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1
Q

What is the most common bacterial cause of sore throat?

A

Strep pyogenes

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2
Q

What are the potential acute and long-term complications of strep throat?

A

Acute: peritonsillar abscess (quinsy), sinusitis, otitis media, scarlet fever.

Late: rheumatic fever (3 weeks post infection), glomerulonephritis (1-3 weeks post op)

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3
Q

How does diphtheria present?

A

Severe sore throat, lymphadenopathy, grey/white membrane across the pharynx

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4
Q

How is diphtheria treated?

A

Antitoxin+ penicillin/erythromycin

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5
Q

Which bacteria are often implicated in acute otitis media?

A

H. influenzae
Strep pneumoniae
Strep pyogenes

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6
Q

How is acute otitis media treated?

A

Most resolve without antibiotics. If perforation/otorrheoa- amoxicillin 1st line 7 days, 2nd line doxycycline

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7
Q

When should antibiotics be used in sinusitis and what is first-line?

A

Deteriorating cases of 7-10 days duration

Penicillin

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8
Q

How is oral thrush treated?

A

Nystatin

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9
Q

What is the classic triad of symptoms in mono?

A

Pharyngitis, lymphadenopathy, fever

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10
Q

What other signs/symptoms may be seen in mono?

A

Palatal petechiae
Jaundice
Splenomegaly

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11
Q

Which lab tests can be used to confirm mono?

A

Blood film- atypical lymphocytes, lymphocytosis.
Heterophil antibody tests
EBV IgM

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12
Q

Which lab tests can be used to confirm mono?

A

Blood film- atypical lymphocytes, lymphocytosis.
Heterophil antibody tests
EBV IgM

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13
Q

How does primary gingivostomatitis present and what is the cause?

A

In childhood-systemic upset, lesions on buccal mucosa and lips
Herpes simplex virus (HSV-1)

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14
Q

Coxsackie enterovirus causes which ENT infections?

A

Hand foot and mouth

Herpangina

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15
Q

Coxsackie enterovirus causes which ENT infections?

A

Hand foot and mouth

Herpangina

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16
Q

What is a cholesteatoma?

A

Squamous epithelium trapped in the skull base

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17
Q

What signs/symptoms are often seen in acute otitis media?

A

Otalgia
Bulging tympanic membrane
Otorrheoa

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18
Q

Why is epiglottitis now less common in children?

A

Immunisation against H. influenzae B

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19
Q

Where is the narrowest part of a childs airway?

A

Sub-glottic space

20
Q

What are the signs of increased work of breathing?

A

Accessory muscle use
Tracheal tug
Sternal indrawing

21
Q

What other signs may indicate a compromised airway?

A

Stridor
Central cyanosis
Inability to complete sentences
Absent chest sounds

22
Q

How should a compromised airway be managed?

A

A B C approach
Nebulised corticosteroids
Nebulised adrenaline

23
Q

How should a compromised airway be managed?

A

A B C approach
Nebulised corticosteroids
Nebulised adrenaline

24
Q

What causes most cases of tonsilitis?

A

Viruses- influenza virus, rhinovirus, EBV

25
What is the purpose of the Centor criteria and what are they?
Distinguish bacterial from viral strep throat (and guide whether to give antibiotics) If three of: fever, purulent tonsils, cervical lymphadenopathy, NO cough then antibiotics may be of benefit
26
What is the empirical treatment of bacterial tonsilitis?
10 days penicillin or erythromycin if true penicillin allergy
27
What are the SIGN guidelines for tonsillectomy?
Tonsillectomy should only be considered if: a) 7 or more episodes in previous year b) 5 or more episodes in each of two previous years c) 3 or more episodes in each of three previous years
28
What is the classical history of quinsy?
History of preceding acute tonsillitis | Unilateral throat pain, dysphagia and trismus
29
How is quinsy treated?
Aspiration of abscess + antibiotics
30
Why should ampicillin and amoxicillin never be used in tonsilitis/glandular fever?
Causes a widespread severe rash in EBV-infected patients
31
How can otitis media with effusion be managed surgically?
Grommet insertion | Adenoidectomy if persistent
32
How can otitis media with effusion be managed surgically?
Grommet insertion | Adenoidectomy if persistent
33
What should be excluded in any patient with unilateral deafness, tinnitus and/or facial nerve palsy? How would this be achieved?
Acoustic neuroma (vestibular Schwannoma). MRI brain scan
34
How is Meniere's disease managed?
Lifestyle: avoid salt, caffeine, alchohol. Tinnitus therapy Hearing aids Betahistine may be trialled
35
What more invasive treatments can be tried for Meniere's disease?
Grommet insertion | Intratympanic steroids/gentamicin
36
Which test is used to clinically confirm posterior BPPV?
Dix-Hallpike test. Patient sits on couch so that head will be off the end if they lie down, ask patient to turn head to 45 and warn not to close eyes if dizzy, lie the patient back as quickly as possible, hold in position and observe. Positive test is nystagmus after a delay of around 30 seconds
37
How does labrynthitis differ from vestibular neuronitis?
Vestibular neuronitis= prolonged vertigo | Labyrinthitis- may be associated hearing loss/tinnitus
38
What disease may BPPV be confused with? What other symptoms need to present for this diagnosis to be made?
Vertebrobasilar insufficiency | Need other central neurological symptoms + vertigo, e.g. visual disturbance, weakness, numbness
39
What disease may BPPV be confused with? What other symptoms need to present for this diagnosis to be made?
Vertebrobasilar insufficiency | Need other central neurological symptoms + vertigo, e.g. visual disturbance, weakness, numbness
40
What are the mainstays of treatment of allergic rhinitis?
Oral antihistamines | Topical nasal corticosteroids
41
What are the two main symptoms of nasal polyps?
Rhinorrhoea | Nasal obstruction
42
What is the mainstay of treatment of nasal polyps, and why should unilateral polyps always be referred?
Topical nasal corticosteroids | Investigation of possible underlying malignancy
43
What are the possible complications of sinusitis?
``` Orbital cellulitis Meningitis Cavernous sinus thrombosis chronic infection brain abscess osteomyelitis ```
44
Sudden onset off facial nerve palsy often after URTI
Bell's palsy
45
Why does stroke spare the upper face?
Bilateral motor innervation of the upper face
46
Management of Bell's palsy?
High dose oral steroids + eye protection (taping, ocular lubricants)

ENT (21 decks)

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