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Things I don't know, but need to know, for fourth year > ENT > Flashcards

ENT Flashcards

1
Q

Someone present with persistent unilateral discharge. How should they be managed?

A

Suspect Cholesteatoma - Referal to ENT

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2
Q

If pressing on the soft part of the nose hasn’t helped in epistaxis. What is the likely origin of the bleed?

A

Sphenopalentine Artery

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3
Q

Management of a severe epistaxis

A

Compression -10-15mins can add cold packs
Cautery + Lidocaine and phenyphrine spray
Nasal Packing
Artery ligation and embolism

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4
Q

Risk Factors for Tympanosclerosis

A

Chronic Otitis Media

Grommets

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5
Q

How does tympanosclerosis present?

A

White chalky patches on ear drum

Hearing loss

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6
Q

How is tympanosclerosis managed?

A

Hearing Aids

Surgical resection of sclerosis

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7
Q

When shoulda perforated ear drum be refereed to ENT?

A

Unresolved by 6-8 weeks

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8
Q

What nerve if damaged would cause a hoarse voice?

A

Recurrent Laryngeal

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9
Q

What nerve is damaged would cause an inability to reach high pitches?

A

Superior Laryngeal

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10
Q

Criteria for diagnosing and administering antibiotics for a soar throat

A 
Absence of cough
>38 degrees
Tender anterior lymphadenopathy 
Exudate 
3/4 = Bacterial Tonsilitis
>3 = Antibiotics given
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11
Q

What antibiotics are used in bacterial tonsillitis?

A

Phenoxymethylpenicillin

Clarithromycin in penicillin allergy

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12
Q

Smooth generalised swelling which moves up on swallowing.

A

Thyroid Goitre

Remember will have systemic symptoms

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13
Q

<20yrs
Midline between isthmus of the thyroid and hyoid bone
Upwards on tongue protusion

A

Thyroglossal Cyst

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14
Q

Present from birth
Left sided #
Transilluminates

A

Cystic Hygroma

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15
Q

Oval mobile mass
Anterior triangle infront of sternocleidomastoid and behind pharynx
Early adulthood
Cholesterol crystals in fluid

A

Branchial cyst

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16
Q

First line management if the source of the epistaxis can be visualised.

A

Cautery

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17
Q

First line management if the source of the epistaxis cant be visualised.

A

Anterior packing

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18
Q

Criteria for administering antibiotics in Acute Otitis Media

A 
Amoxicillin or Clarithromycin
Persistent and no improvement over 4 days
Systemically unwell
<2 years + bilateral
Perforation
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19
Q

What is used to manage Acute Otitis Media

A

Amoxicillin

Erythromycin or clarithromycin in pen allergic

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20
Q

Diagnostic manœuvre that will trigger a rotatory nystagmus Nausea +/- vomiting in BPPV.

A

Dix Hallpike

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21
Q

The manœuvre designer to reposition and treat BPPV

A

Epley

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22
Q

Common causes of acute sinusitis

A

Strep Pneumonia
Haemophilus Influenza
Rhinovirus

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23
Q

Management of acute sinusitis

A

Supportive and Analgesia
Over 10 days of symptoms - intranasal steroid
Severe symptoms - Phenoxymethylpenicillin or Co-Amoxiclav is really bad

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24
Q

Management of nasal polyps

A

All should be referred to ENT

Topical corticosteroids

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25
Risk factors for developing nasal polyps
``` Asthma Aspirin intolerance Infective sinusitis CF Kartenagars syndrome Churgg strauss - cANCA ```
26
In a patient presenting with a persistent hoarse voice what investigation should be done whilst waiting for the 2 week urgent referral?
Chest X ray to exclude apical lung lesion
27
Colickly pain and post prandial swelling | 80% of time affecting submandibular gland
Sialolithiasis - salivary gland stone | Commonly Calcium Phosphate or Carbonate
28
Management and investigation in sialolithiasis
Sialography - visualise where the blockage is occurring Distal Wharton's duct - orally removed Gland excision may be required for the rest
29
What is the commonest organism linked to sialadenitis?
Staph Aureus
30
Women 30-60 Slow progression and long history Parotid gland
Pleomorphic adenoma - commonest benign tumour | Malignant potential if left
31
Men over 50 Strong association with smoking Often bilateral and multi centric
Warthins tumour | Benign
32
Over 40 Parotid gland Perineural invasion - loss of facial nerve
Adenoid Cystic Carcinoma | Commonest malignant salivary gland tumour in UK
33
Malignant tumour that is common in the parotid but can appear in any gland
Mucoepidermoid carcinoma | Commonest malignant tumour of the salivary gland world wide
34
Unilateral persistent epistaxis congestion or discharge Unilateral persistent middle ear effusion Otalgia Cranial nerve palsy III - VI South China origin or lived
Nasopharyngeal Carcinoma Type of squamous cell carcinoma - linked EBV CT and MRI imaging Radiotherapy is management +/- surgical resection
35
Management of Post tonsillectomy haemorrhage.
ALL REFER URGENTLY TO ENT ``` Primary = 6-8hrs post - urgent return to theatre Secondary = 5-10 days later - generally due to infection - Abx and surgery ```
36
If topical antibiotics have failed to slow progression of erythema in Otitis Externa what should you do?
Oral antibiotics | Consider fungal cause
37
Sore throat + pyrexia + lymphadenopathy +/- Malaise, anorexia, palatial petechia, splenomegaly, transient hepatitis Atypical Lymphocytosis Cold haemolytic anaemia
Glandular Fever Symptoms persist over weeks Break out into maculopapular rash if given amoxicillin
38
What test should be done if you are suspecting glandular fever?
FBC and Monospot in 2nd week of symptoms | FBC - haemolytic anaemia and atypical lymphocytosis
39
Common causes of glandular fever?
EBV CMV HHV-6
40
Branchial cyst management
Exclude other causes | USS -> ENT referral -> FNA
41
When examining the eardrum of someone with recurrent unilateral discharge where is the most important part to visualise?
Attic - to ensure you don't miss cholesteatoma
42
Family history of hearing issues Conductive hearing loss Accelerated during pregnancy Schwartz sign positive
Otosclerosis | Redness over cochlear promontory = Schwartz signs
43
Facial pain worse on leaning forwards Nasal discharge - clear Nasal obstruction - mouth breather Post nasal drip - chronic cough
Chronic rhinositus Avoid allergens, Intranasal steroids, nasal irrigation with saline Red flags - unilateral symptoms + persistence despite three months of treatment
44
Management of Acute Otitis Externa
Topical Abx +/- steroid No improvement = refer to ENT -> oral antibiotic (flucloxacillin) or topical anti fungal If severe debris removal may be needed
45
A progressive cellulitis affecting floor of the mouth and the neck.
Ludwigs Angina Medical emergency - immediate admission for IV antibiotics and surgery as airway compromise can be sudden.
46
Air > bone bilaterally | High frequency hearing loss
presybiscus
47
Bilateral nasal polyps
Routine referral to ENT -> intranasal steroids
48
Bilateral non tender parotid swellings + xerostomia
Think sarcoid if alongside other symptoms
49
Preceptal cellulitis
IV antibiotic and admission | Or antibiotics and daily follow up
50
Management of Quincy
IV antibiotics and drainage | Consider tonsillectomy in 6 weeks time
51
Otitis Media with effusion - management
Active observation for 6-12 weeks | Immediate referral if cleft palate or they have Down Syndrome
52
Cause and management of Rhinitis Medicamentosa
Prolonged nasal decongestant use - causes symptoms similar to what they were using it for Management - stop using decongestant causes symptoms to resolve
53
In a hypoglossal nerve lesion the tongue points in what direction?
When stuck out the tongue deviates towards the side of the lesion.
54
How is a sudden onset sensorineural hearing loss managed?
7 days oral prednisolone + urgent ENT referral | Majority are idiopathic
55
Which way does the uvula point in a vagus nerve lesion?
Away from the site of the lesion
56
What is the cut off for normal hearing on an audiogram?
Anything below 20db is classed as hearing loss
57
Menieres - management
Cease driving until symptoms controlled Acute - Prochlorperazine Prevention - Betahistine + Vestibular rehab
58
Vestibular Neuritis - management
Buccal or IM Prochlorperazine is first line | Vestibular rehab is key management for prevention
59
Persistent Dysphonia for over 3 weeks
Referral to ENT
60
What can be used to give a brief period of control to resistant hay fever?
Oral steroids
61
What antibiotics is indicated in otitis externa in diabetics?
Ciprofloxacin to cover pseudomonas

Things I don't know, but need to know, for fourth year (31 decks)

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