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ENT Flashcards

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1
Q

What is the commonest cause of acute tonsillitis

A

streptococcus pyogenes

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2
Q

A 19-year-old man has had a sore throat for the past 5 days. Over the past 24 hours he has noticed increasing and severe throbbing pain in the region of his right tonsil. He is pyrexial and on examination is noted to have a swelling around the right tonsillar region.
What is the potential diagnosis?

A

Quinsy - unilateral swelling and fever - indicative of quinsy

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3
Q

What are the differentials for diphtheria?

A

Infectious mononucleuosis
acute tonsillitis
croup
oropharyngeal candiasis

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4
Q

when is Abx warranted in children?

A

If under 2 years age with bilateral otitis media - 7 day course of amoxicillin is advised

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5
Q

what is the pathophysiology of acute otitis media and its prodrome?

A

whilst viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria, particularly Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis

viral URTIs are thought to disturb the normal nasopharyngeal microbiome, allowing bacteria to infect the middle ear via the Eustachian tube

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6
Q

what is the otoscopy findings of otitis media?

A
  1. bulging tympanic membrane - loss of light reflex
  2. opacification or erythema of the tympanic membrane
  3. perforation with purulent otorrhoea
  4. decreased mobility if using penumatic otoscope
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7
Q

what are the three important criteria to diagnose otitis media?

A
  1. acute onset of symptoms - otalgia or ear tugging
  2. presence of middle ear effusions - bulging of the tympanic membrane, otorrhoea, decreased mobilitic on pneumatic otoscopy
  3. inflammation of the tympanic membrane - erythema
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8
Q

When is Abx warranted in acute otitis media?

A
  1. symptoms lasting more than 4 days or not improving
  2. systemically unwell but not requiring admission
  3. immunocompromised or high risk of complications secondary to significant medical conditions
  4. younger than 2 years with bilateral otitis media
  5. otitis media with perforation and/or discharge in the canal
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9
Q

what are the complications of otitis media?

A

mastoiditis
meningitis
brain abscess
facial nerve paralysis

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10
Q

How does acute necrotizing ulcerative gingiviitis present?

A

painful bleeding gums with halitosis and punched out ulcers on the gums

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11
Q

what is the tx for acute necrotizing ulcerative gingivitis?

A
  1. Oral metranidazole for 3 days
  2. chlorhexidine or hydrogen peroxide mouth wash
  3. simple analgesia
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12
Q

what is a red flag symptom on the nasal canal?

A

unilateral nasal polyp - should be assued to be neoplastic until proven otherwise

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13
Q

78 y old man h/o dental extraction 5 days ago but now developed worsening pain and new fever. He is now febrile and increased HR. tender swelling around the left submandibular region. has mild trismus. tongue displaced upwards and is unable to protrude it. no stridor or respiratory distress.

what is the mx?

A

arrange ambulance for immediate transfer - ludwig’s angina

Features:

  1. neck swelling
  2. dysphagia
  3. fever

mx - needs airway management

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14
Q

what causes black hairy tongue?

A
  • poor oral hygiene
  • antibiotics
  • head and neck radiation
  • HIV
  • intravenous drug use
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15
Q

what is the management of a perforated tympanic membrane?

A
  • No treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks
  • prescribe antibiotics for perforations which occur following acute otitis media
    myringoplasty - a graft is placed in the ear
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16
Q

what are nasal polyps associated with?

A 
Asthma (particularly late-onset asthma)
Aspirin sensitivity
Infective sinusitis
Cystic fibrosis
Kartagener's syndrome
Churg-Strauss syndrome
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17
Q

What is the samter triad?

A

asthma, aspirin sensitivity and nasal polyps

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18
Q

what is the mx of patients with nasal polyps?

A

If small bilateral nasal polyps are seen these can be treated in primary care with a saline nasal douche and intranasal steroids, but if they are causing significant obstruction patients should be referred to ENT.

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19
Q

what is the commonest cause of otitis externa?

A

bacterial - staphylococcus aureus, pseudomonas aeurginosa
seborrhoeic dermatitis
contact dermatitis
recent swimming

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20
Q

what is the initial mx of otitis externa?

A
  • topical Abx or combined topical antibiotic with steroid
  • if tympanic membrane is perforated - aminoglycosides are not used
  • canal debris - consider removal
  • canal is extensively swollen then ear wick is inserted
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21
Q

when is surgery considered for tosillitis?

A

If it satisfies all:

  1. sore throats are due to tonsillitis
  2. the person has five or more episodes of sore throat per year
  3. symptoms have been occuring for at least a year
  4. episodes of sore throat are disabling and prevent normal functioning

OR

  1. recurrent febrile convulsions secondary to tonsillitis
  2. obstructive sleep apnoea, stridor or dysphagia
  3. peritonsillar abscess (quinsy) if unresponsive to standard tx
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22
Q

what are the complications of tonisllitis?

A
  1. otitis media
  2. quinsy
  3. rheumatic fever and glomerulonephritis
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23
Q

what are the complications of tonsillectomy?

A

haemorrhage and pain

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24
Q

who does malignant otitis externa affect?

A

Immunocompromised individual s- 90% of cases in diabetics

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25
what are the features of malignant otitis externa?
severe, unrelenting deep seated otalgia temporal headaches purulent otorrhea possibly dysphagia, hoarseness
26
how is the diagnosis of malignant otitis externa made?
CT scan is typically done
27
what is the cause of malignant otitis externa
pseudomonas aeruginosa
28
what is the tx of malignant otitis externa?
non-resolving otitis externa with worsening pain - should be referred to ENT iV abx - cipro topical - genta and ciprofloxacin (do not use genta in tympanic membrane perforation as its is ototoxic )
29
what is the important features used to diagnose vestibular neuritis?
NO HEARING LOSS + recurrent vertigo attacks lasting hours or days nausea and vomiting may be present horizontal nystagmus is usually present
30
how do you differentiate vestibular neuritis from meniere disease?
vestibular neuritis - no hearing loss or tinnitus (no cochlear symptoms) ; vertigo lasts weeks or months Meniere - hearing and tinnitus present ; vertigo lasts minutes to hours
31
how do you differentiate meniere disease from labyrinthitis?
Both have hearing loss and tinnitus meniere disease - vertigo lasting hours to days labyrnthitis - vertigo lasts days to weeks
32
what is the management of vestibular neuritis?
1. buccal or intramuscular procholorperazine - rapid relief for severe cases 2. short oral course of prochlorperazine or an antihistamine - used to alleviate less severe cases 3. vestibular rehab exercises - preferred treatment for chronic symptoms
33
what are some causes of epistaxis other than trauma and insertion of foreign body?
1. bleeding disorders - ITP, waldenstrom's macroglobulinaemia 2. juvenile angiofibroma - benign tumour that is highly vascularised, seen in adolescent males 3. cocaine use - nasal septum may look abraded or atrophied, inquire about drug abuse 4. hereditary haemorrhagic telengiectasia 5. granulamatosis with polyangiitis
34
what is the Abx used in otitis externa?
Topcial cipro + steroids | PO fluclox
35
what is the tx of sinusitis?
1. analgesia 2. intranasal corticosteroids may be considered if the symptoms have been present for more than 10 days 3. Oral Abx given for severe presentation - phenoxymethylpenicillin - 1st line co-amoxiclav - if systemically very unwell
36
causes of severe hearing loss in children?
1. genetic 2. congenital (cytomegalovirus, rubella or varicella infections) 3. idiopathic (accounts for 30% of childhood deafness) 4. infectious post meningitis
37
what are the causes of severe hearing loss in adults?
1. Viral-induced sudden hearing loss. 2. Ototoxicity e.g. following administration of aminoglycoside 3. antibiotics or loop diuretics. 4. Otosclerosis 5. Ménière disease 6. Trauma
38
How is idiopathic sudden onset sensorineural hearing loss treated?
Oral prednisolone for 7 days
39
what are the features of meneire's disease?
- recurrent episodes of vertigo , tinnitus and hearing loss - a sensation of aural fullness or pressure - nystagmus and a positive romberg test - episodes last mins to hours - typically unilateral but bilateral symptoms might develop after a number of years
40
what is the management of meniere's disease?
- ENT assessment - patients should inform the DVLA and the current advise is to cease driving until satisfactory control of symptoms is achieved - acute attack - buccal or intramuscular prochlorperazine - prevention - betahistine and vestibular rehabilitation exercises may be a benefit
41
how do you differentiate thyroglossal cyst from branchial cyst?
thyroglossal cyst is typically midline and move with tongue protrusion branchial cyst is present laterally , usually anterior to teh sternocleoidomastoid muscle
42
what is the tx for ramsay hunt syndorme?
oral acicolivir and corticosteorids
43
what are the features of ramsay hunt syndrome?
auricular pain facial nerve palsy vesicular rash around the ear features such as vertigo and tinnitus
44
what can be given to sore throat patinet if they are allergic to penicillins?
clarithromycin
45
where is it important to check while examining someone with pus from their ear?
attic of the ear - to rule out cholesteatoma
46
how is bleeding 10 days post op tonisllectomy treated?
admit for IV abx
47
what is the 2 week wait criteria for laryngeal cancer?
Consider a suspected cancer referral for laryngeal cancer in people over 45 with: 1. persistent unexplained hoarseness 2. unexplained lump in the neck
48
what is the 2 week wait criteria for oral cancer?
- unexplained ulceration in the oral cavity lasting for more than 3 weeks or - a persistent and unexplained lump in the neck.
49
when do you consider an urgent referral for oral cancer?
possible oral cancer by a dentist in people who have either: 1. a lump on the lip or in the oral cavity or 2. a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.
50
what is the 2 week wait criteria for thyroid cancer?
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.
51
what virus is tonsillar SCC associated with?
HPV-16 Some studies have shown a trend linking number of sexual partners and oral sex in men, however the level of risk is likely low.
52
what is the typical mode of transmission of otoscleorosis and who is usually affected?
it is autosomal dominant | 2-40 yr olds
53
what are the features of otosclerosis?
conductive deafness tinnitus normal tympanic membrane* positive family history
54
9 yr old boy post trauma has nose with bilateral red swelling arising from the midline and is slightly boggy. No signs of head injury. what is the appropriate mx?
nasal septal haematoma - arrange ENT review for surgical drainage and IV abx nasal septal haematomas are typically boggy whereas deviated septum are firm
55
what are the potential complications of acute otitis media?
1. mastoiditis 2. meningitis 3. brain abscess 4. facial nerve palsies
56
what is cholestaetoma associated with?
cleft palate - increases risk by 100 fold
57
what are the common bugs causing acute otitis media?
Streptococcus pneumonaie, Haemophilus influenzae and Moraxella catarrhalis
58
what are the features of quinsy?
- severe throat pain, which lateralises to one side - deviation of the uvula to the unaffected side - trismus (difficulty opening the mouth) - reduced neck mobility
59
A 45-year-old female h/o two-week history of progressive paraesthesia of the fingers, toes and peri-oral area, associated with muscle cramps and spasms. she recently underwent a thyroidectomy for graves disease. what is the ECG findings ?
Complications of thyroid surgery - damage to parathyroid glands can result in hypocalcaemia
60
what is used to prevent meneire's disease?
betahistine and vestibular rehabilitation
61
what are the drugs causing gingivial hyperplasia?
1. phenytoin 2. ciclosporin 3. calcium channel blockers (nifedipine)
62
what are the 4 arteries in the little's area?
1. sphenopalatine artery 2. greater palantine artery 3. anterior and posterior ethmoidal artery 4. superior labial artery
63
23 yr old rugby player, sustained a blow to the sider of his head. did not lose consciousness and remembers all the events. OE: neurological exam is normal. upper half of the pinna is hot, red and swollen. his obs are normal. what is teh course of action?
refer to hospital for urgent assessment by ENT - auricular haematoma
64
what is the treatment for vestibular neuritis?
1. buccal or IM prochlorperazine 2. short oral course of prochlorperazine or antihistamine (promethizine, cyclizine) - used to alleviate less severe cases 3. vestibular rehabilation exercises are preferred
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