ENT Flashcards
(131 cards)
1
Q
what are red flag symptoms of rhinosinusitis
A
Unilateral symptoms
Persistent symptoms despite compliance with 3 months of treatment
epistaxis
2
Q
what is the criteria for urgent referral of hearing loss
A
Sudden onset ( over 3 days or less) unilateral / bilateral hearing loss occured within past 30 days with no external / middle ear causes
Unilateral hearing loss + focal neurology
hearing loss + head/ neck injury
hearing loss + severe infection ( Necrotising Otitis Externa/ Ramsay Hunt syndrome)
3
Q
What scan is done on urgent referral to ENT for hearing loss ? what condition is it trying to investigate?
A
MRI, Vestibular Schwannoma
4
Q
air conduction louder than bone conduction suggests which type of hearing loss
A
Sensorineural hearing loss
5
Q
how is Quinsy managed
A
IV Antibiotics and surgical drainage
6
Q
give 5 features of viral labyrinthitis
A
sudden onset horizontal nystagmus
hearing disturbances
nausea
vomiting
vertigo
7
Q
which type of hearing loss does ear wax cause
A
conductive hearing loss
8
Q
what is the first line management of impacted ear wax
A
olive oil drops followed by ear syringing
9
Q
what is a benign tumor of the parotid gland known as
A
Pleomorphic adenoma
10
Q
what are 2 clinical features of a Pleomorphic adenoma
A
gradual onset, painless unilateral swelling of parotid gland
movable on examination
11
Q
what is Samter’s triad
A
Asthma
aspirin sensitivity
nasal Polyposis
12
Q
what is a red flag indication in Nasal polyps
A
unilateral polyps
13
Q
name 6 conditions that can lead to Nasal polyps
A
Asthma
Aspirin sensitivity
Infectivity sinusitis
CF
Kartagener’s syndrom
Churg Strauss syndrome
14
Q
give 3 features of nasal polyps
A
nasal obstruction
rhinorrhoea, sneezing
poor sense of taste and smell
15
Q
following referral to ENT , patients with sudden onset sensorineural hearing loss are treated with ____________
A
high dose oral corticosteroids
16
Q
what is a Rinne’s positive
A
air conduction better than bone conduction - as is in a healthy individuals and individuals with significant sensorineural hearing loss
17
Q
what is a normal weber’s test
A
sound is heard equally in both ears
18
Q
what is a sign of sensori-neural hearing loss on Weber’s test
A
sound is heard louder on the side of the intact ear ( opposite to affected one)
19
Q
what is a sign of conductive hearing loss on Weber’s test
A
sound is heard louder on the side of affected ear
20
Q
when is Rinne’s test negative
A
conducting hearing loss
21
Q
what is the management of patients with nasal polyps
A
ENT referral and topical steroids
22
Q
what is an alternative for phenoxymethylpenicillin for a bacterial sore throat
A
Clarithromycin
23
Q
_________ is an example of conductive hearing loss associated with chronic smelly ear discharge and history of glue ear
A
Cholesteatoma
24
Q
what is presbycusis
A
age related Sensorineural hearing loss
25
what is the nature of inheritance of otosclerosis
Autosomal dominant
26
when is the onset of otosclerosis? give 3 features and 1 clinical sign
conductive deafness
tinnitus
positive fhx
- flamingo tinge to tympanic membrane
27
give 4 drugs that can cause deafness
Aminoglycosides ( Gentamicin)
Furosemide
aspirin
cytotoxic agents
28
how do you manage auricular haematomas
same day assessment for ENT
29
what is the most common cause of sudden onset sensorineural hearing loss
idiopathic
30
which swelling most suggests malignancy of cervical lymph nodes
enlarged supra-clavicular nodes
31
what is the first line investigation for Mono
Monospot test
32
name a monoclonal antibody used in the management of squamous cell carcinomas of head and neck
cetuximab
33
which strain of HPV is linked with oral cancer
Strain 16
34
next step in management of persistent mouth ulcer
refer under 2 week wait
35
what sign is indicative of a positive Dix- Hallpike manouvre
Rotatory nystagmus
36
what is an important complication of nasal trauma
Nasal septal haematoma
37
what is the classical sign of a nasal septal haematoma
bilateral red swelling arising from nasal septum
38
what is the management of nasal septal Haematoma
Surgical drainage and IV Abx
39
what is a complication of nasal septal haematoma ? which deformity can it result in
irreversible septal necrosis leading to saddle nose deformity
40
which people commonly present with auricular haematomas
rugby players, wrestlers
41
what type of cyst moves upwards with tongue protrusion
thyroglossal cyst
42
what is '' double sickening'' ? What condition is it associated with ?
initial period of recovery followed by a sudden worsening of symptoms , Bacterial sinusitis
43
what is the main significant complication of a tonsillectomy
bleeding
44
In which patients is malignant otitis externa most common
diabetes
45
what organism causes malignant Otitis externa
Pseudomonas Aeruginosa
46
what is a complication of malignant otitis externa
temporal bone osteomyelitis
47
what investigation is done to diagnose malignant otitis externa
CT Scan
48
which neurological sign can malignant otitis externa precipitate
facial nerve dysfunction
49
give 3 features of malignant Otitis Externa
severe Otalgia
temporal headache
purulent otorrhoea
dysphagia, hoarseness
50
what is the management of malignant Otitis Externa
refer non-resolving --> ENT
IV Abx to cover Pseudomonal infections
51
how is Otosclerosis managed
hearing aid
Stapedectomy
52
what is the management of Ramsay Hunt syndrome
Oral aciclovir
Corticosteroids
53
what is the initial management of vestibular neuronitis
Buccal / IM Prochlorperazine
54
what pattern of hearing loss is seen in Presbycusis
Bilateral sensori-neural pattern hearing loss
55
what is the management of recurrent / chronic sinusitis
avoid allergen
Intra-nasal Corticosteroids
nasal irrigation with saline
56
give 3 contraindications for consideration of cochlear implant
- Chronic Infective Otitis media / mastoid cavity/ tympanic membrane perforation
- lesions of cranial nerve VIII / or in Brainstem causing deafness
- cochlear Aplasia
57
give 4 causes of gingival hyperplasia
phenytoin
ciclosporin
CCB's such as nifedipine
AML
58
what is the most common cause of a perforated tympanic membrane
infection
59
what is the management of tympanic membrane rupture
self resolving in 6-8 weeks
60
what is the management of tympanic membrane perforation if membrane does not heal by itseld
Myringoplasty
61
give 4 complications of tonsillitis
otitis media
quincy
rheumatic fever
glomerulonephritis
62
otitis media with effusion is also known as _______.
Glue ear
63
what is the commonest cause of conductive hearing loss of in childhood
Glue ear
64
which test can be used to distinguish vestibular from posterior circulation stroke
HiNTs
65
What is the criteria used to diagnose Otitis media
Presence of middle ear effusion
Otalgia / ear tugging
inflammation of tympanic membrane
66
which area is a common site for Epistaxis to originate and why
Little's area in the nasal septum because it is the confluence of 4 arteries
67
management of epistaxis where bleed site is difficult to localise
Anterior packing
68
which infection can occur following cat scratch
bartonella infection
69
which exercises can be performed by a patient at home to treat BPPV
Brandt daroff exercises
70
how is otitis media with perforation managed
5-7 day course of amoxicillin
71
how is otitis externa managed in a patient with diabetes
ciprofloxacin ear drops
72
4 features of mastoiditis
otalgia
fever
protruding ear
post-auricular tenderness
73
what is the first line treatment of otitis externa
Topical antibiotic and topical steroid for 1-2 weeks
74
give 3 common bacterial causes of otitis media
streptococcus pneumoniae
H. influenzae
Moraxella Catarrhalis
75
what type of hearing loss is presbycusis
sensorineural deafness
76
what is the first line treatment of acute sinusitis
analgesia and intranasal decongestants
77
what are the conditions for prescription of intranasal corticosteroids in the management of acute sinusitis
symptoms need to have been present for 10 days
78
tonsillar SCC is associated with which infection
HPV
79
unilateral middle ear effusion can be a presenting symptoms of _______________
nasopharyngeal cancer
80
give the three most common causes of acute otitis media
Strep. Pneumonia
Haemophilus Influenzae
Moraxella Catarrhalis
81
under what circumstances would you prescribe antibiotics for acute otitis media
<2 with bilateral infection
symptoms lasting > 4 days and not improving
systemic signs
immunocompromise
Otitis media with perforation / discharge
82
what is the initial management for epistaxis
adequate first aid - pinch nostrils firmly and lean forward for 20 minutes
83
how do you manage epistaxis if first aid provided for 10-15 mins does not work
cautery : if source of bleed is visible
packing : if bleeding point cannot be visualised
84
how do you manage epistaxis that has failed all emergency management
Ligation of the sphenopalatine artery in theatre
85
name 4 medications that can cause tinnitus
Aspirin / NSAIDs
aminoglycosides
quinine
loop diuretics
86
what are the referral guidelines for suspected laryngeal cancer
consider referral to ENT for those 45 and over with -
persistent unexplained hoarseness
unexplained neck lump
87
what is the first line management of otitis externa
topical antibiotic or combined topical antibiotic with a steroid
88
what is the prophylaxis of Meniere's disease
Betahistine and Vestibular rehabilitation
89
which medications cause ototoxicity
Furosemide
Aminoglycoside
Vancomycin
Quinine
Aspirin
Cisplatin
FAVQAC
90
what is the stepwise management of glue ear ?
1. Active observation ( first presentation) for 3 months - unresolving then refer to ENT
** refer immediately to ENT if Down syndrome, Cleft palate
2. Grommet insertion
3. Adenoidectomy
91
what is the pathophysiology + symptoms of sialolithiasis
stones in submandibular gland blocking duct of Wharton
discomfort while eating
postprandial swelling
92
what is the most common parotid malignancy
Benign pleomorphic adenoma
93
what is the second most common benign parotid tumour
Warthin's tumour
94
which parotid disorders might cause facial paralysis
Sarcoidosis
Parotitis
Adenoid cystic adenoma
sialadentitis
mucoepidermoid carcinoma
SPASM
95
how does glue ear normally present ?
hearing loss
peaks at age of 2
secondary problems such as speech and language delay, behavioural or balance problems may also be seen
96
what is the most common cause of sudden sensorineural hearing loss? What investigations are performed? How is it managed?
majority of cases - idiopathic
MRI scan generally performed
High dose corticosteroids
97
what are the key features of vestibular neuronitis ?
recurrent vertigo, nausea and vomiting
horizontal nystagmus
NO HEARING LOSS / TINNITUS
98
what is the acute and chronic management of vestibular neuronitis
acute : buccal / IM prochlorperazine
chronic : vestibular rehabilitation exercise
99
what is the cause of black hairy tongue? what are its predisposing factors? how is it investigated and management?
occurs due to defective desquamation of the filiform papillae.
predisposing factors include : poor oral hygiene, abx, HIV, IVDU
tongue should be swabbed for Candida
management is by tongue scraping / topical antifungals
100
what does the Centor criteria include?
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
101
what is the fever pain score?
Fever
Purulent tonsils
attend rapidly ( 3 days / less)
Inflamed tonsils
No cough / coryza
102
what are the symptoms of Meniere's disease?
recurrent episodes of vertigo, tinnitus and sensorineural hearing loss.
sensation of aural fullness
unilateral symptoms
103
how does a branchial cyst present ? How is it different from a thyroglossal cyst ?
Smooth, fluctuant, non-tender, non translucent mass located anterior to left sternocleidomastoid muscle that does not move on tongue protrusion. Contains cholesterol crystals.
Thyroglossal cysts are typically midline and move with tongue protrusion.
104
what is Ludwig's angina ? How does it present ? How is it managed?
Form of progressive cellulitis that invades the floor of the mouth / soft tissues of the neck. Usually due to odontogenic infections.
Features include :
neck swelling
dysphagia
fever
management is emergency - airways, IV Abx
105
what are the features of allergic rhinitis ?
sneezing
bilateral nasal obstruction
clear nasal discharge
post nasal drip
nasal pruritis
106
what is the management of allergic rhinitis?
allergen avoidance
oral / intranasal antihistamines if there are mild / moderate symptoms
intranasal corticosteroids if patient has moderate / severe symptoms
107
what are the side effects of topical nasal decongestants such as oxymetazoline
increasing doses required to meet same requirements - tachyphylaxis
rebound hypertrophy of nasal mucosa ( rhinitis medicamentosa)
108
what are the complications of a thyroidectomy?
anatomical : recurrent laryngeal nerve damage
bleeding
hypocalcaemia causing QT elongation
109
how is otitis media with perforated tympanic membrane managed
antibiotics
110
what are the guidelines for a 2 week wait referral for oral cancer?
- unexplained ulceration for > 3 weeks
- persistent / unexplained neck lump
- lump on lip
- red / white patch in oral cavity consistent with erythroplakia / erythroleukoplakia
111
what is the main complication of a tonsillectomy? How is it managed depending on the timeline?
Haemorrhage
first 6-8 hours : Immediate return to theatre
5-10 days post surgery : admission and antibiotics
112
how do you manage bleeding and stridor post thyroid surgery
urgent removal of sutures
call for help
this is due to risk of respiratory compromise due to laryngeal oedema
113
what are the causes of sensorineural hearing loss
Sudden
Meniere's
Noise
labyrinthitis
acoustic neuroma
medications
neurological conditions
infections
114
what are the causes of conductive hearing loss
ear wax
infection
fluid
eustachian tube dysfunction
choleastoma
tumours
115
what is the DVLA advice surrounding Meniere's disease
cease driving until satisfactory control of symptoms is achieved
116
how does a cystic hygroma generally presents?
congenital lymphatic lesion typically found in the neck on the left side. Generally trans illuminates and sacs are fluctuant
117
recurrent otitis externa despite numerous antibiotic treatment should raise suspicion for __________
Candida
118
what is the key feature of peritonsillar abscess
deviation of uvula towards unaffected side
119
How does vertebrobasilar ischaemia present?
elderly patient with dizziness on extension of the neck
120
how does otitis externa present on otoscopy
red, swollen or eczematous canal
121
how would you distinguish warthin's tumour from pleomorphic adenoma
pleomorphic adenoma is slow growing and benign whereas Warthin's tumour presents with nearby structure invasion, skin ulceration, skin tethering
122
what is sialadenitis and how does it present
inflammation of the salivary gland likely secondary to obstruction by a stone impacted in the duct causing tender mass and foul taste
123
how does nasopharyngeal carcinoma generally present
painless lymphadenopathy in the posterior triangle of the neck
124
what initial investigation needs to be performed when investigating someone for hoarseness ?
chest xray
125
how is labyrinthitis different from vestibular neuronitis?
labyrinthitis is when both the vestibular nerve and the labyrinth are both involved, whereas only the vestibular nerve is involved in vestibular neuronitis.
126
what are the symptoms of labyrinthitis
vertigo
N+V
Hearing loss
tinnitus
127
what are the signs of labyrinthitis
spontaneous unidirectional nystagmus towards unaffected side
sensorineural hearing loss
abnormal head impulse
gait disturbance
128
what does a typical BPPV history contain
vertigo triggered by change in head position
nausea
each episode lasting 10-20 seconds
129
what is a cholesteatoma ? What are it's main features ? How does it present on otoscopy and how would you manage it?
It is a non-cancerous growth of squamous epithelium that is trapped within the skull base causing local destruction.
Main features include :
foul smelling, non resolving discharge
hearing loss
vertigo, facial nerve palsy and cerebellopontine angle syndrome may also be present.
otoscopy shows : attic crust
management
refer to ENT for surgical removal
130
what is a RF for choleastoma?
cleft palate
131
