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Year 6 - Surgery > Passmed: ENT > Flashcards

Passmed: ENT Flashcards

1
Q

What is vestibular neuronitis?

A

Acute isolated, spontaneous, prolonged vertigo of peripheral origin +/- N+V w/o hearing loss, tinnitus, focal neuro sx

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2
Q

Ddx of Vertigo

A

Peripheral: bppv, vestibular neuronitis, labyrinthitis, Meniere’s

Central: migraine, stroke, cerebellar tumour, MS

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3
Q

When should you refer pts w vertigo?

A

Additional neuro sx, not improving after wk of tx, persists for >6wks

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4
Q

What is the preferred tx for vestibular neuronitis?

A

Short term prochlorperazine for sx + vestibular rehab exercises

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5
Q

How do you distinguish vestibular neuronitis vs posterior circulation stroke?

A

HiNTs

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6
Q

What is Ludwig’s angina?

A

Progressive cellulitis due to odontogenic infection spreading into the submandibular space

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7
Q

Why is Ludwig’s angina an emergency?

A

It can rapidly result in airway obstrc

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8
Q

Which drugs are ototoxic?

A 
Aminoglycosides
Quinine
Aspirin
Furosemide
Cytotoxics
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9
Q

What are the three most common causes of hearing loss?

A

Wax, otitis media, otitis externa

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10
Q

What is presbycussis?

A

Age related sensorineural hearing loss w bilateral high freq loss on audiometry

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11
Q

What are the features of vestibular schwannomas?

A

CN V: absent corneal reflex

CN VII: facial nerve palsy

CN VIII: hearing loss, tinnitus, vertigo

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12
Q

What does bilateral acoustic neuromas suggest?

A

NF2

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13
Q

How is otosclerosis inherited? And usual age of onset?

A

Autosomal dominant + usually 20-40yo

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14
Q

What does otosclerosis cause?

A

The replacement of normal bone to vasc spongy bone results in a bilateral conductive pattern +/- tinnitus

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15
Q

What colour is the tympanic membrane in 1/10 pts w otosclerosis?

A

‘Flamingo Tinge’

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16
Q

BPPV Manoeuvres

A

Dx: Dix-Hallpike + Tx: Epley

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17
Q

Which HPV is linked w tonsillar SCC?

A

HPV-16

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18
Q

What does normal hearing look like on an audiogram?

A

Anything above the 20dB ie <20dB is essentially normal

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19
Q

Audiogram: Sensorineural v Conductive v Mixed

A

Sensorineural: both air and bone impaired

Conductive: only air is impaired

Mixed: both again but air worse than bone

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20
Q

What is black hairy tongue? And tx?

A

Defective desquamation of the filiform papillae, swab for Candida, tx w scrapings +/- topical antifungals

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21
Q

What are the CIs for cochlear implant? (5)

A

Chronic infective otitis media, mastoid cavity, TM perf, cochlear aplasia, deafness from CN VIII or brainstem lesion

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22
Q

What is the cause for the majority of SSNHL?

A

Idiopathic

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23
Q

Why should a MRI be done following SSNHL?

A

Exclude vestibular schwannoma

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24
Q

Mx for SSNHL

A

Urgent ENT referral + high dose oral corticosteroids

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25
Q

What is the biggest RF for malignant otitis externa?

A

Diabetes Mellitus

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26
Q

Which bacteria most commonly causes malignant otitis externa?

A

Pseudomonas aeruginosa

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27
Q

What does a sev sore throat + uvular deviation to the unaffected side suggest?

A

Quinsy

28
Q

How does epiglottitis typically px? (3)

A

Extended head, drooling, tripoding

29
Q

Why should you refrain from examining a pt w epiglottitis?

A

It may induce laryngospasm and obstrc the airway

30
Q

What is otalgia w/o ear signs a red flag for?

A

H+N Malignancy

31
Q

What causes Ramsay Hunt syndrome?

A

Reactivation of VZV in the geniculate ganglion of CN VII

32
Q

When would refrain from tx ear wax? And when would you refer to ENT?

A

No tx if TM perf or grommet in situ + refer is sx >6wks

33
Q

Samter’s Triad

A

Asthma
Aspirin Sensitivity
Nasal Polyposis

34
Q

Which drugs causes gingival hyperplasia? (3)

A

Nifedipine
Phenytoin
Ciclosporin

35
Q

What are the features of Menieres disease?

A

Recurrent eps of vertigo, tinnitus and hearing loss a/w feeling of aural fullness

36
Q

What is found o/e of Menieres disease?

A

Nystagmus + Pos Rombergs

37
Q

Mx of Menieres Disease

A

Consrv: inform DVLA

Acute: buccal/IM prochlorperazine

Prevention: betahistine + vestibular rehab exercises

38
Q

How is 1°/2° haemorrhage following tonsillectomy managed?

A

1°: immediate return to theatre

2°: admission + abx +/- surgery

39
Q

Why do viral URTIs typically precede otitis media?

A

It disturbs the normal nasopharyngeal microbiome allowing bacteria to infect the middle ear via the Eustachian tube

40
Q

Which bacteria cause acute otitis media? (3)

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

41
Q

What are the possible otoscopy findings of acute otitis media?

A

Bulging TM, loss of light reflex, opacification erythema perf of TM

42
Q

What is chronic suppurative otitis media?

A

Perf of TM w otorrhoea for >6wks

43
Q

When should you prescribe abx for acute otitis media? (5)

A

Sx >4days or not improving, sys unwell, immunocomp or high risk of comps, <2yo w bilateral, perf or discharge

44
Q

Comps of acute otitis media (4)

A

Mastoiditis
Meningitis
Brain Abscess
Facial Nerve Paralysis

45
Q

Outline the centor criteria

A

Inc score more likely to be strep: fever, absence of a cough, exudate, tender lymphadenopathy

46
Q

Outline the FeverPAIN criteria

A

Inc score more likely to be strep: fever, absence of a cough, sx onsent <3d, purulence, sev inflamed tonsils

47
Q

Abx for bacterial tonsilitis

A

Phenoxymethylpenicillin or erythromycin 7-10d course

48
Q

Which abx covers pseudomonas?

A

Ciprofloxacin

49
Q

Abx for otitis media + externa

A

Media: Amoxicillin
Externa: Flucloxacillin

50
Q

What benign tumour can cause epistaxis in adolescent males?

A

Juvenile Angiofibroma

51
Q

What rare autosomal dominant disorder can cause prolonged epistaxis in elderly?

A

HHT

52
Q

Rinne Test: pos vs neg

A

It’s normal to be pos ie AC>BC vs abnormal to be neg ie BC>AC

53
Q

What is the rule of 80s for salivary tumours?

A

80% are in the parotid

80% of those are benign

80% of those are pleomorphic adenomas w Warthin’s tumour being the next most common

54
Q

Which salivary gland gets the most stones?

A

Submandibular

55
Q

What can go wrong w the salivary glands?

A

Infection
Inflammation
Malignancy

56
Q

Gingivitis: simple vs acute necrotising ulcerative

A

Simple: painless red swelling w bleeding on contact - seek routine regular review w dentist

Acute: painful bleeding gums w halitosis and punched out ulcers - requires para, 3d oral metronidazole, chlorhexidine mouth wash whilst waiting for dentist

57
Q

What should you avoid for 6wks w EBV?

A

Contact Sports

58
Q

Outline the Centor Criteria

A

One point for: fever, no cough, tonsillar exudate, ant cervical lymphadenopathy

If 0-2 no abx vs 3-4 strep testing and empirical abx both w symptomatic tx

59
Q

Which pts w hearing loss require urgent referral to ENT?

A

SSNHL <3d

Unilateral hearing loss a/w focal neurology eg altered sensation or facial droop

Hearing loss a/w head or neck injury, necrotising otitis externa, Ramsay Hunt syndrome

60
Q

Ix of SSNHL

A

An MRI to exclude vestibular schwannoma

61
Q

Tx of SSNHL

A

High dose oral corticosteroids by ENT

62
Q

What are the ddx for hearing loss following trauma?

A

Perforated TM (conductive) + Base of Skull # (sensorineural)

63
Q

How can nasopharyngeal cancer px?

A

Unilateral middle ear effusion esp if a smoker and from SE Asia

64
Q

Cystic Hygroma vs Branchial Cyst

A

CH: 1yo - soft, non tender and transilluminates

BC: 20yo - smooth, non tender and fluctuant

65
Q

Mx of Auricular Haematoma

A

Same day assessment by ENT for incision and drainage

Year 6 - Surgery (27 decks)

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