ENT + MaxFax Flashcards

Question

USC USS + biopsy criteria for neck lump

Answer 1

Neck lump 3-4 weeks duration No associated upper aerodigestive tract symptoms No red flags, odynophagia, or weight loss No systemic cause

Answer 2

Examine neck, axillae, groin, mouth If ?systemic cause then bloods, CXR and review in 2 weeks. Consider HIV/TB testing

Answer 3

Unexplained fevers, fatigue, night sweats, pruritis, bone pain, bruising, pallor, weight loss. Intercurrent illnesses – URTI/LRTI, mouth ulcers, skin infections. Family or travel contact with TB. Check for pallor, bruising, petechiae, hepatosplenomegaly Temperature, height, and weight loss Consider lymphoma if progressive, > 2 cm, rapidly growing, often rubbery or matted, non-tender cervical lymph nodes. If reducing size<2 cm in 2 weeks no further input required

Answer 4

Admit if: -neonatal vascular mass. -suspected lymphoma or other malignancy. -suspected atypical mycobacterial lymphadenitis (non‑tuberculous). -infected thyroglossal cyst (mid‑line lump). -suspected abscess.

Answer 5

If suspected bacterial lymphadenitis age> 2 years, treat with abx for 1 week. Review after 48 hours. If no improvement, admit for IV abx If midline lump with no red flags, USS + urgent paeds referral

Answer 6

Otalgia out of proportion to clinical findings Otorrhoea Severe canal oedema or signs with open canal and a small granulation of the floor Involvement of cranial nerves (VII to XII)

Answer 7

Acute ENT assessment if: any features of malignant otitis externa. the patient is febrile or systemically unwell. severe cellulitis (perichondritis or facial cellulitis). Hot clinic if: Ear is full of debris. No improvement after using ear drops. Recurrent otitis externa causing significant morbidity. Otitis externa not responding to recommended treatment.

Answer 8

Aged<= 2 years with bilateral acute otitis media. Otorrhoea. Systemically unwell or high risk of complications. Several presentations during the same illness. Recurrent AOM – 3 episodes of AOM within 6 months. Consider delayed script if symptoms not improving within 3 days or worsen rapidly or significantly at any time.

Answer 9

Acute ENT: suspected mastoiditis. facial nerve palsy. bacterial labyrinthitis. Routine paed ENT if: >6 episode within 12 months. persisting otitis media with effusion (OME): more than 3 months if bilateral. more than 6 months if unilateral. Seek ENT advice if: Fails to respond to abx TM still perforated and discharging at 2 weeks.

Answer 10

Presence of fluid in the middle ear without evidence of acute inflammation. Absence of pain, fever minimal inflammatory changes of TM. Peak incidence aged 5 years. Very common Spontaneous resolution is common 6-10 weeks Down's syndrome incr risk, risk hearing +language impairment Reduce recovery time with Otovent nasal ventilation balloon if age>3

Answer 11

Urgent paediatric ENT: -confirmed or suspected structural damage to the tympanic membrane. -negative impacts on speech or education -young patient with physical, structural, or medical comorbidities, or disability precluding audiology. If hearing is normal but there are concerns about speech and language development, consider requesting routine community paediatric assessment. If CSOM and a discharging ear that is not responding to 2 weeks treatment, seek ENT advice. If OME persists and there is high suspicion of significant conductive hearing loss, request paediatric audiology.

Answer 12

Angiofibroma (rare benign nasal tumour, usually in males aged 12–20 years of age) — suggested by nasal obstruction and severe epistaxis. Cancer -nasal obstruction, facial pain, hearing loss, eye symptoms (proptosis or double vision), persistent lymphadenopathy. Incr risk age>50 with occupational exposure to wood dust or chemicals, and South Chinese or North African. Telangiectasia — Red or purple spots on the fingertip pads, lips, lining of the nose, and occasionally the ears and face. FHx hereditary haemorrhagic telangiectasia. Age <2 years is uncommon- inflicted or unintentional injury, bleeding disorder, abuse, or neglect. If abnormal bruising or ecchymosis, weight loss, or pallor, consider bleeding or haematological disorder or malignancy, e.g. leukaemia If recurrent and severe ?FHx ?vonWillebrand ?clotting disorder

Answer 13

Discoloured or purulent secretion in the nose – predominately unilateral. T> 38°C. Moderate to severe facial pain – predominantly unilateral. Deterioration after early improvement of initial milder illness. >10 days

Answer 14

If bleeding is severe or persistent- ED If suspected child neglect or abuse- child safeguarding assessment. If suspected foreign body- acute ENT. If suspected tumour, angiofibroma, or polyp, request urgent paediatric ENT If suspected or confirmed bleeding disorder, seek immediate paediatric medicine advice If suspected malignancy, seek immediate paediatric medicine advice.

Answer 15

<5 days: decongestants, saline irrigation >10 days: mometasone steroid spray Abx (amoxicillin)

Answer 16

Mumps Sjögren syndrome (ANA + RF) diabetes alcohol dependency.

Answer 17

Unilateral firm swelling affecting just part of the parotid gland Facial nerve dysfunction

Answer 18

Usually a bacterial infection – fluclox Regular massage, forwards from the ear to the corner of the mouth. Encourage the patient to keep well-hydrated, take pain relief, and rest. If a stone (sialolithiasis) is suspected, sucking a lemon wedge or sour lolly throughout the day can aid in expulsion of a stone. If it fails to resolve within 7 to 10 days, request acute ENT assessment.

Answer 19

If suspected tumour, USC ENT. If acute sialadenitis +systematically unwell, or abscess, seek ENT advice ?admit for IV abx. If inflammation fails to resolve within 7 -10 days, acute ENT assessment. If chronic or recurrent episodes of infection, consider routine ENT ? surgery. If Sjögren syndrome, routine rheumatology. If suspected mumps, notify Public Health Wales who will organise appropriate testing.

Answer 20

Constant: Recent trauma- loud noise, head injury, barotrauma- should resolve over hours. Ototoxic medications include: Gentamicin, SSRIs, Vancomycin Loop diuretics, NSAIDs Quinine Intermittent: Menieres- Episodic 1-24 hrs vertigo, tinnitus, and sensorineural hearing loss, ear fullness Pulsatile: Atherosclerosis, AV malformations Vascular tumours Benign intracranial hypertension

Answer 21

If tinnitus associated with significant neurological symptoms or signs, e.g. facial weakness- urgent ENT If unilateral tinnitus associated with any neuro symptoms -urgent audiology Routine audiology if: unilateral tinnitus (pulsatile or non-pulsatile). bilateral tinnitus. tinnitus causing distress despite primary care management.

Answer 22

DMARD or carbimazole- withhold drug, urgent FBC HIV, leukaemia, asplenia, post transplant urgent FBC

Answer 23

Acute ENT if quinsy, dehydrated/unable to swallow Tonsillectomy if: The episodes of sore throat are disabling and prevent normal functioning. There is no other explanation for the recurrent symptoms. Number of episodes of well‑documented, clinically significant, and adequately-treated episodes of sore throat: 7 or more per year for 1 year. 5 or more per year for 2 years. 3 or more per year for 3 years

Answer 24

Unilateral tonsillar displacement Trismus Drooling of saliva and severe unilateral ear and neck pain Peritonsillar cellulitis and/or abscess

Answer 25

Fever Purulence Attend rapidly – within 3 days or less of onset of symptoms Severely inflamed tonsils No cough or coryza Manage according to score: 4 to 5 (likelihood of GAS 65%) – pen v 5 days unless immunocompromised/recurrence then 10 days or 5 days clarithromycin, exclude school 24hrs after abx started 2 to 3 – consider no antibiotics or a delayed prescription

Answer 26

Fever, hearing loss, nausea, and vomiting with or without otorrhoea suggest acute bacterial labyrinthitis. Unilateral muscle weakness, sensory loss, or ataxia may suggest stroke Concomitant headache and history of migraine suggest vestibular migraine. Shortness of breath, palpitations, and chest pain suggest arrhythmias, orthostatic hypotension, coronary artery disease Unilateral hearing loss and vertigo are more likely suggestive of labyrinthitis, sudden sensorineural hearing loss or vestibular migraine, but can be due to the relatively uncommon Ménière's disease

Answer 27

The patient is unable to stand up or walk even with open eyes. Hearing loss or tinnitus are usually absent. Changing nystagmus on lateral gaze. Other neurological symptoms – cranial nerve dysfunction, visual disturbance, speech defects, dysarthria, weakness, sensory changes, memory loss, and gait ataxia.

Answer 28

Vestibular Neuronitis- Vertigo on head movement associated with unilateral hearing loss, Lasts days to 1 week, no tinnitus BPPV-Occurs with head turning or head movements, e.g. tipping the head forward or back. Also turning over in bed.Nausea and vomiting May be history of head injury, Attack < 1 minute and settles if head is kept still. Days-Years. Hearing normal. Ménière's disease- Triad of episodic vertigo, tinnitus, and hearing loss. Persistent disequilibrium. "Pressure sensation" in the affected ear. Lasts 1 to 24 hours. Tinitus worsens with time. Hearing Loss intermittent then permanent loss.

Answer 29

Prochlorperazine, 5 mg 3 times a day for no longer than 1 week.

Answer 30

Epley, brandt daroff

Answer 31

avoiding potential triggers such as high salt diet, caffeine, and alcohol. Ref for hearing aids, steroid injection through TM

Answer 32

Herpes zoster oticus- virus infects facial nerve (CN VII). Lesions in the ear, facial paralysis, and associated hearing and vestibular symptoms

Answer 33

When the virus infects the ophthalmic division of the trigeminal nerve. Complications include keratitis, corneal ulceration, conjunctivitis, optic neuritis, retinitis, glaucoma, and blindness if untreated. Hutchinson’s sign (a rash on the tip, side, or root of the nose) indicates nasociliary branch involvement and an increased likelihood of eye inflammation and permanent corneal denervation

ENT + MaxFax Flashcards

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