ENT Flashcards

Question

Management of cholesteatoma

Answer 1

Surgical: mastoidectomy and tympanoplasty

Answer 2

``` Eustachian tube dysfunction -> Negative middle ear pressure -> Retraction of pars flaccida -> Infection -> Erosion and spread ```

Answer 3

CT | Biopsy

Answer 4

``` Pain that originates within ear: External otitis Otitis media Mastoiditis Auricular infections ```

Answer 5

``` Pain originating outside of the ear: Dental pathology Sinusitis Neck problems Tonsillitis Pharyngitis ```

Answer 6

Detailed history and exam | Rule out differentials

Answer 7

Identification of causative aetiology often necessary to treat successfully

Answer 8

Inflammation of the larynx Can lead to oedema of the true vocal fold Acute: Abrupt onset, usually self-limited Chronic symptoms: >3 weeks Thorough evaluation required as symptoms are similar to laryngeal malignancy

Answer 9

Infectious: Most often viral and self-limiting Rhinovirus, parainfluenza, respiratory syncytial virus, influenza, adenoviruses Bacterial: Can be life-threatening H influenzae, Moraxella, Strep pneum, Staph aureus, klebsiella, diptheria, TB ``` Fungal Non-infectious agents Vocal misuse Reflux laryngitis - caused by GORD Chronic irritant laryngitis Allergic Autoimmune (RA, relapsing polychondritis, Wegener granulomatosis, sarcoidosis) ```

Answer 10

Hoarseness of voice (gradually over <7d, preceded by viral URTI) Dysphagia, sore throat May present with airway distress and high fever Infective signs - odynophagia, cough, fever, respiratory distress

Answer 11

Culture Laryngoscopy (inflammation seen, biopsy) Analysis of vocal fold movement (asymmetry) FBC PCR for diphtheria rapid antigen detection test (group A strep)

Answer 12

Secure airway Vocal hygiene Supportive care (cough suppressant, mucolytic) Analgesia Viral: Voice rest Hydration (humidified air) Bacterial: Antibiotics and supportive measures Vocal strain - voice therapy and vocal hygiene

Answer 13

Acute inflammation in supraglottic region of oropharynx With inflammation of the epiglottitis, vallecula, arytenoids, aryepiglottic folds Airway emergency - especially in children (may be more indolent in adults) Classically occurs in children 2-6 yrs

Answer 14

``` Infectious Most common organisms: H. influenzae (25%) H. parainfluenzae Strep pneumoniae Group A strep ``` Can be any other of bacteria/viruses ``` Candida and aspergillus are important causes in immunocompromised patients Non-infectious Thermal (drug smoking, bottle-feeding) Causitic insults Foreign body ingestion Head and neck chemo ```

Answer 15

``` Rapid onset and progression High fever Sore throat Inability to control secretions Tripod positioning Difficulty breathing/swallowing Muffled voice Preceding URTI symptoms ```

Answer 16

``` Meningitis Adenitis Vocal granuloma Pneumonia and other lung pathology Pericarditis Septic arthritis Cellulitis Sepsis Death (asphyxia) ```

Answer 17

Clinical diagnosis (don't delay securing airway) Nasopharyngoscopy/laryngoscopy Radiology (soft tissue lateral neck radiography, USS) Cultures of systemically unwell

Answer 18

ABCDE Airway management, intubate if necessary (respiratory distress, airway compromise, stridor, dysphagia, drooling, deterioration)

Answer 19

Rapid onset sore throat and pharyngeal inflammation With or without exudate Pathophysiology includes infection and inflammation of the pharynx

Answer 20

Acute onset sore throat Pharyngeal exudates Cervical adenopathy Fever Absence of cough, nasal congestion and discharge suggests bacterial aetiology Generally self-limited with resolution within 2 wks

Answer 21

Group A strep Viral: EBV, adenoviruses, enteroviruses, influenza, parainfluenza Candidal pharyngitis Diphtheria Measles Tularaemia Sexually transmitted: Acute HIV, gonorrhoea, chlamydia

Answer 22

``` Epiglottitis Abscess Infectious mononucleosis (EBV) Diphtheria Lemierre's (thrombophlebitis of the jugular vein) Measles Oropharyngeal cancer ```

Answer 23

Throat swab Blood agar RATD

Answer 24

Analgesia, LA Salt water Antibiotics if proven strep A

Answer 25

``` Suppurative (pus) Peri-tonsillar abscess Lymphadenitis Sinusitis Otitis media Mastoiditis Invasive infections e.g. toxic shock syndrome, necrotising fasciitis Non-suppurative Acute rheumatic fever Acute glomerulonephritis ```

Answer 26

Acute infection of the parenchyma of the palatine tonsils May occur in isolation or as part of generalised pharyngitis Clinical distinction between tonsilitis and pharyngitis in the literature is unclear, often referred to as "acute sore throat"

Answer 27

Local inflammatory pathways result in oropharyngeal swelling, oedema, erythema and pain Rarely swelling may progress to soft palate and uvula (uvulitis) or inferiorly to the region of the supraglottis

Answer 28

Mostly viral: Commonly rhinovirus Then coronavirus & adenovirus, influenza, parainfluenza, enteroviruses, herpes, EBV ``` Bacterial causes: 10-30% Group A strep (Beta haemolytic) Strep pyogenes Staph aureus H-influenza ```

Answer 29

``` Acute onset fever Throat pain exacerbated by swallowing Headache Malaise Halitosis Odynophagia Tonsils enlarged, red, purulent exudate Cervical lymphadenopathy ```

Answer 30

``` Throat culture Rapid strep antigen testing FBC Antibody testing for mononucleosis (EBV) Throat swab/ASO titre +/- MONOSPOT ```

Answer 31

Conservative for 7d if pyrexic Analgesia/anaesthesia Salt water gurgling If microbiologically confirmed group A strep: penicillin or macrolide Tonsillectomy if recurrent