secondary care Flashcards
what tuning for is used for ear examination and why must it be that frequency
512 Hz -> if it is a lower frequency then the vibration will be felt more easily and hear less easily
what are the 5 cardinal symptoms of otology
- pain
- discharge
- tinnitus
- vertigo
- hearing loss
mgx for simple otitis externa
- abx drops - ciprofloxacin/gentamicin
- keep ears dry e.g. cover in vaseline if going in water
what causative organism does otitis externa with yellow discharge indicate
pseudamonas areugosia
what causative organism does otitis externa with white creamy discharge indicate
s. Aureus
what causative organism does otitis externa with white discharge indicate
candida
what causative organism does otitis externa with black spores in discharge indicate
apergillus
how long should anti-fungals be given for in otitis externa
2 weeks and then a further 2 weeks after resolving
what is “swimmer’s ear”
otitis externa
what are the ENT lymphnode categories
1a - submental
1b - submandibular
2 - upper jugular (base of skull -> hyloid)
3 - hyloid -> cricoid
4 - lower jugular
5 -posterior triangle (posterior SCM, boarder of trapezius, middle 1/3 of clavical)
6 - anterior triangle (including thyroid)
7 - superior mediastinum
why does the thyroid move when swallowing
it is connected to the trachea via barry’s ligament
why do thyroglossal cyst move on tongue protrusion
embryologically, the thyroid develops from the base of the tongue -> cyst arises from cluster of cells left during formation and so they are attached to the tongue
why can throat pain be referred to the ear
the ear is supplied by the glossopharengeal and vagus nerves (jacob’s plexus) which can refer pain there from the ear
examples of drugs that can cause salivary drying (3)
- amytriptiline
- opiates
- lithium
how can a lipoma be distinguished from other cystic swellings
edges are not distinct
what are the 3 major salivary glands
- parotid
- sublingual
- submandibular
what is stenson’s duct
the main excretory duct of the parotid gland
what is the rule of 80s (salivary tumours)
80% of all salivary tumors are in the parotid, 80% of parotid tumors are benign, and 80% of the benign tumors that arise in the parotid are pleomorphic adenomas
what is a pleomorphic adenoma
benign salivary gland tumors, which predominantly affect the superficial lobe of the parotid gland
what is wharton’s duct
the submandibular gland’s primary excretory duct
what nerves run near to the submandibular gland
CN VII (marginal mandibular); CN XII; lingual nerve (CN V3)
what is pemberton’s sign
used to evaluate venous obstruction in patients with goiters -> The sign is positive when bilateral arm elevation causes facial plethora
why does pemberton’s sign arise
It has been attributed to a “cork effect” resulting from the thyroid obstructing the thoracic inlet (due to goitre), thereby increasing pressure on the venous system
what other symptom is associated w glandular fever (other than swollen tonsils)
hepato/splenomegaly
what are the tonsil grades
grade 1 - This is the normal size of the tonsils, Tonsils occupy less than 25 percent of the oropharynx. The tonsils are not visible properly.
grade 2 - This size is also considered as normal size and the tonsils extend to the pillars. Tonsils occupy 26 to 50 percent of the oropharyngeal airway.
grade 3 - The tonsils can get infected leading to its inflammation. Due to this inflammation, these take up 75% of the oropharyngeal airway. Also, tonsils extend beyond pillars but stop beyond the midline.
grade 4 - The tonsils reach each other and extend to the midline. This is the most enlarged size of tonsils as these take more than 75% of the airways.
3 key features of quinsy
- trismus
- unilateral deviation/uvula deviation
- voice change (hot potato)
abx for quinsy
IV - benzyl penicillin (+fluids + steroids)
oral - Pen V (Phenoxymethylpenicillin)
where is the aspiration performed in quinsy
at the base of the uvula and tonsillar pharyngeal wall
indications for tonsillectomy
- tonsillitis 7 times in 1 year
- peritonsilar abscess
- asymetrical abscess
- suspicion of malignancy
- OSA/ snoring
- speech abnormalities
- dysphagia
risks of neck abscess draining (3)
- incomplete drainage
- recurrence
- risk of injury to important structures e.g. carotid sheath
what is the centor criteria
determines the likelihood of there being a bacterial tonsillitis
1. fever ≥ 38 °C
2. absence of cough
3. swollen anterior cervical lymph nodes
4. tonsillar exudates or swelling
complications of tonsillectomy
- Odynophagia (pain on swallowing)
- bleeding (primary within 24hrs due to surgical reasons or secondary due to infection)
- pulmonary complications
- infection
what should be done in epistaxis to prevent vomiting
sit pt forwards and spit blood out so as to not aspirate of swallow -> swallowing blood can induce vomiting
why does CPAP machine usage increase the risk of epistaxis
it dries out the nasal mucosa
what is an ear wick
a device used to put abx drops into the ear when the ear canal is very swollen/narrow -> otitis externa
how long is the antifungal treatment of otomycosis usually for
1 month
otitis externa mimic
furunculosis in ear - an infected hair follicle at the entrance to the ear canal;
Symptoms may include: sudden onset, extreme pain and a red swelling in the outer canal
what is the sinonasal outcome test (SNOT)
a validated patient-reported outcome measure for chronic rhinosinusitis
dislocation of what leads to deviated frontal septum
Columella: The tissue that links the nasal tip to the nasal base, and separates the nares
what simple test can be used to assess nasal airwaypatency
condensation test
what is a nasal polyp
oedema of mucous lining of the nose causing herniation through the basement membrane
if nasal polyps are present in children what other underlying condition might this indicate
Cystic fibrosis
nasal polyps mgx
- systemic sterois
- steroid spray
- antohisthamine
- monteluekast
- abx
what is nasal vestibulitis
an infection in your nostrils, near the opening of your nose
nasal vestibulitis mgx
- nasceptin
- bactroban
- vaseline
hoe does septal perforation lead to being unable to breath properly
results in turbulent disrupted airflow through the airways
what is an inverted papilloma
a benign but locally aggressive tumor that arises in the nasal cavity and paranasal sinuses - may present as a polyp
