Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ICSM Year 6 > Surgery - ENT > Flashcards

Surgery - ENT Flashcards

(207 cards)

Start Studying
1
Q

What is a normal result in pure tone audiometry?

A

All results above 20dB line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between SNHL, conductive HL and mixed HL?

A

SNHL = both air and bone conduction are impaired (AC is better than BC)
Conductive HL: only air conduction is impaired
Mixed HL: air and bone condution both impaired, but BC is better than AC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can middle ear function be evaluated?

A

Tympanometry - measures stiffness of ear drum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is automated auditory brainstem response audiometry?

A

Auditory stimulus with measurement of elicited brain response by surface electrode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the components of the child hearing exams?

A

All babies get evoked otoacoustic emission testing
If not normal –>
Automated auditory brainstem response audiometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs and symptoms of TMJ dysfunction?

A 
Otalgia (referred pain from auriculotemporal nerve) 
Facial pain 
TMJ joint clicking/popping 
Bruxism (teeth grinding) 
Stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What condition does ‘swimmer’s ear’ refer to?

A

Acute diffuse otitits externa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How should necrotising otitis externa be managed?

A

Urgent ENT referral
CT head
IV ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How should acute otitis externa be managed?

A

Topical abx +/- topical steroid –> oral flucloxacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common pathogen implicated in otitis media?

A

S. pneumoniae (as secondary to URTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should acute otitis media without perforation be managed?

A

Delayed/no script unless:

  • symptoms >4 days and not improving
  • systemically unwell but not requiring admission
  • Immunocompromised
  • <2y with BL OM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should acute otitis media with perforation be managed?

A

Oral amoxicillin 5 days

Review in 6w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What condition is known as ‘glue ear’?

A

Otitis media with effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should glue ear be managed?

A

If no comorbidities: active observation for 6-12w, if no improvement –> ENT referral
If co-existent cleft palate/ Down’s –> refer to ENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How long do grommets last?

A

Up to 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the signs and symptoms of cholesteatoma?

A

Headache, pain
Foul smelling discharge from ear
Hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How should cholesteatoma be managed?

A

Refer for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Recall 4 drugs that can cause tinnitus

A

Aspirin
Aminoglycosides
Loop diuretics
Ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most concerning cause of unilateral tinnitus?

A

Acoustic neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Recall 3 vestibular causes of vertigo

A

Meniere’s
BPPV
Labyrinthitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Recall 5 central causes of vertigo

A 
Vestibular schwannoma
MS
Stroke
Head injury 
Inner ear syphillis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Meniere’s?

A

Dilatation of endolymph spaces of membranous labyrinth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the symptoms of Meniere’s?

A 
Clustered attacks lasting <12 hours
Aural fullness
Progressive SNHL 
Vertigo + N&V + nystagmus 
Tinnitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is Meniere’s managed?

A

Medically:
Betahistine for vertigo
Cyclizine for emesis

Surgically:
Gentamicin installation via grommets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the symptoms of viral labyrinthitis/vestibular neuronitis?
Severe vertigo, nystagmus and vomiting following an URTI
26
How can you differentiate between vestibular neuronitis and viral labyrinthitis clinically?
Hearing may be affected in viral labyrinthitis but isn't in vestibular neuronitis
27
How should viral labyrinthitis/ vestibular neuronitis be managed?
If severe: IV prochlorperazine | If less severe: PO cyclizine and prochlorperazine
28
What is BPPV?
Displacement of otoliths in semi-circular canals
29
What are the symptoms of BPPV?
Suden rotational vertigo for <30s provoked by head turning +/- nystagmus; chronic history
30
How can BPPV be investigated?
Dix-Hallpike manoevre --> up-beat torsional nystagmus
31
How can BPPV be managed?
Epley manoevre and betahistine
32
What is acoustic neuroma also known as?
Vestibular schwannoma
33
What are the symptoms of acoustic neuroma?
Slow-onset, unilateral SNHL, tinnitus +/- vertigo
34
How should possible acoustic neuroma be investigated?
Pure tone audiometry | MRI
35
What are the symptoms of otosclerosis?
Begins early adult life BL conductive deafness and tinnitus Hearing loss improves with noise but worsens with pregnancy, menstruation, menopause
36
How should otosclerosis be managed?
Hearing aid, stapes implant
37
What is the fancy name for age-related hearing loss?
Presbycusis
38
How should sudden SNHL be managed?
Refer to ENT in <24 hours, high dose PO prednisolone
39
How should allergic rhinosinusitis be managed?
- Avoid causative allergen - For mild symptoms: PRN oral antihistamine (eg cetirizine) and PRN intranasal antihistamine (eg azelastine) - For severe symptoms: Intranasal CS (eg beclomethasone) and nasal irrigation
40
What are the red flags in sinusitis that would prompt an urgent ENT referral?
Unilateral symptoms Persistent >3m despite treatment Epistaxis
41
What are the indications for admission to hospital with sinusitis?
``` Severe systemic infection Signs of dangerous complications of sinusitis eg: Periorbital/orbital cellulitis Meningitis Brain abscess ```
42
How should sinusitis be managed?
If symptoms <10 days --> advice and safetynetting If symptoms >10 days --> 14 day course of high-dose nasal corticosteroid Can give back-up prescription of abx
43
What are the symptoms of nasal polyps?
``` Watery anterior rhinorrhoea Sinusitis Snoring Headaches Nasal obstruction ```
44
What is Samter's triad?
Triad of nasal polyps, asthma and aspirin hypersensitivity Therefore if person has nasal polyps and asthma, advise to avoid NSAIDs and aspirin as could cause a life-threatening reaction
45
What would make nasal polyps seem concerning?
If it is single and unilateral - as this may be a sign of a rare but sinister pathology
46
How should nasal polyps be managed?
- Routine referral to ENT for exam - Medical: 4-6w course of topical steroids - Surgically: can be removed endoscopically
47
What is a septal haematoma?
Untreated nasal fracture --> septal necrosis and nasal collapse as cartillage blood supply comes from the mucosa --> boggy swelling with nasal obstruction
48
How should all nosebleeds be initially managed?
Sit up Lean forwards Mouth open Compress nasal cartilage for 15 mins
49
What are the 2 most common causes of tonsilitis?
EBV and Group A strep
50
Recall the score used to determine whether tonsilitis is likely bacterial/viral
``` CENTOR (only used if <3 days of pharyngitis) Cough absent Exudate Nodes (cervical anterior) Temp >38 at any point ```
51
How high a centor score do you need to give abx and do a rapid strep test in tonsilitis?
3 or 4
52
What are the symptoms of infectious mononucleosis?
``` Sore throat Fever Malaise LNopathy pharyngitis petechiae on soft palate splenomegaly ```
53
What antibiotic is used in bacterial tonsilitis?
Phenoxymethylpenicillin
54
How does diptheria classically appear?
Pseudomembranous 'web' at back of throat
55
When would you admit for tonsilitis?
- Difficulty breathing - Clinical dehydration - Peri-tonsillar abscess (quinsy) or cellulitis - Marked systemic illness or sepsis - Suspected rare cause (e.g. Kawasaki disease, diphtheria)
56
How frequent does tonsilitis have to be to indicate tonsillectomy?
7 bouts in 1 year 5 bouts/ year for 2 years 3 bouts/year for 3 years
57
What are the signs that GAS infection has progressed to scarlet fever?
Rash ('sandpaper') | Strawberry tongue
58
What is the risk of scarlet fever?
May progress to rheumatic fever with a week latency period
59
How should scarlet fever be managed?
Notify PHE | Phenoxymethylpenicillin
60
What is the main RF for tonsilar SCC?
HPV infection
61
What are the symptoms of Bell's palsy?
UL facial weakness Otalgia Ageusia (loss of taste) Hyperacusis (due to stapedius palsy)
62
What is Bell's sign?
Failure of eye closure --> dryness and conjunctivitis | Seen in Bell's palsy
63
How should Bell's palsy be investigated?
Serology, possible LP
64
How should Bell's palsy be managed?
Eye care | Prednisolone (50mg PO OD for 10 days)
65
What is the aetiology of RamsayHunt syndrome?
Reactivation of the varicella zoster virus in the genticulate ganglion of CNVII
66
What are the symptoms of Ramsay Hunt syndrome?
Otalgia Facial nerve palsy Vesicular rash around ear Vertigo + tinnitus
67
How should Ramsay Hunt syndrome be managed?
Valaciclovir PO Steroids PO If treated within 72 hours, 75% recover, otherwise only 1/3 fully recover
68
If a small parotid lump enlargens very quickly, what is the likely cause?
Stone that has blocked parotid duct
69
How long after a TM perforation should a referral to ENT be made if it hasn't healed?
6-8w
70
Recall some differentials for the cause of salivary gland swelling
``` Infective (TB/mumps) Neoplastic Calculi blockage Autoimmune (Sjogren's/IgG4) Sarcoidosis ```
71
How is a pharyngeal pouch managed?
Surgical repair with minimally-invasive stapling (Dohlman's procedure)
72
What are the symptoms of pharyngeal pouch?
Hallitosis | Food getting stuck
73
What are the FeverPAIN criteria?
Fever (during previous 24 hours) Purulence (pus on tonsils) Attend rapidly (within 3 days after onset of symptoms) severely Inflamed tonsils No cough or coryza
74
Recall the 2 most common pathogens in otitis externa
Staph aureus | Pseudomonas
75
Recall the management of otitis externa
Take a swab and send for microbiology TOPICAL antibiotics (abx used to cover pseudomas = gentamicin...) +/- steroid Microsuction to clear debris (+/- pope wick) Water precautions
76
How should necrotising otitis externa be managed?
admission and tazocin
77
Name 3 complications of otitis media
Facial nerve palsy Chronic perforation Mastoiditis
78
What is Ludwig's angina?
Rapidly spreading infection of submandibular space Classically "woody" to touch Causes neck pain and drooling
79
Recall 4 predisposing factors to otitis externa
Swimming Ear buds Eczema Diabetes
80
What type of mouth ulcer is typically described as centralised white ulcer and erythematous “halo”?
Apthous ulcers
81
What is this a typical history for? "an indurated ulcer involving the lateral tongue in a patient with a long-term smoking history"
Squamous cell carcinoma
82
What is Heerfordt's syndrome?
A rare manifestation of sarcoidosis characterized by the presence of facial nerve palsy, parotid gland enlargement, anterior uveitis, and low grade fever Source: Capsule case 145
83
What is the most common type of parotid malignancy in adults?
Mucoepidermoid tumours
84
What is Warthin’s tumour?
Benign parotid tumour that typically appears in older male smokers
85
In epistaxis, how long should a rapid rhino stay in place?
24 hours
86
What is binocular vision post-facial trauma indicative of?
Depressed fracture of zygoma
87
What intranasal treatments are used for the treatment vs prophylaxis of sinusitis?
Treatment: intranasal decongestant Prophylaxis: intranasal corticosteroid
88
What is a pope wick and how long can it be left in for?
A stent-like device for the ear canal if inflammation is so severe that ear drops cannot enter the canal otherwise. It can be left in for 72 hours.
89
What are some red flags for otitis externa and what would you be worried about?
* Pain out of proportion * Cranial nerve palsy * Worsening despite treatment You would be worried about necrotising otitis externa (a.k.a malignant otitis externa)
90
What is a cholesteatoma?
A benign accumulation of keratinising squamous cells in the middle ear
91
What percentage of cholesteatomas are congenital?
5%
92
Why is otitis media common in young children?
The eustachian tubes are still quite horizontal in younger children so they do not drain the mucus as well, allowing build-up and growth of bacteria/viruses resulting in otitis media
93
What part of the ear do grommets replace?
Eustachian tubes
94
What is the downside to grommets?
Can cause tympanosclerosis, which causes the eardrum to fibrose and harden so that it does not vibrate normally with sound, impairing hearing
95
What is otosclerosis?
Fusion of the ossicles in the middle ear so they do not vibrate as well, resulting in conductive hearing loss
96
What are the 2 main differentials for unilateral sensorineural hearing loss?
* Sudden sensorineural hearing loss * Vestibular schwannoma (acoustic neuroma)
97
How should a suspected vestibular schwannoma be investigated?
* MRI (internal auditory meatus) * Whilst waiting for MRI, cover with high dose steroids in case it is caused by sudden sensorineural hearing loss (if hearing loss was sudden, otherwise no need)
98
What pattern of hearing loss does presbycusis cause?
Bilateral sensorineural
99
What type of tissue are the tonsils?
Lymphoid
100
What are the different paranasal sinuses?
* Frontal * Ethmoid * Maxillary * Sphenoid
101
When would you image a nose fracture?
* Depends on whether the patient meets NICE criteria * If you are worried about other fractures then you would * Similarly if the history involves potential head injury, you would also image if meeting criteria
102
What window should manipulation of a nose fracture occur within?
7-14 days post-injury
103
What are some SSx of a cavernous sinus thrombosis?
* Ophthalmoplegia (vision loss, double vision) * Headache * Swelling, redness or pain around eyes
104
What is FESS?
Functional endoscopic sinus surgery
105
When would FESS be appropriate?
Used in patients with chronic rhinosinusitis where medical management has failed (usually trialled for at least 6 months)
106
What medication can be given to rhinitis patients?
Xylometazoline (sympathomimetic)
107
What is the maximum duration xylometazoline is given for?
5 days usually (7 on NICE/BNF) as otherwise can cause a rebound inflammation
108
How would you investigate a cholesteatoma?
CT temporal bones
109
What are the most common pathogens to cause otitis media?
2/3rds = viral (RSV, rhinovirus) 1/3rds = bacterial (strep pneumo, Hib)
110
What are some red flags for otitis media and what would you be concerned about?
* Sepsis with post auricular swelling * Cranial nerve palsy * Meningism * Altered consciousness --> MASTOIDITIS
111
How is mastoiditis managed?
* IV antibiotics * If not resolving, may need a myringotomy to drain the middle ear * +/- mastoidectomy
112
In what circumstance would otitis media with effusion be suspicious?
In an adult with unilateral symptoms - think malignancy
113
What is the fancy name for grommet insertion?
Myringotomy
114
What condition is otitis media with effusion associated with?
Cleft palate
115
How long do grommets stay in for?
Up to 12 months, often self-extrude by 9 months
116
What are some possible causes of a tympanic membrane rupture?
* Trauma (barotrauma, noise etc) * Otitis media with effusion * Grommet insertion
117
How long does a tympanic membrane rupture typically take to repair?
2 months
118
What is the management of a tympanic membrane rupture?
* Water precautions whilst healing * If not healing or persistent hearing loss/infections, consider myringoplasty
119
How is the severity of a facial nerve palsy graded?
House-Brackmann scale
120
What are some causes of a facial nerve palsy?
* Trauma * Infection (OM, Ramsey-Hunt) * Neoplastic (parotid tumour) * Stroke (forehead-sparing, UMN) * Bell's palsy (idiopathic)
121
What are some causes of conductive hearing loss?
* Foreign body * Ear wax build-up * Tympanic membrane performation * Otosclerosis * Cholesteatoma
122
What is the difference between conductive and sensorineural hearing loss?
Conductive = occurs when sound waves do not reach the inner ear Sensorineural = occurs when sound waves are not processed correctly
123
What are some trigeminal causes of otalgia?
* TMJ problems * Dental problems * Sinusitis * Trigeminal neuralgia Due to radiation via the auriculotemporal nerve
124
What are some facial nerve causes of otalgia?
* Cerebellopontine lesions * Geniculate neuralgia * Bell's palsy * Parotid infections
125
What are some vagus nerve causes of otalgia?
* Tumours in pharynx or larynx * GORD * Angina/MI * Thyroiditis
126
What are some glossopharyngeal nerve causes of otalgia?
* Tumours in PNS/pharynx * Tonsillitis * Oral apthous ulcers
127
What are some spinal nerve causes of otalgia?
* Spinal arthritis (cervical spine, C1/2/3) * Cervical tumours Due to radiation via the lesser occipital and greater auricular nerves
128
What causes vestibular neuronitis?
Inflammation of the vestibular nerve, associated with a recent viral illness
129
What kind of vertigo do you typically get in vestibular neuronitis?
Rotatory vertigo that is continuous for 24 hours
130
What results from Rhine's and Weber's tests would you expect in sensorineural HL?
Rhine's - either positive or false Weber's - heard in the good ear
131
What results from Rhine's and Weber's tests would you expect in conductive HL?
Rhine's - bone conduction > air conduction Weber's - heard in the bad ear
132
What are the functions of the nose?
* Humidification * Filtering * Olfaction (smell) * Mucous production * Ventilation of middle ear via eustachian tube * Voice tract resonance * Drainage of nasolacrimal duct
133
When would a septoplasty be indicated?
Due to septal/bony vault deviation but must be at least 6-12 months after injury
134
What are some potential complications of acute rhinitis?
* Meningitis * Cavernous sinus thrombosis * Orbital or pre-septal cellulitis
135
What is the aim of FESS?
* Remove diseased tissue * Clear obstructions * Restore function
136
What are the borders of the anterior triangle in the neck?
Mandible, midline and SCM
137
What are the borders of the posterior triangle in the neck?
SCM, clavicle and trapezius
138
What neck lumps are seen in the midline?
* Thyroglossal cyst * Thyroid pathology (goitre, enlargement) * Dermoid cyst
139
What neck lumps are seen in the anterior triangle?
* Lymphadenopathy * Branchial cyst * Laryngocoele * Parotid gland pathology (mumps, stones, tumour, infection) * Salivary gland pathology * Carotid pathology (aneurysm, tumour)
140
What neck lumps are seen in the posterior triangle?
* Lymphadenopathy * Cervical rib * Pharyngeal pouch * Cystic hygroma
141
What are the 3 salivary glands in the face?
* Sublingual * Submandibular * Parotid
142
How is a branchial cyst investigated and managed?
Ix: neck USS --> CT Mx: surgical excision if large
143
What type of tumour is a cystic hygroma?
Lymphangioma (benign malformation of the lymphatic system)
144
What is the concern regarding cystic hygromas?
Depending on their anatomical site, they have the potential to block the airway
145
What is a thyroglossal cyst?
A remnant of the thyroglossal tract that should have been obliterated by birth
146
How can a thyroglossal cyst be differentiated from other neck lumps?
Moves up on tongue protrusion/swallowing
147
What is the Ix and Mx of a thyroglossal cyst?
Ix: USS and FNA Mx: Sistrunks procedure
148
What is a quinsy?
A peritonsillar abscess
149
What are the SSx of a quinsy?
* 'hot potato' voice * Unilateral pain * Trismus (unable to open mouth well) * Significant dysphagia * Uvula deviated
150
What is the Mx of a quinsy?
* Requires aspiration or incision&drainage * IV benpen and metronidazole * IV fluids * Stat dexamethasone dose * Analgesia
151
What is meant by sialadenitis?
Infected salivary gland
152
What is the Mx of sialadenitis?
* Oral Abx * Sialagogues (to encourage salivary production such as citrus fruits) * Analgesia
153
What are some causes of sialadenitis?
* Viral - mumps, coxsackie, parainfluenza * Bacterial - staph aureus, anaerobic bacteria * Stones/calculus * Chronic scarring or strictures * Benign/malignant tumours * Granulomatous conditions - Sjogren's, sarcoidosis, GPA
154
What are some generalised red flags for ENT?
* Persistent hoarse voice AND >45yrs * Unexplained neck lump (inc. thyroid lump) * Unexplained persistent swelling in salivary glands * Unexplained persistent painful throat * Unexplained mouth ulcer >3 weeks * White or red lesion in mouth or oropharynx * New dysphagia
155
What are some risk factors for nasopharyngeal/oral malignancy?
* Smoking * Alcohol * Betel Nut * Chronic dental infection * Immunosuppression * Sun exposure (lips) * Viral exposure - HPV (oropharynx), EBV (nasopharynx)
156
What is the investigation and management of head&neck malignancies?
* USS +/- FNA * Biopsy (if oral cavity/tongue) * Diagnostic panendoscopy +/- biopsy * CT * MRI + MDT discussion for Mx Local excision or resection +/- neck dissection Radiotherapy/chemotherapy
157
What are the indications for a tracheostomy?
* Long-term ventilation * Gradual weaning from ventilation * Airway obstruction or anticipated obstruction
158
What are some common precipitants for epistaxis?
* Anticoagulation * Haematological conditions that impair clotting * Heat * Dryness (e.g. AC, fans etc) * Irritants/smoke * Intranasal drug use
159
What is the immediate Mx of epistaxis?
* Upright position + suction * Wide bore IV access * Bloods including G&S * Fluid resuscitation * IV tranexamic acid * Consider blood products
160
What is the pathway for managing epistaxis (in terms of stopping the bleeding)?
1) Nasal pinching for 15mins at least +/- ice packs 2) Nasal cautery (silver nitrate, only use on one side) 3) Anterior packing 4) Posterior packing 5) Surgical intervention
161
What is the Mx of a post-tonsillectomy bleed?
* If actively bleeding -> ENT senior + anaesthetics * Wide bore cannula, bloods, cross-match * IV fluids / blood products * Magills forceps + gauze + adrenaline * Hydrogen peroxide gargles * Tranexamic acid * Antibiotics If doesn’t stop -> return to theatre
162
What are some red flag foreign objects that need to be removed ASAP?
* Button battery * Adhesives * Magnets * Insects (especially if inside the ear) * Caustic substances
163
How is a foreign body in the ear managed?
Unless it is red flag object, semi-urgent f/u in 2 weeks to see if object has come out on its own
164
How is a foreign body in the nose managed?
Semi-emergency (same day or next day) unless it is red flag object Start with a 'mothers kiss' technique
165
How is a foreign body in the throat managed?
Visible? – attempt removal with xylocaine spray, forceps, headlight and tongue depressor Not visible? * Lateral neck x-ray * Flexible nasoendoscopy – if visible attempt removal If still not visible and short history – reassure and safety net as likely not there anymore, may have left a scratch
166
What are some drugs that are known to cause gingival hyperplasia?
CCBs (e.g. nifedipine, amlodipine) Ciclopsorin Phenytoin
167
What is the acute management of vestibular neuritis?
Prochlorperazine - only use in acute phase otherwise can delay recovery by interfering with central compensatory mechanisms
168
What test can be used to differentiate vestibular neuronitis from a posterior circulation stroke?
HiNTS exam (3 tests)
169
What tests make up the HiNTS exam?
* Head impulse test * Test of skew * Assessing nystagmus
170
What is the management of acute necrotising ulcerative gingivitis?
Refer the patient to a dentist, meanwhile the following is recommended: * Oral metronidazole* for 3 days * Chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash * Simple analgesia
171
What is the management of a post-tonsillectomy bleed?
If a primary haemorrhage, requires immediate return to theatre to stop bleeding If within 5-10 days of surgery, should be admitted for IV antibiotics as associated post-op wound infections
172
What is the Mx of a pleomorphic adenoma?
Surgical resection (non-urgent) due to the risk of malignant transformation
173
What is rhinitis medicamentosa?
Rebound nasal congestion which is associated with prolonged use of nasal decongestants
174
What type of nystagmus is seen in BPPV?
Rotatory
175
How are chronic symptoms of vestibular neuronitis managed?
Vestibular rehabilitation
176
What neck lump characteristically contains cholesterol crystals?
Branchial cyst
177
What exercises can be done at home to treat BPPV?
Brandt-Daroff exercises
178
What is the management of an auricular haematoma?
Same day ENT assessment for early incision and drainage
179
What is the most appropriate initial management of epistaxis where the site of bleeding is difficult to localise?
Anterior packing
180
What characterises a primary and secondary post-tonsillectomy bleed?
Primary - within hours (6/8hrs) of the initial surgery Secondary - within 5-10 days of surgery
181
Where are vesicular lesions seen in Ramsay-Hunt syndrome?
Usually in the external auditory canal and pinna but can also be seen on the anterior 2/3rds of the tongue (facial distribution)
182
What chemotherapy drug can cause ototoxicity?
Cisplatin
183
What is the typical management of adult hearing loss (with no sinister cause)?
3 month trial of acoustic hearing aids --> cochlear implant
184
What can be used to shrink nasal polyps?
Topical corticosteroids
185
What is the most common anatomical area for a nosebleed to occur?
Anterior nasal septum (Little's area) - due to a confluence of 4 arteries in this area
186
What is the Mx of Ramsay-Hunt syndrome?
* High dose acyclovir * High dose steroids * Eye protection
187
What is used for prophylaxis of Sx in Meniere's disease?
Betahistine
188
What drug class is betahistine in?
Histamine analogue
189
What is meant by 'double-sickening' and what is it suggestive of?
A return of symptoms after a period of improvement - it is usually seen in bacterial sinusitis
190
What is vertebrobasilar ischaemia?
Vertigo and dizziness on certain movements of the head, especially when looking up, as a result of reduced blood flow in the vertebrobasilar distribution
191
What Abx should be prescribed for otitis externa in diabetic patients?
Ciprofloxacin
192
Which virus is associated with nasopharyngeal cancer?
EBV
193
Which virus is associated with oropharyngeal cancer?
HPV
194
What is the maximum duration intranasal steroids should be used in chronic rhinosinusitis?
3 months
195
Is an ear swab required in otitis externa?
No usually as most cases will be sensitive to the high Abx concentrations in ear sprays
196
How long is prednisolone given for in sudden SNHL?
7 days
197
What is meant by exostosis?
A benign bony growth in the external auditory canal that occurs as a result of repeated exposure to cold weather and wind, resulting in a conductive HL
198
How long should an ulcer be present to be classed as 'persistent' and therefore require a 2ww referral?
3 weeks
199
Which part of the eardrum is most important to visualise in cholesteatoma cases?
Pars flaccida (attic)
200
Which antimalarial drug is known to cause tinnitus?
Quinine (but usually reverses on stopping)
201
What are the two main contraindications to a cochlear implant?
* Chronic infective OM * Mastoid cavity infection
202
What is black hairy tongue and how is it managed?
A benign, usually asymptomatic condition where dark black/brown deposits accumulate on tongue (accumulation of keratin and dead cells) usually as a result of poor oral hygiene Mx: good oral hygiene
203
What pattern of inheritance does otosclerosis follow?
Autosomal dominant
204
What is the immediate management of a post-tonsillectomy bleed causing stridor/airway compromise?
Cut the sutures to relieve pressure that is pushing on the trachea and arrange urgent return to theatre
205
At what point are you recommended to refer for vestibular rehabilitation (balance specialist) in vestibular neuritis cases?
Symptoms > 1 week
206
What is the head impulse test used for?
Can be used to differentiate between central and peripheral causes of vertigo. It will be positive in peripheral causes (e.g. vestibular neuritis) and negative in central causes (e.g. cerebellar stroke)
207
Do all post-tonsillectomy bleeds need to referred?
Yes - all need to be urgently referred to ENT even if they don't seem severe

ICSM Year 6 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions