ent questions for applied knowledge test dr azhar siddiqui gpst1 2009

ENT Questions for ENT Questions for Applied Knowledge TestApplied Knowledge Test

Dr Azhar SiddiquiDr Azhar SiddiquiGPST1 2009GPST1 2009

Causes of Neck LumpsCauses of Neck Lumps> Branchial Cyst > Ludwigs Angina

> Parotitis > Thyroglossal Cyst

> Dermoid Cyst > Parapharyngeal Abscess

> Thyroid Swelling > Laryngocele

> Pharyngeal pouch > Reactive lymphadenitis

1) 45 yr old clarinet player presents with neck swelling that expands with forced expiration






1) 45 yr old clarinet player presents with neck swelling that expands with forced expiration

Laryngocele

Causes of Neck LumpsCauses of Neck Lumps Laryngocele : Air filled sac associated with larynx becomes dilated High pressure in larynx pushes laryngeal mucosa through

thyrohyoid membrane Found in wind instrument players Symptoms include:

Neck mass Hoarseness Stridor

Treatment usually surgical – dependant upon size






2) 4 yr old boy presents with small midline neck swelling that moves on swallowing. It is painless, mobile, transilluminates and fluctuates

Causes of Neck LumpsCauses of Neck Lumps> Branchial Cyst > Ludwigs Angina> Parotitis > Thyroglossal Cyst> Dermoid Cyst > Parapharyngeal Abscess> Thyroid Swelling > Laryngocele> Pharyngeal pouch > Reactive

lymphadenitis

2) 4 yr old boy presents with small midline neck swelling that moves on swallowing. It is painless, mobile, transilluminates and fluctuates

Thyroglossal Cyst

Causes of Neck LumpsCauses of Neck Lumps Thyroglossal Cyst : Arise from persistent epithelial thyroid duct formed with the

descent of thyroid from foramen caecum to its final position in the front of the neck

Occur at any age, but commonly between 15 – 30 yrs of age Presents with painless smooth cystic midline swelling in

region of hyoid bone Cyst rises when the patient protrudes their tongue


lymphadenitis

3) 30 yr old male presents with 5cm neck swelling anterior to the sterno-mastoid muscle on the left in its upper third. He states the swelling has been treated with antibiotics for infections in the past


lymphadenitis

3) 30 yr old male presents with 5cm neck swelling anterior to the sterno-mastoid muscle on the left in its upper third. He states the swelling has been treated with antibiotics for infections in the past

Branchial Cyst

Causes of Neck LumpsCauses of Neck Lumps

Branchial Cyst: Arises from embryonic remnants of second branchial cleft in

the neck Most common in young adults Presents as smooth swelling in front of the anterior border of

sternomastoid, at the junction of upper and middle thirds Treatment is by excision Treatment may need to be delayed if cyst is acutely infected,

leading to branchial fistula

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases> Malignant Otitis Externa > Otitis Externa> Rhinocerebral mucormycosis > Quinsy> Lymphoma > Acute Otitis Media> Nasal Polyposis > Otitis media with glue ear> Rhinosinusitis > Glandular Fever

1) A 25 yr old man presents with worsening sore throat. On examination he has trismus and unilateral enlargement of his right tonsil.

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases> Malignant Otitis Externa > Otitis Externa> Rhinocerebral mucormycosis > Quinsy> Lymphoma > Acute Otitis Media> Nasal Polyposis > Otitis media with glue ear> Rhinosinusitis > Glandular Fever

1) A 25 yr old man presents with worsening sore throat. On examination he has trismus and unilateral enlargement of his right tonsil.

Quinsy

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases Quinsy :

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases Quinsy : Aka peritonsillar abscess Complication of acute tonsillitis Usually due to streptococcal infection Collection of pus arising outside tonsil capsule. Symptoms include: sore throat, fever, halitosis, dysphagia,

trismus, referred ear ache. Uvula may be very oedematous and displaced downwards

and medially by the infected tonsil Treatment is with penicillin based antibiotics ( IV

Benzylpen, or oral penicillin V, + IV hydrocortisone) Drainage of abscess by aspiration or incision Consider tonsillectomy 6 weeks post acute infection

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases> Malignant Otitis Externa > Otitis Externa

> Rhinocerebral mucormycosis > Quinsy

> Lymphoma > Acute Otitis Media

> Nasal Polyposis > Otitis media with glue ear

> Rhinosinusitis > Glandular Fever

2) A 60 yr old woman noted to have unilateral tonsillar enlargement. She denies having sore throat






2) A 60 yr old woman noted to have unilateral tonsillar enlargement. She denies having sore throat

Lymphoma

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases Lymphoma : Varied presentation – mainly painless lump or swelling Not conclusive without histology Be wary of lymphoma for unilateral tonsillar enlargement,

or unresolving / recurrent lymphadenopathy






3) 30 year old woman complaining of otalgia and purulent discharge from right ear. External auditory meatus is swollen and inflammed and filled with white discharge






3) 30 year old woman complaining of otalgia and purulent discharge from right ear. External auditory meatus is swollen and inflammed and filled with white discharge

Otitis Externa

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases

Otitis Externa :

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases Otitis Externa : Causes :

Infection – bacteria (esp staph), fungi Allergy – eczema, contact allergy Iatrogenic – frequent ear syringing, trauma

Swimmers more commonly affected Symptoms – irritation, discharge, pain, hearing loss Refer to hospital if :

Malignant otitis externa Uncontrolled symptoms Previous history of complex ear problems

Treatment: Antibiotic eardrops +/- oral fluclox Aural toilet If symptoms not resolving after 1/52, consider alternative drops +/-

erythromycin






4) A 60 yr old diabetic woman complains of severe otalgia. On examination, she has granulation tissue in ear






4) A 60 yr old diabetic woman complains of severe otalgia. On examination, she has granulation tissue in ear

Malignant Otitis Externa

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases Malignant Otitis Externa : Otitis externa that has spread to cause osteomyelitis of skull

base Due to Pseudomonas aeruginosa and anaerobes Facial nerve involved in 50% of cases Granulation tissue - diagnostic indicator Ix – swabs for cultures, and CT/MRI to show invasion IV cipro or ceftazidine + metronidazole Surgical removal of granulated tissue may be needed

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases

Otitis Media

Diagnosis of ENT DiseasesDiagnosis of ENT Diseases Otitis Media : Inflammation of middle ear Classified as :

Acute suppurative – caused by viral or bacterial infection. Causes pain and tenderness

Chronic suppurative – persistent drainage from ear associated with TM perforation. Not usually painful due to chronic nature

Serous/secretory – Middle ear effusion without TM perforation. Associated with dysfunction/obstruction of eustachian tube. Important cause of hearing loss in children.

Antibiotics used in AOM – Amoxicillin Tympanoplasty in safe CSOM Aural toilet, antibiotics, exploration of the ear in unsafe

CSOM

Diagnosis of Hearing LossDiagnosis of Hearing Loss> Acoustic neuroma > Ototoxicity

> Blast injury > Fracture base of skull

> Petrous temporal bone fracture > CSOM

> Wax impaction > Glue ear

> Acute otitis media > Herpes Zoster

1) Man treated with gentamicin for peritonitis for 10/7 presents with deafness






1) Man treated with gentamicin for peritonitis for 10/7 presents with deafness

Ototoxicity

Diagnosis of Hearing LossDiagnosis of Hearing Loss Ototoxicity : Various drugs can damage inner ear and cause sensorineural

deafness and tinnitus Ototoxic drugs :

Aminoglycoside antibiotics Diuretics Antimalarials Cytotoxic drugs Analgesics – salicylates, ibuprofen Chemicals – alcohol, tobacco, marijuana






2) A woman presents with deafness and corneal numbness. MRI showed widened internal auditory meatus






2) A woman presents with deafness and corneal numbness. MRI showed widened internal auditory meatus

Acoustic neuroma

Diagnosis of Hearing LossDiagnosis of Hearing Loss Acoustic Neuroma : Benign slow growing neoplasm of the schwann cells of CN

VIII Lesions located in internal auditory canal or

cerebellopontine angle causing compression of vestibular nerve

Clinical features Occipital pain on side of tumour CN VIII damage - Unilateral senssorineural deafness CN V damage – depression of corneal reflex, facial pain, numbness CN VII, IX, X, XI damage - rare

Ix – audiometry, CT with contrast, MRI Treatment

Conservative – watch and wait Radiosurgery – small to medium sized tumours Microsurgery – large neuromas

Diagnosis of Hearing LossDiagnosis of Hearing Loss






3) A 20 yr old male presents with head injury, bruising to right side of the head with hearing loss






3) A 20 yr old male presents with head injury, bruising to right side of the head with hearing loss

Petrous temporal bone fracture

Diagnosis of Hearing LossDiagnosis of Hearing Loss Petrous temporal bone fracture : Head injury can cause hearing loss due to:

Ossicular disruption Haemotympanum CSF otorrhoea CN VIII nerve palsy

All these can occus in fractures petrous temporal bone Complaint of reduced hearing in one ear after trauma poits

to haemotympanum Blood in external auditory meatus caused by basal skull

fracture

Thank youThank you

ent questions for applied knowledge test dr azhar siddiqui gpst1 2009

Documents

thyroglossal cyst slide

past branchial cyst

smooth swelling

small midline neck

region of hyoid bone

past slide

size slide

tongue slide