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Primary care > ENT > Flashcards

ENT Flashcards

1
Q

clinical features of acute tonsillitis

A

pharyngitis
fever
malaise
lymphadenopathy

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2
Q

organism tonsillitis

A

strep pyogenes - over 1/2 bacterial

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3
Q

tx tonsillitis

A

penicillin type abx for bacterial

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4
Q

ddx of tonsillitis

A

infectious mononucelosis

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5
Q

complication tonsillitis

A

local abscess formation - quinsy
otitis media
rheumatic fever and glomerulonephritis rarely

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6
Q

auricular haematomas tx

A

same day assessment by ENT
incision and drainage

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7
Q

define brachial cyst

A

branchial cyst is a benign, developmental defect of the branchial arches. The cyst is filled with acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium. Branchial cysts may have a fistula and are therefore prone to infection. They may enlarge following a respiratory tract infection.

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8
Q

clinical fx of brachial cyst

A

late childhood/early adulthood
asx lateral neck lump anterior to SCM
male risk fx

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9
Q

examination fx of brachial cyst

A

unilateral, typically on the left side
lateral, anterior to the sternocleidomastoid muscle
slowly enlarging
smooth, soft, fluctuant
non-tender
a fistula may be seen
no movement on swallowing
no transillumination

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10
Q

ddx of neck lump in children

A

congenital: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation
inflammatory: reactive lymphadenopathy, lymphadenitis,
neoplastic: lymphoma, thyroid tumour, salivary gland tumour

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11
Q

diagnosis of neck lump

A

consider and exclude other malignancy
ultrasound
referral to ENT
fine-needle aspiration

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12
Q

branchial cyst tx

A

ENT surgeons
concervatively or surgically excised
abx if infective

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13
Q

what are the main features of cholesteatoma?

A

foul smelling non resolving discharge
hearing loss
if local invasion - vertigo, facial nerve palsy, cerebellopontine angle syndrome

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14
Q

otoscopy cholesteatoma

A

attic crust - in uppermost part of ear drum

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15
Q

cholesteatoma management

A

referred to ENT for consideration of surgical removal

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16
Q

causes of severe to profound hearing loss for a cochlear implant

A

In children
Genetic (accounts for up to 50% of cases).
Congenital e.g. following maternal cytomegalovirus, rubella or varicella infection.
idiopathic (accounts for up to 30% of childhood deafness).
Infectious e.g. post meningitis.

In adults
Viral-induced sudden hearing loss.
Ototoxicity e.g. following administration of aminoglycoside antibiotics or loop diuretics.
Otosclerosis
Ménière disease
Trauma

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17
Q

contraindications to cochlear implant

A

Contraindications to consideration for cochlear implant:
Lesions of cranial nerve VIII or in the brain stem causing deafness
Chronic infective otitis media, mastoid cavity or tympanic membrane perforation
Cochlear aplasia

Relative contraindications:
Chronic infective otitis media or mastoid cavity infections
Tympanic membrane perforation
Patients that may be seen to demonstrate a lack of interest in using the implant to develop enhanced oral communication skills.

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18
Q

most common causes of deafness

A

presbycusis - age relating sensorineural hearing loss
otosclerosis - aut dom, replacement of normal bone by vascular spongy bone, conductive
glue ear
meniere’s
drug otoxicity
noise damage
acoustic neuroma

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19
Q

tx of ear wax

A

ear syringing - except if perforation or pt has grommets
olive oil

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20
Q

causes of epistaxis

A

trauma
insertion of foreign bdoies
bleeding disorders
juvenile angiofibroma
cocaine use
hereditary haemorrhagic telangiectasia
granulomatosis with polyangititis

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21
Q

causes of facial pain

A

sinusitis
trigeminal neuralgia
cluster headache
temporal arteritis

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22
Q

what are the drug causes of gingival hyperplasia?

A

phenytoin
ciclosporin
calcium channel blocker

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23
Q

gingivitis

A

secondary to poor dental hygiene. Clinical presentation may range from simple gingivitis (painless, red swelling of the gum margin which bleeds on contact) to acute necrotizing ulcerative gingivitis (painful bleeding gums with halitosis and punched-out ulcers on the gums).

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24
Q

tx gingivitis

A

dentist
abx not usually necessary

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25
Q

tx acute necrotizing ulcerative gingivitis

A

refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia

*the BNF also suggest that amoxicillin may be used

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26
Q

laryngeal cancer

A

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with:
persistent unexplained hoarseness or
an unexplained lump in the neck

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27
Q

oral cancer

A

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:
unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck.
Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
a lump on the lip or in the oral cavity or
a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.

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28
Q

thyroid cancer

A

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.

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29
Q

causes of hoarseness

A

voice overuse
smoking
viral illness
hypothyroidism
gastro-oesophageal reflux
laryngeal cancer
lung cancer

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30
Q

ludwig’s angina

A

a type of progressive cellulitis that invades the floor of the mouth and soft tissues of the neck. Most cases result from odontogenic infections which spread into the submandibular space.

Features
neck swelling
dysphagia
fever

It is a life-threatening emergency as airway obstruction can occur rapidly as a result.

Management
airway management
intravenous antibiotics

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31
Q

define mastoidits

A

when an infection spreads from the middle to the mastoid air spaces of the temporal bone.

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32
Q

fx of mastoiditis

A

otalgia: severe, classically behind the ear
there may be a history of recurrent otitis media
fever
the patient is typically very unwell
swelling, erythema and tenderness over the mastoid process
the external ear may protrude forwards
ear discharge may be present if the eardrum has perforated

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33
Q

diagnosis mastoidits

A

diagnosis clinical
Ct if complications suspected

34
Q

mastoiditis management

A

iV ABX

35
Q

mastoiditis complication

A

facial nerve palsy
hearing loss
meningitis

36
Q

common nasal polyps

A

1% in adults in UK
2-4x more common in men and not in children or elderly

37
Q

nasal polyps assoications

A

asthma (particularly late-onset asthma)
aspirin sensitivity
infective sinusitis
cystic fibrosis
Kartagener’s syndrome
Churg-Strauss syndrome

38
Q

fx of nasal polyps

A

nasal obstruction
rhinorrhoea, sneezing
poor sense of taste and smell

39
Q

management of nasal polyps

A

referred to ENT for full examination
topical corticosteroid to shrink

40
Q

nasal septal haematoma

A

classically a bilateral, red swelling arising from the nasal septum
this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm

41
Q

nasal septal haematoma tx

A

surgical drainage
IV abx

42
Q

nasopharyngeal carcinoma type

A

squamous cell
associated with EBV

43
Q

nasopharyngeal presenting features

A

cervical lymphadenopathy
Otalgia
Unilateral serous otitis media
Nasal obstruction, discharge and/ or epistaxis
Cranial nerve palsies e.g. III-VI

44
Q

nasopharyngeal carcinoma tx

A

radiotherapy

45
Q

causes of neck lump

A

reactive lymphadenopathy
lymphoma
thyroid swelling
thyroglossal cyst
pharyngeal pouch
cystic hygroma
branchial cyst
cervical rib
carotid aneurysm

46
Q

parotid gland tumours

A

Up to 80% of all salivary gland tumours occur in the parotid gland and up to 80% of these are benign. There is no consistent correlation between the rate of growth and the malignant potential of the lesion. However, benign tumours should not invade structures such as the facial nerve. With the exception of Warthins tumours, they are commoner in women than men. The median age of developing a lesion is in the 5th decade of life.

47
Q

imaging for parotid gland tumours

A

Plain x-rays may be used to exclude calculi
Sialography may be used to delineate ductal anatomy
FNAC is used in most cases
Superficial parotidectomy may be either diagnostic of therapeutic depending upon the nature of the lesion
Where malignancy is suspected the primary approach should be definitive resection rather than excisional biopsy
CT/ MRI may be used in cases of malignancy for staging primary disease

48
Q

parotid gland tumours tx

A

For nearly all lesions this consists of surgical resection, for benign disease this will usually consist of a superficial parotidectomy. For malignant disease a radical or extended radical parotidectomy is performed. The facial nerve is included in the resection if involved. The need for neck dissection is determined by the potential for nodal involvement.

49
Q

other conditions affecting parotid gland

A

HIV infection
sjogren’s
sarcoidosis

50
Q

perforated tympanic membrane tx

A

no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time
abx if following AOM

51
Q

clinical fx of quinsy

A

severe throat pain, which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility

52
Q

how is quinsy managed?

A

urgent referral by ENT
needle aspiration or incision & drainage + intravenous antibiotics
tonsillectomy should be considered to prevent recurrence

53
Q

define pleomorphic adenoma

A

Pleomorphic adenoma (also known as a benign mixed tumour) is a benign tumour of the parotid gland. It is the most common tumour of the parotid gland and typically appears at the age of 40-60 years.

54
Q

what are the post op complications of tonsillectomy?

A

Pain

The pain may increase for up to 6 days following a tonsillectomy.

Haemorrhage

Haemorrhage is a feared complication following tonsillectomy. All post-tonsillectomy haemorrhages should be assessed by ENT.

Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.

Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery. Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.

55
Q

which frequency affected prescbycusis

A

high frequency

56
Q

causes of presbycusis

A

The precise cause is unknown however is likely multifactorial
Arteriosclerosis: May cause diminished perfusion and oxygenation of the cochlea, resulting in damage to inner ear structures
Diabetes: Acceleration of arteriosclerosis
Accumulated exposure to noise
Drug exposure (Salicylates, chemotherapy agents etc.)
Stress
Genetic: Certain individuals may be programmed for the early ageing of the auditory system

57
Q

clinical fx of presbycusis

A

chronic, slowly progressing history of:
Speech becoming difficult to understand
Need for increased volume on the television or radio
Difficulty using the telephone
Loss of directionality of sound
Worsening of symptoms in noisy environments
Hyperacusis: Heightened sensitivity to certain frequencies of sound (Less common)
Tinnitus (Uncommon)

58
Q

clinical signs of presbycusis

A

Possible Weber’s test bone conduction localisation to one side if sensorineural hearing loss not completely bilateral

59
Q

investigations presbycusis

A

Otoscopy: Normal, to rule out otosclerosis, cholesteatoma and conductive hearing loss (Foreign body, impacted wax etc.)
Tympanometry: Normal middle ear function with hearing loss (Type A)
Audiometry: Bilateral sensorineural pattern hearing loss
Blood tests including inflammatory markers and specific antibodies: Normal

60
Q

define ramsay hunt syndrome

A

caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

61
Q

fx ramsay hunt syndrome

A

auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

62
Q

ramsay hunt syndrome management

A

oral aciclovir and corticosteroids

63
Q

criteria for bacterial cause of sore throat/tonsillitis

A

centor score - presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
if 3 or 4 - 32-56% chance its bacterial
FeverPAIN score - Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
4 or 5 - 62%-65
…..phenoxymethylpenicillin or clarithromycin for 10 days

64
Q

sialolithiasis

A

80% of all salivary gland calculi occur in the submandibular gland
70% of these calculi are radio-opaque
Stones are usually composed of calcium phosphate or calcium carbonate
Patients typically develop colicky pain and post prandial swelling of the gland
Investigation involves sialography to demonstrate the site of obstruction and associated other stones
Stones impacted in the distal aspect of Wharton’s duct may be removed orally, other stones and chronic inflammation will usually require gland excision

65
Q

sudden onset senorineural hearing loss

A

urgent referral ENT
majority are iditopathic
MRI - vestibular schwannoma
high dose oral corticosteroids

66
Q

clinical fx of thyroglossal cysts

A

More common in patients < 20 years old.

Features
usually midline, between the isthmus of the thyroid and the hyoid bone
moves upwards with protrusion of the tongue
may be painful if infected

67
Q

thryoid surgery complications

A

Anatomical such as recurrent laryngeal nerve damage.
Bleeding. Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.
Damage to the parathyroid glands resulting in hypocalcaemia.

68
Q

causes of tinnitus

A

meniere’s disease
otosclerosis
sudden onset sensorineural hearing loss - acoustic neuroma
hearing loss
drugs
impacted ear wax

69
Q

tinnitus investigated

A

audiological assessment for hearing loss
enerally, non-pulsatile tinnitus does not require imaging unless it is unilateral or there are other neurological or ontological signs. MRI of the internal auditory meatuses (IAM) is first-line
pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause. Magnetic resonance angiography (MRA) is often used to investigate pulsatile tinnitus

70
Q

tinnintus management

A

investigate and treat any underlying cause
amplification devices
more beneficial if associated hearing loss
psychological therapy may help a limited group of patients
examples include cognitive behavioural therapy
tinnitus support groups

71
Q

indications for tonsillectomy

A

meets all criteria:
sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)
the person has five or more episodes of sore throat per year
symptoms have been occurring for at least a year
the episodes of sore throat are disabling and prevent normal functioning

72
Q

less common indications for tonsillectomy

A

recurrent febrile convulsions secondary to episodes of tonsillitis
obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
peritonsillar abscess (quinsy) if unresponsive to standard treatment

73
Q

causes of vertigo

A

viral labyrinthitis
vestibular neuronitis
BPPV
meniere’s disease
vertebrobasilar ischaemia
acoustic neuroma
other - posterior circulation stroke, trauma, MS, ototoxicity

74
Q

clinical fx of vestibular neuronitis

A

recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus

75
Q

ddx for vestibular neuronitis

A

viral labyrinthitis
posterior circulation stroke: the HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

76
Q

vestibular neuronitis management

A

buccal or IM prochlorperazine
short course of oral proclorperazine or antihistamine
vestibular rehab exercises

77
Q

define labyrinthitis

A

nflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs. Labyrinthitis can be viral, bacterial or associated with systemic diseases. Viral labyrinthitis is the most common form of labyrinthitis.

78
Q

vestibular neuritis v labyrinthitis

A

vestibular neuritis is used to define cases in which only the vestibular nerve is involved, hence there is no hearing impairment; Labyrinthitis is used when both the vestibular nerve and the labyrinth are involved, usually resulting in both vertigo and hearing impairment.

79
Q

age labyrinthitis

A

40-70 yrs

80
Q

clinical fx of labyrinthitis

A

acute
vertigo: not triggered by movement but exacerbated by movement
nausea and vomiting
hearing loss: may be unilateral or bilateral, with varying severity
tinnitus
preceding or concurrent symptoms of upper respiratory tract infection

81
Q

signs labyrinthtisi

A

spontaneous unidirectional horizontal nystagmus towards the unaffected side
sensorineural hearing loss: shown by Rinne’s test and Weber test
abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
gait disturbance: the patient may fall towards the affected side

82
Q

management labyrinthitis

A

episodes are usually self-limiting
prochlorperazine or antihistamines may help reduce the sensation of dizziness

Primary care (15 decks)

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