ENT Flashcards
How can you differentiate between a UMN and LMN facial nerve palsy?
Forehead sparing in UMN due to bilateral innervation of the forehead by the brain.
What manouvres can you do to diagnose and treat BPPV?
Dicks Hallpike (diagnosis) and Epley manouvre (treatment)
What does rinnes and webbers tests examine for ?
Rinnes conductive hearing loss
Webbers sensioneural hearing loss.
For someone with conductive hearing loss which side with webbers test localise to?
the affected side
the cone of light is always facing which direction?
anteriorly
what are the (7) categories for differentials for a lump in the neck?
infective
traumatic
neoplastic
conginital (thyroglossal duct, cystic hydroma, dermoid cyst)
Infalmmatory (sarcoidosis)
vascular (aneurysm)
autoimmune: goitre Graves disease
What sort of biopsy do you prefer if you are investigating a neck lump for lymphoma?
excisional biopsy or core biopsy
if you identifiy a single inilateral polyp what further investigations are required?
a biopsy for histopathology to rule out malignant cuases
Which nerves innervate the vocal cords?
the recurrent laryngeal nerve and the External Branch of the Superior Laryngeal nerve (which innervated the cricothyroid muscle) which results in the pitch of voice
what direct imaging tool would you use to investigate hoarseness of the voice?
video laryngoscopy / flexible nasal endoscopy
what are some benign cuases of hoarseness?
Vocal cord, cysts, nodules, oedema, reflux, polyps or papillomas (the last two need biopsy and excision)
Infectious: viral adn bacterial infections
What are some malignanct causes of haerseness.
SCC usually secondary to HPV
What are neurological cause of hoarseness?
A recurrent laryngeal nerve palsy can be caused by a wide range of causes, including thyroid cancer, lung cancer, thoracic aortic aneurysm, multiple sclerosis (MS), or stroke.
what are key points to ask in taking the history of a neck lump?
onset, duration, number, history of radiation exposure, smoking, drinking, previous head and nexk cancer.
What are some red flag features of a neck lump?
hard and fixed. B symptoms. otalgia, dysphagia, stridor or hoarseness. and unilateral discharge, expstaxis or congestion.
what are carotid body tumours?
benign neuroendocrine tumours in the carotid body
What is the mainstay of difinitive investigation of a neck lump?
USS and FNA, or core biopsy if suspecting lymphoma.
when taking a core biopsy of a small lesion in the neck what must be considered to safely collect the biopsy?
the needles throw length and the cutting length, to make sure that the throw length does not go through the lesion into surrounding structures.
stridor at the epiglottis vs the trachea will produce noise at what time in respiration?
epiglottis will be inspiratory and trachea will be expiratory
What are some cuases of acute stridor
infective cuases like abscess or glossitis. anaphylaxis. foriegn body
what are some cuases of chronic stridor ?
papillary lesion, subglottic stensois post long term intubation, subclotting haemangioma, vocal cord paralysis. micrognathia
What are the 4 steps to urgent initial management of a patient with stidor.
- stabilise the patient with HF 02 and call for ENT ro anaesthetics.
- suction secretions.
- give adrenaline (debulised) or steroids.
- take blood tests like ABG and cultures if indicated.
What are some associated symtpoms people may present with accompanying SSNHL?
vertigo and tinnitus
differential disgnoses of SSNHL include?
acuttic nauroma, CVA, Multiple sclerosis.
What are initial investigations for SNNHL?
Tympanometry, audiometry, and MRI brain
When is tinnitus an emergency?
sudden pulsatile tinnitus, neurology, vertigo, head trauma, hearing loss.
What are some central causes of vertigo?
MS, posterior Stroke, migraine or space occupying lesion.
What are some peripheral cuases of vertigo ?
vestibular nerve neuritis, BPPV, menieres disease.
If nystagmus is rotary or hosizontal where are the otoliths in the semicurcular canals?
rotary posterior canal and if in horizontal canal then horizontal nystagmus.
How long do the following pathologies give symptoms for? BPPV, Meniere disease? vestibular neuritis?
BPPV: seconds to minutes
meniered: minuites to hours
vestibular neuritis : days to weeks
What are intratemporal complications of acute otitis media?
fecial nerve palsy, hearing loss, mastoidotis, tympanic membrane perforation, chronic otitis media,
What are some extra temporal complications of acute otitis media?
abscess formation and sigmoid sinus thrombosis
what are come intracranial complications of acute otitis media?
intracranial abscess, cavernous sinus thrombosis, meningitis.
What are some complications of a cholesteatoma?
local inflammation and erosion of structures: erosion of the ossicles, the semicircular canal, cochlea, facial nerve and the temporal bone causing erosion into the intracranial cavity which can cause life threatening meningitis/abscess formation.
What is the definitive management of a cholesteatoma?
surgery +/- mastoidectomy
Post head injury your patient has a facial droop, what bone is likely fractured, what nerve is involved and how will you diagnose?
temporal bone, facial nerve, CT head.
What is a sign of temporal bone fracture?
Battles sign. posterior auricular ecchymosis.
haemotympanum
CSF ottohoea or rhinoroea
hearing loss
how are most temporal bone fractures managed?
conservatively, with audiometry about a week post accident to allow for inflammation to reduce.
What is the facial nerves function in the ear?
nerve to stapedius to dampen down vibrations from loud noises, and also sensation to the inner ear.
What is a severe complication of otitis externa? and what population would be susceptable to this ?
malignant ititis externa, where the infection/ inflammation spreads into the mastoid and temporal bones resulting in skull base osteomyelitis. older, immunocompromised and diabetics.
What are complications of rhinosinusitis?
periorbital cellulitis, osteomyelitis, frontal sinus swelling, and intracranial abscess or venous sinus thrombosis.
What are some compliacation of Functional Endoscopic Sinus Surgery
haematoma which can compress the orbit and cause blindness, epistaxis, with need for nasal packing, risk of infection, injury to the anterior skull base leading to CSF leak.
What is a complication of chrionic rhinosinusitis?
mucocele, can form in one of the sinuses, it can cause erosion of the bone and invade local structures such as the orbit or the brain
what are some common causes of epistaxis?
hypertension, anticoagulants, trauma. foriegn body
the greatest majority of nosebleeds will be from the anterior or posterior nose?
90% will be from the nose, littles area, which has perfusion from 5 arteries.
What is the initial management of epistaxis?
A-E approach becuase not sure how severe the bleeding is if the patient is swallowing it. then run some preliminary tests, FBC, UEC , coags, group and hold. get patient to sit up and spit out blood.
compression to the upper cartilage portion for at least 20 mins
can consider ice for more vasoconstriction.
if conservative management fails for epistaxis what can be used as an alternative?
nasal speculum to identify the area which is bleeding then apply silver nitrate.
Can also try an adrenaline soaked gauze.
apply bactroban ointment post cauterisation
then nasal packing, bilateral may be necessary to tamponade the bleeding.
if a posterior bleed is suspected what is the initial treatment
rapid rhino nasal packing
what surgical intervention is sometimes necessary for epistaxis
embolisation of vessels.
what is the treatment for septal haematoma and what is the consequences of no action?
you need to drian the haematoma and stich up the defect. if not treated can lead to avascular necrosis of the septum which leaves the cartilage susceptable to infection and abscess formation. that can lead to ascending cavernous sinus infection with intracranial and intraoccular manifestations.
how long after nasal fracture should it be reduced?
14-21 days post injury
what are 2 complications of nasal trauma?
CSF leak and anosmia
what is the anatomical difference between a peri-orbital and orbital cellulitis.
peri-orbital is before the septum in the anterior soft tissue space around the eye usually from a small cut or scratch. orbital is posterior to the septum and is usually from tooth or sinus infection.
what is a red flag symptom when treating a peri-/ orbital cellulitis?
bilateral swelling or pain as it may indicate involvement of the cavernous sinus thrombosis, which can be treated with abx but consultation with neurosurgery is indicated to determine if thrombectomy is advised.
What are the three types of deep spcace abscesses in the neck?
parapharyngeal
retorpharyngeal abscess
submandibular asbcess
What anatomical structure devises the superficial and deep layers in the neck?
the platysma
What are red flag signs for deep infections of the neck?
sore throat but normal musocal findings
severe nexk pain and stiffness.
any airway compromise
What is the initial medical management of patients with a neck space infection?
Antibiotics to cover broad spectrum , with anerobic and aerobic cover in accordance with local guidelines. and IV steroids asap. IVH. nebulised saline.
what is the surgical treatment of neck space infection?
drainage or aspiration and washout with CTS involvement if it has gone down to the mediastinum.
What are some red flags when considering foreign body injection ?
drooling, airway compromise, perfroation, button battery injection.
What is Obstructive sleep apnoea?
apnic or hypoapnic episodes while sleeping caused from collapse of the soft upper airways during sleep.
What does STOP BANG stand for ?
S: snoring
T: tiredness
O: observed apnoea
P: blood Pressure
B: BMI high
A: age > 50
N: neck circumference > 40 cm
G: gender male
What conservaitve management options can be provided for OSA ?
weight loss, smokinc cessation, exercise, alcohol reduction.
how does CPAP work?
continuious positive airway pressure, to keep the airways open
what surgical treatment options are available for OSA?
pharyngoplasty, and base of tongue reduction.
what is the major complication of untreated OSA?
cardiovascular complications.
you diagnose a patient with EBV tonsillitis, what discharge infromation to do you give them?
no contact sports due to high risk of splenic rupture.
your patient with tonsillitis you have penicillin to has developed a manulopapular rash , what was the disgnosis?
EBV in the first place
what is the difinitive treatment for peritonsillar abscess?
aspiration and drainage
how is a secondary bleed post tonsillectomy managed?
hydrogen peroxide wash and IV antibiotics. as well as adrenaline soaked gause and transexamic acid.
what type of thyroid cancer leads to increased calcitonin levels
medullary
what are some complications post thyroidectomy ?
haematoma
damage to the recurrent laryngeal nerves, bilateral damage will cause complete paraphysis and stridor and a tracheostomy may be required.
hypocalcaemia with pTH removals
What key things in addition to the basics do you need to consent for in an adenoidectomy?
damage to the lips and teeth
palatal insufficiency, swallowing and talking may be different
regrowth
damage to eustatian tube, lead to pain healing loss dizziness.
What are some things to consent for in gromet insertion?
the basics
and
the gromet may fall into the middle ear
it may fall out before 6 months
tympanosclerosis
tympanic membrane may remain patient after it falls out
might fail to improve hearing
What are some key things to consent someone for a micro laryngoscopy?
bleeding, dental or lip injury, damage to the larynx, anaesthetic risks and pneumothroax.
early:
laryngeal oedema. dysphonia, aspiration.
What are some key features of consent for a mryongioplasty?
bleeding, and infection.
graft site not taking
dizziness and tissitus
hearing loss if the ossicles are disrupted
facial paralyiss rare
taste disturbance because the cauda tympani goes over the superior portion of the tympanic membrane
What are some specific things to talk about in consenting someone for a parotidectomy ?
bleeding, pain , infection amaesthetic risk.
post operatively
Seroma, facial nerve neuropraxia
fistula to skin
late
cosmetic with lack of half face
freys syndrome gustatory sweating
What are some specific things to consent on for a septo plasty?
all about the septum, perforation, haematoma. The nose might not look the same. dental numbness.
