ENT 👀 Flashcards
signs of hereditary hemorrhagic telangiectasia
nose bleeds
and red freckles on lips, face, fingertips, tongue and inside surfaces of the mouth.
what is a Quinsy (peritonsillar abscess)
a complication that develops from untreated acute tonsillitis
on clinical examination of a patient with a peritonsillar abscess what would you see
uni-tonsillar bulge and uvula deviation.
sore throat
headache
pyrexia
lymphadenopathy
tonsilitis
do you order blood tests when investigating tonsillitis
only if they are immunodeficient
what is the Centor criteria for acute tonsillitis
history of fever
no cough
tonsillitis exudates
tender anterior cervical lymphadenopathy
how many centor criteria needs to be fulfilled and other criteria to be able to prescribe antibiotics for tonsillitis
3 or more centor criteria
other features include:
marked systemic upset
immunodeficiency
history of rheumatic fever
what is the most complication of tonsillitis
recurrent tonsiliitis
how does peritonsillar abscess present
presents with difficulty swallowing, sore throat, muffled voice and trismus
what is the first line antibiotic for bacterial tonsillitis
phenoxymethylpenicillin
describe acute otitis media
inflammation of the middle ear with effusion
occurs primarily in children
often associated with URTI
sx of acute otitis media
Neonates
Irritability
Difficulty feeding
Fever
Young children
Holding or tugging ear
Irritability
Fever
Older children and adults
Otalgia (ear pain)
Hearing loss
Fever
features of chronic otitis media - glue ear
persistent pain lasting weeks
drum looks abnormal and reduced mobility of membrane
features of chronic suppurative otitis media
perforation of the tympanic membrane with otorrhoea for > 6 weeks
when do you admit patients for otitis media
any children under 3 months with temp over 38
children with suspected acute complications
children who are very systemically unwell
mx of otitis media when admission or antibiotics are not needed
paracetamol or ibuprofen
when do you offer antibiotics for otitis media and what course do you offer
children who are systemically unwell but don’t require admission or those at high risk of complications
5-7 day course of amoxicillin
extra-cranial complications of otitis media
facial nerve paralysis
mastoiditis - most common
intra-cranial complications of otitis media
meningitis
sigmoid sinus thrombosis
intracranial brain abscess
how would mastoiditis present
as a boggy mass over the mastoid process tender to palpation
systemically unwell
intense ear pain
sx of labyrinthitis
vertigo
nausea
vomiting
imbalance
how does meningitis present
sepsis
headache
vomiting
photophobia
phonophobia
how does sigmoid sinus thrombosis present
sepsis
swinging pyrexia
meningitis
how would a brain abscess present
sepsis and neurological signs
characteristic features with allergic rhinitis
nasal pruritus, sneezing, rhinorrhoea and nasal congestion
what is allergic rhinitis often associated with
allergic conjunctivitis
what is allergic rhinitis
where your nose gets irritated by something you’re allergic to
what type of hypersensitivity reaction is allergic rhinitis
type 1
it is an IgE mediated response to allergens
mx of allergic rhinitis
initial measures
avoiding triggers
nasal irrigation with saline
intra-nasal or oral anti-histamines
mx of allergic rhinitis if initial measures are ineffective
intra-nasal steroids
oral steroid for sever and/or short term cases
why is BPPV predominately seen in elderly population
due to deposition of calcium deposits within the semicircular canals
clinical features of BPPV
provoked by movements of head usually to one side when turning in bed or looking up
episodes last 30 seconds to 1 minute
no hearing loss or tinnitus
how to diagnose BPPV
dix-hallpike manoeuvre
the test is positive if you observe new nystagmus after
how to manage BPPV
epley manoeuvre
what is cholesteatoma?
serious and rare complication of chronic otitis media and commonly occurs in younger patients
what causes cholesteatoma?
caused by abnormal accumulation of skin, squamous epithelium within the middle ear cleft and mastoid air cells
clinical features of cholesteatoma
presents foul smelling discharge, headache and otalgia
will present on examination of tympanic with an area of white in the attic behind the tympanic membrane
what complications occur from cholesteatoma
facial nerve palsy and CNS complications
what would you see with otoscopy on a patient with acute otitis media
red, yellow or cloudy tympanic membrane
bulging tympanic membrane
air-fluid level behind tympanic membrane
what does a normal tympanic membrane look like
slight translucency with a colour sometimes described as pearly-grey
describe otitis externa
inflammation of external auditory canal
can be categorised into acute <3weeks or chronic >3 months
aka swimmers ear
risk factors for otitis externa
swimming
humid air
young age
diabetes
trauma
symptoms of otitis externa
itch
tenderness
hearing loss
discharge
treatment of otitis externa
analgesia and topical therapies - topical abx
most common microbiological cause of otitis externa
pseudomonas aeruginosa
gram negative rod
management of persistent glue ear
2-6 weeks of amoxicillin
grommet insertion if that fails, bilateral, and persistent
management of persistent glue ear
2-6 weeks of amoxicillin
grommet insertion if that fails, bilateral, and persistent
mx mastoiditis
admission for IV abx and monitoring
Symptoms and signs of basal skull fracture
Head injury
Reduced consciousness
Battles sign = bruising of mastoid process
Raccoon eyes = bruising around eyes
Rhinorrhoea = CSF leaking from ear
Cranial nerve palsy
Bleeding from nose/ears
Haemotympanum - blood visible behind tympanic membrane
Classically affects one at between 30-60
vertigo, tinnitus with fluctuating hearing loss
episodic nature
Classically affects one at
Between 30-60
Characterised by attacks of sudden paroxysmal vertigo with associated deafness and tinnitus
Normally occur in clusters with periods of remission
Normal Webers test result
Patient can hear the sound equally in both ears
If patient had sensorineural hearing loss what would their Webers test result be
Sound will be louder in the normal ear
If patient had conductive hearing loss what would their Webers test result be
Sound will be louder in affected ear
Normal rinnes test result (rinnes positive)
When patient can hear the sound again when the tuning fork is hovered over their ear (air conduction)
Air conduction should be better
Abnormal rinnes test (rinnes negative)
When bone conduction is better than air conduction
So the sound is not heard after removing the tuning fork from the mastoid process
This suggest conductive hearing loss
Clinical features of hereditary haemorrhagic telangiectasia
Characterised by telangiectasis on nasal mucosae, lips and gastrointestinal tract
Epistaxis
Anaemia sx
GI blood loss
What is a thyroglossal cyst
Fluid filled sac located in the thyroglossal duct
Generally midline cysts and move on tongue protrusion and swallowing
Typically detected in early childhood
What is a branchial cyst
Most common cause of neck lumps in children
Typically undetectable until the cyst swells in size commonly due to infection
Do not move on tongue protrusion nor auscultation or transilluminate
What is the Pathophysiology of tympanosclerosis
Associated with long term otitis media and grommet insertion
Result of calcium phosphate plaques leaving white patches on the tympanic membrane
What is otosclerosis
Most common cause of progressive deafness in young adults
Usually bilateral and causes conductive deafness (better with background noise)
Frequently associated with tinnitus
A non healing mouth ulcer that is both painful and bleeding raises high suspicion of what
An oral cancer
Squamous cell carcinoma is the most common type
causes of cervical lymphadenopathy
LIST
Lymphoma
Infection
Sarcoidosis
Tumours/Tuberculosis
what is this presentation diagnostic of?
acute, spontaneous vertigo,
nausea and vomiting,
and unsteadiness all often following a viral infection
positive head impulse, unidirectional nystagmus and no abnormal test of skew
vestibular neuronitis
management of vestibular neuronitis
prochlorperazine
what foreign object needs emergency removal
button batteries
when does a vestibular schwannoma become malignant and symptomatic
if they are 40mm+ in size and this requires surgery
