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Primary Care > ENT > Flashcards

ENT Flashcards

1
Q

otitis externa signs and symps

A

signs - ear canal/external ear is inflamed/eczematous and discharge
symptoms - itch, severe ear pain, jaw tenderness, aural fullness

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2
Q

otitis externa - management

A 
ear drops (antibiotics and steroids in it) 
painkillers 
keep ear dry, allow discharge to escape

severe
ear wick
oral antibiotics

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3
Q

noise/age related hearing loss symptoms compared

A
  • diff history of exposure to recurrent loud noises
    compared to age > 50 yrs
  • bilateral, gradual, sensorineural
  • tinnitus
  • loss of high frequency sounds first - conversation, increasing tel vol
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4
Q

loss - management

A

hearing aids

reassurance and assistive listening device (like flashing doorbell)

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5
Q

Meniere’s disease - symptoms

A

recurrent episodes of vertigo, hearing loss, tinnitus
aural fullness
nausea/vomiting
hearing loss is progressive alongside dipping in episodes

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6
Q

Meniere’s disease - management

A
  • antihistamines - improve symptoms (nausea/vomiting, vertigo (can’t improve dizziness though)
  • don’t drive, sit/lie down during episodes, carry around medication in case of attack, move slowly
  • psychological impact
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7
Q

Acute otitis media - symptoms and otoscopy findings

A 
severe pain
fever 
URTI symptoms - common cold 
otoscopy - TM inflamed, tear if ruptured 
conductive hearing loss possibly
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8
Q

acute otitis media -

  1. investigations
  2. management
A
    • tympanometry - measure air pressure - to determine
      rupture (fluid build up can rupture it)
    • confirm infection, test discharge, fbc , crp
  3. resolve itself 1-3 days, simple analgesics
  4. grommets - recurrent AOM
  5. oral antibiotics if: >4 days no improvement, systemically unwell which doesn’t require admission, RF’s - congenital heart disease/immunosuppression
  6. impatient admission - >3months w temp
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9
Q

Chronic suppurative otitis media / Wet tympanic perforations

  1. presentation
  2. investigations
A
  1. recurrent otorrhoea through tymp perforation >2 wks w/out fever/otalgia , conductive heating loss
  2. granulation tissue on otoscopy, imaging if suspect complications e.g CT for cholesteatoma
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10
Q

CSOM/wet T perforations

management

A
  1. advise - ear dry, aural toileting - earplugs when showering, no swim, clean w tissue superficially
  2. topical antibiotics (gram both)/steroid treatments - reduces granuloma formation
  3. surgical - if v severe
    myringoplasty - close eardrum perforation
    tympanoplasty - “ + involve bones of inner ear
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11
Q

Dry tymp perforations

presentation, I and M

A
  1. only mild hearing loss - severity depends on size can be asymptomatic
  2. tympanometry
  3. heals spontaneously in few weeks, advise - avoid blowing nose (pressure), ear dry don’t clean
    if doesn’t- then eardrum patch or tympanoplasty
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12
Q

mastoiditis

presentation

A
  • swelling behind ear
  • redness, tenderness/pain
  • fever/irritability/lethargy
  • headache
  • ear symptoms: hearing loss, discharge
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13
Q

mastoiditis

I and M

A
  1. press on mastoid bone if tender/swollen send to a&E
  2. blood test and ear discharge culture,
  3. hospital admissions - iv antibiotics as can spread
    myringotomy - drain fluid in middle ear, relieve pressure
    mastoidectomy - remove infected bone
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14
Q

otitis media with effusion (glue ear)

presentation and I

A
    • hearing loss
    • mild otalgia
    • aural fullness
    • maybe discharge - yellow, TM retracted
  2. tympanometry - straight line at 1.3
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15
Q

otitis media management

A
  1. self -limiting - actively observe for 2-3 mths, can offer auto-inflation if child is old enough
    - auto inflation - balloon through nostril
  2. if bilateral and persistent - offer hearing aids if surgery contraindicated otherwise grommet
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16
Q

congenital deafness
P
I
M

A

p - bilateral sensorineural hearing loss, can be associated w causes of other genetic conditions or infections, speech/language impairment if not treated early
I - for causes: gene mapping, blood tests for infection, imaging to asses ear structures
M - earlier better, hearing aids, aural rehabilitation (sign language), cochlear implantation if bilateral and severe

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17
Q

Cholesteatoma
P
I - findings

A

P - abnormal sac of keratinizing squamous epithelium/accumulation of keratin in middle ear/mastoid air cell spaces which can become infected/erode into other structures
- Recurrent/chronic purulent, smelly discharge - can be unresponsive
to Abx
- Conductive hearing loss/tinnitus

I
look at TM - otoscope
- if congenital (rare) - white mass behind intact TM w no
other ear history
otherwise - ear discharge (referral if sig and can’t see TM coz)
- TM perforated and retracted
- deep retraction pocket
- crust/keratin in upper part of TM(aka eardrum)

  • CT scan w suspected cholesteatoma/ following surgery for it as cam recur
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18
Q

cholesteatoma - M

A
  1. semi-urgent referral to ENT
  2. prior surgery- topical ABx to treat discharge
  3. surgery - canal wall up mastoidectomy (canal wall left intact)
  4. check up - 9-12mths later - can recur
19
Q

referred pain to ear
P
I
M - causes

A

P - normal examination, pain, could have crepitus, maybe history of dental disorders
I - do an otoscopy (normal), CT of temporal bone, H&N examinations , imaging if negative findings so far of H&N
M - depends on cause
TMJ disorders - analgesics
trigeminal neuralgia - carbamazepine for otalgia
H&N cancer

20
Q

Acute sinusitis - presentation

A

after common cold (obstruction to drainage of paranal sinuses lead to accumulation of mucus here)
acute if worsening > 5 days or persistence >10 but <12 weeks
adults - nasal blockage/discharge w facial pressure/headache and or loss of smell.
can get cough, tenderness of face, altered speech due to obstruction
children - same but cough instead of loss of smell and discoloured discharge.

21
Q

Chronic sinusitis - I and M

A

same but >12 weeks
assess for predisposing conditions - allergic rhinitis, asthma, immunosuppression - improve symptoms if this is managed/controlled well
stop smoking, avoid triggers, good dental hygiene

22
Q

sinusitis - I

A

Inspecting and palpating the maxillofacial area
Anterior rhinoscopy:
-nasal inflammation, mucosal oedema, and purulent nasal discharge.
-nasal polyps, or anatomical abnormalities (septal deviation)
Pulse rate, blood pressure, and temperature

23
Q

sinusitis - M

A

Refer
- to hospital if: severe systemic infection, infraorbital/ periorbital/Intracranial complications,
- for investigations if :unilateral symptoms, epistaxis, blood-stained discharge
If symptoms <10 days
advise: usually viral, clear in 2-3 weeks w out antibiotics, 2/100 chance of becoming bacterial and complicated
paracetamol /ibuprofen for fever
NHS info on sinusitis
Safety net: symptoms worsen rapidly/sig, no improvement after 3 weeks, or become systemically very unwell.
>10 days w no improvement
High dose nasal corticosteroid
back -up antibiotic prescription if symptoms worsen rapidly or significantly, or do not improve within 7 days.
Safety net : no improvement in 3-5 days, stop antibiotic treatment if not well tolerated, complications

24
Q

thyroid nodules - presentation

A

lumps move on swallowing
can be visible or palpable
could be with signs of compression - dysphagia, stridor, voice changes

25
Q

thyroid nodules - I and red flags

A

USS
TSH function tests
Emergency and urgent referral symptoms include:
1. Unexplained thyroid lump
2. Hoarseness of voice
3. Stridor or upper airway obstruction
4. Red Flag Symptoms of Malignancy including: fever, weight loss, night sweats, haemoptysis

26
Q

acute labyrinthitis aka vestibular neuronitis - what is it

A

acute, isolated, spontaneous, and prolonged vertigo of and hearing loss
Inflammation of the labyrinth
Vestibular neuronitis - inflammation of the vestibular nerve

27
Q

labyrinthitis

A

settle after few weeks itself
oral/IM prochlorperazine for vertigo
hospital admission - severe N&V –> risk of dehydration

28
Q

allergic rhinitis - I & M

A

I
skin prick test - raised bump if allergy
allergy test - for IgE means allergy
M
1. limit exposure to allergen e.g. close doors in pollen times
2. nasal douching/irrigation - cleaning it w salt solution to clear irritants
otherwise antihistamines, nasal corticosteroids then oral

29
Q

Nasal polyps
P

red flag?

A

blocked nose, watery rhinorrhoea, reduced smell/taste, bilateral

facial pressure/pain , headaches and in upper teeth
snoring
persistent stiffness

red - unilateral poly w/wout blood tinged secretion –> tumour

30
Q

polyps - I

A

Pale/yellow or fleshy/reddened appearance - not painful on poking but turbinate’s are
nasal endoscopy then imaging (CT) to rule out other structural abnormalities like cancer and pinpoint size/location
allergy tests - as these can contribute to symptoms
CF test - common
Blood test - low vit D as associated

31
Q

polyps - M

A

reduce size or eliminate

  1. nasal corticosteroids - reduce inflammation and may shrink/eliminate
  2. if don’t work oral - but many side effects
  3. injection of a medication called dupilumab
  4. surgery - if drug treatment ineffective after 10 wks
32
Q

cervical lymphadenopathy - P

A
  • > 1cm diameter
  • tender/painful
  • can have cancer red flags
    if stony-hard typical cancer signs, rubbery lymphoma
  • can also be soft-fluctuant - infection, inflammation
33
Q

C lymphadenopathy - I

A 
depends on history:
Localised symptoms - suggest infection 
Systemic symptoms - cancer or TB 
Epidemiological clues - travel history 
Drug history - HIV etc 
Examine other nodal sites as well

biopsy after 3-4 wks observation

HIV antibody testing, syphilis testing - IV drug user could suggest
Monospot testing - for EBV

34
Q

C lymph - M

A

treat underlying cause
safety-net - can recur - so be alert for them
lymphomatous nodes have been known to temporarily regress then reappear

35
Q

Benign Paroxysmal Positional Vertigo - P

A
  • vertigo, dizziness, loss of balance, N&V
  • last < 1 min
  • brought on by changes in head position
36
Q

BPPV - I

A

Dix-Hallpike test
1. sitting to supine rapidly w head at 45 angle to the right
2. return to sitting after 20-30 secs
+ve result nystagmus (vertical upward and rotary)
3. repeat on LHS if -ve result

37
Q

BPPV - M

A

Epley manoeuvre

  • can do it at home themselves
  • may need few times for it tot work
  • once asymptomatic, don’t do the manoeuvre

if doesn’t work - canal plugging surgery

38
Q

deviated nasal septum

  • P
  • I
A

unilateral/bilateral nasal obstruction, post-nasal drip, narrowing of nostrils, recurrent sinus infections

inspect w nasal speculum

39
Q

deviated nasal septum

M

A
  • decongestant tablets - reduce swelling
  • antihistamines - prevent allergy symptoms which would further block nose
  • nasal steroid spray - increase drainage and reduce swelling

septoplasty - surgical, straightens septum
septorhinoplasty - surgical - if cause involves a nasal fracture

40
Q

Nasal fracture - I

P

A

pain, displaced septum, septal haematoma, swelling/bruising, dyspnoea

nasal speculum - to inspect for septal haematoma/deviation
imaging not usually needed as can see on appearance w out

41
Q

Nasal Fracture - M

A

Ice, elevate nose to reduce swelling
if no bone displacement - rest and protection
if nosebleed - packing
bones displaced - repositioned local anaesthesia –> cast
if not fully recovered in >2wks - reconstructive plastic surgery

42
Q

vestibular migraine - P

A

Migraine
recurring vertigo - lasts > few mins

N&V, unilateral widespread weakness of muscles, maybe tinnitus , maybe speech temp affected for 15-60mins

sensitivity to sound and motion

43
Q

vestibular migraine - M

A

Triptans
vestibular suppressant - for dizziness and motion sensitivity
maybe: benzodiazepines, anti-emetics, anti-histamines

44
Q

Vestibulopathy - P

M

A

vestibular apparatus disorders e.g. BPPV, Meniere’s, labrynthitis etc
dizziness, imbalance, nausea , visual problems, hearing loss

vestibular rehabilitation therapy
Epley manoeuvre
medication/surgery
dietary adaptions

Primary Care (14 decks)

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