ENT Flashcards
cat scratch fever
bartonella
branchial cyst features
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood
contain cholesterol crystals
centor criteria
For an antibiotic to be necessary, 3 of the following should be present:
Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough
Presbycusis features
age-related sensorineural hearing loss. Patients may describe difficulty following conversations
Audiometry shows bilateral high-frequency hearing loss
ototoxic drugs
aminoglycosides (e.g. Gentamicin), furosemide, aspirin and a number of cytotoxic agents
quinine causes tinnitus
BPPV manouvers
diagnostic dix-hallpike
treatment- epley
epistaxis red flag
recurrent unilateral (nasal cancer)
complications of acute mastoiditis
meningitis due to intracranial spread; others include cranial nerve palsies, hearing loss, osteomyelitis and carotid artery spasm.
Otitis externa in diabetics: treatment
ciprofloxacin to cover Pseudomonas
oral flucloxacillin if erythema is spreading
otosclerosis features
autosomal dominant. precipitated by pregnancy
Mx- hearing aid, stapedectomy
mx of nasal polyps
unilateral- refer to ENT to exclude malignancy
if small bilateral- due to rhinosinusitis- salin nasal douce and intranasal steroids, non urgent ENT referral
cystic hygroma features
A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age
fluctuant and brilliantly transluminable
black hairy tongue pathology
results from defective desquamation of the filiform papillae
mass in tail of parotid gland
pleomorphic adenoma- commonest, slow ,smooth, mobile
warthins tumour- cyst and lymphoid tissue common in old men
Elderly patient dizzy on extending neck
vertebrobasilar ischaemia
rhinitis medicamentosa
condition of rebound nasal congestion brought on by extended use of topical decongestants
nasal septal haematoma
haematoma between the septal cartilage and the overlying perichondrium.
may be precipitated by relatively minor trauma
the sensation of nasal obstruction is the most common symptom
pain and rhinorrhoea are also seen
on examination, classically a bilateral, red swelling arising from the nasal septum
this may be differentiated from a deviated septum by gently probing the swelling. Nasal septal haematomas are typically boggy whereas septums will be firm
Management
surgical drainage
intravenous antibiotics
cholesteatoma
Cholesteatoma is a non-cancerous growth of squamous epithelium that is ‘trapped’ within the skull base causing local destruction. It is most common in patients aged 10-20 years. Being born with a cleft palate increases the risk of cholesteatoma around 100 fold.
Main features
foul-smelling, non-resolving discharge
hearing loss
Other features are determined by local invasion:
vertigo
facial nerve palsy
cerebellopontine angle syndrome
Otoscopy
‘attic crust’ - seen in the uppermost part of the ear drum
Management
patients are referred to ENT for consideration of surgical removal
acute necrotizing gingivitis mx
refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia
nasal polyp associations
asthma* (particularly late-onset asthma) aspirin sensitivity* infective sinusitis cystic fibrosis Kartagener's syndrome Churg-Strauss syndrome
gingival hyperplasia causes
phenytoin
ciclosporin
calcium channel blockers (especially nifedipine)
Other causes of gingival hyperplasia include
acute myeloid leukaemia (myelomonocytic and monocytic types)
menieres mx
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit
unexplained hoarseness
2 week wait ent referral
bleeding after tonsillectomy mx
primary <24h return to theatre
secondary antibiotics- probably infection
recent illness and vertigo
viral labyrinthitis
acute sinusitis mx
analgesia
intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
NICE CKS recommend that intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days
oral antibiotics are not normally required but may be given for severe presentations. The BNF recommends phenoxymethylpenicillin first-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’
Ramsay Hunt syndrome
type 2, is a condition where reactivation of pre-existing Varicella Zoster virus occurs in the geniculate ganglion. This is the reason for the vesicles on the tympanic membrane. Ramsay Hunt syndrome can also cause pain in the ear, facial paralysis, taste loss, dry eyes, tinnitus, vertigo and hearing loss.
quinsy mx
IV antibiotics and surgical drainage, and a tonsillectomy should be considered in 6 weeks
vestibular neuronitis features
recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus
cause of painless lymph node in posteroir triangle in asian man SCC
nasopharyngeal carcinoma
complications of thyroid surgery
Anatomical such as recurrent laryngeal nerve damage.
Bleeding. Owing to the confined space haematoma’s may rapidly lead to respiratory compromise owing to laryngeal oedema.
Damage to the parathyroid glands resulting in hypocalcaemia.
s/e of taking nasal decongestants
increasing doses are required to achieve the same effect (tachyphylaxis)
ludwig’s angina
Immunocompromised patients with poor dentition can develop airway compromise from cellulitis at the floor of the mouth known as Ludwig’s angina
causes of otitis media
Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.
tonsillar SCC associated with
HPV
