ENT Flashcards
HEARING LOSS
What are the two types of hearing loss and briefly explain them?
- Conductive = sound is not conducted to the inner ear due to problem of external or middle ear
- Sensorineural = sound is conducted to inner ear but issue at the sensory organ (cochlear) or vestibulocochlear nerve
HEARING LOSS
What are the causes of conductive hearing loss?
- Wax impaction
- Otitis media with effusion
- Perforated tympanic membrane
- Otosclerosis
- Cholesteatoma
HEARING LOSS
What are the causes of sensorineural hearing loss?
- Presbycusis = most common (age-related), gradual + insidious (symmetrical high frequency hearing loss)
- Meniere’s disease
- Congenital infections = rubella, CMV
- Acoustic neuroma
- Drugs = loop diuretics, aminoglycosides
HEARING LOSS Explain the axis of an audiogram What is normal? What indicates sensorineural hearing loss? What indicates conductive hearing loss? What indicates mixed hearing loss?
- X-axis is frequency (Hz) going low to high, Y-axis is volume (dB) with top quiet to bottom loud
- Anything <20dB line
- BOTH air + bone conduction impaired (>20dB)
- ONLY air conduction >20dB, bone is normal
- BOTH air + bone impaired but AIR WORSE by >15dB
HEARING LOSS
What two bedside tests would you do in hearing loss and briefly explain them?
- Rinne’s = place tuning fork on mastoid then external acoustic meatus
- Weber’s = place tuning fork on forehead in midline
HEARING LOSS
What are you looking for in Rinne’s test?
- Normal = louder at EAM
- Conductive = louder at mastoid
- Sensorineural = both decreased
HEARING LOSS
What are you looking for in Weber’s test?
- Normal = vibrations equal in both ears
- Conductive = louder in ABNORMAL ear
- Sensorineural = louder in NORMAL ear
HEARING LOSS
What is the management of hearing loss?
- Conductive = resolve issue (e.g., syringe ears, treat infection)
- Sensorineural = hearing aids, cochlear implants if profound hearing loss >95dB
OTOSCLEROSIS
What is the pathophysiology of otosclerosis?
- Autosomal dominant condition with replacement of normal bone by vascular spongy bone mainly affecting base of stapes where it attaches to oval window causing stiffening preventing it from transmitting sound
OTOSCLEROSIS
What is the clinical presentation of otosclerosis?
- Progressive conductive deafness at 20–40y
- Tinnitus
- Audiometry = Carhart’s notch (false depression of bone conduction at 2000Hz)
OTOSCLEROSIS
What is the management of otosclerosis?
- Hearing aid
- Stapedectomy
SSNHL
What is sudden sensorineural hearing loss (SSNHL)?
What is the most common cause?
What are some other causes?
- Sensorineural hearing loss over <72h
- Idiopathic
- Meniere’s disease, ototoxic meds, MS, stroke, acoustic neuroma
SSNHL
How do you manage SSNHL?
- URGENT ENT referral
- Audiometry to establish Dx
- CT/MRI head if ?stroke/acoustic neuroma
- ALL cases receive high dose PO corticosteroids
OTITIS MEDIA
What is otitis media?
What are some causes?
- Acute infection of middle ear, v common in paeds
- Mostly bacterial = strep pneumoniae #1, H. influenzae, moraxella catarrhalis
OTITIS MEDIA
What is the clinical presentation of otitis media?
What would you find on examination?
- Recent viral URTI Sx
- Otalgia = tugging/rubbing ear in paeds
- Conductive hearing loss
- Otoscopy = bright red + bulging tympanic membrane (loss of light reflex)
OTITIS MEDIA
What are the potential sequelae of otitis media?
- Otitis media with perforation
- Otitis media with effusion
- Labyrinthitis
OTITIS MEDIA
How does otitis media with perforation present?
What can happen if unresolved?
- Purulent otorrhoea clinically + on otoscopy
- Chronic suppurative otitis media = perforation of tympanic membrane with otorrhoea for >6w
OTITIS MEDIA
What are some complications of otitis media?
- Mastoiditis
- Meningitis
- Brain abscess
- Facial nerve paralysis
OTITIS MEDIA
What is the first line management of otitis media?
What might be considered afterwards?
- Supportive management with analgesia, safety net to seek help if no improvement after 3d
- First line Abx = amoxicillin 5–7d (erythromycin if pen allergic/pregnant)
OTITIS MEDIA
When would you consider immediate antibiotic prescription?
- Sx ≥4d + not improving
- Systemically unwell
- Immunocompromised
- <2y and bilateral
- Otitis media with perforation
OME
What is otitis media with effusion (OME)?
What are some risk factors for OME?
- Fluid collection within the middle ear space without signs of acute infection.
- Male, siblings with glue ear, trisomy 21, parental smoking
OME
What is the clinical presentation of OME?
- # 1 cause of conductive hearing loss in paeds
- May have secondary problems such as speech + language delay
- Otoscopy = dull + retracted TM with visible fluid level
- Audiometry = flat tympanogram
OME
What is the management of OME?
- Watchful waiting for 3m
- Grommet insertion to allow fluid to drain
- Adenoidectomy
OTITIS EXTERNA
What is otitis externa?
What are some risk factors?
- Infection of outer ear
- Increased water contact (swimming), cotton buds, hearing aids, DM
OTITIS EXTERNA
What is the most common cause of otitis externa?
What are some other causes?
- Bacterial = pseudomonas aeruginosa #1, staph. aureus
- Derm = seborrhoeic dermatitis, contact dermatitis
OTITIS EXTERNA
What is the clinical presentation of otitis externa?
- Otalgia (esp. on tragus palpation), otorrhoea, itch
- Otoscopy = red, swollen, eczematous canal with discharge
OTITIS EXTERNA
What is a key complication of otitis externa?
- Malignant otitis externa = infection spreads to bones surrounding the ear canal + skull + can progress to osteomyelitis of the temporal bone
OTITIS EXTERNA
What patients are susceptible to malignant otitis externa?
How does it present?
What are some potential complications?
- Immunocompromised (DM, HIV)
- Severe otalgia, otorrhoea, temporal headaches
- Facial nerve palsy, meningitis, death
OTITIS EXTERNA
What is the management of malignant otitis externa?
- Non-resolving otitis externa with worsening pain = URGENT ENT REFERRAL
- CT scan
- IV Abx to cover pseudomonas (ciprofloxacin)
OTITIS EXTERNA
What is the first line management of otitis externa?
What if it doesn’t respond?
What is the second line management of otitis externa?
- Topical Abx ± steroid (may need delivery via pope wick)
- ENT referral
- PO flucloxacillin if infection spreading, ?swab, ?antifungal
CHOLESTEATOMA
What is cholesteatoma?
- Hyperproliferative non-malignant growth of keratinising squamous epithelial cells of the middle ear causing local destruction
CHOLESTEATOMA
What is the epidemiology of cholesteatoma?
- Most common patients 10–20y
- Majorly associated with cleft palate
CHOLESTEATOMA
What is the clinical presentation of cholesteatoma?
- Painless, foul-smelling, brown, non-resolving otorrhoea
- Unilateral hearing loss (classically conductive) + tinnitus
- Local invasion > vertigo (semi-circular canals), facial nerve palsy
CHOLESTEATOMA
What investigations would you do in cholesteatoma?
- Otoscopy = white attic crust seen in uppermost part of ear drum
- CT head (temporal bone) to confirm diagnosis + plan for surgery
CHOLESTEATOMA
When would you emergency admit someone with cholesteatoma?
What is the general management?
- Local invasion or neuro Sx
- ENT referral for surgical removal
BPPV
What causes benign positional paroxysmal vertigo (BPPV)?
What is the pathophysiology?
- Canaliths (crystals) in the semi-circular canals
- Normally found in utricle of inner ear but can dislodge into semi-circular canals due to age, infection, head trauma or DM
- On movement, crystals cause abnormal movement of endolymph in canal > vertigo
BPPV
What is the clinical presentation of BPPV?
- Vertigo which is triggered by change in head position ± nausea
- Episodes last for up to 1 minute
BPPV
How is BPPV diagnosed?
- Dix-Hallpike Manoeuvre
- Pt sits upright, head turned 45º to test side, lie down rapidly with head overhanging edge of bed for 1m whilst observing eyes
- Positive = vertigo + rotatory nystagmus
BPPV
How is BPPV managed?
- Epley manoeuvre
- Teach patients exercises = vestibular rehabilitation (Brandt-Daroff exercises)
BPPV
Describe the Epley manoeuvre
- Dix-Hallpike then remain 1m
- Rotate head 90º other side for 1m
- Roll onto shoulder head is facing, rotate head so looking to floor for 1m
- Slowly sit up, tilt head down tucking chin into chest for 1m
MENIERE’S DISEASE
What is the pathophysiology of Meniere’s disease?
What age group does it classically affect?
- Excessive pressure + progressive dilation of the endolymphatic system in the labyrinth of the inner ear
- More common in middle-age adults
MENIERE’S DISEASE
What is the classic triad for clinical presentation of Meniere’s disease?
- Triad of UNILATERAL recurrent vertigo, tinnitus + (low freq) sensorineural hearing loss
- Episodes last mins–hours + often occur in clusters
MENIERE’S DISEASE
Other than the classic triad, what else might occur in Meniere’s disease?
- Sensation of aural fullness
- Nystagmus
- Positive Romberg’s
MENIERE’S DISEASE
How is Meniere’s disease diagnosed and what should you tell patients?
What is the acute management of Meniere’s disease?
What is the prophylactic management of Meniere’s disease?
- ENT referral to confirm, tell them to inform DVLA + stop driving until good symptom control
- Buccal/IM prochlorperazine
- Betahistine + vestibular rehabilitation exercises
VESTIBULAR NEURONITIS
What is vestibular neuronitis?
What is it associated with?
- Inflammation of the vestibular nerve
- Viral URTI
VESTIBULAR NEURONITIS
How does vestibular neuronitis present?
What does it importantly not present with?
- Recurrent vertigo attacks lasting hours–days
- N+V, horizontal nystagmus
- NO hearing loss or tinnitus
VESTIBULAR NEURONITIS
What key exam sign is positive in vestibular neuronitis and explain it?
- +ve head impulse test (sign of peripheral vertigo)
- Pt focuses on examiner’s nose entire time, head rapidly jerked in 1 direction
- Normal vestibular system or CENTRAL vertigo = eyes fixed on nose
- Abnormal = eyes saccade (rapidly move back/forth) then fix back
VESTIBULAR NEURONITIS
What is the management of acute and chronic vestibular neuronitis?
- Rapid relief = buccal/IM prochlorperazine if severe, short PO prochlorperazine or antihistamine (cyclizine) if less severe
- Chronic Sx = vestibular rehabilitation exercises preferred
VIRAL LABYRINTHITIS
What is viral labyrinthitis?
- Inflammation of the labyrinth, affecting both vestibular + cochlear end organs
VIRAL LABYRINTHITIS
What is the clinical presentation of viral labyrinthitis?
How is this differentiated from vestibular neuronitis?
- Acute onset (often post viral URTI)
- Vertigo, N+V, nystagmus (horizontal)
- Gait disturbances = may fall towards affected side
- Sensorineural hearing loss AND tinnitus in labyrinthitis
VIRAL LABYRINTHITIS
What exam finding is positive in viral labyrinthitis?
What is the management of viral labyrinthitis?
- +ve head impulse test (impaired vestibulo-ocular reflex)
- Prochlorperazine or antihistamines to reduce vertigo
ACOUSTIC NEUROMA
What is an acoustic neuroma/vestibular schwannoma?
- Cerebellopontine angle tumour of the vestibulocochlear nerve schwann cells, often slow growing + benign
ACOUSTIC NEUROMA
What is the clinical presentation of acoustic neuroma and why?
Cranial nerves affected –
- CNV = absent corneal reflex
- CNVII = facial palsy (forehead NOT spared)
- CNVIII = vertigo, unilateral SN hearing loss + tinnitus
ACOUSTIC NEUROMA
What is a key association with bilateral acoustic neuromas?
- Neurofibromatosis type 2
ACOUSTIC NEUROMA
What is the management of acoustic neuroma?
- Urgent ENT referral = MRI cerebellopontine angle #1, audiometry
- Treatment with observation, surgery or radiotherapy
RAMSAY HUNT SYNDROME
What is Ramsay Hunt syndrome?
- Herpes zoster oticus = reactivation of the VZV in the geniculate ganglion of CNVII
RAMSAY HUNT SYNDROME
What is the clinical presentation of Ramsay Hunt syndrome?
- Auricular pain can be 1st sign
- Facial nerve palsy
- Painful vesicular rash around ear
- May have vertigo + tinnitus
RAMSAY HUNT SYNDROME
What is the management of Ramsay Hunt syndrome?
- PO aciclovir AND PO prednisolone
AURICULAR HAEMATOMA
What are auricular haematomas associated with?
What is the management?
- Rugby or boxing injuries
- Same-day ENT assessment to avoid cauliflower ear deformity
- Incision + drainage superior to needle aspiration
TMJ DYSFUNCTION
What is the clinical presentation of temporomandibular joint (TMJ) dysfunction?
- Earache (referred from auriculotemporal nerve)
- Facial pain, joint clicking or popping on jaw movement
- Teeth-grinding
TMJ DYSFUNCTION
How is TMJ dysfunction managed?
- Conservative with jaw rest, soft diet
- If chronic = ENT referral
MASTOIDITIS
What is mastoiditis?
What is a key complication of mastoiditis?
- Extension of AOM into mastoid air cells with abscess formation + bone necrosis
- Meningitis, also facial nerve palsy + hearing loss
MASTOIDITIS
What is the clinical presentation of mastoiditis?
- Fever + systemically unwell
- Persistent throbbing pain
- Pinna pushed down + forward
- Mastoid tenderness, erythema + swelling
MASTOIDITIS
What is the management of mastoiditis?
- CT
- IV Abx
- Surgery if subperiosteal abscess
RHINOSINUSITIS
What is rhinosinusitis?
What are the causes?
- Inflammation of the mucosal lining of the nose + paranasal sinuses
- Infectious or allergic
RHINOSINUSITIS
What causes infectious rhinosinusitis?
What causes allergic rhinitis?
- Mostly viral (rhinovirus), can be bacterial (S. pneumoniae)
- Type 1 IgE mediated hypersensitivity reaction
RHINOSINUSITIS
How is allergic rhinitis sub-categorised?
What are some triggers?
- Season, perennial (year-round) or occupational
- Smoke, pollen, house dust mite, exercise
RHINOSINUSITIS
What is the clinical presentation of rhinosinusitis?
- Rhinorrhoea + nasal congestion
- Post-nasal drip = foul taste
- Sinus facial pain, worse on bending forward = cheeks (maxillary), between eyes (ethmoidal), deep headache (sphenoidal)
RHINOSINUSITIS
What investigations would you consider in rhinosinusitis and when would you?
- Nasal endoscopy ± CT if persistent symptoms despite treatment
RHINOSINUSITIS
What are some potential complications of rhinosinusitis?
- Chronic rhinitis > nasal polyps
- Intra-cranial infection = meningitis, cerebral abscess
- Osteomyelitis of frontal bone
- Orbital cellulitis/abscess
- “Double-sickening” viral > bacterial
RHINOSINUSITIS
What is the management of infective rhinosinusitis?
- Analgesia + nasal decongestants, Abx (phenoxymethylpenicillin) if purulent discharge
- Chronic/recurrent (>10d) = intranasal corticosteroids (fluticasone)
RHINOSINUSITIS
What is the management of allergic rhinitis?
- First line (mild-mod) = PO/intranasal antihistamines + allergen avoidance
- Second line (mod-sev) = intranasal steroids
- ?Role of short course nasal decongestants
RHINOSINUSITIS
What is an important note about nasal decongestants?
- Short courses only as increasing doses required to achieve same effect (tachyphylaxis)
- Can lead to rebound hypertrophy of nasal mucosa (rhinitis medicamentosa) upon withdrawal
NASAL POLYPS
What are nasal polyps?
What is the epidemiology?
What are some associations?
- Growths of nasal mucosa
- More common in men, not often seen in paeds/elderly
- Samter’s triad (asthma, aspirin sensitivity + nasal polyposis), chronic rhinitis, congenital (CF, kartagener’s syndrome)
NASAL POLYPS
What is the clinical presentation of nasal polyps?
What is a worrying sign?
- Watery rhinorrhoea + nasal obstruction
- Poor sense of taste/smell
- Unilateral Sx or bleeding = ENT referral as RED flag
NASAL POLYPS
What is the management of nasal polyps?
- All referred to ENT for full exam
- First line = intranasal topical corticosteroids to shrink polyps
- If fail = endoscopic polypectomy
NASAL FRACTURE
What is the clinical presentation of nasal fracture?
- Bruising + tenderness over nose
- Mobility + deformity of the nose
- Epistaxis
NASAL FRACTURE
What is a major complication of nasal fractures?
How does it present?
- Septal haematoma = bilateral haematoma between perichondrium (skin) + septal cartilage
- Soft/boggy swelling, sense of nasal obstruction, pain
NASAL FRACTURE
What is the management of septal haematoma?
Why is this important?
- Incision + drainage and IV Abx
- Prevents septal necrosis (risk of saddle-nose deformity) + abscess
NASAL FRACTURE
What is the management of nasal fracture?
- Only correct if cosmetic deformity or septal haematoma
EPISTAXIS
What are the two locations of epistaxis and which is most common?
- 90% anterior plexus bleed = Kiesselbach’s plexus/little’s area
- Posterior plexus bleed = originate from deeper structures
EPISTAXIS
What is to note about posterior plexus bleeds?
- More profuse, more in older patients
- Higher aspiration risk + airway compromise
EPISTAXIS
What are the causes of epistaxis?
- Most benign + self-limiting = nose picking/blowing
- Trauma to nose or foreign body insertion
- Bleeding disorders = haemophilia, vWD, anticoagulants
- Cocaine use
EPISTAXIS
What is the stepwise management of epistaxis?
- ABCDE approach initially
- Pinch cartilaginous area of nose firmly, lean forward, 10–15m
- Cautery with silver nitrate stick IF source of bleed visible (topical anaesthetic 1st)
- Nose packing if cautery not viable or bleeding point not visible (posterior packing requires catheter)
- Sphenopalatine ligation
EPISTAXIS
What management is considered after first aid measures?
- Consider topical antiseptic Naseptin (chlorhexidine + neomycin) to reduce crusting + risk of vestibulitis
- Avoid blowing/picking nose, heavy lifting, exercise, alcohol
EPISTAXIS
What is a caution with naseptin?
- Peanut or soy allergies
TONSILLITIS
What are the causes of tonsillitis?
- Viral #1 = adenovirus, influenza, rhinovirus
- Bacterial = group A beta-haemolytic streptococcus pyogenes
TONSILLITIS
What scoring systems are used in tonsillitis that link to the clinical presentation?
- FeverPAIN = Fever, Purulence, Attends <3d, severely Inflamed tonsils, No cough/coryza
- CENTOR = tonsillar exudate, fever, tender anterior cervical lymphadenopathy + absent cough
TONSILLITIS
What are some potential complications of tonsillitis?
- Post-strep glomerulonephritis
- Rheumatic fever
- Scarlet fever
- Otitis media
- Peritonsillar abscess (quinsy)
TONSILLITIS
What is quinsy?
What are the features?
- Rare but severe complication of bacterial tonsillitis
- Sore throat, dysphagia, trismus, peritonsillar bulge, uvular deviation (away from quinsy), muffled ‘hot potato’ voice
TONSILLITIS
What is the management of quinsy?
- IV Abx + aspiration preferred to previous incision + drainage
TONSILLITIS
What is the management of tonsillitis?
- Most self-resolve, paracetamol + ibuprofen
- CENTOR ≥3, FeverPAIN ≥4 (2-3=delayed) for Abx
- Phenoxymethylpenicillin or clarithromycin/erythromycin if pen allergic
TONSILLITIS
What is the criteria for tonsillectomy?
- ≥7 episodes in 1 year OR 5 per year for 2 years OR 3 per year for 3 years
- Recurrent quinsy (≥2 episodes)
- Enlarged tonsils causing breathing issues/stridor, dysphagia, snoring
TONSILLITIS
What are some complications with a tonsillectomy?
What’s the management?
- Pain
- Haemorrhage = primary 6-8h due to inadequate haemostasis, secondary 5–10d due to infection
- All haemorrhage > ENT, if primary back to theatre, if secondary/infection admit + Abx
EPIGLOTTITIS
What is epiglottitis?
What causes it?
- Acute infection of supraglottic tissue with risk of airway occlusion
- Haemophilus influenzae type B
EPIGLOTTITIS
What is the clinical presentation of epiglottitis?
- Rapid onset 3Ds = Drooling, Distressed, Dysphagia
- Soft inspiratory stridor in very systemically unwell child
- Tripoding = optimise airway by leaning forward + extending neck
EPIGLOTTITIS
How do you diagnose epiglottitis?
What investigation might you do?
- Clinically via direct visualisation by specialist
- Lateral C-spine XR = epiglottis swelling (thumb sign)
EPIGLOTTITIS
What is the prophylaxis for epiglottitis?
How do you manage epiglottitis?
- Prevention with HiB vaccine, give household contacts rifampicin
- Urgent anaesthetist/ENT input + DO NOT EXAMINE THROAT
- Secure airway (may require ET intubation), IV cefotaxime or ceftriaxone
HEAD AND NECK CANCERS
What is the most common histological type for head and neck cancers?
Where does it spread to?
Why is early recognition crucial?
- Squamous cell carcinoma
- Lymph nodes
- Risk of affecting ability to breathe, swallow + talk
HEAD AND NECK CANCERS
What are the two main risk factors for head and neck cancers?
What are the main locations for head and neck cancers?
- Smoking + alcohol
- Nasopharynx, oral cavity, pharynx, larynx
HEAD AND NECK CANCERS
What are red flag features of nasopharynx cancer?
What are some key risk factors?
- Otalgia, hearing loss (CN palsies), changes to sense of smell, unilateral serous otitis media
- Asian + EBV
HEAD AND NECK CANCERS
What are red flag features of oral cavity cancer?
What are some key risk factors?
- Ulcer for >3w, persistent + unexplained neck lump, erythro(leuko)plakia
- Recurrent dental infections, sun exposure (lips)
HEAD AND NECK CANCERS
What are red flag features of pharynx cancer?
What is a key risk factors?
- Persistent neck lump, dysphagia, otalgia
- HPV
HEAD AND NECK CANCERS
What are red flag features of larynx cancer?
What is a key risk factors?
- Hoarse voice, persistent neck lump, dysphagia, stridor
- Smoking ++
HEAD AND NECK CANCERS
What is the management of head and neck cancers?
- Full ENT exam + flexible nasoendoscopy
- Fine needle aspiration if mass found
- Options = chemo, radiotherapy or surgery
NECK LUMPS
Give 8 differentials for neck lumps and note their location
- Reactive lymphadenopathy = #1
- Thyroid swelling
- Thyroglossal cyst, midline
- Anterior triangle = branchial cyst, carotid aneurysm
- Posterior triangle = pharyngeal pouch (Zencker’s diverticulum), cystic hygroma, cervical rib
NECK LUMPS
What are some differentiating features of…
i) reactive lymphadenopathy?
ii) thyroid swelling?
i) Recent local/generalised infection
ii) Moves upwards on swallowing but NOT tongue protrusion
NECK LUMPS
What is a thyroglossal cyst?
How does it present?
How is it managed?
- Persistent thyroglossal duct in paeds
- Fluctuant, midline mass which MOVES UP with tongue protrusion
- Excise cyst + thyroglossal duct
NECK LUMPS
What is a pharyngeal pouch?
- Outpouching of pharyngeal lining through a weakness in the pharyngeal wall muscles (Killian’s dehiscence)
NECK LUMPS
What is the presentation of pharyngeal pouch?
- Dysphagia
- Regurgitation
- Chronic cough
- Halitosis
- Older men
- Neck mass on L that may gurgle on palpitation
NECK LUMPS
How is a pharyngeal pouch investigated?
What is the management?
- Diagnostic = barium swallow
- Avoid endoscopy as perforation risk
- Excise
NECK LUMPS
What is a cystic hygroma?
How does it present?
What is the management?
- Congenital lymphatic lesion often on L side (posterior triangle)
- Most evident at birth, SNT, transilluminates, increased size when coughs/cries
- Excise
NECK LUMPS
What causes a branchial cyst?
How does it present?
How is it managed?
- Failure of obliteration of second branchial cleft in embryology
- SNT + fluctuant mass anterior to sternocleidomastoid (anterior triangle)
- Early adulthood
- Excise
NECK LUMPS
Who is a cervical rib more commonly seen in?
What can it lead to?
- Adult females
- Thoracic outlet syndrome = compression of brachial plexus, subclavian artery/vein at site of thoracic outlet
NECK LUMPS
How does thoracic outlet syndrome present?
- Neurogenic #1 = weak hand muscles, paraesthesia
- Vascular = painful arm swelling + distended veins
NECK LUMPS
How does a carotid aneurysm present?
- Pulsatile lateral neck mass which does NOT move on swallowing
LUDWIG’S ANGINA
What is Ludwig’s angina?
- Progressive cellulitis that invades the floor of the mouth + soft tissues of the neck often 2º to odontogenic infections which spread to submandibular space
LUDWIG’S ANGINA
What is the clinical presentation of Ludwig’s angina?
- Fever, neck swelling + dysphagia
- Seen in immunocompromised with poor dentition
LUDWIG’S ANGINA
What is the management of Ludwig’s angina?
- Life-threatening emergency as airway obstruction can occur rapidly
- Immediate admission with airway management + IV Abx
