ENT Flashcards by Joseph Rose

Dental procedure, now has tender swelling in jaw and displaced tongue that he cannot protrude

Ludwig’s angina

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What is Ludwig’s angina?

Cellulitis of floor of the mouth and soft tissues of the neck
Rare

Sx = neck swelling
Dysphagia
Fever

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Why is Ludwig’s angina dangerous?

Can quickly cause airway compromise

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Sx of simple ear infection (otitis MEDIA)

Acute onset
Bulging of tympanic membrane
Erythema
EFFUSION

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Signs of otitis externa

Acute onset otalgia (ear pain)

Erythema of EXTERNAL canal

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Samster’s triad

Aspirin sensitivity (allergy)
Nasal polyps
Asthma

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Treatment to shrink nasal polyps

Steroids

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Which scoring system to see if its strep throat?

Centor

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Symptoms of tonsillitis

Tonsilar exudate
Cervical lymphadenopathy
Fever
Tendor cervical lymphadenopathy

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Treatment for strep throat (centor >4)

Phenoxymethylpenicillin with analgesia

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Treatment for sore throat Centor <4

Analgesia (paracetamol/ibuprofen)

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Solutions for hearing impairment

Cochlear implant (for severe)
Hearing aids

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Causes of hearing loss

Genetic (50%)
Idiopathic 
Infectious 
Viral induced 
Ototoxicity (aminoglycosides)
Meniere disease
Trauma

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Meniere disease Sx

Sudden attacks of vertigo and tinnitus

Pressure felt deep inside the ear

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Contraindications of cochlear implant

Repeated ear infections

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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)

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Age related hearing loss features

Bilateral
Usually quite old
Loss of high frequency hearing

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Perforated tympanic membrane symptoms

Acute onset and pain
Can cause tinnitus
Discharge

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Ear wax impactation Sx

History of lots of earwax
CONDUCTIVE hearing loss
Tinnitus

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Ear wax impactation treatment

Olive oil ear drops

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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