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ENT Flashcards

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1
Q

Epistaxis that has failed all emergency management may require?

A

sphenopalatine ligation in theatre

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2
Q

causes of epistaxis?

A
  1. nose blowing/picking
  2. trauma/foreign bodies
  3. bleeding disorders; immune thrombocytopenia,waldenstorms macroglobulinemia
  4. juvenile angiofibroma
  5. cocaine
  6. hereditary haemorrhage telangiectasia
  7. granulomatosis with polyangitis
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3
Q

management of epistaxis

A
  1. torso forward and their mouth open
  2. Pinch the cartilaginous (soft) area of the nose firmly
  3. this should be done for at least 20 minutes
  4. also ask the patient to breathe through their mouth.

If first aid measures are successful
consider using a topical antiseptic (chlorhexidine and neomycin) to reduce crusting and the risk of vestibulitis
Mupirocin is a viable alternative

If bleeding does not stop after 10-15 minutes of continuous pressure on the nose consider cautery or packing;
cautery should be used initially if the source of the bleed is visible and cautery is tolerated

it is not so well-tolerated in younger children!

ask the patient to blow their nose in order to remove any clots. Be wary that bleeding may resume.
use a topical local anaesthetic spray (e.g. Co-phenylcaine) and wait 3-4 minutes for it to take effect
identify the bleeding point and apply the silver nitrate stick for 3-10 seconds until it becomes grey-white.only cauterise one side of the septum as there is a risk of perforation.

cautery is not viable or the bleeding point cannot be visualised.

anaesthetise with topical local anaesthetic spray (e.g. Co-phenylcaine) and wait for 3-4 minutes
pack the patient’s nose while they are sitting with their head forward,
examine the patient’s mouth and throat for any continuing bleeding, and consider packing the other nostril as this increases pressure on the septum and offending vessel.
patients should be admitted to hospital for observation and review, and to ENT if available

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4
Q

admission and follow up care may be considered in patients under if?

A

a comorbidity (e.g. coronary artery disease, or severe hypertension) is present, an underlying cause is suspected
they are aged under 2 years (as underlying causes such as haemophilia or leukaemia are more likely in this age group)

or bleeding not being stopped despite of measures taken above

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5
Q

first line antibiotic for tonsillitis?

and if penicillin allergic?

A

Phenoxymethylpenicillin(7-10 days)

Clarithromycin
both 7-10 days course

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6
Q

classic signs and symptoms of acute tonsillitis:

A

fever, sore throat and cervical lymphadenopathy.

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7
Q

Centor criteria;

Antibiotic be given immediately if the patient is scoring 3 or more

A
  1. presence of tonsillar exudate
  2. tender anterior cervical lymphadenopathy
  3. history of fever
  4. absence of cough
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8
Q

tx for EBV?

A

Analgesia and abundant fluid administration.

most commonly found in adolescents and not children,

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9
Q

Lateralization of weber test

A

in unilateral sensorineural deafness, sound is localised to the unaffected side

in unilateral conductive deafness, sound is localised to the affected side

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10
Q

Rinne test

A

tuning fork is placed over the mastoid process until the sound is no longer heard, followed by repositioning just over external acoustic meatus

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11
Q

Dix-Hallpike manoeuvre

A

Diagnostic

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12
Q

Epley manoeuvre

A

for tx

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13
Q

positive Dix-Hallpike manoeuvre, indicated by:

A

patient experiences vertigo
rotatory nystagmus

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14
Q

Tx of BPPV

A
  1. Epley manoeuvre
  2. vestibular rehabilitation exercises, for example
    Brandt-Daroff exercises
  3. Medication;betahistine
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15
Q

risk factors for ch rhino sinusitis

A

papa 1. atopy: hay fever, asthma
you 2. nasal obstruction e.g. Septal deviation or nasal polyps
3. recent local infection e.g. Rhinitis or dental extraction
4. swimming/diving
5. smoking

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16
Q

features of ch rhinosinusitis

A

frontal pressure pain which is worse on bending forward

nasal discharge:
usually clear if allergic
thicker, purulent discharge suggests secondary infection

nasal obstruction: e.g. ‘mouth breathing’

post-nasal drip

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17
Q

Management of recurrent or chronic sinusitis

A
  1. avoid allergen/smoking cessation
  2. 3 months course of intranasal corticosteroids(fluticasone for mometasone)
  3. nasal irrigation with saline solution
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18
Q

Red flags symptoms of ch rhino sinusitis.

‘Unilateral’ symptoms like rt sided nasal observation with rhinoorhea/bleeding/blood stained discharge we have to refer to ENT

A
  1. unilateral symptoms(suspicion of neoplasia)
  2. persistent symptoms despite compliance with 3 months of treatment
  3. epistaxis
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19
Q

when should we refer a pt to ent who has persistent sore throat and smoking history.

A

sore throat for more than 4 weeks

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20
Q

features associated with head and neck cancer

A

neck lump
hoarseness
persistent sore throat
persistent mouth ulcer

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21
Q

to find out if we should prescribe antibiotics for a sore throat pt use what?

A

cantor criteria

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22
Q

Indications for antibiotics in ENT?

A
  1. features of marked systemic upset secondary to the acute sore throat
  2. unilateral peritonsillitis
  3. a history of rheumatic fever
  4. an increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency)
  5. patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
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23
Q

1-month-history of severe, unrelenting otalgia, associated with temporal headaches and purulent otorrhoea. She has a past medical history of type one diabetes mellitus
Examination identifies an erythematous external auditory canal and periauricular soft tissue on the left side which is exquisitely tender.
Painful tragus on touching.
dx?

A

Otitis extrerna

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24
Q

what do we treat otitis extena in diabetics/immunocomrpomised with?

what is the treatment of otitis externa(pt coming from Spain,having itchy and sore throat, visible tympanic membrane and no discharge)?

A

I/v cipro

topical corticosteroid and aminoglycoside.

and if tympanic membrane is perforated,aminoglycosides are not used.

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25
what causes otitis externa?
pseudomonas areginosa
26
if otitis externa is left untreated it leads to?
temporal bone osteomyelitis
27
tets for otitis externa?
ct scan
28
when will the pt be referred urgently to ENT incase of otitis external?
non-resolving otitis externa with worsening pain
29
Acute unilateral sensorineural hearing loss developed (within 30 days) is an emergency and requires referral(same day) to ENT for audiology assessment and brain MRI. And in case of more than 30 days urgent referral to ENT. WHY?
This is because serious pathology such as a vestibular schwannoma needs to be ruled out immediately high dose steroids (60mg/day) for seven days improves prognosis, so all patients should start treatment as soon as possible.
30
Where problems are associated with wax accumulation, topical treatments such as what are affective?
olive oil can be tried first to soften the wax. t
31
tx for all cases of SNHL?
HIGH dose oral steroids
32
chronic, smelly ear discharge and recurrent glue ear HL no otalgia dx?
Cholesteatoma; Otoscopy; pearly white lump 'attic crust' - seen in the uppermost part of the ear drum Management patients are referred to ENT for consideration of surgical removal
33
ear pain itching occasionally discharge from the affected ear. affects swimmers. It can cause a conductive hearing loss dx?
Otitis externa
34
20-40 years strong family history of early-onset hearing loss. progressive conductive hearing loss and tinnitus Normal tympanic membrane, sometimes flamingo tinge. dx? and tx?
Otosclerosis Hearing aid and stapedectomy
35
Patients may be asymptomatic unilateral conductive hearing loss. chalky patch on the tympanic membrane seen on otoscopy or there may be total middle ear destruction. dx?
Tympanosclerosis
36
reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve. DX?
Ramsay Hunt Syndrome/Herpes Zoster Oticus
37
Ramsay Hunt Syndrome/Herpes Zoster Oticus Features?
1. auricular pain is often the first feature 2. facial nerve palsy 3. vesicular rash(red spots) around the ear;ear canal or soft palate) other features include 4. vertigo and tinnitus
38
tx of Ramsay Hunt Synd?
"oral aciclovir"(not I/V) and corticosteroids are usually given
39
what is glue ear?
otitis media with an effusion/serous otitis media tympanic membrane is retracted. peaks at age 2 Conductive hearing loss is usually the presenting feature
40
risk factors for glue ear?
male sex siblings with glue ear higher incidence in Winter and Spring bottle feeding day care attendance parental smoking
41
tx for glue ear?
management; referral for hearing test/ENT IF EDUCATION OR LIFESTYLE IS BEING AFFECTED BY THE SYMPTOMS otherwise (children should be observed for 6-12 weeks as symptoms are normally self-limiting and referral should be reserved if symptoms persist beyond this period. ) def tx; grommet insertion Adenoidectomy
42
causes of otitis externa
bacteria; staph aureus, pseudomonas sebborhic or contact dermatitis Recent swimming
43
treatment of otitis externa
topical ab or combined topical ab with a steroid OR Alternatively, aluminium acetate drops can be as effective as antibiotics drops. 2nd line; oral flux. If a patient fails to respond to topical antibiotics then the patient should be referred to ENT. if they think it has extended to be a malignant otitis external then I/v antibiotics should be used
44
when should we refer the pts to ENT incase of polyps?
all patients with suspected nasal polyps should be referred to ENT for a full examination. OR If there is a unilateral polyp causing symptoms of post nasal drip, nasal obstruction(because incase of unilat we need to r/o malignancy).
45
Samters triad?
he association of asthma, aspirin sensitivity and nasal polyposis
46
small bilateral nasal polyps are seen these can be treated in primary care with a
saline nasal douche and intranasal steroids
47
1 of the example of CHL
Otosclerosis; tympanic members,flamingo tinge positive family hx
48
1 of the example of SNHL
Presbycusis; Age related progressive b/l HL at high frequencies. No erythema and tympanic membrane is intact on tympanometry. Word recognition is relatively preserved, but many eventually develop poor word distinction (particularly in crowded, noisy settings). Need for increased volume on the television or radio Difficulty using the telephone Downward-sloping of pure tone thresholds.
49
PEAKS AT 2 age HL is the presenting feature comments cause of CHL in children DX?
Glue ear
50
Drug ototoxicity is caused by?
FAG; aminoglycosides (e.g. Gentamicin), furosemide(NOT BENDRO), aspirin and a number of cytotoxic agents
51
A history of unilateral earache with no obvious cause/unremarkable otoscope, persisting for more than 4 weeks warrants referral to ENT under the 2-week wait to investigated for possible underlying malignancy. This is especially important in a smoker, who is at greater risk for head and neck malignancy.
52
Features of otitis media
1. acute onset 2. Otalgia 3. Fever 4. HL 5. otoscopy findings; bulging tympanic membrane; loss of light reflex/ erythema of tympanic memb/ perforation with purulent otorrhea
53
which antibiotic to treat otitis media perforated tympanic membrane and otitis media are 2 diff things; perforation is when only tympanic membrane is torn, developed a whole and otitis media is when an infection develops in the middle ear through that. Treatment of perforated tympanic membrane due to otitis media where the members is not visible due to discharge.
5-7 day course of amoxicillin is first-line. In patients with penicillin allergy, erythromycin or clarithromycin should be given. INDICATIONS; 1. But we only give antibiotics incase of infection persisting for more than 4 days. 2. Systemically unwell but not requiring admission. 3. Immunocompromised. 4. Younger than 2 years with bilateral otitis media 5. Otitis media with perforation and/or discharge in the canal will usually heal after 6-8 weeks, avoid getting water in the ear during this time. myringoplasty may be performed if the tympanic membrane does not heal by itself
54
pathophysiology of otitis media
Secondary to bacteria, particularly Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
55
initial and 2nd line management of epistaxis in children
pinch nasal bones and bend forwards for 20mins if unsuccessful nasal packing
56
difference between vestibular neuritis viral labrynthitis BPPV and Meniere's dis
BPPV episodes lasts for = few mins VN; episodes of dizziness, nausea and vertigo lasts =only for hours viral labrynthitis; =constant symptoms of a shorter duration (1. prolonged and persistent for the first few days, rest can not take it away 2.hearing loss might occur BUT VERY RARE 3. comes on suddenly after a recent viral infection) Menieres dis; lasting mins to hrs vertigo,vomiting,aural fullness, hl,tinnitus scenario like dizziness/vertigo plus hearing loss for hours? meniere's or labrynthitis meniere's because labrynthtitis rarely causes HL
57
how to differentiate VN fro m other causes of vertigo?
In VN there's is only nausea, vertigo,horizontal nystagmus BUT NO tinnitus and HL
58
How to differentiate between vestibular neuritis and PCStroke
HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke
59
tx of VN?
Chronic prob; rehab exercises. Acute rapid relief; I/M or buccal prochlorperazine. In less severe cases; short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine).
60
causes of hoarseness
MOUTH AREA; voice overuse smoking viral illness NECK AREA hypothyroidism gastro-oesophageal reflux CANCERS laryngeal cancer lung cancer
61
When investigating patients with hoarseness, which investigtation should not be forgotten?
chest x-ray should be considered to exclude apical lung lesions.
62
what is sialdinitis?
inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct. The duct from the submandibular gland drain into the floor of the mouth and purulent discharge from this duct causes a foul taste in the mouth.
63
what kind of tumours are pleomorphic adenoma?
common in middle age slow growing, painless lump
64
what kind of tumour is warthin's tumour?
males, middle age softer, more mobile and fluctuant
65
most common tumour in mouth is?
sabmandibular
66
what is an ear canal bony growth that is seen most commonly in cold-water swimmers
osteoma
67
symptoms of osteomalacia
ear pain an eventual cond hearing loss
68
causes of presbycusis
diabetes genetics drug exposure(Salicylates, chemotherapy agents stress
69
facial pain behind the nose throbbing in nature frontal pressure exacerbation on leaning forward dx?
sinusitis
70
acute sinusitis time period?
10 days
71
tx for acute sinusitis
antibiotics are not indicated analgesia abundant fluids intranasal decongestants or nor saline
72
symptoms of acute sinusitis more than 10 days tx?
intranasal corticosteroids or phenoxymethylpenicillin first-line co-amoxiclav if 'systemically very unwell 'double-sickening' may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection
73
sinusitis is caused by which organisms?
Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.
74
in case of malignant otitis externa?
I/V antibiotics are required unlike the simple otitis externa
75
All mouth ulcers persisting for greater than 3 weeks should be sent to?
oral surgery as a 2 week wait referral.
76
which other lesions or problems warrants a referral to oral surgery as a 2 week wait referral?
1. Unexplained red, or red and white patches that are painful, swollen or bleeding. 2. Unexplained one-sided pain in the head and neck area for greater than 4 weeks, which is associated with ear ache, but does not result in any abnormal findings on otoscopy 3. Unexplained persistent sore or painful throat
77
Predisposing factors of hairy tongue?
poor oral hygiene antibiotics head and neck radiation HIV intravenous drug use
78
some facts about meniere's disease.
equal incidence in both males and females rhomerg's test is positive symptoms resolve in the majority of patients after 5-10 years. ENT assessment is required to confirm the diagnosis patients should inform the DVLA. acute attack; buccal or intramuscular prochlorperazine. prevention: betahistine and vestibular rehabilitation exercises may be of benefit
79
only HL with no pain or discharge but with left middle ear effusion. dx?
glue ear/otitis media with effusion
80
management of glue ear in an adult(usually it is more common in children peak age 2)
refer to ENT as 2 week wait to r/o tumours in post nasal space which are blocking the Eustachian tube.
81
Parotid gland swelling b/l causes?
1. viruses: mumps(but it resolves within days so the history in stem will be short) 2. sarcoidosis (look for pulmonary symptoms like dry cough and night sweats in the stem) 3. Sjogren's syndrome(no pul symps) 4. lymphoma 5. alcoholic liver disease
82
Parotid gland swelling unilateral causes?
1. tumour: pleomorphic adenomas 2. stones 3. infection
83
otoscopy is for?
infections
84
audiogram is for?
meniere's dis management strategies if there is a suspicion of meniere's disease; if the prominent symptom is hl over the vertigo/tinnitus attacks=then the first thing to do is to refer for audiogram. if the complaints are general like vertigo, tinnitus and hl then the first thing to do id to refer to ent.
85
dizziness, vertigo triggered by position,after 55,no nystagmus at present. Which test is the best?
Dix Halpike. pehlay nystagmus nae hota lekin is test mein ho jata hai rotatory nytsagmus aur dizziness wagera js say ye show hota hai k dx confirm ho gaya hai BPPV ka
86
tympanic membrane retracted
in glue ear
87
MIDDLE EAR OSTEOMA can cause ?
Nerve paresis
88
repeated otitis media can lead to ?
cholesteatoma
89
how do nasal tumours present?
nosebleeds persistent blocked nose blood stained mucus draining from the nose and a decreased sense of smell.
90
bg of hypercholetsrolemia and ex smoker room spinning nausea constant dizziness high bp nystagmus mild past pointing and dysdiadokokinesia dx?
post stroke an urgent hosp admission is needed to get an MRI done after CT Head as MRI is more affective at visualizing post part of the brain
91
which drug causes gingival hyperplasia?
****phenytoin**** cal channel blockers ciclosporin
92
which cord cause gingival hyperplasia?
AML
93
All the causes of CHL
C2GO3T; Cholesteatma cerumen impaction glue ear otitis externa otitis media with effusion otosclerosis tympanosclerosis
94
causes of SNHL
presbycusis stickler syndrome acoustic neuroma VN VL Menieres
95
HI -> bilateral red swelling arising from the midline, which is slightly boggy. No other signs of a head injury are seen. What is the most appropriate management
NOTES FROM PLAB :( minor trauma bilateral red swelling in the nose causing nasal obstruction boggy in nature tx; drain and abs comps if untreated: necrosis, abcess, saddle nose deformity
96
Tender around temples Raised ESR DX?
Temporal arteritis
97
complications of otitis media
perforation of tympanic membrane leading to otorrhea HL Labrynthitis (we have to refer to the secondary in the following complications if developed as a result of primary prob;otitis media) mastoiditis(ear displaced anteriorly) meningitis brain access facial nerve paralysis
98
Uncomplicated tympanic membrane perforation
managed with watchful waiting for a month. Most perforations will resolve spontaneously in 4-8 weeks.
99
Interpretation of Rinne and Weber tests
normal; air conduction is better than bone conduction on rings test and the weber test will be midline,lateralzed to both of the ears. CHL; rinnes=bone conduction >air cond weber=lateralizes to the affected side SNHL; rinnes=air conduction>bone cond weber will lateralize to the unaffected side.
100
common cause of speech and language delay in young children
Glue ear
101
geographic tongue management?
is benign reassurance
102
Notes from PLAB :(
Epidermoid Cyst; firm, round,central puncutm Cystic hygromas; congenital lymphatic lesion, left side lump on neck or axilla, soft ,painless, transilluminate brightly. Usually presents before 2 years of age. Branchial cleft cyst; smooth,painless,do not transilluminate. usually present in adulthood lymphoma; fever,wt loss, night sweats, spleenomegaly differentiate it from tb, painless rubbery lymph nodes thyroid swelling; moves upward on swallowing thyroglossal cyst; moves on tongue protrusion carotid aneurysm; pulsatile, does not move on swallowing. cervical rib=10% develop thoracic outlet synd phatrygeal pouch=dysphagia,aspiration,regurg,cough reactive lymphadenopathy; hx of local infections
103
which condition categorised in CHL worsens in pregnancy?
Otosclerosis
104
otosclerosis is associated with which genetic category?
autosomal dominant
105
otosclerosis happens during which age group?
20-40yrs
106
could otosclerosis be b/l?
yes it can cause b/l CHL
107
tx of otosclerosis
hearing aid stapedectomy
108
A 54-year-old male smoker one day history of sore throat hoarse voice. no cough. He has been unable to swallow for the last 3 hours and is temperature of 38ºC. He has trismus. oropharynx; no obvious abnormality and his tonsils are normal. bilateral cervical lymphadenopathy Dx?
Acute sore throat with no obvious oropharyngeal signs, associated with symptoms such as inability to swallow, sepsis, or trismus warrants urgent ENT evaluation to look for a deeper airway infection (e.g. supraglottitis)
109
Tx of Suproglottitis
IV antibiotics IV dexamethasone adrenaline nebulisers. Patients should be in an airway monitored bed (ENT ward) or ITU if required.
110
people who have a history of glandular fever and have received amoxicillin
a non allergic maculopapular rash can develop.
111
Unilateral facial nerve palsy with sparing of the forehead cause?
sparing of the forehead means that the patient is able to raise the eyebrows. Possible CVA
112
U/l facial nerve palsy with forehead being affected ?cause
Bells palsy

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