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FCM Y1 SGUL > ENT > Flashcards

ENT Flashcards

1
Q

otalgia
+ some children may tug or rub their ear
recent URTI
bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea

A

acute otitis media

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2
Q

management of acute otitis media

A

usually conservative - analgesia

in some exceptions/severe cases = amoxicillin is given for 5-7 days
eg if prolonged for 4 days, if immunocompromised or have a lot of systemic symptoms

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3
Q

pain
conductive hearing loss
tinnitus
vertigo

A

cerumen impaction

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4
Q

management of cerumen impaction

A

Initial management of earwax includes ear drops for 3–5 days initially, to soften wax.

If symptoms persist, ear irrigation can be considered, providing that there are no contraindications.

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5
Q 
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
vertigo
A

labyrinthitis

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6
Q

labyrinthitis

A

antiemetics or antihistamines

prochlorperazine or cyclizine

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7
Q

ear pain, itch, discharge

otoscopy: red, swollen, or eczematous canal

A

otitis externa

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8
Q

management of otitis externa

A

topical antibiotic or a combined topical antibiotic with a steroid
ciprofloxacin in diabetics
second line = flucloxacillin
analgesia for any pain

failure to respond to treatment = ENT referral

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9
Q

dizziness triggered by head movement ~10-20
room is spinning around them/still objects moving
associated nausea

A

Benign paroxysmal peripheral vertigo

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10
Q

diagnosis of BPPV

A

positive Dix Hallpike manoeuvre - rotatory nystagmus and vertigo)

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11
Q

management of BPPV

A

epley manoeuvre
betahistine

vestibular rehabilitation (brandt-Daroff exercises)

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12
Q

severe deep otalgia
temporal headaches
purulent otorrhoea
facial palsy

more common in elderly and diabetics

A

malignant otitis externa

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13
Q

Ix for malignant otitis externa

A

CT scan

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14
Q

management of malignancy otitis externa

A

IV Abx = ciprofloxacin

non-resolving otalgia = ENT referral

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15
Q 
severe otalgia behind the ear 
fever 
swelling and erythema 
tenderness over the mastoid process 
external ear protrudes forward
A

mastoiditis

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16
Q

management of mastoiditis

A

managed in hospital

usually IV broad spec antibiotics (Cefixime) for 1-2 days and then 1-2 weeks of oral ABx

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17
Q

‘glue ear’

usually 3-6year olds

A

chronic otitis media

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18
Q

management of chronic otitis media

A

offer otovent devices
myringotomy and insert grommets
recurrent = adenoidectomy

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19
Q

keratinising epithelium in the middle ear

usually longstanding eustachian tube dysfunction

A

cholesteatoma

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20
Q

cholesteatoma management

A

refer to ENT if suspected

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21
Q 
vertigo 
tinnitus 
sensorineural hearing loss
nystagmus 
usually unilateral 
aural fullness/pressure
A

meniere’s disease

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22
Q

management of meniere’s disease

A

confirm diagnosis at ENT
pt to inform DVLA

acute attacks = buccal/IM prochlorperazine

prevention/prophylaxis = betahistine and vestibular rehabilitation

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23
Q

hearing loss
vertigo
tinnitus
absent corneal reflex

A

acoustic neuroma

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24
Q

management of acoustic neuroma

A

ENT referral

Management is with either surgery, radiotherapy or observation.

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25
Q

Ix of choice for acoustic neuroma

A

MRI of the cerebellopontine angle is the investigation of choice. Audiometry is also important

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26
Q

hearing loss
may have some discharge

recent history of infection or trauma
loud noisy work/concert

A

perforated TM

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27
Q

management of perforated TM

A

no treatment is needed in the majority of cases as the tympanic membrane will usually heal 4-6 weeks
myringoplasty may be performed if the tympanic membrane does not heal by itself
advise to keep the ear dry

28
Q

facial pain - frontal pressure worsens it (leaning forward)
nasal discharge
nasal obstruction/congestion
some may have a low-grade fever and coryzal symptoms

recent infection/cold

A

acute sinusitis

29
Q

management of acute sinusitis

A

analgesia and intranasal decongestants/nasal saline
intranasal corticosteroids if persists for 10days+

severe cases - ABx = phenoxymethyl-penicillin or co-amoxiclav

30
Q

management of epistaxis

persistence for 10-15mins

A

first aid measures = sit with torso forward and mouth open whilst pinch cartilaginous area firmly
if unsuccessful consider topical antiseptic = naseptin

if persists for cautery & packing for a visualised anterior nosebleed - anaesthetic spray and packing needed for this

31
Q

nasal obstruction
rhinorrhea and sneezing
poor sense of smell/taste

more common in men and also in children/elderly

A

nasal polyps

32
Q

management of nasal polyps

A

referral to ENT & topical corticosteroids

33
Q 
sneezing 
clear nasal discharge 
bilateral nasal obstruction/congestion
post-nasal drip 
nasal pruritus
A

allergic rhinitis

34
Q

management of allergic rhinitis

A

oral/intranasal antihistamines
intranasal corticosteroids

and general allergen avoidance

35
Q 
facial pain 
nasal discharge 
nasal obstruction - mouth breathing 
post nasal drip - chronic cough
usually ongoing for 12 weeks
A

chronic sinusitis

36
Q

management of chronic sinusitis

A

intranasal corticosteroids
nasal irrigation with saline solution

allergen avoidance

37
Q 
otalgia 
unilateral serous otitis externa 
nasal obstruction, discharge of epistaxis 
cranial nerve (3-6) palsies 
cervical lymphadenopathy
A

Nasopharyngeal/oral cancers

38
Q

Ix for Nasopharyngeal/oral cancers

A

combined CT & MRI

39
Q

management of Nasopharyngeal/oral cancers

A

radiotherapy first line

40
Q

itchy feeling in the the throat, painful/sore and dysphagia

A

acute pharyngitis

41
Q 
inflamed/swollen/enlarged tonsils 
white exudate may be seen on the top of tonsils 
erythematous tonsils 
enlarged lymph nodes 
low grade fever 
dysphagia 
sore throat
A

acute tonsillitis

42
Q

Scoring FEVERpain & Centor criteria for tonsillitis

A

centor = tonsillar exudate, tender anterior cervical lymphadenopathy, hx of fever and absence of a cough

= 3-4 = 32-56% likely

feverpain = fever >38°
purulent exudate 
acute onset - within 3 days 
severely inflamed tonsils 
no cough/coryza

= 4-5 = 62-65% likely

43
Q

management of tonsilitis

A

paracetamol/ibuprofen
antibiotics not routinely indicated

if require Abx = penicillin 7-10 day course
or clarithromycin
(systemic upset, unilateral tonsillitis, hx of rheumatic fever, immunocompromised, 3+ on centor score)

44
Q 
acute rapid onset 
stridor 
drooling 
tripod position - leaning forward with neck extended 
muffled/hoarse voice 
blue skin/lips
A

epiglottitis

45
Q

Ix epiglottitis

A

thumb print/sign on X-ray

46
Q

Management of epiglottitis

A

immediate senior involvement - emergency airway support from anaesthetist
oxygen and IV Abx

47
Q

severe sore throat pain - lateralises to one side
deviation of uvula to unaffected side
trismus = difficulty opening mouth
reduced neck mobility

hx of tonsillitis

A

Quinsy/peritonsillar abscess

48
Q

management of quinsy

A

urgent review by ENT specialist
needle aspiration/Incision and drainage
IV Abx

potential tonsillectomy to prevent recurrence

49
Q

plaque like lesion cannot be rubbed away
bright white
sharply defined patches

more common in males and smokers
usually in 50s-70s

A

oral leukoplakia

50
Q

Ix/management oral leukoplakia

A

Biopsies are usually performed to exclude alternative diagnoses

51
Q

prodromal itching, pain and tingling in the lower mouth
initially vesicles
collapse into ulcers

often manifest as a result of recent illness/under stress, immunocompromised

A

Oral herpes simplex

52
Q

management of oral herpes simplex

A

topical antivirals (aciclovir) use as soon as symptoms begin - usually 5 days
(can also use chlorhexidine mouthwash)
topical pain relief

53
Q

usually preceding malaise, fever and headaches
can also have myalgia
bilateral swelling of parotid glands - near the ear

A

parotitis

54
Q

Ix for parotitis

A

Salivary IgM against mumps

55
Q

management of parotitis

A

mainly supportive - analgesia, fluids and bed rest

Prevention = MMR vaccine

56
Q

white patches on oral mucosa

can be wiped off - reveals a erythematous/bleeding base

A

oral candidiasis

57
Q

management of oral candidiasis

A

topical fluconazole

advise good oral hygiene

58
Q

clearly defined, painful, shallow, rounded ulcers

can be caused by trauma, stress, food allergies and hormonal changes

A

aphthous ulcer

59
Q

diagnosis of aphthous ulcer

A

usually diagnosis of exclusion

need to rule out = HSV, carcinoma, IBD or autoimmune disease

60
Q

management of aphthous ulcer

A

saline mouthwash
topical corticosteroids
avoid picking

61
Q

painful enlarged salivary gland
fever
decreased salivary secretion
purulent drainage from duct orifice

A

sialadenitis

62
Q

management of sialadenitis

A

hot/cold compress & massage
aggressive hydration
analgesia
lemon drops = promotes salivation

63
Q

sore throat
lymphadenopathy in the anterior/posterior triangles)
pyrexia/fever

sore throat/coryza
splenomegaly
hepatitis
palatal petechiae

A

glandular fever / infectious mononucleosis

64
Q

diagnosis of glandular fever

A 
maculopapular rash with amoxicillin use 
monospot test (2nd week of symptoms)
65
Q

management of glandular fever

A

conservative management

avoid contact sports for 8 weeks (avoid ruptured spleen)

66
Q

Pain (toothache) which can quickly become worse. It can be severe and throbbing.
Swelling of the gum, which can be tender.
Swelling of the face
malaise/temperature

A

dental abscess

67
Q

management of dental abscess

A

analgesia

refer to dentist to drain the abscess (lancing)

FCM Y1 SGUL (15 decks)

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