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ENT Flashcards

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1
Q

DDx of cervical lymphadenopathy

A 
EBV
HIV
Adenovirus
CMV
HZV
Steptococcal pharyngitis
NHL, HL, CLL
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2
Q

What travels through parotid?

A

Facial nerve (if facial nerve palsy = malignant parotid)

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3
Q

Causes of parotitis?

A 
Mumps
Stone
Sarcoid
Tumour
HIV
Wegeners
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4
Q

B/l swelling of parotids for 1w, low grade fever.

What Ix?

A

FBC, ESR/CRP, U+Es, Blood cultures. Viral serology.
Salivary antibody testing (salivary mumps IgM)
Pus swab
USS
Sialography
CT/MRI (r/o neoplasm)

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5
Q

Which salivary gland is commonly obstructed?

A

Submandibular

parotid is wider, more watery saliva

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6
Q

Parotid pain + swelling at meal times, colicky, relapse + remitting.
Likely dx?
Ix?

A

Obstruction

USS + contrast sialography

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7
Q

Mx of obstruction?

A

Conservative [good hydration, warm compress, massage]

Surgical removal

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8
Q

Red flags of salivary glands that would indicate malignancy

A 
Rapid increase in size
Ulceration
Fixation
Paraesthesia (facial nerve)
Past hx of skin cancer
Sjogrens
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9
Q

Ix for salivary gland tumour

A

USS
+ FNA
+ core biopsy

MRI for staging
CT for met spread

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10
Q

Complication of salivary gland tumour removal?

A

Damage to facial nerve
Recurrence
Freys syndrome (redness/swelling of cheek when eating)

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11
Q

Most common cause of vertigo?

A

BPPV

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12
Q

Pres of BPPV?

A

Vertigo provoked by head movement, worse when head tilted to on e side
Sudden onset attacks 20-30seconds
Assos N+V

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13
Q

Red flags in vertigo

A

Hearing loss
Tinnitus
Pain
Headache

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14
Q

Ix in BPPV?

A

Dix-Hallpike (positive on one side ONLY)
Otoscopy
Cranial nerve examination

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15
Q

What if Dix-Hallpike positive bilaterally?

A

Vestibular neuritis / central cause

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16
Q

DDx in vertigo

A 
BPPV
Vestibular labrythitis
MS
Menieres
Acoustic neuroma
Ramsay-Hunt
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17
Q

Mx of BPPV

A

Get out of bed slowly, reduce head movements

Epley’s manoeuvre

Dont drive when dizzy

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18
Q

Pres of Menieres?

A

Episodic auditory and vestibular disease –> Sudden onset vertigo (30mins), hearing loss, tinnitus and aural fullness [unilateral]

Drop attacks, positive Rombergs

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19
Q

Pathophysiology of Menieres?

A

Overprod / lack of absorption of endolymph

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20
Q

Ix in Menieres?

A

Mainly exclusion!

MRI, TFT, Syphillis serology

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21
Q

Initial hearing loss in Menieres?

A

Low frequency

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22
Q

Initial hearing loss in acoustic neuroma?

A

High frequency

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23
Q

Mx of Menieres?

A

Low salt diet + diuretics

Medical [topical meclozine; Meniett device; intratympanic corticosteroids]

Surgical [endolymphatic sac surgery]

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24
Q

Vestibular neuritis pres?

A

Acute vertigo

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25
Labrythitis pres?
Acute vertigo + hearing loss
26
Cause of vestibular neuritis?
Usually due to reactivation of HSV in vestibular ganglion
27
cause of labrynthitis?
Post viral URTI (50%)
28
Pres of VN/L ?
Sudden, servere incapacitating vertigo (illusion of moving), N+V NOT triggered by movement (Dix-Hallpike negative) Hearing loss = labrythitis URTI sx
29
Ix in VN/L
Otoscopy CN examination Rinnes/Webers HINTS [Head impulse, nystagmus type, skew] to differentiate from stroke
30
HINTS indicating VN/L?
Unidirectional nystagmus, no vertical skew In stroke - bidirectional nystagmus and a vertical skew are present
31
Mx of VN/L
Prochlorperazine for vertigo
32
Acoustic neuroma? | Where is it?
CN8 tumour of Schwann cell Cerebellopontine angle
33
Pres of acoustic neuroma?
Unilat hearing loss, tinnitus (progressive) Impaired facial sensation Impaired balance
34
When do you see bilat acoustic neuroma?
NF T2
35
Ix in acoustic neuroma?
Audiology | MRI
36
Mx of acoustic neuroma?
Microsurgery | If small tumour and preserved hearing can watch and wait
37
Examination of sinus?
Palpate + assess nose
38
Cause of sinusitis?
S. pneumoniae H. influenza Moraxella Catarrhalis (children)
39
Mx of sinusitis?
pcm/NSAIDs Intranasal decongestant Nasal douching Warm face packs If bacterial --> amoxicillin (7days)
40
Comps of sinusitis?
Orbital cellulitis Meningitis Osteomyelitis
41
Mx of chronic sinusitis?
Topical nasal steroids (beclamethasone)
42
TMJ dysfunction
Pain (in front of tragus, radiating to ear) Limited mouth opening Joint noises
43
Mx of TMJ dysfunction?
Reassurance Rest NSAIDs +/- muscle relaxants
44
Cause of congenital hearing loss?
Rubella CMV Malformation
45
Cause of post natal hearing loss?
Measles | Mumps
46
Ix in deafness?
Audiometry | Tympanometry
47
Sudden hearing loss? What to do?
Urgent referral to ENT
48
Pres of otitis externa?
Erythematous ear canal + oedema + exudate Mobile TM Pain on moving tragus Pre-auricular lymphadenopathy
49
3 types of otitis externa?
acute otitis externa - bacterial (swimmers ear) Chronic otitis externa - fungal Necrotising otitis externa - P. aeruginosa in mastoid + temporal bones
50
Mx of necrotising otitis externa?
Oral and topical quinolones for 6 - 8 weeks | eg ciprofloxacin
51
Mx of otitis externa
analgesia Neomycin drops Oral abx if cellulitis / cervical lymphadenopathy
52
Mx of fungal otitis externa
clotrimazole
53
Mx of chronic otitis externa
Acetic acid | Corticosteroid ear drops (hydrocortisone)
54
Prevention of otitis externa
Keep ear dry NO COTTON BUDS olive oil to prevent waxy build up
55
Pres of acute otitis media
Hearing loss Otalgia Otorrhoea Fever
56
Ix in otitis media
Culture if d/c | CT/MRI to r/o complications
57
Mx of otitis media
Analgeisa Nasal steroids Abx
58
Otitis media with effusion. AKA?
Glue ear
59
Pres of glue ear?
Conductive hearing loss Aural fullness Crackling tinnitus
60
Pres of mastoiditis?
Intense pain behind ear Fever Boggy mass behind ear External ear protrudes fwd
61
Ix in mastoiditis?
FBC, Blood cultures CT/MRI LP if suspect has spread intracranially Fluid extraction for gram stain + culture
62
Mx of mastoiditis?
High dose broad spec IV Abx: 3rd gen cephalosporin (2 days) Oral abx for 2 weeks
63
What to do if cranial extension of mastoiditis?
Mastoidectomy + tympanoplasty
64
What is cholesteatoma?
Keratinising squamous epithelium within middle ear (on attic)
65
Comps of cholesteatoma?
Locally invasive into bones (mastoid + middle ear)
66
Pres of cholesteatoma?
Progressive conductive hearing loss Erosion - vertigo, headache, CN7 palsy, meningitis Frequent otorrhoea (foul smelling)
67
Ix for cholesteatoma?
CT | MRI
68
Mx of cholesteatoma?
Surgical removal
69
Which nerve runs over temporal bone?
Abducens
70
Ix in oral cancer?
FNA Biopsy CT/MRI for staging CT thorax
71
Mx of oral cancer?
Surgical resection / brachytherapy +/- cisplatin
72
RFs for oral cancer?
Tobacco, alcohol, HPV, Asian
73
Nasopharyngeal cancer? RFs? Problemo?
EBV, smoking, Asian 50% have cervical mets at presentation
74
Pres of laryngeal cancer?
Chronic hoarseness, persistent cough, pain, dysphagia, lump, soar throat, wt loss
75
Ix in chronic hoarseness?
CXR --> ?lung or ENT cancer
76
Epiglottitis? Causative organism? Presentation?
HIb Sore throat, drooling, fever, high temp, stridor, resp distress, TOXIC
77
Seen on lateral XRay of epiglottitis?
Thumbprint sign
78
Mx of epiglottitis?
IV abx +/- intubation
79
Cause of quinsy?
Strep. pyogenes Peritonsilar abscess!
80
Mx of quinsy?
IV fluids, analgesia, IV abx (penicillin/cephalosporin/co-amox) Needle aspiration, incision + drainage
81
Ix in recurrent epistaxis?
FBC, coag ?malignancy - ENT for nasopharyngoscopy
82
Mx severe epistaxis?
Nasal packing Cautery [silver nitrate; electrocautery]
83
Ix of nasal polyps?
Rhinoscopy by ENT
84
Mx of nasal polyps?
1. topical corticostroids + saline douche | 2. endoscopic sinus surgery
85
DDx of swallowing difficulties?
Obstructive [GORD, oesophagitis, cancer, stricture] Neuro [CVA, achalasia, spasm, MND, MS, PD] Other [Pharyngeal pouch, compression, CREST]
86
``` OSA. RF? Pres? Score? Mx? ```
Obesity, male, middle age, smoking, alcohol, FHx Snoring, daytime sleepiness, macroglossia Epworth sleepiness score Wt loss. CPAP.
87
Otosclerosis? Presents when? Causes?
Autosomal dominant 20 - 40 Normal bone replaced by vascular spongy bone --> progressive conductive deafness
88
Mx of otosclerosis?
Hearing aid | Stapedectomy
89
Ototoxic drugs?
Aminoglycosides (gentamicin) Furosemide Aspirin Cytotoxics
90
What would make you suspicious of a Quinsy?
``` Prolonged Sever pain on one side Deviation of uvula Difficulty opening mouth Reduced neck movements ```
91
Ramsay-Hunt? | Pres?
Reactivation of VZV in CN7 Rash in ear / mouth Weakness Dizziness / vertigo
92
Mx of ramsay hunt?
Oral aciclovir | Corticosteroids
93
Mx of unilateral vs bilateral nasal polyps?
Uni - urgent referral to ENT Bilat - topical corticosteroids + routine referral
94
How long does perforated ear drum usually take to heal?
6 - 8 weeks
95
Samter's triad?
Asthma + aspirin hypersensitivity + nasal polyposis
96
Why cant you give amoxicillin in sore throat?
If its EBV --> scaring rash

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