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Liverpool (Year 4) > ENT (Paeds and Adult) > Flashcards

ENT (Paeds and Adult) Flashcards

1
Q

The three cardinal features of Menieres Disease are ____

A

Tinnitus
Deafness
Vertigo

Can also give the feeling of “Aural Fullness”

These symptoms can last hours before they settle and are not associated with movement (vs BPPV which is usually only for a couple of minutes and is triggered by a certain position)

The disease classically only affects one ear, first producing symptoms between the ages of 30 to 60 years old

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2
Q

____ Carcinoma is the most common form of oral cancer.

A

Squamous Cell

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3
Q

Common risk factors for adult head and neck cancers?

A

Smoking

Alcohol misuse

Viral infections including human papilloma virus (HPV) infection (type 16 in particular) and Epstein Barr Virus (EBV) infection

Radiation exposure (UV and ionizing radiation e.g. CT scans)

Immunosuppression (organ transplantation)

Occupational exposure (acid mists, asbestos, wood dust)

Family history

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4
Q

The ____ criteria can be used to estimate the probability that tonsilitis is bacterial in origin and thus will benefit from antibiotics.

A score of ___ or more gives a 40-60% probability of bacterial tonsillitis and thus it is appropriate to offer antibiotics.

Name the four components of this criteria.

A

Centor
3

Fever (>38)
Tonsillar exudate
Absence of cough (cough suggests viral cause)
Tender anterior cervical lymph nodes (lymphadenopathy)

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5
Q

Complications of Tonsillitis

A

Quinsy (peritonsillar abscess)

Otitis Media (infection can spread through the eustachian tube)
Scarlet Fever

Rheumatic Fever

Post Streptococcal Glomerulonephritis

Post Streptococcal Reactive Arthritis

Bleeding (post-op)

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6
Q

Indications for tonsillectomy

A

7 or more in 1 yr
5 or more for 2 yrs
3 or more for 3 years

Or

Recurrent tonsillar abscesses (2 episodes)
Sleep disordered breathing
Suspected cancer

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7
Q

____- ____ manoeuvre can be used to diagnose Benign positional paroxysmal vertigo (BPPV)

A

Dix-Hallpike

Nystagmus to the side of the lesion

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8
Q

Labrynthitis can cause _____ which distinguishes it from acute vestibular neuronitis.

A

Hearing loss

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9
Q

______ may be used to help reduce the attacks in patients diagnosed with Vertigo (includes menieres disease)

A

Betahistine

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10
Q

Name two short-term management options for acute attacks of peripheral vertigo.

A

Prochlorperazine (dopamine antagonist)

and

Antihistamines (Cyclizine/Cinnarizine/Promethazine)

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11
Q

The ____ manoeuvre can be used to treat BPPV.

A

Epley

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12
Q

_____ is a _____ abscess that develops in the frontal bone as a complication of rhinosinusitis.

A

Pott’s puffy tumour
Subperiosteal

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13
Q

Name the classical triad of symptoms associated with cholesteatoma.

A

It presents with:

Persistent foul smelling discharge
Headache
Otalgia (Ear pain)

and hearing loss

It will present on examination of the tympanic with an area of white in the attic behind the tympanic membrane.

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14
Q

____ is the most common cause of progressive deafness in ___ adults. It is an ____ condition and thus the majority of patients have significant family histories.

A

Otosclerosis
Young
Autosomal dominant

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15
Q

Name the two main management options for otosclerosis

A

1st line: Hearing aids

2nd line: Stapedectomy

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16
Q

If direct compression of the nasal alae for 10-15 minutes does not resolve epistaxis then ___ is the next step in management.

A

Nasal cautery (thermal or chemical - silver nitrate sticks)

Nasal packing is the next step in management

Aggressive therapies such as nasal balloon catheter and transnasal endoscopy with direct cautery/arterial ligation are reserved for patients with posterior bleeds and uncontrollable severe bleeding unamenable to nasal packing.

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17
Q

_____ is the imaging modality of choice for a neck lump.

A

Ultrasound

Ultrasound ultimately allows for an ultrasound guided biopsy (either fine needle aspiration or core biopsy) which is crucial for investigating a neck lump. The biopsy may not be required if the ultrasound does not show a suspicious lesion.

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18
Q

Hoarseness lasting more than ____ must be referred under a 2 week wait to ENT clinic.

A

3 weeks

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19
Q

Cancer of the ___ sinuses should be suspected in any adult that presents with chronic (___ weeks) rhinosinusitis for the first time

A

Paranasal
>12

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20
Q

The most common malignant tumour of the parotid gland is _____ carcinoma, which accounts for approximately 30% of parotid gland malignancies

A

Mucoepidermoid carcinoma.

Remember facial palsy associated with a parotid tumour indicates likelihood of malignancy

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21
Q

_____ and ____ are the two most common causes of otitis externa.

A

Pseudomonas Aeruginosa
Staph Aureus

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22
Q

A single nasal polyp ____ should be investigated as suspected nasopharyngeal cancer.

A

unilaterally

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23
Q

Hearing loss is a key complication of which neurological illness ?

A

Meningitis

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24
Q

As a Vestibular Schwannoma enlarges, it can compress local nerves including CN ___ (leading to loss of corneal reflex) and/or the brainstem. Late in the disease course, it can rarely affect CN ___ The enlarging tumour can also cause a ____ due to mass effect, which is most frequently _____ in location.

A

V (Trigeminal)
VII (Facial) - which may cause unilateral lower motor neuron palsy manifesting in inability to bear teeth on one side and change in taste).

Headache
Occipital

(so overall a vestibular schwannoma can affect CN 5, 7 and 8)

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25
Q

Cranial nerve ___ is responsible for the afferent arm of the corneal reflex, whilst cranial nerve ___ is responsible for the efferent.

A

Vi (ophthalmic division of trigeminal)

VII (facial)

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26
Q

5 Complications of Thyroid Surgery

A

Hypocalcaemia (damage to parathyroid)
Hypothyroidism
Thyroid storm
Neck Haematoma
Recurrent or superior laryngeal nerve palsy (hoarseness and dyspnoea/SOB)

Superior laryngeal nerve supplies the cricothryoid muscle and thus can result in an inability to use the voice at high pitches.

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27
Q

The _____ muscle is one of two small muscles located in the middle ear. Its purpose is to dampen loud sounds that might otherwise cause damage to the ear.

What is the innervation of this muscle?

A

Tensor Tympani

Viii (mandibular division of the Trigeminal nerve)

Tensor tympani, acts on the handle of malleus, tensing the tympanic membrane and thus reducing transmitted sound vibrations.

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28
Q

The facial nerve gives off the ____ nerve (supplying taste to the anterior tongue) along with a nerve to ___ , the smaller of two muscles located in the middle ear. The ___ muscle acts on the stapes to stabilise it and prevent excessive oscillation.

A

Chorda Tympani
Stapedius

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29
Q

Unlike thyroglossal and dermoid cysts, ___ cysts, ___ and ____ do not present in the midline.

A

Branchial (surgical
Hemangiomas
Vascular malformations

30
Q

Name three classes of drugs that can cause ototoxicity

A

Aminoglycosides (Gentamicin)
Quinolones (Ciprofloxacin) - remember can also cause tendinopathy
Loop Diuretics (furosemide)

31
Q

Atopy is a type ___ hypersensitivity reaction.

A

Type 1

32
Q

Which organisms most commonly cause bacterial tonsillitis? (remember tonsillitis is most commonly caused by viral infection)

A 
Streptococcus Pyogenes (or Group A streptococcus) 
Streptococcus Pneumoniae

Haemophilus influenza
Moraxella Catarrhalis
Staph aureus

33
Q

Which antibiotics are 1st line in the treatment of Tonsillitis? (i.e when the centor score is 3 or more)

A

Phenoxymethylpenicillin (Penicillin V)

or if penicillin allergic

Clarithromycin (macrolide)

34
Q

____ oedema or vocal cord oedema is a progressive problem caused by ____ of the vocal cords. It is commonly linked to ______.

A

Reinke’s
Thickening
Hypothyroidism

35
Q

Tympanometry showing a type B (flat) curve with ___ canal volume has a very high positive predictive value for otitis media with effusion (OME).

Type B (flat) curve can also represent tympanic membrane perforation but the canal volume measurement will be ____.

A

Normal

High

36
Q

Risk factors associated with nasopharyngeal carcinoma.

A

Chinese ethnicity
Male
Diets with high salt intake
Cured meats
Fish (common in parts of Asia)
EBV infection
Family history
Tobacco smoking
Alcohol

37
Q

In patients with high suspicion of nasopharyngeal carcinoma (or any head and neck cancer), a full ENT examination is warranted, and you must inspect the post nasal space with ___ to identify/rule out a mass.

A

Flexible nasoendoscopy

38
Q

What are the classic clinical features that make a benign parotid tumour more likely to be warthin’s and not a pleomorphic adenoma?

A

Older Male
Smoking

39
Q

_____ is the only thyroid cancer that CANNOT be diagnosed on fine needle aspiration cytology alone?

A

Follicular Carcinoma (due to the similarity to follicular adenoma on cytology) - thus needs lobectomy and formal histological analysis

40
Q

After how many weeks post-injury should surgical repair of a tympanic membrane perforation be considered?

A

6 weeks

41
Q

The _____ is the key finding that indicates Hodgkin’s lymphoma in a biopsy of a patient with cervical lymphadenopathy.

A

Reed-Sternburg Cell

42
Q

The ______ Staging system is used for both Hodgkins and non-Hodgkins lymphoma.

A

Ann Arbor

43
Q

A characteristic finding of a carotid body tumour on imaging investigations is ____ (separating) of the internal and external carotid arteries. This is called ____ sign.

A

Splaying
Lyre

44
Q

Carotid body tumours are also referred to as _____, and are more often then not benign. Key features of a carotid body tumour are:

A

Paragangliomas

Anterior triangle of the neck
Painless
Pulsatile
Can be moved side to side but not vertically
Can hear bruits on auscultation.

45
Q

_____ is a key differential of a thyroglossal cyst as this commonly occurs at the same location. Both of these masses occur at the ___.

A

Ectopic thyroid tissue
Midline

46
Q

A ____ cyst will transilluminate with light and is located just anterior to the sternocleidomastoid muscle and is round and soft.

A

branchial

47
Q

Congenital hearing loss is most often inherited in a ______ pattern, and in 50% of cases is caused by a mutation in the ___ gene.

A

Autosomal Recessive
GJB2

48
Q

Neonatal hearing screening in the Uk is called ____

A

Otoacoustic emissions (OAE) - detects noise in the cochlea

49
Q

Lymph nodes > ___cm lasting longer than ___ weeks should be referred to ENT as a red flag.

A

1.5cm
6 week

50
Q

No speech by ___ yrs in a child is a red flag ENT referral and suggests hearing loss.

A

2

51
Q

The HPV vaccine (_____) protects against strains _, _, _, and _.

Strain ___ confers and increased risk of adult head and neck cancer.

A

Garsadil

6, 11, 16 and 18.

16

52
Q

______ is an example of a monoclonal antibody used in the ADJUVANT treatment of adult head and neck cancers. It is also used in ___ cancer. It works by inhibiting the activity of the _____ receptor. It is primarily used for advanced or metastatic disease as an adjuvant therapy.

A

Cituximab
Bowel
Epidermal Growth Factor Receptors (EGFR)

53
Q

The 3 top causes of angioedema are ____

A

Allergic reactions
ACE inhibitors
Hereditary angioedema (C1 esterase inhibitor deficiency)

54
Q

Name 3 treatment options for oral candidiasis.

A

Miconazole (gel)
Nystatin (suspension)
Fluconazole (tablets)

55
Q

Both Erythroplakia and Leukoplakia are precancerous conditions and are strongly associated with the development ____ carcinoma.

A

Squamous cell

56
Q

Vestibular schwannomas are benign tumours but they can become life threatening when they increase to sizes of ____ or above. For most small and medium sized tumours, the recommended management is to reassess at _____ with a repeat scan to determine whether there has been any growth.

A

40mm
6 months

57
Q

Name both extracranial and intracranial complications of otitis media.

A

Extracranial:

Facial nerve palsy
Mastoiditis
Petrositis
Labyrinthitis

Intracranial:

Meningitis
Brain Abscess
Venous sinus thrombosis

58
Q

_____ blanches the conjunctival and episcleral vessels but leaves the scleral vessels undisturbed. If a patient’s eye redness improves after _____ instillation, the diagnosis of episcleritis can be made. This differentiates the diagnosis from scleritis.

A

Phenylephrine

59
Q

A classic presentation of lymphoma (especially Hodgkin’s lymphoma) is ______ , which is specific but only present in a minority of patients.

A

Alcohol-induced neck pain

60
Q

The recurrent laryngeal nerve enters the larynx at the ____. This is at the level of ____ ligament

A

Cricothryoid
Berry’s

61
Q

5 divisions of the facial nerve

A

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

Facial nerve exits the brain stem at the cerebellopontine angle (CPA) and passes through temporal bone and the parotid gland on its way to the face.

62
Q

Name a grading system used for the severity of a facial nerve palsy.

A

House-Brackmann

63
Q

_____ Grading system is used to grade maxillary fractures of the face and is broken into ___ categories

A

(le) Fort
3 (1 lower 3 higher)

64
Q

A sublingual haematoma is pathognomonic of a ______

A

Mandibular Fracture

65
Q

Retrobulbar haemorrhage due to trauma is more common in _____ patient and is a surgical emergency. The definitive treatment is surgical decompression via a _____. Name 3 medical interventions that can be given in A+E whilst waiting for theatre.

A

Anticoagulated
Lateral canthotomy

IV Steroids
Acetazolamide
Mannitol

66
Q

HPV is only associated with ____ cancer. EPV is associated most strongly with ____ cancer.

A

Oropharyngeal
Nasopharyngeal

67
Q

Head and neck cancers often metastasise to the ____ and thus a _____ is needed if clinically suspicious.

A

Lungs
CT Chest

68
Q

Skin graft or recipient site heals by _____ in the first 24-48 hrs. This involves oxygen and nutrients infiltrating through the nearby capillaries. Compressive dressings are often used in tandem to prevent any shearing forces disrupting this process. 36-48 hours later _____ occurs. This involves the sprouting of capillaries through the skin graft bed and anastomosis with some of the pre-existing vasculature of the recipient site. Collagen formation occurs at this point.

A

Plasmatic Imbibition
Inosculation

69
Q

Which cranial nerve is responsible for the presentation of otalgia in pharyngeal malignancy?

A

Glossopharyngeal (IX)

Remember posterolateral SCC in CBL, glossopharyngeal nerve supplies sensory innervation to posterior 1/3 tongue.

The tympanic nerve (a branch of cranial nerve IX) directly innervates the ear but also has pharyngeal, lingual, and tonsillar branches to supply the posterior one-third portion of the tongue, tonsillar fossa/pillars, pharynx, eustachian tube, parapharyngeal and retropharyngeal spaces. Any pathologic process involving these areas can result in referred otalgia

70
Q

Eye discharge in a 0-12 month year old is most commonly caused by ____.

A

Lacrimal insufficiency

71
Q

What is the 2nd line treatment for otitis externa?

A

1st line: 2% acetic acid and ear hygiene.

2nd line: Ciprofloxacin (500mg twice daily for 7 days) (check dose)

*If infection involves pinna - consider ancilliary flucloxacillin*

Liverpool (Year 4) (15 decks)

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