ENT Flashcards
Common site of epistaxis?
Anterior part of medial wall
Most internal and external carotidal branches anastomose here
What artery supplies most of nasal cavitY?
Sphenopalantine artery
From External Carotid artery
Systemic causes of epistaxis?
Coagulopathies e.g. haemophilia, vWD, overwarfarinization
Local causes of 코피?
Life threatening = carotid blowout.
Trauma to nose.
Complication from use of nasal packing? Give what
Toxic Shock Syndrome.
Give prophylactic clindamycin or penicillin.
Complication and conditions a/w JNA?
Complication = OM with effusion
Conditions = Sinusitis, OSA
Epidemiology of JNA?
Adolescent male
Complication of septal hematoma?
Due to rupture of vessels in nasal septum causing separation of perichondrium from cartilaginous portion.
Can cause septal abscess -> septal perforation -> saddle nose deformity
Mx of septal hematoma?
urgent refer to ENT for I&D to prevent hematoma from becoming abscess
Immediate mx of epistaxis?
Epistaxis first aid
Topic decongestants
AgNO3 cautery
2nd line mx of epistaxis?
Through endoscope.
Packing or electrocautery
Merocel mainly used over balloon
Red flags of epistaxis?
Unilateral
Blood stained secretions
Large volume
Short hx
Eye involvement
Worrying causes of epistaxis?
Unilateral OME
Unilateral polyp (NPC)
Cervical lymphadenopathy
CN palsies
Mx of nasal frac?
Reassess pt in 3-5 days after edema subsides
Rx Nasal frac for cosmesis and NO
M&R within 2 weeks
Can vestibular neuritis have BPPV symptoms?
Can have a bit lol
Causes of nasal obstruction?
Anatomy - deviated septum, inf turb hypertrophy
Rhinitis
Rhinosinusitis
+ polyps / foreign body
Mx of NPC?
Stage 1 = IMRT
Stage 2 = IMRT / chemo-IMRT
Stage 3 = Chemo-IMRT
Stage 4 = Neoadjuvant chemo f/u chemo-IMRT
Clinical presentation of NPC?
CN palsy
Tinnitus
Nasal obstruction
Epistaxis
Deafness
Blood in saliva
Neck lump
ascending order of prevalence
What is leukoplakia
White patch in oral cavity that cannot be scraped off.
6% risk of malignancy
Causes of inflammatory cervical LNs
SLE
Kikuchi’s disease
Kimura disease
Pattern of LN spread in H&N cancer?
Cancers of H&N spread to neck LNs in predicable pattern.
Skip mets is rare.
Cancers from diff locations spread to diff levels first
What is quinsy?
Spread of infection into peritonsillar space
Signs and symptoms of quinsy?
Fever
Sever unilat sore throat, drooling, halitosis
Trismus, hot-potato voice
Uvula deviation to contralat side
Fluctuant soft palate swelling
Mx of quinsy?
I&D under LA
Abx
Elective tonsillectomy if repeated
Cause of acute tonsilitis?
Often viral infection before bacterial superinfection
Commonly GAS (beta-hemolytic)
Symptoms and signs of acute tonsilitis?
Fever, sore throat, halitosis, odynophagia
Tender cervical adenopathy, red and exudative tonsils
Mx of acute tonsilitis?
Penicillin 10 days
Elective tonsillectomy for recurrent tonsilitis
Pathogens for acute supraglottitis or epiglottitis?
H. Influenzae
Strep pneumo
Streps beta hemolytic
Staph aureus
Symptoms and signs of acute supraglottitis or epiglottitis?
High fever
Muffled voice
Stridor
Dysphagia
Odynophagia
Drooling
Sudden onset, short course
Mx of acute supraglottitis / epiglottitis?
Evaluate airway
Steroids to reduce airway edema
IV abx
Hydration + humidification
Mx of oropharyngeal candidiasis?
Topical nystatin swish and swallow
PO fluconazole for severe infection
Facts about retropharyngeal abscess?
Usu in kids <4yo
GAS, Staphs, respiratory anaerobes
A/w prior URTI with suppurative adenitis or retropharyngeal LN
Symptoms of retropharyngeal abscess?
Fever
Dysphagia
Stiff neck!!!
Neck pain
Respi distress
Imaging for retropharyngeal abscess?
Lateral neck XR = widened prevertebral soft tissue
CT neck
Which cervical LN level hit from which conditions?
Tongue SCC = 2
Oral cavity / oropharynx = 1
NPC = level 2, 5
Thyroid = Level 4
Ocular manifestations of RA?
Keratoconjunctivitis sicca
Peripheral ulcerative keratitis
Contact lens cornea
Corneal melt
Episcleritis / scleritis
Sicca is commonest
