emergency ENT - copied toE EXAMS

Question 1

Answer 1

Ludwig’s angina is a form of severe diffuse cellulitis with bilateral involvement, primarily of the submandibular space.

It presents with an acute onset and spreads very rapidly meaning early diagnosis and immediate treatment planning is key to saving lives

Question 2

What must never be missed and could cause avascular necrosis?

Answer 2

septal haematoma

(swelling from the medial side of a fractured nose)

Question 3

What causes hot potato voice and tender, swollen lymph nodes?

Answer 3

A progressively severe sore throat on one side, odynophagia, usually are the earliest symptoms.

As the abscess develops, persistent pain in the peritonsillar area, fever, a general sense of feeling unwell, headache and a distortion of vowels informally known as “hot potato voice” may appear. Neck pain associated with tender, swollen lymph nodes, referred ear pain and foul breath are also common.

PTA should be specifically considered if there is limited ability to open the mouth (trismus).

Question 4

main clinical features of AOM (acute otitis media)

Answer 4

otalgia

fever and deafness

otorrhoea

children; pain often worse at night

Question 5

Otitis media bugs

Answer 5

haemophilus influenzae

streptococcus pneumoniae

moraxella catarrhalis

if viral then short-lived and self-limiting.

Question 6

Management of Otitis media

Answer 6

analgesia. 80% improve spontaneously.

>48hrs require antibiotics

Question 7

Answer 7

osteoma

more in males, unilateral.

often at junction of bony and cartilaginous ear canal.

Question 8

Answer 8

AOM

Question 9

Answer 9

Anatomy

Question 10

Answer 10

otomycosis

Question 11

Treatment, presentation and organism of malignant otitis externa

Answer 11

tympanic membrane normal

Pseudomonas aeruginosa infection which becomes invasive and erodes the temporal bone.

(diabetics are risk group)

>> Offensive discharge, chronic, pain, headaches

abx: ciprofloxacin

(amoxicillin for otitis media)

Flucloxacillin if uncomplicated otitis externa + signs of systemic infection

Question 12

Answer 12

Rinne test

Question 13

Answer 13

Exostoses

broad based and bilateral.

wax can collect behind.

cold water swimmers; inflammatory response to extremes of temperature.

Question 14

What is found here?

Answer 14

• SOLID:
• lymph nodes, cervical rib
• • CYSTIC:
• cystic hygroma (lymphangioma)
• Pharyngeal pouch
• Subclavian aneurysm
  *

Question 15

Name some cystic lumps

Answer 15

• Branchial cyst
• Cystic degeneration of tumour
• Larynogocoele

Question 16

Parotid tail lump - Solid

What other solid lumps are there?

Answer 16

• lymph node
• tumours
• vagal schwannoma

Question 17

What’s this? + info.

Answer 17

Thyroglossal cysts

asymptomatic midline neck mass at or below the level of the hyoid bone, above the thyroid cartilage.

Most often in the midline

They may present in childhood (less than 50%) or, usually as a young adult < 20 years.

Move up when the tongue is protruded & with swallowing- cysts attached to the base of the tongue by the thyroglossal tract.

Question 18

What lumps move with swallowing?

Answer 18

SOLID:

Goitre

lymph node

CYSTIC:

Thyroid cyst

Question 19

What is FNAC?

Answer 19

Fine Needle Aspiration for Cytology

• may be used for neck lumps

Question 20

Some possible red flags for neck lumps

Answer 20

Dark colour suggestive of malignant melanoma,

ulceration,

skin fixation,

bleeding, or

hard texture

Question 21

Otitis Externa

Answer 21

Otitis externa results from a disturbance of the lipid/acid balance of the ear canal.

It is most usually infectious but may be caused by allergies, irritants or inflammatory conditions (all of which may also underlie bacterial infection).

Infection of the outer ear is usually bacterial (90%) or fungal (10%)[4]. Staphylococcus aureus and/or P. aeruginosa.

Fungal infection usually follows prolonged treatment with antibiotics, with or without steroids. About 10% of cases are fungal. 90% of fungal infections involve Aspergillus spp. and the rest are Candida spp.

Herpes zoster (Ramsay Hunt syndrome).

Infection may be localised to an infected hair follicle, causing a furuncle or localised otitis externa (S. aureus is the usual infecting organism).

Question 22

What is Ramsay Hunt Syndrome?

Answer 22

Ramsay Hunt syndrome; varicella-zoster virus (chickenpox) becomes reactivated in the geniculate ganglion of the VIIth cranial nerve (facial nerve) causing facial paralysis, loss of taste, vestibulocochlear dysfunction and pain.

As a general rule, shingles is a disease of sensory nerves but Ramsay Hunt syndrome is distinctive in that there is a motor component.

Question 23

How does an acoustic neuroma present?

Answer 23

should always be considered in patients with unilateral sensorineural deafness or tinnitus.

NB. otosclerosis causes a conductive deafness, and symptoms are bilateral.

Question 24

What could a unilateral nasal polyp be a red flag sign for?

Answer 24

nasopharyngeal cancer and therefore warrant an urgent referral to ENT.

bilateral nasal polyps require non-urgent referral and topical corticosteroid therapy is first-line management.