Year 4 - NSS > ENT > Flashcards

ENT Flashcards

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1
Q

Nasal blockage

Common causes in adults

A
  1. Infective rhinosinusitis (acute/chronic)
  2. Allergic rhinitis
  3. Non-allergic rhinitis (e.g., vasomotor)
  4. Nasal polyps
  5. Deviated nasal septum
  6. Tumours (e.g., inverted papilloma, nasopharyngeal carcinoma)
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2
Q

Nasal blockage

key history features

A
  1. Duration: acute vs chronic (>12 weeks = chronic)
  2. Associated symptoms: facial pain, discharge, anosmia
  3. Allergy history: sneezing, itchy eyes
  4. Laterality: unilateral (consider neoplasm or polyp)
  5. Systemic symptoms: red flags for malignancy
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3
Q

Rhinitis

Allergic vs non-allergic differentiation

A

Allergic:

  • itchy nose/eyes,
  • sneezing,
  • clear discharge,
  • seasonal pattern,
  • family/personal atopy

Non-allergic:

  • nasal congestion,
  • postnasal drip,
  • triggered by irritants (smoke, perfumes),
  • no itch or sneezing
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4
Q

allergic rhinitis

basic mx

A
  1. Allergen avoidance
  2. Intranasal corticosteroids (first-line)
  3. Oral antihistamines
  4. Saline nasal irrigation
  5. Consider referral for immunotherapy if severe
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5
Q

epistaxis

common causes
(local and systemic)

A

Local:

  • trauma (nose-picking)
  • dry mucosa
  • infection
  • nasal polyps
  • tumour

Systemic:

  • hypertension
  • anticoagulants
  • coagulopathy (e.g. liver disease thrombocytopenia)
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6
Q

epistaxis

Mx of anterior epistaxis

A
  1. First aid: pinch soft part of nose, lean forward
  2. Topical vasoconstrictor + silver nitrate cautery if visible vessel
  3. Nasal packing if persistent
  4. Refer ENT if posterior or recurrent bleeds
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7
Q

deafness

common causes (conductive)

A
  1. wax
  2. otitis media
  3. otitis externa
  4. perforated TM
  5. otosclerosis
  6. cholesteatoma
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8
Q

deafness

common causes (sensorineural)

A
  1. presbycusis
  2. noise exposure
  3. Ménière’s
  4. vestibular schwannoma (acoustic neuroma)
  5. ototoxic drugs
  6. sudden sensorineural hearing loss
  7. labyrinthitis
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9
Q

hearing loss

Rinnes test

A

air vs bone conduction

  • Normal/sensorineural: AC > BC (positive)
  • Conductive: BC > AC (negative)
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10
Q

hearing loss

weber’s test

A

lateralisation

  • Conductive: lateralises to affected ear
  • Sensorineural: lateralises to unaffected ear
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11
Q

hearing loss

investigations

A
  1. Otoscopy
  2. Pure tone audiometry
  3. Tympanometry
  4. MRI head (if unilateral sensorineural loss to rule out schwannoma)
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12
Q

Otalgia (ear pain)

common causes

A
  1. Otitis externa
  2. Acute otitis media
  3. Foreign body
  4. Mastoiditis (complication)
  5. referred pain
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13
Q

otalgia

reffered causes of pain

A
  1. Temporomandibular joint dysfunction
  2. Dental infection
  3. Pharyngeal or laryngeal cancer (via glossopharyngeal/vagus nerve)
  4. Cervical spine pathology
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14
Q

throat pain

common causes of sore throat

A
  1. Viral or bacterial pharyngitis/tonsillitis
  2. Infectious mononucleosis
  3. Quinsy (peritonsillar abscess)
  4. Epiglottitis (life-threatening)
  5. Malignancy (if persistent/unilateral with red flags)
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15
Q

throat pain

red flags for malignancy

A
  1. Persistent sore throat >3 weeks
  2. Dysphagia or odynophagia
  3. Unilateral symptoms
  4. Weight loss,
  5. hoarseness
  6. Neck lump
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16
Q

difficulty swallowing (dysphagia)

oropharyngeal dysphagia features

A
  1. difficulty initiating swallow,
  2. coughing/choking,
  3. neuromuscular cause
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17
Q

dysphagia

oesophageal dysphagia features

A
  1. food sticking after swallowing,
  2. progressive with solids → liquids,
  3. consider cancer
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18
Q

dysphagia

red flags (need referral)

A
  1. Progressive symptoms
  2. Weight loss
  3. Hoarseness
  4. Neck lump
  5. Age >55 with new onset
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19
Q

neck lumps

common causes

A
  1. Reactive lymphadenopathy (infection)
  2. Malignancy (H&N SCC, lymphoma, metastases)
  3. Congenital (thyroglossal cyst, branchial cyst)
  4. Thyroid nodule or goitre
  5. Salivary gland pathology
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20
Q

neck lumps

Ix

A
  1. Full head and neck exam including oral cavity
  2. Flexible nasoendoscopy
  3. USS neck + FNA
  4. Consider CT if malignancy suspected
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21
Q

hoarseness

common causes

A
  1. Acute laryngitis (viral)
  2. Vocal cord nodules/polyp (voice overuse)
  3. Recurrent laryngeal nerve palsy (e.g. malignancy, thyroid surgery)
  4. Laryngeal carcinoma (esp. if >3 weeks)
  5. GORD
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22
Q

vertigo

key differentials

A
  1. BPPV (brief episodes triggered by head movement)
  2. Vestibular neuritis (acute onset, post-viral, no hearing loss)
  3. Ménière’s disease (recurrent, with tinnitus and hearing loss)
  4. Vestibular migraine
  5. Acoustic neuroma
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23
Q

vertigo

examinations and invx

A
  1. Ear exam: otoscopy
  2. Neurological exam (Romberg, gait)
  3. Dix-Hallpike manoeuvre for BPPV
  4. HiNTS
  5. Audiometry
  6. MRI head if unilateral hearing loss or persistent symptoms
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24
Q

HiNTS - what tests?

A
  1. Head impulse:
    +ve if vestibular, -ve if central
  2. Nystagmus:
    Unilateral horizontal = peripheral cause. Bilateral/vertical = stroke
  3. Test of Skew:
    Abnormal movement = central cause
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25
# otoscopy Abnormal findings
* Bulging TM: otitis media * Retracted TM: eustachian tube dysfunction (OME) * Perforation: infection or trauma * Fluid level/bubbles: otitis media with effusion (OME) * Redness + pain on movement of tragus: otitis externa
26
when to refer to ENT (Ear, nost, throat)
Ear: * Sudden sensorineural hearing loss Nose: * Epistaxis not controlled with initial measures * Unilateral nasal obstruction + bleeding (esp. older adult) Throat: * Stridor or airway compromise * Suspected peritonsillar abscess (quinsy) * Neck lump >3 weeks, especially if hard/fixed * Hoarseness >3 weeks
27
# faster diagnostic standards (FDS) ENT Red flags for urgent (fds) referral
* Persistent unilateral sore throat * Otalgia with normal ear exam (consider referred pain from cancer) * Hoarseness >3 weeks * Unexplained neck lump * Dysphagia with weight loss * Persistent nasal obstruction/bleeding (esp. unilateral)
28
# Acute otitis media features
1. Ear pain, 1. fever, 1. bulging TM, 1. conductive hearing loss, 1. often viral (secondary bacterial)
29
# Acute otitis media Mx
1. Analgesia (paracetamol/ibuprofen) 1. Delayed antibiotics (amoxicillin 5 days) if not resolving or systemically unwell 1. Admit if < 3 months old, septic, complications
30
# Otitis media with effusion (glue ear) Features
1. Hearing loss, 1. speech delay in children, 1. no pain, 1. dull retracted TM with air bubbles
31
# Otitis media with effusion (glue ear) invx
1. Otoscopy 1. Tympanometry (flat trace) 1. audiometry
32
# Otitis media with effusion (glue ear) Mx
1. Watchful waiting 3 months 1. Grommet insertion if persistent or developmental delay 1. Hearing aids as alternative
33
# Otitis externa features
1. Pain on tragal movement, 1. itchy ear, 1. discharge, 1. swollen canal
34
# otitis externa mx
1. Topical antibiotic/steroid drops (e.g. ciprofloxacin/dexamethasone) 1. Aural toilet by ENT 1. Oral antibiotics if spreading cellulitis 1. Exclude necrotising OE in diabetics (CT, ENT input)
35
# perforated TM features and mx
Sudden pain with discharge after AOM or trauma. can have tinnitus, hearing loss and vertigo Mx: 1. Keep dry, usually heals spontaneously in 6-8 weeks 1. ENT referral if recurrent, large, or persistent 1. Surgery (myringoplasty) if chronic
36
# mastoiditis features
1. Fever, 1. ear pain, 1. protruding pinna, 1. post-auricular swelling
37
# mastoiditis inv
1. Bloods, 1. CT temporal bone if suspected abscess
38
# mastoiditis mx
1. IV antibiotics 1. ENT admission 1. Possible mastoidectomy if not improving
39
# Presbycusis features + invx + mx
- Gradual bilateral high-frequency SNHL in elderly - invx: Audiometry (sensorineural pattern) - Mx: Hearing aids
40
# Ménière’s Disease features
1. Recurrent vertigo (mins–hrs), 1. tinnitus, 1. fluctuating SNHL, 1. ear fullness
41
# Ménière’s Disease invx
1. Audiometry (low-frequency SNHL), 1. MRI to exclude vestibular schwannoma
42
# Ménière’s Disease mx
1. ENT referral 1. Salt restriction, betahistine 1. Buccal prochlorperazine during attacks 2. vestibular rehabilitation 1. Surgery or gentamicin injection in refractory cases
43
# vestibular schwannoma/acoustic neuroma features
1. Unilateral SNHL, 1. tinnitus, 1. imbalance, 1. facial numbness (late)
44
# vestibular schwannoma/acoustic neuroma invx
1. Audiogram, 1. MRI internal acoustic meatus (IAM)
45
# vestibular schwannoma/acoustic neuroma Mx
1. MDT: observation, radiosurgery, or excision 1. ENT/neurosurgery referral
46
# Tonsillitis Features
1. Sore throat, 1. fever, 1. enlarged red tonsils +/- exudate, 1. tender cervical nodes
47
# tonsillitis mx
1. Supportive (analgesia, fluids) 1. Phenoxymethylpenicillin 10 days if bacterial (Centor ≥3) 1. Admit if unable to swallow, systemic illness 1. Consider tonsillectomy if ≥7 episodes/year (NICE criteria)
48
# Infectious mononucleosis (EBV) features
Features: * Tonsillitis, * fatigue, * fever, * cervical lymphadenopathy, * splenomegaly
49
# Infectious mononucleosis (EBV) invx+ mx
Investigations: * Monospot (heterophile), * EBV serology, * FBC (atypical lymphocytes) Management: * Supportive care * Avoid amoxicillin (rash) * No contact sports 4–6 weeks (splenic rupture risk)
50
# quinsy (peritonsillar abscess) features
1. Severe unilateral sore throat, 1. trismus, 1. uvula deviation, 1. muffled voice
51
# quinsy (peritonsillar abscess) mx
1. ENT referral 1. Needle aspiration or I&D 1. IV antibiotics and fluids 1. Tonsillectomy if recurrent
52
# Epiglottitis (life-threatening) Features
1. Rapid onset sore throat, 1. drooling, 1. stridor, 1. tripod position, 1. fever
53
# Epiglottitis mx
1. Do not examine throat 1. Call anaesthetics/ENT, prepare for intubation 1. IV antibiotics (cefotaxime + dexamethasone) 1. Admit to ICU
54
# Head and neck cancer Invx + mx
Invx: 1. Nasoendoscopy 1. USS + FNA of lump 1. CT/MRI for staging 1. Panendoscopy and biopsy Mx 1. MDT approach 1. Surgery ± radiotherapy/chemotherapy 1. Speech and dietician input
55
# Salivary gland tumours features
1. Painless parotid/submandibular lump, 1. facial nerve palsy (worrying)
56
# Salivary gland tumours Invx
1. USS + FNA, 1. MRI for deep lobe or malignancy suspicion
57
# Salivary gland tumours Mx
1. Surgical excision 1. Radiotherapy if malignant 1. Avoid biopsy due to seeding risk
58
# Congenital throat cysts Types + location
1. Thyroglossal cyst: * midline, moves with tongue protrusion 2. Branchial cyst: - lateral (anterior triangle), often anterior to SCM
59
# congenital throat cysts invx + mx
Investigations: * USS - exclude thyroid tissue in thyroglossal cyst Mx: * Surgical excision
60
# Vocal cord nodules Features + invx + mx
Features: * Hoarseness, * worse with voice use, Investigations: * Nasoendoscopy Management: 1. Voice rest 1. Speech and language therapy 1. Surgery if persistent
61
# Recurrent laryngeal nerve palsy features
1. Hoarseness, 1. weak cough, 1. aspiration risk
62
# Recurrent laryngeal nerve palsy causes
1. surgery - thyroidectomy, neck dissection 1. malignancy (lung, thyroid, oesophageal), 2. trauma - chest, neck 1. idiopathic
63
# Recurrent laryngeal nerve palsy Invx + mx
Investigations: * Nasoendoscopy, * CT neck/chest Management: * ENT referral * Voice therapy, * surgery if severe
64
# Benign Paroxysmal Positional Vertigo (BPPV) Features + inx + mx
Features: * Short episodes (<1 min) triggered by movement, * no hearing loss Investigations: * Dix-Hallpike (rotatory nystagmus) Management: * Epley manoeuvre * Reassure, safety-net for persistent symptoms
65
# Vestibular neuritis Features
1. Sudden vertigo (hours–days), 1. nausea, 1. unsteady gait, 1. no hearing loss Clinical diagnosis, MRI if its atypical
66
# Vestibular neuritis Mx
1. Buccal prochlorperazine short-term 1. Vestibular rehabilitation exercises 1. Exclude stroke (esp. elderly or vascular RF)
67
# Vestibular migraine Features + invx
Features: 1. Vertigo episodes with migraine history 1. photophobia, 1. aura ± headache Investigations: 1. Diagnosis of exclusion; 1. consider MRI if first episode
68
# vestibular migraine mx
1. Lifestyle advice 1. Migraine prophylaxis (e.g. propranolol, amitriptyline) 1. Vestibular therapy
69
# Balance 5 inputs that help with balance
1. Vestibular 1. Proprioceptive 1. Ocular 1. Cerebral 1. Cerebellar
70
# otoscopy Structures seen
1. Attic 1. Handle of malleus 1. Pars flaccida 1. Pars tensa 1. Light reflex
71
Exostoses (swimmers osteoma)
- Cold water swimmers condition - Benign bony protrusions in external ear canal
72
# Parotid gland tumours Types
1. Pleomorphic adenoma (70%) 1. Wharthins Tumors (30%) 1. Malignant (1%)
73
# Rhinosinusitis Features
1. Facial pain/pressure, 1. nasal discharge, 1. congestion, 1. reduced smell 1. Acute = <4 weeks; often viral 1. Suspect bacterial if >10 days or severe onset
74
# Rhinosinusitis Mx
1. Analgesia, 1. nasal saline rinse 1. Intranasal corticosteroids (e.g. mometasone) 1. Delayed or immediate antibiotics if bacterial (phenoxymethylpenicillin or co-amoxiclav) 1. ENT referral for chronic/refractory cases (may CT sinuses)
75
# Nasal polyps Features
1. Bilateral nasal obstruction, 1. anosmia, 1. mouth breathing, 1. snoring 1. Associated with asthma, aspirin sensitivity (Samter’s triad)
76
# Nasal polyps Invx
1. Nasoendoscopy 1. CT sinuses before surgery
77
# Nasal polyps Mx
1. Intranasal steroids (e.g. fluticasone) 1. Oral steroids short course if severe 1. Polypectomy ± FESS (Functional Endoscopic Sinus Surgery) if persistent 1. Refer urgently if unilateral (rule out malignancy)
78
# Pinna haematoma Features + invx
f: Fluctuant swelling of outer ear following trauma (e.g. rugby) i: Clinical; aspiration may confirm blood collection
79
# Pinna haematoma Mx
1. Urgent ENT or plastics referral 1. Drain + compression dressing 1. Antibiotic prophylaxis (e.g. flucloxacillin) 1. Prevents cauliflower ear
80
# Ramsay Hunt Syndrome Features
1. Facial nerve palsy, 1. painful vesicular rash in ear canal or pinna, 1. hearing loss, 1. vertigo 1. Caused by Herpes Zoster
81
# Ramsay Hunt Syndrome Mx
1. Urgent treatment (ideally <72 hrs): 1. Oral aciclovir 1. Oral prednisolone 1. Lubricating eye drops and eye protection 1. ENT referral
82
# Malignant otitis externa Features
1. Severe persistent otalgia, 1. granulation tissue in canal, 1. CN palsies (late) 1. Seen in elderly diabetics or immunocompromised
83
# Malignant otitis externa Invx
1. Swab, 1. CRP 1. CT/MRI skull base 1. Technetium bone scan
84
# Malignant otitis externa mx
1. Admit under ENT 1. IV anti-pseudomonal antibiotics (e.g. ciprofloxacin) 1. Strict diabetic control 1. Long course (6–8 weeks)
85
# Otosclerosis Features
1. Progressive conductive hearing loss, 1. bilateral, 1. young adults (esp. women), 1. normal TM, 1. may have tinnitus
86
# Otosclerosis Invx
1. Audiogram: conductive loss with Carhart’s notch 1. Tympanometry: normal 1. CT if uncertain
87
# Otosclerosis Mx
1. Hearing aids 1. Stapedectomy if appropriate 1. Genetic counselling (autosomal dominant)
88
# Obstructive sleep apnoea Features + RF
Loud snoring, 1. witnessed apnoeas, 1. daytime sleepiness, 1. morning headache Risk factors: 1. obesity, 1. alcohol, 1. male sex
89
# Obstructive sleep apnoea Invx
Polysomnography or home sleep study
90
# Obstructive sleep apnoea Mx
1. Weight loss, avoid alcohol/sedatives 1. CPAP if moderate–severe 1. Mandibular advancement device (mild cases) 1. ENT referral if considering surgical options (e.g. uvulopalatopharyngoplasty)
91
# Cholesteatoma Features
1. Persistent foul-smelling otorrhoea 1. Painless discharge 1. Progressive conductive hearing loss 1. May have retraction pocket or visible mass behind TM 1. Late: vertigo, facial nerve palsy, or other CN involvement - extends intracranially
92
# Cholesteatoma Invx
1. Otoscopy: pearly white mass or attic retraction pocket 1. Audiogram: conductive hearing loss 1. CT temporal bones: assess bone erosion and extent 1. MRI if intracranial extension suspected
93
# Cholesteatoma Mx
1. ENT referral (urgent if complications suspected) 1. Surgical: mastoidectomy or tympanomastoidectomy to remove disease 1. Long-term follow-up due to recurrence risk 1. Treat infection pre-op with topical antibiotics and aural toilet
94
# Nasal septal haematoma Feat + mx + complication
**Feat:** - Nasal obstruction after trauma - Bilateral red swelling of septum - Boggy (compared to devaited septum which is firm) **Mx:** - Surgical drainage - IV Abx (reduce risk of infection/abscess after drainage) **Complication:** - Irreversible septal necrosis
95
# Pinna haematoma Mx + complication
**Mx:** - Same day ENT assessment - Incision + drainage - Pressure dressing (stop reformation of haematoma) **Complication:** - Avascular necrosis leading to cauliflower ear deformity
Year 4 - NSS
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