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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

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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

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3
Q

What are the red flags of chronic rhinosinusitis?

A

unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis

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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

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5
Q

Chronic rhinosinusitis Mx

A

Avoid allergen, intranasal corticosteroids, nasal irrigation with saline solution.

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6
Q

Vestibular neuronitis vs acute labyrinthitis?

A

Hearing will not be affected in VN

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7
Q

Ear swelling/rash behind the ear in someone with ?otitis media

A

Same day referral to Paeds ?Mastoiditis

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8
Q

Horizontal nystagmus is a sign of what?

A

Vestibular neuronitis

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9
Q

How should a perforated ear drum be managed?

A

Refer to ENT if persists beyond 6 weeks

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10
Q

What is a C/I to prescribing naseptin cream?

A

peanut, soy or neomycin allergies

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11
Q

conductive hearing loss, tinnitus and positive family history

A

Otosclerosis

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12
Q

bilateral high-frequency hearing loss suggests what?

A

Prebycusis

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13
Q

What are the 2 common post op complications of tonsillectomy?

A
  • Pain
  • Haemorrhage
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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

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15
Q

When should intranasal steroids be considered for sinusitis?

A

If symptoms have been present for 10 days or more

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16
Q

What is the management of acute sensorineural hearing loss?

A

Urgent referral to ENT for audiology and brain MRI

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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

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18
Q

How does Ludwigs angina present?

A
  • Neck swelling
  • Dysphagia
  • Fever
  • Needs immediate referral to hospital for airway management and IV Abx
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19
Q

Management of post op stridor for thyroidectomy?

A

Urgent removal of sutures and call for senior help

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20
Q

What does post thyroidectomy stridor suggest?

A

Post op bleed which build pressure behind suture line and compresses trachea causing stridor

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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
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22
Q

What is the most common cause of bacterial otitis media?

A

H influenzae

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23
Q

What does pain on palpation of the tragus, itching, discharge and hearing loss suggest?

A

Otitis externa

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24
Q

What is the management of a patient with persistent hoarse voice?

A

Refer to ENT

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25
Q

What causes gingival hyperplasia?

A

phenytoin, ciclosporin, calcium channel blockers and AML

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26
Q

When should Abx be given for acute otitis media?

A
  • 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
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27
Q

CP of acute otitis media?

A

Very common
Otalgia; fever (50%); hearing loss; recent URTI symptoms; ear discharge if tympanic membrane perforates.

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28
Q

Possible otoscopy findings in acute otitis media?

A
  • 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
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29
Q

Sequelae and Cx of acute otitis media?

A
  • Otorrhoea if perforation of tympanic mem; CSOM (perforation with otorrhoea >6w)
  • Cx: mastoiditis, meningitis, brain abscess, facial nerve paralysis
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30
Q

Which drugs cause tinnitus?

A
  • Aspirin/NSAIDs
  • Aminoglycosides e.g gentamicin
  • Loop diuretics
  • Quinine
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31
Q

What is the most important part of the tympanic membrane to visualise in patients with chronic discharge?

A

Attic - rule of cholesteatoma

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32
Q

After referral to ENT, patients with sudden onset sensorineural loss should be given what?

A

high-dose oral corticosteroids

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33
Q

What is an indication of positive Dix-Hallpike?

A

Rotatory nystagmus

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34
Q

What can be used to shrink nasal polyps?

A

Intranasal steroid spray/drops

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35
Q

What is the biggest risk factor for malignant otitis externa?

A

Diabetes Mellitus

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36
Q

What is malignant otitis externa?

A

Uncommon, most in diabetics; caused by pseudomonas aeruginosa. Starts in soft tissues of external auditory meastus then progresses to temporal bone osteomyelitis.

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37
Q

Key features in history for malignant otitis externa?

A
  • diabetes or immunosupression
  • severe unreleting deep-seated otalgia
  • temoral headaches
  • purulent otorrhea
  • possible dysphagia, hoarseness and/or facial nerve dysfunction
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38
Q

Maligant otitis externa Mx?

A

Typically CT.
Non-resolving otitis externa worsening pain refer urgent ENT.
IV Abx that cover pseudomonal infections.

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39
Q

What is the most common cause of sudden onset sensorineural hearing loss?

A

Idiopathic

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40
Q

What is a complication of nasal trauma?

A

Nasal septal haematoma

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41
Q

What is a nasal septal haematoma?

A
  • Bilateral red swelling arising from the nasal septum
  • Needs ENT referral for surgical drainage and IV Abx
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42
Q

Otitis externa CP

A

Ear pain, itch, discharge. Otoscopy: red, swollen or exzematous canal.

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43
Q

What are signs of more severe otitis externa?

A
  • a red, oedematous ear canal which is narrowed and obscured by debris
  • conductive hearing loss
  • discharge
  • regional lymphadenopathy
  • cellulitis spreading beyond the ear
  • fever
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44
Q

How should otitis externa be managed?

A

Over the counter acetic acid ear drops or spray. Consider topical Abx or Abx + Steroids.

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45
Q

How to interpret audiograms?

A
  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
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46
Q

What would be the results of audiometric testing for presbycusis?

A

Bilateral high-frequency hearing loss with air conduction better than bone

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47
Q

Patient with black/brown/green tongue?

A
  • Think black hairy tongue
  • More common in those with poor hygiene/IV drug users/HIV
  • Treated with tongue scraping/antifungals if candida
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48
Q

What can occur after trauma to the ear?

A

Auricular haemtoma - needs same day assessment by ENT for drainage

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49
Q

What is the first line oral abx for otitis externa?

A

Oral Flucloxacillin

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50
Q

What is the management of otitis externa in diabetics?

A

Ciprofloxacin ear drops to cover for Pseudomonas

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51
Q

Elderly patient dizzy on extending neck/moving head up?

A

Vertebrobasilar ischaemia

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52
Q

Managament of Children presenting with glue ear with a background of Down’s syndrome or cleft palate

A

Refer to ENT

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53
Q

Epistaxsis management?

A
  1. Direct compression
  2. Nasal cautery
  3. Nasal packing
  4. Aggressive therapies such as balloon catheter
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54
Q

Why do FBC when someone has epistaxis?

A
  • Assess HB
  • Assess platelet count
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55
Q

What is the term for pain upon swallowing?

A

Odynophagia

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56
Q

What is the name of the lymph node commonly enlarged in tonsillitis?

A

Jugulodigastric lymph node

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57
Q

What does difficulty swallowing solids suggests vs solids and liquids?

A

Solids - stricture issue (benign or malignant)
Both - motility issue

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58
Q

Management of oesophageal carcinoma

A
  • Surgery
  • Chemoradiotherapy
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59
Q

Recurrent otitis externa despite antibiotic treatment?

A

Candida

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60
Q

Unilateral symptoms in someone with chronic rhinosinusitis?

A

Urgent referral to ENT

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60
Q

BPPV Mx

A

Usually resolves spontaneously after w-mths. Symptomatic relief: epley manoeuvre, home exercies (Brandt-Daroff exercies); Betahistine prescribed. May reoccur 3-5yrs later.

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61
Q

dysphagia, regurgitation, halitosis, and a bulging neck on swallowing

A

Pharyngeal pouch

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62
Q

Branches of the facial nerve

A

Two Zebras Bite My Cake
Temporal
Zygomatic
Buccal
Mandibular
Cervical

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63
Q

What are long term impacts of Bells?

A
  • Damage to eye
  • Inability to close eye
  • Altered taste
  • Psychological impacts
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64
Q

What is vertigo?

A

The illusion of movement

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65
Q

Pathophysiology of BPPV

A

Debris in the semi circular canals which are disrupt movement of endolymph

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66
Q

BPPV CP

A

sudden onset dizziness and vertigo triggered by changes in head position. Typically 10-20secs, may be associated with nausea and +ve Dix-Hallpike manoeuvre.

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67
Q

How do childrens and adult eustachian tubes differ?

A

Childrens is shorter, narrower and more horizontal

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68
Q

What are the 4 paranasal sinuses?

A

Ethmoid, Frontal, Maxillary, Sphenoid

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69
Q

What are risk factors for head and neck cancers?

A
  • Smoking
  • HPV 16
  • EBV
  • Immunosuppression
  • FH
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70
Q

Loss of corneal reflex

A

Acoustic neuroma

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71
Q

Unilateral glue ear in an adult

A

Refer to ENT to rule out posterior nasal space tumour

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72
Q

Prophylaxis of sinusitis?

A

Intranasal corticosteroids

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73
Q

What does ulnar deviation in someone with tonsillitis suggest?

A

Peritonsilar abscess- Quinsy

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74
Q

Atypical lymphocytes on blood film are suggestive of what?

A

Infective mono

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75
Q

palatal petechiae + cervical lymphadenopathy are suggestive of what?

A

Glandular fever

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76
Q

What can deranged LFTs with sore throat be indicative of>

A

Infective mononucleosis

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77
Q

What anaemia can infective mono cause?

A

Cold Haemolytic anaemia - IgM

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77
Q

C

A
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78
Q

Infectious mononucleosis (glandular fever) caused by what maining?

A

EBV. Spread by contact with saliva eg. kissing, sharing food or drink; sexual contact (blood/semen), blood transmission.

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79
Q

Infective mono triad?

A

sore throat, pyrexia and lymphadenopathy (anterior and posterior triangles of neck). Also: malaise, palatal petechiae, splenomegaly, hepatitis, lmphocytosis.

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80
Q

When do symptoms resolve in patients with infective mono? Incubation period?

A

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.

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81
Q

Infective mono diagnosis?

A

Monospot test (heterophil antibody test) and FBC in 2nd week of illness to confirm.

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82
Q

Infective mono Mx?

A

Supportive, rest, fluids, simple analgesia. AVOID SPORTS FOR 4 weeks AFTER having glandular fever to reduce risk of splenic rupture.

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83
Q

What happens to patients who take ampicillin/amoxicillin whilst they have infective mono?

A

Maculopapular pruritic rash.

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84
Q

Cx of infective mono

A

upper airway obstruction, splenic rupture, neutropenia, fatigue. if immunocompromised can lead to hodgkins or nasopharyngeal carcinoma.

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85
Q

OSA can cause what?

A

HTN

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86
Q

What are risk factors for OSA?

A
  • Obesity
  • Macroglossia (acromegaly, hypothyroidism)
  • Large tonsils
  • Marfans
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87
Q

What acid base problem can OSA cause?

A

Compensated respiratory acidosis

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88
Q

Epistaxis which fails all management may require ligation of what?

A

Sphenopalatine ligation

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89
Q

Types of epistaxis?

A

Anterior (visible source of bleeding, usually due to insult of network of capillaries forming Kiesselbach’s plexus) and Posterior (profuse, deeper structures)

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90
Q

Epistaxis Mx

A

First aid measures (sit forward with mouth open and pinch carilaginous area of nose for >20min). If doesn’t stop then cautery or packing.

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91
Q

What are signs of quinsy?

A
  • Deviation of uvula to unaffected side
  • Trismus
  • Reduced neck mobility
  • Bulging of the soft palate
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92
Q

Which organism cause quinsy?

A

Strep pyogenes

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93
Q

Management options for nasal fractures?

A
  • See in clinic in a week to allow swelling to subside
  • Manipulate under anaesthetic
94
Q

Discharge from nose which tests positive for beta-2 transferrin?

A

CSF

95
Q

Why should haematomas be aspirated as soon as possible?

A

Risk of avascular necrosis

96
Q

What is a cholesteatoma?

A

Overgrowth of keratinised squamous epithelium in the middle ear

97
Q

What can suggest cholesteatoma on otoscopy?

A
  • Discharge
  • Attic crust
  • Retracted/Perforated tympanic membrane
98
Q

What are complications of cholesteatoma?

A
  • Facial nerve palsy
  • Meningitis
  • Abscess
  • Deafness
  • Recurence
99
Q

What are signs of thyroglossal cyst?

A
  • Moves up when protruding tongue
  • Mobile
  • Non tender
100
Q

What causes trismus in quinsy?

A

Pus causes the pterygoid muscles to go into spasm which prevents a patient from opening their mouth

101
Q

Post tonsillectomy haemorrhage?

A

Refer for same day ENT assessment even if bleeding has resolved

102
Q

Hearing impairment post head trauma?

A

Perforated tympanic membrane

103
Q

What is the name for a malignant tumour of the parotid gland?

A

Adenoid cystic carcinoma

104
Q

Most common bacteria which cause otitis externa?

A
  • Staph aureus
  • Pseudomonas
105
Q

What can be exacerbated in pregnancy?

A

Otosclerosis

106
Q

Pink tinge to tympanic membrane?

A

Schwarze sign -> otosclerosis

107
Q

What can be a S/E of removal of mastoid abscess?

A

Unilateral facial weakness -> facial nerve runs close to the mastoid

108
Q

Which sinus is most commonly involved in chronic sinusitis when mucus drains out upon leaning forward?

A

Maxillary

109
Q

Which virus is associated with squamous cell carcinoma of the oropharynx?

A

HPV

110
Q

What is the pathophysiology of Menieres?

A

Excessive build up of endolymph in inner ear which increases pressure and disrupts sensory signals -> sensorineural hearing loss

111
Q

What are symptoms of Ramsay-Hunt?

A
  • Vesicular rash
  • Facial weakness
  • Vertigo
  • Headaches
  • Fever
  • Tinnitus
112
Q

What is a complication of untreated tonsillitis?

A
  • Parapharyngeal abscess
  • Lemeirre’s syndrome: infective thrombophlebitis
113
Q

What is the most common tumour of parotid gland?

A

Pleomorphic adenoma -> benign

114
Q

Bilateral conductive hearing loss and tinnitus in young person?

A

Think otosclerosis

115
Q

Snoring in someone with chronic sinusitis?

A

Nasal polyps have formed -> nasal steroid drops needed

116
Q

Glue ear

A

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.

117
Q

Glue ear Mx

A

Observe 3m if 1st presentation. Grommet insertion (does job normally done by eustachian tube allowing air to pass through middle ear, lasts 10m). Adenoidectomy.

118
Q

Management of otosclerosis?

A
  • Hearing aids
  • Stapedectomy is gold standard
119
Q

Unilateral glue ear?

A

Red flag -> nasopharyngeal carcinoma

120
Q

Chinese person with history of EBV infection and one sided hearing loss?

A

Nasopharyngeal tumour

121
Q

p16 is a marker for what?

A

HPV -> squamous cell carcinoma of oropharynx

122
Q

What is temporo-mandibular joint dysfunction?

A

Pain in jaw with difficulty moving it as well as clicking/popping in the jaw when opening mouth

123
Q

What can trigger temporomandibular dysfunction?

A

Trauma to the jaw
Stress

124
Q

Management of TMD?

A

Resting, address triggers and ENT referral if severe

125
Q

Anaphylaxis acute Mx

A

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.

126
Q

Anaphylaxis Mx if presence of hypotension or shock, or poor response to adrenaline

A

IV fluid bolus (Hartmann’s or saline), 500-100ml for adult or 10ml/kgfor child.

127
Q

Adrenaline dose in anaphylaxis?

A

1mg/mL (1:1000) conc.
>12yrs= 500 micrograms (0.5ml 1:1000 solution)
6-12: 300
6m-6yrs: 150
<6m: 100-150

128
Q

Anaphylaxis Mx following stabilisation

A
  • 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
129
Q

Anaphylaxis discharge?

A
  • 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.
130
Q

Acute epiglottitis caused by?

A

H.influenzae type B

131
Q

Acute epiglottitis features?

A

rapid onset, stridor, tripod position, drooling, high temp, generally unwell

132
Q

Acute epiglottitis diagnosis?

A

If suspected DO NOT examine throat. Direct visualisation by senior staff. X-ray: lateral view will show swelling of epiglottis- thumb sign.

133
Q

Acute epiglottitis Mx?

A

Immediate senior invol. (endotracheal intubation). Oxygen, IV antibiotics.

134
Q

Croup cause and aage most common?

A

Parainfluenzae. 6m-3yrs.

135
Q

Croup CP

A

Barking seal-like cough worse at night; stridor (due to laryngeal oedema and secretions); fever; retraction-increase work of breathing; coryzal

136
Q

Croup sign on xray (posterior anterior view)

A

Steep sign due to subglottic narrowing

137
Q

Croup Mx

A

Single dose dexamethasone (0.15mg/kg).
Emergency: high flow O2 and nebulised adrenaline

138
Q

Vestibular schwannoma (acoustic neuroma) CP

A

Vertigo, hearing loss, tinnitus and absent corneal reflex. Seen in neurofibromatosis type 2.

139
Q

Acoustic neuroma Ix

A

Urgent ENT referral. MRI of cerebellopontine angle and audiometry.

140
Q

Acoustic neuroma Mx

A

Surgery, radiotherapy or observe. Often benign tumour, slow growing.

141
Q

Achalasia?

A

Failure of oesophageal peristalsis & relaxation of lower oesophageal sphincter due to degenerative loss of ganglia from Auerbach’s plexus. LOS contracted, oesophagus above dilated.

142
Q

Achalasia CP

A

Commonly middle aged. Dysphagia of BOTH liquids and solids, heartburn, regurgitation, malignant change in small no. patients.

143
Q

Achalasia Ix

A

Oesophageal manometry: XS LOS tone which doesn’t relax on swallowing. Barium swallow- bird’s beak.

144
Q

Achalasia Mx

A

Pneumatic (balloon) dilation. Surgical intervention with Heller cardiomyotomy if recurrent.

145
Q

Causes of dysphagia

A

Oesophaeal cancer; oesophagitis; oesophageal candidiasis; achalasia; pharyngeal pouch; systemic sclerosis; MG; globus hystericus.

146
Q

New onset dysphagia

A

Urgent endoscopy

147
Q

Samter’s triad

A

Association of asthma, aspirin sensitivity and nasal polyposis

148
Q

What shrinks nasal polyps in 80% pts?

A

topical corticosteroids

149
Q

Bell’s palsy?

A

Acute unilateral, idiopathic facial nerve paralysis. ?HSV. More common in pregnant.

150
Q

Bell’s CP

A

LMN facial nerve palsy = forehead AFFECTED. Post-auricular pain, altered taste, dry eyes, hyperacusis.

151
Q

Bell’s Mx

A

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.

152
Q

Meniere’s disease?

A

Disorder of inner ear of unknown cause. Excessive pressure and progressive dilation of endolymphatic system.

153
Q

Meniere CP

A

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.

154
Q

Meniere Mx

A

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.

155
Q

Face innervation

A

Trigeminal nerve (V) which has 3 branches: opthalmic (V1), maxillary (V2), mandibular (V3)

156
Q

Facial pain differential diagnosis

A

Trigeminal neuralgia, sinusitis, dental problems, tension headache, migraine, giant cell arteritis.

157
Q

Trigeminal neuralgia CP

A

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

158
Q

Trigeminal neuralgia red flags

A

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

159
Q

Trigeminal neuralgia Mx

A

Carbamazepine 200mg 3/4times per day. Refer neurology if failure to respond.

160
Q

Rinne’s test

A
  • Normal= air conduction>bone condition bilaterally
  • Conductive hearing loss= BC>AC in affected ear
  • Sensorineual hearing loss= AC>BC bilaterally
161
Q

Weber test

A
  • Normal= midline
  • Conductive hearing loss= lateralises to affected ear
  • Sensorineural hearing loss= lateralises to unaffected ear
162
Q

Sensorineual hearing loss vs conductive hearing loss

A

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.

163
Q

Causes of hoarseness?

A

Voice overuse, smoking, viral illness, hypothyroidism, GORD, laryngeal cancer, lung cancer.
CXR should be considered to exclude apical lung lesions.

164
Q

Suspected laryngeal cancer- ENT referral for people 45yrs+ with what?

A

Peristent unexplained hoarseness of unexplained lump in neck.

165
Q

What does the term head and neck cancer include?

A
  • oral cavity cancers
  • cancers of pharynx (incl oropharynx, hypopharynx & nasopharynx)
  • cancers of larynx
166
Q

Features of head and neck cancers

A

neck lump, hoarseness, persistent sore throat, persistent mouth ulcer

167
Q

When to consider 2ww cancer referral for oral cancer?

A
  • 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
168
Q

2 ww cancer referral for thryoid cancer?

A

Unexplained thyroid lump

169
Q

Causes of neck lumps

A

Reactive lymphadenopathy, lymphoma, thyroid swelling, thyroglossal cyst, pharyngeal pouch, cystic hygroma, branchial cyst, cervical rib, carotid aneurysm

170
Q

Obstructive sleep apnoea/hypopnoea syndrome CP?

A

Snoring, daytime somnolence, compensated respiratory acidosis, HTN

171
Q

Obstructive sleep apnoea/hypopnoea syndrome Ix?

A

Assess sleepiness: Epworth Sleepiness Scale, Multiple Sleep Latency Test.
Diagnostic= polysomnography.

172
Q

Obstructive sleep apnoea/hypopnoea syndrome Mx

A

Weight loss; CPAP if moderate/severe; inform DVLA.

173
Q

Polysomnography includes what?

A

EEG, respiratory airflow, thoraco-abdo movement, snoring and pulse oximetry.

174
Q

Antiviral drug for influenza

A

Oral oseltamivir. Only if serious risk of developing serious complications or in an at risk group eg. pregnant

175
Q

Sore throat includes what?

A

Pharyngitis, tonsilitis, larygngitis

176
Q

Indications for Abx if sore throat?

A

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.

177
Q

Scoring systems that indicate need to ABx?

A

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.

178
Q

Abx if indicated for sore throat

A

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.

179
Q

Main causes of viral URTIs?

A

Rhinoviruses most.

180
Q

Cause of whooping cough?

A

Gram -ve Bordeteela pertussis. Vaccination doesn’t have lifelong protection so adolescents and adults may still develop.

181
Q

Features of whooping cough

A
  • Catarrhal phase (1-2w)= similar to viral URTI
  • Paroxysmal phase (2-8w)
  • Convalescent phase= cough subsides over weeks to months
182
Q

Paroxysmal phase of whooping cough

A

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).

183
Q

Diagnostic criteria for whooping cough?

A

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

184
Q

Diagnosis of whooping cough?

A

Nasal swab culture for Bordetella pertussis/PCR if cough <21d. Serology if cough >14d

185
Q

Whooping cough Mx

A
  • 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
186
Q

Whooping cough- pregnant?

A
  • Erythromycin
  • Vaccinate women between 16-32w
187
Q

Cx of whooping cough

A

Subconjunctival haemorrhage, pneumonia, bronchiectasis, seizures.

188
Q

Causes of tinnitus?

A

Idiopathic; meniere’s; otosclerosis; SSNHL; acoustic neuroma; hearing loss; drugs (aspirin, NSAIDs, loop diuretics, aminoglycosides, quinnine); impacted ear wax

189
Q

Assessment and Mx of tinnitus

A
  • 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
190
Q
A
191
Q

What is vertigo?

A

False sensation that body or environment is moving

192
Q

Causes of vertigo?

A

Viral labyrinthitis; vestibular neuronitis; BPPV; meniere’s; vertebrobasilar ischaemia; acoustic neuroma; posterior circulation stroke; trauma; MS; Ototoxicity eg. gentamicin.

193
Q

Vestibular neuronitis?

A

Cause of vertigo often develops following viral infection

194
Q

Vestibular neuronitis CP?

A

Recurrent vertigo attacks lasting hrs or days; nausea & vomiting; horizontal nystagmus; no hearing loss or tinnitus

195
Q

Vestibular neuronitis differentials?

A

Viral labryinthitis; posterior circulation stroke (the HiNTs exam can distinguish)

196
Q

Vestibular neuronitis Mx

A

Buccal or IM prochlorperazine for rapid relief for severe. Less severe: oral prochlorperazine or antihistamine eg. cyclizine. Vestibular rehab exercises preferred.

197
Q

What is peritonsillar abscess (qunisy)?

A

Peritonsillar abscess develops as a Cx of bacterial tonsillitis

198
Q

CP of quinsy?

A

Severe throat pain lateralises to one side; deviation of uvula to unaffected side; trismus (diff opening mouth); reduced neck mobility

199
Q

Qunisy Mx

A

Urgent ENT review. Needle aspiration or inscision & drainage + IV Abx. Tonsillectomy considered to prevent recuurence.

200
Q

Post op Cx of tonsillectomy?

A

Pain (increase for up to 6days after). Haemorrhage- all should be assessed by ENT.

201
Q

Primary or reactionary haemorrhage following tonsillectomy?

A

First 6-8hrs after surgery; immediate return to theatre

202
Q

Secondary haemorrhage after tonsillectomy?

A

> 24hrs-10d after surgery, often associated with wound infection. Admission and Abx, severe may need surgery.

203
Q

Cx of tonsillitis?

A

Otitis media; quinsy; RF and glomerulorephritis very rare

204
Q

Indications for tonsillectomy?

A
  • 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
205
Q

Rare indications for tonsillectomy?

A

Recurrent febrile convulsions secondary to tonsillitis; obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils; quinsy if unresp to standard Mx

206
Q

What is Ramsay hunt syndrome (herpes zoster oticus) caused by?

A

Reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

207
Q

Ramsay hunt syndrome (herpes zoster oticus) Mx?

A

Oral aciclovir and corticosteroids

208
Q

3 pairs of salivary glands?

A

parotid (serous) - most tumours
submandibular (mixed) - most stones
sublingual (mucous)

209
Q

Branchial cysts characteristically contain what?

A

Cholesterol crystals

210
Q

Immunocompromised patients with poor dentition can develop airway compromise from cellulitis at the floor of the mouth known as?

A

Ludwig’s angina

211
Q

Loop diuretics can be a cause of…

A

Tinnitus

212
Q

Elderly patient dizzy on extending neck

A

Vertebrobasilar ischaemia

213
Q

Otosclerosis may be precipiated by

A

pregnancy in those who are genetically predisposed

214
Q

What does spontaneous rotatory nystagmus and positive head impulse test suggest?

A

Signs of a peripheral cause of vertigo (not central).

215
Q

Peripheral causes of vertigo?

A

BPPV, middle ear infections, menieres, vestibular neuritis ect.

216
Q

Central causes of vertigo?

A

Stroke, tumours

217
Q

Most common bacterial cause of ottitis media?

A

H.influenzae

218
Q

Rhinitis medicamentosa?

A

Rebound nasal congestion brought on by extended use of topical decongestants

219
Q

Mastoiditis Mx?

A

IV antibiotics

220
Q

Complications of thyroid surgery

A

Damage to parathyroid glands can result in hypocalcaemia

221
Q

If a perforated tympanic membrane does not heal by itself what may be performed?

A

myringoplasty

222
Q

In patients with chronic or recurrent ear discharge, ensure the attic is visualised to exclude…

A

cholesteatoma

223
Q

Consider 2ww appointment for laryngeal cancer in people >45yrs and over with…

A

persistent unexplained hoarseness or unexplained lump in neck

224
Q

Consider 2ww appointment for oral cancer in people with….

A

unexplained ulceration in oral cavity lasting >3w or persistent and unexplained lump in neck

225
Q

Consider urgent 2ww referral for oral cancer by dentist in people with…

A

lump on lip or in oral cavity or a red/red and white patch in oral cavity consistent with erythroplakia or erythroleukoplakia

226
Q

Consider 2ww for thyroid cancer in people with…

A

Unexplained thyroid lump

227
Q

Reactive lymphadenopathy

A

By far the most common cause of neck swellings. There may be a history of local infection or a generalised viral illness

228
Q

Lymphoma

A

Rubbery, painless lymphadenopathy
The phenomenon of pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly

229
Q

Thyroid swelling

A

May be hypo-, eu- or hyperthyroid symptomatically
Moves upwards on swallowing

230
Q

Thyroglossal cyst

A

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

231
Q

Pharyngeal pouch

A

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.

232
Q

Cystic hygroma

A

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

233
Q

Brachial cyst

A

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

234
Q

Cervical rib

A

More common in adult females
Around 10% develop thoracic outlet syndrome

235
Q

Carotid aneurysm

A

Pulsatile lateral neck mass which doesn’t move on swallowing

FINALS (34 decks)

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