ENT Flashcards by Vansh A

When should prochlorperazine be used in vestibular neuronitis?

In the acute phases only as it can delay recovery if used long term

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What can be used to distinguish vestibular neuronitis from a posterior circulation stroke?

HiNTs exam - head impulse test, test of skew and assessing nystagmus

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What are the red flags of chronic rhinosinusitis?

unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis

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Vestibular neuronitis vs acute labyrinthitis?

Hearing will not be affected in VN

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Ear swelling/rash behind the ear in someone with ?otitis media

Same day referral to Paeds ?Mastoiditis

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Horizontal nystagmus is a sign of what?

Vestibular neuronitis

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How should a perforated ear drum be managed?

Refer to ENT if persists beyond 6 weeks

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What is a C/I to prescribing naseptin cream?

peanut, soy or neomycin allergies

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conductive hearing loss, tinnitus and positive family history

Otosclerosis

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bilateral high-frequency hearing loss suggests what?

Prebycusis

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What are the 2 common post op complications of tonsillectomy?

Pain
Haemorrhage

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How does haemorrhage present following tonsillectomy?

Primary: Within 6-8 hours following surgery -> needs immediate return to theatre
Secondary: 5-10 days after surgery usually associated with wound infection -> treated with admission/abx

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When should intranasal steroids be considered for sinusitis?

If symptoms have been present for 10 days or more

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What is the management of acute sensorineural hearing loss?

Urgent referral to ENT for audiology and brain MRI

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What is Ludwigs angina?

A progressive cellulitis which invades floor of the mouth and soft tissues of the neck usually following dental infection

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How does Ludwigs angina present?

Neck swelling
Dysphagia
Fever
Needs immediate referral to hospital for airway management and IV Abx

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Management of post op stridor for thyroidectomy?

Urgent removal of sutures and call for senior help

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What does post thyroidectomy stridor suggest?

Post op bleed which build pressure behind suture line and compresses trachea causing stridor

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What are the NICE indications for tonsillectomy?

Sore throats due to tonsillitis
5 or more episodes per year
Symptoms occurring for atleast 1 year
Episodes of sore throat are preventing normal function

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What is the most common cause of bacterial otitis media?

H influenzae

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What does pain on palpation of the tragus, itching, discharge and hearing loss suggest?

Otitis externa

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What is the management of a patient with persistent hoarse voice?

Refer to ENT

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What causes gingival hyperplasia?

phenytoin, ciclosporin, calcium channel blockers and AML

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When should Abx be given for acute otitis media?

Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

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Which drugs cause tinnitus?

- Aspirin/NSAIDs - Aminoglycosides e.g gentamicin - Loop diuretics - Quinine

What is the most important part of the tympanic membrane to visualise in patients with chronic discharge?

Attic - rule of cholesteatoma

After referral to ENT, patients with sudden onset sensorineural loss should be given what?

high-dose oral corticosteroids

What is an indication of positive Dix-Hallpike?

Rotatory nystagmus

What can be used to shrink nasal polyps?

Intranasal steroid spray/drops

What is the biggest risk factor for malignant otitis externa?

Diabetes Mellitus

What is the most common cause of sudden onset sensorineural hearing loss?

Idiopathic

What is a complication of nasal trauma?

Nasal septal haematoma

What is a nasal septal haematoma?

- Bilateral red swelling arising from the nasal septum - Needs ENT referral for surgical drainage and IV Abx

What are signs of more severe otitis externa?

- a red, oedematous ear canal which is narrowed and obscured by debris - conductive hearing loss - discharge - regional lymphadenopathy - cellulitis spreading beyond the ear - fever

How should otitis externa be managed?

Topical Abx or Abx + Steroids

How to interpret audiograms?

1. is there anything below 20dB yes = move to step 2 no = normal hearing 2. is there a gap? (b/w air and bone conduction) yes = conductive or mixed hearing loss no = sensorineural hearing loss 3. is one below or both below the 20dB line one = conductive both = mixed

What would be the results of audiometric testing for presbycusis?

Bilateral high-frequency hearing loss with air conduction better than bone

Patient with black/brown/green tongue?

- Think black hairy tongue - More common in those with poor hygiene/IV drug users/HIV - Treated with tongue scraping/antifungals if candida

What can occur after trauma to the ear?

Auricular haemtoma - needs same day assessment by ENT for drainage

What is the first line oral abx for otitis externa?

Oral Flucloxacillin

What is the management of otitis externa in diabetics?

Ciprofloxacin ear drops to cover for Pseudomonas

Elderly patient dizzy on extending neck/moving head up?

Vertebrobasilar ischaemia

Managament of Children presenting with glue ear with a background of Down's syndrome or cleft palate

Refer to ENT

Epistaxsis management?

1. Direct compression 2. Nasal cautery 3. Nasal packing 4. Aggressive therapies such as balloon catheter

Why do FBC when someone has epistaxis?

- Assess HB - Assess platelet count

What is the term for pain upon swallowing?

Odynophagia

What is the name of the lymph node commonly enlarged in tonsillitis?

Jugulodigastric lymph node

What does difficulty swallowing solids suggests vs solids and liquids?

Solids - stricture issue (benign or malignant) Both - motility issue

Management of oesophageal carcinoma

- Surgery - Chemoradiotherapy

Recurrent otitis externa despite antibiotic treatment?

Candida

Unilateral symptoms in someone with chronic rhinosinusitis?

Urgent referral to ENT

dysphagia, regurgitation, halitosis, and a bulging neck on swallowing

Pharyngeal pouch

Branches of the facial nerve

Two Zebras Bite My Cake Temporal Zygomatic Buccal Mandibular Cervical

What are long term impacts of Bells?

- Damage to eye - Inability to close eye - Altered taste - Psychological impacts

What is vertigo?

The illusion of movement

Pathophysiology of BPPV

Debris in the semi circular canals which are disrupt movement of endolymph

How do childrens and adult eustachian tubes differ?

Childrens is shorter, narrower and more horizontal

What are the 4 paranasal sinuses?

Ethmoid, Frontal, Maxillary, Sphenoid

What are risk factors for head and neck cancers?

- Smoking - HPV 16 - EBV - Immunosuppression - FH

Loss of corneal reflex

Acoustic neuroma

Unilateral glue ear in an adult

Refer to ENT to rule out posterior nasal space tumour

Prophylaxis of sinusitis?

Intranasal corticosteroids

What does ulnar deviation in someone with tonsillitis suggest?

Peritonsilar abscess- Quinsy

Atypical lymphocytes on blood film are suggestive of what?

Infective mono

palatal petechiae + cervical lymphadenopathy are suggestive of what?

Glandular fever

What can deranged LFTs with sore throat be indicative of>

Infective mononucleosis

What anaemia can infective mono cause?

Cold Haemolytic anaemia - IgM

OSA can cause what?

HTN

What are risk factors for OSA?

- Obesity - Macroglossia (acromegaly, hypothyroidism) - Large tonsils - Marfans

What acid base problem can OSA cause?

Compensated respiratory acidosis

Epistaxis which fails all management may require ligation of what?

Sphenopalatine ligation

What are signs of quinsy?

- Deviation of uvula to unaffected side - Trismus - Reduced neck mobility - Bulging of the soft palate

Which organism cause quinsy?

Strep pyogenes

Management options for nasal fractures?

- See in clinic in a week to allow swelling to subside - Manipulate under anaesthetic

Discharge from nose which tests positive for beta-2 transferrin?

CSF

Why should haematomas be aspirated as soon as possible?

Risk of avascular necrosis

What is a cholesteatoma?

Overgrowth of keratinised squamous epithelium in the middle ear

What can suggest cholesteatoma on otoscopy?

- Discharge - Attic crust - Retracted/Perforated tympanic membrane

What are complications of cholesteatoma?

- Facial nerve palsy - Meningitis - Abscess - Deafness - Recurence

What are signs of thyroglossal cyst?

- Moves up when protruding tongue - Mobile - Non tender

What causes trismus in quinsy?

Pus causes the pterygoid muscles to go into spasm which prevents a patient from opening their mouth

Post tonsillectomy haemorrhage?

Refer for same day ENT assessment even if bleeding has resolved

Hearing impairment post head trauma?

Perforated tympanic membrane

What is the name for a malignant tumour of the parotid gland?

Adenoid cystic carcinoma

Most common bacteria which cause otitis externa?

- Staph aureus - Pseudomonas

What can be exacerbated in pregnancy?

Otosclerosis

Pink tinge to tympanic membrane?

Schwarze sign -> otosclerosis

What can be a S/E of removal of mastoid abscess?

Unilateral facial weakness -> facial nerve runs close to the mastoid

Which sinus is most commonly involved in chronic sinusitis when mucus drains out upon leaning forward?

Maxillary

Which virus is associated with squamous cell carcinoma of the oropharynx?

HPV

What is the pathophysiology of Menieres?

Excessive build up of endolymph in inner ear which increases pressure and disrupts sensory signals -> sensorineural hearing loss

What are symptoms of Ramsay-Hunt?

- Vesicular rash - Facial weakness - Vertigo - Headaches - Fever - Tinnitus

What is a complication of untreated tonsillitis?

- Parapharyngeal abscess - Lemeirre's syndrome: infective thrombophlebitis

What is the most common tumour of parotid gland?

Pleomorphic adenoma -> benign

Bilateral conductive hearing loss and tinnitus in young person?

Think otosclerosis

Snoring in someone with chronic sinusitis?

Nasal polyps have formed -> nasal steroid drops needed

Management of otosclerosis?

- Hearing aids - Stapedectomy is gold standard

Unilateral glue ear?

Red flag -> nasopharyngeal carcinoma

Chinese person with history of EBV infection and one sided hearing loss?

Nasopharyngeal tumour

p16 is a marker for what?

HPV -> squamous cell carcinoma of oropharynx

What is temporo-mandibular joint dysfunction?

Pain in jaw with difficulty moving it as well as clicking/popping in the jaw when opening mouth

What can trigger temporomandibular dysfunction?

Trauma to the jaw Stress

Management of TMD?

Resting, address triggers and ENT referral if severe

ENT Flashcards

(103 cards)