ENT Flashcards
Acute otitis media presentation
otalgia, fever, hearing loss, recent viral URTI and may present with ear discharge in children
Acute otitis media otoscope
bulging tympanic membrane with loss of light reflex, perforation with purulent otorrhoea
Acute otitis media Management
Generally self-limiting and does not required but if persists more than 4 days.
Abx if perforation or comorbidities
Acute sinusitis common causes
Haemophylis influenza and streptococcus pneumonia
Acute sinusitis presentation
Facial pain, nasal obstruction and nasal discharge
Acute sinusitis management
Analgesia, saline washout and intranasal decongestants
Intranasal corticosteroids if symptoms persist for more than 10 days
Oral Pen V if symptoms are severe
Most common organism causing tonsilitis
Strep pyogenes
Criteria for tonsilitis
CENTORS criteria:
No cough
Exudative tonsils
Cervical lymphadenopathy
Fever >38
FEVERPAIN score:
Fever for the previous 24 hours
Purulent tonsils
Attends within 3 days
Inflammed tonsils
No cough
Management of tonsillitis
If centor score>3 and feverpain score>4, prescribe antibiotics.
PenV (first-line)
Clari (if pen allergic)
Allergic rhinitis presentation
Sneezing, nasal obstruction and post-nasal drip
Management of allergic rhinitis
Allergen avoidance
Mild-to-moderate -> oral or intranasal antihistamines
Moderate-to-severe -> intranasal corticosteroids
Management of auricular haematomas
Same day assessment by ENT for incision and drainage
Benign paroxysmal positional vertigo presentation
Vertigo triggered by changes in head position. Lasts for 10-20 seconds each. Associated with nausea
Diagnosis of benign paroxysmal positional vertigo
Dix-hallpike manouevre - will show rotatory nystagmus
Managment of BPPV
Epley manoeuvre
Betahistine
What is a cholesteatoma?
Non-cancerous growth of squamous epithelium
Presenting features of cholesteatomas
Foul smelling
Non-resolving discharge
Hearing loss
What would you find on otoscopy with cholesteatoma?
Attic crust in the upper most part of the ear drum
Management of cholesteatoma
Refer to ENT
Cochlear impact suitability
Must have trialled hearign aids for a minimum of 3 months
Otosclerosis presentation
conductive hearing loss with positive family history
Autosomal dominant
Difference between glue ear and acute otitis media
Glue ear is otitis media with effusions
Meniere’s disease triad
Vertigo, tinnitus and hearing loss
sensation of fullness within the ear
Acoustic neuroma presentation
Tinnitus, vertigo and hearing loss
facial palsy
Ear wax management
Irrigation or ear drops (olive oil)
Causes of epistaxis
Trauma
Foreign body
Nose-picking
Cocaine use
Granulomatosis with polyangitis
Bleeding disorders
Management of epistasis
First aid: lean forward and pinch nasal folds
If bleeding does not stop:
and bleeding point visible - silver nitrate cautery
if bleeding point not visible - packing
if bleeding continues - theatre for sphenopalatine ligation
Management of glue ear
Grommet
Adenoidectomy
What would you be worried about if patient comes in with unilateral serous otitis media?
Nasopharyngeal cancer
How would you manage a perforated tympanic membrane that’s not healing?
Myringoplasty
Malignant otitis externa - who gets it?
Immunocompromised individuals
Malignant otitis externa - common causative organism
pseudomonas aureginosa
Malignant otitis externa - progresses to what?
temporal osteomyolitis
Diagnosis of Malignant otitis externa
CT scan
Malignant otitis externa - management
refer to ENT for IV antibiotics
Management of mastoiditis
IV antibiotics
What is samster’s triad?
Asthma, aspirin sensitivity and nasal polyps
Features of nasal polyps
Nasal obstruction, rhinorrhoea and poor sense of taste and smell
Management of nasal polyps
Topical corticosteroids to shrink the polyp
What features of polyps would make you worry?
Unilateral + bleeding
Management of otitis externa
Topical antibiotics and a steroid for 1-2 weeks
If patients fail to respond to topical antibiotics, refer to ENT
Features of quinsys
Severe throat pain which lateralises to one side
Deviation of the uvula to the unaffected side
Reduced neck mobility
Definition of primary vs secondary haemorrhage following a tonsillectomy
Primary within the first 6-8 hours
Secondary within 5-10 days post surgery
Management of primary haemorrhage following a tonsillectomy
Immediate return to theatre
Management of secondary haemorrhage following tonsillectomy
IV antibiotics and admission
Organism causing ramsay hunt syndrome
Varicella zoster virus
Features of ramsay hunt syndrome
Auricular pain
Facial nerve palsy
Vesicular rash around the ear and eye
Management of ramsay hunt syndrome
Oral aciclovir and corticosteroid
Complications of thyroid surgery
Recurrent laryngeal nerve damage
Bleeding
Hypocalcaemia - damage to parotid glands
