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Year 3 GP Block Aashi Jade Pam > ENT > Flashcards

ENT Flashcards

(98 cards)

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1
Q

What is the function of the Eustachian tube?

A

Connect middle ear with nasopharynx, equalise pressure, drain mucus from middle ear, aerate middle ear.

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2
Q

A child present with otitis media with effusion. It has been ongoing for 10 days now, and the child is not getting any better. Obs include a temperature of 37.9C, the child looks in pain, pulling at ear. With regard to the Eustachian tube, why is it important to resolve this infection?

A

Not resolved = can lead to speech impediment and delay in language development or school performance

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3
Q

A man presents with a 3 day onset of facial pain, nasal discharge and headache. He has a recent PMH of a URTI. What is your diagnosis?

A

Acute Sinusitis

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4
Q

A child presents with acute otitis media. What might you find on examination?

A

Using otoscope, find a bulging, red/yellow/cloudy TM, potential perforation, some discharge in ear canal

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5
Q

A 1 year old child comes in to the GP surgery to see the on call doctor. His notes mention acute otitis media 6 days ago. His temperature is 39C. He is not acting himself. On examination he has neck stiffness and a non-blanching rash on his back. What are your next steps?

A

Arrange ambulance for immediate admission to Paeds A&E. Child may have meningitis - a complication of acute otitis media.

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6
Q

A woman may have BPPV after listening to her Hx. What manoeuvres would you carry out if comfortable to do so?

A

Dix-Hallpike, Epley

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7
Q

Describe the presentation of vestibular neuritis

A

Rotational vertigo which happens spontaneously, nausea, vomiting, balance problems, tinnitus, recent URTI

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8
Q

What are the causes of acute sinusitis?

A

Post- URTI

Tooth infection

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9
Q

How does acute sinusitis present

A

Frontal headache, facial pain, worse on movement , worse on bending, nasal discharge and +/- fever

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10
Q

What is chronic sinusitis?

A

Over 3 months or greater than 3 episodes of sinusitis in a year

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11
Q

How does chronic sinusitis present?

A

Over 3 months or greater than 3 episodes of sinusitis in a year

Post nasal drip, frontal headache, facial pain, blocked nose, PMH of nasal polyps

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12
Q

How do you treat acute sinusitis?

A

Supportive- analgesia, fluids, steam inhalation, decongestants

Abx if very severe- amoxicillin

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13
Q

How does acute Otitis media present?

A

Earache, fever, in kids, children- tugging ear, restlessness, poor feeding , cough, runny nose

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14
Q

How does acute otitis media look on a otoscope?

A

Red, yellow, cloudy TM; bulging TM, possible perforated, some discharge in ear canal

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15
Q

How do you treat acute otitis media?

A

Analgesia, safety net on worsening sx, Abx only needed if no improvement in symptoms within 3 days.

Abx- 5-7 day–> amoxicillin/erythromycin

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16
Q

What is the presentation of otitis media with effusion?

A

Hearing loss, aural fullness, crackling, popping tinnitus, aural pain, dizziness.

Children- the above + mishearing, lack of conc, impaired speech, impaired school progress, hx of URTI, ear infection

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17
Q

What are the otoscope findings for otitis media with effusion?

A

TM is yellow or amber, retracted, loss of cone of light, air bubbles

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18
Q

How do you treat otitis media with effusion

A

Watch and wait for 3 months, hearing tests 3 months apart with audiometry and tympanometry.

grommets after 3 months

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19
Q

How does Otitis externa present?

A

Itchy, severe ear pain, which is worse when more ear/otoscope inserted, discharge on pillow, tenderness on moving jaw, fever,

V serious cases–> loss of hearing, tender regional lymphadenitis

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20
Q

What are the otoscope findings in Otitis externa?

A

red, swollen ear canal, shedding of scaly skin in ear, pus in ear canal, discharge, inflamed eardrum

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21
Q

How do treat otitis externa?

A

Analgesia- oral paracetamol, ibuprofen, warm flannel, topical abx, topical acetic acid 2%.

Oral abx if swollen ear canal, celluitis beyond ear canal,
Flucloxacillin for 7 days, or erythromycin
Self care - no swimming! Keep dry. Use ear drops such as EarCalm

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22
Q

What is BPPV?

A

Benign paroxsymal positional vertigo.

Vertigo brought on by moving/changing positions. Vertigo <1 min

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23
Q

What are the symptoms of BPPV?

A

Vertigo lasts less than minute
Nausea and Vomitting
Light headless

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24
Q

How do you investigate BPPV?

A

Dix- Hallpike- diagnostic

Epley- helps relieve the dizziness

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25
How do you manage BPPV?
Repositioning to help symptoms | Advise on safety e.g. driving, workplace, falls at home
26
What is vestibular neuritis?
Inflammation of inner ear labyrinth.
27
How does vestibular neuritis present?
Rotational vertigo happens spontaneously. Can worsen as the day goes on Nausea and vomitting Balance affected Recent URTI
28
How is vestibular neuritis management?
Reassure, symptoms get better within few days Bed rest Safety issues If symptoms of nausea and vom--> buccal prochlorperazine or oral if severe
29
What is Mernieres disease?
``` Spontaneous vertigo Tinitus Fluctuating SN hearing loss Aural fullness Balance problems Postural instability ```
30
How do you investigate Mernieres disease?
Refer ENT to confirm diagnosis | Refer if no improvement in 5-7 days
31
How do you treat Mernieres?
Admit if sx are severe Refer to ENT, audiology Reassure will mostly settle within 24 hrs Prochlorperazine for nausea or antihistamine. To prevent further attacks, trial betahistine
32
What symptoms can ear wax cause?
``` Hearing loss Blocked ears discomfort earache itchiness ```
33
How do you treat earwax?
Soften it using sodium bicarb, olive oil--> use 3-4x daily for 3-5 days Ear irrigation Microsuction
34
What is presbycusis?
Gradual hearing loss in older people, difficulty understanding speech, tinnitus
35
What is otosclerosis?
``` Gradual onset of hearing loss in patients between 30-50 Bilateral usually, unilateral is rare Fhx of hearing loss Speaking softly Hearing better in noisy surroundings ```
36
What are the investigations in otosclerosis?
Conductive pattern in Rinne's and Webers audiometry, CT scan
37
How do you treat otosclerosis?
Refer to ENT, bilateral hearing aids, surgery to remove part of stapes
38
What are the symptoms of cholesteatoma?
``` Discharge from the ear Hearing loss Tinnitus If advanced: Otalgia Vertigo facial N involvement ```
39
What are the otoscopic findings of cholesteatoma?
Deep retraction pocket TM, crust/ keratin in upper TM, TM perforation
40
How do you treat cholesteatoma?
referral for surgery. If infection is present, treat for OE or OM
41
Presentation of tonsillitis
Fever Sore throat Pain on swallowing tonsillar exudate
42
Indicates viral tonsillitis rather than bacterial?
Coryzal symptoms and cough= viral
43
Examination findings in tonsillitis?
Inflamed tonsils White on the tonsils Fever
44
Management of tonsillitis?
Self limiting- conservative: analgesia, water, rest | If no change in 5 days, abx: erythromycin or penicillin for 5-10 days
45
Scoring system for an acute sore throat?
FeverPAIN
46
Complications of tonsillitis?
Peritonsillar abscess | Glandular fever
47
Presentation of glandular fever?
Fever Enlarged lymph nodes Sore throat general malaise
48
Investigations for glandular fever?
Blood test for EBV
49
Management of glandular fever?
Conservative | If cannot swallow fluids - admit to hospital
50
Complication of glandular fever?
Splenic rupture
51
Presentation of tonsillar tumour?
Elderly Sore throat for >1 month Difficulty swallowing
52
Management for tonsillar tumour?
Refer to ENT
53
Presentation of laryngitis?
``` Sore throat Fever Pain using voice Hoarseness Hx of URTI ```
54
Management of laryngitis?
Conservative- rest, fluids and analgesia, self limiting, resolves 1-2 weeks Rarely abx if bacterial infection is suspected
55
Presentation of vocal chord nodules?
hoarseness | repetitive use of voice e.g. singer
56
Presentation of laryngeal cancer?
``` Hoarseness Neck lump difficulty swallowing Pain 45yrs and over hx of smoking/ alcohol excess ```
57
Presentation of croup?
``` young children barking cough usually at night difficulty breathing mild fever sometimes stridor ```
58
Management of croup?
usually self limiting- give dexamethosone May need hospital admission for O2
59
Examination findings in croup?
Increased RR Clear chest No cyanosis Normal O2 sats
60
Presentation of epiglottitis?
``` Stridor Sniffing position drooling v unwell fever Hx of bacterial infection ```
61
Management of epiglottitis?
Straight to hospital for IV abx
62
Presentation of branchial cyst in adults?
Painless cyst on anterior border of SCM Smooth Usually noticed after URTI
63
Examination findings of branchial cyst?
Does not move on swallowing
64
management of branchial cyst?
refer to ENT
65
Presentation of thyroglossal cyst?
Midline cyst Smooth May be inflamed- tender with localised swelling
66
Examination findings for thyroglossal cyst?
Moves with tongue protrusion
67
Management of thyroglossal cyst?
Refer to ENT
68
Presentation of epistaxis
Nosebleeds | hx of trauma? hx of infection
69
Investigations in epistaxis?
If recurrent/regular FBC to check for anaemia
70
Examination in epistaxis?
Look into nose
71
Management for epistaxis?
Acute- hold soft part of nose and lean forward If recurrent- cauterise or nasal packing If bleeding from posterior part- admit to hospital Self care advice- no blowing or picking nose, no hot drinks or alcohol and no lying flat
72
Presentation of nasal polyps?
``` Snoring post nasal drip blocked nose stuffy nose Fix of asthma ```
73
Examination for nasal polyps?
Look up nose- bilateral smooth polyps | Unilateral/ irregula-?malignancy
74
Management for nasal polyps?
Nasal spray- steroid | Abx if discharge
75
Presentation of septal haematoma?
Pain | associated fracture/ recent nasal trauma
76
Examination of septal haematoma?
Look into nasal passages - see bilateral soft bulging of the septum.
77
management of septal haematoma?
Refer to ENT
78
Presentation of allergic rhinitis?
``` Itchy nose/eyes/throat Sneezing red eyes Nasal congestion bilateral Hx of atopy? ```
79
Management for allergy rhinitis?
Self care- NHS leaflets OTC nasal spry Antihistamine Sever- corticosteroids intranasally for periods of exposure
80
Presentation common cold?
``` Sore throat, Rhinorrhoea, cough, hoarse voice, general malaise Onset is 1-2days and rapid Fever, headache, loss of taste/smell, pressure in ears/sinuses ```
81
Examination of common cold?
Examine for viral spread to other organs facial pain? sinusitis chesty cough, asthma? LRTI ear pain/dishcarge? acute otitis media
82
Management of common cold?
Adequate fluids, rest, analgesia, anti-pyretic. Steam inhalation, gargling salt water, vapour rubs. Follow up if symptoms worsen after 5 days or persist after 7-14days.
83
Presentation fo deviated nasal septum?
Secondary to injury May also present with external deformity Unilateral nasal blockage
84
Management of deviated nasal septum
Treat mucosal swelling as if rhinitis. Not helped? Refer to ENT for surgery
85
Presentation of septal perforation?
Bleeding, crusting Pain/discomfort Recent Hx of trauma, nose picking , malignancy Substance misuse - cocaine
86
Management of septal perforation?
Refer if features of malignancy Treat symptomatically - vaseline, and antiseptic nasal spray for crusting Refer for surgery if symptomatic treatment not helping
87
Presentation of snoring/sleep apnoea
``` Sleeping in the day Snoring Witnessed brreathing pauses Gasping or choking when sleeping Unrefreshed sleep Unexplained morning headache Wakes up in the night Nocturia Obese, depressed, HTN, stroke ```
88
What examinations would you do for sleep apnoea?
BMI, BP Examine for COPD signs, jaw abnormalities, nasopharyngeal obstruction, check neck circumference
89
Management for sleep apnoea
Referral to sleep clinic Referral to paeds ENT if a child with adenotonsillar hypertrophy or regular snoring at night. Manage weight, lifestyle. NHS leaflets of sleep apnoea
90
Presentation of nose fracture?
``` Pain, swelling, redness Crack/crunch when touch nose Hard to breathe through nose Shape of nose changed Bruising under eyes, cut on nose, nosebleeds ```
91
Management of nose fracture?
Advise ice pack, analgesia, treat nosebleeds, keep head upright when lying down, strong painkillers Refer if not getting better
92
Presentation of non-allergic rhinitis?
Blocked nose sneezing irritation of nose loss of smell
93
Management of non-allergic rhinitis?
Rinsing nasal passafe | Nasal spray with steroids
94
Why are tinnitus and hearing loss NOT a feature of vestibular neuronitis?
As cochlea and cochlear nerve not affected
95
If a pt presents with vertigo, tinnitus and hearing loss which 2 diagnosis should you consider?
Labrinthitis | Mernieres disease
96
Compare labyrinthitis and vestibular neuronitis in terms of hearing loss
Labyrinthitis - hearing loss | Vestibular neuronitis - no hearing loss
97
If vertigo is present as a symptom what is important to explore?
``` If central (brain) or peripheral (inner ear) cause Neuro signs - central, urgent management e.g. posterior circulation infarction (stroke) ```
98
What is typical triad of mernieres?
Hearing loss Vertigo Tinnitus (Can get fullness in ear)

Year 3 GP Block Aashi Jade Pam (14 decks)

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