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2MB: disease summaries > ENT > Flashcards

ENT Flashcards

1
Q

Bilateral hearing loss
Normal tympanic membrane
Audiometry: conductive hearing loss
Usually < 50yrs old

A

Otosclerosis

Treatment: Stapedectomy +/- hearing loss

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2
Q

What is the CENTOR criteria

A

-Tonsillar exudate
-Tender lymph nodes
-Fever
-No cough
(need 3+ to give antibiotics)

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3
Q

What is the typically protocol with a sore throat?

A 
Supportive measures
Check CENTOR: 3+ give ABs (penicillin/eryhtromycin)
Worry if: 
- Cancer history 
- > 3 weeks dysphagia
- Get ambulance if stridor
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4
Q

How is a perforated tympanic membrane dealt with?

A

Keep dry
Review in 4 weeks
ENT referral if not better (for myringoplasty)

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5
Q

Vesicles on tympanic membrane (or ant 2/3rds tongue)
facial weakness
Tinnitus
Vertigo hearing loss

A

Ramsay hunt syndrome ( Varicella Zoster Virus on genciculate ganglion)

Treatment: Oral aciclovir + corticosteroids

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6
Q 
Vertigo
Tinnitus 
'fullness' in ear
Audiometry: sensorineural hearing loss
Recurrent attacks >20 mins each
A

Menieres (Imbalance in perilymph/endolymph)

Treatment: Therapy + steroids + gentamicin

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7
Q 
Slow onset of hearing loss
Usually bilateral
Loss of high frequency first
Otoscopy: Normal 
Tympanometry: normal middle ear with hearing loss
Audiometry: Sensorineual hearing loss
A

Presbycusis (age-related deterioration of hearing)

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8
Q 
Hearing loss: 
Baseline for normal is: >20db
Sensorineural: \_\_\_ conduction is impaired
Conductive: \_\_\_ conduction is impaired  
Mixed: \_\_\_ conduction is impaired
A

S: both
C: bone
M: Both (air more severe than bone)

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9
Q 
Asian male
Ear pain/dysfunction without any signs
Sore throat
Odynophagia
Nasal discharge +/ nosebleeds
Signs of cranial nerve palsy
A

Nasopharyngeal carcinoma

  • SqCC
  • EBV associations

Confirm with: CT and MRI

Treatment: Radiotherapy

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10
Q

Red, irritated ear

Debris and discharge

A

Otitis externa
Confirm organism with swab ( usually Staph aureus, P. aeruginosa/fungal)

Treatment:
Irrigate
gentamicin or ciprofloxacin (bacteria)/clotrimoxazole (fungal)
+ Steroids

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11
Q 
Diabetic/ Immuno-compromised
Severe ear pain
Discharge
Facial nerve dysfunction 
Hoarse voice
A

Malignant otitis externa
(P.aerunginosa infection that spreads to bone and causes osteomyelitis)
Confirm with CT

Treatment: IV ciprofloxacin

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12
Q 
Patient with cleft palate
Foul smelling discharge from ear
Hearing loss
Can have: 
-vertigo
-facial nerve palsy
Otoscopy: 'attic crust'
A

Cholesteatoma (trapped squamous epithelium causing local destruction)

Management: ENT referral

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13
Q

Sudden onset of vertigo when changing head position
Lasts about 20s
Tends to be >50s

A

Benign Paroxysmal
Positional vertigo

Confirm with: 
Dix-Hallpike manouvre
Treatment: 
-Epley manouvre
-Betahistine can help
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14
Q

Vertigo lasting hours
nausea and vomiting
Horizontal nystagmus
NO HEARING LOSS

A

Vestibular neuronitis (inner ear inflammation)

Treatment: Self-limiting

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15
Q

Haemorrhage 5-10 days post tonsillectomy warrants

A

IV antibiotics (wound infection)

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16
Q

Haemorrhage 6 hours post tonsillectomy warrants

A

Return to theatre

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17
Q

Short history of earache
hard of hearing
Bulging of eardrum

A

Acute otitis media ( viral URTI causing bacterial infection)

Usually resp pathogens (H.influenzae, S.pneumoniae, S. pyogenes)

18
Q

Enlarged tonsils that meet in midline
White film
Systemically well

A

Acute bacterial tonsilitis
(GAS or ‘resp’ pathogens)

Treatment; Penicillin
Stubborn: Tonsillectomy

19
Q

kid/teen presents with large tonsils that meet in midline
White patches on red-raw membrane
-Nodes: Anterior and posterior chain enlarged
-Fever
-Haemorrhages on oropharynx
-Systemic upset
(splenomegaly)

A

Infective mononucleosis
(EBV, CMV)

Diagnosis: FBC and Monospot

Management :

  • Supportive
  • Dont play sport
20
Q

Aspirin insensitivity + asthma + nasal polyps indicates what triad?

A

Samters triad

21
Q 
Vertigo
Hearing loss
Nerve palsy:
V: absent corneal reflex affected side
VII: facial palsy
VIII: hearing loss, vertigo, tinnitus
Verocay bodies on histology
A

Acoustic neuroma (vestibular schwannoma)

Ix: ‘Ice cream cone’ CT

Treatment: Removal

22
Q

Severe throat pain
Deviation of uvula to unaffected side
Opening mouth is difficult

A

Quinsy (peri-tonsillar abscess)

Treatment: ENT specialist
Needle aspiration under anaesthesia
-IV antibiotics

23
Q

Intermittent discharge

Perforation of pars tensa/flaccida

A

Chronic otitis media
Can co-exist with cholesteatoma

Leave for 4 weeks and review
Myrinngoplasty if severe

If flaccida then mastoidectomy

24
Q

Sensorineural loss

Patient on chemo/antibiotics/NSAIDS

A

Drug induced hearing loss (ABs: Gentamicin and Aminoglycosides)

Stop drugs and give cochlear implant

25
Q

Infection/comes on in summer
Blockage
Loss of smell
Post nasal drip

A 
Rhinitis
If allergic: 
1 Cetrizine (anti-histamine)
2. IN steroids (corticosteroid)
3.  Oxymetazoline (a agonist)
26
Q

old Man complains of:
Blocked/runny nose
poor taste and smell

A

Nasal polyps

Investigate: Oral steroids and CT sinuses

Treatment: topical corticosteroids

27
Q

What is done if suspected nasal polyps are unilateral/bleding?

A

Refer to ENT immediately

28
Q 
Patient with trauma to face
pain
runny nose
bilateral red swelling 
Boggy on pressing
A

Nasal septal haematoma (haematoma between cartilage and perichondrium)
Drainage
IV antibiotics

29
Q

Bleeding from nose

A

Epistaxis
Ant: kiesselbach’s (ethmoidal)
Post: posterior inferior venous plexus

Investigate: 30 degree rigid endoscopy

Treatment:
Lean forward and pinch nose
Vasoconstrictors (lignocaine)
Cautery/ligate after 15 mins

30
Q

What are the 3 grades of LeFort fracture

A

I: horizontal
II: Pyramidal
III: Transverse

Treat: surgery

31
Q

Nasal blockage
saddle nose
eye involvement
Strawberry gingivitis

A 
GPA
c-ANCA +ve
Mild: MTX + Steroids
Moderate: cyclophosphamide and steroids
Severe: Rituximab + Steroids
32
Q

which ENT tumour is related to HPV 6 and 11?

A

Squamous papilloma

33
Q

40-60 year old

single Slow growing lump near parotid

A

Benign pleomorphic adenoma (most common)

Biopsy: increased epithelial and stromal components

34
Q

60-70 year old

Bilateral and multicentric tumour near parotid

A

Warthins tumour

Biopsy: cystic spaces with uniform epithelium

35
Q

Whats the most common malignant tumour of the parotid?

A

muco-epidermoid (encapsulated and affects all ages)

36
Q

Whats the most malignant tumour of the palate?

A

Adenoid cystic carcinoma

Painful and perineural invasion

37
Q

cold sores

Local lymphadenopathy

A

HSV I infection

Investigate: Swab for PCT

Management: Aciclovir

38
Q

Soft palate vesicles
Sore throat
Fever

A

Herpangina

Investigation: PCR (coxsackie)

Treatment: Self-limiting

39
Q

Farmer

Lesions on hand, feet and mouth

A

Hand foot and mouth
(Coxsackie)
Investigate: PCR
Self-limiting

40
Q

Young patient who sleeps around
painless ulcers at mouth/groin
lymphadenopathy
Progresses to a rash

A

Syphilis

Investigate: Microscopy (spirochetes)

Treatment:
IM Penicillin/doxycycline

41
Q

Round ulcers with halo around them

A

Aphthous ulcers

Self limiting

42
Q

Severe sore throat

Grey-white membrane

A 
Diphtheria
C.Diptheriae
Management: 
Antitoxin
Supportive 
Sometimes antibiotics

2MB: disease summaries (10 decks)

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