ENT Flashcards
(204 cards)
1
Q
whilst viral URTI typically precede otitis media, most infections are secondary to
A
bacteria
2
Q
otitis media
A
bulging tympanci memebrane causing loss of light reflex
erythema of tymanci membraen
3
Q
presence of middle ear effusion can diagnsoe
A
otitis media
4
Q
when should seek help if otitis media not improived by
A
3 days
5
Q
some examples of when give antibiotic for otitis media
A
lasting more than 4 dyas
younger than 2 with bialteral otitis media
otitis media with perforation
6
Q
first line ax for otitis media
A
amox
7
Q
what is it called if perforation of the tympanic membrane with otorrhoea for >6 weeks
A
chronic suppurative otitis media
8
Q
what are usually sterile
A
sinuses
9
Q
facial pain from sinusiitis is worse on
A
bending forward
10
Q
nasal discahrge in sinusitis can be
A
thick and purueltn
11
Q
what may be given if sinusitis been there for more than 10 days
A
corticosteriods- intranasal
12
Q
if antibiotics are needed for sinusitis what is the first line
A
phenoxymethypenicllin(first line). co amox if very unwell
13
Q
“Double sickening” in sinusitis refers to a clinical pattern where a patient with viral sinusitis initially starts to improve, but then gets worse again after a few days.
A
suggests a secondary bacterial infection
14
Q
seasonal rhinitis is known as
A
hay fever
15
Q
why shouldnt nasal degonestatants eg oxymetazoline be used for prolonged periods
A
as you develop tolerance to them &rebound hypertrophy of the nasal mucosa may occur upon withdrawl
16
Q
symptoms of sneezing, clear nasal discharge and post nasal drip can suggest
A
allergic rhinitis
17
Q
in sensorieural hearing loss
A
air and bone conduction are impaired
18
Q
in conductive hearing loss only
A
air conduction is impaired
19
Q
what are common in rugby players and prompt treatmetn needed to avoid cauliflower ear
A
auricular haematoma
20
Q
mx of auricular haematoma
A
same day assessment by ENT
21
Q
actual mx for auricular haematoma
A
incision and drainage
22
Q
what is positive to suggest BBPV in dix hallpike maneovre
A
rotatory nystagmus
23
Q
what exercise can also help in BBPV
A
Brandt- daroff
24
Q
ix to do in black, hairy tongue
A
swabbed to exclude candida
25
mx of black hairy tongue
tongue scraping and topical antifungal if candida
26
lateral neck lump anterior to sternocleidomastoid
branchial cyst
27
what can make branchial cysts more prone to infectoon
they may have a fistula
28
when might branchial cysts enlarge
following resp tract infection
29
do branchial cysts transilluminate
no - cyst is filled with acellular fluid with cholesterol crystals
30
in branchial cyst what ix
US to exclude maglignnacy?
31
is a cholesteatoma cancerous
No
32
what majorly increases your risk of a cholesteatoma
cleft palate
33
how does cholesteatoma presetn
foul smelling, non resolving discharge
34
what might otoscopy show in cholesteatoma
attic crust- seen in the uppermost part of ear drum
35
nasal obstruction seen in chronic sinusitis can mean the pt
mouth breathes
36
post nasal drip in chronic sinusitis can cause
chronic cough
37
mx of chronic sinusotis
intranasal cotricosteriods, nasal irrigiation with saline
38
for an adult to get a cochlear implant they need to have tried
hearing aids for at least 3 months and not worked
39
2 classess of medications that can cause ototoxcity
aminoglycsides or loop diuretics
40
for cochlear implant to happen what needs to be checked
surviving spiral ganglion neurons
41
what is destrucetd in putting in a cohlear implant
organ of corti
42
what vaccines should pts get who are gettign cochlear implant to reduce the risk of meningitis
strep and haemophilus hsould be up to date
43
contraindications for cochler implant
lesions of vestibulocochlear damage causing deafness
chronic infective otitsi media
cochlear aplasia
44
what does audiometry show in presbycusis
bilateral high frequency hearing loss (sensorineural)
45
otosclerosis has what symptoms
conductive deafness and tinntitus
46
10% of pts might have what on otosclerosis
flamingo tingue (caused by hyperaemia) on tympanic membrane
47
otosclerosus is normal bone replaced by vascular spongy bone. what is the inheritance
autosomal dom
48
what is usually the promonent symoptom in menieres
vertigo
49
what from gentamicin and furosemide what other drugs can be ototoxic
aspirin
50
noise damage related hearing loss is worse at what frequencies
3000-6000
51
acoustic neuromas affect cranial nerve - 5,7,8 so affecting 5 can present with
absent corneal reflex
52
what ear drops may be used for ear wax causing symptoms
olive oil
53
first aid for nose bleed
mouth open
54
pinch soft part of nose for how long
20misn
55
what after first aid is inital mx of nosebleedds
cautery(silver nitrate) if bleeding source is visible
56
why should you only cauterise one side of the steptum
as there is risk of perforation
57
alternative to naseptin that can be used
muciprocin
58
what is used if the bleeding pooitn is not visible
packing
59
the aneasthetic spray used for cautery and packing takes 3-4mins to work and is called
co-phenylcaine
60
what is the last line for epistaxis bleeding
sphenopalatine ligation
61
what are you worried about in older patients with new osnet facial pain
GCA
62
drugs that can cause gingival hyperplasia
phenytoin
ciclosporin
ccb especially nifedipine
63
haem cause of gingival hyperplasia
AML
64
painkless red swelling of the gum margin which may bleed
simple gingivitis
65
acute necrotizing ulcerative gingivitis
painful bleeding gums with halitosis and punched out ulcer on gums
66
simple gingivitis mx
refer to dentist
67
acute necrotizing ulcerative gingivitis mx
refer to dentist
oral metrondazole for 3 days
chlorhexidine or hydrogen peroxide mouth wash
simple analgesia
(amox may be used )
68
grommets stop working after about
10 months
69
last line for glue ear
adenoidectomy
70
oral cancer referral if
ucleration for more than 3 weeks or neck lump
71
what should be done to exclude apical lung lesions if prestn with hoarseness
CXR
72
laryngopharyngeal reflux
globus and is typically worse when swallowinf saliva rather than eating or drinkign. may also have hoarseness or chronic cough
73
mx of laryngopharyngeal reflux
avoid fatty foods etc
PPI
gavsicon
74
is larygopharynegal reflux common
yes thought to be around 10% of ENT referrals
75
ludwigs angina
progressive cellulitis that invades the floor of the mouth and soft tissue of neck
76
ludwigs angina may present as
neck swelling, dysphagia, fever
77
ludwigs angina is life threatening emrrgency and mx is
airway mx and IV antibiotics
78
most cases of ludwigs angina re from odontogenic infections which spread into the
submandibular space
79
90% of malignant otitis externa are found in
diabetics
80
malignant otitis externa is most comonly casued by
pseudomaonas aeruginosa
81
maligant ototis externa can progress to
temporal bone osteomyeltis and can be sevre unreletnting otalgia, temporal headahce, purulent otorrhoea
82
malignant otitis externa
CT typically doen
83
non resolving otitis externa with worsenign pain should be referred to ENT as worries about
malignant otitis media - give IV antibiotics that cover pseudomonas eg piperacillin tazobactam
84
mx of mastoidits
Iv antibiotics
85
complication of mastoiditis
meningitis
86
symptoms of menieres are unilateral but
bilateral symptoms may develop after a number of years
87
symptoms of menieres resolve in the majority of pts after how ling
5-10 years & are left with a degree of hearing loss
88
can gp diagnosis menieres
no ENT
89
need to infrom DVLA if get dx of menieres and
cease driving until satisfactory conrol of symptoms is acheived
90
how is prochlorperazine given in menieres
buccal or IM
91
nasal polyps are not commonly seen in
chidlren or elderly
92
what % of population have nasal polyps
1%
93
some things that are asscoiate with nasal polyps
asthma (particualrly late onset asthma)
aspirin sensitivity
churg strauss
cystic fibrosis
94
samter triad refers to
asthma, aspirin sensitivity and nasal poylpsosis
95
features of ansal polyps
nasal obstruction ,rhinorrhoea, poor sense of taste and smell
96
red flag for nasal polyps
one sided
97
all pts with nasal polpys should be
refered to ent for full examination
98
what shrinks nasal polyps in 80% of pts
topical corticosterids
99
important complication of nasal trauma
nasal septal haematoma
100
what is the most common symptoms of nasal septal haematoma
sensation of nasal obstruction
101
mx of nasal septal haematoma
surgical drainage
iv antibiotics
102
complication of nasal deptal haematoma
septal necrosis that may result in a saddle nose deformity
103
nasopharyngeal carcinoma is associated with what virus
ebstein barr
104
what can be a symptom of nasopharyngeal carcinoma
unilateral middle ear effusion in an adult
105
first line therapy for nasopharyngeal carcinoma
radiotherapy
106
lymphoma (rubbery painless lymphadenoapthy ) associarted with
night sweats and splenomegaly
107
most common cause of neck swellings
reactive lymphadenopathy
108
thyroid swellings move -- on swallowing
upwards
109
more common in<20 y/o, usually midline, moves upwards with protrusion of tongue, may be painful if infected
thyroglossal cyst
110
pharyngeal pouch
more common in older men
posteriomedial herniation (between thyropharyngeus and cricopharngeus muscles)
gurgles on palpation (if can be seen)
111
cystic hygroma
congential lesion classically on left side, most are evident at birth if not up to 2 years
112
branchial cyst
oval, mobile cystic mass between the sternocleidomastoid and pharynx
113
women with firm swelling at bottom of rib, sufferign from weakness and numbnesss of her arm on the same side
cervical rib
114
pulsatile lateral neck mass which doesnt move on swallowing
carotid aneurysm
115
what is a common trigger for otitis externa
recent swimming
116
initial mx of otitis externa
topical antibiotic or a combined topical antibiotioc with a steriod
117
otoscopy in ottis externa
red, swollen or eczematous canal
118
poor response of topical antibiotics for otitis externa should be
referred to ENT
119
what describes the replacemetn of normal bone by vascular spongy bone
otosclerosis
120
type of hearing loss in otoscelrosis
conductive
121
inheritance of otosclerossi
auto dom
122
flamingo tinge in 10% of pts
otosclerosis
123
mx of otoscelrosis
hearing aid
stapedectomy
124
what causes fixation of the stapes at the oval window
otosclerosis
125
most common parotid neoplasm
benign pleomorphic adenoma
126
small % of pleomorphic adenomas becoming malignant what kind most often
adeno
127
is warthin tumour beingn
yes
128
warthin tumour is strongly associated with
smoking
129
what is the most common bilateral benign neoplasm of the parotid
warthin
130
what accounts for 90% of parotid tumours in children under 1
haemangioma - hypervascularity on imaging
131
30% of al parotid malignancies
mucoepidermoid carcinoma
132
malignant partoid lesions
final needle aspiration cytology done in most cases to differentiate benign from malignat
133
where malignancy is suspected in parotid gland disease
definitive resection rather than excisional biopsy
134
nearly all lesions of parotid even beingn need to be
removed
135
for malignant disease of parotid tumour what nerve is removed
facial
136
bilateral multicystic symmetrical swelling in parotid can be due to
HIV
137
sjogrens you get
parotid enlargement
138
what is parotids like in sygogrens
bilateral enlargement
139
acinar units and epimyoepithelial islands
parotid in syogrens
140
sarcoidosis can also affect
parotid
141
mx of perforated tymapnic memebrane
no treatemnt as wll usually heal in 6-8 weeks but advisable to avlid getting water in ear
142
when might you give antibiotics for perforated tympanic memebraen
if the perforation followed an episode of acute otitis media
143
what is the surgery if the tympanic membrane does not heal by itself
myringoplasty
144
mx of peritonsillar abscess
needle aspiration or incision and drainage. + antibiotics
145
features of quinsy
thraot pain which lateralises to one side, deviation of the uvula to teh unaffected side, trismus(difficulty openign mouth), reduced neck mobility
146
most common tumour of the parotid gland
pleomorphic adenoma
147
increase in stromal components in
pleomorphic adenoma
148
are pleomorphic adeoma well encapsualted
no
149
are pleomorphic adenoma typically movable
yes
150
mx of pleomorhpic adenoma
surgical excision
- can reccur
- can develop into adenocarcinoma if not removed
151
unusual fact post tonsillectomy
pain may increase for up to 6 days following a tonsillectomy
152
what is a feared complication following a tonsillectomy
haemorrhage
153
haemorrhage post tonsilectomy occuring 6-8hrs after surgery what should happen
immediate return to theatre
154
haeorrhage occuring 5-10 days after tonsilelctomy is usally because of a
wound infection
155
treatment of secodnary haemorrhage
admit and antibiotics
156
presbycusis affects what frequency
high
157
in presbycusis webers test may localise to one side
if sensorineural hearing loss is not completely bilateral
158
ramsay hunt what virus
varicella zoster
159
auricular pain is often the first feature of
ramsay hunt
160
mx of ramsay hunt
oral aciclovir and corticosteriods
161
what salivary gland gets most tumours
parotid
162
what salivary glands gets most stones
submandibualr
163
what are the 3 pairs of salivary glands
parotid, submandibular and sublignual
164
mx of pleomorphic adenoma
superficial parotidectomy
165
warthins tumours are
softer, more mobile and fluctuant
166
stones in parotid present as
recurrent unilateral pain & swelling on eating
167
168
syogrens may get
enlargement of parotid
169
antibiotics for sore throat if centor score greater than
3
170
hx of rhematic fever is an indication for
antibiotics in sore throat
171
a feature of centor criteria
abscence of cough
172
if got sore throat what are the antibiotics you give
phenoxymethylpenicllin or clarithrmycin if pen allergic
173
most stones in sumandibular gland (most common gland for stones ) made of what
calcium phosphoris or calcium carbonate
174
symptoms of stone in gland
colciky pain and post prandial swlling of gland
175
ix of stones in salivary gland
sialography
176
sialadenitis infection of what
staph aureus - pus
177
tumours of submadibular gland despite being more rare most are
adenoic cystic carcinoma
178
all masses of submandibular gland should be
excised
179
sudden onset sensorienural hearing loss an MRI is usually performed to exclude a
vestibular schwannoma
180
majority of cases of sudden onset sensorineural hearing loss are
idiopathic
181
key to understanding thyroglossal cyst
think about name - thyroid and tongue
182
thyroid develops from the floor fo teh
pharynx
183
point of attachment of teh thyroglossal duct to tongue
foramen cecum
184
how does a thyroglssal cyst present
<20, midline, moves upwards with protrusion of tongue
185
gurgles on palpation
pahryngeal pouch
186
cystic hygroma
under 2y/o
187
absent corneal refelx is an imporatn sign in
acoustic neuroma
188
drugs associated with tinnitus
aspirin/nsaids
aminoglycosides
loop direutics
quinine
189
first line if iamging needed for tinnitus
MRI of internal audiotry meatus
190
pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause what is used to invesigate pulsatile tinnitus
magnetic resonacne angiography
191
mx of tinnitus
underlying cause
amplification devices
cbt
192
requirements for tonsillectomy
7 episodes for one year, 5 per year for 2 years, 3 per year for 3 years
193
other indications for tonsilectomy
recurrent febrile convuslions secodanry to toniltiis,
stridor, OSA, quinsy not responding to tretmetn
194
haemorrhage 24 hrs after tonsielctomy most commonly due to
inadeqaute haemostasis
195
haemorrhage post tonsillectomy >24hrs after most commonly due to
infection
196
what has no hearing loss
vestibular neuronitis
197
elderly pt with dizzines on extension of neck
vertebrobasilar ischaemia
198
what is usually present in vestibualr neuronitis
horizontal nystagmus
199
what can distinguosh vestibular neuonitis from posterior circualtionn stroke
HiNTs exam
200
as part of the hints exam - head impulse test typically pos in
vestibualr neuonitis
201
preferred trament for chronic symotoms of vesticualr neuronitis
vestibular rehabilitation exercises
202
is need rapid cessation of symptoms in vestibular neuonitis given how
Im or buccal. if not needed rapid can givce oral
203
signs of labyrinthitis
spontaenous horizontal nystagmus to unaffected side
sensorienural hearing loss
abnormal head impulse test (impaired vestibulocualr reflex)
gait distubance
204
mx of labyrinthisits
epsideos are usually self limiting but prochlorperaxine or antihistamines may help reduced the sensation of dizziness
