emergencies in ENT Flashcards
what are the factors that can worsen epistaxis ?
anticoagulants
hypertension
haematological disorders
what are the areas of anastomosis in the nose causing nosebleeds ?
anterior nosebleed - little’s area (kiesselbach’s area)
posterior nosebleed - woodruff’s area
what is the immediate management for epistaxis ?
1.if the bleeding point can be seen
perform cauterisation
2. source of bleeding cannot be seen clean out the nose with Nacl and insert adrenalin patties , if there is improvement then cauterize
3. if there is no improvement after adrenalin patties then insert an anterior nasal pack
4. no resolution after anterior nasal pack then insert a posterior nasal pack
5. if there is still no resolution then surgery or interventional radiology is indicated
what is the supportive care associated with epistaxis management ?
resuscitate with IV fluids and O- blood
correct coagulopathy and manage hypertension
what is the definitive treatment ladder for epistaxis ?
endoscopic sphenopalatine artery ligation
anterior ethmoid artery ligation
maxillary artery ligation
external carotid artery ligation
interventional radiology
laser of hereditary hemorrhagic telangiectasia
wheere do the digestive and respiiratory tract overlap ?
oropharynx and hypopharynx
what iis the function of the velopharyngeal reflex ?
prevents passage of undigested food into the nose
what is thee relation between velopharyngeal reflex and adenoidectomies ?
sometimes a partial adenoidectomy is indicated when the palate is not completely formed , in order to keep thee velopharyngeal reflex a supeerior adenoidectomy is performed
how is aspiration prevented ?
by the epiglottis
glottis
and laryngeal elevation
when is a laryngectomy performed ?
in advanced laryngeal cancers
larynx is removed and air is taken in straight from the outside into the trachea
what problems do patients face who have a laryngectomy ?
loss of humidification
problems swallowing
what are thee anatomical positions of the larynx?
supra glottis
glottis
subglottis
what is a trachesotomy ?
temporary or permanent prosthesis which is surgically placed in the trachea to improve breathing
what are thee indications associated with a tracheostomy ?
upper airway obstruction
long term ventilation
low consciousness level
patient unable to clear upper airway secretions
what does the term neck breather refer to ?
patient with a laryngectomy or a tracheostomy
what is thee most common cause of OSA in addults ?
obesity
what is the most common cause of OSA in children ?
adenoids
what is the most sensitive investigation that can be used for OSA patients ?
nocturnal polysomnography
what might you suspect inn a patient suffering from recurrent food bolus ?
oesophageal stricture
what are the tonsils in waldezyers ring ?
pharyngeal tonsils = adenoids
tubal tonsils = Eustachian tube tonsils
Palatine tonsils
Lingual tonsils
what tare the regional lymph nodes associated with waldeyers ring ?
retropharyngeal LN
Jugulo-digastric LN
Jugular chain LN
Submental and Submandibular LN
what are the indications for a tonsillectomy ?
7 or more episodes in on year
5 or more episodes in thee past 2 years each
3 or more episodes in the past 3 years each
gagging is not an absolute indication for a tonsillectomy
when should you suspect pharyngitis ?
posterior wall of the oropharynx may be red and inflamed without any change or infections in the tonsils
often associated with cough, coryza, fatigue and pallor
what criteria is used to asses strep pharyngitis ?
FeverPAIN
what is the presentation of tonsillitis ?
infection of the tonsils marked by fever, rapid onset and absence of other viral symptoms such as coryza and cough
severe inflammation of thee tonsils along with pus exudate on the surface
if a patient with pharyngitis seems to not be doing very well physically what should you exclude ?
epiglottitis
what is quinsy ?
pritonsillar abscess
what are thee complications of acute tonsillitis ?
quinsy ( peritonsillar abscess )
retro and parapharyngeal abscess
acute glomerulonephritis
rheumatic fever
what is the presentation of quinsy ?
unilateral throbbing pain
hot potato voice
trismus
congestion and oedema of the soft palate
tonsils displaced downwards and medially
uvula pushed to the opposite side
+/- torticollis
what is thee management for quinsy ?
drainage under cover of antibiotics
what is the necessary treatment for supraglottitis or epiglottitis ?
airway management
IV antibiotics
aerosolised adrenaline
