ENT Flashcards
how long does otitis externa have to last to be chronic?
3 months
where does localised otitis externa affect?
infection of a hair follicle in the ear which can develop into a boil
where does diffuse otitis externa affect?
widespread inflammation of the skin and subdermis
what causes malignant otitis externa ?
arises when the infection spreads to the mastoid and temporal bones causing osteomyelitis
what bacteria can cause otitis externa ?
Pseudomonas Aeruginosa or Staphylococcus Aureus
what are some risk factors of otitis externa ?
hot and humid climates swimming older age DM eczema wax build up trauma
what are DD for otitis externa ?
acute otitis media with perforation furunculosis viral infections tumours cholesteatoma impacted wax
what is the management of otitis externa ?
avoid getting ear wet
analgesia
antibiotic or anti fungal ear drops
what complications can occur with otitis externa ?
abscesses ear canal stenosis perforated ear drum celllulitis malignant otitis externa
what age is most affected by acute mastoiditis ?
<2yrs
how does the mastoid air cells communicate with the middle ear?
via a small canal known as the aditus to mastoid antrum.
what are the 3 locations that an abscess from acute mastoiditis ?
Behind the pinna in an area known as Macewen’s triangle, or higher
Superior to the pinna towards the zygomatic process
Over the squamous temporal bone
where is MacEwen’s triangle?
area behind the pinna
what are DD for acute mastoiditis ?
Infected pre-auricular sinus (located near the front of the ear)
Infected/inflamed post-aural lymph node
Langerhans cell histiocytosis
Rhabdomyosarcoma
what antibiotics are used for acute mastoiditis?
high-dose co-amoxiclav or ceftriaxone
what are intracranial complications of acute mastoiditis ?
Intracranial infections including meningitis; epidural, temporal lobe or cerebral abscess; subdural empyema
Dural sinus thrombosis
what age is most affected by peri orbital cellulitis?
10yrs
what sex is more affected by peri orbital cellulitis ?
males
what sinus is most affected during periorbital cellulitis ?
ethmoidal sinusitis
what organisms cause periorbital cellulitis
Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, group A streptococcus
what vaccine has reduced the numbers of periorbital cellulitis cases?
HiB vaccine
what will orbital cellulitis present with?
Proptosis Ophthalmoplegia Decreased visual acuity Loss of red colour vision – first sign of optic neuropathy Chemosis Painful diplopia
what classification is used for periorbital cellulitis ?
Chandler classification
what blood test is used to measure response to treatment ?
CRP and WBC count
what imaging can be done for periorbital cellulitis ?
CT scan
what is DD for periorbital cellulitis ?
Vesicles of herpes zoster ophthalmicus Erythematous irritation of contact dermatitis Raised, dry plaques of atopic dermatitis Hordeolum or stye Chalazion Dacrocystitis Blepharitits
what is Chalazion?
blocked meibomian gland
what is dacrocystitis ?
infection of the lacrimal sac,
when is urgent drainage recommended during peri orbital cellulitis ?
when there are intracranial complications at time of presentation and frontal sinusitis
what is chandler classification used for?
classifying peri orbital cellulitis
how many stages of chandler classification is there?
5
what are the 5 stages of the chandler classification?
1 = confined to eyelid 2 = extends into orbital tissue, no abscess 3 = abscess forms deep to the periosteum of the orbit 4 = collection of pus inside or outside muscle cone, intra orbital abscess 5 = infection into cavernous sinus
what cranial nerves could be damaged when the cavernous sinus is involved in periorbital cellulitis ?
3rd, 5th, 6th
what % of children with sinus related problems with develop peri orbital cellulitis ?
35%
what % of people with orbital cellulitis will loss their vision?
11%
infection of which sinus carries the highest risk of intracranial spread?
frontal sinus
what tonsils are inflamed in tonsillitis ?
palatine tonsils
what is the commonest bacterial cause of tonsillitis ?
streptococcus
- group A strep (strep pyogenes)
what viruses commonly cause tonsillitis ?
adenovirus and EBV
what is a risk factor for tonsillitis in children?
smoking
how long does tonsillitis usually last for?
5-7days
if tonsillitis lasts for more than 7 days what might this suggest?
glandular fever
on examination what might be seen during tonsillitis ?
red inflamed tonsils
white exudate spots
cervical lymphadenopathy
what two criteria are used to assess what patients require antibiotics for tonsillitis ?
centor criteria
feverPAIN criteria
what are the four features of Centor criteria ?
tonsillar exudate
tender anterior cervical lymphadenopathy
fever
absence of a cough
what are the four features of feverPAIN criteria ?
Fever (during previous 24 hours) Purulence Attend rapidly (within 3 days after onset of symptoms) Severely Inflamed tonsils No cough or coryza
what 6 criteria are used to predict the likeliness of a group A strep infection ?
Age 5-15 Season (between late autumn and early spring) Fever (>38.3°C) Cervical lymphadenopathy Pharyngeal erythema, oedema, or exudate No viral URTI symptoms
for what ENT condition should the child not be examined ?
epiglottitis
what are some DD for tonsillitis ?
peritonsillar abscess pharyngitis glandular fever tonsillar malignancy epiglottitis
is tonsillar malignancy usually bilateral or unilateral
unilateral
what investigations can be done for tonsillitis ?
if child is admitted
- FBC, LFTs (glandular fever will have deranged LFTs), U&Es (dehydration may lead to AKI)
what signs may indicate a child needs to be admitted?
respiratory compromise - tachypnoea, low sats, use of accessory muscles
patients unable to eat or drink
patients who are not getting better on antibiotics in the community
what score of the centor criteria is highly suggestive of bacterial infection?
3 or more out of 4
what antibiotic can be given for tonsillitis ?
Benzylpenicillin for 7-10days
- dose according to age
when can a pt be offered tonsillectomy ?
number of infections in 1,2 and 3 years ?
in 1 year = 7 or more
in 2 years = 5 or more per year
in 3 years = 3 or more per year
state 2 post strep conditions ?
post streptococcal glomerulonephritis (PSGM)
acute rheumatic fever
what is the classic triad of symptoms with post strep glomerulonephritis ?
HTN, haematuria, oedema
what causes acute rheumatic fever?
is an autoimmune response to group A strep that cause prolonged fever, anaemia, arthritis and pancarditis
what ages are most affected by peritonsillar abscess?
20-40yrs
what is another name for peritonsillar abscess?
quinsy
are complications of tonsillitis common?
no
what muscle forms the anterior tonsillar pillar?
glossopalatine muscle
what muscle forms the posterior tonsillar pillar?
pharyngopalatine muscle
what bacterial infection in peritonsillar abscesses is common in 15-24yrs ?
fusobacterium necrophorum
what antibiotics are used for peritonsillar abscesses?
co-amoxiclav
clindamycin (if penicillin allergic)
what clinical features suggest peritonsillar abscess?
trismus (muscle spasm preventing jaw opening fully)
deviation of uvula away from affected side
unilateral throat pain
fever
fatigue
drooling
what blood tests can be done for peritonsillar abscess?
FBC, LFT, U&Es, CRP
ebstein barr virus antibodies
can co-amoxiclav be prescribed for tonsillitis ?
no
- there is a small risk of permanent skin rash if the tonsillitis is due to glandular fever
after IV benpen antibiotics for peritonsillar abscess, what oral antibiotics should be prescribed on discharge?
oral penicillin V (Phenoxymethylpenicillin)
how can epstein barre virus be transmitted ?
exchange of saliva
blood transfusion
organ transplant
what clinical signs on examination may be present during infectious mononucleosis ?
inflamed tonsils
significant cervical lymphadenopathy
HSM
palatal petechiae
what WBC will be raised in infectious mononucleosis ?
lymphocytes
what specific tests can be done for glandular fever ?
monospot test (relies on generation of non specific heterophiles IgM autoantibodies)
ELISA based immunoassays
state some complications of infectious mononucleosis ?
post viral fatigue malignancy guillain barre syndrome encephalitis splenic rupture
what malignancies are associated with Epstein barre virus ?
burkitts, Hodgkins, T cell lymphomas and nasopharyngeal carcinoma
due to the risk of splenic rupture what advice should be given to infectious mononucleosis patients?
avoiding contact sports for 4-6 weeks post treatment
a quinsy is a collection of pus in which space?
peritonsilllar
