ENT Flashcards
TONSILITIS
i) what is the most common cause? what is the most common bacterial cause? how is it treated?
ii) which bacteria causes otitis media, rhinosinusitis? name three other causes of tonsilitis
iii) what are the two peak age incidence? how may younger children present? (4) what other area should also be examined?
iv) what criteria is used to determine whether it is likely to be caused by bacteria? over what score is bac tonsilitis likely? what 4 things does the score comprise of
v) what is the fever pain score? what 5 things does it include?
i) most common cause is viral
bacterial - group A strep eg strep pyogenes that can be tx with pen V
ii) strep pneumoniae is common alternative cause
also cause dby haemoph influenzae, mroazella caarrhalis, staph aureus
iii) peaak at 5-10 and 15-20yrs
non spec symptoms in young children eg fever, poor oral intake, vomiting, headache, abdo pain
also examine ears and cervical LNs
iv) centor criteria - 3 more more means bac tons is likely
points for - fever over 38, tonsillar exudates, absence of cough, tender anterior cervical LNs
v) fever pain is alternative to centor score - fever in prev 24hpurs, pus on tonsils, attended within 3 days of symp onset, inflamed tonsils, no cough or coryza
MANAGEMENT OF TONSILITIS
i) name three serious pathologies that need to be excluded? what tx should be given initially? when should patients come back to hospital?
ii) when should abx be considered? (centor or fever pain) hx of which condition should be given abx?
iii) name three things that may need admission?
iv) what is first line abx? for how many days? what is given if penicillin allergy?
v) name three complications
i) exclude meningitis, epiglottitis, peritonsilar abscess
tx with analgesia initially
return if pain not settled after 3 days, fever over 38.3
ii) abx considered at centor >3 or fever pain >4
also give if immcomp or hx of rheumatic fever
iii) admit if immunocomp, sys unwell, dehydrated, stridor, resp distress, evidence of peritonsilar abscess or cellulitis
iv) first line is pen V for 10 days
allergic give clarithromycin
v) complicats - chronic tonsilitis, perotonsillar abscess eg quinsy, otitis media, scarlet fever, rheumatic fever, post strep glomneph, post strep reactive arthritis
QUINSY
i) what is it? why does it happen? name four ways it can present
ii) what is trismus? why do patients get a change in voice?
iii) what is the most common bacterial causative? name two others?
iv) what needs to be done to treat? what antibiotic may be appropriate? what can be given to help recovery?
i) peritonsilar abscess - bacterial infection due to trapped pus
px with sore throat, painful swallow, fever, neck pain, ear pain, swollen LNs
ii) trismus - cant open mouth
change in voice due to pharyngeal swelling
iii) group A strep eg strep pyogenes
also caused by staph aureus and haemoph influenzae
iv) needs incision and drain by ENT
give abx pre and post sx - co amox
may give dex to help recovery
OTITIS MEDIA
i) what part of the ear is infected? where does this area sit? how do bacteria enter? what is it often preceeded by?
ii) what is the most common causative bacteria? name two others
iii) name three ways it can present? what other symptoms may be seen when the vestibular system is affected? what may be seen if the tympanic membrane is perforated?
iv) what colour is a normal tympanic membrane? how will it look in OM? (2) what may be seen if there is a perforation? (2)
i) infection of the middle ear which sits between the tympanic membrane and inner ear
bacteria enters from back of throat through eustacian tube and often preceeded by viral URTI
ii) causatives = strep pneumoniae
haemoph influenzae, mrazella catarrhalis or staph aureus
iii) ear pain, reduced hearing, URTI symptoms eg fever, cough, coryzaa, sore throat
vestib system - balance issues and vertigo
perf - discharge
iv) normally tympanic membraane is pearly grey, translucent, slightly shiny
OM - bulging, red, inflamed
perf - discharge in ear canal and hole in tympanic membrane
OTITIS MEDIA MANAGEMENT
i) when should specialist referal be made? do most cases need abx? how quickly should most resolve?
ii) what is treatment mainstay? what are the three tx options?
iii) when should abx be prescribed? which two situations are patients more likely to benefit from OM?
iv) what is first line abx? what can be given if pen allergic?
v) name four complications
i) refer is <3m w temp over 38 or 3-6m w temp over 39
most dont need abx and will resolve in 3 days (up to 1 week)
ii) mainstay tx is analgesia
options are immed abx, delayed prescription and no abx
iii) prescribe if signif co morbids, systemically unwell or imm comp
likely to benefit if <2y with bilateral OM, or otorrhoea (discharge)
iv) first line is amoxicillin or clarith/erythro
v) OM with effusion, temp hearing loss, perf eardrum, recurrent infection, mastoiditis
GLUE EAR
i) what is it? what causes hearing loss?
ii) what connects the middle ear to back of throat? what happens when it becomes blocked?
iii) what is the main symptom? what may be seen on otoscopy? (3)
iv) what should the patient be referred for? how is it treated? how long does it last?
v) what are grommets? whaat do they allow? who should they be given to?
i) otitis media with effusion - middle ear becomes full of fluid leading to hearing loss
ii) eustacian tube (helps drain secretions from middle ear) - gets blocked and causes secretions to build up in the middle eaar
iii) main symptom is reduction of hearing
otoscopy - dull tympanic membrane with air bubbles or a visible fluid level (may look normal)
iv) refer for audiometry to establish dx and extent of hearing loss
treaat conserv and should resolve in 3m with no tx
v) grommets are small tubes inserted into tympanic membrane ro allow fluid to drain into the ear canal
usually fall out within a year and only 1 in 3 need them re inserted
give to children with co morbids eg downs, cleft palate
HEARING LOSS
i) name three congenital causes? name two perinataal causes? name three post natal causes?
ii) what programme tests hearing in all neonaates? how can older children be tested? what two types of hearing loss can be differentiated between?
iii) what does an audiogram document? what two types of conduction are tested
iv) in which type of hearing loss will both types of conduction be more than 20db?
v) in which type of hearing loss will bone conduction be normal but air conduction >20 db?
i) congenital - maternal rubella or CMV, genetic deafness, downs syndrome
perinatal - prematurity, hypoxia
post natal - jaundice, meningitis, encephalitis, OM or glue ear, chemotherapy
ii) newborn. hearing screening programme
older children - audiometry, differentiates between conductive and sensorineural hearing loss
iii) audiogram - documents the volume at which patients can hear different tones
then test air and bone conduction
iv) sensorineural
v) conductive
CLEFT LIP
i) what is it? what is a cleft palate? is there a familial component?
ii) name three things it can lead to problems with?
iii) who should patients be referred to? what is the first priority?
iv) what is definitive management? when is this done for cleft lip? for palate?
i) congenital condition - split or open section of upper lip
cleft palate - defect in hard or soft palate at roof of mouth leaving an opening between mouth and nasal cavity
occur randomly
ii) problems with feeding, swallowing and speech
iii) refer to cleft lip services
first priority is that the baby can eat and drink
iv) definitive is surgery
cleft lip sx at 3m and cleft palate sx at 6-12 months
CYSTIC HYGROMA
i) what is it a malformation of? what does this result in? where is it usually located?
ii) where do they most commonly present? are they hard or soft? tender or non tender? do they transluminate?
iii) name three complications
iv) how is it managed? name two tx options
i) malform of lymphatic system > cyst filled with lymphatic fluid
usually located in posterior triangle on left side of neck
ii) common in armpit or neck
are soft, non tender, and do transluminate
iii) complicats - interfere with feeding, breathing, swallowing, infection or haemmorhage into the cyst
iv) mx by watch and wait - dont resolve spont but may regress
tx - aspiration, sx removal, sclerotherapy
THYROGLOSSAL CYST
i) where does the thyroid gland start during development? where does it travel to definitively? what is the track called that it leaves behind? how does this result in a cyst?
ii) what is a DD? what is the main complication?
iii) are they mobile or fixed? tender or non tender? hard or soft? what is the key thing that demonstrates a TG cyst?
iv) which imaging can be used to confirm the dx? how are they treated?
i) thyroid starts at base of tongue nad trvel tdown the neck to front of the trachea and beneath the larynx
leaves behind a tract called thyroglossal duct > duct can persist and give rise to a fluid filled cyst
ii) DD is ectopic thyroid tissue
main complicat is infection (hot, tender, swollen lump)
iii) mobile, non tender, soft, fluctuant
key feature - moves up and down with movement of the tongue
stick out tongue and see lump move upwards
iv) US or CT scan to confirm
tx with surgical removal
BRANCHIAL CYST
i) what is it? what branchial cleft does it arise from? what causes a cyst to develop?
ii) how do they feel? where are they found - which triangle of the neck? do they translluminate? what age do they px in
iii) what is a sinus? what is a fistula? what is a branchial cleft sinus? what is a branchial pouch sinus? what is a branchial fistula?
iv) when may it be conservatively managed? when may it be surgically excised?
i) congenital abnormality arising when the second branchial cleft fails to properly form during foetal development - leaves a space surrounded by epithelial tissue which can fill with fluid
ii) round soft cystic swelling between angle of jaw and SCM in the anterior triangle of the neck
dont transluminate (if they do - cytic hygroma)
px after 10 years
iii) sinus = blind end pouch
fistula = abnormal connection between two epithelial surfaces
branchial cleft sinus - cyst is connectd to outer skin surface and discharge may be seen
branchial pouch sinus - cyst connects to oropharynx
branchial fistula - traact connects oropharynx to outer skin surface via the cyst
iv) cons mx if not causing func or cosmetic issues
surgical excision if recurrent infections or diagnostic doubt/cosmetic issues
