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Neurology > 22 Jan 24 Ent > Flashcards

22 Jan 24 Ent Flashcards

1
Q

Pt with rhinoplasty has whistling noise during respiration

A

Septal perforation

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2
Q

Post op Septal perforation mech

A

Septum is made of cartilage and has poor blood supply
Cartilage Depends completely on overlying mucosa for nurishment by diffusion
Because of poor regenerating capacity of septal cartilage trauma or surgery may result in septal perforation.

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3
Q

Suppurative parotitis RF

A

🤪Elderly , dehydareted , post op
🤪Decreased oral intake (NPO perioperatively)
🤪Medications (anticholinergics)
🤪Obstruction (calculi , neoplasm)

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4
Q

Suppurative parotitis CF

A

🛞Firm, erythematous pre/postauricular swelling

🛞Exquisite tenderness exacerbated by chewing and palpation

🛞Trismus , systemic findings (fever,chills)

🛞Elevated serum amylase without pancreatitis

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5
Q

Suppurative parotitis ttt

A

USG/CT (to diff between stones , cancer, supp parotitis and an abscess)

Hydration, oral hygiene

Antibiotic

Massage (milking pus out of gland)

Sialagogues (inc salivary flow)

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6
Q

Suppurative parotitis mech

A

Elderly post op patients with dementia have poor hydration and poor hygiene

Salivary stasis (due to NPO , poor hygiene, dehydration) leads to retrograde seeding of bacteria from oral cavity thru stensen duct to parotid.

Rapid onset painful swelling of parotid aggravated by chewing.

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7
Q

Infectious epiglottitis CF

A

Epiglottitis is cellulitis of epiglottis , aryepiglottic folds and surrounding tissues.
Children have abrupt onset
Adults have subtle symptoms

Rapidly progressive and life threatening
Fever, sorethroat, drooling, muffled voice
Diff swallowing due to pain
Airway obs (stridor, dyspnea)
Pooled oropharyngeal secretions
Laryngotracheal tenderness
(Anterior neck tender to palpation)

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8
Q

Dx of infectious epiglotitis

A

Direct visualization
Lateral neck XRay ( thumb sign)

Patients with hypoxia resistant to non invasive intervention need aiway establishment prior to Xray.

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9
Q

Infectious epiglottitis RF

A

Strept pneumo , H influenzae
Diabetic
Obese
Preceding upper resp infection

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10
Q

Ttt of IE

A

Early artificial airway if needed
IV antibiotics (ceftriaxone plus vanco)

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11
Q

Centor criteria for evaluation and management of pharyngitis

A

👉🏼Fever by history
👉🏼Tender anterior cervical lymphadenopathy
👉🏼Tonsillar exudates
👉🏼Absence of cough

0-1 : No test or ttt

2-3.: Rapid streptococcal antigen test
Give penicillin/amoxicillin for positive results

  1. : Empiric penicillin or RSAT and then pencillin for positive results.
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12
Q

Otosclerosis CF

A

🚨Progressive Conductive hearing loss
🚨Normal otoscopic exam
🚨Mayb reddish hue behind TM
🚨Paradoxical improvement in speech discrimination in noisy environments
🚨May progress in pregnancy

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13
Q

Ttt of otosclerosis

A

Hearing amplification -hearing aids
Surgical (stapes) reconstruction

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14
Q

Auricular hematoma RF and CF with ttt

A

Contact sports injury (wrestling , martial arts)

Tender fluctuant blood collection on anterior pinna

Ttt

Immediate incision and drainage 
Pressure dressings
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15
Q

Complication of auricular hematoma

A
  1. Cauliflower ear (fibrocartilage overgrowth
  2. Rapid developement of Bacterial superinfection in 2-3 days (abscess)
  3. Reaccumulation of hematoma
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16
Q

Where is auricular hematoma blood collected ?

A

Between perichondrium and cartilage.

As auricular cartilage has no direct blood supply and receives all its nutrition via diffusion from perichondrium
Auricular hematoma can cause AVASCULAR NECROSIS of auricle.

Subsequent fribrocartilage overgrowth can lead to permanent deformity called cauliflower ear.

Hence ttt involves prompt incision and drainage to prevent reaccumulation if hematoma

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17
Q

Complications of septal hematoma

A

Avscular necrosis of septal cartilage
Septal perforation
External nasal deformities (saddle nose)
Internal nasal valve collapse (nasal obstruction)

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18
Q

RF of septal hematoma

A

Trauma

All pts with nasal truma should have examination of nasal septum

Palpation to diff between deviated nasal septum (firm) vs septal hematoma(soft and fluctuant)

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19
Q

Torus palatinus CF

A

👄Genetic
👄 benign bony growth exostosis
👄Immobile ,non tender ,hard consistency
🫦 <2cm size but enlarges over time.
Thin epithelium over bony growth ulcerates with minor trauma and heals slowly

👄Surgery for symptomatic pts.

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20
Q

Branchial cleft cyst location

A

BCC is located between the internal and external carotid arteries anterior to sternocleidomastoid muscle and inf to mandible.

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21
Q

Branchial cleft cyst CF

A

Presents due to secondary infection after uppr resp tract infection

CF :
erythema , tenderness and sometimes drainage of fluid from a sinus tract.

22
Q

Episodes of jaw pain with tender mass worse with eating , resolve with AB.

A

Recurrent sialadenitis

If pt has no RF (elderly post op )
most common cause is stones
Sialolithiasis

23
Q

Salivary stones Mechanism

A

Common in submandibular glands as they have high mucus content and duct travels against gravity ➡️ dec salivary flow.
Stones are made of Ca and seen on CT scan.

Retrograde seeding of bacteria (staph aureus) in obstructed duct leads to sialadenitis.

24
Q

Ttt of sialadenitis

A

NSAIDS and AB.

Reccurent infection:
Stone removal.

25
Q

Common cause of refered otalgia

A

Dental dx
TMD
Head n neck CA. HNSCC
Tumor at the base of tongue
Tumors of larynx
Hypopharynx

26
Q

Referred otalgia management

A

Otalgia in the setting if normal ear exam is reffered.

If suspicion of CA do
Flexible laryngoscopy

27
Q

Deep neck space structure sequence

A

Pharyngeal mucosa

Buccopharyngeal fascia

RETROPHARYNGEAL SPACE (superior mediatinum) contains internal jugular vein , CN 9 10 11 12.

Alar fascia

Danger space : posterior mediastinum (potential space between pericardium & vertebral column)

Prevertebral fascia

Prevertebral space (extends to coccyx)

Anterior spinal ligament.

28
Q

Signs of retropharyngeal abscess

A

Neck pain
Odynophagia
Fever
Neck stiffness
Bulging pharyngeal wall
H/o trauma

29
Q

Acute nectrotizing mediastinitis

A

Infection from retropharyngeal space extends posteriorly thru alar fascia into danger space which can trasmit infection into posterior mediastinum.

30
Q

Management of Acute nectrotizing mediastinitis

A

Urgent surgery.

Do Chest Xray AP and lateral view for mediastinal widening in all pts with retropharyngeal abscess.

31
Q

Ludwig angina Pathophys

A

Rapid progressive cellulitis of BL submandibular & sublingual spaces most often arising from infected mandibular molar.
Displacement of tongue obstructs airflow.

CF : Fever ,dysphagia , odynophagia drooling.

32
Q

Nasopharyngeal CA. NPC Rf

A

Endemic in South China
Genetics
EBV reactivation

33
Q

NPC CF

A

🍔Nasal congestion (tumor obstruction)
🍔Epistaxis
🍔Headache
🍔Cranial neuropathies (facial numbness)
🍔Serous otitis media (eustachian tube obstruction)
🍔cervical lymphadenopathy causing non tender neck mass (early presentation)

34
Q

Otosclerosis epidemiology

A

Younger(early to mid30s) caucasian patients
More common in women
AD with incomplete penetrance

35
Q

Otosclerosis pathophys

A

Imbalance of bone resorption and deposition ➡️ stiffening of stapes.
And fixation of ossicukar chain.

Paracusis of willis (paradoxical speech improvement in noisy env)

Excessive bone resorption exposes underlying blood vessels causing reddish hue seen behind TM

36
Q

Laryngeal SCC RF

A

Smoking
Alcohol

37
Q

Laryngeal SCC

A

Hoarseness (persistent)
Dysphagia
Airway obstruction
Referred otalgia
Hemoptysis
Cervical adenopathy(mets)

38
Q

Vestibular schwannoma CF

A

Median age 50
U/L ( bilateral is ass with NF2 )

CF:

SNHL and imbalance
Facial numbness /paralysis (CN 5,7 compression)

39
Q

Acoustic neuroma Dx

A

Audiogram
MRI with contrast of Internal auditory canal

40
Q

Acoustic neuroma ttt

A

Observation (small tumors , minimal SS,
Older and infirm patients )

Surgery

Radiation therapy.

41
Q

Why do schwannoma pts have vertigo? Esp in dark…..

A

Most pts do not exp vertigo bcz of tumor slow growth allows for central compensation of gradual UL loss of input.
In dark pts are deprived of visual input hence the imbalance.

42
Q

Barotrauma managemnet

A

Self resolving in a few weeks

43
Q

Enlarged ulcerated tonsil with LAD and sorethroat in non smoker non alcoholic
With multiple Sexual partners

A

HNSCC due to HPV

44
Q

HNSCC CF

A

Pharyngitis
Dysphagia
Halitosis (bad breath)
Persistent enlarged firm neck mass
Ulcerated tonsillar lesion
Neck LAD

45
Q

HNSCC RF

A

Smoking
Old age
Alcohol
Poor dentition
Incidence of oropharyngeal HNSCC has dramaticaly increased

46
Q

Why HPV HNSCC afftects oropharynx

A

Higher conc of lymphatic tissue facilitating viral processing

47
Q

Management of HPV HNSCC

A

Biopsy
Neck imaging (CT) for nodal mets
Endoscopic evaluation of upper aerodigestive tract.

48
Q

Lemiere syndrome

A

Deep neck space infection progressing to suppurative thrombophlebitis of internal jugular vein

Causes of fusobacterium necrophorum
Painful pharyngitis
Odynophagia
Acute
High fevers >102
Rigors.
Resp distress (septic pulm emboli)

49
Q

Pt with hoarseness and irregular exophytic growths in clusters on surface of vocal cords

A

HPV 6 11. (Laryngeal papillomas)

50
Q

Recurrent Resp Papillomatosis CF

A

Hoarseness (constant > 1 Mo)
Irregular exophytic growth
Warty lesions
Dark red punctate areas(blood vessels)

Transfer;

Vertical in infants
Sexual in adults
Reactivation of HPV

51
Q

Managemnet of RRP

A

Antivirals (interferon , cidofovir)
Surgical debridement

Ass with significant morbidity (voice outcomes, airway obs , repeated operative interventions)

Neurology (19 decks)

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