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PLABABLE 2.0 > ENT > Flashcards

ENT Flashcards

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1
Q

Management of recurrent epistaxis with visible blood vessels in the anteroinferior part of the nasal septum BILATERALLY + NO active bleeding.

A

Nasal cautery at ONE side of the septum initially

If no active bleeding: Topical treatment with Naseptin (Chlorhexidine + Neomycin)

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2
Q

Why is cautery with silver nitrate not advised when there is active bleeding in the mgt of epistaxis?

A

AgNO3 will just be washed out if there is active bleeding

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3
Q

Why is cautery not done bilaterally if the active bleeding is noted on both nostrils?

A

There is risk of septal perforation if you do cautery on both sides

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4
Q

Mgt of recurrent epistaxis with visible blood vessels in the anteroinferior part of the nasal septum bilaterally + ACTIVELY bleeding on presentation to GP

A

Anterior nasal packing BILATERALLY

Instruct the patient to breathe per mouth. Nasal packing is left in for 24-48 hours

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5
Q

Important risk factor for oral thrush

A

Immunosuppresion (recent use of antibiotics, long-term steroids intake, DM)

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6
Q

Differentiate leukoplakia from oral thrush in terms of rubbing out of the white marks

A

Oral thrush - can be rubbed out

Leukoplakia - cannot be rubbed out

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7
Q

What is the management for oral thrush?

A

If patient is a smoker, stop smoking.
Good inhaler technique if patient uses inhaler. (Spacer device and rinse mouth with water every inhalation).
Oral Fluconazole 50mg x 7 days or Fluconazole oral suspension

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8
Q

Management for Leukoplakia

A

Stop smoking and BIOPSY (leukoplakia is pre-malignant)

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9
Q

Mainstay of treatment for oral lichen planus (purple, pruritic, polygonal, papular rash)

A

Topical steroids

For oral lichen planus - benzydamine gargle or spray

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10
Q

Ear foreign body removal: insect

A

Kill with lidocaine or olive oil or mineral oil then water irrigation

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11
Q

Ear foreign body removal: Seeds

A

Suction by catheter or hook

NO-NO to instill oil as it would be more difficult to remove

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12
Q

Ear foreign body removal: Super glue

A

Can be removed after 1-2 days after desquamation

BUT! Refer to ENT if ear drum is involved

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13
Q

Earwax buildup

A

Instill olive oil to soften hard wax

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14
Q

Batteries inside the ear

A

Refer to ENT, they should be removed within 24 hours

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15
Q

Any spherical object inside the ear

A

Remove by a hook

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16
Q

Swollen cervical lymph nodes (painless lump in the upper neck) + eustachian tube obstruction (recurrent nasal bleeds, nasal obstruction, otitis media) + conductive HL + tinnitus

A

Nasopharyngeal CA

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17
Q

Persistent sore throat over weeks + progressive hoarseness of voice + dysphagia + feeling of a persistent lump in the throat + palpable lump in the anterolateral portion of the neck

A

Tonsil carcinoma

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18
Q

Tonsilar cancer patient presents with pain in the throat + trismus

A

Cancer might have spread to the Mandible

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19
Q

Post-tonsillitis or sore throat + drooling of saliva + otalgia + hot potato voice + uvular deviation

A

Peritonsillar abscess

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20
Q

DIG of Plummer-Vinson syndrome

A

Dysphagia
Iron-deficiency Anemia
Glossitis

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21
Q

Why is PVS importanT?

A

Risk factor for oropharyngeal CA. Common in post-menopausal women

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22
Q

Treatment for otiitis externa

A

Topical Gentamicin + Hydrocortisone

OR

Acetic acid

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23
Q

Significant in the history of a patient who presents with otitis externa

A

History of travel, swimming or high humidity + Initial complaint of itching followed by pain in the ear

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24
Q

First investigation for a patient who sustained trauma to the ear presenting with intense otalgia, bleeding from the ear, tinnitus and temporary hearing loss

A

Otoscopy (to rule out TM perforation)

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25
According to the guidelines in England, this is the 1st line treatment for otitis externa. 2nd line?
1st line - Acetic acid 2% spray | 2nd line - topical Gentamicin + Hydrocortisone
26
Usual metastatic spread of tonsillar carcinoma
Mandible Remember that tonsillar carcinoma presents with long-standing dysphagia with hoarseness of voice. If this patient, presents with trismus, suspect metastatic spread to the mandible.
27
Investigation of choice for mandibular lumps and salivary gland masses
Fine needle aspiration cytology
28
Secondary to sarcoidosis, TB or lymphoma, this presents with a triad of dry mouth, dry eyes and enlarged salivary glands
Miculikz syndrome
29
Swelling in the submandibular region + pain aggravated when chewing + sour taste in the mouth + decreased mobility of jaw
Chronic sialadenitis
30
Symptoms of Meniere’s disease
DVT + Fullness Deafness + Vertigo + Tinnitus + Fullness *** fullness is more specific for Meniere’s disease (BUT!!! Important to remember that when fullnesss is associated with cranial nerve involvement, think of acoustic neuroma
31
How does SNHL in the left ear present with Rinne and Webber?
Rinne: AC > BC | Weber lateralises to the RIGHT
32
What do you request if a patient presents with sensorineural hearing loss?
MRI (NOT otoscopy)
33
AC > BC, what are the two only possible diagnoses?
Normal (no Weber lateralisation) | SNHL (Weber lateralisation to the opposite side of the lesion)
34
Differentiate vestibular neuritis from labyrinthitis.
Both present with 3Vs: vertigo, viral URTI and vomiting. Labyrinthitis: presents with TINNITUS AND HEARING LOSS
35
Commonest cause of conductive hearing loss in children. Diagnostic test of choice. Management?
Otitis Media with effusion Audiogram Advice patients to stop smoking (if parents are smokers) Other Management: If first visit or recent diagnosis: REASSURE (spontaneously resolves) If persists over 3 mos: Grommets insertion IF surgery is contraindicated or rejected: Hearing aid
36
What is the indication of hearing aid for patients who present with acute otitis media with effusion?
If surgery is rejected or contraindicated
37
When would you offer Gommets insertion for a patient who presents with Otitis media with effusion?
If otitis media persists after three months
38
Chalky white patches over the eardrum
Tympanosclerosis
39
Common cause of malignant otitis externa | Drug of choice
Pseudomonas | Ciprofloxacin
40
Diagnostic test of choice for malignant otitis externa
CT scan
41
Commonest viral cause of otitis media
RSV
42
Painless lump in the anterior midline neck + moves with tongue protrusion
Thyroglossal duct cyst
43
Fluctuant lump that transilluminates
Cystic hygroma
44
Lump that moves up with swallowing
Goitre vs. Large thyroid nodule
45
Hearing test for patient below 6 months
OAE or ABR
46
When is distraction testing used for hearing test?
6-18 months
47
Hearing test indicated for 2-4 years old
Speech Discrimination | Or Conditioned Response Audiometry
48
Hearing test indicated for more than 5 years
Pure Tone Audiogram
49
In laryngitis, weakness of voice occurs AFTER or DURING respiratory infection?
DURING
50
When do you start phenoxymethylpenicllin as treatment for acute tonsillitis?
3 out 4 Centor Criteria = bacterial tonsillitis 1. T > 37.8 2. Tender and enlarged anterior cervical LNs 3. Tonsillar exudates/pus 4. No associated cough
51
Asymptomatic + solitary, painless, firm and mobile swelling at the angle of mandible which grows very slowly? Management?
Superificial parotidectomy OR enucleation Likely Pleomorphic adenoma - most common cause of salivary gland tumor which appears as a lump just behind the angle of the mandible
52
DVT vs 3Vs
DVT - Meniere’s disease vs. acoustic neuroma | 3Vs - vestibular neuritis vs. labyrinthitis
53
Elderly + Smoker + dysphagia + unilateral otalgia + unilateral red lesion with central ulcer that bleeds on touch
Tonsillar Cancer
54
Indications of tonsillectomy
7,5,3 for 1,2,3 7 episodes per year for 1 year 5 episodes per year for 2 years 3 episodes per year for 3 years
55
Appropriate test for deafness in neonates
ABR
56
Differentiate presbycusis from otosclerosis
Presbycusis - elderly - hearing loss in noisy environment - sensorineural Otosclerosis - young adult - conductive - hearing loss in quiet environment - (+) family history
57
Hoarseness of voice + HISTORY of smoking
Always suspect Laryngeal Cancer
58
Gold standard for the diagnosis of obstructive sleep apnea
Polysomnography
59
Initial diagnostic test for OSA
Pulse oximetry, overnight study of breathing pattern
60
Conservative treatment of OSA
Weight reduction | Or decrease alcohol intake
61
1st line treatment for moderate to severe OSA
CPAP
62
How do you manage tonsillectomy complications?
Within the first 24 hours after tonsillectomy, if patient presents with bleeding, patient must be returned back to OR theatre as the following may possibilities may have occurred: displaced tie, inadequate hemostasis and loss of eschar. From Days 2-10, if patient presents with bleeding after tonsillectomy, patient must be admitted and given IV antibiotics.
63
Hoarseness of the voice + smoker + white patch leukoplakia in the vocal cords
MSD of the larynx (mild squamous dysplasia) Mgt: Stop smoking REMEMBER!!! Hoarseness in a smoker, you have to rule out laryngeal cancer. Mild squamous dysplasia of the larynx presents with hoarseness of the voice with accompanying white patch leukoplakia in the vocal cords with a patient with a significant history of smoking.
64
When should DVLA be informed regarding your patient with OSA?
If patient is diagnosed with moderate to severe OSA. | If patient is diagnosed with mild OSA, however, patient still has excessive sleepiness after 3 months.
65
Involvement of the mandible of a squamous cell cancer of the tonsils would present as
TRISMUS
66
Squamous cell cancer of the tonsils with metastasis to the mandible would result in:
Mandible
67
Spherical white mass on otoscopy behind an intact membrane + hearing loss + purulent discharge + 30’s to 40’s
Acquired cholesteatoma

PLABABLE 2.0 (33 decks)

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