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Y4 medicine > ENT > Flashcards

ENT Flashcards

1
Q

what are the causes fo epistaxis?

A

idiopathic
truamatic
iatrogneic
froeign body
inflammatory (polyps, rhinitis)
neoplastic
HTN/coagulopathies

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2
Q

name the managemnt step by step of epistaxis?

A
  1. A-E (check for shock)
  2. pinch soft part of nose and lean forward (spit out blood) for 15 mins
  3. cautery with silver nitrate (with anterior rhinoscopy - anterior or rigid endoscope - posterior) + adrenaline topically if needed (IF able to LOCATE source of bleeding)
  4. nasal packing if all else fails (anterior +/or posterior pack)
  5. surgical ligation of radiological embolisation to sphenopalatine/anterior ethmoidal/external carotid
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3
Q

what are teh two complications from a nasal fracture?

A
  • CSF leak
  • septal heamatoma
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4
Q

what is teh initial management of a septal fracture?

A
  • A-E
  • exclude for septal heamatoma
  • MUA within 2 weeks (after swelling has gone down)
  • if major truama needs evacuation under GA with packing +/- suturing
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5
Q

what is teh main complication from a septal heamatom?

A

saddle nose deformity

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6
Q

what are nasal polyps?

A

benign growths than can be seen in chronic sinusitis due to extreme inflammation
normally bilateral (if unilateral must biopsy just in case malignant)

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7
Q

red flags for polyps?

A

polyps that are unilateral, fast growing, bleeding

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8
Q

what is teh best imaging for rhinosinusitis?

A

CT sinuses -> done if surgery planned

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9
Q

what is the surgical treatment done for chronic rhinosinusitis?

A

nasal polypectomy -> very high rate of recurrence
functional endoscopic sinus surgery to improve ventilation/drainage
septoplasty and reduction of inferior turbinates

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10
Q

name complications of functional endoscopic sinus surgery

A

bleeding, infection, CSF leak, visual loss or disturbnace

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11
Q

medical treatment for chronic rhinosinusitis?

A
  • antihistamines
  • topical nsala steroids
  • oral steroids (1 wk course)
  • oral ABx (at least 6-8 weeks)
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12
Q

what is the defintiion of rhinosinusitis?

A

2 symptoms of:
- nasal blockage
- nasal discharge or post nasal drip
- facial pain
- reduced or loss of smell

+/- endoscopic signs of polyps, mucopurulent discharge or oedema in middle meatus

+/- CT changes (mucosal or sinus changes)

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13
Q

what investigations are doen to test for alleric rhinitis?

A
  • skin prick test for speicifc allergens
  • RAST blood tests if SPT not possible (tests IgE antibodies)
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14
Q

tretament fro allergic rhinitis

A
  • allegren avoidance
  • nasal douching
  • antihistamines
  • topical nasal steroids
  • immunotherapy
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15
Q

what defines the difference between mild and moderate allergic rhinitis?

A

mild: normal daily acitvities and sleep
moderate: impairment of daily activites nd sleep

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16
Q

what are the mian risk factors for head and neck cancer ?

A

alcohol (MAIN)
tobacco (MAIN)
beetle nut chewing for oral cavity malignancies
chinese ethnic origin for nasopharyngeal malignancy
male

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17
Q

what investigations are importnat to do for supsetced H&N cancers?

A

CT neck
panendoscopy or laryngopharyngo-oesophagoscopy with biopsy
FNA of lymph nodes is suspected spread
CT chest if mets suspetced

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18
Q

most common type of head and neck cancer

A

SCC (90%)

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19
Q

management of head and neck cancers?

A
  1. palliation
  2. radiotherapy to primary site +/- to neck +/ chemo
  3. surgery - endoscopic (laser) or open
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20
Q

where do the recurrent laryngeal nerves run and what is the consquence of injuring them during thyroid surgery?

A

run in the tracheo-oesophageal groove
- they suply muscles of larynx and sensation below vocal cords = hoarsness and airway obstruction porblems

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21
Q

complications of thyroid surgery?

A
  • recurrent laryngeal nevre palsy (=hoarseness and airway obstruction)
  • superior laryngeal nerve palsy
  • bleeding
  • infection
  • pain
  • laryngeal oedeam = airway obstruction
  • hypoparathyroidism (if parathyroid glands removed by accident) = hypocalcemia
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22
Q

if thyroid carcinoma is suspected, woudl investigation needs to be done?

A

fine needle aspiration of nodule
OR can just do a hemithyroidectomy to do definitive histology if there is diagnostic uncertainty

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23
Q

what are teh signs of a septal heamotoma?

A
  • pinky, large mass in either side of nasal airway (feels boggy when palpated, not firm (firm wld indicate you are touchign part of the deviated septum)
24
Q

presentation of a pt with polyps?

A
  • males, >40yo
  • watery anterio rhinorrhea
  • pururlent post nasal drip
  • nasal obstruction
  • sinusitis
  • headaches
  • snoring
25
Q

what investigations need to been done if polyps are suspected?

A

nasal endoscopy
CT scan and biopsy - if single, unilateral polyp/peadiatric polyp

26
Q

managemnt for nasal polyps?

A
  • medical: nasal steroids e/e/ betamethsone drops
  • surgical: endoscopic polypectomy
27
Q

complications of rhinosinusitis?

A
  • orbital cellulitis/abcsess
  • osteomyelitis
  • intracranial infection
28
Q

what are teh common signs and symptoms of head and neck cancers?

A
  • dysphonia
  • persistent dysphagia
  • persistnet mouth ulcers (>3wks)
  • dyspnoea
  • unexplained neck lump
  • pain (e..g otalgia with no ear signs)
  • heamatemsis/epistaxis (rare)
  • nasal blockage (progressive unilateral)
29
Q

what is acute sialadenitis?

A
  • infection to the salivary glands
30
Q

how does acute sialadenitis present?

A
  • foul tasting purulent discharge
31
Q

causative organisms for acute sialadenitis?

A

bacterial (staph aureus due to poor dental hygeine)
viral (HIV, mumps, coxsackie)

32
Q

what is sialolithiasis?

A

calculi in the salivary ducts -> 80% submandibular

33
Q

what is the presentation of sialolithiasis?

A
  • recurrent unilateral pain and swelling
  • red tender and swollen gland
  • worse upon eating
34
Q

complciations of sialothiasis?

A

sialadenitis and abscess formation (pyrexia, drooling, dysphagia)

35
Q

Ix done for pts with suspected sialolithiasis?

A
  • US
  • sialography
36
Q

Tx for sialolithiasis?

A

(mostly conservative)

conservative: hydration and analgesia
surgical: intraoral removal of palpable stones/removal of salivary glands

37
Q

what is sjogrens syndrome?

A

autoimmune disease causing lymphatic infiltration into the ductal tissue of teh salivary glands = reduced production of saliva

38
Q

what is teh presentation of sjogrens syndrome?

A
  • dry eyes, dry mouth and enlarged salivary glands
39
Q

whic gland do most salivary neoplasms occur?

A

parotid gland

40
Q

presenation of a parotid gland tumour?

A
  • facial nerve palsy
  • painless swelling
41
Q

Ix done to investigate for parotid neoplasm?

A
  • ENT exmaination
  • US +/- CT
  • FNAC
42
Q

Mx for salivary neoplasms?

A
  • parotidectomy
43
Q

complications of parotidectomy?

A
  • facial nerve palsy
  • salivary fistula
  • freys syndrome
44
Q

what is freys syndrome?

A

redness and sweating over the parotid gland when eating/salivating
this is due to the auriculotemporal nevre reconnecting to skin sweat glands

45
Q

presentation of a pt with retropharngeal abscess?

A
  • commonly in young children after an URTI
  • stiff, extended neck
  • dysphagia/odynophagia (difficulty eating and drinking)
  • systemically unwell
  • failure to improve with IV ABx
46
Q

what investigations are done to diagnose a retropharyngeal abscess?

A
  • lateral neck XR shows widneing of the retropharygneal space
47
Q

managment fo retropharyngeal abscess?

A
  • secure airway if compromise
  • IV ABx
  • surgery -> incision and drainage
48
Q

what is ludwigs angina?

A
  • severe form of cellulitis involving the space between the floor of the mouth and the mylohyoid (mandible -> hyoid bone)
49
Q

what does ludwigs angina present with?

A
  • neck oedema
  • bilateral submandibualr swelling
  • dysphonia
  • protruding tongue
  • drooling
  • airway comprimise
50
Q

cause of ludwigs angina?

A

Bacteria from dental infections or poor oral hygiene are the cause of this skin infection.

51
Q

what investigation is doen to diagnose ludwigs angina?

A

CT neck

52
Q

what is the managment of ludwigs angina?

A

secure airway if comprimisd
IV ABx
surgery -> incision and drainage

53
Q

common causes of OSA?

A
  • obesity in adults
  • adenotonsillar hypertrophy in peads
54
Q

management of OSA?

A
  • advice on lifestyle chnages including weight loss
  • CPAP (mainstay treatment)
  • surgeyr - adenotonsillectomy in children
55
Q

what is epiglottitis?

A

inflammation and swelling of the epiglottitis usually seen in children aged 2-6yo
main causative agents -> heamophilus influenzae and group A strep

56
Q

what is the managemnt of epiglottitis?

A
  • EMERGENCY!
  • intubation in theatre
  • IV ABx (ceftriaxone) and dexamethasone

Y4 medicine (17 decks)

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