ENT Flashcards
1
Q
When should prochlorperazine be used in vestibular neuronitis?
A
In the acute phases only as it can delay recovery if used long term
2
Q
What can be used to distinguish vestibular neuronitis from a posterior circulation stroke?
A
HiNTs exam - head impulse test, test of skew and assessing nystagmus
3
Q
What are the red flags of chronic rhinosinusitis?
A
unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis
4
Q
Chronic rhinosinusitis features? Predisposing factors?
A
Frontal pressure facial pain worse bending forward; nasal discharge/obstruction. Atopy; nasal obstruction (nasal polyps); recent infection (rhinitis); swimming; smoking
5
Q
Chronic rhinosinusitis Mx
A
Avoid allergen, intranasal corticosteroids, nasal irrigation with saline solution.
6
Q
Vestibular neuronitis vs acute labyrinthitis?
A
Hearing will not be affected in VN
7
Q
Ear swelling/rash behind the ear in someone with ?otitis media
A
Same day referral to Paeds ?Mastoiditis
8
Q
Horizontal nystagmus is a sign of what?
A
Vestibular neuronitis
9
Q
How should a perforated ear drum be managed?
A
Refer to ENT if persists beyond 6 weeks
10
Q
What is a C/I to prescribing naseptin cream?
A
peanut, soy or neomycin allergies
11
Q
conductive hearing loss, tinnitus and positive family history
A
Otosclerosis
12
Q
bilateral high-frequency hearing loss suggests what?
A
Prebycusis
13
Q
What are the 2 common post op complications of tonsillectomy?
A
- Pain
- Haemorrhage
14
Q
How does haemorrhage present following tonsillectomy?
A
Primary: Within 6-8 hours following surgery -> needs immediate return to theatre
Secondary: 5-10 days after surgery usually associated with wound infection -> treated with admission/abx
15
Q
When should intranasal steroids be considered for sinusitis?
A
If symptoms have been present for 10 days or more
16
Q
What is the management of acute sensorineural hearing loss?
A
Urgent referral to ENT for audiology and brain MRI
17
Q
What is Ludwigs angina?
A
A progressive cellulitis which invades floor of the mouth and soft tissues of the neck usually following dental infection
18
Q
How does Ludwigs angina present?
A
- Neck swelling
- Dysphagia
- Fever
- Needs immediate referral to hospital for airway management and IV Abx
19
Q
Management of post op stridor for thyroidectomy?
A
Urgent removal of sutures and call for senior help
20
Q
What does post thyroidectomy stridor suggest?
A
Post op bleed which build pressure behind suture line and compresses trachea causing stridor
21
Q
What are the NICE indications for tonsillectomy?
A
- Sore throats due to tonsillitis
- 5 or more episodes per year
- Symptoms occurring for atleast 1 year
- Episodes of sore throat are preventing normal function
22
Q
What is the most common cause of bacterial otitis media?
A
H influenzae
23
Q
What does pain on palpation of the tragus, itching, discharge and hearing loss suggest?
A
Otitis externa
24
Q
What is the management of a patient with persistent hoarse voice?
A
Refer to ENT
25
What causes gingival hyperplasia?
phenytoin, ciclosporin, calcium channel blockers and AML
26
When should Abx be given for acute otitis media?
- Symptoms lasting more than 4 days or not improving
- Systemically unwell but not requiring admission
- Immunocompromise or high risk of complications
- Younger than 2 years with bilateral otitis media
- Otitis media with perforation and/or discharge in the canal
If give Abx then 5-7d amoxicillin or clarithromycin
27
CP of acute otitis media?
Very common
Otalgia; fever (50%); hearing loss; recent URTI symptoms; ear discharge if tympanic membrane perforates.
28
Possible otoscopy findings in acute otitis media?
- bulging tympanic membrane → loss of light reflex
- opacification or erythema of the tympanic membrane
- perforation with purulent otorrhoea
- decreased mobility if using a pneumatic otoscope
29
Sequelae and Cx of acute otitis media?
- Otorrhoea if perforation of tympanic mem; CSOM (perforation with otorrhoea >6w)
- Cx: mastoiditis, meningitis, brain abscess, facial nerve paralysis
30
Which drugs cause tinnitus?
- Aspirin/NSAIDs
- Aminoglycosides e.g gentamicin
- Loop diuretics
- Quinine
31
What is the most important part of the tympanic membrane to visualise in patients with chronic discharge?
Attic - rule of cholesteatoma
32
After referral to ENT, patients with sudden onset sensorineural loss should be given what?
high-dose oral corticosteroids
33
What is an indication of positive Dix-Hallpike?
Rotatory nystagmus
34
What can be used to shrink nasal polyps?
Intranasal steroid spray/drops
35
What is the biggest risk factor for malignant otitis externa?
Diabetes Mellitus
36
What is malignant otitis externa?
Uncommon, most in diabetics; caused by pseudomonas aeruginosa. Starts in soft tissues of external auditory meastus then progresses to temporal bone osteomyelitis.
37
Key features in history for malignant otitis externa?
- diabetes or immunosupression
- severe unreleting deep-seated otalgia
- temoral headaches
- purulent otorrhea
- possible dysphagia, hoarseness and/or facial nerve dysfunction
38
Maligant otitis externa Mx?
Typically CT.
Non-resolving otitis externa worsening pain refer urgent ENT.
IV Abx that cover pseudomonal infections.
39
What is the most common cause of sudden onset sensorineural hearing loss?
Idiopathic
40
What is a complication of nasal trauma?
Nasal septal haematoma
41
What is a nasal septal haematoma?
- Bilateral red swelling arising from the nasal septum
- Needs ENT referral for surgical drainage and IV Abx
42
Otitis externa CP
Ear pain, itch, discharge. Otoscopy: red, swollen or exzematous canal.
43
What are signs of more severe otitis externa?
- a red, oedematous ear canal which is narrowed and obscured by debris
- conductive hearing loss
- discharge
- regional lymphadenopathy
- cellulitis spreading beyond the ear
- fever
44
How should otitis externa be managed?
Over the counter acetic acid ear drops or spray. Consider topical Abx or Abx + Steroids.
45
How to interpret audiograms?
1. is there anything below 20dB
yes = move to step 2
no = normal hearing
2. is there a gap? (b/w air and bone conduction)
yes = conductive or mixed hearing loss
no = sensorineural hearing loss
3. is one below or both below the 20dB line
one = conductive
both = mixed
46
What would be the results of audiometric testing for presbycusis?
Bilateral high-frequency hearing loss with air conduction better than bone
47
Patient with black/brown/green tongue?
- Think black hairy tongue
- More common in those with poor hygiene/IV drug users/HIV
- Treated with tongue scraping/antifungals if candida
48
What can occur after trauma to the ear?
Auricular haemtoma - needs same day assessment by ENT for drainage
49
What is the first line oral abx for otitis externa?
Oral Flucloxacillin
50
What is the management of otitis externa in diabetics?
Ciprofloxacin ear drops to cover for Pseudomonas
51
Elderly patient dizzy on extending neck/moving head up?
Vertebrobasilar ischaemia
52
Managament of Children presenting with glue ear with a background of Down's syndrome or cleft palate
Refer to ENT
53
Epistaxsis management?
1. Direct compression
2. Nasal cautery
3. Nasal packing
4. Aggressive therapies such as balloon catheter
54
Why do FBC when someone has epistaxis?
- Assess HB
- Assess platelet count
55
What is the term for pain upon swallowing?
Odynophagia
56
What is the name of the lymph node commonly enlarged in tonsillitis?
Jugulodigastric lymph node
57
What does difficulty swallowing solids suggests vs solids and liquids?
Solids - stricture issue (benign or malignant)
Both - motility issue
58
Management of oesophageal carcinoma
- Surgery
- Chemoradiotherapy
59
Recurrent otitis externa despite antibiotic treatment?
Candida
60
Unilateral symptoms in someone with chronic rhinosinusitis?
Urgent referral to ENT
61
BPPV Mx
Usually resolves spontaneously after w-mths. Symptomatic relief: epley manoeuvre, home exercies (Brandt-Daroff exercies); Betahistine prescribed. May reoccur 3-5yrs later.
62
dysphagia, regurgitation, halitosis, and a bulging neck on swallowing
Pharyngeal pouch
63
Branches of the facial nerve
Two Zebras Bite My Cake
Temporal
Zygomatic
Buccal
Mandibular
Cervical
64
What are long term impacts of Bells?
- Damage to eye
- Inability to close eye
- Altered taste
- Psychological impacts
65
What is vertigo?
The illusion of movement
66
Pathophysiology of BPPV
Debris in the semi circular canals which are disrupt movement of endolymph
67
BPPV CP
sudden onset dizziness and vertigo triggered by changes in head position. Typically 10-20secs, may be associated with nausea and +ve Dix-Hallpike manoeuvre.
68
How do childrens and adult eustachian tubes differ?
Childrens is shorter, narrower and more horizontal
69
What are the 4 paranasal sinuses?
Ethmoid, Frontal, Maxillary, Sphenoid
70
What are risk factors for head and neck cancers?
- Smoking
- HPV 16
- EBV
- Immunosuppression
- FH
71
Loss of corneal reflex
Acoustic neuroma
72
Unilateral glue ear in an adult
Refer to ENT to rule out posterior nasal space tumour
73
Prophylaxis of sinusitis?
Intranasal corticosteroids
74
What does ulnar deviation in someone with tonsillitis suggest?
Peritonsilar abscess- Quinsy
75
Atypical lymphocytes on blood film are suggestive of what?
Infective mono
76
palatal petechiae + cervical lymphadenopathy are suggestive of what?
Glandular fever
77
What can deranged LFTs with sore throat be indicative of>
Infective mononucleosis
78
What anaemia can infective mono cause?
Cold Haemolytic anaemia - IgM
79
C
80
Infectious mononucleosis (glandular fever) caused by what maining?
EBV. Spread by contact with saliva eg. kissing, sharing food or drink; sexual contact (blood/semen), blood transmission.
81
Infective mono triad?
sore throat, pyrexia and lymphadenopathy (anterior and posterior triangles of neck). Also: malaise, palatal petechiae, splenomegaly, hepatitis, lmphocytosis.
82
When do symptoms resolve in patients with infective mono? Incubation period?
After 2-4w, sometimes longer. Incubation period 4-7w. May be contagious for up to 18m after. EBV is lifelong latentent carrier state so may reactivate but doesn't always cause symptoms.
83
Infective mono diagnosis?
Monospot test (heterophil antibody test) and FBC in 2nd week of illness to confirm.
84
Infective mono Mx?
Supportive, rest, fluids, simple analgesia. AVOID SPORTS FOR 4 weeks AFTER having glandular fever to reduce risk of splenic rupture.
85
What happens to patients who take ampicillin/amoxicillin whilst they have infective mono?
Maculopapular pruritic rash.
86
Cx of infective mono
upper airway obstruction, splenic rupture, neutropenia, fatigue. if immunocompromised can lead to hodgkins or nasopharyngeal carcinoma.
87
OSA can cause what?
HTN
88
What are risk factors for OSA?
- Obesity
- Macroglossia (acromegaly, hypothyroidism)
- Large tonsils
- Marfans
89
What acid base problem can OSA cause?
Compensated respiratory acidosis
90
Epistaxis which fails all management may require ligation of what?
Sphenopalatine ligation
91
Types of epistaxis?
Anterior (visible source of bleeding, usually due to insult of network of capillaries forming Kiesselbach's plexus) and Posterior (profuse, deeper structures)
92
Epistaxis Mx
First aid measures (sit forward with mouth open and pinch carilaginous area of nose for >20min). If doesn't stop then cautery or packing.
93
What are signs of quinsy?
- Deviation of uvula to unaffected side
- Trismus
- Reduced neck mobility
- Bulging of the soft palate
94
Which organism cause quinsy?
Strep pyogenes
95
Management options for nasal fractures?
- See in clinic in a week to allow swelling to subside
- Manipulate under anaesthetic
96
Discharge from nose which tests positive for beta-2 transferrin?
CSF
97
Why should haematomas be aspirated as soon as possible?
Risk of avascular necrosis
98
What is a cholesteatoma?
Overgrowth of keratinised squamous epithelium in the middle ear
99
What can suggest cholesteatoma on otoscopy?
- Discharge
- Attic crust
- Retracted/Perforated tympanic membrane
100
What are complications of cholesteatoma?
- Facial nerve palsy
- Meningitis
- Abscess
- Deafness
- Recurence
101
What are signs of thyroglossal cyst?
- Moves up when protruding tongue
- Mobile
- Non tender
102
What causes trismus in quinsy?
Pus causes the pterygoid muscles to go into spasm which prevents a patient from opening their mouth
103
Post tonsillectomy haemorrhage?
Refer for same day ENT assessment even if bleeding has resolved
104
Hearing impairment post head trauma?
Perforated tympanic membrane
105
What is the name for a malignant tumour of the parotid gland?
Adenoid cystic carcinoma
106
Most common bacteria which cause otitis externa?
- Staph aureus
- Pseudomonas
107
What can be exacerbated in pregnancy?
Otosclerosis
108
Pink tinge to tympanic membrane?
Schwarze sign -> otosclerosis
109
What can be a S/E of removal of mastoid abscess?
Unilateral facial weakness -> facial nerve runs close to the mastoid
110
Which sinus is most commonly involved in chronic sinusitis when mucus drains out upon leaning forward?
Maxillary
111
Which virus is associated with squamous cell carcinoma of the oropharynx?
HPV
112
What is the pathophysiology of Menieres?
Excessive build up of endolymph in inner ear which increases pressure and disrupts sensory signals -> sensorineural hearing loss
113
What are symptoms of Ramsay-Hunt?
- Vesicular rash
- Facial weakness
- Vertigo
- Headaches
- Fever
- Tinnitus
114
What is a complication of untreated tonsillitis?
- Parapharyngeal abscess
- Lemeirre's syndrome: infective thrombophlebitis
115
What is the most common tumour of parotid gland?
Pleomorphic adenoma -> benign
116
Bilateral conductive hearing loss and tinnitus in young person?
Think otosclerosis
117
Snoring in someone with chronic sinusitis?
Nasal polyps have formed -> nasal steroid drops needed
118
Glue ear
Otitis media with an effusion, most children will have at least one episode. Peaks at 2yrs; hearing loss (conductive); secondary problems eg. speech delay, balance problems.
119
Glue ear Mx
Observe 3m if 1st presentation. Grommet insertion (does job normally done by eustachian tube allowing air to pass through middle ear, lasts 10m). Adenoidectomy.
120
Management of otosclerosis?
- Hearing aids
- Stapedectomy is gold standard
121
Unilateral glue ear?
Red flag -> nasopharyngeal carcinoma
122
Chinese person with history of EBV infection and one sided hearing loss?
Nasopharyngeal tumour
123
p16 is a marker for what?
HPV -> squamous cell carcinoma of oropharynx
124
What is temporo-mandibular joint dysfunction?
Pain in jaw with difficulty moving it as well as clicking/popping in the jaw when opening mouth
125
What can trigger temporomandibular dysfunction?
Trauma to the jaw
Stress
126
Management of TMD?
Resting, address triggers and ENT referral if severe
127
Anaphylaxis acute Mx
IM adrenaline 1:1000 in anterolateral aspect of middle third of thigh/arm. Repeat in 5mins if no response. If no response keep giving every 5mins. Remove trigger; Oxygen; inhaled salbutamol or ipratropium if wheezy/asthmatic.
128
Anaphylaxis Mx if presence of hypotension or shock, or poor response to adrenaline
IV fluid bolus (Hartmann's or saline), 500-100ml for adult or 10ml/kgfor child.
129
Adrenaline dose in anaphylaxis?
1mg/mL (1:1000) conc.
>12yrs= 500 micrograms (0.5ml 1:1000 solution)
6-12: 300
6m-6yrs: 150
<6m: 100-150
130
Anaphylaxis Mx following stabilisation
- oral antihistamines eg. chlorphenamine
- serum tryptase levels (elevated for 12hrs following acute episode)
- refer to specialist allergy service
- prescribe 2 adrenaline auto-injectors
- biphasic reaction can occur in up to 20% patients
131
Anaphylaxis discharge?
- Fast track (2hrs after symptom resolution): complete resolution and good response to single dose
- 6hrs after: 2 does of adrenaline or previous biphasic reaction
- 12hrs: >2 doses, severe asthma, ongoing reaction (eg. slow release meds), late at night.
132
Acute epiglottitis caused by?
H.influenzae type B
133
Acute epiglottitis features?
rapid onset, stridor, tripod position, drooling, high temp, generally unwell
134
Acute epiglottitis diagnosis?
If suspected DO NOT examine throat. Direct visualisation by senior staff. X-ray: lateral view will show swelling of epiglottis- thumb sign.
135
Acute epiglottitis Mx?
Immediate senior invol. (endotracheal intubation). Oxygen, IV antibiotics.
136
Croup cause and aage most common?
Parainfluenzae. 6m-3yrs.
137
Croup CP
Barking seal-like cough worse at night; stridor (due to laryngeal oedema and secretions); fever; retraction-increase work of breathing; coryzal
138
Croup sign on xray (posterior anterior view)
Steep sign due to subglottic narrowing
139
Croup Mx
Single dose dexamethasone (0.15mg/kg).
Emergency: high flow O2 and nebulised adrenaline
140
Vestibular schwannoma (acoustic neuroma) CP
Vertigo, hearing loss, tinnitus and absent corneal reflex. Seen in neurofibromatosis type 2.
Features can be precipitated by the affected CNs:
- cranial nerve VIII: vertigo, unilateral sensorineural hearing loss, unilateral tinnitus
- cranial nerve V: absent corneal reflex
- cranial nerve VII: facial palsy
141
Acoustic neuroma Ix
Urgent ENT referral. MRI of cerebellopontine angle and audiometry.
142
Acoustic neuroma Mx
Surgery, radiotherapy or observe. Often benign tumour, slow growing and often observed initially.
143
Acoustic neuroma?
account for approximately 5% of intracranial tumours and 90% of cerebellopontine angle tumours
144
Achalasia?
Failure of oesophageal peristalsis & relaxation of lower oesophageal sphincter due to degenerative loss of ganglia from Auerbach's plexus. LOS contracted, oesophagus above dilated.
145
Achalasia CP
Commonly middle aged. Dysphagia of BOTH liquids and solids, heartburn, regurgitation, malignant change in small no. patients.
146
Achalasia Ix
Oesophageal manometry: XS LOS tone which doesn't relax on swallowing. Barium swallow- bird's beak.
147
Achalasia Mx
Pneumatic (balloon) dilation. Surgical intervention with Heller cardiomyotomy if recurrent.
148
Causes of dysphagia
Oesophaeal cancer; oesophagitis; oesophageal candidiasis; achalasia; pharyngeal pouch; systemic sclerosis; MG; globus hystericus.
149
New onset dysphagia
Urgent endoscopy
150
Samter's triad
Association of asthma, aspirin sensitivity and nasal polyposis
151
What shrinks nasal polyps in 80% pts?
topical corticosteroids
152
Bell's palsy?
Acute unilateral, idiopathic facial nerve paralysis. ?HSV. More common in pregnant.
153
Bell's CP
LMN facial nerve palsy = forehead AFFECTED. Post-auricular pain, altered taste, dry eyes, hyperacusis.
154
Bell's Mx
Oral pred within 72hrs onset. Eyecare to prevent exposure keratopathy (artifical tears and eye lubricants, tape eye at night). If no improvement after 3w urgent ENT referral. Most fully recover in 3-4m.
155
Meniere's disease?
Disorder of inner ear of unknown cause. Excessive pressure and progressive dilation of endolymphatic system.
156
Meniere CP
Recurrent episodes of VERTIGO (20mins to 24hrs), tinnitus, hearing loss (sensorineural). Sensation of aural fullness or pressure; nystagmus; +ve Rombergs. Episodes mins to hrs. Usually unilateral.
157
Meniere Mx
ENT assessment to confirm. Inform DVLA- stop until control of symptoms. Acute attacks= buccal or IM prochlorperazine. Severe= admit for IV labyrinthine sedatives and fluids. Prevention= betahistine and vestibular rehab.
158
Face innervation
Trigeminal nerve (V) which has 3 branches: opthalmic (V1), maxillary (V2), mandibular (V3)
159
Facial pain differential diagnosis
Trigeminal neuralgia, sinusitis, dental problems, tension headache, migraine, giant cell arteritis.
160
Trigeminal neuralgia CP
Severe unilateral pain- brief electic shock like pains limited to 1+ divisions of trigeminal nerve. Evoked by light touch eg. shaving. Most idiopathic but sometimes by compression of nerve roots by tumour or vasular problems
161
Trigeminal neuralgia red flags
Sensory changes; deafness; pain only in opthalmic division (eye, forehead and nose); optic neuritis; Fx of MS; <40yrs; history of skin or oral lesions that could spread perineurally
162
Trigeminal neuralgia Mx
Carbamazepine 200mg 3/4times per day. Refer neurology if failure to respond.
163
Rinne's test
- Normal= air conduction>bone condition bilaterally
- Conductive hearing loss= BC>AC in affected ear
- Sensorineual hearing loss= AC>BC bilaterally
164
Weber test
- Normal= midline
- Conductive hearing loss= lateralises to affected ear
- Sensorineural hearing loss= lateralises to unaffected ear
165
Sensorineual hearing loss vs conductive hearing loss
Sensorineural hearing loss stems from damage in the inner ear, whereas conductive hearing loss is caused by a breakdown or blockage in the outer and/or middle ear.
166
Causes of hoarseness?
Voice overuse, smoking, viral illness, hypothyroidism, GORD, laryngeal cancer, lung cancer.
CXR should be considered to exclude apical lung lesions.
167
Suspected laryngeal cancer- ENT referral for people 45yrs+ with what?
Peristent unexplained hoarseness of unexplained lump in neck.
168
What does the term head and neck cancer include?
- oral cavity cancers
- cancers of pharynx (incl oropharynx, hypopharynx & nasopharynx)
- cancers of larynx
169
Features of head and neck cancers
neck lump, hoarseness, persistent sore throat, persistent mouth ulcer
170
When to consider 2ww cancer referral for oral cancer?
- unexplained ulceration in oral cavity >3w or
- persistent and unexplained lump in neck or
- (dentist) lump on lip/in oral cavity or red/red&white patch in oral cavity consistent with erythroplakia or erythroleukoplakia
171
2 ww cancer referral for thryoid cancer?
Unexplained thyroid lump
172
Causes of neck lumps
Reactive lymphadenopathy, lymphoma, thyroid swelling, thyroglossal cyst, pharyngeal pouch, cystic hygroma, branchial cyst, cervical rib, carotid aneurysm
173
Obstructive sleep apnoea/hypopnoea syndrome CP?
Snoring, daytime somnolence, compensated respiratory acidosis, HTN
174
Obstructive sleep apnoea/hypopnoea syndrome Ix?
Assess sleepiness: Epworth Sleepiness Scale, Multiple Sleep Latency Test.
Diagnostic= polysomnography.
175
Obstructive sleep apnoea/hypopnoea syndrome Mx
Weight loss; CPAP if moderate/severe; inform DVLA.
176
Polysomnography includes what?
EEG, respiratory airflow, thoraco-abdo movement, snoring and pulse oximetry.
177
Antiviral drug for influenza
Oral oseltamivir. Only if serious risk of developing serious complications or in an at risk group eg. pregnant
178
Sore throat includes what?
Pharyngitis, tonsilitis, larygngitis
179
Indications for Abx if sore throat?
Systemic very unwell;; 3 or more centor criteria present/ FeverPAIN score of 4 or 5; group A strep confirmed by rapid antigen testing, history RF, increased risk from acute infection eg. child with DM or immunodef.
180
Scoring systems that indicate need to ABx?
Centor cirteria and FeverPAIN (Fever over 38, Purulence- tonsillar exudate, Attend rapidly-3 days or less, severely Inflamed tonsils, No cough or coryza). Assesses likelihood of isolating strep and guide decision making re Abx.
181
Abx if indicated for sore throat
Phenoxymethylpenicillin or clarithromycin if allergy. Back-up prescription if don't improve within 3-5days or worsen rapidly. Abx only shorten symptoms by 16 hours and most people feel better within 1w regardless.
182
Main causes of viral URTIs?
Rhinoviruses most.
183
Cause of whooping cough?
Gram -ve Bordeteela pertussis. Vaccination doesn't have lifelong protection so adolescents and adults may still develop.
184
Features of whooping cough
- Catarrhal phase (1-2w)= similar to viral URTI
- Paroxysmal phase (2-8w)
- Convalescent phase= cough subsides over weeks to months
185
Paroxysmal phase of whooping cough
Cough increases in severity; worse at night and after eating; can cause vomiting and central cyanosis; inspiratory whoop (not always); infants- apnoea spells; subconjunctival haemorrhages or anoxia (causing syncope and seizures).
186
Diagnostic criteria for whooping cough?
Acute cough 14d or more without apparent cause + 1 or more of:
- paroxysmal cough
- inspiratory 'whoop'
- post-tussive vomiting
- undiagnosed apnoeic attacks in young infants
187
Diagnosis of whooping cough?
Nasal swab culture for Bordetella pertussis/PCR if cough <21d. Serology if cough >14d
188
Whooping cough Mx
- NOTIFIABLE DISEASE
- <6m admit to hospital
- if cough <21days then oral macrolide eg. clarithromycin
- school exclusion= 48hrs after starting Abx or 21 days from onset of symptoms.
- Close contacts (at risk or household)= clarithromycin
189
Whooping cough- pregnant?
- Erythromycin
- Vaccinate women between 16-32w
190
Cx of whooping cough
Subconjunctival haemorrhage, pneumonia, bronchiectasis, seizures.
191
Causes of tinnitus?
Idiopathic; meniere's; otosclerosis; SSNHL; acoustic neuroma; hearing loss; drugs (aspirin, NSAIDs, loop diuretics, aminoglycosides, quinnine); impacted ear wax
192
Assessment and Mx of tinnitus
- Audiological assessment. Sometimes MRI of internal auditory meatuses. If pulsatile then magnetic resonance angiography as may be vascular cause.
- Mx= TUC, amplification devices if associated hearing loss; support groups
193
194
What is vertigo?
False sensation that body or environment is moving
195
Causes of vertigo?
Viral labyrinthitis; vestibular neuronitis; BPPV; meniere's; vertebrobasilar ischaemia; acoustic neuroma; posterior circulation stroke; trauma; MS; Ototoxicity eg. gentamicin.
196
Vestibular neuronitis?
Cause of vertigo often develops following viral infection
197
Vestibular neuronitis CP?
Recurrent vertigo attacks lasting hrs or days; nausea & vomiting; horizontal nystagmus; no hearing loss or tinnitus
198
Vestibular neuronitis differentials?
Viral labryinthitis; posterior circulation stroke (the HiNTs exam can distinguish)
199
Vestibular neuronitis Mx
Buccal or IM prochlorperazine for rapid relief for severe. Less severe: oral prochlorperazine or antihistamine eg. cyclizine. Vestibular rehab exercises preferred.
200
What is peritonsillar abscess (qunisy)?
Peritonsillar abscess develops as a Cx of bacterial tonsillitis
201
CP of quinsy?
Severe throat pain lateralises to one side; deviation of uvula to unaffected side; trismus (diff opening mouth); reduced neck mobility
202
Qunisy Mx
Urgent ENT review. Needle aspiration or inscision & drainage + IV Abx. Tonsillectomy considered to prevent recuurence.
203
Post op Cx of tonsillectomy?
Pain (increase for up to 6days after). Haemorrhage- all should be assessed by ENT.
204
Primary or reactionary haemorrhage following tonsillectomy?
First 6-8hrs after surgery; immediate return to theatre
205
Secondary haemorrhage after tonsillectomy?
>24hrs-10d after surgery, often associated with wound infection. Admission and Abx, severe may need surgery.
206
Cx of tonsillitis?
Otitis media; quinsy; RF and glomerulorephritis very rare
207
Indications for tonsillectomy?
- Sore throats are due to tonsillitis (eg. not URTR)
- 7 episodes for 1 year; 5 per year for 2 years or 3 per year for 3 years and no other explanation for recurrent symptoms
- episodes are disabling and prevent normal functioning
208
Rare indications for tonsillectomy?
Recurrent febrile convulsions secondary to tonsillitis; obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils; quinsy if unresp to standard Mx
209
What is Ramsay hunt syndrome (herpes zoster oticus) caused by?
Reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.
210
Ramsay hunt syndrome (herpes zoster oticus) Mx?
Oral aciclovir and corticosteroids
211
3 pairs of salivary glands?
parotid (serous) - most tumours
submandibular (mixed) - most stones
sublingual (mucous)
212
Branchial cysts characteristically contain what?
Cholesterol crystals
213
Immunocompromised patients with poor dentition can develop airway compromise from cellulitis at the floor of the mouth known as?
Ludwig's angina
214
Loop diuretics can be a cause of...
Tinnitus
215
Elderly patient dizzy on extending neck
Vertebrobasilar ischaemia
216
Otosclerosis may be precipiated by
pregnancy in those who are genetically predisposed
217
What does spontaneous rotatory nystagmus and positive head impulse test suggest?
Signs of a peripheral cause of vertigo (not central).
218
Peripheral causes of vertigo?
BPPV, middle ear infections, menieres, vestibular neuritis ect.
219
Central causes of vertigo?
Stroke, tumours
220
Most common bacterial cause of ottitis media?
H.influenzae
221
Rhinitis medicamentosa?
Rebound nasal congestion brought on by extended use of topical decongestants
222
Mastoiditis Mx?
IV antibiotics
223
Complications of thyroid surgery
Damage to parathyroid glands can result in hypocalcaemia
224
If a perforated tympanic membrane does not heal by itself what may be performed?
myringoplasty
225
In patients with chronic or recurrent ear discharge, ensure the attic is visualised to exclude...
cholesteatoma
226
Consider 2ww appointment for laryngeal cancer in people >45yrs and over with...
persistent unexplained hoarseness or unexplained lump in neck
227
Consider 2ww appointment for oral cancer in people with....
unexplained ulceration in oral cavity lasting >3w or persistent and unexplained lump in neck
228
Consider urgent 2ww referral for oral cancer by dentist in people with...
lump on lip or in oral cavity or a red/red and white patch in oral cavity consistent with erythroplakia or erythroleukoplakia
229
Consider 2ww for thyroid cancer in people with...
Unexplained thyroid lump
230
Reactive lymphadenopathy
By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness
231
Lymphoma
Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly
232
Thyroid swelling
May be hypo-, eu- or hyperthyroid symptomatically
Moves upwards on swallowing
233
Thyroglossal cyst
More common in patients < 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected
234
Pharyngeal pouch
More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough, halitosis.
235
Cystic hygroma
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
236
Brachial cyst
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
237
Cervical rib
More common in adult females
Around 10% develop thoracic outlet syndrome
238
Carotid aneurysm
Pulsatile lateral neck mass which doesn't move on swallowing
239
Thyroid nodules may be found by...
pt, during exam or imaging
240
Primary aim of investigating thyroid nodules?
exclude thyroid ca, accounts for 5% of all nodules
241
Benign causes of thyroid nodules?
Multinodular goitre
Thyroid adenoma
Hashimoto's thyroiditis
Cysts (colloid, simple, or hemorrhagic)
242
Malignant causes of thyroid nodules?
Papillary carcinoma (most common malignant cause)
Follicular carcinoma
Medullary carcinoma
Anaplastic carcinoma
Lymphoma
243
Ix for thyroid nodules?
TFTs
USS
244
