ENT Flashcards
Give 4 criteria for an urgent suspicion of head and neck cancer referral
- Hoarseness >6 weeks
- Ulceration/swelling of oral mucosa >3 weeks
- Dysphagia
- Neck lumps >3 weeks
Why can laryngeal cancer present with hoarseness?
Tumour prevents vocal cords moving normally
What is the most common type of head and neck cancer?
Squamous cell carcinoma
Give 3 differentials for a midline neck mass
- Thyroglossal duct cyst
- Thyroid nodules
- Diffuse goitre
Give 3 differentials for a lateral neck mass
- Malignant lymphadenopathy
- Parotid lump
- Branchial cysts
Which 2 malignancies are most commonly associated with dysphagia?
Laryngeal and Lung (tumour infiltrating recurrent laryngeal nerve)
Which 2 groups of people should you have a high index of suspicion for when presenting with otitis media with effusion?
Young South-East Asian men = nasopharyngeal carcinoma
Middle aged adults = Neck nodules
Give 3 red flags for sinonasal cancers
- Unilateral symptoms
- Blood stained discharge
- Dental/orbital signs e.g. loose teeth
Which vessels are branches of the external carotid artery?
- Sphenopalatine
- Greater palatine
- Superior labial
- Lateral nasal
Which vessels are branches of the internal carotid artery?
Anterior and posterior ethmoidal
Which 4 vessels comprise the Kiesselbach’s plexus? (GASS)
Greater Palatine
Anterior ethmoidal
Sphenopalatine
Superior labial
Give 5 causes of epistaxis
- Trauma
- Nasal septal deviation
- Inflammation
- Malignancy
- Foreign body
What are the 1st aid measures for epistaxis?
Trotter’s method: upright position and leaning forward
o Head forward over bowl
o Pinch soft part of nose
o Ice over bridge/back of neck/ in mouth for vasoconstriction
Give 3 medical management options for epistaxis
- Silver nitrate cautery
- Diathermy cautery
- Nasal packing
Give 2 secondary care interventions for epistaxis
- Suction clot
- Spray local anaesthetic
What is a septal haematoma and why does it need immediate management?
Blood collection under lining of nose which can become infection = septal perforation and nasal collapse (Saddle deformity)
Give 4 points in the management of a septal haematoma
- Anaesthetic
- Incise
- Drain
- Pack
Give 3 complications of sinusitis
- Periorbital cellulitis
- Potts Puffy tumour
- Intracranial sepsis
Define allergic rhinitis and its cause
Nasal obstruction causing sneezing and watery eyes due to IgE mediated reaction to inhaled allergens
Give 3 management options for allergic rhinitis
- Non-sedative antihistamine
- Nasal decongestant
- Allergen avoidance
What is chronic rhinosinusitis?
Inflammation of nose + sinuses with nasal obstruction or nasal discharge +/- facial pain
Give 4 red flag symptoms in chronic rhinosinusitis
- Periorbital oedema
- Double vision
- Severe headache
- Bleeding
What is a septal deformity and what surgery can be used to correct it?
Unilateral nasal obstruction treated by septoplasty
Give 3 causes of septal perforation
- Trauma
- Malignancy
- Cocaine use
Give 2 medical management options for septal perforation
Saline rinses
Emollients
Give 4 differentials for facial pain
- Migraine
- TMJ problem
- Trigeminal neuralgia
- Sinusitis (10%)
Which symptoms does a patient need to have to have sinusitis?
Nasal blockage +/- discharge
Which antibiotic should be given in tonsillitis?
Penicillin B or erythromycin
Define Ludwig’s angina
Infection of the deep neck space of a dental origin
Give 3 risks of oral cancer
Smoking
Alcohol excess
Betel
Which virus is implicated in oropharyngeal cancer?
HPV 16
Which test is used to test newborn hearing in Scotland?
Automated Brainstem Responses
How many words should a 2 year old know?
150-300 words
How many words should a 3 year old know?
900-1000 words
What should be done for all children with delayed speech?
Hearing test
Define otitis media with effusion (glue ear)
Middle ear fluid for at least 3 months in absence of overt signs of infection
Why is otitis media with effusion more common in children?
Shorter Eustachian tube means less distance for fluid to travel
Give 4 risks of otitis media with effusion
- Parental smoking
- Bottle feeding
- Nursery attendance
- Low SE status
What is the management of glue ear?
Watch and wait with 3 month follow up
Persistent: grommets and hearing aids
Define acute otitis media
Inflammation of middle ear = infected effusion and presenting most often with local symptoms e.g. URTI, otalgia
What is the management strategy for acute otitis media?
48-72hrs: watch and wait
If not resolved: 5 days amoxicillin
Define recurrent acute otitis media
3 or more episodes in 6 month
OR
4 in a year
What is the name of the congenital abnormality when the external ear fails to develop?
Microtia
What is usually the cause of chronic otitis media?
Perforation of tympanic membrane
What is a cholesteatoma?
Skin cells collecting in the middle ear and becomes infected, releasing enzymes to destroy ossicles
What is the treatment of a cholesteatoma?
Surgery to excise
Give 4 risks of tympanomastoid surgery
- Hearing loss
- Dizziness
- Taste alteration
- Facial nerve palsy
Give 3 subjective hearing tests for children and the ages at which they are performed
- Distraction testing 6-9 months
- Visual response audiometry 9-24 months
- Play audiometry >24 months
Give 3 objective hearing tests for children
- Otoacoustic emissions
- Auditory brainstem response
- Tympanometry
Give 5 signs of increased WOB in children
- Nasal flaring
- Tracheal tug
- Head bobbing
- Grunting
- Subcostal recessions
Define Choanal atresia
Congenial condition which is neonatal emergency, holes at the back of the nose closed off by bony deformity
What is the most common cause of stridor in infants?
Laryngomalacia
Define Laryngomalacia
Floppiness of the airway with a curled epiglottis = obstructed airway
What is the difference between stertor and stridor?
Stertor: above larynx
Stridor: larynx and below
Give 2 causes of midline neck lumps in children
Thyroglossal duct cysts
Thyroid mass
Give 2 causes of lateral neck lumps in children
Reactive lymph nodes
Lymphoma
