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6th Year Surgery MJ > derm + ENT > Flashcards

derm + ENT Flashcards

1
Q

malignant melanoma 4 types

A
  1. SS
  2. Nodular
  3. Lentigo maligna
  4. Acral lentiginous
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2
Q

SS - frequency, typically affects, appearance

A

freq - 70%
typically affects - arms, legs, back + chest, YOUNG ppl
appear - growing moles with dx feat: change in shape, size, colour

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3
Q

Nodular - frequency, typically affects, appearance

A

frequency - second commonest
typically affects - sun exposed skin, middle aged ppl
appearance - red or black lump or lump which bleeds or oozes

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4
Q

Lentigo Maligna - frequency, typically affects, appearance

A

frequency - less common
typically affects - chronically sun exposed skin, OLDER ppl
appearance - growing mole with dx feat: change in shape, size, colour

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5
Q

Acral Lentiginous - frequency, typically affects, appearance

A

frequency - rare form
typically affects - nails, palms or soles, AFRICAN AMERICANS OR ASIANS
appearance - SUBUNGUAL PIGEMNTATION (hutchinsons sign) or on palms or feet

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6
Q

mm Mx breslow thickness + related margins of excision

A

Margins of excision-Related to Breslow thickness
Lesions 0-1mm thick 1cm
Lesions 1-2mm thick 1- 2cm (Depending upon site and pathological features)
Lesions 2-4mm thick 2-3 cm (Depending upon site and pathological features)
Lesions >4 mm thick 3cm

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7
Q

drugs causing gingival hyperplasia x3 + 1 condition

A

phenytoin
ciclosporin
CCBs
AML = condition

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8
Q

pityriasis versicolor cause + tx

A

malassezia furfur

tx = topical antifungal = ketoconazole shampoo

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9
Q

what class of drugs causes rare SE of TEN

A 
PENICILLINS
phenytoin
sulphonamides
allopurinol
carbamazepine
NSAIDs
--systemically unwell e.g. pyrexia, tachycardic
positive Nikolsky's sign: the epidermis separates with mild lateral pressure
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10
Q

imp complication of nasal trauma which o/e you see: classically a bilateral, red swelling arising from the nasal septum

A

nasal septal haematoma

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11
Q

nasal septal haematoma anatomy

A

It describes the development of a haematoma between the septal cartilage and the overlying perichondrium

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12
Q

nasal septal haematoma what happens if untreated

A

If untreated irreversible septal necrosis may develop within 3-4 days.
-This is thought to be due to pressure-related ischaemia of the cartilage resulting in necrosis. This may result in a ‘saddle-nose’ deformity

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13
Q

nasopharyngeal C presentation

A

more common in people of Asian origin, and typically presents with:
SYSTEMIC - cervical lymphadenopathy
LOCAL - otalgia, unilateral serous OM, nasal obstruction, discharge +/or epistaxis, CN palsies eg III-VI
-can also present with PAINLESS LYMPHADENOPATHY due to tendency for early spread

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14
Q

what drains to posterior triangle

A

nasopharynx

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15
Q

what drains to anterior triangle

A

larynx, buccal mucosa, and tonsillar fossa

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16
Q

thyroglossal cyst features

A

usually midline, between the isthmus of the thyroid and the hyoid bone
moves upwards with protrusion of the tongue
may be painful if infected

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17
Q

DDx of neck lump in children - 3 categories

A

DDx of a neck lump in children:

  1. CONGENITAL: branchial cyst, thyroglossal cyst, dermoid cyst, vascular malformation
  2. INFLAMMATORY: reactive lymphadenopathy, lymphadenitis,
  3. NEOPLASTIC: lymphoma, thyroid tumour, salivary gland tumour
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18
Q

acute OM complicated by post-auricular swelling mx

A

post-auricular swelling = mastoiditis so needs urgent admission to hospital for assessm + tx due to risk of meningitis

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19
Q

SSNHL causes

A

85% IDIOPATHIC
infections - Meningitis, HZV, Syphillis, AIDS, Lyme disease
tumour - acoustic neuroma/vestibular schwannoma
trauma + barotrauma (scuba diving, flights)
strokes
Mx ==> URGENT REFERRAL TO ENT + high dose CS

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20
Q

Viral labrynthitis

A 
stereotypical hx: recent URTI presents with triad of:
1.vertigo
2.vomiting
3.nystagmus
\+Hearing is also affected. 
-The sx came on SUDDENLY
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21
Q

Vestibular neuronitis

A

stereotypical hx: recent URTI presents with triad of:

  1. vertigo
  2. vomiting
  3. nystagmus
    - Hearing is NOT affected.
    - recurrent vertigo attacks lasting hrs or days
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22
Q

BPPV define + sx

A 
=displacement of otoliths in semi-circular canals
gradual onset
rotational vertigo for <30s
triggered by change in head posn 
nystagmus
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23
Q

BPPV Ix + Mx

A 
Ix = Dix-Hallpike manouvre --> UP-BEAT TORSIONAL NYSTAGMUS
Mx = Epley manouvre + BETAHISTINE (histamine analogue)
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24
Q

Ddx for BPPV in elderly pt with vascular RF

A

VERTEROBASILAR ISCHAEMIA

  • elderly pt
  • sudden dizziness on full extension of the neck
  • vasculopath (ie. strokes. chronic stable angina, HTN)
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25
Q

Merniere’s disease define

A

=dilatation of enolymph spaces of membranous labyrinth (ENDOLYMPHATIC OEDEMA)

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26
Q

Merniere’s disease Signs & Sx

A

associated with triad of 1.SSNHL 2.tinnitus 3.vertigo + feeling of fullness

  • often affects 1 ear
  • ep of vertigo last >30 mins + <12hr with clustered attacks
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27
Q

Merniere’s disease Ix + Mx

A 
Audiometry (low frequency SSNHL, fluctuant)
Medical Mx (vertigo) - cyclizine (acute) + betahistine (prophylaxis)
Surgical mx - gentamicin instillation (via grommets); saccus decompression
28
Q

Acoustic Neuroma

A

1.hearing loss 2.vertigo 3.tinnitus
ABSENT CORNEAL REFLEX is IMP SIGN
associated with NF type 2

29
Q

Tinnitus define

A

perception of sounds in the ears or head that doesn’t come from an outside source

30
Q

Tinnitus drug causes

A

Aspirin/NSAIDs
Aminogylcosides
Loop diuretics
Quinine

31
Q

mx of perf tympanic membr

A
  1. NO TX in MOST CASES as TM heals after 6-8 wks (if not healed then refer to ENT)
  2. if occurs after acute OM prescribe ABs too
  3. MYRINGOPLASTY performed if TM doesn’t heal itself
32
Q

Complications after thyroid surgery x3

A
  1. ANATOMICAL - recurrent laryngeal nerve damage
  2. BLEEDING - confined space means haematomas rapidly lead to respiratory compromise due to laryngeal oedema
  3. HYPOCALCAEMIA from Parathyroid gland damage –> irritability, seizures, spasms, perioral parasthesia, prolonged QT interval
33
Q

mx of post-op stridor in pt after neck surgery

A

LIFE THREATENING

  • post op bleed can incr pressure behind suture lines –> trachea gets compressed –> STRIDOR
  • immediate removal of pressure relieves stridor using suture blades
34
Q

causes of otitis externa

A
  • infection: bacterial (Staphylococcus aureus, Pseudomonas aeruginosa) or fungal
  • seborrhoeic dermatitis
  • contact dermatitis (allergic and irritant)
  • recent swimming is a common trigger of otitis externa
35
Q

otitis externa features

A

ear pain, itchy, discharge

otoscopy: red, swollen or eczematous canal

36
Q

otitis externa Mx

A
  1. TOPICAL ABx or a combined topical antibiotic + a TOPICAL STEROID
    - if the tympanic membrane is perforated aminoglycosides are traditionally not used*
  2. WICKING + REMOVAL OF DEBRIS
37
Q

malignant otitis externa

A

more common in ELDERLY DIABETICS

  • extension of infection into the bony ear canal + soft tissues deep to the bony canal
  • IV ABx required
38
Q

salivary glands how many pairs + common pathology

A

3 x pairs:

  1. parotid (serous) - most tumours
  2. submandibular (mixed) - most stones
  3. sublingual (mucous)
39
Q

salivary glands tumour pathology - 80 rule

A
  • tumours: 80% parotid, 80% of these = pleomorphic adenomas, 80% superficial lobe
  • malignant rare: short hx, painful, hot skin, hard, fixation, CN VII involvement
40
Q

Pleomorphic adenomas (benign, mixed parotid tumour, 80%)

A

middle age
slow growing painless lump
superficial parotidectomy; risk = CN VII damange

41
Q

Warthin’s Tumour (benign, adenolymphomas, 10%)

A

males, middle age

softer, more mobile, fluctuant (although difficult to differentiate)

42
Q

Salivary gland stones

A 
recurrent unilateral pain + swelling on eating 
may become infected --> Ludwig's angina
80% submandibular 
Ix: plain XRs; sialography
Mx: surgical removal
43
Q

what organism can cause tonsillar SCC

A

HPV infection

44
Q

AUDIOGRAM 1st line Ix in hearing diffic, what’s normal

A

anything above the 20dB line is essentially normal

45
Q

AUDIOGRAM in SNHL

A

BOTH air and bone conduction impaired

46
Q

AUDIOGRAM in CHL

A

ONLY AIR conduction impaired

47
Q

AUDIOGRAM in MIXED HL

A

BOTH air and bone cond impaired, AIR WORSE THAN BONE

48
Q

cholesteatoma define + features

A

non-cancerous growth of SQUAMOUS epithelium that is TRAPPED within the skull base causing local destruction

  • most common in pts aged 10-20yrs
  • being born with a CLEFT PALATE incr risk of cholesteatoma 100x
  • main features: FOUL smelling, non-resolving DISCHARGE, HEARING LOSS
  • other features: vertigo, FN palsy, cerebellopontine angle syndrome
49
Q

cholesteatoma findings on otoscopy + mx

A

ATTIC CRUST - seen in uppermost part of ear drum

mx - refer to ENT for surgical removal

50
Q

what does head impulse test in vertigo help with

A

differentiate between peripheral + central causes of vertigo

  • POSITIVE in PERIPHERAL causes
  • central causes indicated by other signs like bi-directional nystagmus
51
Q

NICE 2 WW for laryngeal C

A

Laryngeal cancer

  • Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with:
  • -persistent unexplained hoarseness or
  • -an unexplained lump in the neck
52
Q

NICE 2 WW for oral C

A
  • Consider a suspected cancer pathway referral (for an appt within 2w) for oral cancer in people with either:
  • ->unexplained ulceration in the oral cavity lasting for more than 3w or
  • ->a persistent and unexplained lump in the neck
  • Consider an urgent referral (for an apt within 2w) for assessment for possible oral cancer by a dentist in people who have either:
  • ->a lump on the lip or in the oral cavity or
  • ->a red or red + white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia
53
Q

NICE 2 WW for thyroid C

A

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.

54
Q

chronic rhinosinusitis features

A

FACIAL PAIN - frontal pressure pain worse on bending forwards
NASAL DISCHARGE - clear if allergic or VM, thick + purulent if 2ndry infection
NASAL OBSTRUCTION - mouth breathing
POST-NASAL DRIP - may produce chronic cough

55
Q

chronic rhinosinusitis Mx

A
  • AVOID ALLERGEN
  • intranasal CS
  • nasal irrigation with SALINE solution
56
Q

chronic rhinosinusitis RED FLAGS

A
  • unilateral symptoms
  • persistent SX despite compliance with 3 months of tx
  • epistaxis
57
Q

otosclerosis define + inheritance

A

=describes the REPLACEMENT of NORMAL BONE by VASCULAR SPONGY BONE

  • It causes a progressive CONDUCTIVE deafness due to fixation of the stapes at the oval window
  • Otosclerosis is ADom and typically affects young adults
58
Q

Otosclerosis features

A 
20-40Y
conductive deafness
tinnitus
NORMAL TYM M (but 10% hv SCHWARTZ sign = flamingo tinge/redness of promontory of cochlea- caused by HYPERAEMIA)
POS FHx
59
Q

epistaxis mx

A

1.if pt haemodyn stable, control bleeding with first aid measures (sit forward and pinch cartilagenous (soft) are of nose firmly)
2.consider topical antiseptic = naseptin (chlorhexidine + neomycin) to reduce crusting + risk of vestibulitis
-CAUTION: PEANUT, SOY, OR NEOMYCIN allergies
3.if bleeding NOT stopped after 10-25 mins –> consider CAUTERY - if source of bleed visible + cautery tolerated
OR
PACKING - if cautery not viable or bleeding point not visualised
4.pts H UNSTABLE or compromised –> admit, and pts with bleed from UNKOWN or POSTERIOR source
5.failed all emerg mx —> require SPHENOPALATINE LIGATION in theatre

60
Q

Acute otitis media pathophysiology

A

Viral URTIs typically precede OM, most INF are secondary to BACTERIA eg Strep Pneumonia, H.Influenzae, Moraxella Catarrhalis
-Viral URTIS disturb normal nasopharyngeal microbioma allowing bacteria to infect the middle ear via the Eustachian tube

61
Q

acute sinusitis define + what inf organisms x3

A

= inflammation of MUCOUS MEMBR of the PARANASAL sinuses
the sinuses are usually sterile - the most common inf agents seen in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae and rhinoviruses.

62
Q

acute sinusitis predisposing factors

A

nasal obstruction e.g. septal deviation or nasal polyps
recent local infection e.g. rhinitis or dental extraction
swimming/diving
smoking

63
Q

acute sinusitis features

A

FACIAL PAIN
NASAL DISCHARGE
NASAL OBSTRUCTION

64
Q

acute sinusitis Mx

A
  • analgesia
  • intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited
  • NICE CKS recommend that intranasal CS may be considered if the Sx have been present for > 10d
  • oral ABx are not normally req but may be given for severe pres
  • –>The BNF recommends phenoxymethylpenicillin 1st-line, co-amoxiclav if ‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of compl
  • –>’DOUBLE-SICKENING’ may sometimes be seen, where an intial VIRAL sinusitis WORSENS due to secondary BACTERIAL INF
65
Q

RAMSAY HUNT define + feaures

A

= (herpes zoster oticus) is caused by the reactivation of the VZV in the geniculate ganglion of the 7th CN
Features:
1.AURICULAR PAIN is often the 1st feature
2.FN palsy
3.VESICULAR RASH around the ear
4.other features include VERTIGO + TINNITUS

66
Q

RAMSAY HUNT Mx

A

Oral aciclovir + corticosteroids usually given

6th Year Surgery MJ (6 decks)

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