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GP block (Y3) > Week 5: ENT 2 (common conditions of the nose, mouth and throat) > Flashcards

Week 5: ENT 2 (common conditions of the nose, mouth and throat) Flashcards

1
Q

Nasal polyps Background

A
  • Fleshy, benign swelling of the nasal mucosa
  • Usually bilateral: common (>40 years)
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2
Q

causes of nasal polyps

A
  • They result from chronic inflammation and are associated with:
    • Asthma
    • recurring infection,
    • allergies
    • drug sensitivity
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3
Q

presentation of nasal polyps

A
  • Polyps look slightly lighter
  • In this pic: Emerge out of the middle meatus (between middle and inferior turbinate’s)
  • Pale or yellow in appearance/ fleshy and reddened
  • Symptoms
    • Blocked nose and water rhinorrhoea
    • Post-nasal drip
      • Drip goes into the pharynx and larynx- irritation and cough
      • Decrease smell and reduced taste
      • Sinusitis- blockage of the sinus air cavities
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4
Q

Unilateral poly +/- blood tinged secretion may

A

suggest tumour – cancer

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5
Q

management of nasal polyps

A

Medical management with topical (nasal drops) and possibly systemic corticosteroids is usually considered the initial treatment of choice, with endoscopic sinus surgery reserved for those patients who fail to improve

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6
Q

rhinitis

A
  • Inflammation of the nasal mucosa lining
  • Entire nasal cavity affected- bilateral
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7
Q

causes of rhinitis

A
  • Simple acute infective rhinitis (viral- common cold)
  • Allergic rhinitis- similar symptoms to infective rhinitis
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8
Q

presentation of rhinitis

A
  • Nasal congestion
  • Rhinorrhoea – runny nose
  • Sneezing
  • Nasal irritation
  • Postnasal drip
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9
Q

management of rhinitis

A
  • Topical/ oral nasal antihistamines
  • Topical intranasal steroids
  • Nasal saline wash
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10
Q

septal haematoma

A
  • Potential complication from nasal injury
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11
Q

septal haematoma causes

A
  • Buckling(bending) of cartilage due to trauma
    • Tears/shears blood vessel
    • Accumulation of blood
    • Strips perichondrium away from cartilage (nasal septum)
    • Starving cartilage of blood supply
    • Cartilage dies fibrosis and affects shape
    • Infection can be an issue
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12
Q

diagnosis of septal haematoma

A

must look up the nostrils for swelling

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13
Q

management of septal haematoma

A

must be incised and drain and a tamponade placed to stick perichondrium back onto cartilage

But if you don’t treat septal haematoma- Saddle nose deformity

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14
Q

acute sinusitis

A

<3 weeks

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15
Q

background to acute sinusitis

A
  • Inflammation of the mucous membrane of the paranasal sinuses
  • Paranasal sinuses are air filled spaces lined with resp mucosa and therefor have cilia and goblets cells – extensions of the nasal cavity

Sinuses drain into nasal cavities via ostia’s into a meatus  most commonly the middle meatus

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16
Q

pathophysiology of acute sinusitis

A
  • Infection leads to reduced ciliary function, oedema of nasal mucosa and sinus ostia and increased nasal secretions → that cant drain
  • Maxillary most commonly affected due to gravity
  • Stagnant secretions- breeding ground for bacterial infection
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17
Q

causes of acute sinusitis

A
  • Causes
    • Usually viral infection
      • Rhinovirus
      • Parainfluenza virus
    • Only 3% require antibiotics
      • Streptococcus pneumonia
      • Haemophilus influenzae
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18
Q

presentation of acute sinusitis

A
  • Facial pain- esp when looking down
  • Headache
  • Nasal discharge
  • Loss of smell
  • Nasal obstruction
  • Coryzal symptoms- yellow sputum
  • Vertigo if mucus builds up in eustachian tube
  • Ear pain, tiredsness
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19
Q

management of acute sinusitis

A
  • Analgesia
  • Intranasal decongestants and nasal saline
  • Don’t give abx if symptoms have been present for 10 days or less
  • Intranasal corticosteroids for 14 days if symptoms present for more than 10 days
  • Oral abx e.g. phenoxymethylpenicillin if severe presentation
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20
Q

chronic sinusitis

A

>3 months

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21
Q

causes of chronic sinusitis

A
  • Allergies esp hay fever and environment allergies
  • Nasal polyps/ Deviated septum
  • Resp tract infection
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22
Q

management of chronic sinusitis

A
  • Avoid triggers, stop smoking
  • Nasal irrigation with saline solution to relieve congestion and nasal discharge
  • Intranasal corticosteroids for up to 3 months
  • Specialist referral if unilateral symptoms
  • Recurrent otitis media/pneumonia in child
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23
Q

deviated nasal septum

A
  • A deviated septum occurs when the thin wall (nasal septum) between your nasal passages is displaced to one side. In many people, the nasal septum is off-center — or deviated — making one nasal passage smaller
24
Q

causes of deviated nasal septum

A
  • Present at birth
  • Injury to the nose
25
Q

presentation of deviated nasal septum

A

difficulty breathing, crusting + bleeding, recurrent sinus infections, may also have no symptoms

26
Q

investigations for deviated nasal septum

A

CT scan and nasal endoscopy

27
Q

management of deviated nasal septum

A
  • Nasal sprays including decongestants, antihistamine and corticosteroids
  • Surgery: may need a septoplasty operation to correct the septum deviation if causing significant problems
28
Q

nasal fracture causes

A
  • Trauma to the nose
29
Q

presentation of nasal fracture

A

deformity to the nose, swelling, skin laceration, ecchymosis, epistaxis and CSF rhinorrhea

30
Q

investigations for nasal fracture

A

X-ray would only be needed with more serious injuries needing facial and skull x-ray

31
Q

management of nasal fracture

A
  • non-displaced fractures can be managed conservatively
  • if displaced- manipulation under either local or general anaesthetic, , if not it may need surgery 12 months after the operation
  • must also exclude complications like septal haematoma which would need draining
  • Refer to ENT if required
32
Q

salivary stones (sialothiaiss)

A
  • Most stones are located in submandibular glands
    • Dehydration, reduced salivary flow
    • Most stoned less than 1cm
33
Q

presentation of sialothiasis

A
  • Pain in gland
  • Swelling
  • Infection
34
Q

diagnosis of sialothiasis

A
  • History
  • X-ray
  • Sialogram- contrast dye injected into gland
35
Q

Peritonsillar abscess ‘quinsy’

*

A
  • Diff to tonsilitis
  • Affects tissue around the tonsil
  • If its unilateral (quinsy)→ will deviate the uvula towards the swelling
36
Q

Pharyngeal tonsil (adenoid)- clinical correlates

A
  • Enlarged pharyngeal tonsils
    • Block eustachian tube (recurrent/persistent middle ear infection
    • Snoring/sleep apnoea
    • Sleeping with mouth open
    • Chronic sinusitis
      • Sore throat
    • Nasal tone to voice
37
Q

dysphagia signs and symptoms

A
  • Coughing and chocking
  • Sialorrhea (drooling)
  • Recurrent pneumonia
  • Change in voice/speech (wet voice)
  • Nasal regurgitation
38
Q

causes of dysphagia

A
  • Stroke
    • 30% of post stroke death are due to pneumonia
      • E.g. aspiration pneumonia
  • Progressive neurological disease
  • Parkinson’s/MS
  • COPD
  • Dementia
  • MALIGNANCY e.g. oesophageal cancer
39
Q

interventions of dysphagia

A
  • Fluids are thickened
40
Q

false diverticulum

A

Caused by a posteromedial (false diverticulum)→ arises in weakness between the 2 parts of the inferior constrictor (Killians dehiscence)

  • Probably due to
    • Failure of UOS to relax
    • Abnormal timing of swallowing
      • Essentially there is a higher pressure in laryngopharynx
        • Weakness in inferior constrictor muscle produces outpouching
41
Q

presentation of false diverticulum

A

bad breath

regurg of food

occasional choking on fluids

general difficulty swallowing

42
Q

Tonsilitis

A

inflammation of the palatine tonsils

43
Q

presentation of tonsillitis

A
  • Fever
  • Sore throat
  • Pain/difficulty swallowing
  • Cervical lymph nodes
  • Bad breath
  • Viral causes (most common)
  • Bacterial causes (up to 40% of cases)
    • Strep pyogenes
    • White spots
  • Can be bacterial secondary to viral tonsilitis
44
Q

injury to either the IX (glossopharyngeal) and X (vagus) can cause

A
  • Obvious things
    • Absent gag
    • Uvula deviated away from lesion (Lower Motor Neurone lesion)
    • More subtle
      • Dysphagia
      • Taste impairment (posterior tongue IX)
      • Loss of sensation oropharynx
45
Q

Injury to IX/V caused by

A

Medullary infarct, jugular foramen issues (fracture)

46
Q

injury to XII- hypoglossal

A
  • Wasted tongue
  • Stick tongue out- tongue may deviated
    • Damage to nerve itself (LMN)- points to side of the lesion (tongue never lies)
    • Muscle wasting
    • Fasciculations
47
Q

thyroid nodules differentials

A
  • Common head and neck presentation with patient presenting with thyroid masses or nodules
  • Can be benign or malignant
48
Q

benign causes of thyroid nodules

A
  • Colloid nodules
  • Hyperplastic nodules
  • Thyroid adenoma
  • Thyroid cyst
  • Viral thyroiditis
  • Graves disease
49
Q

malignant causes of thyroid nodules

A
50
Q

investigations for thyroid nodules

A
  • Swallow and stick out tongue
    • Any lump related to thyroid will move on swallowing
    • If the lump moves when tongue being stuck out- thyroglossal
  • TSH and T4 levels
  • US
  • Fine needle aspiration if malignancy suspected
  • Calcitonin levels, calcium and PTH in suspected PT pathology
  • Radioactive iodine uptake- graves and multinodular goitre and thyroiditis differentiation
51
Q

presentation of thyroid nodule

A
  • Presentation
    • Mass effect symptoms of thyroid neck lump
    • SOB due to tracheal compression
    • Dysphagia
    • Hoarseness- irritation of recurrent laryngeal nerve
    • Hyperthyroid symptoms
    • Systemic malignant features e.g. weight loss, night sweats and lymphadenopathy
    • Hypothyroid symptoms
52
Q

cervical lymphadenopathy

A
  • Enlargement of cervical lymph nodes in the neck region
  • Important clinical indicator of underlying condition of infection
53
Q

causes of cervical lymphadenopathy

A
  • Throat infection
  • Dental decay
  • Ear infection
  • Salivary glands
  • Cancer
  • HIV, HEP
54
Q

presentation of cervical lymphadenopathy

A
  • Cervical lymph nodes are usually very small cand cannot be felt upon touch until underlying infection or malignancy has triggered increase in size
  • Symptoms
    • >6 weeks
    • Firm, hard
    • Lymph nodes >2cm
    • Unintentional weight loss, night sweats, appetite loss
    • Exposure to HIV or hep
    • Unexplained fever
    • Any associated facial swelling
55
Q

diagnosis of cervical lymphadenopathy

A
  • Physical exam
  • US, CT and MRI
  • Further test dependent on findings of examination
  • Biopsy needed if malignancy is being considered
  • Persistent cervical lymphadenopathy- FBC, LFT, CRP

GP block (Y3) (39 decks)

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