Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

ENT teaching – Nose/throat/face Dr Aaisha Patel FY1 Demographic quiz …not to stereotypebut…. •25 year old female presents with left sided sharp facialpain which lasts 30 seconds and disappears. •2 year old child presents high temperature, sore throat, difficulty breathing. O/Edrooling and has stridor •30 year old female presents with facial pain, high temperature and cold like symptomsTrigeminal neuralgia • Facial pain occurs across branches of trigeminal nerve • Due to vascular compression of trigeminal nerve • Lasts seconds – few minutes, multiple times a day • Treatment: Carbamazepine 200mg TDS/QDS. If not tolerated pain teamRhinosinusitis • Acute rhinosinusitis • Chronic rhinosinusitis • Presents with: Nasal congestion, Nasal discharge, Facial pain or • Similar symptoms as acute headache, Facial pressure, Loss of without fever and lasting 12 smell weeks • Usually viraldue to URTI so self limiting resolving in 2-3 weeks • Can be associated with nasal • Common causative organisms: polyps Rhinovirus, Parainfluenza virus, Influenza virus • Can give antipyretics, analgesics or nasal irrigation.Epiglottitis • Inflammation of epiglottis • Cause H. influenza B • LIFE THREATENING EMERGENCY • Usually in unvaccinated child • Do not distress px, do not examine • Alert anaesthetist nd seniors STATStation 1 You are a FY1 doctor in the Emergency department. Hayley an 10 year old girl has presented to Paeds A+E with her mum bleeding from her nose. Please take a history and consider next steps. At7 minutes, the examiner will ask you to suggest 3 differentials for this presentation and one additional question.Causes of epistaxis: Environmental factors - Trauma (pickingnose, inserting foreign bodies, facial trauma) - Changes in temperature - Stress - Cocaineuse Coagulopathy/renal disorders: - Von Willebrand's disease - HHT - Granulomatosis with polyangitis Infections - Rhinitis - Sinusitis Cancer (notto miss but rare) - Malignancy of noseSTATION 1 MARK SCHEME DONE? Associated symptoms (asks 4out of 5 is sufficient) SOB (ask about onein turn) Introduces self with nameand role Chest pain (don’t dismiss pain and offer pain relief) Check patients details full name, preferred nameand DOB Palpitations [not as relevant] Purpose of discussion and consent Fever Fatigue Open question ICE explored Dizziness Exploration of presenting complaint: Headache Where she is bleeding from – R/L PMH, PSH, Sudden orgradual Birth/preg history, Frank or dark red blood/clots DH (Allergy + nature) FH (bleeding disorders), Estimatehow much bleeding Constant or intermittent SH – school,siblings,parents job,living situation,social services, drug use Severity – worsening? Summary and invite questions Trauma Previous episodes/treatment Station 2 You are a FY1 doctor in the Emergency department. Anne a 40 year old female has presented with facial drooping. Please take a history and consider next steps. At 7 minutes, the examiner will ask you to suggest 3 differentials for this presentation and one additional question.Bells Palsy • facial paralysis due to trauma to facial nerve • Usually due to HSV activation • Presents with facial pain/droop/reduced taste anterior 2/3 tongue/hyperacusis, dry eyes/mouth • Recovery 2-3 months self limiting • Steroids in reducing regime reduces inflammation of nerveSTATION 2 MARK SCHEME DONE? Associated symptoms (asks 4out of 5 is sufficient) Weakness in arms and legs Introduces self with nameand role Difficulty with speech/swallow Changes to vision/hearing/balance Check patients details full name, preferred Headache, vomiting, seizures,WL, NS, malaise nameand DOB Sensory loss Purpose of discussion and consent Head injury Open question PMH, PSH, ICE explored DH (Allergy + nature) Exploration of presenting complaint: FH SH – occupation/schooling, how affecting functionally, Sudden orgradual onset Previous episodes driving, smoking,alcohol,rec drugs, travel One side/both sides Intermittent Summary and invite questions Station 3 You are a FY2 doctor in GP. Max a 18 year old male presents to your morning clinic with a sore throat. Please take a history and consider next steps. At 7 minutes, the examiner will ask you to suggest 3 differentials for this presentation and one additional question.STATION 3 MARK SCHEME DONE? Associated symptoms (asks 4out of 5 is sufficient) Headache, malaise, fever Introduces self with nameand role Contact hx – travel/family friends Ableto eat/drink/swallow saliva Check patients details full name, preferred Mass around neck nameand DOB Rash Purpose of discussion and consent Open question PMH, PSH, DH (Allergy + nature) ICE explored FH Exploration of presenting complaint: SH – occupation/schooling, how affecting functionally, SOCRATES for pain driving, smoking,alcohol,rec drugs Number of previous episodes and treatment (seen by ENT?) Summary and invite questionsQuinsy • Quinsy is a complication of untreated tonsillitis • Similar symptoms to tonsillitis but have hot potato voice, drooling, inability to swallow saliva, trismus (cant open mouth) • Caused by strep A/staph a • This needs urgent incision and drainage or needle aspirationTopics covered today: 1. Rhinosinusitis 2. Epiglottitis 3. Trigeminal neuralgia 4. Tonsillitis, quinsy 5. Approach to epistaxis 6. Bells palsybig shout out to.... • Pulse notes for theMCQs • Geeky medics • ENT SHO • Zero to finals • CKS • Good ol’ NHS website