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General Practice YR3 > ENT B presentations > Flashcards

ENT B presentations Flashcards

1
Q

BPPV presentation

A
  • Variety of head movements trigger vertigo
  • Typical trigger is turning over in bed
  • Settle after 20-60s
  • Episodes occur overal several weeks then resolve but can reoccur
  • NO hearing loss or tinnitus
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2
Q

Diagnosis and management of BPPV

A
  • Diagnose with Dix Hallpike maneuvre
  • Treat with Epley
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3
Q

Cause of allergic rhinitis

A
  • Inflammatory condition of nasal mucosa
  • Caused by IgE mediated response to allergens within environment eg pollen/dust mites
  • Can show seasonal variation
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4
Q

Signs and symptoms of allergic rhinitis

A
  • Nasal pruritis
  • Sneezing
  • Rhinorrhoea
  • Nasal congestion
  • May be associated with allergic conjuctivitis = eye redness, puffiness and watery dishcarge
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5
Q

Diagnosis for allergic rhinitis

A
  • Clinical and pt history based
  • If needed can refer for skin prick test or blood tests for specific IgE antibodies to identify allergen
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6
Q

Investigations if diagnosis doubt or failure to respond to treatment in allergic rhinitis

A
  • Nasal endoscopy
  • Nasal allergy challenge
  • Evaluation of nasal nitric oxide and ciliary beat frequency
  • Analysis of nasal fluid
  • CT scan
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7
Q

What are nasal polyps?

A
  • Growths of nasal mucosa that occur in nasal cavity/sinuses
  • Often associated with inflammation, eg chronic rhinitis
  • Grow slowly and gradually obstruct passage
  • More common in men esp those 40+
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8
Q

Polyps patten

A
  • Bilateral usually
  • Unilateral is red flag - tumour?
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9
Q

Presentation of nasal polyps

A
  • Chronic rhinosinusitis
  • Difficulty breathing through nose
  • Snoring
  • Nasal discharge
  • Hypo or anosmia
  • Post nasal drip = cough
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10
Q

Investigations for nasal polyps

A
  • Examine with nasal speculum to hold nostrils open
  • Otoscope + large speculum attached
  • Specialist can do nasal endoscopy
  • Appear as round, pale/grey/yellow growrht on mucosal wall
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11
Q

When to refer polyps?

A

Unilateral - 2WW

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12
Q

Management polyps

A
  • Intranasal steroid drops or sprays
  • Surgery - intranasal polypectomy (when polyps are visibilt OR
  • Endoscopic nasal polypectomy (polyps are further in nose or in sinuses)
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13
Q

Infective cervical lymphadenopathy characteristics

A
  • Tender
  • Mobile
  • Associated fever, cough, sore throat
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14
Q

Maligmant cervical lymphadenopathy characteristics

A
  • Irregular
  • Hard
  • Tethered to surrounding tissues
  • Painless
  • Larger than 2cm
  • Associated systemic symptoms - weight loss, night sweats, fatigue
  • Other symptoms - change in voice, dysphagia, haemoptysis, rapidly growing
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15
Q

Investigations for cervical lynphadenopathy

A
  • Depends
  • May just resolve if viral
  • Can do EBV, cyomegalovirus and HIV serology
  • Urgent CXR if suspect TB or lung cancer (within 2 weeks)
  • If suspect leukaemia need FBC
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16
Q

Management cervical lymphadenopathy

A
  • Viral - self limiting
  • Bacterial - assess need for abx,
  • If unresolved after 2-4 weeks consider urgent ENT referral
  • If suspect cancer 2WW pathway for cancer
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17
Q

Acute sinusitis presentation

A
  • Lasting less than 4 weeks
  • Facial pain
  • Anosmia
  • Purulent discharge
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18
Q

Investigations for chronic sinusitis

A
  • Nasal endoscopy
  • Nasal and sinus cultures
  • CT if indicated - complications and extent of disease
  • Skin prick testing
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19
Q

Management acute sinusitis

A
  • Analgesia
  • Intranasal decongestants or nasal saline
  • Intranasal corticosteroids if symptoms present for more than 10 days
  • Oral abx if severe presentation and suspect bacterial - phenoxymethylpenicillin, co-amoxiclav is systemically very unwell
20
Q

What is double sickening?

A
  • Viral sinusitis worsens due to secondary bacterial infection - get better and then worse
21
Q

When to refer to ENT acute sinusitis?

A
  • No improvement after 7-14 days or red flag
22
Q

Red flag for sinusitis

A
  • Eye signs - periorbital swelling or erythema, displaced globe, visual changes, opthalmoplegia
  • Severe unilateral headache
  • Bilateral frontal headache
  • Frontal swelling
  • Neurological signs or reduced conc level
23
Q

Chronic sinusitis - what is it?

A
  • Inflammation of the paranasal sinuses in the face for more than 12 weeks
  • Rhinosinusitis if nasal cavity is also inflamed
  • Can last several months
24
Q

Underlying cause chronic sinusitis

A

More likely to be inflammatory rather than infection (acute more likely to be infection)

25
Q

RF for chronic sinusitis

A
  • Allergic rhinitis
  • Asthma
  • Cystic fibrosis
  • Immunocompromised
  • Smoking
  • Previous sinus surgery
  • Nasal polyps - blocks drainage
26
Q

Signs and symptoms chronic sinusitis

A
  • Nasal blockage
  • Nasal discharge with facial pain/pressure or headache
  • +/- reduced sense of smell
  • Cough
27
Q

Management chronic sinusitis

A
  • Good control of asthma or any allergic rhinitis
  • Avoid triggers
  • Smoking cessation
  • Nasal irrigation with saline solution
  • Consider course intranasal corticosteroids for up to 3 months (esp if allergic cause) - reduces swelling
28
Q

When to refer chronic sinusitis?

A
  • Persistent symptoms past 3 months
  • Unilateral symptoms (cancer?)
  • Interefering with QOL
  • Allergic/immunologic factors that need investigating
29
Q

Thyroid nodules - presentation

A
  • Identified on routine examination/incidentally on imaging
  • If large can be palpable
  • Move upwards on swallowing
  • Can present with hyper or hypothyroidism or compressive symptoms
30
Q

Compressive symptoms of thyroid nodules

A

On oesophagus or trachea:
* Dysphagua
* Stridor
* Voice changes (hoarseness)
* SVCO - face/neck swelling, distended neck veins and dyspnoea

31
Q

Causes of thyroid nodules

A
  • Most benign - adenoma, multinodular goitre, hashimotos thyroiditis or cysts (colloid, simple, haemorrhagic)
  • Malignancy - PFAM, lymphoma
  • Mets - breast, kidney, prostate
32
Q

Invetsigations for thyroid nodules

A
  • TFTs
  • Thyroid USS - solid, irregular, hyperechoic, >1cm, rapid growth and central vascularity suggests cancer
  • Thyroid scintigraphy (radioisotope scanning)
  • Fine needle aspiration and histological diagnosis
33
Q

Thyroid scintigraphy findings and meanings

A
  • Non-functioning cold nodule, no uptake of iodine - malignant
  • Autonomous hot nodule, increased uptake - unlikely malignancy eg adenoma
  • Hot and cold areas, patchy uptake - toxic multinodular goitre
34
Q

What is thyroid scintigraphy?

A

Radioactive labelled iodine is given to pt
Measure thyroid uptake using nuclear scan

35
Q

Management thyroid nodules options

A
  • Emergency hospital admission if signs of obstruction
  • Urgent referral to endocrinology (2weeks)
  • Serum TFTs
  • Routine endo referral
  • Monitor
36
Q

When to urgent refer thyroid nodules to endo?

A
  • Unexplained thyroid lump
  • Unexplained hoarseness/voice change
  • Cervical lymphadenopathy or supraclavicular
  • Sudden onset and rapidly expanding painless thyroid mass - increased in size over days/weeks
  • Compressive symptoms
37
Q

When to routine endo referral thyroid nodule?

A
  • Non-suspicious nodule with abnormal TFTs and normal TFTs
  • Sudden onset, painful expansion in pre-existing lump - haemorrhage into benign cyst?
  • Non suspcious incidental finding on imaging more than 1cm
38
Q

When to just monitor thyroid lump in primary care?

A
  • Long standing unchanging over several years
  • Non-palpable, asymptomatic incidental finding on imaging less than 1cm
  • Non palpable cervical lymphadenopathy and no red flags for malignancy
39
Q

Acute labyrinthitis vs vestibular neuronitis

A
  • Labyrinthitis = vestibule, semicircular canals and cochlea inflamed
  • VN - vestibular portion of CN8th inflamed so no hearing loss/tinnitus present
40
Q

Cause of AL and VN

A
  • Viral URTI is usually cause (can be otitis media or meningitis too)
41
Q

Presentaiton of AL and VN

A
  • Acute onset of vertigo, nausea and vomitting
  • Can have symptoms of URTI - cough, sore throat, blocked nose etc
  • AL can have tinnitus and hearing loss also
42
Q

Diagnosing AL and VN

A
  • Clinical
  • Can do head impulse test to distinguish between peripheral and central causes of vertigo
43
Q

Management acute labyrinthitis/VN

A
  • Supportive - settles over several weeks
  • Advise not to drive if very dizzy
  • Short term (up to 3 days) of prochlorperazine or antihistamines (cyclizine, cinnarizine and promethazine) to relieve symptoms
  • Abx used if suspect bacterial cause (more likely in otitis media or meningitis)
44
Q

Hearing loss after acute labyrinthitis

A
  • Rarely have permanent hearing loss
  • More common following bacterial infection esp from meningitis
  • All patients after meningitis recovery should have audiology assessment
45
Q
A

General Practice YR3 (31 decks)

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