ENT Flashcards

Question

Oral candidiasis - investigations/ management

Answer 1

Clinical If recurrent/ severe screen for underlying diaginosis Investigations - FBC (look for anaemia/ iron + B12 deficiency/ HbA1c Oral examination Management - Hygiene advice (e.g cleaning dentures) Smoking cessation Control diabetes ICS - advice on rinsing mounth 1st line - miconazole oral gel - continue 2 days after symptoms start 1st line - immunocomprised - fluconazole oral Hospital admission - widespread candidiasis

Answer 2

Thick, white patches in the oral cavity - white discoloration that cant be rubbed off Aetiology - repeated injury or irritation/ vitamin deficiencies/ dentures etc Chronic candidiasis Usually asymptomatic

Answer 3

Ill fitting dentures/ smoking/ alcohol/ endocrine disturbances FBC - vit deficiency Swab if suspecting candida Refer for biopsy if lesion appear suspicious Management - refer to ENT for biopsy

Answer 4

Oral herpes simplex virus (HSV) 'Cold sore' 90% HSV 1 Transmitted via direct contact of skin or mucous membranes with infected secretions Primary infection - remains dormant - can lead to recurrent infections Symptoms - Prodrome - pain/ burning/ tingling Painful blisters Fever/ malaise/ sore throat Cervical lymphadenopathy Clustered erythematous vesicles

Answer 5

Clinical Swab for HSV if diagnosis unclear Management - Topical anti-viral OTC Oral antiviral - primary/ severe/ recurrent or immunocomprised Minimise infection risk

Answer 6

Infection of the major salivary glands - transmission of bacteria from oral cavity via the salivary duct Symptoms - Enlarged painful salivary gland Decreased salivary secretion Red/painful duct Management- Heat/cold compression Hydration Lemon drops/ citrus drops - promote salivary flow Analgesia medication

Answer 7

D- symptomatic inflammation of paranasal sinuses for <12 weeks (Frontal/ ethmoid + maxillary sinuses) A- Viral URI - less than 2% - bacterial infection Haemophilus influenza/ staphylococcus aureus RF's - Allergic rhinitis/ asthma/ smoking/ nasal polyps etc

Answer 8

Previous UTI symptoms Symptoms lasting more than 10 days Nasal blockage Rhinorrhea Facial pressure/ pain Maxillofacial sinus swelling Discoloured nasal discharge Fever Nasal mucosa oedema Diagnosis Clinical

Answer 9

Conservative management Analgesia/ nasal decongestant/ nasal saline spray Symptoms more than 10 days - Consider high dose nasal corticosteroid - 2 weeks Consider back-up anti-biotic prescription - phenoxymethylpenicillin or co-amoxiclav for 5 days

Answer 10

Symptomatic paranasal sinus inflammation for more than 12 weeks A- inflammatory rather than infectious RF's - Atopy/ asthma/ aspirin sensitivity - can lead to nasal polyps/ smoking/ immunocomprised Symptoms - same as acute Signs - maxillofacial tenderness/ pain/ inflamed nasal mucosa

Answer 11

Clinical diagnosis CT scan of sinuses - ordered by ENT Management Supportive care Smoking cessation/ avoid allergic triggers Nasal saline Intranasal corticosteroid - 3 months Seek specialist advice if considering anti-biotics More than 3 months - refer to ENT

Answer 12

D- IgE-mediated inflammatory disorder of the nose Nasal mucosa sensitised to allergens, causing release of histamine A- Causes Genetics Environmental House dust mites Grass, tree, weed pollens Moulds Animal dander

Answer 13

Clinical diagnosis Consider ENT referral - persistent symptoms despite primary care management Allergy testing, immunotherapy, skin prick testing Nasal obstruction or structural abnormality

Answer 14

Mild - moderate - As needed intranasal antihistamine (azelastine) or non -sedating oral antihistamine Moderate to severe - Daily intranasal corticosteroid - allergen exposure - up to 2 weeks to be effective Saline nasal spray + allergen avoidance Treatment failure - Compliance Consider stepping-up treatment Nasal congestion - add intranasal decongestant x5-7 days Rhinorrhoea - add intranasal anticholinergic (ipratropium bromide) Nasal itching, sneezing - add regular oral antihistamine or combination intranasal antihistamine with corticosteroid (Dymista) Concurrent asthma - add leukotriene receptor antagonist (montelukast) Severe symptoms affecting QOL Short-course oral corticosteroid (prednisolone) x5-10 days Refer for immunotherapy - IgE sensitivity

Answer 15

Benign swellings of nasal mucosa of paranasal sinuses Often associated with chronic sinusitis Risk factors Asthma Eosinophilic granulomatous polyangiitis (EGPA) Aspirin sensitivity Genetics

Answer 16

Symptoms Nasal obstruction Most often bilateral Nasal discharge Facial pain/pressure Reduced sense of smell (anosmia) Cough Postnasal drip Signs Visualisation of nasal polyp(s) Nasal discharge Diagnosis Clinical diagnosis Nasal endoscopy If not visualized via anterior rhinoscopy CT scan sinuses If unilateral symptoms, concern for neoplasm (eg bleeding, foul odour, impaired vision etc)

Answer 17

1st-line Intranasal corticosteroid Daily x3 months, then re-evaluate Continue indefinitely with review q 6 months Nasal saline irrigation +/- doxycycline x3-12 weeks 2nd-line Surgical polypectomy

Answer 18

Nosebleed 80-95% originate anterior nasal septum, location of Kiesselbach plexus of vessels Less common posterior epistaxis Older patients, bilateral bleeding, more profuse Trauma Inflammation Infection (eg chronic sinusitis), allergic rhinitis, nasal polyps Topical drugs Cocaine, decongestants, corticosteroids Systemic drugs Anticoagulants, antiplatelets (eg aspirin, clopidogrel) Tumours Nasal oxygen therapy Clotting disorders Excessive alcohol consumption Environmental factors Humidity, altitude, temperatures, cigarette smoke, dust

Answer 19

Perfused nose bleed Anterior rhinoscopy to identify bleed location Ask patient to first gently blow nose to remove clots Bleeding point appears as small red dot Suspect posterior bleed if Unable to visualize, bleeding first began down throat, profuse bleeding, bilateral bleeding FBC, coagulation studies if underlying cause suspected or significant bleeding

Answer 20

Admit if suspect posterior epistaxis or haemodynamically unstable First aid measures Patient sit upright, leaning slightly forward while pinching cartilaginous nose x10-15 minutes If bleeding stops, prescribe topical antiseptic (Naseptin) applied to nares QD x10 days and recommend avoid following for 24 hours: Blowing nose, heavy lifting, strenuous exercise, lying supine, avoid alcohol/hot drinks If first aid unsuccessful after 15 minutes Nasal cautery - silver nitrate stick Nasal packing

Answer 21

See within 7 days - ENT Refer immediately if Gross displacement Compound - bone protruding skin Uncontrolled bleed CSF rhinorrhoea - nasal or head trauma - sign of skull fracture Septal haematoma Septal Gently palpate If boggy = haematoma If hard = displaced cartilage or turbinate If you suspect it - refer immediately

Answer 22

If direct compression of the nasal alae for 10-15 minutes does not resolve epistaxis. the next most appropriate management step would be nasal cautery as there is a visible bleeding site amenable to cautery. Lifestyle advice should be given once the bleeding is controlled