23 Jan 24 Ent Flashcards
CSF rhinorrhea etiology
➡️ accidental trauma (most common)
Fracture of skull base (cribriform plate , temporal bone.
➡️ surgical trauma. (eg sinus surgery)
➡️ non traumatic. (eg elevated ICP)
CSF rhinorrhea CF
UL watery rhinorrhea with salty or metallic taste
Can have instant as well as delayed presentation after trauma.
Possible complication meningitis
How to evaluate for CSF rhinorrhea
➡️ test for CSF specific proteins (beta 2 trasferrin, beta trace protein)
➡️ imaging (with intrathecal contrast)
➡️ endoscopy (intrathecal fluorescein dye)
Management if CSF rhinorrhea
▶️ inpatient bed rest , head of bed elevation , avoidance of straining
▶️ freq neurologic evaluation bcz of risk of meningitis due to nasal flora contamination if CSF
▶️ lumbar drain placement
▶️ surgical repair
Bisphosphonate related osteonecrosis Of Jaw RF
High dose parenteral bisphonates
Dental procedures (extractions , implants)
Area of exposed necrotic bone after tooth extraction is classic
Concurrent glucocorticoid use
Concurrent or prev malignancy
Bisphosphonate related ON of jaw cause
Impaired bone healing
CF of osteonecrosis of jaw
Chronic indolent symptoms
Mild pain , swelling
Exposed bone , loosening if teeth , pathologic fractures
Ttt of ON of jaw
Oral hygiene
Antibacterial rinses
Antibiotics and debridement as needed.
Epiglottitis pt with resp failure CF
Tripod positioning
Drooling
hoarseness
How to manage epiglottitis patient with resp failure
Bag valve mask ventilation with 100% O2 to keep saturation > 88%
If BVM ventilation does not cause adequate oxygenation
ETT using video laryngoscope
If Single attempt of ETT fails
Cricothyrotomy(surgical airway)
➡️multiple attempts at ETT with video laryngoscope is not recommended as it would delay adequate oxygenation in a hypoxic pt.
If intubation without video Laryngoscope fails then 2nd attempt is done with a video laryngoscope.
Parotid gland tumor and signs of malignancy
Cranial nerve involvement
5th nerve (facial numbness)
7th nerve (facial droop)
Do Cranial nerve exam in all patients with parotid mass
Perilymphatic fistula
Complication of head injury or barotrauma causing leakage of endolymph from semicircular canals and cochlea into surrounding tissues
CF of perilymphatic fistula
Progressive SNHL
Episodic vertigo with Nystagmus triggered by pressure changes ;
Valsalva
Elevator ride (causing inc pressure in endolymph)
Clinical test ;
Tullio phenomenon : a loud clap near pts ear and observing nystagmus
Ttt of perilymphatic fistula
Limit activities that inc ear pressure
ENT referral
Why do we supplement levothyroxine in pts after total thyroidectomy
😡 to replace thyroid hormone
😡 to supress pituitary release of TSH
(Prevents cancer recurrence )
Indication of Thyroid cancer recurrence after total thyroidectomy
Measure serum THyroglobulin levels
(Precursor to active thyroid hormone T3 and T4 formed by healthy and cancerous thyroid tissue. Rising levels after total thyroidectomy and radioactive iodine ttt means TG coming from reccurent tumor)
🚑 TG is formed by papillary and follicular cancer but not medullary cancer which doesnt produce thyroid hormone.
Medullary thyroid cancer Epidemiology
Neuroendocrine malignancy
Arises from calcitonin secreting Parafollicular C cells
Mostly Sporadic
25% due to RET mutations (MEN 2)
Pt can have MTC being RET negative
MTC tumor markers
Serum calcitonin
CEA
Ulcerated tonsil in a pt with smoking
Oropharyngeal SCC
RF for Oropharyngeal SCC Age >40 Smoker Alcohol Immunicomp status
🧇 tonsilloliths are not known risk factor
But manipulation for stone removel can be mistaken for ulcerated neoplasm.
Sialoadenosis RF
Non tender beningn enlargement of parotids
Cause : overaccumulation of secretory granules in
Alcoholics
Bulimics
Malnutrition
Liver dx and diabetics (due to fatty infltration)
Vs Cancer: Cancer is unilateral with a palpable distinct mass
Pregnant Pt with thyroid nodule and USG findings of malignancy
Do FNA biopsy (safe in pregnancy)
If thyroidectomy is need it can be delayed until delivery.
For aggressive cancer do surgery in second trimester.
Thyroid nodules workup
Nodule > 1cm with high risk features
Do FNA
Nodule >2cm do FNA for all
Except cystic
High risk features :
microcalcifications , irregular margins, internal vascularity
Post op pt has expanding neck mass ballotable neck swelling
Do immediate wound exploration and drain hematoma promptly to avoid potential upper airway obstruction.
Peritonsillar abscess CF
Acute bacterial infection between tonsil and pharyngeal muscles.
CF:
Fever dysphagia throat pain
Muffled voice
UL swelling of soft palate
Uvular deviation
Trismus ( involvement of pterygoids)
Cervical LAD
