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ENT Flashcards

1
Q

Cervical lymphadenopathy Causes + Complication

A 
EBV (fever, pharyngitis, lymphadenopathy)
HIV (Cervical, axillary, occipital)
Adenovirus
Strep pharyngitis (Pyogenes)
Malig: NHL, HL, CLL

SVC obstruction

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2
Q

When to refer Cervical lymphadenopathy

A

Not resolving with ABx at 2 weeks,
Unexplained Cervical lymphadenopathy

48 hour urgent blood count for leukaemia if under 25

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3
Q

Salivary gland swellings

  • Causes
  • Glands
A

Infection
Inflammation
Obstruction
Tumour

Parotid, Submandibular, sublingual

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4
Q

Parotid swelling:

  • Causes
  • When to worry
A

Viral parotitis (Mumps)
Stone in duct, benign/malig tumours
Sjogren’s
Sarcoidosis

Assoc withFacial nerve palsy - suggests malignant infiltration

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5
Q 
Parotitis
- Causes
- Mumps pres
- Ix
Tx
A

Viral (mumps), Bacterial (s.aureus from oral cavity)

Bilateral swelling, pyrexia, orchitis

Viral serology, antibody testing (Mumps IgM)
Sialography for blockage
CT/MRI exclude malignancy

Mumps self limiting (supportive analgesia)

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6
Q

Salivary gland obstruction

  • Main gland
  • Pres
  • Ix
  • Tx
A

Submandibular

Pain and swelling at meal time (when they prod most)

USS and contrast sialogaphy

Many pass spontaneously (warm compress, gland massage. oral hygiene)

Surgical removal

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7
Q

Sialadenosis

  • What is it
  • Assoc with what
A

Generalised Parotid gland swelling

Sjogren’s & Sarcoid

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8
Q

Salivary gland tumours

  • Benign v Malig and E.G of each
  • Red flags
A

70% benign

Benign: Pleomorphic adenoma (Parotid)
Malignant: Mucoepithelioid carcinoma (Parotid)

Nerve parenthesis (CN VII palsy = malignant), Hx skin cancer, rapid growth

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9
Q

Salivary gland tumour

  • Ix
  • Tx
A

USS 1st line
Fine needle aspiration (cytology). Core needle biopsy for histology if FNA +ve

MRI - staging, CT - mets

Surgery - superficial parotidectomy + facial nerve
Radiotherapy

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10
Q

Benign paroxysmal positional vertigo

  • Epi
  • Pathophys
  • Cause
  • Attack character
A

Commonest cause of vertigo

Caused by otolith (crystal) detachment. Sensation of ongoing movement

Idiopathic (60%)
Head injury, labyrinth degeneration

Vertigo provoked by head movement. Attacks 20-30 seconds
No hearing loss/tinnitus/pain (red flags)
May cause nausea

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11
Q

BPPV examination + management

A

Otoscopy, CN exam, Dix-Hallpike (+ve = rotary nystagmus. usually unilateral. Bilateral = central cause)

Reduce head movement,

Epleys manoeuvre (reposition otoliths in utricles)

Contact DVLA - don’t drive when dizzy

Recurrence common

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12
Q

Menieres

  • Def/pathophys
  • Pres
  • Cause
A

Overproduction/impaired absorption of endolymph

Auditory and vestibular disease (vertigo - mins/hours assoc N&V, hearing loss - unilateral, sensorineural, tinnitus, fullness in ear)

Genetic, Trauma (acoustic/physical), recent virus

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13
Q

Menieres

  • Ix
  • ddx
  • Tx
  • Complications
A

Positive Rombergs (standing with arms out)

Sensorineural hearing loss

MRI normal, TFT normal, lyme disease serology normal
- rule out acoustic neuroma, viral labyrinthitis/neuritis

Low salt and diuretics
(Acetazolamide - Carbonic anhydrase inhibitor … also used in glaucoma)

Falls, Progressive hearing loss

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14
Q

Vesitbular neuritis and labyrinthitis

  • Pres
  • Cause
  • Nystagmus
A

VN - vertigo only (only vestibular nerve)
L - Vertigo and hearing loss

VN - HSV reactivation

L - Post viral URTI, aminoglycosides also cause (assoc with sensorineural hearing loss e.g. Gent)

Nystagmus usually unidirectional (bidirectional seen in stroke)

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15
Q

Vestibular neuritis and labyrinthitis Tx

A

Vertigo: Prochlorperazien

Encourage to be active ASAP

Surgery considered in Labyrinthitis

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16
Q

Acoustic neuroma

  • Def
  • Pres
  • Assoc gene
A

Tumour of CN8 (vestibulocochlear) arising from schwann cells

Unilateral hearing loss/tinnitus (AN until proven otherwise)
Impaired facial sensation (Trigeminal involvement)
Balance problems
Ataxia - cerebellar compression

NF-t2 (Bilateral AN)§

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17
Q

AN Tx

A

Microsurgery

Conservative if small tumours with preserved sharing

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18
Q

Tinnitus

  • Types
  • Causes
  • General management
A

Objectivists (actual noise in head), subjective (inorganic)

Pulsatile: carotid stenosis, valvular heart disease
TMJ dysfunction

Merniers, infection, MS, Acoustic neuroma, Head injury, acoustic trauma, stress (strong assoc(

After through Head, neck, ear and jaw exam most can be reassured

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19
Q

Sinuses:

  • names
  • sinusitis def
  • Referred pain
  • Viral Vs bacterial
A

Frontal, Ethmoid, Sphenoid, Maxillary

Inflam of mucous membrane slinging sinuses

Toothache, upper jaw, skin

Viral lasts less than ten days. Purulent discharge& worse after 5 days = bacterial

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20
Q

Sinusitis:

  • Pres
  • Predisposing factors
  • Assessment
  • Organisms
A

Rhinitis/nasal purulence, sinus pain, loss of smell

URTI, allergy, asthma, smoking, DM, swimming,

Palpation - tenderness

Strep pneumoniae, H.influenza

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21
Q

Sinusitis:

- management add referral

A 
Reassure 2.5 wk recovery
Paracetamol/Ibuprofen
Nasal decongestant (7d max)
Nasal douching
Chronic - Topical nasal steroids (Beclomethasone)

Severe: 1st line amoxicillin, 2nd line coamoxiclav

Refer if recurrent, Or complication (orbital cellulitis, meningitis osteomyelitis)

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22
Q

Trigeminal neuralgia

  • Def
  • Tx
A

Sharp pain in distribution of trigeminal nerve

TCA - amitryptaline ± CBT

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23
Q

TMJ dysfunction

  • Pres triad
  • Cause
  • Tx
A

Pain, limited mouth opening, joint noises

OA, RA, Ank spond, Grinding teeth (muscle affected)

Reassurance (self limiting)
Drugs: NSAIDs, muscle relaxants

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24
Q

Causes of congenital hearing loss

A

Rubella and CMV

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25
Q

Causes of post-natal hearing loss

A

Mumps and measles

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26
Q

Rinnes

  • Hz
  • Conductive loss
  • SN loss
A

512Hz

Louder at mastoid

Both air and mastoid lost

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27
Q

Webers

  • Hz
  • conductive
  • SN
A

512Hz

Louder in affected ear

Quieter in affected ear

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28
Q

Causes of conductive loss

A

Occlusion (foreign body, bony growth - Otosclerosis = bone deposition at stapes)

Infection (otitis externa - S.aureus, media - effusion)

Perforation (chronic otitis, trauma, surgery)

Growths (cysts, tumours (sarcoma, melanoma, carcinoma)

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29
Q

Sensorineural deafness causes

A

Acoustic neuroma
Mernier’s
Paget’s disease of bone (auditory canal stenosis)
Occupational (auditory trauma - refer for legal)

Ototoxics (ahminoglycosides, Cis-platinum)

MS

Other: age related (Presbycusis), trauma, infection (meningitis)

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30
Q

Management of Deafness

A

Urgent ENT referral

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31
Q

Ossicles

Type of joint, what can affect

A

Malleus–>Incus–>Stapes–>Oval window

Synovial joint. Can be affected by RA

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32
Q

What nerve runs through middle ear?

A

Chorda tympani

Branch of CNVII (facial)

Carries taste to anterior two thirds of the tongue

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33
Q

Otosclerosis:

  • Genes
  • Def
  • Pres
A

Autosomal dominant

Normal bone replaced by spongy bone

Conductive deafness, Flamingo tinge of Tympanic membrane (inc vascularity)

34
Q

Causes of Otorrhoea(discharge)

  • If with pain
  • If there was pain but now not
  • If with hearing loss
A

Otitis externa

Acute otitis media

Cholesteatoma (keratinisation in the middle ear)

35
Q

Otitis externa:

  • def and cause
  • pres
  • complication
A

Painful discharging ear. Normally infection (can also be inflammatory, allergic)

Erythematous ear, discharge, pain on moving trigs, pre-auricular lymphadenopathy, May have cellulitis

Facial nerve palsy

36
Q

Otitis externa pathogen

A

Bact: S.aureus

Fungus (aspergillus)

37
Q

Viral otitis externa

A

Ramsay hunt syndrome (Bell’s palsy, Rash behind ear)

38
Q

Otitis externa Tx

A

Topical neomycin (also covers fungal)
ENT review
Flucloxacillin (erythromycin if allergic)
Olive oil for waxy build up

39
Q

Otitis media

  • What is it & types
  • Who gets
  • Causes (Bact + Viral)
A

Acute otitis media- inflammation of middle ear. may have pus = risk perforation

Otitis media with effusion - acute inflammation with effusion behind TM (glue ear)

Children

B: S.pneumoniae, H.influenza

V: Rhinovirus, RSV

40
Q

Otiti media

  • RF
  • Pres
  • Ix
  • Tx
A

Smoking, winter, URTI, DM, immunosuppression

Hearing loss, otalgia, pyorrhoea, fever.

Culture of discharge, CT/MRI (exclude complications)
Analgesics (Para, NSIADs)
Abx: amoxicillin (only if symptom over 5 days)

41
Q

Otitis media complications

A

Perforation, Glue ear

Meningitis, mastoiditis/osteomyelitis (air cell infect), Facial nerve palsy, brain abscess

42
Q

Glue ear

  • Complications
  • management
A

Conducive hearing loss (may fall behind in school)

Grommets if persistent over 3m

43
Q

Chronic supportive otitis media:

  • What is it
  • Pres
  • Ix
  • Tx
A

chronic inflammation of middle ear (often with perforation)

Ottorhoea, conductive hearing loss, red flags (fever, vertigo, otalgia)

CT/MRI to rule out intracranial complications

Topical Abx (Fluclox) Surgical repair eardrum

44
Q

Mastoiditis

  • What bone
  • What is the concern
  • Organism
  • Ix
  • Tx
A

Petrous temporal bone

Air cells in close relation to cranial fossa Infection with boney destruction can cause meningitis, cerebral abscess, facial nerve damage

S.pneumonia/pyogenes

Blood cultures
CT/MRI
LP if intracranial spread suspected
Tympanocentesis (G stain and culture)

3rd Gen cephalosporin
Para + Ibuprofen
Surgery (mastoidectomy) if osteomyelitis

45
Q

Blood in middle ear. Cause? What nerve?

A

Worry about head trauma

Abducens runs over temporal bone

46
Q

Staging head and neck cancer

A 
1 = early disease
2 = locally advanced 
3 = LN spread
4 = distant mets
47
Q

Head and neck cancer Tx

A

Surgery or radiotherapy for early disease

Later stage - surgery and chemoradiotherapy ± reconstruction

48
Q

Oral cancer

  • Cell type
  • RF
  • Appearance
  • Pres
A

Squamous cell carcinomas

Smoking, Alcohol, Chewing tobacco, low fruit

Leukoplakia, mass, speech/swllow difficulty, bleeding/ulcerating

49
Q

What to refer for suspected oral cancer

A

Unexplained ulceration for over 2 weeks

Lump in oral cavity over 2 weeks

Red or white patch (erythro/leukoplakia)

50
Q

Oral cancer diagnosis

A

Fine needle aspiration/biopsy
CT/MRI for staging
CT thorax all H&N Ca

surgical resection ±reconstruct
External beam radiotherapy ± Cisplatin

51
Q

Pharyngeal cancer

- Tx

A

Surgery ± neck dissection (LN removal)

Radiochemoherapy (cisplatin, External bam radio)

52
Q

Laryngeal cancer

  • Cell type
  • Where
  • RF
  • Pres
A

SCC

Most commonly at Glottis

Smoking, Alc, HPV16, asbestos/nickel

Chronic hoarseness, pain, dysphagia, lump in neck, weightless, sore throat, stridor

53
Q

Laryngeal cancer

  • Ix
  • Tx
A 
Palpate for Los
CXR to see if hoarseness lung or ENT
Laryngoscopy
FNA neck mass
CT/MRI staging

Transoral microsurgery/Partial/Total laryngectomy depending on stage

Postop chemoradio

54
Q

Cause of tonsilitis

A

Bacterial: strep pyogenes

Viral: Coxsakie, EBV/IM in teens (splenomegaly), Herpes simplex (Adolescents)

55
Q

Centor criteria and Tx

A

1) Fever > 38
2) Tender anterior cervical lymphadenopathy
3) No cough
4) Tonsillar exudate

3/4 = 40-60% chance bacterial
Give phenoxymethypenicillin (Clarithromycin if allergic)
56
Q

Signs of strep throat

A

Red, swollen, Exudate, LNs, Temperature

57
Q

Tx tonsilitis

A

Reassure self limiting, Ibuprofen/Paracetamol

ABx if 3+ on Centor (10d phenoxymethypenicillin)

58
Q

When tosillitis get surgery

A

7 well documented episodes in last 12m

Tonsils obstructing airway

59
Q

Tonsilitis compliations

A

Peritonsillar abscess, acute otitis media

60
Q

Group A strep throat (pyogenes) complication

A

Rheumatic fever
Glomerulonephritis
Scarlet fever (red skin eruption, flushed face, strawberry tongue)

61
Q

Causes of pharyngitis (Pharyngeal inflam)

A

Viral: rhinovirus, coronavirus, influenza, parainfluenza, adenovirus

Bact: Group A strep

62
Q

When not to examine sore throat?

  • Sympt
  • What is it and what organis?
A

Drooling, stridor

Epiglottitis

H.influenza type b

63
Q

Tx for normal pharyngitis

  • normal
  • Abx?
  • When refer
A

Reassure
Para, Ibuprofen, oral fluids

If doesn’t settle in 1 week or if cantor 3/4 then Abx

Urgent referral:

  • resp diffuculty,
  • stridor,
  • suspected kawasaki’s (sore throat, palm/sole peeling - risk Coronary aneurysm)
64
Q

Complications of pharyngitis:

  • Suppurative
  • Non-suppurative
A

Otits media, Sinusitis, Quinsy, Mastoiditis, Scarlet fever

Rheumatic fever (Pyogenes), Glomerulonephritis

65
Q

Causes of Laryngitis

A

Infection: viral (corona, adeno, HSV), bacterial (H.influenza b, S.pneum)

Reflux
Allergy
AI disease (SLE, RA, Amyloid)
Smoking

Tx according to cause e.g. GORD -> PPI

66
Q

Epiglotitis:

  • Cause
  • Age
  • Pres
  • DONT …
  • Ix
  • Tx
A

Haemophilus Influenzae b

2-5 or adults 40-50

Sore throat, unable to swallow (drooling), Muffled voice, Fever/hihg temp, tripod sign (leaning forward)
Stridor + resp distress

Examine airway with tongue depressor - precipitates laryngeal oedema

Same day urgent laryngoscopy IN THEATRE

IV abs ± intubation/Tracheostomy

67
Q

Peritosilar abscess (Quinsy)

  • Assoc with..
  • Organism
  • RF
  • Pres
  • Diagnosis
  • Tx
A

Complication of acute tonsillitis

Strep pyogenes, Staph aureus, H.influenzae

Smoking

Severe pain, fever, drooling, foul breath, reduced jaw mobility (Trismus)
Ipsilateral LN
Unilateral bulge with uvula displacement

Clinical Dx, may need CT

IV fluids, IV ABx (Penicillin, co-amoxiclav, cephalosporin)
Needle aspiration and drainage

68
Q

Quinsy complications

A

Abscess Spread

Haemorrhage

69
Q

Stridor (loud inspiratory sound)

  • Causes in child
  • Causes in adult
A

Croup, inhaled foreign body, epiglottis

Airway trauma, anaphylaxis, acute laryngitis
Chronic: Laryngeal ca, Mediastinal tumour,

70
Q

Where do foreign bodies lodge

A

Right lung

Right main bronchus is more vertical than left

71
Q

Worrying presentation following nasal injury

A

CSF rhinorrhoea
Septal haematoma
Septal deviation
Facila anaesthesia (loss of feeling)

72
Q

Commonest cause Rhinorrhoea

A

Coryza (cold)
Hay fever
Nasal polyps (due to chronic allergy or inflammation)

73
Q

Nasal polyps

  • Causes
  • Tx
A

Chronic inflammation, asthma, CF, Churg-Strauss, aspirin sensitivity

1st line: Topical corticosteroid (fluticasone)

Gold standar = surgery (endoscopic sinus surgery)

74
Q

Lump in neck Ddx:

1- Rubbery painless lymphadenopathy
2- Hx of local infection
3- Palpitations, thin hair
4- Midline lump which moves up when stick out tongue
5- Older man with a midline lump that gurgles on palpation
6- Left sided lump on child under 2
7- Young adult with oval, mobile cystic mass between sternocleidomastoid and pharynx
8- Adult female with thoracic outlet syndrome
9- Pulsatile lateral neck mass which doesn’t move on swallowing

A

1) Lymphoma
2) Reactive lymphadenopathy
3) Thyroid swelling
4) Thyroglossal cyst
5) Pharyngeal pouch
6) Cystic hygroma
7) Branchial cyst
8) Cervical rib
9) Carotid aneurysm

75
Q

Neurological causes of dysphagia

A

CVA, achalasia, oesophageal spasm, MND, MS, Parkinson’s

76
Q

Obstructive causes of dysphagia

A

GORD, oesophagitis, oesophageal/gastric cancer, pharyngeal cancer, oesophageal stricture

77
Q

CREST dysphagia pathophys

A

Thickening of oesophageal wall due to fibrosis = reduced motility

78
Q

Dysphagia red flags

A

Weight loss
Pain
Hoarseness
Regurgitation

79
Q

Obstructive sleep apnoea

  • Def
  • Assess
  • Assoc
  • Tx
A

Repeated Upper airway collapse during sleep going excessive waking and daytime sleepiness. Due to relaxation of neck soft tissue = obstruction

Epworth sleepiness scale, Polysomnography

HTN, Obesity, asthma, Big neck circumference

Stop smoking, weight loss
CPAP = gold standard

80
Q

Bell’s palsy

  • Def
  • Type of palsy
  • Assoc features
  • Tx
A

Acute, idiopathic facial nerve paralysis

LMN lesion (forehead affected)

Hyperacusis (hearing - CNVII innervation of stapedius muscle)
Altered taste (lingual nerve)

Prednisolone +artificial tears

81
Q

Ddx Bells palsy

A

Ramsay-Hunt syndrome

Due to Herpes Zoster

Rash behind ear with symptoms of Bell’s

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