Emergency ENT Flashcards
List three causes of airway obstruction
foreign body
tongue enlargement
angioedema
goitre
tonsil bleed
larynx infection
trauma (+ facial)
bilateral vocal cord palsy
List three airway noises
stridor
stertor
silence
speaking in sentences
If stridor is inspiratory, where is the pathology?
larynx
If stridor is expiratory, where is the pathology?
tracheobronchial
When would you see epiglottitis?
in unvaccinated patient
Haemophilus influenzae type b (Hib) vaccine
When should you have high suspiscion for suprglottitis?
born before 1992- no vaccine schedule
Four aspects of management for airway obstruction?
oxygen
airway maneouvres
airway adjuncts
senior help
nebulised adrenaline
IV steroids 4mg
NBM
What is the dose of nebulised adrenaline?
1:1000 1mg in 5 ml N saline
Where is tracheostomy placed?
3rd -4th trachel ring to avoid glottis and prevent stenosis
Why is the nose not as dangerous as throat for foreign body to get stuck?
inferior turbinate structure reduces airway obstruction risk
Two differentials for sore throat
Quinsy
glandular fever
epiglottitis/supraglottitis
deep neck space infection
Why is penicillin given for tonsillitis and not amoxicillin?
if glandular fever, amox can cause rash
What is trismus and when is this commonly seen?
decreased mouth opening- quinsy
Management of quinsy?
drain abscess
admit
IV abx +- dexamethasone
tonsillectomy >1 episode
What is ludwig’s angina?
Ludwig’s angina is a bacterial infection (cellulitis) that affects your neck and the floor of your mouth. It is not contagious. It typically starts from a tooth infection (abscessed tooth). This rare type of cellulitis can spread rapidly, causing life-threatening swelling that can affect your ability to breathe.
One example of deep neck mass?
ludwig’s angina
retropharygneal abscess
How to determine whether necrotising/malignant externa?
pain keeps them up at night, then discharge
diabetic
immunocompromised
facial palsy
Three complications of acute otitis media?
intracranial abscess
facial palsy
mastoiditis
meningitis
Two serious complications of sinusitis?
periorbital cellulitis
pott’s puffy tumour- swollen head
How to determine whether nose blood is anterior or posterior?
blood trickling down throat- posterior
Name a hereditary cause of epistaxis
HHT- hereditary haemorrhagic telangiectasia
1st aid for nose bleed?
head foward bent over bowl/sink
pinch soft part of nose
ice in mouth??
How should you approach nose bleeds?
like any bleeding patient e.g. variceal bleeding
What are the conservative management options of epistaxis?
cautery of bleeding vessels
nasal packing
Three differentials for epistaxis?
trauma
nasal septal deviation/perforation
iatrogenic- antithrombotic medications
inflammation
foreign body
malignancy
systemic disorders
What is the walrus sign?
incorrect way to insert anterior nasal pack
You spot a septal haematoma. When should ENT see this patient and why?
that day!!! risk of abscess, necrosis can lead to septal perforation
Treatment of septal haematoma?
aspiration
When should fractured nose without septal haematoma be seen?
assessment 5 to 7 days for reduction of swelling
manipulation before 14 days
Three differential causes for facial nerve palsy?
acoustic neuroma
schwannoma
ramsay hunt syndrome
lyme disease
syphillis
meningitis
Idiopathic- most common
Tumour
Trauma
Infection
Name two organisms associated with bell’s palsy
CMV
EBV
HSV-1
Which scale is used for facial palsy
House Brackmann, I-VII
Patient has Facial nerve paralysis and vesicles on pinna and mouth. What is the diagnosis?
ramsay hunt syndrome
Which virus causes ramsay hunt syndrome?
herpes zoster
Is vertigo an emergency??
no not at all, should not be in A&E with isolated symptom
Three signs of base of skull fracture?
panda eyes
post auricar haematoma/bleeding
facial palsy
haema tympania- blood behind tympanic membrane
What is halo sign?
discharge coming from ear double ring- blood and CSF
What is a rule for origin of arteries in the head?
if begin with vowel then all internal carotid
if begin with consonant then all external carotid
e.g. sphenopalatine- external carotid
ant ethmoid- internal carotid
List three sites for nose bleeds
little’s area
sphenopalatine
anterior ethmoid
If the origin of nose bleed is not the septum, where else can bleed originate from?
septum= little’s area
sphenopalatine- 80%
anterior ethmoid- 20%
What is the ladder approach to epistaxis?
First aid- pressure
Cautery
Anterior packing
Posterior packing
Embolisation
Surgery
Management of epistaxis?
Ladder
Manage blood pressure
INR and blood thinning medication- hold off giving Vit K if on warfarin…
Patient with epistaxis and purple dots on lips. Broken blood vessels all over face. What is the diagnosis?
HHT
Patient has deviated nose. Where do you manipulate to correct the fracture?
the bone (higher up) and not the soft cartilaginous part
Weird structure in nose/odd rhinology presentation, what should you think about?
cocaine use
Wegner’s
What is a quick way to determine whether someone has orbital cellulitis/how severe the infection is?
red colour testing
if they can’t distinguish colour then worry!
Which imaging should you do for orbital cellulitis
CT contrast orbit and brain
Which protein do you test for in CSF leak?
Beta2 transferrin
What is the most painful ear presentation?
otitis externa- admit for pain relief
What is a serious presentation of otitis externa?
malignant/necrotising otitis externa
What is an aberrant feature of malignant otitis externa
facial paralysis
Name two risk factors for malignant otitis externa
diabetes
immunocompromised
Battle haematoma is a sign of?
temporal bone fracture
Patient has had two quinsys in one year. Should they get tonsillectomy?
yes!!
>2 in one year
What is the ‘mother of all emergencies’?
epiglottitis- watch out for in kids especially
Does stridor always feature in epiglottitis?
not always!!! always act on suspicion
What is the most common reason for someone having tracheostomy?
9/10 due to ICU admission with inability to wean off trachey
Name two differences between quinsy and tonsillitis?
quinsy- stertor and trismus
anterior arch being pushed medially and a deviated uvula
tonsillitis- you can see anterior arch
When can tonsillitis/quinsy patient be discharged?
eating and drinking again
apyrexial
no pain
Antibiotics for tonsillitis?
benpen
Why must you assess the abdomen with any tonsillar swelling?
Differentials: glandular fever, quinsy, deep neck infection, tonsillitis
Glandular fever- risk of splenic rupture
What discharge advice should you offer to glandular fever patient
no contact sport or alcohol for 4-6 weeks
What is the tonsillectomy rule?
2, 5, 7
2 quinsy in one year
5 tonsillitis in two years
7 tonsillitis in one year
Aside from tonsillitis, name one other indication for tonsillectomy?
emergency airway obstruction
obstructive sleep apnoea
