ENT: Throat + Nose Flashcards by Sam Donnelly

Causes of sore throat

50% Group A beta-haemolytic strep (Strep pyogenes)

How well did you know this?

Not at all

Perfectly

Criteria used to gauge the likelihood of a bacterial (streptococcus) sore throat

Fever Pain Criteria

How well did you know this?

Not at all

Perfectly

Criteria used to identify those likely to benefit from use of antibiotics for a sore throat

Centor Criteria

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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%

How well did you know this?

Not at all

Perfectly

Management for sore throat

Phenoxymethylpenicillin (Penicillin V) 7-10 days

Erythromycin if PA

How well did you know this?

Not at all

Perfectly

Types of “sore throat”

Pharyngitis
Tonsillitis
Laryngitis

How well did you know this?

Not at all

Perfectly

Management of dental abscess

Amoxicillin

How well did you know this?

Not at all

Perfectly

Management of gingivitis

Metronidazole

Chlorhexidine mouth wash

How well did you know this?

Not at all

Perfectly

Thyroid surgery complications

Laryngeal nerve damage (hoarse voice)

Parathyroid gland damage (hypocalcaemia)

How well did you know this?

Not at all

Perfectly

Inflammation pushed the muscles of the mouth floor upwards blocking air entry

Ludwig’s Angina

common in immunocompromised patients

How well did you know this?

Not at all

Perfectly

Tonsillar SCC is associated with

HPV 16

How well did you know this?

Not at all

Perfectly

Tonsillectomy complications

Post op haemorrhage = wound infection
6-8 hours post-op: Return to theatre
5-10 days post-op: Admit + IV ABx

How well did you know this?

Not at all

Perfectly

Severe unilateral throat pain 
Deviation of uvula to unaffected side
Trismus (painful to open mouth)
Reduced neck mobility 
Voice change

Quinsy “Peritonsillar abscess”

How well did you know this?

Not at all

Perfectly

Management of Quinsy

IV ABx + needle drainage

How well did you know this?

Not at all

Perfectly

Globus (lump in throat)
Hoarseness
Chronic cough
Dysphagia 
Heartburn
Sore throat
Erythematous posterior pharynx

Laryngopharyngeal reflux

Caused my GORD

How well did you know this?

Not at all

Perfectly

Management of Laryngopharyngeal reflux

Lifestyle
PPI
Gaviscon

How well did you know this?

Not at all

Perfectly

Causes of gingival hyperplasia

Phenytoin
Ciclosporins
CCBs (Nifedipine)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Investigations for Branchial cyst

FNA: Cholesterol crystals

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

Pulsatile lateral neck mass

Doesn’t move when swallowing

Carotid aneurysm

How well did you know this?

Not at all

Perfectly

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) 1. Pleomorphic adenoma 2. 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

1. Sit forward, mouth open + pinch cartilage for 20 mins - ice on mouth or back of neck 2. If bleeding site seen = silver nitrate cautery 3. If bleeding not seen = co-phenylcaine + packing (rapid rhino pack) 4. Ligation of sphenopalatine artery 5. Ligation of external carotid Can also give topical antiseptic (chlorhexidine + neomycin) to decrease risk of vestibulitis + crusting - contraindicated in nut allergy, use Mupirocin instead