ENT: Throat + Nose Flashcards
Causes of sore throat
50% Group A beta-haemolytic strep (Strep pyogenes)
Criteria used to gauge the likelihood of a bacterial (streptococcus) sore throat
Fever Pain Criteria
Criteria used to identify those likely to benefit from use of antibiotics for a sore throat
Centor Criteria
Tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever
Absence of cough
Centor Criteria
0-2 = 3-17% risk of Strep 3-4 = 32-56% risk of Strep
Fever > 38 Purluence Attend rapidly (< 3 days) Severely inflamed tonsils No cough/ coryza
Fever pain Criteria
0-1: 13-18%
2-3: 34-40%
4-5: 62-65%
Management for sore throat
Phenoxymethylpenicillin (Penicillin V) 7-10 days
Erythromycin if PA
Types of “sore throat”
Pharyngitis
Tonsillitis
Laryngitis
Management of dental abscess
Amoxicillin
Management of gingivitis
Metronidazole
Chlorhexidine mouth wash
Thyroid surgery complications
Laryngeal nerve damage (hoarse voice)
Parathyroid gland damage (hypocalcaemia)
Inflammation pushed the muscles of the mouth floor upwards blocking air entry
Ludwig’s Angina
- common in immunocompromised patients
Tonsillar SCC is associated with
HPV 16
Tonsillectomy complications
Post op haemorrhage = wound infection
6-8 hours post-op: Return to theatre
5-10 days post-op: Admit + IV ABx
Severe unilateral throat pain Deviation of uvula to unaffected side Trismus (painful to open mouth) Reduced neck mobility Voice change
Quinsy “Peritonsillar abscess”
Management of Quinsy
IV ABx + needle drainage
Globus (lump in throat) Hoarseness Chronic cough Dysphagia Heartburn Sore throat Erythematous posterior pharynx
Laryngopharyngeal reflux
- Caused my GORD
Management of Laryngopharyngeal reflux
Lifestyle
PPI
Gaviscon
Causes of gingival hyperplasia
Phenytoin
Ciclosporins
CCBs (Nifedipine)
Mobile cystic mass Oval shaped Between sternocleidomastoid + pharynx Unilateral Water consistency
Branchial cyst
- common in early adulthood
- remnant of the 2nd branchial cleft
- doesn’t show on US
Investigations for Branchial cyst
FNA: Cholesterol crystals
Lump left side of neck, posterior to sternocleidomastoid
Painless fluid-filled
90% present < 2 years old
Hypoechoic on US
Cystic Hygroma
- congenital lymphatic lesion (lymphangioma)
Pulsatile lateral neck mass
Doesn’t move when swallowing
Carotid aneurysm
Neck swelling
Post-viral illness
Reactive lymphadenopathy
- most common neck swelling
Midline neck swelling
Non-tender
Moves upwards upon swallowing
Weight loss etc
Goitre
Rubbery neck mass Painless lymphadenopathy Pain (with alcohol) Night sweats Splenomegaly
Lymphoma
Age <20s
Midline neck swelling
Anterior triangle, midline
Between isthmus of thyroid + hyoid bone (below)
Moves upwards with protrusion of the tongue
Painful if infected
Thyroglossal cyst
- thin walled doesn’t show on US well
Midline lump in neck Gurgles on palpitation Dysphagia Halitosis Regurgitation Aspiration Chronic cough
Pharyngeal pouch
- Older males
Posteromedial herniation
Pus from salivary ducts
Erythema
Sialadentitis
- Staph aureus infection (usually)
- Can develop into submandibular abscess
Colicky pain
Post prandial swelling
Halitosis
Sialolithiasis
Stones in salivary glands
- 80% occur in submandibular gland
- 70% stones are radio opaque
Stone impacted in distal aspect of Wharton’s duct
Sialolithiasis stones are made from
Calcium phosphate
Calcium carbonate
Investigation for Sialolithiasis
Sinlography to find site of obstruction
Management for Sialolithiasis
Removed orally
Gland excision
Salivary glands produce
800-1000ml per day
- more serous liquid when increased parasympathetic activity
Most common salivary gland tumours
Serous (from parotid)
- Pleomorphic adenoma
- Adenolymphoma (papillary cyst adenoma lymphoma) “Warthin’s tumour”
Slow growing salivary gland mass
Smooth
Mobile
Pleomorphic adenoma
- 80% superficial lobe
- epithelial + myo-epithelial cells
Management of Pleomorphic adenoma
Parotidectomy
Lymphocytic infiltration + cystic epithelial proliferation
Found in tail or parotid gland
Adenolymphoma (papillary cyst adenoma lymphoma) “Warthin’s tumour”
- common in elderly males in 60-70s
Management for idiopathic rhinitis
Ipatropium
Facial pain (worse on bending forward) Thick purulent nasal discharge
Sinusitis
- can lead to cerebral abscess
if gets better, then worse again = bacterial
Risk factors for sinusitis
Obstruction
Local infection
Swimming/ diving
smoking
Causes of sinusitis
Strep pneumoniae
Haemophilus influenzae
Rhinovirus
Viral
Management of sinusitis
Analgesia
>10 days: Intranasal corticosteroids
Severe: Penicillin V
Management of nasal haematoma
Drainage
- may lead to septic necrosis
Sneezing Bilateral nasal obstruction Clear nasal discharge Post-nasal drip Nasal pruritus
Allergic rhinitis
Seasonal: hay fever
Perennial: throughout the year
Occupational: Particular allergens
- IgE sensitivity
Management of Allergic rhinitis
Mild: Antihistamines
Severe: Corticosteroids
Oxymetazoline (decongestant)
- can cause rebound congestion if chronic use
Montelukast
Rebound nasal discharge
Rhinitis Medicamentosa
Management of unilateral nasal symptoms
ENT Referral
Otalgia
Unilateral serous otitis media
Nasal obstruction + discharge
Cranial nerve palsies
Nasopharyngeal carcinoma
- Squamous cell carcinoma
- Associated with EBV
- Southern Chineses patients
Management of Nasopharyngeal carcinoma
Radiotherapy
Nasal obstruction
Rhinorrhoea
Sneezing
Decreased sense of smell + taste
Nasal polyps
- 3M:F
Nasal polyps are associated with
Asthma Aspirin insensitivity Infective sinusitis CF Kartagener's syndrome Churg-Strauss Syndrome
Management of Nasal polyps
ENT referral
Topical corticosteroids
Asthma
Aspirin sensitivity
Nasal polyps
Samter’s triad
Location of anterior epistaxis bleed
Kesselbach’s plexus (Little’s area)
Posterior epistaxis bleeds
Risk or airway compression
Common in elderly
Management of epistaxis
- Sit forward, mouth open + pinch cartilage for 20 mins
- ice on mouth or back of neck
- If bleeding site seen = silver nitrate cautery
- If bleeding not seen = co-phenylcaine + packing (rapid rhino pack)
- Ligation of sphenopalatine artery
- Ligation of external carotid
Can also give topical antiseptic (chlorhexidine + neomycin) to decrease risk of vestibulitis + crusting
- contraindicated in nut allergy, use Mupirocin instead
