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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
Merniere's disease define
=dilatation of enolymph spaces of membranous labyrinth (ENDOLYMPHATIC OEDEMA)
26
Merniere's disease Signs & Sx
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
27
Merniere's disease Ix + Mx
``` Audiometry (low frequency SSNHL, fluctuant) Medical Mx (vertigo) - cyclizine (acute) + betahistine (prophylaxis) Surgical mx - gentamicin instillation (via grommets); saccus decompression ```
28
Acoustic Neuroma
1.hearing loss 2.vertigo 3.tinnitus ABSENT CORNEAL REFLEX is IMP SIGN associated with NF type 2
29
Tinnitus define
perception of sounds in the ears or head that doesn't come from an outside source
30
Tinnitus drug causes
Aspirin/NSAIDs Aminogylcosides Loop diuretics Quinine
31
mx of perf tympanic membr
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
Complications after thyroid surgery x3
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
mx of post-op stridor in pt after neck surgery
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
causes of otitis externa
- 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
otitis externa features
ear pain, itchy, discharge | otoscopy: red, swollen or eczematous canal
36
otitis externa Mx
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
malignant otitis externa
more common in ELDERLY DIABETICS - extension of infection into the bony ear canal + soft tissues deep to the bony canal - IV ABx required
38
salivary glands how many pairs + common pathology
3 x pairs: 1. parotid (serous) - most tumours 2. submandibular (mixed) - most stones 3. sublingual (mucous)
39
salivary glands tumour pathology - 80 rule
- tumours: 80% parotid, 80% of these = pleomorphic adenomas, 80% superficial lobe - malignant rare: short hx, painful, hot skin, hard, fixation, CN VII involvement
40
Pleomorphic adenomas (benign, mixed parotid tumour, 80%)
middle age slow growing painless lump superficial parotidectomy; risk = CN VII damange
41
Warthin's Tumour (benign, adenolymphomas, 10%)
males, middle age | softer, more mobile, fluctuant (although difficult to differentiate)
42
Salivary gland stones
``` recurrent unilateral pain + swelling on eating may become infected --> Ludwig's angina 80% submandibular Ix: plain XRs; sialography Mx: surgical removal ```
43
what organism can cause tonsillar SCC
HPV infection
44
AUDIOGRAM 1st line Ix in hearing diffic, what's normal
anything above the 20dB line is essentially normal
45
AUDIOGRAM in SNHL
BOTH air and bone conduction impaired
46
AUDIOGRAM in CHL
ONLY AIR conduction impaired
47
AUDIOGRAM in MIXED HL
BOTH air and bone cond impaired, AIR WORSE THAN BONE
48
cholesteatoma define + features
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
cholesteatoma findings on otoscopy + mx
ATTIC CRUST - seen in uppermost part of ear drum | mx - refer to ENT for surgical removal
50
what does head impulse test in vertigo help with
differentiate between peripheral + central causes of vertigo - POSITIVE in PERIPHERAL causes - central causes indicated by other signs like bi-directional nystagmus
51
NICE 2 WW for laryngeal C
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
NICE 2 WW for oral C
- 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
NICE 2 WW for thyroid C
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.
54
chronic rhinosinusitis features
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
chronic rhinosinusitis Mx
- AVOID ALLERGEN - intranasal CS - nasal irrigation with SALINE solution
56
chronic rhinosinusitis RED FLAGS
- unilateral symptoms - persistent SX despite compliance with 3 months of tx - epistaxis
57
otosclerosis define + inheritance
=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
Otosclerosis features
``` 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
epistaxis mx
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
Acute otitis media pathophysiology
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
acute sinusitis define + what inf organisms x3
= 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
acute sinusitis predisposing factors
nasal obstruction e.g. septal deviation or nasal polyps recent local infection e.g. rhinitis or dental extraction swimming/diving smoking
63
acute sinusitis features
FACIAL PAIN NASAL DISCHARGE NASAL OBSTRUCTION
64
acute sinusitis Mx
- 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
RAMSAY HUNT define + feaures
= (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
RAMSAY HUNT Mx
Oral aciclovir + corticosteroids usually given

6th Year Surgery MJ (6 decks)

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