ENT Flashcards
Causes of Stridor
Congenital: Laryngomalacia, vascular rings
Inflammation: Laryngitis, epiglottis, croup, anaphylaxis
Tumours
Trauma: Thermal/chemical burns, intubation
Signs of impending obstruction
Swallowing difficulty, drooling, pallor/cyonosis, use of accessory breathing muscles, downward plunging of trachea
Croup
Symptoms
Treatment
Barking cough & increased respiratory effort. Worse at night.
Dexamethasone IM
Acute epiglottis
Cause
Symptoms
Management
H influenzae
Fever, irritability, sore throat, drooling, leaning forward.
Do not examine throat, keep upright, IV antibiotics & Dexamethasone IM
Acute airway obstruction management
- O2
- Nebulised adrenaline
- Note 02 saturation, RR, HR, BP
- Call ENT/Anaesthetics
Sore throat causes
- Viral: Coronovirus, rhinovirus, adenovirus, epstien barr
2. Bacterial: Group A B-haem strep (Pyogenes)
Sore throat treatment
- Paracetamol & Ibuprofen
- Pen V/Clarithromycin if 3 Centor criteria
Nb avoid amoxicillin as causes rash in EBV
Centor criteria (4)
- Absence of cough
- Lymphadenopathy
- Exudates
- History of fever
Tonsillitis complications (5)
- Otitis media
- Sinusitis
- Quincy
- Parapharngeal abcess
- Lemierre syndrome - Acute septicemia, and jugular vein thrombosis
Quincy
What?
Symptoms/Signs?
Peritonsillar abcess
Sore throat Peritonsilar bulge Uvular deviation Trismus Muffled voice.
Scarlet fever
Cause
Signs/symptoms
Management
Caused by exotoxins of S.Pyogenes.
Sandpaper red rash 12 hours after sore throat & fever. Strawberry tongue.
Pen V/Clarithromycin
Hoarseness causes
Reflux laryngitis
Laryngeal carcinoma (>3 weeks & smoking indicators), Vocal cord palsy.
Reinke’s oedema (Chronic cord irritation causing oedematous cords)
Smoking, stress, singing, shouting, voice overuse.
Recurrent laryngeal nerve palsy
Symptoms?
Causes?
Weak breathy voice
Repeated coughing
Exertional dyspnoea.
Cancer Iatrogentic (oesophageal/pharangeal pouch surgery), Post viral.
Dysphagia
Causes?
Malignant (Oesophageal/Pharyngeal/Gastric/Lung)
Neurological (Bulbar palsy, Myasthenia gravis)
Other (Benign stritcures, pharyngeal pouch, achalasia, systemic sclerosis)
Nb. If fluid can be drank = Stricture (with pain = malignant)
Difficulty swalling = Bulbar palsy
Oesophageal cancer associated with.
Achalasia, smoking, alcohol, Barrets oesophagus.
Benign oesophageal stricture caused by:
GORD
Swallowing corrosives/foreign body
Pharyngeal pouch
What?
Symptoms?
Investigation?
Pharyngeal mucosa herniates through an area of weakness.
Dysphagia, gurgling, halitosis, lump in the neck, aspiration pneumonia.
Barium swallow
Head and neck SSC
Associations
Smoking Alcohol HPV GORD Vitamin A & C deficiency
Facial palsy
Causes
Intracranial - Brain stem tumours, stroke, MS, Acoustic neuroma, meningitis
Intratemporal - Otitis media, Ramsay hunt, cholesteatoma
Infratemporal - Parotid tumour
Bells palsy
Ramsay Hunt syndrome
What?
Symptoms?
Facial nerve shingles (VZV)
Painful rash or blisters in or around the ear, scalp or hair line, facial droop and weakness, altered taste, difficulty closing eye.
Bells palsy
What?
Symptoms?
Treatment
Idiopathic LMN unilateral facial palsy
Abrupt onset of drooling, facial droop, poor facial expressions, reduced taste and speech.
Prednisolone & eye drops. 80% better in 3 months.
Nb Refer in recurrent & bilateral facial palsy (Lyme/Guillian barre, leukaemia, sarcoidosis)
Forehead sparing facial paralysis
UMN lesion as has bilateral innervation.
Sialadenitis
What?
Symptoms?
Treatment?
Acute infection of the submandibular or parotid gland. Common in elderly, dehydrated and poor oral hygiene.
Painful swelling, fever, pus leakage.
Abx and good oral hygine
Sialolithiasis What? Which gland? Symptoms? Investigations? Management?
Salivary gland stone
Submandibular most common.
Painful swelling after/during meals.
X-ray or salinograph
Warm compress or surgery if big.
Causes of salivary gland swelling
Malignancy
Stones
Mumps
Sjogrens syndrome
Dry mouth causes
Antipsychotics B blockers Diuretics Dehydrations Sjogrens syndrome Parotid stones SLE & Scleroderma
Salivary gland tumour
Where?
Suggestive symptoms?
Parotid most common
Hard fixed mass, overlying ulceration, lymph node enlargement, facial palsy.
Otitis externa causes
Trauma
Eczmea/psoriasis
Pseudomonas
Staph aureus
Otitis externa mild/moderate/severe
Symptoms
Management
Mild
Scaly skin with some erythema. Normal canal diameter
Cleaning EAC - Gentle syringing, dry moping, microsuction
Moderate
Painful narrowed EAC with malodorous creamy discharge
Acetic acid + steroid drops (Aminoglycosides contraindicated)
Severe
Occluded EAC
Aluminium acetate wick to open canal.
Necrotizing otitis externa
Persitant OE that is life threatening through osteomyelitis. Common in immunosuppresed, diabetics and elderly.
Pseudomonas
Temporomandibular joint dysfunction
Earache, facial pain and joint clicking/popping related to teeth grinding or joint degeneration.
Stress can play a key role.
Pain in exaggerated on lateral jaw movement
Acute otitis media What Organisms Presentation Treatment
Middle ear infection presenting with rapid onset fever pain, irritability, vomiting after a URTI.
Caused by Pseudomonas/Haemophilus
Pain associated with bulging TM which eases when rupture occurs.
Treatment - Optimize ear spray + Amoxcillin (in systemically unwell or delayed perscription)
CFS discharge from ear/nose diagnosis
Transferrin B or glucose
Otits media with effusion What? Signs? Associations in children? Treatment?
Occurs when effusion present after symptoms of OM have subsided.
Retracted or bulging TM with bubbles/fluid level
URTI, oversized adenoids, congenital malformations e.g cleft palate, down syndrome, kartangers syndrome.
Active observation for 3 months then grommets (can cause tympanosclerosis)/auto inflation of eustation tube.
Childhood deafness
Genetic
Acquired
Conductive - Pierre Robin & congential anatomy abnormalities.
SN - Waardrenburg syndrome, Turners
TORCH infections Perinatal causes - Hypoxia, premature Infections - Meningitis, measles, mumps Ototoxic drugs Trauma
Hearing tests in babies/children
Otoacoustic emissions testing
Audiological brainstem response
Distraction testing (>18months)
Visually reinforced audiometry.
Conductive hearing loss
Causes
Weber & Rinne
Impaired sound transmission due to obstruction, TM rupture, and ossicular problems (otosclerosis & infection)
Weber = Sound best in abnormal ear Rinne = Bone conduction better.
Sensorineural hearing loss
Causes
Weber & Rinne
Results from defects in the cochlea or nerves caused by ototoxic drugs, infection (meningitis, measles, mumps), vascular disease, menieres and trauma.
Weber = Sound heard best in normal ear Rinne = Air conduction better.
Presbyacusis
Age related SN hearing loss due to loss of hair cells
Tinnitus causes
Objective
Vascular disorders (AV malformation, carotid pathology)
High ouput cardiac states (Pagets, hyperthyroid)
Subjective Meniere's Ototoxic drugs Aspirin, NSAIDS, quinine. MS Trauma Acoustic neuroma
Acoustic neuroma
Benign tumour of swann cell of the superior vesitbular nerve.
Progressive ipsilateral tinnitus +/- SN hearing loss.
Can cause increased ICP signs and trigeminal nerve compression (numb face)
Vestibular vs Central vertigo
Vestibular is often severe associated with loss of balance, nausea, vomiting, hearing loss and tinnitus and horizontal nystagmus.
E.g. Menieres, BBPV, Labyrinthitis
Central is often less severe not associated with hearing loss and tinnitus and nystagmus can be horizontal or vertical.
E.g. Acoustic neuroma, MS, Head injury
BBPV
Attacks of sudden rotational vertigo lasting 30s provoked by head turning.
Dix hallpike test to diagnose.
Epley manoeuvres as treatment. Drugs dont work
Menieres disease
Cause
Presentation
Treatment - Acute/prophylaxis
Dialitiation of endolymph spaces causing sudden attacks lasting 2-4hrs.
With fluctuating SN hearing loss, tinnitus and nystagmus.
Acute treatment: Prochlorperazine.
Prophylaxis: Betahistine.
Acute vestibular failure
Sudden attacks of unilateral vertigo and vomiting often following a URTI.
Lasts for 1-2 days improving over a week.
Nystagmus away from the affected side
Rhinosinusitis
Inflamation of the nose and paranasal sinuses with 2 or more of: Nasal blockage/congestion Discharge Facial pain/pressure Reduced smell
Nasal polyps
Causing water nasal discharge, sneezing, purulent postnasal drip, mouth breathing and snoring.
Betamethasone steroid drops can shrink.
Surgery is definitive.
Causes of bacterial sinusitis (4)
Direct spread - Swimming/diving
Odd anatomy - Septal deviation
Mechanical ventilation
Kartageners
Common causative organisms & treatment for sinusitis
S.pneumoniae, H.influenzae, S.aureus
Amoxicillin. Most are viral though
