ENT Flashcards
Describe the fever pain score
Fever in past 24 hours
Puss on tonsils
Attends within 72 hours
Severely inflamed tonsils
No cough or coryza
Describe the centor criteria for diagnosing acute tonsilitis
Can’t cough
Exudates
Nodes
Temperature
OR: Young (other)
Management of acute tonsilitis
First line: aracetamol
When are antibiotics indicated in Acute Tonsilitis
If three or more centor criterions are present
If fever pain score is 2 or more
Specific sign of peritonsilar abscesses
Trismus
Ulnar deviation
Dysphagia
Torticolis
What often preceeds acute otitis media
A viral URTI
Features of acute otitis media
Pain
Hearing Loss
Aural fullness before going away as the tympanic membrane perforates
What is Chronic Otitis Media
Dry tympanic membrane without a fever etc (no signs of infection
Signs of Glue Ear (otitis media with effusion) on examination
Dull tympanic membrane
Pain persists for a few weeks since onset (whereas the other perforates)
Management of otitis media in children under 3 months
If 38 degrees or more = refer to hospital
When are antibiotics indicated for acute otitis media
After 4 days
When should the four day rule be scrapped in children with otitis media
If they’re systemically unwell (but not enough for admission)
Complications of otitis media
Mastoiditis
Labrynthitis
Facial nerve palsy (CN 7)
Indications for an adenoidectomy
Persistent otitis media
Obstructive sleep apnoea or snoring
Tonsillelctomy alongside
CHornic sinusitis or adenoiditis
Dysphagia with failure to thrive
If someone who has had an adenoidectomy presents with persistent bleeding, what should be done
Post-nasal pack insertion and taken back to theatres again
Describe the onset of acute rhinosinusitis
Sudden onset for less than 12 weeks
What is the criteria to diagnose acute rhinosinusitis
1 nasal blockage or discharge + 1 of facial pain/reduction in sense of smell
Management of acute rhinosinusitis if symptoms are <5 days
Paracetamol, decongestants and irrigation with saline
Management of symptoms in rhinosinusitis lasting >10 days or worsening
Topical steroids or antibiotics
When should someone with rhinosinusitis be referred to ENT
If tehre are red flag signs (displaced globe, double vision or periorbital oedema
What causes BPPV
Calcium deposits in the semicircular canals
What brings on BPPV symptoms
Turning head to one side, turning in bed or looking upwards
How long do BPPV attacks last for
1 minute
Are there auditory symptoms in BPPV
No
Do BPPV symptoms recur
Yes
Diagnosis of BPPV
Dix-Hallpike manoeuvre
Treatment of BPPV
Epley Manouevre
What is a branchial cyst and where does it manifest
Manifests as a painful cyst ANTERIOR to sternocleidomastoid muscle just below the ear
What is a cholesteatoma
accumulation of skin debris iwthin th emiddle ear
What is cholesteatoma a complication of
Chronic otitis media
Features of Cholesteatoma
Foul smelling discharge, headache and otalgia
Examination findings in cholesteatoma
Areas of white in the attack behind the tympanic membrane
COmplication of cholesteatoma
Facial nerve palsy
What preceeds chornic sinusitis
Acute URTI
Signs of acute sinusitis
Unilateral, intense apin
Unilateral nasal discharge
Pain worse on sitting forwards
SIgns of chronic sinusitis
Painless but discharge full
Differentials for Sinusitis
TMJ
Migraines
Temporal arteritis
Herpes Zoster virus
COmplications of thyroid surgery
Hypoparathyroidismn
Hypothyroidism
Recurrent or superior laryngeal nerve destruction
Neck Haematoma
Thyrotoxic Storm
What is conductive hearing loss
Obstruction of sound waves between the outer ear and the stapes in the middle ear (path of osund movement
auses of conductive hearing loss
Wax
Otitis media with effusion
Eustachian tube dysfunction
Ear Infections
Perforations
Chornic Otitis Media
Examination findings in conductive hearing loss
Bone conduction greater than air conduction
First line management of epixstasis
Direct compression of nasal alae and sit forwards - spit out blood.
If direct compression does not work to fix epixstasis, what should be done
Cautery
If nasal cautery doesn’t work to fix epixstasis, what should be done
Nasal packing
What aggressive therapies may be used for persistent nasal bleeds
Nasal Balloon Catheter
What condition is a big risk factor for malignant otitis externa
DM
WHat species usually causes malignant otitis externa
Pseudomonas Aeruginosa
If pain is worsening in otitis externa, what should be doen
Refer to ENT
Is hering affected in Vestibular Neuritis
No
SIgns of Meniere’s disease
Hering loss, tinnitus and sensation of fullness or pressure in one or both ears
Signs of an acoustic neuroma
Absent corneal reflexes
What condtiions is an acoustic neuroma associated with
Neurofibromatsosis Type 2
First line treatment of otitis externa
Topical antibiotic + topical steroid for 1-2 weeks
What finding is Dix-Hallpike manoeuvre supposed to sus out
Rotary Nystagmus
What is Sialadenitis
Inflammatorion of slaivary gland secondary to obstructed stones in the duct
What medication is most useful to prevent taccks of meniere’s disease
Betahistine
What surgery is commonly used to improve airflow thorugh the nasal passage
INferior Turbinectomy
What is Empty Nose SYndrome
Complication of a turbinectomy - secondary atrophic rhinitis (nasal obstruction, sob and dryness)
Management of button batteries being put up the nose
Emergency removal (surgical)
WHy do button batteries need to be removed form the nasal passage immediately
The negative pole and cause tissue necrosis through electolysis
Main type of cancer of the head and neck
SCC
RIsk factors for head and neck neoplasms
Smoking
Alcohol
EBV
HPV 16
UV exposure
Immunosuppression
Asbestosis
Signs of Head and Neck neoplasms
Hoarseness
Throat Pain
Tongue Ulcers
Painless neck lumps
When should someone with a neck lump be referred to ENT
If the neck lump / symptoms persist for more than 3 months
Management of hereditary haemorrhagic telangiectasia
BLood transfusion and iron supplements
When should a patient presenting with hoarsness be referred to ENT 2 week rule
> 3 weeks symptom durations
When is chronic laryngitis from GORD most commonly experienced
Morning
What is Reinke’s Oedema
Enlargement of the vocal cords (hypothyoridism oassociated)
Signs of Reinke’s Oedema
Persistent Hoarsness
What is Meniere’s Disease
Dilation of endolymphatic spaces
How long does vertigo last in Meniere’s disease
12-24 hours
Onset of Meniere’s Disease
30-60
Is Meniere’s disease unilateral or bilateral
Unilateral
Describe the pattern of onset of meniere’s disease
Comes in clusters with periods of remission where function recovers
Management of Meniere’s Disease
Betahistine
Role of betahistine
Reduces frequency of attacks
What branch of the facial nerve supplies taste to the anterior tnoguse
Chorda Tympani nerve
Investigations for bleeding noses (specifically after trauma)
Anterior rhinoscopy
If there has been nasal trauma, what is the first line management
Refer all patients suspected of septal haematoma to ENT for emergency incision and drainage
What is the most commmon cause of otitis externa
Staph aureus
Pseudomonas
Management of mild to moderate otitis externa
Topical antibiotic and steroid drops
Keep ear dry for 7-10 days
Management of severe otitis media
Topical Gentamycin
What indictaes severe otitis media
When the meatus is completely occluded or has significant swelling
When should oral antibiotics be considered for otitis externa
WHen infection spreads beyond external ear canal or a wick cannot be inserted for topical antibiotics
People with diabetes or immunocompromised
Signs of otosclerosis
Progressive deafness in young adults (not acute)
What causes otosclerosis
Bone at the base of the stapes thickens and fuses with the choclea
Stops stapes from banging into the chochloea - conductive hearingl oss
Initial management of otosclerosis
Hearing aids
Last lie management of otosclerosis
Stapedectomy
Management of a pinna haematoma
Decompression of the haematoma within 24 horus
Most common cause of pinna haematomas
Rugby tackles
Name two glands affected in sialdenitis
Sub-mandibular glands
Parotid glands
What examination sign points to a thyroglossal cyst
It will move up when the tongue is pushed out
What is Presbycusis
Age-related conductive hearing los (loss of higher frequency noise)
Labrynthitis vs vetsibular neuritis
Labrynthitis has hearing loss whereas vestibular neuritis does not
How is Ramsay hunt syndrome treated
Aciclovir and high dose prednisolone
Name two medications that can cause ototoxicity
Gentamycin
Vacomycin
First line investigation and GOLD standard for presbycusis
Audiometry
Medical managmenet of nasal polyps
Intransala topical steroid drops
What can cause glossitis
Iron deficiency anaemia
B12 deiciency
Folate deficiency
Coeliac’s
Treatment of oral candidiasis
Miconazoel gel
How long does it take for a perforate ear drum to resolve
6 weeks
What is the most common cause of sudden onsett sensineural hearing loss
Idiopathic
First line management from chronic rhino sinusitis (>12 weeks)
Nasal irrigation with saline
How is a haemorrhage 5-10 days after a tonsillectomy treated differently to one that happens hours after
More likely to be wound infection as a cause rather than a primary haemorrhage cause
Where are cystic hygromas commonly found
In babies on the left side of the neck
Where is a branchial cyst located
Sternocleidomastoid and the pharynx
What is the role of the weber’s test
To check for sensorineural hearing loss
What is the role of Rhinne’s test
To check for conductive hearing loss
In sensorineural hearing loss, what is a positive weber’s test
If the sound localises to the unaffected side
In conductive deafness, what is a positive Weber’s test
Sound localises to the affected side
Medical treatment of vestibular neuronitis
Prochlorperazine (antiemetic)
How long should prochlorperazine be given for vestibular neuronitis
3 days maximum
What is the threshold at which an audiometry reading is normal
20db
Management of post operative stridor
urgent removal of sutures and call for help - EMERGENCY
What drugs cause gingival hyperplasia
Phenytoin
Ciclosporins
CCBs
In what gland are Whartons ducts found
Submandibular gland
What type of nystagmus is seen with Vetsibular Neuritis
Horiztonal
Management of Vestibular Neritis
Oral Prochlorperazine
Risk Factors of nasopharyngeal carcniomas
Southern Chinese people
EBV
CLinical features of nasopharyngeal carcniomas
Otalgia
Cervical Lymphadenopathy
Unilateral otitis media
Epizstasis
First line management of a nasopharyngeal carcniomas
Radiotherapy
What findings are consistent with presbycusis on audiometry
Bilateral high-frequency hearing loss
Air conduction better than bon e
AGe onset of cholesteatoma
30+
Signs of otitis media in children
Touching and pulling at her ear
Criteria for referring mouth ulcers to oral surgery
Ulcer persisting for over 3 weeks
Unexplained
Bleeding at site
Associated neck lump
Pain in neck >4 weeks
Signs of oral cavities >6 weeks
> 40
Management of septal haematoma
Admission to hospital: Surgical incision and drianage + antibiotics
Is aural fullness experienced in Meniere’s disease?
Yes
Indications for 1-yearly outpatient surveillance
When the patient refuses active treatment for malignant ear tumours
Management of sensirneural hearing loss
High dose prednisolone
Where is the origin of Kiesselbach’s plexus
Anterior Nasal Septum
HOw many arteries suppply Kiesselbach’s plexus
4 arteries
Management of glue ear in adults
Refer to ENT under 2 weeks rule
Glue ear not common in adults -> possibly nasopharyngeal carcnioma
What drug causes nasal polyps
Aspirin
When, with someone who has nasal polyps, should they be referred to ENT as first line
If polyps are unilateral
Where are pleomorphic adenomas commonly found
IN the tail of the parotid glands
Warthins tumour vs pleomorphic adenomas
Warthin tumours affect males vs females
Warthin tumours is multiple tumour nodules vs one large mass
What medications can cause tinnitus
NSAIDs and Aspirin
