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The One Deck To Rule Them All > ENT: Throat + Nose > Flashcards

ENT: Throat + Nose Flashcards

1
Q

Causes of sore throat

A

50% Group A beta-haemolytic strep (Strep pyogenes)

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2
Q

Criteria used to gauge the likelihood of a bacterial (streptococcus) sore throat

A

Fever Pain Criteria

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3
Q

Criteria used to identify those likely to benefit from use of antibiotics for a sore throat

A

Centor Criteria

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4
Q

Tonsillar exudate
Tender anterior cervical lymphadenopathy
Fever
Absence of cough

A

Centor Criteria

0-2 = 3-17% risk of Strep
3-4 = 32-56% risk of Strep
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5
Q 
Fever > 38
Purluence
Attend rapidly (< 3 days)
Severely inflamed tonsils 
No cough/ coryza
A

Fever pain Criteria

0-1: 13-18%
2-3: 34-40%
4-5: 62-65%

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6
Q

Management for sore throat

A

Phenoxymethylpenicillin (Penicillin V) 7-10 days

Erythromycin if PA

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7
Q

Types of “sore throat”

A

Pharyngitis
Tonsillitis
Laryngitis

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8
Q

Management of dental abscess

A

Amoxicillin

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9
Q

Management of gingivitis

A

Metronidazole

Chlorhexidine mouth wash

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10
Q

Thyroid surgery complications

A

Laryngeal nerve damage (hoarse voice)

Parathyroid gland damage (hypocalcaemia)

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11
Q

Inflammation pushed the muscles of the mouth floor upwards blocking air entry

A

Ludwig’s Angina

  • common in immunocompromised patients
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12
Q

Tonsillar SCC is associated with

A

HPV 16

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13
Q

Tonsillectomy complications

A

Post op haemorrhage = wound infection
6-8 hours post-op: Return to theatre
5-10 days post-op: Admit + IV ABx

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14
Q 
Severe unilateral throat pain 
Deviation of uvula to unaffected side
Trismus (painful to open mouth)
Reduced neck mobility 
Voice change
A

Quinsy “Peritonsillar abscess”

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15
Q

Management of Quinsy

A

IV ABx + needle drainage

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16
Q 
Globus (lump in throat)
Hoarseness
Chronic cough
Dysphagia 
Heartburn
Sore throat
Erythematous posterior pharynx
A

Laryngopharyngeal reflux

  • Caused my GORD
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17
Q

Management of Laryngopharyngeal reflux

A

Lifestyle
PPI
Gaviscon

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18
Q

Causes of gingival hyperplasia

A

Phenytoin
Ciclosporins
CCBs (Nifedipine)

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19
Q 
Mobile cystic mass
Oval shaped
Between sternocleidomastoid + pharynx
Unilateral
Water consistency
A

Branchial cyst

  • common in early adulthood
  • remnant of the 2nd branchial cleft
  • doesn’t show on US
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20
Q

Investigations for Branchial cyst

A

FNA: Cholesterol crystals

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21
Q

Lump left side of neck, posterior to sternocleidomastoid
Painless fluid-filled
90% present < 2 years old
Hypoechoic on US

A

Cystic Hygroma

- congenital lymphatic lesion (lymphangioma)

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22
Q

Pulsatile lateral neck mass

Doesn’t move when swallowing

A

Carotid aneurysm

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23
Q

Neck swelling

Post-viral illness

A

Reactive lymphadenopathy

  • most common neck swelling
24
Q

Midline neck swelling
Non-tender
Moves upwards upon swallowing
Weight loss etc

A

Goitre

25
Q 
Rubbery neck mass
Painless lymphadenopathy
Pain (with alcohol)
Night sweats 
Splenomegaly
A

Lymphoma

26
Q

Age <20s
Midline neck swelling
Anterior triangle, midline
Between isthmus of thyroid + hyoid bone (below)
Moves upwards with protrusion of the tongue
Painful if infected

A

Thyroglossal cyst

  • thin walled doesn’t show on US well
27
Q 
Midline lump in neck
Gurgles on palpitation 
Dysphagia
Halitosis 
Regurgitation
Aspiration
Chronic cough
A

Pharyngeal pouch

  • Older males

Posteromedial herniation

28
Q

Pus from salivary ducts

Erythema

A

Sialadentitis

  • Staph aureus infection (usually)
  • Can develop into submandibular abscess
29
Q

Colicky pain
Post prandial swelling
Halitosis

A

Sialolithiasis

Stones in salivary glands

  • 80% occur in submandibular gland
  • 70% stones are radio opaque

Stone impacted in distal aspect of Wharton’s duct

30
Q

Sialolithiasis stones are made from

A

Calcium phosphate

Calcium carbonate

31
Q

Investigation for Sialolithiasis

A

Sinlography to find site of obstruction

32
Q

Management for Sialolithiasis

A

Removed orally

Gland excision

33
Q

Salivary glands produce

A

800-1000ml per day

  • more serous liquid when increased parasympathetic activity
34
Q

Most common salivary gland tumours

A

Serous (from parotid)

  1. Pleomorphic adenoma
  2. Adenolymphoma (papillary cyst adenoma lymphoma) “Warthin’s tumour”
35
Q

Slow growing salivary gland mass
Smooth
Mobile

A

Pleomorphic adenoma

  • 80% superficial lobe
  • epithelial + myo-epithelial cells
36
Q

Management of Pleomorphic adenoma

A

Parotidectomy

37
Q

Lymphocytic infiltration + cystic epithelial proliferation

Found in tail or parotid gland

A

Adenolymphoma (papillary cyst adenoma lymphoma) “Warthin’s tumour”

  • common in elderly males in 60-70s
38
Q

Management for idiopathic rhinitis

A

Ipatropium

39
Q 
Facial pain (worse on bending forward)
Thick purulent nasal discharge
A

Sinusitis

  • can lead to cerebral abscess

if gets better, then worse again = bacterial

40
Q

Risk factors for sinusitis

A

Obstruction
Local infection
Swimming/ diving
smoking

41
Q

Causes of sinusitis

A

Strep pneumoniae
Haemophilus influenzae
Rhinovirus
Viral

42
Q

Management of sinusitis

A

Analgesia
>10 days: Intranasal corticosteroids
Severe: Penicillin V

43
Q

Management of nasal haematoma

A

Drainage

  • may lead to septic necrosis
44
Q 
Sneezing
Bilateral nasal obstruction
Clear nasal discharge
Post-nasal drip
Nasal pruritus
A

Allergic rhinitis

Seasonal: hay fever
Perennial: throughout the year
Occupational: Particular allergens

  • IgE sensitivity
45
Q

Management of Allergic rhinitis

A

Mild: Antihistamines
Severe: Corticosteroids

Oxymetazoline (decongestant)
- can cause rebound congestion if chronic use

Montelukast

46
Q

Rebound nasal discharge

A

Rhinitis Medicamentosa

47
Q

Management of unilateral nasal symptoms

A

ENT Referral

48
Q

Otalgia
Unilateral serous otitis media
Nasal obstruction + discharge
Cranial nerve palsies

A

Nasopharyngeal carcinoma

  • Squamous cell carcinoma
  • Associated with EBV
  • Southern Chineses patients
49
Q

Management of Nasopharyngeal carcinoma

A

Radiotherapy

50
Q

Nasal obstruction
Rhinorrhoea
Sneezing
Decreased sense of smell + taste

A

Nasal polyps

  • 3M:F
51
Q

Nasal polyps are associated with

A 
Asthma
Aspirin insensitivity
Infective sinusitis
CF
Kartagener's syndrome
Churg-Strauss Syndrome
52
Q

Management of Nasal polyps

A

ENT referral

Topical corticosteroids

53
Q

Asthma
Aspirin sensitivity
Nasal polyps

A

Samter’s triad

54
Q

Location of anterior epistaxis bleed

A

Kesselbach’s plexus (Little’s area)

55
Q

Posterior epistaxis bleeds

A

Risk or airway compression

Common in elderly

56
Q

Management of epistaxis

A
  1. Sit forward, mouth open + pinch cartilage for 20 mins
    • ice on mouth or back of neck
  2. If bleeding site seen = silver nitrate cautery
  3. If bleeding not seen = co-phenylcaine + packing (rapid rhino pack)
  4. Ligation of sphenopalatine artery
  5. Ligation of external carotid

Can also give topical antiseptic (chlorhexidine + neomycin) to decrease risk of vestibulitis + crusting
- contraindicated in nut allergy, use Mupirocin instead

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