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Year 6 > ENT > Flashcards

ENT Flashcards

1
Q

Centor criteria for Group A Strep tonsilitis

A

1 Point for:
- Hx of fever
- White exudates on tonsils
- Abscence of cough
- Tender cervical lymphadenopathy

Pts w/ 3-4 points should be concidered for abx therapy

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2
Q

Bacterial tonsilitis management

A

Phenoxymethylpenicillin - clari/erythromycin if pen allergic

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3
Q

Tonsilitis complications

A
  • Recurrent tonsilitis
  • Retropharyngeal abcess
  • Quincy
  • Lemierre’s syndrome = inflammation leads to pharygeotonsilitis, inflammation w/in the internal jugular vein and septic emboli - treated w/ high dose benzylpencillin and debridement
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4
Q

Paediatric otitis media management

A
  • Admit if < 3 months old or worried about severe complications
  • Offer a delayed abx perscription to be taken if symptoms arnt improving after 4 days (can offer immediate perscirption if pt is systemically unwell)
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5
Q

Otitis media complications

A

Extra-cranial:
- Facial nerve palsy
- Mastoiditis
- Petrositis
- Labrynthitis

Intra-cranial:
- Meningitis
- Sigmoid sinus thrombosis
- Brain abscess

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6
Q

Indications for adenoidectomy

A
  • Recurrent or persistent otitis media (due to obstruction of the eustachian tubes by enlarged adenoids)
  • Adenoid hypertrophy leading to upper airway obstrucion (snorking, OSA)
  • In association w/ tonsilectomy for recurrent tonsilitis
  • Recurrent sinusitis or adenoiditis
  • Dysphagia w/ failure to thrive
  • Speech impendements
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7
Q

Allergic rhinitis management

A
  • Avoid triggers
  • Nasal irrigation w/ saline
  • Oral/intra-nasal antihistamines
  • Regular intra-nasal steroids
  • Oral steroids if QOL severely affected
  • Referal to ENT (red flags, refractory, for allergen testing)
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8
Q

Define Basal skull fractures

A

Fracturing of one or more of the bones at the base of the skull

Anterior cranial fossa = superior sphenoid and ethmoid bones
Posterior cranial fossa = occipital, temporal and part of the spehnoid bone

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9
Q

Basal skull fractures features

A
  • Hx of head trauma
  • Reduced consciousness
  • Rhinorrhoea (CSF leakage from nose)
  • Otorrhoea (CSF leakge from ears)
  • Cranial nerve palsy
  • Epistaxis or ottorhagia (bleeding from ears)
  • Haemotympanum (blood visible behind the tympanic membrane)
  • Battle sign = bruising of the mastoid process
  • Racoon eyes = periorbital bruising
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10
Q

Define Benign paroxysmal positional vertigo

A

A condition caused by detachment of otoliths in the inner ear during head movements, resulting in hair cell stimulation and vertigo

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11
Q

Benign paroxysmal positional vertigo features

A
  • Vertigo attacks triggered by head movements
  • Episodes of rotational vertigo lasting 30 secs - 1 min
  • Absence of audiotory symptoms
  • Reccurent episodes, often resolving naturally over weeks to months
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12
Q

Benign paroxysmal positional vertigo investigations

A

Dix-Hallpike manoeuvre - causes vertigo and nystagmus if +ve for BPPV

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13
Q

Benign paroxysmal positional vertigo management

A

Epley manoeuvre - aims to move the detached otholiths out of the semicircular canal and back into the urticle where they belong

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14
Q

Define Branchial cyst

A

A congenital malformation formed from the incomplete obliteration of the branchial arches (an integral part in devloping the structure of the head and neck)

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15
Q

Branchial cyst features

A

A painless, cystic mass located anterior to the sternocleidomastoid just below the ear - it may increase in size during URTI

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16
Q

Branchial cyst investigations

A
  • US
  • CT/MRI
  • Fine-needle aspiration to rule out malignancy
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17
Q

Define Cholesteatoma

A

An abnormal accumulation of skin and squamous cells w/in the middle ear clerft and mastoid air cells - often caused by recurrent otitis media

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18
Q

Cholesteatoma features

A
  • Persisten foul-smelling discharge
  • Headache
  • Otalgia
  • White area in attic behind the tympanic membrane
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19
Q

Sinusitis features

A

Acute:
- Bilateral intense pain
- Fever
- Pain worse on sitting forwards
- Purulent discharge

Chronic:
- Bilateral pain
- Purulent discharge
- Nasal obstruction due to muscosal hypertrophy

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20
Q

Sinusitis investigations

A
  • Hx and examination
  • Imaging
  • Nasal endoscopy
  • Microbiology
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21
Q

Sinusitis management

A
  • Analgesia
  • Nasal sprays to reduce inflammation
  • Abx if bacterial
  • Surgery for severe or recurent cases (to remove polyps that may have formed)
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22
Q

Conductive hearing loss causes

A
  • Wax impaction
  • Glue ear
  • Eustachian tube dysfunction
  • Ear infections
  • Perforated tympanic membrane
  • Chronic suppurative otitis media
  • Otosclerosis
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23
Q

Conductive hearing loss investigations

A

Audiometry shows bone conduction greater than air conduction

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24
Q

Which vessels are involved in anterior epistaxis?

A

Kiesselbach’s plexus, a vascular network located on the anterior part of the nasal septum

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25
Q

Which vessels are involved in posterior epistaxis?

A

Branches of the sphenopalatine artery

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26
Q

Epistaxis management

A

Stepwise approach:

1) Direct compression = pinch nose and lean fowards (to avoid aspirating) - mostly resolves w/in 10-15 min
2) Cautery w/ silver nitrate or electricity - must have a visible bleeding point
3) Nasal packing to tamponade the bleeding
4) Aggressive therapies = reserved to posterior bleeds and uncontrolled severe bleeds that dont resolve w/ nasal packing - includes nasal balloon catheters, transnasal endoscopy w/ cautery/ligation, embolisation, oral/IV transexamic acid

Posterior bleed signs = profuse bleeding, both nostrils involved, unidentifiable bleeding site

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27
Q

Nasal foreign body features

A
  • Organic objects = local inflammation, secondary infections and sinusitis
  • Inorganic objects = asymptomatic unless big enough to cause nasal obstruction
  • Button batteries = tissue necrosis though electrolysis at the negative pole, leading to septal perforation (epistaxis, purulent/black discharge, facial swelling, pain and fever)
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28
Q

Head and neck cancer features

A
  • Hoarsness
  • Throat pain
  • Tonhue ulcers
  • Painless neck lump
  • WL, fevers, NS
  • Lymphadenopathy
  • Sympoms persisiting longer than 3 wks
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29
Q
A
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30
Q

Laryngeal papillomatosis management

A

Surgery to remove the papillomas +/- cidofovir

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30
Q

Define Laryngeal papillomatosis

A

A rare disease caused by HPV which results in the growth of papillomas inside thew voice box, vocal cords, or anywhere in the air passages from the nose to the lungs

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30
Q

Laryngeal papillomatosis features

A
  • Dysphagia
  • SOB
  • Hoarsness
  • Feeling something stuck in the throat
  • Choking
  • Coughing
  • Recurrent pnuemonia
  • Snoring
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31
Q

Define Hereditary haemorrhagic telangiectasia

A

A rare genetic condition characterised in the abnormal formation of blood vessles - results in telangiectasia and AV malformations

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32
Q

Hereditary haemorrhagic telangiectasia features

A
  • Episatxis
  • Anaemia
  • GI blood loss
  • Emobolic manifestations
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33
Q

Hereditary haemorrhagic telangiectasia investigations

A
  • Nasoendoscopy - may show telangectasia in the nose
  • CT/MRI to find AV malfomrations
  • FHx
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34
Q

Hereditary haemorrhagic telangiectasia management

A
  • Iron replacement
  • Blood transfusion
  • Emobolisation of AV malformations w/in organs
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35
Q

Primary causes of hoarsness

A
  • Laryngeal cancer = hoarsness >3 wks, sig smoking history
  • Chronic laryngitis = associated w/ GORD, worse in the mornings
  • Acute laryngitis = usually viral and self-limiting
  • Reinke’s oedema = enlargement of the vocal cords associated w/ hypothyroidism
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36
Q

Define Meniere’s disease

A

An inner ear disorder caused by dilation and subsequent increased fluid pressure in the endolymphatic spaces of the membranous labyrinth

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37
Q

Meniere’s disease features

A
  • Sudden attacks of vertigo - often in clusters
  • Associated deafness
  • Tinnitus
  • N&V
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38
Q

Meniere’s disease management

A
  • Betahistine (anti-vertigo medication) for prophylaxis
  • Prochlorperazine to reduce N&V during attacks
  • Duiretics to reduce endolymphatic volume (only done by ENT)
  • Low salt diet to reduce endolymphatic volume
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39
Q

Acute VS chronic nasal obstruction

A

Acute lasts < 12 wks, chronic lasts >12 wks

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40
Q

Define Septal haematoma

A

The accumulation of blood in the septal space due to bleeding under the perichondrium lining the septal cartilage - often due to nasal trauma and can lead to a disruption in blood supply to the septum, resulting in septal perforation and necrosis w/in 24hrs and a saddle-nose deformity

41
Q

Septal haematoma features

A

Bilateral cherry-red swelling visible on the nasal septum (from inside the nose)

Should be suspected w/ any nasal trauma

42
Q

Septal haematoma management

A

ENT referal for immediate incision and drainage

43
Q

Most common caustive agents of Otitis externa

A

Staph aureus and Pseudomonas species

44
Q

Otitis externa features

A
  • Otalgia
  • Minimal discharge
  • Itchiness
  • Impaired hearing if the meatus becomes blocked due to inflammation
45
Q

Otitis externa management

A

Mild - moderate:
- Combined steroid/abx drops (e.g. Gentamix)
- Acetic acid drops
- Advice to keep ear dry for 7-10 days

Severe:
- Pope wicks (strips of ribbon gauze) to enable deeper penetration of abx (usually gentamicin)
- Oral abx if cellulitis beyond the ear canal, or canal so swollen that wicks cannot enter

46
Q

Otits media features

A

Acute:
- Rapid-onset of deep-seated ear pain
- Systemically unwell
- Impaired hearing
- Aural fullness followed by discharge when the typanic membrane perforates, leading to relief of pain
- Injection of blood vessels and diffuse erythema of the typnaic membrane

Benign chronic - dry tympanic membrane perforation w/out infection

Chronic secretory (glue ear) = persitent pain lasting wks after the initial episode w/ an abnormal looking drum and reduced membrane mobility

Chronic suppurative = persistent purulent discharge through the perforated tympanic membrane

47
Q

Define Otosclerosis

A

An autosomal dominant condition where abnormal bone growth occurs around the stapes bone in the middle ear, impeding its function as a piston onto the cochlea - results in progressive conductive hearing loss

48
Q

Otosclerosis features

A
  • Progressive hearing loss, starting unilaterally and then becoming bilateral
  • Tinnitus
49
Q

Otosclerosis investigations

A

Adiometry shows conductive hearing loss and may present w/ Carhart’s notch (an apparent loss of bone conduction at 2000 Hz)

50
Q

Otosclerosis management

A
  • Hearing aids
  • Stapedecetomy (removal and replacement of the stapes) which can restore hearing in many cases
51
Q

Define Pinna haematoma

A

The formation of a blood clot between the cartilage of the pinna and the overlying perichondrium - occurs due to shearing injuries to the ear (e.g. in rugby)

52
Q

Pinna haematoma features

A

Pain, swelling of the ear - may become discoloured due to the accumulation of blood

53
Q

Pinna haematoma management

A

Decompress the haematoma w/in 24 hrs to avoid complications such as avascular necrosis

54
Q

Define Quinsy

A

A complication of tonsilitis where an abscess forms around the tonsil (peritonsilar abscess)

55
Q

Quinsy features

A
  • Sore throat
  • Dysphagia
  • Bulge behind 1 tonsil
  • Uvula devation (due to the abscess pushing it away)
56
Q

Quinsy management

A
  • Broad spectrum abx
  • Aspiration w/ a needle to remove the abscess
57
Q

Nasopharangeal carcinoma features

A
  • Symptoms of eustachians tube blockage (hearling loss, tinnitus, otalgia, feeling of aural fullness)
  • Nasal obstruction
  • Blood-stained nasal discharge
  • Persisten epistaxis
  • Development of glue ear
58
Q

Nasopharangeal carcinoma investigations

A
  • Full ENT exam including inspecting the post-nasal space with a flexible nasoendoscopy
  • Biopsy of any massess seen
  • Imaging and histology
59
Q

Define Rhinosinusitis

A

Inflammation of the nose and paranasal sinuses - caused by viral, bacterial or fungal infections, allergies, AI or deviations/obstructions of the septum

60
Q

Rhinosinusitis features

A

Need to have 2 symptoms of which 1 must be:
- Nasal blockage
- Nasal obstruction
- Nasal congestion
- Nasal discharge

Other possible symptoms:
- Facial pain or heaviness
- Reduced olfaction
- Headache
- Ear pain
- Sore throat
- Cough

61
Q

Rhinosinusitis investigations

A
  • Nasal endoscopy
  • CT = to look for sinus inflammation
  • Cultures
62
Q

Rhinosinusitis management

A
  • Nasal saline irrigation
  • Analgesia
  • Intranasal steroids
  • Oral high dose corticosteroids if symptoms persisitng for >10 days
  • Abx if severe
63
Q

Salivary gland tumours features

A
  • Swelling in the associated gland (parotid, submanibular or sublingual)
  • Invasion of surrounding structures if malignant leading to facial nerve palsy
64
Q

Salivary gland tumours management

A

Removal of glands which have been swollen for 1 month or longer w/ no clear underlying cause

65
Q

Causes of Sensorineural hearing loss

A
  • Presbycusis (most common)
  • Noise-induced hearing loss
  • Congenital infections (CMV, rubella)
  • Neonatal complications = kernictus or menigitis
  • Drug-induced (esp aminoglycosides)
  • Stroke/TIA
66
Q

Sensorineural hearing loss investigations

A

Audiogram - shows hearing loss at higher frequencies

67
Q

Define Turbinectomy

A

Surgical removal of all or some of the tissue or bone from the turbinate’s in the nasal passage - used to fix snoring/nasal obstruction due to enlarged turbinates

68
Q

Define Septoplasty

A

A surgical procedure that straightens a deviates septum

69
Q

Define Empty nose syndrome

A

A rare complication of nasal surgery due to unknown aetiology

70
Q

Empty nose syndrome features

A
  • SOB
  • Nasal obstruction or dryness
  • Paradoxical nasal obstruction = pt feels obstructed despite being unobstructed on nasal examination
71
Q

Empty nose syndrome management

A
  • Nasal irrigation = to moisturise the nasal cavity
  • Topical therapies = nasal saline and oil-based emollients
  • Psychological support
  • Reconstructive surgery in severe cases
72
Q

Define Sialadenitis

A

Inflammation of the salivary glands, commonly due to viral/bacterial infections

73
Q

Sialadenitis features

A

Pain, tenderness, redness and localised swelling of the affected area

74
Q

Sialadenitis investigations

A
  • Examination
  • USS or CT
  • Saliva culture
75
Q

Sialadenitis management

A
  • Abx
  • Oral hygiene advice
  • Ensuring good hydration/use of saliva stimulants to encourage good saliva flow
  • Incision and drainage of any abscess’ formed
76
Q

Define Stridor

A

High-pitched, musical noise heard during inspiration hat results for a partial obstruction of the larynx or large airways

77
Q

Major causes of Sialadenitis

A
  • Croup
  • Epiglottitis
  • Bacterial tracheitis = bacterial infection of the trachea
  • Foreign body inhalation
78
Q

Define Temporo-mandibular joint dysfunction

A

A collection of clinical problems involving the masticatory musculature, the tempomandibular joint and associated structures

79
Q

Temporo-mandibular joint dysfunction causes

A
  • Jaw trauma
  • Stress which leads to clenching or grinding of teeth
  • Arthritis of the TMJ
  • Abnormal jaw/tooth alignment
80
Q

Temporo-mandibular joint dysfunction features

A
  • Pain in the jaw, face and ear
  • Difficulty opening/closing the mouth
  • Clicking, popping or grating sounds in the jaw when opening/closing - A sense of the jaw being stuck or locked
81
Q

Temporo-mandibular joint dysfunction management

A

Conservative:
- Resting the jaw
- Adhering to a soft diet
- Avoid opening the jaw wide
- Physio
- Heat/cold packs

Medical:
- Analgesia
- Muscle relaxants
- NSAIDs

Dental:
- Oral splints
- Mouth guards
- Correct misaligned teeth

82
Q

Define Thyroglossal cyst

A

A benign neck mass that raised from the remnants of the thyroglossal duct - forms a cyst

83
Q

Thyroglossal cyst features

A
  • Painless midline neck mass
  • Fluctuant swelling
  • Moves upwards on tongue protrusion and swallowing
  • Can become infected
84
Q

Thyroglossal cyst investigations

A
  • Examination
  • USS
  • Fine-needle aspiration
85
Q

Thyroglossal cyst management

A

Surgical excision via Sistrunk procedure = removal of the cyst + the middle part of the hyoid bone and core of the tongue base (to prevent reoccurrence)

86
Q

Define Tinnitus

A

A condition characterised by the perception of non-verbal sounds in the absence of external stimuli, often described as a hissing, ringing, clicking or buzzing - it may be constant or intermittent

87
Q

Tinnitus causes

A
  • Chronic noise exposure
  • Presbycusis
  • Acute acoustic trauma
  • Perforation of the tympanic membrane
  • Otitis media
  • Meniere’s disease
  • Vestibular schwannoma
  • Ototoxic drugs (quinine, aminoglycosides, loop diuretics)
  • Trauma
88
Q

Tinnitus management

A
  • Treat underlying cause
  • CBT
  • Sound therapy = background noise to mask the tinnitus
  • Hearing aids
89
Q

Define Tympanosclerosis

A

A chronic disease which involves inflammation, fibrosis and calcification of the tympanic membrane - associated w/ chronic otitis media and the insertion of gromets

90
Q

Tympanosclerosis features

A
  • Significant hearing loss
  • Chalky white patches on tympanic membrane
91
Q

Tympanosclerosis management

A
  • Hearing aids
  • Surgical excision of the sclerotic areas and repair of the ossicular chain
92
Q

Vestibular neuritis causes

A

Viral infections

93
Q

Vestibular neuritis features

A

Have an acute phase (~1 week) and then a chronic phase (weeks to months)

Acute:
- Sudden, severe, prolonged vertigo/dizziness
- Severe balance issues
- N&V
- Nystagmus (non-fatiguing)

Chronic:
- Light-headedness
- Mild dizziness w/ head and body movements
- Mild nausea
- Feeling of aural fullness
- Anxiety

94
Q

Vestibular neuritis management

A
  • Antivirals
  • Anti-sickness medication
  • Corticosteroids
  • Vestibular rehabilitation therapy
95
Q

Define Vestibular migraine

A

A neurological condition that is the 2nd most common cause of vertigo - may or may not be associated with a headache

96
Q

Vestibular migraine features

A
  • Vertigo lasting minutes-days
  • N&V
  • Photo/phonophobia
  • Headache
97
Q

Vestibular migraine management

A

Prophylactic:
- TCA’s
- CCBs
- Antiepileptics
- Beta-blockers

Acute:
- NSAIDs
- Motion-sickness mediation
- Antipsychotics

Lifestyle changes + vestibular rehabilitation therapy

98
Q

Define Vestibular schwannoma

A

A benign subarachnoid tumour originating from the Schwan cells of the vestibulocochlear nerve - can rarely be associated with Neurofibromatosis type 2

99
Q

Vestibular schwannoma features

A
  • Asymmetrical/unilateral sensorineural hearing loss and progressive ipsilateral tinnitus
  • Large tumours may become SOL
  • Dizziness
  • Headache
  • Disequilibrium
100
Q

Vestibular schwannoma investigations

A

All pts w/ unilateral tinnitus and sensorineural deafness should have an MRI to exclude malignancy

101
Q

Vestibular schwannoma management

A

Definitive management is surgery - but only for tumours >40mm in size

For smaller tumours - 6 monthly MRIs for surveillance + symptomatic relief

Year 6 (8 decks)

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