ENT 3 Flashcards by John Darlington

Where else in someone with suspected glandular fever should you examine other than just the throat? and what additional blood tests would you consider?

Abdomen for hepatosplenomegaly

LFTs
Monospot test

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What is the management for quinsy?

Drainage - aspiration/ incision
- under LA

IV antibiotics

metronidazole
Penicillin V

Dexamethasone

IV fluids

Analgesia

*tonsillectomy if >1 episode

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Other a parapharyngeal abscess name two other deep neck spaces which can become infected in complications of tonsillitis:

Submental
pre-vertabral

*requires max fax input and may require tracheostomy

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Outline your immediate management of someone with epiglottitis or supraglottis:

High flow oxygen
Senior help
Nebulised adrenaline 1:1000 1mg in 5ml solution
IV dexamethasone 6.6mg
IV ceftriaxone 2mg

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What is supraglottis?

Inflammation of epiglottis and aryepiglottic folds

*note the patient may actually look relatively well, and only have abnormal findings on examination
there is an impeding airway compromise coming

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Name a clinic finding when examining the throat that may suggest epiglottitis:

Cherry red swelling

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What is the most common pathogen of otitis externa?

Pseudomonas aeruginosa

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As well as examining the ear on an otoscopy, which other place should you examine and why?

Finger nails

- long dirty nails may be used for picking which harbour bacteria

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If the patients ear canal is too thin for drops what can be done?

ENT referral and a Pope Wick can be inserted

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What are the key symptoms of necrotising otitis externa? What may be seen on otoscopy?
What other neurological signs may be seen?

Ear pain that keeps patient up at night

Continual discharge despite antibiotic therapy

granulation tissue on floor of ear canal

Neuro:

facial nerve palsy
Abducens nerve palsy

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What is treatment for otitis media?

paracetamol if stable

If unstable or:
- <2 years old
- co-morbities
Amoxicillin

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A complication of otitis media is intracerebral abscess, how is this identified and how is it scanned for?

CT with contrast

Ring enhanced lesion

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What is the differential for pina cellulitis and how doe sit differ?

perichondritis
- infection of cartilage
- the lobe will be spared as no cartilage there.
much more serious and can lead to long term deformity cutting of blood supply to cartilage

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What blood vessels make up Kiesselbach’s plexus in Littles area?

GASS

Greater palatine
Anterior ethmoid
Sphenopalatine
Superior labial

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If there is a posterior nose bleed, which artery is it most likely to be?

Sphenopalatine

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What would you expect to see on a tympanogram with someone with a grommet or perforated ear drum? and what about with a middle ear effusion?

High volume
- Type B

Type B
- Low volume

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What does a type C tympanogram suggest?

Eustachian tube dysfunction

*tympanogram still has a small peak but is pulled more to the left showing it is negative and thus.

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What is the underlying pathology of otosclerosis?

Abnormal bone formation around stapes leading to its fixation

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What is the definition of tinnitus and how is it differentiated from an auditory hallucination?

Sound perceived for >5mins in the absence of any external acoustical or electrical stimulus. and does not occur after loud noise.

differentiated from hallucination as it has no organised content. i.e. voice

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Define objective and subjective tinnitus:

Objective is when both patient and practitioner can hear the tinnitus.

usually vascular pathology
hyperdynamic states
myoclonus of the middle ear muscles

Subjective is when only the patient can hear the tinnitus

meiners
presbycusis
ototoxic drugs

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When should tinnitus be referred?

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Pulsatile tinnitus
- CT angio

Unilateral
- MRI head

Focal neurology

Asymmetric hearing loss
- MRI head

What may present with tinnitus, pulsatile mass and hypertension?

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Glomus tumours

- paragangliomas in middle ear usually of carotid decent which can release catecholamines

Name a risk factor for more intrusive tinnitus:

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Depression

List the symptoms of allergic rhinitis and describe what may be seen on nasoscopy:

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Itchy eyes
Blocked nose
Runny nose
Sneezing

Pale large Turbinates

In allergic rhinitis what medication is recommend when there is also asthma and what other circumstances is this medication useful?

Leukotriene receptor antagonists Useful in: - exercise induced - Aspirin

What are the causes of non- allergic rhinitis? and what is the treatment?

Air pollutants Smoke Odours Food Saline douche

In nasal trauma what should you inspect for and when is imaging required?

Bilateral/ unilateral ecchymosis Swelling over nasal bridge (develops within 2 hours) Visible deformity Anterior Rhinoscopy: - Epistaxis - septal deviation - Septal haematoma (requires immediate ENT) Imaging: - maxilla or skull fracture suspected

What is the management of a septal haematoma?

Incision and drainage Antibiotics

How many days following a nasal fracture should an ENT assessment take place? When is the window for manipulation if needed? and what i sthe surgery done if manipulation is unsuccessful and when?

5-7 days 7-21days - ideally within 14 days Septorhinoplasty - >6 months following initial injury

What investigations are wanted into laryngeal carcinoma?

Nasoendoscopy FNA - including cervical lymph nodes Imaging - CT

Name two universal newborn hearing screening methods that can be conducted:

otoacoustic Emissions - usually done first. Listening to outer hair cells for click of noise back * conducted in the first three months Audiological Brainstem responses - Headphones on and monitoring for response

What imaging is used for rhinosinusitis and when is it implemented?

CT paranasal sinuses - usually used for planning for surgery When chronic or recurrent acute sinusitis

What differentiates acute and chronic rhinosinusitis?

Acute: <12 weeks - most commonly due to cold Chronic >4 episodes throughout the year

What investigations should be done into a child with hearing loss?

Audiometry Tympanometry - to assess for glue ear Otoscopy

What is the management of glue ear?

Chronic otitis media with effusion in children requires: - grommets - hearing aid

What are the symptoms suggestive of bacterial rhinosinusitis?

``` Discoloured discharge Fever Severe pain Elevated CRP Double sickening ```

What are the complications of bacterial rhinosinusitis?

Orbital cellulitis / Abscess Meningitis Cerebral abscess Osteomylitis Pott's puffy tumour - subperiosteal abscess arising from osteomyelitis

What are the causes of otitis externa and what is the most common organism?

Swimming Hearing aid Finger picking Lack of wax Pseudomonas is most common, followed by Staph

What are the core symptoms of malignant otitis externa?

Severe otalgia - worse at night Continual discharge/ Copious otorrhea Granulation tissue within the ear drum

What are the signs of TMJ dysfunction?

Pain on lateral movement of jaw Signs of bruxism Earache - this is via the auriculotemporal nerve Facial pain

What are the most common causes of Ottis media?

Pneumococcus Haemophilus Influenza

How does otitis media with effusion/ glue ear, usually present and what may be seen on examination and what examinations can be conducted:

Inattention Poor speech development Hearing impairment Examination: - retraction of the ear drum - loss of light reflex Investigations: - Audiogram - Tympanogram (will be flat due to pressure within the middle ear restricting the amount of response of the tympanic membrane)

What are some of the causes of a type B tympanogram?

Otitis media with effusion Perforation/ grommet in situ Otosclerosis Cholesteatoma

Highlight the common causes of hearing loss in an adult:

``` Conductive: External meatus obstruction: - wax - pus - foreign body ``` TM dysfunction: - Infection - trauma Ossicles defects: - otosclerosis - infection - trauma Sensorineural: Drugs: - gent - Vancomycin Post infective: - mumps - measles - meningitis Neuro: - Meniere's disease - acoustic neuroma - MS

List some congenital causes of SNHL in children:

Waardenburg's syndrome - Hetrochromia - telecanthus - AD Alport's syndrome - Haematuria - AR Congenital Rubella

What are the causes of bacterial sinusitis?

Bacterial infection secondary to viral infection - most common cause - double sick sign Dental root infections Direct contact with pathogens - swimming Anatomical susceptible - deviated septum Systemic disease - primary ciliary dyskinesia

in recurrent sinusitis, what investigations should be done and what is usually the treatment?

Further investigations into the cause should be undertaken. typically it is due to anatomical defects. Investigations: - flexible nasal endoscopy - CT head and sinus Treatment may include: - functional endoscopic sinus surgery

What are the core symptoms of acute bacterial sinusitis?

``` Discoloured discharge Severe localised facial pain Pyrexia Raised CRP Prior viral infection ```

What are the symptoms of nasal polyps and how would you distinguish them from swollen turbinate's? and what is the investigations that should be undertaken into a single nasal polyp?

``` Watery Rhinorrhoea Sneezing Nasal obstuction Mouth breathing Snoring ``` Differentiate because they are: - pale - mobile - non tender when gentle palpation Single: - referral for endoscopy and biopsy to assess for malignancy

List some causes to epistaxis:

Local causes: - idiopathic - Trauma - nose picking - Neoplasm - bleeding polyp Systemic: - bleeding disorder - Primary haemostatic bleeding disorders (platelets) - hypertension - leukaemia - pancytopenia

What is the secondary haemorrhage of tonsillectomy and what is the management?

Bleeding >24 hours. usually in the 5-10day mark. Medical Emergancy: - contact anaesthetist - contact ENT - IV access - Cross match/ bloods

ENT 3 Flashcards

(51 cards)