ENT summary Flashcards
Why do we want to the know the drug history of patient who presents complaining of a sore throat?
check for any drugs that cause an agranulocytosis e.g. carbimazole-for hyperthyroidism, carbamazepine-epilepsy, trigeminal neuralgia, bipolar, neuropathic pain, phenytoin, clozapine-tment resistant schizophrenia, antibiotics, chemotherapy drugs.
organism most commonly implicated in bacterial acute tonsillitis?
group A beta-haemolytic streptococcus
a patient presents with a thyroid gland lump, what could be the cause, and how would you have confirmed that this was indeed part of the thyroid gland o/e?**
confirmation: ask pt to swallow-lump will move upwards with swallowing due to thyroid gland being ensheathed within visceral part of pre-tracheal layer of fascia which also surrounds the larynx which moves upwards with swallowing.
causes: diffuse thryoid gland enlargement=goitre=graves diseases, hashimotos thyroiditis, goitrogenic drugs e.g. amiodarone, lithium-?patients DH or PMH of cardiac arrhythmias, bipolar, subacute thyroiditis-painful goitre, pyrexia, raised ESR, low isotope uptake on scan.
single nodule-cyst, adenoma, Ca
mutlinodular-multiple nodules and euthyroid, toxic multinodular goitre
what features other than facial drooping might be noted by a patient with Bell’s palsy: an acute unilateral idiopathic facial nerve paralysis?
auricular pain-may occur before or after the paralysis
hyperacusis-loss of function of stapedius which controls movement of stapes
altered taste
dry eyes*
what should be prescribed for patients with Bell’s palsy when considering loss of facial nerve innervation to orbicularis oculi?
artificial tears and eye lubricants to protect against dry eye and irritation from inability to close eye properly.
nasal polyps may be associated with 2 features/conditions forming a triad, what are these and what name is given to the triad?
nasal polyps along with asthma and aspirin sensitivity-known as samter’s triad.
complications of local invasion of a cholesteatoma (chronic otitis media with squamous disease)?
facial nerve palsy
vertigo
cerebellopontine angle syndrome
what is cerebellopontine angle syndrome?
result of a SOL at junction of cerebellum and pons
features:
ipsilateral deafness
nystagmus
reduced corneal reflex
trigeminal and facial nerve palsies
ipsilateral cerebellar signs:DANISH-dysdiadochokinesis, ataxia, nystagmus, intention tremor, scanning dysarthria, heel-shin test positivity.
in what condition are bilateral vestibular schwannomas seen?
NF2
investigation of choice for an acoustic neuroma?
MRI-cerebellopontine angle
management of ramsay hunt syndrome (herpes zoster oticus)?
PO steroids and aciclovir
what is black hairy tongue the result of? what are some predisposing factors?
defective desquamation of the filliform papillae predisposing: poor oral hygiene Abx HIV IV drug abuse head and neck radiation
why is medical management of chronic rhinitis the mainstay of treatment rather than surgical?
surgery comes with it’s own set of complications, and chronic rhinitis likely to come back after surgery
main treatment should be avoidance of allergens known to worsen condition, and use of antihistamines and steroid nasal sprays, which usually need to be used indefinitely.
differences in presentation of vestibular neuronitis and a cerebellar stroke?
both can present with dizziness (vertigo) and N+V
however, cerebellar stroke=central lesion=vertical nystagmus rather than the horizontal seen in vestibular neuronitis
cerebellar stoke=vascular insult=SUDDEN onset of symptoms
Rombergs test +ve in vestibular neuronitis BUT pt should be able to stand with their eyes open unaided whereas pt with cerebellar stroke usually cannot stand without support.
management of all unilateral nasal polyps?
require ENT r/f for polyp biopsy to make histological diagnosis to exclude malignancy.
would also do this in the case of unusual features e.g. bleeding.
