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ENT Flashcards

1
Q

Cervical lymphadenopathy Causes + Complication

A 
EBV (fever, pharyngitis, lymphadenopathy)
HIV (Cervical, axillary, occipital)
Adenovirus
Strep pharyngitis (Pyogenes)
Malig: NHL, HL, CLL

SVC obstruction

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2
Q

When to refer Cervical lymphadenopathy

A

Not resolving with ABx at 2 weeks,
Unexplained Cervical lymphadenopathy

48 hour urgent blood count for leukaemia if under 25

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3
Q

Salivary gland swellings

  • Causes
  • Glands
A

Infection
Inflammation
Obstruction
Tumour

Parotid, Submandibular, sublingual

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4
Q

Parotid swelling:

  • Causes
  • When to worry
A

Viral parotitis (Mumps)
Stone in duct, benign/malig tumours
Sjogren’s
Sarcoidosis

Assoc withFacial nerve palsy - suggests malignant infiltration

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5
Q 
Parotitis
- Causes
- Mumps pres
- Ix
Tx
A

Viral (mumps), Bacterial (s.aureus from oral cavity)

Bilateral swelling, pyrexia, orchitis

Viral serology, antibody testing (Mumps IgM)
Sialography for blockage
CT/MRI exclude malignancy

Mumps self limiting (supportive analgesia)

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6
Q

Salivary gland obstruction

  • Main gland
  • Pres
  • Ix
  • Tx
A

Submandibular

Pain and swelling at meal time (when they prod most)

USS and contrast sialogaphy

Many pass spontaneously (warm compress, gland massage. oral hygiene)

Surgical removal

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7
Q

Sialadenosis

  • What is it
  • Assoc with what
A

Generalised Parotid gland swelling

Sjogren’s & Sarcoid

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8
Q

Salivary gland tumours

  • Benign v Malig and E.G of each
  • Red flags
A

70% benign

Benign: Pleomorphic adenoma (Parotid)
Malignant: Mucoepithelioid carcinoma (Parotid)

Nerve parenthesis (CN VII palsy = malignant), Hx skin cancer, rapid growth

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9
Q

Salivary gland tumour

  • Ix
  • Tx
A

USS 1st line
Fine needle aspiration (cytology). Core needle biopsy for histology if FNA +ve

MRI - staging, CT - mets

Surgery - superficial parotidectomy + facial nerve
Radiotherapy

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10
Q

Benign paroxysmal positional vertigo

  • Epi
  • Pathophys
  • Cause
  • Attack character
A

Commonest cause of vertigo

Caused by otolith (crystal) detachment. Sensation of ongoing movement

Idiopathic (60%)
Head injury, labyrinth degeneration

Vertigo provoked by head movement. Attacks 20-30 seconds
No hearing loss/tinnitus/pain (red flags)
May cause nausea

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11
Q

BPPV examination + management

A

Otoscopy, CN exam, Dix-Hallpike (+ve = rotary nystagmus. usually unilateral. Bilateral = central cause)

Reduce head movement,

Epleys manoeuvre (reposition otoliths in utricles)

Contact DVLA - don’t drive when dizzy

Recurrence common

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12
Q

Menieres

  • Def/pathophys
  • Pres
  • Cause
A

Overproduction/impaired absorption of endolymph

Auditory and vestibular disease (vertigo - mins/hours assoc N&V, hearing loss - unilateral, sensorineural, tinnitus, fullness in ear)

Genetic, Trauma (acoustic/physical), recent virus

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13
Q

Menieres

  • Ix
  • ddx
  • Tx
  • Complications
A

Positive Rombergs (standing with arms out)

Sensorineural hearing loss

MRI normal, TFT normal, lyme disease serology normal
- rule out acoustic neuroma, viral labyrinthitis/neuritis

Low salt and diuretics
(Acetazolamide - Carbonic anhydrase inhibitor … also used in glaucoma)

Falls, Progressive hearing loss

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14
Q

Vesitbular neuritis and labyrinthitis

  • Pres
  • Cause
  • Nystagmus
A

VN - vertigo only (only vestibular nerve)
L - Vertigo and hearing loss

VN - HSV reactivation

L - Post viral URTI, aminoglycosides also cause (assoc with sensorineural hearing loss e.g. Gent)

Nystagmus usually unidirectional (bidirectional seen in stroke)

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15
Q

Vestibular neuritis and labyrinthitis Tx

A

Vertigo: Prochlorperazien

Encourage to be active ASAP

Surgery considered in Labyrinthitis

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16
Q

Acoustic neuroma

  • Def
  • Pres
  • Assoc gene
A

Tumour of CN8 (vestibulocochlear) arising from schwann cells

Unilateral hearing loss/tinnitus (AN until proven otherwise)
Impaired facial sensation (Trigeminal involvement)
Balance problems
Ataxia - cerebellar compression

NF-t2 (Bilateral AN)§

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17
Q

AN Tx

A

Microsurgery

Conservative if small tumours with preserved sharing

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18
Q

Tinnitus

  • Types
  • Causes
  • General management
A

Objectivists (actual noise in head), subjective (inorganic)

Pulsatile: carotid stenosis, valvular heart disease
TMJ dysfunction

Merniers, infection, MS, Acoustic neuroma, Head injury, acoustic trauma, stress (strong assoc(

After through Head, neck, ear and jaw exam most can be reassured

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19
Q

Sinuses:

  • names
  • sinusitis def
  • Referred pain
  • Viral Vs bacterial
A

Frontal, Ethmoid, Sphenoid, Maxillary

Inflam of mucous membrane slinging sinuses

Toothache, upper jaw, skin

Viral lasts less than ten days. Purulent discharge& worse after 5 days = bacterial

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20
Q

Sinusitis:

  • Pres
  • Predisposing factors
  • Assessment
  • Organisms
A

Rhinitis/nasal purulence, sinus pain, loss of smell

URTI, allergy, asthma, smoking, DM, swimming,

Palpation - tenderness

Strep pneumoniae, H.influenza

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21
Q

Sinusitis:

- management add referral

A 
Reassure 2.5 wk recovery
Paracetamol/Ibuprofen
Nasal decongestant (7d max)
Nasal douching
Chronic - Topical nasal steroids (Beclomethasone)

Severe: 1st line amoxicillin, 2nd line coamoxiclav

Refer if recurrent, Or complication (orbital cellulitis, meningitis osteomyelitis)

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22
Q

Trigeminal neuralgia

  • Def
  • Tx
A

Sharp pain in distribution of trigeminal nerve

TCA - amitryptaline ± CBT

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23
Q

TMJ dysfunction

  • Pres triad
  • Cause
  • Tx
A

Pain, limited mouth opening, joint noises

OA, RA, Ank spond, Grinding teeth (muscle affected)

Reassurance (self limiting)
Drugs: NSAIDs, muscle relaxants

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24
Q

Causes of congenital hearing loss

A

Rubella and CMV

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25
Causes of post-natal hearing loss
Mumps and measles
26
Rinnes - Hz - Conductive loss - SN loss
512Hz Louder at mastoid Both air and mastoid lost
27
Webers - Hz - conductive - SN
512Hz Louder in affected ear Quieter in affected ear
28
Causes of conductive loss
Occlusion (foreign body, bony growth - Otosclerosis = bone deposition at stapes) Infection (otitis externa - S.aureus, media - effusion) Perforation (chronic otitis, trauma, surgery) Growths (cysts, tumours (sarcoma, melanoma, carcinoma)
29
Sensorineural deafness causes
Acoustic neuroma Mernier's Paget's disease of bone (auditory canal stenosis) Occupational (auditory trauma - refer for legal) Ototoxics (ahminoglycosides, Cis-platinum) MS Other: age related (Presbycusis), trauma, infection (meningitis)
30
Management of Deafness
Urgent ENT referral
31
Ossicles Type of joint, what can affect
Malleus-->Incus-->Stapes-->Oval window Synovial joint. Can be affected by RA
32
What nerve runs through middle ear?
Chorda tympani Branch of CNVII (facial) Carries taste to anterior two thirds of the tongue
33
Otosclerosis: - Genes - Def - Pres
Autosomal dominant Normal bone replaced by spongy bone Conductive deafness, Flamingo tinge of Tympanic membrane (inc vascularity)
34
Causes of Otorrhoea(discharge) - If with pain - If there was pain but now not - If with hearing loss
Otitis externa Acute otitis media Cholesteatoma (keratinisation in the middle ear)
35
Otitis externa: - def and cause - pres - complication
Painful discharging ear. Normally infection (can also be inflammatory, allergic) Erythematous ear, discharge, pain on moving trigs, pre-auricular lymphadenopathy, May have cellulitis Facial nerve palsy
36
Otitis externa pathogen
Bact: S.aureus | Fungus (aspergillus)
37
Viral otitis externa
Ramsay hunt syndrome (Bell's palsy, Rash behind ear)
38
Otitis externa Tx
Topical neomycin (also covers fungal) ENT review Flucloxacillin (erythromycin if allergic) Olive oil for waxy build up
39
Otitis media - What is it & types - Who gets - Causes (Bact + Viral)
Acute otitis media- inflammation of middle ear. may have pus = risk perforation Otitis media with effusion - acute inflammation with effusion behind TM (glue ear) Children B: S.pneumoniae, H.influenza V: Rhinovirus, RSV
40
Otiti media - RF - Pres - Ix - Tx
Smoking, winter, URTI, DM, immunosuppression Hearing loss, otalgia, pyorrhoea, fever. Culture of discharge, CT/MRI (exclude complications) Analgesics (Para, NSIADs) Abx: amoxicillin (only if symptom over 5 days)
41
Otitis media complications
Perforation, Glue ear Meningitis, mastoiditis/osteomyelitis (air cell infect), Facial nerve palsy, brain abscess
42
Glue ear - Complications - management
Conducive hearing loss (may fall behind in school) Grommets if persistent over 3m
43
Chronic supportive otitis media: - What is it - Pres - Ix - Tx
chronic inflammation of middle ear (often with perforation) Ottorhoea, conductive hearing loss, red flags (fever, vertigo, otalgia) CT/MRI to rule out intracranial complications Topical Abx (Fluclox) Surgical repair eardrum
44
Mastoiditis - What bone - What is the concern - Organism - Ix - Tx
Petrous temporal bone Air cells in close relation to cranial fossa Infection with boney destruction can cause meningitis, cerebral abscess, facial nerve damage S.pneumonia/pyogenes Blood cultures CT/MRI LP if intracranial spread suspected Tympanocentesis (G stain and culture) 3rd Gen cephalosporin Para + Ibuprofen Surgery (mastoidectomy) if osteomyelitis
45
Blood in middle ear. Cause? What nerve?
Worry about head trauma Abducens runs over temporal bone
46
Staging head and neck cancer
``` 1 = early disease 2 = locally advanced 3 = LN spread 4 = distant mets ```
47
Head and neck cancer Tx
Surgery or radiotherapy for early disease Later stage - surgery and chemoradiotherapy ± reconstruction
48
Oral cancer - Cell type - RF - Appearance - Pres
Squamous cell carcinomas Smoking, Alcohol, Chewing tobacco, low fruit Leukoplakia, mass, speech/swllow difficulty, bleeding/ulcerating
49
What to refer for suspected oral cancer
Unexplained ulceration for over 2 weeks Lump in oral cavity over 2 weeks Red or white patch (erythro/leukoplakia)
50
Oral cancer diagnosis
Fine needle aspiration/biopsy CT/MRI for staging CT thorax all H&N Ca surgical resection ±reconstruct External beam radiotherapy ± Cisplatin
51
Pharyngeal cancer | - Tx
Surgery ± neck dissection (LN removal) | Radiochemoherapy (cisplatin, External bam radio)
52
Laryngeal cancer - Cell type - Where - RF - Pres
SCC Most commonly at Glottis Smoking, Alc, HPV16, asbestos/nickel Chronic hoarseness, pain, dysphagia, lump in neck, weightless, sore throat, stridor
53
Laryngeal cancer - Ix - Tx
``` Palpate for Los CXR to see if hoarseness lung or ENT Laryngoscopy FNA neck mass CT/MRI staging ``` Transoral microsurgery/Partial/Total laryngectomy depending on stage Postop chemoradio
54
Cause of tonsilitis
Bacterial: strep pyogenes Viral: Coxsakie, EBV/IM in teens (splenomegaly), Herpes simplex (Adolescents)
55
Centor criteria and Tx
1) Fever > 38 2) Tender anterior cervical lymphadenopathy 3) No cough 4) Tonsillar exudate ``` 3/4 = 40-60% chance bacterial Give phenoxymethypenicillin (Clarithromycin if allergic) ```
56
Signs of strep throat
Red, swollen, Exudate, LNs, Temperature
57
Tx tonsilitis
Reassure self limiting, Ibuprofen/Paracetamol | ABx if 3+ on Centor (10d phenoxymethypenicillin)
58
When tosillitis get surgery
7 well documented episodes in last 12m | Tonsils obstructing airway
59
Tonsilitis compliations
Peritonsillar abscess, acute otitis media
60
Group A strep throat (pyogenes) complication
Rheumatic fever Glomerulonephritis Scarlet fever (red skin eruption, flushed face, strawberry tongue)
61
Causes of pharyngitis (Pharyngeal inflam)
Viral: rhinovirus, coronavirus, influenza, parainfluenza, adenovirus Bact: Group A strep
62
When not to examine sore throat? - Sympt - What is it and what organis?
Drooling, stridor Epiglottitis H.influenza type b
63
Tx for normal pharyngitis - normal - Abx? - When refer
Reassure Para, Ibuprofen, oral fluids If doesn't settle in 1 week or if cantor 3/4 then Abx Urgent referral: - resp diffuculty, - stridor, - suspected kawasaki's (sore throat, palm/sole peeling - risk Coronary aneurysm)
64
Complications of pharyngitis: - Suppurative - Non-suppurative
Otits media, Sinusitis, Quinsy, Mastoiditis, Scarlet fever Rheumatic fever (Pyogenes), Glomerulonephritis
65
Causes of Laryngitis
Infection: viral (corona, adeno, HSV), bacterial (H.influenza b, S.pneum) Reflux Allergy AI disease (SLE, RA, Amyloid) Smoking Tx according to cause e.g. GORD -> PPI
66
Epiglotitis: - Cause - Age - Pres - DONT ... - Ix - Tx
Haemophilus Influenzae b 2-5 or adults 40-50 Sore throat, unable to swallow (drooling), Muffled voice, Fever/hihg temp, tripod sign (leaning forward) Stridor + resp distress Examine airway with tongue depressor - precipitates laryngeal oedema Same day urgent laryngoscopy IN THEATRE IV abs ± intubation/Tracheostomy
67
Peritosilar abscess (Quinsy) - Assoc with.. - Organism - RF - Pres - Diagnosis - Tx
Complication of acute tonsillitis Strep pyogenes, Staph aureus, H.influenzae Smoking Severe pain, fever, drooling, foul breath, reduced jaw mobility (Trismus) Ipsilateral LN Unilateral bulge with uvula displacement Clinical Dx, may need CT IV fluids, IV ABx (Penicillin, co-amoxiclav, cephalosporin) Needle aspiration and drainage
68
Quinsy complications
Abscess Spread Haemorrhage
69
Stridor (loud inspiratory sound) - Causes in child - Causes in adult
Croup, inhaled foreign body, epiglottis Airway trauma, anaphylaxis, acute laryngitis Chronic: Laryngeal ca, Mediastinal tumour,
70
Where do foreign bodies lodge
Right lung | Right main bronchus is more vertical than left
71
Worrying presentation following nasal injury
CSF rhinorrhoea Septal haematoma Septal deviation Facila anaesthesia (loss of feeling)
72
Commonest cause Rhinorrhoea
Coryza (cold) Hay fever Nasal polyps (due to chronic allergy or inflammation)
73
Nasal polyps - Causes - Tx
Chronic inflammation, asthma, CF, Churg-Strauss, aspirin sensitivity 1st line: Topical corticosteroid (fluticasone) Gold standar = surgery (endoscopic sinus surgery)
74
Lump in neck Ddx: 1- Rubbery painless lymphadenopathy 2- Hx of local infection 3- Palpitations, thin hair 4- Midline lump which moves up when stick out tongue 5- Older man with a midline lump that gurgles on palpation 6- Left sided lump on child under 2 7- Young adult with oval, mobile cystic mass between sternocleidomastoid and pharynx 8- Adult female with thoracic outlet syndrome 9- Pulsatile lateral neck mass which doesn’t move on swallowing
1) Lymphoma 2) Reactive lymphadenopathy 3) Thyroid swelling 4) Thyroglossal cyst 5) Pharyngeal pouch 6) Cystic hygroma 7) Branchial cyst 8) Cervical rib 9) Carotid aneurysm
75
Neurological causes of dysphagia
CVA, achalasia, oesophageal spasm, MND, MS, Parkinson’s
76
Obstructive causes of dysphagia
GORD, oesophagitis, oesophageal/gastric cancer, pharyngeal cancer, oesophageal stricture
77
CREST dysphagia pathophys
Thickening of oesophageal wall due to fibrosis = reduced motility
78
Dysphagia red flags
Weight loss Pain Hoarseness Regurgitation
79
Obstructive sleep apnoea - Def - Assess - Assoc - Tx
Repeated Upper airway collapse during sleep going excessive waking and daytime sleepiness. Due to relaxation of neck soft tissue = obstruction Epworth sleepiness scale, Polysomnography HTN, Obesity, asthma, Big neck circumference Stop smoking, weight loss CPAP = gold standard
80
Bell's palsy - Def - Type of palsy - Assoc features - Tx
Acute, idiopathic facial nerve paralysis LMN lesion (forehead affected) ``` Hyperacusis (hearing - CNVII innervation of stapedius muscle) Altered taste (lingual nerve) ``` Prednisolone +artificial tears
81
Ddx Bells palsy
Ramsay-Hunt syndrome Due to Herpes Zoster Rash behind ear with symptoms of Bell's

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