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http://www.encyclopedia.com/topic/Perforated_eardrum.aspx

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DIZZINESS

HistoryDizziness

Vertigo

INNER EAR

Single episodeMultipleepisodes

Disequilibrium

Presyncope

Other

Spinning

History of 1st episode

Predisposing factors

Associated symptoms

How long?

Single or recurrent

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able: Summary of typical clinical features of

common causes of vertigo

Onset Duration Precipita

nts

Associati

ons

Vestibula

r

neuroniti

s

(neuritis)

Sudden Constant

for many

hours or

even a

day

Viral

illness

(occasion

ally)

Nausea

and

vomiting

BPPV Intermitt

ent

Episodes

up to 60

seconds

Head

moveme

nts

None

Mnire'

s disease

Intermitt

ent

Unpredic

table,episodes

may last

hours

- Deafness

TinnitusAural

fullness

Recurren

t

vestibulo

pathy

Intermitt

ent

Episodes

lasting

minutes

to hours

- -

able: Summary of typical clinical features of common causes of vertigo

Onset Duration Precipitants Associations

Vestibular

neuronitis

(neuritis)

Sudden Constant for

many hours or

even a day

Viral illness

(occasionally)

Nausea and

vomiting

BPPV Intermittent Episodes up to

60 seconds

Head

movements

None

Mnire's

disease

Intermittent Unpredictable,

episodes may

last hours

- Deafness

Tinnitus

Aural fullness

Recurrent

vestibulopathy

Intermittent Episodes lasting

minutes to

hours

- -

7/29/2019 Ent 2

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Homework

Chondrodermatitis

nodularis chronica helicis

Hallpike test

Epleys manouver

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The Nose

http://www.google.com.eg/url?sa=i&rct=j&q=the+nose&source=images&cd=&cad=rja&docid=iWxoG_IxWUVLAM&tbnid=dEvAN_EqOpZ-wM:&ved=0CAUQjRw&url=http://www.homepagedaily.com/Pages/article9095-research-making-sense-of-the-nose-and-tongue.aspx&ei=4sCEUe-DDMbL0QXdz4C4DQ&bvm=bv.45960087,d.d2k&psig=AFQjCNFvbi8y8FkvPXlEum1VZTyBQnFZEA&ust=1367740988891318

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Anatomy

http://www.google.com.eg/url?sa=i&rct=j&q=nose+anatomy&source=images&cd=&cad=rja&docid=68wBqabYxM6JcM&tbnid=f611SvyK52sQBM:&ved=0CAUQjRw&url=http://entdr.com/sinonasal_conditions.html&ei=_C6EUYrnLMbMPeaHgKgH&bvm=bv.45960087,d.ZWU&psig=AFQjCNHTpmW4VHnZOnbr9D8g7Ah1tQv7FQ&ust=1367703661711573

7/29/2019 Ent 2

7/45

Anatomy

http://www.google.com.eg/url?sa=i&rct=j&q=nasal+sinus+anatomy&source=images&cd=&cad=rja&docid=mfYN1HXn5OMEJM&tbnid=byq1da2jid7_IM:&ved=0CAUQjRw&url=http://www.treatingasinusinfection.com/&ei=xDCEUaaEA8XwOtavgaAO&bvm=bv.45960087,d.ZWU&psig=AFQjCNH9YnB8V9BwbjGLSIA_iVTyiwBCKg&ust=1367704069555572http://www.google.com.eg/url?sa=i&rct=j&q=the+nose+little%27s+area&source=images&cd=&cad=rja&docid=x1HQEaZTd2zHfM&tbnid=c4BZdU8rgPbkKM:&ved=0CAUQjRw&url=http://www.mwap.co.uk/ENT_acute_nose.html&ei=hcGEUfD6Gsmv0QX2tYHYAQ&bvm=bv.45960087,d.d2k&psig=AFQjCNGEqSbyjnCPeJmgFer9shiP6pLH4A&ust=1367741178627232

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# nasal bones

http://www.google.com.eg/url?sa=i&rct=j&q=fracture+nasal+bones&source=images&cd=&cad=rja&docid=4nX1kWs2lPvpKM&tbnid=VTz7dTnb8T9nrM:&ved=0CAUQjRw&url=http://www.sinusrhinoplastynyc.com/procedures/broken-nose/&ei=MMOEUY_PNsqM0wW7gIGICg&psig=AFQjCNE_mkibZ-0f2tVA3FiixyRuXwC7Eg&ust=1367741597058818

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http://www.google.com.eg/url?sa=i&rct=j&q=epistaxis&source=images&cd=&cad=rja&docid=0jgAy78bd4EbaM&tbnid=ePsvoGNZ5abQpM:&ved=0CAUQjRw&url=http://www.accessmedicine.ca/search/searchAMResultImg.aspx?searchStr=&searchType=1&rootTerm=nasal%20septal%20hematoma&rootID=41451&resourceID=40&narrowing=yes&ei=C6eEUdWhK4KH0AXfvoHQBQ&bvm=bv.45960087,d.ZWU&psig=AFQjCNG4yMmNBq9ZIytZf9S_BfoHBaoeaw&ust=1367704524423547http://2.bp.blogspot.com/-Dr1IMX1PxqI/UYdllcputOI/AAAAAAAADBQ/F-ZY7-_U_es/s1600/Septal_Abscess_.jpg

7/29/2019 Ent 2

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Epistaxis

http://www.google.com.eg/url?sa=i&rct=j&q=epistaxis&source=images&cd=&cad=rja&docid=H2vsoLdumEfd4M&tbnid=1HZkdBjkGDCx1M:&ved=0CAUQjRw&url=http://www.primehealthchannel.com/epistaxis.html&ei=YTKEUfDiGM3EPdLUgaAM&bvm=bv.45960087,d.ZWU&psig=AFQjCNG4yMmNBq9ZIytZf9S_BfoHBaoeaw&ust=1367704524423547http://www.google.com.eg/url?sa=i&rct=j&q=epistaxis&source=images&cd=&cad=rja&docid=PuVO5vu4AP6KRM&tbnid=p_h3GNa-EtMVjM:&ved=0CAUQjRw&url=http://www.networkmedical.co.uk/ent_netcell_epistaxis_pack.html&ei=jDKEUf_DOMXfPbzPgMAG&bvm=bv.45960087,d.ZWU&psig=AFQjCNG4yMmNBq9ZIytZf9S_BfoHBaoeaw&ust=1367704524423547http://www.google.co.uk/imgres?q=little+area+nose+bleed&sa=X&hl=en&qscrl=1&rlz=1T4ACPW_enGB356GB357&biw=1360&bih=603&tbm=isch&tbnid=oQhmTtxiftVk8M:&imgrefurl=http://www.childrenscolorado.org/wellness/at_home/nose/nosebleed.aspx&docid=Lln4CwQCAzLQYM&imgurl=http://www.childrenscolorado.org/imgs/Housecalls/nosebleed.jpg&w=320&h=342&ei=R1WGUeSOJaSx0QWzkoDYCw&zoom=1&ved=1t:3588,r:40,s:0,i:211&iact=rc&dur=1531&page=2&tbnh=186&tbnw=173&start=18&ndsp=26&tx=152.9473876953125&ty=85.3157958984375

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7/29/2019 Ent 2

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Septal perforation

http://www.google.com.eg/url?sa=i&rct=j&q=nasal+mseptum+perforation&source=images&cd=&cad=rja&docid=5gxeMjNBLqqk1M&tbnid=4yHpw4rTlWYUVM:&ved=0CAUQjRw&url=http://njfaces.com/index.cfm/PageID/3503&ei=_DGEUfrEFsXbPcA1&bvm=bv.45960087,d.ZWU&psig=AFQjCNEw8tY4BEffafuluQEZ6kwZ5OYV2Q&ust=1367704306028123http://www.google.com.eg/url?sa=i&rct=j&q=nasal+mseptum+perforation&source=images&cd=&cad=rja&docid=MkzqDlXyQxvPqM&tbnid=JHBCcyP4pz7jxM:&ved=0CAUQjRw&url=http://drugline.org/medic/term/perforation-nasal-septum/&ei=kjGEUZj6GILcOcvPgPgH&bvm=bv.45960087,d.ZWU&psig=AFQjCNEw8tY4BEffafuluQEZ6kwZ5OYV2Q&ust=1367704306028123

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Septal perforation

Trauma ,iatrogenig,Wegners

,sarcoidosis,TB,Syphilis, COCAINE,NEOPLASTIC.

Asynptomatic, wistling,blockage,epistaxis

FBC,ESR,CANCA,ACE level?VDRL.Biopsy

Saline nasal douches ,surgical

7/29/2019 Ent 2

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http://www.google.com.eg/url?sa=i&rct=j&q=correct+head+position+to+instill+nasal+drops&source=images&cd=&cad=rja&docid=Njst_CXsm9Ok-M&tbnid=KOUYPXc6jkzIrM:&ved=0CAUQjRw&url=http://oxfordmedicine.com/oso/fullsizeimage?imageUri=/10.1093/med/9780199230228.001.0001/med_9780199230228_graphic020017-full.jpg&uriChapter=/10.1093/med/9780199230228.001.0001/med-9780199230228-chapter-020&ei=mMWEUeXbEOmW0AXQ8YHoDg&psig=AFQjCNFv1nTyzQ4jxG24jVVmlJ49kVxwGQ&ust=1367742188972129

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Rhinitis

2 out of 3 for >1 hour every day for >2 weeks.

-Nasal congestion

-rhinorrhoea (Ant. Or Post.)

-sneezing

- itching (nasal cavity),facial pain ,anosmia

*RAST

*steroides (beclomethazone,fluticasone,mometasone)

*Antihistaminics

*Oral steroides

*Montelukast*saline douches

*surgical

NB Rhinits and sinusits usually coexist and are

concurrent in most individuals; thus, the correct

terminology is now rhinosinusits.

http://www.wikihow.com/Image:Get-Rid-of-a-Runny-Nose-Step-1.jpg

7/29/2019 Ent 2

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Sinusitis

Acute:12 weeksRAST ,ESR,CANCA,ACE,CT scan Sinuses

Medical treatment for 3 months

mild :fluticasone 2 puffs OD

Severe (polyps) :Betamethasone 2 drops for 6 weeks followed by steroides spray

Oral antihistaminics (if allergic)

Oral steroids (very severe)

Oral antibiotics (clarythromycin)

Surgical: FESSReferral:failure of treatmentred flagspatient willing to have surgery.

http://www.google.com.eg/url?sa=i&rct=j&q=sinusitis&source=images&cd=&cad=rja&docid=HQKL0xb7rusvwM&tbnid=AumV2VrRxosKaM:&ved=0CAUQjRw&url=http://entcenterslc.com/blog/nose/5-signs-you-may-have-sinusitis/&ei=P8yEUaHPEOWr0AWenIGgAw&bvm=bv.45960087,d.d2k&psig=AFQjCNFPL22teHkxglZtFeIIRuAAlM1mUg&ust=1367743921878645

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Periorbital cellulitis

N l

7/29/2019 Ent 2

18/45

Nasal

polyps

What are they?

Paediatric polyps?

?Unilateral polyps?( neoplastic until proven otherwise)

Associated with

Asthma (particularly late-onset asthma)

Aspirin sensitivity.......... Samter's triad

infective sinusitis

cystic fibrosis

Kartagener's syndrome

Churg-Strauss syndrome all patients with suspected nasal polyps should be referred to ENT

for a full examination

topical corticosteroids shrink polyp size in around 80% of patients

Around in 1% of adults in the UK have

nasal polyps. They are around 2-4

times more common in men and are

not commonly seen in children or the

elderly.

http://www.google.com.eg/url?sa=i&rct=j&q=enlarged+inferior+turbinate&source=images&cd=&cad=rja&docid=V9CMj946iB-MeM&tbnid=C9j2Uxes5iQNAM:&ved=0CAUQjRw&url=http://www.reddyentclinic.co.uk/Krishna-Reddy-Photos-Nose.htm&ei=GqiEUcfTDKGr0AXk84HACQ&bvm=bv.45960087,d.d2k&psig=AFQjCNEqskowLa9eS17fogQjmv9M9_ujpA&ust=1367734666083502

7/29/2019 Ent 2

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http://www.google.com.eg/url?sa=i&rct=j&q=enlarged+inferior+turbinate&source=images&cd=&cad=rja&docid=V9CMj946iB-MeM&tbnid=C9j2Uxes5iQNAM:&ved=0CAUQjRw&url=http://www.reddyentclinic.co.uk/Krishna-Reddy-Photos-Nose.htm&ei=GqiEUcfTDKGr0AXk84HACQ&bvm=bv.45960087,d.d2k&psig=AFQjCNEqskowLa9eS17fogQjmv9M9_ujpA&ust=1367734666083502

7/29/2019 Ent 2

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http://www.google.com.eg/url?sa=i&rct=j&q=nasal+plyps&source=images&cd=&cad=rja&docid=WuGLCipVq7NRDM&tbnid=mbMnFraJRyNODM:&ved=0CAUQjRw&url=http://www.drrahmatorlummc.com/nasalpolyps.htm&ei=1qeEUdWJKYqy0QXsmYHwAw&bvm=bv.45960087,d.d2k&psig=AFQjCNGX-VpPu1AZZ4g8qgm2_QCHjWp9rA&ust=1367734541999651http://www.google.com.eg/url?sa=i&rct=j&q=nasal+plyps&source=images&cd=&cad=rja&docid=WxWbnQ735HcrCM&tbnid=aS_oVtd6OJ1vnM:&ved=0CAUQjRw&url=http://www.entusa.com/nasal_pictures_html/nasal_polyp_1.htm&ei=p6eEUa5BzJPRBdeZgKAC&bvm=bv.45960087,d.d2k&psig=AFQjCNGX-VpPu1AZZ4g8qgm2_QCHjWp9rA&ust=1367734541999651

7/29/2019 Ent 2

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Red flags

Unilateral blockage

Unilateral dischargeBlood stained discharge

Eye signs /symptoms

Facial swelling (smokers, elderly)

http://www.google.com.eg/url?sa=i&rct=j&q=red+flag&source=images&cd=&cad=rja&docid=OxNzq-eaSbDnkM&tbnid=PxG-PS6VY7TNDM:&ved=0CAUQjRw&url=http://www.123rf.com/photo_14336615_illustration--businessman-and-red-flag-a-businessman-holding-a-red-flag.html&ei=QH-FUYncMqfV0QXy7oCoCA&bvm=bv.45960087,d.d2k&psig=AFQjCNGOBrprMMDB3aiYTcP7RhXFFSLMWg&ust=1367789741425463http://www.google.com.eg/url?sa=i&rct=j&q=sinusitis+CT+SCAN&source=images&cd=&cad=rja&docid=9TBQr08q7wYEsM&tbnid=-WpmT9KGvijyiM:&ved=0CAUQjRw&url=http://www2.luriechildrens.org/ce/online/article.aspx?articleID=127&ei=Zs2EUe20POe30QXdloDQBA&bvm=bv.45960087,d.d2k&psig=AFQjCNFqFovQcIpWoaKNbA359lPHk8kmzw&ust=1367744083308938http://www.google.com.eg/url?sa=i&rct=j&q=sinusitis+CT+SCAN&source=images&cd=&cad=rja&docid=GuTaCiIlAdPiGM&tbnid=EELAwaaZeBAPCM:&ved=0CAUQjRw&url=http://blog.remakehealth.com/blog_Healthcare_Consumers-0/bid/12024/What-does-a-CT-scan-of-the-Sinuses-show&ei=CM2EUaK3MKml0AWM34CQBA&bvm=bv.45960087,d.d2k&psig=AFQjCNFqFovQcIpWoaKNbA359lPHk8kmzw&ust=1367744083308938

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SNORING

Causes

Epworth sore...?sleep apnoea(is it witnessed)

Day time somnolesence

TreatmentWight loss

Surgical UVPPP

CPAP

DLVAPatients responsibility to inform DVLA when OSAsuspected/investigated. Doctors responsibility to informDVLA if untreated OSA pt is witnessed driving

http://www.google.com.eg/url?sa=i&rct=j&q=red+flag&source=images&cd=&cad=rja&docid=OxNzq-eaSbDnkM&tbnid=PxG-PS6VY7TNDM:&ved=0CAUQjRw&url=http://www.123rf.com/photo_14336615_illustration--businessman-and-red-flag-a-businessman-holding-a-red-flag.html&ei=QH-FUYncMqfV0QXy7oCoCA&bvm=bv.45960087,d.d2k&psig=AFQjCNGOBrprMMDB3aiYTcP7RhXFFSLMWg&ust=1367789741425463http://www.google.co.uk/url?sa=i&rct=j&q=snoring&source=images&cd=&cad=rja&docid=rrgnOJBLG6IDaM&tbnid=ukRq_OD4UgxjTM:&ved=0CAUQjRw&url=http://www.britishsnoring.co.uk/stock_photos.html&ei=qlCGUbG2H4nW0QXRv4DADQ&bvm=bv.45960087,d.d2k&psig=AFQjCNHTOsxcwmHZuddO8IOCWcCHGcYR9g&ust=1367843099249125http://www.google.co.uk/url?sa=i&rct=j&q=snoring&source=images&cd=&cad=rja&docid=UvyrPDKZodZrjM&tbnid=5SVXtN--8_Of3M:&ved=0CAUQjRw&url=http://www.easterndrugs.com/blog/general-health/sleep-disorder/ayurvedic-snoroff-capsules-to-stop-your-snoring&ei=uk-GUY3cHoPN0QXDg4GoBQ&bvm=bv.45960087,d.d2k&psig=AFQjCNHTOsxcwmHZuddO8IOCWcCHGcYR9g&ust=1367843099249125http://www.google.com.eg/url?sa=i&rct=j&q=red+flag&source=images&cd=&cad=rja&docid=OxNzq-eaSbDnkM&tbnid=PxG-PS6VY7TNDM:&ved=0CAUQjRw&url=http://www.123rf.com/photo_14336615_illustration--businessman-and-red-flag-a-businessman-holding-a-red-flag.html&ei=QH-FUYncMqfV0QXy7oCoCA&bvm=bv.45960087,d.d2k&psig=AFQjCNGOBrprMMDB3aiYTcP7RhXFFSLMWg&ust=1367789741425463http://www.google.com.eg/url?sa=i&rct=j&q=red+flag&source=images&cd=&cad=rja&docid=OxNzq-eaSbDnkM&tbnid=PxG-PS6VY7TNDM:&ved=0CAUQjRw&url=http://www.123rf.com/photo_14336615_illustration--businessman-and-red-flag-a-businessman-holding-a-red-flag.html&ei=QH-FUYncMqfV0QXy7oCoCA&bvm=bv.45960087,d.d2k&psig=AFQjCNGOBrprMMDB3aiYTcP7RhXFFSLMWg&ust=1367789741425463

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http://www.google.co.uk/url?sa=i&rct=j&q=epworth+score&source=images&cd=&cad=rja&docid=yyFsFdVuo1fQDM&tbnid=TkTyl71LfYx9FM:&ved=0CAUQjRw&url=http://www.livingwithhypersomnia.com/tag/the-epworth-sleepiness-scale/&ei=TOSPUZjfDorW0QWxzYDwBA&bvm=bv.46340616,d.d2k&psig=AFQjCNFqL7uE5I4W6oaHj9ujMGKyc6ukWw&ust=1368470974314262

7/29/2019 Ent 2

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Homework

CSF rhinorrhoea

7/29/2019 Ent 2

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Throat

http://www.google.co.uk/imgres?q=asymmetrical+tonsils&sa=X&hl=en&qscrl=1&rlz=1T4ACPW_enGB356GB357&biw=1436&bih=637&tbm=isch&tbnid=MrJmktVV8B5waM:&imgrefurl=http://www.drpaulose.com/ear/ent-pediatric-children/snoring-in-children-3&docid=4BtJMc0XBKphlM&imgurl=http://farm4.static.flickr.com/3429/3369481641_b2dcb8646d_m.jpg&w=240&h=180&ei=RJCJUYGRBeKN0wXx5oGoBw&zoom=1&ved=1t:3588,r:70,s:0,i:301&iact=rc&dur=4425&page=3&tbnh=144&tbnw=192&start=48&ndsp=25&tx=134.77777099609375&ty=42.66667175292969

7/29/2019 Ent 2

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Anatomy

http://www.google.com.eg/url?sa=i&rct=j&q=mouth+largest+mouth&source=images&cd=&docid=_RbY5VovaE4WkM&tbnid=AGhzpSbqV24DSM:&ved=0CAUQjRw&url=http://www.couriermail.com.au/news/francisco-domingo-joaquim-has-the-worlds-largest-mouth/story-e6frep26-1225944874496&ei=nwBUUZKEAsqx0QXAl4HwCQ&bvm=bv.44442042,d.d2k&psig=AFQjCNG8oP4QAzyDmtfWgPVbsapiiWzuaQ&ust=1364546053032379

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7/29/2019 Ent 2

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http://www.google.co.uk/url?sa=i&rct=j&q=asymmetrical+tonsils&source=images&cd=&cad=rja&docid=5APPczNydYtsiM&tbnid=VkP_tK5Bhs2AeM:&ved=0CAUQjRw&url=http://www.jomfp.in/article.asp?issn=0973-029X;year=2013;volume=17;issue=1;spage=148;epage=148;aulast=Erol&ei=_5CJUfyKGOiT0AXJs4HwAQ&bvm=bv.46226182,d.d2k&psig=AFQjCNGMpajug58upjsTLFPuTMvawgh3cw&ust=1368056260416272http://www.google.co.uk/url?sa=i&rct=j&q=asymmetrical+tonsils&source=images&cd=&cad=rja&docid=C7Er43-8NBBq_M&tbnid=r9xNueNaqWOpXM:&ved=0CAUQjRw&url=http://theyearoflivinghealthy.blogspot.com/&ei=Y5CJUb7ZEcjQ0QWNsIHIDw&bvm=bv.46226182,d.d2k&psig=AFQjCNGMpajug58upjsTLFPuTMvawgh3cw&ust=1368056260416272

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Acute tonsillitis

Acute tonsillitis

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NICE indications for antibiotics

features of marked systemicupset secondary to the acutesore throat

unilateral peritonsillitis

a history of rheumatic fever

an increased risk from acuteinfection (such as a child withdiabetes mellitus orimmunodeficiency)

patients with acute sorethroat/acute pharyngitis/acutetonsillitis when 3 or more

Centorcriteria are present WHICH ANTIBIOTICS?

Presence of tonsillar

exudate

Tender anteriorcervical

lymphadenopathy or

lymphadenitis

History of fever

Absence of cough

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Quinsy

http://www.google.com.eg/url?sa=i&rct=j&q=PERITONSILLAR+ABSCESS&source=images&cd=&cad=rja&docid=ensVyqJs2GAUvM&tbnid=xLZ_yixj34BJnM:&ved=0CAUQjRw&url=http://entsho.com/quinsy/&ei=GteEUdr_JvOT0QWh94HYAw&psig=AFQjCNHMPB4D5GlPH344Hs5Xd6kMX0XoGQ&ust=1367746543410590

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http://www.google.com.eg/url?sa=i&rct=j&q=PERITONSILLAR+ABSCESS&source=images&cd=&cad=rja&docid=ensVyqJs2GAUvM&tbnid=xLZ_yixj34BJnM:&ved=0CAUQjRw&url=http://entsho.com/quinsy/&ei=GteEUdr_JvOT0QWh94HYAw&psig=AFQjCNHMPB4D5GlPH344Hs5Xd6kMX0XoGQ&ust=1367746543410590

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Glandular fever

http://www.google.com.eg/url?sa=i&rct=j&q=glandular+fever&source=images&cd=&cad=rja&docid=icvOkcfjRj7HhM&tbnid=ZCbb93EtigBF_M:&ved=0CAUQjRw&url=http://glandularfeversymptoms.com/&ei=ggpUUczFJILOOMiSgIAH&bvm=bv.44342787,d.ZWU&psig=AFQjCNFpa20NcJSL-VAsFD3xm6tsXlSKRw&ust=1364548607769005

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http://www.google.com.eg/url?sa=i&rct=j&q=GLANDULAR%20FEVER&source=images&cd=&cad=rja&docid=DoFUs7f-2xc32M&tbnid=LgA04ZirV0zUBM:&ved=0CAUQjRw&url=http://www.reddyentclinic.co.uk/Krishna-Reddy-Photos-Throat.htm&ei=utWEUZTHMZTB0gWhpYDYCA&psig=AFQjCNH7Zk57sNjHGKKta_0rzpheio3KtQ&ust=1367746330978501http://www.google.com.eg/url?sa=i&rct=j&q=glandular+fever&source=images&cd=&cad=rja&docid=icvOkcfjRj7HhM&tbnid=ZCbb93EtigBF_M:&ved=0CAUQjRw&url=http://glandularfeversymptoms.com/&ei=ggpUUczFJILOOMiSgIAH&bvm=bv.44342787,d.ZWU&psig=AFQjCNFpa20NcJSL-VAsFD3xm6tsXlSKRw&ust=1364548607769005

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http://1.bp.blogspot.com/-xyGhr9LzkrI/UYnE9K0B7HI/AAAAAAAADIY/BLKIe5oIFsA/s1600/Ludwig_s_Angina_.jpg

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Laryngology

http://www.google.com.eg/url?sa=i&rct=j&q=larynx+anatomy&source=images&cd=&cad=rja&docid=1fmw0dd-oNoTjM&tbnid=16MM5UAAhQEfRM:&ved=0CAUQjRw&url=http://g09biorespirationa.wikispaces.com/(3)+Respiratory+system+structure&ei=U9uEUeoogrHRBfHBgOAC&psig=AFQjCNF1Mgw9EoiSfVFxIP1PTxFPHcMOdA&ust=1367747647346097http://www.google.com.eg/url?sa=i&rct=j&q=larynx+anatomy&source=images&cd=&cad=rja&docid=ful7IMIitRxz9M&tbnid=4trHrbcLZsf1uM:&ved=0CAUQjRw&url=http://www.yoursurgery.com/proceduredetails.cfm?br=6&proc=31&ei=JNuEUaCdAe6M0wWu44FA&psig=AFQjCNF1Mgw9EoiSfVFxIP1PTxFPHcMOdA&ust=1367747647346097

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Hoarseness Causes:

URTI (Most common)

Trauma(shouting/nodules).

Iatrogenic

tumour

neurological (?)

functional(young women)

Ask about ? Reflux symptoms , Wight loss, inhalers use, voice misuse, stress,swallowing, breathing

Investigations :TFT,weight ,indirect laryngoscopoy.

Urgent Chest XRAY (IF SYMPTOMS >3 WEEKS)

If X-ray shows positive signs ..urgent referral to chest physician

If X-ray shows negative signs ..urgent referral to ENT

Early laryngeal tumours confined to vocal cords have 80-90% 5 Ysurvival .

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2WW

Red flags

Persistent hoarseness > 3 weeks

Pain

Dysphagia

HaemoptysisOtalgia

Neck lump

Especially in - smokers

- over 40yrs

http://www.google.com.eg/url?sa=i&rct=j&q=LARYNX+LOGO&source=images&cd=&cad=rja&docid=G634vNbGv7CLZM&tbnid=MQ-u_J49VUZViM:&ved=0CAUQjRw&url=http://www.shutterstock.com/pic-128575862/stock-photo--d-rendered-illustration-larynx.html&ei=gI2FUcL-FPGb0AXOqIGwDQ&psig=AFQjCNGyhjK8JoPxYClGqxujNfAjfqcUCw&ust=1367793392950677http://www.google.com.eg/url?sa=i&rct=j&q=red+flag&source=images&cd=&cad=rja&docid=OxNzq-eaSbDnkM&tbnid=PxG-PS6VY7TNDM:&ved=0CAUQjRw&url=http://www.123rf.com/photo_14336615_illustration--businessman-and-red-flag-a-businessman-holding-a-red-flag.html&ei=QH-FUYncMqfV0QXy7oCoCA&bvm=bv.45960087,d.d2k&psig=AFQjCNGOBrprMMDB3aiYTcP7RhXFFSLMWg&ust=1367789741425463

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Croup versus epiglottitisFeatures CROUP Epiglottitis

Organism Para influanze virus H InfluanzaAge < 2 years 2-6

Onset gradual rapid

Previous attack often no

Cough Parking no

Dysphagia NO +++

stridor inspiratory Insp/expiratory

Pyrexia + ++

position Lying Down Sitting forward

drooling No +++

nodes +++ +

behavior struggling Quiet

voice hoarse muffled

colour pink grey

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Neck lumps

Lymphadenopathy

Branchial cyst

Thyroglossal cyst

Salivary glands

Refer urgently to ENT

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Urgent referral

Mouth ulcers> 3weeks.

Lumps in mouth >3 weeks

Ubexplained sore throat>1 month

Hoarseness >3 weeks, negativeCXR.

Unexplained salivary glandswelling>4 weeks

Unilateral unexplained ear ache

with normal otoscopy Asymmetrical /unilateral

deafness

Unilateral tinnitus

http://www.google.co.uk/url?sa=i&rct=j&q=laryngectomy&source=images&cd=&cad=rja&docid=g1kA9hedygVfNM&tbnid=FQmFTUoeZEW_HM:&ved=0CAUQjRw&url=http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/laryngeal-cancer/image-typical-neck-stoma-laryngeal.shtml&ei=msmOUZPmAfCU0QXR94D4AQ&psig=AFQjCNErPXGWLdKhD2tiVuoIw6qw-awwKw&ust=1368398607311319http://www.google.co.uk/url?sa=i&rct=j&q=tracheoesophageal+puncture&source=images&cd=&cad=rja&docid=yBm0sQNWQ4E9fM&tbnid=TwiXWjLob7uEAM:&ved=0CAUQjRw&url=http://southwestrehabilitation.com/service-list/adult/&ei=vsiOUeLHHvHM0AWQvIGgDA&psig=AFQjCNHhbdMDXA8bLaZ4a6HiVB1vLQKv1g&ust=1368398381878629

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http://www.google.co.uk/url?sa=i&rct=j&q=laryngectomy&source=images&cd=&cad=rja&docid=v6k0vZz_BSETyM&tbnid=mpExuqo-nO-c-M:&ved=0CAUQjRw&url=http://www.cancerresearchuk.org/cancer-help/type/larynx-cancer/living/speaking-after-laryngectomy&ei=jMqOUYzTHYq80QWB7YDABQ&psig=AFQjCNErPXGWLdKhD2tiVuoIw6qw-awwKw&ust=1368398607311319http://www.google.co.uk/url?sa=i&rct=j&q=laryngectomy&source=images&cd=&cad=rja&docid=3b3pwDElepB-yM&tbnid=LU8nbiiKMrURHM:&ved=0CAUQjRw&url=http://dribrook.blogspot.com/p/treatment-of-laryngeal-cancer-often.html&ei=y8mOUbmhIMnM0QWs1IHIAw&psig=AFQjCNErPXGWLdKhD2tiVuoIw6qw-awwKw&ust=1368398607311319http://www.google.co.uk/url?sa=i&rct=j&q=laryngectomy&source=images&cd=&cad=rja&docid=g1kA9hedygVfNM&tbnid=FQmFTUoeZEW_HM:&ved=0CAUQjRw&url=http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/laryngeal-cancer/image-typical-neck-stoma-laryngeal.shtml&ei=msmOUZPmAfCU0QXR94D4AQ&psig=AFQjCNErPXGWLdKhD2tiVuoIw6qw-awwKw&ust=1368398607311319http://www.google.co.uk/url?sa=i&rct=j&q=tracheoesophageal+puncture&source=images&cd=&cad=rja&docid=yBm0sQNWQ4E9fM&tbnid=TwiXWjLob7uEAM:&ved=0CAUQjRw&url=http://southwestrehabilitation.com/service-list/adult/&ei=vsiOUeLHHvHM0AWQvIGgDA&psig=AFQjCNHhbdMDXA8bLaZ4a6HiVB1vLQKv1g&ust=1368398381878629

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The ear

http://www.youtube.com/watch?feature=play

er_embedded&v=0kEKoQ33dB0

http://www.google.com.eg/url?sa=i&rct=j&q=EAR&source=images&cd=&cad=rja&docid=iV5CTDVqe1-EJM&tbnid=ongkdiYJsiQTIM:&ved=0CAUQjRw&url=http://theearfilm.blogspot.com/&ei=B4yFUYnGD-O-0QWAyICAAQ&bvm=bv.45960087,d.d2k&psig=AFQjCNHnY4Yld4vHBFs-JR4NKrFgG1bueQ&ust=1367793021352720http://media.photobucket.com/user/prissicat214/media/thankyounote-animated.gif.html?filters[term]=animated%20thank%20you&filters[primary]=images&sort=1&o=25

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http://www.google.co.uk/url?sa=i&rct=j&q=otolaryngology+animation&source=images&cd=&cad=rja&docid=ZsJujWGOlQ79zM&tbnid=JTrKoMN93WPwhM:&ved=&url=http://www.zazzle.com/otolaryngology+posters&ei=W7iPUaL1NuSa0QWq7YDQCQ&psig=AFQjCNEECzoJs4gZzop9I1Xqx0HY_v3n7Q&ust=1368459740448229http://media.photobucket.com/user/prissicat214/media/thankyounote-animated.gif.html?filters[term]=animated%20thank%20you&filters[primary]=images&sort=1&o=25