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FCM - Year 1 PA > ENT > Flashcards

ENT Flashcards

1
Q

What is stridor?

A

High pitched sound/ whistling on inspiration
Commonly caused by a lower respiratory tract infection - below the larynx

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2
Q

What are differentials for stridor (children)?

A

Croup ( commonly caused by a virus - typically parainfluenza virus)
Epiglottitis (bacterial cause - Haemophilus influenza B)
Anaphylaxis
Foreign body
Trauma
Congenital

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3
Q

What are differentials for stridor (adults)?

A

Laryngitis
FB
Trauma
Epiglottitis
Laryngeal tumour
Anaphylaxis
Iatrogenic - neck surgery/ prolonged intubation

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4
Q

What is epiglottitis? Aetiology? Risk factors?

A

Inflammation of the epiglottitis (closes to prevent food bolus entering the trachea)

Medical emergency

Invasion of bacteria to the epiglottitis or supraglottic tissue
Bacterial cause - commonly haemophilus influenza b/ streptococcus pneumonia/ streptococcus aureus

Risk factors - young children 6-12/ unvaccinated/ immunocompromised

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5
Q

Epiglottitis - signs + symptoms

A

Swollen epiglottitis
Erythema
Severe sore throat
Dysphagia
Odynophagia
Drooling
Distress

3 D’s - drooling/ distress/ dysphagia

Children ( few hours)/ Adults (few days)

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6
Q

Epiglottitis - investigations + management

A

Clinically diagnosed -
if pt stabilised further investigation can be considered
Soft tissue x-ray - thumbprint sign

Emergency management

Call secondary care
O2 supplementation
IV fluids
IV anti-biotics - ceftriaxone

If awaiting ambulance consider nebulised adrenaline

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7
Q

Nasopharyngeal + oral cancer risk factors

A

South Asian background
Aged 40-70
EBV (nasal)
Males
Smoking
Excessive alcohol intake
Chewing tobacco
HPV

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8
Q

Nasopharyngeal + oral cancer signs + symptoms

A

Palpable mass/ lump
Painless ulcerations
Bleeding of mouth/gums
Dysphagia
Swelling of lymph nodes
Blood tinged sputum
Unilateral hearing loss
Localised pain
Changes to appetite

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9
Q

Head + neck cancer diagnosis?

A

US of neck/ biopsy/ MRI or CT/ laryngoscopy

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10
Q

Tonsillitis - diagnosis/ aetiology/ risk factors

A

Inflammation of tonsils

Causes -
Viral - adenovirus/ EBV/ parainfluenza etc
Bacterial - commonly streptococcus A

Risk factors-
Younger age/ family history / immunosuppressed

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11
Q

Tonsillitis - Investigations/ management

A

Clinical diagnosis

Not routinely performed - microbiological testing/ throat culture/ rapid antigen test

Management -

Viral - conservative/ hydration/ salt water/ analgesia

Bacterial - anti-biotics
1st line - phenoxymethylpenicillin
2nd line -
Clarithromycin
3rd line-
Erythromycin if pregnant

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12
Q

What are the Group A streptococcus tonsillitis diagnosis criteria?

A

Centre criteria
FeverPAIN criteria

Score 3-4 - anti-biotics are recommended

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13
Q

Quinsy - definition + aetiology/ risk factors

A

Commonly occurs as a complication of acute tonsillitis/ bacterial cause

Formation of an abscess between the wall of pharynx and tonsil

RF- Acute tonsillitis/ 5-25yrs

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14
Q

Quinsy - Investigations + management

A

Clinical diagnosis
Routine blood test - FBC, U&E, CRP, LFTs - access inflammatory markers + dehydration
Swab culture

Management-

Immediate referral to ENT
Drainage of abscess - aspiration
IV antibiotics - amoxicillin/ clarithromycin
Possible tonsillectomy

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15
Q

Quinsy - signs + symptoms

A

Recent/ recurrent tonsilitis
Dysphagia
Earache
Headache/ malaise
Drooling
Fever
Trismus

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16
Q

Glandular fever - definition/ aetiology/ presentation

A

Transmitted through saliva/ commonly caused by EBV virus (epstein-barr virus) - human herpes virus

Spread through kissing , sharing food , drink + utensils

Most common adolescents + young people
90% by age 40

Sore throat/ malaise/ fatigue. myalgias

Fever/ tonsillar exudate/ cervical lymph nodes/ rash/ splenomegaly/ hepatomegaly

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17
Q

Glandular fever - symptoms/ diagnosis

A

FBC - lymphocytes
Monospot test - tests body’s immune response to EBV infection

Fever/ lymph nodes/ severe sore throat/ tonsillar exudate/ enlargement/ pharyngeal inflammation/ non-specific rash/ splenomegaly (2 weeks after)/ hepatomegaly

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18
Q

Glandular fever - Management

A

Mostly self-limiting lasts 2 - 4 weeks
May last longer few months

Analgesia
Fatigue is common - patient education
Avoid collision sports + heavy lifting - due to increased risk of splenic rupture

Advise to limit spread of disease

Arrange hospital admission if serious complications suspected

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19
Q

Risk factors of pharyngitis?

A

Group A streptococcus contact
Oral sex
Immunocomprised
ICS

20
Q

Management of pharyngitis?

A

Conservative - fluid intake/ analgesia/ salt water
Viral - conservative management
Bacterial - Antibiotics - 1st line - phenoxymethypenicillin
2nd line - Clarithromycin
If pregnant - erythromycin
Candida - Nystatin
Chlamydia - doxycycline
Gonorrhoea - Ciprofloxacin

21
Q

Management of laryngitis?

A

Acute - self-limiting
Avoid smoking/ alcohol/ rest voice/ hydration
Fever/ sputum for more than 48 hours - anti-biotics
Chronic laryngitis- Referred for laryngoscopy
Urgent referral - Weight loss/ neck mass/ dysphagia/ odynophagia/ recent intubation or radiotherapy

22
Q

Management of aphthous ulcers?

A

Saline mouthwash/ antiseptic mouthwash/ local anaesthetics (bonjela)
Recurrent ulceration - routine referral
Ulceration more than 3 weeks - 2WW maxillofacial surgeons

23
Q

2WW criteria for oral cancer

A

Unexplained ulceration in oral cavity for more than 3 weeks / Unexplained lump/ Red or white patch in oral cavity / Persistent unexplained hoarseness

24
Q

Oral candidiasis - aetiology/ risk factors/ symptoms

A

Overgrowth of normal GI flora yeast like fungus - candida species (can be rubbed off)

RF’s - oral or inhaled steroids/ broad spectrum anti-biotics/ diabetes/ denture wearing/ anaemia/ vit B12 deficiency/ smoking/ prolonged antibiotic use/ extremes of age

Symptoms - usually asymptomatic
mouth soreness/ problems swallowing

Signs - acute erythematous/ angular cheilitis

25
Q

Oral candidiasis - investigations/ management

A

Clinical
If recurrent/ severe screen for underlying diaginosis
Investigations - FBC (look for anaemia/ iron + B12 deficiency/ HbA1c
Oral examination

Management -

Hygiene advice (e.g cleaning dentures)
Smoking cessation
Control diabetes
ICS - advice on rinsing mounth

1st line - miconazole oral gel - continue 2 days after symptoms start
1st line - immunocomprised - fluconazole oral

Hospital admission - widespread candidiasis

26
Q

Oral leukoplakia (definition/ aetiology/ symptoms?)

A

Thick, white patches in the oral cavity - white discoloration that cant be rubbed off

Aetiology - repeated injury or irritation/ vitamin deficiencies/ dentures etc
Chronic candidiasis

Usually asymptomatic

27
Q

Oral leukoplakia (risk factors/ investigations/ management)

A

Ill fitting dentures/ smoking/ alcohol/ endocrine disturbances

FBC - vit deficiency
Swab if suspecting candida
Refer for biopsy if lesion appear suspicious

Management - refer to ENT for biopsy

28
Q

HSV definition/ aetiology/ symptoms

A

Oral herpes simplex virus (HSV)
‘Cold sore’
90% HSV 1

Transmitted via direct contact of skin or mucous membranes with infected secretions

Primary infection - remains dormant - can lead to recurrent infections

Symptoms -
Prodrome - pain/ burning/ tingling
Painful blisters
Fever/ malaise/ sore throat

Cervical lymphadenopathy
Clustered erythematous vesicles

29
Q

Oral herpes simplex virus (HSV) diagnosis + management?

A

Clinical
Swab for HSV if diagnosis unclear

Management -

Topical anti-viral OTC
Oral antiviral - primary/ severe/ recurrent or immunocomprised
Minimise infection risk

30
Q

Sialadenitis - definition/ signs + symptoms + management

A

Infection of the major salivary glands - transmission of bacteria from oral cavity via the salivary duct

Symptoms -
Enlarged painful salivary gland
Decreased salivary secretion
Red/painful duct

Management-
Heat/cold compression
Hydration
Lemon drops/ citrus drops - promote salivary flow
Analgesia medication

31
Q

Acute sinusitis - definition/ aetiology/ risk factors

A

D- symptomatic inflammation of paranasal sinuses for <12 weeks (Frontal/ ethmoid + maxillary sinuses)

A- Viral URI - less than 2% - bacterial infection
Haemophilus influenza/ staphylococcus aureus

RF’s - Allergic rhinitis/ asthma/ smoking/ nasal polyps etc

32
Q

Acute sinusitis - signs + symptoms/ diagnosis

A

Previous UTI symptoms
Symptoms lasting more than 10 days
Nasal blockage
Rhinorrhea
Facial pressure/ pain

Maxillofacial sinus swelling
Discoloured nasal discharge
Fever
Nasal mucosa oedema

Diagnosis

Clinical

33
Q

Acute sinusitis -management

A

Conservative management

Analgesia/ nasal decongestant/ nasal saline spray

Symptoms more than 10 days -

Consider high dose nasal corticosteroid - 2 weeks
Consider back-up anti-biotic prescription - phenoxymethylpenicillin or co-amoxiclav for 5 days

34
Q

Chronic sinusitis - definition/ aetiology/ signs + symptoms

A

Symptomatic paranasal sinus inflammation for more than 12 weeks

A- inflammatory rather than infectious

RF’s - Atopy/ asthma/ aspirin sensitivity - can lead to nasal polyps/ smoking/ immunocomprised

Symptoms - same as acute
Signs - maxillofacial tenderness/ pain/ inflamed nasal mucosa

35
Q

Chronic sinusitis - diagnosis/ management

A

Clinical diagnosis
CT scan of sinuses - ordered by ENT

Management

Supportive care
Smoking cessation/ avoid allergic triggers
Nasal saline
Intranasal corticosteroid - 3 months

Seek specialist advice if considering anti-biotics

More than 3 months - refer to ENT

36
Q

Allergic rhinitis - definition/ aetiology

A

D- IgE-mediated inflammatory disorder of the nose
Nasal mucosa sensitised to allergens, causing release of histamine

A- Causes
Genetics
Environmental
House dust mites
Grass, tree, weed pollens
Moulds
Animal dander

37
Q

Allergic rhinitis - diagnosis

A

Clinical diagnosis

Consider ENT referral - persistent symptoms despite primary care management

Allergy testing, immunotherapy, skin prick testing

Nasal obstruction or structural abnormality

38
Q

Allergic rhinitis - management

A

Mild - moderate -
As needed intranasal antihistamine (azelastine) or non -sedating oral antihistamine

Moderate to severe -
Daily intranasal corticosteroid - allergen exposure - up to 2 weeks to be effective

Saline nasal spray + allergen avoidance

Treatment failure -

Compliance
Consider stepping-up treatment
Nasal congestion - add intranasal decongestant x5-7 days
Rhinorrhoea - add intranasal anticholinergic (ipratropium bromide)
Nasal itching, sneezing - add regular oral antihistamine or combination intranasal antihistamine with corticosteroid (Dymista)
Concurrent asthma - add leukotriene receptor antagonist (montelukast)

Severe symptoms affecting QOL
Short-course oral corticosteroid (prednisolone) x5-10 days
Refer for immunotherapy - IgE sensitivity

39
Q

Nasal polyps - definition/ risk factors

A

Benign swellings of nasal mucosa of paranasal sinuses
Often associated with chronic sinusitis

Risk factors
Asthma
Eosinophilic granulomatous polyangiitis (EGPA)
Aspirin sensitivity
Genetics

40
Q

Nasal polyps - symptoms. signs/ diagnosis

A

Symptoms
Nasal obstruction
Most often bilateral
Nasal discharge
Facial pain/pressure
Reduced sense of smell (anosmia)
Cough
Postnasal drip

Signs
Visualisation of nasal polyp(s)
Nasal discharge

Diagnosis

Clinical diagnosis
Nasal endoscopy
If not visualized via anterior rhinoscopy
CT scan sinuses
If unilateral symptoms, concern for neoplasm
(eg bleeding, foul odour, impaired vision etc)

41
Q

Nasal polyps - management

A

1st-line
Intranasal corticosteroid
Daily x3 months, then re-evaluate
Continue indefinitely with review q 6 months
Nasal saline irrigation
+/- doxycycline x3-12 weeks

2nd-line
Surgical polypectomy

42
Q

Epistaxis - definition/ aetiology

A

Nosebleed
80-95% originate anterior nasal septum, location of Kiesselbach plexus of vessels
Less common posterior epistaxis
Older patients, bilateral bleeding, more profuse

Trauma
Inflammation
Infection (eg chronic sinusitis), allergic rhinitis, nasal polyps
Topical drugs
Cocaine, decongestants, corticosteroids
Systemic drugs
Anticoagulants, antiplatelets (eg aspirin, clopidogrel)
Tumours
Nasal oxygen therapy
Clotting disorders
Excessive alcohol consumption
Environmental factors
Humidity, altitude, temperatures, cigarette smoke, dust

43
Q

Epistaxis - diagnosis

A

Perfused nose bleed
Anterior rhinoscopy to identify bleed location
Ask patient to first gently blow nose to remove clots
Bleeding point appears as small red dot
Suspect posterior bleed if
Unable to visualize, bleeding first began down throat, profuse bleeding, bilateral bleeding

FBC, coagulation studies if underlying cause suspected or significant bleeding

44
Q

Epistaxis - management

A

Admit if suspect posterior epistaxis or haemodynamically unstable

First aid measures
Patient sit upright, leaning slightly forward while pinching cartilaginous nose x10-15 minutes
If bleeding stops, prescribe topical antiseptic (Naseptin) applied to nares QD x10 days and recommend avoid following
for 24 hours:

Blowing nose, heavy lifting, strenuous
exercise, lying supine, avoid alcohol/hot drinks
If first aid unsuccessful after 15 minutes
Nasal cautery - silver nitrate stick
Nasal packing

45
Q

Fractured nose

A

See within 7 days - ENT

Refer immediately if
Gross displacement
Compound - bone protruding skin
Uncontrolled bleed
CSF rhinorrhoea - nasal or head trauma - sign of skull fracture
Septal haematoma

Septal
Gently palpate
If boggy = haematoma
If hard = displaced cartilage or turbinate
If you suspect it - refer immediately

46
Q

Treatment for epistaxis?

A

If direct compression of the nasal alae for 10-15 minutes does not resolve epistaxis.

the next most appropriate management step would be nasal cautery as there is a visible bleeding site amenable to cautery.

Lifestyle advice should be given once the bleeding is controlled

FCM - Year 1 PA (8 decks)

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