ENT B presentations Flashcards
1
Q
BPPV presentation
A
- Variety of head movements trigger vertigo
- Typical trigger is turning over in bed
- Settle after 20-60s
- Episodes occur overal several weeks then resolve but can reoccur
- NO hearing loss or tinnitus
2
Q
Diagnosis and management of BPPV
A
- Diagnose with Dix Hallpike maneuvre
- Treat with Epley
3
Q
Cause of allergic rhinitis
A
- Inflammatory condition of nasal mucosa
- Caused by IgE mediated response to allergens within environment eg pollen/dust mites
- Can show seasonal variation
4
Q
Signs and symptoms of allergic rhinitis
A
- Nasal pruritis
- Sneezing
- Rhinorrhoea
- Nasal congestion
- May be associated with allergic conjuctivitis = eye redness, puffiness and watery dishcarge
5
Q
Diagnosis for allergic rhinitis
A
- Clinical and pt history based
- If needed can refer for skin prick test or blood tests for specific IgE antibodies to identify allergen
6
Q
Investigations if diagnosis doubt or failure to respond to treatment in allergic rhinitis
A
- Nasal endoscopy
- Nasal allergy challenge
- Evaluation of nasal nitric oxide and ciliary beat frequency
- Analysis of nasal fluid
- CT scan
7
Q
What are nasal polyps?
A
- Growths of nasal mucosa that occur in nasal cavity/sinuses
- Often associated with inflammation, eg chronic rhinitis
- Grow slowly and gradually obstruct passage
- More common in men esp those 40+
8
Q
Polyps patten
A
- Bilateral usually
- Unilateral is red flag - tumour?
9
Q
Presentation of nasal polyps
A
- Chronic rhinosinusitis
- Difficulty breathing through nose
- Snoring
- Nasal discharge
- Hypo or anosmia
- Post nasal drip = cough
10
Q
Investigations for nasal polyps
A
- Examine with nasal speculum to hold nostrils open
- Otoscope + large speculum attached
- Specialist can do nasal endoscopy
- Appear as round, pale/grey/yellow growrht on mucosal wall
11
Q
When to refer polyps?
A
Unilateral - 2WW
12
Q
Management polyps
A
- Intranasal steroid drops or sprays
- Surgery - intranasal polypectomy (when polyps are visibilt OR
- Endoscopic nasal polypectomy (polyps are further in nose or in sinuses)
13
Q
Infective cervical lymphadenopathy characteristics
A
- Tender
- Mobile
- Associated fever, cough, sore throat
14
Q
Maligmant cervical lymphadenopathy characteristics
A
- Irregular
- Hard
- Tethered to surrounding tissues
- Painless
- Larger than 2cm
- Associated systemic symptoms - weight loss, night sweats, fatigue
- Other symptoms - change in voice, dysphagia, haemoptysis, rapidly growing
15
Q
Investigations for cervical lynphadenopathy
A
- Depends
- May just resolve if viral
- Can do EBV, cyomegalovirus and HIV serology
- Urgent CXR if suspect TB or lung cancer (within 2 weeks)
- If suspect leukaemia need FBC
16
Q
Management cervical lymphadenopathy
A
- Viral - self limiting
- Bacterial - assess need for abx,
- If unresolved after 2-4 weeks consider urgent ENT referral
- If suspect cancer 2WW pathway for cancer
17
Q
Acute sinusitis presentation
A
- Lasting less than 4 weeks
- Facial pain
- Anosmia
- Purulent discharge
18
Q
Investigations for chronic sinusitis
A
- Nasal endoscopy
- Nasal and sinus cultures
- CT if indicated - complications and extent of disease
- Skin prick testing
19
Q
Management acute sinusitis
A
- Analgesia
- Intranasal decongestants or nasal saline
- Intranasal corticosteroids if symptoms present for more than 10 days
- Oral abx if severe presentation and suspect bacterial - phenoxymethylpenicillin, co-amoxiclav is systemically very unwell
20
Q
What is double sickening?
A
- Viral sinusitis worsens due to secondary bacterial infection - get better and then worse
21
Q
When to refer to ENT acute sinusitis?
A
- No improvement after 7-14 days or red flag
22
Q
Red flag for sinusitis
A
- Eye signs - periorbital swelling or erythema, displaced globe, visual changes, opthalmoplegia
- Severe unilateral headache
- Bilateral frontal headache
- Frontal swelling
- Neurological signs or reduced conc level
23
Q
Chronic sinusitis - what is it?
A
- Inflammation of the paranasal sinuses in the face for more than 12 weeks
- Rhinosinusitis if nasal cavity is also inflamed
- Can last several months
24
Q
Underlying cause chronic sinusitis
A
More likely to be inflammatory rather than infection (acute more likely to be infection)
25
RF for chronic sinusitis
* Allergic rhinitis
* Asthma
* Cystic fibrosis
* Immunocompromised
* Smoking
* Previous sinus surgery
* Nasal polyps - blocks drainage
26
Signs and symptoms chronic sinusitis
* Nasal blockage
* Nasal discharge with facial pain/pressure or headache
* +/- reduced sense of smell
* Cough
27
Management chronic sinusitis
* Good control of asthma or any allergic rhinitis
* Avoid triggers
* Smoking cessation
* Nasal irrigation with saline solution
* Consider course intranasal corticosteroids for up to 3 months (esp if allergic cause) - reduces swelling
28
When to refer chronic sinusitis?
* Persistent symptoms past 3 months
* Unilateral symptoms (cancer?)
* Interefering with QOL
* Allergic/immunologic factors that need investigating
29
Thyroid nodules - presentation
* Identified on routine examination/incidentally on imaging
* If large can be palpable
* Move upwards on swallowing
* Can present with hyper or hypothyroidism or compressive symptoms
30
Compressive symptoms of thyroid nodules
On oesophagus or trachea:
* Dysphagua
* Stridor
* Voice changes (hoarseness)
* SVCO - face/neck swelling, distended neck veins and dyspnoea
31
Causes of thyroid nodules
* Most benign - adenoma, multinodular goitre, hashimotos thyroiditis or cysts (colloid, simple, haemorrhagic)
* Malignancy - PFAM, lymphoma
* Mets - breast, kidney, prostate
32
Invetsigations for thyroid nodules
* TFTs
* Thyroid USS - solid, irregular, hyperechoic, >1cm, rapid growth and central vascularity suggests cancer
* Thyroid scintigraphy (radioisotope scanning)
* Fine needle aspiration and histological diagnosis
33
Thyroid scintigraphy findings and meanings
* Non-functioning cold nodule, no uptake of iodine - malignant
* Autonomous hot nodule, increased uptake - unlikely malignancy eg adenoma
* Hot and cold areas, patchy uptake - toxic multinodular goitre
34
What is thyroid scintigraphy?
Radioactive labelled iodine is given to pt
Measure thyroid uptake using nuclear scan
35
Management thyroid nodules options
* Emergency hospital admission if signs of obstruction
* Urgent referral to endocrinology (2weeks)
* Serum TFTs
* Routine endo referral
* Monitor
36
When to urgent refer thyroid nodules to endo?
* Unexplained thyroid lump
* Unexplained hoarseness/voice change
* Cervical lymphadenopathy or supraclavicular
* Sudden onset and rapidly expanding painless thyroid mass - increased in size over days/weeks
* Compressive symptoms
37
When to routine endo referral thyroid nodule?
* Non-suspicious nodule with abnormal TFTs and normal TFTs
* Sudden onset, painful expansion in pre-existing lump - haemorrhage into benign cyst?
* Non suspcious incidental finding on imaging more than 1cm
38
When to just monitor thyroid lump in primary care?
* Long standing unchanging over several years
* Non-palpable, asymptomatic incidental finding on imaging less than 1cm
* Non palpable cervical lymphadenopathy and no red flags for malignancy
39
Acute labyrinthitis vs vestibular neuronitis
* Labyrinthitis = vestibule, semicircular canals and cochlea inflamed
* VN - vestibular portion of CN8th inflamed so no hearing loss/tinnitus present
40
Cause of AL and VN
* Viral URTI is usually cause (can be otitis media or meningitis too)
41
Presentaiton of AL and VN
* Acute onset of vertigo, nausea and vomitting
* Can have symptoms of URTI - cough, sore throat, blocked nose etc
* AL can have tinnitus and hearing loss also
42
Diagnosing AL and VN
* Clinical
* Can do head impulse test to distinguish between peripheral and central causes of vertigo
43
Management acute labyrinthitis/VN
* Supportive - settles over several weeks
* Advise not to drive if very dizzy
* Short term (up to 3 days) of prochlorperazine or antihistamines (cyclizine, cinnarizine and promethazine) to relieve symptoms
* Abx used if suspect bacterial cause (more likely in otitis media or meningitis)
44
Hearing loss after acute labyrinthitis
* Rarely have permanent hearing loss
* More common following bacterial infection esp from meningitis
* All patients after meningitis recovery should have audiology assessment
45
