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Year 3 - GP Block > 6&10 - ENT > Flashcards

6&10 - ENT Flashcards

1
Q

Otitis Externa

  1. S&S
  2. Mx
  3. Complications
A

Otitis Externa

  1. Itchy + discharge
  2. Avoid swimming
  3. Malignant OE -> Osteomyelitis (can spread)
    ABx
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2
Q

Noise related hearing loss

  1. Three categories
  2. Mx
A

Noise-related hearing loss

  1. Occupational
    Recreational
    Accidental
  2. Steroids
    Hearing aids
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3
Q

Age related hearing loss

  1. Pattern
  2. Mx
A

Age-related hearing loss

  1. Higher frequencies lost (and conversation)
  2. Hearing aids
    Reduced environmental noise
    Cochlear implants
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4
Q

Acute Otitis Media

- Management

A
  1. 3-7/7 Analgesia
  2. ABx 10/7
    Children: Amoxicillin 80mg
    Adults: Co-amoxiclav 80-90mg
  3. Tympanocentesis
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5
Q

Dry Tympanic Perforation

  1. Causes
  2. S&S
A

Dry Tympanic Perforation

Traumatic injury

  1. Sudden loud noise (can be very severe)
  2. Barotrauma
  3. Dislodged grommit

S&S

  1. Asymptomatic
  2. Conductive hearing loss/muffling
  3. Tinnitus
  4. Otalgia
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6
Q

Mastoiditis

  1. Hx
  2. Mx
  3. Red flags
A

Mastoiditis

Hx

  1. Otalgia
  2. Ear ‘Pushed forward’
  3. Rubor & Tumor
  4. Fever+Confusion+Meningism

Mx

  1. ABx IV -> PO (14/7)
  2. Aspiration/debridement/mastoidectomy

Red flags
- No improvement, Meningism, VST

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7
Q

Cholesteatoma Presentation

A
  1. Smelly otorrhoea
  2. Erythema
  3. Keratin/dead skin build upx
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8
Q

Referred Otalgia?

1 Nerves

2 Red flags

A

CNs:

  1. Trigeminal:
    Dental abscess
    Joint lesion (TMJ)
  2. Facial:
    Ramsay Hunt Syndrome?
  3. Glosopharyngeal:
    Tonsillectomy
  4. Vagus:
    Laryngeal cancer
    Cricoid cancer

Otalgia red flags:

  1. Sudden hearing loss/pain
  2. Unilateral
  3. Pulsatile tinitus
  4. Repeated OE - ?Cholesteatoma?
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9
Q

Otitis media with effusion

  1. S&S
  2. Mx
A

‘Glue ear’

  1. Hearing loss
  2. Mild intermittent pain
  3. Fullness
  4. Popping

Mx
1. Active observation for 3/12

  1. Pure tone audiometry
    +/-Tympanometry
  2. Hearing aids
  3. Myringotomy
  4. Grommets and adenoidectomy
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10
Q

Congenital hearing loss

  1. Causes
  2. Mx
A

Congenital hearing loss

  1. Causes:
    AD/AR/X-Linked
    Rubella/Toxins/Pre-eclampsia/Anoxia
  2. BSL & SALT
    Hearing aid/implant
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11
Q

Thyroid nodule symptoms (5)

A
  1. Neck lump or mass when swallowing
  2. Pain
  3. Dyspnoea
  4. Horseness
  5. Thyrotoxicosis
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12
Q

Thyroid lump investigations?

A
  1. Exam
  2. TFTs
  3. USS and Radiodine
  4. Biopsy
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13
Q

Management of a thyroid lump:

  1. Non-malignant
    • Asymptomatic
      - Symptomatic
  2. Malignant
  3. Thyrotoxicosis
A

Management of a thyroid lump:

  1. Non-malignant
    • Asymptomatic
      Monitor TFTs
      - Symptomatic
      Surgical removal
  2. Malignant
    - Removal
  3. Thyrotoxicosis
    - Radioactive iodine
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14
Q

Nasal fracture redflags

A
  1. Septal haematoma
  2. Battle’s sign (blood behind ear)
    or bloody otorrhoea
    • Petrous fracture
  3. Peri-orbital ecchymosis (Panda eyes)
    or cerebrospinal rhinorrhoea
    • anterial cranial fossa injury
  4. Neurological deficit (incl. Low GCS)
    • CT
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15
Q

Nasal fracture management

  1. Conservative
  2. Displacement
  3. Complicated fracture
A
  1. PRICE
    • Pain relief
    • Raise/rest
    • Ice
  2. Displaced
    • Closed reduction
    • Splinting
  3. Complicated
    • Open surgical reduction
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16
Q

Alergic rhinitis management

A
  1. Reduce allergen contact

2. OTC antihistamines

17
Q

Vestibular neuritis S&S (4)

A
  1. Severe continuous vertigo
    • Fall to affected side
  2. N+V
  3. Nystagmus
  4. Osciloplasia (obects appear to jump, jiggle, or vibrate)
18
Q

Vestibular neuritis test?

A

Head impulse test

  1. Pt focus eyes on examiner
  2. Examiner turn pt’s head
  3. If positive test, eyes move with head, then return
  4. If negative test, eyes remain fixed while head turns
19
Q

Vestibular neuritis management?

A
  1. Reassure - will settle over several weeks
  2. Buccal prochlorperazine (H2)
    • Rapid vertigo relief
  3. Cyclizine (H2) IM
    • Rapid vertigo relief
  4. Cyclizine PO
    • N&V
20
Q

Nasal polyps

  1. Ix
  2. DDs
A

Nasal polys

  1. Ix
    - Endoscopy
    - CT
    - Biopsy
  2. DDs
    - Malignancy
    - CF
21
Q

Nasal polyps Mx

A
  1. Intra-nasal Steroids (fluticasone propionate 50mcg BD)
    + Nasal saline irrigation
    ( + Doxycycline 100mg OD 3-12/52 after 200mg 1/7)
  2. Surgical polypectomy
    + Saline irrigatiion
    + Post op abx PO
22
Q

What are distinguishing features of BPPV?

A

BPPV

  1. Only vertigo when moving
  2. Dix-Hallpike Manoeuvre (quick drop from 45° to -30°)
23
Q

Management of BPPV?

A

BPPV

  1. Self limiting
    1/3 resolve in 3 weeks
    Majority resolve in 6 months
  2. Epley manoeuvre
24
Q

What are the symptoms of Vestibular Migraine?

A
  1. Migraine
    Photophobia
    Unilateral headache
  2. Vestibular symptoms
    Vertigo
    Noise sensitivity
25
Q

Vestibular Migraine Management

A

Vestibular migraine

  1. Lifestyle:
    Regular patterns
    Manage stress
  2. Analgesia
    Paracetamol
    Ibuprofen
3. Triptans 
	5-Ht agonists
	Prevent CGRP [Caltcitonin gene-related peptide] )
Almotriptan 12.5mg
Sumatriptan 50-100mg
  1. Antiemetics
    Metoclopramide
    Prochlorazapine
26
Q

What is the indication for triptans and what is their mechanism?

A
  1. Triptans are 5-Ht agonists used in migraines
  2. They prevent CGRP [Caltcitonin gene-related peptide]
  3. Examples include:
    Almotriptan 12.5mg
    Sumatriptan 50-100mg
27
Q

What antiemetics are used in migraines?

A

Metoclopramide
1 sachet at start
Next sachet at 2hrs
Maximum TDS)

Procholorperazine
PO 20mg initially
10 mg after 2 hours

IM 12.5mg
6hrs PO further dose

28
Q

Labarynthitis S&S (4)

A
  1. Vertigo
    Constant
    Sudden
    Severe
  2. N&V
  3. Hearing loss &/or Tinitus
  4. Can follow URTI
29
Q

Labarynthitis Ix

A

Labarynthitis

  1. Otoscopy
  2. Head impulse test
    Turn head to side
    Rapidly re-centre
    Note eye-movements (lag?)
30
Q

Labarynthitis Mx

A

Labarynthitis

  1. Reassure
  2. Days-weeks self-resolving
  3. Vertigo
    Prochlorperazine
    Anti-histamine
31
Q

Cervical lymphadenopathy DDs and Mx

A

> 1cm - Get a Scan

  1. Viral Ifx
    Reassure
  2. Malignancy
    Refer
  3. Autoimmune + HIV
    Refer
32
Q

Septal Devation S&S

A
  1. Sleep apnoea
  2. Anosmia
  3. Infections
  4. Blocked nose/dry opposite nostril
  5. Pain
  6. Aesthetics
33
Q

ENT Red Flags

A
  1. Unilateral nasal obstruction
    Urgent referal
  2. Trauma to nose
    Look up nose same-day
    ?Septal haematoma
  3. Unilteral hearing loss
    ?Stroke
    ?Neuritis
    ? Cerebellar schwannoma
34
Q

Glossodynia DDx

A

Glossodynia differentials

  1. Infection
  2. Trauma
  3. Nerve damage
  4. Deficiency (B12, Iron, Zinc, Selenium)
35
Q

Dry tympanic perforation

- Mx

A

Dry tympanic mx

  1. Self limiting (6-8/52)
    - Keep dry
    - Analgesia
  2. Not healing or large
    - Refer to otologist
    - Myringoplasty/Tympanoplasty
  3. If infected
    - ABx
36
Q

Acute sinusitis

- Mx

A

Acute sinusitis mx

  1. Supportive
    - Rest and hydration
    - Vitamin C ad Zinc
  2. Analgesic/antipyretic
    - Paracetamol/ibuprofen
  3. Lavage
  4. Decongestant
    - Oxymetazoline
    - Pseudoephedrine
  5. CST
    - Mometasone
  6. Ipratropium
37
Q

Bacterial Sinusitis

- Mx

A

Bacterial Sinusitis

  1. ABx
    - Co-Amox
    - Clinda & Cefixime
    - Doxy
  2. ENT Referral
  3. Supportive
    - Rest, fluids, lavage
    - Analgesia/antipyrexial
    - Decongestant, CST
38
Q

Sinuses

- Four Sinuses

A

Sinuses

  1. Frontal
  2. Maxillary
  3. Ethmoidal
  4. Sphenoid

Year 3 - GP Block (13 decks)

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