ENT P2 Flashcards
1
Q
What does head and neck cancers contain:
A
- oral cavity cancers
- cancers of the pharynx (oropharynx, hypo pharynx and nasopharynx)
- cancers of larynx
2
Q
Features of head and neck cancers:
A
- neck lump
- hoarseness
- persistent sore throat
- persistent mouth ulcer
3
Q
When should you consider suspected cancer pathway referral for laryngeal cancer:
A
- > 45yo with
- persistent unexplained hoarseness or
- unexplained lump in neck
4
Q
When should you consider suspected cancer pathway referral for oral cancer?
A
- unexplained ulceration in oral cavity for more than 3 weeks
- or persistent and unexplained lump in neck
- urgent referral: lump on lip or oral cavity or red or red and white patch in oral cavity consistent with erythroplakia or erythroleukoplakia
5
Q
When should you consider suspected cancer pathway referral for thyroid cancer:
A
unexplained thyroid lump
within 2 weeks
6
Q
Causes of hoarseness:
A
- voice overuse
- smoking
- viral illness
- hypothyroidism
- gastro-oesophageal reflux
- laryngeal cancer
- lung cancer
7
Q
Investigating hoarseness:
A
CXR to exclude apical lung lesions
8
Q
What is laryngopharyngeal reflux?
A
- caused by gastro-oesophageal reflux
- inflammatory changes to larynx/hypopharynx mucosa
- 10% referrals
9
Q
Features of laryngopharyngeal reflux:
A
- 70% sensation of lump in throat - globus: midline, worse when swallowing saliva rather than eating or drinking
- hoarseness
- chronic cough
- dysphagia
- heartburn
- sore throat
- erythematous posterior pharynx
10
Q
Diagnosis laryngopharyngeal reflux:
A
- absence of red flags - clinical diagnosis
- cancer referral: persistent unilateral throat discomfort, dysphagia, odynophagia, persistent hoarseness
11
Q
Mangement laryngopharyngeal reflux:
A
- lifestyle: fatty foods, caffeine, chocolate, alcohol
- PPI
- sodium alginate liquids e.g. gaviscon
12
Q
What is Ludwig’s angina:
A
- progressive cellulitis
- invades floor of mouth and soft tissues o neck
- odontogenic infection spread to submandibular space
- life-threatening emergency as airway obstruction can occur rapidly as a result
13
Q
Features Ludwig’s angina:
A
- neck swelling
- dysphagia
- fever
14
Q
Management Ludwig’s angina:
A
- airway management
- IV Abx
15
Q
What is malignant otitis externa:
A
- uncommon type of otitis externally found in immunocompromised
- 90% diabetics
- psuedomonas aeruginosa
- infection commences in external auditory meatus - progresses to involve soft tissues and into bony ear canal
- progresses to temporal bone osteomyelitis
16
Q
Features in history of malignant otitis externa:
A
- diabetes or immunosuppression
- severe, unrelenting, deep seated otalgia
- temporal headaches
- purulent otorrhoea
- possibly dysphagia, hoarseness and/or facial nerve dysfunction
17
Q
Diagnosis or treatment of otitis externa:
A
- CT scan
- non-resolving otitis externa with worsening pain should be referred urgency to ENT
- intravenous antibiotics that cover pseudomonas infections
18
Q
Features of mastoiditis:
A
- otalgia: severe, classically behind the ear
- history of recurrent otitis media
- fever
- typically very unwell
- swelling, erythema and tenderness over the mastoid process
- external ear may protrude forwards
- ear discharge may be present if eardrum has perforated
19
Q
What is Meniere’s disease?
A
- inner ear
- unknown cause
- characterised by excessive pressure and progressive dilation of end-lymphatic system
- more common in middle aged adults but at any age
20
Q
Features of Meniere’s disease:
A
- recurrent episodes of vertigo, tinnitus and hearing loss (sensorineural), vertigo usually prominent symptom
- sensation of aural fullness or pressure or pressure
- nystagmus and positive Romberg test
- episode minutes to hours
- typically unilateral but bilateral may develop
21
Q
Management Meniere’s disease:
A
- ENT assessment
- inform DVLA - cease driving until satisfactory control
- acute attacks: buccal or IM prochlorperazine (sometimes admission)
- prevention: betahistine and vestibular rehabilitation exercises
22
Q
2 week wait referrals to oral surgery:
A
- unexplained oral ulceration or mass for >3 weeks
- unexplained red, red and white patches, painful, swollen or bleeding
- one sided pain in neck and head for >4weeks, ear ache but no findings on otoscopy
- unexplained neck lump or change over 3-6 weeks
- unexplained persistent sore or painful throat
- signs and symptoms in oral cavity for >6 weeks that cannot be diagnosed as benign
23
Q
Associations nasal polyps:
A
- asthma
- aspirin sensitivity
- infective sinusitis
- cystic fibrosis
- Kartagener’s syndrome
- Chrug-Strauss syndrome
24
Q
Samter’s triad:
A
- asthma
- aspirin sensitivity
- nasal polyposis
25
Features of nasal polyps:
- nasal obstruction
- rhinorrhoea, sneezing
- poor sense of taste and smell
26
Further investigations and management of nasal polyps:
- unilateral symptoms or bleeding - further investigation
- refer to ENT for full examination
- topical corticosteroids shrink polyp size in 80%
27
What is nasal septal haematoma?
- complication of nasal trauma
| - development of haematoma between septal cartilage and overlying perichondrium
28
Features of nasal septal haematoma:
- precipitated by minor truma
- sensation of nasal obstruction most common
- pain and rhinorrhoea
- bilateral, red swelling from nasal septum
- nasal septal haematomas boggy heras deviated septum is firm
29
Management and complication of nasal septal haematoma:
- surgical drainage and IV antibiotics
| - if untreated irreversible septal necrosis within 3-4 days due to pressure repeated ischaemia (saddle nose deformity)
30
What virus is nasopharyngeal carcinoma associated with:
EBV
31
Type of nasopharyngeal carcinoma:
squamous cell carcinoma
32
Presenting features nasopharyngeal carcinoma:
- cervical lymphadenopathy
- otalgia
- unilateral serous otitis media
- nasal obstruction, discharge and/or epistaxis
- cranial nerve palsies III-VI
33
Imaging and treatment of nasopharyngeal carcinoma:
- combined CT and MRI
| - radiotherapy first line
34
What is thyroglossal cyst:
- <20 years old
- midline between isthmus of thyroid and hyoid bone
- moves upwards with protrusion of the tongue
- may be painful if infected
35
What is a cystic hygroma?
- congenital lymphatic lesion (lymphangioma)
- neck mostly on left
- 90% before 2yo
36
How does a carotid aneurysm appear?
- pulsatile lateral neck mass
| - doesn't move on swallowing
37
Causes of otitis externally:
- infection: staph aureus, pseudomonas aeruginosa or fungal
- seborrhoeic dermatitis
- contact dermatitis (allergic and irritant)
38
Features of otitis externally:
- ear pain, itch, discharge
| - otoscopy: red, swollen or eczematous canal
39
Initial management of otitis externa:
- topical antibiotic or combined topical with steroid
- if tympanic membrane perforated, ahminoglycosides are not traditionally used
- remove canal debris
- if extensively swollen canal, ear wick inserted
40
Second line management of otitis externa:
-contact dermatitis secondary to neomycin
-oral antibiotics (flucloxacillin) if infection spreading
-swab inside ear canal
-empirical use of anti fungal
if fail to respond, refer to ENT
41
In whom is malignant otitis externa more common?
```
elderly diabetics
(extension of infection into bony ear canal and soft tissues to bony canal)
```
42
What is otosclerosis?
- replacement of normal bone by vascular spongy bone
- progressive conductive deafness due to fixation of stapes at oval window
- autosomal dominant
- affects young adults
43
Features of otosclerosis:
- conductive deafness
- tinnitus
- normal tympanic membrane
- positive family history
44
Management of otosclerosis:
- hearing aid
| - stapedectomy
45
Parotid gland benign tumour types:
- benign pleomorphic adenoma or benign mixed tumour
- Warthin tumour (papillary cystadenoma lymphoma or aden-lymphoma)
- monomorphic adenoma
- haemangioma
46
Types of malignant parotid tumour:
- mucoepidermoid carcinoma
- adenoid cystic carcinoma
- mixed tumours
- acinic cell carcinoma
- adenocarcinoma
- lymphoma
47
Diagnostic evaluation parotid gland tumours:
- plain x rays to exclude calculi
- sialography to delineate ductal anatomy
- FNAC
- superficial parotidectomy
- CT/MRI for staging primary disease
48
Treatment parotid gland tumours:
- surgical resection
- malignant - radical or extended radical parotidectomy
- benign - superficial
- facial nerve included in resection if involved
- neck dissection determined by potential for nodal involvement
49
Sjogren syndrome characteristics:
- autoimmune: parotid enlargement, xerostomia and keratoconjunctivitis
- 90% females
- second most common CTD
- bilateral non tender enlargement of gland usual
50
Perforated tympanic membrane:
- most common cause infection
- also barotrauma, direct trauma
- may lead to hearing loss depending on size and increases risk of otitis media
51
Management perforated tympanic membrane:
- none as usually heals 6-8 weeks (avoid water)
- prescribe antibiotics following episode of acute otitis media
- myringoplasty if it does not heal
52
What is peritonsillar abscess (quinsy) a complication of?
bacterial tonsillitis
53
Features of peritonsillar abscess:
- severe throat pain, lateralises to one side
- deviation of uvula to unaffected side
- trismus (difficulty opening mouth)
- reduced neck mobility
54
Management of peritonsillar abscess:
- needle aspiration or incision and drainage and intravenous antibiotics
- tonsillectomy should be considered to prevent recurrence
- urgent ENT specialist
