ENT Flashcards
What different categories of problems can cause neck lumps?
cerviacle swellings saliva gland swelling developmental abnormalities thyroid conditions sternomastoid tumours in neonates
what can cause cervicle lymphadenopathy?
Infections: mononucleosis CMV URTI
malignancy: lymphoma or metastatic
what are the causes of saliva gland swellings?
Mumps sialadenitis
what type of developmental abnormalities cause neck lumps?
thyroglossal cysts or branchial cysts
up what type of thyroid conditions cause lumps?
thyroid swellings such as goitre or benign/malignant nodules and hyper/hypothyroidism
what is benign paroxysmal positional vertigo
a peripheral vestibular disorder manifesting as sudden short lived episodes of vertigo elicited by specific head movements
what causes benign paroxysmal positional vertigo
the endolymphcalinth particles migrate to the semicircular canals rendering them sensitive to gravity
what are risk factors for benign paroxysmal positional vertigo?
Female increased age head trauma labyrinthitis inner ear surgery merniers disease
what are the symptoms of benign paroxysmal positional vertigo?
Brief and severe vertigo provoked by specific positions of the head
what would the findings of a neurological and otological examination be in benign paroxysmal positional vertigo?
normal
what is diagnostic for benign paroxysmal positional vertigo?
Positive Dicks HallPike manoeuvre and supine lateral head turns
what is the management of benign paroxysmal positional vertigo?
Reassurance and particle repositioning manoeuvres
what is Merniers disease?
aka. Endolymphatic hydrops . It episodic auditory and vestibular disease of unknown cause
what are the symptoms of Merniers disease?
sudden onset of vertigo sudden onset of hearing loss Sudden onset of tinnitus sensation of fullness in the ear symptoms lasting from minutes to hours
what is the pathophysiology of Merniers disease?
overproduction or impaired absorption of Endo length causing excess pressure which disrupts and ruptures Reisners membrane releasing potassium rich and live into the perilymphatic space causing injury to the inner ear which leads to symptoms
what tests are diagnostic in Merniers disease? And what they show?
pure tone audiometry and bone conduction audiometry showing sensorineural hearing loss with positive Rosenberg’s test
what is the management of Merniers disease?
low-salt diets Vertigo: vestibular suppressants antiemetics or corticosteroids (more severe cases or in acute hearing loss) or intra-tympanic injections tonight as: benzodiazepines or antidepressants
what is labyrinthitis?
The stimulate new writers. An inflammatory condition affecting the inner ear
what causes labyrinthitis?
Usually caused by viral infections also bacterial ones it is a complication of otitis media or meningitis
what is the presentation of labyrinthitis and how does it differ between bacterial and viral?
bacterial: profound hearing loss and vertigo viral has less severe symptoms and hearing loss usually recovers. There is vertigo and dizziness nausea and vomiting hearing ortorrhoea nystagmus tinnitis
what does ortorrhoea in labyrinthitis?
cause of labyrinthitis is acute or chronic at otitis media with tympanic membrane perforation
what tests are diagnostic for labyrinthitis?
audiogram showing hearing loss . webbers and rinnies shows neural hearing loss
what is the management of labyrinthitis?
Bacterial: antibiotics – ofloxacin vertigo: diazepam antiemetics: promethezine corticosteroids: prednisolone
how can a brainstem TIA present?
Dizziness vertigo and imbalance sometimes :double vision slurred speech and decreased consciousness
how do you diagnose a brainstem TIA?
Imaging such as CT and angiogram
what is the management of a brainstem TIA?
thrombolysis
what is orthostatic hypotension?
A fall in systolic blood pressure of at least 20 or 13 patients with hypertension +/or a fall of 10 in diastolic blood pressure within three minutes the standing
what is the presentation of orthostatic hypotension?
Dizziness lightheadedness and other symptoms of cerebrally hypoperfusion such as loss of vision and tinnitus
what are the causes of orthostatic hypotension?
Frailty volume depletion autonomic neuropathy Parkinson's or Lewy body dementia multisystem atrophy anaemia
what is the management of orthostatic hypotension?
treating the cause and if that’s not enough add fludrocortisone –> midrodine a short acting pressor
is newly mediated reflex syncope?
group of conditions where there is a symptomatic hypotension. These occur as a neural reflex of the vagal nerve causing vasodilation and/or bradycardia
what is the most common type of neuroly mediated reflex syncope?
Vaso vagal a.k.a. faints
what may cause a vaso vagal episode?
Emotional or lifestyle factors such as stress dehydration low blood sugar standing still for too long heat
are vasovagal episodes harmful?
in itself no however they can cause injury because of the fall
what is the management of vasovagal syncope?
physical techniques to improve orthostatic intolerance
drinking electrolyte rich drink
flucoortisone can be used in exceptional cases
what is a vestibular migraine?
the most common cause of spontaneous episodic vertigo occurring in 10% of migraine patients
what is the presentation of vestbular migraines?
Spontaneous positional vertigo head motion vertigo dizziness and a taxi - photophobia and aura may be present if these are present as it is a diagnostic factor
do vestibular migraines always accompany headaches?
No they can occur independently from headaches and are of variable duration
what is the management of vestibular migraine?
Same management as normal migraines
walks ENT problem can HSV cause in the ears?
Vestibular neuritis a.k.a. labyrinthitis
how does HSV cause labyrinthitis?
An acute peripheral vestibular with the caused by the reactivation of HSP in the vestibular ganglia on nerve or labyrinth
what is the management of HSV caused vestibular neuritis?
Corticosteroids and acyclovir
what are differences of signs and symptoms in the common causes of vertigo/dizziness?
insert picture page 9
what is acute sinusitis?
An acute inflammation of the mucosal lining of the nasal cavity and paranasal sinuses. Lasting less than four weeks
what causes sinusitis?
Usually a viral cause – rhinovirus and coronavirus bacterial infections can occur – S pneumoniae and H influenza
what is the presentation of sinusitis?
Facial pain/pressure purulent nasal discharge causing a blocked nose if symptoms are lasting more than 10 days it can be a bacterial cause. Systemic features and sore throat usually also indicate a viral aetiology
when would you want to do a swab in sinusitis?
if sinusitis is lasting more than 10 days do a swab and culture for bacteria
what is the management of sinusitis?
analgesia/antipyretic decongestant intranasal corticosteroid ipratropium intranasal saline possibly antibiotics
what is the name of a common decongesant?
oxymetazoline
What is the name of a common intranasal corticosteroid?
mometasone
when would you want to use ipratropium?
to manage rhinorrhea
what is a common mucolytic?
guafenasine
When would you want to refer sinusitis to ENT?
if you know compromised patient or refractory sinusitis after antibiotics
what is chronic sinusitis?
Inflammation of the paranasal sinuses lasting more than 12 weeks
what are the causes of chronic sinusitis?
This is not refractory acute sinusitis chronic sinusitis has an unknown aetiology but seems to be an endpoint for many pathologies such as smoking cystic fibrosis and structural abnormalities or microbiological imbalances
a patient presents with facial pain/pressure they have recently had new RTI symptoms and symptoms have been present for three weeks what is the diagnosis?
acute sinusitis
what are the symptoms of chronic sinusitis?
Facial pain/pressure and nasal discharge
what investigations are required in chronic sinusitis?
Anterior rhinoscopy checks for structural defects and for presence of purulent if required nasal endoscopy can be used and swabs may be taken
what structural defects can cause chronic sinusitis?
Polyps and deviated septum
what is the management of chronic sinusitis?
try antibiotics nasal saline nasal corticosteroids decongestanta oral corticosteroids (prednisolone if nasal corticosteroids are working and if there are polyps or oedema) antihistamine or L RTA if concomitant allergic rhinitis is present finally surgery
what is atypical facial pain?
Facial pain that doesn’t fit any diagnosis and no abnormalities have been found in facial structures. Also doesn’t have characteristics of facial neuralgias
what is the presentation of atypical facial pain?
Facial pain present daily and persisting for most of the day usually confined to one aspect of the face it is deep and poorly localised there is no associated sensory loss or physical signs
how do you diagnose atypical facial pain?
it is a diagnosis of exclusion clean swabs normal x-ray CT and MRI
what is oral dyaesthesia?
altered sensation in the mouth or gums or a nasty taste
what are some symptoms of oral dyasthesia?
nasty taste increased sensation of saliva or decreased sensation of saliva difficulty tolerating dentures or new fittings crowns or bridges
what is phantom bite?
the unpleasant awareness that your teeth do not meet comfortably together which does not respond to altering your bite
what is atypical odontalgia?
adult or severe discomfort in the teeth or in a tooth sometimes after filling root canal treatments or even extraction
what are the symptoms of atypical odontalgia?
burning pain or pins and needles in the tooth area with no dental cause pain can be made further with more treatment touching area makes the pain worse
What is trigeminal neuralgia?
A facial pain syndrome in one or more of the trigeminal branches
which cranial nerve is the trigeminal nerve?
V
Describe the branches of the trigeminal nerve?
healthy ophthalmic branch maxillary branch and mandibular branch
insert picture page 12
what is usually the cause of trigeminal neuralgia?
Compression of nerve root usually by a vascular loop of the superior cerebellar artery. However can also be because of MS and other demyelinating diseases or herpetic infection
what is the presentation of trigeminal neuralgia?
Facial pain following the distribution of the nerves paroxysmal pain sharp intense and stabbing lasting less than two minutes repeated attacks often triggered by brushing teeth or cold wind can also be a component of constant burning/aching with no neurological deficits
does trigeminal neuralgia cause neurological deficit?
No
how would you investigate trigeminal neuralgia?
MRI shows structural abnormalities or demyelination trigeminal nerve reflex testing is used in symptomatic trigeminal neuralgia and shows early reflexes
why might someone perform an intraoral x-ray in trigeminal neuralgia?
Symptoms of the maxillary or the mandibular nerve can be akin to dental problems
what is the management of trigeminal neuralgia?
Anticonvulsants: carbamazepine or baclofen if it is anti-convulsive unresponsive
What is temporal mandibular joint dysfunction?
An umbrella term used for various disorders involving the mandibular joint
What is the most common type of temporomandibular joint dysfunction?
myofascial pain and dysfunction
What are the three types of temporomandibular joint dysfunction
internal derangement ( when the articular disc is dislocated from its place in the glenoid fossa) osteoarthritis and myofascial pain and dysfunction
describe the anatomy of the TMJ?
Insert pictures page 13
what are risk factors which predispose someone to developing TMJ dysfunction?
trauma orthodontic treatment arthritis in excess use of the joint such as clenching of teeth
what is the presentation of TMJ joint dysfunction?
Pain abnormal mandibular movement which may be reduced and have uncorrected deviation tender muscles on palpation clicking and catching of the joints
what symptoms and signs would indicate that TMJ dysfunction is caused by osteoarthritis?
Continuous pain and crepitus
how would you diagnose TMJ joint dysfunction?
An x-ray would show osteoarthritis or internal derangement but it is usually made on clinical diagnosis
what is the management of TMJ dysfunction?
joint rest and physiotherapy CBT splints/bikes cards NSAIDs (osteoarthritis and internal derangement) benzodiazepines (myofascial) and surgery
what is a dental abscess?
An orthodontic infection, Usually poly microbial, which invades neurovascular structures
what are the three types of dental abscesses?
Peri apical periodontal and precordial
what is the main pathogen which causes dental abscesses?
Streptococcus viridans although it is poly microbial
what are risk factors to developing dental abscesses?
Gingivitis and tooth decay/improper dental hygiene
what is a presentation of a dental abscess?
Dental pain intra-or extra oral oedema erythema discharge thermal hypersensitivity if severe enough can cause airway obstruction
what investigations are required in dental abscesses?
panoramic x-ray shows the infection
how would you manage a dental abscess?
Drain antibiotics and if high-risk admit to hospital for airway management and supportive care
which part of the ear does conductive hearing loss occur from?
Outer/middle ear
which part of the ear does sensorineural hearing loss occur from?
the cochlear or cranial nerve eight
what are the five parts of an ear examination?
Examine the pinna: scars quality of cartilage active infection and compare symmetry with the other side master: Move the pin forwards and gently assess the tenderness free auricular area: pits sinuses or fistulas Kong conchal bowl and perform internal ear examination
describe the anatomy of the eardrum?
insert picture page 16
what might you see in an ear exam on the Pars Tensa?
perforations
retraction pockets
ossicles and grommets
what does the image below show?
perforation of the eardrum insert picture
what is the picture below show what is a common cause of it?
retraction pockets commonly because of chronic otitis media inset picture
what might you see in an ear exam on the Pars Flaccida?
attic retraction pockets and cholesteatoma
what does the image below show?
Attic retraction pocket insert picture
what two tests are used to determine type of hearing loss?
Turning fork tests: Rinnies and Webers
Describe Rinnes test
is used to assess for air conduction. Tuning fork is placed against the mastoid bone and then by the ear in normal hearing air conduction is louder than bone conduction this also occurs in sensorineural hearing loss which is why Webber’s test is required AC>BC means +ve test
Describe Webers test
in the Webers test normal hearing hears the sound equally in both ears this is also the case for bilateral either conductive or sensorineural hearing loss . If the test is being performed on the right-hand side and the sound lateral licence to the left this indicates sensorineural hearing loss of the right side. if the test is being performed on the right side and sound is louder on the right side then indicates a unilateral conductive hearing loss of the right side
during a tuning fork exam revenues is positive in both years and Webbers lateral rises to the left what does this indicate?
Right-sided sensorineural hearing loss
if rinnes was negative on the L ear and webers lateralised L what does this mean?
leaft conductive hearing loss
what is conductive deafness?
Decreased transmission of sound to the cochlea via air conduction
what are the causes of conductive deafness?
obstructive causes
perforation of the tympanic membrane
discontinuation of the ossicular chain
fixation of the ossicular chain
what are some causes of obstruction which can lead to conductive deafness?
wax inflammatory oedema degree and foreign bodies and atresia
what types of things can cause the discontinuation of the ossicular chain?
infection or trauma
what usually causes the fixation of the ossicular chain?
osteo sclerosis
what is otitis media?
A common complication of viral respiratory illnesses causing infection involving the middle ear space
how does a URTI lead to otitis media?
Inflammation of the nasal passages of the eustation tube in the middle ear means mucosal flow and ventilation of the eustachian tube is impaired.
Nasopharyngeal flora cannot be cleared and the bacteria colonise the effusion from the respiratory tract infection
what bacteria usually is present in otitis media?
S pneumoniae
a 15 year old presents with ear pain, some hearing loss, on examination they have a fever and when you take the history they had a proceeding upper respiratory tract infection they also have a feeling of fullness and pressure within the ear what is the most likely diagnosis
otitis media
how would the presentation of otitis media present in young children?
irritability and sleep disturbances
what does the image below show?
bulging tympanic membrane and redness/erythema (myringitis) from acute otitis media
how would you manage acute otitis media?
simple analgesia and antibiotics such as amoxicillin
what are the complications of acute otitis media?
Perforation of the tympanic membrane cranial nerve seven palsy or mastoiditis
what is a cholesteatoma?
the presence of a keratinising squamous epithelium within the middle ear or other areas of the temporal bone. This epithelium shows independent growth and leads to expansion and resorption of the underlying bone
how does a cholesteatoma occur?
eustachian tube dysfunction causes and negative pressure in the ear which causes the tympanic membrane to be pulled into the middle ear causing retraction pockets these pockets fill with degree and scream cells these cells then proliferate and formulate cholesteatoma although they can also be congenital
What are risk factors in the development of eustachian tube dysfunction?
Turners and Down’s syndrome
what are symptoms of a Cholesteatoma?
hearing loss is a discharge resistant to antibiotic therapy and tinnitis
what does the picture below show?
Attic crust in the retraction pocket - acquired cholesteatoma
what does the picture below show?
A white mass behind an intact tympanic membrane a congenital cholasteoma
what should you always do in the investigations of Cholesteatoma?
audiogram as may show conductive hearing loss and a CT of the petro’s temporal bones to assess bone damage
how do you manage a cholesteatoma?
surgery
what is otitis externa?
Diffuse inflammation of the external air canal which can involve the pinna or the external ear canal it is a form of cellulitis involving skin and sub- dermis.
what pathogen usually causes otitis externa?
P Aeruginosa and staphylococcus
What can predispose you to developing otitis externa?
humidity warmer conditions swimming external auditory canal obstruction diabetes
patient presents with you with ear pain fullness ear discharge which is usually clear itching of the ear canal and some symptoms of decreased hearing what is the most likely diagnosis?
otitis externa
what would an otoscope show in otitis externa?
oedematous ear canal and erythematous tympanic membrane
what is the management of otitis externa?
antibacterial drops – Ciproflaxin/dexamethasone mix
what is chronic ototis media?
persistentdrainage from themiddle earthrough aperforatedtympanic membranelasting> 6–12 weeks
what causes chronic otitis media?
bacterial infection following perforation of the tympanic membrane due to
(Recurrent) acute otitis media
Placement of ventilation tube
Trauma
what is the presentation of chronic ottis media?
Clinical features
Painless, recurrent otorrhea (usually odorless; mucoid or serous )
Conductive hearing loss → Weber test lateralizes to the affected ear
Possibly development of concurrent cholesteatoma
Fever is not typical and indicative of complications if it occurs.
what is the management of chronic otitis media?
rinsing of the ear; topical antibiotic (e.g., ciprofloxacin) and steroid drops (e.g., dexamethasone)
Surgical treatment: tympanoplasty with insertion of a graft
what is eustachian tube dysfunction?
The inability of the eustachian tube to properly regulate air pressure inside the middle ear or effectively drain secretions (or both) sometimes there can be reflux of nasopharyngeal secretions into the middle ear
what causes eustachian tube dysfunction?
Infections or inflammatory conditions such as allergy or chronic rhinosinusitis or less commonly from tumour or malformations
what is the pathophysiology of eustachian tube dysfunction?
inflammation causes Deem out which compares mucosal ore clearance or because of inflammation there is hypersecretion of mucus causing obstruction
what is a fairly common consequence of eustachian tube dysfunction?
Otitis media and chronic otitis media
what is the presentation of eustachian tube dysfunction?
Feeling of fullness and hearing loss (not true hearing loss as it is caused by the inability to clear or pop the ear)
what is the management of eustachian tube dysfunction?
Monitoring and supportive care or treating the underlying cause such as infection give antibiotics allergies gives antihistamine if it is persistent to give intranasal corticosteroids
what is the image below show?
perforation of the tympanic membrane
what other causes of perforation of the tympanic membrane
Here infections such as otitis media trauma for sudden changes in pressure/loud noises
what is the presentation of perforation of the eardrum?
Sudden hearing loss / muffled hearing earache itching fluid leakage and tinnitus
what is the management of perforated eardrum?
If it is small usually heals on its own however after a few weeks it does not heal or the whole is large it will require surgery
What is osteo sclerosis of the ear bones?
Abnormal bone growth inside the ear causing the stapes to begin to fuse with surrounding bone eventually becoming fixed so it cannot move causing conductive hearing loss
who does osteo sclerosis of the ears usually affect?
young adults aged 20 to 30
What is the presentation of osteo sclerosis of the ears?
gradual hearing loss getting worse over time usually affecting low-frequency sound and tinnitis
what investigations are required for the diagnosis of osteo sclerosis of the ear?
Audiometry showing the conductive hearing loss and CT show fusion of bones
what does atresia of the ear refer to?
Absence of the ear canal and it can be associated with malformations of the external part of the ear
Describe the sensorineural deafness?
Sound is transmitted normally to the inner air but either at the cochlea or the vestibular cochlear nerve (or both) there is a fault/damage
What are the causes of bilateral progressive sensorineural hearing loss?
presbycusis, Drug toxicity or noise damage
what are the causes of unilateral sensorineural progressive hearing loss?
merniers disease or acoustic neuroma
what causes of sudden sensorineural hearing loss?
Trauma viral infections (measles mumps or via seller) CVA impaired flow acoustic neuroma barotrauma leakage of her lymph fluid from the inner ear
what is Presbycusis?
age-related hearing loss are progressive and irreversible sensorineural hearing loss
What is the pathophysiology of Presbycusis?
theirs degeneration of the organ of Corsie (the hair cells) or degeneration of spiral ganglion or loss of capillaries of the street vascular’s causing difficulties in maintaining resting and… Potential
what is the presentation of Presbycusis?
hearing loss difficulty understanding group conversations loss of high-frequency hearing
how do you diagnose Presbycusis?
audiology testing and tympanography
what is the management of Presbycusis?
hearing aid
what drugs cause ototoxicity?
insert picture page 22
how do ototoxic drugs affect hearing?
Tonight is loss of high-frequency hearing and can cause the stipulated function
how he do loud noises cause hearing loss?
loud noises condemning the hair cells in your ears, can also damage the auditory nerve. and can be from either extreme loud noises or prolonged listening to loud noises damage is irreversible
what is an acoustic neuroma?
A benign tumour which grows from the vestibular component of the tubular cochlear nerve aka vestibular schannoma
workers and acoustic neuroma occur?
cerebro pontine angle
what is the presentation of an acoustic neuroma?
Asymmetrical hearing loss which is usually gradual tonight progressive episodes of dizziness and facial numbness - this is a late stage symptom
how do you diagnose an acoustic neuroma?
and audiogram shows sensorineural hearing loss and MRIs diagnostic
what is the management of an acoustic neuroma?
observation as it is stable and slow-growing until it is large enough to need radiation or surgery
what are late stage symptoms of acoustic neuroma?
Headaches coordination difficulties obstructive hydrocephalus facial numbness severe tinnitus and hearing loss
how does a a cerebrovascular aneurysm cause hearing loss?
causes impaired blood flow to the cochlear
what is tinnitis??
The perception of sound in the absence of an external auditory stimulus it is a symptom not a diagnosis
what are two types of tinnitus and which is more common?
Objective and subjective (more common)
What other causes of subjective tinnitus
Presbycusis sensorineural last wax impaction tympanic membrane perforation otosclerosis ototoxicity merniers disease acoustic neuroma
what is objective tinnitus?
Due to the perception of sounds caused by neighbouring structures such as vascular noise or muscle contractions
what are the causes of objective tinnitus??
AV malformations anaemia viral toxicity middle ear infection vascular neoplasms benign intracranial hypertension
what can cause referred pain?
Insert image page 24
what is oropharyngeal cancer?
Escuela cell carcinoma arising from the oral pharynx namely the base of the tongue soft palate and palatine tonsils as well as the pharyngeal wall
what other risk factors for developing oropharyngeal cancer?
also raised of the mucosa causing oral pain persistent sore throat net lamp dysphasia next lymphadenopathy and otalgia as well as systemic Fx
what causes ear pain in oropharyngeal cancer?
referred pain from cranial nerve nine and 10 although this is usually a late sign
how do you diagnose oropharyngeal cancer?
Biopsy inc. lymph nodes and CT , barium swallow to assess dysphasia and HPV immune chemistry may be indicated?
what other methods of removing a foreign body?
forceps irrigation balloon catheter or endoscopy (nasal)
what are the common types of oral lesion?
apathous ulcers herpes simplex and infectious causes
what are apathous ulcers?
of common condition of the oral mucosa occurring mainly in healthy patients causing recurrent multiple erythematous ulcers
what is the appearance of an apathous ulcers?
Eric Emeritus round while circumcised with a blister in the middle
what are the types of apathous ulcers?
minor the most common less than 10 mm diameter major larger more painful herpetiformis the rarest
describe herpetic apathous ulcers?
very painful clusters of tiny ulcers often converging into larger patches mimics herpes simplex but doesn’t have proceeding these calls or blisters
what investigations should you carry out the diagnosis of apathous ulcers?
FBC and iron studies including B12 to roll out apathous like ulcers which occur in deficiencies if any deficiencies occur then finding the cause is important
if in the investigations of apathous ulcers there appears to be deficiencies what further investigation could you perform?
Zero IgA TTG for coeliac and ESL/CRP for any other inflammatory conditions
what should you do if an apathous ulcers isn’t healing?
take a biopsy and check for oral cancer
what is the management of apathous ulcers?
change toothpaste use antibacterial mouthwash avoid triggers and use over-the-counter symptomatic relief if they are more severe use corticosteroids topically then move on to systemic or immune modulation even if vitamin B12 is normal oral Whitsun B12 may help
what does the image below show?
apathous ulcer
what does the image below show?
herpes simplex
describe the pathophysiology of herpes simplex virus oral ?
replicates in the epidermis and effects sensory autonomic nerve endings travels up the nurse to the sensory ganglia where it enters the latent stage when it reactivates the travel down the nerves to the mucosal surfaces for the cutaneous ones
what is the management of oral herpes simplex?
oral or topical antivirals like acyclovir
what does image below show
oral candidiasis
who does oral candidiasis usually infect?
immunosuppressed infants for older adults
what is the presentation of oral candidiasis?
Creamy white/yellowish plaque fairly adhering to the oral mucosa can have angular colitis can experience burning or pain and can be erythematous
what is the management of oral candidiasis?
Topical antifungal is such as lozenge if more severe you systemic such as fluconozole
How do you diagnose oral candidiasis?
superficial smear of lesion and microscopy
what is gingivitis?
Inflammation of the gingiva usually caused by bacterial induced inflammation from dental plaques form on the teeth
what is a serious consequence of gingivitis and wonders that usually occur?
can become necrotising and tends to occur in less developed countries where there is no treatment
what is glandular fever?
also known as infectious mononucleosis is a clinical syndrome caused by EBV in 90% of cases
what is a presentation of glandular fever?
characterised by pharyngitis fever - lasting from 2-5weeks and lymphadenopathy - generalising can be long lasting usually most prominent by the end of the second week fatigue and splenomegaly present 50% of cases
how do you diagnose glandular fever?
Diagnosed with EBV antibodies IgM shows acute infection and IgG shows past infection
what should you always check and gradually fever and why?
Liver function can be + ALT and Ast
what is the management of glandular fever?
Supportive management unless there is a upper airway obstruction or presence of haemolytic anaemia or thromcocytopenia is in which case give corticosteroids IVIg also can be given in thrombocytopenia
what is a Quinsy?
Perry tonsillar abscess or a retro foreign jewel abscess it’s an accumulation of pus behind the tonsils
what pathogen usually causes Quinsy?
S viriridan Saureus S epidermidis or B heamolytic strep
what usually triggers the formation of a Quinsy??
URTI usually proceeds
what is the presentation of a Quinsy?
spiking fever that pain severely sore throat with painful swallows resulting in decreased oral intake neck and oropharyngeal swelling and lymphadenopathy irritability and weight loss due to decreased intake
how do you diagnose a Quinsy?
CT with contrast ultrasound scan is commonly used to differentiate from normal lymphadenopathy and then culture of pus is needed
what is the management of a Quinsy?
empirical IV antibiotics of clindamycin and ceftriaxone with supportive care and simple analgesia and give more targeted antibiotics if necessary if there is airway obstruction give Ivy corticosteroids followed by surgery
what is epistaxis?
nosebleeds from nasal cavity and/or nasopharynx
what is the most common area which epistaxis occurs from?
little the area of the anterior septum where the kiesselbachs plexus is found
what are causes of epistaxis?
mucosal compromise (trauma or impairment of vasoconstriction and inadequate clotting) or less commonly sinus tumours or juvenile nasal angiofibroma. HTN can be a cause in adults
what must you do when a patient presents with epistaxis?
patient will not present unless there is active at the stacks and if they are significantly concerned so should take it seriously if possible always try and identify the bleeding started anteriorly or posteriorly - if bleeding does not stop with simple packing then you must visualise it and this can be done directly using nasal speculum headlamp
what is the management of epistaxis?
anterior septal pressure plus vasoconstrictor spray (oxymrtazoline) topical anaesthetic and vasoconstrictor – Lidocaine helps any discomfort if packing is required anterior nasal packing or balloon catheter however if posterior bleed is detected IV sedation with morphine and antiemetic plus give antibiotics endoscopic Magnet and and cautery surgical ligation
What is Sialadenitis?
Inflammation of any of the saliva glands which can be caused by bacterial viral or autoimmune causes
what bacterial cause usually causes Sialadenitis?
Staphylococcus aureus
what is the pathophysiology of Sialadenitis?
infections arise and there is decreased saliva reflow this can be due to mechanical obstruction ductal abnormalities or sjorgens syndrome causing predisposition to infection
how does Sialadenitis present?
fever pain and dysphagia facial/neck swelling episodic swelling during eating
what is the presentation of severe Sialadenitis?
respiratory distress and cranial nerve 7 9 12 - from compression causing palsy
what might be seen on examination of the mouth in Sialadenitis?
purse exudates at the saliva gland openings
what investigations are required in Sialadenitis?
cultures and sensitivity of exudates and FBC
why might you perform a facial x-ray in a patient with Sialadenitis?
if he suspects the library stones sialolithitis
What is the management of Sialadenitis?
broad-spectrum antibiotics analgesia and hydration and sialogues to increase saliva. If there is lots of swelling corticosteroids and drainage of abscess is detected
what is mumps?
aka parotitis systemic infectious disease caused by RNA paramyoxy virus
what does the image below show?
Mumps
what is the presentation of mumps?
para tightest constitutional symptoms orchitis or oophotritis . Can cause aseptic meningitis
how do you diagnose mumps?
saliva gland IgM
what is the management of mumps?
If isolation and supportive care
How many episodes of tonsillitis are required in one year to warrant a tonsillectomy according to SIGN?
7
16 year old female presented sore throat is a febrile has no tender neck no no cough what would be her Centor score? (insert image)
2
describes the Centor score?
insert image
what is the most appropriate management of an individual who scores a centor score of 2?
reassure and give analgesia do a throat swab and review if symptoms persist
what would be the management of an individual with a Centor score of 5?
give oral antibiotics - consider the delayed prescription do rapid antigen test (SWAB)
you suspect the patient has EBV what is the most management of a patient with EBV?
consider hospital admission is struggling to swallow liquids if they have abnormal liver function tests consider steroids if there is any sign of airway obstruction
why is koa moxa curve contraindicated in the management of sore throats?
Because if so throat is caused by EBV amoxicillin causes a large rash
25 old man has had right ear pain for eight weeks the tympanic membrane looks as such (insert image) What is the most likely cause of ear pain?
Tympanic membrane is normal most likely is referred pain
a 70 year old gentleman says he has suddenly gone deaf in his right ear Webers test is heard loudest in his left ear and Rinnies is positive in both years what is the diagnosis?
sensorineural loss in right ear
are 45 old woman has recurring a pain discharge when you examine the is the following is seen (insert picture – what is most likely diagnosis
fungal otitis externa what you see fungal spores
are seven professional rugby player presents with vertigo following a concussion six months ago he finds that episodes are worse when he bends over what is most likely diagnosis?
BPPV
what is the first line management of BPPV?
Epley manoeuvre
how would you manage a broken nose?
If a broken nose has obvious deformity and swelling they need referral within five days this is because after five days swelling has reduced enough for you to see the full impact of the break bones then be manipulated under local anaesthetic or in general anaesthetic in adults
what is glue ear?
when the middle ear feel fills with viscous fluid instead of air
what causes glue ear?
typically caused by eustachian tube dysfunction after a proceeding upper respiratory tract infection also can be caused by recurrent otitis media
what is the management of glue ear?
Supportive as hearing usually goes back to normal within a few months but if it doesn’t then grommets are inserted
what are grommets?
A.k.a. tympanostomy tubes allow for air to pass through the eardrum equalising the pressure and the fallout on their own after 6 to 12 months
what is a cleft pallet?
An abnormal opening secondary to developmental failure en utero
what are the types of cleft palates?
Cleft lip with or without cleft palate which can be unilateral or bilateral
describe the pathophysiology of cleft palates?
failure of fusion of the frontonasal and maxillary process as well as failure to fuse the palatine process and nasal septum
what are some causes of cleft palates?
Foley acid deficiency chromosomal abnormalities maternal anticonvulsants therapy maternal smoking
what are some consequences of cleft palates?
Difficulty feeding causing poor weight gain airway obstruction and hearing difficulties may present
which members of the MDT are required in the management of a cleft pallet?
Audiology surgery (early life) nursing dentistry orthodontics speech and language therapy
what is a stenocleido mastoid tumour?
tumour of infancy which is a rare benign mass in the muscle on the side of the neck
when do stenocleido mastoid tumours commonly present?
at two – four weeks
what investigations are required in a stenocleido mastoid tumour?
diagnosis is usually clinical but ultrasound scan and fine-needle aspiration may be used for confirmation
what is the management of a stenocleido mastoid tumour?
physiotherapy and if it is persistent after one year then surgery is sometimes required
what is a branchial cyst?
swelling caused by an embryological remenent
what is the pathophysiology behind branchial cysts?
failure of the obliteration of the second third and fourth branchial cleft
what is the presentation of a branchial cyst
solitary painless mass on the side of the neck which are usually unnoticed until there is an upper respiratory tract infection which causes them to get infected and enlarge
how do you diagnose a branchial cyst?
clinical aided by CT imaging
what is the management of a branchial cyst?
antibiotics and then surgery is required to prevent recurrence
what is a thyroglossal cyst?
a for breast cyst forming a persistent viral glottal duct caused by remnant cells from the formation of the thyroid gland during development
what is the presentation of a thyroglossal cyst?
bump in the middle of the neck which is usually painless and moves during swallowing however can become painful if infected which can lead to swelling and dysphagia
how do you diagnose a thyroglossal cyst?
clinical diagnosis aided by ultrasound scan and thyroid scan if necessary
what is the management of a thyroglossal cyst?
surgical
what is a retinopathy of prematurity?
vascular proliferation causing retinal detachment
what are the risk factors associated with retinopathy of prematurity?
Hi O2 therapy low birthweight premature (under 28 weeks increased risk of bilateral)
what is the management of retinopathy of prematurity?
weekly funduscopy to monitor progress and laser surgery
