ENT Flashcards
Describe the origin of epistaxis
Originates from Kiesselbach’s plexus which is also known as little’s area
What is the management of epistaxis?
Sit up
Tilt head forward
If doesn’t stop after 15 mins:
Nasal packing
Nasal cautery
What is benign paroxysmal positional vertigo?
Most common cause of vertigo characterised by sudden onset dizziness and vertigo triggered by changes in head position.
What are the features of BPPH?
Vertigo triggered by change in head position
Nausea
Episode typically lasts 10-20s
Positive Dix-Hallpike manoeuvre (Vertigo and nystagmus)
What is the management of BPPV?
Usually resolves spontaneously after few weeks-months
Epley manoeuvre
Betahistine
What is the causative organism in epiglottitis?
Haemophilus influenza type B
What is the presentation of Epiglottitis?
Sore throat and stridor Drooling Tripod position High fever Difficulty or painful swallowing Septic and unwell appearance
What are the investigation and diagnosis for epiglottitis?
Lateral xray of neck: thumb sign or thumbprint sign
Diagnosis: direct visualisation only by senior/airway trained staff
What is the management of epiglottitis?
Intubate
IV antibiotics (cefrtriaxone)
Steroids (dexamethasone)
What is infectious mononucleosis?
Caused by EBV.
Spread by saliva
What are the features of infectious mononucleosis?
Fever Sore throat Fatigue Lymphadenopathy Tonsillar enlargement Splenomegaly
Rash following antibiotics (amoxicillin or cefalosporins)
What are the investigations for infectious mononucleosis?
Monospot test
Paul-Bunnell test
Specific antibody test
What is the management of infectious mononucleosis?
Usually self limiting - lasting 2-3 wks
What is the complications of infectious mononucleosis?
Burkitt’s lymphoma is associated with EBV
What is labyrinthitis?
Inflammatory disorder of the membranous labyrinth affecting both vestibular and cochlear end organs
What is the presentation of labyrinthitis?
Vertigo N+V Hearing loss Tinnitus Preceding or concurrent sy of URTI
What are the signs of labyrinthitis?
Spontaneous horizontal nystagmus
Sensorinueral hearing loss
Abnormal head impulse test
Gait disturbance
What is the diagnosis and management of labyrinthitis?
Largely based on history and examination
Management:
Usually self-limiting
Prochlorperazine or antihistamines
What is meniere’s disease?
Disorder of the inner ear characterised by excessive pressure and progressive dilation of the endolymphatic system.
What are the features of meniere’s disease?
Recurrent vertigo, tinnitus and hearing loss
Sensation of aural fullness or pressure
Nystagmus and positive romberg test
Episodes last min-hours
Typically unilateral but can become bilateral
What is the diagnosis and management of meniere’s disease?
ENT assessment required to confirm diagnosis
Patient informs DVLA and stop driving until control of symptoms
Acute: buccal or IM prochlorperazine
Prevention: Betahistine and vestibular rehab exercises.
What is otosclerosis and give the inheritance?
Replacement of normal bone by vascular spongy bone.
Autosomal dominant and affects young adults
What is the features of otosclerosis?
Conductive deafness
Tinnitus
normal TM
Positive family history
What is the management of otosclerosis?
Hearing air
Stapedectomy
What is the causative organism of otitis media/
Strep Pneumonia is most common cause
Other causes:
Haemophilus influenzae
Moraxella catarrhalis
Staph aureus
What is the presentation of otitis media?
Ear pain Reduced hearing URTI syndroms Balance issues Vertigo Discharge
What is the examination of otitis media
Otoscopy shows bulging red inflamed looking membrane.
If perforated: discharge and hole in TM
What is the management of otitis media?
Resolve without antibiotics unless:
Immunocomprimised, <2yr or otorrhoea = amoxicillin
Simple analgesics
Antibiotics and review if perforated TM
What are the features of otitis externa?
Ear pain
Itch
Discharge
Otoscopy: red, swollen or eczematous canal
What is the management of otitis externa?
- Topical antibiotic or combined topical antibiotic with a steroid
- Consider contact dermatitis secondary to neomycin
Oral antibiotics
Taking a swab
Empirical use of antifungal agent
What is sinusitis
Can be bacterial or viral. Usually lasts 2-3 weeks and resolves without treatment
What is the management of sinusitis?
Symptoms <10days = no abs
No improvement after 10 days = 2 weeks high dose steroid nasal spray
No improvement after 10 days and likely bacterial cause = consider delayed or immediate prescription abs
1. Penicillin V for 5 days course Alternatives: Clarithromycin Erythromycin Doxycycline
What is tonsillitis and give the causative agents
Inflammation of the tonsils
Most common cause = viral infection
Most common bacteria = Group A strep (strep pyogenes)
Second more common bacteria = Strep pneumonia
What are the features of tonsillitis?
Sore throat
Painful swallowing
Red, inflamed and enlarged tonsils ± Exudates
What is the centor criteria?
Used to estimate probability that tonsillitis is due to bacteria
3 or more = abs
Fever >38
Tonsillar exudates
Absence of cough
Tender cervical lymphadenopathy
What is the management of tonsillitis?
Only if centor score >3 or feverpain score >4 give abs
Pen V for 10 days
Clarithromycin if allergic to penicillin
Investigation for achalasia?
Oesophageal manometry study
Treatment for achalasia?
Pneumatic dilation
What is the surgical treatment for achalasia?
Heller cardiomyotomy
