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UKMLA Prep > ENT Conditions and presentation > Flashcards

ENT Conditions and presentation Flashcards

1
Q

Define acute epiglottiits

A

infection of the epiglottis (level of c3)
typically caused by HIB

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2
Q

what is the epiglottis (anatomy question)

A

small flap of tissue located at C3
Prevents entry of food in the trachea.
innvervated by the glossopharyngeal and hypoglossal nerves.

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3
Q

Case presentation: 5 year old presents to ED with drooling and leaning forward supporting himself (tripod poition)

A

epiglottis

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4
Q

signs and symptoms of epiglottitis (8)

A
  1. High fevers
  2. Appear ill or toxic
  3. . Intense throat pain swallowing, leading to drooling
  4. Soft inspiratory stridor
  5. . Rapid increase in respiratory difficulty over hours
  6. sit upright with an open mouth to optimize airway patency
  7. Minimal or absent cough
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5
Q

what is Croup?

A

Croup is inflammation of the trachea typically assoicated with seal (barking) cough
typically caused by parainfluenza virus

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6
Q

Peritonsillar abscess

A

pus-filled tissue at the back of the mouth, next to one of the tonsils
typically occurs when there is untreated tonsilitis.

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7
Q

signs and symptoms of croup

A

barking cough
inspiratory stridor
hoarseness.

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8
Q

signs and symptoms of pertitonsalar abcess

A

Severe throat pain
muffled “hot potato” voice,
drooling,
trismus (difficulty opening the mouth).

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9
Q

Signs and symptoms of Bacterial tracheitis

A
  • Severe respiratory distress
  • high fever
  • purulent tracheal secretions
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10
Q

Bacterial tracheitis

A

secondary bacterial infection of the trachea
typically follow viral URTI
most often caused by the bacteria Staphylococcus aureus

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11
Q

Investigations for epiglottis

A

ONLY TO BE DONE BY SENIOR MEMBER OF STAFF DUE TO LARYNGOSPASM RISK
visualistation of the epiglottiis.

  • cherry-red epiglottitis will be seen on endoscopy
  • thumbprint sign will be seen on CXR
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12
Q

managment of epiglottitis

A

Do not examine or upset the child without senior support

  • Securing the airway, possibly through endotracheal intubation, as a first priority
  • Culturing and examination of the throat once the airway is secure
    Administration of IV antibiotics, typically cefuroxime
  • IV antibiotics (e.g. ceftriaxone)
  • Steroids (i.e. dexamethasone)
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13
Q

X-ray findings epiglottis

A

lateral xray of the neck shows a characteristic “thumb sign” or “thumbprint sign”.
- epiglottis looks like thumb pressed against the trachea

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14
Q

what is peritonsalar abcess aka?

A

quinsy

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15
Q

presentation of quinsy

A

severe throat pain
which lateralises to one side
deviation of the uvula to the unaffected side
trismus (difficulty opening the mouth)
reduced neck mobility

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16
Q

causes of quinsy

A

streptococcus pyogenes (group A strep) staphylococcus aureus
haemophilus influenzae.

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17
Q

managment of quinsy (4)

A
  • REFER TO ENT

needle aspiration or surgical incision and drainage to remove the pus from the abscess.

broad-spectrum antibiotic such as ** co-amoxiclav **

Tonsilectomy

note: some local guidelines suggest dexamethasone as well

-IV antibiotics and surgical drainage

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18
Q

Tonsilits

viral causes?

A

Inflammation of the tonsils

Typically caused by viral causes
- rhinovirus
- influenza
- parainfluenza

  • can also be caused by staph Auerus
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19
Q

causes of tonisilits

A

Strep A is the most common cause
Streptococcus pneumoniae.
————————————————————–

Haemophilus influenzae
Morazella catarrhalis
Staphylococcus aureus

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20
Q

Waldeyer’s Tonsillar Ring

A

A ring of lymphoid tissue found in the throat

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21
Q

what are the complications of tonsilits?

A

Chronic tonsillitis
Peritonsillar abscess, also known as quinsy
Otitis media if the infection spreads to the inner ear (THINK STAPH)
Scarlet fever
Rheumatic fever
Post-streptococcal glomerulonephritis
Post-streptococcal reactive arthritis

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22
Q

managment of tonsilitis

A

Penicillin V (10 day course) (tastes bad, so kids may avoid it.
Clarithromycin is 1st line is pencillin allergy.

Tonsilectomy is contreversial

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23
Q

what is the centor criteria?

A

Estimates probability that pharyngitis is streptococcal, and suggests management course.

prescribing antibiotics if the Centor score is ≥ 3

streptococcal Pyrogenes is most common cause of tonsilitis

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24
Q

What is the FeverPain score?

A
  • The FeverPAIN score for bacterial tonsilits
  • of 2 – 3 gives a 34 – 40% probability
  • 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis:

Fever during previous 24 hours
P – Purulence (pus on tonsils)
A – Attended within 3 days of the onset of symptoms
I – Inflamed tonsils (severely inflamed)
N – No cough or coryza

prescribe if FeverPAIN score is ≥ 4

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25
Q

complications of tonsilectomy

A

haemorrhage

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26
Q

post tonsilectomy haemorrhages- primary

A

Primary, or reactionary haemorrhage most commonly occurs in the first 6-8 hours following surgery.

It is managed by immediate return to theatre.

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27
Q

post tonsilectomy haemorrhages- secondary

A

5 and 10 days after surgery and is often associated with a wound infection.

Treatment admission and antibiotics.

Severe bleeding may require surgery.

Secondary haemorrhage occurs in around 1-2% of all tonsillectomies.

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28
Q

BPPV

A

Benign Paroxymal Positional Vertigo

  • one of the most common causes of vertigo, typically due to middle ear
  • triggered by change in head movement.
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29
Q

tests and managment of BPPV

A

Diagnosis- Dix-Haplike manouver

mangmEment- Eply manouver

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30
Q

cause of BPPV

A

cholelithiasis- accumulation of calcium deposits, known as , within the semicircular canals of the inner ear.

When the cholelithiasis dettach from the semicircular canals

stiumlation of the hairs = vertigo

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31
Q

Signs and symptoms of BPPV

A

Vertigo attacks provoked by specific head movements, such as turning the head to one side while in bed or looking upwards

may be associated with nausea

  • lasts 10-20 seconds

Rotational vertigo lasting between 30 seconds to 1 minute

Absence of auditory symptoms

Recurrent episodes, often resolving naturally over weeks to months

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32
Q

Meniere’s disease

A

Meniere’s disease is a chronic condition which affectes the inner ear

primarily involves an abnormal buildup of fluid in the inner ear, known as endolymphatic hydrops. This causes change in balance and hearing.

episodic vertigo, tinnitus, hearing loss, and a sensation of fullness in the ear

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33
Q

What is the managment of anaphylaxis

A

A-E reponse

-intramuscular adrenaline 1:1,000
- oxygen
- fluids

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34
Q

adrenaline dose for < 6 months experiencing anaphylaxis

A

100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)

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35
Q

adrenaline dose 6 months - 6 years

A

150 micrograms (0.15 ml 1 in 1,000)

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36
Q

adrenaline dose for 6-12 years

A

300 micrograms (0.3ml 1 in 1,000)

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37
Q

adrenaline dose Adult and child > 12 years

A

500 micrograms (0.5ml 1 in 1,000)

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38
Q

What is refractory anaphylaxis

A

defined as respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline

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39
Q

Managment of refactory adrenaline

A

IV fluids should be given for shock
expert help should be sought for consideration of an IV adrenaline infusion

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40
Q

Managment of refactory anaphylaxis after stabilisation

A
  • non-sedating oral antihistamines, in preference to chlorphenamine

– Serum tryptase levels are sometimes taken in such patients as they remain elevated for up to 12 hours following an acute episode of anaphylaxi

  • refer to allergy clinic

-Adrenaline injector should be givens an interim measure before the specialist allergy assessment (unless the reaction was drug-induced)

  • patients should be prescribed two injectors
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41
Q

Chronic rhinosinusitis definition

A

inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer.

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42
Q

factors which increase the likelihood of chronic rhinosinusitis

A

atopy: hay fever, asthma
nasal obstruction e.g. Septal deviation or nasal polyps
recent local infection e.g. Rhinitis or dental extraction
swimming/diving
smoking

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43
Q

what are the features of chronic rhinosinusitis

A
  • facial pain (typically frontal, wose on leaning forward).
  • nasal discharge (usually clear if allergic or vasomotor. Thicker, purulent discharge suggests secondary infection
    nasal obstruction: e.g. ‘mouth breathing’)
  • post-nasal drip: may produce chronic cough
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44
Q

Managment of chronic rhinosinusisitis

A

avoid allergen

intranasal corticosteroids
(150 to 352 mg)

nasal irrigation with saline solution

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45
Q

viral labyrinthitis

A

inflammation of the labyrinth which is typically caused by infection (e.g common cold)

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46
Q

symptoms of labyrinthitis

A

Vertigo (spinning sensation)
Nausea and vomiting
Dizziness
Balance problems
Hearing loss or changes in hearing
Tinnitus (ringing in the ears)
A feeling of fullness or pressure in the ear
Nystagmus (involuntary eye movements)

typically presentation occurs after illness, such as the common cold

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47
Q

labyrinthitis vs Vestibular neuronitis

A
  • both are typically caused by viral infections
    L is caused by common cold (rhinovirus) whereas VN is caused by herpes virus
  • VN is not typically assoicated with hearing loss, but L is

Labyrinthitis: Treatment for labyrinthitis often involves managing symptoms, such as medications for nausea and dizziness, corticosteroids to reduce inflammation, and vestibular rehabilitation exercises to improve balance and reduce dizziness. If hearing loss is significant, additional interventions such as hearing aids may be necessary.

Vestibular Neuronitis: Treatment for vestibular neuronitis also focuses on managing symptoms, typically with medications for nausea and dizziness and vestibular rehabilitation exercises. Corticosteroids may also be prescribed to reduce inflammation. Since vestibular neuronitis does not involve hearing loss, interventions specific to hearing impairment are not required.

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48
Q

Vestibular neuronitis

A

inflammation of the vestibular nerve, which is responsible for transmitting balance and spatial orientation information from the inner ear to the brain.

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49
Q

ototoxic medications (6 main classes of drug)

A
  • Aminoglycoside antibiotics: e.g gentamicin
  • Loop Diuretics: furosemide
    -Chemotherapy Drugs: cisplatin, carboplatin
  • Salicylates: high doses of asprin
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): high doses of ibruprofen or naproxen
  • Certain Antimalarial Drugs: Chloroquine and hydroxychloroquine
  • Antidepressants: SSRIS (setraline)
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50
Q

Acoustic neuroma

A
  • also known as a vestibular schwannoma
  • noncancerous tumor that develops on the vestibular (balance) nerve, which connects the inner ear to the brain.
  • generally a slow-growing and benign condition
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51
Q

Symptoms of acoustic neuroma

A
  • gradual hearing loss
  • tinnitus
  • vertigo
  • fullness in ear
  • facial numbness or weakness on one side of the face, difficulty swallowing, and headaches.
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52
Q

Diagnostics of acoustic neuroma

A

-Audiology exam (sensoneural hearing loss)
- MRI with gadolinium contrast

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53
Q

treatment of acoustic neuroma

A
  • observation (see the growth progression)
  • radiotherapy: gamma knife, cyberknife
  • surgery
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54
Q

who is affected by acoustic neuroma

A
  • commonly diagnosed btween 30-60
  • people with family hx of the condition
  • people who have neurofibromatosis 2 (NF2)
  • more common in females than males
  • people who have greater exposure to radiation
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55
Q

rinne’s and webers

A

-rinne’s: differentiates sound transmission via air conduction from sound transmission via bone conduction

-Weber’s: differentiates which ear the sound is better/worst in

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56
Q

sensorineural hearing loss

A

Sensorineural hearing loss is a type of hearing loss that occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain.

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57
Q

Conductive hearing loss

A

Conductive hearing loss occurs when there is a problem conducting sound waves through the outer or middle ear. This type of hearing loss can result from various issues that interfere with the transmission of sound vibrations to the inner ear.

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58
Q

examples of sensioneural hearing loss

A
  • presbycusis
  • genetics
  • noise exposure
  • ototoxic drugs
  • trauma
  • viral infections can cause damage
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59
Q

examples of conductive hearing loss (6)

A
  • ear wax build up
  • middle ear infection
  • otitis externa
  • perforated ear drum
  • Otosclerosis (abnormal bone growth around the stapes bone)
  • malformation of the outer ear
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60
Q

Otitis externa

A

Inflammation or infection of the external ear canal.

Common causes include bacterial or fungal infection, irritation from water exposure, or allergic reactions.

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61
Q

Otitis externa symptoms

A

ear pain, itching, redness, swelling of the ear canal, and drainage of pus.

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62
Q

Managment of Otitis Externa

A

Acetic acid or an aminoglycoside for uncomplicated cases of otitis externa.

If the ear canal is obstructed, use wicks or wools to facilitate delivery of topical treatments.

Advise patients to avoid water exposure and manipulation of the ear canal during treatment.

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63
Q

Managment of Otitis Media

A

For mild cases with non-severe symptoms and no risk factors for complications, offer advice and self-care measures such as pain relief with paracetamol or ibuprofen.

For moderate to severe cases or those with risk factors for complications, consider immediate antibiotic treatment with amoxicillin or phenoxymethylpenicillin.

Educate patients about the appropriate use of antibiotics, including completing the full course as prescribed.

  • if patients are allergic to pencillin consider prescribing a 5–7 day course of clarithromycin or erythromycin (erythromycin is preferred in pregnant women).
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64
Q

Otitis Media

A

Infection or inflammation of the middle ear, typically due to bacterial or viral pathogens.

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65
Q

Otitis Media symptoms

A

ear pain, fever, irritability (in infants), hearing loss, and drainage of fluid from the ear.

Chronic otitis media may lead to persistent ear infections, fluid accumulation in the middle ear (effusion), and hearing loss.

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66
Q

Mastoiditis

A

Mastoiditis is an infection of the mastoid bone, which is located behind the ear.

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67
Q

Causes of mastoiditis

A

Often arises as a complication of untreated or inadequately treated acute otitis media (ear infection).

Bacterial infection, usually by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.

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68
Q

Managment of Mastoiditis (3+2)

A

Antibiotics: Initial treatment usually involves antibiotics, typically amoxicillin or co-amoxiclav, guided by local antibiotic policies and patient allergies.

Pain relief: Paracetamol or ibuprofen for pain and fever control.

Regular review to monitor response to treatment.

Reassessment if symptoms worsen or fail to improve with initial therapy.
Consideration of referral to an ear, nose, and throat (ENT) specialist if needed.

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69
Q

How to diagnose mastoiditis

A

Clinical examination by a healthcare professional.

May include imaging studies like CT scans or MRI to confirm the diagnosis and assess the extent of the infection.

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70
Q

symptoms of mastoiditis

A

Persistent ear pain, often severe.
Swelling and redness behind the ear.
Fever.
Drainage from the ear.
Hearing loss.
Headache.
Irritability (in children).

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71
Q

complications of mastoiditis

A

Intracranial complications: Such as meningitis, brain abscess, or thrombosis of intracranial veins, which require urgent management.
Hearing loss: Can be temporary or permanent.
Spread of infection to nearby structures.

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72
Q

Glue ear

A
  • Glue ear describes otitis media with an effusion (other terms include serous otitis media). It is common with the majority of children having at least one episode during childhood
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73
Q

risks for glue ear

A

male sex
siblings with glue ear
higher incidence in Winter and Spring
bottle feeding
day care attendance
parental smoking

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74
Q

managment of glue ear

A

active observation: the management for a child with a first presentation of otitis media with effusion is active observation for 3 months - no intervention is required
grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months

adenoidectomy

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75
Q

Features of glue ear

A

peaks at 2 years of age
hearing loss is usually the presenting feature (glue ear is the commonest cause of conductive hearing loss and elective surgery in childhood)

secondary problems such as speech and language delay, behavioural or balance problems may also be seen

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76
Q

Malignant otitis externa causes

A

** Pseudomonas aeruginosa **
* Often occurs in individuals with compromised immune systems, such as the elderly or those with diabetes mellitus.

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77
Q

Malignant otitis externa

A

Malignant otitis externa (MOE), also known as necrotizing otitis externa, is a severe and potentially life-threatening infection of the external ear canal and surrounding structures.

-pseudomonas cause
- typically affects immune compromised patients
- Diabetic patients

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78
Q

symptoms of Malignant otitis externa (4)

A

Severe ear pain, often worsening over time.

Discharge from the ear, which may be foul-smelling.

Swelling and redness around the ear.
Fever.

Cranial nerve palsies (e.g., facial nerve palsy) in advanced cases.

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79
Q

diagnosis of MOE

A

Clinical examination by a healthcare professional.

Microbiological culture of ear discharge to identify the causative organism.

Imaging studies such as CT scans may be performed to assess the extent of infection and involvement of surrounding structures.

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80
Q

TX of MOE
Malignant (necrotising) otitis media

A

Antibiotics: Aggressive antibiotic therapy is the mainstay of treatment, typically involving broad-spectrum antibiotics such as fluoroquinolones (e.g., ciprofloxacin) or aminoglycosides (e.g., gentamicin), guided by local antibiogram data.

Analgesics: Pain relief with medications such as paracetamol or opioids as needed.

Surgical intervention: May be necessary in severe cases to debride necrotic tissue or to drain abscesses.

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81
Q

Complications of MOE (3)

A

Skull base osteomyelitis: Infection spreading to the bones at the base of the skull, which can lead to serious neurological complications.

Cranial nerve involvement: Especially facial nerve palsy, which can cause facial weakness or paralysis.

Sepsis: Systemic spread of infection leading to a potentially life-threatening condition.

82
Q

Infectious mononucleosis

A

Infectious mononucleosis, also known as glandular fever, is a viral infection

caused by the Epstein-Barr virus (EBV), primarily affecting adolescents and young adults.

  • kissing disease
83
Q

vertebrobasilar ischaemia

A

Elderly patient
Dizziness on extension of neck

84
Q

vertebrobasilar ischaemia

A

Elderly patient
Dizziness on extension of neck

85
Q

Which medications is most useful for helping to prevent attacks of Meniere’s disease?

A

Betahistines

86
Q

exercises can be performed by the patient at home to treat BPPV

A

Brandt-Daroff

87
Q

Achalasia

A

Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus

Achalasia typically presents in middle-age and is equally common in men and women.

88
Q

Clinical features of Achalasia (6)

A

dysphagia of BOTH liquids and solids
typically variation in severity of symptoms
heartburn
regurgitation of food
may lead to cough, aspiration pneumonia etc
malignant change in small number of patients

89
Q

Investigations for Achalasia

A

-oesophageal manometry
excessive LOS tone which doesn’t relax on swallowing
considered the most important diagnostic test

-barium swallow
shows grossly expanded oesophagus, fluid level
‘bird’s beak’ appearance

-chest x-ray
wide mediastinum
fluid level

90
Q

Treatment of Achalasia

A
  • pneumatic (balloon) dilation is increasingly the preferred first-line option
    -less invasive and quicker recovery time than surgery
    -patients should be a low surgical risk as surgery may be required if complications occur

-surgical intervention with a Heller cardiomyotomy should be considered if recurrent or persistent symptoms

-intra-sphincteric injection of botulinum toxin is sometimes used in patients who are a high surgical risk

-drug therapy (e.g. nitrates, calcium channel blockers) has a role but is limited by side-effects

91
Q

Association/ causes of Dysphagia- Oesophageal cancer

A

Dysphagia may be associated with
-weight loss
-anorexia or vomiting during eating

Past history may include
-Barrett’s oesophagus
-GORD
-Excessive smoking or alcohol use

92
Q

Dysphagia- Oesophagitis (presentation)

A

-There may be a history of heartburn
- Odynophagia but no weight loss and systemically well

93
Q

Oesophageal candidiasis

A

There may be a history of HIV or other risk factors such as steroid inhaler use

94
Q

Pharyngeal pouch

A
  • More common in older men
    -Halitosis may occasionally be seen
  • Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
    -Usually not seen but if large then a midline lump in the neck that gurgles on palpation
  • Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough.
95
Q

CREST syndrome

A

CREST syndrome, also known as limited cutaneous systemic sclerosis, is a subtype of systemic sclerosis, a chronic autoimmune connective tissue disorder. The acronym “CREST” stands for five common features of the syndrome:

Calcinosis
Raynaud’s phenomenon
oEsophageal dysmotility
Sclerodactyly
Telangiectasia

95
Q

Systemic sclerosis

A

Other features of CREST syndrome may be present, namely Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

As well as oesophageal dysmotility the lower oesophageal sphincter (LES) pressure is decreased. This contrasts to achalasia where the LES pressure is increased

96
Q

Myasthenia gravis

A
  • Chronic autoimmune condition casues weakness muscle

-Other symptoms may include extraocular muscle weakness or ptosis

-Dysphagia with liquids as well as solids

97
Q

Globus hystericus

A

This is the feeling of a lump in the throat without a physical cause.

There may be a history of anxiety
-Symptoms are often intermittent and relieved by swallowing
-Usually painless - the presence of pain should warrant further investigation for organic causes

requent association with menopause or psychogenic factors

98
Q

What are the extrinsic causes of dysphagia?

A

Mediastinal masses
Cervical spondylosis

99
Q

what are Oesophageal wall causes of dysphagia

A

Achalasia
Diffuse oesophageal spasm
Hypertensive lower oesophageal sphincter

100
Q

Intrinsic causes of dysphagia

A
  • Tumours
  • Strictures
  • Oesophageal web
  • Schatzki rings
101
Q

Neurological causes of dysphagia

A
  • CVA
  • Parkinson’s disease
  • Multiple Sclerosis
  • Brainstem pathology
  • Myasthenia Gravis
102
Q

what investigations should be carried out for dysphagia

A
  • upper GI endoscopy unless there are compelling reasons for this not to be performed
    -Motility disorders may be best appreciated by undertaking fluoroscopic swallowing studies.
  • full blood count

-Ambulatory oesophageal pH and manometry studies will be required to evaluate conditions such as achalasia and patients with GORD being considered for fundoplication surgery.

103
Q

drugs which cause tinititus

A

Aspirin/NSAIDs
Aminoglycosides
Loop diuretics
Quinine

104
Q

Investigations for tinitus

A
  • audiology to find hearing loss

Imaging
MRI of the internal auditory meatuses (IAM) is first-line
pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause. Magnetic resonance angiography (MRA) is often used to investigate pulsatile tinnitus

105
Q

Managment of tinititus

A

Investigate and treat any underlying cause
amplification devices
more beneficial if associated hearing loss
psychological therapy may help a limited group of patients
examples include cognitive behavioural therapy
tinnitus support groups

106
Q

Causes of hoarseness

A

voice overuse
smoking
viral illness
hypothyroidism
gastro-oesophageal reflux
laryngeal cancer
lung cancer

107
Q

Influenza

A

Influenza, commonly known as the flu, is a highly contagious viral infection affecting the respiratory system.

Etiology: Caused by influenza viruses, primarily influenza A and B.

Spread through respiratory droplets when an infected person coughs, sneezes, or talks, or by touching contaminated surfaces.

108
Q

Symptoms of influenza

A

-Fever
-cough
-sore throat
- body aches
-fatigue
-headache
-nasal congestion
-vomiting or diarrhea.

109
Q

What are the complications of influenza

A

Pneumonia, bronchitis, sinus infections, ear infections, exacerbation of underlying medical conditions, and rarely, death.

110
Q
A
111
Q

Management of VN

A

Prochlorperazine
Alleviates vertigo, nausea and vomiting

112
Q

Bell’s palsy

A

acute, unilateral, idiopathic, facial nerve paralysis.
- herpes simplex virus
- peak incidence of 20-40 years

113
Q

Features of Bell’s palsy

A

lower motor neuron facial nerve palsy → forehead affected

in contrast, an upper motor neuron lesion ‘spares’ the upper face

Bell’s palsy usually involves the forehead

patients may also notice
post-auricular pain (may precede paralysis)
altered taste
dry eyes
hyperacusis

114
Q

Managment of Bell’s palsy

A
  • mixture of antivirals and presnisolone
  • Patients should receive Prednisolone in 72 hours
  • eye care is important as well; lubricants
115
Q

Follow up of Bell’s palsy

A
  • if paralysis shows no improvement after 3 weeks, urgent referral to ENT
    -referral to Plastivs may be needed for long standing weakness
116
Q

Prognosis of Bell’s palsy

A

most people with Bell’s palsy make a full recovery within 3-4 months
if untreated around 15% of patients have permanent moderate to severe weakness

117
Q

What condition is this?

What is this?
A

Bell’s Palsy

118
Q

Whooping cough- Pertussis

A

Causes by gram-negative bacterium Bordatella pertussis
- usually present in children

119
Q

Whooping cough vaccinations

A
  • children usually immunised at 2,3 and 4 months
    3-5 years as well.
    -Newborn infants are vulnerable, so pregnant women also vaccinated

neither infection nor immunisation results in lifelong protection - hence adolescents and adults may develop whooping cough despite having had their routine immunisations

120
Q

Catarrhal phase of pertussis

A

symptoms are similar to a viral upper respiratory tract infection
lasts around 1-2 weeks

121
Q

Paroxysmal phase of whooping cough

A
  • Cough increases in severity
  • worse at night and after feeding, may be ended by vomiting & associated central cyanosis
  • Inspiratory whoop: not always present (caused by forced inspiration against a closed glottis)
  • infants= apnoea
    persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures
    lasts between 2-8 weeks
122
Q

Convalescent phase of pertussis

A

Cough subsides over weeks to months

123
Q

Diagnostic criteria of pertussis

A
  • acute cough for at least 14 days without apparent cause
    Also has any of the following features:

Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.

124
Q

Investigations to diagnose pertussis

A
  • Nasal swab culture- Bordetella pertussis
  • PCR and serology
125
Q

Managment of pertussis

A
  • Infants under 6 months with suspect pertussis should be admitted
  • Notifiable disease
    * Oral macrolide
    (e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread
  • household contacts should be offered antibiotic prophylaxis
  • antibiotic therapy has not been shown to alter the course of the illness
  • school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

O

126
Q

Complications of pertussis

A
  • subconjuctuval haemorrhage
  • pneumonia
  • bronchiectasis
  • seizures
127
Q

Nasal polyps

A

Around in 1% of adults in the UK have nasal polyps. They are around 2-4 times more common in men and are not commonly seen in children or the elderly.

128
Q

Associations with nasal polyps

A
  • asthma (particularly late-onset asthma)
  • aspirin sensitivity
  • infective sinusitis
  • cystic fibrosis
  • Kartagener’s syndrome
  • Churg-Strauss syndrome
129
Q

Samster’s triad

A
  • nasal polyposis
  • aspirin sensitivity
  • asthma
130
Q

Features of nasal polyps

A
  • nasal obstruction
  • rhinorrhoea, sneezing
  • poor sense of taste and smell
131
Q

Red flag of nasal polyps

A
  • unilateral symptoms or bleeding
132
Q

Managment of nasal polyps

A
  • Refer to ENT for full examination
  • topical corticosteroids to shrink the polyps
133
Q

what drugs cause gingival hyperplasia

A
  • phenytoin
  • ciclosporin
  • calcium channel blockers (especially nifedipine)
134
Q

Auricular haematomas managment

A
  • Auricular haematomas need same-day assessment by ENT
  • incision and drainage has been shown to be superior to needle aspiration
135
Q

Osteosclerosis

A
  • Replacement of normal bone by** vascular spongy bone**.
  • progressive conductive deafness due to fixation of the stapes at the oval window.
  • autosomal dominant and typically affects young adults
136
Q

Features of Osteosclerosis

A
  • conductive deafness
  • tinnitus
  • tympanic membrane
  • the majority of patients will have a normal tympanic membrane
  • 10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
  • positive family history
137
Q

Managment of Osteosclerosis

A
  • hearing aid
  • stapedectomy
138
Q

SSNHL managment

A

High-dose oral corticosteroids

139
Q

interpretation of audiograms

A
  1. is there anything below 20dB
    yes = move to step 2
    no = normal hearing
  2. is there a gap? (b/w air and bone conduction)
    yes = conductive or mixed hearing loss
    no = sensorineural hearing loss
  3. is one below or both below the 20dB line
    one = conductive
    both = mixed
140
Q

Features of brachial cyst

there are 8 points

A
  • unilateral, typically on the left side
  • lateral, anterior to the sternocleidomastoid muscle
  • slowly enlarging
  • smooth, soft, fluctuant
  • non-tender
  • a fistula may be seen
  • no movement on swallowing
  • no transillumination
141
Q

Investigations for brachial cyst

A
  • consider and exclude other malignancy
  • ultrasound
  • referral to ENT
  • fine-needle aspiration
142
Q

Brachial cyst

A
  • a benign, developmental defect of the branchial arches.
  • Acellular fluid with cholesterol crystals and encapsulated by stratified squamous epithelium.
  • May have a fistula and are therefore** prone to infection.**
  • They may enlarge following a respiratory tract infection.
143
Q

under 3 months age, when to admit for Otitis media

A
  • Temperature of 38 or more,
  • suspected acute
    complications of otitis media such as
  • meningitis
  • mastoiditis
  • facial nerve palsy.
144
Q

Extra-cranial complications of otitis media

A
  • Facial nerve palsy
  • Mastoiditis
  • Petrositis
  • Labrynthtitis
145
Q

Intra-cranial complications of otitis media

A
  • Meningitis
  • Sigmoid sinus thrombosis
  • Brain abcess
146
Q

Gradenigo syndrome

A
  • otorrhoea
  • deep ear and eye pain
  • ipsilateral VI nerve palsy.
147
Q

Indications for Adenoidectomy

A
  • persistent otitis media
  • adenoid hypertrophy
  • recurrent tonsillitis
  • sinusitis
  • adenoiditis
  • dysphagia with failure to thrive
  • speech impairment.
148
Q

Allergic Rhinitis signs and symptoms

A

Nasal pruritus
Sneezing
Rhinorrhoea
Nasal congestion It may also be associated with allergic conjunctivitis, manifesting as:
Eye redness
Eye puffiness
Watery eye discharge

149
Q

Managment of allergic rhinitis

A
  • Avoiding triggers
  • Nasal irrigation with saline
  • Intra-nasal or oral anti-histamines
  • Regular intranasal steroids if initial measures are ineffective
  • Oral steroids for severe cases affecting quality of life
150
Q

Allergic rhinitis when to refer to ENT

A
  • There are red flag features suggesting an alternative/serious diagnosis
  • Cases are refractory
  • Allergen testing is needed
151
Q

Signs and symptoms of basal skull fracture

A
  • History of severe head injury
  • Reduced consciousness
  • Battle’s sign: bruising of the mastoid process
  • Raccoon eyes: periorbital bruising
  • Rhinorrhoea: CSF leakage from the nose
  • Otorrhoea: CSF leaking from the ear
  • Cranial nerve palsy
  • Epistaxis or otorrhagia: Bleeding from the nose or ears
  • Haemotympanum: blood visible behind the tympanic membrane
152
Q
A
153
Q

Investigation for basal skull fracture

A

CT head scan

154
Q

Managment of basal skull head fracture

A
  • Dependent on the severity of the injury.
  • Raised ICP- surgery + meds
  • Neurosurgery
  • Antibiotics are administered if there is a risk of meningitis (CSF leakage)
155
Q

Signs and symptoms of hyperparathyroidism

A
  • Moans: Painful bones
  • Stones: Renal stones
  • Groans: Gastrointestinal symptoms (nausea, vomiting, constipation, indigestion)
  • Psychiatric Moans: Neurological effects (lethargy, fatigue, memory loss, psychosis, depression)
156
Q

Primary Hyperparathyroidism (PHPT) managment

A

parathyroidectomy

157
Q

Secondary Hyperparathyroidism (SHPT) managment

A
  • correct underlying cause
  • Vitamin D supplementation and phosphate binders may be needed.
158
Q

Tertiary Hyperparathyroidism (THPT) managment

A
  • Cinacalcet
  • total or subtotal parathyroidectomy
159
Q

complications of thyorid surgery

A
  • Hypocalcaemia
  • Hypothyroidism
  • damage to recurrent or superior larygneal nerve
  • Neck haematoma
  • thyrotoxic storm
160
Q

Hypocalcaemia managment

A

IV calcium replacement therapy

161
Q
A
162
Q

Management of thyrotoxic storm

A

beta-blockers, antithyroid medications, and supportive care.

163
Q
A
164
Q

Neck haematoma managment

A

immediate surgical intervention.

165
Q

branchial cyst

A
  • congenital malformation that arises from an embryological remnant
  • result of the incomplete obliteration of the branchial arches, which are integral in the development of structures in the head and neck.
166
Q
A
167
Q

Branchial cysts malformation

A
  • accounting for approximately 20% of all pediatric neck masses.
168
Q

Aetiology brachial cyst

A

incomplete obliteration of the branchial clefts during embryological development.

169
Q

Signs and symptoms of brachial cyst

A
  • painless, cystic mass located anterior to the sternocleidomastoid muscle just below the ear.
  • The mass may increase in size during episodes of upper respiratory tract infections.
170
Q

Brachial cyst investigation

A
  • Ultrasound: To assess the size and location of the cyst.
  • CT scan or MRI: For a more detailed view of the cyst and its relation to surrounding structures.
  • Fine-needle aspiration cytology: To rule out malignancy.
171
Q

Managment of brachial cyst

A
  • conservative, involving observation and antibiotics for infection
  • or active, involving surgical excision of the cyst
172
Q

Red flag nasal symptoms

A
  • Symptoms of eustachian tube obstruction (hearing loss, tinnitus, otalgia, sensation of aural fullness)
  • Nasal obstruction (blocked nose, facial pain)
  • Blood-stained nasal discharge
  • Persistent epistaxis
  • Development of a glue ear
173
Q

Siladenitis signs and symptoms

A
  • Pain
  • Tenderness
  • Redness
  • Localized swelling of the affected area
174
Q

Siladenitis investigation

A

ultrasound or CT scan
laboratory tests including culture of saliva or pus to identify the causative organism.

175
Q

Siladenitis managment

A
  • Antibiotics, if the cause is bacterial
  • Oral hygiene advice to prevent future occurrences
  • Measures to encourage salivary flow such as hydrating well and use of salivary stimulants
  • Incision and drainage if there is an associated abscess
176
Q

Foreign objects that needed immediate removal

A
  • Button batteries
  • bones
  • sharp objects, and non-organic materials require immediate removal due to the risk of oesophageal perforation and other serious complications.
177
Q

foreign body investigtion

A
  • radio-opaque object with a ‘halo’ or ‘double ring’ on X-ray
178
Q

Stridor

A

high-pitched, musical noise heard during inspiration that results from partial obstruction of the larynx or large airways.

179
Q

Stridor assoication

A
  • croup
  • epiglottitis
  • bacterial tracheitis.
180
Q

Stridor managment

A

DR ABCDE

181
Q

Investigations for cervical lymphadenopathy

A
  • Full Blood Count (FBC)
  • Blood cultures if infection is suspected
  • Serologic tests for specific infections
  • Imaging studies such as ultrasound or CT scan
  • Biopsy of the lymph node if malignancy is suspected
182
Q

Cervical lymphadenopathy managment

A
  • Antibiotics for bacterial infections
  • Antiviral drugs for viral infections
  • Antiretroviral therapy for HIV
  • Chemotherapy, radiation therapy or surgical intervention for malignancies
  • Immunosuppressive drugs for autoimmune conditions
183
Q

Sinusitis signs and symptoms

A
  • Bilateral intense pain
  • Fever
  • Nasal obstruction
  • Purulent discharge
  • In acute exacerbations, the pain is worse when sitting forward
  • In chronic sinusitis, there is nasal obstruction due to mucosal hypertrophy and purulent discharge
184
Q
A
185
Q
A
186
Q

What virus primarily causes infectious mononucleosis?

A

Epstein-Barr virus (EBV)

Also known as human herpesvirus 4 (HHV-4)

187
Q

What are the less frequent causes of infectious mononucleosis?

A

Cytomegalovirus and HHV-6

188
Q

In which age group is infectious mononucleosis most common?

A

Adolescents and young adults

189
Q

What is the classic triad of symptoms for infectious mononucleosis?

A

Sore throat, pyrexia, lymphadenopathy

190
Q

What is lymphadenopathy and how does it differ in infectious mononucleosis compared to tonsillitis?

A

Enlargement of lymph nodes; in mononucleosis, it can be present in anterior and posterior triangles of the neck

191
Q

What percentage of patients with infectious mononucleosis typically present with sore throat?

A

98%

192
Q

List other common features of infectious mononucleosis.

A
  • Malaise
  • Anorexia
  • Headache
  • Palatal petechiae
  • Splenomegaly
  • Hepatitis
  • Lymphocytosis
  • Haemolytic anaemia
  • Maculopapular rash with ampicillin/amoxicillin
193
Q

What is the typical duration for the resolution of symptoms in infectious mononucleosis?

A

2-4 weeks

194
Q

What test is commonly used for the diagnosis of infectious mononucleosis?

A

Heterophil antibody test (Monospot test)

195
Q

What do NICE guidelines suggest for confirming a diagnosis of glandular fever?

A

FBC and Monospot in the 2nd week of the illness

196
Q

What are the supportive management strategies for infectious mononucleosis?

A
  • Rest during early stages
  • Drink plenty of fluid
  • Avoid alcohol
  • Simple analgesia for aches or pains
197
Q

How long should contact sports be avoided after having glandular fever?

A

4 weeks

198
Q

True or False: There is a correlation between EBV and socioeconomic groups.

A

True

199
Q

What pattern of EBV seropositivity is seen in lower socioeconomic groups?

A

Higher rates of EBV seropositivity, often acquired in early childhood

200
Q

In higher socioeconomic groups, what is the incidence of infectious mononucleosis related to?

A

Higher incidence due to acquiring EBV in adolescence or early adulthood

UKMLA Prep (39 decks)

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