ENT Flashcards
Classical triad of PD + other features
Rigidity
Resting tremor
Bradykinesia
Shuffling gait
Mask like face
Micorgraphia
Dementia
Normal pressure hydrocephalus presentation
Characterised by progressive mental impairment and dementia
Difficulty walking
Impaired bladder control
Gait disturbance is often most noticeable symptom
No rigidity/ tremor
Progressive supranuclear palsy
Starts with impairment of balance- falls
Vertical gaze palsy
Symmetrical onset
Poorly responsive to levodopa
Corticobasal syndrome
Begins as a movement disorder
Unilateral absence of moment
Muscle rigidity with tremor
Progressive neurological disorder that can also affect cognition
Multi system atrophy
Shy drawer is a type Fts; Parkinsonism Autonomic disturbance- post hypotension, atomic bladder Cerebrellar signs Poor response to levodopa
NICE guidelines - sore throat and antibiotics
Features of marked systemic upset secondary to acute sore throat
Unilateral peritonsillitits
Hx of RF
Increased risk from acute infection- diabetes/ immunodeficiency
Patients with acute sore throat/ when 3 or more center criteria are present
Centor criteria
Tonsillar exudate
Tender anterior cervical LN or lymphadenitits
Hx of fever
Absence of cough
3 or more 40-60% chance strep group A beta haemolytic
Ménière’s disease
Disorder of inner ear of unknown cause Characterised by excessive pressure and progressive dilation of the endolymphatic system. More common in middle aged adults May be seen at any age M & F equally effected
Features of Ménière’s disease
Recurrent episodes of vertigo tinnitus and sensorineural hearing loss . VERTIGO. PROMINENT SYMPTOM
Sensation of aural fullness or pressure common
Nystagmus and positive Romberg test
Episodes lasts minutes to hours
Typically unilateral but bilateral symptoms may develop after a number of years
NATURAL HX of menieres
Symptoms resolves in the majority of patients after 5-10 years
Usually left with a degrees of hearing loss
Psychological distress is common
Mgmt of Ménière’s disease
ENT assessment to confirm diagnosis
Acute atttacks- buccaneers or IM prochlorperazine
Prevention; betahistine and vestibular rehab
Nasal tumors
Nosebleeeds, persistent blocked nose
Blood strained mucus
Decreased sense of smell
Smokers cough
Chronic cough that occurs as a result of damage and destruction of cilia
Nasal polyp
Nasal obstruction, sneezing, rhionorrhoea, poor sense of taste and smell
Sinister if unilateral symptoms or bleeding
Post nasal drip
Excessive mucus production but nasal mucosa
Excess mucus accumulates in the throat and bad of nose- chronic cough and bad breath
Causes of tinnitus
Otoscloeroiss Acoustic neuroma Hearing loss Drugs- aspirin, aminoglycosides, loop diuretics and Quinine Impacted ear wax Chronic suprrurative OM
Otosclerosis
Onset 29-40 Conductive deafness Tinnitus Normal tympanic membrane- 10% flamingo tongue Positive family history 10% flamingo tinge- hyperaemia Hearing aid Stapedectomy
Acoustic neuroma
Hearing loss Vertigo Tinnitus Absent corneal reflex Neurofibromatosis type 2
CNV absent corneal reflex
CN VII facial palsy
CNVIII hearing loss vertigo tinnitus
Cholesteatoma
Consist of squamous epithelium trapped within the skull base causing local destruction Most common in patients 10-20 Main fts- foul discharge Hearing loss Vertigo Facial nerve palsy
Glue ear
OM with effusion
Peaks at 2
Hearing loss is usually the presenting feature
Secondary problems such as speech and language delay
Ototoxic drugs
Aminogglycosides- gentamicin
Furosemide
Aspirin
Perforated TM
Most common cause is infection
May lead to hearing loss
Increased risk of OM
No tx usually needed- 6-8 weeks to heal - try and avoid water in ear
Antibiotics inf perforation happened after infection
Myringoplasty if it wont heal
Reactive lymphadenopathy
Most common cause of neck swellings
May be a history of local infection or generalized viral illness
Lymphoma
Rubbery, painless lymphadenopathy
Pain when drinking alcohol- VERY UNCOMMON
Night sweats and splenomegaly
Thyroid swelling
May be hypo eu or hyper
Moves upward on swallowing
Thyrglossal cyst
Common under 20
Usually midline between isthmus of thyroid and hyoid one
Moves upwards with protrusion of the tongue
May be painful if infected
Pharyngeal pouch
More common in older men
Posteromedial herniation between thyropharyngeus and cricipharyngeus muscles.
Usually not seen unless large, then a midline lump- gurgles on palpating
Typical symptoms are dysphasia regurg aspiration and cough, halitosis and throat infections
Cystic hygroma
Congenital lymphatic lesion typically found in the neck, classically on the left side
Most evident at birth
90% present by 2yrs
Fluctuant and transilluminable
Brachial cyst
An oval mobile cystic mass that develops between the SCM and pharynx
Develop due to failure of obliteration of the second brachial cleft in embryonic development
Present in early adulthood
Cervical rib
More common in adult females
10% develop thoracic outlet syndrome
Carotid aneurysm
Pulsatile lateral neck mass which doesn’t move on swallowing
Nasopharyngeal carcinoma
Squamous cell carcinoma of the nasopharyngeal
Rare on most parts of the world apart from s. China
Associated with EBV
Causes of vertigo
Viral labyrinthitis Vestibular neuronitits BPPV Ménière’s disease Bertebrobasilar ischemia Acoustic neuroma Trauma MS Ototoxicity
Viral labyrinthitis
Recent viral infection
Sudden onset
Nausea and vomiting
Hearing may be affected
Vestibular neuronitis
Recent viral infection
Recurrent vertigo attacks lasting hours/days
No hearing loss
BPPV
Gradual onset.. Average age of onset 55years Triggered by change in head position Each episode lasts 10-20 seconds May have nausea Positive dix hallpike manoeuvre
Tx; spontaneous resolution weeks to months
Epley manoeuvre- successful in 805
Vertebrobasialr ischaemia
Elderly patient
Dizziness on extension of neck
Complications of thyroid surgery
Anatomical- recurrent laryngeal nerve damage
Bleeding- respiratory compromise
Damage to parathyroid glands- hypocalcemia
Ramsay- Hunt syndrome
Shingles affecting the facial nerve
Auricular pain- first features
Facial nerve palsy
Vesicular rash around ear
Vertigo and tinnitus
Oral aciclovir and corticosteroids
Sinusitis
Inflammation of the mucous membranes of the paranasal sinuses
Usually strep pneumonia, h influenza, rhinovirus
Fts nasal discharge
Facial pain- pressure frontal- worse bending forward
Post nasal drip
Analgesia
Inhaled decongesations
OAB not normally indicated
Nasal polyps
1% of adults
2-4 more times common in males
Associations Asthma * Samters triad Aspirin sensitivity * Infective sinusitis CF
Fts
Nasal obs
Rhinorrhoea
Sneezing- poor taste and smell
Refer ENT
2 week referral to oral surgery if
Unexplained oral ulceration persisting for more 3weeks
Unexplained red/ white patches painful swollen and bleeding
Unexplained lump persisting more 3 weeks
Otalgia
In absence of any ear sings is a ref flag for head and neck malignancy
Complications of tonsillitis
Otitis media
Quinsy
Rheumatic fever and glomerulonephritis very rarely
INdications for tonsillectomy
NICE- fiver or more episodes per year
Disabling and prevent normal functioning
Complications of tonsillectomy
Primary <24hrs- haemorrhage in 2-3%, pain
Secondary- same
Hoarseness
Causes ; Voice overuse Smoking Viral illness Hypothyroidism GORD Laryngeal cancer Lung cancer
Always do CXR
Referral if >45 persistent and unexplained hoarseness
Benign tumours ENT
80% of all salivary gland tumours occur in the parotid gland and 80% of these are benign .
Median age 50’s
Examples of benign tumours
Benign pleomorphic adenoma or benign mixed tumour
Warthin tumour
Monoporphic adenoma
Haemiangioma
Benign pleomorphic adenoma or benign mixed tumour
Most common parotid neoplasm 80%
Slow growing lobular
Recurrence of 1-5%
Malignant degeneration in 2-10% of adenoma
Warthin tumour
Second most common benign parotid tumor Most common bilateral benign neoplasm of the parotid Male predominance 6th 7 th decade Malignancy trasnformation is rare
Monomorphic adenoma
Less than 5% of tumours
Slow growing
Haemangioma
Differential for a parotid mass in ac hold
90% of parotid tumours in children less than 1 year
Hypervascular on imaging
Spontaneous regression may occur
Malignant tumours
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Mixed tumours
Sjögren’s syndrome
Autoimmune
Parotid enlargement, xerostomia and keratoconjuncitvitis sicca
90% female
Bilateral non tender englargement of gland
Increased risk of subsequent lymphoma
Sarcoidosis
Paroid involvement in 6%
Bilateral
Gland non tender
Xerostomia
Black hairy tongue
Common due to defective desquamation of the filliform papillae
Tongue may be brown, green, pink , other
RF; poor oral hygiene, OAB, head and neck radiation, HIV, IV drug
Mgmt; tongue scraping to exclude candida
Sudden sensorineural hearing loss
Majority of cases is idiopathic
Some evidence that high does steroids 60mg/dat for 1/52 improves prognosis. Urgent ENT referral
Epidermoid cysts
Common cutaneous cysts proliferation of epidermal cells
Typically asymptomatic
Firm round central punctual may be present
Gingivitis
Secondary to poor dental hygiene
Presentation can range from simple gingivits( painless red swelling of gum margin which bleeds on contact) to acute necrotizing ulcerative gingivits (painful bleeding gums with halitosis and punched out ulcers on gums
Refer to dentist
3days if metronidazole/amoxicillin
Cholrhexidine mouthwash
Sialadenitis
Inflammation of the salivary gland often secondary to obstruction by a stone impacted in the duct
Salivary glands
Parotid glands are anterior and inferior to each ear
Submandibular lie below the angle of the jaw
Sublingual lie beneath the tongue
Nasal septal haematoma
Complication of nasal trauma
Development of a haematoma between the septal cartilage and the overlying perichondrium
Features; may be precipitated by minor trauma
Sensation of nasal obstruction
Pain and rhionorrhoea
Bilateral red swelling
Feels boggy
Surgical drainage
Iv antibiotics
If untreated- septal necrosis, saddle nose deformity
