ENT card Flashcards
ramsey hunt presentation?
ear pain, cn7 palsy, vesicles around earvertigo, tinnitus,
TX: give aciclovir and pred
cx of AOM?
complications?
Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
CSOM, mastoiditis, labyrinthitis, meningitis, abscess, fn palsy
chronic suppurative otitis media (CSOM)
perforation of the tympanic membrane with otorrhoea for > 6 weeks
post viral infection vertigo with horizontal nystagmus?
hrs to days. vestibular neuronitis., no HL.prochloperazine
perforated ear drum - when to refer
if not healed in 6 weeks
positive rinne?
air conduction better than bone condution (normal)
bone conduction better than air condution in right ear. weber lateralises to right ear. air conduction better than bone conduction in left ear
conductive HL right year
positive rinne test B/L (air conduction better). weber lateralises to left ear??
right sensorineural HL
post thyroidectomy parasthesia around mouth, muscle cramps/ what is in ECG?
hypocalcaemia - long QT. (when u dont put enough milk in ur tea, u get long QT)
2ww pathway for oral cancer?
Unexplained oral ulceration or mass 3 weeks +
Unexplained red, or red and white patches that are painful, swollen or bleeding
Unexplained one-sided pain in the head and neck 4 weeks+ ear ache, but does not result in any abnormal findings on otoscopy
Unexplained recent neck lump, or a previously undiagnosed lump that has changed over a period of 3 to 6 weeks
Unexplained persistent sore or painful throat
Signs and symptoms in the oral cavity persisting for more than 6 weeks, that cannot be definitively diagnosed as a benign lesion
abx in AOM?
what to cover diabetes with in OE/
4321 - 4days of fever, <3 months old, <2 and B/L, immunocompromised. amoxicillin
DM+ ottitis externa - cover with ciprofloxacin
drugs causing tinnitus? (QANAL?)
quinines, aspirin, nsaids, aminoglycosides, loop diuretics
right sided tinnitus, HL, vertigo, 10-30mins, easr feels full
meniere’s. MX: acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit
sore throat abx?
scoring systems?
systemic upsert, unilateral peritonsillitis, RF hx, immunodeficient, dm, 3+ centor criteria
centor/ fever pain gives liklihood of isolating streptococci
centor: exudate/ cervical LN, fever, no cough - 3/4 points - 32-56% likely of streptococci
feverpain: fever 38+, exucate, over 3 days onset, severely inflamed tonsils, no cough/ coryzal
0-1 d/c, 2-3 delayed px, 4+ immediate abx
tonsilectomy indications?
7 per year/
5 per year for 2 years,
3 per year for 3 years, disabling and prevent normal functioning
recurrent febrile convulsions
obstructive sleep apnoea, stridor or dysphagia secondary to enlarged tonsils
peritonsillar abscess (quinsy) if unresponsive to standard treatment
chronic rhinorrhea tx?
red flags?
optimise asthma, triggers, saline irrigation
3 month trial of CS intranasal
red flags:
unilateral symptoms
persistent symptoms despite compliance with 3 months of treatment
epistaxis
Hearing loss, vertigo, tinnitus
Absent corneal reflex is important sign
Associated with neurofibromatosis type 2
acoustic neuroma
Elderly patient
Dizziness on extension of neck
vertebrobasilar ischaemia
facial pain (frontal pressure pain worse on bending forward), nasal discharge (usually thick and purulent) and difficulty breathing.
cx?
precipitating factors?
acute sinusitis. pen V if systemically unwell.
cx:Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.
Predisposing factors include:
nasal obstruction e.g. septal deviation or nasal polyps
recent local infection e.g. rhinitis or dental extraction
swimming/diving
smoking
what is samter’s triad?
asthma, aspirin sensitivity and nasal polyposis
what are associated conditons with nasal polyps?
red flags?
polyp in child?
asthma
aspirin sensitivity
infective sinusitis
cystic fibrosis
Kartagener’s syndrome
Churg-Strauss syndrome
refer to eNT always.
red flag: unilateral/ bleeding
child - consider Cystic fibrosis
do coronal sinus CT
DM with left ear pain, red ear, discharge, not responding to abx?
refer to ENT. malignant OE/pseudomonas elading to temporal bone OM/
OM with perforated ear canal?
avoid aminoglycosides
vertigo, horizontal nystagmus, no HL no tinnitus, N+V, attacks last hrs/days. post URTI
vestibular neuronitis. buccal/ im prochlorperazine trial. resolves
