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1. Fellowship - Written SAQ > ENT > Flashcards

ENT Flashcards

1
Q

describe the injury and management steps

A

Injury:
Auricular haematoma to the right pinna with small skin tear
negatives - no involvement of pinna or tragus

management:
analgesia
drainage
check for damage to other aspects of ear
block pinna
pressure dressing after
ADT
follow up

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2
Q

list the indications for surgical review of this injury?

What are contraindications to ED drainage?

A
  • large overlying skin avulsion
  • severe crush injury
  • complete or near amputaiton/avulsion
  • large cartilage defect
  • devitalization of tissue
  • large haematoma

Contraindications:

over 7/7 haematoma
recurrent haematoma

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3
Q

What is the diagnosis and three supportive findings?

A

Acute suppurative otitis media

  1. Bulging TM
  2. Erythematous TM
  3. pus behind TM
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4
Q

What are the options for analgesia?

A

paracetamol 15mg.kg
ibuprofen 10mg/kg
IN fentanyl 1.5mcg/kg

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5
Q

what are the indications for antibiotics?

A

Prior hearing impairment
Failure of conservative Rx (ie worsening Symptoms at 48hrs)
Cochlear Implant
Immunosuppression

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6
Q

List four methods and pros and cons of removing ear foreign body

A

Method - suction catheter
Pros - soft and atraumatic
Cons - nosy

Method - alligator forceps
Pros - not noisy
Cons - difficult to grip small objects and may cause trauma

Method - wax curette/bent paperclip
Pros - good for smooth objects to get behind
Cons - risk of trauma or pushing deeper

Method - irrigation or syringing
Pros - can flood out loose objects
Con - cant use if grommets or perforation

Method - refer to ENT
Pros - little risk to ED
Cons -

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7
Q

with epistaxis, what are key features in a history?

A
    • estimate amount of blood loss eg duration, volume
  • effects of blood loss - dizziness, collapse
  • co-morbidities eg uncontrolled hypertension
  • reason for anticoagulation if reversal is needed
  • social situaiton - can they manage at home
  • other meds - to increase bleeding
  • ?trauma
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8
Q

What are the steps for controlling untraumatic epistaxis

A
  • first aid- sit up lean forward and squeeze
  • suction clots and blood
  • topical constrictor eg adrenaline or co-phenylcaine
  • cautery eg nitrate sticks
  • optimise anticoag
  • rapid rhino
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9
Q

list three pieces of advice for epistaxis on discharge

A
  • general - do not pick or blow nose for 4/7, moisturise nostrils
  • see GP for anticoag FU
  • when to return - on going bleeding not controlled with first aid or needing pack removal
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10
Q

what are the causes of epistaxis in adult patient

A

alcohol
htn
bleeding disease eg VWD
meds - antiplatelets
recreational drugs eg cocaine
trauma
neoplasm eg SCC

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11
Q

what are the features concerning for a malignant cause of epistaxis?

A
  • Unilateral nasal blockage +/- discharge
  • Local oral features – eg ill-fitting dentures or loose teeth and buccal soft tissue swelling
  • Localised lymphadenopathy
  • Hearing loss
  • Trismus
  • Neuralgia
  • Risk factors for nasopharyngeal malignancy - alcohol, tobacco, race – SE Asian, Chinese
    predominance
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12
Q

What are the specific managements for posterior epistaxis?

A
  • posterior cauterisation under GA
  • arterial ligation
  • local injection of lidocaine and adrenaline around sphenopalantine artery
  • embolisation via femoral artery under IR
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13
Q

what are the signs of airway obstruction due to FB in a child?

A

stridor
drooling
wheeze
resp distress
abnormal hoarse voice or cry

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14
Q

what are the relevant features of this x ray

A

radio opague FB in oesophagus - likely coin
it is below laryngeal inlet and not obstructing trachea

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15
Q

a child who ingests FB becomes unresponsive and apnoiec. What is the stepwise approach to management

A

open airway and remove FB
BVM with 5 breaths
5 back blows of chest thrusts
direct laryngoscopy and removal with mcgills

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16
Q

Likely diagnosis?
What are the anatomical structures involved?
what is the approach to imaging?

A

bilateral TMJ dislocation
mandibular condyle moves anteriorly out of mandidular fossa

imaging:
spontaneous - none
traumatic - CT

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17
Q

What is the approach to managing TMJ dislocation?

A

syringe technique -
10ml syringe place between maxillary and mandibular molars and roll back and forth awaiting reduction

manual reduction-
using gloves place thumb on mandibular molars and firm constant pressure inferioposteriorly until reduction

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18
Q

what are the discharge instructions post tmj relocation

A
  • Simple analgesia – paracetamol / ibuprofen
  • Soft / liquid diet
  • Avoid yawning / taking large bites
  • if recurrent, maxillofacial review
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19
Q

What are the features of occult nasal FB in kids?

A
  • unilateral epistaxis
  • unilateal blockage
  • foul smell
  • unilateral nasal breathing
  • septal necrosis
20
Q

What equipment is used in nasal FB extraction

A

topical anaeasthetic and vasoconstrictor
airway equipment incase of obstruction
nasal speculum
head torch
PPE
forceps

21
Q

with nasal FB what are the indications for referral to surgeon?

A

posterior or not easily visualised
chronic or impacted with marked inflammation
penetrating or hooked FB
failure to remove eg bleeding, uncooperative patient

22
Q

name three methds for nasal FB removal and pros and cons

A

Method - direct instrumentation eg forceps or hooks
Pros - useful if object easily visualised
Cons - may not be able to grasp, may pusch deeper

Method - suction catheter
Pros - can remove anterior things and blood/mucours
Cons - loud

Method - positve pressre eg mothers kiss or blowing out one nostrol
Pros - easy if coooperate and can sooth child
Cons - needs cooperation and may be difficult for larger objects

23
Q

what are the complications of nasal FB?

A

mucosal necrosis
aspiration
sinus infection

24
Q

what are the options for ensuring child is cooperative?

A

GA
physical restraint
procedural sedation

25
Q

What are the ways to remove nasal FB?

A

suction
mothers kiss
blowing one side
foley cathter
direct visualisation

26
Q

with nasal FB would would suggest need for bronchoscopy?

A

stridor
unilateral wheeze
hypoxia
coughing and choking

27
Q

what are the differentials for neck lump?
What investigations may help diagnose?

A

HL or NHL
EBV
bacterial tonsilitis
reactive lymph node
hyperthyroidism

28
Q

what clinical features are used to assess severity of upper airway obstruction?

A

nature of stridor eg continuous or not
self positioning - relaxed or upright
?swallow secretions
?hot potato voice
respiratory distress
anxiety

29
Q

how do you manage acute upper airway obstruction eg quinsy

A

keep sitting up
keep calm
IV hydrocortisine 200mg
IV abx ceftriaxone 2g
nebulsed adrenaline
involved ENT early
difficult airway equipment to bed

30
Q

What are the considerations needed when transferrings someone with airway compromise?

A

Patient- severty, difficulty of airway, response to treatment

Equipment - airway equipment, drugs

Escort - senior doctor

Distance - road v air - plan for deterioration

31
Q

Describe injury

A

large zig zag shaped would
penetrates platysma
evidence of blood soaked gauze
soft tissue swelling at mandible
face not involved

32
Q
A
33
Q

List the indications for emergent intbation of someone with penetrating neck injury

A

stridor
acute resp distress
profound shock
altered mental state
expanding haematoma
airway obstruction from blood or secretions

34
Q

list differentials and features that would suggest that

A

chronic supparative otitis media
meningits - photophobia, rash
mastoiditis - boggy swelling over mastoid
encephalitis - confusion
cerebral abscess - ataxia, cerebellar signs
cholesteatoma

35
Q

with strangulation what features or in the history suggest further investigtion

A

hoarse voice
ligature marks
LOC
haematoma/petichial rash
carotid bruit
dyspnoea

36
Q

what are the differentials for stridor in kids

A

croup
laryngomalacia
laryngeal FB
epliglottis
bacterial tracheitis
retropharyngeal abscess

37
Q

what are the indications for intubation with stridor?

A

exhaustion
type 1 failure
type 2 failure
reduced level of consciousness

38
Q

What is the intubation equipment for a child

A

Bag Valve Mask (with size - child)
Laryngoscope with Miller blade (size 2) and Macintosh blade (size 2)
ETT 4.0-4.5 and one size below due to anticipated laryngeal oedema
Bougie
Suction
Laryngeal Mask Airway (size 2)
Surgical airway equipment – needle cricothyrotomy
Ketamine 2mg/kg or Fentanyl 2-5 mcg/kg or Propofol 1-2 mg/kg
Suxamethonium 1-2 mg/kg or Rocuronium 1.2 mg/kg

39
Q

what is the radiographical sign of epiglottitis?

What is the usual causative agent and treatment?

A

thumb printing
strep pneumonae. ceftriaxone 1g

40
Q

epiglottis -
factor, anticipated problem and solution

A
41
Q

What is this?
Why

A

large unilateral swelling below mandible with surrounding erythema

ludwigs angina (submandibular abscess)

42
Q

what is the management of ludwigs angina

A

analgesia eg fentanyl
iv abx - metro and benpen
urgent ent/max fax review for drainage or airway support

43
Q

what are the initial management steps of a post tonsillectomy bleed?

A

2 large iv cannula
bolus nacl at 20ml/kg
o neg blood
aim for pulse under 120 and bp over 90

44
Q

with a post tonsillectomy bleed what intubation difficulties may you experience and how will you prepare?

A
45
Q

what are four methods for reducing bleeding in post tonsillectomy blood

A

ice gargles
co-phenycaine spray
adrenaline soaked gauzze
packing

1. Fellowship - Written SAQ (20 decks)

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