Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > ENT > Flashcards

ENT Flashcards

1
Q

What are the conductive causes of hearing loss?

A

o Wax production
o Eardrum perforation
o Chronic otitis media with effusion
o Nasopharyngeal tumours blocking eustachian tube
o Otosclerosis
o Eustachian tube dysfunction
o Cholesteatoma
o Exostoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Sensorineural causes of hearing loss

A

o Presbyacusis
o Idiopathic hearing loss
o Noise exposure
o Inflammatory diseases
o Ototoxicity from drugs (loop diuretics, gentamicin, chemotherapy)
o Acoustic tumours (vestibular schwannoma)
o Meniere’s disease
o Labyrinthitis
o Neurological conditions (stroke, multiple sclerosis, brain tumours)
o Infections (meningitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is weber’s test?

A

Tuning fork in middle of patient’s forehead
o Conductive deafness = louder in affected ear
o Unilateral sensorineural deafness = louder in normal ear
o Symmetrical hearing loss = heard in middle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Rinne’s test?

A

o Normal  sound louder at ear, air conduction is better than bone conduction, also in sensorineural deafness (POSITIVE)
o Abnormal  sound louder on mastoid process, bone conduction better than air conduction (NEGATIVE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is presbycusis?

A

Age related hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk factors for presbycusis

A
  • Male
  • Family history
  • Loud noise exposure
  • Diabetes
  • Hypertension
  • Ototoxic medications  salicylates, chemo
  • Smoking
  • Stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of presbycusis

A
  • Gradual symmetrical hearing loss
  • Loss of high-pitched sounds can make speech difficult to hear and understand
  • Patients noticed not paying attention or missing details of conversations
  • Need for increased volume on TV/radio
  • Loss of directionality of sound
  • Concerns about dementia
  • Hyperacusis  heighted sensitivity to certain frequencies (less common)
  • Tinnitus (uncommon)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations for presbycusis

A
  • Audiogram = sounds have to be made louder before they are heard in high frequencies = bilateral sensorineural pattern hearing loss
  • Weber’s test = bone conduction localisation to one side if sensorineural hearing loss not completely bilateral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management of presbycusis

A
  • Cannot be reversed
  • Optimising environment
  • Hearing aids may be prescribed if significant
  • Cochlear implants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Prevention of presbycusis

A

Hearing protection should be worn in environments where there is exposure to loud noises for prolonged periods (woodworking, construction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Presentation of impacted ear wax

A
  • feeling of fullness in ear
  • Conductive hearing loss
  • Tinnitus
  • Can cause pain if excess or has been impacted by cotton buds
  • Otoscope = wax cover tympanic membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of impacted ear wax

A
  • No intervention needed in most cases
  • Avoid inserted cotton buds
  • Olive oil or bicarbonate 5% drops for 2-3 days
  • Irrigation/syringing (after softening)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of foreign bodies in the ear

A
  • Soft foreign bodies may be grasped with crocodile forceps
  • Solid foreign bodies passing a wax hook or Jobson-Horne probe beyond object and pulling it back towards you
  • Irrigation (as long as not trauma to ear canal or ear drum
  • Insects drowned and floated out with oil
  • Never probe blind
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cause of auditory exostosis (surfer’s ear)

A

Local bone hypertrophy from cold exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of auditory exostosis

A
  • Smooth, multiple, bilateral swellings of bony canals
  • Symptomless as long as lumen of EAC is sufficient for sound conduction
  • If hinder passage of wax can cause clogging and conductive hearing loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of sudden onset sensorineural hearing loss

A
  • Idiopathic
  • Vestibular schwannoma
  • Infection (meningitis, HIV, mumps)
  • Menieres disease
  • Ototoxic medications
  • Multiple sclerosis
  • Migraine
  • Stroke
  • Cogan’s syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of sudden onset sensorineural hearing loss

A
  • High dose steroids
  • Urgent referral to ENT within 24 hrs of presenting with sudden sensorineural hearing loss within 30 days of onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is otosclerosis

A

Autosomal dominant,
replacement of normal bone by vascular spongy bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Presentation of otosclerosis

A
  • Conductive hearing loss (typically lower-pitched sounds)
  • Tinnitus
  • Tympanic membrane  flamingo tinge cause by hyperaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of otosclerosis

A
  • Conservative  hearing aids
  • Surgical (stapedectomy or stapedotomy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risk factors for Eustachian tube dysfunction

A
  • URTI
  • Allergies (hayfever)
  • Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Presentation of eustachian tube dysfunction

A
  • Reduced or altered hearing
  • Popping noises or sensations in ear
  • Fullness sensation in ear
  • Pain or discomfort
  • Tinnitus
  • Symptoms worse when external air pressure changes (flying, climbing a mountain, scuba diving)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of eustachian tube dysfunction

A
  • Conservative  waiting for it to resolve spontaneously
  • Valsalva manoeuvre
  • Decongestant nasal sprays
  • Antihistamines and steroid nasal spray (allergies/rhinitis)
  • Surgery
    o Adenoidectomy
    o Grommets
    o Balloon dilatation Eustachian tuboplasty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Secondary causes of tinnitus

A

o Impacted ear wax
o Ear infection
o Meniere’s disease
o Noise exposure
o Medications = loop diuretics, gentamicin, chemotherapy drugs (cisplatin)
o Acoustic neuroma
o Multiple sclerosis
o Depression
o Anaemia
o Diabetes
o Hypothyroidism or hyperthyroidism
o Hyperlipidaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Objective tinnitus causes

A

o Carotid artery stenosis
o Aortic stenosis
o Arteriovenous malformations
o Eustachian tube dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Tinnitus Red Flags

A
  • Unilateral tinnitus
  • Pulsatile tinnitus
  • Hyperacusis = hypersensitivity, pain or distress with environmental sounds
  • Associated unilateral hearing loss
  • Associated vertigo or dizziness
  • Headaches or visual symptoms
  • Associated neurological symptoms or signs = facial nerve palsy or signs of stroke
  • Suicidal ideation related to tinnitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Risk factors for otitis externa

A
  • Excess canal moisture (swimming)
  • Trauma from fingernails or cotton buds
  • Absence of wax from self-cleaning
  • Eczema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of otitis externa

A
  • Pseduomonas aeruginosa
  • Staph aureus
  • E.coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Presentation of otitis externa

A
  • Discharge
  • Itch
  • Pain
  • Tenderness when moving jaw/ear
  • Feeling of fullness in ear
  • Tragal tenderness due to acute inflammation of skin of meatus
  • Mild  scaly skin with some erythema, normal diameter of EAC
  • Moderate  painful ear, narrowed external auditory canal, malodourous creamy discharge
  • Severe  EAC completely occluded
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Management of otitis externa

A
  • General  Cleaning and topical steroids/antibiotics
  • Mild
    o Cleaning of EAC  increases penetration of drops and reduces bacterial load
    o Gentle syringing or irrigation to remove debris (as long as tympanic membrane intact
    o Dry mopping  under direct vision using Jobson-Horne probe with small piece of cotton wool on its end
    o Microsuction (may need ENT referral)
    o Avoid swimming and prevent water entering ear
  • Moderate
    o Cleaning
    o Swab for microscopy
    o Prescribe topical antibiotics and steroid drops for 1w
     Ciprofloxacin
     Chloramphenicol drops
     Gentamicin drops (avoid if perforated ear drum due to ototoxicity)
  • Severe
    o Cleaning, swabs and topical treatment
    o Thin ear wick inserted with aluminium acetate  few days later meatus will be open enough for microsuction or careful cleansing
    o May have persistent unilateral otitis externa in diabetes/immunocompromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Criteria for referral of otitis externa

A
  • Non responsive
  • Canal oedematous
  • Needs aural toilet
  • Suspicion of invasive OE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Complications of otitis externa

A
  • Fungal infection post antibiotics
  • Malignant OE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is malignant otitis externa?

A

Aggressive, life-threatening invasive infection of bone of external ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Risk factors for malignant otitis externa

A
  • Diabetes
  • Immunocompromised
  • Increased age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Presentation of malignant otitis externa

A
  • Otitis externa resistant to treatment
  • Temporal headaches
  • Deep boring night pain
  • Otorrhoea
  • Possible dysphagia/hoarseness
  • Cranial nerve palsies  VII, IX, X, XI, XII
  • Inferior granulation tissue at bony cartilaginous junction of ear canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Investigation for malignant OE

A

CT = see extent of disease in skull base

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of malignant OE

A
  • Hospital admission if non-resolving/worsening
  • Surgical debridement
  • Systemic IV antibiotics  high dose ciprofloxacin for 12wks
  • Specific immunoglobulins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Complications of malignant OE

A
  • Osteomyelitis (base of skull)
  • Temporal bone destruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Causes of otitis media

A
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Moraxella catarrhalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Presentation of otitis media

A
  • Acute onset
  • Recent viral URTI common
  • Otalgia
  • Fever
  • Hearing loss  pain subsides
  • Ear discharge if tympanic membrane perforates
  • Bulging tympanic membrane = loss of light reflex
  • Opacification or erythema or tympanic membrane
  • Perforation with purulent otorrhoea
  • Decreased mobility if using pneumatic otoscope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Management of otitis media

A
  • Generally self-limiting and does not require antibiotics
  • Simple Analgesia
  • Advise parents to seek medical help if symptoms worse or do not improve after 3 days
  • Oral Antibiotics (5-7 days amoxicillin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When should antibiotics be prescribed in otitis media?

A

Symptoms lasting >4 days or not improving
o Systemically unwell but not requiring admission
o Immunocompromise or high risk of complications
o <2yrs with bilateral otitis media
o Otitis media with perforation and/or discharge in canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Complications of otitis media

A
  • Mastoiditis
    o IV Coamoxiclavulanic aicd + analgesia
    o Urgent referral and surgical drainage
  • Meningitis
  • Brain abscess
  • Facial nerve paralysis
  • Hearing loss
  • Labyrinths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Management of a perforated eardrum

A
  • Conservative = if asymptomatic, reassurance and water precaution advice
  • Medical = topical antibiotics drops in patients with intermittent episodes of discharge
  • Surgical = myringoplasty if recurrent discharge/ patient wants surgical intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is glue ear?

A

Otitis media with effusion
Presence of fluid in middle ear without symptoms and signs of ear infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Risk factors for glue ear

A
  • More common in children
  • Recurrent acute otitis media
  • Down syndrome
  • Cleft lip children
  • Cystic fibrosis
  • Allergic rhinitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Presentation of glue ear

A
  • Painless
  • Hearing loss (mild)
  • Behavioural issues
  • Poor speech development
  • Variable appearance of tympanic membrane on otoscopy  retracted or bulging drum
  • Can look dull, grey, yellow, may be bubbles of fluid level
48
Q

Investigations for glue ear

A

Tympanometry

49
Q

Cause of subperichondrial haematoma

A

Shear force trauma

50
Q

Management of subperichondrial haematoma

A
  • Drain before cartilaginous necrosis
  • Leave drain
  • Antibiotics
  • Bolster dressing
  • Monitor for 24 hrs
51
Q

Complications of subperichondrial haematoma

A

Cauliflower ear

52
Q

Causes of vertigo

A

Viral labrinthitis
Vestibular neuronitis
BPPV
Meniere’s disease
Vertebrobasilar ischaemia
Acoustic neuroma
Posterior circulation stroke
TRauma
Multiple sclerosis
Ototoxicity drugs (gentamicin)

53
Q

Epidemiology of Meniere’s disease

A

Middle aged adults

54
Q

Presentation of meniere’s disease

A
  • Recurrent episodes of vertigo, tinnitus, sensorineural hearing loss
    o Vertigo lasts 20 mins to several hrs before settling
    o Episodes come in clusters over several weeks
  • Sensation of aural fullness or pressure now recognised as being common
  • Unexplained falls without loss of consciousness
  • Imbalance
  • Spontaneous unidirectional Nystagmus,
  • positive Romberg test
  • Symptoms typically unilateral
55
Q

Management of Meniere’s disease

A
  • ENT assessment
  • Inform DVLA  cease driving until satisfactory control of symptoms achieved
  • Acute attacks  buccal or IM prochlorperazine, antihistamines
  • Admission sometimes required
56
Q

Prevention of Meniere’s disease

A

Betahistine
Vestibular rehabilitation exercises

57
Q

Epidemiology of Benign Paroxysmal Postitional Vertigo

A

Older adults

58
Q

Risk factors for BPPV

A

Viral infection
Head trauma
Ageing

59
Q

Presentation of BPPV

A
  • Head movements can trigger attacks of vertigo, Often turning over in bed
  • Vertigo settles in 20-60s
  • Patients asymptomatic between attacks
60
Q

Investigation of BPPV

A

Dix-Hallpike Manoeuvre

61
Q

Management of BPPV

A
  • Epley maneouvre
  • Brandt-Daroff Exercises
62
Q

PResentation of vestibular neuronitis

A
  • Acute onset of vertigo
  • History of recent viral URTI
  • Nausea and vomiting
  • Balance problems
  • No hearing loss
63
Q

Investigation of vestibular neuronitis

A

Head impulse test

64
Q

Management of vestibular neuronitis

A
  • Sx Mx for up to 3 days = prochlorperazine, antihistamines
  • May require admission if severely dehydrated
  • Referral if Sx do not improve after 1 week or resolve after 6 weeks
    o Vestibular rehabilitation therapy
65
Q

What is Labyrinthitis

A

Inflammation of bony labyrinth of inner ear including semiciruclar canals, vestibule and cochlea

66
Q

Triggers of labyrinthitis

A
  • Viral URTI
  • Otitis media
  • Meningitis
67
Q

Presentation of labyrinthitis

A
  • Acute onset vertigo
  • Hearing loss
  • Tinnitus
68
Q

Investigation of labyrinthitis

A

Head impulse test

69
Q

Management of labyrinthitis

A
  • Sx control  prochlorperazine, antihistamines
  • Abx if bacterial labyrinthitis
70
Q

What is an acoustic neuroma

A

Benign tumours of Schwann cells surrounding auditory nerve that innervates the inner ear

71
Q

Associations of acoustic neuromas

A

If bilateral, neurofibromatosis type 2

72
Q

Presentation of acoustic neuroma

A
  • Typically aged 40-60
  • Gradual onset
  • Unilateral sensorineural hearing loss
  • Unilateral tinnitus
  • Dizziness or imbalance
  • Sensation of fullness in ear
  • Facial nerve palsy
73
Q

Investigation of acoustic neuroma

A
  • Audiometry  sensorineural hearing loss
  • MRI of cerebellopontine angle
74
Q

Management of acoustic neuroma

A
  • Urgent referral to ENT specialist
  • Conservative  monitoring
  • Surgery to remove tumour
  • Radiotherapy to reduce growth
75
Q

Complications of treatment of acoustic neuroma

A
  • Vestibulocochlear nerve injury with permanent hearing loss or dizziness
  • Facial nerve injury with facial weakness
76
Q

What is cholesteatoma?

A

Abnormal collection of squamous epithelial cells in middle ear

77
Q

Presentation of cholesteatoma

A
  • Foul discharge from ear
  • Unilateral conductive hearing loss
  • Infection
  • Pain
  • Vertigo
  • Facial nerve palsy
78
Q

Investigations of cholesteatoma

A
  • Otoscopy  abnormal build-up of whitish debris or crust in upper tympanic membrane
  • CT /MRI head
79
Q

Triggers of epistaxis

A
  • Nose picking
  • URTIs  Colds, Sinusitis, Vigorous nose-blowing
  • Trauma
  • Changes in weather
  • Coagulation disorders  thrombocytopenia or Von Willebrand disease
  • Anticoagulant medication  aspirin, DOACs, warfarin
  • Snorting cocaine
  • Tumours  SCC
80
Q

Presentation of epistaxis

A
  • Bleeding usually unilateral
  • May be vomiting blood if swallows blood during nose bleed
81
Q

Where does bleeding usually originate from in nosebleeds?

A

Klesselbach’s plexus / Little’s area

82
Q

Management of epistaxis

A
  • General advice
    o Sit up and tilt head forwards
    o Squeeze soft part of nostrils together for 10-15 mins
    o Spit out any blood in mouth rather than swallowing
  • If bleeding does not stop, nosebleed is severe, bleeding from both nostrils, haemodynamically unstable
    o Hospital admission
    o IV access and may require cross match blood
    o Nasal cautery using silver nitrate sticks if source of bleed visible
    o Nasal packing using nasal tampons or inflatable packs if source of blood not visible
    o Sphenoplatine ligation in theatre
  • Medication
    o Naseptin nasal cream (chlorhexidine and neomycin) 4x daily for 10 days
83
Q

Complications of epistaxis

A
  • Risk of aspiration
  • Septal haematoma  surgical drainage by ENT
84
Q

Risk factors of sinusitis

A
  • Asthma
  • Infection (viral URTI)
  • Allergies (hayfever)
  • Obstruction of drainage (foreign body, trauma, polyps)
  • Smoking
85
Q

Presentation of sinusitis

A
  • Acute or chronic
  • Nasal congestion
  • Nasal discharge
  • Facial pain or headache
  • Facial pressure
  • Facial swelling over affected areas
  • Loss of smell
  • Tenderness to palpation of affected areas
  • Inflammation and oedema of nasal mucosa
  • Discharge
  • Fever
  • Other signs of systemic infection = tachycardia
  • Nasal polyps (chronic)
86
Q

Management of sinusitis

A
  • Most cases are viral and will resolve in 2-3 wks
  • If Sx not improving after 10 days
    o High dose steroid nasal spray for 14 days
    o Delayed Abx prescription if worsening or not improving within 7 days
  • Chronic sinusitis
    o Saline nasal irrigation
    o Steroid nasal sprays or drops
    o Functional endoscopic sinus surgery
87
Q

Complications of sinusitis

A
  • Periorbital/Orbital cellulitis = Systemic broad-spec antibiotics, otrivine, analgesia
  • Subperiosteal/ intraorbital abscess
  • Cavernous sinus thrombosis
  • Pott’s puffy tumour
  • Meningitis
  • Brain abscess
88
Q

Associations of nasal polyps

A
  • Chronic rhinitis or sinusitis
  • Asthma
  • Samter’s triad  nasal polyps, asthma and aspiring intolerance/allergy
  • Cystic fibrosis
  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
89
Q

Presentation of nasal polyps

A
  • Usually bilateral (unilateral is red flag)
  • Chronic rhinosinusitis
  • Difficulty breathing through nose
  • Snoring
  • Nasal discharge
  • Loss of sense of smell
90
Q

Investigations of nasal polyps

A
  • Nasal speculum  round pale grey/yellow growths on mucosal wall
  • Otoscope with large speculum attached
  • Nasal endoscopy (specialist)
91
Q

Management of nasal polyps

A
  • Intranasal topical steroid drops or spray
  • Surgery
    o Intranasal polypectomy
    o Endoscopic nasal polypectomy
92
Q

Management of allergic rhinitis

A
  • Allergen avoidance
  • Oral or intranasal antihistamines
    o Non-sedating  certirizine, loratadine, fexofenadine
    o Sedating  chlorphenamine, promethazine
  • Intranasal corticosteroids  fluticasone, mometasone
  • Short course oral corticosteroids
  • Short courses of topical nasal decongestants (oxymetazoline)
    o Increasing doses required to achieve same effect  tachyphylaxis
    o Rebound hypertrophy of nasal mucosa may occur upon withdrawal
  • Referral to immunologist
93
Q

Causes of tonsillitis

A
  • Viral infection
  • Group A strep
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Staphylococcus aureus
94
Q

Presentation of tonsillitis

A
  • Sore throat
  • Fever (>38)
  • Pain on swallowing
  • Red, inflamed and enlarged tonsils ± exudates
  • Anterior cervical lymphadenopathy
95
Q

Centor criteria for tonsillitis

A

o Fever over 38
o Tonsillar exudates
o Absence of cough
o Tender anterior cervical lymph nodes

Score of 3+ offer Abx

96
Q

FeverPAIN score for tonsillitis

A

o Fever during previous 24 hrs
o Purulence
o Attended within 3 days of onset of Sx
o Inflamed tonsils
o No cough or coryza

2-3 delayed abx, 4+ give abx

97
Q

Management of tonsillitis

A

Safety netting advice
o Simple analgesia
o Return if pain not settled after 3 days or fever >38.3

  • Penicillin V for 10 days if centor >3 or feverPAIN >4
    o Or if at risk = young infants, immunocompromised patients, significant co-morbidity, history of rheumatic fever
    o Delayed prescriptions can be considered
    o Clarithromycin if penicillin allergy
98
Q

When to consider admission for tonsillitis?

A

Consider admission if patient is:
Immunocompromised
Systemically unwell
Dehydrated
Stridor
Respiratory distress
Evidence or peritonsillar abscess or cellulitis

99
Q

Complications of tonsillitis

A
  • Peritonsillar abscess (quinsy)
  • Otitis media
  • Scarlet fever
  • Rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Post-streptococcal reactive arthritis
100
Q

What is a peritonsillar abscess/quinsy?

A

Cellulitis of space behind tonsillar capsule extending onto soft palate leading to abscess

101
Q

Causes of a quinsy

A
  • Streptococcus pyogenes
  • Staph aureus
  • Haemophilus influenzae
  • Anaerobes
102
Q

Presentation of a quinsy

A
  • Severe throat and neck pain, which lateralises to one side
  • Painful swallowing
  • Fever
  • Referred ear pain
  • Swollen tender lymph nodes
  • Deviation of uvula to unaffected side
  • Trismus (difficulty opening mouth)
  • Reduced neck mobility
  • Change in voice due to pharyngeal swelling (hot potato voice)
  • Swelling and erythema in area beside tonsils
103
Q

Management of a quinsy

A
  • Urgent review by ENT
  • Needle aspiration or surgical incision and drainage
  • IV Abx (co-amoxiclav)
  • Tonsillectomy considered to prevent recurrence
  • Sometimes dexamethasone to reduce inflammation
104
Q

Indications for a tonsillectomy

A
  • 7 or more in 1 year
  • 5 per year for 2 years
  • 3 per year for 3 years
  • Recurrent tonsillar abscesses (2 episodes)
  • Enlarged tonsils causing difficulty breathing, swallowing or snoring
105
Q

Complications of a tonsillectomy

A
  • Sore throat where tonsillar tissue removed
  • Damage to teeth
  • Infection
  • Post-tonsillectomy bleeding
    o Encourage spit blood rather than swallow
    o IV fluids
    o Severe or airway compromise  intubation and return to theatre
    o Less severe bleeds  hydrogen peroxide, topical adrenalin soaked swab
  • Risks associated with general anaesthetic
106
Q

Causes of neck lumps

A
  • Normal structures = bony prominence
  • Skin abscess
  • Lymphadenopathy
  • Tumour (SCC or sarcoma)
  • Lipoma
  • Goitre or thyroid nodules
  • Salivary gland stones or infection
  • Carotid body tumour
  • Haematoma
  • Thyroglossal cysts
  • Branchial cysts
  • Young children  cystic hygromas, dermoid cysts, haemangiomas, venous malformation
107
Q

Red flags of neck lumps

A
  • Unexplained neck lump in someone aged 45+
  • Persistent unexplained neck lump at any age
108
Q

Lymph node red flags

A
  • Unexplained
  • Persistently enlarged (>3cm)
  • Abnormal shape
  • Hard or rubbery
  • Non-tender
  • Tethered or fixed to skin or underlying tissues
  • Associated Sx  night sweats, weight loss, fatigue, fevers
109
Q

Investigations of Red Flags

A
  • Urgent US in patients with lump growing in size
    o Within 2wks if 25+ or within 48 hrs if <25
  • FBC and blood film  leukaemia and infection
  • HIV test
  • Monospot test or EBV  infectious mononucleosis
  • TFTs  goitre or thyroid nodules
  • ANA  SLE
  • Lactate dehydrogenase  Hodgkin’s lymphoma
  • CT/MRI
  • Nuclear medicine scan
  • Biopsy
    o Fine needle aspiration cytology
    o Core biopsy
    o Incision biopsy
    o Removal of lump
110
Q

Head and neck cancer includes:

A
  1. Oral cavity cancers
  2. Cancers of pharynx (oropharynx, hypopharynx, nasopharynx)
  3. Cancer of larynx
111
Q

Risk factors for head and neck cancer

A
  • Smoking
  • Chewing tobacco
  • Chewing betel quid
  • Alcohol
  • HPV (esp 16)
  • EBV infection
112
Q

Features of head and neck cancer

A
  • Neck lump
  • Hoarseness
  • Persistent sore throat
  • Persistent mouth ulcer
113
Q

Red flags for head and neck cancer

A
  • Lump in mouth or on lip
  • Unexplained ulceration in mouth lasting >3wks
  • Erythroplakia or erythroleukoplakia
  • Persistent neck lump
  • Unexplained hoarseness of voice
  • Unexplained thyroid lump
114
Q

Referral criteria for head and neck cancer

A
  • Laryngeal cancer
    o People aged >45 with persistent unexplained hoarseness or unexplained lump in neck
  • Oral cancer
    o Unexplained ulceration in oral cavity lasting more than 3 weeks
    o Persistent and unexplained lump in neck
    o Lump on lip or in oral cavity
    o Red/ red and white patch in oral cavity consistent with erythroplakia or erythroleukoplakia
  • Thyroid cancer
    o Unexplained thyroid lump
115
Q

Management of head and neck cancer

A
  • MDT
  • Options  chemo, radiotherapy, surgery, targeted cancer drugs, palliative care
116
Q

Risk factors for parotitis

A

Dehydration
Immunosuppressed

117
Q

Management of parotitis

A
  • Metronidazole, flucloxacillin
  • Hydrate
  • Sialogogues (fresh pineapple)
  • Analgesia

Finals (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions