ENT Investigations and Management Flashcards Preview

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Flashcards in ENT Investigations and Management Deck (80)
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1
Q

Tonsillitis investigations

A

None (throat swab not recommended)

2
Q

Bacterial tonsillitis criteria

A

Centor

Fever PAIN

3
Q

Bacterial tonsillitis management

A

Penicillin (clarithromycin if allergic)

If severe: IV fluids, IV antibiotics, steroids

Only need admission if can’t eat or drink

4
Q

Tonsillectomy criteria

A
  1. Sore throats are due to tonsillitis
  2. Episodes of sore throat are disabling and prevent normal functioning
  3. 7 or more in past year OR
  4. 5 or more each of the past 2 years OR
  5. 3 or more each of the past 3 years
5
Q

Peritonsillar abscess management

A

Aspiration and antibiotics

6
Q

Infectious mononucleosis investigations

A

Atypical lymphocytes in peripheral blood
+ve monospot/Paul-bunnel test (heterophile antibody tests)
Low CRP
EBV IgM

7
Q

Infectious mononucleosis management

A

Supportive management
Antibiotics in secondary bacterial infection
Maybe steroids if severe

8
Q

Glue ear investigations

A

“age appropriate hearing assessment”
Audiometry
Tympanometry

9
Q

Glue ear management

A

Review at 3 months with otoscopy, audiometry and tympanometry

May try autoinflation
If persistent for >3/12 with symptoms:
<3 years - grommets
>3 years, first intervention - grommets
>3 years, second intervention - grommets and adenoidectomy

If nasal syptoms, adenoidectomy may be considered earlier

10
Q

Referral criteria for OME

A
Bilateral OME for 3 months 
CHL>25dB
Speech/language problems
Developmental behavioural problems
Basically if symptoms persist
11
Q

Management of airway obstruction

A
ABCDE
Oxygen/heliox
Steroid
Nebulised adrenaline
Flexible fibre-optic endoscopy
ET tube (first line)
Emerency needle cricothyroidotomy (temporary measure pending tracheostomy, only works for 30-45 mins as CO2 builds up)
Tracheostomy

Treat underlying pathology

12
Q

What may you need to give before airway endoscopy?

A

General anaesthesis (gas - sevoflurane. IV - propofol, remifentanyl)

13
Q

Otitis externa management

A

Mild - acetic acid spray (Ear Calm) continuing 2 days after resolution
Moderate - sofradex or otomise (antibiotic and steroid) spray
Don’t swab

Severe - oral or IV antibiotics

14
Q

Otitis media management

A

Most will resolve without antibiotics
Consider if otorrhoea

1st line amoxicillin
2nd line clarithromycin

15
Q

Tympanic membrane perforation management

A

Nothing, usually heals spontaneously

Requires surgery if doesn’t heal (myringoplasty)

16
Q

Management of cholesteatoma

A

Mastoid surgery (mastoidectomy)

17
Q

Mastoiditis management

A

IV antbiotics
Middle ear drainage (myringotomy)
Mastoidectomy

18
Q

Otosclerosis investigation

A

Audiometry with masked bone conduction shows a dip at 2kHz (Cahart’s notch)

19
Q

Otosclerosis management

A

Stapedectomy

Or hearing aid

20
Q

Vestibular schwannoma investigation

A

MRI scan

21
Q

Septal haematoma management

A

Incision, drainage and packing

22
Q

Nasal fracture investigations

A

None - clinical diagnosis

23
Q

Nasal fracture management

A

Treat any symptoms
Reasses 5-7 days post-injury
Consider digital manipulation under anaesthetic within 3 weeks (10-14 days in handbook)

24
Q

Epistaxis first aid management

A
Local treatment
External pressure to nose
Ice
Cautery
Nasal packing
25
Q

Epistaxis specialist management

A

Resus on arrival if necessary
Pressure, ice, topical vasoconstrictor with maybe local anaesthetic
Remove clot (suction/nose blowing)
Anterior rhinoscopy
Cauterise vessel: silver nitrate/diathermy
Use rapid rhino pack if bleeding continues

26
Q

Management of epistaxis controlled with initial specialist management

A

Arrange admission if packed/poor social circumstances
FBC, G&S (group and save)
NO SEDATION

27
Q

Management of epistaxis not controlled with initial specialist management

A
Arterial ligation
Maybe embolisation (can cause stroke)
28
Q

Management of CSF leak

A

Often settle spontaneously

Need repair if lasting for 10 days

29
Q

Management of pinna haematoma

A

Aspiration OR
Incision and drainage OR
Pressure dressing

No good evidence which technique is best

30
Q

Management of pinna lacerations

A

Debridement
Close (primary or reconstruction)
Local anaesthetic
Antibiotics if exposed cartilage

31
Q

Temporal bone fracture investigation

A

Axial CT

32
Q

Temporal bone fracture management

A

Often delayed as polytrauma
Facial nerve decompression if no recovery and EMG studies
CSF leak, most settle but need repair
May need hearing restoration (hearing aid or ossiculoplasty)

33
Q

Difference between immediate and delayed facial paralysis in temporal bone fracture

A

Immediate - disruption to facial nerve by fracture that can be treated.
Delayed - likely swelling causing it which will improve with time

34
Q

Management of sudden sensorineural hearing loss

A

Steroid
Urgent referral to ENT
If no improvement then intra-tympanic steroids

35
Q

Foreign body in ear management

A

Can wait till urgent clinic
Remove watch batteries immediately
Drown live animals with oil which can be removed the next day

36
Q

Management of neck injury that has not gone through the platysma

A

Just stitch it up

37
Q

Neck trauma investigations

A
FBC, G&amp;S/cross matching
AP/lateral neck x-ray (foreign body?)
CXR (haemopneumothorax, emphysema)
CT angiogram (vascular, pseudoaneurysm, laryngeal, aerodigestive tract)
MR angiogram
38
Q

Neck trauma management

A

Urgent exploration - expanding haematoma, hypovolaemic shock, airway obstruction, blood in aerodigestive tract
Laryngoscopy, bronchoscopy, pharyngoscopy and oesophagoscopy
Angiography - embolise

39
Q

Deep space neck infection investigation

A

CT

40
Q

Deep space neck infection management

A

Fluid resus
IV antibiotics
Incision and drainage of neck space

41
Q

Orbital blowout fracture investigation

A

CT sinuses (tear drop sign)

42
Q

Orbital blowout fracture management

A

Conservative

Surgical repair of bony walls if: entrapment, large defect, significant enophthalmos

43
Q

Le fort fracture investigation

A

CT

44
Q

Le fort fracture management

A

Surgery

45
Q

Ageing cosmetic treatment ladder

A
Botulinum toxin
Fillers
Blepharoplasty
Skin rejuvenation
Face lift
46
Q

Skin and soft tissue reconstruction options

A

Primary closure
Healing by secondary intention
Skin grafts
Skin flaps

47
Q

What is used to harvest skin in skin grafts?

A

Dermatome

48
Q

Investigation for laryngeal cancer

A

Ultrasound and FNA
Laryngoscopy and biopsy
HPV status
CT/MRI for staging

49
Q

Investigation for salivary gland tumour

A
US
FNA
CT (staging)
MRI (deep lobe)
PET (metastatic nodes)
50
Q

Minimally invasive technique for parotidectomy

A

Facelift approach

51
Q

Indications of transoral robotic surgery

A

Tonsil cancer
Laryngeal cancer
Pharyngeal cancer
Tongue cancer

52
Q

Laryngeal cancer management

A

Radical radiotherapy for small tumours

Larger tumours treated with laryngectomy and block dissection of neck glands

53
Q

Oropharyngeal cancer investigations

A

Forceps biopsy of lesion

CT/PET CT of neck

54
Q

Orophayngeal cancer management

A

Surgery and radiotherapy (either first line in early cancer)

55
Q

General management of salivary gland tumours

A

Surgery

Radiotherapy

56
Q

Management of pleomorphic adenoma

A

Surgical removal

57
Q

Management of warthins tumour

A

Partial parotidectomy

58
Q

Management of mucoepidermoid carcinoma

A

Low grade - excision

High grade - excision and radiotherapy

59
Q

Management of adenoid cystic carcinoma

A

Surgical excision and post-operative radiotherapy

60
Q

Pain management where oral route no-longer an option

A

Syringe driver

Transdermal patch

61
Q

Palliative management of stridor

A

Active sedation

62
Q

Palliative management of major haemorrhage

A

Large doses of midazolam IM or IV

Don’t leave patient alone

63
Q

Rhinitis examination

A

Airway patency
External nose
Rhinoscopy

64
Q

Allergic rhinitis management

A

Allergen avoidance
Nasal irrigation
1. Intranasal antihistamine/oral antihistamine
2. Intranasal steroid

65
Q

Nasal polyps management (commoner in non-allergic asthma)

A

Steroid drops for 6 weeks then long term nasal spray

If no better then endoscopic sinus surgery

66
Q

Acute infective rhinosinusitis management

A

Analgesics and decongestants (98% are viral)

If persisting/worsening add antibiotic

67
Q

Potential allergy testing

A

Skin prick tests
RAST (IgE levels)
(I don’t think you do these unless clinical suspicion)

68
Q

Vasomotor rhinitis management

A

Topical anticholinergic

69
Q

Management of unilateral nasal discharge

A

Refer urgently

In a young child it might be foreign body
In adult it might be nasal or paranasal tumour

70
Q

BPPV investigation

A

Dix-hallpike test

71
Q

BPPV management

A

Epley manoeuvre
Semont manoeuvre
Brandt-Daroff exercises

72
Q

Vestibular neuronitis/labyrinthitis management

A

Supportive management with vestibular sedatives
Prolonged or atypical then may require further investigation
Rehab exercises if prolonged

73
Q

Menieres disease investigation

A

Audiometry

74
Q

Menieres disease management

A
Supportive during episodes
Tinnitus therapy
Hearing aids
Grommet insertion (meniette)
Intratympanic steroid/gentamicin
Surgery e.g. labyrinthectomy/vestibular nerve section
75
Q

Diphtheria management

A

Antitoxin and supportive

Penicillin/erythromycin

76
Q

Candida throat infection management

A

Nystatin or fluconazole

77
Q

Malignant otitis (basically osteomyelitis) investigations

A

PV/CRP
radiological imaging
Biopsy and culture

78
Q

Malignant otitis management

A

Ciprofloxacin PO or piperacillin/tazobactam IV

79
Q

Fungal otitis externa management

A

Topical clotrimazole

80
Q

Acute sinusitis management

A

1st line - phenoxymethypenicillin

2nd line - doxycycline (not in children)