ENT Flashcards
What is the most common cause of sore throat?
aka pharyngitis
viral (rhinovirus) or bac/tonsillitis (strep pyogenes)
What criteria are used to assess sore throat? (2)
FeverPAIN predicts likelihood of group A strep
🔹Fever (during previous 24 hours)
🔹Purulence (pus on tonsils)
🔹Attend rapidly (within 3 days after onset of symptoms)
🔹Severely Inflamed tonsils
🔹No cough or coryza (inflammation of mucus membranes in the nose)
:::::::
0-1 = 13-18% - no Rx
2-3 = 34-40% - delayed Rx
4-5 = 62-65% - consider Rx
The Centor criteria predicts likelihood of group A strep
🔹Tonsillar exudate
🔹Tender anterior cervical lymphadenopathy or lymphadenitis
🔹History of fever (over 38 degrees Celsius)
🔹Absence of cough
::::::::
0-2 = 3-17% - no testing or Abx
3-4 = 32-56% - consider culture +/- Abx
What is the most common pathogen causing bacterial tonsillitis? What antibiotics can be used to treat?
Streptococcus pyogenes
Penicillin V (phenoxymethylpenicillin) for 10 days
:::::::::clarithromycin in penicillin allergy
What is Waldeyer’s Tonsillar Ring?
ring of lymphoid tissue
comprising of the adenoids, tubal tonsils, palatine tonsils and the lingual tonsil
palatine tonsils are usually infected in tonsillitis
What are the symptoms and signs of tonsillitis?
Symptoms:
🔹sore throat
🔹fever >38°C
🔹pain on swallowing
Signs:
🔹red, inflamed, enlarged tonsils +/- exudates
🔹+/- anterior cervical lymphadenopathy
When should you consider admission for pt with sore throat?
immunocompromised,
systemically unwell,
dehydrated,
has stridor,
respiratory distress or
evidence of a peritonsillar abscess or
cellulitis.
What are some complications of tonsillitis?
🔹Peritonsillar abscess, also known as quinsy
🔹Otitis media, if the infection spreads to the inner ear
🔹Scarlet fever
🔹Rheumatic fever
🔹Post-streptococcal glomerulonephritis
🔹Post-streptococcal reactive arthritis
What is laryngomalacia?
most common congenital anomaly of the larynx
inward collapse of supraglottic structures during inspiration
results in partial airway obstruction, presenting clinically with stridor that typically manifests within the first two weeks of life
self-limiting and resolves by 18 to 24 months as the laryngeal cartilage matures
What is quinsy?
Peritonsillar abscess
complication of tonsillitis
What are the symptoms of quinsy?
Same as tonsillitis: fever, sore throat, pain on swallowing
+ neck pain
+ referred ear pain
+ swollen tender lymph nodes
+ trismus (can’t open mouth)
+ ‘hot potato voice’
+ swelling and erythema
What is the management of quinsy?
referral to ENT for needle aspiration or I+D
+ Abx
What is the difference between conductive and sensorineural hearing loss?
Conductive hearing loss relates to a problem with sound travelling from the environment to the inner ear. The sensory system may be working correctly, but the sound is not reaching it. Putting earplugs in your ears causes conductive hearing loss.
Sensorineural hearing loss is caused by a problem with the sensory system or vestibulocochlear nerve in the inner ear.
How does sudden-onset sensorineural hearing loss present and what is it’s significance?
SSNHL is a medical emergency ‼️
sudden deterioration in hearing
assoc symptoms: tinnitus, vertigo, dizziness, aural fullness, hyperacusis
How to investigate sudden-onsent sensorineural hearing loss?
audiometry within 24 hrs of presentation
otoscopic exam to exclude other causes
MRI brain and internal auditory meatus - to find retrochlear pathology e.g. vestibular schwannoma or demyelinating disease
Vestibular Function Tests such as electronystagmography (ENG) or videonystagmography (VNG)
How does Weber’s test differentiate conductive and sensorineural hearing loss?
In sensorineural hearing loss, the sound will be louder in the normal ear (quieter in the affected ear). The normal ear is better at sensing the sound.
In conductive hearing loss, the sound will be louder in the affected ear. affected ear is more sensitive to compensate for conductive block
