ENT - Preading Flashcards
What is the difference between anterior and posterior rhinorrhea?
- Anterior rhinorrhea = mucus secretions coming out of nose
- Posterior rhinorrhea = mucus secretions flowin down throat
What are the 5 main symptoms to ask about for the nose?
- Nasal obstruction
- Runny nose (i.e. anterior rhinorrhoea)
- Loss of sense of smell (i.e. hyposmia or anosmia)
- Nose bleeds (i.e. epistaxis)
- Facial pain
Other symptoms:
- Post nasal drip (excess mucus secretions dripping down throat)
- Nasal itch
- Sneezing
- Ocular itching
What are the 5 main symptoms to ask about for the ear?
- Earache (i.e. otalgia)
- Ear discharge (i.e. otorrhoea)
- Hearing loss
- Tinnitus (the sensation of sound without any external stimulus)
- Dizziness
Other symptoms:
- Aural blockage (ear block)
- Itching
What are the 5 main symptoms to ask about for the throat?
- Sore throat
- Difficulty swallowing (i.e. dysphagia)
- Pain on swallowing (i.e. odynophagia)
- Hoarse voice (i.e. dysphonia)
- Regurgitation
Other symptoms:
- A feeling of a lump in the throat
- Burning in the throat (GORD)
- Weight loss
What are the 6 anatomical triangles of the neck + what are their borders?
Anterior triangle:
-
Submental triangle:
- Post border = anterior belly of digastric
- Ant border = throat midline
- Inf border = body of hyoid
- Contains = lymph nodes draining floor of mouth
-
Submandibular / digastric triangle:
- Post border = posterior belly of digastric
- Ant border = anterior belly of digastric
- Sup border = lower border of mandible
- Contains = submandibular nerve, hypoglossal nerve, internal + external carotids, internal jugular vein
-
Carotid triangle:
- Post border = ant border of sternocleidomastoid
- Ant.inf border = omohyoid
- Ant.sup border = posterior belly of digastric
- Contains = lower part of pharynx + upper larynx, carotid sheath and this in turn contains:
- common, internal and external carotid arteries, the vagus nerve and the sympathetic chain
-
Muscular triangle
- Sup border = hyoid bone
- Med border = midline of throat
- Sup.lat = sup. belly of omohyoid
- Inf.lat = inferior part of sternocleidomastoid
Posterior triangle:
- Ocipital triangle
- Subclavian triangle
Neck lymphatics are split into levels and correspond to a specific area of drainage.
What are these levels and their drainage?
- Level 1: Submental and submandibular
- Level 2: Upper deep cervical
- Level 3: Mid-deep cervical
- Level 4: Lower deep cervical
- Level 5: Posterior triangle
- Level 6: Paratracheal
- Level 7: Upper mediastinal
N.B. Lymph nodes in a specific region can indicate the area of a tumour
Why do patients with sore throat often complain of earache (otalgia)?
The glossopharyngeal nerve supplies sensation to the throat (tonsils and pharynx) but also to the ear (middle ear) !!
This is called referred otalgia
What are the features of acute tonsillitis?
Symptoms:
- Sore throat (due to pharyngitis)
- Tonsils appear: oaedematous, yellow / white pustules may be present
- Fever
- Malaise
- Lymphadenopathy
Info:
- > 50% cases are bacterial (Streptococcus pyogenes = most common)
- Infectious mononucleosis may mimic the condition
- Severe acute bacterial tonsillitis can results in a peritonsillar abscess i.e. Quinsy
- Local anaesthetic + aspiration or incision and drainage
Management:
- Penicillin-type Abx for bacterial tonsillits e.g. Phenoxymethylpenicillin
A peritonsillar abscess i.e. quinsy is a complication of severe bacterial tonsillitis.
What are the features of a quinsy?
Features:
- severe throat pain - which lateralises to one side
- uvula deviation - to unaffected side
- trismus (difficulty opening the mouth)
- ↓ neck mobility
What are the common causes of referred otalgia?
- TMJ pathology
- Pharyngeal pathology
- Dental infection
Examine the following image of an ear drum.
Identify all relevent structures.
