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Yr 5 neuro > ENT > Flashcards

ENT Flashcards

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1
Q

when does a primary haemorrhage occur after tonsillectomy

A

within 24 hours

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2
Q

when does a secondary haemorrhage occur after tonsillectomy

A

within 5-10 days - normally due to infection and requires admission and Abx

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3
Q

what does the head impulse test show as part of HINTS

A

if there is a corrective saccade this shows a PERIPHERAL cause as it is testing the vestibular system

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4
Q

what nystagmus indicates a peripheral cause

A

a horizontal nystagmus / unidirectional

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5
Q

what is the skew test as part of HINTS

A

if there is abnormal movement of the eye when one is covered this indicates a CENTRAL cause

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6
Q

what does a unilateral glue ear in an adult require

A

a 2WW referral to ENT as it can indicate a posterior nasal space tumour

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7
Q

causes of BPPV

A

idiopathic, head injury, complication of mastoid surgery

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8
Q

what kind of nystagmus is seen on Dix Hallpike test for BPPV

A

rotatory

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9
Q

what nerves can be affected by an acoustic neuroma

A

V, VII and VIII

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10
Q

when is acoustic neuroma bilateral

A

in neurofibromatosis T2

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11
Q

skin features of tuberous sclerosis

A

ash leaf spots
shagreen patches
Cafe au lait spots (although these are in neurofibromatosis too)
(caused by hamartomas - which are overgrowth of skin)
EPILEPSY and BRAIN TUMOURs

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12
Q

what skin features do you get in neurofibromatosis

A

axillary freckles and cafe au lait spots

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13
Q

Mx for acoustic neuroma

A

-active observation
-microsurgery
-stereotactic radiotherapy

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14
Q

Ix for acoustic neuroma

A

-pure tone audiometry
-MRI gold standard

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15
Q

what does Dx of Menieres require

A

2+ episodes of vertigo, aural fullness and there must be sensorineural hearing loss on affected side

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16
Q

MX of menieres

A

-minimise salt (to reduce endolymphatic volume) and caffeine
-prophylactic use of betahistine -prochlorperazine in attacks
-vestibular rehab
-informDVLA and cease driving until control of symptoms is achieved

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17
Q

blood supply to nose

A

Greater palatine (maxillary)
Anterior ethmoidal (ophthalmic)
Sphenopalatine (branch of maxillary)
Posterior ethmoidal

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18
Q

RF for nose bleeds

A

<10 (digital trauma), >65
septal deviation
bleeding disorder
cocaine
HTN
vWF disease

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19
Q

Ix for a nose bleed

A

FBC, G+S, coag studies, visualise bleed using rhinos copy

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20
Q

Mx of a nose bleed

A

1) pinch soft bit of nose for 20 leaning forwards
-if simple first aid measures work, can use naseptin (topical antiseptic) to reduce crusting
2) cautery if source of bleed is identifiable (involves getting patient to blow their nose to get rid of clots, then using a topical local anaesthetic spray and wait 3-4 minutes for it to take effect, any spply silver nitrate stick for up to 10 seconds, onyly do one side of the septum)
3) packing if not visualised (pack both nostrils)
4) sphenopalatine ligation in theatre

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21
Q

what is firstline for a posterior nose bleed

A

packing

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22
Q

complications of epistaxis

A

hypovolaemia shock, aspiration

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23
Q

what causes nasal polyps

A

they are inflammatory so often linked with chronic inflammatory conditions like asthma and allergic rhinitis

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24
Q

Ix for nasal polyps

A

nasal endoscopy / anterior rhinoscopy

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25
Mx of polyps
1) topical steroids (administer with head upside down) 2) polypectomy +/- FESS
26
for allergic rhinitis symptoms lasting >5 days what is the Mx
topical steroids
27
RF for otitis media
young (under 4), bottle fed, immunocompromised, CF, PCD, passive smoking
28
what does ear discharge in otitis media indicate
a TM perforation
29
What does a tympanometry show for otitis media
B - flat wave
30
what Ix do you do for mastoiditis
CT of temporal bone and brain
31
complications of otitis media
1) cranial nerve VII palsy 2) mastoiditis 3) CSOM 4) intracranial complications
32
Abx of choice for otitis media (if bilateral and under 2, systemically unwell, perforation)
amoxicillin
33
what is CSOM
persistent inflammation of the middle ear that results in the discharge of pus for > 2 weeks
34
what are the two classifications of CSOM
1) squamous (cholesteatoma) 2) mucosal - TM perforation and subsequent inflam of the middle ear -NO OTALGIA
35
non infectious causes of otitis externa
atopic dermatitis, psoriasis, acne
36
RF of otitis externa
swimming, older age, DS, derm conditions
37
apart from signs in the ear, what are the other signs of otitis externa
pre/post auricular lymph nodes and pain on movement of the tragus
38
Tx for otitis externa
-FIRSTLINE = topical Tx antibiotic (quinolone) +/- topical steroids -can also use acetic acid 2% which is a vinegar and works by reducing pH to stop the bacteria growing -consider oral abx if patient is immuncompromised -may need ENT referral (micro suction for debris)
39
what are the complications of otitis externa
NOE (pseudomonas aeruginosa)
40
what should you suspect if antibiotics don't work for otitis externa
fungal - more common following perforation due to an increased moisture (will see hyphae and black spores)
41
how long do you have sinusitis before it is classed as chronic sinusitis
12 weeks
42
Rf for rhino sinusitis
nasal polyps, recent local infection, septal deviation, smoking
43
IX for sinusitis
may do nasal cultures is unresponsive to Tx, can do a rhiinoscope to look for signs of obstruction
44
Mx of rhinosinusitis
<10 days --> oral analgesics, nasal saline >10 days --> intranasal corticosteroids + amoxicillin FESS for chronic sinusitis
45
what can otosclerosis (mature bone replaced by woven bone) be precipitated by
pregnancy (in those that are genetically susceptible)
46
IX for otosclerosis
pure tone audiogram (conductive hearing loss) and a CT can confirm diagnosis
47
how can cholesteatoma cause a sensorineural hearing loss
when the stratified squamous expands and causes enzymatic bony destruction which can affect the cochlea
48
everyone with a cholesteatoma needs a referral to ENT but when would you need a emergency referral
if there was vertigo or a facial nerve palsy
49
when would you surgically repair a TM perforation
after6 months
50
what is the procedure to repair a TM perforation
myringoplasty
51
complications of myringoplasty
hearing loss if the ossicular chain is disrupted, graft failure, pain, infection, bleeding
52
Mx of a haemotympanum (where there is blood behind the tympanic membrane in the middle eaR)
should heal conservatively but need to rule out a basilar skull fracture with a CT
53
where is the retropharyngeal space between
the buccopharyngeal fascia and the preverterbral fascia
54
what is the most superficial layer of the deep cervical fascia
the investing layer
55
when should you consider a DNSI
when there is a sore throat on a normal oropharyngeal exam When there is severe neck pain and stiffness if there is any sign of airway compromise
56
RF for a DNSI (such a retropharyngeal abscess)
male, smoker, recurrent tonsillitis, poor oral hygiene
57
Presentation of a DNSI
severe sore throat, difficulty breathing, new onset dysphagia, odynophagia, voice change and neck stiffness
58
when Ix do you do for a DNSI
FNE / T neck with IV contrast
59
Mx of DNSI / abscess
-broad spec abx -IV dex - if airway involved -humidified O2 with saline nebs -low threshold for intubation -mainstay of management is through surgical drainage
59
Complications of DNSI
mediastinitis, airway obstruction, sepsis
60
what is Ludwigs angina
cellulitis which spreads through floor of mouth, normally from a tooth infection of dental work
61
presentation of Ludwigs angina
neck swelling, dysphagia, swollen and elevated tongue
61
MX of Ludwigs angina
broad spec Abx and airway Mx
62
Complications of Ludwigs angina
same as for DNSI
62
where is the pharyngeal space in the neck
potential space poster-lateral to the oropharynx and nasopharynx (abscess here can be caused by dental infection or tonsilitis)
63
organism most commonly causing sialadenitis
staph aureus but can also be viral eg mumps
63
symptoms of sialadenitis
pain, halitosis, swollen glands, pus draining from gland, dry mouth
64
Ix for sialdentiis
salivary culture to look at the causative organisms and may do imaging with US or CT
65
Mx for sialadentiis
abx and oral hygiene
66
RF for sialadentiis
dehydrations and immunocomp
67
what stones cause sialolithiasis
calcium carbonate
68
why are salivary stones most common in the submandibular
secretions more mucoid and the duct is long
69
IX for stones
USS and sialography
70
complications of salivary stones
abscess formatin and sialadentiis
71
MX of stones
most settle on their own but use analgesia and maintain adequate hydration - some may need radiological removal
72
what is Freys syndrome
after parotid surgery, the auriculotemporal nerve is damaged and when it heals it reattaches to a sweat gland rather than the salivary gland and this creates excess sweating
73
complications of salivary gland surgery
-freys syndrome -bleeding / haematomas -nerve injury --> parotid (facial nerve injury), submandibular (hypoglossal / lingual)
74
reasons to 2WW a thyroid nodule
unexplained hoarseness, lymphadenopathy, rapidly enlarging mass
75
how does follicular thyroid cancer spread
haematogenous
76
RF for thyroid cancer
female, obesity, benign thyroid disease and radiation exposure
77
red flags of thyroid malignancy
age <20 or >50, firmess of nodule, rapid growth and regional lymphadenopathy
78
What Ix would you do for a thyroid nodule
ECG urinanalaysis (metanephrines for phaeochromocytoma) TFT calcitonin FNA and US
79
what is it always important to check after thyroid surgery
calcium!!!
80
what is a VC papilloma caused by
HPV
81
how would a VC papilloma present
cough and hoarseness
82
Imaging for larynx cancer
FNE or direct laryngoscope -or FNA if presenting with a lump in neck
83
what is laryngopharyngeal reflux
GORD causing inflammatory changes to the larynx / hypopharynx
84
presentation of laryngopharyngeal reflux
sensation of lump in throat, hoarseness, chronic cough, dysphagia, heartburn and sore throat -NOTE --> any unilateral symptoms need referral. If classic presentation can give lifestyle advice and PPI
85
what do bloods show for infectious mononucleosis
atypical lymphocytosis
85
when should a monospot test be done for EBV
in the 2nd week of illness to confirm diagnosis
86
recovery trajectory of EBV
symptoms should ease after 2-4 weeks and then avoid contact sport for 8 weeks
87
what is a cystic hygroma
a congenital lymphatic lesion in the posterior triangle of the neck which presents before age 2 and is soft and fluctuant
88
cause of branchial cyst
failure of obliteration of the secondary branchial cleft in embryonic development
89
what can a cervical rib cause
a thoracic outlet syndrome where there is compression of nerves, veins, arteries of the neck
90
where does the larynx span from
C3-C6
91
what does the larynx become inferiorly
the trachea
92
what are the borders for the supra glottis
inferior surface of the epiglottis to the vestibular folds (false VC)
93
border of the sub glottis
inferior border of the glottis to the inferior border of the cricoid cartilage
94
border of glottis
true VC
95
borders of the nasopharynx, oropharynx and the laryngophraynx
nasopharynx - base of skull to soft palate oropharynx - soft palate to epiglottis Laryngopharynx - epiglottis to the inferior border of the cricoid (C6)
96
borders of carotid triangle
posterior belly digastric, superior belly omohyoid and lateral border SCM
97
what neck fascia surrounds SCM
investing
98
which salivary gland is serous
parotid
99
which salivary gland is mucinous
sublingual
100
noise induced hearing loss audiogram
notch at 4000hz
101
what is samters triad
nasal polyps, aspirin sensitivity and asthma
102
drugs which cause gingival hyperplasia
phenytoin, ciclosporin and nifedipine
103
if someone presents with sudden onset sensorineural hearing loss to GP, what should happen
start them on high dose prednisolone and same review by eNT
104
what does rinnes negative mean
bone conduction > air conduction (abnormal)
105
what do you get in surfers/swimmers ear
exostoses
106
IX for a salivary gland pathology
1) plain xray to rule out stones 2) sialography 3) FNAC

Yr 5 neuro (6 decks)

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