Ear, Nose Throat, Surgery

Question 1

What can ear ache be a manifestation of?

List some signs of ear disease:

Answer 1

Referred pain: teeth (dental sepsis), tongue (cancer), tonsils (tonsillar tumours/tonsilitis), throat (cancer of pharynx), TMJ pathology

Signs of ear disease: discharge, pathologies of skin (pina) of ear, hearing loss, balance

Question 2

Should you be concerned about unilateral or bilateral blockage of the nose?

Answer 2

Bilateral blockage is usually benign, whereas unilateral blockage, especially with pain/bleeding may be a sign of a tumour or chronic sinusitis

Question 3

What is a possible manifestation of cancer in the tonsils/tongue area?

Which virus is commonly associated with cancers in these areas?

Answer 3

• unilateral pain in throat and difficulty swallowing

—–> refer to ENT

HPV virus STI is associated with throat/tongue cancer

Question 4

Which symptoms may a patient present with if they have pathology in the larynx/pharynx area?

Answer 4

• voice change (larynx)
• swallowing problem - usually unilateral
• obstruction of upper airway - stridor (harsh course sound on inspiration, opposite to wheeze)

Question 5

Which swellings are likely to be benign?

Answer 5

Acute painful swelling of lymph nodes is most likely to be benign/sepsis

Question 6

What is the best maintenance fluid for a fasting patient?

Who should ask for consent?

Answer 6

• 0.18% saline with 4% dextrose with or w/out potassium

Consent:

• only consent when you can perform the procedure yourself either independently or under direct supervision of a competent clinician

Question 7

What does acute abdomen refer to?

List some causes of acute abdomen:

Answer 7

Acute abdomen: rapid onset of severe symptoms that may indicate potentially life-threatening intra-abdominal pathology that requires urgent surgical intervention

Causes: appendicitis, pancreatitis, adhesions, gastric ulcer, hepatitis, pelvic inflammatory disease, gastroenteritis

Question 8

What is appendicitis?

Presentations?

Investigations?

Management?

Answer 8

Appendicitis: inflammation of the appendix commonly caused by an obstruction of the appendix

Presentation: pain in umbilical region and spread to R iliac region, nausea/vomiting, anorexia, constipation/diarrhoea, pyrexia, tachycardia

Investigations:

• FBC will show leukocytosis
• UE to assess hydration
• USS abdomen
• pregnancy test if female

Management:

• NBM, analgesia, hydration, antibiotics
• appendicectomy

Question 9

How may opiate toxicity present?

How is this managed?

Answer 9

Opiate toxicity:

• reduced consciousness
• pin-point pupils
• hypotension
• seizures
• muscle spasms
• cyanosis from respiratory depression

Give patient Nalaxone 0.4-2.0 mg IV at intervals of 2-3mins with max dose of 10mg