ENT Flashcards
1
Q
What is used to test hearing range?
A
Audiogram (the higher up the better the hearing)
- 20-40 = moderate hearing loss
- 70-90 = severe hearing loss
2
Q
Function of external ear?
A
Receives sound
3
Q
Function of middle ear?
Tympanic memrane : oval window ratio?
A
Acts as an amplifier
* 18:1 (impedance matching air to liquid)
4
Q
Closure and opening of eustachian tube?
Function of tube?
A
Resting state of cartilaginous tube is closed but opened by tensor veli palatini & levator palatine muscles
*pressure equalisation in ears (dysfunction leads to middle ear negative pressure)
5
Q
Oval and round windows?
Function?
A
2 openings of cochlea into middle ear
* transmission of pressure wave + vibration of basilar membrane
6
Q
What causes fluid vibration?
Explain how vibration is picked up by basilar membrane?
A
Movement of stapes via stapedius (smallest skeletal muscle in the entire body)
- High frequency sound at beginning of membrane
- Low frequency sound towards apex (end of the spiral)
7
Q
Function of inner ear?
Structure?
What is found in centre?
A
Receiver/transducer (fluid -> AP)
- Spiral lamina wrapped around central modiolus
- cochlear nerve found inside central modiolus
8
Q
Explain structure of cochlea
What do these open up into?
A
Scala media (endolymph) suspended in between scala tympani & scala vestibuli (perilymph)
- Scala vestibuli = oval window
- scala tympani = round window
9
Q
Ionic composition of periplymph and endolymph?
A
Perilymph
* Na+
Endolymph
* K+
10
Q
Explain central pathway of sound perception? (5)
A
Organ of Corti depolarises and fires
Stimulates VIIIth nerve and then central pathways
E COLI
- Ear ->
- Cochlear nucleus ->
- superior Olivary complex ->
- Lateral lemniscus ->
- Inferior colliculus
11
Q
Where is primary auditory cortex?
A
Posterior superior temporal gyrus
12
Q
When can foetus hear?
A
18 weeks - foetus can hear
26 weeks - foetus will respond to sound/voice
13
Q
Universal neonatal screening for hearing loss?
A
OAEs can be identified in normal cochlea - if absent, suggest a problem
14
Q
Explain how cochlear implant works
A
- Inserted into scala tympani
* Will coil around cochlear nerve
15
Q
Normal development of hearing/vocals? (5)
A
- 3 months - cooing, recognises mother’s voice
- 6 months - babbling, makes happy and sad sounds, eyes towards sounds
- 12 months - mama/dada, follows instructions
- 12-18 months - syllable deletion/substitution
- 24 months - two word phrases, 50+ words, understands questions and follows commands
16
Q
Explain balance input/output to central pathway?
A
Input (4)
- visual
- cardiovascular
- vestibular
- proprioceptive
Output (2)
- vestibulospinal tract
- vestibulo-ocular reflex
17
Q
Explain the input/output involved in Rombergs test? (standing on foam)
A
Input = vestibular Output = vestibulospinal
(if fall over = positive rombergs)
18
Q
vestibular nerve supply to inner ear?
A
- Superior vestibular nerve = lateral, anterior semi-circular canal, and utricle
- inferior vestibular nerve = poserior semi-circular canal and saccule
19
Q
Hair cells of inner ear? (2)
Mechanism?
A
- Kinocilium = longest hair
- stereocilia = the rest
Movement of hair cells towards longest = depolarises (increases firing rate)
If movement away from longest = hyperpolarised (decreases firing rate)
20
Q
Otolith organs?
Explain structure
A
Utricle and saccule
* maculae of these organs have stereocilia projecting upwards into gel membrane + otoconia (the gel membrane pulls the hairs in different directions)
21
Q
What allows the head to perceive position and movement when tilting head or making horizontal movements?
A
Otolith organs
Also in a lift, it is your otolith organ that allows you to sense whether you’e going up or down even tho you can’t see
22
Q
how many semi-circular canals are there?
Orientation?
A
3 on each side of the head
- lateral
- anterior
- posterior
They are paired
* orientated at 90* from each other
23
Q
What is the ampullary capula?
Function?
A
Sits in ampulla of semi-circular canal
- it is pushed by perilymph in opposite direction response to movement
- “bending” cause cilia to deflect
- sends signals to vestibular nerve
24
Q
Vestibulo-occular reflex input and output?
A
- input: vestibular
- output: vestibulo-ocular reflex
(hold thumb, look at it, turn head)
25
S/s of dysfunctional vestibulo-ocular reflex as a result of damaged ear?
Nystagmus
| * if lose left ear, eyes move left then flick back to right quickly
26
Oscillopsia?
| Ax?
Shaky eye movement
| * gentamicin toxcicity (no vestibular input)
27
What is vestibulospinal tract?
motor output to the neck, back and leg muscles
28
What comprises the vestibulo-ocular tract?
fasciculus + ocular muscles - motor output to eyes
29
What are receptors for taste and smell?
Chemoreceptors - stimulated by binding of particular chemicals
30
Gustation?
Taste
31
Taste buds made up of?
* sensory receptor cells
* support cells
(arranged like slices of orange)
32
How are taste receptor cells replaced?
From basal cells
33
What do taste receptor cells synapse with?
afferent nerve fibres
34
Where are taste buds found?
* tongue
* palate
* epiglottis
* pharynx
35
Where do most taste buds sit?
| Types? (4)
majority of taste buds sits in papillae in the tongue
* filliform
* fungiform
* vallate
* foliate
36
Nerve supply to tongue?
* Posterior 1/3rd = glossopharyngeal nerve
| * anterior 2/3rds = chorda tympani (CN VII)
37
Physiology of taste (gustation)?
| Nerves involved?
* Binding of tastant to receptor cells causes depolarisation
* APs conveyed by cranial nerves to cortical gustatory areas
Afferent taste fibres reach the brainstem via:
* VIIth cranial nerve (chorda tympani branch of facial nerve) - anterior two-thirds of the tongue
* IXth cranial (glossopharyngeal) nerve - posterior third of the tongue
* Xth caranial (vagus) nerve - areas other than tongue, including e.g. epiglottis and pharynx
38
What are 5 primary tastes?
* Salty - stimulated by NaCl
* Sour - stimulated by acids with free H+ ions
* Sweet - glucose
* Bitter - alkaloids + poisonous substances
* Umami - triggered by amino acids (esp. glutamate)
39
Abnormalities of taste? (3)
* Ageusia (loss of taste) = nerve damage, inflammation, endocrine disorders
* Hypogeusia (reduced taste) = chemo, medications
* Dysgeusia (distortion of taste) = gum infection, tooth decay, reflex, URTI, chemo, meds
40
What does olfactory mucosa contain? (3)
3 cell types
* olfactory receptor cells
* supporting cells
* basal cells (secrete mucus)
41
Explain structure of olfactory receptor
Each neuron has thick short dendrite and expanded end called olfactory rod (rods attach to cilia)
* odorants (molecules that can be smelled) attach to cilia
* axons of olfactory receptors form olfactory nerve
* pierce cribiform plate and enter olfactory bulbs in brain
* olfactory bulbs send signals to olfactory areas of temporal lobe
42
What properties must a substance have in order to be smelled? (2)
* volatile
| * water soluble
43
Abnormalities of smell? (3)
* Anosmia (inability to smell) = infections, allergy, nasal polyps
* Hyposmia (reduced ability to smell) = may be early sign of parkinsons
* dysosmia (altered sense of smell) = hallucinations etc
44
Viral causes of oral ulceration? (2)
* herpes simplex
| * Coxsackie
45
Which type of herpes simplex causes oral lesions?
| How is it transmitted?
```
Type 1 (acquired in childhood)
* thru saliva contact
```
46
What is primary gingivostomatitis caused by?
Which group of people are affected?
S/s? (3)
HSV1
Pre-school children
s/s
* fever
* lymphadenopathy
* ulcers on lips, buccal mucosa, hard palate
47
Tx for primary gingivostomatitis?
Aciclovir
48
Is herpes simplex "curable"?
No
| Latent form remains in trigeminal nerve and can reactivate
49
Tx cold sore?
Aciclovir (DOES NOT PREVENT LATENCY)
50
Are recurrent intra-oral lesions likely to be HSV?
No, usually only on lips (cold sore)
51
Herpetic whitlow?
lesion (whitlow) on a finger or thumb caused by the herpes simplex virus (HSV1 or 2)
52
Dx HSV?
Swab of vesicle, then detection of viral DNA by PCR
53
Significant complication of HSV?
herpes simplex encephalitis (high mortality!)
54
Herpangina?
Ax?
Dx?
Ulcers on the soft palate
* Ax = coxsackie viruses e.g. enterovirus (not HSV)
* Dx = viral PCR
55
Hand, foot and mouth disease?
Ax?
Dx?
Blisters on hands, feet and mouth
* Ax = coxsackie virus (enterovirus)
* Dx = PCR for viral DNA
56
What is ulcer caused by syphillis called?
Is it a virus?
S/s?
Tx?
Chancre
* no, it is caused by bacterium called treponema pallidum
s/s
* painless oral lesions (unlike herpes)
Tx = penicillin :)
57
apthous ulcers?
Ax?
Tx?
recurring painful ulcers of the mouth that are round and have inflammatory halos
* non-viral (not infectious but INCREDIBLY common)
* Tx = self-limiting
58
Differentials for recurrent painful ulcers?
* Apthous ulcers
| * Herpes simplex
59
Recurrent ulcers associated with systemic disease?
* Bechet's disease (oral ulcers, genital ulcers, uveitis - common in Asia)
* Coeliacs or IBD (diarrhoea, weight loss)
* Reiter's disease (arthritis)
* Skin diseases (lichen planus, pemphigus, pemphigoid)
60
When should EBV be suspected as a cause of sore throat?
| Other possible differentials? (3)
If sore throat and lethargy persist into the second week, especially if the person is 15-25 years of age, infectious mononucleosis (EBV) should be suspected
Less common causes
* HIV
* gonococcal pharyngitis
* diptheria
61
When should you not examine a sore throat?
Sore throat with stridor or respiratory difficulty is an absolute indication for
admission to hospital, and attempts to examine the throat should be avoided
62
What are most sore throats caused by?
| Tx?
Virus
| self-limiting
63
Most common bacterial cause of sore throat?
What condition does it cause?
Tx?
Strep pyogenes (GAS)
* acute follicular tonsilitis
* Tx = phenoxymethylpenicillin
64
Strep pyogenes complications? (2)
* Rheumatic fever - fever, arthritis, pancreatitis
| * Glomerulonephritis - haematuria, albuminuria, oedema
65
What can cause neutropenia?
Drugs like carbimazole, chemo
66
Tx group A strep?
What about if severe?
What is classed as severe?
Penicillin
* phenoxymethylpenicillin
* severe = Fever PAIN 4 or 5, CENTOR 3 or 4
67
What is diptheria caused by?
S/s? (3)
Tx?
```
Corneobacterium diptherae
S/s
* pseudomembrane
* severe sore throat
* produces exotoxin which is cardiotoxic and neurotixic
```
Tx = antitoxin + supportive (if doesn't work, penicillin/erythromycin)
68
S/s infectious mononucleosis? (6)
* Enlarged lymph nodes
* Sore throat
* Pharyngitis
* Tonsilitis
* Malsaise
* lethargy
69
Complications of EBV? (4)
* anaemia, thrombocytopenia
* splenic rupture
* upper airway obstruction
* increased risk of lymphoma
70
Tx EBV? (4)
* Bed rest
* paracetamol
* antivirals NOT effective
* steroids MAKE WORSE
71
Dx EBV? (4)
* EBV IgM
* Heterophile antibody (paul-bunnell test, monospot test)
* blood count
* LFT (EBV can result in jaundice)
72
Differential diagnosis of EBV?
* cytomegalovirus
* toxoplasmosis
* primary HIV
common s/s: malaise, sore throay, leucocytosis
73
Tx candida?
nystatin or fluconazole
74
What is acute otitis media?
Group of people?
S/s?
URTI infection involving the middle ear by extension of infection up the Eustachian tube
* infants and children
* presents with ear ache
75
Infections of middle ear (otitis media) Ax?
Common bacteria?
Dx?
Often viral with secondary bacterial infection
* Haemophilus influenzae, strep pneumoniae, strep pyogenes
Dx = swab of pus if eardrum perforates (otherwise samples can't be obtained)
76
Tx of middle ear infections?
normally resolve on their own within 4 days
* First line = amoxicillin
* second line = erythromycin
77
Malignant otitis?
| S/s? (4)
Fatal condition without Tx (can lead to osteomyelitis of skull and meninges)
* Severe headache
* SEVERE +++ ear pain (even tho ear just appears a bit red)
* granulation tissue in ear canal
* facial nerve palsy (drooping face on side of lesion)
78
Risk factors for malignant otitis?
* diabetes
| * radiotherapy to head and neck
79
Dx malignant otitis?
Ax?
Tx?
Dx = PV/CRP, imaging, biopsy, culture
* cause is usually pseudomonas aerguinosa
* Tx = ciprofloxacin
80
Tx malignant otitis?
Ciprofloxacin
81
Otitis externa?
| S/s? (5)
Inflammation of outer ear canal
* redness
* itchy
* pain
* discharge or increased amounts of earwax
* hearing loss can occur if canal becomes blocked by earwax or discharge
82
Ax otitis externa? (3)
Bacterial causes
* staph aureus
* proteus
* pseudomonas aeruginosa (swimmers)
Fungal
* aspergillus niger (appears black)
* candida albicans
83
Tx otitis externa?
Depends on cause
* Aspergillus niger = topical clotrimazole
* bacterial = gentamicin
84
Ax acute sinusitis?
| What indicates secondary bacterial infection?
Preceded URTI
| * severe pain and tenderness with purulent nasal discharge indicates secondary bacterial infection
85
Organisms in acute sinusitis?
Mostly viral
| * bacteria similar to otitis media (H. influenzae, strep pneumoniae, strep pyogenes)
86
Tx acute sinusitis? (2)
Antibiotics
* 1st line = phenoxymethylpenicillin
* 2nd line = doxycycline (NOT IN CHILDREN - tooth staining)
87
types of hearing loss?(3)
* conductive
* sensorineural
* mixed
88
Otalgia?
ear ache (not necessary indicative of ear pathology as can be referred)
89
Otitis externa?
Ax?
S/s?
Inflammation of the skin of the ear canal
* Ax = bacterial or fungal (cotton buds, water)
* Sore + itchy
90
Features of acute otitis media?
* More common in children
* Associated with glue ear
* Commonly associated with URTIs
91
Types of chronic otitis media? (3)
* Otitis media with effusion (glue ear)
* Cholesteatoma
* Perforation
92
Glue ear in children?
| Adults?
```
In children associated with eustachian tube dysfunction or obstruction
IN adults
* rhinosinusitis
* nasopharyngeal carcinoma
* nasopharyngeal lymphoma
```
93
Symptoms of chronic otitis media with effusion?
Conductive hearing loss with flat tympanogram
94
Tx chronic otitis media with effusion?
myringotomy + gromet to stop hole closing
95
Tx acute otitis media?
Eardrum normally perforates then heals on its own
96
Cholesteatoma?
Prescence of keratin within middle ear - can erode ossicles!!
97
S/s cholesteatoma?
| Tx?
Hearing loss, discharge
| * Surgery
98
Complications of acute otitis media and cholesteatoma?
* Medially = tinnitus, vertigo, sensorineural hearing loss, facial palsy
* Superiorly = brain abscess, meningitis
* posteriorly = venous sinus thrombosis
99
Otosclerosis?
| Tx?
Fixation of stapes footplate resulting in gradual conductive hearing loss!
Tx = stapedectomy
100
Otosclerosis affects?
Women mostly
| progresses faster during pregnancy
101
Presbycusis?
Sensorineural hearing loss
| usually high frequency
102
Noise-induced hearing loss classical dip?
4 kHz
103
Drug-induced hearing loss? (3)
* Gentamicin
* Chemo - cisplatin, vincristine
* Aspirin + NSAIDs (overdose)
104
Vestibular schwannoma?
Benign tumour arising in internal acoustic meatus (vestibular nerve)
105
Vestibular schwannoma s/s? (3)
| Dx?
* hearing loss
* tinnitus
* imbalance
Dx = MRI
106
Difference between dizziness and vertigo?
```
Dizziness = non-speciic term
Vertigo = spinning
```
107
diseases affecting balance pathways?
* Visual = cataracts, DM
* Cardio = arrhythmias, postural hypotension
* Vestibular = BPPV, Menieres, Vestibular neuronitis
* Proprioceptive = DM, arthritis, neurology
* Vestibulospinal tract + VOR = stress, migraine, space-occupying lesion, MS
108
Duration of vertigo episodes?
* Seconds = BPPV
* Hours = Menieres
* Days = Vestibular neuritis
* Variable = migraine
109
Top questions for quick dizziness diagnosis? (4)
* Do you get dizzy rolling over in bed? = BPPV
* First attack severe, lasting hours with nausea and vomiting? = vestibular neuritis
* Light-sensitive during dizzy spells? = migraine
* Ear feel full or hearing loss during dizzy spell? = meniere's
110
Benign positional paroxysmal vertigo?
VERY COMMON - commonest cause of vertigo on looking up
111
Ax BPPV?
Idiopathic, head trauma, ear surgery
112
Pathophysiology BPPV?
| Tx? (3)
Otolith material from utricle displaced into semicircular canals (usually posterior SCC)
* Epley manoeuvre
* Semont manouevre
* Brand-Daroff exercises
113
Dx BPPV?
Hallpike test
114
Vestibular neuronitis s/s?
* Prolonged vertigo (days)
| * NO tinnitus or hearing loss!!
115
Labyrinthitis s/s? (3)
* prolonged vertigo (days)
* tinnitus
* hearing loss
116
Vestibular neuronitis + labyrinthitis tx?
* Vestibular sedatives e.g. diazepam
| * Self-limiting (viral aetiology)
117
Menieres disease Ax?
| Pathophysiology?
Unknown
| * endolymphatic hydrops
118
Menieres disease s/s? (5)
* recurrent, spontaneous, rotational vertigo with at last 2 episodes lasting >20 mins
* Tinnitus on affected side
* aural fullness on affected side
* SNHL
119
Meniere's disease tx?
* supportive
* avoid things like caffeine, alcohol, stress
If severe
* gentamicin
* grommet
* surgery (e.g. vestibular nerve section)
120
Epithelium of middle ear?
Non-ciliated cuboidal
121
Otic capsule surrounds?
Vestibule, cochlea + semi-circular canals
122
Types of rhinitis?
* Infective = viral URTI
| * Non-infective = allergic and non-allergic
123
Tx allergic rhinitis?
Stepwise
* allergen avoidance
* then antihistamines
* topical steroids
* topical steroids + antihistamine combo
124
Nasal polyps associated with?
| Tx?
Often associated with non-allergic asthma
Tx
* oral then topical steroids
* if not better, then surgery
125
How to tell the difference between a nasal polyp and a large inferior turbinate?
If touch a polyp, won't have any sensation
126
Acute infective rhinitis s/s? (3)
| Tx?
* Facial pain
* discharge
* nasal blockage
Tx
* analgesics and decongestants
* if persistent, add antibiotic
127
Rhinosinusitis complications? (2)
* Cavernous sinus thrombosis
| * Orbital cellulitis
128
Infective rhinitis called?
Rhinosinusitis
129
Types of non-allergic rhinitis? (2)
* Polyps
| * vasomotor rhinitis
130
Investigations rhinitis?
* RAST
131
Unilateral discharge from nose differentials?
Adult
* nasal or paranasal tumour
* REFER URGENTLY
Child
* foreign body
132
What is orbital cellulitis a complication of?
Acute sinusitis
| * EMERGENCY REFERRAL (can cause blindness)
133
Benign salivary gland tumours? (4)
* pleomorphic adenoma
* warthins
* oncocytoma
* monomorphic
134
Malignant salivary gland tumours? (5)
* mucoepidermoid
* adenoid cystic
* acinic cell Ca
* SCC
* adenocarcinoma
135
Non-epithelial salivary gland tumour?
Lymphoma
136
What is important to exclude in nasal trauma?
Septal haematoma
137
Tx nasal fracture?
Digital manipulation <3 weeks
138
Complications of nasal trauma? (3)
* Epistaxis - anterior ethmoid artery
* CSF leak, meningitis
* Anosmia - cribiform plate fracture
139
Blood supply in epistaxis? (3)
* Sphenopalatine artery
* Ethmoid artery
* Greater palatine artery
from ICA and ETA??
140
Management epistaxis? (3)
* external pressure to nose
* cautery
* nasal packing
141
What should you never do to patient with nasal trauma?
Sedate
142
CSF leak management?
Often settle spontaneously
* need repair if >10 days
(site of fracture may be cribiform plate)
143
Ear emergencies? (4)
* Pinna haematoma
* Ear lacerations
* Temporal bone fractures
* sudden sensorineural hearing loss
144
Tx pinna haematoma? (3)
* Aspirate
* Incision and drainage
* Pressure dressing
(no evidence on which technique is best?)
145
Tx ear lacerations? (3)
* Debridement
* Closure
* Antibiotics - cartilage
146
Classification temporal lobe fracture? (3)
* Longitudinal vs transverse
* otic capsule involved
* otic capsule spared
147
Longitudinal temporal bone fracture caused by?
| Complications? (4)
Lateral blows
* haematympanum (conductive deafness)
* ossicular chain disruption (conductive deafness)
* Facial palsy
* CSF otorrhea
148
Transverse temporal bone fracture caused by?
| Complications? (3)
```
Frontal blows
Complications = can cross IAM causing damage to auditory and facial nerves
* sensorineural hearing loss
* Facial nerve palsy
* Vertigo
```
149
Causes of conductive hearing loss? (3)
* Fluid
* TM perforation
* Ossicular problem
150
Mx foreign bodies in ear?
Can usually wait until urgent clinic for removal
* EXCEPT watch batteries - remove immediately
* Live animals - drown with oil then can be removed next day
151
Classification neck trauma? (3)
* Zone 1 = trachea, oesophagus, throacic duct, thryoid, vessels (brachiocephalic, subclavian, common carotid), spinal cord
* Zone 2 - larynx, hypopharynx, CN 10, 11, 12, vessels (carotids, internal jugular), spinal cord
* Zone 3 - pharynx, cranial nerves, vessels (carotids, IJV, vertebral), spinal cord
152
Ix neck trauma? (4)
* FBC
* Neck X-ray
* CXR (haemo-pneumothorax)
* CT angiogram
153
Deep neck space infection?
* extension of infection from tonsil or oropharynx into deeper tissues
154
Deep space neck infection tx? (3)
* Fluid resus
* IV antibiotics
* Incision and drainage of neck space
155
Orbital blowout fracture?
Medial wall + floor
156
Management orbital blowout fracture?
```
Conservative
Surgical repair of bony walls if:
* entrapment
* large defect
* significant enopthalmos
```
157
Ix head and neck cancer? (3)
* radiology
* fine needle aspiration
* endoscopy/biopsy
158
Waldeyer's ring found?
| What is it made up of? (3)
Found in subepithelial layer of oropharynx and nasopharynx
* tonsils (palatine tonsil)
* adenoids (pharyngeal tonsil)
* Lingual tonsil
159
```
Histology tonsils (palatine)?
Adenoids?
```
* Palatine = Specialised squamous
| * Adenoids = ciliated pseudostratified columnar + stratified squamous
160
Histology of throat?
Upper aerodigestive
* ciliated columnar respiratory mucosa
* squamous epithelium
Where food goes
* squamous (oral, pharyngeal, vocal cords, oesophagus)
Where air goes
* pseudostratified columnar (nose, nasopharynx, larynx, trachea)
161
Common diseases of the tonsils and adenoids? (6)
* acute tonsillitis
* recurrent/chronic tonsilitis
* onstructive hyperplasia
* malignancy
* tonsiliths (tonsil crypt debris)
* (otitis media with effusion)
162
Ax acute tonsilitis?
Viral = EBV, rhinovirus, influenza
| (sometimes bacterial) - GAS very important due to complications!!
163
Most common pathogens involved in chronic tonsilitis? (4)
* GAS
* H.infleunza
* Staph aureus
* strep. pneumoniae
164
Differentials acute tonsilitis? (6)
* Infectious mononucleosis
* peritonsilar abscess
* candida infection
* malignancy
* diptheria
* scarlet fever
165
S/s tonsilitis?
Viral
* malaise
* sore throat
* lasts 3-4 days
Bacterial
* systemic upset
* fever
* odynophagia
* hallitosis
* unable to work/school
* lymphadenopathy
* lasts >1 week (reqs antibiotics)
166
Centor criteria?
Differentiate bacterial from viral tonsilitis
* Fever
* tonsillar exudates
* tender anterior cervical adenopathy
* absence of cough
0 or 1 point = no antibiotics
2 - 3 = antibiotics
167
Tx bacterial tonsilitis?
Antibiotics
* penicillin 500mg for 10 days
* clarithromycin if allergic
168
Peritonsilar abscess?
Bacteria between muscle and tonsil produce pus - complication of acute tonsilitis
169
S/s peritonsilar abscess? (5)
| Tx?
* history of acute tonsilitis
* unilateral throat pain and odynophagia
* medial displacement of tonsil and uvula
* concavity of palate lost
Tx
* aspiration
* antibiotics
170
Glandular fever?
| S/s? (4)
Infectious mononucleosis - EBV
* Tonsillar enlargement with membranous exudate
* cervical lymphadenopathy
* petechial haemorrhages on palate
* hepatoplenomegaly
171
Dx glandular fever?
* atypical lymphocytes in blood
* Monospot or Paul-Bunnel test
* Low CRP (<100)
172
Tx glandular fever?
* Antibiotics - DO NOT PRESCRIBE AMPICILLIN (macular rash will result!!)
* Steroids
173
Why should never give amoxicillin to tonsilitis?
In case it is infectious mononucleosis
| * can cause macular rash
174
Chronic tonsilitis s/s?
* chronic sore throat
* malodorous breath
* tonsiliths
* peritonsillar erythema
* persistent tender cervical lymphadenopathy
175
Obstructive hyperplasia s/s? (2)
* snoring
| * AOM/OME (if affects adenoids)
176
Glue ear?
* otitis media with effusion
* serous otitis media
* acute otitis media
Inflammation of middle ear with accumulation of fluid
177
Difference between OME and AOM?
OME
* fluid
* hearing loss
AOM
* no fluid
* no hearing loss
178
OME incidence?
* Children
* M > F
Increased incidence with daycare, smoking household, recurrent URTI
179
S/s eustachian tube dysfunction? (5)
* TM retraction
* reduced TM mobility
* altered TM colour
* visible fluid/bubbles
* tuning fork tests
180
Tx AOM?
Supportive
| refer if persistent, CHL, speech/language problems
181
Surgical management of SEVERE acute otitis media?
* grommets
| * if failure, grommets + adenoidectomy
