarseness
A
Voice overuse
Smoking
Viral illness
Hypothyroidism
GORD
Laryngeal cancer
Lung cancer
10
Q
When to 2ww refer patients with suspected oral cancer?
A
Unexplained ulceration in oral cavity >3 weeks
Persistent lump in neck
Lump on lip or oral cavity
Red/white patch in oral cavity consistent with
erythroplakia or erythroleukoplakia
11
Q
When to 2ww refer patients for suspected thyroid cancer?
A
Unexplained thyroid lump
12
Q
What is surfer’s ear called?
A
Exostosis
13
Q
What is exostosis also called?
A
Surfer’s ear
14
Q
Features of exostosis/surfer’s ear
A
Repeated ear infections
Decreased hearing
Water plugging
15
Q
Features of nasopharyngeal carcinoma
A
Cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge or epistaxis
Cranial nerve palsies
16
Q
Management of epistaxis if first aid is successful
A
Topical naseptin (Chlorhexidine and neomycin)
Reduces risk of vestibulitis and crusting
17
Q
Who can’t have naseptin?
A
Allergies to peanut, soy or neomycin
18
Q
Management of TMJ dysfunction
A
Soft foods
Simple analgesia
Short course of benzodiazepines
Review by dentist
19
Q
Complications of tonsillectomy
A
Pain
Haemohrragic
20
Q
Indications for tonsillectomy
A
5 or more episodes per year
Symptoms occurring for at least a year
Episodes are disabling and prevent normal functioning
21
Q
Inheritance of otosclerosis
A
autosomal dominant
22
Q
Features of otosclerosis
A
Onset age 20-40 Conductive deafness Tinnitus 10% have 'flamingo tinge' on TM Positive family history
23
Q
Management of otosclerosis
A
Hearing aid
Stapedectomy
24
Q
What does a nasal septal haematoma look like?
A
Bilateral red swelling from nasal septum
Septum firm
25
Consequences of nasal septal haematoma
Septal necrosis
| causes 'saddle nose' deformity
26
Criteria for adults to get a cochlear implant
3 month trial of hearing aids with no/little benefit
27
Where do you find a branchial cyst?
Lateral neck lump, anterior to sternocleidomastoid muscle
28
Features of branchial cyst
Unilateral (typically left)
Slowly enlarging
Smooth, soft, fluctuant
Non-tender
No movement on swallowing
No transillumination
29
Management of perforated tympanic membrane
None as will heal in 6-8 weeks
Avoid water in the ear
Review to ensure resolution and refer if doesn't
30
Management of auricular haematoma
Same day assessment by ENT
| I+D of haematoma to prevent 'cauliflower ear'
31
Causes of gingival hyperplasia
Phenytoin
Ciclosporin
CCBs e.g. nifedipine
Acute myeloid leukaemia
32
Explain the centor criteria
1 point for each:
- tonsillar exudate
- tender anterior cervical lymphadenopathy or lymphadenitis
- history of fever
- absence of cough
33
Centor criteria and the likelihood of isolating streptococci
0-2 = 3-17%
3-4 = up to 56%
34
Antibiotics for sore throat
Antibiotics if penicillin allergic
Phenoxymethylpenicillin
Clarithromycin if penicillin allergic
35
Sensorineural hearing loss on audiometry
AC and BC equally reduced
36
Mixed hearing loss on audiometry
AC and BC both reduced
| AC reduced more
37
What is Ramsay Hunt syndrome?
Reactivation of VZV in the 7th cranial nerve ganglion
38
Features of ramsay hunt syndrome
Auricular pain
Facial nerve palsy
Vesicular rash around ear
39
Management of ramsay hunt syndrome
oral aciclovir
| corticosteroids
40
Management of black hairy tongue
Tongue scrapping
| Topical antifungals if candida
41
Black hairy tongue - predisposing factors
Poor oral hygiene
Antibiotics
Head and neck radiation
HIV
IVDU
42
Management of simple gingivitis
Routine dental review
43
Management of acute necrotising ulcerative gingivitis
Refer to dentist
Start oral metronidazole
Chlorhexidine or hydrogen peroxide mouth wash
44
Features of acute necrotising ulcerative gingivitis
Painful bleeding gums with halitosis and punched out ulcers on gums
45
What is erythroplakia?
erythematous area on a mucous membrane that cannot be attributed to any other pathology
46
What is leukoplakia?
White area on a mucous membrane that cannot be attributed to any other cause
47
What is erythroleukoplakia?
Lesions on a mucous membrane that have white and red lesions, without obvious cause
48
Risks associated with erythroplakia
Transformation to squamous cell carcinoma is 50%
49
Risks associated with leukoplakia
Transformation to squamous cell carcinoma is 5%
50
What can you not prescribe with pseudoephedrine?
Monoamine oxidase inhibitor
Could cause hypertensive crisis
51
Red flags for oral ulcerations
Ulcer for >3 weeks
Unexplained red/white patches
Symptoms or signs persisting for more than 6 weeks and benign lesion can't be diagnosed
52
Management of mouth ulcers
Hydrocortisone lozenges
Antimicrobial mouthwash
Topical anaesthetic
53
Associations with mouth ulcers
Stopping smoking
Stress
High socioeconomic status
Oral trauma e.g. excessive brushes
Hormonal changes related to menstruation
54
Presentation of glue ear
Peaks at age 2
Presents with hearing loss
May have language delay, behavioural and balance problems
55
Management of allergic rhinitis
Mild - oral/intranasal antihistamines
Severe - intranasal steroids
Oral steroids for significant life events
56
1st line management of otitis externa
topical antibiotic with steroids
57
2nd line management of otitis externa
swab ear, clear debris, ear wick
empirical use of antifungal
oral flucloxicillin if spreading
58
Cholesteatoma - features
foul-smelling, non-resolving discharge
hearing loss
vertigo
facial nerve palsy
59
What is a cholesteatoma?
Non-cancerous growth of squamous epithelium that is trapped in skull base causing local destruction
60
Neck lumps - lymphoma features
Rubbery, painless lymphadenopathy
Night sweats
Splenomegaly
61
Neck lumps - thyroid swelling features
moves upwards on swallowing
62
Neck lumps - thyrogossal cyst features
<20 years old
midline
moves up on tongue protrusion
painful if infected
63
Neck lumps - carotid aneurysm features
pulsatile neck mass, doesn't move on swallowing
64
Neck lumps - pharyngeal pouch features
Older men
Gurgles on palpation
Dysphagia, regurgitation, aspiration, cough
65
Neck lumps - cystic hygroma features
Congenital lymphatic lesion
| Most are evident at birth, 90% present by age 2
66
Neck lumps - branchial cyst features
Oval mobile cystic mass
| Presents early adulthood
67
Main cause of a neck lump
Reactive lymph node
68
Features of viral labyrinthitis
Recent viral infection
Sudden onset
N+V
Hearing is affected
69
Drugs causing ototoxicity
Gentamicin
Furosemide
Aspirin
Cytotoxic agents
70
Features of vertebrobasilar ischaemia
Elderly patient
| Dizzy on extending neck
71
Meniere's disease - features
Recurrent episodes of vertigo, tinnitus and sensorineural hearing loss
Aural fullness
Nystagmus
Episodes last minutes to hours
Unilateral symptoms
72
Meniere's disease - acute attack management
buccal or IM prochlorperazine
73
Meniere's disease - DVLA rules
Tell DVLA
| Stop driving until symptoms well controlled
74
Meniere's disease - prevention of attacks
Beta histine
| Vestibular rehabilitation exercises
75
What is presbycusis?
Age-related sensorineural hearing loss
76
Presbycusis on audiometry
Bilateral high frequency hearing loss
77
Features of vestibular neuronitis
Recurrent vertigo attacks lasting hours/days
N+V
Horizontal nystagmus
hearing is NOT affected
78
Management of vestibular neuronitis
Prochlorperazine
| Vestibular rehabilitation exercises
79
What else is an acoustic neuroma called?
vestibular schwannoma
80
Acoustic neuroma - features
Vertigo, hearing loss, tinnitis (due to CN VIII)
Absent corneal reflex (due to CN V)
Facial palsy (due to CN VII)
81
What is associated with bilateral acoustic neuromas?
Neurofibromatosis type 2
82
Acoustic neuroma - investigations
MRI cerebellopontine angle
Audiometry abnormal in 95%
83
Malignant otitis externa - features
Diabetic or immunosuppressed
Severe unrelenting deep seated otalgia
Purulent otorrhoea
84
What is malignant otitis externa?
When infection spreads to become temporal bone osteomyelitis
85
What is laryngopharyngeal reflux?
gastro oesophageal reflux causes inflammatory changes to the larynx mucosa
86
Laryngopharyngeal reflux - symptoms
Lump in the throat "globus", worse when swallowing saliva
Hoarseness
Chronic cough
Dysphagia
Heartburn
Sore throat
87
Laryngopharyngeal reflux - red flags for urgent referral
Persistent unilateral throat discomfort
Dysphagia, odynophagia
Persistent hoarseness
88
Laryngopharyngeal reflux - management
Avoid fatty foods, caffeine, chocolate, alcohol
PPI
Sodium alginate liquids (gaviscon)
89
Chronic rhinosinusitis - features
Facial pain
Nasal discharge - clear
Nasal obstruction
Post-nasal drip
90
Chronic rhinosinusitis - management
Avoid allergen
Intranasal steroid
Nasal irrigation with saline solution
91
Chronic rhinosinusitis - red flags for urgent referral
Unilateral symptoms
Persistent symptoms despite 3 months of treatment
Epistaxis
92
Acute sinusitis - features
Facial pain
Nasal discharge - thick, purulent
Nasal obstruction
93
Acute sinusitis - management
Analgesia
Intranasal steroids if symptoms >10 days
Oral antibiotics if severe
94
Antibiotics for acute sinusitis
Phenoxymethylpenicillin
Co-amoxiclav if systemically unwell
95
Benign paroxysmal positional vertigo - features
Vertigo triggered by change in head position (e.g. rolling over in bed)
Associated with nausea
Episodes last 10-20 seconds
96
Benign paroxysmal positional vertigo - diagnosis
Dix-Hallpike manoeuvre causes rotatory nystagmus
97
Benign paroxysmal positional vertigo - management
```
Epley manoeuvre (successful in 80%)
Vestibular rehabilitation exercises - Brandt-Daroff exercises
```
98
What is the name of the vestibular rehabilitation exercises used in BPPV?
Brandt-Daroff exercises
99
Benign paroxysmal positional vertigo - prognosis
Usually self resolves over a few weeks/months
50% will have recurrence in 3-5 years
100
Acute otitis media - features
Otalgia
Fever in 50%
Hearing loss
Ear discharge if TM perforates
101
Acute otitis media - otoscopy findings
Bulging TM so loss of light reflex
Opacification/erythema of TM
Perforation with purulent otorrhoea
102
Indications for antibiotics in acute otitis media
Symptoms >4 days
Systemically unwell
Immunocompromised or significant co-morbidity
<2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
103
Antibiotic choice in acute otitis media
Antibiotic choice if penicillin allergic
Amoxicillin
Erythromycin if penicillin allergic
