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Year 3 - Diseases > ENT > Flashcards

ENT Flashcards

1
Q

Define tonsillitis

A

Inflammation of the parenchyma of the palatine tonsils

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2
Q

Define acute pharyngitis

A

Inflammation of the oropharynx (behind the soft palate)

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3
Q

Describe epidemiology of tonsillitis

A
  • 70% viral
  • 30% bacterial
  • 90% will recover within a week without treatment
  • Common in children age 5-10 and young adults age 15-25
  • Bacterial tonsillitis is most commonly cause by Group A streptococcus (aka “Strep Throat”). This is carried in normal healthy throats in the general population. Rates of carriage decline with age, from about 10% of under 14’s to <1% of over 45s.
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4
Q

Describe symptoms of tonsillitis

A
  • Sudden onset sore throat, fever, no cough

- Some patients may get headache, abdo pain, nausea and vomiting, cough or runny nose

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5
Q

List signs of tonsillitis

A
  • Pus on tonsils (exudate)
  • Tender cervical lymph nodes
  • Swollen tonsils (erythema and elargement)
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6
Q

List investigations in tonsillitis

A
  • Throat swabs to diagnose streptococccus
  • Rapid antigen testing
  • Mostly diagnosed from history alone

Centor criteria (3 or more rapid streptococcal antigen test):

  • Tonsillar exudate
  • Tender anterior cervical lymph nodes
  • Fever over 38
  • Absence of cough
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7
Q

List risk factors for tonsillitis

A
  • Young age

- Being in contact with peers who have it eg. in schools

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8
Q

Define infectious mononucleosis

A

Glandular fever (infectious mononucleosis) is an infection most commonly caused by the Epstein-Barr virus (EBV)

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9
Q

List symptoms of infectious mononucleosis

A
  • Fever
  • Lymphadenopathy
  • Severe sore throat that fails to improve
  • Prodromal symptoms (general malaise, fatigue, myalgia, chills, sweats, anorexia)
  • Non-specific rash
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10
Q

Describe aetiology of infectious mononucleosis

A
  • Spread through kissing and sexual contact
  • Generally via asymptomatic carriers
  • Lifelong latent carrier state after infection
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11
Q

Describe epidemiology of infectious mononucleosis

A
  • Glandular fever is most common in people aged 15–24 years
  • 5 cases per 1000 persons; however, in a practice with a large young adult population, the annual incidence can be as high as 48 cases per 1000 persons
  • The annual incidence in people younger than 10 years or older than 30 years is less than 1 case per 1000 persons
  • Glandular fever is rare during the first year of life
  • 95% of adults worldwide have been infected with the Epstein-Barr virus (EBV)
  • Glandular fever is more likely to affect those who acquire primary EBV in their teenage years. In young adults, the rate of developing glandular fever from primary EBV infection is estimated at 50%, with a range between 26–74%. In older adults, EBV infection often does not progress to glandular fever
  • Glandular fever is less commonly seen in developing countries
  • In developing countries, most children acquire EBV by the age of 4 years.
  • In developed countries, primary EBV infection tends to occur later in life, and between 25–75% of people with EBV infection develop glandular fever.
  • There is no seasonal variation or gender or sex predisposition
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12
Q

List signs of infectious mononucleosis

A
  • White wash exudate on tonsils, with tonsilar enlargement
  • Palatal petechiae
  • Non-specific rash
  • Splenomegaly
  • Hepatomegaly
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13
Q

Describe investigations of infectious mononucleosis

A
  • Blood tests for EBV if immunocompromised or under 12
  • Over 12 and immunocompetent perform FBC, looking for positive monospot test with high atypical lymphocytes.
  • If negative repeat in 5-7 days. If second test is negative, test for CMV and HIV
  • Check LFT
  • 3 components: EBV viral capsid antigen (IgM - early primary infection), EBV VCA IgG (acute primary infection if with IgM or if with EBNA past infection)
  • Paul brunelll antigen
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14
Q

Describe management of infectious mononucleosis

A
  • Hospital admission if stridor, dehydration, or complication suspected
  • Or advise to use simple analgesia, and advise symptoms last 2-4 weeks. Not necessary to miss school or work, avoid sharing utensils and kissing.
  • Avoid heavy lifting and contact sports for first month of illness due to splenic rupture
  • If taking amoxicillin, will cause a maculopapular rash
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15
Q

List complications of infectious mononucleosis

A
  • Hepatitis
  • Upper airways obstruction
  • Cardiac complications (Pericarditis, myocarditis, conduction abnormalities)
  • Renal complications (interstitial nephritis, myositis associated kidney injury, haemolytic uraemic syndrome)
  • Neurological complications (guillian barre, encephalitis, facial nerve palsy)
  • Haematological complications (neutropenia and thrombocytopaenia)
  • Splenic rupture
  • Chronic fatigue
  • Cancer
  • MS
  • Chronic active EBV
  • Abnormal LFT
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16
Q

Describe prognosis of infectious mononucleosis

A
  • In most people, glandular fever is self limiting and lasts 2–4 weeks. Occasionally the disease course can be prolonged (lasting for weeks or months)
  • Serious complications are rare and include upper airways obstruction, splenic rupture, and neutropenia. In immunocompromized people, EBV infection may result in malignant disease, such as Hodgkin’s lymphoma and nasopharyngeal carcinoma.
  • Fatigue is common and usually lasts for a few weeks, or for several months in a minority of people (about 10%).
  • Epstein-Barr virus (EBV) infection leads to a lifelong latent carrier state. People who are immunocompromized are more likely to develop symptoms if EBV reactivates
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17
Q

List 6 cardinal ear symptoms

A
  • Otorrhoea (discharge)
  • Otalgia (ear pain)
  • Hearing loss
  • Dizziness
  • Tinnitus
  • Facial weakness (facial nerve)
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18
Q

Compare the appearance of acute otitis media to otitis media with effusion

A

Acute otitis media

  • Painful
  • Red bulging ear drum)

Otitis media with effusion

  • Painless
  • Retracted ear drum with thick “glue” behind
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19
Q

Describe the appearance of otitis externa on otoscopy and examination

A
  • Pain upon palpation of tragus

- Erythema, edema, and narrowing of the external auditory canal , and a purulent or serous discharge

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20
Q

List the functions of the nose

A
  • Warming
  • Humidification
  • Olfaction
  • Respiration
  • Filtration
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21
Q

Define thyroglossal cyst

A

A remnant of the thyroglossal duct, which forms during the embryonic development of the thyroid gland and normally regresses before birth

22
Q

Describe epidemiology of thyroglossal cyst

A
  • TGC was reported as the most common cause of congenital neck swelling (53%) in a Jordanian study.
  • They may be found in as many as 7% of the population.
  • Most commonly, they present in the first decade of life.
  • They are, however, also seen in adults.
23
Q

List signs and symptoms of thyroglossal cyst

A
  • Midline swelling, moves when sticking out the tongue and swallowing
  • Fluctuant
  • Infected TGCs may present as a tender mass.
  • A tender infected TGC may be associated with dysphagia, dysphonia, draining sinus, fever or increasing neck mass.
  • An infected TGC may present like an upper respiratory tract infection.
24
Q

Describes investigations for thyroglossal cyst

A
  • History and neck exam
  • Ultrasound of thyroid, CT or MRI (well circumscribed anechoic mass above thyroid)
  • TFTs
  • Barium swallow
  • Laryngoscopy
25
Q

List causes of thyroglossal cyst

A
  • Blocking or inflammation of duct
  • Parotitis (mumps, bacterial TB, HIV)
  • Autoimmune (sorjens)
  • Cancer
26
Q

Define BPPV

A
  • Benign paroxysmal positional vertigo is a peripheral vestibular disorder that manifests as sudden, short-lived episodes of vertigo elicited by specific head movements.
  • BPPV is one of the most common causes of vertigo.
  • It is often self-limiting, but can become chronic and relapsing with considerable effects on a patient’s quality of life.
27
Q

Describe epidemiology of BPPV

A
  • Primary peak incidence 50-60
  • 2.4% lifetime prevalence in europe
  • Females more likely to be affected
28
Q

Describe aetiology of BPPV

A
  • 50% to 70% of BPPV occurs without a known cause and is referred to as primary (or idiopathic) BPPV.
  • The remainder is termed secondary BPPV and is associated with a range of underlying conditions, including head trauma, labyrinthitis, vestibular neuronitis, Meniere’s disease (endolymphatic hydrops), migraines, ischaemic processes, and iatrogenic causes (otological and non-otological surgery, repositioning manoeuvres).
  • Most cases result from the migration of free-floating endolymph canalith particles (thought to be displaced otoconia from the utricular otolithic membrane) into the posterior (more commonly), horizontal (less commonly), or anterior (rarely) semicircular canals, rendering them sensitive to gravity.
29
Q

List risk factors for BPPV

A
  • Age >50 years
  • Female sex
  • Positional vertigo in absence of nystagmus
30
Q

List symptoms of BPPV

A
  • Vertigo provoked by specific head movements (e.g., looking up or bending down, getting up, turning the head, and rolling over in bed to one side).
  • Brief duration and episodic
  • Sudden onset severe episodes
  • Nausea, imbalance, lightheadedness
  • Absent neruo/ oto symptoms
31
Q

List signs of BPPV

A
  • Positive Dix-Hallpike manoeuvre and positive supine lateral head turn
  • Normal otological exam
  • Nystagmus in the plane of the canal affected
32
Q

List investigations for BPPV

A

Dix hallpike manouvre

  • The patient’s head is turned 45° towards the ear being tested.
  • The head is supported, and then the patient is quickly lowered into the supine position with the head extending about 30° below the horizontal while remaining turned 45° towards the ear being tested.
  • The head is held in this position and the physician checks for nystagmus.
  • To complete the manoeuvre, the patient is returned to a seated position and the eyes are again observed for reversal nystagmus.
  • The nystagmus and vertigo occur with 1 to 5 seconds of latency and last <30 seconds; nystagmus is torsional (rotatory) in nature, reversible with sitting, and fatigable with repeat testing; left ear BPPV has a clockwise torsional nystagmus response, while right ear BPPV has an anti-clockwise response

Supine lateral head turn

  • The head is then rotated to one side, left for a minute, and then rotated to the opposite side.
  • Similar to the Dix-Hallpike manoeuvre, a positive test is noted when the patient experiences vertigo with nystagmus.

Audiogram/brain MRI normal

33
Q

Define conjunctivitis

A

The inflammation of the lining of the eyelids and eyeball caused by bacteria, viruses, allergic or immunological reactions, mechanical irritation, or medicines.

34
Q

Describe epidemiology of conjunctivitis

A
  • 1% of all primary care consultations
  • 13-14 cases per 1000 per year
  • Higher in children age under 1
  • Perennial conjunctivitis is rarer, 80% have seasonal flares
  • Atopic allergic conjunctivitis disease more common in adults
  • Bacterial more common in children and viral more common in adults
35
Q

Describe aetiology of conjunctivitis

A
  • Pneumococcus, Staph aureus, Moraxella catarrhalis, H. Influenzae
  • Chlamydia is a common cause of persistent conjunctivitis
  • Viral adenovirus, herpes simplex, epstein barr, varicella zoster, coxsackie and enterovirus.
  • Contact lense wear keratoconjunctivitis
  • Mechanical (chronic conjunctival irritation)
  • Toxic/chemical
  • Neoplasmic - sebaceous gland carcinoma
36
Q

List risk factors for conjunctivitis

A
  • Exposure to infected person
  • Infection in one eye
  • Environmental irritants
  • Allergen exposure
  • Cramps, swimming pools, military bases
  • Asian or mediterranean young male
  • Atopy
  • Contact lens
  • Ocular prosthesis
  • Mechanical irritation
  • Topical eye medicine
  • Rheumatological disease
37
Q

List investigations for conjunctivitis

A
  • Rapid adenovirus immunoassay
  • Cell culture
  • Gram stain
  • PCR
  • Ocular pH
38
Q

Define uveitis

A
  • Inflammation of one or all parts of the uvea, or the vascular area between the retina and sclera of the eye.
  • The anterior uvea is composed of the iris and ciliary body; an irritation of this segment, or anterior uveitis, leads to acute painful symptoms and photophobia.
  • Inflammation of the posterior uvea, including the choroid, retina, and retinal vasculature, carries a risk of painless visual loss.
39
Q

Describe epidemiology of uveitis

A
  • May affect individuals of any age, sex, or geographical location
  • 15 per 100000 person-years
  • Western prevalence 38 per 100000
  • Anterior particularly common in finland
  • Anterior most common (75%)
40
Q

Describe aetiology of uveitis

A
  • Idiopathic, infectious and non-infectious
  • HSV, herpes zoster, CMV, HIC, Lyme, toxoplasmosis, TB, syphilis, histoplasmosis
  • Non-infectious seronegative arthropathies, IBD, autoimmune, sarcoidosis, MS, eye trauma
  • May be associated witb HLAB27
41
Q

Describe symptoms of uveitis

A
  • Pain (anterior)
  • Decreased vision
  • Synechiae
  • Flare
  • Keratic precipitates
  • Tearing
  • Photophobia
  • Floaters
42
Q

List signs of uveitis

A
  • Redness no discharge
  • Constrictive non-reactive pupil
  • Decreased intraocular pressure
  • Oedema, opitic nerve oedema
  • Retinal vascular sheathing
  • Macular oedema
  • Optic disc swelling
  • Retinal haemorrhages
  • Ciliary flush (+circumlimbal redness)
  • Corneal oedema
  • Anterior chamber WBC’s and flare (hypophyon)
  • Keratic precipitates (aggregates of lymphocytes in corneal endothelium)
  • Buscca, berlins or Koeppes cell clusters (granulomatois)
43
Q

List risk factors for uveitis

A
  • Inflammatory diseases
  • HLA-B27
  • Ocular trauma
  • Age 30-40 years
44
Q

List investigations for uveitis

A
  • Clinical diagnosis
  • FBC (high WBC in infection)
  • ESR (raised)
  • CRP (raised)
  • FTA-ABS (syphilis)
  • ACE (raised)
  • Antinuclear antibodies
  • HLA-B27
  • Lyme titre
  • Putrified protein derivative skin test
  • Antineutrophil cytoplasmic antibodies
  • anti-DSDNA, anti CCP, HLA, rheumatoid factor
45
Q

Define menieres disease

A
  • An auditory disease characterised by an episodic sudden onset of virtigo, low-frequency hearing loss, tinnitus, and fullness in the affected year
  • Menieres disease idiopathic, menieres syndrome if there is a known cause
  • Also called endolymphatic hydrops
46
Q

Describe epidemiology of meniere’s disease

A
  • Unknown
  • More common in adulthood, usually in the 4th decade.
  • 50% patients present with family history of MD
  • 1.1:1 female-to-male ratio
  • Bilateral disease in up to 50% patients
47
Q

Describe aetiology/risks of Meniere’s disease

A
  • Idiopathic
  • Allergic responses
  • Congenital or acquired syphillis,
  • Lyme disease
  • Hypothyroidism
  • Stenosis of the internal auditory canal
  • Pre-existing autoimmune disease
  • Acoustic or physical trauma
  • Hereditary - multifactorial, leading to endolymphatic malabsorption and subsequent hydrops
48
Q

List symptoms and signs of Meniere’s disease

A
  • Vertigo (recurrent, minutes to hours, n+v), sudden loss of balance (‘drop attacks’)
  • Hearing loss (fluctuating)
  • Tinnitus (Roaring, usually unilateral)
  • Aural fullness
  • Drop attacks (sudden loss of balance without LOC)
  • Positive Romberg’s test
  • Failed tandem walk
  • Fukuda’s stepping test (turning towards the affected side when asked to march in place with eyes closed)
  • Nystagmus
49
Q

List investigations for Meniere’s disease

A
  • Pure tone air and bone conduction with masking (unilateral sensorineural hearing loss, low frequency in early stages)
  • Speech audiometry (no discrepancies)
  • Tympanometry, immitance, stapedal reflex levels normal
  • Otoacoustic admissions absent
  • Electrocochleography/ electronystagmography
50
Q

Compare presentation of allergic, viral, and bacterial conunctivitis

A

Allergic

  • Watery/ropy mucoid discharge + Itching
  • Often seasonal
  • Hx Atopic dermatitis (especially eyelids), hay fever, asthma.
  • Vernal conjunctivitis - young Asian/Mediterranean males

Viral
- Starts in one eye & spreads
- Recent URTI Sx or infectious exposure
- Red eye + itching, burning, foreign body sensation
- Watery/mucous discharge + pre-auricular lymphadenopathy
+/- Corneal subepithelial infiltrates

Bacterial
- Bilateral > unilateral
- Red eye + burning or foreign body sensation
- Itching uncommon
- Papillary conjunctival reaction, eyelid matting, purulent discharge
+/- Concurrent otitis media.

51
Q

Describe presentation of conjunctivitis caused by chlamydia and neisseria

A 
Chlamydia
- 3% infectious cases
- Stringy or mucous discharge
- Conjunctival follicles + corneal pannus
\+/- Corneal infiltrates
- Pre-auricular lymphadenopathy
- Becomes chronic/recurrent
Neisseria
- Young, sexually active adult (genitals -> hands -> eyes)
- Lots ofpurulent discharge
- Eyelid swelling
- Chemosis
- Develops over 12 to 24 hours
\+/- Peripheral corneal ulcers, pre-auricular lymphadenopathy
- Progresses to blindness

Year 3 - Diseases (27 decks)

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