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Final Year > ENT > Flashcards

ENT Flashcards

1
Q

What is the eustachian tube?

A

Connects middle ear to throat to equalise pressure

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2
Q

What are the 3 small bones of the ear called?

A

Malleus, incus, stapes

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3
Q

What is the role of the semicircular canals?

A

Sense head movement (vestibular system)

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4
Q

What is the role of the cochlea?

A

Converts sound vibration to nervous signal

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5
Q

What is a normal Weber’s?

A

Equal in both ears

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6
Q

What is seen in sensorineural hearing loss in Weber’s?

A

Sound louder in normal ear

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7
Q

What is seen in conductive hearing loss in Weber’s?

A

Sound louder in affected ear

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8
Q

Why in conductive hearing loss is the sound louder in affected ear in Weber’s?

A

Affected ear ‘turns up the volume’ and becomes more sensitive

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9
Q

What is Rinne’s positive?

A

Normal- Air conduction better than bone

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10
Q

What is Rinne’s negative?

A

Abnormal- Bone conduction better than air- Suggests conductive cause

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11
Q

List medications that can cause sensorineural hearing loss

A

Loop diuretics- Furosemide
Aminoglycosides- Gentamicin
Chemotherapy- Cisplatin

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12
Q

List neurological conditions that can cause sensorineural hearing loss

A

Stroke
MS
Brain tumour

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13
Q

List causes of conductive hearing loss

A

Tumour, exostoses, cholesteatoma, otosclerosis, perforated tympanic membrane, eustachian tube dysfunction, fluid in middle ear, otitis externa/media, ear wax

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14
Q

What is leukoplakia?

A

White patches in mouth
Precancerous- Increased risk SCC of mouth

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15
Q

What are the characteristics of leukoplakia?

A

Asymptomatic patches
Irregular
Slightly raised
Not able to scrape off

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16
Q

Outline management of leukoplakia

A

Biopsy to exclude abnormal cells
Stop smoking, reduce alcohol intake, close monitoring
Potentially laser removal or surgical excision

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17
Q

What are erythroplakia?

A

Similar to leukoplakia, but lesions are red

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18
Q

What is lichen planus?

A

Autoimmune condition
Causes localised chronic inflammation

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19
Q

Outline characteristics of lichen planus

A

Shiny, purplish, flat-topped raised areas with white lines across surface- Wickham’s striae
Occurs in >45y women

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20
Q

What are the 3 potential patterns of lichen planus in the mouth?

A

Reticular- Wickham’s striae
Erosive lesions- Surface of mucosa eroded- Bright red sore areas
Plaques- Large continuous areas of white mucosa

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21
Q

Outline management of lichen planus

A

Good oral hygiene, stop smoking
Topical steroids

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22
Q

What is gingivitis?

A

Inflammation of gums

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23
Q

How does gingivitis present?

A

Swollen gums
Bleeding after brushing
Painful gums
Bad breath (halitosis)

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24
Q

What is a key complication of gingivitis?

A

Periodontitis

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25
Q

What is periodontitis?

A

Severe and chronic inflammation of gums and tissue that support the teeth
Can lead to loss of teeth

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26
Q

What is acute necrotising ulcerative gingivitis?

A

Rapid onset of severe inflammation in gums
Painful
Caused by anaerobic bacteria

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27
Q

What is the key difference in presentation of gingivitis and acute necrotising ulcerative gingivitis?

A

ANUG is painful and caused by anaerobic bacteria

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28
Q

List the risk factors for gingivitis

A

Plaque build up (inadequate brushing)
Smoking
Diabetes
Malnutrition
Stress

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29
Q

What is tartar?

A

A sawce
Hardened plaque

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30
Q

Outline management of gingivitis

A

Dentist
Good oral hygiene
Stop smoking
Chlorhexidine mouthwash

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31
Q

Outline management of acute necrotising ulcerative gingivitis

A

Antibiotics (metronidazole)

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32
Q

What is gingival hyperplasia?

A

Abnormal growth of gums
Gums notably enlarged around teeth

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33
Q

What are the causes of gingival hyperplasia?

A

Gingivitis
Pregnancy
Vit C deficiency (scurvy)
Acute myeloid leukaemia (AML)
Meds- CCBs, phenytoin, ciclosporin

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34
Q

What can a vit C deficiency cause?

A

Scurvy

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35
Q

What are aphthous ulcers?

A

Very common, small, painful ulcers of mucosa in mouth
Well-circumscribed, punched-out, white appearance

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36
Q

What are the causes of aphthous ulcers?

A

Emotional or physical stress
Trauma to mucosa
Particular foods

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37
Q

What underlying conditions could aphthous ulcers suggest?

A

IBD (Crohn’s disease, UC)
Coeliac disease
Behcet disease
Vit deficiency (iron, B12, folate, vit D)
HIV

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38
Q

Outline initial management of Aphthous ulcers

A

Usually heal within 2wks
Bonjela (choline salicylate)
Benzydamine (Difflam spray)
Lidocaine

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39
Q

Outline management of severe aphthous ulcers

A

(each is applied to lesion, not swallowed)
Hydrocortisone buccal tablets
Betamethasone soluble tablets
Beclomethasone inhaler

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40
Q

How would you manage unexplained ulceration lasting over 3wks?

A

2wk wait

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41
Q

What causes a black, hairy tongue?

A

Decreased exfoliation of keratin from tongue’s surface
Papillae elongate and take on appearance of hair
Bacteria and food cause dark pigmentation

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42
Q

What are the causes of black hairy tongue?

A

Dehydration
Dry mouth
Poor oral hygiene
Smoking

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43
Q

What are the symptoms of a black hairy tongue?

A

Sticky saliva
Metallic taste

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44
Q

What is the management of a black hairy tongue?

A

Hydration
Gentle brushing of tongue
Stop smoking

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45
Q

What is strawberry tongue?

A

Tongue swollen and red
Papillae become enlarged, white and prominent

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46
Q

What are the causes of strawberry tongue?

A

Scarlet fever
Kawasaki disease

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47
Q

What is a geographic tongue?

A

Inflammatory condition where patches of tongue’s surface lose epithelium and papillae
Patches form irregular shape on tongue

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48
Q

What is the progression of a geographic tongue?

A

Relapses and remits

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49
Q

What are the associations of geographic tongue?

A

Sometimes none
Stress and mental illness
Psoriasis
Atopy (asthma, hayfever, eczema)
Diabetes

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50
Q

What is the prognosis of geographic tongue?

A

Benign
Doesn’t cause harmful effects

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51
Q

What is the management of geographic tongue?

A

No treatment required
If discomfort/burning- Treat with topical steroids or antihistamines

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52
Q

What is oral candidiasis?

A

Oral thrush
Overgrowth of candida- Fungus

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53
Q

How does oral candidiasis present?

A

White spots/patches that coat surface of tongue and palate

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54
Q

What are the risk factors that predispose a patient to oral candidiasis?

A

Inhaled corticosteroids (poor technique, not using a spacer, not rinsing with water)
Antibiotics (disrupt normal flora)
Diabetes
Immunodeficiency (consider HIV)
Smoking

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55
Q

Outline the management of oral candidiasis

A

Miconazole gel
Nystatin suspension
Fluconazole tablets (severe/recurrent)

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56
Q

What is angioedema?

A

Accumulation of fluid in tissues resulting in swelling
Can affect limbs, face, lips, and tongue

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57
Q

What are the top 3 causes of angioedema?

A

Allergic reactions
ACE-is
C1 esterase inhibitor deficiency (hereditary)

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58
Q

What is glossitis?

A

Inflamed tongue
Tongue swollen, red and sore
Papillae of tongue atrophy- Gives tongue smooth appearance

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59
Q

What are the causes of glossitis?

A

Iron deficiency anaemia
B12 deficiency
Folate deficiency
Coeliac disease
Injury or irritant exposure

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60
Q

What is the most common type of head and neck cancer?

A

Squamous cell carcinoma

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61
Q

List the potential areas of head and neck cancer

A

Nasal cavity
Paranasal sinuses
Mouth
Salivary glands
Pharynx
Larynx (epiglottis, supraglottis, vocal cords, glottis and subglottis)

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62
Q

Where do head and neck cancers usually spread to first?

A

Lymph nodes

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63
Q

What are the risk factors for head and neck cancer?

A

Smoking
Chewing tobacco
Chewing betel quid
Alcohol
HPV 16
EBV infection

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64
Q

List the red flags that may indicate head and neck cancer

A

Lump in mouth/on lip
Unexplained ulceration in mouth >3wks
Erythroplakia/erythroleukoplakia
Persistent neck lump
Unexplained hoarse voice
Unexplained thyroid lump

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65
Q

Outline management of head and neck cancer

A

TNM staging system- Grades tumour, node involvement and metastasis
Chemo/radiotherapy
Surgery
Targeted cancer drugs (monoclonal antibodies)
Palliative care

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66
Q

Give an example of a monoclonal antibody used to treat squamous cell carcinomas of head and neck

A

Cetuximab- Targets and blocks epidermal growth factor receptor and inhibits growth and metastasis of tumour
(can also treat bowel cancer)

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67
Q

What are the borders of the anterior triangle?

A

Mandible forms superior border
Midline of neck forms medial border
SCM forms lateral border

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68
Q

What are the borders of the posterior triangle?

A

Clavicle forms inferior border
Trapezius forms posterior border
SCM forms lateral border

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69
Q

List differential diagnoses of neck lumps in adults

A

Normal structures (eg: Bony prominence)
Skin abscess
Lymphadenopathy (enlarged lymph nodes)
Tumour (eg: Squamous cell carcinoma or sarcoma)
Lipoma
Goitre (swollen thyroid gland) or thyroid nodules
Salivary gland stones or infection
Carotid body tumour
Haematoma (collection of blood after trauma)
Thyroglossal cysts
Branchial cysts

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70
Q

List differential diagnoses of neck lumps in young children

A

Cystic hygromas
Dermoid cysts
Haemangiomas
Venous malformation

71
Q

Neck lump, skin pallor, bruising + Hepatosplenomegaly

A

Leukaemia

72
Q

Neck lump, focal chest sounds and clubbing

A

Lung cancer

73
Q

Neck lump and weight loss

A

Malignancy or hyperthyroidism

74
Q

ENT infection and neck lump

A

Reactive lymph nodes

75
Q

Outline red flag criteria for neck lump 2 week wait referrals

A

Unexplained neck lump in someone >45y
Persistent unexplained neck lump at any age lump growing in size- Within 2wks if >25y, within 48h if <25y

76
Q

List blood test investigations of neck lumps

A

FBC and blood film- Leukaemia and infection
HIV test
Monospot test or EBV antibodies- Infectious mononucleosis
TFTs- Goitre or thyroid nodules
Antinuclear antibodies- SLE
Lactate dehydrogenase (LDH)- Non-specific tumour marker for Hodgkin’s lymphoma

77
Q

What is the monospot test used for?

A

Infectious mononucleosis
Can also look for ABV antibodies

78
Q

Outline imaging of neck lumps

A

US- 1st line
CT or MRI
Nuclear medicine scan (eg: Toxic thyroid nodules or PET scans for metastatic cancer)

79
Q

Outline types of biopsy used to investigate neck cancer

A

Fine needle aspiration cytology- Aspirating cells from lump using needle
Core biopsy- Taking sample of tissue with thicker needle
Incision biopsy- Cutting out tissue sample with scalpel
Removal of lump- Entire lump removed and examined

80
Q

Outline the groupings of lymphadenopathy

A

Reactive lymph nodes- Swelling caused by viral URTI, dental infections, tonsillitis
Infected lymph nodes- TB, HIV, EBV
Inflammatory conditions- SLE or sarcoidosis
Malignancy- Lymphoma, leukaemia, metastasis

81
Q

What are the most concerning enlarged nodes for malignancy of cervical lymph nodes?

A

Supraclavicular nodes- May be caused by malignancy in chest or abdomen

82
Q

List features of enlarged lymph nodes that suggest malignancy

A

Unexplained (eg: Not associated with an infection)
Persistently enlarged (particularly >3cm diameter)
Abnormal shape (normally oval shaped where length more than double width)
Hard or rubbery
Non-tender
Tethered or fixed to skin or underlying tissues
Associated symptoms- Night sweats, weight loss, fatigue, fevers

83
Q

What is infectious mononucleosis?

A

Infection with Epstein Barr virus (EBV)
Cause of lymphadenopathy
Most often affects teenagers and young adults

84
Q

How is EBV transmitted?

A

Saliva

85
Q

How can EBV present?

A

Fever
Sore throat
Fatigue
Lymphadenopathy

86
Q

What can happen when amoxicillin or cephalosporins are given to patients with EBV?

A

Intensely itchy maculopapular rash

87
Q

Outline investigations of EBV

A

1st line- Monospot test
IgM (acute infection) and IgG (immunity

88
Q

How is EBV managed?

A

Supportive
Avoid alcohol (risk of liver impairment)
Avoid contact sports (risk of splenic rupture)

89
Q

What are the B symptoms of lymphoma?

A

Fever
Weight loss
Night sweats

90
Q

What is lymphoma?

A

Group of cancers that affect lymphocytes inside lymphatic system
Proliferate within lymph nodes = Become abnormally large (lymphadenopathy)

91
Q

What is the difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma?

A

Hodgkin’s- Specific disease

92
Q

What is the age distribution of Hodgkin’s lymphoma?

A

Bimodal age distribution with peaks around 20y and 75y

93
Q

What is the key presenting symptom of lymphoma?

A

Lymphadenopathy- May be in neck/axilla/inguinal regions- Non-tender, rubbery
Some patients experience pain in lymph nodes when drink alcohol
B symptoms

94
Q

What is the key finding from a lymph node biopsy in patients with Hodgkin’s lymphoma?

A

Reed-Sternberg cell

95
Q

What is the staging system for Hodgkins and non-Hodgkins lymphoma?

A

Ann Arbor staging system

96
Q

What is leukaemia?

A

Cancer of particular stem cells in the bone marrow causing unregulated production of certain types of blood cells
Classified by how rapidly they progress and the cell line that is affected (myeloid or lymphoid)

97
Q

List the 4 types of leukaemia

A

Acute myeloid leukaemia (AML)
Acute lymphoblastic leukaemia (ALL)
Chronic myeloid leukaemia (CML)
Chronic lymphocytic leukaemia (CLL)

98
Q

Outline presentation of leukaemia

A

Fatigue
Fever
Pallor due to anaemia
Petechiae and abnormal bruising due to thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly

99
Q

What is a goitre?

A

Generalised swelling of thyroid gland

100
Q

What can cause a goitre?

A

Graves disease (hyperthyroidism)
Toxic multinodular goitre (hyperthyroidism)
Hashimoto’s thyroiditis
Iodine deficiency
Lithium

101
Q

List causes of individual lumps in thyroid

A

Benign hyperplastic nodules
Thyroid cysts
Thyroid adenomas (benign tumours that can release excessive thyroid hormone)
Thyroid cancer (papillary or follicular)
Parathyroid tumour

102
Q

What are the locations of the salivary glands?

A

Parotid glands
Submandibular glands
Sublingual glands

103
Q

List the 3 main reasons for enlargement of the salivary glands

A

Stones- Blocking drainage of glands through ducts (sialolithiasis)
Infection
Tumours (benign or malignant)

104
Q

Where is the carotid body located?

A

Just above the carotid bifurcation (where common carotid splits into internal and external carotids)

105
Q

What is the function of the carotid body?

A

Contains glomus cells- Chemoreceptors
Detect blood’s oxygen, carbon dioxide, pH
Groups of glomus cells = Paraganglia

106
Q

What are carotid body tumours?

A

Excessive growth of glomus cells
Most are benign

107
Q

Outline presentation of carotid body tumours

A

Slow-growing lump
Upper anterior triangle of neck (near angle of mandible)
Painless
Pulsatile
Associated with bruit on auscultation
Mobile side to side, but not up and down
Horner syndrome

108
Q

How can carotid body tumour affect nerve structures?

A

May compress glossopharyngeal (IX), vagus (X), accessory (XI), or hypoglossal (XII) nerves
Pressure on sympathetic nerves- Horner syndrome

109
Q

What is the triad of Horner’s syndrome?

A

Ptosis
Miosis
Anhidrosis (loss of sweating)

110
Q

What is the characteristic finding on imaging investigations of carotid body tumour?

A

Splaying of internal and external carotid arteries (lyre sign)

111
Q

How are carotid body tumours most commonly treated?

A

Surgical removal

112
Q

What are lipomas?

A

Benign tumours of fat (adipose tissue)
Can occur almost anywhere on the body where there is adipose tissue

113
Q

What is the presentation of a lipoma?

A

Soft
Painless
Mobile
Do not cause skin changes

114
Q

How are lipomas treated?

A

Treated conservatively with reassurance
Can be surgically removed

115
Q

How and where can thyroglossal cysts develop?

A

Develop during fetal development when part of the thyroglossal duct persists- Gives rise to fluid-filled cyst

116
Q

What is the key differential diagnosis of thyroglossal cyst?

A

Ectopic thyroid tissue

117
Q

Describe thyroglossal cyst

A

Midline neck lump
Mobile
Non-tender
Soft
Fluctuant
Move up and down with movement of the tongue

118
Q

How is a thyroglossal cyst diagnosed?

A

US or CT scan

119
Q

How are thyroglossal cysts managed?

A

Surgically removed to provide confirmation of diagnosis on histology an prevent infections- Can reoccur unless fully removed

120
Q

What is the main complication of a thyroglossal cyst?

A

Infection- Hot, tender, painful lump

121
Q

What is a branchial cyst?

A

Congenital abnormality arising when 2nd branchial cleft fails to form properly during fetal development leaving space surrounded by epithelial tissue in lateral aspect of neck

122
Q

Outline presentation of branchial cyst

A

Round, soft, cystic swelling between angle of jaw and SCM muscle in anterior triangle of neck
Present after 10y, most commonly in young adulthood when cyst become noticeable or infected

123
Q

Outline management of branchial cysts

A

Conservative
Surgical excision- If recurrent infection/diagnostic doubt/causing other problems

124
Q

List indications for a tonsillectomy

A

7+ in 1yr
5/y for 2y
3/y for 3y
Recurrent tonsillar abscess (2 episodes)
Enlarged tonsils causing difficulty breathing/swallowing/snoring

125
Q

List complications of tonsillectomy

A

Sore throat where tonsillar tissue removed
Damage to teeth
Infection
Post-tonsillectomy bleeding
Risks associated with general anaesthetic

126
Q

What is the most significant complication of tonsillectomy?

A

Post tonsillectomy bleeding
Significant bleeding can occur in up to 5% patients requiring urgent management
Can happen up to 2wks after operation
Bleeding can be severe and in rare cases, life-threatening due to aspiration of blood

127
Q

Outline management of post tonsillectomy bleeding

A

Senior help
IV access and bloods
Keep patient calm and give adequate anaesthesia
Sit patient up and encourage spitting out blood, not swallowing
Nil by mouth
IV fluids for maintenance and resuscitation

128
Q

What are the options for stopping less severe bleeds in post tonsillectomy bleeding?

A

Hydrogen peroxide gargle
Adrenalin soaked swab applied topically

129
Q

What is quinsy?

A

Peritonsillar abscess
Arises when bacterial infection with trapped pus forming abscess in region of tonsils
Complication of untreated/partially treated tonsillitis (can arise w/o tonsillitis)

130
Q

Outline presentation of quinsy

A

Sore throat
Painful swallowing
Fever
Neck pain
Referred ear pain
Swollen tender lymph nodes
Trismus- Unable to open mouth
Change in voice due to pharyngeal swelling- Hot potato voice
Swelling and erythema in area beside the tonsils

131
Q

What is the most common organism causing quinsy?

A

Strep pyogenes (group A strep) most common
Also caused by staph aureus and haemophilus influenzae

132
Q

Outline management of quinsy

A

ENT needle aspiration or surgical incision and drainage
Co-amoxiclav
Some ENT give steroids (dexamethasone) to settle inflammation

133
Q

What is the most common cause of tonsillitis?

A

Viral infection

134
Q

What is the most common cause of bacterial tonsillitis?

A

Group A Streptococcus
2nd most common- Streptococcus pneumoniae

135
Q

What is Waldeyer’s Tonsillar Ring?

A

Ring of lymphoid tissue at back of throat in pharynx
6 areas- Adenoids, bubal tonsils, palatine tonsils, lingual tonsil
Palatine tonsils only ones enlarged in tonsillitis

136
Q

Outline presentation of tonsillitis

A

Sore throat
Fever
Pain on swallowing
Red, inflamed, enlarged tonsils, with or w/o exudates
May have anterior cervical lymphadenopathy- Swollen, tender lymph nodes in ant. triangle of the neck- Tonsillar lymph nodes just behind angle of mandible

137
Q

Outline Centor Criteria

A

> 3 offer antibiotics
Fever >38 degrees
Tonsillar exudates
Absence of cough
Tender anterior cervical lymph nodes (lymphadenopathy)

138
Q

Outline FeverPAIN score

A

2-3= 34-40% probability bacteria
4-5= 62-65% probability bacteria- Give antibiotics
Fever during previous 24h
P- Purulence
A- Attended within 3d onset symptoms
I- Inflamed tonsils
N- No cough or coryza

139
Q

Outline management of tonsillitis

A

Consider admission if patient immunocompromised/systemically unwell/dehydrated/stridor/respiratory distress/evidence peritonsillar abscess/cellulitis
Calculate Centor criteria or FeverPAIN- Give antibiotics if required
Safety net- Advise simple analgesia, return if not settled after 3d or fever rises >38.3 degrees
Consider delayed prescription

140
Q

List complications of tonsillitis

A

Peritonsillar abscess- Quinsy
Otitis media- If infection spreads to inner ear
Scarlet fever
Rheumatic fever
Post-strep glomerulonephritis
Post-strep reactive arthritis

141
Q

Outline choice of antibiotic in tonsillitis

A

Penicillin V- Phenoxymethylpenicillin- 10d course
Penicillin allergy- Clarithromycin

142
Q

What is obstructive sleep apnoea?

A

Caused by collapse of pharyngeal airway

143
Q

List risk factors for OSA

A

Middle age
Male
Obesity
Alcohol
Smoking

144
Q

List features of OSA

A

Episodes of apnoea during sleep
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
Concentration problems
Reduced O2 sats during sleep
Severe cases can cause HTN, HF, increased risk of MI and stroke

145
Q

Outline management of OSA

A

ENT specialist
Specialist sleep clinic
Correct reversible risk factors- Stop drinking alcohol, stop smoking, lose weight
CPAP- Maintains patency of airway
Surgery- Significant reconstruction of soft palate and jaw- Uvulopalatopharyngoplasty (UPPP)
Full screening for occupation- Daytime sleepiness- No operating heavy machinery

146
Q

What are nasal polyps?

A

Growths of nasal mucosa that occur in nasal cavity or sinuses
Associated with inflammation and chronic rhinitis
Grow slowly, gradually obstruct nasal passage

147
Q

What is a red flag of a nasal polyp?

A

Unilateral polyp

148
Q

List associations of nasal polyps

A

Chronic rhinitis or sinusitis
Asthma
Samter’s triad (nasal polyps, asthma, aspirin intolerance/allergy)
Cystic fibrosis
Eosinophilic granulomatosis with polyangiitis

149
Q

What is in Samter’s triad?

A

Nasal polyps
Asthma
Aspirin intolerance/allergy

150
Q

Outline presentation of nasal polyps

A

Chronic rhinosinusitis
Difficulty breathing through nose
Snoring
Nasal discharge
Loss of sense of smell (anosmia)
Round pale grey/yellow growths on mucosal wall

151
Q

Outline management of nasal polyps

A

Unilateral polyp- Refer
Intranasal topical steroid drops/spray
Intranasal polypectomy
Endoscopic nasal polypectomy- If polyp further in nose/sinuses

152
Q

What is sinusitis?

A

Inflammation of paranasal sinuses of face
Usually accompanied by inflammation of nasal cavity- Rhinosinusitis
Acute- <12wks
Chronic- >12wks

153
Q

List the 4 sets of paranasal sinuses

A

Frontal sinuses (above eyebrows)
Maxillary sinuses (either side of nose below eyes)
Ethmoid sinuses (in ethmoid bone in middle of nasal cavity)
Sphenoid sinuses (in sphenoid bone at back of nasal cavity)

154
Q

Outline causes of sinuses

A

Infection- Particularly following viral URTI
Allergies- Hayfever (allergic rhinitis)
Obstruction of drainage- Foreign body, trauma, polyp
Smoking
People with asthma more likely to suffer from sinusitis

155
Q

Outline presentation of acute sinusitis

A

Recent viral URTI
Nasal congestion
Nasal discharge
Facial pain or headache
Facial pressure
Facial swelling over affected areas
Loss of smell

156
Q

Outline possible examination findings of sinusitis

A

Tenderness to palpation of affected areas
Inflammation and oedema of nasal mucosa
Discharge
Fever
Systemic infection signs- Tachycardia

157
Q

Outline presentation of chronic sinusitis

A

Duration >12wks
May be associated with nasal polyps

158
Q

Outline investigations of sinusitis

A

If symptoms persist despite treatment
Nasal endoscopy
CT scan

159
Q

Outline management of acute sinusitis

A

Systemic infection or sepsis- Admission to hospital for emergency management
Don’t offer antibiotics to patients with symptoms for up to 10d
Most cases viral and resolve within 2-3wks
If not improving after 10d- High dose steroid nasal spray for 14d (mometasone) and delayed antibiotic prescription (Pen V) if worsening/not improving within 7d

160
Q

Outline management of chronic sinusitis

A

Saline nasal irrigation
Steroid nasal sprays/drops (mometasone or fluticasone)
Functional endoscopic sinus surgery (FESS)

161
Q

Outline nasal spray technique

A

Tilt head slightly forward
Use left hand to spray right nostril and vice versa
Do not sniff hard during spray
Gently inhale through nose after spray

162
Q

What is functional endoscopic sinus surgery (FESS) and what is it used for?

A

Small endoscope inserted through nostrils and sinuses- Remove obstructions- Need CT scan before procedure to confirm diagnosis and assess structures

163
Q

List potential triggers of nosebleeds

A

Nose picking
Colds
Sinusitis
Vigorous nose-blowing
Trauma
Changes in weather
Coagulation disorder (thrombocytopenia or VWD)
Anticoagulation meds (aspirin, DOACs, warfarin)
Snorting cocaine
Tumours (SCC)

164
Q

What is the most common origin of nosebleeds?

A

Kiesselbach’s plexus located in Little’s area- Area of nasal mucosa at front of nasal cavity

165
Q

Are nosebleeds normally unilateral or bilateral?

A

Usually unilateral
If bilateral- May indicate bleeding posteriorly

166
Q

What are the risks of a posterior nose bleed?

A

Aspiration of blood
Usually bilateral

167
Q

Outline management of nosebleeds

A

Usually resolve
Recurrent- Investigate for thrombocytopenia or clotting disorders
Sit up, tilt head forward, squeeze soft part nostrils together for 10-15mins, spit out blood don’t swallow it
If not stopping- Nasal packing using nasal tampons or inflatable packs, Nasal cautery using silver nitrate sticks
After treating acute nosebleed- Can prescribe naseptin nasal cream (chlorhexidine and neomycin)- CI in peanut or soya allergy

168
Q

What are the five branches of the facial nerve?

A

Facial nerve exits brainstem at cerebellopontine angle- Passes through temporal bone and parotid gland
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

169
Q

What are the 3 functions of the facial nerve?

A

Motor
Sensory
Parasympathetic

170
Q

What is the motor function of the facial nerve?

A

Muscles of facial expression
Stapedius in inner ear
Posterior digastric, stylohyoid and platysma muscles of neck

171
Q

What is the sensory function of the facial nerve?

A

Carries taste from ant. 2/3 of tongue

172
Q

What is the parasympathetic function of the facial nerve?

A

Submandibular and sublingual salivary glands
Lacrimal gland (stimulating tear production)

173
Q
A

Final Year (14 decks)

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