ENT Flashcards
Dental procedure, now has tender swelling in jaw and displaced tongue that he cannot protrude
Ludwig’s angina
What is Ludwig’s angina?
Cellulitis of floor of the mouth and soft tissues of the neck
Rare
Sx = neck swelling
Dysphagia
Fever
Why is Ludwig’s angina dangerous?
Can quickly cause airway compromise
Sx of simple ear infection (otitis MEDIA)
Acute onset
Bulging of tympanic membrane
Erythema
EFFUSION
Signs of otitis externa
Acute onset otalgia (ear pain)
Erythema of EXTERNAL canal
Samster’s triad
Aspirin sensitivity (allergy)
Nasal polyps
Asthma
Treatment to shrink nasal polyps
Steroids
Which scoring system to see if its strep throat?
Centor
Symptoms of tonsillitis
Tonsilar exudate
Cervical lymphadenopathy
Fever
Tendor cervical lymphadenopathy
Treatment for strep throat (centor >4)
Phenoxymethylpenicillin with analgesia
Treatment for sore throat Centor <4
Analgesia (paracetamol/ibuprofen)
Solutions for hearing impairment
Cochlear implant (for severe) Hearing aids
Causes of hearing loss
Genetic (50%) Idiopathic Infectious Viral induced Ototoxicity (aminoglycosides) Meniere disease Trauma
Meniere disease Sx
Sudden attacks of vertigo and tinnitus
Pressure felt deep inside the ear
Contraindications of cochlear implant
Repeated ear infections
Patient with congested nose (say hayfever), using nasal congestants for too long (>7days), what do they get?
Rhinitis medicamentosa!
Need to stop the decongestants (cold turkey)
Age related hearing loss features
Bilateral
Usually quite old
Loss of high frequency hearing
Perforated tympanic membrane symptoms
Acute onset and pain
Can cause tinnitus
Discharge
Ear wax impactation Sx
History of lots of earwax
CONDUCTIVE hearing loss
Tinnitus
Ear wax impactation treatment
Olive oil ear drops
Enlarged tonsils covered with a white film that bleeds on contact
Acute bacterial tonsillitis
Pharyngitis and tonsillitis with splenomegaly and fatigue
Infectious mononucleosis
Sore throat, severe throbbing pain on one side with swelling
Quinsy (pus collection)
Painful, tender neck swelling
Foul taste in the mouth
Sialadentitis (inflammation of the salivary gland)
Pus is the bad taste
3 main salivary glands
Parotid
Submandibular
Sublingual
What causes gingivitis
Poor dental hygeine
Symptoms of gingivitis
Can be painless, red swelling of the gum margin that bleeds on contact
OR
painful bleeding gums with halitosis and punched out ulcers on gums
Complex ulcerative gingitivitis treatment
Refer to dentist
Oral metronidazole
Chlorhexidine wash
Simple analgesia
Reactivation of herpes infection in the ganglion of facial nerve is called…
Ramsey Hunt syndrome
Symptoms of Ramsey Hunt syndrome
Ear pain
Facial nerve palsy
Vesicular rash around the ear
Management of Ramsey Hunt syndrome
Oral aciclovir and steroids
Drug treatment of Meniere’s disease
Betahistine
Recurrent, bilateral ear infections and Hx of Down’s syndrome, most likely Dx?
Glue ear
A 9 year old boy has suffered with intermittent episodes of a painful right ear with suppurative discharge for five years. He currently is suffering from an episode which began two days ago. On otoscopy, there is mucosal oedema and profuse white-coloured debris within the external auditory meatus. Given the most likely diagnosis, what is the most appropriate management?
Ear wash out (aural toilet) and topical antibiotics
A 52 year old man complains of a swollen right jaw that has progressed over five weeks. He also complains of numbness over the right side of his lips. On examination, there is hard swelling of the parotid gland. There is no apparent tethering to overlying skin. ENT examination is unremarkable. What is the most likely diagnosis?
Parotid carcinoma because of nerve involvement
If nerves weren’t involved it would probably be a pleomorphic adenoma
Management of quinsy
Antibiotics and aspiration if the pt is relatively well and airway is not compromised
Incision and drainage if any signs of airway compromise
Management of epiglottitis
Contact senior ENT and anaesthetics
Nebulised adrenaline and oxygen put near the patient but not putting the mask on
How many episodes of tonsillitis do you need to be considered for a tonsillectomy?
5 or more per year for 2 years
Treatment of centor 4 tonsillitis
1st line: Penicillin V 500mg PO QDS for 5-10 days
Alternative in pen allergy: Clarithromycin/Erythromycin 250-500mg PO BD for 5 days
Stepwise management of epistaxis
Direct compression (pinch the nose and tip head forward) spit out any blood
Cautery
Nasal packing
Rare condition that causes vascular malformations and predisposes to lots of nosebleeds
Osler-Weber-Rendu
Hereditary telangiectasia
What actually is tympanosclerosis
Repeated damage results in scarring of the ear drum
Often seen in repeated ear infections
See calcified eardrum
Causes of conductive hearing loss
Wax impaction Otitis media with effusion (glue ear) Eustachian tube dysfunction Ear infections Perforations of the tympanic membrane Chronic suppurative otitis media.
What type of hypersensitivity is hay fever (allergic rhinitis)
Type 1 (IgE)
Management of tonsillectomy that you have noticed has continued to bleed post surgery
Get them back to theatre
Can lose A LOT of blood
Other name for tonsils
Adenhoids
Features of Beurger’s syndrome
Like necrotic Raynaud’s
Inflammation of small vessels
Pathophysiology of aortic dissection
Tear in the tunica intima
Features of aortic dissection
Differing radial pressures
Radio-radio and radio-femoral delay
Management of aortic dissection
Type A: Usually requires surgical management (e.g. aortic graft)
Type B: Normally managed conservatively with blood pressure control (IV labetalol). If there is evidence of end organ damage then endovascular/open repair may be performed.
Classification of aortic dissection
Stanford A or B
Initial management of aortic dissection with high BP
IV labetalol to reduce blood pressure
