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Year 6 > Post exam 1 > Flashcards

Post exam 1 Flashcards

1
Q

Overdose, dilated pupils with widened QRS. Patient refuses to disclose what medication was overdosed. What was the agent?

A

Amitriptyline

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2
Q

History of atopy, with pollen being the trigger. Now spring and both eyes are watery, red and sore. – allergic conjunctivitis. Treatment?

A

Anti-histamine eye drops

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3
Q

House fire inhaled. Patient needs increased ventilatory pressures, what is the reason?

A

Surfactory deficiency

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4
Q

Medial epicondyle

A

Flex the wrist

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5
Q

Lateral epicondyle

A

Extends the wrist

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6
Q

Patient due for colonic resection surgery, when do you give prophylactic antibiotics?

A

8-12 hours?????

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7
Q

histology results of: glandular cells with cellular atypia, something about nuclei and something else.

A

Adenocarcinoma of the lung

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8
Q

Went on holiday and swam in the ocean, now pain when pressing on tragus and canal looks macerated. Nothing wrong with tympanic membrane. What’s the treatment?

A

??

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9
Q

Long thoracic nerve innervates which muscle

A

Serratus anterior

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10
Q

Radio femoral delay - which condition?

A

Coarctation of the aorta

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11
Q

Dermatomyositis antibody

A

Anti-Jo1

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12
Q

Treatment of chronic rhinosinusitis?

A

Topical corticosteroid

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13
Q

Ix for TMJ?

A

MRI

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14
Q

 Necrotising otitis externa mx?

A

urgent ENT referral; ix: CT head;
Ciprofloxacin

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14
Q

 Acute otitis media with perforation

A
  • Oral amoxicillin, 5 days
  • Review in 6 weeks (should heal in 6-8 weeks – if not, refer to ENT  myringoplasty)
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14
Q

o Management (acute otitis externa):

A

 Topical antibiotics (‘sofradex’) ± topical steroid  oral ABx (flucloxacillin)
 Wicking and removal of debris

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15
Q

 Acute otitis media without perforation:
* Immediate prescription indications?

A
  • Symptoms lasting more than 4 days (normally ~3 days) or not improving
  • Systemically unwell but not requiring admission
  • Immunocompromise or high risk (heart, lung, kidney, liver, or NM disease)
  • Younger than 2 years with bilateral otitis media
  • Otitis media with perforation and/or discharge in the canal
  • Otherwise  delayed script / no prescription (amoxicillin, PO, 5 days)
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16
Q

s/s cholesteatoma?

A
  • Signs & symptoms  98% = ear discharge OR conductive hearing loss: 10-20yo
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17
Q

Mx cholesteatoma?

A

Surgery

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18
Q

o Unilateral tinnitus?

A

acoustic neuroma/vestibular schwannoma.

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19
Q

Vestibular schwannomas (also called acoustic neuromas) associated with what?

A

Neurofibromatosis 2

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20
Q

Meniere’s disease

A

Tinnitus, vertigo, hearing loss, sensation of fullness

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21
Q

Vestibular neuronitis?

A

No hearing loss

22
Q

Acoustic neuroma signs?

A

Unilateral hearing loss, loss of corneal reflex, neurofibromatosis 2

23
Mx of vestibular neuronitis?
o Management:  Acute phase: * Severe  buccal / IM prochlorperazine * Less severe  PO cyclizine or prochlorperazine (stopped after few days – can delay recovery)  Chronic  vestibular rehabilitation exercises [referral to balance specialist – 2ww]
24
Otosclerosis:
AD condition * Bilateral conductive deafness + tinnitus * HL improves with noise (“Willis’ paracousis”) * HL worsens with pregnancy, menstruation, menopause  Ix: PTA (dip at 2kHz – “Cahart’s notch”) Hearing aid and implant
25
Mx of allergic rhinosinusitis?
o Mild-moderate intermittent symptoms; mild persistent symptoms:  1st line: PRN oral antihistamine (cetirizine, loratadine) or PRN intranasal antihistamine (azelastine)  2nd line: PRN intranasal sodium cromoglicate o Moderate-severe persistent symptoms; initial treatment ineffective:  Main issue (nasal blockage / polyps)  intranasal corticosteroid (beclomethasone), nasal irrigation  Main issue (sneezing / discharge)  intranasal corticosteroid or oral antihistamine
26
Sinusitis is where?
Maxillary sinuses
27
Red flags (urgent ENT referral) of sinusitis?
unilateral S/S, persistent >3m S/S despite tx, epistaxis
28
Mx of sinusitis?
o Symptoms lasting >10 days:  High-dose nasal corticosteroid for 14 days (if >12yo, e.g. mometasone) * May improve symptoms but unlikely to affect duration of illness * Could cause systemic side-effects  ABx not indicated (as per guidelines) but can give back up prescription (if given, only use if symptoms don’t get better in 7 days or if symptoms get rapidly worse): * 1st line: phenoxymethylpenicillin (clarithromycin if penicillin-allergic) * 2nd line: co-amoxiclav
29
o Samter’s/ASA triad?
Nasal polyps, asthma, aspirin hypersensitivity
30
o Single, unilateral polyp
may be a sign of a rare but sinister pathology…  ix: CT, histology
31
* Management of polyps?
o Routine referral to ENT for examination (do medical therapy in the meantime) o Medical (topical steroids (betamethasone drops) 4-6w  short course of oral steroids) o Surgical (endoscopic polypectomy)
32
When to manage nose fracture?
o Immediate, before swelling  reduce immediately o Swelling  re-examine after 1 week (↓ swelling)  EUA ± MUA reduction + post-op splinting (<2 weeks)
33
Treatment of epistaxis?
 1st  remove clots  gauze (soaked in vasoconstrictor + local anaesthetic)  ix: rhinoscopy  Bleeding visualised  silver nitrate cautery (3-10 seconds, dab clean, add naseptin/muciprocin)  Bleeding cannot be visualised  packing (anterior or posterior and anterior packing) * Anterior pack (pack as per instructions) * Posterior pack (18G foley to nasopharynx, inflate, pull back until lodging) * Admit for up to 48 hours ± ENT review; examine patient’s mouth and throat for bleeding  Continue bleeding  NBM and refer to ENT (? ligation of sphenopalatine artery)
34
Tonsilitis?
“Centor Score” determines likelihood of bacterial over viral (only used if ≤3 days of pharyngitis): o +1 = Exudate/swelling on tonsils o +1 = Tender/swollen anterior cervical lymph nodes o +1 = Temperature >38C (at any point) o +1 = Cough absent 0, 1, 2 = 3-17% chance GAS, no ABx 3, 4 = 32-56% chance GAS, ABx + rapid strep test
35
Tonsilitis causes?
o Group A β-haemolytic streptococcus (GAS) – N.B. rare under 3yo or ≥45yo, common 3-14yo o EBV (i.e. bacterial or viral) – no amoxicillin treatment (as you can get a generalised maculopapular eruption)
36
Glandular fever?
S/S: sore throat, fever, malaise, lymphadenopathy, pharyngitis, petechiae on soft palate, splenomegaly
37
If persistent (>3w) change in voice, refer for what?
laryngoscopy
38
o Specific cases to watch out for (take urgent FBC): tonsilitis?
 DMARDs – could cause immunodeficiency  Carbimazole – idiosyncratic neutropoenia
39
'web’/pseudomembrane at back of throat
Diptheria ; tx: penicillin + anti-toxin
40
Bleed post-tonsillectomy
Post-op delayed bleed  same-day ENT assessment Post-op <24 hours bleed  immediate return to theatre
41
* Tonsillar SCC rf?
HPV infection
42
s/s of ramsay hunt syndrome?
o S/S: otalgia, facial nerve palsy, vesicular rash around ear (incl. inside ear), vertigo, tinnitus
43
Warthin tumour
M > F (the only one) 60-80yo most common bilateral benign neoplasm Lymphocytic infiltrate, cystic epithelial proliferation
44
Benign pleomorphic adenoma
80% of parotid neoplasms, young patient Slow-growing, lobular, poorly encapsulated Mx: superficial parathyroidectomy
45
Haemangioma
90% of parotid tumours in child <1yo Hypervascular imaging Spontaneous regression may occur
46
Monomorphic adenoma
Slow growing One morphological cell type (i.e. basal cell adenoma)
47
Mucoepidermoid carcinoma
30% of all parotid malignancies Low potential for local invasion Slow growing (low grade) OR high grade (fast)
48
Adenoid cystic carcinoma
Unpredictable growth + tendency for perineural spread Distant metastasis common 5-year survival at 35%
49
Adenocarcinoma
Develops from secretory portions of the gland 5-year survival depends on the stage at presentation
50
* Pinna haematoma mx?
o Mx: incision + drainage
51
* TM perforation:
o Mx: watch & wait for 6-8 weeks (if not healed, refer to ENT)
52
* Nasopharyngeal carcinoma:
Associated with EBV  Cervical lymphadenopathy Unilateral serous otitis media  Otalgia Nasal obstruction, discharge or epistaxis  Cranial nerve palsies
53
Mx of nasopharyngeal carcinoma?
o Ix: combined CT/MRI o Mx: radiotherapy
54
* Ludwig’s angina:
o Aetiology: a rare infection of the floor of the mouth and soft tissue of the neck  RFs: dental surgery o S/S: neck swelling, dysphagia, fever o Ix: clinical o Mx: urgent admission + airway management + IV ABx
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Year 6 (26 decks)

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