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ENT Flashcards

1
Q

What is the most common cause of tonsillitis?

A

Viral infection

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2
Q

What is the most common cause of bacterial tonsillitis?

A

Group A streptococcus (strep pyogenes)

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3
Q

How can bacterial tonsillitis be treated?

A

Penicillin V

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4
Q

What is the most common cause of otitis media, rhinosinusitis and alternative bacterial cause of tonsillitis?

A

Streptococcus pneumoniae

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5
Q

What are some other common causes of tonsillitis?

A

Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus

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6
Q

What is the throat made up of?

A

Oral cavity (teeth + tongue)
Pharynx
Tonsils
Larynx

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7
Q

What is the key anatomical difference in throat anatomy in childs compared to adults?

A

Narrowest point in children is the subglottis compared to the glottis in adults

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8
Q

What are the six areas of lympoid tissue in the throat?

A

Adenoid
Tubal tonsils
Palatine tonsils
Lingual tonsil

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9
Q

What tonsils are most commonly enlarged and infected in tonsillitis?

A

Palatine tonsials (at either side at back of throat)

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10
Q

What is Waldeyer’s tonsillar ring?

A

The ring of lymphoid tissue in the pharynx

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11
Q

What age range is most affected by tonsillitis?

A

5-10

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12
Q

How does tonsillitis usually present?

A

Fever
Sore throat
Painful swallowing

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13
Q

How may tonsillitis present in younger children?

A 
Fever
Poor oral intake
Headache
Vomiting
Abdominal pain
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14
Q

What are exudates?

A

Small white patches of pus on the tonsil

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15
Q

What should you also assess when examining a child with tonsillitis/

A

The ears to visualise the tympanic membranes

Palpate for any cervical lymphadenopathy

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16
Q

What is the Centor criteria used to estimate?

A

The probability that tonsillitis is due to baacterial infection and will benefit from antibiotics

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17
Q

What are the features included in the centor criteria and how many ponts would qualify to offer antibiotics?

A

Fever >38
Tonsillar exudates
Absence of cough
Lymphadenopathy

(3 or more)

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18
Q

What are the FeverPAIN criteria when considering antibiotics in tonsillitis?

A 
Fever
Purulence
Attended within 3 days of onset of symptoms
Inflamed tonsils
No cough or coryza
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19
Q

What should be excluded when diagnosing tonsillitis?

A

Meningitis
Epiglottitis
Peritonsillar abscess
Calculate centor/ feverPAIN score

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20
Q

How is viral tonsillitis managed?

A

Give safety net advice (if not settled after 3 days or fever above 38.3)
Advise simple analgesia with paracetamol and ibuprofen

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21
Q

How is bacterial tonsillitis managed?

A

Penicillin V 10- day course
Clarithromycin= second choice
(can give delayed prescription if needed)

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22
Q

What are the complications of tonsillitis?

A 
Chronic tonsillitis
Peritonsillar abscess 
Otitis media
Scarlet fever
Rheumatic fever
Post-strep glomerulonephritis
Post-strep reactive arthritis
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23
Q

What is a quinsy?

A

Peritonsillar abscess

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24
Q

What causes a quinsy?

A

When there is a bacterial infection with trapped pus that forms an abscess on the tonsils

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25
Q

When does a quinsy commonly occur?

A

In untreated or partially treated tonsillitis

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26
Q

Are tonsillitis and quincies more common in children or adults?

A

Tonsillitis much more common in children

Quinsy just as common in children as adults

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27
Q

How does quinsy present?

A 
Similar to tonsilitis
May also have: 
Trismus
Change in voice (hot potato voice) 
Swelling/ erythema in area besides tonsils
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28
Q

What is trismus?

A

When a patient is unable to open their mouth

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29
Q

What is the most common cause of a quinsy?

A

Strep. pygones (group A)

Staph aureus
Haemophilus influenxae

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30
Q

How is a quinsy managed?

A

Incision and drainage of abscess under general anaesthetic

Broad spectrum antibiotics

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31
Q

What are the criteria for tonsillectomy?

A

7 or more episodes of tonsillitis in 1 year
5 per year for 2 years
3 per year for 3 years
Recurrent tonsilar abscesses
Tonsils causing difficulty breathing, swallowing or snoring

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32
Q

What are the complications of a tonsillectomy?

A 
Pain/ sore throat for up to 2 weeks after
Damage to teeth
Infection
Post-tonsillectomy bleeding
Risks of GA
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33
Q

What is the most significant complication of tonsillectomy?

A

Post tonsillectomy bleeding which can happen up to 2 weeks after operation

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34
Q

How is post-tonsillectomy bleeding managed?

A 
Called ENT registrar
IV access 
Keep calm
Analgesia
Sit them up and get the to spit instead of swallow blood 
IV fluids 
May need intubation
Theatre
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35
Q

What makes up the external ear?

A

Auricle (/pinna)

External acoustic meatus

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36
Q

What is the auricle made of and what is the exception?

A

Cartilage

Lobule is not supported by cartilage

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37
Q

What are the different components of the auricle?

A 
Helix
Antihelix
Superior and inferior crus
Tragus
Antitragus
Concha
Lobule
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38
Q

What is the action of the concha?

A

Directs sound into the external acoustic meatus

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39
Q

Where does the external acoustic meatus begin and end?

A

Extends from the deep part of the concha to the tympanic membrane

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40
Q

What are the walls of the external acoustic meatus composed of?

A

External 1/3= cartilage

Internal 2/3= temporal bone

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41
Q

What is the tympanic membrane made of?

A

Connective tissue structure covered with skin on outside and mucous membrane on inside

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42
Q

What are the margins of the middle ear?

A

Tympanic membrane to lateral wall of inner ear

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43
Q

What are the two parts of the middle ear?

A

Tympanic membrane

Epitympanic recess

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44
Q

What is the tympanic membrane and what does it contain?

A

The space behind the tympanic membrane containing the auditory ossicles

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45
Q

What are the auditory ossicles?

A

The three small bones

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46
Q

What is the epitympanic recess?

A

The space above the tympanic cavity

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47
Q

What are the bones of the middle ear?

A

Malleus
Incus
Stapes

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48
Q

What is the action of the auditory ossicles?

A

Transfer sound vibrations from the tympanic membrane to the oval window of the internal ear

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49
Q

What is the eustachian tube?

A

The cartilaginous and bony tube that connects the middle ear to the nasopharynx

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50
Q

Where is the inner ear located?

A

In the temporal bone

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51
Q

What does the innerear contain?

A

The vestibulocochlear organs

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52
Q

What are the two main functions of the inner ear?

A

Convert mechanical signals into electrical signals

Maintain balance

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53
Q

How does the inner ear maintain balance?

A

Detects position and motion

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54
Q

What are the margins of the inner ear?

A

Middle ear to internal acoustic meatus

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55
Q

What are the two main components of the inner ear?

A

Bony labyrinth

Membranous labyrinth

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56
Q

What is the bony labyrinth?

A

Series of bony cavities within the petrous temporal bone

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57
Q

What is the bony labyrinth composed of?

A

Cochlea, vestibule and three semi-circular canals

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58
Q

Where is the membranous labyrinth and what is it composed of?

A

Lies within bony labyrinth and consists of cochlear duct, semi-circular ducts, urticle and saccule
Filled with fluid (endolymph)

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59
Q

What are the two openings in the inner ear?

A

Oval window

Round window

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60
Q

Which part of the inner ear is responsible for converting sound vibrations into electrical signals?

A

Cochlea

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61
Q

Which part of the inner ear is responsible to balance?

A

Saccule and urticle

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62
Q

What is otitis media?

A

Infection of the middle ear

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63
Q

Where is the most common site of ear infection in children?

A

Middle ear

64
Q

How does the middle ear get infected?

A

Bacteria enter the ear from the back of the throat via the eustachian tube

65
Q

What is bacterial infection of the ear often preceded by?

A

Viral upper respiratory tract infection

66
Q

What are the most common bacterial causes of otitis media?

A

Strep pneumonia*
Haem. influenzae
Moraxella catarrhalis
Staph aureus

67
Q

How does otitis media typically present?

A

Ear pain
Reduced hearing
Upper airway infection symptoms

68
Q

What symptoms may occur if the infection affects the vestibular system?

A

Balance issues

Vertigo

69
Q

When would you get discharge from the ear?

A

IF the tympanic membrane is perforated

70
Q

How may otitis media present in young children and infants?

A 
Non-specific 
Fever
Vomiting
Irritability
Lethargy
Poor feeding
71
Q

How should you examine a child with suspected otitis media?

A

Examine both ears and throat

Use otoscope to visualise tympanic membrane

72
Q

What should the tympanic membrane look like in a healthy child?

A

‘pearly-grey’, translucent and shiny

73
Q

How should otitis media be managed?

A

Simple analgesia

Most cases resolve within 3 days without antibiotics

74
Q

What are the three options regarding prescribing antibiotics to patients with otitis media?

A
  1. Immediate if severe, immunocompromised or multiple co-morbidities
  2. Delayed prescription for if it doesn’t clear
  3. No antibiotics
75
Q

What is the first line choice of antibiotic with otitis media?

A

Amoxicillin for 5 days

76
Q

What are the complications of otitis media?

A 
Glue ear
Hearing loss
Perforated eardrum
Recurrent infection
Mastoiditis
Abscess
77
Q

What is glue ear?

A

Otitis media with effusion

78
Q

What happens in glue ear?

A

The middle ear becomes full of fluid, causing a loss of hearing in that ear

79
Q

What causes glue ear?

A

When the eustachian tube becomes blocked, middle ear secretions build up in the middle ear space

80
Q

What is the main symptom of glue ear?

A

Reduction of hearing in that ear

81
Q

What is the main complication of glue ear?

A

Infection (Otitis media)

82
Q

What will otoscopy show with glue ear?

A

Dull tympanic membrane with air bubble or visible fluid level
(may look normal)

83
Q

How is glue ear diagnosis confirmed?

A

Refer for audiometry to establish extent of hearing loss

84
Q

How is glue ear treated?

A

Conservatively

85
Q

How long does it usually take glue ear to clear up?

A

3 months

86
Q

How may children with co-morbidities affecting the ear be treated for glue ear?

A

Grommets

87
Q

What are grommets?

A

Tiny tubes inserted into the tympanic membrane, which allow fluid from the middle ear to drain through the tympanic membrane to the ear canal

88
Q

How long do grommets last?

A

Around a year

89
Q

What are the 3 categories of causes of hearing loss?

A

Congenital
Perinatal
Acquired

90
Q

What are the most common congenital causes of hearing loss?

A

Maternal infection
Genetic
Syndromes (e.g. Down’s)

91
Q

What are the most common perinatal causes of hearing loss?

A

Prematurity

Hypoxia during/ after birth

92
Q

What are the most common causes of acquired hearing loss?

A

Jaundice
Meningitis/ encephalitis
Otitis media/ glue ear
Chemotherapy

93
Q

How is congenital hearing problems usually picked up?

A

Newborn hearing screening programme

94
Q

How may hearing problems present?

A

At screening

Parental concerns about hearing or behavioural changes (poor speech and language, school behaviour, ignoring)

95
Q

How are young children tested for hearing problems?

A

Special equipment used to deliver sound to each eardrum individually and check for basic response

96
Q

How are older children tested for hearing problems?

A

Using headphones and specific tones and volumes

97
Q

What are the results of audiometry recorded on?

A

An audiogram

98
Q

What are audiograms?

A

Charts that document the volume at which patients can hear different tones

99
Q

What is on the x axis of an audiogram?

A

Frequency (in hertz) from low to high pitched

100
Q

What is on the y-axis of an audiogram?

A

Volume (in decibels) from loud to quiet

101
Q

What two things are tested separately when assessing hearing?

A

Bone and air conduction

102
Q

What should readings be between if a patient has normal hearing?

A

0-20dB

103
Q

What is sensorineural hearing loss?

A

When the route cause is due to the inner ear (cochlea or nerve)

104
Q

What will be found in audiography or sensorineural hearing loss?

A

Both bone and air conduction readings will be >20dB

105
Q

What is conductive hearing loss?

A

When there is a problem transferring sound waves somewhere along the pathway

106
Q

What will be found on audiography of conductive hearing loss?

A

Normal bone conduction readings (0-20) but air conduction readings >20dB

107
Q

What will be found on audiography of mixed hearing loss?

A

Both air and bone conduction readings >20dB, but with a difference of >15 between the two

108
Q

How is hearing loss managed?

A 
MDT: 
SALT
Educational psychology
ENT specialist
Hearing aids
Sign language
109
Q

What are nosebleeds also known as?

A

Epistaxis

110
Q

Where do nosebleeds originate from?

A

Kiesselbach’s plexus (Little’s area)

111
Q

What is Kiesselbach’s plexus?

A

Area of the nasal mucosa at the front of the nasal cavity that contains a lot of blood vessels

112
Q

What may trigger nosebleeds?

A 
Nose picking
Colds
Vigorous blowing
Trauma 
Changes in weather
113
Q

Are nosebleeds usually uni or bilateral?

A

Unilateral

114
Q

How should you advise patients with nosebleeds to position themselves?

A

Sit up and tilt head forewards to avoid blocking airway
Squeeze soft part of nostrils for 15 minutes
Spit any blood

115
Q

What should be done if epistaxis does not stop after 10-15 minutes?

A

Nasal packing with nasal tampons/ inflatable packs

Nasal cautery using a silver nitrate stick

116
Q

What kind of condition is cleft lip?

A

Congenital

117
Q

What is cleft palate?

A

When there is a defect in the hard or soft palate leaving an opening between the mouth and nasal cavity

118
Q

Do cleft lip and palate always occur together?

A

No, they can occur on their own

119
Q

What are the complications of cleft lip/ palate?

A

Problems feeding & swallowing
Speech issues
Psycho-social implications

120
Q

How is cleft lip/ palate managed?

A

Local cleft lip services MDT:

Specialist nurses, surgeons, dentists, SALT, psychologitsts

121
Q

What is the first priority in treated cleft lip/ palate?

A

Ensure baby can eat/ drink

122
Q

What is the definitive treatment of cleft lip/ palate?

A

Surgically correct

123
Q

At what age is cleft lip surgery usually performed?

A

3 months

124
Q

At what age is cleft palate surgery usually performed?

A

6-12 months

125
Q

What is ankyloglossia?

A

Tongue tie

126
Q

What is tongue tie?

A

When a baby is born with a short and tight lingual frenulum

127
Q

What is the lingual frenulum?

A

The attachment of the tongue to the floor of the mouth

128
Q

What are the complications of tongue tie?

A

Difficulties extending tongue and latching onto breast

129
Q

How does tongue tie usually present?

A

Poor feeding

Newborn check

130
Q

How is tongue tie managed?

A

Mild= monitored

If affects feeding= frenotomy

131
Q

What is a cystic hygroma?

A

Malformation of the lymphatic system, resulting in a cyst filled with lymphatic fluid

132
Q

Where is a cystic hygroma usually located?

A

Posterior triangle on left side of neck

133
Q

What is the cause of cystic hygroma?

A

Congenital abnormality

134
Q

When is cystic hygroma usually picked up?

A

Antenatal scans
Routine baby checks
Incidental finding

135
Q

What are the key features of cystic hygromas?

A

Large, soft, non-tender, transilluminate lump in neck or armpit

136
Q

What are the complications of cystic hygroma?

A

Can interfere with feeding, swallowing or breathing
Can become infected
Can be haemorrhage into cyst

137
Q

What are the different management options for cystic hygromas?

A

Watch and wait
Aspiration
Surgical removal
Sclerotherapy

138
Q

Where does the thyroid gland begin a the start of fetal development?

A

At the base of the tongue

139
Q

How does the thyroid gland get to its final position?

A

It descends

140
Q

What is the thyroglossal duct?

A

The track left behind as the thyroid gland descends down the neck

141
Q

What is a thyroglossal cyst?

A

When a part of the thyroglossal duct persists and gives rise to a fluid filled cyst

142
Q

What is a key differential diagnosis of a thyroglossal cyst?

A

Ectopic thyroid tissue

143
Q

What is the main complication of thyroglossal cyst?

A

Infection

144
Q

What are the features of thyroglossal cysts?

A 
Mobile
Non-tender
Soft 
Fluctuant 
On midline of neck
*Move up and down with movement of tongue
145
Q

How are thyroglossal cysts diagnosed?

A

USS

CT scan

146
Q

How are Thyroglossal cysts treated?

A

Surgically removed

147
Q

What is a branchial cyst?

A

Congenital abnormality arising when second branchial cleft fails to form properly

148
Q

How do branchial cysts form?

A

When the second branchial cleft fails to develop, it leaves a space surrounded by epithelial tissue which can fill with fluid

149
Q

Where are branchial cysts found?

A

Between angle of jaw and sternocleidomastoid muscle in anterior triangle of neck

150
Q

What are the features of branchial cysts?

A

Round
Soft
Non-tender
Anterior to sternocleidoastoid

151
Q

After what age to branchial cysts usually present?

A

10

152
Q

What is a sinus?

A

A blind ending pouch

153
Q

What is a fistula?

A

Abnormal connection between two epithelial surfaces

154
Q

What is a branchial cleft sinus?

A

When the branchial cyst is connected via a tract to the outer skin surface

155
Q

What is a branchial pouch sinus?

A

When the branchial cyst is connected via a tract to the oropharynx

156
Q

What is a branchial fistula?

A

When there is a tract connecting the oropharynx to the outer skin surface via the branchial cyst

157
Q

How are branchial cysts managed?

A

Conservative

If causing issues, surgical excision

Paeds (18 decks)

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