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ENT Flashcards

1
Q

CENTOR Criteria

A

Absence of cough
Swollen and tender anterior cervical nodes
Temperature
Tonsillar exudates or swelling

+1 if between 3-14
-1 if over 45

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2
Q

Surfers Ear

A

Exocitosis

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3
Q

Otosclerosis

A

Accelerated by pregnancy

Autosomal dominant
Age 20-40

Conductive deafness
Tinnitus
Normal tympanic membrane
Positive family history

Manage - hearing aid, stapedectomy

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4
Q

Epiglottitis

A

Stridor
Drooling
Send to A&E

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5
Q

Headache fever worse on leaning forward

A

Frontal Sinusitis

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6
Q

Mastoiditis

A

Otalgia, severe and classically behind ear
Recurrent otitis media
Fever
Swelling erythema and tender over mastoid process
External ear may protrude forward
Ear discharge if eardrum perforated

Medical emergency - risk of meningitis

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7
Q

Otitis Media

When to give antibiotics

A 
Symptoms over four days or not improving
Systemically unwell
Immunicompromised 
Younger than 2yrs and bilateral
Perforation and/or discharge in the canal
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8
Q

Otitis media

Antibiotics

A

5 day amoxicillin

Penicillin allergy - erythromycin

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9
Q

Perforated tympanic membrane

Treatment

A

Usually heal after 6-8 weeks
Avoid water in this time

Prescribe antibiotics if perforation after episode of acute otitis media

Myringioplasty if doesn’t heal by itself

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10
Q

Causes of otitis externa

A

Infection (bacterial Staph A, Psuedomonas aeruginosa or fungal)

Seborrhoeic dermatitis

Contact dermatitis (allergic and irritant)

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11
Q

Features of otitis externa

A

Ear pain
Itch
Discharge
Otoscopy : red, swollen, or eczematous canal

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12
Q

Treatment of otitis externa

A

Initially

Topical antibiotic or combined topical antibiotic with steroid

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13
Q

Malignant otitis externa

A

Uncommon
In immunocompromised

PSEUDOMONAS AERUGINOSA

Progresses to temporal bone osteomyelitis

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14
Q

History of malignant otitis externa

A

DIABETES or immunosuppression

Severe unrelenting deep seated otalgia
Temporal headaches
Purulent otorrhoea
Possibly dysphasia, hoarseness and/or facial nerve dysfunction

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15
Q

Treatment of malignant otitis externa

A

Anti pseudomonal antimucrobial agents - CIPROFLOXACIN
Topical agents
Hyperbaric oxygen in refractory cases

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16
Q

Cholesteatoma

A

Squamous epithelium trapped in skull causing local destruction. Age 10-20

Foul smelling discharge + hearing loss

Other features of local invasion = vertigo, facial nerve palsy, cerebellopontine angle syndrome

Otoscopy - ATTIC crust in upper part

Manage - urgent ENT referral for consideration of surgical removal

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17
Q

Causes of tinnitus

A 
Menieres
Otosclerosis
Acoustic neuroma
Hearing loss
Drugs
Impacted ear wax
Chronic suppurations otitis media
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18
Q

Drugs causing tinnitus

A

Aspirin
Aminoglycosides
Loop diuretics
Quinine

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19
Q

Acoustic neuroma

Symptoms

A

Hearing loss, vertigo, tinnitus
Absent corneal reflex
Associated with neurofibromatosis type 2

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20
Q

Webers test

If sound heard better in DEAFER ear

A

Conductive

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21
Q

Webers test

If sound heard better in BETTER ear

A

Sensorineural

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22
Q

Rinnes

AC better than BC

A

Positive

Middle and outer ears normal

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23
Q

Rinnes

BC better than AC

A

Conductive deafness

As defective function of outer or middle ear

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24
Q

Mixed hearing loss

A

Both air and bone conduction impaired. Air often worse than bone

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25
Presbyacusis
Age related SENSORINEURAL hearing loss Bilateral high frequency hearing loss
26
Glue ear (otitis media with effusion)
Peaks at age 2 Hearing loss presenting feature Secondary problems with speech and language, balance etc
27
Ototoxicity drugs
Aminoglycosides eg Gentamycin Furosemide Aspirin Cytotoxic agents
28
Noise damage
Worse at 3000-6000Hz
29
Acoustic neuroma (vestibular schwannoma)
Features can be predicted by affected cranial nerves CN VIII: hearing loss, vertigo, tinnitus CN V: absent corneal reflex CN VII: facial palsy Bilateral acoustic neuromas seen in neurofibromatosis type 2
30
Viral Labyrinthitis
Recent viral infection Sudden onset Nausea and vomiting Hearing may be affected
31
Vestibular neuronitis
Recent viral infection Recurrent vertigo lasting hours or days May have nausea and vomiting No hearing loss or tinnitus Vestibular rehab
32
BPPV
Gradual onset Triggered by head position change 10-20s Positive Dix Halpike
33
Menieres
Hearing loss, tinnitus, aural fullness Nystagmus and positive Romberg ENT assessment to confirm diagnosis Inform DVLA and cease driving until controlled Acute attacks - prochlorperazine Prevent - betahistine and vestibular rehabilitation
34
Vertebrobasilar ischaemia
Elderly | Dizzy on neck extension
35
BPPV treatment
Epley manoeuvre (80%) Limited value - betahistine
36
Ramsay Hunt syndrome (Herpes zoster oticus) Reactivation of VZV in CN VII
Auricular pain first feature Facial nerve palsy Vesicular rash around ear Vertigo and tinnitus Oral acyclovir and corticosteroids
37
Infectious agents in acute sinusitis
Strep Pneumoniae, Haemophilus influenzae, rhinoviruses
38
Features of acute sinusitis
Facial pain - worse on leaning forward Nasal discharge Nasal obstruction Post nasal drip - may produce chronic cough
39
Management of acute sinusitis
Analgesia Intranasal decongestants Not usually antibiotics but if warranted phenoxymethylpenicillin first line Intranasal steroid should be considered if symptoms lasted over 10days so far
40
Management of recurrent or chronic sinusitis
Intranasal corticosteroids often beneficial
41
Allergic rhinitis Types
Seasonal - same type every year. Hay fever is seasonal rhinitis secondary to pollens Perennial - symptoms throughout year Occupational - symptoms follow exposure to allergens in workplace
42
Features of allergic rhinitis
``` Sneezing Bilateral nasal obstruction Clear nasal discharge Post nasal drip Nasal pruritus ```
43
Management of allergic rhinitis
Allergen avoidance Oral or intranasal antihistamines first line Intranasal corticosteroids May need oral corticosteroids May be a role for topical nasal decongestants but long term tachyphylaxis occurs and need bigger dose for same effect and rebound hypertrophy of nasal mucosa after stopping
44
Diagnosing allergic rhinitis
RAST
45
Nasal septal haematoma
Bilateral red swelling from nasal septum usually after Garima Boggy Manage with surgical drainage - septoplasty and IV antibiotics Irreversible septal necrosis and saddle nose deformity may occur in 3-4 days
46
Nasal polyps Associations
Asthma Aspirin sensitivity Infective sinusitis Cystic fibrosis Kartageners syndrome Churg Strauss syndrome
47
Nasal polyps Features
Nasal obstruction Rhinorrhoea Sneezing Poor sense of taste and smell Unusual and require further investigations if.. Unilateral Bleeding
48
Nasal polyps Management
All patients with nasal polyps should be referred to ENT Topical corticosteroids shrink polyp size in 80%
49
Mouth lesions Two week wait referrals to oral surgery if...
Unexplained oral ulceration or mass for over 3weeks Unexplained red or red and white patches that are painful swollen or bleeding Unexplained one sided head and neck pain for over 4 weeks with ear pain but normal otoscopy Unexplained recent neck lump or lump that has changed over 3-6weeks Unexplained persistent sore or painful throat Signs in oral cavity that can't be certain to be benign for over 6 weeks
50
Acute tonsillitis
Fever Malaise Pharyngitis Lymphadenopathy Tonsils usually oedematous and yellow or white pustules Over half all cases bacterial - usually Strep pyogenes
51
SIGN criteria for tonsillectomy
Over five episodes of tonsillitis a year for two years Or over 7 in the last year Or over 3 in the last three years Other - recurrent febrile convulsions secondary to tonsillitis - obstructive sleep apnoea, stridor or dysphasia secondary to enlarged tonsils - quinsy unresponsive to standard treatment
52
Complications of tonsillectomy
Primary (under 24hrs) Haemorrhage in 2-3% and pain Secondary (24hrs to 10days) Haemorrhage (due to infection) and pain
53
Quinsy Features
Severe throats pain which lateralises to one side Deviation of uvula to unaffected side Trismus Reduced neck mobility
54
Quinsy Management
Urgent ENT review Need aspiration under local anaesthesia
55
Sore throat (pharyngitis, tonsillitis, laryngitis) Management
Paracetamol or ibuprofen for pain Not routinely antibiotics Should not routinely do throat swabs and rapid antigen tests
56
Sore throat Indications for antibiotics
Marked systemic upset secondary to sore throat Unilateral peritonsillitis History of rheumatic fever Increased risk (child with diabetes or immunodeficiency) 3 or more CENTOR criteria
57
Neck Lumps Reactive lymphadenopathy
Common | History of local infection or generalised viral illness
58
Neck Lumps Lymphoma
Rubbery painless lymphadenopathy Pain with alcohol (although uncommon) Associated with night sweats and splenomegaly
59
Neck Lumps Thyroid swelling
Symptomatic of hypo eu or hyperthyroid Moves up on swallow
60
Neck Lumps Thyroglossal cyst
More common under 20yrs Usually midline - between isthmus of thyroid and hyoid bone Moves upwards with tongue protrusion May be painful if infected
61
Neck Lumps Pharyngeal pouch
More common in older men Gurgles on palpating if large Typically dysphagia, Regurgitation, aspiration and chronic cough. May cause bad breath
62
Neck Lumps Cystic hygroma
Congenital lymphangioma found in neck. Usually left side | Most present before age 2yrs
63
Neck Lumps Brachial cyst
Oval, mobile mass between sternocleidomastoid muscle and pharynx Embryonic Usually present in early adulthood
64
Neck Lumps Carotid aneurysm
Pulsatilla lateral neck mass which doesn't move on swallow
65
Causes of hoarseness
``` Voice overuse Smoking Viral illness Hypothyroidism GORD Laryngeal cancer Lung cancer ``` While investigating consider CXR
66
Referral guidelines | Suspected laryngeal cancer
Over 45 with Persistent unexplained hoarseness Or An unexplained neck lump
67
Nasopharyngeal carcinoma
Squamous cell More common in southern china Associated with EBV Cervical lymphadenopathy, otalgia, unilateral serous otitis media, nasal obstruction, discharge and or epistaxis, cranial nerve palsy Combined CT and MRI Radiotherapy first line
68
Immunocompromised patient with poor dentition
Airway compromise from cellulitis of floor of mouth | Ludwigs angina
69
Common cause of bacterial otitis media
Haemophilia influenzae
70
Causes of gingival hyperplasia
Phenytoin Ciclosporin CCB AML
71
Samters Triad
Asthma Aspirin sensitivity Nasal polyps
72
Coxsackie
Sore throat | Pustules hands and feet
73
Dysphagia and anaemia
Patterson Kelly Brown | Oesophageal web
74
Bird beak swallow
Achalasia
75
Sinusitis for under three days
Decongestants Not abx
76
Orphan Annie nuclei
Papillary thyroid cancer
77
6 weeks later still hoarse
Urgent ENT
78
Vasomotor rhinitis
Elderly, thin clear discharge
79
Epiglottitis
Stridor and drooling | In child call 999
80
Which nerve interferes with cough if damaged
Recurrent laryngeal
81
Chronic sinusitis and discharge
CT Sinus
82
Tilt test
Used to diagnose vasovagal syncope or neurocardiogenic syncope (also known as common faints)
83
In EBV infection do not give
Amoxicillin - rash

Revision lectures (15 decks)

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