ENT Flashcards
(103 cards)
1
Q
Centor criteria for Group A Strep tonsilitis
A
1 Point for:
- Hx of fever
- White exudates on tonsils
- Abscence of cough
- Tender cervical lymphadenopathy
Pts w/ 3-4 points should be concidered for abx therapy
2
Q
Bacterial tonsilitis management
A
Phenoxymethylpenicillin - clari/erythromycin if pen allergic
3
Q
Tonsilitis complications
A
- Recurrent tonsilitis
- Retropharyngeal abcess
- Quincy
- Lemierre’s syndrome = inflammation leads to pharygeotonsilitis, inflammation w/in the internal jugular vein and septic emboli - treated w/ high dose benzylpencillin and debridement
4
Q
Paediatric otitis media management
A
- Admit if < 3 months old or worried about severe complications
- Offer a delayed abx perscription to be taken if symptoms arnt improving after 4 days (can offer immediate perscirption if pt is systemically unwell)
5
Q
Otitis media complications
A
Extra-cranial:
- Facial nerve palsy
- Mastoiditis
- Petrositis
- Labrynthitis
Intra-cranial:
- Meningitis
- Sigmoid sinus thrombosis
- Brain abscess
6
Q
Indications for adenoidectomy
A
- Recurrent or persistent otitis media (due to obstruction of the eustachian tubes by enlarged adenoids)
- Adenoid hypertrophy leading to upper airway obstrucion (snorking, OSA)
- In association w/ tonsilectomy for recurrent tonsilitis
- Recurrent sinusitis or adenoiditis
- Dysphagia w/ failure to thrive
- Speech impendements
7
Q
Allergic rhinitis management
A
- Avoid triggers
- Nasal irrigation w/ saline
- Oral/intra-nasal antihistamines
- Regular intra-nasal steroids
- Oral steroids if QOL severely affected
- Referal to ENT (red flags, refractory, for allergen testing)
8
Q
Define Basal skull fractures
A
Fracturing of one or more of the bones at the base of the skull
Anterior cranial fossa = superior sphenoid and ethmoid bones
Posterior cranial fossa = occipital, temporal and part of the spehnoid bone
9
Q
Basal skull fractures features
A
- Hx of head trauma
- Reduced consciousness
- Rhinorrhoea (CSF leakage from nose)
- Otorrhoea (CSF leakge from ears)
- Cranial nerve palsy
- Epistaxis or ottorhagia (bleeding from ears)
- Haemotympanum (blood visible behind the tympanic membrane)
- Battle sign = bruising of the mastoid process
- Racoon eyes = periorbital bruising
10
Q
Define Benign paroxysmal positional vertigo
A
A condition caused by detachment of otoliths in the inner ear during head movements, resulting in hair cell stimulation and vertigo
11
Q
Benign paroxysmal positional vertigo features
A
- Vertigo attacks triggered by head movements
- Episodes of rotational vertigo lasting 30 secs - 1 min
- Absence of audiotory symptoms
- Reccurent episodes, often resolving naturally over weeks to months
12
Q
Benign paroxysmal positional vertigo investigations
A
Dix-Hallpike manoeuvre - causes vertigo and nystagmus if +ve for BPPV
13
Q
Benign paroxysmal positional vertigo management
A
Epley manoeuvre - aims to move the detached otholiths out of the semicircular canal and back into the urticle where they belong
14
Q
Define Branchial cyst
A
A congenital malformation formed from the incomplete obliteration of the branchial arches (an integral part in devloping the structure of the head and neck)
15
Q
Branchial cyst features
A
A painless, cystic mass located anterior to the sternocleidomastoid just below the ear - it may increase in size during URTI
16
Q
Branchial cyst investigations
A
- US
- CT/MRI
- Fine-needle aspiration to rule out malignancy
17
Q
Define Cholesteatoma
A
An abnormal accumulation of skin and squamous cells w/in the middle ear clerft and mastoid air cells - often caused by recurrent otitis media
18
Q
Cholesteatoma features
A
- Persisten foul-smelling discharge
- Headache
- Otalgia
- White area in attic behind the tympanic membrane
19
Q
Sinusitis features
A
Acute:
- Bilateral intense pain
- Fever
- Pain worse on sitting forwards
- Purulent discharge
Chronic:
- Bilateral pain
- Purulent discharge
- Nasal obstruction due to muscosal hypertrophy
20
Q
Sinusitis investigations
A
- Hx and examination
- Imaging
- Nasal endoscopy
- Microbiology
21
Q
Sinusitis management
A
- Analgesia
- Nasal sprays to reduce inflammation
- Abx if bacterial
- Surgery for severe or recurent cases (to remove polyps that may have formed)
22
Q
Conductive hearing loss causes
A
- Wax impaction
- Glue ear
- Eustachian tube dysfunction
- Ear infections
- Perforated tympanic membrane
- Chronic suppurative otitis media
- Otosclerosis
23
Q
Conductive hearing loss investigations
A
Audiometry shows bone conduction greater than air conduction
24
Q
Which vessels are involved in anterior epistaxis?
A
Kiesselbach’s plexus, a vascular network located on the anterior part of the nasal septum
25
Which vessels are involved in posterior epistaxis?
Branches of the sphenopalatine artery
26
Epistaxis management
Stepwise approach:
1) Direct compression = pinch nose and lean fowards (to avoid aspirating) - mostly resolves w/in 10-15 min
2) Cautery w/ silver nitrate or electricity - must have a visible bleeding point
3) Nasal packing to tamponade the bleeding
4) Aggressive therapies = reserved to posterior bleeds and uncontrolled severe bleeds that dont resolve w/ nasal packing - includes nasal balloon catheters, transnasal endoscopy w/ cautery/ligation, embolisation, oral/IV transexamic acid
Posterior bleed signs = profuse bleeding, both nostrils involved, unidentifiable bleeding site
27
Nasal foreign body features
- Organic objects = local inflammation, secondary infections and sinusitis
- Inorganic objects = asymptomatic unless big enough to cause nasal obstruction
- Button batteries = tissue necrosis though electrolysis at the negative pole, leading to septal perforation (epistaxis, purulent/black discharge, facial swelling, pain and fever)
28
Head and neck cancer features
- Hoarsness
- Throat pain
- Tonhue ulcers
- Painless neck lump
- WL, fevers, NS
- Lymphadenopathy
- Sympoms persisiting longer than 3 wks
29
30
Laryngeal papillomatosis management
Surgery to remove the papillomas +/- cidofovir
30
Define Laryngeal papillomatosis
A rare disease caused by HPV which results in the growth of papillomas inside thew voice box, vocal cords, or anywhere in the air passages from the nose to the lungs
30
Laryngeal papillomatosis features
- Dysphagia
- SOB
- Hoarsness
- Feeling something stuck in the throat
- Choking
- Coughing
- Recurrent pnuemonia
- Snoring
31
Define Hereditary haemorrhagic telangiectasia
A rare genetic condition characterised in the abnormal formation of blood vessles - results in telangiectasia and AV malformations
32
Hereditary haemorrhagic telangiectasia features
- Episatxis
- Anaemia
- GI blood loss
- Emobolic manifestations
33
Hereditary haemorrhagic telangiectasia investigations
- Nasoendoscopy - may show telangectasia in the nose
- CT/MRI to find AV malfomrations
- FHx
34
Hereditary haemorrhagic telangiectasia management
- Iron replacement
- Blood transfusion
- Emobolisation of AV malformations w/in organs
35
Primary causes of hoarsness
- Laryngeal cancer = hoarsness >3 wks, sig smoking history
- Chronic laryngitis = associated w/ GORD, worse in the mornings
- Acute laryngitis = usually viral and self-limiting
- Reinke's oedema = enlargement of the vocal cords associated w/ hypothyroidism
36
Define Meniere's disease
An inner ear disorder caused by dilation and subsequent increased fluid pressure in the endolymphatic spaces of the membranous labyrinth
37
Meniere's disease features
- Sudden attacks of vertigo - often in clusters
- Associated deafness
- Tinnitus
- N&V
38
Meniere's disease management
- Betahistine (anti-vertigo medication) for prophylaxis
- Prochlorperazine to reduce N&V during attacks
- Duiretics to reduce endolymphatic volume (only done by ENT)
- Low salt diet to reduce endolymphatic volume
39
Acute VS chronic nasal obstruction
Acute lasts < 12 wks, chronic lasts >12 wks
40
Define Septal haematoma
The accumulation of blood in the septal space due to bleeding under the perichondrium lining the septal cartilage - often due to nasal trauma and can lead to a disruption in blood supply to the septum, resulting in septal perforation and necrosis w/in 24hrs and a saddle-nose deformity
41
Septal haematoma features
Bilateral cherry-red swelling visible on the nasal septum (from inside the nose)
Should be suspected w/ any nasal trauma
42
Septal haematoma management
ENT referal for immediate incision and drainage
43
Most common caustive agents of Otitis externa
Staph aureus and Pseudomonas species
44
Otitis externa features
- Otalgia
- Minimal discharge
- Itchiness
- Impaired hearing if the meatus becomes blocked due to inflammation
45
Otitis externa management
Mild - moderate:
- Combined steroid/abx drops (e.g. Gentamix)
- Acetic acid drops
- Advice to keep ear dry for 7-10 days
Severe:
- Pope wicks (strips of ribbon gauze) to enable deeper penetration of abx (usually gentamicin)
- Oral abx if cellulitis beyond the ear canal, or canal so swollen that wicks cannot enter
46
Otits media features
Acute:
- Rapid-onset of deep-seated ear pain
- Systemically unwell
- Impaired hearing
- Aural fullness followed by discharge when the typanic membrane perforates, leading to relief of pain
- Injection of blood vessels and diffuse erythema of the typnaic membrane
Benign chronic - dry tympanic membrane perforation w/out infection
Chronic secretory (glue ear) = persitent pain lasting wks after the initial episode w/ an abnormal looking drum and reduced membrane mobility
Chronic suppurative = persistent purulent discharge through the perforated tympanic membrane
47
Define Otosclerosis
An autosomal dominant condition where abnormal bone growth occurs around the stapes bone in the middle ear, impeding its function as a piston onto the cochlea - results in progressive conductive hearing loss
48
Otosclerosis features
- Progressive hearing loss, starting unilaterally and then becoming bilateral
- Tinnitus
49
Otosclerosis investigations
Adiometry shows conductive hearing loss and may present w/ Carhart's notch (an apparent loss of bone conduction at 2000 Hz)
50
Otosclerosis management
- Hearing aids
- Stapedecetomy (removal and replacement of the stapes) which can restore hearing in many cases
51
Define Pinna haematoma
The formation of a blood clot between the cartilage of the pinna and the overlying perichondrium - occurs due to shearing injuries to the ear (e.g. in rugby)
52
Pinna haematoma features
Pain, swelling of the ear - may become discoloured due to the accumulation of blood
53
Pinna haematoma management
Decompress the haematoma w/in 24 hrs to avoid complications such as avascular necrosis
54
Define Quinsy
A complication of tonsilitis where an abscess forms around the tonsil (peritonsilar abscess)
55
Quinsy features
- Sore throat
- Dysphagia
- Bulge behind 1 tonsil
- Uvula devation (due to the abscess pushing it away)
56
Quinsy management
- Broad spectrum abx
- Aspiration w/ a needle to remove the abscess
57
Nasopharangeal carcinoma features
- Symptoms of eustachians tube blockage (hearling loss, tinnitus, otalgia, feeling of aural fullness)
- Nasal obstruction
- Blood-stained nasal discharge
- Persisten epistaxis
- Development of glue ear
58
Nasopharangeal carcinoma investigations
- Full ENT exam including inspecting the post-nasal space with a flexible nasoendoscopy
- Biopsy of any massess seen
- Imaging and histology
59
Define Rhinosinusitis
Inflammation of the nose and paranasal sinuses - caused by viral, bacterial or fungal infections, allergies, AI or deviations/obstructions of the septum
60
Rhinosinusitis features
Need to have 2 symptoms of which 1 must be:
- Nasal blockage
- Nasal obstruction
- Nasal congestion
- Nasal discharge
Other possible symptoms:
- Facial pain or heaviness
- Reduced olfaction
- Headache
- Ear pain
- Sore throat
- Cough
61
Rhinosinusitis investigations
- Nasal endoscopy
- CT = to look for sinus inflammation
- Cultures
62
Rhinosinusitis management
- Nasal saline irrigation
- Analgesia
- Intranasal steroids
- Oral high dose corticosteroids if symptoms persisitng for >10 days
- Abx if severe
63
Salivary gland tumours features
- Swelling in the associated gland (parotid, submanibular or sublingual)
- Invasion of surrounding structures if malignant leading to facial nerve palsy
64
Salivary gland tumours management
Removal of glands which have been swollen for 1 month or longer w/ no clear underlying cause
65
Causes of Sensorineural hearing loss
- Presbycusis (most common)
- Noise-induced hearing loss
- Congenital infections (CMV, rubella)
- Neonatal complications = kernictus or menigitis
- Drug-induced (esp aminoglycosides)
- Stroke/TIA
66
Sensorineural hearing loss investigations
Audiogram - shows hearing loss at higher frequencies
67
Define Turbinectomy
Surgical removal of all or some of the tissue or bone from the turbinate's in the nasal passage - used to fix snoring/nasal obstruction due to enlarged turbinates
68
Define Septoplasty
A surgical procedure that straightens a deviates septum
69
Define Empty nose syndrome
A rare complication of nasal surgery due to unknown aetiology
70
Empty nose syndrome features
- SOB
- Nasal obstruction or dryness
- Paradoxical nasal obstruction = pt feels obstructed despite being unobstructed on nasal examination
71
Empty nose syndrome management
- Nasal irrigation = to moisturise the nasal cavity
- Topical therapies = nasal saline and oil-based emollients
- Psychological support
- Reconstructive surgery in severe cases
72
Define Sialadenitis
Inflammation of the salivary glands, commonly due to viral/bacterial infections
73
Sialadenitis features
Pain, tenderness, redness and localised swelling of the affected area
74
Sialadenitis investigations
- Examination
- USS or CT
- Saliva culture
75
Sialadenitis management
- Abx
- Oral hygiene advice
- Ensuring good hydration/use of saliva stimulants to encourage good saliva flow
- Incision and drainage of any abscess' formed
76
Define Stridor
High-pitched, musical noise heard during inspiration hat results for a partial obstruction of the larynx or large airways
77
Major causes of Sialadenitis
- Croup
- Epiglottitis
- Bacterial tracheitis = bacterial infection of the trachea
- Foreign body inhalation
78
Define Temporo-mandibular joint dysfunction
A collection of clinical problems involving the masticatory musculature, the tempomandibular joint and associated structures
79
Temporo-mandibular joint dysfunction causes
- Jaw trauma
- Stress which leads to clenching or grinding of teeth
- Arthritis of the TMJ
- Abnormal jaw/tooth alignment
80
Temporo-mandibular joint dysfunction features
- Pain in the jaw, face and ear
- Difficulty opening/closing the mouth
- Clicking, popping or grating sounds in the jaw when opening/closing - A sense of the jaw being stuck or locked
81
Temporo-mandibular joint dysfunction management
Conservative:
- Resting the jaw
- Adhering to a soft diet
- Avoid opening the jaw wide
- Physio
- Heat/cold packs
Medical:
- Analgesia
- Muscle relaxants
- NSAIDs
Dental:
- Oral splints
- Mouth guards
- Correct misaligned teeth
82
Define Thyroglossal cyst
A benign neck mass that raised from the remnants of the thyroglossal duct - forms a cyst
83
Thyroglossal cyst features
- Painless midline neck mass
- Fluctuant swelling
- Moves upwards on tongue protrusion and swallowing
- Can become infected
84
Thyroglossal cyst investigations
- Examination
- USS
- Fine-needle aspiration
85
Thyroglossal cyst management
Surgical excision via Sistrunk procedure = removal of the cyst + the middle part of the hyoid bone and core of the tongue base (to prevent reoccurrence)
86
Define Tinnitus
A condition characterised by the perception of non-verbal sounds in the absence of external stimuli, often described as a hissing, ringing, clicking or buzzing - it may be constant or intermittent
87
Tinnitus causes
- Chronic noise exposure
- Presbycusis
- Acute acoustic trauma
- Perforation of the tympanic membrane
- Otitis media
- Meniere's disease
- Vestibular schwannoma
- Ototoxic drugs (quinine, aminoglycosides, loop diuretics)
- Trauma
88
Tinnitus management
- Treat underlying cause
- CBT
- Sound therapy = background noise to mask the tinnitus
- Hearing aids
89
Define Tympanosclerosis
A chronic disease which involves inflammation, fibrosis and calcification of the tympanic membrane - associated w/ chronic otitis media and the insertion of gromets
90
Tympanosclerosis features
- Significant hearing loss
- Chalky white patches on tympanic membrane
91
Tympanosclerosis management
- Hearing aids
- Surgical excision of the sclerotic areas and repair of the ossicular chain
92
Vestibular neuritis causes
Viral infections
93
Vestibular neuritis features
Have an acute phase (~1 week) and then a chronic phase (weeks to months)
Acute:
- Sudden, severe, prolonged vertigo/dizziness
- Severe balance issues
- N&V
- Nystagmus (non-fatiguing)
Chronic:
- Light-headedness
- Mild dizziness w/ head and body movements
- Mild nausea
- Feeling of aural fullness
- Anxiety
94
Vestibular neuritis management
- Antivirals
- Anti-sickness medication
- Corticosteroids
- Vestibular rehabilitation therapy
95
Define Vestibular migraine
A neurological condition that is the 2nd most common cause of vertigo - may or may not be associated with a headache
96
Vestibular migraine features
- Vertigo lasting minutes-days
- N&V
- Photo/phonophobia
- Headache
97
Vestibular migraine management
Prophylactic:
- TCA's
- CCBs
- Antiepileptics
- Beta-blockers
Acute:
- NSAIDs
- Motion-sickness mediation
- Antipsychotics
Lifestyle changes + vestibular rehabilitation therapy
98
Define Vestibular schwannoma
A benign subarachnoid tumour originating from the Schwan cells of the vestibulocochlear nerve - can rarely be associated with Neurofibromatosis type 2
99
Vestibular schwannoma features
- Asymmetrical/unilateral sensorineural hearing loss and progressive ipsilateral tinnitus
- Large tumours may become SOL
- Dizziness
- Headache
- Disequilibrium
100
Vestibular schwannoma investigations
All pts w/ unilateral tinnitus and sensorineural deafness should have an MRI to exclude malignancy
101
Vestibular schwannoma management
Definitive management is surgery - but only for tumours >40mm in size
For smaller tumours - 6 monthly MRIs for surveillance + symptomatic relief
