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Year 6 > ENT > Flashcards

ENT Flashcards

1
Q

Three complications of thyroid surgery

A

1- recurrent laryngeal nerve injury
2- haematoma
3- hypocalcaemia ( irritability, seizures, spasms and paresthesia periorally)

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2
Q

most common infective causes of otitis externa [3]

A
  • pseudomonas
  • staph aureus
  • fungi
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3
Q

how is a visualised nose bleed treated

A

cautery

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4
Q

how is a nose bleed that can’t be visualised treated?

A

anterior packing

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5
Q

benign tumours of the parotid gland

A

pleomorphic adenoma (most common)
Warthin’s tumour

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6
Q

malignant tumours of the parotid gland

A

mucoepidermoid carcinoma

adenoid cystic carcinoma (these are invasive and cause palsies)

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7
Q

how should unilateral nasal polyps be investigated?

A

urgent referral to ENT for suspected cancer

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8
Q

inheritance of hereditary haemorrhagic telangectasia

A

Autosomal dominant

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9
Q

definitive management of otosclerosis

A

stapedectomy

hearing aids is the other one

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10
Q

mode of inheritance of otosclerosis

A

autosomal dominant

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11
Q

what can exacerbate otosclerosis

A

pregnancy

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12
Q

what are children with Down syndrome at risk of with their ears

A

OME and therefore conductive hearing loss

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13
Q

Definition of OME/glue ear

A

presence of middle ear fluid without acute signs of bacterial infection or illness.

expect to find visible fluid behind an intact tympanic membrane. Viscous bubbles may also be seen behind the tympanic membrane.

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14
Q

How is OME in adults investigated

A

Unilateral glue ear in an adult needs evaluation for a posterior nasal space tumour therefore a two week wait referral needed

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15
Q

features of vestibular neuronitis [4]

A
  • horizontal nystagmus
  • vertigo and dizziness
  • nausea and vomiting
  • no hearing loss
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16
Q

features of acute labrinythitis [5]

A
  • horizontal nystagmus
  • vertigo and dizziness (exacerbated by movement)
  • nausea and vomiting
  • tinnitus
  • HEARING LOSS (uni- or bilateral)
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17
Q

features of Menieres disease [4]

A

recurrent attacks of vertigo
symptoms of hearing loss
tinnitus
nystagmus and postive Romberg
a feeling of fullness in the ear

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18
Q

management of vestibular neuronitis [3]

A
  • buccal or intramuscular prochlorperazine (rapid relief for severe cases)
  • a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine)
  • vestibular rehabilitation exercises (chronic symptoms)
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19
Q

what is the purpose of the HiNTS exam

A

distinguish between a peripheral and central vestibular cause of vertigo e.g. neuronitis vs posterior circulation infarct

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20
Q

how long would voice hoarseness be present in suspicious cases? what age group

A

3 weeks or longer in those over 45

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21
Q

signs of OME in a child [3]

A

retracted ear drum
absent of light reflex
no discharge

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22
Q

which children with OME need immediate referral to ENT [2]

A

Down’s and cleft palate

Children with persisting significant hearing loss on two separate occasions (usually 6-12 weeks apart) need referral to ENT for further management

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23
Q

management of OME in children

A

active observation for 3 months from initial presentation then grommet

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24
Q

management of labrinythitis

A

usually self limiting
prochlorperazine or antihistamines may help reduce the sensation of dizziness

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25
Q

what does an abnormal head impulse show

A

impaired vestibulo-ocular reflex

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26
Q

how does OME present in childhood

A

peaks at 2 years of age
hearing loss is usually the presenting feature
secondary problems such as speech and language delay, behavioural or balance problems may also be see

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27
Q

Main complications post tonsillectomy

A

pain and haemorrhage

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28
Q

when does primary haemorrhage post tonsillectomy occur and how is it managed

A

bleeding 6-8 hours after

immediate return to theatres

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29
Q

when does secondary haemorrhage post tonsillectomy occur and how is it managed

A

between 5 and 10 days after surgery, associated with a wound infection.

admission and antibiotics.

Severe bleeding may require surgery.

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30
Q

what is malignant otitis externa

A

chronic Pseudomonas aeruginosa infection which becomes invasive and erodes the temporal bone eventually leading to osteomyelitis

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31
Q

key differentiating factors between otitis externa and otitis media [3]

A

OM affects the tympanic membrane while OE doesnt

OM has discharge followed by perforation that receives pain
OE has pain and discharge that co-exist

Children with otitis media often tug or rub their ears, whereas, in otitis externa, this is likely to exacerbate pain.

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32
Q

who are most commonly affected by malignant otitis externa

A

diabetics and the immunosuppressed

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33
Q

how is malignant otitis externa treated

A

ciprofloxacin

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34
Q

how is Otitis externa treated

A

topical flucloxacillin +/- steroid

not used if perforated

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35
Q

which Abx is used to treated otitis media

A

amoxicillin

5-7 days

macrolides if allergic

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36
Q

features of malignant otitis externa

A
  • purulent discharge
  • deep seated, severe otalgia
  • temporal headaches
  • possibly dysphagia, hoarseness, and/or facial nerve dysfunction
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37
Q

what is the sign that an acute otitis media ear has perforated

A

bloody discharge followed by resolving of ear pain

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38
Q

when should Abx be given immediately for acute otitis media [5]

A
  • Symptoms lasting more than 4 days or not improving
  • Systemically unwell but not requiring admission
  • Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
  • Younger than 2 years with bilateral otitis media
  • Otitis media with perforation and/or discharge in the canal
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39
Q

What is the initial management of otitis media

A

Observe for 3 days for any worsening, delayed ABx

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40
Q

complication of otitis media [4]

A
  • mastoiditis
  • meningitis
  • brain abscess
  • facial nerve paralysis
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41
Q

3 common sequelae of acute otitis media

A

1) chronic suppurative otitis media (CSOM) defined as perforation of the tympanic membrane with otorrhoea for > 6 weeks
2) hearing loss
3) labyrinthitis

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42
Q

drugs that can cause tinnitus [4]

A
  • Aspirin/NSAIDs
  • Aminoglycosides
  • Loop diuretics
  • Quinine
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43
Q

management of auricular haematomas [2]

A

need same-day assessment by ENT

incision and drainage has been shown to be superior to needle aspiration

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44
Q

features of otosclerosis [4]

A
  • conductive deafness
  • tinnitus
  • normal tympanic membrane
    10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
  • positive family history
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45
Q

which ENT structure drains into the posterior triangle lymphatics

A

nasopharynx

46
Q

which ENT structure drains into the anterior triangle lymphatics [3]

A

larynx, buccal mucosa, and tonsillar fossa

47
Q

which demographic are nasopharyngeal carcinomas most common in

A

Asian

48
Q

how do nasopharyngeal carcinomas present [4]

A
  • epistaxis
  • headaches
  • lymph node metastasis
  • unilateral hearing loss
49
Q

what is elicits in a positive Dix Hallpike manoever

A

rotational nystagmus

50
Q

what drains the submandibular gland

A

Whartons duct

51
Q

what drains the parotid gland

A

Stensens duct

52
Q

where does sialolithiasis commonly occur

what are the stones made of

A

submandibular gland

calcium phosphate or calcium carbonate

53
Q

two symptoms of sialolithiasis

A

colicky pain and post prandial swelling of the gland

54
Q

investigation for sialolithiasis

A

sialography to demonstrate the site of obstruction and associated other stones

55
Q

Sialadenitis: causative agent

A

staph aureus

56
Q

diagnosis of submandibular tumours

A

FNA
CT and MRI

57
Q

In a young adult with parotid swelling and pancreatitis/orchitis/reduced hearing/meningoencephalitis suspect…

A

mumps

58
Q

treatment of Ramsey Hunt syndrome

A

oral aciclovir and steroids

59
Q

how is otitis externa treated in diabetics

A

ciprofloxacin

60
Q

otosclerosis: conductive or sensorineural hearing loss

A

conductive

61
Q

In Weber’s test if there is a sensorineural problem the sound is localised to the

A

unaffected side

62
Q

When performing the Weber test, the patient should localise the sound to the side of a _________ hearing loss, as bone conduction is increased. The sound will localise away from a __________ hearing loss.

A

When performing the Weber test, the patient should localise the sound to the side of a conductive hearing loss, as bone conduction is increased. The sound will localise away from a sensorineural hearing loss.

63
Q

presbycusis: conductive or sensorineural hearing loss

A

bilateral sensorineural

shows deafness to high frequency

64
Q

Menieres disease: conductive or sensorineural hearing loss

A

sensorineural

65
Q

ototoxic drugs [4]

A

aminoglycosides (e.g. Gentamicin)
furosemide
aspirin
number of cytotoxic agents

66
Q

management of bilateral nasal polyps

A

routine referral to ENT and intranasal steroids

67
Q

Samter’s triad

A

asthma
aspirin sensitivity
nasal polyposis

68
Q

what is gingivitis

A

secondary to poor dental hygiene. Clinical presentation may range from simple gingivitis (painless, red swelling of the gum margin which bleeds on contact) to acute necrotizing ulcerative gingivitis (painful bleeding gums with halitosis and punched-out ulcers on the gums).

69
Q

management of simple gingivitis

A

seek dentist

no Abx

70
Q

management of acute necrotising ulcerative gingivitis

A

refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia

i.e. paracetomol + metronidazole + chlorhexidine mouthwash

71
Q

what is tympanosclerosis and what does it suggest

A

Characterised by a chalky, white plaque on the tympanic membrane, suggestive of a previous middle ear infection or trauma.

72
Q

a sign of unilateral glue ear in an adult

A

effusion

73
Q

what is Ludwig’s angina

A

progressive cellulitis that invades the floor of the mouth and soft tissues of the neck. Most cases result from odontogenic infections which spread into the submandibular space.

74
Q

presentation of Ludwig’s angina

A

fever
dysphagia
neck swelling

75
Q

management of Ludwig’s angina

A

It is a life-threatening emergency as airway obstruction can occur rapidly as a result:
urgent hospitalisation
airway management
intravenous antibiotics

76
Q

Thyroglossal cyst:

More common in patients < __________
Usually _________, between the isthmus of the thyroid and the hyoid bone, linked to the__________
Moves ________ with protrusion of the tongue
May be painful if infected

A

More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone, linked to the foramen caecum
Moves upwards with protrusion of the tongue
May be painful if infected

77
Q

Pharyngeal pouch:

More common in older _______
Represents a __________ herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a ______ lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration, halitosis and chronic cough

A

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration, halitosis and chronic cough

78
Q

Cystic hygroma:

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the _____side
Most are evident at birth, around 90% present before __ years of age

A

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age

79
Q

Branchial cyst:

An oval, mobile cystic mass that develops between the _____________ and the _________
Develop due to failure of obliteration of the _________ branchial cleft in embryonic development
Usually present in early adulthood

A

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood

80
Q

Cervical rib:

More common in adult _________
Around 10% develop ____________________

A

More common in adult females
Around 10% develop thoracic outlet syndrome

81
Q

Carotid aneurysm:

Pulsatile lateral neck mass which _______ ________on swallowing

A

Pulsatile lateral neck mass which doesn’t move on swallowing

82
Q

treatment of chronic rhino sinusitis [3]

A

avoid allergen
intranasal corticosteroids
nasal irrigation with saline solution

83
Q

features of chronic rhino sinusitis [4]

A

facial pain: typically frontal pressure pain which is worse on bending forward
nasal discharge: usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection
nasal obstruction: e.g. ‘mouth breathing’
post-nasal drip: may produce chronic cough

84
Q

features of Ramsay Hunt Syndrome [4]

A

auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear (may also be seen on the tongue)
other features include vertigo and tinnitus

85
Q

treatment of Ramsay Hunt syndrome [2]

A

oral aciclovir and corticosteroids are usually given

86
Q

treatment of strep throat

A

phenoxymethylpenicillin or clarithromycin

87
Q

features of benign pleomorphic adenoma [2] and its management

A

Clinical features
gradual onset, painless unilateral swelling of the parotid gland
typically movable on examination rather than fixed

Management
surgical excision (risk of transformation)

88
Q

features of the Centor score [4]

A

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever (not necessarily at appointment)
absence of cough

3/4 –> give ABx

89
Q

what is black hairy tongue swabbed for

management?

A

candida

management: tongue scraper and antifungals if candida positive

90
Q

complications of tonsillitis

A

otitis media
quinsy - peritonsillar abscess
rheumatic fever and glomerulonephritis very rarel

91
Q

how many episodes of tonsillitis in a year warrant a tonsillectomy

A

the person has five or more episodes of sore throat per year

92
Q

management of glue ear [3]

A

active observation: the management for a child with a first presentation of otitis media with effusion is active observation for 3 months - no intervention is required

grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months

adenoidectomy

93
Q

in Ramsey Hunt syndrome, where does VZV reactivate

A

geniculate ganglion of the seventh cranial nerve

94
Q

what is exostosis of the ear

A

Exostosis is where bone grows abnormally in the ear due to repeated exposure to cold water. It affects people who swim or surf a lot in cold water – that’s why it’s sometimes called surfer’s ear.

95
Q

which part of the nose is epistaxis most likely to come from?

A

Little’s area in the anterior nasal septum is the site of Kiesselbach’s plexus, supplied by 4 arteries

96
Q

which infection is tonsils SCC associated with

A

HPV-16

97
Q

why should ntranasal decongestants (e.g. oxymetazoline) not be used for prolonged periods

A

increasing doses are required to achieve the same effect (tachyphylaxis) and rebound hypertrophy of the nasal mucosa (rhinitis medicamentosa) may occur upon withdrawal

98
Q

observation period in otitis media vs otitis media with effusion

A

OM is just 3/4 days

OME is 3 months

99
Q

when does OME need urgent referral

A

in an adult, especially if unilateral

if bilateral OME as first time presentation , 3 month observation

100
Q

how does a quinsy present

A

presents with severe sore throat that can cause difficulty in opening mouth (trismus), drooling, foul-smelling breath and deviation of uvula towards unaffected side due to swelling on one side of the throat.

101
Q

causative agents of acute otitis media

A

whilst viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria, particularly

Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

102
Q

normal threshold on audiogram

A

20db

in sensorineural hearing loss both air and bone conduction are impaired
in conductive hearing loss only air conduction is impaired
in mixed hearing loss both air and bone conduction are impaired, with air conduction often being ‘worse’ than bone

103
Q

what should be done if otitis externa does not respond to topical abx

A

refer to ENT

104
Q

recent swimming is a risk factor for

A

otitis externa

105
Q

features of Otitis externa

A

ear pain, itch, discharge
otoscopy: red, swollen, or eczematous canal

106
Q

treatment of quinsy

A

need urgent review by an ENT specialist.
needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence in 6 weeks

107
Q

management of acute sinusitis

A

analgesia
intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
oral antibiotics are not normally required but may be given for severe presentations.
The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’
‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection

108
Q

If a perforated tympanic membrane does not heal by itself a _________ may be performed

A

If a perforated tympanic membrane does not heal by itself a myringoplasty may be performed

109
Q

sudden onset sensorineural hearing loss

A

urgent referral to ENT.
High-dose oral corticosteroids

110
Q

Nasal septal haematoma: treatment

A

surgical drainage
intravenous antibiotics

111
Q
A

Year 6 (19 decks)

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