ENT Flashcards

Question

Presentation of allergic rhinitis?

Answer 1

Nasal pruritus Sneezing Rhinorrhoea Nasal congestion It may also be associated with allergic conjunctivitis, manifesting as: Eye redness Eye puffiness Watery eye discharge

Answer 2

Sinusitis Nasal polyps Deviated nasal septum Common cold

Answer 3

Avoiding triggers Nasal irrigation with saline Intra-nasal or oral anti-histamines Regular intranasal steroids if initial measures are ineffective Oral steroids for severe cases affecting quality of life Referral to an ENT specialist if: There are red flag features suggesting an alternative/serious diagnosis Cases are refractory Allergen testing is needed

Answer 4

Fracture of one or more bones at the base of the skull

Answer 5

severe head injury or blunt force trauma. This can occur from road traffic accidents, falls, assaults, or other forms of high-energy impact.

Answer 6

History of severe head injury Reduced consciousness Battle's sign: bruising of the mastoid process Raccoon eyes: periorbital bruising Rhinorrhoea: CSF leakage from the nose Otorrhoea: CSF leaking from the ear Cranial nerve palsy (I, II, III, IV, V, VI, VII, and VIII can all be affected) Epistaxis or otorrhagia: bleeding from the nose or ears Haemotympanum: blood visible behind the tympanic membrane

Answer 7

Confusion Intracranial haemorrhage Brain contusion Skull fracture without base involvement

Answer 8

CT scan within 1 hour

Answer 9

Raised intracranial pressure is managed with medications, and in severe cases, surgery. Neurosurgery might be required depending on the extent of the injury. Antibiotics are administered if there is a risk of meningitis, especially in situations where there is CSF leakage.

Answer 10

Congenital malformation that arises from an embryological remnant due to incomplete obliteration of brachial arches which are integral to the development of structures in the head and neck

Answer 11

20% of all paediactric neck masses Present in late childhood/ early adulthood

Answer 12

Painless, cystic mass anterior to the sternocleidomastoid muscle just below the ear. The mass may increase in size during episodes of upper respiratory tract infections. Tend to present above the age of 10 years.

Answer 13

Lymphadenopathy Thyroglossal cyst Laryngocele Dermoid cyst

Answer 14

USS CT MRI Fine needle aspiration cytology

Answer 15

If asymptomatic: conservative management with observation may be most appropriate If infected: antibiotics may be required Surgical excision of the cyst is used if there are cosmetic or functional complications of the cyst, or following an infection.

Answer 16

Leakage of CSF from the nose

Answer 17

Complication of illness Common post infection or trauma

Answer 18

Fracture of the anterior skull base Iatrogenic Trauma Spontaneous leak Infection

Answer 19

Clear watery nasal discharge which may increase when bending forward

Answer 20

Allergic rhinitis Vasomotor rhinitis Sinusitis Nasal polyps

Answer 21

CT head scan Glucose oxidase Transferrin analysis

Answer 22

Conservative; bed rest and avoid activities that increase intracranial pressure Surgery to repair leak

Answer 23

Acute infections, which may be bacterial or viral Chronic infections such as tuberculosis and HIV Malignancies, particularly lymphomas and head and neck cancers Other causes such as autoimmune disease and sarcoidosis

Answer 24

Accumulation of skin and squamous epithelium within the middle ear cleft and mastoid air cells.

Answer 25

Severe complication of chronic otitis media Common in younger patients

Answer 26

Chronic otitis media

Answer 27

Male sex Middle ear disease Prior ENT surgery Congenital abnormalities of the middle ear compromising eustchian tube function

Answer 28

Persistent foul-smelling discharge Headaches Otalgia Otoscopy; white area is often visible in the attic behind the membrane.

Answer 29

Chronic otitis media Osteosclerosis Squamous cell carcinoma

Answer 30

Examination of the tympanic membrane CT MRI Audiometry

Answer 31

Refer to ENT Surgical removal

Answer 32

Progressive conductive deafness Facial nerve palsy Meningitis or intracranial abscess Mastoiditis Cavernous sinus thrombosis

Answer 33

Inflammation/ swelling of the tissue that lines sinuses Acute sinusitis describes symptoms that last less than 12 weeks. Chronic sinusitis describes symptoms lasting more than 12 weeks.

Answer 34

viral URTI The most common causes of bacterial sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

Answer 35

Impaired ciliary function - caused by smoking, cystic fibrosis or primary ciliary dyskinesia Atopic conditions including asthma and allergic rhinitis Mechanical obstruction of the upper respiratory pathways Immunodeficiency Recent instrumentation, including sinus surgery

Answer 36

Facial pain, often worse when sitting forward Tenderness overlying the sinuses Nasal obstruction Nasal discharge Reduced sense of smell Purulent nasal discharge and fever in bacterial infections

Answer 37

Migraine TMJ dysfunction Neuralgia Cervical spine disease Temporal arteritis Vasculitis Herpes zoster

Answer 38

Analgesia Nasal spray; mometasone Antibiotics; phenoxymethylpenicillin, if non resolving consider co-amoxiclav

Answer 39

Hypocalcaemia Hypothyroidism Damage to recurrent or superior laryngeal nerve Neck haematoma Thyrotoxic storm

Answer 40

Type of hearing impairment that occurs due to the obstruction of sound waves at any point along the path from the outer ear to the footplate of the stapes in the middle ear

Answer 41

Common in children and elderly

Answer 42

Wax impaction Otitis media with effusion (glue ear) Eustachian tube dysfunction Ear infections Perforations of the tympanic membrane Chronic suppurative otitis media

Answer 43

Audiometry; Air conduction thresholds: Elevated (poorer hearing). Bone conduction thresholds: Normal (reflects preserved inner ear function). Air-Bone Gap: Significant gap (> 15 dB) between air and bone conduction thresholds, indicating conductive loss. Typically affects low frequencies more than high.

Answer 44

Removal of impacted wax Antibiotics for ear infections Surgical intervention for chronic conditions such as chronic suppurative otitis media or perforations of the tympanic membrane.

Answer 45

Bleeding from the nose - this usually originates from the anterior nasal septum. Approximately 10% of cases are posterior, originating from branches of the sphenopalatine artery.

Answer 46

Trauma, including nose-picking, blunt trauma, septal perforations and foreign bodies in the nose Oxygen via nasal cannulae, which causes drying and irritation of the nasal mucosa Recent ENT or maxillofacial surgery Tumours, which may be benign or malignant Inflammation, including rhinosinusitis, nasal polyps Alcohol excess Illicit drug use, including cocaine Medications such as nasal steroids Vasculitides, for example granulomatosis with polyangiitis Bleeding disorders including thrombocytopenia, Von Willebrand disease, haemophilia, antiplatelet or anticoagulant medications Environmental factors, such as inhaled irritants, temperature and humidity

Answer 47

Bleeding down the throat (which may present as haemoptysis or haematemesis), which may signify posterior epistaxis Bleeding from both nostrils is another sign of possible posterior epistaxis Signs and symptoms of haemodynamic instability if blood loss is significant Signs and symptoms of an underlying cause, for example nasal obstruction in the case of tumours or polyps

Answer 48

Haemoptysis Haematemesis

Answer 49

VBG FBC, Clotting screen Group and save LFT Test for bleeding disorder

Answer 50

Conservative measures are sufficient to treat most non-severe nosebleeds. This involves Sitting forward, breathing through the mouth and pinching the cartilaginous part of the nose for 10-15 minutes. A topic antiseptic (e.g. Naseptin or mupirocin) Nasal cautery Nasal packing TXA

Answer 51

Anaemia Recurrent epistaxis Hypovolaemia Aspiration of blood and airway compromise Nasal cautery may cause septal perforation Nasal packing may lead to sinusitis, septal haematoma or pressure necrosis

Answer 52

Glandular fever, commonly caused by infection with EBV

Answer 53

Fever and general malaise. Sore throat. Transient macular rash. Lymphadenopathy, particularly in the neck region. Mild hepatosplenomegaly.

Answer 54

Streptococcal pharyngitis Influenza HIV seroconversion CMV

Answer 55

FBC; elevated lymphocytes Monospot test; conducted in the 2nd week of illness EBV serology Abdominal USS

Answer 56

Resolves in 2-4 weeks Analgesia Avoid alcohol Antibiotics: Ampicillin and amoxicillin should be avoided as they can trigger an itchy maculopapular rash. Contact sports: These should be avoided for at least 3 weeks due to the risk of splenic trauma.

Answer 57

Haemophagocytic lymphohistiocytosis Aplastic anaemia Liver failure Upper airway obstruction

Answer 58

Tobacco use Alcohol consumption Advancing age Human papillomavirus (HPV) infection (oropharyngeal cancer) Epstein-Barr Virus (EBV) infection (nasopharyngeal cancer) Male sex

Answer 59

Laryngeal cancer typically presents as persistent hoarseness. Other clinical features include dysphagia, painful swallowing and lymphadenopathy. There may also be signs of upper airway obstruction, such as stridor. Oropharyngeal cancer can present with an oral ulcer or mass, or abnormal bleeding. It may also present later with regional lymphadenopathy. Other key features include mouth or ear pain and dysphagia. Nasopharyngeal cancers may present with symptoms of unilateral nasal obstruction, unilateral otitis media with effusions, or impaired hearing. They may also present late with lymphadenopathy or, more rarely, cranial nerve palsies. Patients may also have systemic symptoms of malignancy, including tiredness, unexplained weight loss and loss of appetite.

Answer 60

Thyroid nodules Lymphadenopathy GORD Vocal cord polyps Nasal polyps

Answer 61

2WW pathway for anyone over 45 with unexplained hoarseness or neck swelling Endoscopy Biopsy Imaging CXR FBC, LFT's, U&E's and TFT

Answer 62

Surgery Radiotherapy Chemotherapy

Answer 63

Rare genetic disorder characterised by the abnormal formation of blood vessels, causing telangiectasia and arteriovenous malformations (AVMs).

Answer 64

Autosomal dominant Mutations in genes responsible for blood vessel integrity, primarily affecting the ENG (endoglin) and ACVRL1 (activin receptor-like kinase 1) genes These genes encode proteins that are involved in the TGF-β (transforming growth factor-beta) signalling pathway, which is essential for the development and maintenance of the vascular system

Answer 65

Epistaxis Symptoms of anaemia, including fatigue, pallor and palpitations Gastrointestinal bleeding Respiratory symptoms such as shortness of breath, chest pain and haemoptysis Intracerebral bleeds due to AVMs Embolic manifestations such as stroke and myocardial infarction

Answer 66

Von willebrand disease Idiopathic pulmonary arterial hypertension Cirrhosis with portal hypertension CREST syndrome SLE

Answer 67

Physical examination CT MRI Genetic testing

Answer 68

Blood transfusion Iron supplementation Embolisation of AVM

Answer 69

Inability to produce sound or a change in voice pitch or quality

Answer 70

Laryngeal cancer Chronic sinusitis Acute laryngitis Reinke's oedema Lung cancer Laryngeal nerve injury

Answer 71

Viral infection (e.g., influenza, rhinovirus) Allergic rhinitis Rhinosinusitis Nasal polyps Septal haematoma Tumours

Answer 72

Difficulty breathing through the nose Nasal congestion Runny nose Sneezing Reduced sense of smell

Answer 73

Allergic rhinitis Rhinosinusitis Nasal polyps Septal haematoma Tumours

Answer 74

Persistent unilateral symptoms are present, including nasal obstruction, nasal discharge, nosebleeds, crusting and facial swelling.

Answer 75

Medication: Antihistamines for allergic rhinitis, antibiotics for infections, or nasal sprays for rhinosinusitis. Surgical intervention: For conditions such as nasal polyps or septal hematoma. Lifestyle changes: Such as avoiding allergens, using a humidifier or steam inhalation.

Answer 76

Epistaxis (nosebleed) Pain around the nose A change in appearance of the nose Swelling surrounding the nose Nasal congestion A preceding injury to the nose

Answer 77

Nasal fracture Epistaxis Nasal septal haematoma Facial bone fracture Basal skull fracture Damaged cribriform plate

Answer 78

Nasopharyngeal carcinoma is a malignancy that originates in the nasopharynx, the area at the back of the nose towards the base of skull

Answer 79

Nasopharyngeal carcinoma is more prevalent in certain areas including southern China and southeast Asia

Answer 80

Epstein-Barr virus infection Consuming salted fish Smoking Family history of nasopharyngeal carcinoma

Answer 81

Symptoms of eustachian tube obstruction (hearing loss, tinnitus, otalgia, sensation of aural fullness) Nasal obstruction (blocked nose, facial pain) Blood-stained nasal discharge Persistent epistaxis Development of a glue ear

Answer 82

Nasal polyps Nasopharyngeal angiofibroma Lymphoma

Answer 83

History and physical examination Flexible nasendoscopy and biopsy

Answer 84

Inflammatory condition affecting the skin of the external auditory meatus, often resulting in otalgia It is characterised by minimal discharge, itchiness and pain.

Answer 85

Most common causative agents are Pseudomonas species and Staphylococcus aureus.

Answer 86

Otalgia (ear pain) Minimal discharge Itchiness Pain due to inflammation Impaired hearing if the meatus becomes blocked by swelling or discharge

Answer 87

Otitis media Furunculosis Eczema

Answer 88

Clincal, otoscopy Swabs for cultures

Answer 89

Mild to Moderate Otitis Externa: Can be treated with topical drops including combined antibiotic/steroid drops (e.g. Gentamix), acetic acid and other preparations. Patients should be advised to keep the ear dry for the next 7-10 days. Severe Otitis Externa: Treated using a strip of ribbon gauze known as undefinedPope” wicks which can be used for the application of topical antibiotics (classically gentamicin) enabling deeper penetration. Indications to Consider Oral Antibiotics: Cellulitis extending beyond the external ear canal, when the ear canal is occluded by swelling and debris and a wick cannot be inserted, and in people with diabetes or compromised immunity with severe infection or high risk of severe infection.

Answer 90

Infection-induced inflammation of the middle ear, frequently occurring after a viral upper respiratory tract infection

Answer 91

More common in young children

Answer 92

Bacterial infection following viral URTI

Answer 93

Rapid onset of deep-seated ear pain Fever & irritability Anorexia & vomiting Impaired hearing Systemic illness Aural fullness followed by discharge when the tympanic membrane perforates, leading to relief of pain Injection of blood vessels and diffuse erythema of the tympanic membrane

Answer 94

Otitis externa Mastoiditis TMJ disorder

Answer 95

Patients presenting with severe systemic infection or signs of complications should be admitted to hospital for intravenous antibiotics and supportive care. Analgesia and supportive care Amoxicillin for 5-7 days

Answer 96

Extra-cranial complications include: Facial nerve palsy Mastoiditis Petrositis Labrynthtitis Intra-cranial complications include: Meningitis Sigmoid sinus thrombosis Brain abscess

Answer 97

Otosclerosis is a pathological condition of the ear where abnormal bone growth occurs around the stapes bone in the middle ear, impeding its function as a piston onto the cochlea. This can result in progressive conductive hearing loss.

Answer 98

Most common cause of progressive deafness in young adults.

Answer 99

Autosomal dominant

Answer 100

Progressive hearing loss, often starting unilaterally and then affecting both ears Tinnitus, often associated with the hearing loss Sometimes vertigo, although this is less common

Answer 101

Presbycusis Menieres disease Acoustic neuroma

Answer 102

History Audiometric testing; conductive hearing loss CT scan

Answer 103

Hearing aids Surgical replacement of the stapes bone through a stapedectomy, which can restore hearing in many cases.

Answer 104

Formation of a blood clot between the cartilage of the pinna and overlying perichondrium

Answer 105

Sporting related injury Physical contact

Answer 106

Pain in the affected ear Swelling of the auricle Discolouration due to the accumulation of blood

Answer 107

Acute otitis externa Perichondritis

Answer 108

Physical examination History CT USS

Answer 109

Decompress within 24 hours ether by aspiration or incision and drainage Oral antibiotics

Answer 110

Avascular necrosis Infection and abscess formation

Answer 111

Pleomorphic adenoma, an epithelial tumour of the parotid gland - the most common tumour of the salivary gland Warthin tumour, also an epithelial tumour of the parotid gland, typically presents in older male patients and may be bilateral Non-epithelial tumours include haemangiomas, lymphangiomas and lipomas

Answer 112

Mucoepidermoid are most common Adenoid cystic

Answer 113

Salivary gland tumours typically present as a lump or swelling in the affected gland. Red flag features of malignant salivary gland tumours include: Facial muscle weakness or sensory changes Rapidly growing lump Overlying ulceration of induration Progressive pain Past history of cancer or previous radiation

Answer 114

First-line management for persistent salivary gland lumps is surgical removal. Further management strategies depend on the type and stage of the tumour, and may include radiation therapy or chemotherapy for malignant tumour

Answer 115

Sensorineural hearing loss (SNHL) is a type of hearing impairment resulting from a dysfunction or pathological condition within the cochlea or auditory nerve.

Answer 116

Presbycusis (age-related hearing loss), the most common cause Noise-induced hearing loss Congenital infections, such as rubella or cytomegalovirus (CMV) Neonatal complications, such as kernicterus or meningitis Drug-induced deafness, particularly with aminoglycosides Vascular pathology, such as stroke or transient ischaemic attacks

Answer 117

Gradual loss of hearing, often at high frequencies Difficulty understanding speech, especially in noisy environments Tinnitus, or ringing in the ears

Answer 118

Conductive hearing loss Mixed hearing loss

Answer 119

Audiogram; loss of hearing at high frequencies

Answer 120

Avoidance of noise exposure Treatment or management of underlying conditions Adjustments to medications, particularly if SNHL is drug-induced Use of hearing aids or cochlear implants

Answer 121

Inflammation of the salivary glands

Answer 122

More common in elderly and immunocompramised

Answer 123

viral and bacterial infection Dehydration Autoimmune disease Medications that reduce salivary flow

Answer 124

Pain Tenderness Redness Localised swelling of the affected area

Answer 125

Reactive lymphadenopathy Malignant lymphadenopathy Tumour Submandibular salivary stone

Answer 126

Antibiotics, if the cause is bacterial Oral hygiene advice to prevent future occurrences Measures to encourage salivary flow such as hydrating well and use of salivary stimulants Incision and drainage if there is an associated abscess Optimisation of underlying conditions/medication

Answer 127

Croup Epiglottitis Bacterial tracheitis

Answer 128

Collection of clinical problems involving the masticatory musculature, the temporomandibular joint (TMJ) and associated structures. They are characterised by pain in the jaw joint and surrounding tissues, including the ear, difficulty in jaw movement and noises from the temporomandibular joint during jaw movements.

Answer 129

Trauma to the jaw Stress, which can cause clenching or grinding of the teeth (bruxism) Arthritis in the temporo-mandibular joints Abnormal jaw or tooth alignment

Answer 130

Pain in the jaw, face, and ear Difficulty in opening and closing the mouth Clicking, popping, or grating sounds in the jaw when opening or closing the mouth A sense of the jaw being "stuck" or "locked"

Answer 131

Dental/ tooth pain Sinusitis Trigeminal neuralgia Otitis media

Answer 132

Detailed history and examination Dental radiographs CT scan or MRI to provide detailed images of the bones and soft tissues

Answer 133

Conservative measures: Resting the jaw, adhering to a soft diet, avoiding wide yawning and loud singing, physiotherapy, and use of heat or cold packs Medications: Analgesics, muscle relaxants, and anti-inflammatory drugs Dental treatments: Use of oral splints or mouth guards, correction of misaligned teeth In severe or chronic cases, referral to an ENT specialist may be necessary

Answer 134

Benign neck mass that arises from the remnants of the thyroglossal duct, a tube that typically disappears before birth. This cyst is filled with fluid and presents as a painless, palpable mass in the midline of the neck that moves upwards during tongue protrusion and swallowing

Answer 135

Persistence of the thyroglossal duct beyond foetal period

Answer 136

Painless midline neck mass Fluctuant swelling Upward movement of the mass on tongue protrusion or swallowing Possible secondary infection leading to tenderness, redness, and fever

Answer 137

Cystic hygroma Branchial cleft cyst Dermoid cyst Goitre

Answer 138

USS Fine needle aspiration CT scan MRI scan

Answer 139

Surgical excision vis sistrunk procedure

Answer 140

symptom characterised by the perception of non-verbal sound in the absence of external stimuli, often described as hissing or buzzing.

Answer 141

Chronic noise exposure Age-related hearing loss Presbycusis (age-related hearing loss) Acute acoustic trauma Perforation of the tympanic membrane Otitis media (middle ear infection) Meniere's disease (inner ear disorder causing vertigo and tinnitus) Vestibular schwannoma (benign tumour on the balance nerve) Use of ototoxic drugs such as quinine, aminoglycosides, and loop diuretics

Answer 142

Meniere's disease Acoustic neuroma Otitis media Presbycusis

Answer 143

Audiometry Bloods; FBC, TFT Imaging; MRI/ CT

Answer 144

Treat the cause

Answer 145

Chronic disease that involves inflammation, fibrosis, and calcification of the tympanic membrane and other structures within the middle ear.

Answer 146

Chronic otitis media Tympanostomy tubes Trauma Ototoxic drugs Genetic pre-disposition

Answer 147

Significant hearing loss Chalky white patches on tympanic membrane

Answer 148

Chronic otitis media Otosclerosis Cholesteatoma

Answer 149

Hearing aids Surgery

Answer 150

Vertigo is a sensory phenomenon where an individual perceives a false sensation of movement or spinning. This perceived motion frequently gives the impression of a tilting or spinning environment.

Answer 151

BPPV Acute labyrinthitis Stroke Meniere's disease Acoustic neuroma Ramsay Hunt syndrome Ototoxicity Orthostatic Hypotension Cardiac arrhythmias Medications (e.g., aminoglycoside antibiotics and loop diuretics).

ENT Flashcards

(176 cards)