ENT 2 Flashcards
nasal fracture symptoms
exclude what
ix
complications and management
deviation, swelling, tender, bruising, epistaxis, facial tenderness
septal haematoma
clinical dx
epistaxis esp ant ethmoid
CSF leak - settles spontaneously if >10d repair
anaemia
cribriform plate fracture
epistaxis causes
management
idiopathic, trauma, anticoagulant, bleeding disease, htn, forcing body, iatrogenic
pinch fleshy part of nose for 10mins, ice pack, suction for clots
- silver nitrate cautery
- nasal packing
- ligation of sphenopalative
lateral wall of nose
GP management
visual disturbances, bleeding, CSF leak
ligation of external carotid
embolisation
topical naseptin - decrease crusting, SA infection
lacerations cause
managemtn
blunt trauma, avulsions, dog bites
debridement, closure, primary reconstruction
don’t give ABs - cartilage
pinna haematoma is what cause cx symp rx
blood collects in space between cartilage of pinna and overlying skin
sport, blunt trauma
prompt treatment to permanent deformity - cauliflower ear
painful swollen ears with fluctuant collection
aspiration. incision and draining. pressure dressing
maxillary fracture
orbital fracture
symptoms
ix
rx
high energy and blunt
injury impact to globe
pain, decreased vision, diplopia, bruising, oedema, ocular movements affected
ophthalmic exam, CT of sinuses-tear drop sign, blow out fracture - medial wall and floor
conservative. surgical repair if entrapment, large defect, significant exopthalmus
temporal bone fracture symptoms
ix
rx
HL, VII palsy, vertigo, CSF freak
bruising battle sign, VII, hearing test, TM and ear canal
VII nerve decompression, manage CSF leak, hearing restoration
longitudinal fracture
paralel to long axis of petrous triangle bleeding from external canal CHL facial palsy ottorhoea
transverse
right angle to petrous
damage to auditory and facial nerves
SNHL, VII palsy in 80%
neck injury ix
rx
inspect, CT CXR MRI
angiography - embolism, occlude
nasal polyp
assoc with aspirin and NA asthma
young - CF
oral then topical steroids
benign nose tumours
malignant nose tumours
squamous papilloma, angiofribroma
SSC
rx of rhinitis
avoid - housemites
itch, runny, sneeze - antihistamines - loratidine
block - intranasal steroids - beclametasone
trial LRTA - montelukast
immunotherapy - omalizumab (monoclonal AB)
PO steroids
surgery
sinusitis uncomplicated
complicated
chronic
will resolve in 14 days without ABs - paracetamol, ibobrufen, intranasal steroids if >10d/severye symp
phenomethylpenicillin 500mg QDS 5days. no improvement co amoxiclav 500/125 TDS for 5 days
PA doxy/clarithro 5 days
intranasal steroids for 3 months is suspected allergic cause. paracetamol/ibobrufen, nasal decongestants in acute attacks
meniers disease
disorder in middle ear
recurrent sponeatouns rotational vertigo. tinnitus. aural fullness. SNHL. vom/nystagmus attack
reduce salt, caffeine, stress, alcohol
histamine. phorcoramazine for acute attacks
intratympanic gent
surgery
BPPV dx
rx
hillpike test
epleys manouvure, brats - darrof, semont menouvre, exercise
primary ging cause
symp
rx
HSV
systemic upset, lips, buccal mucosa, hard palate, vesicles 1-2mm, fever LN
recover in 2-3 weeks
herpetic whitlow
fingers
dentist. anaesthetics
apthous ulcers
non viral self limiting
round inflam halo - painful ulcers
pleomorphic adenoma
long history
parotid benign
difficult to excise
war thins tumour
rare out with parotid
benign
bilateral and multicentric
smoking - RF
adenoid cyst
malignancy > 40
parotid palate
freq perineurial invasion
lump in neck ix
USS and FNA
MRI if salivary/oropharynx
CT staging
PET CT if unknown primary
Parotid lumps
benign pleomorphic, warthins
muccoepidermoid, adenoid cyst
peadiritc lump in neck congenital
dermoid - midline under skin
thyroglossal cyst - stick tongue moves
branchial ban-chronic swelling 2,3,4
cystic hygroma - lymphatic malformation, dilated channels epithelial lined cysts
acquired lumps in neck
concern if >3cm, supraclavicualr LN, hepatosplenomegaly, decreased weight, B symp
malignancies in kid lymphoma/NHL
rhabdomyosarcoma
neuroblastoma
r: orbit, nose, middle ear
N: commonest malignancy <1, undifferentiated sympathetic nervous system - adrenal gland most common, post mediastinum/cervical swelling, horners
