Ear, Nose and Throat Flashcards
What is Benign Paroxysmal Positional Vertigo?
BPPV is the most common cause of vertigo, which is a spinning sensation that occurs when changing head position
It occurs when small crystals (otoliths) in the inner ear become dislodged and stimulate the vestibular system, which controls balance and orientation
H&E of BPPV
- Recurrent episodes of vertigo lasting <1 minute
- Triggered by head movements such as rolling over in bed, looking up, or bending over
- Negative HINTS examination
- No symptoms of hearing loss, tinnitus or neurological deficits
- Dix-Hallpike test is the first-line diagnostic test which is preformed to elicit nystagmus from BPPV
Investigations for BPPV
- First line is Dix-Hallpike test
- Latent and fatiguable nystagmus
- Additional testing to rule out other causes of vertigo
Management of BPPV
- Particle repositioning manoeuvres, such as Epley manoeuvre or the Semont manoeuvre
- Home exercises (Brandt-Daroff)
- Referral to balance specialist if unresolving and resistant to manoeuvres
- Education about avoiding head positions that can caused BPPV
What is Tonsilitis?
Infection and inflammation of the tonsils
Viral causes:
- Rhinovirus
- Adenovirus
- Respiratory Syncytial Virus
Bacterial causes:
- Group A Streptococcus
What are the risk factors for Tonsilitis?
- 5-15 year olds
- Crowded environments
- Winter/early Spring
- Incomplete Abx course
H&E for Tonsilitis
Viral:
- low grade fever
- cough
- rhinorrhoea
Bacterial:
- high grade fever
- sore throat
- odynophagia, dysphagia
What is the Fever-PAIN and CENTOR grading system for Tonsilitis?
Both 1 point each -
Fever
P - Pus
A - Attend rapidly <3 days
I - Inflamed tonsils (severe)
N - No cough or coryza
C - Can’t cough
E - Exudate (tonsillar)
N - Nodes (ant. cervical lymphadenopathy)
T - Temperature > 38
OR (age < 15 = +1, OR age > 44 = -1)
Investigations for Tonsilitis
Confirm diagnoses if high risk of rheumatic fever, very old/young, immunosuppressed or very severe
- Rapid antigen group A strep test - RAST
- Culture if negative
Management of Tonsilitis
If Fever-PAIN is 0-1 or CENTOR is 0-2:
- do not offer antibiotic
If Fever-PAIN is 2-3:
- Consider no Abx or backup prescription
If Fever-PAIN is 4-5, or CENTOR is 3-4:
- consider immediate Abx
- Phenoxymethylpenicillin
- If allergic - clarithromycin OR erythromycin (if pregnant)
Complications of Tonsillitis
- otitis media
- quinsy - peritonsillar abscess
- rheumatic fever and glomerulonephritis very rarely
NICE recommendations for surgical intervention of Tonsillitis
- sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
- the person has five or more episodes of sore throat per year
- symptoms have been occurring for at least a year
- the episodes of sore throat are disabling and prevent normal functioning
What is Epistaxis and types?
Nose bleeds - bimodal onset - <10yo or 45-65yo
Anterior - Kisselbach’s plexus (Little’s area)
Posterior - Sphenopalatine artery
Causes of Epistaxis
Common:
- Idiopathic
- Nose picking
- Trauma
- Age-related
Uncommon:
- Irritants
- Anticoagulants/ anti platelets
Rare:
- Sinonasal neoplasm
- Coagulopathy
- Hereditary haemorrhagic telangiectasia
H&E of Epistaxis
- Blood at back of throat if posterior (even if anterior packed)
Red flags:
- Obstruction
- Serosanguinous discharge
ABCDE approach
Investigation for Epistaxis
Examine with thudicum nasal speculum +/- endoscopy
Management of Epistaxis
- IV access for crystalloids for hypovolaemia
- Hippocratic method - lean forwards and pinch anterior nares, hold for 20 mins
- Cauterise anterior point bleeds with silver nitrate
- Anterior packing for multiple bleeds - nasal tampon or gauze in paraffin
- Bilateral anterior packing +/- posterior packing (oleg catheter)
- Arterial ligation for unresolving bleeds
Features of Acute Haemolytic Transfusion Reaction
- Fever
- Hypotension
- Chest pain
- Timing of blood product delivery
- Change in urine colour
Management of Anaphylaxis during blood transfusion
Stop the transfusion
IM adrenaline
ABC support - oxygen, fluids
Description and Management of Transfusion-associated circulatory overload (TACO)
Excessive rate of transfusion or pre-existing HF - causes pulmonary oedema and HT
Slow or stop transfusion
Consider IV loop diuretic (e.g. furosemide) and oxygen
Description and Management of Transfusion-related acute lung injury (TRALI)
Non-cardiogenic pulmonary oedema, due to increased vascular permeability caused by host neutrophils activated by substances in donated blood - leads to hypoxia, fever, HYPOtension and pulmonary infiltrates
Stop transfusion
Oxygen and supportive care
Description and Management of Non-haemolytic febrile reaction
Caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from blood cell during storage - causes fever and chills
RBC transfusion - 1-2%
Platelet transfusion - 10-30%
Slow or stop transfusion
Paracetamol
Monitor
Description and Management of Minor Allergic Reaction during Transfusion
Caused by foreign plasma proteins - pruritis and urticaria
Temporarily stop transfusion
Antihistamine
Monitor
Causes of Iron Deficiency Anaemia
Reduced uptake - IBD, malnutrition, coeliac disease
Increased loss - GI malignancy, IBD, malnutrition, peptic ulcer disease
Increased demand - pregnancy, breastfeeding
