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Thick Stuff > ENT - Level 1 > Flashcards

ENT - Level 1 Flashcards

1
Q

Definition of otitis media?

A
  • Middle ear inflammation
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2
Q

Definition of recurrent otitis media with effusion?

A
  • Recurrent ear infections – secretory otitis media (Glue ear)
    Middle ear effusion without the symptoms of acute otitis media
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3
Q

How common is otitis media?

A

o Bacterial (most commonly)
 Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, streptococcus pyogenes
o Viral
 RSV, rhinovirus, adenovirus, influenza and parainfluenza

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4
Q

Causative organisms of otitis media?

A

o Bacterial (most commonly)
 Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, streptococcus pyogenes
o Viral
 RSV, rhinovirus, adenovirus, influenza and parainfluenza

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5
Q

Symptoms of otitis media?

A
  • May follow URTI
  • Symptoms
    o Rapid onset pain in the ear
    o Fever
    o Irritability
    o Vomiting
    o Deafness
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6
Q

Signs of otitis media?

A

o Bright red and bulging with loss of normal light reflection
o Occasional acute perforation with pus in ear canal
o Look for swelling over mastoid – mastoiditis secondary

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7
Q

Diagnosis of acute otitis media?

A

o Acute onset – earache, holding, tugging ear or non-specific symptoms
o Otoscopy – red, tallow or cloudy tympanic membrane with bulging and loss of normal landmarks, air fluid level behind tympanic membrane or perforation

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8
Q

When to admit of otitis media for specialist assessment from primary care?

A

o Severe systemic infection
o Acute complications of otitis media (meningitis, mastoiditis, incracranial abscess, sinus thrombosis, facial nerve paralysis)
o Child <3 months with temperature >38

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9
Q

Management of otitis media - general advice?

A 
o	Analgesia (regular paracetamol and ibuprofen)
o	Most cases resolve spontaneously within 3 days but can be up to 1 week
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10
Q

Management of otitis media - antibiotics?

A

o If very unwell, have symptoms and signs of illness or high risk:
 Immediate antibiotic
o For those who may benefit from antibiotics, consider delayed prescription, no prescription or immediate
 Amoxicillin for 5-7 days
 Can give clarithromycin or erythromycin if penicillin allergic

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11
Q

Management of otitis media - if perforation?

A

o Follow up with ENT and do not swim

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12
Q

Management of otitis media - if treatment failure?

A

o If not taken antibiotic – give prescription
 Amoxicillin for 5-7 days
 Can give clarithromycin or erythromycin if penicillin allergic
o If taken first-line antibiotics, give co-amoxiclav for 5-7 days
o If symptoms persist despite two courses of antibiotics – refer to ENT

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13
Q

Management of otitis media if persistent symptoms - hearing loss with no pain or fever?

A

 Active observation for 6-12 weeks

 Two hearing tests using pure tone audiometry >3 months apart

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14
Q

Management of otitis media if persistent symptoms - hearing loss with no pain or fever - when to refer?

A

o Hearing loss impacting child development
o Hearing loss >61dB
o Significant hearing loss on two occasions
o Tympanic membrane abnormal
o Foul-smelling discharge (cholesteatoma)
o Down’s syndrome or cleft palate

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15
Q

Management of otitis media if persistent symptoms - hearing loss with no pain or fever - non-surgical and surgical management?

A

o Active observation for 3 months with regular audiology follow up
o Hearing aids
o Autoinflation

o Myringotomy with Grommet insertion, with or without adenoidectomy
 If persistent bilateral OME over 3 months with hearing in better ear <25-30dB averaged at 0.5, 1, 2 and 4 kHz or if affecting development
 Adenoidectomy only if frequent URTIs
 Follow up until grommets extruded and eardrum healed

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16
Q

Management of otitis media if persistent symptoms - discharge from ear canal for 2 weeks?

A

 Refer to ENT assessment – given steroids and antibiotics and intensive cleaning of ear

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17
Q

Complications of otitis media?

A
  • Mastoiditis

- Meningitis

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18
Q

Definition of pharyngitis?

A

local inflammation of oropharynx with enlarged and tender lymph nodes

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19
Q

Definition of tonsilitis?

A

form of pharyngitis where there is intense inflammation of the tonsils, often with purulent exudate

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20
Q

Definition of influenza?

A

acute respiratory illness caused by RNA Orthomyxoviridae viruses

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21
Q

Epidemiology of URTIs?

A
  • Highest incidence in children and young adults
  • More common in winter
  • URTI are 80% of respiratory infections
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22
Q

Causative organisms of common cold (coryza)?

A

 Rhinovirus, coronaviruses, influenza virus, parainfluenza and RSV (however RSV usually causes acute bronchiolitis)
 Lasts 1 ½ weeks
 Common – adults 2-3x colds per year, children 5-6x colds per year

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23
Q

Causative organisms of Pharyngitis/tonsilits?

A

 Adenoviruses, enteroviruses, rhinoviruses, influenza types A and B, parainfluenza, group A B-haemolytic streptococcus, HSV-1, EBV, Candida
 Non-infectious – physical irritation, hayfever, GORD, Kawasaki’s disease, oral mucositis
 Lasts 1 week

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24
Q

Causative organisms of epiglottitis?

A

 Hib

25
Q

Causative organisms of influenza?

A

 Type A – frequent and more virulent, local outbreaks and epidemics
 Type B – co-circulates with A during yearly outbreaks, less severe
 Type C – mild/asymptomatic infection similar to common cold
 Peak during winter months

26
Q

Symptoms of tonsillitis/pharyngitis?

A 
o	Fever (+/- febrile convulsions)
o	Painful throat
o	Exudate present in bacterial tonsillitis
o	Earache and nasal discharge
o	Difficulty feeding and drinking
27
Q

Symptoms of common cold?

A

o Sore throat
o Nasal irritation, congestion, nasal discharge and sneezing
o Cough
o Hoarse voice
o General malaise
o Fever, myalgia and headache less common

28
Q

Symptoms of uncomplicated influenza?

A

 Coryza, cough, fever, Diarrhoea, headache, myalgia, malaise, sore throat, photophobia, conjunctivitis

29
Q

Symptoms of complicated influenza?

A

 Signs and symptoms requiring hospital admission, LRTIs, CNS involvement, exacerbation of underlying medical condition

30
Q

Assessment of tonsillitis/pharyngitis?

A

o Clinical examination – pus on tonsils indicates bacterial infection
o Neck – think bacterial infection if tender lymphadenopathy
o FeverPAIN score
o Centor Criteria

31
Q

What is FeverPain score in tonsillitis?

A 
	Fever >38
	Purulent (exudate on tonsils/pharyngeal)
	Attend rapidly (<3 days)
	Inflamed tonsils
	No cough/coryza
•	Score 4 or 5 - Abx
32
Q

What is Centor Criteria in tonsillitis?

A 
	Tonsilllar exudate
	Tender anterior cervical lymphadenopathy
	Fever
	Absence of cough
•	3 or 4 needs Abx
33
Q

Investigations in influenza?

A

o Laboratory diagnosis for complicated influenza (in hospital)
o Viral PCR
o Alternatives – serology and culture

34
Q

Management of tonsillitis - hospital admission needed when?

A

 Breathing difficulty
 Dehydration
 Peri-tonsillar abscess or cellulitis
 Sepsis

35
Q

Management of tonsillitis - if on DMARDs, carbimazole, chemotherapy, HIV, asplenia?

A

 Seek immediate advice

 FBC urgently

36
Q

Management of tonsillitis - general advice?

A

 Majority caused by viral infections
 40% of symptoms resolve within 3 day and 85% within 1 week
 Symptomatic relief
• Keep hydrated
• Paracetamol and ibuprofen
• Avoid hot drinks – worsen pain
 Children return to school after fever resolved and no longer feel unwell or after 24h of Abx

37
Q

Management of tonsillitis - Antibiotics?

A

 If positive culture or Centor criteria 3 or 4 or FeverPAIN 4 or 5
 If FeverPAIN 2 or 3 – consider delayed prescription
 Prescribe penicillin V (phenoxymethylpenicillin 500mg QDS) for 10 days
 Alternatives: erythromycin or clarithromycin for 5 days
 AVOID AMOXICILLIN AS CAUSES RASH IN EBV

38
Q

Management of tonsillitis - recurrent tonsillitis?

A

o If recurrent tonsillitis (>7 episodes per year for one year, >5 episodes per year for 2 years or >3 episodes per year for 3 years)
 Refer to ENT for tonsillectomy advice

39
Q

Criteria for referral to ENT for tonsillectomy?

A

> 7 episodes per year for one year

> 5 episodes per year for 2 years

> 3 episodes per year for 3 years

40
Q

Management of common cold - general advice?

A

o Self-limiting and symptoms peak around 2-3 days then decrease up to 1 week or 2 weeks for young children, cough may last for 3 weeks

41
Q

Management of common cold - symptomatic relief?

A
  • Keep hydrated
  • Paracetamol and ibuprofen
  • Avoid hot drinks – worsen pain
  • Steam inhalation relieves congestion (or sitting in hot shower)
  • Intranasal decongestants, cough medicine available OTC
42
Q

Management of common cold - hygiene methods?

A
  • Washing hands frequently with soap and water

* Avoid sharing towels

43
Q

Management of common cold - follow up?

A

 Come back if symptoms worsen or persist longer than 7/14 days

44
Q

Management of influenza - prevention with seasonal vaccine - when to give?

A

• All people >65 (trivalent)

• All people 6m-65y if in following groups (quadrivalent):
o Chronic respiratory illness
 COPD, bronchiectasis, CF, ILD, pneumoconiosis, BPD, asthma needed ICS
o Chronic heart disease
 CHD, hypertension with cardiac complications, HF, regular medication for IHD
o CKD (Stage 3-5), nephrotic syndrome, transplant
o Chronic liver disease – cirrhosis, biliary atresia, chronic hepatitis
o Neurological
 Stroke/TIA, at risk of co-morbidity exacerbated by flu (CP, LD, PD, MS, MND, degenerative disease, polio)
o DM type 1 and 2 needing OHA/insulin
o Immunosuppressed
 Chemotherapy, bone marrow transplant, HIV, systemic steroids (>1m of 20mg daily), myeloma, asplenia, or SCD
o Pregnant women
o BMI>40

45
Q

Management of influenza - symptomatic relief?

A
  • Keep hydrated
  • Paracetamol and ibuprofen
  • Rest in bed
  • Stay off work/school until feel able to attend
46
Q

Management of influenza - antiviral therapy criteria?

A

o Antiviral (oral oseltamivir or inhaled zanamivir) if all of following apply:
 National surveillance scheme indicate influenza circulating
 Person at ‘high risk’ group
• Aged >65, <6m or pregnant women
• People with following conditions:
• Asplenia, COPD, bronchiectasis, CF, ILD, pneumoconiosis, Asthma needing inhaled corticosteroids
• HF, CHD, IHD
• CKD (Stage 3-5), chronic liver disease
• Stroke/TIA
• DM
• Immunosuppressed – chemotherapy, bone marrow transplant, HIV, systemic steroids (>1m of 20mg daily), myeloma
• BMI >40
 Person can start treatment within 48 hours of onset of symptoms (36 with zanamivir with children)

47
Q

Management of influenza - follow up?

A

 Within 1 weeks if >65 or <6m to confirm improving

 After 1 week if not improving

48
Q

Management of influenza - admission to hospital if?

A

 Complication – pneumonia
 High risk of complications
 <2 years and at risk group
 Febrile seizure

49
Q

Management of influenza - post-exposure prophylaxis given when and what?

A

• National surveillance scheme indicates influenza circulating
• Person exposed (in same household or residential setting)
• At risk group and:
o Not vaccinated since previous season
o Vaccination not well-matched to circulating scheme
o <14 days between vaccination and date of contact
• Person can start treatment within 48 hours of onset of symptoms (36 with zanamivir with children)
 Oral oseltamivir or inhaled zanamivir for 10 days

50
Q

Complications of tonsilitis/cold?

A

o Otitis Media
o Sinusitis
o Peritonsillar abscess (quinsy)
o Para-pharyngeal abscess

51
Q

Complications of influenza?

A 
o	Bronchitis
o	Exacerbation of asthma or COPD
o	Otitis media
o	Pneumonia
o	Sinusitis
o	Myocarditis, pericarditis
o	Febrile convulsions
o	Myalgia, rhabdomyolysis
o	GBS
o	In pregnancy – preterm labour and low birth weight
52
Q

Neck lumps - key features of reactive lymphadenopathy?

A

Most common cause
History of localised infection or generalised viral illness

53
Q

Neck lumps - key features of lymphoma?

A

Rubbery, painless lymphadenopathy
Pain whilst drinking alcohol (rare)
Night sweats and splenomegaly

54
Q

Neck lumps - key features of thyroid goitres/lumps

A

Symptomatic hypo/hyperthyroid
Moves upward on swallowing

55
Q

Neck lumps - key features of thyroglossal cyst

A

Common in patients <20
Midline between thyroid isthmus and hyoid bone
Moves upwards with tongue protrusion
Painful if infected

56
Q

Neck lumps - key features of pharyngeal pouch

A

Older men
Posteromedial herniation between thyropharyngeal and cricopharyngeus muscles
If large midline lump in neck that gurgles on palpation
Symptoms - dysphagia, regurgitation, aspiration, chronic cough

57
Q

Neck lumps - key features of cystic hydroma?

A

Congenital lymphatic lesion
Left side neck
Most evident at birth but 90% by 2

58
Q

Neck lumps - key features of branchial cyst

A

Oval mobile cystic mass between sternocleidomastoid muscle and pharynx
Presents in early adulthood

59
Q

Key features of salivary gland stones (sialolithiasis)

A

primarily affect the submandibular glands but are also seen in the parotid and sublingual glands
Age 50-60
Majority calcium phosphate stones
Symptoms - Pain and swelling of gland on eating or chewing. Resolve after mealtimes
Management - conservative management -well hydrated, NSAIDs for pain
If recurrent then refer to ENT

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