ENT Flashcards
Features of neck lumps caused by reactive lymphadenopathy
History of local infection or generalised viral illness
Features of neck lump caused by lymphoma
- Rubbery, painless lymphadenopathy
- Pain when drinking alcohol (very uncommon)
- Associated night sweats and splenomegaly
Features of neck lump caused by thyroid swelling
- May be hypo, eu, or hyperthyroid symptomatically
- Moves upwards on swallowing
Features of neck lump caused by thyroglossal cyst
- More common in patients <20 years old
- Usually midline, between isthmus of thyroid and hyoid bone
- Moves upwards with tongue protrusion
- May be painful if infected
Features of neck lump caused by pharyngeal pouch
- More common in older men
- If large, midline lump that gargles on palpation
- Dysphagia, regurgitation, aspiration, and chronic cough
Features of neck lump caused by cystic hygroma
- Left side of neck
- Most evident at birth, 90% before 2 years of age
Features of neck lump caused by branchial cyst
- Oval, mobile cystic mass between sternocleidomastoid muscle and pharynx
- Present in early adulthood
Features of neck lump caused by cervical rib
- More common in adult females
- Can cause thoracic outlet syndrome (10%)
Features of neck lump caused by carotid aneurysm
- Pulsatile lateral neck mass
- Doesn’t move on swallowing
Most common causes acute otitis media
Streptococcus pneumoniae
Haemophilus influenzae
Morazella catarrhalis
Indications for antibiotics in otitis media
Symptoms lasting 4 days or not improving
Systemically unwell
Immunocompromised or high risk of complications - significant heart, lung, kidney, liver, neuromuscular disease
Younger than 2 with bilateral
Otitis media with perforation and/or discharge in canal
Antibiotics for otitis media
Amoxicillin
Erythromycin or clarithromycin if pen allergic
Most common causes acute sinusitis
Streptococcus pneumoniae
Haemophilus influenzae
Rhinoviruses
Treatment acute sinusitis
Intranasal decongestants or nasal saline
Intranasal corticosteroids if symptoms 10+ days
Oral antibiotics if severe
Antibiotics acute sinusitiis
Phenoxymethylpenicillin first line
Co-amox if systemically very unwell, high risk of complications
BPPV treatment
Epley manoeuvre
Vestibular rehabilitation (Brandt-Daroff exercises)
Betahistine
Audiometry presbycusis
Bilateral high frequency hearing loss
What is otosclerosis
Inherited condition, replacement of normal bone by vascular spongy bone
Inheritance otosclerosis
Autosomal dominant
Features of otosclerosis
Age of onset 20-40
Conductive deafness
Tinnitus
‘Flamingo tinge’ to tympanic membrane
Features of Meniere’s disease
Recurrent episodes of vertigo, tinnitus, and hearing loss
Sensation of aural fullness
Nystagmus
Positive Romberg test
Drugs causing ototoxicity
Aminoglycosides
Furosemide
Aspirin
Cytotoxic agents
Audiogram features noise damage
Bilateral, worse at frequencys 3000-6000Hz
Features of acoustic neuroma
Hearing loss, vertigo, tinnitus
Absent corneal reflex
Facial palsy
What condition are bilateral acoustic neuromas seen in
NF 2
Management of epistaxis
- First aid - sit forward, pinch cartilage
- Cautery if bleeding visible, packing if not
- Sphenopalatine ligation in theatre
Epistaxis management if first aid successful
Consider topical antiseptic e.g. naseptin, mupirocin - reduce crusting and risk of vestibulitis
When to consider admission in epistaxis
Comorbidity, e.g. coronary artery disease, severe hypertension
Underlying cause suspected
Under 2 - more likely to have haemophilia or leukaemia
Features of geographic tongue
Eryhematous areas with white-grey border
Burning after eating certain foods
Management geographic tongue
Reassurance about benign nature
Causes gingival hyperplasia
Phenytoin
Ciclosporin
CCBs, esp nifedipine
AML
Most common causative organism malignant otitis externa
Pseudomonas aeruginosa
Features of malignant otitis externa
Diabetes (90%) or immunosupression
Severe, unrelenting, deep seated otalgia
Temporal headaches
Purulent otorrhoea
Possible dysphagia, hoarseness, and/or facial nerve dysfunction
Treatment Menieres disease
Acute attacks - buccal or IM prochlorperazine
Prevention - betahistine and vestibular rehabilitation
Driving and Menieres disease
Patients must inform DVLA, not drive until satisfactory control of symptoms
Conditions associated with nasal polyps
Asthma
Aspirin sensitivity
Infective sinusitis
Cystic fibrosis
Kartagener’s syndrome
Churg-Strauss syndrome
Management of nasal polyps
All patients with suspected nasal polyps refer to ENT for full examination
Topical corticosteroids
Most common pathogens causing otitis externa
Staphylococcus aureus
Pseudomonas aeruginosa
Fungal
Causes of bilateral parotid gland swelling
Mumps
Sarcoidosis
Sjorgen’s syndrome
Lymphoma
Alcoholic liver disease
Causes of unilateral parotid gland swelling
Tumour - plemorphic adenomas
Stones
Infection
Categories of haemorrhage post-tonsillectomy
Primary, or reactionary occurring in first 6-8 hours
Secondary, occuring 5-10 days
Treatment of primary post-tonsillectomy haemorrhage
Immediate return to theatre
Cause of secondary post-tonsillectomy haemorrhage
Often associated with wound infection
Treatment of secondary post-tonsillectomy haemorrhage
Admission and antibiotics
Severe bleeding may need surgery
Most common site of salivary gland tumours
Parotid (superficial lobe)
Most common site of salivary gland stones
Submandibular
Most common type of salivary gland tumour
Pleomorphic adenoma (non malignant)
Features of malignant salivary gland tumour
- Short history
- Painful
- Hot skin
- Hard
- Fixation
- CN 7 involvement
Features of salivary gland pleomorphic adenoma
Middle age
Slow growing, painless lump
Indications for antibiotics in sore throat
Features of marked systemic upset secondary to acute sore throat
Unilateral peritonsillitis
History of rheumatic fever
Increased risk from acute infection
3 or more Centor criteria present
Antibiotics sore throat
Phenoxymethylpencillin
Clarithromycin if allergic
Management of sudden onset sensorineural hearing loss
Urgent referral to ENT
MRI scan to exclude vestibular schwannoma
High dose oral corticosteroidsW
What is thyroglossal cyst
Persistence of the thyroglossal duct (embryological connection between thyroid and the tongue)
Complications of thyroid surgery
Anatomical, e.g. laryngeal nerve damage
Bleeding - due to confined space, may rapidly lead to respiratory compromise
Damage to parathyroids → hypocalcaemia
Drugs causing tinnitus
Aspirin
NSAIDs
Aminoglycosides
Loop diuretics
Quinine
Indications for surgery for tonsillitis
7 episodes in 1 year, 5/year for 2 years, 3/year for 3 years
Recurrent feb con secondary to tonsillitis
Obstructive sleep apnoea, stridor, or dysphagia secondary to enlarged tonsils
Peritonsillar abscess unresponsive to standard treatment
Features of viral labyrinthitis
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
Features of vestibular neuronitis
Recent viral infection
Recurrent vertigo attacks lasting hours or days
No hearing loss or tinnitus
Horizontal nystagmus
Feaures of benign paroxysmal positional vertigo
Gradual onset
Triggered by change in head position
Each episode lasts 10-20 seconds
Features of vertebrobasiliar ischaemia
Elderly patient
Dizziness on extension of neck
Features of acoustic neuroma
Hearing loss, vertigo, tinnitus
Absent corneal reflex
Management vestibular neuronitis
Buccal or IM prochlorperazine for rapid relief in severe cases
Short oral course of prochlorperazine or antihistamine in less severe cases
Vestibular rehabilitation exercises in chronic
Viral labyrinthitis vs vestibular neuronitis
Vestibular neuronitis only affects vestibular nerve, so no hearing impairment. Labyrinthitis affects vestibular nerve and labyrinth, so vertigo and hearing impairment
Examination findings of vestibular labyrinthitis
Spontaneous unidirectional horizontal nystagmus towards affected side
Sensorineural hearing loss
Abnormal head impulse test
Gait disturbance
Management vestibular labyrinthritis
Episodes usually self limiting
Prochlorperazine or antihistamines may help reduce sensation of dizziness
