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ENT Flashcards

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1
Q

Epistaxis management

recurrent + visible blood vessels on nasal septum bilaterally + NO active bleeding

A

1- nasal cautery @ 1 side or topical naseptin (chlorhexidine & neomycin)
Can’t do cautery on both sides at same time

Avoid cautery with silver nitrate when there is active bleeding

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2
Q

Epistaxis management

recurrent + visible blood vessels on nasal septum bilaterally + ACTIVE bleeding

A

anterior nasal packing bilaterally
- left for 24-48 hrs
Encourage mouth breathing

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3
Q

Oral lichen planus

Treatment

A

Lace like appearance
Topical steroids - benzydamine mouthwash/spray recommended
If extensive - oral steroids

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4
Q

Ear Foreign body removal

- insect

A

1- kill with 2% lidocaine/ olive oil/mineral oil or alcohol drops
Syringe out water irrigation or olive oil

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5
Q

Ear FB removal

- seed

A

Rapid access - not urgent referral to ENT
Removal by suction with catheter or by hook

Do not irrigate - can cause it to swell

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6
Q

Ear FB removal

-super glues

A

Remove manually in 1-2 days - after desquamation

Refer to ENT if eardrum involved

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7
Q

Ear was build up

A

Olive oil to soften hard wax

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8
Q

Batteries in ear

A

Refer ent , should be taken without 24 hrs

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9
Q

Any spherical object in the ear should be removed by. -

A

Hook

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10
Q

RFs for nasopharyngeal carcinoma

A

EBV
Smoking
Alcohol

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11
Q

Features of nasopharyngeal ca

A

Swollen cerviacal LNs - painless
Eustachian tube obstruction
CHL , tinnitus

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12
Q

Tonsil ca spreads to

A

Mandible

- pain in the throat + trismus - spasm of jaw muscles

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13
Q

Quinsy / peritonsillar abscess

Features

A 
Usually after hx of tonsillitis 
Severe trismus 
Drooling saliva 
Otalgia 
Uvular deviation 
Hot potato voice
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14
Q

Quinsy treatment

A

Admit for IV antibiotics - benzylpenicillin

I&D

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15
Q

Majority of sinusitis caused by

A

Viral infection

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16
Q

Treatment sinusitis

A

Mostly self limiting
Symptomatic relief
- nasal decongestant containing ephedrine
Paracetamol/ ibuprofen
Nasal steroids if sx >10 days w/o improvement

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17
Q

Plummer Vinson syndrome
Features (3)
It is a RF for -
Common in -

AKA Paterson Kelly / sideropenic dysphagia

A

IDA + gloss it is + dysphagia (due to post-cricoid oesophageal web )
Koilonychia

RF for oropharyngeal ca

Common in postmenopausal women

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18
Q

Treatment of Plummer Vinson

A

Balloon dilation

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19
Q

Paranasal sinus tumour

Features

A 
Pressure/pain/tenderness/swelling - cheek upper teeth 
Blood in nasal discharge 
Nasal obstruction 
Hx of chronic sinusitis 
If orbit involved - epiphora , diploia
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20
Q

Treatment otitis media

A

Viral - analgesics, supportive

Bacterial - oral amoxicillin

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21
Q

Otitis external
Features
Treatment

A

Itching - pain
Travel tenderness

T-
1- acetic acid 2%, 1 spray TID 7 days
2- topical gentamicin
3- aminoglycoside + topical corticosteroid 3 drops TID 7-14 days
Aminogly - gentamicin
= avoid if TM rupture - ototoxic ; use cipro instead

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22
Q

Fist investigation in ear trauma

A

Otoscopy

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23
Q

Investigation for mandibular lump / salivary gland mass

A

US FNAC

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24
Q

Chronic sialadenitis

A

Submandibular swelling - more painful and prominent on chewing
Usually 2ry to sialolithiasis
Sour taste in my mouth , dry mouth
Decreased jaw mobility

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25
Mikulicz syndrome
Triad of Symmetrical enlargement of all salivary glands Lacrimal gland enlargement - narrowing of palpebral fissures Dryness of mouth - parchment like 2ry to sarcoidosis , TB or lymphoma
26
Rinne test vs Weber test
``` Both use 512 hz Normal AC > BC twice as long Rinne: CHL - BC> AC SNHL - AC > BC - not twice as long ``` Weber : CHL - sound heard best in abnormal ear SNHL - hear best in normal ear
27
Ménière’s disease | Features
``` DVT + fullness Deafness - usually unilateral SNHL vertigo Tinnitus Fullness/ pressure in ear +/- nausea and vomiting Lasts mins to hrs ```
28
Treatment of Ménière’s
Prochlorperazine - buccal or IM Or Promethazine , cyclizine, cinnarizine
29
SNHL means | Investigations
Defect in cochlea - hair cells in inner ear , cochlear nerve or brain stem MRI
30
Vestibular neuritis Features Treatment
VN - vestibular nerves inflammation , vestibular neuropathy 3 Vs - vertigo, vomiting , viral URTI No hearing loss! Treatment - prochlorperazine
31
Labyrinthitis Features Treatment
Inflammation of vestibular nerve AND labyrinth Attacks of vertigo nausea and vomiting aggravated by moving head Preceded by URTI SNHL +- tinnitus
32
Vestibular neuritis vs BPPV
VN - hours - day s | BPPV - minutes
33
Otitis media with effusion / glue ear
Commonest cause of CHL in children TM - retracted (more common) or bulging - bluish gre , dull to yellow +- an air fluid level CHL
34
Treatment of OME
1st visit / recent dx - reassure and review in 3 months > 3 months & bilateral - grommets insertion - if CI - ear aids Advise parents to stop smoking
35
Commonest cause of progressive CHL in young adults (15-45 yrs old)
Otosclerosis
36
Bluish grey or yellow TM with air fluid level
OME
37
Flamingo pink blush TM (Schwartz sign)
Otosclerosis
38
Inflamed TM cartwheel appearance of vessels
Acute suppurative OM
39
``` Otosclerosis -cause - genetics -uni/bilateral - male:female -hearing loss Accelerated by ```
``` Increased stapes bony growth (turnover) 50% genetic 80% bilateral F>M 2:1 CHL Accelerated by - pregnancy ```
40
Otosclerosis treatment
No cure Stapedectomy or stapedotomy with prosthesis insertion Not fit for surger - bilateral hearing aids
41
Chalky white patches over eardrum
CHL
42
Acquired cholesteatoma Features Complications
Collection of keratinising squamous epithelium in middle ear Expands and can erode adj structures - TM perforation and ossicle damage Pearly white mass behind TM Chronic foul discharge. Hx recurrent otitis media CHL
43
Congenital vs acquired cholesteatoma
Congenital - child 6mo to 5 years | Usually no recurrent hx of OM or TM perforation
44
Management of cholesteatoma
Referral ENT for surgical removal
45
Acoustic neuroma / vestibular Schwannoma
``` Pressure effect on CN 8th - DVT deafness, vertigo, tinnitus 7- facial palsy/drooping 6- diplopia same side 5- loss of corneal reflex +- ICP sx ```
46
Imaging for Acoustic neuroma / vestibular Schwannoma
MRI cerebellopontine angle / MRI internal auditory meats | MRI brain
47
MRI in Ménière’s disease
Normal
48
Malignant otitis externa Usually caused by - Features-
``` Aggressive infection - NOT cancer Pseudomonas infection of auditory canal - gangrene & necrosis Necrosis can extend deep - facial n palsy 50% Severe pain , foul discharge, CHL ```
49
Malignant otitis externa Imaging Management
CT scan Urgent referral to ENT - it can be fatal 50% death if untreated IV antibiotics - cipro
50
Malignant otitis externa - important RF
Immunocompromised
51
Commonest organism in OM
RSV , rhinovirus H influenza S.pneumoniae S.pyogenes
52
Dx of BPPV
Hallpike’s manoeuvre
53
Epley’s manoeuvre
Treatment of BPPV BPPV mostly resolves spontaneously
54
BPPV involves what part of the ear
Posterior Semi circular canal - usually but not exclusively
55
BC >AC - bilateral; Weber not lateralised In a child , can’t hear teacher well in class Think of ___
OME
56
Hearing test in children | < 6 months
Otoacoustic emission | Audiological brainstem response
57
Hearing test | 6-18 mo
Distraction testing
58
2- 4 years | Hearing test
Speech discrimination or | Conditioned response audiometry
59
>5 - hearing test used
Pure tone audiogram
60
Ear furuncle - common organism -RFs Treatment
S. Aureus DM , immunocompromised Mostly resolves spontaneously Or give flucloxacillin If large - I & D
61
Furuncle vs carbuncle
Furuncle - infection of hair follicle | Carbuncle - group of hair follicles next
62
Arrange or refer for hearing assessment in following conditions (6)
Any parental concern about hearing loss at any time - despite normal tests before ! Professional doctor’s concern Temporal bone fracture Bacterial meningitis Severe unconjugated indirect hyperbilirubinemia Delayed speech and language milestones
63
Itching in ear followed by ear pain and serum discharge
Otitis externa
64
Nasal trauma Later develops nasal pain tenderness general malaise and fever Dx?
Nasal septal abscess | - possible infected nasal hematoma
65
Functional dysphonia
Voic disturbance in absence of any structural abnormality of larynx and vocal cords
66
Presbycusis | Features
``` Can’t hear high frequency sounds Affects elderly Bilateral SNHL Difficulty understanding speech and follow convo Poor hearing esp in noisy environment ```
67
Presbycusis treatment
Bilateral digital hearing aids that increase high frequency sound
68
Otosclerosis vs presbycusis
Otosclerosis - CHL, can’t hear LOW freq sounds Presbycusis - SNHL , can’t hear HIGH frequency sounds Oto - young 15-45 yrs , can hear better in noisy environments
69
First aid measure - epistaxis
Pinch nose - cartilaginous soft tissue , open mouth Hold 10-15 mins If hemodynamically unstable - send to a&e
70
Acute tonsillitis | Viral vs bacterial - centor criteria
``` Centor criteria 1- Fever >38 2- tender and enlarged anterior cervical LNs 3- tonsillar exudates/pus 4- no associated cough ```
71
1st line bacterial otitis media
Amoxicillin
72
1st line bacterial tonsillitis
Phenoxymethylpenicllin - penicillin V
73
1st line in bacterial sinusitis
Phenoxymethylpenicillin - penicillin V
74
Asthmatic patient on long term oral steroid | + hoarseness of voice
Think of laryngeal candidiasis 2ry to prolonged steroid intake.
75
Most common type of parotid tumour
Benign pleomorphic adenoma | = benign mixed tumour
76
Features of benign pleomorphic adenoma
``` Painless Firm Mobile Grows slowly Solitary Asymptomatic ```
77
Treatment benign pleomorphic adenoma
Superficial parotidectomy or enucleation
78
Risk of malignant transformation of benign pleomorphic adenoma
2-10% risk
79
Parotid enlargement | DDX
Sjögren’s syndrome | Mumps
80
Mumps is infective during what period | How long is the IP
7 days before and 9 days after parotid swelling starts | 14-21 days
81
Mumps complications
Orchitis Meningoencephalitis Pancreatitis Hearing loss - usually unilateral transient HL
82
Temporomandibular mandibular joint | Features
Pain in ear cheek mandible | Increases on chewing + bruxism
83
Noise induced hearing loss
2nd most common form of SNHL (1-presbycusis) Cause - exposure to loud sounds Form of occupational hearing loss - bilateral SNHL
84
Mixed hearing loss seen in
Paget’s disease | Osteogenesis imperfecta
85
Insect removal from ear Initial step Next step
Initial - kill with lidocaine or alcohol | Next - Instill mineral or olive oil
86
Indication for tonsillectomy
>7 episodes tonsillitis / year >5/yr for 2 years >3/year for 3 years
87
How do you know the TM is bulging?
Absent light reflex
88
RF for laryngeal ca
Smoking Asbestos, formaldehyde Poor fruit and veggie diet HPV16 - oral pharyngeal and laryngeal ca
89
Samter’s triad
Asthma + aspirin sensitivity + nasal polyps
90
Initial & gold standard diagnosis fro obstructive sleep apnoea
Initial - pulse oximetry, overnight breathing study pattern | Gold standard - polysomnography
91
Treatment OSA
Conservative - wt loss, reduce alcohol intake Mod/sever - CPAP = 1st line Rarely surgery to alleviate pharyngeal obstruction DVLA should be informed if its causing excessive daytime sleepiness
92
Complications of tonsillectomy
1ry bleeding - first 24 hrs = return to theatre 2ry /reactive bleeding - >24 hrs post op (1-10 days) - infection - admit for IV antibiotics Antiseptic mouth washes also indicated
93
Large hematoma of the ear pinna treatment
I&D | + co amoxiclav 1 week - prophylaxis
94
Buccal ulcer with palpable cervical LNs | Dx?
Think SCC
95
CHL seen in
``` Otosclerosis Tympanosclerosis OME “glue ear” Malignant otitis extrerna Cholesteatoma ```
96
SBHL seen in
Presbycusis Ménière’s disease Acoustic neuroma Noise induced hearing loss
97
Suspected ca pathway referral (appt within 2 weeks ) to ENT specialist considered for:
Aged 45 + older with “ Persistent unexplained hoarseness of voice >3 weeks Unexplained lump in neck
98
Perichondritis - organism - causes
Pseudomonas | Infection if hematoma, complication of severe otitis externa, laceration, mastoid surgery, high ear piercing
99
Perichondritis treatment
Oral ABx - fluoroquinolone +- aminoglycoside & semisynthetic penicillin
100
Fluoroquinolones:
Cipro Ofloxacin Levofloxacin
101
When should DVLA be informed in OSA
Already diagnosed mod-sever OSAor | Mild OSA diagnosed + excessive daytime sleepiness not controlled for >3 months
102
Nasal fracture dx
Imaging unreliable It’s a clinical diagnosis Speculum exam done
103
Treatment allergic rhinitis
Xylometazoline - intranasal - should not be used > 7 days - can cause rebound nasal congestion Advise pt to stop and medicine free interval
104
Antibiotic indicated in sinusitis
Phenoxymethylpenicillin If very unwell - co amoxiclav If allergic - doxy or clarithromycin

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