ent Flashcards
NICE recommend that clinicians 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
rules for interpreting audiogram
< 20 = normal. > 20 = abnormal (need loudness to hear)
Air > bone = normal (alphabetically you I remember as A comes before B)
Bone > air = abnormal (it is abnormal to start counting alphabets from B)
this is conduction loss
Air + Bone loss = mixed sensory and conduction loss
sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo –> ?
Acute viral labrynthitis
Non-resolving otitis externa with worsening pain. Mx?
should be referred urgently to ENT
Horizontal nystagmus is a feature of____________
vestibular neuronitis
Recurrent otitis externa following numerous antibiotic treatment should raise suspicion of ________
Candida infection
Meniere’s tends to come in ________
episodes; no Hx makes Dx unlikely
otitis externa tx?
topical ciprofloxacin + dexamethasone
Gingival hyperplasia: _______________________________
phenytoin, ciclosporin, calcium channel blockers and AML
‘Double-sickening’ suggests –>
bacterial sinusitis
__________ may be useful in the acute phase of vestibular neuronitis, but should be stopped after a few days as it delays recovery by interfering with central compensatory mechanisms
Prochlorperazine
All post-tonsillectomy haemorrhages should be assessed by ENT
Unilateral glue ear in an adult:
needs evaluation for a posterior nasal space tumour
how would you describe the pain in sinusitis
frontal pressure pain which is worse on bending forward
tx for sinusitis lasting 10 or more days?
intranasal corticosteroids
what is double sickening
‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection
auricular haematomas - who is it common in? what do you want to avoid? how will you manage?
rugby players/wrestlers
cauliflower ear
samdeday assessment by ENT, incision and drainage
BPPV - Dx? TX?
Dx: Dix-hallpike manoeuvre
Tx: Epley manoeuvre
branchial cyst
smooth, soft, fluctuant, non-tender, does not move on swallowing, does not transilluminate
Pt born with cleft palate has foul-smelling, non-resolving discharge and hearing loss
Cholesteatoma - non-cancerous growth of squamous epithelium
what do you see on otoscopy for cholesteatoma?
‘attic crust’ - seen in the uppermost part of the ear drum
acoustic neuromas: damage to
- cranial nerve VIII:
- cranial nerve V:
- cranial nerve VII:
- cranial nerve VIII: hearing loss, vertigo, tinnitus
- cranial nerve V: absent corneal reflex
- cranial nerve VII: facial palsy
epistaxis: anterior vs posterior bleeds
anterior: visible source of bleeding, usually due to damage to Kiesselbache plexus
Posterior: more profuse bleeding, originates in deeper structures, higher risk of aspiration and airway compromise
Epistaxis Mx
- is pt stable? if yes
- Sit forward with mouth open
- Pinch nose firmly
If unsuccessful,
3. use topical antiseptic like Nasepetin
If bleeding persists for 10-15 min, consider
4. cautery - used if source of bleed is visible
5. packing if bleeding point cannot be visualised/cautery not tolerated
If pt unstable –> surgery (sphenopalatine ligation)
features of head/neck cancers
- neck lump
- hoarseness
- persistent sore throat
- persistent mouth ulcer
2 week wait for head and neck cancers: laryngeal, oral, thyroid
- laryngeal: age >45 with persistent unexplained hoarseness/neck lump
- ulceration in oral cavity lasting for more than 3 weeks
- thyroid: unexplained thyroid lump
When investigating patients with hoarseness a _______ should be considered
chest x-ray
to exclude apical lung lesions.
ear condition mostly found in diabetics + caused by pseudomonas aeruginosa
malignant otitis externa –> progresses to temporal bone osteomyelitis
Tx for Meniere’s: acute/prevention
acute: buccal/IM prochlorperazine
prevention: betahistine/vestibular rehab exercises
Samter’s triad
- asthma
- nasal polyps
- aspirin sensitivity
nose features that always require investigation
unilateral Sx
what shrinks nasal polyps well
topical corticosteroids
Cancer that is
- associated with EBV
- cervical lymphadenopathy
- otalgia, unilateral serous OM
- nasal obstruction
- cranial nerve palsies
nasopharyngeal
CT/MRI (combined)
treat with radiotherapy
you can tell its a thyroid swelling because
moves upwards with swallowing
otoscopy: red, swollen, or eczematous canal = _______. mx?
otitis externa
topical antibiotic or a combined topical antibiotic with a steroid
severe throat pain localising to one side + deviation of uvula to unaffected side + trismus + reduced neck mobility =
Peritonsillar abscess (quinsy)
which post-tonsillectomy haemorrhages must be seen by ENT?
all
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.
CENTOR score
Cough absent
Exudative tonsils
Node - lymphadenopathy
Temperature
Tx for sudden-onset SHL?
- urgent ENT referral
- high-dose corticosteroids
cyst that moves upwards with protrusion of tongue?
thyroglossal cyst
Elderly patient
Dizziness on extension of neck
Vertebrobasilar ischaemia
impt sign of acoustic neuroma?
absent corneal reflex
____________ is a treatment option for chronic rhinosinusitis
Nasal irrigation with saline solution
Unilateral glue ear in an adult:
Antibodies titres for streptolysin O
Diseases include rheumatic fever, post streptococcal glomerulonephritis and scarlet fever
Tx for otitis externa
NICE recommend that for mild cases (mild discomfort and/or pruritus; no deafness or discharge), consider prescribing topical acetic acid 2% spray.
When features of more severe inflammation are present they advise 7 days of a topical antibiotic with or without a topical steroid.
oral antibiotics (flucloxacillin) if the infection is spreading
If a patient fails to respond to topical antibiotics then the patient should be referred to ENT.
Otitis externa in diabetics:
in non-diabetics:
treat with ciprofloxacin to cover Pseudomonas
gentamicin
After fundoscopy, next Ix for suspected agre-related wet macular degenration
fluorescein angiography –> particularly useful for identifying macular neovascularisation, which is a hallmark of wet age-related macular degeneration (AMD)
Otitis externa in diabetics: treat with
ciprofloxacin to cover Pseudomonas
A 45-year-old male presents with a painful and swollen right cheek. He reports having a bad taste in his mouth and difficulty opening his mouth due to pain. Examination reveals a tender and erythematous swelling of the right parotid gland. The patient is febrile and has an elevated white blood cell count. What is the most likely diagnosis?
Sialadenitis
inflammation of the salivary glands. The parotid gland is the most commonly affected, and the presentation can be acute or chronic. Sialadenitis is typically caused by bacterial infection, and the symptoms include painful swelling of the affected gland, difficulty opening the mouth, fever, and a bad taste in the mouth. Treatment includes antibiotics and adequate hydration. Complications of sialadenitis include abscess formation, duct obstruction, and recurrent infections.
_______________ characteristically contain cholesterol crystals + commonly in anterior triangle of neck. ___________is more common in posterior triangle and transilluminates
Branchial cysts
Cystic hyGLOWma = transilluminates
____________________ is the persistent sensation of having a ‘lump in the throat’, when there is none
Globus pharyngis (also known as globus hystericus)
