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MSRA > ENT > Flashcards

ENT Flashcards

1
Q

What is the most common cause of sore throat?

A

aka pharyngitis
viral (rhinovirus) or bac/tonsillitis (strep pyogenes)

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2
Q

What criteria are used to assess sore throat? (2)

A

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

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3
Q

What is the most common pathogen causing bacterial tonsillitis? What antibiotics can be used to treat?

A

Streptococcus pyogenes
Penicillin V (phenoxymethylpenicillin) for 10 days
:::::::::clarithromycin in penicillin allergy

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4
Q

What is Waldeyer’s Tonsillar Ring?

A

ring of lymphoid tissue
comprising of the adenoids, tubal tonsils, palatine tonsils and the lingual tonsil

palatine tonsils are usually infected in tonsillitis

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5
Q

What are the symptoms and signs of tonsillitis?

A

Symptoms:
🔹sore throat
🔹fever >38°C
🔹pain on swallowing

Signs:
🔹red, inflamed, enlarged tonsils +/- exudates
🔹+/- anterior cervical lymphadenopathy

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6
Q

When should you consider admission for pt with sore throat?

A

immunocompromised,
systemically unwell,
dehydrated,
has stridor,
respiratory distress or
evidence of a peritonsillar abscess or
cellulitis.

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7
Q

What are some complications of tonsillitis?

A

🔹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

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8
Q

What is laryngomalacia?

A

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

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9
Q

What is quinsy?

A

Peritonsillar abscess
complication of tonsillitis

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10
Q

What are the symptoms of quinsy?

A

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

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11
Q

What is the management of quinsy?

A

referral to ENT for needle aspiration or I+D
+ Abx

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12
Q

What is the difference between conductive and sensorineural hearing loss?

A

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.

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13
Q

How does sudden-onset sensorineural hearing loss present and what is it’s significance?

A

SSNHL is a medical emergency ‼️

sudden deterioration in hearing
assoc symptoms: tinnitus, vertigo, dizziness, aural fullness, hyperacusis

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14
Q

How to investigate sudden-onsent sensorineural hearing loss?

A

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)

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15
Q

How does Weber’s test differentiate conductive and sensorineural hearing loss?

A

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

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16
Q

What is Rinne’s test and how does it assess hearing?

A

tuning fork on mastoid process then next to the ear (when they can stop hearing the humming) , assess air vs bone conduction

Rinne’s positive (normal!!!) = can still hear sound when next to ear = air conduction > bone conduction

Rinne’s negative (abnormal) = can’t hear when next to ear = bone conduction > air conduction = conductive hearing loss

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17
Q

What are some causes of sensorineural hearing loss?

A

The causes of adult-onset sensorineural hearing loss are:
🔹Sudden sensorineural hearing loss (over less than 72 hours)
🔹Presbycusis (age-related)
🔹Noise exposure
🔹Ménière’s disease
🔹Labyrinthitis
🔹Acoustic neuroma
🔹Neurological conditions (e.g., stroke, multiple sclerosis or brain tumours)
🔹Infections (e.g., meningitis)
🔹Medications: loop diuretics (furosemide), aminoglycosides (gentamicin), chemo (cisplatin)

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18
Q

What are some causes of conductive hearing loss?

A

🔹Ear wax (or something else blocking the canal)
🔹Infection (e.g., otitis media or otitis externa)
🔹Fluid in the middle ear (effusion)
🔹Eustachian tube dysfunction
🔹Perforated tympanic membrane
🔹Otosclerosis
🔹Cholesteatoma
🔹Exostoses
🔹Tumours

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19
Q

What is a cholesteatoma?

A

A cholesteatoma is an abnormal collection of squamous epithelial cells in the middle ear, which can invade local tissues, nerves, and erode the bones of the middle ear. NOT A TUMOUR

20
Q

What is the typical presentation of cholesteatoma?

A

The typical symptoms include:
- Foul-smelling discharge from the ear
- Unilateral conductive hearing loss

21
Q

What additional symptoms may develop as a cholesteatoma grows?

A
  • Infection
  • Pain
  • Vertigo
  • Facial nerve palsy
22
Q

How is cholesteatoma diagnosed and assessed?

A

Diagnosis is often confirmed with a CT scan of the head to assess bone involvement, while MRI may be used to evaluate soft tissue invasion and damage.

23
Q

What is the treatment for cholesteatoma?

A

The primary treatment is surgical removal of the cholesteatoma to prevent further damage and infection.

24
Q

What are the two general categories of vertigo causes?

A

The two categories are:
- Peripheral vertigo (involving the vestibular system)
- Central vertigo (involving the brainstem or cerebellum)

25
Q

Name four common peripheral causes of vertigo

A

Four common peripheral causes are:
- Benign paroxysmal positional vertigo (BPPV)
- Ménière’s disease
- Vestibular neuronitis
- Labyrinthitis

26
Q

What causes benign paroxysmal positional vertigo (BPPV)?

A

BPPV is caused by displaced calcium carbonate crystals (otoconia) in the semicircular canals, disrupting normal fluid flow and causing vertigo triggered by movement.

27
Q

What symptoms are typical of Ménière’s disease?

A

Symptoms of Ménière’s disease include:
- Hearing loss
- Tinnitus
- Vertigo
- A sensation of fullness in the ear

28
Q

How does vestibular neuronitis differ from labyrinthitis?

A

Vestibular neuronitis involves inflammation of the vestibular nerve, causing vertigo without hearing loss, while labyrinthitis affects the inner ear structures and includes hearing loss.

29
Q

What are the common causes of central vertigo?

A

Common causes of central vertigo include:
- Posterior circulation infarction (stroke)
- Tumour
- Multiple sclerosis
- Vestibular migraine

30
Q

How can you distinguish between peripheral and central vertigo based on the onset and duration?

A

Peripheral vertigo has a sudden onset and short duration (seconds or minutes), while central vertigo has a gradual onset (except stroke) and is persistent.

31
Q

What are some key features that suggest a central cause of vertigo?

A

Key features include:
- Gradual onset
- Sustained vertigo
- Impaired coordination
- Diplopia, ataxia, or other neurological symptoms

32
Q

What is the HINTS examination used for?

A

The HINTS examination is used to distinguish between central and peripheral vertigo. It includes:
- Head Impulse Test
- Nystagmus
- Test of Skew

33
Q

What is the significance of a positive head impulse test?

A

A positive head impulse test, where the eyes saccade to refocus (move away then return back) after head movement, suggests a peripheral cause of vertigo, such as vestibular neuronitis.

34
Q

What medications are commonly used for symptomatic relief in peripheral vertigo?

A

Medications include:
- Prochlorperazine
- Antihistamines (e.g., cyclizine, cinnarizine, promethazine)

35
Q

What is the recommended management for patients with vestibular migraine?

A

Management includes lifestyle changes (e.g., avoiding triggers, proper hydration), and medical options such as triptans for acute symptoms, and propranolol, topiramate, or amitriptyline for preventing attacks.

36
Q

Where do most nosebleeds originate from?

A

Most nosebleeds originate from Kiesselbach’s plexus in Little’s area, located at the front of the nasal cavity

37
Q

What management steps should you advise for a nosebleed in an exam setting?

A

Management steps:

  1. Sit up and tilt the head forwards.
  2. Squeeze the soft part of the nostrils for 10-15 minutes.
  3. Spit out any blood rather than swallowing it.
38
Q

What should be done if a nosebleed doesn’t stop after 15 minutes or involves both nostrils?

A

If the nosebleed continues or is severe, medical intervention may include:
- Nasal packing (tampons or inflatable packs)
- Nasal cautery (silver nitrate sticks)

39
Q

What nasal cream may be prescribed after treating a nosebleed, and what is the contraindication?

A

Naseptin nasal cream (chlorhexidine and neomycin) may be prescribed to reduce crusting and infection. It is contraindicated in patients with peanut or soya allergies.

40
Q

What is sinusitis and how can it be classified by duration?

A

Sinusitis is the inflammation of the paranasal sinuses. It can be classified as:
- Acute (less than 12 weeks)
- Chronic (more than 12 weeks)

41
Q

What causes sinusitis?

A
  • Viral or bacterial infections (often following URTIs)
  • Allergies (e.g., hayfever)
  • Obstruction (foreign bodies, trauma, polyps)
  • Smoking
  • Asthma (increases risk)
42
Q

What is the general approach to managing acute sinusitis according to NICE?

A

No antibiotics for symptoms lasting up to 10 days (likely viral)

For symptoms persisting beyond 10 days:
- Steroid nasal spray for 14 days (e.g., mometasone)
- Delayed antibiotic prescription if symptoms worsen (first-line: phenoxymethylpenicillin)

43
Q

What options are available for chronic sinusitis management?

A
  • Saline nasal irrigation
  • Steroid nasal sprays or drops (e.g., mometasone or fluticasone)
  • Functional endoscopic sinus surgery (FESS) for persistent cases
44
Q

What is the key red flag when assessing nasal polyps?

A

Unilateral nasal polyps are a red flag and raise suspicion of tumours or malignancy, requiring specialist referral for assessment.

45
Q

What conditions are associated with nasal polyps?

A

Nasal polyps are associated with:
- Chronic rhinitis or sinusitis
- Asthma
- Samter’s triad (nasal polyps, asthma, aspirin intolerance)
- Cystic fibrosis
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

46
Q

How do nasal polyps typically present in patients?

A

Patients with nasal polyps may present with:
- Chronic rhinosinusitis
- Difficulty breathing through the nose
- Snoring
- Nasal discharge
- Loss of smell (anosmia)

47
Q

What is the medical management for nasal polyps? What are the surgical options for nasal polyps if medical treatment fails?

A

Medical management involves the use of intranasal topical steroid drops or sprays to reduce inflammation and the size of polyps.

Surgical options include:
- Intranasal polypectomy for polyps visible close to the nostrils.
- Endoscopic nasal polypectomy for polyps located further inside the nose or sinuses.

MSRA (18 decks)

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