ENT Flashcards
What test can be done to assess if rhinorrhoea is CSF?
Beta Transferrin test
or
CT of sinuses
What things do you want to know regarding a neck lump?
Site, size, shape, surface
Consistency
Skin changes/ discharge
Fixation
Fluctuance Mobility Transillumination Temperature changes Pain
What grading scale is used to assess fascial nerve palsy?
House Brackmann Grading
I - normal
II - slight weakness on close inspection
III - obvious but not disfiguring
IV - Obvious weakness and disfiguring - incomplete closure of eye
V - Barely perceptible motion. asymmetry at rest
VI - complete paralysis
What can be worn to help humify air over a laryngeal stoma?
Buchanan Bib
What primary investigations would you want to conduct into a neck mass?
Full examination
Ultrasound + FNA/ Core aspiration
CT/ PET scan
What is the most common benign parotid lump?
Pleomorphic Adenoma
- has potential to become malignant
followed by:
Warthin’s (often bilateral)
What features suggest malignancy in a parotid lump?
Pain
Facial nerve palsy
Overlying skin changes
Associated lymphadenopathy
What is a key distinguishing feature between a thyroglossal cyst and a enlarged thyroid?
and what is the surgical procedure done to fix these?
The neck lump moves when swallowing or sticking tongue out
*thyroid nodules do not move
Sistrunk’s procedure `
How is the submandibular gland palpated?
Bimanual palpation
What are the red flags for head and neck cancer?
Hoarseness for >6 weeks Ulceration and swelling of the oral mucosa >3 weeks Red and white patches in oral mucosa Dysphagia Neck masses >3 weeks Cranial nerve involvement Persistent otalgia with normal otoscopy Persistent nasal congestion that is unilateral. especially with discharge
List some differentials for a hoarse voice:
Laryngeal cancer
Laryngitis
Prebysphonia - old age
Reinke’s oedema
Vocal cord granulomas
Vocal cord nodules
Muscle tension
What is stertor?
This is a breathing noise made by upper respiratory difficult due to larynx pathology
- very similar to snoring
Stridor can be broken down into inspiratory, expiratory and biphasic, where does each correspond to in a pathology?
Inspiratory:
- larynx
Expiratory:
- tracheobronchial
Biphasic
- Subglottic/ glottis
What upper airway obstruction can occur in people born before 1992, and how does it present?
Supraglottitis
presents with sore throat with normal tonsils
How should a patient with an upper airway obstruction be managed?
Oxygen
- airway manoeuvres
- airway adjuvants
Senior help immediately
- Anaesthetist
- ENT
Nebulised adrenaline - 1:1000mg in 5mls of N saline
IV steroids
- dexamethasone 4mg
+/-
IV antibiotics
Nil by Mouth
- they may need surgery
**do not leave patient
At what level does a tracheostomy go?
3rd and 4th ring
In Tonsillitis what is the antibiotic of choice? and why?
also what additional features may suggest the other pathology?
Penicillin
- due to the risk of them also having Glandular fever as well (secondary bacterial infection on top of the EBV)
- avoid amoxicillin due to the rash
- white exudate over the tonsils
- lymphadenopathy
- Hepatosplenomegaly (jaundiced?)
What is a peritonsillar abscess called? and what is a key symptoms associated with this? and how is it treated?
Quinsy
Trismus - decreased mouth opening
Often the uvula will be deviated.
Drained - aspiration under LA IV antibiotics IV steroids \+/- Tonsillectomy
How does a parapharyngeal abscess present?
Sore throat
Reduced neck turning ability
systemically unwell
*typically in children
IV antibiotics
How does a retropharyngeal abscess present?
Sore throat - especially on neck movement
Swinging fever
Relatively well patient
Usually in children
- CT scan is needed for definitive diagnosis
- can cause severe airway obstruction in some conditions
What are some of the complications of otitis media?
Intracranial abscess formation
- seizure
- confusion
- need neurosurgical review and imaging (CT)
Facial palsy
Mastoiditis - usually in children - IV Antibiotics \+/- - Surgery (so keep them NBM)
Meningitis
What is a major complications of a URTI which causes visual changes to the eye, and how is it managed?
Orbital cellulitis
- eye proptosis
- red swollen eye
- visual defects
**must check red vision
- IV antibiotics
- NBM
+/- Surgery
In facial palsy - when should antivirals NOT be given?
If no vesicles are seen then antivirals should not be given.
this is because they can actually make it worse
*look around the mouth and ear for these vesicles
In traumatic facial palsy what is an important thing to document?
Onset of timing.
Sudden onset: suggests transection
Gradual onset: suggests oedema
What is one of the first things that should be checked before carrying out the Halmaygi head thrust test?
If the patient has any pain or neck problems
What are some of the complications of tonsillitis?
Otitis media
Quinsy - peritonsillar abscess
Rheumatic fever
Glomerulonephritis
PANDAS in children
What clinical features of GORD causing laryngeal- pharyngeal reflux may be seen?
Posterior Commissure Oedema
Cobble stoning of posterior pharyngeal wall
Give some differentials for tinnitus:
Idiopathic
Drugs
- Salicylate
- Quinine
Noise induced
Meniere’s disease (part of prodrome)
Otosclerosis
Vestibular schwannoma
How can vestibular neuronitis be differentiated from labyrinthitis?
and what is the treatment for severe episodes of vertigo?
There is no hearing loss or tinnitus
Prochlorperazine
What condition is exacerbated by pregnancy leading to increased conductive hearing loss:
Otosclerosis
If a person has suspected otitis externa but symptoms progress despite topical antibiotics - what should be done next and why?
and which organism is most associated with this condition?
Referral to ENT
Suggestive of necrotising otitis externa (malignant otitis externa)
Pseudomonas aeruginosa
Which drugs are highly associated with tinnitus?
NSAIDs
Aminoglycosides
Loop diuretics
Quinine
What set of tests can be conducted to help establish if the cause of vertigo is due to a posterior circulatory stroke or a peripheral cause?
HINTs examination
- Head Impulse test (Positive is suggestive of peripheral i.e. abnormal is good)
- Nystagmus assessment (vertical, long duration suggests central)
- Skew Eye test (cover of one eye which then bounces back, deviation suggests central cause)
What features suggest a bacterial cause of pharyngitis and tonsilitis?
and what scoring system can be used to help establish this?
Fever >38
Exudate present
No cough
Tender anterior cervical lymphadenopathy
Centor Score
- <2 points make it unlikely to be bacterial
>3 points suggest bacterial
What is the name given to a peritonsillar abscess? and how is it treated?
Quinsy
Incision and IV antibiotics
What is a complication following allergic rhinitis following the use of nasal decongestants?
Rhinitis Medicamentosa
rebound hypertropy of the mucosa with use of nasal decongestants, especially Xylometazoline
they should not be used for more than 7 days.
After 10 days is average start of the medicamentosa
What are the major risk factors for head and neck cancer?
Smoking Alcohol HPV - 16,18 Nitrosamines EBV
What are some premalignant conditions of head and neck cancer?
Leukoplakia
Erythroplakia
Oral lichen planus
Actinic cheilitis
How does Oral-pharyngeal cancer present?
Odynophagia Dysphagia Stretor Otalgia Neck pain/ lump
How does laryngeal cancer present and what are the subtypes?
Supraglottis
Glottis
Hypoglottis
Hoarse voice Stridor Persistent cough Dysphagia Otalgia Neck lump/ pain
What investigations should be done into suspected head and neck cancer?
Flexible Nasal endoscopy
- this includes larynx
FNA aspiration of lesion
- including lymph nodes
MRI/ CT scan
What are the treatment options for head, neck and mouth cancer?
General:
- Radiotherapy
- Surgical resection / Transoral laser therapy
- Chemotherapy
Oral:
- Wide local Excision
+/-
Neck dissection
Oropharynx: - Laser - Transoral robotic surgery \+/- - neck resection
Larynx: - Transoral laser surgery - Laryngectomy \+/- - neck dissection
List some congenital causes of neck lumps and distinguishing features:
Carotid body tumour
- carotid paragangliomas
- pulsating neck lump
- bruit
Branchial cyst:
- Anterior to SCM
- Compressional symptoms
Cystic Hygroma:
- Axilla/ Posterior
- Transillumination
Infantile Haemangioma;
What is the diagnostic and therapeutic maneuvers done for BPPV?
Dix- Hallpike Maneuver - diagnostic
Epley maneuver - treatment
What does trismus mean?
Jaw locking
What is the management of Meiner’s disease?
Conservative:
- reduce salt intake
- reduce caffeine
- reduce cheese intake
Acute attacks
- Prochlorperazine
Betahistine
- vasodilator to improve endolymph
What conditions should be suspected if there is referred ear pain, how do you know its referred and what nerves are involved?
If external ear and ear drum are normal the pain is not from the ear.
Parotid/ TMJ/ upper molar teeth - Cranial nerve V
Ramsay Hunt syndrome
- Cranial nerve VII
Malignancy of 1/3 posterior tongue, piriform, larynx, nasopharynx
- cranial IX, X
List some LMN causes of facial palsy?
Bell’s palsy
Acute otitis media
Cholesteatoma
Viral infection
- HSV-1
- CMV
- EBV
What are the symptoms of otosclerosis?
Onset 20-40 years old Conductive hearing loss Tinnitus Normal tympanic membrane AD family history
Where is a nosebleed most likely to occur?
Keisselbach area/ Littel area
- anterior of the nose
