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ENT Flashcards

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1
Q

what is parotitis?

A

inflammation of the parotid glands- most commonly caused by mumps, herpes, Epstein-Barr virus.

treatment- treat the underlaying cause

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2
Q

what is sialadenitis?- which glands are affected?
risks?
symptoms?
investigations?
management?

A

Inflammation of the salivary glands- parotid, submandibular and sublingual glands. Risk of spreading into deep tissues of the neck and head causing severe infection

Risks:
Infants
Sick or recovering from surgery
Dehydration, malnutrition, immunosuppression

Symptoms:
Enlargement of salivary glands/ swelling of cheek/ neck
Fever
Decreased saliva/ dry mouth (xerostomia)
Pain when eating

Investigations: USS, CT, endoscope

Management:
Abx- clindamycin
Home remedies- warm compress, massage of salivary glands
Non-surgical- IV fluids for hydrations
Surgical- abscess drainage, removal of stones/ blockage

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3
Q

Management of haemorrhage post tonsillectomy?

Primary
Secondary

A

Primary, or reactionary haemorrhage, most commonly occurs in the first 6-8 hours following surgery. It is managed by immediate return to theatre.

Secondary haemorrhage occurs between 5 and 10 days after surgery and is often associated with a wound infection. Treatment is usually with admission and antibiotics. Severe bleeding may require surgery.

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4
Q

What are the indications for tonsillectomy?

A

sore throats are due to tonsillitis (i.e. not recurrent upper respiratory tract infections)

The person has: (71, 52, 33)
7 episodes per year for one year
5 per year for 2 years,
3 per year for 3 years,

The episodes of sore throat are disabling and prevent normal functioning

Other established indications for a tonsillectomy include

recurrent febrile convulsions
obstructive sleep apnoea
stridor
dysphagia secondary to enlarged tonsils
peritonsillar abscess (quinsy) if unresponsive to standard treatment

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5
Q

Classic triad for infectious mononucleosis?

A

Sore throat
Pyrexia
Lymphadenopathy

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6
Q

Triad of symptoms for Croup? 4

A

Fever
Stridor
Barking cough
Intercostal/ subcostal recession

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7
Q

Causes of hoarseness?

A

voice overuse
smoking
viral illness
hypothyroidism
GORD
laryngeal cancer
lung cancer

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8
Q

What are the suspected laryngeal cancer referral guidelines?
2ww

A

A suspected cancer pathway referral to an ENT specialist should be considered for people

Aged 45 and over with:
-persistent unexplained hoarseness
or
-An unexplained lump in the neck.

When investigating patients with hoarseness a chest x-ray should be considered to exclude apical lung lesions.

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9
Q

Features of head and neck cancer?

A

neck lump
hoarseness
persistent sore throat
persistent mouth/ lip ulcer > 3 weeks

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10
Q

Risk factors for sleep apnoea?

Symptoms?

A

obesity
macroglossia: acromegaly, hypothyroidism, amyloidosis
large tonsils
Marfan’s syndrome

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11
Q

Emergency treatment for Croup?

A

Management
Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
Prednisolone is an alternative if dexamethasone is not available

Emergency treatment:
-high-flow oxygen
-nebulised adrenaline

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12
Q

Causes of conductive hearing loss?

A

wax impaction
infection- otitis externa/ media
Eustachian tube dysfunction
tympanic membrane perforation
foreign body
otosclerosis
tumours

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13
Q

Causes of sensorineural hearing loss?

A

-presbycusis
-noise-induced hearing loss
-congenital infection- rubella, CMV
neonatal complications- meningitis
-drug induced- aminoglycosides
-vascular- stroke/ TIA
-Meniere’s disease
-labyrinthitis
-acoustic neuroma

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14
Q

Causes of peripheral vertigo?

Symptoms?

A

BPPV
Meniere’s disease
Vestibular neuritis/ labrynthitis
Ramsay Hunt syndrome
Cholesteatoma
Otosclerosis

No neurological signs present
Horizontal nystagmus

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15
Q

Causes of central vertigo?

Symptoms?

A

Stroke/ TIA
CPA tumour
Meningitis
MS

Hearing loss uncommon but can happen in stroke/ tumour
Other neurological signs present
Direction changing nystagmus

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16
Q

Sx for Meniere’s disease?

A

recurrent vertigo, tinnitus, sensorineural hearing loss
ear fullness/ pressure
nystagmus

mainly unilateral but can be bilateral after several years

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17
Q

Management for Meniere’s disease?

A

Prophylactic- betahistine
Acute- buccal or IM prochloperazine
Diuretics- specialist only
DVLA inform
Vestibular rehab exercises

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18
Q

Common causes of otitis externa?

A

Bacterial: Staphylococcus aureus, Pseudomonas aeruginosa or fungal

-Seborrhoeic dermatitis
-Contact dermatitis (allergic and irritant)
-Recent swimming is a common trigger of otitis externa

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19
Q

Causes of tinnitus?

A

Idopathic
Meniere’s disease
Otosclerosis
Presbycusis
Loud noise hearing loss
Drugs- aspirin, NSAIDs, aminoglycosides, loop diuretics, quinine
Ear wax impaction
Acoustic neuroma

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20
Q

Investigations for acute severe epistaxis?

A

FBC
VBG
Clotting screen
G&S + cross-match

Flexible nasendoscopy -> suspected tumour
Vwb bloods

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21
Q

Causes of epistaxis?

A

Trauma
Foreign bodies in the nose
Oxygen via nasal cannula
Recent ENT or maxillofacial surgery
Tumours
Inflammation, including rhinosinusitis, nasal polyps
Alcohol excess
Illicit drug use- cocaine
Medications such as nasal steroids
Bleeding disorders-thrombocytopenia, Von Willebrand disease, haemophilia, antiplatelet or anticoagulant medications
Environmental factors- inhaled irritants, temperature and humidity

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22
Q

Management for epistaxis?

A

ABCDE + MHP if haemodynamic instability

-Conservative: sitting forward + pinching nose 10-15 mins
-Topical antiseptic (naseptin) to reduce crusting + re-bleeding (check for nut allergy).
Chemical with silver nitrate or electrocautery

-If bleeding point can be visualised: nasal cautery (only 1 side to avoid perforation)
-If bleeding point cannot be visualised/ bleeding persists despite cautery: nasal packing. Posterior packing with Foley catheter left in place for 24-48 hours

-If bleeding persists then surgical approach with embolization

Medical approach with tranexamic acid to all patients with severe bleeding

Hold anticoag/ antiplatelets and discuss with haematology

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23
Q

Common cause of otitis media in children?

A

Viral upper respiratory tract infections (URTIs) typically precede otitis media, most infections are secondary to bacteria

Streptococcus pneumonaie
Haemophilus influenzae
Moraxella catarrhalis

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24
Q

Diuretics that cause tinnitus?

A

Loop diuretics

bumetanide and furosemide

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25
Common area for nosebleed?
Anterior nasal septum AKA Little's area in the nasal septum is a common site for epistaxis to originate because it is the confluence of 4 arteries
26
Management for Bell's Palsy?
All patients with Bell's palsy should be given oral prednisolone within 72 hours of onset Eye care: artificial tears and lubricants to prevent keratopathy if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT
27
Common cause of hearing loss in young people? Symptoms? Management?
Otosclerosis Onset is usually at 20-40 years - features include: conductive deafness tinnitus tympanic membrane the majority of patients will have a normal tympanic membrane 10% of patients may have a 'flamingo tinge', caused by hyperaemia positive family history Management hearing aid stapedectomy
28
What does the HINTS exam distinguish?
The HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke
29
How is sudden-onset sensorineural hearing loss treated?
High dose oral prednisone
30
Management for Ramsey hunt?
oral aciclovir and corticosteroids
31
Complications of total thyroidectomy, causing what abnormality?
Damage to the parathyroid glands resulting in hypocalcaemia Bleeding- respiratory compromise Recurrent laryngeal nerve damage- causing voice hoarseness
32
Management for an unhealed perforated tympanic membrane?
Myringoplasty
33
Common causes of neck lumps?
reactive lymphadenopathy lymphoma thyroid swelling thyroglossal cyst pharyngeal pouch cystic hygroma branchial cyst carotid aneurysm
34
features of reactive lymphadenopathy?
history of local infection or a generalised viral illness
35
features of lymphoma?
rubbery, painless lymphadenopathy pain while drinking alcohol night sweats splenomegaly
36
features of thyroid swelling?
May be hypo-, eu- or hyperthyroid symptomatically Moves upwards on swallowing
37
features of a thyroglossal cysts?
More common in patients < 20 years old Usually midline, between the isthmus of the thyroid and the hyoid bone Moves upwards with protrusion of the tongue May be painful if infected
38
features of a pharyngeal pouch?
More common in older men Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles Usually not seen but if large then a midline lump in the neck that gurgles on palpation Typical symptoms are dysphagia, halitosis, regurgitation, aspiration and chronic cough
39
features of a branchial cyst?
An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx Develop due to failure of obliteration of the second branchial cleft in embryonic development Usually present in early adulthood
40
features of a carotid aneurysm?
Pulsatile lateral neck mass which doesn't move on swallowing
41
Management for acute epiglottitis?
ABCDE Call ENT/ anaesthetics Give high-flow oxygen Nebulised adrenaline 1:1000 should also be given IV dexamethasone should also be given to reduce inflammation IV antibiotics should also be given urgently (e.g. ceftriaxone and metronidazole) IV fluids to maintain hydration whilst unable to swallow Airway protection- tracheostomy or needle cricothyroidotomy
42
What abx are given for acute epiglottitis?
ceftriaxone and metronidazole
43
What bloods should be done for epistaxis?
FBC Clotting screen G&S ABG Cross match
44
What is the most common area for a nosebleed?
Kiesselbach's plexus in the Little's area
45
Causes of epistaxis?
Trauma Nose picking Sinusitis Nose blowing Weather and environment Coagulation disorders- thrombocytopaenia, vWD Anti-coag medications- aspirin, DOACs, warfarin Illicit drugs Nasal tumours
46
Anterior vs posterior nose bleeds?
Anterior- unilateral Posterior- bilateral, higher risk of blood aspiration
47
How to manage epistaxis in an OSCE scenario?- explain to patient
Sit up and tilt the head forwards (tilting the head backwards is not advised as blood will flow towards the airway) Squeeze the soft part of the nostrils together for 10 – 15 minutes Spit out any blood in the mouth, rather than swallowing
48
When to advise a hospital trip for a patient with epistaxis?
Bleeding >10-15 mins Severe bleeding Bilateral bleeding Haemodynamically unstable
49
Post epistaxis treatment? Contraindication?
Naseptin Soya/ peanut allergy
50
Epistaxis management of bleeding point can be visualised vs not visualised?
Visualised- nasal cautery via silver nitrate, only 1 side to avoid perforation Non-visualised- nasal packing via nasal tampons/ inflatable packs, both nostrils to increase pressure on the area of bleeding
51
Posterior epistaxis management?
Posterior packing via insertion of Foley catheter with an inflated balloon to compress bleeding area Should be left in place for 24-28 hours
52
Surgical management options for epistaxis?
Surgical: Ligation Emobilisation Medical: Tranexamic acid- for severe bleeding Hold anti-platelets/ anti-coag
53
What type of nystagmus does BPPV have?
Rotatory nystagmus
54
What ECG abnormality is present post thyroidectomy and cause?
Prolonged QT interval caused by hypocalcaemia due to damage to parathyroid glands
55
Peripheral vertigo features: postural stability hearing/ tinnitus neurological symptoms nystagmus type head impulse test dix-hallpike manoeuvre alternate cover test
postural stability- able to walk, unstable hearing/ tinnitus- possible with Menieres/ labrynthitis neurological symptoms- no nystagmus type- horizontal, does not alter in direction when gaze changes, Beats away from the affected side. Disappears with fixation of the gaze. Large amplitude nystagmus is usually only seen early in the course of Meniere's disease or vestibular neuronitis. head impulse test- May be positive with acute unilateral vestibular loss dix-hallpike manoeuvre- In BPPV: latency of symptoms and nystagmus with fatiguability and habituation; severe vertigo alternate cover test- normal
56
Central vertigo features: postural stability hearing/ tinnitus neurological symptoms nystagmus type head impulse test dix-hallpike manoeuvre alternate cover test
postural stability- inability to stand-up, walk or open eyes hearing/ tinnitus- uncommon but can occur in stroke/ intracranial tumour neurological symptoms- yes, cranial nerve dysfunction, visual disturbance, speech defects, dysarthria, weakness, sensory changes, memory loss, and gait ataxia nystagmus type- Direction-changing nystagmus on lateral gaze (right beating on right gaze, left beating on left gaze). Purely vertical or torsional. Not suppressed by visual fixation. Non-fatiguable. Commonly large amplitude nystagmus. head impulse test- negative dix-hallpike manoeuvre- abnormal alternate cover test- Slight vertical correction (up on one side, down on the other) suggestive of a central lesion such as stroke.
57
Common causative agent of recurrent otitis externa?
Candida albicans
58
In which patients is Vertebrobasilar ischaemia present and when does it tend come on?
Elderly patient Dizziness on extension of neck
59
Which drug is responsible for gingival hyperplasia?
Nifedipine
60
Management of sudden-onset sensorineural hearing loss (SSNHL)?
Urgent referral to ENT MRI scan to exclude vestibular schwannoma High-dose oral corticosteroids
61
What part of the ear is most important to visualise in recurrent otitis media/ cholesteatoma?
Attic
62
What other infection is tonsillar SCC associated with?
HPV
63
What other pathologies are nasal polyps associated with? Management?
Asthma Aspirin sensitivity Management: Nasal corticosteroids- first line Oral corticosteroids
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