ENT 1 Flashcards
tonsillitis causes viral and bacterial
symptoms
ix
treatment
viral: rhinovirus, adenovirus, influenza, EBV
group a strep, pneumonia, HI
malaise. sore throat. odynophagia. fever, cough, hallitosis
throat swab not recommended. FBC and monospot
supportive. penicillin 10d (clarithro 5d)
IV penicillin IV dexa Iv fluids
tonsillectomy and cx
cx of acute tonsillitis
censor criteria
over 7 in 1y over 5 in 2 over 3 in 3
pain esp d5-7, bleeding, infection
local: resp obstruction, absces
general: septiczaemia, rheumatic fever, post strep GN
fever, no cough, cervical LD, tonsils exudate, under 15 add 1, over 44 minus 1
3/4 ABs or if history of OM then ABs
chronic causes
symptoms
strep progenies, HI, SA, pneumonia, betal lactamase producing
chronic sore throat, bad breath, peritonsilar erythema, persistent tender cervical LD
organic causes of speech and language changes
congenital (laryngeal web) acquired - trauma right laryngeal nerve paralysis endocrine ;laryngeal disease like cancer
quincy symptoms
managemetn
preceecing tonsillitis. unilateral throat paina and odynophagia. trismus. displacement of uvula. concavity of palate lost. hot potato voice medilization of a tonsil. change in voice
aspiratiom and IV benzylpencillin PA clinda PO can’t swallow IV clinda
not resolving at 48 hours add metro
tonsillectomy if history to 2 episodes
diphtheria toxins
symp
manageemnt
exotoxin, cardiotoxin, neurotixin
severe sore throat with green/grey psueommebrane across pharynx
anti toxin. erythro/pencillin for 14 days
contact tracing. vaccine available
glandular fever cause symptoms complications ix rx
EBV
fever, cervical LD, sore throat, malaise, lethergy, fever, jaundice, splenomegaly, mild rash, atypical lymphocytes
mild thrombocytopenia, splenic rupture, risk of lymphoma in immunosuppressed
EBV IGM, heterophiles AB, FBC, LFTs,
atypical lymphocytes CRP <100, mono spot
bed rest steroids if cx
obstructive hyperplasia in adenoids
in tonsils
mouth breathing, hypo nasal voice, snoring, AOM/OME
snoring, muffled voice, dysphagia
candida cause
symp
rx
candida albicans, endogenous
white patches on red raw mucosa of throat/mought
nystatin suspension topically
laryngeal polyps cause
nodules
polyps
active change in laryngeal mucos a- vocal abuse smoking hypothyroid
young women bilateral middle 1/3 to posterior 1/3 on cords
unilateral and pedenculated
contact ulcer is what
cause
benign rposnse to injury
chronic throat
vocal abuse
GORD
laryngeal papillomatosis cause in who symp ix rx
HPV 6 and 11 <5 and 20-40s change in voice quality, hoarseness, SOB, chronic cough, stridor laryngoscopy and biopsy surgery
laryngomalasia symp
rx
chronic inspiratory stridor. feeding problems
will improve by 2y. surgery if severe
laryngeal cancer RF
symp
ix
rx
old, male, smoker
persisten dysphagia, dysphonia, stridor, otalgia, neck nodes, haemoptysis, hoarseness, fatigue, weight down
CXR for lung cancer, flex laryngoscopy, FNA, CT/MRI
radical radiotherapy, laryngectomy: electrolynx, oesophageal voicing, tracheooeseophageal voice prosthesis
oropharyngeal cancer symp
pre cancerous
ix
rx
persistent sore throat, lump in mouth/throat, otalgia
leukoplakia, erythroplakia, mixed
biopsy, CXR, CT abd
surgery
nasopharyngeal cancer symp rf mets ix rx
most likely to cause lump in neck, nasal obstruction, deafness. presents at a late stage
chinese, EBV, alcohol
mets-bone, liver, lungs
endoscopy/biopsy, PCR for EBV, MRI for staging
radio
sleep apnoea RF
ix
rx
DVLA
enlarged tonsils/adenoids, acromegaly, hypothyroid, obesity, oropharyngeal deformity, drugs: BZDs, opiates, alcohol
epworth scale, overnight polysomnography, 5 episodes 5 espisdes of apnoea/hypopnoea per hour of sleep
underlying cause. CPAP. mandibular enhancement. surgery. in children: remove tonsils/adenoids
tell if using CPAP
tell if dx and sleeping affecting driving
otitis externa cause
rx
infections. allergies. irritants. inflam conditions. SA. proteus. pseudomonas. fungal
topical aural toilet acetic acid 7days gentison. locrtrom swab pseudomonas - cipro fungal - clotrimazole ear canal oedema - topical steroid
vestibular nystagmus
damage to vestibulocular reflex
involuntary eye movements
AOM cause
symptoms
rx
viral with secondary bacterial infections, HI strep pneumonia, strep pyogenes
sudden pain drum perforates pain resolves. red bulging drum can be perforated
80% resolve in 4 days without ABs bilateral in under 2s or AOM with otto rhea -ABs amox (clarithro) 5 days recurrent 3 or over 6m 5 or over in 12m
chronic cause
management
cholesteatoma
non-cholesteatoma
perforation
graft it
low dose AB coruse
grommets
mastoiditis
follows what
symp
rx
follows OM
tender/erythema overlying mastoid. displacement of ear forward. red/bulging TM
ABs, mastoidecomy
OME what is it commones cause of what symp ix rx cx of grommets
presence of fluid behind an intact drum in the absence of infection
commonest cause of HL in children
poor school performance, behavioural problems, balance problems, speech delay
TM dull retracted and fluid level. CHL
nothing for 3 months
refer for over 3 months, bilateral, CHL >25, speech/lang problems
surgical intervention <3 grommets >3 grommets +/- adenectomy
hearing aids
infection/DC, early extroversion, retention, persistent perf, swimming/bathing
otosclerosis
stapediotomy
cholesteatoma is what symp primary acquired secondary acquired ix rx
3d collection of epidermal and connective tissue in middle ear
recurrent ear infection, foul smell, dc, CHL, vertigo, headache, VII palsy
CT - extent of lesion
surgery and follow up as does reoccur
congenital cholesteatoma
childhood. incidental finding on asymptotic child
pearly white mass behind intact TM
acoustic neuroma is what symp 95% what others ix rx
tumours of CNIIIths arise from schwann
progressive ipsilateral tinnitus, SNHL, impaired facial sensation, balance problems
sporadic and unilateral
bilateral and young - NF2
MRI
conservative. surgery - gamma knife
facial nerve palsy bells palsy symptoms
ramsay hunt symptoms
management
viral. red in 72h
pain and vesicles acyclovir
eye care. decompression surgery
