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GP - General Practice > ENT > Flashcards

ENT Flashcards

1
Q

70% of tonsillitis is caused by viral infections, 30% by bacterial. What is the presentation of tonsillitis?

A

Pain on swallowing
fever, nausea, vomiting, headache
Tonsillar exudates

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2
Q

A 10 year old patient presents with the following
Pain on swallowing
37 degree fever, nausea, vomiting, headache
Tonsillar exudates
No other findings
What is your next step in managing this patient?

A

Investigations are not routinely performed for tonsillitis
=> send patient home with analgesics, antipyretics and advise increased fluid intake
Salt water gargles also advised
+
Give delayed prescription to collect in 5 days if not feeling better

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3
Q

90% of tonsillitis cases resolve within 1 week without treatment. When are antibiotics prescribed for tonsillitis

A

1) Delayed prescription if not improving within 5 days
2) 3+ on Centor Score
3) 4+ on FPAIN score
4) Systemically unwell

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4
Q

A patient with tonsillitis is sent home with analgesics, antipyretics and advised increased fluid intake as well salt-water gargles. You prescribe delayed antibiotics incase there is no improvement within 5 days. Give 2 antibiotics you would prescribe

A

Phenoxymethylpenicillin
erythromycin
clarithromycin

point is not amoxicillin to prevent rash in glandular fever

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5
Q

Explain the Centor Score

A

Score used to indicate antibiotic use for tonsillitis. 3+ indicates this
1) Fever >38
2) Tonsillar exudate
3) Tender Ant. Cervical LN
4) No cough

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6
Q

Explain the FPAIN score

A

Score used to indicate antibiotic use for tonsillitis. 4+ indicates this
Fever (>38)
Pus (Tonsillar exudate)
Attends rapidly (<3 days from onset)
Inflamed tonsils
No cough/coryza

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7
Q

a 14 year old presents with persistent fever and sore throat lasting 2 weeks. On examination, the tonsils appear inflamed and there is pain on swallowing. What is the most likely diagnosis?

What are some other findings present on exam?

A

Glandular fever

lymphadenopathy is present (mobile, tender, and soft).
+ Splenomegaly

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8
Q

Give 5 complications of tonsillitis

A

1) Rheumatic fever
2) Glomerulonephritis
3) Quinsy (Peritonsillar abscess)
4) Retropharyngeal Abscess
5) Glandular fever

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9
Q

What are the features of Quinsy?

A

Peritonsilar swelling deviating Uvula
Hot potato mouth => difficulty swallowing and speaking
Trismus

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10
Q

What is trismus

A

Jaw muscle spasms => unable to open jaw

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11
Q

What is the management of Quinsy?

A

Refer for IV antibiotics and incisional drainage

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12
Q

Which typically occurs in children? Reteopharyngeal abscess or Quinsy (Peritonsillar abscess)?

A

Retropharyngeal occurs in children
Peritonsillar typically occurs in adults (presents with inability to swallow and also tx via IV antibiotics and incisional drainage)

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13
Q

What is the causative organism in glandular fever?

How would you confirm the diagnosis in a child presenting with tonsillitis?

How is it managed?

A

EBV

1) FBC showing atypical WCC
2) Raised LFTs
3) Monospot test for EBV

Management is supportive => rest, fluids, paracetamol, salt water gargles etc.

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14
Q

What advice would you give the child’s parents after confirming diagnosis of glandular fever with lymphadenopathy and splenomegaly on abdominal exam?

The child’s parents return with worsened symptoms and the child can barely breath. Before sending him off to A&E what would you give the child?

A

No contact sports or heavy lifting for 1 week (splenic rupture)

In severe cases of glandular fever, give Prednisolone

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15
Q

An elderly patient presents with unilateral tonsillar swelling. They do not have a fever, no exudate from tonsils, no lymphadenopathy and no sore throat. What is the reason behind this?

What is the next step?

A

Tonsillar tumour
Refer to ENT for excisional biopsy

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16
Q

Hoarseness is the change in the quality of the voice affecting pitch, volume or resonance. Give 5 causes

A

1) Damage to vocal cords (URTI, laryngitis, trauma, carcinoma, hypothyroidism, instrumentation)
2) Neurological problems (Laryngeal nerve palsy, laryngomalacia, myasthenia gravis, motor neuron disease, MS)
3) Muscular dystrophy
4) Functional
5) Tracheostomy

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17
Q

A patient presents with hoarsness, fever and pain when speaking. What is the most likely diagnosis?

How will you manage this patient?

A

Laryngitis

Typically viral infection => supportive. there may be a superinfection though so if it does not improve, give antibiotics

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18
Q

A singer presents with hoarsness of voice and is worried about her musical next week. What is the most likely diagnosis?

How will you manage this patient?

A

Vocal cord nodules

Rest voice and if this does not resolve it, then refer to ENT for surgical removal

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19
Q

What are the risk factors for laryngeal carcinoma (3)?

How will you manage this patient?

A

Smoking, alcohol, HPV 16/18 (like everything)

Refer to ENT for flexible laryngoscopy (and then surgery, radiotherapy…)

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20
Q

Give 5 complications of a tracheostomy

A

!Excessive secretions
!Stenosis (=> ENT referral)
!Recurrent pneumonia
Difficulty swallowing
Speech difficulties
Depression

21
Q

Sinusitis is the inflammation of one of the sinuses (frontal, maxillary, ethmoid, sphenoid). How does sinusitis present?

how is it managed?

A

Presents with all the usual shit but must mention Headache!! and Facial pain!!

1) Decongestants
2) Steroid nasal sprays
3) Antibiotics only if severe and not resolving (vast majority are viral)
4) ENT referral

22
Q

A patient presents to the GP with sinusitis. On examination they are sent to A&E due to a complication. What is this complication?

A

Orbital cellulitis
or Potty Puff’s tumour (frontal osteomyelitis)

23
Q

A patient has recurrent sinusitis (>3/yr) with one of them lasting >3 months. They suffer from post-nasal drip, a frontal headache, facial pain and anosmia. With this, they are diagnosed with chronic sinusitis.

On examination of the nose, what is found? (typically associated with it)

What other disease is chronic sinusitis associated with?

How is chronic sinusitis treated?

A

Chronic sinusitis is associated with nasal polyps and vasomotor rhinitis

Tx:
As acute:
1) Decongestants
2) Steroid nasal sprays
3) Antibiotics only if severe and not resolving (vast majority are viral)
4) ENT referral

+ Nasal irrigation with saline

24
Q

A patient presents with nasal discharge that is recurrent as well as sneezing and nasal congestion. They do not have any facial pain nor a headache. What is the most likely diagnosis?

A

Rhinitis

25
Q

What are the 2 types of rhinitis?

A

Allergic rhinitis
Vasomotor rhinitis

Both can be perennial (all year) or seasonal and can be intermittent or persistent

26
Q

Rhinitis is the inflammation of the nasal mucosa. What is vasomotor rhinitis?

A

Vasomotor rhinitis is rhinitis triggered by physical/chemical agents such as cold air, tobacco, perfume, or drug induced

27
Q

How is allergic rhinitis diagnosed?

What is the treatment ladder for it? (also include what is used in acute cases)

A

1) Skin prick test or RAS test
2) Blood showing increased eosinophils and IgE

Tx:
Acute -> Nasal steroid spray (fluticazone)
1) Prevention of triggers (e.g. wear face mask in pollen season)
2) Antihistamines
3) LTRA (like asthma)
4) Immunotherapy (desensitisation)

28
Q

Define Hayfever

How is it managed?

A

Rhinitis +/- conjunctivitis +/- wheeze due to allergic reaction to pollen

1) Avoid triggers (when pollen count is high, close windows, pollen filter, eye glasses, avoid grassy places)
2) Topical chromone eyedrops
+ tx of allergic rhinitis
3) Tx of Allergic rhinitis => antihistamines, LTRA, immunotherapy

29
Q

An ear ache can have a large set of differentials as it can be classified as local or referred pain from cranial nerves. Give 5 ddx

A

Just keep looking at it. Unlikely to be important just remember what can be referred

30
Q

What is Myringitis?

What is Myringitis Bullosa?

A

Myringitis is the inflammation of the tympanic membrane

Myringitis Bullosa is painful vesicles on tympanic membrane causing inflammation. A/w mycoplasma and URTI

31
Q

Give 4 differentials for otorrhoea

A

Otitis externa
Perforated otitis media
Cholesteatoma
CSF leak

32
Q

A patient presents to you with ear pain on his right ear. They said it started the day after they went swimming. They mention the same thing happened to a friend of his who wears a hearing aid but that was much worse than what he had and had to be admitted to hospital immediately.

What is the most likely diagnosis?

What would the results of the Rinne and Weber test show?

What did the friend likely have? What can pre-dispose his friend to having that diagnosis?

A

Otitis Externa
Conductive hearing loss => BC>AC on right side with sound being heard louder on the SAME side

His friend has necrotizing otitis externa which occurs in diabetic and immunosuppressed individuals with otitis externa

33
Q

How is otitis externa managed?

A

1) Aluminum acetate drops/steroids/antibiotics
2) Otosporin (antibiotic + steroid drops)

34
Q

A patient presents with severe ear pain that is exacerbated by moving the tragus and when opening the jaw. What is the most likely diagnosis?

What would be found on exam to confirm the diagnosis?

How is it treated?

A

Forniculosis

Boil in ear canal +/- cellulitis

Tx:
If no cellulitis => analgesia + Hot compress
If surrounding cellulitis => Flucloxacillin
If large/unresolving => refer to ENT for incision and draining

35
Q

Ear wax is only a problem if there is an obstruction to the normal extrusion of wax (hearing aid, wax impaction) causing deafness, pain or other related sx.
If that is the case, how is it managed?

A

1) Ear syringing/irrgiation (given cerumenolytics) earwax is called cerumen
2) Referral for microsuction by ENT

36
Q

What are the contraindications to ear irrigation/syringing for wax impaction?

A

1) deafness in other ear
2) Grommet or hx of perforation in same ear
3) Previous mastoid procedure
4) Chronic middle ear disease

37
Q

A patient presents with ear pain worse in the cold. It started after waking up one day when sleeping on that side and now it is painful to sleep on that side. On examination there is a tender lump on the pinna of the hear. It does not resemble a gouty tophus and the dermatologist has confirmed that it is not an SCC nor a BCC. What is the most likely diagnosis?
How is it managed?

A

CNH - Chondrodermatitis Nodularis Helicis
Tx:
1) Pressure relief
2) Topical steroids
3) Antibiotic cream
4) Referral to ENT for Cryotherapy or surgical excision

38
Q

A patient presents with severe ear pain. On exam, there is a red, bulging tympanic membrane with reduced movement on otoscopy. How is it managed?

A

Conservative: Healthy children => 72 hour observation with analgesia and antipyretic

Medical: (if unwell, or otorrhoea) Amoxicillin or co-amoxiclav.

Surgical: (if recurrent/unresolving) => Grommet placement

39
Q

Where is a grommet inserted?

What is it’s role?

How long does it last?

Can you swim with it in?

A

Inserted in the anterior inferior quadrant of the tympanic membrane at the light reflex.

Prevents fluctuations between the external and inner ear and relieves the pressure.

Lasts approximately 9 months before extruding on its own

Yes you can swim with it but not dive

40
Q

What is the medical term for glue ear?

What is its pathophysiology?

A

Serous secretory otitis media

Non-infected fluid accumulation in the middle ear due to ET dysfunction/obstruction typically secondary to throat infection or tonsillar hyperplasia

41
Q

A patient presents with persistent otorrhoea for 1 month in the left ear. There is no pain. What is the most likely diagnosis?

A

Chronic suppurative otitis media (no pain because it has perforated but infection still there)

42
Q

A patient presents with persistent otorrhoea for 1 month in the left ear. There is no pain. On otoscopy, there appears to be central perforation of the tympanic membrane. They were diagnosed with chronic suppurative otitis media. What is the most appropriate next step in management?

What would the results of the Renne and Weber test show?

A

If central perforation => safe disease -> treat with topical steroid or antibiotic drops

Conductive hearing loss => BC>AC on left side with sound being heard louder on the SAME side

43
Q

A patient presents with persistent otorrhoea for 1 month in the right ear. There is no pain. On otoscopy, there appears to be marginal perforation in the attic of the tympanic membrane. They were diagnosed with chronic suppurative otitis media. What is the most appropriate next step in management?

What would the results of the Renne and Weber test show?

A

If attic or marginal perforation => unsafe disease => may indicate cholesteatoma => referral to ENT

Sensorineural hearing loss (that is ofcourse once it is confirmed to be a cholesteatoma)
=>AC>BC in both ears with lateralization to the CONTRALATERAL side => to the right ear

44
Q

What is a cholesteatoma?
Include where it is located and the main complications

A

Stratified squamous epithelium in the middle ear!! from retraction pockets in the pars flaccida. It grows and affects nearby structures including inner ear causing !!sensorineural hearing loss and facial nerve palsy!!

45
Q

A 2 year old child is brought to the GP office by his mother. She explains that he keeps crying and putting his hand on his ear. She also notices that he speaks less and doesnt turn around to look at her when calling him. What is the most likely diagnosis?

What would be seen on otoscopy?

How is this managed?

A

Glue ear or serous secretory otitis media

Dull, retracted tympanic membrane with brown-yellow tinge

Typically resolves in 3 months on its own, otherwise refer to ENT

46
Q

Mastoiditis is a complication of otitis media and presents as severe otitis media. How is it managed?

A

Referral to ENT for IV antibiotics

47
Q

Tympanosclerosis is the scarring of the tympanic membrane. How is it managed?

A

No management necessary

48
Q

A patient presents to you with ear pain. They are a diver who has just come back from the maldives. They say there was a bloody discharge when it started and nothing happened after that. What is the most likely cause of the ear pain?

How is it managed?

A

Barotrauma

Resolves spontaneously but if not, refer to ENT

GP - General Practice (15 decks)

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