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Year 3 GP Block > ENT > Flashcards

ENT Flashcards

1
Q

What is the function of the Eustachian tube?

A

Connect middle ear with nasopharynx, equalise pressure, drain mucus from middle ear, aerate middle ear.

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2
Q

A child present with otitis media with effusion. It has been ongoing for 10 days now, and the child is not getting any better. Obs include a temperature of 37.9C, the child looks in pain, pulling at ear. With regard to the Eustachian tube, why is it important to resolve this infection?

A

Not resolved = can lead to speech impediment and delay in language development or school performance

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3
Q

A man presents with a 3 day onset of facial pain, nasal discharge and headache. He has a recent PMH of a URTI. What is your diagnosis?

A

Acute Sinusitis

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4
Q

A child presents with acute otitis media. What might you find on examination?

A

Using otoscope, find a bulging, red/yellow/cloudy TM, potential perforation, some discharge in ear canal

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5
Q

A 1 year old child comes in to the GP surgery to see the on call doctor. His notes mention acute otitis media 6 days ago. His temperature is 39C. He is not acting himself. On examination he has neck stiffness and a non-blanching rash on his back. What are your next steps?

A

Arrange ambulance for immediate admission to Paeds A&E. Child may have meningitis - a complication of acute otitis media.

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6
Q

A woman may have BPPV after listening to her Hx. What manoeuvres would you carry out if comfortable to do so?

A

Dix-Hallpike, Epley

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7
Q

Describe the presentation of vestibular neuritis

A

Rotational vertigo which happens spontaneously, nausea, vomiting, balance problems, tinnitus, recent URTI

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8
Q

What are the causes of acute sinusitis?

A

Post- URTI

Tooth infection

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9
Q

How does acute sinusitis present

A

Frontal headache, facial pain, worse on movement , worse on bending, nasal discharge and +/- fever

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10
Q

What is chronic sinusitis?

A

Over 3 months or greater than 3 episodes of sinusitis in a year

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11
Q

How does chronic sinusitis present?

A

Over 3 months or greater than 3 episodes of sinusitis in a year

Post nasal drip, frontal headache, facial pain, blocked nose, PMH of nasal polyps

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12
Q

How do you treat acute sinusitis?

A

Supportive- analgesia, fluids, steam inhalation, decongestants

Abx if very severe- amoxicillin

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13
Q

How does acute Otitis media present?

A

Earache, fever, in kids, children- tugging ear, restlessness, poor feeding , cough, runny nose

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14
Q

How does acute otitis media look on a otoscope?

A

Red, yellow, cloudy TM; bulging TM, possible perforated, some discharge in ear canal

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15
Q

How do you treat acute otitis media?

A

Analgesia, safety net on worsening sx, Abx only needed if no improvement in symptoms within 3 days.

Abx- 5-7 day–> amoxicillin/erythromycin

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16
Q

What is the presentation of otitis media with effusion?

A

Hearing loss, aural fullness, crackling, popping tinnitus, aural pain, dizziness.

Children- the above + mishearing, lack of conc, impaired speech, impaired school progress, hx of URTI, ear infection

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17
Q

What are the otoscope findings for otitis media with effusion?

A

TM is yellow or amber, retracted, loss of cone of light, air bubbles

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18
Q

How do you treat otitis media with effusion

A

Watch and wait for 3 months, hearing tests 3 months apart with audiometry and tympanometry.

grommets after 3 months

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19
Q

How does Otitis externa present?

A

Itchy, severe ear pain, which is worse when more ear/otoscope inserted, discharge on pillow, tenderness on moving jaw, fever,

V serious cases–> loss of hearing, tender regional lymphadenitis

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20
Q

What are the otoscope findings in Otitis externa?

A

red, swollen ear canal, shedding of scaly skin in ear, pus in ear canal, discharge, inflamed eardrum

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21
Q

How do treat otitis externa?

A

Analgesia- oral paracetamol, ibuprofen, warm flannel, topical abx, topical acetic acid 2%.

Oral abx if swollen ear canal, celluitis beyond ear canal,
Flucloxacillin for 7 days, or erythromycin
Self care - no swimming! Keep dry. Use ear drops such as EarCalm

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22
Q

What is BPPV?

A

Benign paroxsymal positional vertigo.

Vertigo brought on by moving/changing positions. Vertigo <1 min

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23
Q

What are the symptoms of BPPV?

A

Vertigo lasts less than minute
Nausea and Vomitting
Light headless

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24
Q

How do you investigate BPPV?

A

Dix- Hallpike- diagnostic

Epley- helps relieve the dizziness

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25
Q

How do you manage BPPV?

A

Repositioning to help symptoms

Advise on safety e.g. driving, workplace, falls at home

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26
Q

What is vestibular neuritis?

A

Inflammation of inner ear labyrinth.

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27
Q

How does vestibular neuritis present?

A

Rotational vertigo happens spontaneously.

Can worsen as the day goes on
Nausea and vomitting
Balance affected
Recent URTI

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28
Q

How is vestibular neuritis management?

A

Reassure, symptoms get better within few days
Bed rest
Safety issues
If symptoms of nausea and vom–> buccal prochlorperazine or oral if severe

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29
Q

What is Mernieres disease?

A 
Spontaneous vertigo
Tinitus 
Fluctuating SN hearing loss 
Aural fullness 
Balance problems 
Postural instability
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30
Q

How do you investigate Mernieres disease?

A

Refer ENT to confirm diagnosis

Refer if no improvement in 5-7 days

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31
Q

How do you treat Mernieres?

A

Admit if sx are severe
Refer to ENT, audiology

Reassure will mostly settle within 24 hrs
Prochlorperazine for nausea or antihistamine.

To prevent further attacks, trial betahistine

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32
Q

What symptoms can ear wax cause?

A 
Hearing loss 
Blocked ears 
discomfort 
earache 
itchiness
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33
Q

How do you treat earwax?

A

Soften it using sodium bicarb, olive oil–> use 3-4x daily for 3-5 days

Ear irrigation
Microsuction

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34
Q

What is presbycusis?

A

Gradual hearing loss in older people, difficulty understanding speech, tinnitus

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35
Q

What is otosclerosis?

A 
Gradual onset of hearing loss in patients between 30-50 
Bilateral usually, unilateral is rare 
Fhx of hearing loss 
Speaking softly 
Hearing better in noisy surroundings
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36
Q

What are the investigations in otosclerosis?

A

Conductive pattern in Rinne’s and Webers audiometry, CT scan

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37
Q

How do you treat otosclerosis?

A

Refer to ENT, bilateral hearing aids, surgery to remove part of stapes

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38
Q

What are the symptoms of cholesteatoma?

A 
Discharge from the ear 
Hearing loss 
Tinnitus 
If advanced: 
Otalgia
Vertigo 
facial N involvement
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39
Q

What are the otoscopic findings of cholesteatoma?

A

Deep retraction pocket TM, crust/ keratin in upper TM, TM perforation

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40
Q

How do you treat cholesteatoma?

A

referral for surgery. If infection is present, treat for OE or OM

41
Q

Presentation of tonsillitis

A

Fever
Sore throat
Pain on swallowing
tonsillar exudate

42
Q

Indicates viral tonsillitis rather than bacterial?

A

Coryzal symptoms and cough= viral

43
Q

Examination findings in tonsillitis?

A

Inflamed tonsils
White on the tonsils
Fever

44
Q

Management of tonsillitis?

A

Self limiting- conservative: analgesia, water, rest

If no change in 5 days, abx: erythromycin or penicillin for 5-10 days

45
Q

Scoring system for an acute sore throat?

A

FeverPAIN

46
Q

Complications of tonsillitis?

A

Peritonsillar abscess

Glandular fever

47
Q

Presentation of glandular fever?

A

Fever
Enlarged lymph nodes
Sore throat
general malaise

48
Q

Investigations for glandular fever?

A

Blood test for EBV

49
Q

Management of glandular fever?

A

Conservative

If cannot swallow fluids - admit to hospital

50
Q

Complication of glandular fever?

A

Splenic rupture

51
Q

Presentation of tonsillar tumour?

A

Elderly
Sore throat for >1 month
Difficulty swallowing

52
Q

Management for tonsillar tumour?

A

Refer to ENT

53
Q

Presentation of laryngitis?

A 
Sore throat 
Fever 
Pain using voice 
Hoarseness 
Hx of URTI
54
Q

Management of laryngitis?

A

Conservative- rest, fluids and analgesia, self limiting, resolves 1-2 weeks

Rarely abx if bacterial infection is suspected

55
Q

Presentation of vocal chord nodules?

A

hoarseness

repetitive use of voice e.g. singer

56
Q

Presentation of laryngeal cancer?

A 
Hoarseness 
Neck lump 
difficulty swallowing 
Pain 
45yrs and over 
hx of smoking/ alcohol excess
57
Q

Presentation of croup?

A 
young children 
barking cough 
usually at night 
difficulty breathing 
mild fever 
sometimes stridor
58
Q

Management of croup?

A

usually self limiting- give dexamethosone

May need hospital admission for O2

59
Q

Examination findings in croup?

A

Increased RR
Clear chest
No cyanosis
Normal O2 sats

60
Q

Presentation of epiglottitis?

A 
Stridor 
Sniffing position 
drooling 
v unwell 
fever 
Hx of bacterial infection
61
Q

Management of epiglottitis?

A

Straight to hospital for IV abx

62
Q

Presentation of branchial cyst in adults?

A

Painless cyst on anterior border of SCM
Smooth
Usually noticed after URTI

63
Q

Examination findings of branchial cyst?

A

Does not move on swallowing

64
Q

management of branchial cyst?

A

refer to ENT

65
Q

Presentation of thyroglossal cyst?

A

Midline cyst
Smooth
May be inflamed- tender with localised swelling

66
Q

Examination findings for thyroglossal cyst?

A

Moves with tongue protrusion

67
Q

Management of thyroglossal cyst?

A

Refer to ENT

68
Q

Presentation of epistaxis

A

Nosebleeds

hx of trauma? hx of infection

69
Q

Investigations in epistaxis?

A

If recurrent/regular FBC to check for anaemia

70
Q

Examination in epistaxis?

A

Look into nose

71
Q

Management for epistaxis?

A

Acute- hold soft part of nose and lean forward

If recurrent- cauterise or nasal packing
If bleeding from posterior part- admit to hospital

Self care advice- no blowing or picking nose, no hot drinks or alcohol and no lying flat

72
Q

Presentation of nasal polyps?

A 
Snoring 
post nasal drip 
blocked nose 
stuffy nose 
Fix of asthma
73
Q

Examination for nasal polyps?

A

Look up nose- bilateral smooth polyps

Unilateral/ irregula-?malignancy

74
Q

Management for nasal polyps?

A

Nasal spray- steroid

Abx if discharge

75
Q

Presentation of septal haematoma?

A

Pain

associated fracture/ recent nasal trauma

76
Q

Examination of septal haematoma?

A

Look into nasal passages - see bilateral soft bulging of the septum.

77
Q

management of septal haematoma?

A

Refer to ENT

78
Q

Presentation of allergic rhinitis?

A 
Itchy nose/eyes/throat 
Sneezing 
red eyes 
Nasal congestion 
bilateral 
Hx of atopy?
79
Q

Management for allergy rhinitis?

A

Self care- NHS leaflets
OTC nasal spry
Antihistamine
Sever- corticosteroids intranasally for periods of exposure

80
Q

Presentation common cold?

A 
Sore throat,
Rhinorrhoea, 
cough, 
hoarse voice, general malaise
Onset is 1-2days and rapid
Fever, headache, loss of taste/smell, pressure in ears/sinuses
81
Q

Examination of common cold?

A

Examine for viral spread to other organs
facial pain? sinusitis
chesty cough, asthma? LRTI
ear pain/dishcarge? acute otitis media

82
Q

Management of common cold?

A

Adequate fluids, rest, analgesia, anti-pyretic. Steam inhalation, gargling salt water, vapour rubs.
Follow up if symptoms worsen after 5 days or persist after 7-14days.

83
Q

Presentation fo deviated nasal septum?

A

Secondary to injury
May also present with external deformity
Unilateral nasal blockage

84
Q

Management of deviated nasal septum

A

Treat mucosal swelling as if rhinitis. Not helped? Refer to ENT for surgery

85
Q

Presentation of septal perforation?

A

Bleeding, crusting
Pain/discomfort
Recent Hx of trauma, nose picking , malignancy
Substance misuse - cocaine

86
Q

Management of septal perforation?

A

Refer if features of malignancy
Treat symptomatically - vaseline, and antiseptic nasal spray for crusting
Refer for surgery if symptomatic treatment not helping

87
Q

Presentation of snoring/sleep apnoea

A 
Sleeping in the day 
Snoring 
Witnessed brreathing pauses 
Gasping or choking when sleeping 
Unrefreshed sleep 
Unexplained morning headache
Wakes up in the night 
Nocturia 
Obese, depressed, HTN, stroke
88
Q

What examinations would you do for sleep apnoea?

A

BMI, BP
Examine for COPD signs, jaw abnormalities, nasopharyngeal obstruction,
check neck circumference

89
Q

Management for sleep apnoea

A

Referral to sleep clinic
Referral to paeds ENT if a child with adenotonsillar hypertrophy or regular snoring at night.
Manage weight, lifestyle.
NHS leaflets of sleep apnoea

90
Q

Presentation of nose fracture?

A 
Pain, swelling, redness
Crack/crunch when touch nose
Hard to breathe through nose
Shape of nose changed
Bruising under eyes, cut on nose, nosebleeds
91
Q

Management of nose fracture?

A

Advise ice pack, analgesia, treat nosebleeds, keep head upright when lying down, strong painkillers

Refer if not getting better

92
Q

Presentation of non-allergic rhinitis?

A

Blocked nose
sneezing
irritation of nose
loss of smell

93
Q

Management of non-allergic rhinitis?

A

Rinsing nasal passafe

Nasal spray with steroids

94
Q

Why are tinnitus and hearing loss NOT a feature of vestibular neuronitis?

A

As cochlea and cochlear nerve not affected

95
Q

If a pt presents with vertigo, tinnitus and hearing loss which 2 diagnosis should you consider?

A

Labrinthitis

Mernieres disease

96
Q

Compare labyrinthitis and vestibular neuronitis in terms of hearing loss

A

Labyrinthitis - hearing loss

Vestibular neuronitis - no hearing loss

97
Q

If vertigo is present as a symptom what is important to explore?

A 
If central (brain) or peripheral (inner ear) cause 
Neuro signs - central, urgent management e.g. posterior circulation infarction (stroke)
98
Q

What is typical triad of mernieres?

A

Hearing loss
Vertigo
Tinnitus

(Can get fullness in ear)

Year 3 GP Block (14 decks)

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