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ENT > ENT P2 > Flashcards

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
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2
Q

Features of head and neck cancers:

A
  • neck lump
  • hoarseness
  • persistent sore throat
  • persistent mouth ulcer
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3
Q

When should you consider suspected cancer pathway referral for laryngeal cancer:

A
  • > 45yo with
  • persistent unexplained hoarseness or
  • unexplained lump in neck
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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
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5
Q

When should you consider suspected cancer pathway referral for thyroid cancer:

A

unexplained thyroid lump

within 2 weeks

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6
Q

Causes of hoarseness:

A
  • voice overuse
  • smoking
  • viral illness
  • hypothyroidism
  • gastro-oesophageal reflux
  • laryngeal cancer
  • lung cancer
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7
Q

Investigating hoarseness:

A

CXR to exclude apical lung lesions

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8
Q

What is laryngopharyngeal reflux?

A
  • caused by gastro-oesophageal reflux
  • inflammatory changes to larynx/hypopharynx mucosa
  • 10% referrals
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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
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10
Q

Diagnosis laryngopharyngeal reflux:

A
  • absence of red flags - clinical diagnosis

- cancer referral: persistent unilateral throat discomfort, dysphagia, odynophagia, persistent hoarseness

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11
Q

Mangement laryngopharyngeal reflux:

A
  • lifestyle: fatty foods, caffeine, chocolate, alcohol
  • PPI
  • sodium alginate liquids e.g. gaviscon
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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
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13
Q

Features Ludwig’s angina:

A
  • neck swelling
  • dysphagia
  • fever
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14
Q

Management Ludwig’s angina:

A
  • airway management

- IV Abx

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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
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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
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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
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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
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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
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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
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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
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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
Q

Features of nasal polyps:

A
  • nasal obstruction
  • rhinorrhoea, sneezing
  • poor sense of taste and smell
26
Q

Further investigations and management of nasal polyps:

A
  • unilateral symptoms or bleeding - further investigation
  • refer to ENT for full examination
  • topical corticosteroids shrink polyp size in 80%
27
Q

What is nasal septal haematoma?

A
  • complication of nasal trauma

- development of haematoma between septal cartilage and overlying perichondrium

28
Q

Features of nasal septal haematoma:

A
  • 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
Q

Management and complication of nasal septal haematoma:

A
  • surgical drainage and IV antibiotics

- if untreated irreversible septal necrosis within 3-4 days due to pressure repeated ischaemia (saddle nose deformity)

30
Q

What virus is nasopharyngeal carcinoma associated with:

A

EBV

31
Q

Type of nasopharyngeal carcinoma:

A

squamous cell carcinoma

32
Q

Presenting features nasopharyngeal carcinoma:

A
  • cervical lymphadenopathy
  • otalgia
  • unilateral serous otitis media
  • nasal obstruction, discharge and/or epistaxis
  • cranial nerve palsies III-VI
33
Q

Imaging and treatment of nasopharyngeal carcinoma:

A
  • combined CT and MRI

- radiotherapy first line

34
Q

What is thyroglossal cyst:

A
  • <20 years old
  • midline between isthmus of thyroid and hyoid bone
  • moves upwards with protrusion of the tongue
  • may be painful if infected
35
Q

What is a cystic hygroma?

A
  • congenital lymphatic lesion (lymphangioma)
  • neck mostly on left
  • 90% before 2yo
36
Q

How does a carotid aneurysm appear?

A
  • pulsatile lateral neck mass

- doesn’t move on swallowing

37
Q

Causes of otitis externally:

A
  • infection: staph aureus, pseudomonas aeruginosa or fungal
  • seborrhoeic dermatitis
  • contact dermatitis (allergic and irritant)
38
Q

Features of otitis externally:

A
  • ear pain, itch, discharge

- otoscopy: red, swollen or eczematous canal

39
Q

Initial management of otitis externa:

A
  • 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
Q

Second line management of otitis externa:

A

-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
Q

In whom is malignant otitis externa more common?

A 
elderly diabetics
(extension of infection into bony ear canal and soft tissues to bony canal)
42
Q

What is otosclerosis?

A
  • 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
Q

Features of otosclerosis:

A
  • conductive deafness
  • tinnitus
  • normal tympanic membrane
  • positive family history
44
Q

Management of otosclerosis:

A
  • hearing aid

- stapedectomy

45
Q

Parotid gland benign tumour types:

A
  • benign pleomorphic adenoma or benign mixed tumour
  • Warthin tumour (papillary cystadenoma lymphoma or aden-lymphoma)
  • monomorphic adenoma
  • haemangioma
46
Q

Types of malignant parotid tumour:

A
  • mucoepidermoid carcinoma
  • adenoid cystic carcinoma
  • mixed tumours
  • acinic cell carcinoma
  • adenocarcinoma
  • lymphoma
47
Q

Diagnostic evaluation parotid gland tumours:

A
  • plain x rays to exclude calculi
  • sialography to delineate ductal anatomy
  • FNAC
  • superficial parotidectomy
  • CT/MRI for staging primary disease
48
Q

Treatment parotid gland tumours:

A
  • 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
Q

Sjogren syndrome characteristics:

A
  • autoimmune: parotid enlargement, xerostomia and keratoconjunctivitis
  • 90% females
  • second most common CTD
  • bilateral non tender enlargement of gland usual
50
Q

Perforated tympanic membrane:

A
  • most common cause infection
  • also barotrauma, direct trauma
  • may lead to hearing loss depending on size and increases risk of otitis media
51
Q

Management perforated tympanic membrane:

A
  • none as usually heals 6-8 weeks (avoid water)
  • prescribe antibiotics following episode of acute otitis media
  • myringoplasty if it does not heal
52
Q

What is peritonsillar abscess (quinsy) a complication of?

A

bacterial tonsillitis

53
Q

Features of peritonsillar abscess:

A
  • severe throat pain, lateralises to one side
  • deviation of uvula to unaffected side
  • trismus (difficulty opening mouth)
  • reduced neck mobility
54
Q

Management of peritonsillar abscess:

A
  • needle aspiration or incision and drainage and intravenous antibiotics
  • tonsillectomy should be considered to prevent recurrence
  • urgent ENT specialist

ENT (3 decks)

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